Normal values of [99mTc]pertechnetate uptake and excretion fraction by major salivary glands

The assessment of the functional status of the salivary glands has been used in the scintigraphic evaluation of xerostomia. Several quantitative methods derived from standard dynamic scintigraphy have been suggested. However, the indices proposed are quite variable and unlikely to be useful in clinical practice.The objectives of this study were to obtain reference values of major salivary glands uptake and excretion fraction in healthy subjects and to obtain normal ratios of Tc-pertechnetate uptake by the major salivary glands in comparison to the thyroid gland uptake. The standardization of these values has the purpose of making this evaluation faster and more objective.Fifty volunteers without clinical evidence of xerostomia or thyroid disease underwent static salivary glands scintigraphy with Tc-pertechnetate. Static images were obtained at 20 minutes and then at 3 minutes after oral stimulation with lemon juice. Percent uptake, excretion fraction and salivary gland to thyroid ratio rates were calculated for the parotid and the submandibular glands.The mean of the uptake values at 20 minutes for the right and left parotid glands were respectively 0.31% and 0.26%, and for the submandibular glands 0.15%. The excretion fraction of the tracer after the lemon juice stimulation was 70% for the parotids glands, 50% for the right and 49% for the left submandibular glands. The mean+/-SD salivary gland to thyroid count ratio was 0.79+/-0.45 for the right parotid, 0.78+/-0.5 for the left parotid, 0.67+/-0.33 and 0.66+/-0.34 for the right and left submandibular glands, respectively.Salivary glands scintigraphy with uptake and excretion fraction calculation is an easy to perform, non-invasive and objective method to investigate salivary glands function. These findings help the nuclear physician to interpret salivary gland scintigraphy more objectively, even in patients with thyroid gland dysfunction in whom Tc-pertechnetate thyroid uptake may be abnormal.     

Rosai Dorfman disease of the parotid and submandibular glands: salivary gland scintigraphy and oral findings in two siblings

Rosai-Dorfman disease (RDD) is an unusual clinical entity characterized by benign pseudolymphomatous proliferation with significant histiocytic infiltration. In the present paper, extranodal RDD of the major salivary glands causing salivary hypofunction and the results of salivary gland scintigraphy and ultrasound are presented in two siblings. Case 1: a 10-year-old boy with bilateral painless masses around the parotid and submandibular glands was referred. Ultrasound examination showed bilateral, well-defined, hypoechoic solid mass lesions within both parotid glands with minimal normal parenchyma in the upper poles. Both submandibular glands were markedly hypoechoic and heterogeneous. Mass lesions within the parotid glands appeared as cold lesions with regular contours on scintigraphy. Dynamic images showed normal uptake and normal response to secretion in the upper poles of the parotid glands, corresponding with ultrasonographically normal parenchyma. Both submandibular glands showed markedly diminished uptake and secretion. Case 2: a 9-year-old boy presented with mass lesions around the submandibular glands. Ultrasound examination showed normal parotid glands and markedly hypoechoic and heterogeneous submandibular glands. Salivary gland scintigraphy showed normal uptake and secretion of parotid glands with markedly diminished uptake and secretion in both submandibular glands. There were severe carious lesions in both patients due to salivary hypofunction. Treatments of the two patients' teeth were performed. Major salivary gland involvement of RDD is important for dentists as it may cause xerostomia and can mimic dental abscess. Functional evaluation of salivary glands with scintigraphy, besides radiological and pathological techniques, will help to explain whether salivary glands are affected or not and improve the diagnostic effectiveness.     

Salivary gland function evaluated by diffusion-weighted MR imaging with gustatory stimulation: preliminary results

Purpose:

To evaluate the usefulness of diffusion‐weighted MR imaging using a transient gustatory stimulation method in patients with xerostomia.

Materials and Methods:

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.

Results:

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).

Conclusion:

Our preliminary results indicate that diffusion‐weighted MR imaging using a transient gustatory stimulation method is potentially useful for evaluating patients with xerostomia. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc.     

Scintigraphic evaluation of salivary gland dysfunction in patients with thyroid cancer after radioiodine treatment

PURPOSE: Sialadenitis is a well-recognized adverse effect of high-dose radioactive iodine treatment. This study was undertaken to determine whether Tc-99m pertechnetate salivary gland scintigraphy may be used for objective assessment of salivary gland function in patients with thyroid cancer treated with I-131. PATIENTS AND METHODS: The study group consisted of 71 patients (16 men, 55 women) with a mean age of 44 years (range, 16 to 73 years). Twenty-six (37%) patients were not given any radioiodine, and 18, 16, and 11 patients received doses of 100, 150, or 200 mCi (or higher), respectively. Parotid and submandibular glands were evaluated based on a four-grade scoring system. Correlation between the type of surgery, administered dose, time since therapy, subjective symptoms, and findings of salivary gland scintigraphy were evaluated. RESULTS: Subjective symptoms were questioned in 39 of the 45 patients who received radioactive iodine treatment. Fifty-four percent (21 of 39) of the patients reported xerostomia, of whom 86% (18 of 21) showed salivary gland dysfunction. Objective salivary gland dysfunction was observed in 69% (31 of 45) of patients. In 81% of the patients, the parotid glands were affected; in 13% of the patients, the submandibular glands were affected; and in 6%, both were affected ( < 0.000001). The frequency of salivary gland dysfunction showed a dose dependence to cumulative activity ( = 0.007). A greater complication rate was observed in patients with total thyroidectomy compared with subtotal surgery, although the correlation was not significant ( = 0.625). CONCLUSIONS: Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment is worse in the parotid glands and increases with the total dose.     

Sj?gren's syndrome: comparison of assessments with quantitative salivary gland scintigraphy and contrast sialography.

This study compared the quantitative parameters of salivary gland scintigraphy and the sialographic stages in patients with Sj?gren's syndrome. METHODS: One hundred sixteen patients suspected of having Sj?gren's syndrome were examined with salivary gland scintigraphy and contrast sialography. When contrast sialography was used as the gold standard, Sj?gren's syndrome was diagnosed in 50 of these 116 patients; Sj?gren's syndrome was not seen in the other 66 patients. After injection of 370 MBq 99mTc-sodium pertechnetate, dynamic salivary gland scintigraphy with lemon juice stimulation was performed for 50 min. Functional parameters for the parotid and submandibular glands were calculated, and scintigraphic and sialographic results were compared. RESULTS: With the progression of sialographic stages from 0 to 4, the quantity of tracer accumulation decreased in the submandibular gland (P < 0.0001), and the quantity of tracer secretion decreased in the parotid gland (P < 0.0001). The sialographic stage in patients with Sj?gren's syndrome was correlated with these scintigraphic parameters (P < 0.0001): sialographic stage = 3.243 - 0.337 x (submandibular gland uptake ratio) - 0.026 x (parotid gland maximum secretion). CONCLUSION: The decreased accumulation in the submandibular gland and the decreased secretion in the parotid gland were highly sensitive indicators of salivary gland disease in Sj?gren's syndrome. The sialographic stage was correlated with these scintigraphic parameters.     

综合干预措施下评估首次131I清甲治疗对分化型甲状腺癌患者唾液腺的慢性损伤

目的研究探讨分化型甲状腺癌（DTC）患者在采取综合干预措施后首次131I清甲治疗对唾液腺功能的慢性损伤情况。方法选取2016年8月至2017年9月在攀枝花市中心医院核医学科首次行131I（4200.24±604.21）MBq清甲治疗的DTC患者52例,所有患者均在131I清甲治疗后立即采取综合干预措施（饮食护理、心理护理、物理护理、口腔卫生护理、健康宣教及药物治疗等）,并分别于131I清甲前和治疗后6个月行99TcmO₄-唾液腺动态显像,计算其摄取峰值和排泌分数,所得数据采用自身配对t检验分析,同时联合口干评分法评估唾液腺功能的损伤情况。结果（1）左侧腮腺摄取峰值在131I清甲前为45.157±19.421,治疗后6个月为52.600±21.716,差异有统计学意义（t=2.470,P=0.018）。（2）右侧腮腺、双侧颌下腺的摄取峰值及双侧腮腺、双侧颌下腺的排泌分数之间的差异均无统计学意义（t=0.784、0.524、0.514、0.362、0.731、0.596、0.507,均P>0.05）。（3）对52例患者行问卷调查和口干评分法分析,其中,50例（96.2%）患者无口干症状,仅有2例（3.8%）出现轻度口干症状。结论（1）首次131I清甲治疗可引起DTC患者唾液腺功能受损,损伤主要以单侧腮腺摄取功能为主,呈非对称性损伤。双侧颌下腺的摄取和排泌功能则未受到明显影响。（2）症状上,在综合干预保护措施下,绝大部分患者在接受首次131I清甲治疗后6个月无明显口干情况,生活质量无明显影响。     

Correlation between quantitative salivary gland scintigraphy and salivary secretion rates in children and young adults treated for hematological, malignant and metabolic diseases

OBJECTIVES: To study the correlation between whole salivary secretion rates and different variables from the radionuclide time-activity curve and to determine a reliable region for background correction in salivary gland scintigraphy. METHODS: Salivary gland scintigraphy (SGS) was performed before bone marrow transplantation or more than 4 years later in 23 patients aged 13.5 (s.d. 4.9) years. Unstimulated and stimulated whole salivary secretion rates were measured before SGS. Six different methods for background correction were evaluated. RESULTS: The unstimulated secretion rate was significantly correlated (P < 0.05) with the percentage stimulated secretion (S) and reaccumulation-slope (RS) after stimulation. The stimulated secretion rate was significantly correlated with RS, S and down-slope (DS). The temporal region above the parotid glands and the area above the thyroid gland was used for subtraction of background radiation for the parotid and submandibular glands respectively showed a strong correlation between repeated measurements of the variables analysed. The mean maximum uptake was 0.73-1.34% of total dose injected. CONCLUSIONS: The salivary scintigraphic variables which correlated more strongly with salivary secretion rates were RS, S and DS. The temporal region above the parotid gland and the area above the thyroid gland can be used reliably for correction background radiation in the analysis of the time-activity curve in SGS of the parotid and submandibular glands respectively.     

Salivary gland scintigraphy in Sjögren's syndrome: are quantitative indices the answer?

We evaluated the role of quantitative indices derived from dynamic 99mTc-pertechnetate salivary scintigraphy in the differentiation between a group of patients with Sj?gren's syndrome (SS), a group of patients without xerostomia, but with underlying autoimmune disorders, and a group of controls. Seventeen patients with SS (group A), 18 patients with autoimmune disorders (group B) and 15 controls (group C) underwent dynamic salivary gland scintigraphy. Functional indices for the parotid and submandibular glands were calculated and comparisons were made between the groups. There were no significant differences between the three groups in terms of the maximum accumulation (MA), maximum secretion (MS) and pre-stimulatory oral index (PRI). The uptake ratios (URs) for both the right and left parotid glands and the left submandibular gland in group A were significantly lower than those in group C, but no different from those in group B. The URs for the parotid glands in group B were significantly less than those in group C. The percentage uptake by the right parotid gland at 4 min (U4) was significantly lower in group A than in groups B or C, and lower than the percentage uptake by the left parotid gland at 4 min in group A. The rest of the U4 values and all of the uptakes at 14 min (U14) were not significantly different between the three groups. The time taken for the right parotid gland to reach peak activity (Tmax) was significantly less in group A than in the other groups, but other glands showed no significant differences. It can be concluded that MA, MS and PRI cannot be used to differentiate between the three groups. The URs in groups A and B were no different, but were significantly lower than those in group C. However, the extensive overlap between xerostomic patients and normal controls for all the quantitative indices calculated imposes a severe limitation on their discriminatory power.     

Evidence for early and persistent impairment of salivary gland excretion after irradiation of head and neck tumours

Salivary gland scintigraphy with technetium-99m pertechnetate was used to follow changes in the excretion and uptake function of the major salivary glands until 1 year after irradiation. Twenty-five patients who received radiotherapy for head and neck tumours were included in the study. Seventy-nine salivary glands (39 parotid and 40 submandibular) were evaluated in relation to the average received radiation dose. Salivary gland scintigraphy was performed before and 1, 6 and 12 months after radiotherapy. For each gland the excretion response to carbachol, evaluated by calculation of the salivary excretion fraction (SEF), the cumulative gland uptake (CGU) and the absolute excreted activity (AEA) at various intervals after radiotherapy were compared with the baseline values. The excretion response decreased in 20 of 25 patients at 1 month after radiotherapy. One month after radiotherapy both SEF and AEA decreased significantly in relation to the radiation dose. These decreases in excretion parameters persisted during the follow-up period. Parotid excretion was affected significantly more than submandibular excretion. CGU values did not change significantly until 6 months after radiotherapy, but at 12 months a significant decrease related to radiation dose was observed. Xerostomia was assessed during radiotherapy and on the days of the scintigraphic tests. The incidence of xerostomia did not correspond to the effects observed in the scintigraphy studies. It is concluded that radiotherapy induces early and persistent impairment of salivary gland excretion, related to the radiation dose. This impairment is stronger in parotid glands than in submandibular glands.     

Significance of Salivary Gland Radioiodine Retention on Post-ablation 131I Scintigraphy as a Predictor of Salivary Gland Dysfunction in Patients with Differentiated Thyroid Carcinoma

Purpose

We investigated whether ¹³¹I whole-body scintigraphy could predict functional changes in salivary glands after radioiodine therapy.

Methods

We evaluated 90 patients who received initial high-dose (≥3.7 GBq) radioiodine therapy after total thyroidectomy. All patients underwent diagnostic (DWS) and post-ablation (TWS) ¹³¹I whole-body scintigraphy. Visual assessment of salivary radioiodine retention on DWS and TWS was used to divide the patients into two types of groups: a DWS+ or DWS- group and a TWS+ or TWS- group. Salivary gland scintigraphy was also performed before DWS and at the first follow-up visit. Peak uptake and %washout were calculated in ROIs of each gland. Functional changes (Δuptake or Δwashout) of salivary glands after radioiodine therapy were compared between the two groups.

Results

Both peak uptake and the %washout of the parotid glands were significantly lower after radioiodine therapy (all p values <0.001), whereas only the %washout were significantly reduced in the submandibular glands (all p values <0.05). For the parotid glands, the TWS+ group showed larger Δuptake and Δwashout after radioiodine therapy than did the TWS- group (all p values <0.01). In contrast, the Δuptake and Δwashout of the submandibular glands did not significantly differ between the TWS+ and TWS- groups (all p values >0.05). Likewise, no differences in Δuptake or Δwashout were apparent between the DWS+ and DWS- groups in either the parotid or submandibular glands (all p values >0.05).

Conclusion

Salivary gland radioiodine retention on post-ablation ¹³¹I scintigraphy is a good predictor of functional impairment of the parotid glands after high-dose radioiodine therapy.     

Salivary gland scintigraphy: the use of semiquantitative analysis for uptake and clearance

OBJECTIVE: Quantitative analysis of (99m)Tc-pertechnetate salivary gland scintigraphy has been used in the evaluation of salivary gland function, but so far no one method can be considered optimal for this task. In this study, a semiquantitative method providing 2 functional parameters for objective assessment of salivary gland function by scintillation camera imaging was tested. METHODS: Twenty-one patients referred for (99m)Tc-pertechnetate thyroid scanning were studied. Two patients with salivary complaints were also included. Dynamic imaging of the anterior head using a scintillation camera was started after a bolus intravenous injection of 185 MBq (5 mCi) (99m)Tc-pertechnetate at 1 frame per 30 s for 30 min. At 15 min after injection, diluted lemon juice was administered orally. Analysis of the dynamic study included time-activity curves of 4 salivary glands (right and left parotid and right and left submandibular). Two parameters of function were defined: uptake rate, taken as the value of the initial slope of the time-activity curve, and washout fraction, which was the relative mobilizable radioactivity from each salivary gland after ingestion of the sialogogue. A parametric image of the washout fraction was also generated. RESULTS: The images showed gradual uptake in the parotid and submandibular glands. Washout was noted immediately after ingestion of the lemon juice. The pattern of the time-activity curve in all glands showed an early fast-rising part followed by a slow-rising component to nearly a plateau within 6-10 min after injection. The mean value of the uptake rate parameter was 0.10 +/- 0.09 cps/s. There was no significant difference between the parotid and submandibular glands or the right and left sides. Uptake in the parotid gland was 1.5-2 times that in the submandibular gland. The washout fraction was 1.40 +/- 1.60 for the parotid glands and 0.77 +/- 0.41 for the submandibular glands (P = 0.005). CONCLUSION: The quantitative analysis method including the uptake rate and the washout fraction parameters would enable objective assessment of salivary function and provide a reproducible means for follow-up of functional impairment in certain diseases.     

甲状腺癌术后^131I治疗后唾液腺功能的半定量评价

目的应用放射性核素显像对甲状腺癌术后首次和多次^131I治疗后唾液腺功能的变化进行观察和半定量评价。方法收集56例DTC术后^131I治疗后6个月行唾液腺显像患者,其中21例行首次^131I治疗前及治疗后6个月唾液腺显像。通过计算获得摄取功能参数：4min摄取比值（UR4）和15min摄取比值（UR15）;排泄功能参数：最大排泄量（MS）和酸刺激后腺体计数下降到最低所需的时间（Tmin）。21例首次^131I治疗前后定量参数行配对t检验。将所有唾液腺显像按治疗前、第1次治疗后6个月、第2次治疗后6个月、≥3次治疗后6个月分为4组,各组功能参数进行单因素方差分析和Kruskal-Wallis秩和检验,并对^131I治疗次数与功能参数行Spearman等级相关分析。结果21例首次^131I治疗后6个月,左、右侧腮腺UR15分别下降16％和14％（t值为2．188和3．322,P均〈0．05）,腮腺其余参数及颌下腺所有参数与治疗前比较差异均无统计学意义（t值为-0．952～2．039,P均〉0．05）。按治疗次数分组比较,4组腮腺UR4、UR15、MS如下：左侧分别为1．76±0．29,2．60±0．38,（72．8±24．2）％;1．55±0．34,2．15±0．51,（64．4±21．6）％;1．55±0．40,2．02±0．68,（57．2±34．2）％;1．45±0．33,1．69±0．46,（30．6±36．9）％;右侧分别为：1．81±0．33,2．57±0．51,（69．1±18．5）％;1．61±0．38,2．19±0．59,（64．2±25．0）％;1．60±0．42,2．00±0．62,（53．2±41．7）％;1．48±0．38,1．63±0．29,（26．1±45．9）％;组间差异有统计学意义（左右侧UR4、UR15的F值分别为7．018,13．393和3．112,10．194,左右侧MSH=12．240,26．569,P均〈0．05）。Tmin 4组间差异无统计学意义（左右侧H=2．077,3．019,P均〉0．05）。组间两两比较：^131I治疗1次及2次患者与对照组比较仅UR15减低有统计学意义（P均〈0．05）,但^131I治疗1次与2次组间所有参数差异均无统计学意义（P均〉0．05）,^131I治疗≥3次组双侧腮腺UR4、UR15及MS均显著下降（P均〈0．05）。双侧腮腺UR4、UR15、MS与^131I治疗次数呈负相关,r值为-0．296～-0．566,P均〈0．05。颌下腺各项参数各组间差异均无统计学意义（F值为0．275—1．159,P均〉0．05）。结论DTC术后首次大剂量^131I治疗后6个月仅腮腺摄取功能轻度减低,第2次治疗后腮腺功能损害无明显进展,≥3次^131I治疗后腮腺摄取及排泄均明显受损;颌下腺经多次^131I治疗后仍无明显功能受损。     

Quantitative salivary gland scintigraphy.

OBJECTIVE: Uptake of 99mTc-pertechnetate in salivary glands reflects intact salivary gland parenchyma. However, no standardized protocol for an accurate quantification of parenchymal function has been established so far. METHODS: In this paper we report on a validated acquisition protocol supplying a normal database for standardized quantitative salivary gland scintigraphy. RESULTS: The major advantage of salivary gland scintigraphy, as compared to other imaging modalities, is that both parenchymal function and excretion fraction of all four major salivary glands (i.e., parotid and submandibular glands) can be simultaneously quantified with a single intravenous injection. CONCLUSION: Quantitative salivary gland scintigraphy is demonstrated to be a suitable imaging modality for research applications in evaluating the effects of radioprotective drugs on salivary glands. Salivary gland scintigraphy is easy to perform, reproducible and well-tolerated by the patient.     

Gustatory stimulation changes the apparent diffusion coefficient of salivary glands: initial experience

Echo-planar diffusion-weighted (DW) magnetic resonance (MR) imaging was used to evaluate changes in the parotid glands during gustatory stimulation. The study protocol was approved by the local ethics committee, and informed consent was obtained from all volunteers. Twelve healthy volunteers (five women, seven men) with a median age of 25 years (range, 22-30 years) were examined with a 1.5-T MR unit. A DW MR imaging sequence was performed once at rest and continuously repeated over a mean period of 26 minutes (range, 24-28 minutes) during salivary stimulation with a tablet of ascorbic acid given orally. During the first 5 minutes (range, 1 minute 30 seconds--7 minutes 30 seconds) of salivary stimulation, a decrease in apparent diffusion coefficient (ADC) was observed in both the parotid (P = .0001) and the submandibular (P = .0004) glands in all volunteers. During the following 15 minutes, a steady increase in ADC from the baseline value was noted for the parotid glands (P = .0022), and peak ADC was reached a median of 21 minutes (range, 14-21 minutes) after the start of gustatory stimulation. The ADC of the submandibular glands did not increase significantly after the start of gustatory stimulation compared with the ADC at baseline. In conclusion, DW MR imaging allows physicians to noninvasively demonstrate functional changes in the salivary glands.     

Study of quantitative oral radioactivity in salivary gland scintigraphy and determination of the clinical stage of Sj?gren's syndrome.

In this study, the oral radioactivity seen in salivary gland scintigraphy, which was established entirely on the basis of radioactive saliva secreted by the parotid and submandibular glands, was evaluated quantitatively in healthy volunteers and in patients with Sj?gren's syndrome. METHODS: Salivary gland scintigraphy and labial biopsy were performed on 70 patients with Sj?gren's syndrome. After intravenous administration of 99mTc-sodium pertechnetate, dynamic scintigraphy was performed and time-activity curves for the oral cavity and four major salivary glands were generated. Lemon juice stimulation was delivered at 40 min. The prestimulatory oral activity index, poststimulatory oral activity index, and time interval between the vascular perfusion peak and the prestimulated maximum oral activity point were calculated to quantify the oral activity. Other glandular functional parameters-namely, maximum accumulation (MA), maximum secretion, secretion velocity, time at maximum count, time interval from stimulation to minimum count, and uptake ratio (UR) of the parotid and submandibular glands-were also calculated. Salivary gland scintigraphy was also performed on 21 healthy subjects with no evidence of salivary gland malfunction. RESULTS: Histopathologic grade 1 or 2 was found in 29 patients and grade 3 or 4 was found in 41 patients, and they were regarded as being in the early and advanced stages of Sj?gren's syndrome, respectively. After overall analysis, all of the oral activity indices and the MA and UR of the submandibular gland clearly decreased as clinical severity progressed, and statistically significant differences were observed. CONCLUSION: New oral activity indices correlated with the stage of Sj?gren's syndrome, and these quantitative oral indices together with certain glandular parameters (mainly MA and UR of the submandibular gland) were found to be sensitive enough to distinguish the disease severity of Sj?gren's syndrome.     

Effects of gender and age on the quantitative parameters of [99mTc]pertechnetate salivary gland scintigraphy in normal subjects

AIM: To assess the effect of gender and age on [99mTc]pertechnetate salivary gland scintigraphy (SGS) in healthy subjects. METHODS: The study population consisted of 93 normal subjects (46 women, 47 men; age range 20-59 years). The subjects were categorized into eight (four female and four male) subgroups according to age decades. Dynamic SGS was performed after intravenous injection of 370 MBq [99mTc]pertechnetate. Anterior salivary gland images were acquired for 30 min. On the basis of the time-activity curves, three functional parameters were calculated for the parotid and submandibular salivary glands: (1) the first minute uptake ratio, (2) the maximum uptake ratio, and (3) the maximum secretion percentage. RESULTS: For women, all parotid and submandibular functional parameters had a peak in the fourth decade group. The comparison of four age groups in the female subjects showed significant differences, except for the third versus the fifth decades, at least for one parameter. The number of significant differences was highest in the comparison between the second versus the fourth decades. Among men, the highest values for all parotid and submandibular parameters were in the second decade, except for the first minute uptake ratio in the submandibular gland. The number of parameters that were significantly different among the four age groups in men was lower than in women. The first minute uptake ratio of the submandibular gland had the most significant differences among the groups of male subjects. CONCLUSION: Age and gender differences have a significant effect on salivary gland functions which is more apparent in women than in men.     

Semi-quantitative assessment of salivary gland function in patients with differentiated thyroid carcinoma after radioiodine-131 treatment

Sialadenitis and xerostomia are well-known side effects of high-dose radioactive iodine ((131)Iota) treatment in patients with differentiated thyroid carcinoma (DTC). This study was undertaken to determine salivary gland function semi-quantitatively in patients with DTC given (131)I for the treatment of the thyroid remnant and/or metastases. Thirty-six patients, 11 males and 25 females, mean age 53.5 years, range 22-73 years, were studied. Scintigraphy of the salivary glands was performed with (99m)Tc-pertechnetate and the salivary excretion fraction (SEF) of the parotid and the submandibular glands was calculated as a measure of their function. Measurements were performed before (131)I treatment as a baseline study, and three weeks and three months later. The patients were clinically evaluated by a standardized subjective questionnaire. Results were as follows: Mean SEF at three weeks and three months after (131)I treatment was reduced as compared to baseline measurements. The total mean baseline measurements, those of three weeks and those of three months later were: 54.9%, 47.2% and 46% respectively; P<0.05 for both measurements (Table 1). The SEF decrease of the parotid glands was greater than that of the submandibular glands (P<0.05 as compared for both salivary glands before and three weeks and three months after (131)I treatment). This confirmed the higher radiosensitivity of the parotid glands as compared to the submandibular glands. In 12 patients (33%) there was no significant decrease of SEF in the salivary glands after (131)I treatment. The relation between the decrease of SEF after three weeks and after three months and the dose of (131)I administered, was for the right and left submandibular glands significant (P=0.016 and P=0.002), while for the parotid glands it was insignificant (P=0.22 and P=0.27 respectively) (Table 4). Reduction of SEF in the parotid glands three months after (131)I treatment was greater than after three weeks. This difference, as regards the submandibular glands, was not significant. Our results show that high dose (131)I treatment in DTC patients induces a significant effect on salivary gland function, which is dose-related in the submandibular glands, and more prominent in the parotid glands.     

MR sialography using half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences.

We describe our preliminary experience with the half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences for MR imaging of the salivary gland ducts. In the majority of patients, the main parotid and/or submandibular gland ducts and large branches within the glands were detectable on MR images obtained in 2 seconds per section and within 3 minutes for the entire examination. MR sialography using HASTE sequences can be combined with conventional MR studies for the salivary glands.     

Ultrasonography in the diagnosis of post-pubertal epidemic parotitis and its complications

PURPOSE: To assess the yield of US in the study of salivary glands and other organs involved in post-pubertal mumps. PATIENTS AND METHODS: We examined 68 patients with serologically proven post-pubertal mumps (age range 14-34 years). All patients were symptomatic, with fever and salivary gland swelling in 25 cases, marked hyperamylasemia in 32, epigastric pain in 9, unilateral scrotal swelling and/or pain in 19 cases and acute bronchitis in 1 case. All patients underwent US of salivary glands, neck lymph nodes, abdomen and scrotum with 48 hours of admission. RESULTS: Salivary glands: Parotid and submandibular glands showed normal echotexture in all patients. The parotid glands also showed multiple hypeoechoic intraparenchymal lymph nodes which were, ovoid or rounded, with smooth margins and a central hyperechoic area, with diameter ranging 3-14 mm (mean 5.4). No intraparenchymal lymph nodes were observed in submandibular glands. Neck: All patients had enlarged submandibular lymph nodes (maximum diameter ranging 5-22 mm; mean 11 mm); swelling was always bilateral and it was symmetric in 19/68 patients (30%) versus asymmetric because of prevailing right side involvement (more numerous and bigger nodes) in the other 47/68 cases (70%). All lymph nodes showed a benign pattern, with an ovoid or elongated shape, homogeneous hypoechoic echotexture and a hyperechoic hilum. Abdomen: The pancreas showed normal volume and normal parenchymal echotexture in all patients. Liver and spleen were always normal. Testes: US showed mild unilateral hydrocele in 10 cases, hydrocele and unilateral swelling of epidymis in 5 cases, hydrocele and swelling of both epidymis and didymis with inhomogeneous echotexture because of intraparenchymal hypeoechoic areas in 2 cases. There were no US changes in 2 cases. CONCLUSIONS: US of the salivary glands shows a specific pattern in post-pubertal mumps which has never been reported for other salivary gland diseases. In contrast US signs in other organs are not specific.     

Quantitative aspects of pertechnetate concentration in human parotid and submandibular salivary glands..

Quantitative uptakes of 99Tcm-pertechnetate by the salivary glands have been measured in 36 subjects and normal values established. While uptake over the parotid gland increased with time, parotid uptakes were higher at all time intervals than uptakes over the submandibular glands. The uptake over the submandibulars also increased with time. There was no significant difference between resting uptakes of right and left glands, a significant difference would therefore suggest the presence of pathology. Values over the parotid gland are greater under resting conditions than following stimulation, but no such difference was noted for submandibular glands. However, with stimulated glands it was also shown that there was no significant difference between the right and left parotid, or rignt and left submandibular uptakes. The clinical relevance of these findings is discussed.