Recommended Imaging for Salivary Gland Disorders

Abstract

Imaging modalities useful in the contemporary evaluation of salivary gland disorders are discussed. Salivary gland ultrasound—due to its wide applicability, versatility, availability, and low cost—is supported as a frontline evaluation and is frequently done as an in-office procedure by the treating surgeon. Contrast-enhanced CT may be as accurate as non-contrast CT in detecting sialolithiasis. Although conventional sialography (fluoroscopic salivary gland evaluation with ductal dilation and radiocontrast insufflation) was initially designed as a diagnostic procedure, more recently, reported experience has demonstrated it to result in improved salivary function for several disorders—including its use as treatment of juvenile recurrent parotitis. Conventional sialography remains the most accurate method to assess the full ductal anatomy and is superior to MRI sialography which fails to adequately image the more proximal ducts. For benign salivary tumors, US may obviate the need for further imaging and provide reliable estimation of tumor location. Salivary gland disorders are most efficiently imaged with in-office ultrasound. In settings where US cannot be performed, CT (with or without contrast) remains a reliable initial method to detect salivary gland abnormalities including sialolithiasis. MR sialography has become a useful modality for evaluating stenosis and may be considered when conventional sialography is not available.