sodium-pertechnetate-tc-99m and Salivary-Gland-Diseases

The salivary glands belong to the exocrine glands. There are tree main pairs of salivary glands: parotid, submandibular, sublingual. Several modalities are used for salivary gland imaging, such as sonography, computer tomography and magnetic resonance imaging. The aim of these methods is mainly to present morphological impairment. Parenchymal function and excretion function of all salivary glands can be quantified by scintigraphy. After single intravenous injection of 99mTc-pertechnetate sequential images are acquired up to 25-40 minutes. Usually about fifteen minutes postinjection 3 ml of lemon juice are administered intraorally as sialogogue. Salivary scintigraphy can estimate the severity of salivary gland involvement and function disorders, which may not be accurately reflected by the morphological damage. The clinical impact of scintigraphy has been reported in multiple salivary glands diseases, such as Sjogren's syndrome, sialolithiasis with or without parenchymal damage, iatrogenic irradiation of the salivary glands for therapy of head and neck tumors or radioiodine treatment of thyroid cancer. No other method can give so much information about function of salivary glands. Scintigraphy is noninvasive examination, easy to perform, reproducible and well-tolerated by the patient.

Topics: Humans; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Nuclear medicine studies often play a significant role in the diagnosis and treatment of oral and maxillofacial diseases. While not commonly used in everyday dental practice, the dental provider should have a conversational knowledge of these imaging modalities and understand the indications and limitations of these studies. The purpose of this review is to discuss the nuclear medicine studies that have applications in the head and neck region as well as their indications, limitations, and diagnostic conclusions that can be drawn from these studies.

Topics: Citrates; Gallium; Head and Neck Neoplasms; Humans; Jaw Diseases; Radionuclide Imaging; Radiopharmaceuticals; Salivary Gland Diseases; Sentinel Lymph Node Biopsy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Radioactive iodine ((131)I) targets the thyroid gland and has been proven to play an effective role in the treatment of differentiated papillary and follicular cancers. Simultaneously, this radioisotope hones in on the salivary glands where it is concentrated and secreted into the saliva. Dose related damage to the salivary parenchyma results from the (131)I irradiation. Salivary gland swelling and pain, usually involving the parotid, can be seen. The symptoms may develop immediately after a therapeutic dose of (131)I and/or months later and progress in intensity with time. In conjunction with the radiation sialadenitis, secondary complications reported include xerostomia, taste alterations, infection, increases in caries, facial nerve involvement, stomatitis, candidiasis, and neoplasia. Prevention of the (131)I sialadenitis may involve the use of sialogogic agents to hasten the transit time of the radioactive iodine through the salivary glands. However, studies are not available to delineate the efficacy of this approach. Recently, amifostine has been advocated to prevent the effects of irradiation. Treatment of the varied complications that may develop encompass numerous approaches and include gland massage, sialogogic agents, duct probing, antibiotics, mouthwashes, good oral hygiene, and adequate hydration.

Topics: Amifostine; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Radiation Injuries; Radiation-Protective Agents; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Humans; Radionuclide Imaging; Saliva; Salivary Gland Diseases; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Since its introduction in 1965 salivary gland scintigraphy has been an established method to simultaneously investigate excretion function in major salivary glands. In order to elucidate parenchymal function of salivary glands, several authors described various quantitative and semiquantitative methods. However, no standardized protocol for quantitative salivary gland scintigraphy has been established so far.. Therefore, in this paper we report on a standardized and validated acquisition protocol for salivary gland scintigraphy using 99mTc-pertechnetate.. A normal data base for both parenchymal and excretion function is given in detail. In addition, the diagnostic value of salivary gland scintigraphy is reviewed in various clinical settings, such as mild parenchymal damage in beginning Sjögren's syndrome, proof of functional obstruction in sialolithiasis with and without parenchymal damage, and parenchymal damage following radioiodine treatment. In a second part, applications of salivary gland scintigraphy in current clinical research are described, and radiation protection of salivary glands in rabbits and patients treated with high doses of I-131 are discussed.. Salivary gland scintigraphy is a study that is easily performed and well tolerated by the patient. It yields quantitative parameters for parenchymal function and excretion fraction.

Topics: Animals; Gamma Cameras; Humans; Rabbits; Radiation Protection; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Calculi; Salivary Gland Diseases; Salivary Glands; Salivation; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Topics: Biopsy; Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Salivary Gland Diseases; Salivary Glands; Sialography; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed; Ultrasonography

Topics: Abscess; Adenolymphoma; Adenoma, Pleomorphic; Cysts; Humans; Parotitis; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Diseases; Salivary Gland Neoplasms; Salivary Glands; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Xerostomia

Topics: Adenolymphoma; Adenoma; Carcinoma; Gallium Radioisotopes; Humans; Radionuclide Imaging; Saliva; Salivary Gland Diseases; Salivary Gland Fistula; Salivary Gland Neoplasms; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Technetium; Tuberculosis, Oral

The most frequent non-thyroidal complication of high-dose (131)I therapy for thyroid carcinoma is salivary gland dysfunction, which may be transient or permanent. In this study, we assessed radioiodine-induced permanent salivary gland dysfunction using quantitative salivary gland scintigraphy.. Salivary scintigraphy was performed with (99m)Tc-pertechnetate on 50 thyroid carcinoma patients who had been given radioiodine for thyroid ablation; 20 normal subjects were imaged as the control population. Dynamic scintigraphy was performed and time-activity curves for four major salivary glands were generated. The glandular functional parameters maximum secretion, time at maximum count and uptake ratio of the parotid and submandibular glands were calculated. Correlation of the administered dose and subjective symptoms with findings of salivary gland scintigraphy was evaluated.. The maximum secretion and uptake ratio were decreased in 46% and 42% of patients who received radioiodine therapy, respectively. Salivary gland dysfunction correlated well with the administered dose. The parotid glands were more affected than the submandibular glands. Fifty-two per cent of patients were symptomatic, 69.23% of whom showed salivary gland dysfunction.. Parenchymal damage to the salivary glands induced by radioactive iodine treatment can be evaluated by salivary gland scintigraphy. The impairment was worse in parotid glands and increased with the total dose. The maximum secretion and uptake ratio were found to be sufficiently sensitive to distinguish the severity of the damage.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Image Interpretation, Computer-Assisted; Iodine Radioisotopes; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Recovery of Function; Salivary Gland Diseases; Salivary Glands; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Treatment Outcome

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.. 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.. 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).. 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.

Topics: Adolescent; Adult; Humans; Male; Metabolic Clearance Rate; Middle Aged; Models, Biological; Parotid Gland; Radiography; Radioisotope Dilution Technique; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Salivary Gland Diseases; Salivary Glands; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland

Salivary gland scintigraphy (SGS) is used to depict salivary gland dysfunction after radiotherapy (RT). The aim of this study was to investigate the utility of SGS combined with single photon emission computed tomography (SPECT). Twenty-one patients with a carcinoma of head and neck underwent SGS before and 1 month after RT. After injection of 370 MBq 99Tcm-pertechnetate, a biplanar dynamic acquisition (12 x 1 min) was started, followed by a SPECT acquisition during 4 min. Carbachol was then injected and a second dynamic study (16 x 1 min) was performed, again followed by a SPECT acquisition. The salivary excretion fraction (SEF) was calculated both from the geometric mean planar image for each parotid and from the SPECT data for each transverse plane through the parotids. The RT-induced changes in the SEF (dSEF) were correlated with the mean radiation dose calculated using tomography-based dosimetry. The mean radiation dose to the parotids was 44 Gy (range 4.4-68.1 Gy). The mean range of the variation in radiation dose to the transverse slices within the parotids of a patient was 24 Gy (range 6.2-51.9 Gy). Considering all transverse planes through the parotids in all patients, a linear correlation was found between the dSEF calculated using SGS-SPECT and the radiation dose (r=0.45, P=0.0001). Thirteen patients had a variation in radiation dose within the parotids of more than 20 Gy. In nine of these a significant intra-individual correlation between radiation dose and the dSEF of the transverse parotid slices was found (r range 0.55-0.97; P value range 0.037-0.0001). In conclusion, SGS-SPECT can be used for monitoring radiation-induced parotid gland dysfunction. It offers the unique possibility for the assessment of intra-individual dose-dysfunction curves in patients with large variations in the radiation dose within the parotids.

Topics: Adult; Aged; Algorithms; Carcinoma, Squamous Cell; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Parotid Gland; Radiometry; Radiopharmaceuticals; Radiotherapy; Reproducibility of Results; Salivary Gland Diseases; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

The aim of this study was to compare dual-isotope (99Tc(m) and 201Tl) SPET imaging with computed tomography (CT) and magnetic resonance imaging (MRI) in the differentiation of various lesions of the major salivary glands. Twenty-two patients underwent dual-isotope SPET imaging, of whom 12 also had CT and 15 also had an MRI study. The uptake ratio and retention index for 99Tc(m) and 201Tl were calculated by drawing regions of interest on the involved and normal glands. Both CT and MRI were interpreted by two radiologists. All malignant tumours were detected by all three modalities. Warthin's tumours were detected by dual-isotope SPET imaging; however, MRI failed to differentiate Warthin's tumour from pleomorphic adenoma. Of 13 other benign tumours, dual-isotope SPET correctly diagnosed 12. Of 16 tumours showing a cold defect on the 99Tc(m) images, parametric analysis with 201Tl gave an accuracy of 94%, whereas CT gave an accuracy of 70-90%. MRI was 73-91% accurate in differentiating between benign (Warthin's) and malignant tumours. We believe that dual-isotope SPET imaging (99Tc(m) and 201Tl), together with semi-quantitative analysis, is the method of choice for differentiating between various lesions of the major salivary glands.

Topics: Adenolymphoma; Adolescent; Adult; Aged; Female; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radiopharmaceuticals; Salivary Gland Diseases; Salivary Gland Neoplasms; Salivary Glands; Sialadenitis; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

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

Topics: Adult; Aged; Chronic Disease; Diagnosis, Differential; Dilatation; Endoscopy; Humans; Middle Aged; Parotitis; Radionuclide Imaging; Radiopharmaceuticals; Salivary Ducts; Salivary Gland Calculi; Salivary Gland Diseases; Salivary Glands; Sialography; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Therapeutic Irrigation; Tomography, X-Ray Computed; Ultrasonography; Young Adult

Gastro-esophageal reflux disease (GERD) is associated with a decreased salivary flow as well as gastric acid production. This study therefore aimed to investigate functional disorders of salivary glands in patients with GERD.. Thirty-one consecutive patients with GERD underwent salivary gland scintigraphy.. If the results defined the optimal cutoff point for determining the decreased salivary secretion as 51 % in parotid glands and 36 % in submandibular glands, a decreased salivary secretion of right parotid gland, left parotid gland, right submandibular gland, and left submandibular gland was found in 39 %, 32 %, 36 %, and 58 %, respectively. Overall, salivary function disorder of at least one major salivary gland was found in 24 patients (78 %) with GERD. There was no difference in the incidence of impaired salivary function between GERD patients with and without erosive esophagitis. Salivary gland function was more frequently diminished than expected in GERD. We concluded that the presence of impaired salivary gland function was considered to be one of risk factors for developing GERD symptoms.

Topics: Adult; Aged; Aged, 80 and over; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Risk Factors; Salivary Gland Diseases; Salivary Glands; Sodium Pertechnetate Tc 99m; Submandibular Gland

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.. In this paper we report on a validated acquisition protocol supplying a normal database for standardized quantitative salivary gland scintigraphy.. 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.. 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.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Databases, Factual; Female; Humans; Male; Middle Aged; Rabbits; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Salivary Gland Calculi; Salivary Gland Diseases; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon; Xerostomia

The aim of this study was to evaluate possible deterioration of salivary gland function due to radioiodine therapy with low activities using standardized quantitative salivary gland scintigraphy (qSZ). In addition, the prevalence of sialopathies was estimated in patients with thyroid dysfunction.. Prior to routine thyroid scintigraphy qSZ was performed after i.v. injection of 36-126 MBq 99mTc-pertechnetate, and both uptake and excretion fraction were calculated as a measure of parenchymal function and saliva excretion, respectively 312 healthy patients served as reference for a normal data base. 144 patients underwent qSZ prior to and 3 months after radioiodine therapy. Results of qSZ in another 674 thyroid patients were evaluated for determining the prevalence of salivary gland dysfunction.. Normal uptake was 0.45 +/- 0.14% and 0.39 +/- 0.12%, and normal excretion fraction amounted to 49.5 +/- 10.6% and 39.1 +/- 9.2% in parotid and submandibular glands, respectively. Despite salivary gland stimulation with ascorbic acid during radioiodine therapy a significant activity-related functional impairment of 14-90% could be measured after application of 0.4-24 GBq of 131I. Prevalence of pretreatment sialopathies was 77/674 = 11.4% in single glands, and there was a global salivary gland functional impairment in 52/674 = 7.7%.. Together with thyroid scintigraphy qSZ is an easy to perform examination without additional radiation burden. It can be recommended in all patients prior to and after radioiodine therapy both in order to quantify and to document possible parenchymal impairment induced even by low activities of 131I.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ascorbic Acid; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Prevalence; Radiation Injuries; Radionuclide Imaging; Retrospective Studies; Saliva; Salivary Gland Diseases; Salivary Glands; Sodium Pertechnetate Tc 99m; Time Factors

With a view to improve the diagnosis of salivary gland diseases (in particular, Sjögrén's syndrome) associated with decreased salivary gland function and decreased stimulated salivary gland response, the normal range of radionuclide uptake function and the stimulated salivary gland response were established in 27 subjects without any known salivary gland disease. Following injection of 99Tcm-pertechnetate, sequential images were recorded for 40 min with oral administration of citric acid at 30 min. The total uptake index (TUI) was calculated as the sum of the background corrected count rates over the parotid and submandibular glands at 3 min divided by the injected dose. The TUI, expressed as a percentage of dose, was 0.55 +/- 0.12 (mean +/- S.D.). The stimulated salivary gland response (SSGR) was calculated as the difference between the rate constants (min-1) of monoexponential fits to the time-activity curves over the four salivary glands immediately after and before the administration of citric acid. The lower significance limit (P < 0.05) of the SSGR was a 2.4% decrease per min. The parameters TUI and SSGR can be used as a diagnostic tool in, for example, early Sjögren's syndrome.

Topics: Administration, Oral; Adult; Biological Transport; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Radionuclide Imaging; Reference Values; Salivary Gland Diseases; Salivary Glands; Sodium Pertechnetate Tc 99m

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 scintigraphic 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.

Topics: Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Time Factors; Xerostomia

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

The salivary disease in two patients with human immunodeficiency virus infection was investigated by technetium pertechnetate scintiscanning. Although there was good histologic evidence of benign lymphoepithelial disease, scintiscanning failed to delineate any salivary lesions. Technetium pertechnetate scintiscanning seems to be of little value in the detailed investigation of salivary disease in human immunodeficiency virus infection, though gallium scanning can help. Fine needle aspiration or biopsy remain the main diagnostic tools.

Topics: Adult; AIDS-Related Opportunistic Infections; Evaluation Studies as Topic; Female; Gallium; Humans; Male; Parotid Diseases; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands, Minor; Sodium Pertechnetate Tc 99m

An original method of sialoscintigraphy was used to investigate the structure and function of the unchanged salivary glands in 108 patients and in 192 patients with various diseases of the salivary glands (chronic interstitial sialadenitis, chronic parenchymatous sialadenitis, chronic sialadenitis, reactive-dystrophic diseases and tumors. The data obtained are of great importance for the diagnosis and differential diagnosis of salivary gland diseases as well as for the evaluation of effectiveness of therapeutic measures.

Topics: Chronic Disease; Diagnosis, Differential; Humans; Methods; Radionuclide Imaging; Salivary Gland Diseases; Salivary Gland Neoplasms; Salivary Glands; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Time Factors

Thirty-two patients with salivary gland tumors or sialadenitis were studied with Tc-99m pertechnetate and Ga-67 imaging and, in some instances, sialography. The diagnostic algorithm presented allows the correct categorization of the salivary gland pathology in the vast majority of patients. The patients were studied serially with Tc-99m pertechnetate, Ga-67 and in certain situations sialography (or CT-sialography). Use of the algorithm can distinguish benign salivary tumors from malignant tumors and malignant tumors from inflammatory disease. The limitations and pitfalls of interpretation are discussed.

Topics: Adult; Aged; Child; Diagnosis, Differential; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Radionuclide Imaging; Salivary Gland Calculi; Salivary Gland Diseases; Salivary Gland Neoplasms; Salivary Glands; Sialadenitis; Sialography; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

Topics: Humans; Radionuclide Imaging; Salivary Gland Diseases; Salivary Gland Neoplasms; Sodium Pertechnetate Tc 99m

Salivary gland scintigraphy with [99mTc]pertechnetate was performed in a group of 11 subjects without any known salivary pathology, and in a group of 12 xerostomic patients. Time-activity curves, normalized to background, were generated for each of the four major salivary glands in both groups, and averaged into single curves, representing the function of each gland. Comparing the two sets of curves (patients vs controls) demonstrates that utilizing our "normalization" approach enables one not only to determine whether one group of dynamic curves is significantly different from another, but to decide which of the glands are normal and which are malfunctioning. The sensitivity, specificity, accuracy and predictive values of this procedure are all above 0.90.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; ROC Curve; Salivary Gland Diseases; Sodium Pertechnetate Tc 99m; Xerostomia

Unilateral radionuclide accumulation in salivary glands is an uncommon finding on gallium scintigraphy. The differential diagnosis includes malignant tumors and inflammatory processes of these organs. Two cases of unilateral gallium uptake of the parotid and submandibular gland respectively, verified as solitary tuberculosis, are presented, together with the correlative findings of Tc-99m pertechnetate scintigraphy, sialography, and sonography. None of these imaging modalities is specific enough to provide pathognomonic signs for tuberculosis. When assessing unilateral gallium uptake of the salivary glands, one should be aware of the possibility of tuberculosis.

Topics: Adult; Female; Gallium Radioisotopes; Humans; Parotid Diseases; Radionuclide Imaging; Salivary Gland Diseases; Sialography; Sodium Pertechnetate Tc 99m; Submandibular Gland Diseases; Tuberculosis; Tuberculosis, Oral

The authors report a rare complication of nuclear bone imaging, iodide mumps, and describe its appearance on the subsequent radionuclide salivary gland study.

Topics: Administration, Oral; Female; Humans; Middle Aged; Potassium Iodide; Radionuclide Imaging; Salivary Gland Diseases; Sialadenitis; Sodium Pertechnetate Tc 99m

Submandibular gland function following transoral sialolithectomy was examined by 99mTc-pertechnetate sialo-scintigraphy in 10 cases. An intraindividual comparison between the function of the treated gland and that of the contralateral normal gland was made using a time-activity curve. Although glandular recovery was not affected by the duration of symptoms or the existence of the symptom at mealtimes, it was inversely proportional to the size of the calculus. Furthermore, the prognosis was more favorable in patients when the anatomically normal orifice of the submandibular duct was preserved.

Topics: Adolescent; Adult; Aged; Child; Dilatation, Pathologic; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Diseases; Secretory Rate; Sodium Pertechnetate Tc 99m; Submandibular Gland; Submandibular Gland Diseases; Time Factors

A special background subtraction in dynamic scintigraphy of the salivary glands enables the production of net-time-activity-curves and the calculation of quantitative parameters of each gland. Regional functional differences within a single gland are shown by phase and gradient images. The physiological kinetics of the tracer and its modifications in different diseases of the glands (acute and chronic inflammation, tumours, Sjögrens-Syndrome) are analyzed in 367 patients.

Topics: Adenoma; Carcinoma, Adenoid Cystic; Chronic Disease; Humans; Radionuclide Imaging; Salivary Gland Diseases; Salivary Gland Neoplasms; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

In recent years salivary gland scintigraphy has gained widespread acceptance as a useful means for evaluating salivary gland disorders. An absolute indication for this procedure exists when the ductal orifice of one or several major salivary glands cannot be found or cannot be cannulated. Clinical conditions in which this problem occurs include technical failure to probe and cannulate the duct, developmental anomalies, obstructive disorders, traumatic lesions and fistulae and the need of postsurgical information after glandular excision or after ligation or repositioning of a major excretory duct. The clinical value of scintigraphy in these conditions is demonstrated by means of case presentations.

Topics: Adult; Aged; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Diseases; Salivary Gland Fistula; Salivary Glands; Sodium Pertechnetate Tc 99m; Submandibular Gland Diseases

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

The nuclear medical diagnostic procedures listed in this article demonstrate the continual change in the significance of modern and recent techniques. The definition of the current status may be as short-lived as some radioisotopes. The tendencies are determined by aspects of radiological hygiene and the development of new technical procedures and the preference of in-vitro-examinations over in-vivo-diagnostic. On the other hand progress in immunology using labelled antibodies opens new possibilities in diagnosis and therapy. Although these possibilities are still somewhat visionary, they have already been translated into reality by experiment. For examination of thyroids further progress in sonography can be expected. In special problems tests using iodine isotopes with short half-lives and consequently lower radiation exposure will be used. At the moment the combination of technetium scintigram with sonography seems optimal and should if possible applied by the same hand. Scintigraphy of salivary gland and of cerebrospinal fluid have their unquestioned position. Brain scintigraphy has lost its importance but may reappear as an examination method using specially labelled agents for research of cerebral metabolism. The position of bone scintigraphy is similar. Its use is still justified when searching for skeletal changes which may not be seen in classical radiology. The knowledge of disturbance of local osseous metabolical disturbances does not give a specific information on the cause but demonstrates the site of disorder. Contrary its present ranking, important developments are to be expected from tumour scintigraphy. Isotope angiography, isotope lymphography and ventilation scintigraphy are to be employed when special questions arise, especially in fundamental research and for controls of therapeutic concepts.

Topics: Angiography; Bone Diseases; Brain Diseases; Cerebrospinal Fluid Otorrhea; Cerebrospinal Fluid Rhinorrhea; Diagnosis, Differential; Humans; Iodine Radioisotopes; Lymphoscintigraphy; Otorhinolaryngologic Diseases; Otorhinolaryngologic Neoplasms; Salivary Gland Diseases; Sodium Pertechnetate Tc 99m; Thyroid Diseases

Topics: Humans; Parotid Gland; Prospective Studies; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Diseases; Salivary Gland Neoplasms; Sialadenitis; Sodium Pertechnetate Tc 99m; Submandibular Gland; Technetium

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

Topics: Adult; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Salivary Gland Diseases; Salivary Glands; Sodium Pertechnetate Tc 99m; Technetium

The purpose of this study was to examine the diagnostic value of sialographic and scintigraphic tests conducted to determine changes in salivary gland function and structure in patients with salivary gland disorders. A simple sialographic technique using a catheter fitted over a lacrimal probe was performed. For optimal pantomographic study of the salivary glands, a slightly oblique view with the head turned to the side was demonstrated to be of value. Examination of the salivary glands by sialography reveals the detailed morphology of the duct system. Sialograms were evaluated for filling and secretory phases and major ducts were also studied morphologically. Clearing radiographs indicated that glands with impaired function have prolonged clearing times. The contrast sialogram is most useful in evaluating recurrent inflammatory disorders, and the radiosialogram finds its greatest value in evaluating patients with suspected neoplasms. These examinations should not be used in lieu of a histologic diagnosis in tumor cases, except when a smooth margined radiopositive lesion corresponding with a clinically evident Warthin's tumor is noted. Perhaps the most important feature of salivary scintigraphy is its sensitivity in depicting changes in glandular dysfunction. In this study objective documentation provided by the scintigraphy closely parallels the results of sialography.

Topics: Humans; Radiography, Panoramic; Radionuclide Imaging; Salivary Gland Diseases; Sialography; Sodium Pertechnetate Tc 99m; Technetium

The authors report on a computer-assisted method that allows a semi-quantitative assessment of salivary gland function under normal and pathologic conditions. They illustrate some mathematical procedures suitable for this purpose and the results achieved in various salivary gland diseases.

Topics: Diagnosis, Computer-Assisted; Humans; Parotid Gland; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Diseases; Salivary Glands; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland; Technetium