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Sjogren’s Syndrome: Comparison of Assessments with Quantitative Salivary Gland Scintigraphy and Contrast Sialography. J Nucl Med 2000; 41: 257-262. Sjogren’s Syndrome. Autoimmune disease Affecting salivary and lacrimal glands Xerostomia (the most common oral symptom).

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Sjogren’s Syndrome: Comparison of Assessments with Quantitative Salivary Gland Scintigraphy and Contrast Sialography

J Nucl Med 2000; 41: 257-262

sjogren s syndrome
Sjogren’s Syndrome
  • Autoimmune disease
    • Affecting salivary and lacrimal glands
    • Xerostomia (the most common oral symptom).
  • The complaints of patients do not necessarily reflect the severity of their salivary gland disease.
sjogren s syndrome3
Sjogren’s syndrome
  • Contrast sialography
    • Gold standard in the diagnosis of the syndrome
    • Invasive method (disadvantages and complications)
  • Salivary gland scintigraphy with 99mTc-sodium pertechnetate
    • Evaluate salivary gland function in xerostomic pateints
    • Easy and noninvasive method (bilateral parotid and submandibular glands)
slide4
No standard method for assessing Sjorgren’s syndrome has been established
  • No report has deal with the relationships between quantitative scintigraphic parameters and sialographic findings
slide5
In this study
    • Comparing quantitative parameters of salivary gland scintigraphy and sialographic findings in Sjogren’s syndrome.
    • Determining useful scintigaphic parameters for evaluation of salivary gland disease and calculated an equation to correlate the sialographic stage with the scintigraphic parameters.
slide7
Patients
    • 116 consecutive patients (105 woman, 11 men; age range, 18-77 y; mean age, 54 y) who had xerostomia and were clinically suspected of having Sjogren’s syndrome.
    • Sjogren’s syndrome was diagnosed in 50 of the 116 patients (contrast sialography as gold standard), and confirmed by complete P.E., laboratory testing, labial salivary gland biopsy (all showed histopathological changes of grade 1 or greater).
slide8
Imaging Examination
    • Dynamic salivary scintigraphy
      • Performed after intravenous injection of 370 MBq 99mTc-sodium pertechnetate
      • Γ camera and analysis system
slide9

lemon juice

FIGURE 1. Schematic presentation of time-activity curve in salivary gland scintigraphy. This represents normal pattern.

slide11
UR and MA: quantity of accumulation
  • MS: quantity of secretion.
  • Tmax: velocity of accumulation and spontaneous secretion.
  • Tmin: velocity of secretion after stimulation
slide12
Imaging examination
    • Contrast sialography
      • A catheter was used to inject a 0.5 to 0.7 ml dose of iohexol into the Stensen’s duct in patients.
slide13
Contrast sialograms
    • Rubin and Holt classification
slide15

TABLE 2. Comparison of Scintigraphic Parameters in Healthy Volunteers and Patients with Sjogren’s syndrome

slide16

TABLE 3. Correlation of Scintigraphic Parameters and Sialographic Staging in Patients with Sjogren’s syndrome

slide17
Regression analysis
    • In the submandibular gland, decrease of the tracer accumulation highly correlated with the sialographic staging (UR: r= -0.528, P<0.0001; MA: r= -0.554, P<0.0001)
    • in the parotid gland, dcrease of the tracer secretion highly correlated with the sialographic staging (MS: r= -0.570, P<0.0001)
slide21

FIGURE 3. Images of 56-y-old woman (patient 2) with Sjigren’s syndrome (sialographic stage 2).

slide23

FIGURE 4. Images of 54-y-old woman (patient 3) with Sjogren’s syndrome (sialographic stage 4).

slide26
Contrast sialography
    • Gold standard in the diagnosis of the syndrome
    • Invasive method
    • Potential complications
      • Failure of the cannulation procedure, duct trauma, painful overfilling of the gland, infection, and contrast material reactions.
slide27
Salivary gland scintigraphy with 99mTc-sodium pertechnetate
    • Evaluate salivary gland function in xerostomic pateints
    • Easy and noninvasive method (bilateral parotid and submandibular glands)
    • No standard method for assessing Sjorgren’s syndrome has been established
    • No report has deal with the relationships between quantitative scintigraphic parameters and sialographic findings
slide28
UR, Tmax, Tmin, MA, and MS as quantitative parameters of salivary gland function.
  • UR and MA: quantity of accummulation
  • MS: quantity of secretion.
  • Tmax: velocity of accumulation and spontaneous secretion.
  • Tmin: velocity of secretion after stimulation.
slide29
UR and MA of the submandibular gland and the MS of the parotid gland are highly correlated with the sialographic staging
    • Decreased accumulation in the submandibular gland and decreased secretion in the parotid gland are highly sensitive indicators of salivary gland disease in Sjogren’s syndrome
    • Previous report (Umehara et al., 1999)
slide30
Why?
    • Parenchymal volumes, spontaneous secretion, compositions of serous and mucous glands.
    • Further study is needed to clarify the different functional change between the parotid and submandibular glands in Sjogren’s syndrome
    • The function of the submandibular gland was more affected than that of the parotid gland. (Sugihara et al., 1988 and Hakansson et al., 1994 )
slide31
Controversy remains as to which parameter is better for assessing salivary gland disease.( Hausler et al., 1977, Arrago., 1987, Hakansson., 1994, Bohuslavizki., 1995)
  • The study indicated that decreased accumulation in the submandibular gland and decreased secretion in the parotid gland are highly sensitive indicators of salivary gland disease in Sjogren’s syndrome
slide32
Sjogren’s syndrome was statistically significantly correlated with scintigraphic parameters
    • By means of stepwise regression analysis (sialographic stage versus UR of the submandibular gland and MS of the parotid gland)
slide34
Sjogern’s syndrome
    • Salivary gland scintigraphy
      • Easy and noninvasive method
      • Quantitative analysis : decreased accumulation in the submandibular gland and decreased secretion in the parotid gland are highly sensitive parameters
      • Sialographic stage was correlated with these scintigraphic parameters