Sialographic analysis of parotid ductal abnormalities associated with Sjogren's syndrome

Abstract

Objectives To analyze the location and degree of parotid ductal abnormalities associated with Sjogren's syndrome (SS) and to correlate findings with the duration of the disease. To develop a classification system based on contemporary sialography techniques and employ the system to grade findings on sialograms. To assess the role for therapeutic intervention in patients with SS. Methods Retrospective chart review of a consecutive series of 337 sialograms done by the senior investigator over a 10‐year period identified 26 sialograms in patients who met the criteria for SS as defined by the American‐European Consensus Group (2002). A classification system was developed to grade the degree of ductal abnormalities identified on the sialograms. Individual, initial blinded review of these sialograms was performed by two head and neck radiologists to identify and grade abnormalities. Radiographic findings were correlated with patient history including symptom duration. Results All patients with SS had stenoses within the ductal system. About 73.1% of patients had stenoses in each branch of the ductal system (primary, secondary, and tertiary ducts). In 19% of patients, the main duct was of normal caliber despite the presence of stenosis in the more proximal ducts (secondary and tertiary ducts). Peripheral (proximal) duct dilation was characterized among those affected in patterns classified as destructive (34.6%), cavitary (26.9%), globular (11.5%), or punctate (11.5%). A statistically significant positive correlation (p = .0360) was identified between symptom duration and degree of main ductal stenosis. Conclusion Sialography may be useful to objectively assess the degree of parotid ductal damage in SS employing a newly proposed classification system. This assessment may assist clinicians in tailoring management to selectively include ductal dilation.

Sialographic Analysis of Radioiodine‐Associated Chronic Sialadenitis

“…Patterns of structural disease identified on sialography can assist in differentiating I‐131 induced salivary gland destruction from other causes of salivary dysfunction. In contrast to the patterns identified in I‐131 sialadenitis, our previous work demonstrated that Sjogren's syndrome more commonly affects the proximal parotid ducts relative to the distal ducts, which may become involved later in the disease process 13 . The capacity to distinguish etiology of ductal pathology is particularly important for patients with autoimmune disease who undergo I‐131 therapy, as autoimmune thyroid disease and Sjogren's syndrome are the most commonly concomitant polyautoimmunities 30 .…”

“…The sialograms were systematically evaluated and scored by two neuroradiologists (BP and JEM) applying the Iowa parotid sialogram scale to classify ductal stenoses/strictures, peripheral ductal dilations, and patterns of contrast retention, as previously described (Table I). 13 We adapted this classification – initially developed to address the parotid gland – to additionally apply it to submandibular gland sialography. This classification system describes location of the ductal stenosis, degree of the ductal stenosis, retention of contrast, and peripheral duct dilation.…”

“…Sialography has been reported as useful in characterizing the ductal and parenchymal changes associated with many salivary diseases, including sialosis, juvenile recurrent parotitis, Sjogren syndrome, and salivary gland calculi 10–13 . To our knowledge, sialography has yet to be similarly studied in assessing radioiodine‐associated sialadenitis.…”

“…The objective of this study was to analyze the sialographic findings from patients with I‐131‐associated ductal stenosis utilizing a novel classification system as previously described, 13 and to correlate these findings to I‐131 dose and duration of symptoms.…”

Three-dimensional cone-beam computed tomographic sialography in the diagnosis and management of primary Sjögren syndrome: Report of 3 cases

“…Cavitary and destructive sialectasis are more prevalent in advanced cases, and punctate foci of calcifications in major salivary glands and multiple cystic or solid intraglandular masses in a miliary pattern are occasionally seen in Sjögren syndrome patients. 14 …”