Sialography in salivary gland disease

Magnetic resonance sialography

To evaluate a new noninvasive sialographic technique, we applied a new magnetic resonance technique to 10 healthy volunteers and 21 patients with lesions of the parotid gland. In addition to the usually performed T(1) and T(2) cross-sectional sequences, a heavily T(2)-weighted sequence (TR = 3600 msec, TE = 800 msec) was performed that allowed depiction of the fluid-filled parotid duct system. Twenty-one patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 6), sicca syndrome (n = 2), pleomorphic adenoma (n = 4), carcinoma of the parotid gland (n = 2), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 3), non-Hodgkin's lymphoma (n = 2), and congenital duct dilatation (n = 1). Stenseńs duct was reliably depicted in all volunteers and patients. The primary branching ducts were reliably depicted in all normal cases. Intraglandular and extraglandular duct dilatations and duct strictures were well depicted in patients with chronic sialadenitis. Sialolithiasis with a calculus obstructing the duct was demonstrated in 2 cases. In conclusion, Initial experience indicates that magnetic resonance sialography can be applied successfully to investigate the duct system of the parotid gland. The usually performed cross-sectional MRI (T(1)- and T(2)-weighted images, gadolinium-DTPA) depicts the internal architecture of the parotid gland with high reliability. Magnetic resonance sialography with heavily T(2)-weighted images adds important information about the ductal system. Because it is completely noninvasive, the only contraindications are the ones generally accepted for MRI.

Relation of preoperative sialographic findings with histopathological diagnosis in cases of obstructive sialadenitis of the parotid and submandibular glands: retrospective study

The clinical records, preoperative sialograms and histopathological slides of 33 patients who had been operated on for symptoms of obstructive salivary gland disease were reviewed. Twenty patients had had superficial parotidectomy and 13 excision of the submandibular gland. Among those who had required parotidectomy, preoperative sialograms tended to suggest more architectural damage than was actually noted on definitive histopathological examination. Patients whose symptoms had been present for longer had more severe sialographic and histopathological changes. In the submandibular group, there was a closer relation between sialographic and histopathological changes, and a positive correlation between a short history and the severity of histopathological grading. These differences may reflect the different aetiology and course of obstructive disease in the two types of gland.

MR sialography: initial experience using a T2-weighted fast SE sequence

PURPOSE

The aim of this study was to evaluate an MR technique optimized for imaging of the parotid gland ductal system.

METHOD

The pulse sequence was optimized in 10 volunteers to depict static or nearly static fluid in the parotid ductal system. A heavily T2-weighted fast SE sequence (TR 3,600 ms/TE 800 ms) with a slice thickness of 30-40 mm using an 8 cm surface coil allowed depiction of the fluid-filled parotid duct. Thirteen patients with benign as well as malignant parotid gland pathologies were examined: sialadenitis (n = 2), sialadenosis (n = 3), Heerfordt syndrome (n = 1), pleomorphic adenoma (n = 2), parotid carcinoma (n = 1), lymphoepithelial carcinoma (n = 1), cystadenolymphoma (n = 2), and non-Hodgkin lymphoma (n = 1).

RESULTS

The heavily T2-weighted projection image yielded good quality sialographic images. The main duct and primary branching ducts were clearly depicted in all normal cases. The main duct was visualized in all patients. Intra- and extraglandular duct widening and ductal strictures were well depicted. Sialolithiasis with a calculus in the main duct was correctly demonstrated in one case.

CONCLUSION

MR sialography is noninvasive and does not depend on duct cannulation or contrast agent injection. Initial experience with a thick slice projection technique indicates that MR sialography can be successfully applied to image the parotid gland ductal system.

Digital subtraction sialography: technique, advantages and results in 107 cases

Sialographic examinations with the digital subtraction technique were performed in 107 salivary glands (90 parotid and 17 submandibular) of 99 patients. Diagnostic and technical advantages of the digital imaging and subtraction for sialography were investigated. Superior quality enabled detailed imaging of the entire ductal system. Reduced radiation exposure, short examination time and almost painless examinations with good patient tolerance proved to be the major advantages of digital subtraction sialography as a diagnostic tool.