Salivary Gland Scintigraphy Research Articles

Parotid Gland Sparing With Helical Tomotherapy in Head-and-Neck Cancer

This study evaluated the ability of helical tomotherapy to spare the function of the parotid glands in patients with head-and-neck cancer by analyzing dose-volume histograms, salivary gland scintigraphy, and quality of life assessment. Data from 76 consecutive patients treated with helical tomotherapy (Hi-Art Tomotherapy) at the University Hospital Brussel were analyzed. During planning, priority was given to planning target volume (PTV) coverage: ≥ 95% of the dose must be delivered to ≥ 95% of the PTV. Elective nodal regions received 54 Gy (1.8 Gy/fraction). A dose of 70.5 Gy (2.35 Gy/fraction) was prescribed to the primary tumor and pathologic lymph nodes (simultaneous integrated boost scheme). Objective scoring of salivary excretion was performed by salivary gland scintigraphy. Subjective scoring of salivary gland function was evaluated by the European Organization for Research and Treatment of Cancer quality of life questionnaires Quality of Life Questionnaire-C30 (QLQ-C30) and Quality of Life Questionnaire-Head and Neck 35 (H&N35). Analysis of dose-volume histograms (DVHs) showed excellent coverage of the PTV. The volume of PTV receiving 95% of the prescribed dose (V95%) was 99.4 (range, 96.3-99.9). DVH analysis of parotid gland showed a median value of the mean parotid dose of 32.1 Gy (range, 17.5-70.3 Gy). The median parotid volume receiving a dose <26 Gy was 51.2%. Quality of life evaluation demonstrated an initial deterioration of almost all scales and items in QLQ-C30 and QLQ-H&N35. Most items improved in time, and some reached baseline values 18 months after treatment. DVH analysis, scintigraphic evaluation of parotid function, and quality of life assessment of our patient group showed that helical tomotherapy makes it possible to preserve parotid gland function without compromising disease control. We recommend mean parotid doses of <34 Gy and doses <26 Gy to a maximum 47% of the parotid volume as planning goals. Intensity-modulated radiotherapy should be considered as standard treatment in patients with head-and-neck cancer.

Correlations between histopathologic and scintigraphic parameters of salivary glands in patients with Sjögren’s syndrome

The aim of this study is to evaluate the diagnostic value of quantifying salivary gland scintigraphy in correlation to the labial biopsy findings of Sjögren's syndrome (SS). Thirty patients suspected of having SS referred to our clinic for salivary gland scintigraphy were included to this study. All patients underwent salivary gland biopsy as well. The severity of histopathologic changes was graded according to the Chisholm and Mason scoring system. Dynamic scintigraphy was performed and region of interests (ROI) were drawn. Time activity curves for salivary glands were generated. Count rates of maximum, minimum activity after lemon juice stimuli, and last minute activities of parotid and submandibular glands were obtained. On the basis of this ROI counts, excretion fraction (EF%) was calculated for all salivary glands. The mean EF% for normal parotid gland and pathologic parotid gland was 54.5 ± 13.9 and 45.8 ± 18.42, respectively, while it was 46.7 ± 11.7 for the normal submandibular gland and 29.3 ± 18.8 for the pathologic submandibular gland. With progression in histopathologic grades from 0 to 4, the EF decreased in all salivary glands. Decreased EF in the salivary glands is correlated with the SS, and salivary gland scintigraphy is a sensitive and valid method for evaluation of the function of the salivary glands.

Assessment of Salivary Gland Dysfunction after Radioiodine Therapy for Thyroid Carcinoma Using Non-Contrast-Enhanced CT: The Significance of Changes in Volume and Attenuation of the Glands

Although radiation induced damage to the salivary gland is a known complication of radioactive iodine ((131)I) therapy for thyroid carcinoma, prediction of the severity and reversibility of sialoadenitis is difficult. Our aim was to correlate the extent of salivary dysfunction assessed by salivary gland scintigraphy with changes in the volume and attenuation of salivary glands on nonenhanced CT in postoperative patients with thyroid cancer treated with RIT. Forty patients with thyroid carcinoma, 13 men (age range, 21-80 years) and 27 women (age range, 28-75 years) who underwent a total thyroidectomy and were treated with RIT were assessed retrospectively. On CT, the percentage of volume reduction and the difference in attenuation of the parotid and submandibular glands after RIT were determined and correlated with the extent of radiation-induced salivary dysfunction on scintigraphy. The salivary gland volume significantly decreased with an increase in the dysfunction grade on scintigraphy for both the parotid and submandibular glands (P < .001). The attenuation significantly increased with an increase in the dysfunction grade on scintigraphy for the parotid gland (P < .001), but not for the submandibular gland. The cutoff value of volume reduction to diagnose severe gland dysfunction was 19.5% (sensitivity, 86.0%; specificity, 100%) for the parotid gland and 31.0% (sensitivity, 100%; specificity, 97.0%) for the submandibular gland, and that of the attenuation change was 9.8 HU (sensitivity, 81.0%; specificity, 95%) for the parotid gland. The reduction in volume of the parotid and submandibular glands and the increase in attenuation of the parotid gland on nonenhanced CT can be indicators of the grade of RIT-induced salivary dysfunction.

The role of salivary gland scintigraphy in detection of salivary gland dysfunction in type 2 diabetic patients

Objective:The aim of the study was to evaluate the salivary gland dysfunction in a patient with uncontrolled type 2 diabetes using salivary gland scintigraphy.Materials and Methods:patients included in the study were 32 uncontrolled type 2 diabetic and 30 normal healthy individuals. Patients having any other systemic(or) nervous illness(or) taking medications that could affect the normal functioning of the salivary gland were excluded from the study. The salivary gland scintigraphy was performed, with radioactivity measured at 1st, 20th, and 40th minutes. Twenty minutes after the injection, vitamin C chewable tablet was given to stimulate the secretion and continued until the end of the study period (40min). The data were replayed and regions of interest were chosen over four salivary glands to obtain the uptake ratio (UR) and excretory ratio(ER) of the salivary glands. Result: The scintigraphic total URand ER in diabetic and control groups was compared. The values in these two categories showed decrease in both UR and ER in diabetic patients, when compared to control patients.Conclusion and Significance:The result of this study suggests that salivary gland scintigraphy plays a significant role in the evaluation of salivary gland dysfunction in type 2 diabetic patients.

Evaluation of Parotid Gland Function using Equivalent Cross-relaxation Rate Imaging Applied Magnetization Transfer Effect

Safe imaging modalities are needed for evaluating parotid gland function. The aim of this study was to validate the utility of a magnetic resonance imaging (MRI) tool, equivalent cross-relaxation rate imaging (ECRI), as a measurement of parotid gland function after chemoradiotherapy. Subjects comprised 18 patients with head-neck cancer who underwent ECRI and salivary gland scintigraphy. First, we calculated ECR values (signal intensity on ECRI), maximum uptake rate (MUR) and washout rate (WOR) from salivary gland scintigraphy data at the parotid glands. Second, we investigated correlations between ECR values and each parameter of MUR (uptake function) and WOR (secretory function) obtained by salivary gland scintigraphy at the parotid gland. Next, we investigated each dose-response for ECR, MUR and WOR at the parotid gland. A correlation was detected between ECR values and MUR in both the pre- (r = -0.55, p < 0.01) and post-treatment (r = -0.50, p < 0.05) groups. A significant post-treatment correlation was detected between the percentage change in ECR values at 3-5 months after chemoradiotherapy and median dose to the parotid gland (Pearson correlation, r = -0.62, p < 0.05). However, no correlations were detected between median dose to the parotid gland and either MUR or WOR. ECRI is a new imaging tool for evaluating the uptake function of the parotid gland after chemoradiotherapy.

Salivary gland function evaluated by diffusion‐weighted MR imaging with gustatory stimulation: Preliminary results

To evaluate the usefulness of diffusion-weighted MR imaging using a transient gustatory stimulation method in patients with xerostomia. Ten consecutive patients complaining of xerostomia and 10 healthy volunteers were examined with a 1.5 Tesla (T) MR unit. All study subjects completed a questionnaire, and patients underwent salivary gland scintigraphy and Saxon test. T1-, T2-, and diffusion-weighted MR images were obtained before stimulation. One minute after gustatory stimulation with lemon juice, diffusion-weighted sequence was repeated 9 times. A radiologist evaluated signal intensities and apparent diffusion coefficients (ADCs) in parotid and submandibular glands. ADC increase rate (IR) and times to maximum ADC (Tmax) were assessed. IRs showed a moderate positive correlation with washout rates by scintigraphy for parotid (r = 0.554, P < 0.05) and submandibular (r = 0.617, P < 0.01) glands. Furthermore, Tmax values of parotid and submandibular glands were significantly higher in patients (420 ± 226 and 357 ± 232 s, respectively) than in volunteers (181 ± 68 and 200 ± 75 s, respectively) (P < 0.01). Our preliminary results indicate that diffusion-weighted MR imaging using a transient gustatory stimulation method is potentially useful for evaluating patients with xerostomia.

Evaluation of Salivary Gland Dysfunction Using Salivary Gland Scintigraphy in Sjögren's Syndrome Patients and in Thyroid Cancer Patients after Radioactive Iodine Therapy.

Salivary gland scintigraphy (SGS) provides an objective means of diagnosing salivary gland dysfunction in Sjögren's syndrome (SS) patients and in thyroid cancer patients after radioactive iodine (RAI) therapy. In the present study, SGS was performed in SS patients and in thyroid cancer patients post-RAI, and scintigraphic parameters were compared. Twenty-eight SS patients (males:females = 1:27, age 53.3 ± 11.9 years), 28 controls (males:females = 3:25, age 54.1 ± 10.1 years), and 92 thyroid cancer patients (males:females = 28:64, age 46.2 ± 12.9) who had undergone a session of high-dose RAI therapy (mean dose, 5.2 ± 1.5GBq) were included. SGS was performed using Tc-99m pertechnetate (925MBq). Scintigraphic parameters (parotid uptake ratio PU, submandibular uptake ratio SU, percentage parotid excretion %PE, and percentage submandibular excretion %SE) were measured and compared for SS, thyroid cancer post-RAI, and control patients. PU, SU, %SE, and %PE were all significantly lower in SS than in post-RAI thyroid cancer or control patients (p < 0.05), whereas only %PE was significantly lower in post-RAI thyroid cancer patients than in controls (p < 0.05). SU and %SE were found to be correlated with the unstimulated whole salivary flow rate. Scintigraphic parameters derived from SGS can play a crucial role in the detection of salivary gland dysfunction in SS patients and in post-RAI thyroid cancer patients.

Clinical significance and diagnostic usefulness of anti-centromere antibody in Sjögren’s syndrome

Anti-SS-A/Ro antibody (SS-A) and anti-SS-B/La antibody (SS-B) are important serologic markers in the diagnostic criteria for Primary Sjögren's syndrome (SS). Although anti-centromere antibody (ACA)-positive SS is frequently experienced, ACA is not included in these criteria. The purpose of this study was to identify the clinical features of ACA-positive SS and discuss the usefulness of ACA in diagnosing SS. Forty-five patients with SS were divided into the following three groups: SS-A only-positive group (n = 17), SS-A and SS-B both-positive group (n = 18), and ACA only-positive group (n = 10). As a control, 54 patients without SS who were negative for antinuclear antibodies were also evaluated. The following items were compared among groups: Saxon's test, unstimulated whole salivary flow (UWSF), salivary gland scintigraphy (SGS), histopathologic examination of the minor salivary glands, Schirmer's test, and fluorescein staining of the cornea. In the ACA only-positive group, Saxon's test was 0.21 ± 0.26g/2min (mean ± SD) and UWSF was 0.16 ± 0.25ml/10min (mean ± SD), showing a significant decrease in salivary secretion (p < 0.05; vs. non-SS). On SGS, accumulation and disappearance of (99m)TcO (4) (-) were significantly decreased (p < 0.05; vs. non-SS). Histopathologic examination showed moderate or severe lymphocytic infiltration and tissue destruction in all cases, similar to that in the SS-A- and/or SS-B-positive groups. Schirmer's test and fluorescein staining were positive in 60% and 80%, respectively. Impaired lacrimal secretion and keratoconjunctivitis sicca were similar to those in SS-A- and/or SS-B-positive groups. These results suggest that ACA is an autoantibody reflecting impairment in the salivary and lacrimal glands and may be a useful serologic marker for SS.

Late side effects of radioactive iodine on salivary gland function in patients with thyroid cancer

The purpose of this study was to assess the late side effects of radioiodine therapy (RIT) on salivary gland function. One hundred eighty two patients were evaluated. Assessment of salivary gland function was performed with salivary gland scintigraphy (SGS), sialometry, and subjective open questions to determine common side effects of RIT on salivary gland function. RIT had a strong association with decreased elimination counts by SGS. Patient age was the only variable associated with sialometry; age and the use of xerostomic drugs were strongly associated with decreased mean values of salivary flow. Dysphagia was strongly associated with RIT. Using multiple logistic regression analysis, age was determined to be an important factor associated with salivary gland dysfunction, and RIT was associated with impairment of saliva excretion. These results show that patients subjected to RIT have more difficulty in draining saliva, mainly from the parotid glands, which is associated with clinical dysphagia in this subset of patients.

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.

Evaluation of salivary gland scintigraphy, magnetic resonance and diffusion-weighted imaging in clinical diagnosis of Sjgrens Syndrome

To assess diagnostic effectiveness of Sjogren’s syndrome (SS), salivary gland scintigraphy (SGS), magnetic resonance (MR) and diffusion-weighted imaging (DWI) were performed in 54 patients (primary SS, secondary SS and connective tissue disease (CTD) but without SS). Results showed that SGS and diffusion-weighted magnetic resonance imaging (MRI) provided high-resolution images of the parotid glands that enabled apparent diffusion coefficient (ADC) measurements. After overall analysis, all of the oral activity indices, the maximum accumulation (MA) and uptake rate (UR) of the parotid gland clearly decreased asclinical severity progressed, and statistically significant differences were observed. Our technique may prove helpful in diagnosing the progression of SS beyond its early stages. Key words: Diffusion-weighted imaging, salivary gland scintigraphy, Sjogren’s syndrome, receiver operating characteristic curve.

Evaluation of salivary gland function in allergic rhinitis patients by [99mTc] pertechnetate salivary gland scintigraphy

Abstract The purpose of this study was to compare the quantitative parameters of salivary gland functions in patients with allergic rhinitis and healthy volunteers using [99mTc] pertechnetate salivary gland scintigraphy. Thirty-six patients with allergic rhinitis (14 males and 22 females, mean age 30.6 ± 5.2 years) and thirty-nine healthy controls (18 males and 21 females, mean age 32.2 ± 5.6 years) were evaluated. Dynamic salivary gland scintigraphy was performed after intravenous administration of 185 MBq (5 mCi) of [99mTc] pertechnetate for 25 minutes. Lemon juice was used to stimulate the salivary glands. On the basis of the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Statistically, all the functional parameters of the parotid and submandibular glands obtained for the allergic rhinitis patients were significantly lower than those of the healthy controls group (p &lt; 0.05). This study demonstrated that there was a significant difference in salivary gland function between patients with allergic rhinitis and healthy controls, which can easily be evaluated by [99mTc] pertechnetate salivary gland scintigraphy.

Impact of submandibular gland excision on salivary gland function in head and neck cancer patients

Head and neck cancer surgery is often associated with neck dissection and usually includes the submandibular glands. Literature data related to remaining salivary gland function after surgery is scarce and controversial. A reduction in salivary output and increase in complaints of xerostomia have been suggested. However, a compensatory salivary mechanism has also been reported. The aim of this prospective study was to evaluate the effect of neck dissection (with submandibular excision) on salivary gland function measured by salivary flow rate and salivary gland scintigraphy. A total of 80 patients with head and neck tumors were evaluated. The surgery group was composed of 37 patients, who underwent submandibular gland resection, and the non-surgery group of 43 patients evaluated prior to radiation and/or chemotherapy treatment. Whole unstimulated and stimulated saliva collection and salivary gland scintigraphy were performed in all patients. Twenty-one percent of patients in the surgery group reported xerostomia, whereas 7% in the non-surgery group. The mean unstimulated salivary flow was 0.60 and 0.94 m/min for the surgery and non-surgery groups, respectively (p=0.008). Nevertheless, no statistical difference in the stimulated salivary flow was observed between the groups (p=0.26). In addition, the mean uptake and excretion rates for parotid and remaining submandibular glands also showed no statistical difference. The data of the present study support the contention that submandibular gland resection causes a decrease in unstimulated salivary volume. However, the residual submandibular glands in the surgery group showed similar function to that of submandibular glands in the non-surgery group. Consequently, the compensatory salivary mechanism seems not to be a possibility.

Using Tc-99m Pertechnetate Scintigraphy to Predict the Outcome of Sialoendoscopy in Obstructive Submaxillaritis

The purpose of this study was to investigate whether the findings of Tc-99m pertechnetate salivary gland scintigraphy (SGS) can predict the outcome of sialoendoscopic intervention in patients with obstructive submaxillaritis. Eleven patients with obstructive submaxillaritis were prospectively recruited. All patients underwent sialoendoscopy. Tc-99m pertechnetate SGS was performed both before and after sialoendoscopy. Sialoendoscopy was effective in the glands with tracer uptake (n = 9) demonstrated on SGS before the procedure, evidenced by not only relief of the symptoms but also improvement in excretion in post therapy salivary gland scintigraphy. In contrast, sialoendoscopy was ineffective in the glands without tracer uptake (n = 2) in pretherapy scans. In patients with submaxillaritis, whether a sialoendoscopy should be performed depends on the results of salivary gland scintigraphy.

Quantitative salivary gland scintigraphy in head and neck cancer patients following radiotherapy

ObjectiveTo assess the role of quantitative salivary gland scintigraphy (SGS) in the detection of functional impairment of salivary glands in patients with head and neck cancer treated with radiotherapy (RT). Material and methodsWe studied 19 patients (17 men), mean age 62.4 years (44–75). Three studies were performed to each patient: baseline, 3 and 18 months after RT. SGS was acquired for 25 minutes following injection of 3.7MBq/kg of 99mTc-pertechnetate with lemon juice at the end of minute 15.Excretion fraction (EF), counts per minute/pixel/MBq (CMPM) and uptake percentage were obtained from time-activity curves from ROIs placed over parotid (PG) and submandibular glands (SMG) and related to the doses received by the PG. ResultsEF showed a significant reduction from the baseline to the 3 months study (p<0.001) for the PG and SMG and from the baseline to the 18 months study for the SMG (p<0.001). A significant improvement of EF was seen from the 3 months to the 18 months study for the PG (p<0.05).CMPM did not change significantly from the baseline to the 3 months and 18 months studies for the PG and showed a significant reduction (p<0.01) for the SMG from the baseline to 18 months study. The uptake percentage did not change significantly between studies. A moderate association was observed between the doses to PG and the 3m study parameters. ConclusionsEF was more sensitive than uptake in assessing post-RT impairment of salivary function. In addition, it reflected functional recovery of parotid glands over time.

Diagnosis of Anomalous Lacrimal Ductule With the Aid of Salivary Gland Scintigraphy

A 4-year-old boy presented with the complaint of fluid discharge from a 0.5-mm diameter opening at the lateral side of the right outer canthus during crying. The need for general anesthesia for contrast radiography prompted the authors to conducted salivary gland scintigraphy, which demonstrated radioactivity of the collected fluid. Salivary gland scintigraphy can be used as a diagnostic tool in cases with anomalous lacrimal ductule without the use of general anesthesia.

Mikulicz’s disease with severe thrombocytopenia following autologous stem cell transplantation in a multiple myeloma patient

We report the first case of Mikulicz's disease (MD) occurring 2 years after autologous peripheral blood stem cell transplantation (PBSCT) for multiple myeloma (MM). A 70-year-old man developed bilateral enlargement of parotid and submandibular glands. The patient had previously received 2 courses of autologous PBSCT for IgG-kappa type MM, and had been stable for 2 years. This salivary gland enlargement was initially felt to represent a recurrence of MM, since along with gland swelling, IgG was also elevated. However, repeated biopsy of the left submandibular gland revealed chronic sclerosing sialadenitis rather than plasmacytoma. Results of salivary gland scintigraphy, serological testing, and absence of sicca symptoms also supported the diagnosis of MD. Concurrently, the patient developed severe thrombocytopenia (0.8 x 10(4)/microl). Bone marrow biopsy showed abundant megakaryocytes, suggesting enhanced platelet destruction. After high-dose steroid and immunoglobulin therapy, the platelet count gradually returned to normal with complete resolution of the salivary gland enlargement. No apparent signs of MM recurrence were documented during these clinical events.

Infrequently Performed Studies in Nuclear Medicine: Part 2

Nuclear medicine is a diverse medical field, encompassing a wide range of studies. Many studies are performed on a daily basis, whereas some nuclear medicine studies are performed on a more infrequent basis. The following article is the second article in a 2-part series on infrequently performed studies in nuclear medicine. The procedures reviewed include CSF shunt imaging, brain death scintigraphy, testicular scanning, quantitative lung perfusion studies, lymphoscintigraphy, and salivary gland scintigraphy. This article may be of use to technologists faced with the task of performing one of these uncommon studies. After reviewing the article, the reader should be able to list the indications for each study, list the recommended doses, describe the proper method of dose administration for each study, discuss patient preparation for each procedure, and describe issues that may arise when performing these studies.

The effect of amifostine or IMRT to preserve the parotid function after radiotherapy of the head and neck region measured by quantitative salivary gland scintigraphy

Purpose In this retrospective study, two approaches to preserve the parotid function after radiotherapy (RT) were compared: application of the radioprotective agent amifostine during RT and parotid-sparing intensity-modulated radiotherapy (IMRT). Patients and methods Patients were qualified for this analysis if (1) both parotid glands received a radiation dose of ⩾50 Gy using conventional radiotherapy techniques (cRT) or if they received a parotid-sparing IMRT as alternative, if (2) salivary gland scintigraphies before and after RT were performed, and if (3) a normal parotid function was present before RT. Quantitative salivary gland scintigraphy was used to assess the parotid gland function. Results Altogether 275 salivary gland scintigraphies of 100 patients were analyzed. The mean relative tracer uptake (Δ U) of patients treated with cRT, cRT with amifostine and IMRT 1–12 months after RT was 0.59 (95%CI 0.54–0.65), 0.67 (95%CI 0.59–0.76), and 0.93 (95%CI 0.78–1.07), respectively. The mean relative Δ U 13–47 months after RT was 0.40 (95%CI 0.32–0.49), 0.60 (95%CI 0.48–0.71), and 0.92 (95%CI 0.56–1.28). At 1–12 months after RT, ANOVA testing with post-hoc comparison using the Bonferroni correction showed a significant difference between IMRT and cRT ( p < 0.001) or IMRT and amifostine ( p < 0.01). The difference between amifostine and cRT was not significant during the first year. At 13–47 months after RT, the difference between cRT and amifostine was significant ( p = 0.02). Conclusion Our data suggest that both amifostine and IMRT are able to partially preserve the parotid function after radiotherapy. The effect of IMRT appeared to be much greater.

Ultrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy

To compare ultrasonography (US) of salivary glands with contrast sialography and scintigraphy, in order to evaluate the diagnostic value of this method in primary SS (pSS). The diagnostic value of parotid gland US was studied in 77 patients with pSS (male/female ratio 3/74; mean age 54 yrs) and in 79 with sicca symptoms but without SS. The two groups were matched for sex and age. Imaging findings of US were graded using an ultrasonographic score ranging from 0 to 16, which was obtained by the sum of the scores for each parotid and submandibular gland. The sialographic and scintigraphic patterns were classified in four different stages. The area under receiver operating characteristic curve (AUC-ROC) was employed to evaluate the screening method's performance. Of the 77 patients with pSS, 66 had abnormal US findings. Mean US score in pSS patients was 9.0 (range from 3 to 16). Subjects without confirmed pSS had the mean US score 3.9 (range from 0 to 9) (P < 0.0001). Results of sialography showed that 59 pSS patients had abnormal findings at Stage 1 (n = 4), Stage 2 (n = 8), Stage 3 (n = 33) or Stage 4 (n = 14), and 58 patients had abnormal scintigraphic findings at Stage 1 (n = 11), Stage 2 (n = 18), Stage 3 (n = 25) or Stage 4 (n = 4). Through ROC curves US arose as the best performer (AUC = 0.863 +/- 0.030), followed by sialography (AUC = 0.804 +/- 0.035) and by salivary gland scintigraphy (AUC = 0.783 +/- 0.037). The difference between AUC-ROC curve of salivary gland US and scintigraphy was significant (P = 0.034). Setting the cut-off score >6 US resulted in the best ratio of sensitivity (75.3%) to specificity (83.5%), with a likelihood ratio of 4.58. If a threshold >8.0 was applied the test gained specificity, at the cost of a serious loss of sensitivity (sensitivity 54.5%, specificity 97.5%, likelihood ratio 21.5). Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease.