Imaging Sci Dent.  2019 Dec;49(4):301-306. 10.5624/isd.2019.49.4.301.

Power Doppler ultrasound-guided sialography using the phenomenon of increased blood flow: A technical report

• Oh SH
• Seo YK
• Kim GT
• Choi YS
• Hwang EH

• KMID: 2466553
• DOI: http://doi.org/10.5624/isd.2019.49.4.301

Abstract

PURPOSE
This report presents a procedure for performing power Doppler ultrasound-guided sialography using the phenomenon of increased blood flow and illustrates its application to practical patient cases.
MATERIALS AND METHODS
The salivary gland was scanned using ultrasound equipment (GE LOGIQ5 Expert® device; GE Medical Systems, Milwaukee, WI, USA) to identify pathological findings related to the patient's chief complaint. To identify the orifice of the main duct, it should be cannulated using a lacrimal dilator. After inserting the catheter into the cannulated main duct, the position of the catheter within the duct was confirmed by ultrasound. A contrast agent was injected until the patient felt fullness, and ultrasound (B-mode) was used to confirm whether the contrast agent filled the main canal and secondary and tertiary ducts. Then, power Doppler ultrasound was performed to determine whether the salivary gland had increased blood flow.
RESULTS
In 2 cases in this report, a power Doppler ultrasound scan showed a significant increase in blood flow after contrast medium injection, which was not observed on a preoperative scan.
CONCLUSION
Power Doppler ultrasound was found to be a simple, safe, and effective tool for real-time sialography monitoring.

Keyword

Sialography; Ultrasonography; Vasodilation

MeSH Terms

Catheters
Humans
Salivary Glands
Sialography*
Ultrasonography
Vasodilation

Figure

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  Fig. 1 Instruments used for power Doppler ultrasound-guided sialography. A. Lacrimal dilators (Bowman lacrimal probe®, #0.000 – #0.0). B. The plastic section of an intravenous catheter (20 G) with a lacrimal dilator. C. Universal cannula connected to a 5-mL syringe and intravenous infusion set.

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  Fig. 2 Power Doppler ultrasound (US)-guided sialography (51/F) for diagnosing sialodochitis of the left parotid gland. A. On preoperative US images, there are no observable pathologic changes in the parotid gland. B. The position of the catheter in the main duct is confirmed by a linear hyperechoic signal with posterior enhancement (arrow). C. During fluid injection, an increase in blood flow is observed at the tip of the universal cannula. D. As the contrast agent entered, parotid gland duct dilatation, periductal vasodilation, and increased blood flow are observed.

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  Fig. 3 Sialography of the left parotid gland in case 1 shows sialodochitis without sialadenitis. The Stensen duct exhibited dilatation with local strictures, and the intraglandular ductules showed irregular dilatation with constriction.

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  Fig. 4 Power Doppler ultrasound (US)-guided sialography (30/F) for diagnosing xerostomia. A. On preoperative US images, there are no observable pathologic changes in the ductal system or the parenchymal portion of the right parotid gland. B. The position of the catheter in the main duct is confirmed by a linear hyperechoic signal with posterior enhancement (arrow). C and D. As the contrast agent enters, parotid gland duct dilatation, periductal vasodilatation, and increased blood flow are observed.

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  Fig. 5 Sialography shows atrophic changes in the ductal system of the right parotid gland, with narrowing of the secondary and tertiary ductules, but without sialectasis.

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