Özçelik Necdet, Vehbi Husam, Alaskarov Elvin
Department of Otorhinolaryngology, Istanbul Medipol University Health Care Practice and Research Center Esenler Hospital, Istanbul, Turkey.
Department of Radiology, Istanbul Medipol University Health Care Practice and Research Center Esenler Hospital, Istanbul, Turkey.
Ear Nose Throat J. 2024 Nov;103(3_suppl):37S-44S. doi: 10.1177/01455613241287291. Epub 2024 Oct 11.
This study aimed to determine the value of either ultrasonography and computed tomography (CT) alone or both for diagnosing salivary gland stones. Based on their clinical findings and physical examination, 188 patients with salivary stones were included. Initially, an ultrasound was performed, and then a non-contrast-enhanced thin-sliced CT scan was done. The study included 161 patients with suspected submandibular gland (SMG) sialolithiasis and 27 with parotid gland (PG) sialolithiasis. Among the SMG cases, stones were confirmed in 130 patients through interventional sialoendoscopy. Sixteen of the stones were detected by CT scan only and were not seen in the previous ultrasound examination. After the second follow-up ultrasound, which was conducted after reviewing the CT scans, 9 of them were identified. Five patients with distal stones and ductal dilation on ultrasound were confirmed to have sialolithiasis. In 5 patients with stones detected on ultrasound but not on CT, dental filling artifacts were identified as the cause. For PG cases, stones were observed in 18 out of 19 patients with suspected sialolithiasis based on ultrasound and CT findings. Three patients with positive CT findings but negative ultrasound showed stones during sialendoscopy. During an ultrasound examination, palpating the floor of the mouth with the other hand's index finger can help identify stones obscured by the shadow of the mandible, thereby enhancing the test's accuracy. Patients with dental fillings, implants, and permanent dentures should not be referred for a CT scan to avoid unnecessary exposure to ionizing radiation. They also cause significant metallic artifacts in the field of interest. In these cases, ultrasound should be considered. To minimize the effects of ionizing radiation, it is recommended to create limited field requests for the target, focusing solely on the submandibular and PGs.
本研究旨在确定单独使用超声检查和计算机断层扫描（CT）或两者联合用于诊断涎腺结石的价值。根据临床症状和体格检查，纳入了188例涎腺结石患者。首先进行超声检查，然后进行非增强薄层CT扫描。该研究包括161例疑似下颌下腺（SMG）涎石病患者和27例腮腺（PG）涎石病患者。在SMG病例中，通过介入性涎腺内镜检查在130例患者中证实有结石。其中16枚结石仅通过CT扫描检测到，在之前的超声检查中未发现。在复查CT扫描后进行的第二次随访超声检查中，发现了其中9枚。5例超声显示远端结石和导管扩张的患者被证实患有涎石病。在5例超声检测到结石但CT未检测到的患者中，确定牙充填伪影为原因。对于PG病例，根据超声和CT检查结果，19例疑似涎石病患者中有18例观察到结石。3例CT检查结果阳性但超声检查结果阴性的患者在涎腺内镜检查时发现有结石。在超声检查过程中，用另一只手的食指触诊口腔底部有助于识别被下颌骨阴影遮挡的结石，从而提高检查的准确性。有牙充填物、植入物和永久假牙的患者不应进行CT扫描，以避免不必要的电离辐射暴露。它们还会在感兴趣的区域产生明显的金属伪影。在这些情况下，应考虑超声检查。为了尽量减少电离辐射的影响，建议对目标创建有限视野请求，仅聚焦于下颌下腺和腮腺。
