Effect of selenium supplementation for protection of salivary glands from iodine-131 radiation damage in patients with differentiated thyroid cancer

Objective: In the current study, we examined whether selenium supplementation during iodine-131 (131I) treatment had a radio-protective effect on salivary glands. Subjects and methods: Sixteen patients with differentiated thyroid cancer were prospectively enrolled in the study. Patients after total thyroidectomy, before 131I treatment, were divided into two groups; 8 patients in the selenium group and 8 patients in the control group. Patients in the selenium group received 300νg of selenium orally for 10 days, from 3 days before to 6 days after 131I treatment. The control group received a placebo over the same period. To assess salivary gland function, salivary gland scintigraphy was performed before and 6 months after 131I treatment. Serum amylase and whole blood selenium levels were measured before and 2 days and 6 months after 131I treatment. Using salivary gland scintigraphy, maximum uptake ratio (MUR), maximum secretion percentage (MSP), and ejection fraction (EF) of each salivary gland were calculated. Results: Baseline clinical characteristics, baseline amylase and selenium levels, and parameters of baseline salivary gland scintigraphy were not significantly different between selenium and control groups (P>0.05). On a blood test performed 2 days after 131I treatment, the selenium group showed a significantly higher whole blood selenium level (P=0.008) and significantly lower serum amylase level (P=0.009) than the control group. On follow-up salivary gland scintigraphy, the control group showed significantly decreased, MUR of the bilateral parotid and left submandibular glands, MSP of the bilateral parotid and submandibular glands, and EF of the left submandibular glands (P<0.05), while the selenium group only had a significant decrease in MSP of the right submandibular gland and EF of the left submandibular gland (P<0.05). Conclusion: Selenium supplementation during 131I treatment was effective to reduce salivary glands damage by 131I radiation in patients with differentiated thyroid cancer.ope

The Use of Salivary Gland Scintigraphy for Diagnosis of Primary Sjögren Syndrome and Thyroid Disease in Patients with Dry Mouth

Sjögren syndrome (SS) is a chronic autoimmune disease characterized by dryness of the mouth and eyes due to lymphocytic infiltration of the exocrine glands. In American European Consensus Group (AECG) criteria, abnormal salivary gland scintigraphy (SGS) result is one of the objective signs of SS and it has been proposed as a valid and non-invasive alternative approach to functional evaluation of salivary gland, especially in the case when unstimulated whole salivary flow is more than 1.5 mL in 15 minutes or other AECG criteria is unmet. Patients with SS are more likely to have the thyroid disease (TD), but this association remains controversial. We present a case of the use of SGS for diagnosis of primary SS and TD in patients with dry mouth and burning sensation of tongue. Through this case, we suggest the usefulness of salivary scintigraphy for screening TD in addition to diagnosis of SS.ope

Approach to Diagnosis of Salivary Gland Disease from Nuclear Medicine Images

Nuclear medicine images can help in the diagnosis and assessment of some salivary disorders. 99mTcO4−, gallium-67-citrate scintigraphy will be an indication of the function of salivary gland together and it will be used for the diffuse diseases such as sialadenitis, Sjögren’s syndrome, sarcoidosis, glossopharyngeal paralysis, and irradiation. It is also effective for distinguishing benign tumor legion with Warthin’s tumor and others. Moreover, fluorodeoxyglucose positron emission tomography (FDG-PET) is an indispensable modality for determining the localization, focal lesions, and staging of many malignant tumors, the fluorodeoxyglucose (FDG) accumulation is visually and semi-quantitatively assessed using the standardized uptake value (SUV), which is the ratio of uptake to the injected dose per unit body weight. Also for radioactive iodine therapy, attention should be paid to adverse reactions. It is important to note that acute/chronic salivary gland disorders are associated with radioiodine therapy for the treatment of postoperative thyroid cancer. Coordination among healthcare providers including nurses, radiological technologists, and doctors of all departments involved in treatment is important for achieving effective outcomes

Ultrasonography of salivary glands in primary Sjögren's syndrome: A comparison with contrast sialography and scintigraphy

Objective. To compare ultrasonography (US) of salivary glands with contrast sialography and scintigraphy, in order to evaluate the diagnostic value of this method in primary SS (pSS). Methods. The diagnostic value of parotid gland US was studied in 77 patients with pSS (male/female ratio 3/74; mean age 54 yrs) and in 79 with sicca symptoms but without SS. The two groups were matched for sex and age. Imaging findings of US were graded using an ultrasonographic score ranging from 0 to 16, which was obtained by the sum of the scores for each parotid and submandibular gland. The sialographic and scintigraphic patterns were classified in four different stages. The area under receiver operating characteristic curve (AUC-ROC) was employed to evaluate the screening methods performance. Results. Of the 77 patients with pSS, 66 had abnormal US findings. Mean US score in pSS patients was 9.0 (range from 3 to 16). Subjects without confirmed pSS had the mean US score 3.9 (range from 0 to 9) (P < 0.0001). Results of sialography showed that 59 pSS patients had abnormal findings at Stage 1 (n = 4), Stage 2 (n = 8), Stage 3 (n = 33) or Stage 4 (n = 14), and 58 patients had abnormal scintigraphic findings at Stage 1 (n = 11), Stage 2 (n = 18), Stage 3 (n = 25) or Stage 4 (n = 4). Through ROC curves US arose as the best performer (AUC = 0.863 +/- 0.030), followed by sialography (AUC = 0.804 +/- 0.035) and by salivary gland scintigraphy (AUC = 0.783 +/- 0.037). The difference between AUC-ROC curve of salivary gland US and scintigraphy was significant (P = 0.034). Setting the cut-off score 6 US resulted in the best ratio of sensitivity (75.3%) to specificity (83.5%), with a likelihood ratio of 4.58. If a threshold 8.0 was applied the test gained specificity, at the cost of a serious loss of sensitivity (sensitivity 54.5%, specificity 97.5%, likelihood ratio 21.5). Conclusions. Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease

Imaging activated-T-lymphocytes in the salivary glands of patients with sjögren’s syndrome by 99mTc-interleukin-2. diagnostic and therapeutic implications

Background: Sjögren’s syndrome (SS) is a progressive autoimmune disease characterized by local mononuclear cell infiltration of the salivary and lachrymal glands. Labial biopsy demonstrates local infiltration by Th1 cells that produce pro-inflammatory cytokines, such as interleukin-2 (IL2). The aim of this study was to assess the utility of 99mTc-labelled-IL2 (99mTc-IL2) in evaluating in vivo the extent and severity of lympho-mononuclear cell infiltration in the salivary glands of patients with SS. Methods: We investigated 48 patients with primary SS and 27 control subjects using 99mTc-IL2 scintigraphy. Furthermore, in a subgroup of 30 patients, we also performed 99mTc-pertechnetate scintigraphy (99mTcO4−) for evaluation of the salivary gland function. Results: 99mTc-IL2 uptake in the salivary glands of SS patients was higher than in the control subjects (1.30 ± 0.16 vs. 0.83 ± 0.08 for parotids and 1.36 ± 0.15 vs. 1.16 ± 0.07 for submandibular glands; p &lt; 0.0001). The salivary gland uptake of 99mTc-IL2 in patients with a longer history of disease was lower compared with the recently diagnosed patients. A significant direct correlation was found between the uptake of 99mTc-IL2 and histology. Conclusions: 99mTc-IL2 scintigraphy showed that the degree of lymphocytic infiltration of major salivary glands is variable in patients with different disease durations. Patients with a high 99mTc-IL2 uptake could be efficiently treated with immuno-modulatory drugs and the efficacy of treatment could be followed-up by 99mTc-IL2 scintigraphy

Salivary gland scintigraphy with partial volume effects quantification: A phantom feasibility study

BackgroundSalivary gland scintigraphy gives functional information on irradiated glands. Upon irradiation, their size may become less than 2–3 times the resolution of the gamma camera hence underestimation of the regional distribution of administered activity due to partial volume effects (PVEs) which hinder accurate quantification of their function. AimTo accurately quantify planar images of spheres mimicking irradiated parotid and submandibular glands with view of implementing salivary gland scintigraphy that involves quantification of PVEs.MethodsA hollow head and neck phantom was fitted with spheres (diameters: 20mm; 14mm; 12mm and 10mm) filled with technetium-99m solution of activity concentration of 300kBq/mL. The spheres mimicked irradiated parotid glands (right (RP) and left (LP)) and submandibular glands (right (RSM) and left (LSM)) respectively. The phantom was filled with technetium-99m solution of activity concentration 144kBq/mL.1 A planar image was acquired in 5 minutes using Siemens E-Cam dual head gamma camera detector positioned 5cm vertically above the phantom, on 128×128 matrix size following a thyroid protocol. The detector was fitted with low energy high resolution collimators. ImageJ software was used for quantification. ResultsThe image counts post PVEs quantification were: LP=252,690; LP=160,836; RSM=149,315; LSM=68,292. The percentage quantification errors were: 44 per cent, 48 per cent, 51 per cent and 75 per cent for the LP, RP, RSM and LSM glands respectively.ConclusionImageJ software improved quantitative accuracy of sphere images hence it provides a robust quantification tool for irradiated salivary glands

Assessment of post-radiotherapy salivary glands

Salivary glands are usually irradiated during radiotherapy for head and neck cancers, which can lead to radiation-induced damage. Radiation-induced xerostomia (oral dryness) is the most common post-radiotherapy complication for head and neck cancer patients and can reduce the patient's quality of life. Accurate and efficient salivary gland assessment methods provide a better understanding of the cause and degree of xerostomia, and may help in patient management. At present, there are different methods for the assessment of salivary gland hypofunction; however, none of them are considered to be standard procedure. This article reviews the value of common methods in the assessment of post-radiotherapy salivary glands. © 2011 The British Institute of Radiology.link_to_subscribed_fulltex

Evaluation of the concordance of sialometry and salivary glands scintigraphy in dry mouth patients

INTRODUCTION: Many diagnostic tests are used to evaluate dry mouth patients, especially the ones with Sjögren s Syndrome, to whom these tests are part of classification criteria for scientific studies. AIM: Thus, the concordance between results of sialometry and salivary glands scintigraphy was evaluated; if positive, it would enable the choice of one or the other for diagnosis. PATIENTS AND METHOD: Seventy-two dry mouth patients were divided into non-Sjögren s Syndrome group, primary Sjögren s Syndrome group and secondary Sjögren s Syndrome group. The concordance among sialometry and scintigraphy results was evaluated by Kappa test. RESULTS: It was observed that their concordance was equal or near to zero. CONCLUSION: It is not possible to make a choice between these tests and both should be performed.INTRODUÇÃO: São utilizados vários exames para avaliar os pacientes com queixa de boca seca e, especialmente, os pacientes com Síndrome de Sjögren, em que estes exames fazem parte de critérios de classificação para estudos científicos. OBJETIVO: Desta maneira, procurou-se avaliar se haveria concordância entre os resultados da sialometria e da cintilografia de glândulas salivares para, se esta concordância estiver presente, optar por apenas um dos dois exames. CASUÍSTICA E MÉTODO: Foram avaliados 72 pacientes com boca seca, divididos em grupos não-Síndrome de Sjögren, com Síndrome de Sjögren primária e com Síndrome de Sjögren secundária. Os resultados de sialometria e cintilografia de glândulas salivares foram estudados, procurando-se dimensionar a concordância existente entre eles, através do teste de Kappa. RESULTADOS: Observou-se concordância igual ou próxima de zero entre os dois testes. CONCLUSÃO: Pelos resultados observados, não é possível fazer a opção por um ou outro exame, devendo ambos serem realizados.Santa Casa de São Paulo F.C.M.Santa Casa de São Paulo F.C.M. Depto. de MorfologiaHospital Nossa Sra. de LourdesUNIFESPSanta Casa de São Paulo Faculdade de Ciências. Médicas Depto. de OtorrinolaringologiaUNIFESPSciEL