sodium-pertechnetate-tc-99m and Xerostomia

The aim of this study is to call attention to the role that radioactive iodine ((131)I) and stapes surgery may play in causing hyposalivation.. The manner in which (131)I and stapes surgery can cause salivary damage was reviewed. A case report is presented to illustrate the involved pathophysiology.. The case report clearly shows the significant injury to the parotid glands caused by the (131)I. However, subjective symptoms of oral dryness only developed after injury to the chorda tympani nerve (CTN) during stapes surgery.. The loss of function of both parotid glands after (131)I therapy for thyroid cancer was initially compensated by the secretions of the more radiation-resistant submandibular and sublingual salivary glands (SMSG/SLSG). Damage to the CTN's secretory fibers in one SMSG/SLSG complex led to subjective oral dryness by accentuating an existing objective hyposalivation.

Topics: Carcinoma; Carcinoma, Papillary; Chorda Tympani Nerve; Female; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Middle Aged; Otosclerosis; Parotid Gland; Radiopharmaceuticals; Radiotherapy, Adjuvant; Sodium Pertechnetate Tc 99m; Stapes Surgery; Thyroid Cancer, Papillary; Thyroid Neoplasms; Xerostomia

Topics: Humans; Radionuclide Imaging; Salivary Duct Calculi; Salivary Gland Calculi; Salivary Gland Neoplasms; Salivary Glands; Sialadenitis; Sodium Pertechnetate Tc 99m; Xerostomia

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

Impaired salivary flow is found in Sjögren's syndrome, which is a common, chronic, autoimmune, inflammatory connective tissue disease, mainly affecting the exocrine glands. Histopathologically, lymphocytic infiltrations of the salivary glands are found in Sjögren's syndrome that are similar to those of the thyroid gland in autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis). To test this hypothesis by Daniels et al ., salivary function was measured by quantitative salivary scintigraphy in autoimmune thyroiditis patients, as well as in age- and sex-matched controls. Forty patients, each with a history of autoimmune thyroiditis of over 10 years, and 61 healthy controls were enrolled in the study. All of the 40 autoimmune thyroiditis patients had good blood sugar control. None presented autonomic neuropathy. They were separated into two subgroups: patient group 1, 20 patients with xerostomia; patient group 2, 20 patients without xerostomia. Two control groups of healthy subjects were included for comparison: control group 1, 36 subjects without xerostomia; control group 2, 25 subjects with xerostomia. After intravenous injection of 5 mCi (99m)Tc-pertechnetate, sequential images at 1 min per frame were acquired for 30 min. The first and 15th minute uptake ratios (URs) were calculated from the tracer uptakes in the four major salivary glands relative to the background regions of interest (ROIs). Saliva excretion was stimulated by one tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer. The maximal excretion ratios (ERs) of the four major salivary glands after sialagogue stimulation were calculated. Impaired salivary function, represented by significantly decreased UR and ER values, in autoimmune thyroiditis patients with xerostomia was demonstrated in this study. Significantly poorer salivary function was found in autoimmune thyroiditis patients with xerostomia, when compared with autoimmune thyroiditis patients without xerostomia and healthy controls with or without xerostomia, via objective and quantitative salivary scintigraphy. However, a larger series of autoimmune thyroiditis patients is necessary to confirm our findings.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sodium Pertechnetate Tc 99m; Submandibular Gland; Thyroiditis, Autoimmune; Xerostomia

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

To study the efficacy of coumarin/troxerutine for the protection of salivary glands and mucosa during irradiation.. Prospective, randomized, placebo-controlled, double-blind trial.. University hospital, Germany.. 48 patients who had radiotherapy to the head and neck.. Salivary gland scintigraphy and acute side-effects of radiotherapy (Radiation Therapy Oncology Group (RTOG) score).. 23 patients (11 experimental, 12 placebo) completed the study. The global efficacy measure combining scintigraphy and RTOG score favoured the experimental arm (P=0.07). The RTOG score showed significantly fewer acute side-effects of radiation in the experimental arm (P<0.05).. The results suggest that coumarin/troxerutine have a favourable effect in the treatment of radiogenic sialadenitis and mucositis.

Topics: Adult; Aged; Coumarins; Cranial Irradiation; Double-Blind Method; Drug Combinations; Female; Head and Neck Neoplasms; Humans; Hydroxyethylrutoside; Male; Middle Aged; Mouth Mucosa; Prospective Studies; Radiation Injuries; Radiation-Protective Agents; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sialadenitis; Sodium Pertechnetate Tc 99m; Treatment Outcome; Xerostomia

Salivary gland impairment following high-dose radioiodine treatment is a well-recognized side effect, in general caused by free radicals. Therefore, it seemed promising to evaluate the radioprotective effect of the radical scavenger amifostine in patients receiving high-dose radioiodine therapy.. Quantitative salivary gland scintigraphy using 100 to 120 MBq Tc-99m-pertechnetate was performed in 17 patients with differentiated thyroid cancer prior to and 3 months after radioiodine treatment with 6 GBq I-131. Eight patients were treated with 500 mg/m2 amifostine prior to high-dose radioiodine treatment and compared retrospectively with 9 control patients. Xerostomia was graded according to WHO criteria.. In 9 control patients high-dose radioiodine treatment significantly (p < 0.01) reduced Tc-99m-pertechnetate uptake by 35.4 +/- 22.0% and 31.7 +/- 21.1% in parotid and submandibular glands, respectively. Of these 9 patients, 3 exhibited xerostomia Grade I (WHO). In contrast, in 8 amifostine-treated patients, there was no significant (p = 0.878) decrease in parenchymal function following high-dose radioiodine treatment, and xerostomia did not occur in any of them.. Parenchymal damage in salivary glands induced by high-dose radioiodine treatment can be reduced significantly by amifostine. This may help to increase patients' quality of life in differentiated thyroid cancer.

Topics: Adult; Aged; Amifostine; Carcinoma, Papillary; Drug Evaluation; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiation-Protective Agents; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Time Factors; Xerostomia

Radioiodine therapy is a common adjunct to thyroidectomy in papillary thyroid cancer treatment. However, a variety of associated adverse effects have been reported. In this study, we assessed radioiodine-induced salivary gland dysfunction using quantitative scintigraphy, and evaluated the associated complications.. Patients were divided into five groups on the basis of the cumulative I-131 dosage received. Scintigraphic dynamic images of the salivary glands were obtained and converted into clinically relevant parameters: uptake index (UI), maximum secretion rate (%SR), and combined gland function scores. Patients were followed up for 3-66 months and interviewed for side effects including xerostomia, taste alteration, bitter taste, dental caries, xerophthalmia, and pain/swelling.. An increase in I-131 doses resulted in a reduction in the UI and %SR and an increase in the combined scintigraphy score. Parotid glands were more affected than submandibular glands. A cumulative dosage of greater than 600 mCi resulted in complete loss of %SR in the parotid glands. No significant difference in either the UI or the %SR was observed between nontreated patients and patients receiving an I-131 dosage of up to 150 mCi. The occurrence of xerostomia was significantly correlated with the gland scintigraphic score, the number of treatment cycles, and I-131 dosage. The occurrence of pain and swelling was extremely low and only lasted for a short time.. Although the side effects associated with radioiodine treatment were apparent, they were usually small and temporary. Nevertheless, more consideration should be placed on careful dosing of I-131.

Topics: Adult; Female; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Radiation Injuries; Radionuclide Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Xerostomia

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

Our aim was to investigate the prevalence and the clinical role of salivary hypofunction in patients with globus sensation.. We conducted a prospective observational study in 340 patients with globus pharyngeus. A standard questionnaire and (99m)Tc-pertechnate salivary scintigraphy were used to evaluate salivary hypofunction, with a full examination from the nasal cavity to the larynx (N = 303). We also investigated the effect of xerostomia management on globus symptoms (N = 252).. The symptom scores for xerostomia were higher in patients with severe globus (p < .05). Objective salivary hypofunction was noted in 57.4% of the patients, based on the reference values from control groups. Globus symptoms were more severe in the subgroup with salivary hypofunction (p = .0447). Conservative management of xerostomia significantly reduced the severity of globus at 1 and 3 months (p = .0002) regardless of salivary function.. Salivary hypofunction seems to be an aggravating factor in globus pharyngeus, but not a direct cause. Conservative management of xerostomia improves globus symptoms.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Humans; Male; Middle Aged; Pharyngeal Diseases; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Xerostomia

in recent years, the role of intensity-modulated radiotherapy (IMRT) for head and neck irradiation has increased. The main motivation is sparing the parotid gland and reduction of xerostomia. Generally, relative parotid volumes have been evaluated for treatment outcome and planning constraints, neglecting that absolute parotid volumes can vary significantly. The aim of the present study was to investigate changes in parotid gland function and set this in relation to absolute volumes.. 46 head and neck patients were treated by sparing at least the contralateral parotid gland. The mean dose to the contralateral gland was limited to 26 Gy. Parotid function was measured with scintigraphy before and at 3, 6, 9, and 12 months after radiotherapy. Gland recovery was correlated with absolute parotid gland volumes and mean dose. Finally the dose-effect relationship was investigated.. the dose-volume histograms (DVHs) for the ipsi- and contralateral glands were significantly different. A correlation between absolute volumes receiving certain doses and the function loss after 3, 6, 9, and 12 months was found. The most significant correlation was found for the absolute volume that received at least 40 Gy (aV40). ED50 values of 23-38 Gy were observed for more than 50% function loss and and 52-68 Gy afor more than 75% function loss.. the mean dose, aV40 or aV26, revealed similar correlations with the excretion rate and with recovery. Hence, also absolute volumes can be used for treatment planning. Longer recovery times show higher ED50 values indicating partial regeneration of gland functions.

Topics: Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mouth Neoplasms; Neoadjuvant Therapy; Neoplasm Staging; Oropharyngeal Neoplasms; Parotid Gland; Radiation Injuries; Radionuclide Imaging; Radiotherapy Dosage; Radiotherapy, Adjuvant; Radiotherapy, Intensity-Modulated; Salivation; Sodium Pertechnetate Tc 99m; Xerostomia; Young Adult

Conventional radiotherapy is associated with high doses to the salivary glands which causes xerostomia and adverse effects on quality of life. The study aims to investigate the potential of helical tomotherapy (Hi-Art Tomotherapy) to preserve parotid function in head-and-neck cancer patients.. Seven consecutive patients treated with helical tomotherapy at the UZ Brussel, Belgium, were included. During planning, priority was attributed to planning target volume (PTV) coverage: > or =95% of the dose must be delivered to > or =95% of the PTV. Elective nodal regions received 54 Gy (1.8 Gy/fraction). A dose of 70.5 Gy (2.35 Gy/fraction) was prescribed to the primary tumor and pathologic lymph nodes = simultaneous integrated boost scheme. If possible, the mean parotid dose was kept below 26 Gy. Salivary gland function was assessed by technetium scintigraphy.. There was a significant dose-response relationship between mean parotid dose and functional recuperation. If the mean dose was kept <31 Gy, a recuperation of 75% can be expected at 12 months. The authors equally observed a significant correlation between salivary excretion (SE) and the percentage of parotid gland receiving a dose <26 Gy (V26%). In order to preserve 75% of SE, 46% of the parotid volume should receive a dose <26 Gy.. With the use of heLical tomography the parotid gland function can largely be preserved since the mean dose to the entire gland as well as glandular volume receiving >26 Gy can be reduced.

Topics: Aged; Diagnostic Imaging; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Otorhinolaryngologic Neoplasms; Parotid Gland; Radiation Injuries; Radionuclide Imaging; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Salivation; Sodium Pertechnetate Tc 99m; Xerostomia

Topics: Aged; Graves Disease; Humans; Isotopes; Male; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; Sodium Pertechnetate Tc 99m; Treatment Outcome; Xerostomia

Radioactive iodine (131I), used in the treatment of differentiated thyroid carcinoma, is known to cause both short-term and long-term radiation damage to the salivary glands. The injury appears as glandular swellings and/or decreased salivation with 131I dosage and passage of time playing significant roles. A case report is presented to alert the profession to the existence of patients who have received 131I therapy and who complain shortly thereafter of xerostomia, but following a thorough examination are found to represent a group of false-positives. Emphasis is placed on the diagnostic techniques used in the differential diagnosis.

Topics: Adult; Antidepressive Agents, Second-Generation; Diagnosis, Differential; False Positive Reactions; Humans; Iodine Radioisotopes; Male; Parotid Gland; Radiopharmaceuticals; Sialadenitis; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Trazodone; Xerostomia

The aim of this study was to compare changes in salivary gland function after intensity-modulated radiotherapy (IMRT) and conventional radiotherapy (RT), with or without Amifostine, for tumors of the head-and-neck region using quantitative salivary gland scintigraphy (QSGS).. A total of 75 patients received pre- and post-therapeutic QSGS to quantify the salivary gland function. In all, 251 salivary glands were independently evaluated. Changes in the maximum uptake (DeltaU) and relative excretion rate (DeltaF) both pre- and post-RT were determined to characterize radiation-induced changes in the salivary gland function. In addition, dose-response curves were calculated.. In all groups, maximum uptake and relative excretion rate were reduced after RT (DeltaU

Topics: Adult; Aged; Amifostine; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Logistic Models; Male; Middle Aged; Parotid Gland; Radiation-Protective Agents; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Intensity-Modulated; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Xerostomia

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

Topics: Biopsy; Child; Dental Caries; Gingivitis; Histiocytosis, Sinus; Humans; Male; Parotid Diseases; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Submandibular Gland; Submandibular Gland Diseases; Tooth, Deciduous; Ultrasonography; Xerostomia

Dental destruction can develop from numerous causes. Major salivary gland aplasia is an uncommon causative factor. The resulting xerostomia can lead to extensive dental demineralization.. The author examined a 19-year-old man because of the patient's concern regarding decreased salivary volume and his dental condition. There was extensive loss of tooth structure and an astonishing pattern of dental destruction most notable on the palatal portions of the maxillary molars and premolars that is best described as "chipping." It was only after taking the patient's history, clinically examining the patient and conducting a radioisotope study that the author was able to make a confident diagnosis of the absence of four major salivary glands.. Dentists should be aware that salivary gland aplasia is an uncommon cause of dental deterioration. It may manifest itself not by extensive caries but by a dental chipping effect. Early recognition and a therapeutic strategy can prevent progressive dental damage.

Topics: Adult; Dental Enamel; Humans; Male; Mouth Abnormalities; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Submandibular Gland; Tooth Attrition; Xerostomia

To evaluate salivary gland function after inversely planned stereotactic intensity-modulated radiotherapy (IMRT) for tumors of the head-and-neck region using quantitative pertechnetate scintigraphy.. Since January 2000, 18 patients undergoing IMRT for cancer of the head and neck underwent pre- and posttherapeutic scintigraphy to examine salivary gland function. The mean dose to the primary planning target volume was 61.5 Gy (range 50.4-73.2), and the median follow-up was 23 months. In all cases, the parotid glands were directly adjacent to the planning target volume. The treatment planning goal was for at least one parotid gland to receive a mean dose of <26 Gy. Two quantitative parameters (change in maximal uptake and change in the relative excretion rate before and after IMRT) characterizing the change in salivary gland function after radiotherapy were determined. These parameters were compared with respect to the dose thresholds of 26 and 30 Gy for the mean dose. In addition, dose-response curves were calculated.. Using IMRT, it was possible in 16 patients to reduce the dose for at least one parotid gland to < or =26 Gy. In 7 patients, protection of both parotid glands was possible. No recurrent disease adjacent to the protected parotid glands was observed. Using the Radiation Therapy Oncology Group/European Organization for the Research and Treatment of Cancer scoring system, only 3 patients had Grade 2 xerostomia. No greater toxicity was seen for the salivary glands. The change in the relative excretion rate was significantly greater, if the parotid glands received a mean dose of > or =26 Gy or > or =30 Gy. For the change in maximal uptake, a statistically significant difference was seen only for the parotid glands and a dose threshold of 30 Gy. For the end point of a reduction in the parotid excretion rate of >50% and 75%, the dose-response curves yielded a dose at 50% complication probability of 34.8 +/- 3.6 and 40.8 +/- 5.3 Gy, respectively.. Using IMRT, it is possible to protect the parotid glands and reduce the incidence and severity of xerostomia in patients. Doses <26-30 Gy significantly preserve salivary gland function. The results support the hypothesis that application of IMRT does not lead to increased local failure rates.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Parotid Gland; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Radiotherapy, Conformal; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Statistics, Nonparametric; Xerostomia

It has been speculated that impaired salivary flow contributes to autoimmune thyroiditis (chronic thyroiditis, Hashimoto's thyroiditis). To test this hypothesis, salivary function was measured by quantitative salivary scintigraphy in autoimmune thyroiditis patients, as well as in age- and gender-matched controls for comparison.. One hundred and twenty patients with an autoimmune thyroiditis history of more than 10 years each and 36 healthy controls were enrolled in the study. All the 120 autoimmune thyroiditis patients had good blood sugar control. None had autonomic neuropathy. These 120 autoimmune thyroiditis patients were separated into two subgroups: group 1, 60 patients with xerostomia; and group 2, 60 patients without xerostomia. After intravenous injection of 5 mCi Tc-99m pertechnetate, sequential images at 1 min/frame were acquired for 30 min. The first- and 15th-minute uptake ratios (UR) were calculated from the tracer uptakes in the four major salivary glands over the background regions of interest (ROIs). Saliva excretion was stimulated by 1 tablet of 200 mg ascorbic acid given orally 15 min after injection of the tracer. Then, the maximal excretion ratios (ER) of the four major salivary glands after sialagogue stimulation were calculated.. Impaired salivary function, represented by significantly decreased UR and ER values, in autoimmune thyroiditis patients with xerostomia was demonstrated in this study. In addition, there was a significantly higher prevalence of salivary gland dysfunction in group 1 patients than in group 2 patients.. Significantly poorer salivary function was found in autoimmune thyroiditis patients with xerostomia compared with autoimmune thyroiditis patients without xerostomia and healthy controls by means of objective and quantitative salivary scintigraphy.

Topics: Adult; Aged; Analysis of Variance; Case-Control Studies; Chi-Square Distribution; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Saliva; Salivary Glands; Secretory Rate; Sodium Pertechnetate Tc 99m; Surveys and Questionnaires; Thyroiditis, Autoimmune; Time Factors; Xerostomia

Xerostomia is the most debilitating side effect induced by irradiation of head and neck tumours and is caused by irradiation damage to the salivary glands. The aim of this study was to correlate structural histomorphological damages and sialoscintigraphical findings during fractioned radiotherapy. The head and neck area of 27 WAG/RijH rats was irradiated with 60Co-gamma rays (60 Gy/30f 6 weeks). To evaluate salivary gland function, a port system was implanted, and 99mTc-pertechnetate was applied at different stages of irradiation (0, 16, 30, 46, 60 and 6 months post-irradiation). In the course of treatment the parotid glands were examined histopathologically. Rat salivary glands developed a dose-dependent radiosialadenitis. After a dose of 16 Gy an intra- and extra-cellular oedema developed in the salivary glands. Progressive vacuolisation (30 Gy) developed into lipomatosis (46 Gy) and necrotic changes (60 Gy) in the parotid glands. Six months after irradiation treatment, the chronic histomorphological damages corresponded to stage II according to Seifert. The corresponding loss in gland function investigated by measurement of the 99mTc-pertechnetate uptake of the salivary glands was 13% (16 Gy), 26% (30 Gy), 57% (46 Gy), 75% (60 Gy) and 66.5% (6 months post-irradiation). The presented animal model is suitable to demonstrate the correlation of histomorphological and sialoscintigraphical findings.

Topics: Animals; Cobalt Radioisotopes; Disease Models, Animal; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Gamma Rays; Head and Neck Neoplasms; Male; Radiation Injuries; Radiation Tolerance; Radionuclide Imaging; Radiotherapy, Adjuvant; Rats; Salivary Glands; Sialadenitis; Sodium Pertechnetate Tc 99m; Xerostomia

Nasopharyngeal carcinoma (NPC) is mainly treated by radiation therapy. A common complication of radiotherapy is xerostomia. Direct measurements of the amount of saliva produced using suction cups and volumetric assessments are cumbersome and time-consuming. Sequential radionuclide sialography is a reproducible and convenient method of measuring salivary function.. Patients with newly diagnosed NPC underwent a pilot study using technetium-99m pertechnetate sequential radionuclide sialography to assess their salivary function before and at 3 months post radiation therapy. From the sialography, time activity curves were obtained for analysis of salivary function. The shape of the time activity curve with citric acid stimulation was classified into 4 types according to the degree of radiation-induced dysfunction.. All 14 patients had worse (P < 0.005) time activity curves for both parotids and submandibular glands after radiation therapy. All patients with abnormal curves before radiation therapy presented type IV (non-functioning) curve after radiation therapy. A ratio of pre- and post-stimulation counts allowed for quantification of the degree of stimulatory response. We found a significant decrease in Rc before and after radiation therapy for all salivary glands (P < 0.001). The salivary gland to background ratio, which is a reflection of the degree of salivary gland functional uptake, also had a significant reduction after radiation.. It is feasible to use technetium-99m pertechnetate in the measurement of salivary gland function in nasopharyngeal cancer patients treated with radiation therapy.

Topics: Adult; Aged; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Monitoring, Physiologic; Nasopharyngeal Neoplasms; Pilot Projects; Probability; Radionuclide Imaging; Radiotherapy Dosage; Risk Assessment; Salivary Glands; Sensitivity and Specificity; Sialography; Sodium Pertechnetate Tc 99m; Treatment Outcome; Xerostomia

It has been speculated that impaired salivary flow is common in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD). The aim of this study is to investigate the relation between oral manifestations and salivary function in patients with ESRD undergoing HD. Salivary function was measured by quantitative salivary scintigraphy in 60 patients with ESRD undergoing HD, as well as in 36 age- and sex-matched healthy controls for comparison. The 60 patients with ESRD undergoing HD were separated into two subgroups: group 1, 30 patients with oral manifestations, and group 2, 30 patients without oral manifestations. After an intravenous injection of 5 mCi of technetium 99m pertechnetate, sequential images at 1 minute per frame were acquired for 30 minutes. The 1- and 15-minute uptake ratios were calculated as the tracer uptakes in the four major salivary glands over the background regions of interest. Saliva excretion was stimulated by one 200-mg tablet of ascorbic acid administered orally 15 minutes post-tracer injection, then the maximal excretion ratios of the four major salivary glands were calculated. Our results show significantly poorer salivary function in patients with ESRD with oral manifestations compared with patients with ESRD without oral manifestations and healthy controls by means of objective and quantitative salivary scintigraphy.

Topics: Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Radionuclide Imaging; Renal Dialysis; Salivary Glands; Salivation; Scintillation Counting; Sodium Pertechnetate Tc 99m; Xerostomia

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

This study was undertaken to determine whether standard salivary gland scintigraphy may be used for the objective assessment of salivary gland sialogogues, in particular oral pilocarpine, in the treatment of post-radiotherapy xerostomia. Nine patients, with xerostomia following radiotherapy to the head and neck region underwent salivary gland scintigraphy with technetium-99m pertechnetate (40 MBq) both before and following 1 month of oral pilocarpine (5 mg tds). For each scan, the percentage uptake in the first 14 min, the peak uptake, time to peak uptake and the percentage of activity excreted following lemon juice stimulation were calculated. The results were correlated with the subjective response as assessed by questionnaire and visual analogue scale. We found no correlation between subjective response and any of the four scan parameters analysed. We could not identify any parameter that predicted those patients who would respond to pilocarpine. In addition, only one parameter, the percentage of activity excreted following stimulation, correlated with previous dose of radiotherapy to the gland. In conclusion, in this study salivary gland scintigraphy did not appear to correlate with or predict response to oral pilocarpine. However, future studies might consider performing salivary gland scintigraphy prior to radiotherapy as well as at differing time points following the commencement of pilocarpine.

Topics: Administration, Oral; Carcinoma, Squamous Cell; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Parasympathomimetics; Pilocarpine; Pilot Projects; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Salivary Glands; 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

Several quantitative measures of salivary uptake and discharge have been proposed recently in the scintigraphic evaluation of xerostomia. We investigated the scatter of four time-activity curve C(TAC)-derived indices in a group of volunteer subjects who met extensive inclusionary and exclusionary criteria of salivary normalcy.. Thirty-one adult volunteers underwent dynamic salivary scintigraphy with gustatory stimulation. Any candidates with subjective xerostomia, conditions or medications associated with dry mouth, salivary gland enlargement or pregnancy were excluded from study. All subjects had normal oral exams, xerostomia scores and unstimulated whole-mouth salivary flow rates. After the intravenous administration of 99mTcO-4, scintigraphy was performed with generation of TACs derived from regions of interest centered about the four major salivary glands and the oral cavity. At 45 min postinjection, hard lemon candy was given for 15 min as a gustatory stimulus. The following functional indices were calculated for each gland: partitioned percentage (PP) of total prestimulated activity, maximum net uptake ratio (NUR) and its time of occurrence (TNUR) and percentage stimulated discharge fraction (DF).. The following ranges were observed: parotid PP, 22%-49%; submandibular PP, 4%-31%; parotid NUR, 2.2-16.0; submandibular NUR, 1.4-16.2; parotid TNUR, 8-45 min; submandibular TNUR, 2-45 min; parotid DF, 20%-99%; and submandibular DF, 27%-98%. Every subject except one 91-yr-old man showed frequent periodic unstimulated oral transfer of salivary activity with a rising oral TAC and responded to gustatory stimulation.. So-called quantitative indices may perform poorly in the scintigraphic evaluation of xerostomic patients because the effects of normal simultaneous glandular trapping, uptake, oral discharge and possible vascular washout combine to widen reference limits. Coordinated analysis of oral cavity and glandular activities, glandular index averaging and better temporal resolution may help improve diagnostic performance.

Topics: Adult; Aged; Aged, 80 and over; Candy; Female; Humans; Male; Middle Aged; Physical Stimulation; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Salivary Glands; Salivation; Sodium Pertechnetate Tc 99m; Time Factors; Xerostomia

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

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 case of a 5-year-old girl with a lifelong history of xerostomia, poor dentition and decreased lacrimal gland secretion is presented. To our knowledge, this is the youngest reported patient with such symptoms and the first case confirmed with magnetic resonance imaging.

Topics: Child, Preschool; Female; Humans; Lacrimal Apparatus; Magnetic Resonance Imaging; Salivary Glands; Sodium Pertechnetate Tc 99m; Xerostomia

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

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

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 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

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

Physical clearance is an important oral defense mechanism against gram-negative rods. We describe a simple technique that uses commercially available technetium-99m sulfur colloid to measure oral clearance. Technetium-99m sulfur colloid was sprayed into the mouth, and clearance was measured as the percent decrease in radiolabel counts over 2 hours using a radioisotope camera. Results using this technique compared favorably with clearance data using Tc-99m radiolabeled Escherichia coli. Atropine significantly decreased oral clearance rates of the colloid. Decreased clearance may be an important risk factor in the development of gram-negative rod colonization in hospitalized patients.

Topics: Atropine; Escherichia coli Infections; Humans; Immunity, Innate; Isotope Labeling; Kinetics; Mouth; Radionuclide Imaging; Risk; Salivation; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Xerostomia