Imaging the major

salivary glands.
Review article.
C. J. Burke, R.H. Thomas, D. Howlett.

BJOMS 49, issue 4 (2011) 261-269

Introduction
• Methods used to image the major salivary glands.

• To apply these methods to principal pathological processes

that involve the salivary glands.
 Neoplastic lesions
 Non- neoplastic conditions.
Methods of imaging
• Ultrasound.

• Magnetic resonance imaging.

• Computed tomography.

• Sialography.

• Nuclear scintigraphy
Ultrasound

• Initial evaluation of salivary glands.

• Cheap, widely available and safe.

• Can be used to delineate superficial salivary gland lesions as

precisely as CT and MRI (95%)
Ultrasound (US) scan showing an ill-defined, hypoechoic, mass
within the left submandibular gland (S).
US-guided biopsy with the tip of the needle about to enter the
lesion (arrow)
The needle within the submandibular lesion (smaller arrows)
Ultrasound
• Uses:

 Core biopsy and FNAC under US –guidance.

 Identify neoplastic and non-neoplastic lesions.

 Suspected stones

 Abscesses.
Ultrasound….
• Limitations

 deep parotid masses (because they are obscured by the

mandible)

 deep neck adenopathy

 and the extent of an intracranial or skull base mass.

Magnetic resonance imaging
• Gives excellent soft tissue contrast and resolution.

• Superior to CT in evaluating the interface between muscle and

tumor without using ionizing radiation.

 Perineural spread of malignant tumors

 Deep lobe extensions

 Meningeal infiltrations.
MRI
• Limited availability

• High cost

• Length of time it takes to do

• Pacemakers and implanted materials

• Claustrophobic
Axial T1 weighted image which shows a well circumscribed focus within the
left parotid gland within the deep lobe but extending into the superficial lobe
behind the mandible.
Axial T2 weighted image
Axial T2 weighted image showing hypertrophy of muscles on the left.
Computed tomography
• More readily available.

• Unenhanced CT

• Enhanced CT

• High dose of radiation involved

• Conebeam CT
Sialography
• Water soluble contrast material.

• Digital substraction sialography.

• MR sialography

Diagnostic images in sialadenitis, Zenk et al, CONA, 2009.

Digital substraction sialogram with no defect or stricture.
Nuclear scintigraphy
• Tc -99

• Not reliable

• Expensive

• Lengthy
DISEASES
SALIVARY GLAND
NEOPLASMS
Benign salivary gland tumors:

• Pleomorphic adenoma
• 85% parotid gland

• On US , smooth round hypoechoic mass.

• Large tumors appear heterogenous

• CT and MRI
US of pleomorphic adenoma showing lobulated circumscribed hypoechoic
mass with distal acoustic enhancement in the parotid gland .
Malignant salivary gland tumors:

• Primary malignant tumors:

1. Ultrasound

2. MRI

3. CT

• Secondary malignancies:
1. Melanoma 46%
2. SCC 37%
ultrasound of the left parotid gland demonstrates an irregular, poorly defined
mass in the superficial lobe with heterogeneous internal architecture. Biopsy
confirmed this to represent mucoepidermoid carcinoma.
The British Journal of Radiology, April 2003
US of palpable abnormality showing ill defined hypoechoic nodule in parotid
gland in a patient with history of SCC of the right ear.
Axial CT showing hyperdense nodule in preauricular location
Lymphoma:

• Elderly men

• Enlarged gland

• Rubbery consistency

• Hypoechoic intraglandular masses

NON-NEOPLASTIC
DISORDERS

• Sialolithiasis

• Sialadenitis

• Granulomatous disease.
Sialolithiasis
• Ultrasound

• CT

• MR sialography

• Digital substraction sialography

Acute inflammation
Ultrasound:

• Inflamed or edematous gland

• Abscees or stone
• Image –guided aspiration

CT and MRI
 The British Journal of Radiology, April 2003
The gland appears hypoechoic and inflamed and there is a poorly defined hypoechoic
mass in the superficial lobe. The appearances are suggestive of parotid abscess
formation and this was confirmed following ultrasound-guided aspiration of 5 ml of
pus from the lesion from which viridans streptococcus was isolated.
Chronic inflammation
Obstructive

• Strictures

• Sialolithiasis

Non obstructive
• Autoimmune diseases

• Post irradiation

• Granulomatous diseases
 SJOGREN
SYNDROME

The gland is enlarged and heterogeneous and small internal hypoechoic foci
are identified (arrow) which represent areas of sialectasis.
 SA
RC
OI
DO
SIS

The parotid gland is enlarged and hypoechoic and the texture is

heterogeneous.
Summary
• Ultrasound is the first choice.

• MRI can characterise locally invasive lesions, extent, nodal

disease.

• CT is cheap and readily available and can be used where MRI is

contraindicated.
Thank you.