Hermann G A, Vivino F B, Shnier D, Krumm R P, Mayrin V, Shore J B
Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, USA.
J Nucl Med. 1998 Jul;39(7):1260-3.
Several quantitative measures of salivary uptake and discharge have been proposed recently in the scintigraphic evaluation of xerostomia. We investigated the scatter of four time-activity curve C(TAC)-derived indices in a group of volunteer subjects who met extensive inclusionary and exclusionary criteria of salivary normalcy.
Thirty-one adult volunteers underwent dynamic salivary scintigraphy with gustatory stimulation. Any candidates with subjective xerostomia, conditions or medications associated with dry mouth, salivary gland enlargement or pregnancy were excluded from study. All subjects had normal oral exams, xerostomia scores and unstimulated whole-mouth salivary flow rates. After the intravenous administration of 99mTcO-4, scintigraphy was performed with generation of TACs derived from regions of interest centered about the four major salivary glands and the oral cavity. At 45 min postinjection, hard lemon candy was given for 15 min as a gustatory stimulus. The following functional indices were calculated for each gland: partitioned percentage (PP) of total prestimulated activity, maximum net uptake ratio (NUR) and its time of occurrence (TNUR) and percentage stimulated discharge fraction (DF).
The following ranges were observed: parotid PP, 22%-49%; submandibular PP, 4%-31%; parotid NUR, 2.2-16.0; submandibular NUR, 1.4-16.2; parotid TNUR, 8-45 min; submandibular TNUR, 2-45 min; parotid DF, 20%-99%; and submandibular DF, 27%-98%. Every subject except one 91-yr-old man showed frequent periodic unstimulated oral transfer of salivary activity with a rising oral TAC and responded to gustatory stimulation.
So-called quantitative indices may perform poorly in the scintigraphic evaluation of xerostomic patients because the effects of normal simultaneous glandular trapping, uptake, oral discharge and possible vascular washout combine to widen reference limits. Coordinated analysis of oral cavity and glandular activities, glandular index averaging and better temporal resolution may help improve diagnostic performance.
最近在口干燥症的闪烁显像评估中提出了几种唾液摄取和排出的定量测量方法。我们在一组符合广泛的唾液正常纳入和排除标准的志愿者中研究了四种时间-活性曲线（TAC）衍生指标的离散情况。
31名成年志愿者接受了味觉刺激下的动态唾液闪烁显像。任何有主观口干燥症、与口干相关的病症或药物、唾液腺肿大或怀孕的受试者均被排除在研究之外。所有受试者口腔检查、口干燥症评分和非刺激性全口唾液流速均正常。静脉注射99mTcO-4后，进行闪烁显像，生成来自围绕四个主要唾液腺和口腔的感兴趣区域的TAC。注射后45分钟，给予硬柠檬糖15分钟作为味觉刺激。为每个腺体计算以下功能指标：刺激前总活性的分配百分比（PP）、最大净摄取率（NUR）及其出现时间（TNUR）以及刺激后排泄分数（DF）。
观察到以下范围：腮腺PP，22%-49%；颌下腺PP，4%-31%；腮腺NUR，2.2-16.0；颌下腺NUR，1.4-16.2；腮腺TNUR，8-45分钟；颌下腺TNUR，2-45分钟；腮腺DF，20%-99%；颌下腺DF，27%-98%。除一名91岁男性外，每个受试者在非刺激状态下均表现出唾液活性频繁的周期性口腔转移，口腔TAC上升，并对味觉刺激有反应。
在口干燥症患者的闪烁显像评估中，所谓的定量指标可能表现不佳，因为正常的同时腺体捕获、摄取、口腔排出和可能的血管洗脱的影响共同导致参考范围变宽。口腔和腺体活性的协调分析、腺体指标平均化以及更好的时间分辨率可能有助于提高诊断性能。
