Optimization of contrast administration parameters for salivary gland sialography

Relevance. The diagnostic value of conventional sialography is limited by its technical constraints. Digital sialography overcomes these limitations, allowing the resulting data to be considered more reliable and evidence-based.

Objective: To develop practical recommendations for improving the conventional sialography technique based on data obtained from digital subtraction sialography.

Material and methods. A total of 60 patients with salivary gland disorders underwent digital subtraction sialography, which was used to examine 59 parotid glands and 36 submandibular glands. Patient sex, age, diagnosis, and extent of gland involvement were intentionally not considered in the analysis. The study evaluated: 1) Presence or absence of sensations during contrast agent administration; 2) Volume of contrast agent required for complete ductal filling; 3) Rate of contrast loss from the image after catheter removal. Statistical significance of differences was assessed using Student's t-test, with significance set at p ≤ 0.05.

Results. Optimal ductal filling was accompanied by a sensation of pressure and mild pain in only 5.1% of cases during parotid gland sialography and 2.9% of cases during submandibular gland sialography. No sensations were reported in 79.7% of parotid gland cases (t = 12.49175; p < 0.001) and 82.9% of submandibular gland cases (t = 8.976; p < 0.001). The average volume of contrast agent required to fill the parotid ducts was 1.4 ± 0.3 ml, while for the submandibular ducts (n = 35), it was 1.2 ± 0.3 ml (t = 3.1247; p < 0.001).Within approximately 3 minutes after catheter removal, rapid contrast loss occurred in 86.4% of parotid gland sialograms (t = 11.56244; p < 0.001) and in 88.9% of submandibular gland sialograms (t = 10.50; p < 0.001).

Conclusion. Practical parameters established through digital subtraction sialography can be used when examining salivary glands with an initially unclear structural condition. For parotid sialography, the recommended contrast volume is 1.4 ± 0.3 ml, while for submandibular sialography, it is 1.2 ± 0.3 ml. Injecting contrast until the patient experiences a sensation of pressure or pain may result in overfilling (hypercontrast imaging). In conventional sialography, radiographic imaging should be performed immediately after contrast administration, which requires the patient to remain in the radiology suite during the procedure.

1. Afanas'ev VV. Salivary glands diseases and injuries – classification. Stomatology. 2010;89(1):63-65 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=16599370

2. Afanas'ev VV, Abdusalamov MR. Pitfalls in diagnostic and treatment of salivary glands disorders. Stomatology. 2018;97(3):60 61 (In Russ.). doi:10.17116/stomat201897360

3. Shchipskiy AV, Mukhin PN, Kalimatova MM, Akinfeev DM, Sencha AN. Sialology through the prism of precision digital sialography. Vestnik of KSMA named after I.K. Akhunbaev. 2020(2):67-78 (In Russ.). Available from: https://vestnik.kgma.kg/index.php/vestnik/article/view/28/32

4. Ogle OE. Salivary Gland Diseases. Dent Clin North Am. 2020;64(1):87-104. doi: 10.1016/j.cden.2019.08.007

5. Chisholm DM, Blair GS, Low PS, Whaley K. Hydrostatic sialography as an index of salivary gland disease in Sjögren's syndrome. Acta Radiol Diagn (Stockh). 1971;11(6):577-85. doi: 10.1177/028418517101100604

6. Bavykina IA, Titova LA, Bavykin DV, Rostovtsev VV. Sialography and its diagnostic value. Medical Scientific Bulletin of Central Chernozemye. 2023;24(1):73-79 (In Russ.). doi: 10.18499/1990-472X-2023-1-91-73-79

7. Tshchipskiy AV, Kondrashin SA. Contrast radiography of the salivary glands. Stomatologiya. 2015;94(6):45 49 (In Russ.). doi: 10.17116/stomat201594645-49

8. Romacheva IF. [Sialography in inflammatory diseases of the parotic and submaxillary glands. Stomatologiia (Mosk). 1953;6(1):45-51 (In Russ.). Available from: https://pubmed.ncbi.nlm.nih.gov/13076974/

9. Chibisova MA, Batukov NM. Methods of X-Ray examination and modern radiation diagnostics used in dentistry. The dental institute. 2020;(3):24-33 (In Russ.). Available from: https://www.elibrary.ru/item.asp?id=44076240

10. Ziegler L, Hart H, Küffer G, Hahn D. Digitale Sialographie [Digital sialography]. Digitale Bilddiagn. 1990;10(3-4):106-110. Available from: https://pubmed.ncbi.nlm.nih.gov/2085939/

11. Höhmann D, Landwehr P. Klinischer Stellenwert der Sialographie in digitaler und konventioneller Aufnahmetechnik [Clinical value of sialography in digital and conventional imaging technique]. HNO. 1991;39(1):13-17. Available from: https://pubmed.ncbi.nlm.nih.gov/2030081/

12. Borkovic Z, Peric B, Ozegovic I. The Value of Digital Subtraction Sialography in the Diagnosis of Diseases of the Salivary Glands. Acta Stomat Croat. 2002;36(4):505- 506. Available from: https://hrcak.srce.hr/10361