Salivary Gland Scintigraphy In Patients Research Articles

Ocular Surface Staining Score and Salivary Gland Scintigraphy in Patients with Primary Sjögren’s Syndrome

ëª©ì  눈마름 임상증상을 보이는 일차 ì‡¼ê·¸ë Œì¦í›„êµ°(Sjögren’s Syndrome) 환자에서 ì•ˆêµ¬í‘œë©´ì—¼ìƒ‰ì ìˆ˜ì™€ ì •ëŸ‰í™”í•œ 침샘 ì‹ í‹°ê·¸ëž˜í”¼ 지표 간의 상관관계 및 ì§„ë‹¨ì  가치에 대해 ë¶„ì„í•˜ê³ ìž 한다. 대상과 방법 2017ë „ 7월부터 2019ë „ 4월까지 류마티스내과에서 의뢰된 눈마름 임상증상을 보이는 ì‡¼ê·¸ë Œ 및 ë¹„ì‡¼ê·¸ë Œì¦í›„êµ°ì˜ 성인 51ëª ì˜ 의무기록을 í›„í–¥ì ìœ¼ë¡œ ê²€í† í•˜ì˜€ìœ¼ë©°, 일차 ì‡¼ê·¸ë Œì¦í›„êµ°ê³¼ ë¹„ì‡¼ê·¸ë Œì¦í›„êµ° 간에 ì•ˆêµ¬í‘œë©´ì—¼ìƒ‰ì ìˆ˜ì™€ 침샘 ì‹ í‹°ê·¸ëž˜í”¼ 각 지표의 차이가 있는지에 대한 비교에는 각각 Mann Whitney U-test 및 student t-test를 ì‚¬ìš©í•˜ì˜€ê³ , ì•ˆêµ¬í‘œë©´ì—¼ìƒ‰ì ìˆ˜ì™€ 침샘 ì‹ í‹°ê·¸ëž˜í”¼ 지표 간의 상관분석은 Spearman correlation을 사용하였다. ê²°ê³¼ ì•ˆêµ¬í‘œë©´ì—¼ìƒ‰ì ìˆ˜(p=0.021), 귀밑샘의 excretion fraction (p=0.022), 턱밑샘의 excretion fraction (p=0.045)은 일차 ì‡¼ê·¸ë Œì¦í›„êµ°ê³¼ ë¹„ì‡¼ê·¸ë Œì¦í›„êµ° 두 êµ° 간에 í†µê³„ì ìœ¼ë¡œ ìœ ì˜í•œ 차이가 있었으며, 턱밑샘의 uptake ratio (rho=-0.369, p=0.008), 턱밑샘의 excretion fraction (rho=-0.359, p=0.010)은 ì•ˆêµ¬í‘œë©´ì—¼ìƒ‰ì ìˆ˜ì™€ í†µê³„ì ìœ¼ë¡œ ìœ ì˜í•œ 음의 상관관계를 보였다. ê²°ë¡ ì•ˆêµ¬í‘œë©´ì—¼ìƒ‰ì ìˆ˜ëŠ” 일차 ì‡¼ê·¸ë Œì¦í›„êµ°ì—ì„œ 건성안의 ì •ë„ë¥¼ 평가하는 데에 있어서 표준진단법이며, 일차 ì‡¼ê·¸ë Œì¦í›„êµ° 환자가 초기에 눈마름 증상을 호소하지 않아도 침샘 ì‹ í‹°ê·¸ëž˜í”¼ìƒì—ì„œ ê¸°ëŠ¥ì €í•˜ê°€ ê´€ì°°ë ë•Œ 반드시 안구표면병변의 ìœ ë¬´ë¥¼ 확인해야 í• ê²ƒì´ë‹¤. Keywords: Primary Sjögren’s Syndrome, Ocular surface statining score, Salivary gland scintigraphy

Magnetic Resonance Sialography and Salivary Gland Scintigraphy of Parotid Glands in Sjögren's Syndrome.

To assess the correlation between conventional magnetic resonance (MR) imaging and MR sialography of parotid glands with salivary gland scintigraphy in patients with Sjögren's syndrome. A retrospective study was conducted on eight patients with Sjögren's syndrome who underwent MR imaging and salivary gland scintigraphy. Conventional MR imaging techniques, such as T1-weighted images (T1WI), T2-weighted images (T2WI), and short TI inversion recovery images (STIR) were used for changes of fat signal in the parotid gland, while the MR sialography were used for ducts dilation of the parotid gland. Regarding scintigraphy, time-activity curves of each parotid gland were analysed. The salivary gland excretion fraction was defined as A (before stimulation test (counts/20 s)) and B (after stimulation test (counts/20 s)). Regarding characteristic appearances of fat signal, the A/B of parotid gland with homogeneous intensity distribution (3.51 ± 0.75) was higher than that with heterogeneous intensity distribution (1.56 ± 0.66, P = 0.001). Regarding MR sialographic stages, the A/B of parotid gland with stage 0 (3.51 ± 0.75) was higher than that with stage 1 (2.03 ± 0.86, P = 0.009) and with stage 2 (1.26 ± 0.25, P = 0.000). The results suggest that MR sialography of the parotid glands is a useful noninvasive tool for evaluating the decrease of salivary gland excretion in patients with Sjögren's syndrome.

Salivary Gland Scintigraphy in Patients with Sjogren's Syndrome: A local Experience with Dual-tracer.

Objective(s):To review the findings of the patients with Sjögren’s syndrome (SS) having technetium99-m-pertechnetate (99mTc-pertechnetate) and gallium67- citrate (Ga-67) salivary gland scintigraphy in the past eight years.Methods:The patients with SS, who were referred to our department for salivary gland scintigraphy during January -2008December 2015 were studied using both 99mTc-pertechnetate and Ga-67 citrate scintigraphy.Results:Eighteen patients were included in the study, 17 of whom had positive findings on 99mTc-pertechnetate salivary gland scintigraphy. One patient had negative parotid glands findings on 99mTc-pertechnetate, but positive findings in Ga-67 study. Four patients had asymmetric involvement of the parotid glands, and one patient had asymmetric involvement of the submandibular glands in 99mTc-pertechnetate salivary gland scintigraphy. On the other hand, one patient had only submandibular gland involvement in the 99mTc-pertechnetate scan. Nine patients (18/9) had positive parotid gland findings on Ga-67 study. The involvements of the parotid glands were all symmetrical, except for one patient. No abnormal gallium uptake in the submandibular glands in our patients was noted.Conclusion:99mTc-pertechnetate salivary gland scintigraphy is sufficient for the assessment in the majority of patients with SS. Ga-67 scintigraphy may be a useful supplementary test, especially if the result of 99mTc-pertechnetate scintigraphy is not conclusive.

High Prevalence of Thyroid Disease and Role of Salivary Gland Scintigraphy in Patients with Xerostomia.

Although Sjögren's syndrome (SS) is the most common disease causing xerostomia, autoimmune thyroid diseases can also affect the salivary glands. The aim of our study was to estimate the prevalence of thyroid diseases (TD) in subjects with symptoms of xerostomia and evaluate the efficacy of salivary gland scintigraphy (SGS) in the detection of TD in patients with SS and without SS. We retrospectively reviewed the SGS findings of 173 subjects (men:women, 29:144) with symptoms of xerostomia. Ejection fractions (EF) in the parotid and submandibular glands were calculated. Thyroid disease was diagnosed on the basis of the results of the visual assessment of tracer uptake in the thyroid gland on SGS images as well as serological thyroid function tests. Based on the American-European Criteria, 94 patients were diagnosed with SS. Hashimoto's thyroiditis was diagnosed in 63 patients, subacute thyroiditis in 23, subclinical hypothyroidism in five, and Graves' disease in one. There were significant differences in the EF values of the parotid and submandibular glands between patients with TD and those with undetermined diagnoses. More than half of patients with xerostomia exhibited TD. Thyroid assessment by SGS is feasible, and SGS appears to be useful for the patients with xerostomia caused by TD. SGS may be the first imaging modality capable of evaluating both salivary gland function and thyroid gland status in patients with xerostomia. This strategy would make the requirement for additional workup for thyroid disease.

Salivary gland scintigraphy in patients suffering from severe keratoconjunctivitis sicca. Evaluation of the viability of submandibular glands before and after transfer into the temporal fossa.

Low tear production or elevated tear evaporation can lead to severe keratoconjunctivitis sicca. In patients with this disease, the transfer of an autologous submandibular gland into the temporal fossa is currently the most common surgical lacrimal gland substituting procedure. We compared the pre- and postoperative viability of transferred submandibular glands. Altogether 16 submandibular glands had been transferred in 12 patients. The graft's viability was evaluated before and 0.5-1, 1-6 and 8-12 months after transplantation by dynamic salivary gland scintigraphies after application of 40-50 MBq 99mTc-pertechnetate. Quantitative analysis was performed by calculation and comparison of the glandula submandibularis-to-background-ratio (SBR) and the transplant-to-background-ratio (TBR). The scintigraphic results were correlated with the clinical follow-up. All grafts remained viable during clinical follow-up. Salivary gland scintigraphy yielded 15 true positive results and 1 false-negative result. Comparison of presurgical SBR and postsurgical TBR showed good correlation with the clinical course. In 10 patients at least one transplant-reduction was necessary due to excessive epiphora occurring averagely 8 months after transplantation. Our results show that salivary gland scintigraphy very exactly reflects the morphological and biochemical postsurgical changes in a transferred submandibular gland. Thus, it is a reliable tool to exactly and objectively evaluate the viability of the grafts in the postsurgical course.

The Diagnostic Value of Technetium 99m Pertechnetate Salivary Gland Scintigraphy in Patients With Certain Salivary Gland Diseases

To evaluate the diagnostic value of technetium 99m pertechnetate salivary gland scintigraphy in patients with certain salivary gland diseases. We evaluated 47 patients: 25 with chronic obstructive parotitis, 12 with sialolithiasis, and 10 with Sjögren syndrome. All of the patients underwent preoperative (99m)Tc-pertechnetate salivary gland scintigraphy. Patients with chronic obstructive parotitis also underwent ultrasonography, sialography, and sialoendoscopy; patients with sialolithiasis also underwent ultrasonography and computed tomography; and patients with Sjögren syndrome also underwent ultrasonography and sialography. We made comparisons between (99m)Tc-pertechnetate salivary gland scintigraphy and the other aforementioned diagnostic tests to investigate the role of (99m)Tc-pertechnetate salivary gland scintigraphy in diseases of the salivary glands. In patients with chronic obstructive parotitis, (99m)Tc-pertechnetate salivary gland scintigraphy showed reduced excretion by the affected glands, whereas uptake was nearly normal. Among patients with sialolithiasis, (99m)Tc-pertechnetate salivary gland scintigraphy showed reduced excretion by the affected glands and decreased uptake in 5 patients. In patients with Sjögren syndrome, (99m)Tc-pertechnetate salivary gland scintigraphy showed a decrease in both excretion and uptake by the 4 glands. Technetium 99m pertechnetate salivary gland scintigraphy played a substantial role in the diagnosis and differential diagnosis of salivary gland diseases.

SAT0395 Sonoelastography detects salivary gland dysfunction in patients with primary sjögren’s syndrome

BackgroundSialoscintigraphy (Szinti) is used to investigate salivary gland function in patients with primary Sjögren’s syndrome (pSS). Real-time sonoelastography (SElasto) indicates tissue rigidity of salivary glands and correlates with an impaired...

Quantitative and visual evaluation of salivary and thyroid glands in patients with primary Sjögren's syndrome using salivary gland scintigraphy: relationship with clinicopathological features of salivary, lacrimal and thyroid glands

To evaluate quantitative and visual salivary gland scintigraphy in patients with primary Sjögren's syndrome (SS) and to compare the scintigraphic findings with clinicopathological features of the salivary, lacrimal and thyroid glands. Twenty-seven patients with primary SS and 10 healthy age-matched and sex-matched individuals as a control group were included in this study. The diagnosis of SS was made on the basis of the classification criteria of the American-European Consensus Group. The patients with primary SS were divided into two groups as early-stage and advanced-stage according the labial biposy scores (16 early-stage and 11 advanced-stage). After the administration of 370 MBq Tc-99m pertechnetate, static images were obtained at 20 min and also after lemon stimulation. Functional parameters for the parotid, submandibular, and thyroid glands were calculated. Schirmer-I, tear film break-up time and Rose Bengal tests were evaluated. Statistically significant differences existed for the functional parameters of the parotid and submandibular glands between the early-stage and advanced-stage groups. The submandibular glands were more frequently affected than the parotid glands. Asymmetric uptake pattern was more common in the parotid glands during the early-stages of primary SS. When compared with the control group, the thyroid uptake ratio of the early-stage primary SS and advanced-stage group was not significantly different. According to the results of the ophthalmological tests, there was a statistically significant difference between patients with advanced-stage and early-stage disease. There were no significant correlations between functional parameters of salivary gland and any of the ophthalmological tests. The results indicate that quantitative salivary gland scintigraphy may be a useful method for evaluating salivary gland dysfunction and also for determining disease severity in primary SS. Asymmetric activity pattern in the parotid glands commonly observed during the early stages of the disease may be a predictor of progression. In addition, the histopathological stage is related not only to the scintigraphic findings of the salivary glands but also to lacrimal gland function in primary SS. However, thyroid uptake seemed to be unaffected in patients with both early-stage and advanced-stage disease.

Salivary gland scintigraphy in patients with Sjögren's syndrome

Salivary gland scintigraphy in patients with Sjögren's syndrome

Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome

The purpose of the present study was to evaluate the validity of a scoring system based on excretion rate of salivary gland scintigraphy in patients with Sjögren's syndrome (SjS). Total scintigraphic scores were compared with the results of the Saxon test. One hundred and twenty-four subjects who were clinically diagnosed with SjS and 11 normal ones underwent salivary gland scintigraphy and the Saxon test. In salivary gland scintigraphy, the difference between maximum and minimum counts after stimulation using vitamin C divided by maximum counts was defined as the excretion rate. We then defined a scoring system with 4 grades: severe dysfunction = 3 (excretion rate < 25%), moderate dysfunction = 2 (25% < or = excretion rate < 40%), mild dysfunction = 1 (40% < or = excretion rate < 50%) and normal function = 0 (50% < or = excretion rate). The summation of the total scintigraphic score (0-12) of all 4 salivary glands was used as a semi-quantitative index indicating total salivary gland function, and total scintigraphic scores were compared with the results of the Saxon test. A significant inverse linear correlation (R2 = 0.95) was observed between total scintigraphic scores and mean values of the Saxon test within a range of abnormal scintigraphic scores (> or = 4). The scoring system developed in the present study is a clinically available, objective, and reproducible method for evaluation of salivary gland function in patients with SjS.

Salivary gland involvement in chronic pancreatitis of various etiologies

Objective Both the pancreas and salivary glands show many histological and functional similarities. Recently, autoimmune pathogenesis has been postulated in some chronic pancreatitis cases. To examine whether a cell-mediated phenomenon involving the pancreas has a secondary effect on the salivary glands, we assessed the frequency of salivary gland dysfunction in patients with chronic pancreatitis of various etiologies. Methods Function of the salivary glands was examined by sialochemistry and salivary gland scintigraphy in patients with chronic pancreatitis (n = 33), Sjogren’s syndrome (n = 45), and controls (n = 28). Etiologies of chronic pancreatitis were alcoholic (19 cases), idiopathic (seven cases), and autoimmune (seven cases). Concentrations of Na+, amylase, and β2-microglobulin in saliva were investigated. In submandibular and parotid gland scintigraphy, time-activity curves were generated, and the ratios of peak count density and washout were calculated. Results Concentrations of Na+ in saliva of patients with idiopathic chronic pancreatitis and of β2-microglobulin in saliva of patients with idiopathic and autoimmune chronic pancreatitis were significantly elevated than those of the control group. In submandibular and parotid gland scintigraphy, the peak count density ratio of patients with all chronic pancreatitis and washout ratio of patients with alcoholic and idiopathic chronic pancreatitis were significantly lower than those of the control group. Conclusions Salivary gland function was frequently impaired in the course of chronic pancreatitis of various etiologies. Salivary gland dysfunction might be the result of a common pathophysiological effect of alcohol in patients with alcoholic chronic pancreatitis and the aggressive immune mechanism against the pancreatic and the salivary ducts in patients with autoimmune and idiopathic chronic pancreatitis.

Salivary gland involvement in chronic pancreatitis of various etiologies

Both the pancreas and salivary glands show many histological and functional similarities. Recently, autoimmune pathogenesis has been postulated in some chronic pancreatitis cases. To examine whether a cell-mediated phenomenon involving the pancreas has a secondary effect on the salivary glands, we assessed the frequency of salivary gland dysfunction in patients with chronic pancreatitis of various etiologies. Function of the salivary glands was examined by sialochemistry and salivary gland scintigraphy in patients with chronic pancreatitis (n = 33), Sjogren's syndrome (n = 45), and controls (n = 28). Etiologies of chronic pancreatitis were alcoholic (19 cases), idiopathic (seven cases), and autoimmune (seven cases). Concentrations of Na+, amylase, and beta2-microglobulin in saliva were investigated. In submandibular and parotid gland scintigraphy, time-activity curves were generated, and the ratios of peak count density and washout were calculated. Concentrations of Na+ in saliva of patients with idiopathic chronic pancreatitis and of beta2-microglobulin in saliva of patients with idiopathic and autoimmune chronic pancreatitis were significantly elevated than those of the control group. In submandibular and parotid gland scintigraphy, the peak count density ratio of patients with all chronic pancreatitis and washout ratio of patients with alcoholic and idiopathic chronic pancreatitis were significantly lower than those of the control group. Salivary gland function was frequently impaired in the course of chronic pancreatitis of various etiologies. Salivary gland dysfunction might be the result of a common pathophysiological effect of alcohol in patients with alcoholic chronic pancreatitis and the aggressive immune mechanism against the pancreatic and the salivary ducts in patients with autoimmune and idiopathic chronic pancreatitis.

Decreased thyroid uptake of Tc-99m pertechnetate in patients with advanced-stage Sjögren syndrome: evaluation using salivary gland scintigraphy.

The authors assessed the uptake of Tc-99m pertechnetate in the thyroid using salivary gland scintigraphy in patients with Sjögren syndrome and in healthy controls. Salivary gland scintigraphy and a labial biopsy were performed in 73 patients with Sjögren syndrome. Based on the labial biopsy findings, 32 patients with a histopathologic grade of 1 or 2 were regarded as having early-stage Sjögren syndrome and 41 patients with a grade of 3 or 4 were regarded as having an advanced stage. After the administration of 370 MBq (10 mCi) Tc-99m pertechnetate, dynamic salivary gland scintigraphy was performed for 50 minutes. Lemon juice was used to stimulate the salivary glands, and the thyroid gland was included in the imaging area. Scintigraphy was also performed in an age- and sex-matched control group of 25 healthy persons. The thyroid uptake ratio was calculated for the scintigraphic images and compared among the three groups: healthy controls, patients with early-stage Sjögren syndrome, and those with advanced-stage Sjögren syndrome. When compared with the control group, the thyroid uptake ratio of the early-stage Sjögren syndrome group was not significantly different, whereas that of the advanced-stage group was significantly lower. Thyroid uptake of Tc-99m pertechnetate was less in patients with advanced-stage Sjögren syndrome than in patients with early-stage Sjögren syndrome or in healthy controls. Measuring the thyroid uptake of Tc-99m pertechnetate using salivary gland scintigraphy is an easy and useful method for assessing thyroid disorders in Sjögren syndrome and thus should be performed routinely.

The diagnostic value of salivary gland scintigraphy in patients suspected of primary Sjögren's syndrome.

The diagnostic value of salivary gland scintigraphy in patients suspected of having primary Sjögren's syndrome (SS) was studied in 149 consecutive patients who presented with joint and/or muscle complaints in combination with dryness of the mouth and/or eyes and in 20 control subjects. The diagnosis primary SS could be established in 26 of these patients. Salivary gland scintigraphy scored by means of analogue pictures was abnormal in 19 out of 26 patients with primary SS but abnormal scintigrams were also found in 57 of the 123 patients without primary SS and in five of the controls. This resulted in a positive predictive value of an abnormal salivary gland scintigram of 25% and a negative predictive value of a normal investigation of 90%. From the high number of false positive test results in the patient population studied it is concluded that salivary gland scintigraphy has only a limited discriminatory value for the diagnosis of primary SS.

Salivary gland scintigraphy

The diagnostic value of salivary gland scintigraphy in patients without access to the salivary gland duct orfice is exemplified and discussed. The necessity for careful dental examination and treatment in patients with an oroantral fistula is emphasised.