sodium-pertechnetate-tc-99m and Parotid-Neoplasms

An unusual case of bilateral papillary cystadenoma lymphomatosum of the parotid with multiple lesions showing no active uptake of 99mTc pertechnetate is presented. Similar cases showing no accumulation of radionuclide are reviewed.

Topics: Adenolymphoma; Aged; Humans; Magnetic Resonance Imaging; Male; Parotid Neoplasms; Sialography; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed

Warthin's tumor is controversial. This controversy is multifaceted and relates to all aspects of the tumor from its historical beginnings to its pathogenesis, investigations, and treatments. In this paper, an in depth study of Warthin's tumor has been made to help clarify these controversies.

Topics: Adenolymphoma; Adenoma; Adolescent; Adult; Aged; Biopsy, Needle; Child; Child, Preschool; Epithelium; Female; Humans; Lymphocytes; Male; Metaplasia; Microscopy, Electron; Middle Aged; Neoplasms, Multiple Primary; Parotid Gland; Parotid Neoplasms; Sialography; Sodium Pertechnetate Tc 99m; Technetium; Tomography, X-Ray; Tomography, X-Ray Computed; Ultrasonography

Fine needle aspiration cytology (FNAC) for diagnosis of a parotid gland tumor is widely used but its sensitivity is low and non-diagnostic rate is relatively high. In contrast, core needle biopsy (CNB) has a higher sensitivity and lower rate of sampling errors but has a higher risk of injury to adjacent organs such as facial nerve than FNAC. Screening of patients with parotid gland tumors to identify cases of pleomorphic adenoma (PA) and Warthin tumor (WT) may allow CNB to be confined to patients without PA and WT. We established an algorithm for preoperative diagnosis and management of parotid gland tumor using diffusion-weighted MRI and 99mTc pertechnetate scintigraphy. This algorithm was developed with the goal of maximal reduction of the number of patients in whom CNB is required. The purpose of the study is to validate our algorithm prospectively.. A prospective study was conducted in 71 cases who were newly diagnosed with parotid gland tumor and 53 cases were enrolled in the study. In the algorithm, PA (high apparent diffusion coefficient (ADC) mean≥1.5×10(-3) mm(2)/s) and non-PA (low ADCmean<1.5×10(-3) mm(2)/s) cases are first distinguished based on the ADCmean on diffusion-weighed MRI. Second, among suspected non-PA cases, WT and non-WT are distinguished using technetium-99m pertechnetate scintigraphy. CNB is then performed only in probable non-PA and non-WT cases.. Although CNB was only required in 40% (21/53) of all cases, we made a preoperative histopathological diagnosis with an accuracy of 87% (46/53) and we correctly diagnosed whether a tumor was benign or malignant with an accuracy of 96% (51/53). Preoperative surgical planning had to be changed during surgery in only one case (2%).. Our algorithm is valuable in terms of clinical practice with highly potential for preoperative diagnosis and with less risk of CNB procedure.

Topics: Adult; Aged; Aged, 80 and over; Diffusion Magnetic Resonance Imaging; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Prospective Studies; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Selective deep lobe parotidectomy is a demanding technique, but it preserves healthy glandular tissue, improves cosmetic results and minimises the incidence of Frey's syndrome. We have evaluated postoperative function of the superficial lobe of the parotid after selective resection of the deep lobe. Fourteen patients who each had a mass involving the deep lobe of the parotid were selected from 127 patients with tumours of the parotid gland who were seen and treated between January 2001 and March 2004. Of the 14, 12 matched the study criteria. The preoperative diagnosis was made using both computed tomography (CT) and ultrasound or fine needle aspiration cytology, and the diagnosis was confirmed by histological analysis. All cases were treated by the same surgeon. At 6 months follow-up all patients had a House-Brackmann test, iodine starch test, and scintigraphy of both parotid glands. After scintigraphy the maximum uptake value and function of the gland were evaluated with the concentration index (CI) and the CI percentage ratio. The concentration function of the gland in the resected side of the study group had a mean (S.D.) CI index of 5.5 (3.6) and a CI percentage ratio of 84%. Selective deep lobe parotidectomy has the following advantages: it minimises the impact of treatment on the facial contour, it does not increase postoperative morbidity and it preserves the function of the gland.

Topics: Adult; Female; Humans; Male; Middle Aged; Oral Surgical Procedures; Parotid Gland; Parotid Neoplasms; Postoperative Period; Radionuclide Imaging; Recovery of Function; Sodium Pertechnetate Tc 99m; Treatment Outcome

Although salivary gland scintigraphy has been useful for the diagnosis of Warthin's tumor (WT), there are no reports concerning the clinical impact of this scintigraphy.. We retrospectively investigated 127 patients with solitary parotid tumors who had undergone salivary gland scintigraphy.. For patients who had surgery, the sensitivity, specificity, and accuracy of differentiating WT from non-WTs were 95%, 91%, and 92%, respectively. There was a significant correlation between scintigraphic results and the treatment decisions made for the 127 patients (chi2=16.5, P=0.00026). The proportion of WT patients among those who underwent surgery was 19%, whereas 42% of those who were suspected to have WT from scintigraphy were followed without surgical intervention. The main reasons for clinical observation in these patients were comorbidity, refusal of surgery, and age.. The high percentage of nonsurgical patients suspected to have WT can be explained by the high diagnostic accuracy of salivary gland scintigraphy, which is useful for determining further management when surgery is contraindicated or is refused by the patient.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

The aim of this study is to evaluate an imaging approach using computed tomography (CT), magnetic resonance imaging (MRI), technetium-99m pertechnetate scintigraphy (99mTc pertechnetate scintigraphy), gallium-67 scintigraphy (67Ga scintigraphy) and fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET).. We reviewed retrospectively 59 patients with parotid masses. CT, MRI, 67Ga scintigraphy, 99mTc pertechnetate scintigraphy, and 18F-FDG PET were performed.. All of the benign tumors had smooth margins on CT and MRI. Patients with inflammatory lesions and malignant lesions showed well-defined margins or ill-defined margins. All Warthin's tumors showed high technetium accumulation. Many of malignant tumors showed high FDG accumulation. Both pleomorphic adenomas and Warthin's tumors showed high accumulation in some cases on 18F-FDG PET. Among 15 patients with pleomorphic adenoma, 14 patients showed marked hyperintensity relative to CSF on T2-weighted images and partial enhancement on contrast-enhanced T1-weighted images. Combination of several imaging modarity offered usefulness of differential diagnosis for parotid masses.. An efficient combination of imaging methods may be helpful for achieve the correct diagnosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Diagnostic Imaging; Female; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Parotid Neoplasms; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed; Tomography, X-Ray Computed

The purpose of this report was to evaluate the possibility of subclassification of papillary cystadenoma lymphomatosum (PCL) with 99Tc(m)-pertechnetate.. A patient with multiple bilateral PCLs in the parotid glands was examined by using 99Tc(m)-pertechnetate.. All PCLs of the present case, which were diagnosed as the subtype-II histopathologically, showed similar radioactive indexes in scintigraphy (the mean radioactive index = 3.62), although tumours were different in size. The mean radioactive index corresponded well with that from four cases of subtype-II of our previous report (the mean radioactive index = 3.84).. The results of the present report suggest a possibility of histopathological subclassification of PCLs into subtypes by 99Tc(m)-pertechnetate scintigraphy.

Topics: Adenolymphoma; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Whole-body I-131 scintigraphy is an important component of the postoperative follow-up of patients with well-differentiated thyroid cancer. However, false-positive scans showing abnormal uptake in the absence of residual thyroid tissue or metastases may occur. Unless recognized as false positive, these abnormal sites of uptake may lead to unnecessary administration of therapeutic doses of I-131. The authors report a patient with Warthin tumor whose I-131 whole-body scan demonstrated increased uptake in the parotid gland, despite a negative Tc-99m pertechnetate salivary gland scintigraphy.

Topics: Adenolymphoma; False Negative Reactions; Humans; Iodine Radioisotopes; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Oncocytoma is a rare salivary gland tumour consisting of oncocytes with many hyperplastic mitochondria. It usually occurs in the parotid gland. Because the features of oncocytoma resemble those of other benign and low-grade-malignant salivary gland tumours, clinical diagnosis is often challenging. This report presents the pathologic and imaging findings of an oncocytoma arising in the deep lobe of the left parotid gland in a 66-year-old man. Oncocytoma was diagnosed on the basis of histological, magnetic resonance imaging, and scintigraphic findings. The tumour showed accumulation of technetium-99m pertechnetate and decreased signal intensity on both T1- and T2-weighted magnetic resonance images.

Topics: Adenoma, Oxyphilic; Aged; Humans; Magnetic Resonance Imaging; Male; Parotid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m

Is scintigraphy in the preoperative diagnosis of cystadenolymphomas dispensable?. In this prospective study 35 patients with tumors of the parotid gland were examined sonographically and scintigraphycally and the results were compared with the histological findings.. By means of sonography 88 % (22/25) of the cystadenolymphomas were correctly diagnosed and by means of scintigraphy 80 % (20/25).. Sonography is recommendable as the first-line diagnostic procedure in cystadenolymphomas because it is without radiation load, the free choice of the echographic plane, and it can be repeated as often as desired. Scintigraphy adds in selected cases, as in elder patients, additional informations. The combination of sonography and scintigraphy confirms the presence of cystadenolymphoma and allows the surgeon to make a decision and to avoid surgery especially in high-risk patients.

Topics: Adenolymphoma; Adult; Aged; Diagnosis, Differential; Female; Gamma Cameras; Humans; Male; Middle Aged; Parotid Neoplasms; Prospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Ultrasonography

We retrospectively evaluated preoperative radioisotope (RI) scintiscans in 275 patients (283 glands) with parotid tumors who undergoing surgery between 1987 and 2000. Technetium-99m-pertechnetate (Tc) scintigraphy was conducted on 201 glands. Oncocytoma and Warthin's tumor showed a high positive rate. In evaluating Warthin's tumor with Tc scintigraphy, sensitivity was 75% and specificity 88%; above the age of 40 years, specificity exceeded 90%. Gallium-67-citrate (Ga) scintigraphy was conducted on 207 glands. Malignant parotid tumors showed high positivity (85%), but the specificity of positive findings was quite low (38%) because 44% of benign pleomorphic adenoma, which occupied major material, showed Ga-positive findings. Ga-negative findings indicated high probability (95%) of benign tumors. Thus, Tc scintigraphy is effective in diagnosing Warthin's tumor, while Ga scintigraphy is effective in diagnosing benign tumors.

Topics: Adenolymphoma; Adenoma, Oxyphilic; Adolescent; Adult; Aged; Aged, 80 and over; Female; Gallium; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

The aim of this study was to evaluate the usefulness of technetium-99m (Tc-99m) pertechnetate scintigraphy with lemon juice stimulation in the diagnosis of Warthin's tumor and its correlation with Tc-99m uptake, tumor size, and histologic subtype. Tc-99m pertechnetate scintigraphy before and after lemon juice stimulation and pathologic specimens of 34 Warthin's tumors and 47 non-Warthin's lesions were retrospectively evaluated. Tc-99m uptake of Warthin's tumors before and after stimulation was visually graded as follows: absent; indeterminate; low grade; definite; and strong. Tumor size was defined as maximum diameter of the tumor measured from the surgical specimen. Warthin's tumors were classified into three histologic subtypes according to the ratio of epithelial and lymphoid stromal components: predominant epithelial; intermediate; and low-grade epithelial types. Eighteen of 34 (53%) Warthin's tumors and one benign lymphoepithelial cyst showed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy before lemon juice stimulation. Thirty-two of the 34 (94%) Warthin's tumors, one benign lymphoepithelial cyst, one pleomorphic adenoma, and one oncocytoma revealed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy after lemon juice stimulation. The mean size was 37 mm in strong uptake Warthin's tumors, 24 mm in definite uptake tumors, 19 mm in low-grade uptake tumors, and 12 mm in low-grade uptake tumors excluding those tumors with large cystic component. There was a significant correlation between tumor size and degree of Tc-99m uptake after lemon juice stimulation. However, there was no correlation between histologic subtype and Tc-99m uptake, and histologic subtype and tumor size in Warthin's tumors. Our study concludes that Tc-99m pertechnetate scintigraphy with lemon juice stimulation is useful for the detection and diagnosis of Warthin's tumor. The degree of uptake in Warthin's tumor on Tc-99m scintigraphy with lemon juice stimulation depends mainly on tumor size and the presence of large cystic component in it.

Topics: Adenolymphoma; Adolescent; Adult; Aged; Beverages; Child; Citrus; Female; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

This study investigated the diagnostic accuracy of 99mTc-pertechnetate scintigraphy with lemon juice stimulation for evaluating parotid gland Warthin's tumor.. Technetium-99m-pertechnetate scintigraphy with intraoral lemon juice stimulation was used to evaluate a total of 68 parotid gland lesions clinically suspected of being Warthin's tumor in 62 patients. Twenty-three of the 68 lesions were subsequently histologically confirmed to be Warthin's tumor, whereas the remaining 45 lesions were histologically diagnosed as being other lesions.. Technetium-99m-pertechnetate scintigraphy with lemon juice stimulation correctly diagnosed 18 of 23 Warthin's tumors as being Warthin's tumor but was unable to diagnose the other five Warthin's tumors. Further, scintigraphy correctly diagnosed 41 of 45 non-Warthin's tumors as being non-Warthin's tumor but misdiagnosed other four non-Warthin's tumors as Warthin's tumor. Thus, the sensitivity of scintigraphy for diagnosing Warthin's tumor was found to be 78%, its specificity 91% and its accuracy 87%. On the basis of prestimulation images alone, however, the sensitivity was estimated to be 65%, its specificity 93% and its accuracy 84%.. For evaluating Warthin's tumor, the sensitivity of 99mTc-pertechnetate scintigraphy was relatively low, although the specificity was sufficiently high. Lemon juice stimulation improved the sensitivity markedly but decreased the specificity slightly. Thus, 99mTc-pertechnetate scintigraphy with lemon juice stimulation should be carefully performed for diagnosis of Warthin's tumor.

Topics: Adenolymphoma; Adenoma, Pleomorphic; Citrus; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Topics: Adenolymphoma; Female; Humans; Middle Aged; Parotid Gland; Parotid Neoplasms; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

In order to clarify the mechanism of positive scintigraphy with Tc pertechnetate in adenolymphomas of the parotid gland, 10 cases of adenolymphoma were studied morphologically and from a functional view point. Salivary tissue obtained from normal parotid glands were also investigated for comparison with the tumor. In morphological studies, rapid tissue fixation by microwave irradiation produced very good results for examining mitochondria by high resolution light microscopy. A number of mitochondria were found both in the epithelial cells of adenolymphoma and in the striated duct cells of the parotid gland. In functional studies, the one-step method of enzymatic histochemistry was used for detecting Na-K ATPase. Na-K ATPase was found on the baso-lateral side of the epithelial cells of adenolymphoma and the striated duct cells of the parotid gland, and this activity of Na-K ATPase may enhance the accumulation of Tc pertechnetate in these cells. These observations may provide evidence for the bi-cellular theory which indicates that adenolymphoma originated from immature intercalated duct reserve cells.

Topics: Adenolymphoma; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Mitochondria; Parotid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Sodium-Potassium-Exchanging ATPase

A Tc-99m pertechnetate salivary gland scintigraphy, digital subtraction sialography (DSS) and cytological findings of a 48-year-old female who received I-131 therapy for the treatment of follicular carcinoma of thyroid are presented. Post radioiodine therapy sialoscintigraphy showed increased blood flow and uptake with decreased secretion in the left parotid gland suggesting acute inflammation. In contrast, DSS and fine needle aspiration biopsy (FNAB) findings were consistent with chronic sialoadenitis. Follow-up scintigraphy one month later showed normal blood flow and decreased uptake and confirmed the diagnosis of chronic sialoadenitis. In right of this case, we conclude that since management of sialoadenitis depends on the stage of inflammation scintigraphic findings should be interpreted together with radiology and FNAB findings if necessary. When chronic sialoadenitis is followed by acute exacerbations, diagnosis based exclusively on sialoscintigraphic findings may result in inadequate patient management.

Topics: Adenocarcinoma, Follicular; Biopsy, Needle; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sialadenitis; Sialography; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Adenolymphoma; Carcinoma; Diagnosis, Differential; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

The accumulation of 99mTc-pertechnetate in Warthin's tumor was estimated scintigraphically and histopathologically to determine the role of the epithelial component in scintigraphy.. Six cases underwent histopathologic examination and scintigraphic evaluation with 99mTc-pertechnetate. Histopathologically the tumors were classified into types according to the epithelial component and cystic space and compared with scintigraphic results evaluated by dynamic radioactive index and wash-out image.. Histopathologic and scintigraphic observations showed an adequate correlation. Cases with a large epithelial component and poor cystic space showed a large radioactive index of dynamic scintigraphy and hot accumulation of wash-out image.. The scintigraphic results were chiefly due to the epithelial component, but the influence of the cystic space could not be disregarded.

Topics: Adenolymphoma; Aged; Epithelium; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

We report scan findings of Tl-201 in a case of histologically proved Warthin's tumor. Dual isotopes acquisition was performed in a case of left parotid Warthin's tumor. Both early and delayed Tc-99m-pertechnetate (Tc-99m) images showed increased uptake at the tumor. Tl-201 scan also showed an increase of uptake on the early image and retention on the delayed image. The uptake ratios of Tl-201 were 3.0 (early) and 2.3 (delayed). Scan findings of Tl-201 in a case of Warthin's tumor were similar to those of Tc-99m, and the interpretation of Tl-201 images should be accompanied with Tc-99m images.

Topics: Adenolymphoma; Female; Humans; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Tomography, X-Ray Computed

Oncocytoma of the salivary glands is a rare tumor that usually follows a benign course and, in most cases, can be cured by surgical resection. The authors report a rare case of multiple bilateral parotid oncocytomas that presented clinically with two palpable parotid masses. Both CT and MRI scans demonstrated multiple masses in each parotid gland. The tumors exhibited intense uptake and prolonged retention of Tc-99m pertechnetate. The diagnosis was confirmed by fine needle aspiration. Sialoscintigraphy is a simple and noninvasive procedure that can usually separate benign entities like Warthin tumor and oncocytoma of the salivary glands from malignant tumors, and significantly affect the course of treatment.

Topics: Adenoma, Oxyphilic; Aged; Humans; Male; Neoplasms, Multiple Primary; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The usefulness of combined Tc-99m and Ga-67 scans in diagnosing salivary gland disorders was evaluated in a total of 31 patients. Out of 6 patients with Warthin's tumor, 4 showed a typical pattern of high-activity in the gland with retention of Tc-99m, but without an affinity for Ga-67. Out of 9 patients with pleomorphic adenoma, 8 showed a "cold" area in the tumor by Tc-99m and 5 of the 9 patients had accumulated Ga-67. Five of 6 patients with malignant tumor showed an affinity for Ga-67. Nine of 10 patients with sialadenitis showed diffuse uptake of both Tc-99m and Ga-67 in the involved gland. Combined Tc-99m and Ga-67 imaging was useful in detecting the cases of Warthin's tumor and sialadenitis (90% sensitivity and 89% specificity for sialadenitis), but the study had limitations in differentiating malignant tumors from benign tumors (66% sensitivity and 84% specificity). However, Ga-67 imaging showed a 91% negative predictive value. A negative scan could almost rule out the possibility of malignant disease of the salivary gland.

Topics: Adenocarcinoma; Adenolymphoma; Adenoma, Pleomorphic; Adolescent; Adult; Aged; Aged, 80 and over; Child; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Mixed Tumor, Malignant; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Diseases; Sialadenitis; Sodium Pertechnetate Tc 99m; Submandibular Gland Neoplasms

Topics: Adenolymphoma; Aged; Humans; Male; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Salivary gland cavernous haemangiomas are relatively uncommon in the child and even rarer in the adult, and provide diagnostic difficulties. This paper demonstrates how the diagnosis can be established using sonography and red blood cell (RBC) scintigraphy.

Topics: Adolescent; Adult; Child; Child, Preschool; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Infant; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m; Submandibular Gland Neoplasms; Ultrasonography

Of the nine patients included in this study, five with proven unilateral parotitis initially had diffuse high uptake of 99mTc-pertechnetate in the affected glands with adequate washout following vitamin C stimulation. Of four patients with proven Warthin's tumor, two had focal high uptake in the parotid masses and two had diffuse high uptake on baseline images. All tumors were clearly delineated after stimulation. 99mTc-pertechnetate salivary scintigraphy with vitamin C stimulation may provide a useful tool in differentiating unilateral parotitis from Warthin's tumor.

Topics: Adenolymphoma; Ascorbic Acid; Diagnosis, Differential; Humans; Parotid Neoplasms; Parotitis; Radionuclide Imaging; Salivation; Sodium Pertechnetate Tc 99m

Scintigraphically, Warthin's tumour usually demonstrates increased tracer uptake compared to normal adjacent salivary tissue. A case is presented in which tumour uptake is no greater than the normal adjacent gland. Gustatory stimulation results in failure of tumour tracer washout, and this finding rather than 'hot' salivary mass is the sine qua non of the scintigraphic diagnosis of Warthin's tumour.

Topics: Adenolymphoma; Female; Humans; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Taste

A case report of bilateral mixed Warthin's tumors with nonuniform uptake demonstrated by Tc-99m pertechnetate imaging is presented. The findings are compared to CT, surgical, and pathology results.

Topics: Adenolymphoma; Aged; Humans; Male; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

The authors' experience with salivary gland imaging in patients with Warthin's tumor was reviewed and the scans correlated with the pathologic findings of each tumor in an attempt to explain the scintigraphic variants found. Most Warthin's tumors show increased perfusion on imaging. The predischarge static images have a low sensitivity, detecting only 33% of the tumors. Warthin's tumors may appear hot, warm, or cold on the predischarge images but invariably become hot in the postdischarge study, for a 100% sensitivity. Many tumors reveal internal warm or cold areas. These focal defects correlate well with the presence of intratumoral cysts. The presence of these mixed lesions should not lead the physician away from the diagnosis of Warthin's tumor.

Topics: Adenolymphoma; Aged; Cysts; Diagnosis, Differential; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Salivary gland imaging with Tc-99m pertechnetate is a useful procedure for evaluating the functional status of salivary glands. The only neoplasms of salivary glands known to consistently concentrate Tc-99m pertechnetate are Warthin's tumor and oncocytoma. In the five cases presented, increased concentration of Tc-99m pertechnetate was seen in these tumors of the parotid glands. This finding was useful for preoperative identification of Warthin's tumor. During this investigation, the concentration of Tc-99m pertechnetate in Warthin's tumor varied by histologic type. Thus, a dynamic study may be helpful in evaluating the accumulation rate of Tc-99m pertechnetate into this tumor type. Because the retention of Tc-99m pertechnetate in tumor following stimulation is useful for the diagnosis of Warthin's tumor, a washout image is of importance in establishing this diagnosis.

Topics: Adenolymphoma; Aged; Humans; Male; Middle Aged; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adenoma; Aged; Female; Humans; Iodine Radioisotopes; Parotid Neoplasms; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroiditis

Topics: Adenoma; Adolescent; Adult; Carcinoma, Squamous Cell; Gallium Radioisotopes; Humans; Lymphoma; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Hemangioma; Humans; Infant, Newborn; Infant, Premature, Diseases; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adenolymphoma; Aged; Gallium Radioisotopes; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

99mTc-O4 and/or 67Ga-citrate scintigraphies were preoperatively applied to 13 cases of parotid mucoepidermoid tumor. The resected specimens were histopathologically subdivided into three types: well (6 cases), moderately (one case), and poorly differentiated (6 cases). As the other parotid neoplasms except adenolymphoma and oxyphilic adenoma, all poorly differentiated tumors showed focal defect image in 99mTc-O4 scintiscanning (4/4). They indicated a focal hot image in 67Ga-citrate scanning at a high rate (4/6). Otherwise, well differentiated tumors were scarcely pointed out in cold image and were usually indicated as a symmetrical image (5/6) in 99mTc-O4 scanning. None of them showed a focal hot image in 67Ga-citrate scanning, but two cases indicated diffuse increased uptake and another case showed a focal defect image. The clinical prognosis of mucoepidermoid tumors is extremely correlated to the degree of cell differentiation in our prospective study. For that reason, the therapeutic method should be carefully selected in the tumors suspected of low grade malignancy. Our study suggests that RI (99mTc-O4 and 67Ga-citrate) scintigraphy is helpful in evaluating the malignancy grade of mucoepidermoid tumors.

Topics: Adolescent; Adult; Aged; Carcinoma; Gallium Radioisotopes; Humans; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Sialographic investigation of enlarged salivary glands contribute to the important decision whether a secretion blockage is caused by a stone, chronic inflammation, sialoadenosis, or a tumour. The results of sialographic investigations have been much improved by the method described by Brands and Schnepper (1967) of specific serial sialography using a single-shot and fast-repeating camera, under fluoroscopic control. The success rate of the sialographic diagnosis on 141 patients in the ENT Department of Saarland University Hospital was 80%. The fact that in four cases spaces, occupying lesions were falsely interpreted or undetected leads to the conclusion that where a tumour is suspected negative sialography should be followed by further diagnostic steps. Scintigraphy of the salivary glands with 4 mCi 99mTechnetium Pertechnetate produces extra information which clearly increases diagnostic accuracy. However, experience to date shows that it is not an alternative to serial sialography but rather a supporting diagnostic method.

Topics: Adult; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Diseases; Salivary Gland Neoplasms; Sialadenitis; Sialography; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Technetium

Topics: Adenolymphoma; Aged; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Sialography; Sodium Pertechnetate Tc 99m

The clinical efficacy of salivary gland scintigraphy was evaluated in 32 histologically proven cases. In benign tumors, except Warthin's tumor, 16 of the 20 cases (80%) appeared as cold lesions. All six cases of Warthin's tumor appeared as hot lesions. In malignant tumors, one case each of mucoepidermoid carcinoma, adenopapillary carcinoma, and adenoid-cystic carcinoma were shown as cold lesions, while squamous cell carcinoma and malignant mixed tumor were delineated as a defect image (no uptake of radionuclide). On stimulation with ascorbic acid, retention of radionuclide within the tumor was noted only in Warthin's tumors, but it was noted at the periphery of the tumors in 21 of the 24 cases (87.5%), which might be due to inflammation and/or compression of the gland by the tumors. Salivary gland scintigraphy provided useful information for the evaluation of the site of the tumor and the function of the salivary gland.

Topics: Adenolymphoma; Adenoma, Pleomorphic; Adult; Aged; Carcinoma, Squamous Cell; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m; Technetium

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Parotid Diseases; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Salivation; Sialography; Sodium Pertechnetate Tc 99m; Technetium

Topics: Adenolymphoma; Aged; Humans; Male; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

A 71-year old man presented with a parotid mass and a thyroid nodule. An I-123 scan revealed a "cold" nodule in the thyroid and uptake of the radioactive iodine in the parotid mass. On a Tc-99m-pertechnetate salivary gland scan, the parotid mass was "hot" and did not wash out with sodium perchlorate. At surgery, he was found to have a Warthin's tumor of the parotid gland and an adenomatous goiter. The reasons for the scan appearance of the Warthin's tumor are discussed. Since Warthin's tumors are benign and uptake of radioactive iodine in the extrathyroidal deposits of thyroid carcinoma is rare with the thyroid gland in place, the uptake of iodine by a salivary gland mass probably indicates a benign process.

Topics: Adenolymphoma; Aged; Humans; Iodine Radioisotopes; Male; Parotid Gland; Parotid Neoplasms; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Diseases; Thyroid Gland

Salivary gland imaging with 99mTc as pertechnetate provides functional information concerning trapping and excretion of the parotid and submandibular glands. Anatomic information gained often adds little to clinical evaluation. On the other hand, functional information may detect subclinical involvement, which correlates well with biopsy of the minor labial salivary glands. Salivary gland abnormalities in systemic disease such as sarcoidosis, rheumatoid arthritis, lupus erythematosus, and other collagenvascular disorders may be detected before they result in the clinical manifestaions of Sjögren's syndrome. Such glands, after initially demonstrating increased trapping in the acute phase, tend to have decreased trapping and failure to discharge pertechnetate in response to an appropriate physiologic stimulus. Increased uptake of gallium-67 citrate often accompanies these findings. Inflammatory parotitis can be suspected when increased perfusion is evident on radionuclide angiography with any agent. The ability of the salivary gland image to detect and categorize mass lesions, which result in focal areas of diminished activity such as tumors, cysts, and most other masses, is disappointing, while its ability to detect and categorize Warthin's tumor, which concentrates pertechnetate, is much more valuable, although not specific.

Topics: Adenolymphoma; Humans; Lymphangioma; Parotid Diseases; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Diseases; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland Diseases; Submandibular Gland Neoplasms; Technetium