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Premium member Presentation Transcript MR SIALOGRAPHY : MR SIALOGRAPHY Slide 2: Nawaz ali Mohamed Clinical Specialist in MRI King Abdul Aziz Specialist Hospital Taif Saudi Arabia ANATOMY OF SALIVARY GLAND : ANATOMY OF SALIVARY GLAND ANATOMY OF Wharton's Duct : ANATOMY OF Wharton's Duct The sub mandibular duct extends from the sub mandibular gland to the posterior edge of the mylohyoid bone curves around the muscle, then enters the sublingual space on the surface of the mylohyoid muscle and finally drains into the sublingual papilla. The sub mandibular duct is 5-6 mm and the clumen cross-section is 1-3 mm. POTENTIAL CLINICAL APPLICATIONS : POTENTIAL CLINICAL APPLICATIONS TECHNICAL APPLICATIONS : TECHNICAL APPLICATIONS DIGITAL RADIOGRAPHY : DIGITAL RADIOGRAPHY Demerits in Digital Radiography : Demerits in Digital Radiography In the acute setting of sialadenitis - Possibility of exacerbating the symptoms associated with the infection The retrograde injection of contrast agents can force inflammatory products into the more peripheral parenchyma of the gland Act of instrumentation – irritation & may cause narrowing from post traumatic edema or stricture formation and lead to reduce drainage of the saliva For diagnosis of sialolithiasis approx. 20% sialoliths in the SMG and SMD are not radio opaque Phleboliths, Calcified hemangioma, calcified lymph stones may mimic sialoliths ULTRA SONOGRAPHY : ULTRA SONOGRAPHY Demerits in Ultra sonography : Demerits in Ultra sonography Sialoliths smaller than 2-3mm may be overlooked- (acoustic shadow) Be ready for surprises !!! : Be ready for surprises !!! MRI SIALOGRAPHY : MRI SIALOGRAPHY Parotid Ducts MR SIALOGRAPHY OF THE SUBMANDIBULAR DUCT : MR SIALOGRAPHY OF THE SUBMANDIBULAR DUCT DETECTION OF SIALOLITHS DETECTING SALIVARY GLANDULAR CALCULI & DUCTAL STENOSIS DELINEATION OF SUBMANDIBULAR DUCTAL SYSTEM SIALOLITHS : SIALOLITHS EQUIPMENTS : EQUIPMENTS High Tesla MR Scanner Dedicated Brain Coil -12 Channel array Slew rate – gradient amplitude of 25 mT/ at a ramp time of 600 nsec PREPERATION : PREPERATION Prior to MR image the patient were given Lemon juice to stimulate salivation. INDICATIONS : INDICATIONS CONTRA-INDICATIONS : CONTRA-INDICATIONS Patient with Acute Infection TECHNIQUES : TECHNIQUES 3D – CISS (Constructive Interference steady state) RARE (Rapid Acquisition and relaxation enhancement) - HASTE T2 weighted Turbo spin echo T1 weighted spin echo Soft Tissue MR Imaging CISS- An Overview : CISS- An Overview Strongly T2 weighted GRE sequences ((Two FISP) Two FISP sequences are summed , fluid such as saliva have high signal intensity Susceptible to patient motion High In-plane resolution Short Acquisition time High signal to noise ratio Characteristics of CISS : Characteristics of CISS Prone to Magnetic Susceptibility artifacts Excellent tissue/fluid contrast Not affected by the blurring artifact Slow sequences and slow reconstructions Slab profile is poor CISS is available in 2DFT & 3DFT implementations CISS-SEQUENCE PARAMETERS : CISS-SEQUENCE PARAMETERS TR – 12.25 mSec TE – 5.9 mSec Flip Angle – 70* I transverse slab 32 mm thick 46 partitions Matrix - 230x512 (60%) FOV – 200x150 Frequency over-sampling Phase L-R I Acquisitions Scan time – 4 min 20 sec Resolution – 0.7x0.65x0.39 Patient shim before sequence RARE – An Overview : RARE – An Overview HASTE – A modified sequence of RARE technique 128 echo train lengths – in a short time Characteristics of RARE : Characteristics of RARE HASTE images - not only RARE-Sequence Parameters : RARE-Sequence Parameters Plane – Oblique Sagittal TR - 2000 mSec TE - 10.7 mSec Flip Angle - 150* Matrix - 240X256 FOV – 230 mm In plane resolution - 0.79X0.74 mm ST- 4 mm BW - 240 Acquisition time - 7 sec Turbo T2 spin echo parameters : Turbo T2 spin echo parameters Plane -Transverse TR – 4500 mSec TE – 99 (Eff. echo time) Matrix – 256x256 FOV – 170 mm In-plane resolution - 0.70x0.66-mm ST – 3-mm with 0.45-mm Intersection gap NEX - 2 Acquisition time – 3 min 28 sec T1 Spin echo parameters : T1 Spin echo parameters Plane – Transverse TR – 580 mSec TE - 15 mSec Matrix – 256x256 FOV – 170 mm In-plane resolution – 0.66x0.66mm ST – 3-mm with 0.45-mm Intersection gap NEX – 2 Acquisition time – 5 min 58 sec PLANNING TIPS-MRI Sialography : PLANNING TIPS-MRI Sialography 3D CISS- Transaxial – Reformatted coronal and oblique sagittal using MPVR RARE – oblique sagittal orientation parallel to the sub mandibular duct Merits of MR Sialography : Merits of MR Sialography Not requiring Cannulation -Noninvasive No Contrast-Evoked Saliva is the Contrast No Radiation Possible to accurately assess the measurement of a duct Demerits of MR Sialography : Demerits of MR Sialography Visualization of small branches are poor Adjacent Dental amalgam – metallic artifacts Inability to show mild narrowing WHAT IS THE EVIDENCE IN SUPPORT OF THE CURRENT CLINICAL APPLICATIONS OF MR SIALOGRAPHY : WHAT IS THE EVIDENCE IN SUPPORT OF THE CURRENT CLINICAL APPLICATIONS OF MR SIALOGRAPHY CASE PRESENTATIONS : CASE PRESENTATIONS CONCLUSION : CONCLUSION Sensitivity and Specificity : Sensitivity and Specificity Detection of Calculi in MR Sialography : Detection of Calculi in MR Sialography Detection of Ductal Stenosis in MR Sialography : Detection of Ductal Stenosis in MR Sialography Similar of Digital Sialography and superior than US : Similar of Digital Sialography and superior than US THANK YOU : THANK YOU You do not have the permission to view this presentation. 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