Advertisement

Diagnostic Procedures (II): Parotid Scintigraphy, Parotid Ultrasound, Magnetic Resonance, Salivary Gland Biopsy

  • Gabriela Hernández-Molina
  • Eric Kimura-Hayama
  • María del Carmen Ávila-Casado
  • Jorge Sánchez-Guerrero
Chapter

Abstract

Salivary gland involvement is a hallmark of Sjögren’s syndrome (SS). Besides the assessment of salivary gland function with objective tests such as sialometric methods, the analysis of gland specimens as well as some image methods are useful in the evaluation of these patients. For instance, the current American-European Consensus Group (AECG) criteria for SS [1] consider the performance of a labial salivary gland biopsy, salivary gland scintigraphy, and a sialography as tests to evaluate these patients. However, a standard algorithm for the evaluation of SS has not been established. Herein, we describe these tests as well as other imaging methods that are used frequently in the evaluation of patients with possible SS.

Keywords

Salivary Gland Parotid Gland Focus Score Sicca Symptom Labial Salivary Gland 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren’s Syndrome: a revised version of the European criteria proposed by the American-European Consensus group. Ann Rheum Dis. 2002;61:554–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Vivino F, Hermann G. Role of nuclear scintigraphy in the characterization and management of the salivary component of Sjögren’s syndrome. Rheum Dis Clin North Am. 2008;34:973–86.PubMedCrossRefGoogle Scholar
  3. 3.
    Shall G, Anderson L, Wolf R, et al. Xerostomia in Sjögren’s syndrome: evaluation by sequential scintigraphy. JAMA. 1971;216:2109–16.CrossRefGoogle Scholar
  4. 4.
    Vinagre F, Santos M, Prata A, et al. Assessment of salivary gland function in Sjögren’s syndrome: the role of salivary gland scintigraphy. Autoimmun Rev 2009;8(8):672–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Pennec Y, Letoux G, Leroy J, et al. Reappraisal of tests of xerostomia. Clin Exp Rheumatol. 1993;11:523–8.PubMedGoogle Scholar
  6. 6.
    Vitali C, Moutsopoulos H, Bombardieri S, The European Study Group on Diagnostic Criteria for Sjögren’s syndrome. The European Community Study Group on diagnostic criteria for Sjögren’s syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjögren’s syndrome. Ann Rheum Dis. 1994;53:637–47.PubMedCrossRefGoogle Scholar
  7. 7.
    Sugihara T, Yoshimura Y. Scintigraphic evaluation of the salivary glands in patients with Sjögren’s syndrome. Int J Oral Maxillofac Surg. 1988;17:71–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Loutfi I, Nair M, Ebrahim A. Salivary gland scintigraphy: the use of semiquantitative analysis for uptake and clearance. J Nucl Med Technol. 2003;31:81–5.PubMedGoogle Scholar
  9. 9.
    Tensing E, Nordström D, Solovieva S, et al. Salivary gland scintigraphy in Sjögren’s syndrome and patients with sicca symptoms but without Sjögren’s syndrome the psychological profiles and predictors for salivary gland dysfunction. Ann Rheum Dis. 2003;62:964–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Henriksen A, Nossent H. Quantitative salivary gland scintigraphy can distinguish patients with primary Sjögren’s syndrome during the evaluation of sicca symptoms. Clin Rheumatol. 2007;26:1837–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Daniels T, Powell M, Sylvester R, et al. An evaluation of salivary scintigraphy in Sjögren’s syndrome. Arthritis Rheum. 1979;22:809–14.PubMedCrossRefGoogle Scholar
  12. 12.
    Saito T, Fakuda H, Horikawa M, et al. Salivary gland scintigraphy with 99mTC-pertechnetate in Sjögren’s syndrome: relationship to clinicopathologic features of salivary and lacrimal glands. J Oral Pathol Med. 1997;26:46–50.PubMedCrossRefGoogle Scholar
  13. 13.
    Nishiyama S, Miyawaki S, Yoshinaga Y. A study to standardize quantitative evaluation of parotid gland scintigraphy in patients with Sjögren’s syndrome. J Rheumatol. 2006;33:2470–4.PubMedGoogle Scholar
  14. 14.
    Ramos-Casals M, Brito-Zeron P, Perez-De-Lis M, et al. Clinical and prognostic significance of parotid scintigraphy in 405 patients with primary Sjögren’s syndrome. J Rheumatol. 2010;37:585–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Hermann G, Vivino F, Goin J. Scintigraphic features of chronic sialadenitis and Sjögren’s syndrome: a comparison. Nucl Med Commun. 1999;20:1123–32.PubMedCrossRefGoogle Scholar
  16. 16.
    Madani G, Beale T. Inflammatory conditions of the salivary glands. Semin Ultrasound CT MR. 2006;27:440–51.PubMedCrossRefGoogle Scholar
  17. 17.
    Rubin H, Holt M. Secretory sialography in diseases of the major salivary glands. AJR Am J Roentgenol. 1957;77:575–98.Google Scholar
  18. 18.
    Bialek EW, Jakubowski W, Zajkowski P, Szopinski KT, Osmolski A. US of the major salivary glands: anatomy and spatial relationships, pathologic conditions, and pitfalls. Radiographics. 2006;26:745–63.PubMedCrossRefGoogle Scholar
  19. 19.
    Chikui T, Shimizu M, Kawazu T, Okamura K, Shiraishi T, Yoshiura K. A quantitative analysis of sonographic images of the salivary gland: a comparison between sonographic and sialographic findings. Ultrasound Med Biol. 2009;35:1254–64.CrossRefGoogle Scholar
  20. 20.
    Wernicke D, Hess H, Gromnica-Ihle E, Krause A, Schmidt WA. Ultrasonography of salivary glands – a highly specific imaging procedure for diagnosis of Sjögren’s syndrome. J Rheumatol. 2008;35:285–93.PubMedGoogle Scholar
  21. 21.
    Makula E, Pokorny G, Rajtar M, et al. Parotid gland ultrasonography as a diagnostic tool in primary Sjögren’s syndrome. Br J Rheumatol. 1996;35:972–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Ariji Y, Ohki M, Eguchi K, et al. Texture analysis of sonographic features of the parotid gland in Sjögren’s syndrome. AJR Am J Roentgenol. 1996;166:935–41.PubMedGoogle Scholar
  23. 23.
    Donets K, Takagi Y, Sumi M, Nakamura T. Sonography as a replacement for sialography for the diagnosis of salivary glands affected by Sjögren’s syndrome (letter). Ann Rheum Dis. 2002;61:276–7.CrossRefGoogle Scholar
  24. 24.
    Salaffi F, Argalia G, Carotti M, et al. Salivary gland ultrasonography in the evaluation of primary Sjögren’s syndrome. Comparison with minor salivary gland biopsy. J Rheumatol. 2000;27:1229–36.PubMedGoogle Scholar
  25. 25.
    Martinoli C, Derchi LE, Solbiati L, Rizzatto G, Silvestri E, Giannoni M. Color Doppler sonography of the salivary glands. AJR Am J Roentgenol. 1994;163:933–41.PubMedGoogle Scholar
  26. 26.
    Spät M, Kruger K, Dresel S, et al. Magnetic resonance imaging of the parotid gland in patients with Sjögren’s syndrome. J Rheumatol. 1991;18:1372–8.Google Scholar
  27. 27.
    Niemelä RA, Takalo R, Pääkkö E, et al. Ultrasonography in primary Sjögren’s syndrome. A comparison with magnetic resonance imaging and magnetic resonance sialography of parotid glands. Rheumatology. 2004;43:875–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Makula E, Pokorny G, Kiss M, et al. The place of magnetic resonance and ultrasonographic examinations of the parotid gland in the diagnosis and follow-up of primary Sjögren’s syndrome. Rheumatology. 2000;39:97–104.PubMedCrossRefGoogle Scholar
  29. 29.
    El Miedany YM, Ahmed I, Mourad HG, et al. Quantitative ultrasonography and magnetic resonance imaging of the parotid gland: can they replace the histopathologic studies in patients with Sjögren’s syndrome? Joint Bone Spine. 2004;71:29–38.PubMedCrossRefGoogle Scholar
  30. 30.
    Valesini G, Gualdi GF, Priori R, et al. Magnetic resonance imaging of the parotid gland and the lip biopsy in the evaluation of xerostomy in Sjögren’s syndrome. Scand J Rheumatol. 1994;23:103–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Daniels T, Whitcher J. Association of patterns of labial salivary gland inflammation with keratoconjunctivitis sicca. Arthritis Rheum. 1994;37:869–77.PubMedCrossRefGoogle Scholar
  32. 32.
    Daniels T. Labial salivary gland biopsy in Sjögren’s syndrome. Assessment as a diagnostic criterion in 362 suspected cases. Arthritis Rheum. 1984;27:147–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Friedman J, Miller E, Huszar M. A simple technique for minor salivary gland biopsy appropriate for use by rheumatologists in an outpatient setting. Clin Rheumatol. 2002;21:349–50.PubMedCrossRefGoogle Scholar
  34. 34.
    Amigo M, Vidal M, Martinez-Lavin M. Minimally-invasive salivary gland biopsy technique. J Clin Rheumatol. 2007;8:236.CrossRefGoogle Scholar
  35. 35.
    Guevara-Gutierrez W, Tlacuilo-Parra A, Minjares-Padilla L. Minor salivary gland punch biopsy for evaluation of Sjögren’s syndrome. J Clin Rheumatol. 2001;7:401–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Caporali R, Bonacci E, Epis O, et al. Safety and usefulness of minor salivary gland biopsy: retrospective analysis of 502 procedures performed at a single center. Arthritis Rheum. 2008;59:714–20.PubMedCrossRefGoogle Scholar
  37. 37.
    Manthorpe R. How should we interpret the lower lip biopsy finding in patients investigated for Sjögren’s syndrome? Arthritis Rheum. 2002;47:114–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Pijpe J, Kalk W, van der Wal J, et al. Parotid gland biopsy compared with labial biopsy in the diagnosis of patients with primary Sjögren’s syndrome. Rheumatology. 2007;46:335–41.PubMedCrossRefGoogle Scholar
  39. 39.
    Segerber-Konttinen M. A postmortem study of focal adenitis in salivary and lachrymal glands. J Autoimmun. 1989;2:553–8.CrossRefGoogle Scholar
  40. 40.
    Xu K, Katagiri S, Takeuchi T, Tsubota K. Biopsy of labial salivary glands and lachrymal glands in the diagnosis of Sjögren’s syndrome. J Rheumatol. 1996;23:76–82.PubMedGoogle Scholar
  41. 41.
    Chisholm D, Manson D. Labial salivary gland biopsy in Sjögren’s disease. J Clin Pathol. 1968;21:656.PubMedCrossRefGoogle Scholar
  42. 42.
    Greenspan J, Daniels T, Talal N, et al. The histopathology of Sjögren’s syndrome in labial salivary gland biopsies. Oral Surg Oral Med Oral Pathol. 1974;37:21–9.CrossRefGoogle Scholar
  43. 43.
    Tarpley T, Anderson L, White C. Minor salivary gland involvement in Sjögren’s syndrome. Oral Surg Oral Med Oral Pathol. 1974;37:64–73.PubMedCrossRefGoogle Scholar
  44. 44.
    Vitali C, Bombardieri S, Moutsopoulos H, et al. Preliminary criteria for the classification of Sjögren’s syndrome. Results of an EEC prospective concerted action. Arthritis Rheum. 1993;36:340–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Vitali C, Bombardieri S, Moutsopoulos M, et al. Assessment of the European classification criteria for Sjögren’s syndrome in a series of clinically defined cases: results of a prospective multicentre study. Ann Rheum Dis. 1996;55:116–21.PubMedCrossRefGoogle Scholar
  46. 46.
    Langerman A, Blair E, Sweiss N, et al. Utility of lip biopsy in the diagnosis and treatment of Sjögren’s syndrome. Laryngoscope. 2007;117:1004–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Al-Hashimi I, Wright J, Cooley C, et al. Reproducibility of biopsy grade in Sjögren’s syndrome. J Oral Pathol Med. 2001;30:408–12.PubMedCrossRefGoogle Scholar
  48. 48.
    Scardina G, Spano G, Carini F, et al. Diagnostic evaluation of serial sections of labial salivary gland biopsies in Sjögren’s syndrome. Med Oral Patol Oral Cir Bucal. 2007;12:E565–8.PubMedGoogle Scholar
  49. 49.
    Morbini P, Manzo A, Caporali R, et al. Multilevel examination of minor salivary gland biopsy for Sjögren’s syndrome significantly improves diagnostic performance of AECG classification criteria. Arthritis Res Ther. 2005;7:R343–8.PubMedCrossRefGoogle Scholar
  50. 50.
    Manthorpe R, Benoni C, Jacobsson L, et al. Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjögren’s syndrome? Ann Rheum Dis. 2000;59:54–60.PubMedCrossRefGoogle Scholar
  51. 51.
    Segerberg-Konttinen M. Focus score in sialolithiasis. Scand J Rheumatol. 1988;17:87–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Radfar L, Kleiner D, Fox P, et al. Prevalence and clinical significance of lymphocytic foci in minor salivary glands of healthy volunteers. Arthritis Rheum. 2002;47:520–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Segerber-Konttinen M, Konttinen Y, Bergroth V. Focus score in the diagnosis of Sjögren’s syndrome. Scand J Rheumatol Suppl. 1986;61:47–51.Google Scholar
  54. 54.
    Bamba R, Sweiss N, Langerman A, et al. The minor salivary gland biopsy as a diagnostic tool for Sjögren’s syndrome. Laryngoscope. 2009;119:1922–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Lee M, Rutka J, Slomovic A, et al. Establishing guidelines for the role of minor salivary gland biopsy in clinical practice for Sjögren’s syndrome. J Rheumatol. 1998;25:247–53.PubMedGoogle Scholar
  56. 56.
    Gerli R, Muscat C, Giansanti M, et al. Quantitative assessment of salivary gland inflammatory infiltration in primary Sjögren’s syndrome: its relationship to different demographic, clinical and serological features of the disorder. Br J Rheumatol. 1997;36:969–75.PubMedCrossRefGoogle Scholar
  57. 57.
    Wise C, Woodruff R. Minor salivary gland biopsies in patients investigated for primary Sjögren’s syndrome. A review of 187 patients. J Rheumatol. 1993;20:151–8.Google Scholar
  58. 58.
    Brennan M, Sankar V, Leakan R, et al. Risk factors for positive minor salivary gland biopsy findings in Sjögren’s syndrome and dry mouth patients. Arthritis Rheum. 2002;4:189–95.CrossRefGoogle Scholar
  59. 59.
    Govoni M, Trotta F, Cavazzini L. Risk factors for positive minor salivary gland biopsy findings in Sjögren’s syndrome and dry mouth patients: something new? Arthritis Rheum. 2003;15(49):145–6.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Gabriela Hernández-Molina
    • 1
  • Eric Kimura-Hayama
    • 2
  • María del Carmen Ávila-Casado
    • 3
  • Jorge Sánchez-Guerrero
    • 1
  1. 1.Immunology and Rheumatology DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
  2. 2.Tomography DepartmentInstituto Nacional de Cardiología Ignacio, ChávezMexico CityMexico
  3. 3.Department of PathologyInstituto Nacional de Cardiología Ignacio, ChávezMexico CityMexico

Personalised recommendations