Semi-quantitative assessment optimized the grading of pulmonary aspiration on salivagram in children

Abstract

Objective

Salivagram is one of the imaging modalities to detect pulmonary aspiration in children. This study aims to optimize the classification of pulmonary aspiration detected by salivagram with a semi-quantitative analytical method.

Methods

This is a retrospective study involving 737 patients (471 males, 266 females; aged 1 month to 8 years; mean age 5.3 months, median age 3.0 months old) with suspected pulmonary aspiration, who had salivagram done between January 2018 and June 2019. Positive cases were divided into 10 groups (Grade 1, R2, L2, R2L2, R3, L3, R3L2, R2L3, R3L3, and 4) according to the scintigraphic findings. Aspiration index was determined as the ratio of the count in the respiratory tract to the total count in the image field of view and compared among different groups using the receiver operating characteristics (ROC) curve analysis.

Results

A total of 180 cases had positive scintigraphic findings of various grades of aspiration (24.4%, 180/737). There is a high consistency among the two independent nuclear medicine physicians involved in the study, in determining both the disease gradings (κ = 0.919;95% CI: 0.915–0.923) and aspiration index (ICC = 0.994;95% CI: 0.993–0.996). There is no significant difference (p > 0.05) in aspiration index among the gradings in “mild” group (grade 1, R2, L2, L2R2), and “moderate” group (grade R3, R3L2, R3L3). After dividing the different grades into “mild”, “moderate” and “severe” groups, the aspiration index of “mild” group is 4.40 ± 2.01, that of “moderate” group is 16.43 ± 8.20, and that of “severe” group is 46.94 ± 14.81. Difference in groups was statistically significant (p < 0.0001). In ROC curve analysis, AUC of “mild” and “moderate” groups is 0.970 and that of “moderate” and “severe” groups is 0.943; the cut-off value with highest diagnostic efficiency is 6.75 between “mild” and “moderate” groups and 38.00 between “moderate” and “severe” groups.

Conclusions

We introduced a semi-quantitative analytical method in pulmonary aspiration on salivagram, to optimize and supplement to the current classification of pulmonary aspiration.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665–71.

    CAS  Article  Google Scholar 

  2. 2.

    Yu KJ, Park D. Clinical characteristics of dysphagic stroke patients with salivary aspiration: a STROBE-compliant retrospective study. Medicine. 2019;98(12):e14977.

    Article  Google Scholar 

  3. 3.

    Yu KJ, Moon H, Park D. Different clinical predictors of aspiration pneumonia in dysphagic stroke patients related to stroke lesion: a STROBE-complaint retrospective study. Medicine. 2018;97(52):e13968.

    Article  Google Scholar 

  4. 4.

    Hunt EB, Sullivan A, Galvin J, MacSharry J, Murphy DM. Gastric aspiration and its role in airway inflammation. Open Respir Med J. 2018;12:1–10.

    CAS  Article  Google Scholar 

  5. 5.

    Tutor JD, Gosa MM. Dysphagia and aspiration in children. Pediatr Pulmonol. 2012;47(4):321–37.

    Article  Google Scholar 

  6. 6.

    Lanspa MJ, Jones BE, Brown SM, Dean NC. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. 2013;8(2):83–90.

    Article  Google Scholar 

  7. 7.

    Rossi UG, Owens CM. The radiology of chronic lung disease in children. Arch Dis Child. 2005;90(6):601–7.

    CAS  Article  Google Scholar 

  8. 8.

    Heyman S. The radionuclide salivagram for detecting the pulmonary aspiration of saliva in an infant. Pediatr Radiol. 1989;19(3):208–9.

    CAS  Article  Google Scholar 

  9. 9.

    Wu H, Zhao R. Image characteristics and classification of salivagram in the diagnosis of pulmonary aspiration in children. Nucl Med Commun. 2017;38(7):617–22.

    Article  Google Scholar 

  10. 10.

    Wu H, Zhao R, Zhao X. Use of static imaging as a substitute for conventional dynamic imaging for salivagrams in children. Clin Nucl Med. 2019;44(7):532–4.

    Article  Google Scholar 

  11. 11.

    Boesch RP, Daines C, Willging JP, Kaul A, Cohen AP, Wood RE, et al. Advances in the diagnosis and management of chronic pulmonary aspiration in children. Eur Respir J. 2006;28(4):847–61.

    CAS  Article  Google Scholar 

  12. 12.

    Jang DH, Choi KH, Kim DH, Lim CM, Kim JS. Comparison between the radionuclide salivagram and videofluoroscopic swallowing study methods for evaluating patients with aspiration pneumonia. Ann Nucl Med. 2013;27(3):247–52.

    CAS  Article  Google Scholar 

  13. 13.

    Yang J, Codreanu I, Servaes S, Zhuang H. Radionuclide salivagram and gastroesophageal reflux scintigraphy in pediatric patients: targeting different types of pulmonary aspiration. Clin Nucl Med. 2015;40(7):559–63.

    Article  Google Scholar 

  14. 14.

    Bar-Sever Z, Connolly LP, Treves ST. The radionuclide salivagram in children with pulmonary disease and a high risk of aspiration. Pediatr Radiol. 1995;25(Suppl 1):S180–3.

    Article  Google Scholar 

  15. 15.

    Drubach LA, Zurakowski D, Palmer EL 3rd, Tracy DA, Lee EY. Utility of salivagram in pulmonary aspiration in pediatric patients: comparison of salivagram and chest radiography. AJR Am J Roentgenol. 2013;200(2):437–41.

    Article  Google Scholar 

  16. 16.

    Ciofetta G. Gastro-esophageal studies in relationship to respiratory problems. Q J Nucl Med Mol Imaging. 2010;54(4):372–8.

    CAS  PubMed  Google Scholar 

  17. 17.

    Somasundaram VH, Subramanyam P, Palaniswamy S. Salivagram revisited: justifying its routine use for the evaluation of persistent/recurrent lower respiratory tract infections in developmentally normal children. Ann Nucl Med. 2012;26(7):578–85.

    Article  Google Scholar 

  18. 18.

    Cook SP, Lawless S, Mandell GA, Reilly JS. The use of the salivagram in the evaluation of severe and chronic aspiration. Int J Pediatr Otorhinolaryngol. 1997;41(3):353–61.

    CAS  Article  Google Scholar 

  19. 19.

    Lee DH, Kim JM, Lee Z, Park D. The effect of radionuclide solution volume on the detection rate of salivary aspiration in the radionuclide salivagram: a STROBE-compliant retrospective study. Medicine. 2018;97(30):e11729.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the SPECT staff and the technologists at our institute for their excellent support. No potential conflicts of interest were disclosed.

Funding

This work is supported by the Open Program of Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province (No. HYX19026). Shanghai “Rising Stars of Medical Talent” Youth Development Program, youth Medical Talents –Medical Imaging Practitioner Program (No. SHWRS2019072).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ha Wu.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Shao, F., Zhao, X., Toyama, H. et al. Semi-quantitative assessment optimized the grading of pulmonary aspiration on salivagram in children. Ann Nucl Med 35, 321–327 (2021). https://doi.org/10.1007/s12149-020-01564-6

Download citation

Keywords

  • Salivagram
  • Pulmonary aspiration
  • Semi-quantitative
  • Aspiration index
  • Grading