Value of High-Frequency Ultrasonography in the Qualitative and Semi-Quantitative Assessment of Immunoglobulin G4-Related Submandibular Sialadenitis.

OBJECTIVE: To assess the value of high-frequency ultrasonography in the evaluation of immunoglobulin G4-related submandibular sialadenitis (IgG4-SS). METHODS: Thirty-four submandibular glands in 17 patients with IgG4-SS were retrospectively enrolled, as well as 34 submandibular glands in 17 healthy control subjects. Qualitative ultrasonic features including submandibular gland size, border, echogenicity, and vascularity were reviewed. Two different scoring systems (0-16 and 0-48, respectively) were used for semi-quantitative analysis of imaging features. Comparison of both qualitative and semi-quantitative ultrasonic analysis were made between patients with IgG4-SS and healthy controls. Spearman correlation was used to explore relationships between variables. RESULTS: The submandibular glands with IgG4-SS presented with enlarged size, rough border, increased vascularity, and abnormal echogenicity (All P < .05). The most common echogenicity pattern for IgG-SS was diffuse hypoechoic foci pattern (44.1%), followed by superficial hypoechoic pattern (20.6%), tumor-like pattern (14.7%), and diffuse hypoechogenicity pattern (11.8%). Most IgG4-SS glands presented linear hyperechogenicity in parenchyma (91.2%). Based on both scoring system, scores of IgG4-SS were significantly higher than those of the controls (All P < .05). Association analysis of both scoring systems showed positive correlation of scores with vascularity in the gland parenchyma (All P < .05). CONCLUSION: The ultrasonic features of IgG4-SS comprise enlarged gland, rough border, increased vascularity, and abnormal echogenicity, which correlate with its pathological characteristics. The most common echogenicity pattern for IgG4-SS was diffuse hypoechoic foci pattern. Semi-quantitative analysis systems could be useful in the assessment of IgG4-SS. Ultrasound is a potential, valuable, and non-invasive tool for the diagnosis and evaluation of IgG4-SS.

Quantitative assessment of the parotid gland using computed tomography texture analysis to detect parotid sialadenitis.

OBJECTIVE: We aimed to quantitatively assess the parotid gland by using computed tomography (CT) texture analysis to detect parotid sialadenitis (PS). STUDY DESIGN: This retrospective case-control study included 43 patients with PS who underwent CT and magnetic resonance imaging (MRI). Parotid glands with an abnormal signal (STIR: High) on MRI were identified as showing PS. Patients with parotid gland tumors, bilateral PS, marked fatty degeneration, and severe artifacts on CT were excluded. The texture features of parotid glands with PS and the contralateral normal parotid glands were analyzed using the open-access software LIFEx. The regions of interest were manually placed by tracing contours of both parotid glands on CT images. The results were tested with the paired t-test (or Wilcoxon rank-sum test when appropriate). Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of texture features to predict PS. RESULTS: Six gray level run length matrix features, 2 neighborhood gray level difference matrix features, and 5 gray level zone length matrix features displayed significant differences between PS and normal glands (P ≤ .047). ROC curve analysis showed acceptable accuracy in 4 texture features. CONCLUSIONS: CT texture analysis allowed quantitative assessment of parotid glands and may have the potential to detect PS.

Quantitative assessment of normal submandibular glands and submandibular sialadenitis using CT texture analysis: A retrospective study.

OBJECTIVE: The purpose of this study was to quantitatively assess normal submandibular glands and submandibular sialadenitis (SS) using computed tomography (CT) texture analysis as part of radiomics quantitative analysis. STUDY DESIGN: In total, 31 patients with unilateral SS who underwent head and neck magnetic resonance imaging (MRI) and CT and were retrospectively reviewed. Submandibular glands with abnormal signals (STIR: high, T2-weighted image: high, T1-weighted image: low) on MRI were identified as SS. The radiomics features of the contralateral normal submandibular glands and SS were analyzed using an open-access software, MaZda Version 3.3. Sixteen radiomics features were selected with Fisher and probability of error and average correlation coefficient methods in MaZda from 279 original parameters calculated for each of the normal and SS glands. The results were statistically analyzed with the Wilcoxon rank sum test. RESULTS: One gray-level co-occurrence matrix feature and 9 gray-level run length matrix features displayed significant differences between normal submandibular glands and glands with SS (P < .05). CONCLUSIONS: CT texture analysis was able to quantitatively distinguish between normal and diseased submandibular glands. It therefore may have the potential to detect SS.

Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

OBJECTIVES/HYPOTHESIS: The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. STUDY DESIGN: Literature review and cost-effectiveness analysis. METHODS: A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. RESULTS: The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. CONCLUSIONS: Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. LEVEL OF EVIDENCE: NA. Laryngoscope, 1822-1828, 2018.

[Diagnostic value of radiographic and ultrasonic examinations in patients with sialoadenitis and sialolithiasis]. / Röntgen- és ultrahang-vizsgálatok értékelése sialoadenitises és sialolithiasisos betegcsoportokban.

PURPOSE: The aim of this study was to evaluate diagnostic role of the native x-ray and ultrasonography (US) in sialoadenitis and sialolithiasis. MATERIALS AND METHODS: During a period of 30 months 52 patients were selected in a study group with lithiasis and adenitis of the major salivary glands. Panoramic and either occlusal plain radiographs (sublingual and submandibular cases) or anteroposterior "blowed out" bucca and intraoral bucca radiographs (parotid cases), and US were taken of all patients. Further investigations, such as CT, MRI or FNAB were performed to discover probable differential diagnostic problems. RESULTS: The sensitivity of US for salivary stones was 75.0%, for inflammation was 77.4%. The sensitivity of x-ray for salivary stones was 60.7%. The cumulative effectiveness of x-ray and US for sialolithiasis was 91.3%. In the remaining two cases of sialolithiasis, CT supported the earlier diagnosis. In sialoadenitis, twice FNAB, four times MRI verified the supposed diagnosis. CONCLUSIONS: Despite the advantages of CT and MR evaluations, sonography and native x-ray seems to keep their priorities as diagnostic methods, because they are cost-effective and easily available in dento-alveolar surgical practice. The lack of intraductal imaging ability might be considered as one of the major disadvantages in evaluation of possible diagnostic alternatives.

Sonographic assessment of the submandibular space.

There is a wide variety of pathological processes which may present with swelling in the submandibular space. Although the submandibular gland is the most important structure in this region, there are a number of extraglandular causes of swelling which frequently mimic submandibular gland enlargement. In this review the use of high-resolution ultrasound in the assessment of the submandibular gland and adjacent structures is discussed and illustrated.

A computer-assisted method for semi-quantitative assessment of salivary gland diseases.

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.