Single-photon emission computed tomography/computed tomography for evaluation of salivary gland dysfunction: preliminary study on diagnostic ability of maximum standardized uptake value

Submandibular sialolithiasis with CT and SPECT/CT: CT values, standardized uptake values, and salivary gland excretion in the parotid and submandibular glands

OBJECTIVES

Recently, SPECT/CT has been widely accepted as a valuable diagnostic tool in dentistry. The aim of this study was to investigate submandibular sialolithiasis with CT and SPECT/CT, especially CT values, standardized uptake values (SUVs), and salivary gland excretion in the parotid and submandibular glands.

METHODS

A prospective study was performed in 13 patients with submandibular sialolithiasis who underwent CT and salivary gland SPECT/CT. The CT values and the SUVs of parotid and submandibular glands were obtained using a workstation and software. The salivary gland excretion in the parotid and submandibular glands was defined as ratio of pre- to post-stimulation on SUVs. A P-value lower than .05 was considered as statistically significant.

RESULTS

In the submandibular glands with sialoliths, the average CT values were significantly correlated with the maximum SUVs at ratio of pre-stimulation (r = 0.558, P<.05). The maximum SUVs at ratio of pre- to post-stimulation in the submandibular glands with and without sialoliths were 1.5 ± 1.1 and 2.1 ± 0.7, respectively (P = .026).

CONCLUSION

The salivary gland SPECT/CT SUVs can be useful in clinical practice for the quantitative management of parotid and submandibular glands in patients with submandibular sialolithiasis.

Maximum standardized uptake value for parotid and submandibular glands in patients with Sjögren's syndrome and submandibular sialolithiasis using salivary gland SPECT/CT

Recently, SPECT/CT plays an important role in assessing patients with head and neck lesions. The aim of this study was performed to investigate the maximum standardized uptake value (SUVmax) for parotid and submandibular glands in patients with Sjögren's syndrome and submandibular sialolithiasis using salivary gland SPECT/CT. A prospective study was performed in 45 patients with 32 Sjögren's syndrome and 13 submandibular sialolithiasis who underwent salivary gland SPECT/CT. The SUVmax of parotid and submandibular glands was obtained using a workstation and software. The salivary secretion function of parotid and submandibular glands was defined as ratio of pre- to post-stimulation on SUVmax. A p value lower than 0.05 was considered as statistically significant. The SUVmax for parotid glands in patients with Sjögren's syndrome at pre-stimulation (18.0 ± 14.3), post-stimulation (12.0 ± 9.4), and ratio of pre- to post-stimulation (1.46 ± 0.52) were significantly lower than those of submandibular sialolithiasis (44.9 ± 8.4 (p < 0.001), 17.8 ± 6.5 (p < 0.001), and 2.75 ± 0.79 (p < 0.001), respectively). The SUVmax for submandibular glands in patients with Sjögren's syndrome at pre-stimulation (16.9 ± 18.7) were significantly lower than those with sialolithiasis (36.7 ± 27.8, p = 0.004) and without sialolithiasis (39.7 ± 16.0, p = 0.001) in patients with submandibular sialolithiasis. The salivary gland SPECT/CT SUVmax can be useful in clinical practice for the quantitative management of parotid and submandibular glands in patients with Sjögren's syndrome and submandibular sialolithiasis.

Maximum and mean standardized uptake values of medication-related osteonecrosis of the jaw with bone SPECT/CT: comparison of mandibular pathologies, control and temporomandibular joints

OBJECTIVE

Recently, single-photon emission CT/CT (SPECT/CT) plays an important role in assessing patients with medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to investigate maximum and mean standardized uptake values (SUVs) of MRONJ with bone SPECT/CT, especially comparison of mandibular pathologies, control and temporomandibular joints.

METHODS

61 mandibular patients with MRONJ who underwent bone SPECT/CT were included in this study. The maximum and mean SUVs of the lesion, right and left sides of the lesion, opposite side of the lesion as control, right and left temporomandibular joints were analyzed using a workstation and software. The SUVs of MRONJ were analyzed using one-way analysis of variance with Tukey's honestly significant difference test. Patient characteristics with MRONJ and SUVs were analyzed using Mann-Whitney U test. P-values less than 0.05 were considered to indicate statistical significance.

RESULTS

The maximum and mean SUVs for opposite side of the lesions (4.4 ± 2.0 and 1.8 ± 0.7) were significantly lower than those for mandibular lesions (18.3 ± 8.1 and 6.3 ± 2.8), right side of the lesions (8.1 ± 3.9 and 2.9 ± 1.3) and left side of the lesions (8.1 ± 3.9 and 2.8 ± 1.4), respectively. The maximum and mean SUVs for right and left sides of the lesions, and opposite side of the lesions, right and left temporomandibular joints were not significant difference. Furthermore, the maximum SUVs of the mandibular lesions were a significant difference for age and staging.

CONCLUSIONS

The maximum and mean SUVs with SPECT/CT can be useful in the quantitative management of MRONJ patients.

Comparison of maximum and mean standardized uptake values of jaw pathologies with bone SPECT/CT: an especial focus on medication-related osteonecrosis of the jaw

OBJECTIVES

To investigate the comparison of maximum and mean standardized uptake values (SUVs) of jaw pathologies with bone Single-photon emission computed tomography/computed tomography (SPECT/CT), and a special focus on medication-related osteonecrosis of the jaw (MRONJ).

METHODS

Eighty-nine patients with jaw pathologies (63 MRONJ, 13 chronic osteomyelitis, 11 osteoradionecrosis and 2 primary intraosseous carcinoma) underwent bone SPECT/CT scans acquisition at 4 h after intravenous injection of Tc-99m hydroxymethylene diphosphonate in this prospective study. The evaluation of mean and maximum SUVs of jaw pathologies were performed using Q. Metrix and Xeleris workstation and defined the data automatically. Statistical analyses were performed by Pearson's correlation coefficient for comparison of maximum and mean SUVs and Mann-Whitney U-test for SUVs of MRONJ. A P value lower than 0.05 was considered to indicate statistical significance.

RESULTS

Maximum SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 17.6 ± 8.4, 21.7 ± 7.1, 11.9 ± 4.8 and 26.6 ± 7.0, respectively. Mean SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 10.1 ± 4.9, 11.9 ± 3.3, 7.0 ± 2.8 and 10.1 ± 4.5, respectively. The maximum SUV of jaw pathologies was significantly correlated with the mean SUV (Y = 0.494X + 1.228; R2 = 0.786; P < 0.001). Furthermore, maximum and mean SUVs of MRONJ had significant differences in underlying diseases, medication and staging.

CONCLUSION

The maximum and mean SUVs with bone SPECT/CT can be an effective tool for the quantitative evaluation of jaw pathologies, especially MRONJ.

Volumetric analysis of mandibular lesions with SPECT/CT: a pilot clinical study of maximum standardized uptake value

Purpose

This study was designed to investigate mandibular lesions using volumetric analysis with bone single-photon emission computed tomography/computed tomography (SPECT/CT).

Material and methods

Eight patients with mandibular lesions underwent SPECT/CT scan acquisition 4 hours after injection of Tc-99m hydroxymethylene diphosphonate (HMDP). Regarding volumetric analysis, maximum standar-dized uptake value (SUV) was obtained using software and a workstation (Q.Volumetrix MI and GEniE-Xeleris 4 DR, respectively). The localization and size of the volume of interest (VOI) can be drawn over the lesion, mesial, distal, and opposite side as normal using the CT, SPECT, and SPECT/CT transaxials, coronals, and sagittals as the anatomical reference. Q.Volumetrix MI can analyse SUV of lesions by organ segmentation using optional pan and zoom imaging. Then, the dosimetry software provided multiple quantitative data for a given VOI. Statistical analyses for the maximum SUV were performed by Mann-Whitney U test. A p-value lower than 0.05 was considered as statistically significant.

Results

Maximum SUVs for medication-related osteonecrosis of the jaw (n = 4, 25.4 ± 4.9), chronic osteomyelitis (n = 3, 14.6 ± 3.1), and squamous cell carcinoma (n = 1, 31.7) were significantly higher than those of the opposite side as normal mandible (3.8 ± 0.7, 4.6 ± 1.8, and 7.4, respectively; p = 0.000).

Conclusions

Volumetric analysis with SPECT/CT could be useful for the evaluation of mandibular lesions, such as detecting and surgical planning.

Correlations Between Single-Photon Emission Computed Tomography Parameters of Salivary Glands and Dry Eye Tests in Patients With Sjögren's Syndrome

Objective

To evaluate the correlations between Single-Photon Emission Computed Tomography (SPECT) parameters of salivary glands and dry eye parameters in patients with Sjögren's syndrome (SS).

Methods

A total of 28 patients with SS participated in this prospective study. Dry eye assessments include tear film break-up time (TBUT), corneal fluorescein staining scoring (CFS), Schirmer's I test (SIT) examination and SPECT of salivary gland. The following quantitative parameters were derived from SPECT imaging for salivary glands: Uptake index (UI), the time needed to achieve the minimum counts after Vit C stimulation (T_s), and excretion fraction (EF). The relation between the aforementioned parameters and TBUT, CFS and SIT were analyzed with SPSS 22.0 software.

Results

All the 28 eyes of the 28 subjects were examined. The mean SIT was 6.04 ± 4.64 mm/5 min (0–18 mm/5 min); the mean CFS was 3.07 ± 2.65 (0–10) and the mean BUT was 2.11 ± 1.97 s (0–9 s). The mean EF value was 0.52 ± 0.12 (0.26–0.75) in parotid glands and 0.45 ± 0.10 (0.30–0.67) in submandibular glands, respectively. The mean UI value was 9.33 ± 1.68 (6.03–13.20) in parotid glands and 9.92 ± 1.48 (7.08–12.60) in submandibular glands, respectively. The mean T_s (min) was 5.32 ± 3.01 (2.00–12.00) in parotid glands and 11.09 ± 7.40 (2.00- 29.00 min) in submandibular glands, respectively. It was found that EF positively correlates with SIT in patients with SS (r = 0.499 and 0.426 in parotid glands and submandibular glands, with P < 0.05), while no significant correlation was found between the UI, T_s and CFS, TBUT (P > 0.05).

Conclusions

The EF was positively correlated with SIT in patients with SS, it could reflex the dysfunction of salivary glands in SS patients. So, EF may be a valuable parameter for the diagnosis of SS patients with lacrimal gland secretion dysfunction.

Maximum standardized uptake value of normal structures in the head and neck with bone SPECT/CT

INTRODUCTION

The quantitative parameter was successfully derived from the quantitative bone SPECT/CT images. The aim of this study was to evaluate maximum standardized uptake value (SUV) of normal structures in the head and neck with bone SPECT/CT.

METHODS

Fifty-three patients with jaw lesions (11 chronic osteomyelitis, eight osteoradionecrosis and 34 medication-related osteonecrosis of the jaw) who had bone SPECT/CT were prospectively included. The maximum SUV of normal structures including vertebrae, sternal body, parietal bone and hyoid bone were analysed. Statistical analyses for the maximum SUV were performed by Pearson's rank correlation test. A P value lower than 0.05 was considered statistically significant.

RESULTS

The maximum SUVs of vertebrae, sternal body, parietal bone and hyoid bone of all patients were 8.10 ± 3.72, 5.16 ± 2.05, 3.67 ± 1.55 and 1.44 ± 0.56, respectively. Furthermore, the maximum SUV of vertebrae was significantly correlated with that of sternal body (Y = 0.527X + 5.388 (R²  = 0.084, P = 0.035)).

CONCLUSIONS

Maximum SUV with bone SPECT/CT should be useful for characterization of normal structures in the head and neck. Furthermore, the data reported herein can be used for reference in future studies and in clinical settings for head and neck lesions.

A clinical pilot study of salivary gland secretion for xerostomia patients with Sjögren's syndrome using SPECT/CT

INTRODUCTION

This study examined whether time-activity curves (TAC) can be used to differentiate between patients with and without Sjögren's syndrome using SPECT/CT.

METHODS

Thirteen xerostomia patients (5 with Sjögren's syndrome and 8 without Sjögren's syndrome) underwent SPECT/CT. Salivary gland secretion data were digitally observed, producing separate time-activity curves (TAC) for the submandibular glands and parotid glands using SPECT/CT. The salivary gland secretion fraction was defined as A (before stimulation test [counts/frame]) divided by B (after stimulation test [counts/frame]). The A/B ratios of patients with Sjögren's syndrome and those without Sjögren's syndrome were compared using the Mann-Whitney U test for nonparametric data.

RESULTS

The A/B ratio of parotid glands with Sjögren's syndrome (1.3 ± 0.2) was significantly lower than for those without Sjögren's syndrome (2.7 ± 0.7). The A/B ratio of submandibular glands with Sjögren's syndrome (1.3 ± 0.4) is significantly lower than for those without Sjögren's syndrome (1.8 ± 0.6).

CONCLUSION

The TAC for the submandibular glands and parotid glands using SPECT/CT may be useful for the objective and quantitative diagnosis of Sjögren's syndrome.

Can the function of the tubarial glands be evaluated using [99mTc]pertechnetate SPECT/CT, [18F]FDG PET/CT, and [11C]methionine PET/CT?

BACKGROUND

The tubarial glands (TGs) are recently reported as newly found salivary gland structures that can be organs at risk predominantly localized in the tori tubarius in the nasopharynx using prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT). The aims of this study were to analyze uptake in the TGs compared with that in the other salivary glands and palatine tonsils using [^99mTc]pertechnetate SPECT/CT, [¹⁸F]FDG PET/CT, and [¹¹C]methionine PET/CT and to confirm whether these three imaging modalities are useful in evaluating the physiological function of the TGs. Twelve and 130 patients, who underwent [^99mTc]pertechnetate SPECT/CT and [¹⁸F]FDG/[¹¹C]methionine PET/CT, respectively, were retrospectively included. [^99mTc]pertechnetate uptake in the tori tubarius was visually assessed and semiquantitatively compared with that in the background, parotid salivary glands (PSGs), submandibular salivary glands (SmSGs), and sublingual salivary glands (SlSGs). Correlations of [¹⁸F]FDG and [¹¹C]methionine uptakes in the tori tubarius with those in the other three salivary glands and palatine tonsils were analyzed.

RESULTS

[^99mTc]pertechnetate uptake in the tori tubarius was invisible and was not significantly higher than that in the background. Both [¹⁸F]FDG and [¹¹C]methionine uptakes in the tori tubarius were correlated with that in the palatine tonsils (r = 0.56, p < 0.0001; r = 0.48, p < 0.0001, respectively). [¹⁸F]FDG uptake in the tori tubarius was not positively correlated with that in the PSGs, SmSGs, and SlSGs (r = - 0.19, p = 0.03; r = - 0.02, p = 0.81; r = 0.12, p = 0.17, respectively). [¹¹C]methionine uptake in the tori tubarius was correlated with that in the SmSGs and SlSGs (r = 0.24, p = 0.01; r = 0.32, p < 0.01, respectively), but not with that in the PSGs (r = 0.16, p = 0.08).

CONCLUSIONS

The TGs were undetectable on [^99mTc]pertechnetate SPECT/CT. Both [¹⁸F]FDG and [¹¹C]methionine uptakes in the tori tubarius were clearly affected by that in the palatine tonsils and was little related to that in the other salivary glands. Therefore, it seems difficult to evaluate the physiological function of the TGs as salivary glands using [^99mTc]pertechnetate SPECT/CT, [¹⁸F]FDG PET/CT, and [¹¹C]methionine PET/CT imaging.

Assessment of inflammatory jaw pathologies using bone SPECT/CT maximum standardized uptake value

OBJECTIVES

To investigate the assessment of inflammatory jaw pathologies using bone single-photon emission CT-CT (SPECT/CT) maximum standardized uptake value (SUV_max).

METHODS

44 patients with inflammatory jaw pathologies (7 chronic osteomyelitis, 8 osteoradionecrosis and 29 medication-related osteonecrosis of the jaw (MRONJ)) underwent SPECT/CT at 4 h after injection of ^99mTc hydroxymethylene diphosphonate. The SPECT/CT parameters SUV_max of the inflammatory jaw pathologies were analyzed. Statistical analyses for the SUV_max were performed by one-way repeated measures analysis of variance with Tukey's honestly significant difference test. A p-value lower than 0.05 was considered statistically significant.

RESULTS

The mean and standard deviation of SUV_max for 7 chronic osteomyelitis, 8 osteoradionecrosis and 29 MRONJ were 24.94 ± 3.65, 12.27 ± 5.47 and 16.55 ± 9.12, respectively. The SUV_max for chronic osteomyelitis were significantly higher than those for osteoradionecrosis (p = 0.011) and MRONJ (p = 0.043).

CONCLUSIONS

Bone SPECT/CT SUV_max in the uptake of ^99mTc hydroxymethylene diphosphonate reflecting bone physiological changes for chronic osteomyelitis were significantly higher than those of osteonecrosis, such as osteoradionecrosis and MRONJ. Bone SPECT/CT SUV_max should be useful for the assessment of inflammatory jaw pathologies, such as chronic osteomyelitis, osteoradionecrosis and MRONJ.

Gallium-67 SPECT-CT for the evaluation of head and neck: preliminary study on maximum standardised uptake value in lesions, and in the parotid and submandibular glands

Purpose

The aim of this study was to investigate the gallium-67 (⁶⁷Ga) single-photon emission-computed tomography (SPECT-CT) for the evaluation of head and neck, especially maximum standardised uptake value (SUV_max) in lesions, and in the parotid and submandibular glands.

Material and methods

Fourteen patients with head and neck lesions who underwent SPECT-CT at 72 hours after injection of ⁶⁷Ga were included in this study. The ⁶⁷Ga SPECT-CT parameters SUV_max were compared between the parotid glands and submandibular glands. Statistical analyses for the SUV_max were performed by Mann-Whitney U test. A p value lower than 0.05 was considered as statistically significant.

Results

Of all 14 patients, ⁶⁷Ga SPECT-CT was positive for two cases (one malignant lymphoma and one osteomyelitis). The SUV_max for malignant lymphoma and osteomyelitis were 11.21 and 10.95, respectively. Furthermore, SUV_max for parotid glands and submandibular glands of all patients were 4.86 ± 1.89 and 4.64 ± 1.64, respectively (p = 0.694).

Conclusions

This study investigated the ⁶⁷Ga SPECT-CT for the evaluation of head and neck, especially SUV_max of lesions, and the parotid and submandibular glands. ⁶⁷Ga SPECT-CT may be an effective technique for the evaluation of maxillofacial lesions.