1. Sjogren’s Syndrome: Comparison of Assessments with Quantitative Salivary Gland Scintigraphy and Contrast Sialography J Nucl Med 2000; 41: 257-262

2. Sjogren’s 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.

3. Sjogren’s syndrome Contrast sialography –Gold standard in the diagnosis of the syndrome –Invasive method (disadvantages and complications) Salivary gland scintigraphy with 99m Tc-sodium pertechnetate –Evaluate salivary gland function in xerostomic pateints –Easy and noninvasive method (bilateral parotid and submandibular glands)

4. No standard method for assessing Sjorgren’s syndrome has been established No report has deal with the relationships between quantitative scintigraphic parameters and sialographic findings

5. In this study –Comparing quantitative parameters of salivary gland scintigraphy and sialographic findings in Sjogren’s syndrome. –Determining useful scintigaphic parameters for evaluation of salivary gland disease and calculated an equation to correlate the sialographic stage with the scintigraphic parameters.

6. M ATERIALS AND M ETHODS

7. 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 Sjogren’s syndrome. –Sjogren’s 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).

8. Imaging Examination –Dynamic salivary scintigraphy Performed after intravenous injection of 370 MBq 99m Tc-sodium pertechnetate Γ camera and analysis system

9. FIGURE 1. Schematic presentation of time-activity curve in salivary gland scintigraphy. This represents normal pattern. lemon juice

10. TABLE 1. Definition of Functional Parameters in Salivary Gland Scintigraphy

11. UR and MA: quantity of accumulation MS: quantity of secretion. Tmax: velocity of accumulation and spontaneous secretion. Tmin: velocity of secretion after stimulation

12. Imaging examination –Contrast sialography A catheter was used to inject a 0.5 to 0.7 ml dose of iohexol into the Stensen’s duct in patients.

13. Contrast sialograms –Rubin and Holt classification StageContrast Material Collection ( in diameter ) 0 ( normal )No contrast material collection 1 ( punctate )< 1 mm 2 ( globular )1-2 mm 3 ( cavitary )>2 mm 4 ( destructive )Complete destruction of the gland parenchyma

14. R ESULTS

15. TABLE 2. Comparison of Scintigraphic Parameters in Healthy Volunteers and Patients with Sjogren’s syndrome

16. TABLE 3. Correlation of Scintigraphic Parameters and Sialographic Staging in Patients with Sjogren’s syndrome

17. Regression analysis –In the submandibular gland, decrease of the tracer accumulation highly correlated with the sialographic staging (UR: r= -0.528, P<0.0001; MA: r= -0.554, P<0.0001) – in the parotid gland, dcrease of the tracer secretion highly correlated with the sialographic staging (MS: r= -0.570, P<0.0001)

18. Sialographic stage = 3.243 - 0.337× (submandibular UR) – 0.026 × (parotid MS)

19. FIGURE 2. Images of 31-y-old woman without Sjogren’s syndrome (sialographic stage 0)

21. FIGURE 3. Images of 56-y-old woman (patient 2) with Sjigren’s syndrome (sialographic stage 2).

23. FIGURE 4. Images of 54-y-old woman (patient 3) with Sjogren’s syndrome (sialographic stage 4).

25. D ISCUSSION

26. 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.

27. Salivary gland scintigraphy with 99m Tc-sodium pertechnetate –Evaluate salivary gland function in xerostomic pateints –Easy and noninvasive method (bilateral parotid and submandibular glands) –No standard method for assessing Sjorgren’s syndrome has been established –No report has deal with the relationships between quantitative scintigraphic parameters and sialographic findings

28. 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.

29. 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 Sjogren’s syndrome –Previous report ( Umehara et al., 1999 )

30. 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 Sjogren’s 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 )

31. 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 Sjogren’s syndrome

32. Sjogren’s 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)

33. C ONCLUSION

34. Sjogern’s syndrome –Salivary gland scintigraphy Easy and noninvasive method Quantitative analysis : decreased accumulation in the submandibular gland and decreased secretion in the parotid gland are highly sensitive parameters Sialographic stage was correlated with these scintigraphic parameters

35. T HANK Y OU