Quantitative Salivary Scintigraphy Research Articles

Office-based salivary gland ductal irrigation in patients with chronic sialoadenitis: A preliminary study

To evaluate the therapeutic responsiveness of office-based salivary gland ductal irrigation in patients with chronic sialoadenitis. Between August 2017 and April 2019, 55 patients comprising the following three disease groups were enrolled: Sjogren's syndrome: 39 patients; postradiotherapy sialoadenitis: ten patients; and post-RAI sialoadenitis: six patients. Quantitative salivary scintigraphy was recorded, and a formulated questionnaire including the Summated Xerostomia Inventory was utilized to assess acute/chronic symptoms. All patients received at least three serial salivary gland ductal irrigations with a one-month interval in our outpatient department. The general response rates for each disease groups are as follows: Sjogren's syndrome: 61.5% (24/39); postradiotherapy: 60% (6/10); and post-RAI: 83.3% (5/6). Among the patients with Sjogren's syndrome, the parotid scintigraphic Tmin showed a significant positive correlation with the responsiveness of salivary irrigation (P = 0.046), whereas the treatment tended to be irresponsive in patients who previously took medicine for their related discomfort (P = 0.009). In the postradiotherapy and post-RAI groups, no significant factors were found to be associated with the responsiveness of irrigation. Simple salivary ductal irrigation without complex equipment can be performed as an outpatient procedure to alleviate glandular swelling or xerostomia in patients with Sjogren's syndrome, postradiotherapy sialoadenitis or post-RAI sialoadenitis, and it can be considered an alternative management approach for patients refractory to conventional strategies.

PP138: Effects of pilocarpine on salivary gland function after postoperative radioiodine therapy for differntiated thyroid cancer

Purpose The aim of this study was to investigate the effect of pilocarpine on salivary gland function in patients with postoperative 131I therapy-induced salivary dysfunction using a visual analog symptom scale and quantitative analysis of salivary flow rate, as well as salivary gland scintigraphy. Materials and methods Fifty patients who had RI-induced salivary dysfunction (sialadenitis, xerostomia, or hypogeusia) after treatment of 131I for postoperative ablation of differentiated thyroid cancer were enrolled. 25 patients were assigned randomly to the pilocarpine treatment group, which received 5 mg pilocarpine tid in addition to traditional conservative treatment such as hydration, sucking on sour candies or lemons, and massaging the affected gland, and 25 patients were assigned to the control group with only conservative treatment. Salivary dysfunction was graded according to a visual analog symptom scale before and 3 month after treatment. Salivary flow rate was measured and quantitative salivary gland scintigraphy was performed for analysis of salivary parenchymal function. Results There were no statistical differences in the mean age and the mean dose of 131I administered between two groups. The salivary symptom scale on sialadenitis was significantly improved in the treatment group compared to the control group. But pilocarpine treated group showed no significant improvement of the function parameter by salivary flow rate as well as quantitative salivary scintigraphy compared to the control group. Conclusions Pilocarpine treatment reduced the occurrence of symptoms on salivary dysfunction. Salivary flow rate and scintigraphic parameters were not statistically different between the pilocarpine treated and control group, which suggest that adding pilocarpine to traditional sialogogues may not improve the parenchymal damage to salivary gland.

A case of cervical multicentric Castleman disease treated with intensity-modulated radiation therapy using helical tomotherapy

Castleman disease (CD) is a rare lymphoproliferative disorder. Two clinical entities are described: a unicentric form with disease confined to a single lymph node region and a multicentric form characterized by generalized lymphadenopathy and systemic symptoms. Although surgery is regarded as standard therapy for the unicentric form, no consensus has been reached concerning the standard treatment for multicentric CD. We report here a case of cervical multicentric CD treated with intensity-modulated radiation therapy (IMRT), using helical tomotherapy to minimize xerostomia in comparison with conventional radiotherapy. A 29-year-old woman complained of neck swelling. Computed tomography showed lymphadenopathy in both sides of the neck. The patient was diagnosed with the plasma cell subtype of CD on biopsy. After initial treatment with prednisone, IMRT was planned to avoid normal structures, for example the parotid gland. The cervical lymphadenopathy shrank gradually during IMRT with 44 Gy in 22 fractions. Four years and 3 months after IMRT, regrowth of cervical lymph nodes has not been detected. The parotid function improved dramatically on quantitative salivary scintigraphy between 3 and 12 months after IMRT. Radiotherapy could be an option for multicentric CD, and IMRT is an effective means of minimizing xerostomia in head and neck lesions.

Parotid-sparing Tomotherapy for Head and Neck Cancers: Preserved Parotid Function after Tomotherapy on Quantitative Salivary Scintigraphy

Parotid-sparing Tomotherapy for Head and Neck Cancers: Preserved Parotid Function after Tomotherapy on Quantitative Salivary Scintigraphy

Limited Cytoprotective Effects of Amifostine in High-Dose Radioactive Iodine 131–Treated Well-Differentiated Thyroid Cancer Patients: Analysis of Quantitative Salivary Scan

The aim of present study was to investigate the cytoprotective effect of amifostine on salivary glands in 131I-treated differentiated thyroid cancer (DTC) patients using serial quantitative analysis of salivary gland scans. Serial quantitative salivary scintigraphies were performed in 80 newly diagnosed DTC patients (9 men, 71 women; mean age, 43.2 years old; range, 21-58 years old). Forty-two patients were assigned randomly to the amifostine treatment group, which received 300 mg/m2 amifostine intravenously before 131I administration. In both amifostine-treated and nontreated groups statistically significant declines of functional parameters after 131I treatment were revealed by quantitative salivary scintigraphy in DTC patients. Amifostine pretreatment did not prevent the parenchymal damage to major salivary gland function after 131I treatment (F = 1.37, p = 0.2461). However, the dose of 131I had significant effects on salivary gland function after 131I treatment (F = 9.72, p = 0.0002). The present study did not show cytoprotective effects of amifostine for DTC patients treated with 131I.

Parotid-sparing intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma: Preserved parotid function after IMRT on quantitative salivary scintigraphy, and comparison with historical data after conventional radiotherapy

To evaluate the parotid function after parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). From March 2003 to May 2004, 16 patients with nonmetastatic NPC underwent parotid-sparing IMRT. Eight of these patients had Stage III or IV NPC based on the 1997 American Joint Committee on Cancer staging system. The post-IMRT parotid function was evaluated by quantitative salivary scintigraphy and represented by the maximal excretion ratio (MER) of the parotid gland after sialogogue stimulation. The parotid function of 16 NPC patients who were previously treated with conventional radiotherapy was reviewed as the historical control. In the parotid-sparing IMRT group, all 16 patients were alive and without cancer at the end of follow-up period (median, 24.2 months). The mean parotid MER was 53.5% before radiotherapy, 10.7% at 1 month post-IMRT, and 23.3% at 9 months post-IMRT. In the conventional radiotherapy group, the mean parotid MER was 0.6% at 6 to 12 months postradiotherapy. The difference was statistically significant (23.3% vs. 0.6%, p<0.001, Mann-Whitney test). In the IMRT group, the mean parotid doses ranged from 33.2 Gy to 58.8 Gy (average, 43.9 Gy). The correlation between the mean parotid dose and the percentage decrease of parotid MER at 9 months post-IMRT (dMER) was statically significant (p=0.008, Pearson correlation). Although the mean parotid doses are relatively high, the significant preservation of parotid function is achieved with IMRT for NPC patients. The significant correlation between mean parotid dose and parotid dMER demonstrates the dose-function relationship of the parotid gland.

Decreased salivary gland function in patients with autoimmune thyroiditis.

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. 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. 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. 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.

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.

Scintigraphic Evidence of Poor Salivary Function in Type 2 Diabetes

In type 2 diabetes, a high prevalence of oral problems has been detected. These problems include mouth dryness, an increase in periodontal disease, oral Candida , and swelling of the parotid glands (1). Salivary flow rates have often been found to be significantly reduced in type 2 diabetic patients (2), although these findings have not been confirmed (3). Scintigraphic changes correlate well with salivary gland abnormalities (4) and histopathological changes (5). This technique has gained widespread acceptance in evaluating a variety of salivary glandular disorders (6,7). The aim of the present study was to test whether patients with type 2 diabetes suffer from impaired salivary function using objective and quantitative salivary scintigraphy. A total of 40 patients with type 2 diabetes for 10 years and 36 healthy age- and sex-matched …

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.

Evidence for Decreased Salivary Function in Patients with Reflux Esophagitis

It has been speculated that impaired salivary flow contributes to abnormal acid clearance of the esophagus in gastroesophageal reflux and results in reflux esophagitis (RE). To test this hypothesis, salivary functions were measured by quantitative salivary scintigraphies in patients with RE and in age- and sex-matched controls for comparison. Nineteen patients with RE and 36 healthy volunteers were enrolled in the study. After an intravenous injection of 5 mCi Tc-99m pertechnetate, sequential images of 1 min/frame were acquired for 30 min. The 1- and 15-min uptake ratios (UR) of the tracer in the four major salivary glands over the backgrounds were calculated. 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 were calculated for the sialagogue stimulation. RE patients had lower values of 1st and 15th min UR and maximal ER than controls in the 4 major salivary glands. Poor salivary functions which represented a decrease in both UR and ER for patients with RE have been confirmed by quantitative salivary scintigraphy in this study.