Recent Advances in Salivary Scintigraphic Evaluation of Salivary Gland Function

Quantitative assessment of salivary gland scintigraphy with SPECT/CT in the clinical application of Sjögren's syndrome

OBJECTIVE

This study aims to investigate the feasibility and clinical value of single-photon-emission computed tomography/computed tomography (SPECT/CT) in the quantitative assessment of salivary gland function in patients with Sjögren's syndrome (SS).

MATERIALS AND METHODS

Data were collected from 84 patients diagnosed with SS who underwent dynamic salivary gland scintigraphy at the First Affiliated Hospital of Anhui University of Science and Technology between October 2020 and October 2023. Additionally, a control group of 25 thyroid cancer patients who underwent thyroidectomy was selected. Imaging data from dynamic salivary gland scintigraphy were obtained and analyzed to calculate salivary gland functional parameters, including maximum accumulation rate (MAR), uptake ratio (UR), maximum secretion rate (MSR), Tmin (time from peak to lowest point on the time-activity curve), and average secretion rate (Vmin) following acidic stimulation.

RESULTS

Significant differences in MAR, UR, MSR, Vmin, and Tmin of the parotid and submandibular glands were observed between the SS group and the control group (P < 0.05). In the mild impairment group, significant differences were found in MSR, Tmin, and Vmin of the submandibular gland compared to the control group (P < 0.05). Moderate and severe impairment groups exhibited significant differences in MAR, MSR, Tmin, UR, and Vmin of the parotid gland compared to the control group (P < 0.05).

CONCLUSION

In SS patients, MAR, UR, MSR, Vmin, and Tmin are important indicators for evaluating salivary gland damage. The qualitative analysis of SPECT/CT salivary gland dynamic imaging and time-activity curves effectively assesses salivary gland function in SS patients, providing vital information for the development of clinical treatment strategies.

Clinical Efficacy of Sialendoscopy-Assisted Stone Removal for Non-Palpable Hilar and Intraglandular Submandibular Sialoliths

OBJECTIVES

This study aimed to assess the efficacy of sialendoscopy in retrieving non-palpable submandibular stones located in the hilum or deeper parenchyma compared to traditional non-endoscopic transoral stone removal techniques.

METHODS

Seventy patients with non-palpable submandibular hilar or intraparenchymal stones underwent sialendoscopy-assisted stone removal (SASR). Seventeen patients with hilar stones treated with non-endoscopic transoral stone removal (TOSR) were the control group. Parameters evaluated included stone characteristics (size, number, location, mobility, and accessibility) as well as outcomes (success rate, operation time, complications, recurrence, and functional recovery).

RESULTS

The SASR group had four stones in the intraparenchymal glands, two of which were located inferior to the mylohyoid. Complete stone removal was achieved in 69 out of 70 patients (98.57%) in the SASR group. However, one patient had a sialolith measuring less than 2 mm in the intraparenchymal and inferior to mylohyoid that could not be removed. TOSR procedures were exclusively performed to remove hilar stones. Nevertheless, one patient in the TOSR group was unsuccessful in retrieving a 5-mm hilar stone, resulting in an overall success rate of 94.12%. The operation duration was much longer in the SASR group than in the TOSR group. However, the TOSR group had a significantly higher incidence of acute complications (41.18%), such as swelling, pain, or tongue numbness, compared to the SASR group (7.14%).

CONCLUSION

Sialendoscopy is a valuable adjunct to the transoral combined approach for retrieving non-palpable submandibular stones, especially those in the hilum or deeper parenchyma. A precise preoperative assessment of stone location is crucial for determining the appropriate surgical intervention.

STUDY DESIGN

Retrospective review.

SETTING

Two academic tertiary medical centers.

LEVEL OF EVIDENCE: 3

Assessment and Prediction of Salivary Gland Function After Head and Neck Radiotherapy: A Systematic Review

BACKGROUND

Modern imaging techniques with magnetic resonance imaging (MRI) or positron emission tomography/computed tomography (PET/CT) have recently been developed to assess radiation-induced damage to salivary structures. The primary aim of this review was to summarize evidence on the imaging modalities used for the assessment and prediction of xerostomia after head and neck radiotherapy (RT).

METHODS

A systematic review of the literature was performed using successively the MeSH terms "PET," "MRI," "scintigraphy," "xerostomia," and "radiotherapy."

RESULTS

Salivary excretion flow following head and neck RT is correlated with the dose delivered to both parotid and submandibular glands. Salivary gland standardized uptake value extracted from PET/CT following RT has been shown to be correlated with SEF. Models including early SUV decline or ADC increase during RT and clinical parameters can help predict the loss of salivary function after RT.

CONCLUSIONS

Modern imaging parameters appear to be correlated with salivary gland scintigraphy parameters. Models including functional parameters extracted from either PET/CT or MRI unveil new possibilities for adaptive treatment in a selected population of patients.

Cancer therapy-related salivary dysfunction

Salivary gland dysfunction is a common side effect of cancer treatments. Salivary function plays key roles in critical daily activities. Consequently, changes in salivary function can profoundly impair quality of life for cancer patients. We discuss salivary gland anatomy and physiology to understand how anticancer therapies such as chemotherapy, bone marrow transplantation, immunotherapy, and radiation therapy impair salivary function. We discuss approaches to quantify xerostomia in the clinic, including the advantages and limitations of validated quality-of-life instruments and approaches to directly measuring salivary function. Current and emerging approaches to treat cancer therapy-induced dry mouth are presented using radiation-induced salivary dysfunction as a model. Limitations of current sialagogues and salivary analogues are presented. Emerging approaches, including cellular and gene therapy and novel pharmacologic approaches, are described.

Surgical advantage of modified labial salivary gland biopsy using chalazion forceps: a prospective randomized controlled study

Labial salivary gland biopsy (LSGB) is one of the specific diagnostic criteria for primary Sjögren's syndrome (pSS). In traditional LSGB, there is no lower lip fixation device, the field of view is unclear due to intraoperative bleeding, and the incision is large, which is unfavourable for healing. The use of auxiliary devices to improve the shortcomings of traditional LSGB technique would be meaningful. Therefore, this case-control study aimed to assess the value of modified LSGB using chalazion forceps as compared with traditional LSGB. After obtaining written informed consent from all participating parents and patients, we randomly assigned 217 eligible participants to undergo LSGB using chalazion forceps (n = 125) or traditional LSGB (n = 92). The outcome variables were surgical time, incision length, intraoperative bleeding, pain score at 24 h after surgery, incision healing status at 7 days after surgery, gland collection, and pathological results. The final diagnostic results of the two surgical methods were compared, and the match rates between the pathological results and the final clinical diagnoses were compared between the two groups. The data were analysed using parametric and nonparametric tests. Compared with the traditional group, the modified group had a smaller incision, shorter operative time, less blood loss, lower 24 h pain score, and better Grade A incision healing at 7 days after surgery (p < 0.01). There was no statistically significant difference between the patients in the two surgical-method groups in terms of the positive biopsy results and the final diagnosis based on expert opinions (p > 0.05). By multivariable regression analysis, only a focus score (FS) of ≥ 1 (p < 0.01), dry eye disease (p < 0.05) and anti-nuclear antibodies (ANA) titre ≥ 1:320 (p < 0.05) were correlated with the diagnosis of pSS. The positive biopsy results of patients in the different surgical-method groups had a biopsy accuracy of > 80.0% for the diagnosis of pSS. The positive biopsy results in the different surgical-method groups were consistent with the expert opinions and the 2016 ACR-EULAR primary SS classification criteria. The modified LSGB using an auxiliary chalazion forceps offers a good safety with a small incision, shorter operative time, less bleeding, reduced pain and a low incidence of postoperative complications.The match rate of LSGB pathological results of the proposed surgical procedure with the final diagnosis of pSS is high.

Ferroptosis in organ fibrosis: From mechanisms to therapeutic medicines

Fibrosis occurs in many organs, and its sustained progress can lead to organ destruction and malfunction. Although numerous studies on organ fibrosis have been carried out, its underlying mechanism is largely unknown, and no ideal treatment is currently available. Ferroptosis is an iron-dependent process of programmed cell death that is characterized by lipid peroxidation. In the past decade, a growing body of evidence demonstrated the association between ferroptosis and fibrotic diseases, while targeting ferroptosis may serve as a potential therapeutic strategy. This review highlights recent advances in the crosstalk between ferroptosis and organ fibrosis, and discusses ferroptosis-targeted therapeutic approaches against fibrosis that are currently being explored.

Value of Quantitative Salivary Gland SPECT/CT for the Detection of Saliva Leakage

ABSTRACT

A 47-year-old woman presented to our emergency department with a 10-day history of pain, halitosis, and swelling below the left jaw. The patient was diagnosed with left sialadenitis and left submandibular abscess by tissue biopsy. An otolaryngologist performed transcervical incision and drainage of the abscess 1 day after admission. Postoperatively, the patient complained of a sensation of fluid leakage from the mouth, and a continuous purulent discharge was observed. One month postoperatively, a salivary gland scan and SPECT/CT were performed to investigate the sialorrhea and the cause of the discharge. Salivary gland SPECT/CT images localized the saliva leakage site.

A randomized controlled trial to verify the irrigation of salivary glands in relieving xerostomia in patients with Sjögren's syndrome

OBJECTIVE

To verify the effect of triamcinolone acetonide (TA) and major salivary glands saline irrigation on relieving xerostomia in Sjögren's syndrome (SS) patients.

METHODS

The enrolled 49 SS patients were randomly assigned to the control group (no irrigation, n=16), saline group (irrigation with saline, n=17) and TA group (irrigation with TA, n=16). Fourteen cases of each group were treated differently but received the same examinations. The examinations include unstimulated whole saliva flow (UWS), chewing-stimulated whole saliva flow (SWS), citric acid-stimulated parotid flow (SPF), Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) of 1 week before irrigation (T0) and 1 week(T1), 8 weeks (T8), 16 weeks (T16) and 24 weeks (T24) after major salivary irrigation.

RESULTS

Each group had 14 cases with completed follow-ups. Both TA and saline irrigation of major salivary glands resulted in higher SWS and SPF of T8, T16 and than those at T0. ESSPRI (oral dryness domain) of T8, T16 and T24 were significantly lower than that at T0, respectively (P < 0.05). SWS and SPF of T8, T16 and T24 in the saline group were significantly higher than in the control group (P< 0.05). XI and ESSPRI (oral dress domain) of T8, T16 and T24 in the saline group were significantly lower than those in the control group, respectively (P< 0.05). SWS and SPF of T16 and T24 in the TA group were significantly higher than in the control group (P< 0.05). All cases with completed follow-up in TA and saline groups were divided into responders and non-responders. Compared with responders, the UWS, SWS, SPF and CODS of T0 in non-responders were significantly increased (P<0.05). Compared with responders, the XI and ESSPRI of T0 in non-responders were significantly decreased (P<0.05).

CONCLUSION

The irrigation of major salivary glands by TA and saline relieve xerostomia in SS patients. Patients with non-severe xerostomia (responders) have better relief after irrigation than patients with severe xerostomia (non-responders).

CLINICAL TRIAL REGISTRATION

www.chictr.org.cn, identifier (ChiCTR210052314).

Clinical Utility of Quantitative Parameters of Salivary Gland Scintigraphy for Diagnosing Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a chronic disorder characterized by a burning sensation in the oral cavity, often accompanied by xerostomia, with no relevant clinical or laboratory findings. This study aimed to investigate diagnostic values of quantitative parameters of salivary gland scintigraphy for BMS in patients with xerostomia. A total of 164 patients who underwent salivary gland scintigraphy for the workup of xerostomia were retrospectively reviewed. All patients were classified into patient groups with primary BMS, secondary BMS, and non-specific xerostomia. From salivary gland scintigraphy, 22 quantitative parameters were calculated and their diagnostic values were assessed based on the area under the receiver operating characteristic curve (AUC) values. Among salivary gland scintigraphy parameters, uptake speed in the left submandibular gland showed the highest AUC value (0.647) for detecting BMS and pre-stimulatory oral activity showed the highest AUC value (0.710) for detecting primary BMS. A salivary gland scintigraphy scoring system based on these two parameters further enhanced the diagnostic ability, demonstrating AUC values of 0.731 for BMS and 0.782 for primary BMS. These results suggest a potential diagnostic value of the quantitative parameters of salivary gland scintigraphy for detecting BMS in patients with xerostomia.

Diagnosis, Prevention, and Treatment of Radiotherapy-Induced Xerostomia: A Review

In patients with head and neck cancer, irradiation (IR)-sensitive salivary gland (SG) tissue is highly prone to damage during radiotherapy (RT). This leads to SG hypofunction and xerostomia. Xerostomia is defined as the subjective complaint of dry mouth, which can cause other symptoms and adversely affect the quality of life. In recent years, diagnostic techniques have constantly improved with the emergence of more reliable and valid questionnaires as well as more accurate equipment for saliva flow rate measurement and imaging methods. Preventive measures such as the antioxidant MitoTEMPO, botulinum toxin (BoNT), and growth factors have been successfully applied in animal experiments, resulting in positive outcomes. Interventions, such as the new delivery methods of pilocarpine, edible saliva substitutes, acupuncture and electrical stimulation, gene transfer, and stem cell transplantation, have shown potential to alleviate or restore xerostomia in patients. The review summarizes the existing and new diagnostic methods for xerostomia, along with current and potential strategies for reducing IR-induced damage to SG function. We also aim to provide guidance on the advantages and disadvantages of the diagnostic methods. Additionally, most prevention and treatment methods remain in the stage of animal experiments, suggesting a need for further clinical research, among which we believe that antioxidants, gene transfer, and stem cell transplantation have broad prospects.

Correlations between salivary gland scintigraphy and histopathologic data of salivary glands in patients with primary Sjogren's syndrome

OBJECTIVES

Our aim was to evaluate the association between salivary gland scintigraphy and the clinical parameters, including histological characteristics of salivary glands, in patients with primary Sjogren's syndrome (pSS).

METHODS

Forty-one pSS patients were included in the study. The patients who had received salivary gland scintigraphy and minor salivary gland biopsy were retrospectively analyzed. Salivary gland scintigraphy was interpreted via semi-quantitative methods obtained by calculating the peak uptake and washout of each gland using regions of interest. All specimens were examined by pathologists for focus scores and leukocyte common antigen (LCA) to determine the degree of inflammatory infiltration.

RESULTS

The mean age of pSS patients was 46.4 years, 82.9% were female, and the mean duration of symptoms was 2.5 years. The focus score was negatively correlated to the mean peak uptake (r = ‒0.396; p = 0.019), mean uptake (r = ‒0.388; p = 0.021), and mean percentage washout (r = ‒0.391; p = 0.02). In addition, the focus score and number of LCA positive cells per mm² were correlated with the clinical parameters including erythrocyte sedimentation rate, globulin, rheumatoid factor, unstimulated whole saliva, and stimulated whole saliva flow. The number of LCA positive cells per mm² was negatively correlated to leukocytes and hemoglobin.

CONCLUSION

Although the diagnostic role of salivary gland biopsy is widely accepted and features in the classification criteria of Sjogren's syndrome, salivary gland scintigraphy may be an acceptable alternative method especially if a non-invasive test is required.