sodium-pertechnetate-tc-99m and Sjogren-s-Syndrome

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

Topics: Arthritis, Rheumatoid; Diagnostic Techniques, Endocrine; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Radiopharmaceuticals; Saliva; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

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: 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

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

To evaluate the usefulness of Tc-99m-HIG scintigraphy in patients with Sjögren's syndrome.. Twelve consecutive patients with verified secondary Sjögren's syndrome were included in this prospective study. The control group consisted of seven patients with Lupus erythematosus; none of them showed clinical signs of Sjögren's syndrome. Planar and SPECT images of the head were performed six hours after i.v. administration of Tc-99m HIG.. Eleven out of twelve patients with secondary Sjögren's syndrome showed a positive result, while one was false negative. Tracer accumulation in patients with positive scintigraphy varied. All patients of the control group were negative.. Our data in a limited number of patients suggest that Tc-99m HIG scintigraphy could be a modality with high sensitivity and specificity for the diagnosis of Sjögren's syndrome and can provide objective information on the severity of the disease.

Topics: Adult; Aged; Female; Humans; Immunoglobulin G; Male; Middle Aged; Radiopharmaceuticals; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

To examine salivary function in patients with primary Sjögren's syndrome (SS) by assessing unstimulated and stimulated flows using 5 mg of pilocarpine in a 5% solution, in order to define their clinical usefulness in the evaluation of xerostomia in patients with primary SS as well as to identify those factors related to the increase in salivary flow after pilocarpine stimulation.. We investigated the clinical and immunological characteristics of 60 consecutive patients with primary SS. All patients fulfilled four or more of the preliminary diagnostic European criteria for SS. We measured unstimulated (basal) salivary flow (BSF) in all patients. In patients with BSF

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anethole Trithione; Cholinergic Agents; Female; Humans; Male; Middle Aged; Parotid Gland; Pilocarpine; Predictive Value of Tests; Radionuclide Imaging; Reproducibility of Results; Saliva; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Xerostomia

The value of salivary gland scintigraphy (SGS) in the evaluation of Sjögren's syndrome (SS) remains controversial. The aim of this study was to evaluate the diagnostic efficacy of quantitative SGS in patients with xerostomia and to assess the correlation between scintigraphic parameters and pathological features of salivary glands.. Medical records of 165 patients with xerostomia who underwent [99mTc] pertechnetate SGS and labial biopsy were retrospectively reviewed. The maximum accumulation ratio (MAR), maximum secretion ratio (MSR), and time interval from stimulation to minimum count (T. All parameters except for T. Conventional scintigraphic parameters could be used as simple, reliable, and sensitive indicators for the early diagnosis of SS and determination of disease severity.

Topics: Adolescent; Adult; Aged; Biopsy; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Salivary Glands; Severity of Illness Index; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

The aim of this study was the assessment of semi-quantified salivary gland dynamic scintigraphy (SGdS) parameters independently and in an integrated way in order to predict primary Sjögren's syndrome (pSS).. Forty-six consecutive patients (41 females; age 61 ± 11 years) with sicca syndrome were studied by SGdS after injection of 200 MBq of pertechnetate. In sixteen patients, pSS was diagnosed, according to American-European Consensus Group criteria (AECGc). Semi-quantitative parameters (uptake (UP) and excretion fraction (EF)) were obtained for each gland. ROC curves were used to determine the best cut-off value. The area under the curve (AUC) was used to estimate the accuracy of each semi-quantitative analysis. To assess the correlation between scintigraphic results and disease severity, semi-quantitative parameters were plotted versus Sjögren's syndrome disease activity index (ESSDAI). A nomogram was built to perform an integrated evaluation of all the scintigraphic semi-quantitative data.. Both UP and EF of salivary glands were significantly lower in pSS patients compared to those in non-pSS (p < 0.001). ROC curve showed significantly large AUC for both the parameters (p < 0.05). Parotid UP and submandibular EF, assessed by univariated and multivariate logistic regression, showed a significant and independent correlation with pSS diagnosis (p value <0.05). No correlation was found between SGdS semi-quantitative parameters and ESSDAI. The proposed nomogram accuracy was 87%.. SGdS is an accurate and reproducible tool for the diagnosis of pSS. ESSDAI was not shown to be correlated with SGdS data.. SGdS should be the first-line imaging technique in patients with suspected pSS.

Topics: Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

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

The aim of this study was to compare the diagnostic utility of visual versus semi-quantitative analysis of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome (SS).. 99mTc-pertechnetate salivary gland scintigraphy was performed in 145 patients (133 women, 12 men) with clinically suspicious SS. The images were interpreted with visual and semiquantitative methods and the diagnostic performances for SS were compared using uptake and excretory functional parameters.. In total, 76 patients (52.4%) were finally diagnosed with SS. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual analysis for the diagnosis of SS were 88.2%, 48.6%, 65.1%, 79.1%, and 69.2%, respectively. Semiquantitative values, the area under the ROC curve for uptake ratio and percentage excretion in the right salivary glands were significantly greater than 0.5 (p < 0.05). However, the percentage excretion in the left salivary glands did not show a statistically significant diagnostic ability for SS. The diagnostic ability of visual assessment was greater than that of the semiquantitative method in terms of evaluating uptake and excretory function in the submandibular glands.. Visual analysis of salivary gland scintigraphy showed greater diagnostic utility than semiquantitative assessment in the diagnosis of SS, especially in the submandibular glands.

Topics: Adolescent; Adult; Aged; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Observer Variation; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Salivary Glands; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Xerostomia; Young Adult

Beside many actual groups of classification criteria, uniform classification criteria for Sjögren's syndrome (SS) are still missing. The ophtalmic component of SS is well defined. Criteria for classifying its oral component remain controversial. The fifth item of the European Union and the United States of America (EU-US) revised diagnostic classification criteria in 2002, is an objective evidence of xerostomia, diagnosed by one of the tests: unstimulated whole sialometry (UWS), parotid sialography, and dynamic salivary gland scintigraphy (DSGS). The aim of this study was to evaluate senstitivity, specificity, positive and negative predictive value and accuracy of DSGS with ascorbic acid stimulation in detecting xerostomia in SS patients and to compare DSGS findings with UWS values.. Tests DSGS and UWS were done in 20 patients with SS and in 10 of the control subjects. The findings of DSGS were graded from 1 to 4 scintigraphie (SCT) grade 1--normal finding; SCT grade 2--moderate function damage; SCT grade 3--serious function damage, SCT grade 4--very serious function damage. UWS measured 1.5 hour after the breakfast lasted 15 minutes. UWS bellow 2.5 ml/15min min. considered pathological.. All SS patients had pathological SCT findings. Comparing SCT grade between the patients and the control group, high statistical significance was found (p < 0.001). The estimated sensitivity of DSGS was 100%, specificity 80%, positive predictive value 91%, negative predictive value 100% and accuracy 93%. The calculated sensitivity of UWS was 75%. Salivary function damage detected by scintigraphy was in positive correlation with UWS findings.. DSGS is a diagnostic test with high sensitivity, specificity, accuracy and positive and negative predictive values in detecting salivary function damage in SS patients. DSGS and UWS are very sensitive diagnostic tests for objective evidence of xerostomia, and have to be ones of the earliest investigations which shoud be performed in subjects suspected of SS. Test DSGS is more sensitive, and seems to better reflect symptoms of dry mouth than UWS.

Topics: Adult; Aged; Ascorbic Acid; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Saliva; Salivary Glands; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

To standardize quantitative parotid gland scintigraphy for diagnosing Sjögren's syndrome (SS).. Forty-five patients with SS and 23 controls were studied. Dynamic images were obtained up to 50 min after the injection of 185 MBq 99mTc-pertechnetate and salivary excretion was stimulated with lemon juice orally at 40 min after the injection. Peak count and uptake speed in the uptake phase, and excretion speed and excretion fraction in the excretion phase were calculated.. The levels of peak count, uptake speed, and excretion speed in the patients with SS were significantly lower than the levels in the controls, whereas there was no significant difference of excretion fraction level between the patients with SS and the controls. The calculations of peak count and excretion speed levels, which were closely related with the focus scores of minor salivary glands and the amount of stimulated whole saliva, showed higher reproducibility, sensitivity, and specificity than those of uptake speed and excretion fraction levels.. The calculations of peak count and excretion speed were eligible to standardize quantitative parotid gland scintigraphy for diagnosing SS.

Topics: Female; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Rheumatology; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Time Factors

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

Topics: Adolescent; Adult; Aged; Biopsy, Needle; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Salivary Glands, Minor; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Thyroid Gland

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 Sjögren's syndrome.. Salivary gland scintigraphy and labial biopsy were performed on 70 patients with Sjögren'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.. 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 Sjögren'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.. New oral activity indices correlated with the stage of Sjögren'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 Sjögren's syndrome.

Topics: Biopsy; Case-Control Studies; Female; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Saliva; Salivary Glands; Salivary Glands, Minor; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland

This study compared the quantitative parameters of salivary gland scintigraphy and the sialographic stages in patients with Sjögren's syndrome.. One hundred sixteen patients suspected of having Sjögren's syndrome were examined with salivary gland scintigraphy and contrast sialography. When contrast sialography was used as the gold standard, Sjögren's syndrome was diagnosed in 50 of these 116 patients; Sjögren'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.. 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 Sjögren'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).. The decreased accumulation in the submandibular gland and the decreased secretion in the parotid gland were highly sensitive indicators of salivary gland disease in Sjögren's syndrome. The sialographic stage was correlated with these scintigraphic parameters.

Topics: Adult; Contrast Media; Female; Humans; Iohexol; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sialography; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland

The stimulated salivary clearance of Tc-99m pertechnetate (SSCP) introduced in 1985 by Blue and Jackson is revisited here in patients with known or possible salivary disorders and correlated with most commonly cited and up-to-date quantitative indices obtained from standard dynamic salivary scintigraphy.. An SSCP test was performed after dynamic salivary scintigraphy in 19 patients with oral or ocular dryness, among whom 7 had Sjögren's syndrome. Many scintigraphic indices were calculated: salivary to background ratio (S/B[t]), background-corrected uptake U[t]), maximal uptake (Umax), cumulative gland uptake (CGU), initial slope of the uptake curve (IS), stimulated excretion velocity (SEV), stimulated excretion fraction (SEF), and excreted activity (EA).. The SSCP test was well tolerated, except in two patients in whom it had to be interrupted. Clearance values ranged from 5 to 40 ml/minute, with a clear-cut bimodal distribution centered around 15 to 20 ml/ minute. Six of the seven patients with Sjögren's syndrome had values less than 15 ml/minute. SSCP was closely correlated with all uptake indices (S/B, U, Umax, CGU, and IS) and uptake-related indices (EA, ISxSEF) (P < 0.01). A poor correlation was found with the excretion index SEV (P = 0.06) and none with SEF.. SSCP is a quick and objective means to investigate the sicca syndrome that may be useful in most clinical situations. It reflects the parenchymatous salivary gland function and will provide a means to assess and predict salivary gland involvement. Dynamic salivary scintigraphy remains necessary in very early stages because of its high sensitivity rate and ability to locate the impaired gland, or in severe stages in which lemon juice could be deleterious.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Saliva; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Salivary gland scintigraphy allows a non invasive, morphological and functional assessment of parotid and submaxillary salivary glands.. To describe the main features of salivary gland scintigraphy in patients with Sjögren syndrome, rheumatic fibromyalgia and normal controls and compare the results with lip biopsy.. Sixty one normal controls, 66 patients with Sjögren syndrome and 18 patients with rheumatic fibromyalgia were studied. For the diagnosis of Sjögren syndrome and fibromyalgia rheumatica, the Modified European and American College of Rheumatology criteria were used, respectively. Lip biopsies were obtained in 52 patients with Sjögren syndrome. Scintigraphy was done with a gamma camera and computer after the administration of 99mTc-pertechnetate, obtaining images during 30 min and creating time/activity curves. Scintigraphy was classified as normal, with mild or severe alterations.. Scintigraphy was normal in 74% of control subjects and in 26%, it had mild alterations. In 72% of patients with rheumatic fibromyalgia, scintigraphy was normal whereas in 28%, it had mild alterations. In 27% of patients with Sjögren syndrome, scintigraphy was normal, in 27% it had mild alterations and in 46%, severe alterations. There was a positive and significant correlation between pathological alterations of salivary glands and scintigraphic alterations (r = 0.642, p < 0.001).. Severe scintigraphic alterations of salivary glands strongly support the diagnosis of Sjögren syndrome. Mild alterations are non specific and a normal scintigraphy does not exclude the diagnosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Case-Control Studies; Fibromyalgia; Humans; Lip; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Salivary Glands; Sensitivity and Specificity; Severity of Illness Index; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

To explore the value of diagnosis with 99mTcO4- sequential scintigraphy of parotid gland in Sjögren's syndrome.. Technetium-99m(99mTcO4-) sequential scintigraphy was used in 52 cases of Sjögren's syndrome.. The results were analysed quantitatively with activity curve by using ROI computer program. 46 cases (88.46%) were parotid swelling. The contour was clear in 28 cases (53.85%) and blurred in 18 cases (34.62%). The function of parotid was normal in 7 cases (13.46%), parotids with light damage in 15 cases (28.84%), parotids with middle damage in 17 cases (32.69%), and parotids with serious damage in 13 cases (25%). Most cases of damaged secretary function was present in the early phase, and a few cases of damaged absorption function was found in the following process.. 99mTcO4- sequential scintigraphy of parotid gland is greatly valuable to diagnosis of Sjögren's syndrome.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

This study compared the quantitative characteristics of salivary gland scintigraphy in patients with Sjogren's syndrome with the histopathologic grading of labial biopsy.. Thirty-nine patients with Sjögren's syndrome were studied by salivary gland scintigraphy and labial biopsy. Twelve normal volunteers were also studied as a control group for scintigraphic parameters. After injection of 370 MBq 99mTc sodium pertechnetate, dynamic salivary scintigraphy with lemon juice stimulation was performed for 50 min. Functional parameters for the parotid and submandibular glands were calculated, and scintigraphic and histopathologic results were compared.. With the progression of histopathologic grades 1-4, the velocity of tracer secretion decreased in the parotid gland (P < 0.05), and the quantity of tracer accumulation decreased in the submandibular gland (P < 0.05). The histopathologic grade in patients with Sjögren's syndrome was correlated with these scintigraphic parameters (P < 0.05): Histopathologic grade = 2.304 - 0.014 x (submandibular gland maximum accumulation) + 0.196 x (parotid gland time interval of tracer secretion).. Decreased secretion velocity in the parotid gland and decreased accumulation in the submandibular gland were sensitive indicators of salivary gland disease in Sjögren's syndrome. The histopathologic grade was correlated with these scintigraphic parameters.

Topics: Adult; Aged; Biopsy; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Three decades of work to enhance the diagnostic accuracy of salivary scintigraphy have generated various plausible decision criteria. This study evaluates four commonly cited numeric indices in studies of xerostomic populations and how accurately they identify Sjögren's syndrome, chronic sialadenitis, radiation sialadenitis, and drug effects and distinguish each from the other.. Stimulated dynamic salivary scintigraphy was performed on 295 xerostomic patients and on 31 controls. The nonparametric area under the receiver operating characteristic curves expressed the diagnostic accuracy of the following scintigraphic indices: the parotid:submandibular ratio of unstimulated glandular activity, the peak:baseline uptake ratio, its time of occurrence, and the stimulated excretion fraction.. The stimulated excretion fraction distinguished Sjögren's syndrome and radiation sialadenitis from healthy states with respective accuracies of 0.78 and 0.90. The maximum diagnostic payoff in Sjögren's syndrome occurred at a cutoff of 73%, yielding a 73% rate of test sensitivity and a 73% rate of specificity. The other three indices were not useful. Even the stimulated excretion fraction performed indifferently or poorly in most other diagnostic tasks.. In the scintigraphic examination of xerostomic and healthy populations, an acceptable diagnostic utility of the stimulated excretion fraction was evident only in Sjögren's syndrome and radiation sialadenitis. When presented with differential diagnostic alternatives not involving radiation sialadenitis, none of the four numeric indices performed acceptably.

Topics: Case-Control Studies; Female; Humans; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Salivary Glands; Sensitivity and Specificity; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Xerostomia

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

An abnormal salivary scintigram is an accepted objective criterion in the diagnosis of primary and secondary Sjögren's syndrome, an immune-mediated disorder characterized by xerostomia and kerato-conjunctivitis sicca. However, chronic sialadenitis constitutes a major differential diagnostic consideration in the xerostomic population. We investigated 39 cases of biopsy-confirmed chronic sialadenitis and 152 individuals with first- or second-degree Sjögren's syndrome, according to international classification criteria. We analysed scintigraphic defects in terms of glands per patient, distribution patterns, kinetics and severity. Relative to Sjögren's syndrome, chronic sialadenitis showed significantly fewer defective glands per patient, less frequent dual parotid-submandibular defects, fewer combined deficits of uptake and discharge, and milder uptake failure. No statistically significant differences were found in the frequency of single gland abnormality, predilection for submandibular involvement, and respective proportions of uptake-only and discharge-only defects. Unevaluable discharge due to low uptake, although comprising only 34% of test-positive cases, appeared to be a highly specific but insensitive scintigraphic marker for Sjögren's syndrome. In non-irradiated xerostomic populations, scintigraphy provides specific, albeit limited, diagnostic information. The procedure's ability to distinguish uptake failure from secretory failure may be a useful asset in guiding clinical management strategies and estimating outcomes.

Topics: Adult; Aged; Aged, 80 and over; Biopsy; Chronic Disease; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Salivary Glands; Sialadenitis; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Tissue Distribution

Salivary gland scintigraphy was performed on 52 patients who were suspected of having Sjögren's syndrome (SS), and the results were compared with clinicopathologic features of the salivary and lacrimal glands. The time-activity curves which were obtained from computer-assisted analysis of 99mTc-pertechnetate (99mTc) scintigraphy were classified into four types (normal, median, flat and sloped types). The stimulated parotid flow rate decreased and the incidence of SS-related sialographic and histopathologic findings increased significantly as the scintigraphic abnormality advanced. In addition, the lacrimal gland function decreased and the proportion of patients diagnosed as having keratoconjunctivitis sicca (KCS) increased significantly as the scintigraphic abnormality advanced. These results indicate that the results of scintigraphy are related not only to the clinicopathologic features of the salivary glands but also to the lacrimal gland function in SS.

Topics: Chi-Square Distribution; Disease Progression; Female; Humans; Keratoconjunctivitis Sicca; Lacrimal Apparatus; Male; Radionuclide Imaging; Saliva; Salivary Glands; Secretory Rate; Sialography; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Statistics, Nonparametric; Xerostomia

The aim of this study was to test the impact of quantitative salivary gland scintigraphy in patients with suspected Sjögren's syndrome. Thirteen patients with suspected Sjögren's syndrome were investigated. During clinical work-up, three had severe and four had mild Sjögren's syndrome, while six were normal. Quantitative salivary gland scintigraphy was performed using a standardized method. The normal data-base consisted of 172 patients without any evidence of salivary gland malfunction. Visual and quantitative comparisons of the patients' scintigrams were made. In the patients with severe Sjögren's syndrome, uptake was 0.10 +/- 0.04% and 0.09 +/- 0.03% in the parotid and submandibular glands respectively, confirming the visual diagnosis. In the patients without Sjögren's syndrome, concordance between the visual and quantitative evaluations could also be shown. In contrast, among the patients with mild Sjögren's syndrome, uptake was diminished (P < 0.05), amounting to 0.21 +/- 0.05% and 0.16 +/- 0.02% in the parotid and submandibular glands respectively, while visual analysis indicated normal parenchymatous function. In conclusion, quantitative salivary gland scintigraphy is essential for the reliable detection of parenchymatous malfunction at an early stage of Sjögren's syndrome, which may be missed by visual analysis alone.

Topics: Adult; Aged; Case-Control Studies; Female; Humans; Middle Aged; Parotid Gland; Radionuclide Imaging; Reference Values; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland; Time Factors

Topics: Biopsy; Child; Female; Humans; Keratoconjunctivitis; Parotid Gland; Radionuclide Imaging; Salivary Glands; Sialography; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

To evaluate the clinical significance of antibodies to native or denatured (anti-n or anti-d) 60- or 52-kd Ro/SS-A proteins (60K or 52K) in Sjögren's syndrome (SS).. The presence of antibodies to denatured and native Ro/SS-A proteins was determined by immunoblotting and immunoprecipitation, respectively. Salivary gland dysfunction was evaluated by salivary function scintigraphy.. The incidence of anti-d-60K without anti-d-52K was lower among patients with systemic lupus erythematosus with SS (SLE/SS) and among those with primary SS, compared with patients who had SLE without SS, whereas anti-d-52K without anti-d-60K was more common in SLE/SS patients and primary SS patients than in SLE patients without SS. All of the patients with anti-Ro/SS-A had anti-n-60K. Serologic abnormalities and salivary gland dysfunction were associated with anti-n-60K in SS, whereas Hashimoto's thyroiditis in SS was related to anti-d-60K. Anti-d-52K was not associated with any extraglandular or glandular symptoms in SS.. The data indicate that anti-n-60K, which appears to recognize conformational epitopes, is associated with clinical features of SS characterized by glandular dysfunction.

Topics: Autoantibodies; Autoantigens; Female; Humans; Male; Precipitin Tests; Protein Denaturation; Radionuclide Imaging; Ribonucleoproteins; RNA, Small Cytoplasmic; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Glandular function as estimated by salivary function scintigraphy and extraglandular manifestations were compared among 174 Sjögren's syndrome (SS) patients according to their anti-Ro/SSA, anti-La/SSB, and anti-U1RNP autoantibody status, to clarify the relationship between these autoantibodies and clinical parameters in SS. These antibodies were detected by RNA-immunoprecipitation. Anti-La/SSB or only anti-Ro/SSA antibody was common in 84 primary SS (P-SS) patients, whereas the frequency of only anti-U1RNP was high in 90 secondary SS (S-SS) patients, especially in those with systemic lupus erythematosus (SLE). Antibody-negativity was common in SS with rheumatoid arthritis and was also found in 33% of P-SS. In P-SS, salivary gland dysfunction and parotid swelling were severe in patients who had serological abnormalities with anti-Ro/SSA and with or without anti-La/SSB. They were mild in antibody-negative patients who had mild extraglandular symptoms and in patients with only anti-U1RNP antibody who had Raynaud's phenomenon, pulmonary fibrosis, and later disease onset. P-SS patients positive for both anti-Ro/SSA and anti-U1RNP had SLE-like features. SS could be classified clinically according to these autoantibodies.

Topics: Autoantibodies; Autoantigens; Female; Humans; Male; Precipitin Tests; Radionuclide Imaging; Ribonucleoproteins; RNA, Small Cytoplasmic; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; SS-B Antigen; Transcription Factors

Dynamic salivary scintigraphy using 99mTcO4- was performed in 95 patients (a total of 366 glands) suspected of Sjögren's syndrome (SjS) and the results were compared with SjS diagnostic criteria by the Japanese Welfare Ministry. Time-activity curve of ROI created over each salivary gland was classified into four patterns, that is, N, M1, M2, F pattern, depending upon trapping, accumulation and secretion response to the tartaric acid. In definite SjS patients, most of the patients had different patterns in the four glands, and classical F (flat) pattern in all of the four glands was uncommon (3/38, 8%). F and/or M2 (no response to secretary stimulation) patterns were seen in 68.5% (98/143) of the all glands. Provided that F and/or M2 patterns in 2 or more glands is scintigraphic criteria for diagnosis of SjS, sensitivity, specificity and accuracy were 82.9%, 59.5%, 70.8%, respectively. As for salivary uptake of 99mTcO4-, there is a significant difference between the patients with definite SjS and control subjects (parotis p < 0.05, submandibular gland p < 0.01), but there is no significant difference among the patients with definite SjS, suspected SjS and chronic sialoadenitis. In conclusion, the four patterns classification may have potential in screening patients with SjS.

Topics: Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Sequential salivary gland scintigraphy with 99mTc-technetium pertechnetate (Tc-99) is a safe, minimally invasive test for study of major salivary glands. However, its relationship to salivary function has not been investigated in detail. We have investigated the relationship between major salivary gland flow rates and Tc-99 scans and developed a new rating scale using scans of a control group with normal salivary function. Salivary flow rates and Tc-99 scans were obtained from healthy, non-medicated subjects (n = 33) and from xerostomic patients (n = 22). There were significant differences between the groups for salivary flow rates and Tc-99 ratings. Significant correlations were found between salivary flow rates and Tc-99 ratings in the control and xerostomic groups. The Tc-99 rating scale proved reliable in assessing salivary dysfunction, and showed a high inter-examiner correlation. These results demonstrate the usefulness of salivary gland scintigraphy in assessing major salivary gland flow rates and the utility of a new rating scale.

Topics: Adult; Aged; Aged, 80 and over; Aging; Female; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Saliva; Salivary Glands; Secretory Rate; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Sublingual Gland; Submandibular Gland; Thyroid Gland; Xerostomia

A safe and simple technique is reported by which primary Sjögren's syndrome can be detected with a relatively high specificity and sensitivity. The method of serial scintigraphy has been used with reasonable success; however, the application of the linearity index as described here produced superior results. In 71 patients investigated, a sensitivity of 87% and specificity of 93% were recorded and make this the method of choice for evaluating patients suspected of having primary Sjögren's syndrome.

Topics: Humans; Parotid Gland; Radionuclide Imaging; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland

A practical, time-saving procedure for sequential quantitative scintigraphy is introduced and 4 parameters chosen from 12 parameters by discriminant analysis are used to evaluate the function of the parotid gland. The examination was performed in 120 cases, including 16 cases with recurrent parotitis in childhood, 33 with chronic obstructive parotitis (COP), 37 with Sjögren's syndrome (SS), 4 with sialadenosis, and 30 normal controls. The scintigraphic findings were analyzed and compared with the histologic findings. The diagnostic value of this method was investigated and scaling for differential diagnosis of COP and SS was established. Scintigraphy is considered to be a useful method for evaluation of parotid function and as a diagnostic aid for SS and COP, especially in patients in whom sialography cannot be performed.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Chronic Disease; Discriminant Analysis; Female; Humans; Hypertrophy; Male; Middle Aged; Parotid Diseases; Parotid Gland; Parotitis; Radionuclide Imaging; Secretory Rate; Sensitivity and Specificity; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Sequential quantitative scintigraphy of parotid glands was performed in 16 cases with recurrent parotitis in childhood, 33 with chronic obstructive parotitis, 37 with Sjögren's syndrome, 4 with sialadenosis and 30 normal controls. Uptake function was normal, but excretion was retarded in recurrent parotitis in childhood. Chronic obstructive parotitis exhibited that excretion was obstructed and the uptake and excretion function between bilateral parotids was marked different. In Sjögren's syndrome, uptake was very low and excretion was heavily delayed. Sialadenosis showed that excretion was retarded and uptake function was not definitely involved. The possible mechanism of the scintigraphical features were analyzed combined with the histopathological findings.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Parotid Gland; Parotitis; Radionuclide Imaging; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

Esophageal involvement by scleroderma is frequent. Investigation by manometry or radiography is invasive and nonphysiological. Scintigraphy of the clearance of small radiolabelled liquid boluses in the supine position, while sensitive and noninvasive, may also be nonphysiological and does not allow the simultaneous determination of gastric emptying. We thus studied the esophageal clearance of a semisolid test meal ingested in the upright position. Forty-seven patients with scleroderma and 24 with Sjogren's syndrome were compared with ten normal controls and ten patients with gastric emptying abnormalities but no esophageal involvement. Results of scintigraphy were also correlated with manometry and contrast radiography. Quantitative evaluation of esophageal tracer retention at ten minutes postingestion was: (mean +/- SD), 2.8 +/- 1.0% in normals, 2.9 +/- 0.9% in gastric dysmotility, 4.8 +/- 2.9% in Sjogren's syndrome, and 22.3 +/- 25.0% in scleroderma; similar results were found at 20 and 60 minutes. The T 1/2 of gastric emptying was 47.1 +/- 5.7 minutes in normals, 95.9 +/- 25.3 minutes in gastric dysmotility, 62.9 +/- 19.5 minutes in Sjogren's syndrome, and 52.9 +/- 13.5 minutes in scleroderma. We conclude that esophageal clearance of a semisolid test meal is a sensitive index of esophageal dysmotility and correlates well with results from manometry and contrast radiography but is noninvasive and quantifiable. The simultaneous measurement of gastric emptying is also possible in many cases.

Topics: Adult; Chelating Agents; Esophageal Motility Disorders; Esophagus; Female; Food; Humans; Male; Manometry; Middle Aged; Radionuclide Imaging; Resins, Synthetic; Scleroderma, Systemic; Sjogren's Syndrome; 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

Scintigraphy of the salivary glands with technetium-sodium pertechnetate (99mTc) was undertaken on 320 patients with oral dryness or connective tissue disease using a computer assisted method that gave quantitative results about the major salivary gland function. Compared with clinical and histological data, scintigraphy provides a sensitive method, even though it is not specific, for detecting minimal injuries to salivary glands in patients suspected of having Sjögen's syndrome. Moreover, it might differentiate between the Sjögen-like syndrome and the sequelae of radiotherapy in patients with bone marrow graft. Scintigraphy of the major salivary glands could therefore form part of the routine investigation of patients with Sjögen's syndrome.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Male; Middle Aged; Parotid Gland; Pilocarpine; Radionuclide Imaging; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland; Xerostomia

A systematic evaluation of Sjögren-like syndrome (SLS) was performed in 68 bone marrow transplant (BMT) recipients (60 allogeneic and 8 syngeneic recipients). At day 100, the patients underwent clinical evaluation, functional salivary scintigraphy, and lip biopsy. If any findings were abnormal, the examinations were repeated annually for 3 years. Twenty-two patients with SLS and extensive chronic graft-versus-host disease (CGVHD) had abnormal scintiscan and lip biopsy at day 100. Marked keratoconjunctivitis sicca and xerostomia developed between 12 and 24 months after BMT and, thereafter, progressively decreased. Twenty-seven irradiated recipients (7 syngeneic and 20 allogeneic recipients without CGVHD) had isolated xerostomia and disturbed scintiscan but normal biopsy. Seven other patients with limited CGVHD had a lymphocytic infiltrate on lip biopsy but no SLS and a normal scintiscan. Schirmer's test, functional salivary scintigraphy, and lip biopsy allowed us to distinguish SLS from radiotherapy sequelae. As early as day 100, these 3 tests have a predictive value for SLS, one of the criteria for extensive CGVHD.

Topics: Biopsy; Bone Marrow Transplantation; Graft vs Host Disease; Humans; Lip; Radionuclide Imaging; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m

A method to determine stimulated salivary clearance of pertechnetate is presented. It is easy to perform and separates normal patients (range 15.0 to 40.3 ml/min) from patients with known salivary disorders (range 1.2 to 10.6 ml/min).

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

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

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

Forty-nine patients were studied prospectively by salivary scanning to assess the value of this investigation in possible Sjögren's syndrome (SS). Twenty-three had rheumatoid arthritis (RA) with sicca symptoms and a positive Schirmer's test. Fifteen had RA with no sicca symptoms and a negative Schirmer's test. Eleven had osteoarthrosis (OA) with no sicca symptoms and a negative Schirmer's test. Scanning differentiated only poorly between the three groups. We conclude that it has only limited application in the diagnosis of SS associated with RA.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Osteoarthritis; Parotid Gland; Radionuclide Imaging; Salivary Glands; Sjogren's Syndrome; Sodium Pertechnetate Tc 99m; Submandibular Gland; Technetium; Thyroid Gland; Xerostomia

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

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