电算体层和涎腺造影:1.正常解剖

应用电算体层(CT)检查明显改善了涎腺及邻近软组织的显示。普通CT检查即可显示腮腺和颌下腺,CT联合涎腺造影对涎腺病变诊断非常有帮助。本文介绍正常涎腺CT检查及联合涎腺造影CT检查横断面及冠状面表现。造影方法,首先用泪腺探子扩张涎腺管,于荧光屏监视下注入造影剂,多数病人用碘油制剂,少数具狭窄、结石等梗阻病例则使用水溶性造影剂。其后行CT横断及冠状扫描。正常腮腺密度因含有多量脂肪和浓缩唾液而低于肌肉,范围-20～+20Hu。腮腺大小因人而异。在横断层面上,腮腺位于乳突尖与下颌骨髁状突之     

电算体层和涎腺造影:2.疾病诊断

本文通过分析常规涎腺造影及电算体层(CT)表现,说明涎腺造影联合CT检查对涎腺区肿瘤具较高诊断价值。 98例涎腺病变来自两个医疗中心。其中涎腺病变76例、颌下腺病变22例,病变包括良、恶性肿瘤、炎症、脓肿等。多数病人于常规涎腺造影后即行CT检查,部份病例进行了常规断层。常规涎腺造影主要依据各级腺管移位这个间接征象来进行疾病诊断。CT具较高密度分辨力,普通CT检查即可显示涎腺大小及形态,涎腺造影后CT检查可进一步显示涎腺内部结构。涎腺良性肿瘤如涎腺混合瘤、神经鞘瘤、脂肪瘤、血管瘤等,     

MR涎管造影临床研究及应用

目的 评价MR涎管造影的各种序列技术和临床应用。方法 依次采用短时反转恢复序列(STIR)、重T2加权快速自旋回波序列(重T2WIFSE)、单次激发快速自旋回波序列(SSFSE)，厚层扫描，快速采集，于服用维生素C(VitC)前后分别扫描。检查了30例，其中13例为志愿者，17例为可疑涎管异常者。结果 3种序列均能显示正常腮腺和颌下腺主导管。13例志愿者STIR序列均能清晰显示涎管1级和2级分支，2例能显示管径约为0．8mm的末梢分支；重T2WIFSE序列可清晰显示13例志愿者1级分支、10例2级分支；SSFSE序列可显示10例涎管1级分支、6例2级分支。STIR序列能清晰显示患者主导管和涎管1、2级分支；重T2WIFSE序列清晰显示患者12例涎管1级、8例2级分支；SSFSE序列清晰显示患者10例1级分支、4例2级分支。17例可疑异常者，腺体炎症7例，急性炎症主导管稍增粗，末梢导管呈点、球状扩张；颌下腺癌1例，导管受压移位，呈截断状改变；良性肿瘤7例，涎管受压移位，无中断；干燥综合征及涎腺病各1例，涎管未见明显异常。16例患者含服VitC0．2g后5min重复扫描，涎管显示较前增粗。结论 MR涎管造影能清晰显示腮腺和颌下腺导管系统，其中STIR序列能清晰显示导管2级分支，是1种显示涎管的非侵袭性方法，含服VitC后可使唾液分泌增多，从而使涎管显示率增加，具有较高的临床实用价值。     

曲面体层摄影受检者的X线辐射剂量研究

目的：测量颌骨牙列曲面体层摄影人体不同组织器官的X线吸收剂量,并计算当量剂量、有效剂量以及涎腺有效剂量。方法：使用仿真成年人体模测量颌骨牙列曲面体层摄影时腮腺、颌下腺、舌下腺、下颌骨表面、眼晶体、垂体、受照区皮肤、颈椎红骨髓、甲状腺、乳腺、卵巢以及睾丸等器官组织的X线吸收剂量,计算各器官组织的X线当量剂量、有效剂量以及涎腺有效剂量。结果：X线吸收剂量0μGy~730.50μGy,当量剂量0μSv~730.50μSv,有效剂量36.28μSv,涎腺有效剂量47.78μSv。结论：颌骨牙列曲面体层摄影受检者X线吸收剂量、当量剂量、有效剂量均较小,对眼晶体、甲状腺、性腺等敏感器官组织有较高安全性,从放射防护角度,使用曲面体层摄影观察上下颌牙列、牙槽骨的形态是合理的。     

腮腺造影在诊断副腮腺及副腮腺肿瘤的价值

本文分析了6例发生于副腮腺的肿瘤与1例正常副腮腺的腮腺造影表现。指出正常副腮腺的形态和解削部位。副腮腺肿瘤的X 线特征:(1)发生在鼻翼至耳屏底部联线中1/3处;(2)腺泡内充盈缺损;(3)副腮腺肿瘤对分支导管拉直、移位、分支导管远端呈残根样改变;(4)肿块大于1cm.作者认为腮腺造影对诊断副腮腺肿瘤有不可忽视的价值。     

下颌骨数字化曲面体层X线摄影技术及其临床应用

目的 :研究下颌骨数字化曲面体层X线摄影技术及其临床应用。材料和方法 :采用德国西门子公司的sirona5 9685 73D3 2 0 0型ORTHOPHOSPLUSDS系统 ,对 10 0例患者进行下颌骨数字化曲面体层X线摄影。结果 :与传统胶片曲面体层摄影技术比较 ,下颌骨数字化曲面体层X线摄影技术曝光量减少了 5 0 %～ 60 % ,影像质量 :甲级 86例 ,乙级 10例 ,丙级 4例。结论 :下颌骨数字化曲面体层X线摄影技术具有普通胶片曲面体层摄影技术所不具备的优越性 ,是临床及科研的一种新检查手段。     

腮腺造影对诊断干燥综合征的价值

目的 研究腮腺造影诊断干燥综合征（Sjogren’s syndrome，SS）的价值。方法 以2002年SS国际分类（诊断）标准为对照，对SS的腮腺造影诊断标准进行诊断试验。入选病例共202例，其中SS患者149例，慢性腮腺炎14例，良性腮腺肥大2例，正常者37例。结果 SS患者以末梢导管病变发生率最高（80．20％，239／298侧），主导管病变表现为边缘毛糙（28．19％，84／298侧）或管腔扩张，但边缘不毛糙（13．09％，39／298侧），也可以表现为前2种病变的混合形式，但较少见（2．68％，8／298侧）。分支导管病变与主导管类似，但不同的是观察效果受末梢导管病变的广泛程度影响。SS累及腮腺的0～Ⅴ期病变均有发生，同一患者两侧腮腺病变分期不同的病例占25．98％（33／127例）。非SS患者中，慢性腮腺炎也可表现为末梢导管扩张（7／28侧）、分支导管扩张（10／28侧）、主导管扩张（11／28侧），但导管无边缘毛糙征象。其他非SS病例无导管病变征象。诊断试验结果中，分支导管或主导管边缘毛糙的诊断特异度为100％，末梢导管扩张的敏感度及Youden’s指数最高。结论 （1）在以腮腺导管病变诊断SS时，末梢导管扩张是理想的筛选诊断标准，而分支导管和主导管边缘毛糙则是对SS的确诊标准。（2）腮腺造影诊断SS的价值可受导管病变表现形式及是否为双侧腮腺同时造影等因素的影响。     

3.0T磁共振腮腺管水成像对腮腺疾病的临床应用

目的:探讨3.0T磁共振水成像(MRS)对腮腺疾病导管显像的临床应用,结合手术及病理结果,评价其对腮腺疾病诊断与治疗的指导意义.方法:对25例临床诊断腮腺疾病患者进行常规扫描后,利用IR-FSE序列进行腮腺导管成像,然后给患者含服VitC于3min后再次扫描,对获得图像按腮腺管及其分支显示效果进行分级及效果评价.结果:25例腮腺病变中,腮腺炎6例,腮腺脓肿1例,腮腺管结石4例,多形性腺瘤10例,腺淋巴瘤2例,T细胞淋巴瘤1例.粘液表皮样癌1例.MRS结果显示,11例非肿瘤性病变中,导管系统变形者8例,占72.7％;14例肿瘤性病变中,导管系统变形者12例,占85.7％.导管系统变形多以2级以上导管改变为主.结论:IR-FSE序列MR腮腺导管成像能较好显示腮腺管及其分支受压、扩张、移位、破坏等征象,对腮腺疾病诊断与治疗具有重要指导意义.     

磁共振腮腺管成像技术探讨

目的 :通过优化和改进磁共振腮腺管造影技术 ,更清晰显示腮腺导管及其分支 ,提高腮腺管显示效果。方法 :采用几种序列显示 2 3例腮腺部位病变患者的腮腺管 ,然后给患者含服 2 0 0mg维生素C ,于服药后 3min和 10min分别再次扫描 ,将所获图像按腮腺管及其分支显示效果进行分级 ,比较各种序列及其服药前后的显示效果。结果 :IR FSE序列较传统FSE扫描腮腺管的显示效果明显提高 (P <0 .0 5 ) ,而SS FSE和SS IR FSE的成像时间虽然极短 ,但其分辨率及信噪比相对较差。服药后腮腺管的显示效果有一定程度的提高但不显著 (P >0 .0 5 )。结论 :在相同的扫描参数下 ,超长TR和TE的IRFSE脂肪抑制序列较其它序列能更好的显示腮腺管及其分支     

连载

gain 增益galactogram 乳腺造影〔照〕片galactography 乳腺造影〔术〕,乳腺腺管造影〔术〕gantry ①扫描架(计算体层扫描机部件)②机架gas-contrasted computer tomography 气体对比计算体层摄影〔术〕gas detector 气体探测器(通常为含有氙气的探测器,可用于计算体层扫描等装置)Ga scanning 〔放射性〕镓扫描gastrointestinal radjology 胃肠放射学9elatin 明胶(①可用为硫酸钡造影的添加剂②制备X 线胶片感光涂层的村料之一)gelatin sponge 明胶海绵(可用作治疗性人工栓塞的栓子材料)     

Image analysis of microsialograms of the mouse parotid gland: a study of the effect of contrast medium in experimentally induced sialoadenitis

Quantitative image analysis of mouse parotid gland sialograms was achieved by conversion of the digital image to a histogram. The relationships between histogram pattern, microsialographic appearance and the amount of contrast medium infused were compared in normal glands and in experimentally induced sialoadenitis. Differences in the pattern enabled a distinction to be drawn between poor sialographic technique and genuine pathology.     

Functional evaluations of the parotid and submandibular glands using dynamic magnetic resonance sialography

PURPOSE: To evaluate the functional differences between the parotid and submandibular glands using dynamic MR sialography. METHODS: In 30 volunteers, the time-dependent changes (dynamic changes) in the maximum area of the detectable parotid and submandibular gland ducts on dynamic MR sialographic images were analysed. RESULTS: Dynamic changes in the parotid gland ducts were detectable on MR sialographic images in all volunteers, but images of the submandibular gland ducts were detectable in only 23 volunteers. In addition, the dynamic changes in the submandibular gland ducts in these 23 subjects were less than those seen in the parotid gland ducts. A relationship was found between the changing ratio of parotid (Pearson r=0.448, P=0.013) or submandibular gland ducts (Pearson r=0.418, P=0.047) and the salivary flow rate during the stimulation period. CONCLUSIONS: Dynamic MR sialography allows evaluation of rest and stimulated functioning and morphological evaluation of the parotid and submandibular glands. This technique appears to have many possible applications in the dental, medical and biological fields.     

3D MR sialography protocol for postradiotherapy follow-up of the salivary duct system

PURPOSE: To develop and evaluate an MR sialography protocol that reproducibly images the parotid and submandibular ducts over time, in 3D. Such a protocol is needed in order to investigate the possible radiation-induced changes to the salivary ducts in patients receiving radiotherapy to the head-and-neck. MATERIALS AND METHODS: MR sialography was performed on a 1.5-T MR scanner. Sequence parameters were optimized on 11 healthy volunteers. A 3D water-selective turbo spin echo (TSE) pulse sequence (TR/TE = 6000 msec/190 msec), using a two-element circular surface coil was applied twice in one MR session. In order to assess the reproducibility, the same procedure was repeated four to six months later. The quality of the MR sialograms was measured subjectively by developing a visibility scoring system and objectively by the means of contrast-to-noise ratio (CNR) of the ducts vs. fat (CNR(duct-fat)). RESULTS: High-quality, 3D MR sialographic images were obtained. The quality of the MR sialograms and the subjective visibility score of the salivary ducts were constant over time. The CNR(duct-fat) varied between volunteers (standard deviation, SD 26%) but it was relatively constant per volunteer (SD 5%). CONCLUSION: The MR sialography protocol presented in this study provides good quality 3D imaging of the major salivary ducts, submandibular duct, and the parotid duct and it can be used for the comparison of the salivary duct system of an individual over time.     

MR sialography in patients with Sjögren syndrome.

PURPOSEThe purpose of this study was to evaluate the effectiveness of MR sialography of the parotid gland ducts in the diagnosis and staging of Sjögren syndrome.METHODSMR imaging was performed on a 1.5-T unit with a neck phased-array coil. MR sialographic source images were obtained using a heavily T2-weighted fast spin-echo sequence with spectral fat suppression. All images were analyzed on the basis of maximum intensity projection reconstruction. Five healthy control subjects and 51 patients with definite Sjögren syndrome (43 with primary disease and eight with secondary disease) were examined with MR sialography. A labial gland biopsy was performed in all patients and histopathologic grading was done by means of focal scores. The findings of MR sialography were compared with the results of labial gland biopsy to determine the effectiveness of the technique in the diagnosis and staging of Sjögren syndrome.RESULTSIn all five control subjects, the main duct and the primary branching ducts of the parotid glands were clearly visible on MR sialographic images. In patients with Sjögren syndrome, a punctate, globular, cavitary, or destructive appearance was well seen within the parotid glands. Findings obtained at MR sialography correlated well with the results of labial gland biopsy.CONCLUSIONMR sialography has the potential to produce diagnostic findings in the parotid gland ducts of patients with Sjögren syndrome. Our results suggest that this method will augment and possibly replace X-ray sialography.     

Salivary duct strictures: nature and incidence in benign salivary obstruction

OBJECTIVES: The aim of this study was to establish the incidence and character of salivary duct strictures by carrying out a 10 year retrospective review. Salivary gland obstruction is most commonly caused either by salivary calculi or duct strictures. These strictures or stenoses develop secondarily to inflammation in the duct wall and may be single or multiple. METHODS: All reports of sialographic examinations performed on patients referred to the Dental Radiology Department in a London Dental Hospital between 1995 and 2004 were reviewed and those patients with symptoms of salivary obstruction identified. In total, 1362 sialograms using the conventional hand injection technique with water-soluble contrast media were performed on 1349 patients with obstructive symptoms during the 10-year period. RESULTS: Of the 1362 sialograms performed, the reports revealed that 877 (64.4%) showed evidence of benign intraductal obstruction. The remaining 485 (35.6%) were normal. 642 of the cases (73.2%) revealing obstruction were reported to be due to salivary calculi, 198 due to duct strictures (22.6%) and the remaining 37 (4.2%) were considered to be due to mucous plugs. Detailed analysis of the patients with strictures showed they were more common in women with a mean age of 52 years. Single strictures were evident in 66.7% of cases while 33.3% showed multiple stenoses. Strictures were more common in the parotid duct (75.3%). 7% of patients presented with bilateral stenoses. CONCLUSION: This is the largest review of duct strictures to be reported. It has shown that ductal stricture formation accounts for almost 25% of cases of benign salivary obstruction and appears to have been an under-recognized condition. Strictures more commonly affect parotid ducts and are typically found in the fourth, fifth or sixth decades, particularly in women.     

Sj?gren's syndrome: comparison of assessments with quantitative salivary gland scintigraphy and contrast sialography.

This study compared the quantitative parameters of salivary gland scintigraphy and the sialographic stages in patients with Sj?gren's syndrome. METHODS: One hundred sixteen patients suspected of having Sj?gren's syndrome were examined with salivary gland scintigraphy and contrast sialography. When contrast sialography was used as the gold standard, Sj?gren's syndrome was diagnosed in 50 of these 116 patients; Sj?gren's syndrome was not seen in the other 66 patients. After injection of 370 MBq 99mTc-sodium pertechnetate, dynamic salivary gland scintigraphy with lemon juice stimulation was performed for 50 min. Functional parameters for the parotid and submandibular glands were calculated, and scintigraphic and sialographic results were compared. RESULTS: With the progression of sialographic stages from 0 to 4, the quantity of tracer accumulation decreased in the submandibular gland (P < 0.0001), and the quantity of tracer secretion decreased in the parotid gland (P < 0.0001). The sialographic stage in patients with Sj?gren's syndrome was correlated with these scintigraphic parameters (P < 0.0001): sialographic stage = 3.243 - 0.337 x (submandibular gland uptake ratio) - 0.026 x (parotid gland maximum secretion). CONCLUSION: The decreased accumulation in the submandibular gland and the decreased secretion in the parotid gland were highly sensitive indicators of salivary gland disease in Sj?gren's syndrome. The sialographic stage was correlated with these scintigraphic parameters.     

Evaluation of pulse sequences used for magnetic resonance sialography

OBJECTIVES: To determine the most appropriate sequences for the visualization of small parotid ducts in MR sialography. METHODS: MR images of a phantom consisting of distilled water in polyethylene tubes were obtained with turbo-spin echo (TSE), single-shot turbo-spin echo (SSTSE), half-fourier acquisition, single-shot turbo-spin echo (HASTE) and turbo gradient-spin echo (TGSE) pulse sequences and compared visually and quantitatively. MR sialograms obtained from healthy volunteers and patients with Sj?gren's syndrome (SS) were obtained using the same four sequences. RESULTS: In the phantom, TSE images were best and the contrast-noise ratio (CNR) highest. In the volunteers, the main ducts were especially clearly visualized with TSE and in SSTSE; however, the majority of secondary and/or tertiary parotid ducts were not depicted by any of the sequences used. In SS patients, images of small main ducts and small pseudocysts were clearer using TSE. However, TSE could not depict the narrow main ducts or peripheral ducts or very small pseudocysts. CONCLUSIONS: TSE is considered the most suitable MR sequence for assessing small parotid gland ducts. However, further improvement is needed since it does not always visualize them sufficiently.     

Prospective comparison of magnetic resonance sialography and digital subtraction sialography

We sought to compare the diagnostic utility of magnetic resonance sialography (MRS) and digital subtraction sialography (DSS) in patients with suspected sialolithiasis or sialadenitis. Sixteen consecutive patients (4 female and 12 male, mean age 51+/-16 years) with suspected sialolithiasis or sialadenitis underwent DSS by a standard technique and MRS. MRS was obtained with a T2-weighted single-shot TSE sequence (TR/TE 2800/1100 msec, acquisition time 7 seconds) using a quadrature head (n = 16) and a surface coil (n = 8). Nineteen symptomatic glands were investigated with DSS: eight submandibular glands in 6 patients (two bilateral) and unilateral parotid glands in 11 patients. MRS was always carried out to visualize gland ducts bilaterally. The ductal system was visualized in all glands examined by MRS. DSS depicted the ductal system in all 11 parotid glands, but only 4 of the 8 submandibular glands (50%). Sialolithiasis was diagnosed in three cases (one parotid, two submandibular glands) by MRS and in two cases by DSS. DSS demonstrated tertiary branching ducts and MRS secondary branching ducts. MRS is able to visualize the ductal system of the parotid and submandibular gland noninvasively and is thus not dependent on successful cannulation of the orifice of the ductal system. Our preliminary data indicate that MRS is useful for diagnosing sialolithiasis. MRS allows diagnosis of sialadenitic changes, but DSS achieves a better diagnostic performance due to higher spatial resolution.     

Organ doses and subjective image quality of indirect digital panoramic radiography

OBJECTIVES: To determine if slight variations in exposure will affect diagnostic image quality and absorbed radiation doses for digital and analogue panoramic radiography. METHODS: Thermoluminescent dosimeters were placed in the thyroid gland, eyes, submandibular glands, parotid glands and skin of two human cadaver heads. Three different exposure settings were used: 70 kV, 120 mAs; 77 kV, 75 mAs; and 81 kV, 60 mAs. Subjective image quality was assessed using a phantom head. Storage phosphor (SP) images were printed on film and both analogue and SP images were assessed for their subjective image quality on a five-point rating scale. The results were statistically analysed using logistic regression analysis and chi(2) tests. RESULTS: Highest organ doses were measured for the submandibular glands, followed by the parotid glands. Salivary gland doses tended to be higher at lower kV settings. Image quality was not statistically different for the different exposure settings. Imaging technique did not seem to influence diagnostic image quality, except for the periapical status of upper premolars where SP was better. The main reason for any differences appeared to be interobserver variation. CONCLUSIONS: Analogue and SP panoramic radiography performed equally well for subjective diagnostic image quality. No significant differences could be found at the exposure settings used in this study. Radiation doses were highest for the salivary glands, especially at lower kV settings.     

Diffusion-weighted echoplanar MR imaging of the salivary glands

OBJECTIVE: We determined the apparent diffusion coefficients of normal and dysfunctional salivary glands. SUBJECTS AND METHODS: A diffusion-weighted single-shot spin-echo type of echoplanar MR imaging was performed on the parotid or submandibular glands, or both, in 36 healthy subjects, 20 patients with Sj?gren's syndrome, and six patients with sialoadenitis. The apparent diffusion coefficient of the salivary gland was calculated using two b factors (b = 500 and 1,000 sec/mm(2)). RESULTS: The apparent diffusion coefficient was lower in the parotid glands (0.28 x 10(-3) mm(2)/sec) than that of the submandibular glands (0.37 x 10(-3) mm(2)/sec). The apparent diffusion coefficient was increased in sialoadenitis, whereas it decreased with abscess formation. The apparent diffusion coefficients of the parotid glands in patients with Sj?gren's syndrome correlated with the salivary flow rates but not with the sialographic gradings of the glands. We also found a correlation of the decreases in apparent diffusion coefficients with the severity of gland damage as assessed on T1-weighted MR images. CONCLUSION: Diffusion-weighted echoplanar MR imaging may reveal diseased states of the salivary glands.