_syndrome comparison of assessments with 干燥综合征的评估与比较课件

Sjogrens Syndrome: Comparison of Assessments with Quantitative Salivary Gland Scintigraphy and Contrast Sialography J Nucl Med 2000; 41: 257-262 Sjogrens Syndrome Autoimmune disease Affecting salivary and lacrimal glands Xerostomia (the most common oral symptom). The complaints of patients do not necessarily reflect the severity of their salivary gland disease. Sjogrens syndrome Contrast sialography Gold standard in the diagnosis of the syndrome Invasive method (disadvantages and complications) Salivary gland scintigraphy with 99mTc-sodium pertechnetate Evaluate salivary gland function in xerostomic pateints Easy and noninvasive method (bilateral parotid and submandibular glands) No standard method for assessing Sjorgrens syndrome has been established No report has deal with the relationships between quantitative scintigraphic parameters and sialographic findings In this study Comparing quantitative parameters of salivary gland scintigraphy and sialographic findings in Sjogrens syndrome. Determining useful scintigaphic parameters for evaluation of salivary gland disease and calculated an equation to correlate the sialographic stage with the scintigraphic parameters. MATERIALS AND METHODS Patients 116 consecutive patients (105 woman, 11 men; age range, 18-77 y; mean age, 54 y) who had xerostomia and were clinically suspected of having Sjogrens syndrome. Sjogrens syndrome was diagnosed in 50 of the 116 patients (contrast sialography as gold standard), and confirmed by complete P.E., laboratory testing, labial salivary gland biopsy (all showed histopathological changes of grade 1 or greater). Imaging Examination Dynamic salivary scintigraphy Performed after intravenous injection of 370 MBq 99mTc-sodium pertechnetate camera and analysis system FIGURE 1. Schematic presentation of time-activity curve in salivary gland scintigraphy. This represents normal pattern. lemon juice TABLE 1. Definition of Functional Parameters in Salivary Gland Scintigraphy UR and MA: quantity of accumulation MS: quantity of secretion. Tmax: velocity of accumulation and spontaneous secretion. Tmin: velocity of secretion after stimulation Imaging examination Contrast sialography A catheter was used to inject a 0.5 to 0.7 ml dose of iohexol into the Stensens duct in patients. Contrast sialograms Rubin and Holt classification StageContrast Material Collection ( in diameter ) 0 ( normal )No contrast material collection 1 ( punctate )2 mm 4 ( destructive )Complete destruction of the gland parenchyma RESULTS TABLE 2. Comparison of Scintigraphic Parameters in Healthy Volunteers and Patients with Sjogrens syndrome TABLE 3. Correlation of Scintigraphic Parameters and Sialographic Staging in Patients with Sjogrens syndrome Regression analysis In the submandibular gland, decrease of the tracer accumulation highly correlated with the sialographic staging (UR: r= -0.528, P0.0001; MA: r= -0.554, P0.0001) in the parotid gland, dcrease of the tracer secretion highly correlated with the sialographic staging (MS: r= -0.570, P0.0001) Sialographic stage = 3.243 - 0.337 (submandibular UR) 0.026 (parotid MS) FIGURE 2. Images of 31-y-old woman without Sjogrens syndrome (sialographic stage 0) FIGURE 3. Images of 56-y-old woman (patient 2) with Sjigrens syndrome (sialographic stage 2). FIGURE 4. Images of 54-y-old woman (patient 3) with Sjogrens syndrome (sialographic stage 4). DISCUSSION Contrast sialography Gold standard in the diagnosis of the syndrome Invasive method Potential complications Failure of the cannulation procedure, duct trauma, painful overfilling of the gland, infection, and contrast material reactions. Salivary gland scintigraphy with 99mTc-sodium pertechnetate Evaluate salivary gland function in xerostomic pateints Easy and noninvasive method (bilateral parotid and submandibular glands) No standard method for assessing Sjorgrens syndrome has been established No report has deal with the relationships between quantitative scintigraphic parameters and sialographic findings UR, Tmax, Tmin, MA, and MS as quantitative parameters of salivary gland function. UR and MA: quantity of accummulation MS: quantity of secretion. Tmax: velocity of accumulation and spontaneous secretion. Tmin: velocity of secretion after stimulation. UR and MA of the submandibular gland and the MS of the parotid gland are highly correlated with the sialographic staging Decreased accumulation in the submandibular gland and decreased secretion in the parotid gland are highly sensitive indicators of salivary gland disease in Sjogrens syndrome Previous report (Umehara et al., 1999) Why? Parenchymal volumes, spontaneous secretion, compositions of serous and mucous glands. Further study is needed to clarify the different functional change between the parotid and submandibular glands in Sjogrens syndrome The function of the submandibular gland was more affected than that of the parotid gland. (Sugihara et al., 1988 and Hakansson et al., 1994 ) Controversy remains as to which parameter is better for assessing salivary gland disease.( Hausler et al., 1977, Arrago., 1987, Hakansson., 1994, Bohuslavizki., 1995) The study indicated that decreased accumulation in the submandibular gland and decreased secretion in the parotid gland are highly sensitive indicators of salivary gland disease in Sjogrens syndrome Sjogrens syndrome was statistically significantly correlated with scintigraphic parameters By means of stepwise regression analysis (sialographic stage versus UR of the submandibular gland and MS of the parotid gland) CONCLUSION Sjogerns syn