SCINTIGRAPHIC EVALUATION OF SIALADENITIS

Salivary gland scintigraphy using (TCm)-T-99 sodium pertechnetate and a 20-min dynamic data acquisition with a sialogogue at 10 min was empl oyed as the primary imaging modality in sialadenitis in 32 patients. P aired asymptomatic glands within the study group were used to establis h control values for a number of computer-derived functional parameter s. The shape of the activity-time curve was described as: H = hyperact ive, N = normal, M = median, S = sloped, F = flat, O = obstructed. Of seven patients who had ductal stones on plain films, two passed stones prior to sialography and had normal curves, whole the remaining five patients had Type O curves. Parametric evidence of gland dysfunction w as identified in an additional seven symptomatic glands, six being hyp eractive; histology identified an acute inflammatory infiltrate in the only excised gland in this group. Glandular hypofunction was identifi ed in one case, in which histology revealed extensive fibrosis and gla ndular atrophy. Type M and S curves were found in 28 glands, 75% of wh ich were asymptomatic. Only one gland was indicated as hypoactive by c alculated parameters, and this showed a Type S curve. Scintigraphy and plain films represent the least invasive and, we feel, the most suita ble primary method of investigating sialadenitis. Conventional contras t sialography may be reserved for cases with no identifiable stone but an obstructed curve. The use of functional parameters and curve morph ology to determine gland dysfunction other than obstruction is non-spe cific, probably insensitive and is unlikely to alter clinical manageme nt. We propose an algorithm for the investigation of sialadenitis.