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Imaging diagnosis of salivary diseases

Imaging diagnosis of salivary diseases. 病史 疼痛 肿大 / 肿胀 口腔干燥 多涎 味觉异常 全身情况 / 既往史. introduction. 病史 临床检查 影像学检查 细针吸活检 唾液流率 唾液生化. Diseases associated with salivary gland enlargement Nutritional deficiency hypovitaminosis A Generalized malnutrition Pellagra beriberi

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Imaging diagnosis of salivary diseases

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  1. Imaging diagnosis of salivary diseases

  2. 病史 疼痛 肿大/肿胀 • 口腔干燥 多涎 • 味觉异常 全身情况/既往史 introduction 病史 临床检查 影像学检查 细针吸活检 唾液流率 唾液生化

  3. Diseases associated with salivary gland enlargement • Nutritional deficiency • hypovitaminosis A • Generalized malnutrition • Pellagra • beriberi • Hormonal abnormalities • diebetes mellitus • hypothyroidism • testicular atrophy • menopause • pregnancy, lactation

  4. (cont’d) • metabolic disorders • bacillary dysentery (Japanese dysentery) • celiac disease • ancylostomiasis 钩虫病 • cardiospasm 贲门痉挛 • obesity • alcoholic cirrhosis • others • carcinoma of the esophagus • SS • sarcoidosis • Uremia

  5. Drugs affecting salivary glands analgesics iodine anticonvulsants/antispasmotics muscle relaxants antiemetics/antinauseants 止吐药CNS depressants antihistamines dibenzoxepine derivatives antihypertensives monoamine oxidase inhibitors antiparkinsons phenothiazine derivatives antipruritic 止痒剂tranquilizers/sedatives appetite suppressants expectorants 化痰剂 digitalis 洋地黄decongestants 解充血药 diuretics 利尿剂

  6. introduction • 临床检查 • 视诊 扪诊 • 肿大 腺体大小 • 神经损害 质地 • 口腔粘膜/舌 压痛 • 导管口 肿物 • 病史 临床检查 • 影像学检查 细针吸活检 • 唾液流率 唾液生化

  7. introduction 初步印象? 是否需要辅助检查? 检查方法及检查顺序? 可望获得哪些信息? 是否有助于诊断和治疗? 权衡利弊? 平片 plain film 造影 sialography 核素 radionuclide 超声 ultrasound CT MRI

  8. PLAIN FILM RADIOPAQUE SIALOLITH 阳性结石 BONE INVOLVEMENT 涎腺疾病导致骨改变

  9. Sialography CONTRAINDICATION Acute inflammation Allergy to iodine SIALOGRAPHY INDICATION DUCT SYSTEM OBSTRUCTION fistula RECURRENT PAROTITIS AUTOIMMUNE DISEASES OTHER NON-NEOPLASTIC DISEASES

  10. Sialography

  11. Sialography

  12. Sialography • Digital subtraction • vascular tree • nonvascular application • laryngography • dacryocystogrphy • sialography • DSS of 7 cases first reported by JB Lightfoote et al in 1984 • superiority • subtraction of overlying structures • dynamic images • simpler, faster, and less radiation than CT • intervention

  13. Imaging diagnosis of salivary diseases Scintigraphy • 核素 • 1960年Richards 首先报告 technetium-99m 的医学应用 • 涎腺检查 1965年由Borner首先报告 • 定量评价大涎腺功能状态的唯一方法

  14. Scintigraphy Radionuclide imaging 动态功能曲线 摄取指数 分泌指数

  15. Imaging diagnosis of salivary diseases ultrasound 超声 高频换能器 涎腺肿瘤的首选检查 成象原理 高频换能器 近场分辨率好 穿透能力差

  16. Imaging diagnosis of salivary diseases ultrasound 高频电流 声波-电信号 压电晶体 诊断用超声5-10兆赫 声波在声学界面反射形成回声 受检组织

  17. 1895年 伦琴发现“X射线” • 1917年 JH Radon根据透射测量法提出重建断面图像的数学基础 • 1963年 AM Cormack提出计算人体放射吸收分布特性的技术方法 • 1972年 GN Hounsfield和J Ambrose进行第一次临床CT检查 • 1974年 共安装60台临床CT • 1974年 美国GeorgeTown医学中心Ledley设计出第一台全身CT • 1979年 Hounsfield和Cormack获诺贝尔医学奖 • 1989年 WA Kalender 和P Vock 进行第一次螺旋CT临床检查 • 1992年双螺旋CT问世 • 1998年4层螺旋CT • 2004年64层螺旋CT进入市场 • 256层螺旋CT样机已进入实验室

  18. MRI MRI 1930年代，物理学家伊西多·拉比发现原子核与磁场以及外加射频场相互作用。拉比于1944年获得了诺贝尔物理学奖 NMR nuclear magnetic resonance The experimental foundations of magnetic resonance were laid by Block and Purcell more than six decades ago (1945), work for which they were awarded a Nobel Prize in 1952

  19. MRI magnetic resonance imaging Lauterbur and Damadian introduced MRI in the early seventies Lauterbur and Mansfield were awarded a Nobel Prize in 2003

  20. excellent contrast resolution • 直接作出横断面、矢状面、冠状面和各种斜面的体层图像 • 不需注射造影剂 • 无电离辐射，对机体没有不良影响 • 空间分辨率不及CT • 价格昂贵 • Contraindication • claustrophobic • those not fully cooperative • patients with cardiac pacemakers or insulin pumps, intracranial ferromagnetic clips or hemoclips on cerebral aneurysm • 带有心脏起搏器的患者或有某些金属异物的部位不能作MR的检查

  21. 涎腺发育异常 先天缺失/发育不全 导管发育异常 异位/迷走涎腺

  22. sialolithiasis SIALOLITHIASIS 涎石症 plain radiography 平片 submandibular gland 頜下腺 occlusal radiograph lateral mandibular radiograph 頜下腺側位 parotid gland 腮腺 intraoral view 口内片 PA 后前位 sialography (digital subtraction) 涎腺造影

  23. sialolithiasis

  24. Sialolithiasis echo-dense spots posterior acoustic shadowing stones of 2 mm and larger

  25. Sialographic findings Filling defect frequently more or less dilated ductal system not normally indicated when a radiopaque stone revealed

  26. fistula fistula Introduction clinical sialography

  27. Imaging diagnosis of salivary diseases inflammation Recurrent parotitis juvenile etiology: infection, immunology, dysplasia, virus clinical sialectasia adult

  28. obstructive sialadenitis • etiology: calculus, stricture, mass, foreign body, • clinical • duct dilation

  29. inflammation

  30. Obstructive sialadenitis left submandibular gland

  31. tuberculosis tuberculosis clinical sialography US

  32. tumorsultrasound Shape regular irregular Border well defined ill defined Internal echo homogeneous hetero- Posterior enhancement enhanced attenuation, acoustic shadow

  33. tumors 腮腺良性肿物

  34. Pleomorphic adenoma

  35. Imaging diagnosis of salivary diseases tumor • 恶性肿瘤 • 边界不清，内部回声不均匀， • mucoepidermoid和acinic cell tumors 及较小的恶性肿瘤可呈良性表现 • lymphoma 可呈良性肿瘤甚至囊性表现

  36. tumors Cross-sectional imaing intra- and extraglandular tumours adjacent structures metastatic lymphadenopathy contrast-enhanced CT scans • deep lobe of the parotid and parapharyngeal space • vascular and nodal structures adjacent to the gland • dense parotid gland

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