Imaging diagnosis of salivary diseases

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Imaging diagnosis of salivary diseases
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introduction
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Diseases associated with salivary gland
enlargement Nutritional deficiency hypovitaminosi
s A Generalized malnutrition Pellagra beriberi
Hormonal abnormalities diebetes
mellitus hypothyroidism testicular
atrophy menopause pregnancy, lactation
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(contd) metabolic disorders bacillary dysentery
(Japanese dysentery) celiac disease ancylostomiasi
s ??? cardiospasm ???? obesity alcoholic
cirrhosis others carcinoma of the
esophagus SS sarcoidosis Uremia
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Drugs affecting salivary glands analgesics iodi
ne anticonvulsants/antispasmotics muscle
relaxants antiemetics/antinauseants ??? CNS
depressants antihistamines dibenzoxepine
derivatives antihypertensives monoamine oxidase
inhibitors antiparkinsons phenothiazine
derivatives antipruritic ??? tranquilizers/sedat
ives appetite suppressants expectorants
??? digitalis ??? decongestants
???? diuretics ???
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introduction
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introduction

• ?? plain film
• ?? sialography
• ?? radionuclide
• ?? ultrasound
• CT
• MRI

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• PLAIN FILM
• RADIOPAQUE SIALOLITH ????
• BONE INVOLVEMENT ?????????

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Sialography

• SIALOGRAPHY
• INDICATION
• DUCT SYSTEM
• OBSTRUCTION
• fistula
• RECURRENT PAROTITIS
• AUTOIMMUNE DISEASES
• OTHER NON-NEOPLASTIC DISEASES

CONTRAINDICATION Acute inflammation Allergy to
iodine
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Sialography
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Sialography
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Sialography
Digital subtraction vascular tree nonvascular
application laryngography dacryocystogrphy sialogr
aphy DSS of 7 cases first reported by JB
Lightfoote et al in 1984 superiority subtraction
of overlying structures dynamic images simpler,
faster, and less radiation than CT intervention
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Imaging diagnosis of salivary diseases
Scintigraphy

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• 1960?Richards ???? technetium-99m ?????
• ???? 1965??Borner????
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Scintigraphy
Radionuclide imaging ?????? ???? ????
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Imaging diagnosis of salivary diseases ultrasound

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Imaging diagnosis of salivary diseases ultrasound
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1895? ????X?? 1917? JH Radon????????????????????
1963? AM Cormack??????????????????? 1972? GN
Hounsfield?J Ambrose???????CT?? 1974? ???60???CT
1974? ??GeorgeTown????Ledley????????CT 1979? Houns
field?Cormack??????? 1989? WA Kalender ?P Vock
???????CT???? 1992????CT?? 1998?4???CT 2004?64???
CT???? 256???CT????????
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MRI

• MRI
• 1930??,????????????????????????????????1944??????
  ?????
• NMR nuclear magnetic resonance
• The experimental foundations of magnetic
  resonance were laid by Block and Purcell more
  than six decades ago (1945), work for which they
  were awarded a Nobel Prize in 1952

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MRI magnetic resonance imaging Lauterbur and
Damadian introduced MRI in the early seventies
Lauterbur and Mansfield were awarded a Nobel
Prize in 2003
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excellent contrast resolution ????????????????????
????? ??????? ?????,????????? ???????CT ????
Contraindication claustrophobic those not fully
cooperative patients with cardiac pacemakers or
insulin pumps, intracranial ferromagnetic clips
or hemoclips on cerebral aneurysm ????????????????
????????MR???
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sialolithiasis

• SIALOLITHIASIS ???
• plain radiography ??
• submandibular gland ???
• occlusal radiograph
• lateral mandibular radiograph ?????
• parotid gland ??
• intraoral view ???
• PA ???
• sialography (digital subtraction) ????

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sialolithiasis
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Sialolithiasis echo-dense spots posterior
acoustic shadowing stones of 2 mm and larger
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Sialographic findings Filling defect frequently
more or less dilated ductal system not normally
indicated when a radiopaque stone revealed
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fistula

• fistula
• Introduction
• clinical
• sialography

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Imaging diagnosis of salivary diseases
inflammation

• Recurrent parotitis
• juvenile
• etiology infection, immunology, dysplasia, virus
• clinical
• sialectasia
• adult

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obstructive sialadenitis etiology calculus,
stricture, mass, foreign body, clinical duct
dilation
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inflammation
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Obstructive sialadenitis left submandibular gland
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tuberculosis

• tuberculosis
• clinical
• sialography
• US

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tumorsultrasound
Shape regular irregular Border well
defined ill defined Internal echo homogeneous he
tero- Posterior enhancement enhanced attenuation,
acoustic shadow
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tumors
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Pleomorphic adenoma
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Imaging diagnosis of salivary diseases tumor
???? ????,???????, mucoepidermoid?acinic cell
tumors ?????????????? lymphoma ????????????
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tumors

• Cross-sectional imaing
• intra- and extraglandular tumours
• adjacent structures
• metastatic lymphadenopathy
• contrast-enhanced CT scans
• deep lobe of the parotid and parapharyngeal space
• vascular and nodal structures adjacent to the
  gland
• dense parotid gland

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Imaging diagnosis of salivary diseases tumors

• CT sialography
• stronge clinical suspicion of disease but
  negative or equivocal with conventional CT
  scanning
• possible mass lesions in submandibular gland
• CT guided biopsy

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tumor
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Imaging diagnosis of salivary diseases tumor
Normal parotid transaxial postcontrast CT
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Imaging diagnosis of salivary diseases tumor
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Imaging diagnosis of salivary diseases tumors

• CT
• characteristics
• benign
• round, well defined, calcification
• malignant
• lobulated or irregular in contour, heterogeneous
  density or central necrosis
• cervical lymphadenopathy
• bone invasion
• location

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Pleomorphic adenoma well defined isodense with
normal parotid tissue usually homogeneous
enhancement indicators of malignancy indistinct
border low density centres thin enhancing rim
transaxial postcontrast CT
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High-density rim in a pleomorphic adenoma, caused
by small calcification
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Warthins tumor most often the tumor is localized
in the inferior part of the parotid gland can be
multifocal in one or both parotid
glands homogeneous with smooth margins
Lymphoma, sarcoidosis, or metastases also may
present as multiple mass lesions in or both
parotid glandds
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Lipoma of the parotid gland readily recognized on
CT as low density lesions well defined margins
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Malignant tumours painful facial nerve
involvement fixed ill defined margins necrosis loc
al invasion lymphadenopathy
retromandibular vein
Carcinoma of the parotid, transaxial postcontrast
CT
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Lymphomas the majority due to intraparotid nodal
involvement an association with autoimmune
diseases dense infiltrative process on imaging
tonsils
Lymphoma of the intraparotid lymph glands
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Imaging diagnosis of salivary diseases tumors

• MRI
• provide cross-sectional images in different
  planes without repositioning the patient
• produces images superior to those of CT for mass
  lesions
• Major blood vessels depicted without the use of
  intravenous administration of contrast medium
• lesions in the deep lobe and the parapharyngeal
  space
• identification of the fat plane between a normal
  appearing gland and an extrinsic mass
• facial nerve (?)

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Imaging diagnosis of salivary diseases tumors
T1 weighted images ?????????????,??????????,?T1/T2
?????
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Imaging diagnosis of salivary diseases tumors

• T2 weighted images
• water has the most intense signal of all
  substances due to its long T2
• fat has a low signal intensity

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Imaging diagnosis of salivary diseases tumor
???? T1?????-??? T2????????? ?????????????????????
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Imaging diagnosis of salivary diseases tumor
Pleomorphic adenoma transaxial T1 weighted MR
postcontrast T1 weighted MR
T2 weighted MR
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Imaging diagnosis of salivary diseases tumor
Pleomorphic adenoma low signal intensity on
T1 very high signal intensity on T2 homogeneous
or inhomogeneous correlate with the presence of
myxoid and/or chondroid or very cellular areas
within the tumor
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Imaging diagnosis of salivary diseases tumor
T1 weighted spin echo image low signal
intensity homogeneous, lobulated tumor
Pleomorphic adenoma T2 weighted spin echo
image very high signal intensity homogeneous and
lobulated tumor
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Imaging diagnosis of salivary diseases tumor
Recurrent pleomorphic adenoma multiple
tumors same signal characteristics as primary
pleomorphic adenomas easily depicted by MRI exact
localization correctly assessed bright
lesions granulomas cyst isolated lymph nodes
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Imaging diagnosis of salivary diseases tumor
Recurrent pleomorphic adenoma T1 weighted image
T2 weighted image
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Imaging diagnosis of salivary diseases tumor
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Imaging diagnosis of salivary diseases tumor
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gadolinium DTPA???
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Imaging diagnosis of salivary diseases tumor
Undifferentiated carcinoma, T1/T2 image
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Imaging diagnosis of salivary diseases tumor
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Imaging diagnosis of salivary diseases tumors

• Sialograph
• most authors nowadays agree that sialography is
  of limited use in tumor diagnosis
• duct system
• acinar
• bone
• leakage

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radionuclide imaging Warthins tumours increased
activity on technetium scans not wash out after a
sialogogue
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Imaging diagnosis of salivary diseases Sjogrens
syndrome

• Sjogrens syndrome
• primary (sicca syndrome)
• secondary characterized by a clinical triad
  consisting of dry eyes, dry mouth, and a
  connective tissue disease, usually rheumatoid
  arthritis
• clinical
• salivary flow rate measurements
• labial gland biopsy scores
• scintigraphic/ sialographic changes
• keratoconjunctivitis sicca
• serological

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Imaging diagnosis of salivary diseases Sjogren
syndrome
sialography delayed emptying sialectasis (Robin P
and Holt JF, 1957) punctate early in the disease
tiny collections of contrast material are seen to
be evenly distributed throughout the
gland globular an apple tree in blossom image in
a more advanced stage cavity the picture
progresses to the presence of a few large,
irregular globules of contrast material destructiv
e the end stage reflects the total destruction of
the gland, characterized by bizarre pooling and
puddling of contrast material atrophic mass
lesions
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Imaging diagnosis of salivary diseases
sialadenosis
Sialadenosis endocrine dystrophic-metabolic neurog
enic associated systemic diseases diabetes
mellitus hypothyroidism cirrhosis protein and
vitamin deficiencies anorexia nervosa clinically
reflected by the presence of a bilateral chronic
or recurrent, painless swelling
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Imaging diagnosis of salivary diseases
sialadenosis
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THANKS FOR ATTENTION