Sjogrens Syndrome: Comparison of Assessments with Quantitative Salivary Gland Scintigraphy and Contr

1
Sjogrens Syndrome Comparison of Assessments
with Quantitative Salivary Gland Scintigraphy and
Contrast Sialography

• J Nucl Med 2000 41 257-262

2
Sjogrens 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.

3
Sjogrens 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)

4

• No standard method for assessing Sjorgrens
  syndrome has been established
• No report has deal with the relationships between
  quantitative scintigraphic parameters and
  sialographic findings

5

• In this study
• Comparing quantitative parameters of salivary
  gland scintigraphy and sialographic findings in
  Sjogrens syndrome.
• Determining useful scintigaphic parameters for
  evaluation of salivary gland disease and
  calculated an equation to correlate the
  sialographic stage with the scintigraphic
  parameters.

6
MATERIALS AND METHODS
7

• 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 Sjogrens syndrome.
• Sjogrens 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).

8

• Imaging Examination
• Dynamic salivary scintigraphy
• Performed after intravenous injection of 370 MBq
  99mTc-sodium pertechnetate
• G camera and analysis system

9
lemon juice
FIGURE 1. Schematic presentation of
time-activity curve in salivary gland
scintigraphy. This represents normal pattern.
10
TABLE 1. Definition of Functional Parameters in
Salivary Gland Scintigraphy
11

• UR and MA quantity of accumulation
• MS quantity of secretion.
• Tmax velocity of accumulation and spontaneous
  secretion.
• Tmin velocity of secretion after stimulation

12

• Imaging examination
• Contrast sialography
• A catheter was used to inject a 0.5 to 0.7 ml
  dose of iohexol into the Stensens duct in
  patients.

13

• Contrast sialograms
• Rubin and Holt classification

14
RESULTS
15
TABLE 2. Comparison of Scintigraphic Parameters
in Healthy Volunteers and Patients with Sjogrens
syndrome
16
TABLE 3. Correlation of Scintigraphic Parameters
and Sialographic Staging in Patients with
Sjogrens syndrome
17

• Regression analysis
• In the submandibular gland, decrease of the
  tracer accumulation highly correlated with the
  sialographic staging (UR r -0.528, Plt0.0001
  MA r -0.554, Plt0.0001)
• in the parotid gland, dcrease of the tracer
  secretion highly correlated with the sialographic
  staging (MS r -0.570, Plt0.0001)

18

• Sialographic stage 3.243 - 0.337
  (submandibular UR) 0.026 (parotid MS)

19
FIGURE 2. Images of 31-y-old woman without
Sjogrens syndrome (sialographic stage 0)
20
(No Transcript)
21
FIGURE 3. Images of 56-y-old woman (patient 2)
with Sjigrens syndrome (sialographic stage 2).
22
(No Transcript)
23
FIGURE 4. Images of 54-y-old woman (patient 3)
with Sjogrens syndrome (sialographic stage 4).
24
(No Transcript)
25
DISCUSSION
26

• 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.

27

• 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 Sjorgrens
  syndrome has been established
• No report has deal with the relationships between
  quantitative scintigraphic parameters and
  sialographic findings

28

• 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.

29

• 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 Sjogrens syndrome
• Previous report (Umehara et al., 1999)

30

• 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 Sjogrens 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
  )

31

• 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
  Sjogrens syndrome

32

• Sjogrens 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)

33
CONCLUSION
34

• Sjogerns 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

35
THANK YOU