Diagnostic Imaging Pathways - Salivary Gland Swelling
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This pathway provides guidance on the imaging of adult patients with salivary gland swelling.
Date reviewed: January 2012
Date of next review: January 2015
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|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- Ultrasound is the initial imaging modality in suspected salivary gland disease
- In suspected sialolithiasis, MR sialography is the prefered non-invasive investigation for further assessment of salivary gland calculi
- With a salivary gland mass, CT or MRI can be used for further investigation
- CT is the method of choice in patients suspicious for inflammatory disease (abscess, calculi, major salivary duct dilatation, and acute inflammation) or in patients with contraindication for MR imaging.
- Superior to plain radiographs and US in detection of sialolithiasis.
- Allows detection and assessment of extent of salivary gland tumours. ,
- Helpful in the differential diagnosis of salivary gland tumours.
- Helpful in assessment of deep lobe of parotid gland and the minor salivary glands.
- For lesions in the superficial parotid and submandibular gland, ultrasound is an ideal tool for initial assessment.
- For CT imaging both pre- and post-contrast studies must be performed in order to detect calcifications (pre-contrast) and enhancement pattern (post-contrast) .
Fine Needle Aspiration Cytology (FNAC)
Magnetic Resonance Imaging
- MR imaging (MRI) is the method of choice for patients with palpable masses and a strong suspicion that the lesion is neoplastic.
- MRI gives information on the exact localisation and extent of the lesion, addresses neighbouring structures, and allows perineural spread, bone invasion and meningeal infiltration to be assessed.
- For all tumours in the sublingual gland, MRI should be performed as the risk of malignancy is high.
- For lesions of the deep lobe of parotid gland and the minor salivary glands, MRI and CT are the modalities of choice.
Magnetic Resonance Sialography
- Non-invasive alternative to conventional/digital sialography. ,
- Allows accurate assessment of salivary gland calculi and stenoses.
- No exposure to ionising radiation.
- Does not require use of contrast material.
- False negative readings may occur in patients with very small calculi that are causing no ductal dilatation.
- Inability to distinguish solid calculi from inspissated mucus and/or debris.
- Distortion artefacts caused by dental amalgam may impair visualisation of calculi or stenoses near the main ductal orifice.
- Limited availability.
- Most detailed way to image the salivary ductal system. ,
- Invasive procedure with a risk of complications such as damage to the orifice, overfilling and rupture of the ductal system, exacerbation of infection, and adverse reaction to contrast material.
- Exposure to ionising radiation.
- Need for experienced operator to cannulate the small, often oedematous ductal orifices.
- Pain during retrograde injection of contrast material (minimise with fluoroscopic screening).
- Contraindicated in acute salivary infection.
- Initial imaging modality of choice for evaluation of suspected salivary gland masses and inflammatory disease of the salivary glands.
- Relatively inexpensive.
- Safe (non-invasive and does not involve use of ionising radiation or contrast medium).
- Widely available.
- Inability to evaluate deep parotid masses, lesions obscured by the mandible, parapharyngeal and deep neck adenopathy, and the intracranial or skull base extent of a mass.
- Lacks specificity for cystic lesions.
- Difficult to demonstrate relationship of a tumour to the facial nerve to the surgeons.
- Murray ME, Buckenham TM, Joseph AEA. The role of ultrasound in screening patients referred for sialography: a possible protocol. Clin Otolaryngol Allied Sci. 1996;21:21-3. (Level III evidence)
- Gritzmann N. Sonography of the salivary glands. AJR Am J Roentgenol. 1989;153:161-6. (Level III evidence)
- Jager L, Menauer F, Holzknecht N, et al. Sialolithiasis: MR sialography of the submandibular duct - an alternative to conventional sialography and US? Radiology. 2000;216:665-71. (Level II evidence) View the reference
- Yousem DM, Kraut MA, Chalian AA. Major salivary gland imaging. Radiology. 2000;216:19-29. (Review article)
- Casselman JW, Mancuso AA. Major salivary gland masses: comparison of MR imaging and CT. Radiology. 1987;165:183-9. (Level III evidence)
- Bryan RN, Miller RH, Ferreyro RI, et al. Computed tomography of the major salivary glands. AJR Am J Roentgenol. 1982;139:547-54. (Level III evidence)
- Avrahami E, Englender M, Chen E, et al. CT of submandibular gland sialolithiasis. Neuroradiology. 1996;38:287-90. (Level II/III evidence)
- Choi DS, Na DG, Byun HS, et al. Salivary gland tumors: evaluation with two-phase helical CT. Radiology. 2000;214:231-6. (Level II/III evidence)
- Berg HM, Jacobs JB, Kaufman D, et al. Correlation of fine needle aspiration biopsy and CT scanning of parotid masses. Laryngoscope. 1986;96:1357-62. (Level III evidence)
- Kaneda T, Minami M, Ozawa K, et al. Imaging tumors of the minor salivary glands. Oral Surg Oral Med Oral Pathol. 1994;77:385-90. (Level IV evidence)
- Silvers AR, Som PM. Salivary glands. Radiol Clin North Am. 1998;36(5):941-66. (Review article)
- Buckenham TM, George CD, McVicar D, et al. Digital sialography: imaging and intervention. Br J Radiol. 1994;67:524-9. (Level II/III evidence)
- Becker M, Marchal F, Becker CD, et al. Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence. Radiology. 2000;217:347-58. (Level II evidence) View the reference
- Sack MJ, Weber RS, Weinstein GS, et al. Image-guided fine-needle aspiration of the head and neck: five years' experience. Arch Otolaryngol Head Neck Surg. 1998;124:1155-61. (Level III evidence)
- Yousem DM, Sack MJ, Weinstein GS, et al. Computed tomography-guided aspirations of parapharyngeal and skull base masses. Skull Base Surg. 1995;5:131-6. (Level III evidence)
- Thoeny H C. Imaging of salivary gland tumours. Cancer Imaging. 2007;7(1):52-62. (Review article)
- Lee YY, Wong KT, King AD, Ahuja AT. Imaging of salivary gland tumours. Eur J Radiol. 2008;66(3):419-36. (Review article)
- Parker GD, Harnsberger HR. Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 1991;11(3):383-99. (Level III evidence)
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