COLOR DOPPLER SONOGRAPHY OF SALIVARY-GLANDS

OBJECTIVE. We used color Doppler sonography to evaluate the vascular a natomy of the salivary glands and to analyze physiologic changes that occur during salivary stimulation in normal subjects and the flow alte rations that occur in diseased glands. SUBJECTS AND METHODS. The vascu lar appearance of the three major salivary glands was examined in heal thy volunteers (n = 24); in patients with chronic autoimmune diseases, including Sjogren's syndrome (n = 23) and salivary sarcoidosis (n = 2 ); and in a variety of benign (n = 49) and malignant (n = 13) nodules. Physiologic changes were assessed in healthy volunteers by means of a stimulation test with lemon and were quantified with color images and spectral analysis. Tumor vascularity was graded on a four-step analog scale of 0 to +++ and classified as either peripheral or hilar, depen ding on the distribution of vessels. RESULTS. In the control subjects, color Doppler imaging accurately reflected the complex vascular anato my of the salivary glands and showed dramatic changes occurring in par enchymal vessels during lemon stimulation as a result of the intense h yperemia associated with the secretion of saliva. Sjogren's syndrome a nd sarcoidosis showed a diffuse hypervascular pattern when morphologic changes of salivary parenchyma were seen on gray-scale sonograms. Ben ign tumors showed a lower grade of vascularity than did malignant tumo rs. All but one of the hypovascular nodules graded as 0 (n = 8) and (n = 23) were benign. Conversely, eight of 11 nodules labeled with the highest grade of tumor vascularity (+++) were malignant. When the pat tern of tumor flow signals was peripheral, it could be considered spec ific enough to aid in diagnosing pleomorphic adenoma. Peak systolic ve locities greater than 60 cm/sec were never detected in benign tumors a nd were seen in only 44% of malignant tumors. CONCLUSION. Color Dopple r sonography is a promising technique for analyzing the vascularity of the salivary glands and for characterizing some pathologic conditions . Our experience suggests that color Doppler sonography can provide ad ditional diagnostic information in patients with chronic inflammatory diseases or suspected malignant tumors and can help in differentiating pleomorphic adenomas from other salivary gland tumors.