Scintigraphy of the salivary glands in Sjögen's syndrome

Sjögren's syndrome

Sjögren's syndrome (SS) is characterised as keratoconjunctivitis sicca (dry eyes), xerostomia (dry mouth) commonly associated with salivary gland enlargement, and is referred to as Primary Sjögren's syndrome. It is known as Secondary Sjögren's syndrome when it occurs in patients, with connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, polyarthritis nodosa, polymyositis, and systemic sclerosis. SS has also been associated with chronic graft-versus-host disease after allogeneic bone marrow transplantation, human immunodeficiency syndrome (AIDS), hepatitis C infection (HCV), chronic biliary cirrhosis, neoplastic and myeloplastic syndromes, fibromyalgia, and chronic fatigue syndrome.

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.

Salivary gland scintigraphy in Sjögren’s syndrome

The aim of this study was to compare the diagnostic utility of visual versus semiquantitative analysis of salivary gland scintigraphy in the diagnosis of Sjögren’s syndrome (SS). Patients, methods: 99mTc-pertech- netate salivary gland scintigraphy was performed in 145 patients (133 women, 12 men) with clinically suspicious SS. The images were interpreted with visual and semiquantitative methods and the diagnostic performances for SS were compared using uptake and excretory functional parameters. Results: In total, 76 patients (52.4%) were finally diagnosed with SS. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual analysis for the diagnosis of SS were 88.2%, 48.6%, 65.1%, 79.1%, and 69.2%, respectively. Semiquantitative values, the area under the ROC curve for uptake ratio and percentage excretion in the right salivary glands were significantly greater than 0.5 (p < 0.05). However, the percentage excretion in the left salivary glands did not show a statistically significant diagnostic ability for SS. The diagnostic ability of visual assessment was greater than that of the semiquantitative method in terms of evaluating uptake and excretory function in the sub- mandibular glands. Conclusion: Visual analysis of salivary gland scintigraphy showed greater diagnostic utility than semiquantitative assessment in the diagnosis of SS, especially in the submandibular glands.

Evaluating Instantaneous Perfusion Responses of Parotid Glands to Gustatory Stimulation Using High-Temporal-Resolution Echo-Planar Diffusion-Weighted Imaging

BACKGROUND AND PURPOSE

Parotid glands secrete and empty saliva into the oral cavity rapidly after gustatory stimulation. However, the role of the temporal resolution of DWI in investigating parotid gland function remains uncertain. Our aim was to design a high-temporal-resolution echo-planar DWI pulse sequence and to evaluate the instantaneous MR perfusion responses of the parotid glands to gustatory stimulation.

MATERIALS AND METHODS

This prospective study enrolled 21 healthy volunteers (M/F = 2:1; mean age, 45.2 ± 12.9 years). All participants underwent echo-planar DWI (total scan time, 304 seconds; temporal resolution, 4 s/scan) on a 1.5T MR imaging scanner. T2WI (b = 0 s/mm²) and DWI (b = 200 s/mm²) were qualitatively assessed. Signal intensity of the parotid glands on T2WI, DWI, and ADC was quantitatively analyzed. One-way ANOVA with post hoc group comparisons with Bonferroni correction was used for statistical analysis. P < .05 was statistically significant.

RESULTS

Almost perfect interobserver agreement was achieved (κ ≥ 0.656). The parotid glands had magnetic susceptibility artifacts in 14.3% (3 of 21) of volunteers during swallowing on DWI but were free from perceptible artifacts at the baseline and at the end of scans on all images. Increased ADC and reduced signal intensity of the parotid glands on T2WI and DWI occurred immediately after oral administration of lemon juice. Maximal signal change of ADC (24.8% ± 10.8%) was significantly higher than that of T2WI (-10.1% ± 5.2%, P < .001). The recovery ratio of ADC (100.71% ± 42.34%) was also significantly higher than that of T2WI (22.36% ± 15.54%, P < .001).

CONCLUSIONS

Instantaneous parotid perfusion responses to gustatory stimulation can be quantified by ADC by using high-temporal-resolution echo-planar DWI.

Semi-quantitative evaluation of salivary gland function in Sjögren's syndrome using salivary gland scintigraphy

This retrospective study is designed to evaluate the diagnostic value of semi-quantitative parameters of salivary gland scintigraphy (SGS) in Sjögren's syndrome (SS) and explore the relationship between SGS parameters and salivary gland histopathologic manifestations. SGS and labial salivary gland biopsy were performed on 95 SS patients and 36 healthy age-matched and sex-matched volunteers. Uptake ratios at 15 min (UR(15)) and stimulated excretion fraction (EF) of each parotid and submandibular gland were calculated automatically from SGS; histopathologic grades were classified based on focal lymphocytic infiltration, and biopsy focus scores were calculated simultaneously. As a result, the UR(15) and EF of each salivary gland in SS patients were significantly lower than that in controls. Multivariate logistic regression equation was: logit p = 6.965 - 1.680 × UR(15) of left submandibular gland - 0.040 × EF of left parotid gland - 0.050 × EF of right submandibular gland. The receiver operating characteristic (ROC) curve validated high efficiency of this model with the area under curve of 0.911. And logistic regression analysis on combined original and validation cohorts confirmed its diagnostic value. Moreover, the EF of right parotid gland and both submandibular glands was correlated with histopathologic changes. Consequently, the semi-quantitative parameters of SGS may be helpful for diagnosing SS; UR(15) of left submandibular gland, EF of left parotid gland, and EF of right submandibular gland are more powerful predictor of SS. Besides, SGS parameters reflect the degree of salivary gland involvement, severe patients with low parameters would have high histopathologic grades and biopsy focus scores.

Assessment of salivary gland function in Sjögren's syndrome: the role of salivary gland scintigraphy

Salivary gland scintigraphy (SGS) is a non invasive method of salivary gland function assessment. This technique is easy to perform, reproducible and well tolerated by patients. Additionally, an abnormal salivary gland scintigraphy result is accepted by the American-European consensus group as a criterion for the diagnosis of Sjögren's syndrome. Scintigraphic evaluation of salivary gland function also plays an important role in therapeutic decision and patient follow-up. Schall's categorical classification is usually considered the standard method for salivary scintigraphy interpretation, though subjective and with limited capacity to discriminate borderline results. In order to improve the diagnostic accuracy of SGS, there has been an increasing interest in the quantification of glandular function. However, the debate on the most reliable and suitable parameters for the diagnosis of SS persists.

[Diagnostic imaging for connective tissue diseases]

Guidelines and diagnostic algorithms for the introduction of diagnostic procedures for connective tissue diseases have not yet been established and standardized. Diagnosis is often based on the patients's typical history, clinical symptoms and specific laboratory profiles. The use of diagnostic imaging procedures is relevant for differential diagnosis, for the assessment of disease activity and organ involvement, for defining the prognosis and monitoring responses to therapy and side effects. Experience with these techniques and diagnostic procedures, their application, indications and analysis represent the platform for rational and optimal diagnosis as well of defined therapy stratification.

Effects of gender and age on the quantitative parameters of [99mTc]pertechnetate salivary gland scintigraphy in normal subjects

AIM

To assess the effect of gender and age on [99mTc]pertechnetate salivary gland scintigraphy (SGS) in healthy subjects.

METHODS

The study population consisted of 93 normal subjects (46 women, 47 men; age range 20-59 years). The subjects were categorized into eight (four female and four male) subgroups according to age decades. Dynamic SGS was performed after intravenous injection of 370 MBq [99mTc]pertechnetate. Anterior salivary gland images were acquired for 30 min. On the basis of the time-activity curves, three functional parameters were calculated for the parotid and submandibular salivary glands: (1) the first minute uptake ratio, (2) the maximum uptake ratio, and (3) the maximum secretion percentage.

RESULTS

For women, all parotid and submandibular functional parameters had a peak in the fourth decade group. The comparison of four age groups in the female subjects showed significant differences, except for the third versus the fifth decades, at least for one parameter. The number of significant differences was highest in the comparison between the second versus the fourth decades. Among men, the highest values for all parotid and submandibular parameters were in the second decade, except for the first minute uptake ratio in the submandibular gland. The number of parameters that were significantly different among the four age groups in men was lower than in women. The first minute uptake ratio of the submandibular gland had the most significant differences among the groups of male subjects.

CONCLUSION

Age and gender differences have a significant effect on salivary gland functions which is more apparent in women than in men.

Evaluation of the concordance of sialometry and salivary glands scintigraphy in dry mouth patients

Introduction

Many diagnostic tests are used to evaluate dry mouth patients, especially the ones with Sjögren's Syndrome, to whom these tests are part of classification criteria for scientific studies.

Aim

Thus, the concordance between results of sialometry and salivary glands scintigraphy was evaluated; if positive, it would enable the choice of one or the other for diagnosis.

Patients and Method

Seventy-two dry mouth patients were divided into non-Sjögren's Syndrome group, primary Sjögren's Syndrome group and secondary Sjögren's Syndrome group. The concordance among sialometry and scintigraphy results was evaluated by Kappa test.

Results

It was observed that their concordance was equal or near to zero.

Conclusion

It is not possible to make a choice between these tests and both should be performed.

Appropriate utilization of semi-quantitative analysis in salivary scintigraphy

AIM

The purpose of this case-control study was to determine whether semi-quantitative indices derived from salivary time-activity curves (TACs) are useful in the diagnosis and management of xerostomia.

METHODS

Twenty-six healthy volunteers and 83 consecutive patients with xerostomia, including a subset of 40 patients with Sjogren's syndrome, underwent sequential salivary scintigraphy (SSS). Semi-quantitative analysis of the TACs was performed, deriving six different indices, previously cited in the literature, for each patient. These reflected trapping and uptake, stimulated excretion, or stimulated and unstimulated oral radioactivity. The indices were the percentage uptake, uptake ratios, maximum accumulation, pre-stimulatory oral radioactivity index, post-stimulatory oral radioactivity index and ejection fraction.

RESULTS

Reduced parotid activity relative to submandibular activity, expressed as the P : S ratio, was able to distinguish abnormal from normal salivary function, and a parotid ejection fraction of greater than 50% also indicated normal parotid function. The other parameters showed no statistically significant difference between controls and patients. Individual variation in all indices served to widen the reference limits obtained from controls to the extent that they overlapped with those from the xerostomic population.

CONCLUSIONS

This finding, together with previous work indicating that uptake parameters are only sensitive to differences exceeding 25% of the gland mass, the possibility that xerostomia may result from qualitative as well as quantitative changes in saliva and the probability that immune factors decrease neurosecretory circuits without affecting acinar mass, suggest that those indices derived from salivary TACs that directly reflect trapping and uptake are not useful in the detection of salivary gland disease.

Salivary gland scintigraphy in Sjögren's syndrome and patients with sicca symptoms but without Sjögren's syndrome: the psychological profiles and predictors for salivary gland dysfunction

OBJECTIVE

To characterise the psychological profiles of Sjögren's syndrome (SS) and patients with sicca symptoms but without SS; to find predictors for salivary gland function; to evaluate salivary scintigraphy as a method to differentiate between SS and patients with sicca symptoms but without SS.

PATIENTS AND METHODS

Psychological tests (Medical Outcomes Study Short Form General Health Survey (SF-36), Jenkins Activity Survey, Toronto Alexithymia Scale, and Maastricht Questionnaire for vital exhaustion) were performed and assessment of the function of the salivary glands made in 26 patients with primary SS, 8 with secondary SS, and 9 with sicca symptoms but without SS. Data were analysed with BMDP new system version 1.0 statistical program.

RESULTS

Psychological profiles were similar in all groups. Hb, RF, ANA, and SSA differentiated between the groups. Results of salivary scintigraphy were predicted to 51% by ANA, SSA, SSB, IgG, IgA, diagnosis, vitality, and role limitations due to emotional problems. No predictors were found for the resting salivary flow. Salivary scintigraphy was pathological in 21/26 (81%) and in 8/8 (100%) patients with secondary SS, but only in 2/9 (22%) patients with sicca symptoms without SS (p=0.002) (sensitivity 85.3%, specificity 77.8%).

CONCLUSIONS

Patients with sicca symptoms but without SS have sickness behaviour similar to that of patients with SS. The results of salivary scintigraphy can be predicted by diagnosis and autoimmune findings; psychological characteristics added 20% to this predictive value. Distinction between SS and patients with sicca symptoms but without SS is difficult, but in addition to autoantibodies, salivary scintigraphy can be used for this purpose.

Decreased salivary gland function in patients with autoimmune thyroiditis

BACKGROUND/AIMS

It has been speculated that impaired salivary flow contributes to autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis). To test this hypothesis, salivary function was measured by quantitative salivary scintigraphy in autoimmune thyroiditis patients, as well as in age- and gender-matched controls for comparison.

METHODOLOGY

One hundred and twenty patients with an autoimmune thyroiditis history of more than 10 years each and 36 healthy controls were enrolled in the study. All the 120 autoimmune thyroiditis patients had good blood sugar control. None had autonomic neuropathy. These 120 autoimmune thyroiditis patients were separated into two subgroups: group 1, 60 patients with xerostomia; and group 2, 60 patients without xerostomia. After intravenous injection of 5 mCi Tc-99m pertechnetate, sequential images at 1 min/frame were acquired for 30 min. The first- and 15th-minute uptake ratios (UR) were calculated from the tracer uptakes in the four major salivary glands over the background regions of interest (ROIs). Saliva excretion was stimulated by 1 tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer. Then, the maximal excretion ratios (ER) of the four major salivary glands after sialagogue stimulation were calculated.

RESULTS

Impaired salivary function, represented by significantly decreased UR and ER values, in autoimmune thyroiditis patients with xerostomia was demonstrated in this study. In addition, there was a significantly higher prevalence of salivary gland dysfunction in group 1 patients than in group 2 patients.

CONCLUSIONS

Significantly poorer salivary function was found in autoimmune thyroiditis patients with xerostomia compared with autoimmune thyroiditis patients without xerostomia and healthy controls by means of objective and quantitative salivary scintigraphy.

Objective evidence of decreased salivary function in patients with autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis)

Impaired salivary flow is found in Sjögren's syndrome, which is a common, chronic, autoimmune, inflammatory connective tissue disease, mainly affecting the exocrine glands. Histopathologically, lymphocytic infiltrations of the salivary glands are found in Sjögren's syndrome that are similar to those of the thyroid gland in autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis). To test this hypothesis by Daniels et al ., salivary function was measured by quantitative salivary scintigraphy in autoimmune thyroiditis patients, as well as in age- and sex-matched controls. Forty patients, each with a history of autoimmune thyroiditis of over 10 years, and 61 healthy controls were enrolled in the study. All of the 40 autoimmune thyroiditis patients had good blood sugar control. None presented autonomic neuropathy. They were separated into two subgroups: patient group 1, 20 patients with xerostomia; patient group 2, 20 patients without xerostomia. Two control groups of healthy subjects were included for comparison: control group 1, 36 subjects without xerostomia; control group 2, 25 subjects with xerostomia. After intravenous injection of 5 mCi (99m)Tc-pertechnetate, sequential images at 1 min per frame were acquired for 30 min. The first and 15th minute uptake ratios (URs) were calculated from the tracer uptakes in the four major salivary glands relative to the background regions of interest (ROIs). Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer. The maximal excretion ratios (ERs) of the four major salivary glands after sialagogue stimulation were calculated. Impaired salivary function, represented by significantly decreased UR and ER values, in autoimmune thyroiditis patients with xerostomia was demonstrated in this study. Significantly poorer salivary function was found in autoimmune thyroiditis patients with xerostomia, when compared with autoimmune thyroiditis patients without xerostomia and healthy controls with or without xerostomia, via objective and quantitative salivary scintigraphy. However, a larger series of autoimmune thyroiditis patients is necessary to confirm our findings.

Impaired salivary function in patients with noninsulin-dependent diabetes mellitus with xerostomia

To test this hypothesis, salivary function was measured by quantitative salivary scintigraphy in noninsulin-dependent diabetes mellitus (NIDDM) patients, as well as in age- and sex-matched controls for comparison. Seventy-two patients with NIDDM history of over 10 years and 36 healthy age- and sex-matched controls were enrolled in the study. All of the 72 NIDDM patients had good blood sugar control. None presented with autonomic neuropathy. These 72 NIDDM patients were separated into two subgroups. Group 1: 36 patients with xerostomia and Group 2: 36 patients without xerostomia. After intravenous injection of 5mCi Tc-99m pertechnetate, sequential images at 1 min/frame were acquired for 30 min. The 1st and 15th minute uptake ratios (UR) were calculated from the tracer uptakes in the four major salivary glands over the background regions of interest. Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15-min postinjection of the tracer. Then, the maximal excretion ratios (ER) of the four major salivary glands after sialagogue stimulation were calculated. Significantly poorer salivary function was found, represented by significantly decreased UR and ER values, in 36 NIDDM patients with xerostomia, when compared with 36 NIDDM patients without xerostomia and 36 healthy controls, via objective and quantitative salivary scintigraphy. It has been speculated that impaired salivary function contributes to NIDDM with xerostomia. However, further studies with a larger series of NIDDM patients are necessary to confirm our findings.

Decreased salivary function in patients with end-stage renal disease requiring hemodialysis

It has been speculated that impaired salivary flow is common in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). The aim of this study is to investigate the relation between oral manifestations and salivary function in patients with ESRD undergoing HD. Salivary function was measured by quantitative salivary scintigraphy in 60 patients with ESRD undergoing HD, as well as in 36 age- and sex-matched healthy controls for comparison. The 60 patients with ESRD undergoing HD were separated into two subgroups: group 1, 30 patients with oral manifestations, and group 2, 30 patients without oral manifestations. After an intravenous injection of 5 mCi of technetium 99m pertechnetate, sequential images at 1 minute per frame were acquired for 30 minutes. The 1- and 15-minute uptake ratios were calculated as the tracer uptakes in the four major salivary glands over the background regions of interest. Saliva excretion was stimulated by one 200-mg tablet of ascorbic acid administered orally 15 minutes post-tracer injection, then the maximal excretion ratios of the four major salivary glands were calculated. Our results show significantly poorer salivary function in patients with ESRD with oral manifestations compared with patients with ESRD without oral manifestations and healthy controls by means of objective and quantitative salivary scintigraphy.

Stimulated salivary pertechnetate clearance revisited: correlation with dynamic scintigraphic indices in Sicca syndrome

PURPOSE

The stimulated salivary clearance of Tc-99m pertechnetate (SSCP) introduced in 1985 by Blue and Jackson is revisited here in patients with known or possible salivary disorders and correlated with most commonly cited and up-to-date quantitative indices obtained from standard dynamic salivary scintigraphy.

METHODS

An SSCP test was performed after dynamic salivary scintigraphy in 19 patients with oral or ocular dryness, among whom 7 had Sjögren's syndrome. Many scintigraphic indices were calculated: salivary to background ratio (S/B[t]), background-corrected uptake U[t]), maximal uptake (Umax), cumulative gland uptake (CGU), initial slope of the uptake curve (IS), stimulated excretion velocity (SEV), stimulated excretion fraction (SEF), and excreted activity (EA).

RESULTS

The SSCP test was well tolerated, except in two patients in whom it had to be interrupted. Clearance values ranged from 5 to 40 ml/minute, with a clear-cut bimodal distribution centered around 15 to 20 ml/ minute. Six of the seven patients with Sjögren's syndrome had values less than 15 ml/minute. SSCP was closely correlated with all uptake indices (S/B, U, Umax, CGU, and IS) and uptake-related indices (EA, ISxSEF) (P < 0.01). A poor correlation was found with the excretion index SEV (P = 0.06) and none with SEF.

CONCLUSIONS

SSCP is a quick and objective means to investigate the sicca syndrome that may be useful in most clinical situations. It reflects the parenchymatous salivary gland function and will provide a means to assess and predict salivary gland involvement. Dynamic salivary scintigraphy remains necessary in very early stages because of its high sensitivity rate and ability to locate the impaired gland, or in severe stages in which lemon juice could be deleterious.

Diagnostic accuracy of salivary scintigraphic indices in xerostomic populations

PURPOSE

Three decades of work to enhance the diagnostic accuracy of salivary scintigraphy have generated various plausible decision criteria. This study evaluates four commonly cited numeric indices in studies of xerostomic populations and how accurately they identify Sjögren's syndrome, chronic sialadenitis, radiation sialadenitis, and drug effects and distinguish each from the other.

METHODS

Stimulated dynamic salivary scintigraphy was performed on 295 xerostomic patients and on 31 controls. The nonparametric area under the receiver operating characteristic curves expressed the diagnostic accuracy of the following scintigraphic indices: the parotid:submandibular ratio of unstimulated glandular activity, the peak:baseline uptake ratio, its time of occurrence, and the stimulated excretion fraction.

RESULTS

The stimulated excretion fraction distinguished Sjögren's syndrome and radiation sialadenitis from healthy states with respective accuracies of 0.78 and 0.90. The maximum diagnostic payoff in Sjögren's syndrome occurred at a cutoff of 73%, yielding a 73% rate of test sensitivity and a 73% rate of specificity. The other three indices were not useful. Even the stimulated excretion fraction performed indifferently or poorly in most other diagnostic tasks.

CONCLUSIONS

In the scintigraphic examination of xerostomic and healthy populations, an acceptable diagnostic utility of the stimulated excretion fraction was evident only in Sjögren's syndrome and radiation sialadenitis. When presented with differential diagnostic alternatives not involving radiation sialadenitis, none of the four numeric indices performed acceptably.

Salivary gland scintigraphy in subjects with and without symptoms of dry mouth and/or eyes, and in patients with primary Sjögren's syndrome

The major salivary glands were examined with 99m-Tc-pertechnetate scintigraphy in randomly selected subjects with (n = 30) and without (n = 12) symptoms of dry mouth and/or eyes, and in patients with primary Sjögren's syndrome (1 degree SS, n = 17). The scans were quantitatively evaluated and compared to other objective tests used to diagnose 1 degree SS. As compared with those for asymptomatic subjects, most values for the scintigraphic variables were non-significantly lower for symptomatic subjects and the time-activity curves were slightly flatter for all major salivary glands. In patients with 1 degree SS most values for the scintigraphic variables were significantly lowered and the submandibular glands were the glands most affected, as reflected in a flat time-activity curve, while the parotid glands were mainly affected during stimulated secretion. The scintigraphic variables correlated with the self-rated dryness of mouth in symptomatic subjects and with the abnormality of sialometry results in patients with 1 degree SS. We conclude that salivary gland scintigraphy is a sensitive and valid method to measure salivary gland function and abnormalities.

Diagnosis and management of salivary dysfunction

Salivary gland dysfunction may occur as a result of common medications, cancer therapy, or Sjögren's syndrome. Affected patients may develop significant oral, dental, and upper gastrointestinal sequelae. This article reviews the basic elements in diagnosis of salivary dysfunction, including initial evaluation and specialized diagnostic procedures. Patient management depends primarily on the severity of salivary dysfunction. More severe permanent forms of dysfunction, such as radiation-induced and Sjögren's syndrome, require long-term care, with preventive measures to maintain the dentition and therapeutic attempts to increase oral fluids.

Salivary gland 99mTc-scintigraphy: a grading scale and correlation with major salivary gland flow rates

Sequential salivary gland scintigraphy with 99mTc-technetium pertechnetate (Tc-99) is a safe, minimally invasive test for study of major salivary glands. However, its relationship to salivary function has not been investigated in detail. We have investigated the relationship between major salivary gland flow rates and Tc-99 scans and developed a new rating scale using scans of a control group with normal salivary function. Salivary flow rates and Tc-99 scans were obtained from healthy, non-medicated subjects (n = 33) and from xerostomic patients (n = 22). There were significant differences between the groups for salivary flow rates and Tc-99 ratings. Significant correlations were found between salivary flow rates and Tc-99 ratings in the control and xerostomic groups. The Tc-99 rating scale proved reliable in assessing salivary dysfunction, and showed a high inter-examiner correlation. These results demonstrate the usefulness of salivary gland scintigraphy in assessing major salivary gland flow rates and the utility of a new rating scale.

Salivary gland echography in patients with Sjögren's syndrome

Ultrasonographic examinations of salivary glands were performed on 24 patients with Sjögren's syndrome. On B-mode echographic images, the submandibular glands of 21 of the patients (88%) showed a heterogeneous pattern, whereas all of the control subjects had homogeneous patterns. This distinction was further confirmed by the results of the analysis of the histogram patterns of echo intensity and echo frequency of the submandibular glands, which showed that the width of the echo level at 0% and 10% of the maximum normalized frequency was significantly greater in patients with Sjögren's syndrome than in the control subjects. Similar histographic findings were present in the parotid glands, although the heterogeneous ultrasonographic pattern was observed in only 8 of the 24 patients (33%). These results indicate that ultrasonography may be useful in the evaluation of salivary gland involvement in patients with Sjögren's syndrome.