A comparative study of three-dimensional cone-beam CT sialography and MR sialography for the detection of non-tumorous salivary pathologies.

BACKGROUND: Imaging of the salivary ductal system is relevant prior to an endoscopic or a surgical procedure. Various imaging modalities can be used for this purpose. The aim of this study was to compare the diagnostic capability of three-dimensional (3D)-cone-beam computed tomography (CBCT) sialography versus magnetic resonance (MR) sialography in non-tumorous salivary pathologies. METHODS: This prospective, monocenter, pilot study compared both imaging modalities in 46 patients (mean age 50.1 ± 14.9 years) referred for salivary symptoms. The analyses were performed by two independent radiologists and referred to identification of a salivary disease including sialolithiasis, stenosis, or dilatation (primary endpoint). The location and size of an abnormality, the last branch of division of the salivary duct that can be visualized, potential complications, and exposure parameters were also collected (secondary endpoints). RESULTS: Salivary symptoms involved both the submandibular (60.9%) and parotid (39.1%) glands. Sialolithiasis, dilatations, and stenosis were observed in 24, 25, and 9 patients, respectively, with no statistical differences observed between the two imaging modalities in terms of lesion identification (p1 = 0.66, p2 = 0.63, and p3 = 0.24, respectively). The inter-observer agreement was perfect (> 0.90) for lesion identification. MR sialography outperformed 3D-CBCT sialography for visualization of salivary stones and dilatations, as evidenced by higher positive percent agreement (sensitivity) of 0.90 [95% CI 0.70-0.98] vs. 0.82 [95% CI 0.61-0.93], and 0.84 [95% CI 0.62-0.94] vs. 0.70 [95% CI 0.49-0.84], respectively. For the identification of stenosis, the same low positive percent agreement was obtained with both procedures (0.20 [95% CI 0.01-0.62]). There was a good concordance for the location of a stone (Kappa coefficient of 0.62). Catheterization failure was observed in two patients by 3D-CBCT sialography. CONCLUSIONS: Both imaging procedures warrant being part of the diagnostic arsenal of non-tumorous salivary pathologies. However, MR sialography may be more effective than 3D-CBCT sialography for the identification of sialolithiasis and ductal dilatations. TRIAL REGISTRATION: NCT02883140.

A comparative study of three-dimensional cone beam computed tomographic sialography and ultrasonography in the detection of non-tumoral salivary duct diseases.

OBJECTIVES: To compare the overall diagnostic outcomes of 3D-CBCT sialography and ultrasonography (US) in the detection of sialolithiasis, ductal dilatation, and ductal stenosis. METHODS: This retrospective monocentric study compared the two imaging modalities carried out in the same patients referred for salivary symptoms of the parotid and submandibular glands. The primary endpoint was the capacity of the imaging procedure to diagnose a lesion. The secondary objectives were the detection rates according to the type of lesion, analysis of the causes of failure, and the parameters of radiation exposure and safety (for 3D-CBCT sialography). RESULTS: Of the 236 patients who received a 3D-CBCT sialography in our institution, 157 were ultimately included in the per-protocol analysis. 3D-CBCT sialography allowed detection of ductal lesions in 113 patients versus 86 with US. The two imaging modalities yielded congruent interpretations in 104 out of 157 subjects (66.2%). Higher sensitivity and negative predictive value were observed with 3D-CBCT sialography compared with US, irrespective of the lesions studied: 0.85 vs 0.65 and 0.70 vs 0.44, respectively. Regarding the sialolithiasis, both 3D-CBCT sialography and US allowed identification of lesions with high sensitivity and negative predictive value (0.80 vs 0.75 and 0.88 vs 0.78, respectively). CONCLUSIONS: US remains the first-line examination for exploration of the salivary lesions. 3D-CBCT sialography is an alternative in case of inconclusive US, and prior to any endoscopic procedure.