The Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Patients With Brain Lesions: A Preliminary Study

Abstract

ObjectiveTo evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions.MethodsThe medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed.ResultsEleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p<0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%).ConclusionIn patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.

Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion

“…The sample size calculation was based on the author's preliminary data of 35 patients by using the value and those standard deviation of parameters correlated with aspiration pneumonia. [3] The largest SD was 2.0. With α of less than 0.05 in two-tailed tests and a power of 80%, the authors calculated that their target sample size was 84 stroke patients with dysphagia.…”

“…[16] Based on the previous study that has shown that salivary aspiration was associated with MMSE, GDS, and total score of the MBI, these clinical parameters were investigated in this study. [3] We excluded patients who had a more than 7-day interval between the VFSS and the measurement of clinical parameters. Therefore, in all patients included in this study, the radionuclide salivagram, VFSS, and the measurement of clinical parameters were performed within a week.…”

“…Images were taken with a gamma camera (GE Healthcare, 102 Discovery NM630, Buckinghamshire, England). [3,25,26] The radionuclide salivagram images were analyzed by an experienced nuclear medicine doctor. Aspiration was reported to be present when radiopharmaceutical activity was detected in tracheobronchial fields.…”

“…[1] In diagnosis of dysphagia in stroke patients, videofluoroscopic swallowing study (VFSS) is considered as the golden standard and has become the most common method to assess swallowing ability and aspiration in clinical practice. [2,3] However, despite this usefulness of VFSS in evaluating dysphagia, previous studies using VFSS have reported significant false-negative results in predicting aspiration pneumonia. [4] In those studies, the authors estimated that the significant false-negative results of VFSS in predicting aspiration pneumonia may be due to episodic aspiration that may not be accurately reflected during examination, or salivary aspiration, which cannot be detected in VFSS.…”

“…In order to overcome these limitations of VFSS in predicting aspiration pneumonia, the radionuclide salivagram has been investigated as a tool to complement VFSS in previous studies. [3,5–7] In addition to aspiration in VFSS, multiple previous cerebral infarctions, brainstem stroke, oral hygiene, previous cardiopulmonary disease (e.g., chronic obstructive pulmonary disease and congestive heart failure), salivary aspiration, masticatory muscle paralysis, abolition of gag reflex, and impaired cough reflex have been reported as another risk factor of the aspiration pneumonia in the previous studies. [8–11] However, although stroke is one of the most common causes of dysphagia, no studies have investigated the radionuclide salivagram as a predictor of aspiration pneumonia in patients with stroke.…”