Wenzel Piper A, Thorpe Ryan K, Maley Joan E, Policeni Bruno A, Beichel Reinhard R, Henkle Kailey D, Hoffman Henry T
Department of Otolaryngology - Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Ear Nose Throat J. 2024 Aug 27:1455613241272451. doi: 10.1177/01455613241272451.
The presence of a catheter required for contrast infusion during sialography obscures imaging of the distal duct. Static imaging via cone beam computed tomography and magnetic resonance sialography fails to address changes that occur dynamically to the anatomy of the flexible salivary ductal system. We aim to identify dynamic changes to the parotid gland by introducing a novel approach to analyze the full extent of Stensen's duct based on dynamic infusion digital sialography. Retrospective chart review of a single-center consecutive series of 409 parotid sialograms performed between April 2008 and June 2023 permitted selection of a contemporary series including seven normal sialograms and seven sialograms with stricture(s). Dynamic (fluoroscopic) infusion (iopamidol/gadolinium) sialograms were assessed through blinded review by two radiologists employing the institution's picture archiving and communication (PACS) system (©2023 Koninklijke Philips N.V., Amsterdam, Netherlands). Measurements determined changes, in two dimensions, to the angle of the masseteric bend and duct length while the catheter was in place (repose), during catheter withdrawal (stretch), and during recoil after withdrawal. Differences in median lengths and angles of Stensen's duct between the three time points were compared using Wilcoxon matched-pairs signed rank and Mann-Whitney tests. Fourteen patients [median age (IQR), 55 years (24.7); 10 women] were evaluated. The median angle of the masseteric bend was 117.7° in repose versus 155.4° during catheter withdrawal ( < .001, n = 14). The median distance measured from the Stensen's duct orifice to the first major ductal bifurcation was 81.5 mm (IQR = 12.3) in repose. The median percent increase in length from repose to stretch was 6.3% ( < .001, n = 14). Dynamic infusion digital sialography with fluoroscopic recording during catheter removal permits assessment of the distal duct unobstructed by the presence of a catheter. The technique also identifies the dynamic nature and varying length and angulation of Stensen's duct.
唾液腺造影术中进行造影剂注入所需的导管会遮挡远端导管的成像。锥形束计算机断层扫描和磁共振唾液腺造影的静态成像无法解决灵活的唾液导管系统解剖结构动态发生的变化。我们旨在通过引入一种基于动态注入数字唾液腺造影分析腮腺导管全长的新方法，来识别腮腺的动态变化。对2008年4月至2023年6月期间在单中心连续进行的409例腮腺唾液腺造影进行回顾性图表审查，从中选择了一个当代系列，包括7例正常唾液腺造影和7例有狭窄的唾液腺造影。由两名放射科医生通过盲法审查，利用该机构的图像存档和通信（PACS）系统（©2023 Koninklijke Philips N.V., Amsterdam, Netherlands）评估动态（荧光透视）注入（碘帕醇/钆）唾液腺造影。测量确定了在导管在位（静止）、导管撤出（拉伸）和撤出后回弹期间，咬肌弯曲角度和导管长度在两个维度上的变化。使用Wilcoxon配对符号秩检验和Mann-Whitney检验比较三个时间点之间腮腺导管中位长度和角度的差异。对14例患者[中位年龄（IQR），55岁（24.7）；10名女性]进行了评估。咬肌弯曲的中位角度在静止时为117.7°，而在导管撤出时为155.4°（P <.001，n = 14）。从腮腺导管口到第一个主要导管分支的中位距离在静止时为81.5 mm（IQR = 12.3）。从静止到拉伸长度的中位百分比增加为6.3%（P <.001，n = 14）。在导管移除期间进行荧光透视记录的动态注入数字唾液腺造影能够评估未被导管遮挡的远端导管。该技术还能识别腮腺导管的动态特性以及其长度和角度的变化。
