Value of sonography in sialodochitis and ductal stenosis of the parotid gland

Introduction Ductal stenosis (DS) and sialodochitis are the most important causes of obstructive sialopathies not caused by stones, 75% of which are located in the parotid gland (PG). These are currently mostly diagnosed using sialography and MR sialography.

Objective Evaluation of the diagnostic value of the ultrasound (US) in sialodochitis and ductal stenosis.

Methods Retrospective evaluation of the findings of all patients diagnosed with obstructive sialopathy of the PG. 525 patients (691 PG) were examined. Patients with salivary stones were excluded. All patients received sonography followed by sialendoscopy. US parameters were parenchymal texture and duct diameter. These were compared with sialendoscopy, which served as the reference standard.

Results Sialendoscopy showed sialodochitis in 223 (32.9%), DS in 315 (45.6%, 21.6% associated with duct anomalies) and normal findings in 149 (21.6%) of cases. GP with normal findings showed duct diameter of 0.3 mm (0-2.7 mm) and hyperechoic parenchyma in 98.7%. In comparison, sialodochitis showed a larger duct diameter (0.7 mm, 0-4.3 mm, p<0.001) and a hypoechoic parenchyma in 78.0% of cases (p<0.001). In DS 52.6% showed a hypoechoic parenchyma and a duct diameter of 4.1mm (0-19mm), in association with duct anomalies the parenchyma was 85.3% hyperechoic, the duct diameter was 8.9mm (4.0-19mm). Starting at a duct diameter of 2.7mm in sonography, DS was present in 96.1% of cases (AUC 0.886, p<0.001). A duct diameter of 5.2 mm identified a DS with duct anomaly with 92.6% sensitivity and 97.0% specificity (AUC: 0.986, p<0.001).

Conclusions The data suggest that the US, as the only imaging option for V. a. sialodochitis or ductal stenosis of PG, can provide a valid diagnosis in most cases and contribute to therapy planning.

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Publication History

Article published online:
10 June 2020