MR sialographic assessment of the masseter muscle and the ductal kinking in patients with recurrent parotitis.

Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen's duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.

[Clinical usefulness of salivary gland ultrasonography in Sjögren's syndrome: Where are we now?]. / Apport de l'échographie des glandes salivaires dans la prise en charge du syndrome de Sjögren: où en sommes-nous?

Salivary gland ultrasonography is a simple, noninvasive and inexpensive procedure, which provides valuable information for the diagnosis of primary Sjögren's syndrome (pSS). The main sonographic characteristic of the major salivary glands (parotid and submandibular) in pSS patients is the heterogeneity of the parenchyma, with the appearance of hypoechoic areas. Numerous studies published over the past 20 years report a sensitivity of 70% and a specificity of more than 90% for the diagnosis of pSS. Before the widespread use of this procedure in daily practice and its integration into classification criteria of the disease, it has yet to be validated in terms of reproducibility and a consensus score should be established. This work is being conducted by an international group of experts. Other ultrasound techniques such as elastography could also be of interest to objectively quantify changes in the glandular tissue that occur during the disease.

Assessment of salivary gland dysfunction after radioiodine therapy for thyroid carcinoma using non-contrast-enhanced CT: the significance of changes in volume and attenuation of the glands.

BACKGROUND AND PURPOSE: Although radiation induced damage to the salivary gland is a known complication of radioactive iodine ((131)I) therapy for thyroid carcinoma, prediction of the severity and reversibility of sialoadenitis is difficult. Our aim was to correlate the extent of salivary dysfunction assessed by salivary gland scintigraphy with changes in the volume and attenuation of salivary glands on nonenhanced CT in postoperative patients with thyroid cancer treated with RIT. MATERIALS AND METHODS: Forty patients with thyroid carcinoma, 13 men (age range, 21-80 years) and 27 women (age range, 28-75 years) who underwent a total thyroidectomy and were treated with RIT were assessed retrospectively. On CT, the percentage of volume reduction and the difference in attenuation of the parotid and submandibular glands after RIT were determined and correlated with the extent of radiation-induced salivary dysfunction on scintigraphy. RESULTS: The salivary gland volume significantly decreased with an increase in the dysfunction grade on scintigraphy for both the parotid and submandibular glands (P < .001). The attenuation significantly increased with an increase in the dysfunction grade on scintigraphy for the parotid gland (P < .001), but not for the submandibular gland. The cutoff value of volume reduction to diagnose severe gland dysfunction was 19.5% (sensitivity, 86.0%; specificity, 100%) for the parotid gland and 31.0% (sensitivity, 100%; specificity, 97.0%) for the submandibular gland, and that of the attenuation change was 9.8 HU (sensitivity, 81.0%; specificity, 95%) for the parotid gland. CONCLUSIONS: The reduction in volume of the parotid and submandibular glands and the increase in attenuation of the parotid gland on nonenhanced CT can be indicators of the grade of RIT-induced salivary dysfunction.

[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.

[MR Sialography]. / SIALO-IRM.

Indications for sialography have became rare and radiologists are less and less experienced for salivary gland cannulation. MR Sialography allows opacification of salivary ducts without any cannulation and could replace residual indications for sialography. The purpose of this paper is to review the principle of the technique, the normal and pathologic aspects of MR Sialography and to emphasize advantages and limitations compared to other techniques.