CT Sialography Research Articles

Radiološka dijagnostika sijalolitijaze

The existence of possible pathological conditions of the salivary glands requires the use of certain imaging techniques, which contributes to a better diagnosis of the disorder and proper treatment. Stones, inflammatory processes and tumors are conditions that are accompanied by unpleasant symptoms inside the oral cavity. Sialolithiasis is the presence of stones in the salivary glands and is a common pathological disorder. The aim of this paper is to present the diagnostic imaging of sialolithiasis. That includes the methods of dental radiography and different methods of sialography. Conventional imaging techniques in dental radiography have been abandoned over time. USG and sialography methods are more often used in clinical practice nowadays. Sialographic methods include the application of a contrast medium, which results in a better visualization of the excretory ducts of the salivary glands, in both conventional and digital imaging. CT and MRI sialography methods visualize smaller stones better in the salivary excretory ducts, with some limitations. The results of the recently reviewed scientific researches show that the radiographic imaging methods for sialolithiasis are complementary. Sialography and USG are the initial methods in diagnosing sialolithiasis, but the use of CT and MR can provide valuable additional diagnostic information.

Optimizing effective dose and image quality in cone beam CT sialography

The purpose of this study was to develop protocols that optimize patient radiation dose and image quality for cone beam computed tomographic (CBCT) sialography for the major salivary glands. Radiation absorbed dose measurements were repeated in triplicate using 25 sites in the head and neck of a Radiation ANalog DOsimetry system (RANDO) phantom, and effective doses were calculated across a range of peak kilovoltage (kVp) and milliamperage (mA) settings using an 8 cm (diameter) by 5 cm (height) field of view (FOV) for submandibular imaging and an 8 cm (diameter) by 8 cm (height) FOV for parotid imaging. Image signal difference-to-noise ratio (SDNR) was determined, and the figure-of-merit (FOM), a measure of image quality, was calculated. For submandibular sialography, 85 kVp and 6 mA were chosen as the optimal exposure parameters, resulting in a mean effective dose of 82.47 µSv and a mean SDNR of 13.86, with a mean FOM of 2.33 µSv-1. For parotid sialography, 70 kVp and 6 mA were chosen, and these settings resulted in a mean effective dose of 39.99 µSv, a mean SDNR of 17.43, and a mean FOM of 7.60 µSv-1. Low-dose 3-dimensional sialography with high image quality and minimal effective dose can be delivered using CBCT with localized, small FOVs.

Sialography: a pictorial review.

Non-tumour inflammatory and obstructive salivary gland pathologies such as sialadenitis, sialolithiasis, sialadenosis, ductal strictures, etc. require precise radiological evaluation and mapping of salivary gland ductal system for better treatment outcome. Conventional sialography is considered as a useful and reliable technique in evaluation of salivary glands especially intrinsic and acquired abnormalities involving the ductal system and is useful for detection of non-radiopaque sialoliths which are invisible on routine plain radiographs. Primarily sialography is used as a diagnostic tool, additionally it plays an important therapeutic role as salivary gland lavage in cases of recurrent salivary gland infections and in obstructive salivary gland disorders by helping in clearance of mucous plugs or small sialoliths within the ducts. Recently, diagnostic performance of computed tomography (CT) sialography is being explored and has been reported to have high sensitivity in detection of small sialoliths and allows differentiation of sialoliths from other calcifications in glandular ductal system. Multiplanar three dimensional (3D) reconstructed CT images have been reported to play a key role in determination of anatomical location or extent of salivary gland disease without superimposition or distortion of structures. This review aims to discuss the disease specific applications of sialography and CT Sialography in particular for visualization of salivary gland disorders.

Clinical and CT sialography findings in 22 dogs with surgically confirmed sialoceles.

Sialoceles are an uncommon canine salivary gland disease, and complete surgical resection is important for a positive outcome. Radiographic sialography has been described as a diagnostic test for presurgical planning; however, superimposition artifacts may limit the diagnosis and detection of all affected glands. Computed tomographic (CT) sialography is a promising technique for delineating the salivary gland apparatus. The aims of this retrospective, observational study were to describe clinical and CT sialographic findings in a group of dogs with confirmed sialoceles, to determine the sensitivity of CT sialography for detecting affected salivary glands using surgery as the reference standard and to determine interobserver agreement for CT sialographic assessments. Dogs were included if they underwent a CT sialography study followed by surgical resection of the diseased gland(s) and histopathological analysis. Computed tomography sialography studies of dogs with surgically confirmed sialoceles (n = 22) were reviewed by a European College of Veterinary Diagnostic Imaging (ECVDI)-certified radiologist and an ECVDI resident. Interobserver agreement was calculated using Cohen's kappa statistics. CT sialography results were compared to surgical findings to determine sensitivity. Contrast leakage was detected in 12 of 22 dogs (54.5%), with intrasialocele leakage being most frequently observed (7/12, 58.3%). There was substantial agreement (κ = 0.70) between reviewers identifying diseased glands, substantial agreement (κ = 0.62) on the diagnostic quality, and no to slight agreement (к = 0.13) in the detection of contrast leakage. The overall sensitivity of CT sialography to detect surgically confirmed diseased glands was 66.7% (95% confidence interval: 48.8-80.8). In conclusion, these findings support the use of CT sialography as an adjunct diagnostic test for treatment planning in dogs with sialoceles.

ROLE OF MAGNETIC RESONANCE IMAGING SIALOGRAPHY IN DIAGNOSIS OF SALIVARY GLAND DUCT DISEASES

Salivary gland duct diseases have been commonly addressed and investigated using ultrasound and conventional radiographic techniques. However, ultrasound assessment displays a limited view of the salivary ductal tree. While conventional X-ray or CT sialography may provide acceptable spatial anatomy, a number of drawbacks were reported, with complications such as trauma or acinar rupture and sepsis, and contraindications such as acute parotitis or contrast material allergy, not to mention the required high operator experience and patient compliance.MR sialography is a new nonionizing noninvasive technique that is being developed to evaluate diseases of the salivary ducts. Adequate assessment of the duct system is obtainable, with no involvement of invasive techniques, or contrast material or radiation exposure.MR sialography offers many advantages over alternative imaging techniques such as conventional x-ray sialography. These include the noninvasive technique; avoiding contrast media, ionizing radiation, and dependence on an experienced operator.Details provided by MRI sialography are considered to be of value for the interventional decision-making process. These details include the distance of the obstructing cause from the ductal punctum, the size and number of stones, ductal mapping and diameters, Upstream dilatation, and ductal condition.

Three dimensional cone-beam CT sialography in non tumour salivary pathologies: procedure and results

Background: Three-dimensional cone-beam CT sialography (3D-CBCT sialography) tends to replace conventional sialography for exploring salivary gland diseases.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. Literature review and cost-effectiveness analysis. A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. NA. Laryngoscope, 1822-1828, 2018.

Three-dimensional cone-beam CT sialography in non tumour salivary pathologies: procedure and results.

Non-tumour salivary diseases are common. Imaging studies are essential for their diagnosis and before undergoing an endoscopic or surgical treatment. In this study, we aimed at presenting our procedure and results obtained with three-dimensional CBCT (3D-CBCT) sialography for non-tumour salivary gland diseases. Patients with parotid or submandibular salivary symptoms were examined by 3D-CBCT sialography. They received an intraductal injection of 0.5 mL of water-soluble contrast medium maintained in the gland, followed by examination in a NewTom wide-field CBCT device. Images were processed with multiplanar and 3D reconstructions. A ductal exploration could be performed until the fourth divisions. The main lesions found were stones, stenosis, dilatations and "dead tree" appearance of the ductal system. No side effects of the catheterization or the iodine contrast were reported, nor tissue damages related to the contrast keeping technique. 3D-CBCT sialography seems to represent a reliable non-invasive diagnostic tool for ductal salivary diseases. More studies are needed to assess the value of 3D-CBCT sialography compared with conventional imaging.

Salivary Gland Imaging: A Pictorial Essay

The major salivary glands are parotid, submandibular and sublingual glands. Imaging has an important role to play in detection, diagnosis, aiding biopsy and differentiating benign from malignant pathology. The traditional imaging modalities include plain radiography and sialography. With the advent of modern imaging methods like high resolution ultrasound with color doppler, contrast enhanced CT, MRI and MR sialography, the imaging has become increasingly reliable in making a confident diagnosis. A wide variety of conditions including obstructive, infectious, autoimmune and neoplastic pathologies affect the salivary glands, thus resulting in a wide imaging spectrum. This article is aimed at presenting the imaging appearances of common salivary gland diseases.

A type-II first branchial cleft anomaly presenting as a post-auricular salivary fistula: A rare presentation

First branchial cleft anomalies are rare with the average age of presentation as 19 years. There is an average delay of 3.5 years between initial presentation and adequate treatment due to diagnostic dilemma. A very rare variant of first branchial cleft anomaly presenting as a post-auricular salivary fistula is reported. A 12-year-old girl presented with a history of intermittent watery discharge, more so at the time of meals from a right post-auricular opening for last 3 years. Computed tomography sialography revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal. Superficial parotidectomy with identification of facial nerve branches was carried out for excision of the tract. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland. We classified our case into work's type-2 based on anatomical location at an angle of mandible, its relationship to parotid gland and facial nerve and previous history of ear discharge. To the best of our knowledge, this is the first case of its type to be reported.

Hypoplasia of the parotid gland: computed tomography sialography diagnosis

We report two unusual cases of non-syndromic hypoplasia of the parotid gland. The hypoplastic parotid gland mimicked a preauricular parotid tumor in one case and presented as an incidental image finding in the other case. Absence of the deep lobe and isthmus of the parotid parenchyma could be determined on axial computed tomography (CT) by revealing fat tissue composition of the parotid space. The underdeveloped superficial lobe of the gland was observed on three-dimensional CT sialography.

A comparative study of the diagnostic capabilities of 2D plain radiograph and 3D cone beam CT sialography

The aim of this study was to compare the diagnostic capabilities of two-dimensional sialography with a novel three-dimensional technique using cone beam CT (CBCT). 47 subjects underwent parotid or submandibular gland sialography over a 2 year period using both plain imaging and CBCT. Both image sets were anonymized and independently reviewed by three certified oral and maxillofacial radiologists blinded to the clinical data. McNemar's χ(2) test was used to determine differences between the two modalities for feature visualization and interpretation. CBCT outperformed plain imaging with respect to visualization of the gland parenchyma (p < 0.001) and identification of sialoliths (p = 0.02). Plain imaging outperformed CBCT for the identification of strictures (p = 0.04); however, the negative per cent agreement ("specificity") between the two imaging modalities was 100%. Although both imaging modalities performed equally in identifying normal and abnormal sialographic examinations, CBCT demonstrated a high negative per cent agreement for normal glands and a high positive per cent agreement ("sensitivity") for abnormal glands with inflammatory changes. CBCT sialography allowed better visualization of gland parenchyma and identification of sialoliths. The high negative per cent agreement for strictures suggests that, if strictures are identified on CBCT images, then obstruction can be ruled in. Relative to plain images, the high negative per cent agreement for normal glands suggests that, if an abnormal finding is detected on CBCT images, then disease can be ruled in, and the high positive per cent agreement for glands with inflammatory changes suggests that inflammation can be ruled out if these changes are not seen on CBCT images.

Computational fluid dynamics for investigation of saliva pressure in parotid obstruction

OBJECTIVES/HYOTHESIS: Parotid obstruction is one of the most common problems affecting the parotid gland. We aimed to investigate the blockage ratio (BR) and the intraductal pressure change of Stensen's duct using computational fluid dynamics. Retrospective review of 16 patients who had undergone interventional sialendoscopy for parotid obstruction from 2009 to 2011. The three-dimensional configurations of Stensen's duct were reconstructed from computed tomography (CT) sialographic images. Finite volume modeling in fluid dynamics of parotid obstruction was used to analyze the pressure distribution under conditions of rest and stimulation. Intraductal pressure increased with increasing distance from the orifice. The upstream pressure was higher than that of downstream pressure in the same BR (P < .05). The upstream pressure increased as the BR increased. Statistically, the pressure turning point was indicated when BR = 60%. Only when the BR was much greater than 90% did the pressure reach 811.64 Pa, at which point patients could feel the painful swelling under the rest condition. Under the stimulated condition, the upstream pressure increased from 1.3- to 2.9-fold of that of the no blocking state when the BR increased from 80% to 90%, which may aggravate the obstructive symptoms. There was no significant difference observed for downstream pressure under the same condition (P > .05). CT sialography was effectively used for analysis of the intraductal pressure distribution in patients with parotid obstruction. Analysis of salivary fluid dynamics in Stensen's duct may provide a further pathophysiological mechanism for obstructive diseases.

Diagnostic accuracy of parotid CT for identifying Sjögren's syndrome

PurposeTo evaluate the diagnostic accuracy of computed tomography (CT) of the parotid gland for Sjögren's syndrome in comparison with conventional X-ray sialography. MethodsCT scans and X-ray sialography were performed in 34 patients with confirmed Sjögren's syndrome and 22 symptomatic controls without the disease. CT data from 57 asymptomatic controls were included for quantitative analysis. The CT findings of heterogeneity, abnormal diffuse fat tissue deposition, diffuse punctate calcification, swelling or atrophy, nodularity or cystic changes of the parotid gland were analyzed by two independent blinded readers. The correlation between CT and X-ray sialography findings was evaluated. Diagnostic performance and receiver operating characteristics curves were calculated. ResultsOn CT, heterogeneity of the parotid gland was seen in 30/31 (reader 1/reader 2) Sjögren's syndrome patients by the two readers (sensitivity 88.2%/91.2%; specificity 100%/90.9%). Abnormal diffuse fat tissue deposition was seen in 28/28 SS patients by the readers (sensitivity 82.3%/82.3%; specificity 100%/90.9%). Diffuse punctate calcification was seen in 10/12 Sjögren's syndrome patients (sensitivity 29.4%/35.2%; specificity 100%/100%). Stagings of CT findings correlate positively with sialography. The areas under the receiver operating characteristics curves were 0.887 (P=0.000) and 0.908 (P=0.000) for the maximum and standard deviation (SD) of the CT value. ConclusionsParotid CT is accurate and reliable in the diagnosis of Sjögren's syndrome. Heterogeneity, abnormal diffuse fat tissue deposition, and diffuse punctate calcification are specific for Sjögren's syndrome. CT attenuation analysis is helpful in diagnosis.

Cone beam CT sialography of Stafne bone cavity

Stafne bone cavity (SBC) was mostly described as a small oval radiolucency in the posterior mandibular region. To the best of our knowledge, the literature does not contain any report of the use of cone beam CT (CBCT) sialography for the diagnosis of this entity. The aim of this paper is to present a large, irregular and expanded atypical SBC, which made diagnosis difficult. A CBCT sialography was performed to get a definite diagnosis of this rare entity.

Nowe spojrzenie na klasyfikację przewlekłego zapalenia dużych gruczołów ślinowych i algorytm postępowania

Approximately 5% of patients visit the ENT doctors with major salivary gland complaints. Chronic sialadenitis is one of the major disorders that can cause salivary hypofunction and correct diagnosis and management is essential for its recovery. The classification of this pathological condition have changed in the past eight decades and nowadays was revised and modified, for new diagnostic (high resolution ultrasonography, CT and MR sialography and sonoelastography) and therapeutic methods (sialoendoscopy) were introduced. was to revive the past classifications of chronic inflammatory diseases of the major salivary glands and present the current one with implications for diagnostic and treatment schedule. 20 patients with parotid and 44 with submandibular gland sialadenitis were treated in Otolaryngology, Head and Neck Surgery Department Poznań Medical University in the years 2007–2010. Two periods of time: 2007–8 and 2009–10 were compared, the turn point was December 2008, when sialoendoscopy was introduced. 25 out of 50 patients with parotid and 73 out of 95 with submandibular sialadenitis suffered from lithiasis. Surgical evacuation of the stone was performed in 10 cases in 2007–08, and in 4 between 2009 and 10. In this last period 94 sialoendoskopies was performed, in this number in case 38 submandibular and 7 parotid lithiasis. Stensens duct stenosis was diagnosed in 7 and Wharton duct in 12 patients. To conclude, authors underline that the prompt diagnosis is indispensible for the proper further treatment. The recommended treatment of chronic and obstructive sialadenitis obtains the novel technique, sialoendoscopy.

Sialotomografia: revisão de literatura e relato de caso clínico

CT sialography is an excellent method for observation and evaluation of salivary gland tumors. The purpose of this study is to review the literature regarding CT sialography, describing its acquisition protocol through a case report and discuss its advantages and contraindications. 33-year-old male patient, presenting a well defined, painless swelling, in the region of the left parotid gland. The association between the use of a contrast media and the tomographic technique allowed for a more precise evaluation of the lesion boundaries. However, contrast media should be used with caution considering its possible adverse reactions.

Congenital salivary fistula of accessory parotid gland: imaging findings

We report the imaging findings in a rare case of an accessory parotid gland fistula. An eight-year-old boy was presented with complaints of serous discharge from his left cheek since birth. As part of the radiological investigation, magnetic resonance imaging, computed tomography sialography with fistulography, and digital sialography with fistulography were performed. Magnetic resonance imaging demonstrated the exact location of an accessory parotid gland but failed to demonstrate the accessory duct. The presence of an accessory gland was well delineated on computed tomography fistulography and computed tomography sialography. Fistulography revealed a small accessory parotid duct and gland. No communication between the ductal systems of both glands was demonstrated. In such cases, pre-operative imaging (with sialography, magnetic resonance sialography and computed tomography sialography with fistulography) is helpful for exact delineation of the ductal anatomy. To the best of our knowledge, only four previous cases of congenital accessory parotid gland fistula have been reported in the English literature.

Status of the remaining parotid duct and gland following superficial parotidectomy

The changes in Stensen's duct and remaining parotid tissue following superficial parotidectomy have not been studied previously. The aim of this clinical case control study is to describe these changes using sialography and CT-sialography techniques. Fourteen superficial parotidectomy cases underwent parotid sialography bilaterally. CT sialography was also done. Stensen's duct was patent in 11 cases (79%), and non-patent in three cases (21%). Its angle in relation to our reference line was 20 degrees in operated cases versus 37 degrees for the non-operated cases. Following superficial parotidectomy, the remaining parotid tissues usually remain functional and retain drainage through Stensen's duct. Furthermore, superficial parotidectomy changes the direction of this duct. Parotid sialography and CT sialography can still be used to study the status of remaining parotid tissue following superficial parotidectomy. The post-surgical changes should be reviewed with care before interpreting these studies.

Interpretation of the origin of a submandibular mass by CT and MRI imaging

Objective To clarify the useful findings for determining whether the submandibular mass is intraglandular or extraglandular. Study design Forty-eight patients with swelling of the submandibular region were reviewed. The relationship between the lesion and the submandibular gland and the displacement of the anterior facial vein were analyzed. Results The accuracy of the predictions based on the relationship between the lesion and the submandibular gland (SMG) was 87% on contrast-enhanced CT (CECT), 85% on CT sialography (CTS), and 91% on MRI. Although the displacement of the facial vein outside the lesion suggested an intraglandular lesion, and inside the lesion suggested an extraglandular lesion, these were not sufficient to differentiate the lesions in 7 out of 23 CECT cases and 4 out of 11 MRI cases. Conclusion The finding of a relationship between the lesion and the SMG is the most important finding of this study.