applied diagnostic imaging of salivary glands
TRANSCRIPT
![Page 1: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/1.jpg)
TASHI FUTI SHERPA
ROLL NO: 37
BDS 4TH YEAR
APPLIED DIAGNOSTIC IMAGING OF SALIVARY GLANDS.
![Page 2: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/2.jpg)
2
CONTENTS : Introduction
Strategies for diagnostic imaging
• Projection radiograph
• Conventional sialography
• Computed tomography
• Cone beam computed tomography
• Magnetic resonance imaging
• Scintigraphy
• Ultrasonography
• Sialoendoscopy
Summary
References
![Page 3: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/3.jpg)
3
INTRODUCTION Diagnostic imaging of salivary gland diseases
may be undertaken
To diffrentiate inflammatory process from neoplastic disease
To distinguish diffuse disease from focal suppurative disease
To identify and localize sialoliths
To demonstrate ductal morphology
To determine the anatomic location of tumor
To diffrentiate benign from malignant disease
To aid in selection of biopsy sites
![Page 4: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/4.jpg)
4
STRATEGIES FOR DIAGNOSTIC IMAGING.Imaging modalities available to assess salivary
glands include:
• Projection radiograph
• Conventional sialography
• Computed tomography
• Cone beam computed tomography
• Magnetic resonance imaging
• Scintigraphy
• Ultrasonography
• Sialoendoscopy
![Page 5: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/5.jpg)
5
PROJECTION RADIOGRAPH- Fundamental part of the examination of salivary
glands.
- Two dimensional images acquired which can demonstrate moderaely calcified sialoliths and possible involvement of adjacent osseous structures.
-Intraoral radiography
-Extraoral radiography
![Page 6: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/6.jpg)
6
INTRAORAL RADIOGRAPHY:
• Intra oral occlusal view is helpful.
• Sialoliths in anterior two thirds of the submandibular ducts are typically imaged by cross-sectional mandibular occlusal projection.
• The posterior portion of duct may be demonstrated with over the shoulder occlusal projection.
![Page 7: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/7.jpg)
7
• Parotid sialoliths difficult to demonstrate tortuous course of Stensen’s duct around the anterior border of masseter.
• As a rule, only sialoliths anterior to the masseter muscle can be imaged on an intraoral image.
• Intraoral image receptor placed inside the cheek as high as possible in the buccal sulcus. Central ray is directed perpendicular to the centre of receptor.
![Page 8: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/8.jpg)
8
Fig: Mandibular occlusal view
![Page 9: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/9.jpg)
9
Fig: over the shoulder occlusal projection reveals a sialolith.
![Page 10: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/10.jpg)
10
EXTRAORAL RADIOGRAPHY:
Parotid gland.• PA view• Panoramic projection
Submandibuar gland.
• Lateral view• Panoramic projection
![Page 11: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/11.jpg)
11
Fig: pantamograph , calculus in distal segment of left wharton”s duct.
![Page 12: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/12.jpg)
12
Fig: parotid sialolith superimposed over condylar neck.
![Page 13: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/13.jpg)
13
![Page 14: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/14.jpg)
14
CONVENTIONAL SIALOGRAPHY• First performed in 1902
• It is a radiographic technique where a radiopaque contrast agent is infused into the ductal system of a salivary gland before imaging with plain films/digital image receptors, panoramic radiographhy,
CBCT imaging or MDCT imaging.
ADVANTAGES:
- multiplanar and 3D visualization of ductal structures
- Ability to remove overlapping anatomic structures
![Page 15: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/15.jpg)
15
• The ductal systems of parotid & submandibular glands are most readily studied.
• A survey or “scout” image aid in verifying the optimal exposure factors and patient positioning parameters as well as detection of radiopaque sialoliths or extraglandular pathosis.
![Page 16: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/16.jpg)
16
Indications :• Detection of sialoliths or foreign bodies.
• Evaluation of fistulae,strictures,diverticula,communicating cysts & ductal trauma.
• Evaluating the extent of irreversible ductal damage.
• Diffrentiating between diseases.
• Evaluation of masses within the salivary glands.
Contraindications:• Allergic to contrast agent.
• Malignant lesions
• Acute infections.
• Pregnancy
• Immediately anticipated thyroid function tests.
![Page 17: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/17.jpg)
17
TECHNIQUE:
Lacrimal dilators:dilate the sphincters at ductal orifice
Passage of cannula connected by extension tubing to a syringe.
Slowly infuse the contrast solution.
Filling phase monitored by fluoroscopy or projection images.
-The image of ductal system appears as “tree limbs”.-With acinar filling,the “tree” comes into “bloom”.
![Page 18: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/18.jpg)
18
• The gland is allowed to empty for 5 mins without stimulation.
• Sialogogues such as lemon juice or 2% citric acid augment evacuation.
• The opacified gland can be imaged with:
Projection radiographs
CBCT
MDCT
MRI
![Page 19: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/19.jpg)
19
![Page 20: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/20.jpg)
20
COMPUTED TOMOGRAPY:• Provides precise anatomical detail.
• Detects calcifications with high sensitivity .
• Indicated for evaluation of masses or generalized enlargement of glands, acute inflammatory processes or abscesses.
• Poor visualization of salivary ducts inferior to sialography.
![Page 21: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/21.jpg)
21
![Page 22: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/22.jpg)
22
Fig: axial view demonstrates bilateral enlargement of parotid glands.
![Page 23: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/23.jpg)
23
CONE-BEAM COMPUTED TOMOGRAPHY • Minimally calcified sialolithiasis is well
depicted
• Provides three-dimensional visualization of ductal structure
Fig:submandibular sialolith
![Page 24: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/24.jpg)
24
MAGNETIC RESONANCE IMAGING:• Noninvasive & nonionizing radiation
• Best contrast resolution of soft tissues
Indications:• Evaluating parenchymal masses/ cystic lesions
• Neoplasia
• Sublingual masses
![Page 25: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/25.jpg)
25
Advantages :
• Noninvasive & use nonionizing radiation
• Excellent soft tissue contrast resolution.
Disadvantages:
• Contraindicated with pacemaker or metal implant.
• Long imaging time
• High cost
![Page 26: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/26.jpg)
26
MR SIALOGRAPHY
• Allows for precise morphological evaluation of salivary ducts & enables the visualization of tertiary branches.
• Performed before/after stimulation with lemon juice.
• It can reveal:
- intraglandular duct dilatation
- reveals stenoses
- Very tiny stones
![Page 27: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/27.jpg)
27
MR Sialography of left submandibular gland.
Dilated proximal segment of wharton”s
duct
Dilated intraglandular salivary duct
![Page 28: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/28.jpg)
28
![Page 29: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/29.jpg)
29
SCINTIGRAPHY:
• Uses radioactive atoms or molecules that emit gamma rays
• Distribute in the body according to chemical properties
• Gamma camera detects gamma rays and forms planar images.
Indicated in patients when sialography is contraindicated or cannot be performed.
Sod. Pertechnetate (technetium99) is the commonly used element.
.
![Page 30: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/30.jpg)
30
• i.v injection of Tc-99m pertechnate is performed with gamma camera images obtained in every2 mins.
• Radionuclide appears in the ducts within minutes & reaches maximal concentration within 30-45 mins.
• A sialogogue is then administered to evaluate secretory capacity.
Abnormalities may be demonstrated by an increased, decreased or absent radionuclide uptake.
Increased uptake is seen in – Warthin”s tumor
- Oncocytomas
- Sialadenitis
- Granulomatous disease
- Resulting in formation of “hot spot”
![Page 31: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/31.jpg)
31
Fig: salivary gland scintigraphy showing parotid and submandibuar glands.
![Page 32: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/32.jpg)
32
![Page 33: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/33.jpg)
33
ULTRASONOGRAPHY:
• Technique based on sound waves that acquires images without the use of ionizing radition.
• The primary application are the diffrentiation of solid masses from cystic ones & guided FNAC.
• More recent studies suggest thet this technique may also be helpful in detecting sialoliths & dignosing autoimmune lesions( Sjogren”s syndrome )
![Page 34: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/34.jpg)
34
![Page 35: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/35.jpg)
35
Fig: ultrasonogram of submandibular gland , salivary stone in Wharton”s duct.
![Page 36: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/36.jpg)
36
SIALOENDOSCOPY• Introduced in 1990’s
• Allows direct visualisation of salivary duct lumen i.e
- Calculi
- Mucosal plugs
- Foreign bodies
- Polyp
• Enabled the surgeons to examine the duct from inside
![Page 37: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/37.jpg)
37
Fig: A.sialoendoscopic view of intraglandular branches of stensen’s duct B.sialoendoscopic view of calculus inside the wharton’s duct
![Page 38: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/38.jpg)
38
SUMMARY
![Page 39: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/39.jpg)
39
![Page 40: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/40.jpg)
40
REFERENCES
• Oral radiology – principles & interpretation
- Stuart C. white
- Micheal J. pharoah
• Salivary gland calculi – contemporary methods of imaging (pol J radiol,2010 july-sep;75(3) PMC3389885 )
- Iwona rzymska ,Zygmunt stopa, Bartomiej grala,
Marek golebioski, Hubert wanyura, Monika sawika
• Burket”s oral medicine , 11th edition
- Greenberg
- Glick
- Ship
![Page 41: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/41.jpg)
41
Thank you !
![Page 42: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/42.jpg)
42
QUESTIONS:
• 1. injection technique: -hydrostatic injection
• Distention injection
• Hand injection
• Contraindications of sialography:
• Allergic to contrast agent
• Malignant lesions of salivary gland
• Pregnancy
• Acute salivary gland infections
![Page 43: Applied diagnostic imaging of salivary glands](https://reader036.vdocuments.us/reader036/viewer/2022062304/55d08993bb61ebd9188b460b/html5/thumbnails/43.jpg)
43
• Evacuation phase of sialography
• Non stimulated
• Stimulated
• Contrast agents:
• Lipiodol
• Conray 80
• Myodil
• Amipaque
• sinographin