Salivary Gland Scintigraphy in Patients with Sjogren’s Syndrome: A local Experience with Dual-tracer

Document Type : Original Article


1 Princess Margaret Hospital, Hong Kong

2 Princess Margaret Hospital

3 Kwong Wah Hospital

4 Baptist Hospital

5 Hong Kong Education University


Objective(s): To review the findings of the patients with Sjögren’s syndrome (SS) having technetium-99m-pertechnetate (99mTc-pertechnetate) and gallium-67 citrate (Ga-67) salivary gland scintigraphy in the past eight years.
Methods: The patients with SS, who were referred to our department for salivary gland scintigraphy during January 2008-December 2015 were studied using both 99mTc-pertechnetate and Ga-67 citrate scintigraphy.
Results: Eighteen patients were included in the study, 17 of whom had positive findings on 99mTc- pertechnetate salivary gland scintigraphy. One patient had negative parotid glands findings on 99mTc-pertechnetate, but positive findings in Ga-67 study. Four patients had asymmetric involvement of the parotid glands, and one patient had asymmetric involvement of the submandibular glands in 99mTc-pertechnetate salivary gland scintigraphy. On the other hand, one patient had only submandibular gland involvement in the 99mTc-pertechnetate scan.Nine patients (9/18) had positive parotid gland findings on Ga-67 study. The involvements of the parotid glands were all symmetrical, except for one patient. No abnormal gallium uptake in the submandibular glands in our patients was noted.
Conclusion: 99mTc-pertechnetate salivary gland scintigraphy is sufficient for the assessment in the majority of patients with SS. Ga-67 scintigraphy may be a useful supplementary test, especially if the result of 99mTc-pertechnetate scintigraphy is not conclusive.


Main Subjects

1. Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, et al. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American- European Consensus Group. Ann Rheum Dis. 2002;61(6):554-8.
2. Baldini C, Talarico R, Tzioufas AG, Bombardieri S. Classification criteria for Sjogren’s syndrome: a critical review. J Autoimmun. 2011; 39(1-2):9-14.
3. Aung W, Murata Y, Ishida R, Takahashi Y, Okada N, Shibuya H. Study of quantitative oral radioactivity in salivary gland scintigraphy and determination of the clinical stage of Sjögren’s syndrome. J Nucl Med. 2001;42(1):38-43.
4. Klutmann S, Bohuslavizki KH, Kröger S, Bleckmann C, Brenner W, Mester J, et al. Quantitative salivary gland scintigraphy. J Nucl Med Technol. 1999;27(1):20-6.
5. Gomes Pde S, Juodzbalys G, Fernandes MH, Guobis Z. Diagnostic approaches to Sjögren’s syndrome: a literature review and own clinical experience. J Oral Maxillofac Res. 2012;3(1):e3.
6. Staab EV, McCartney WH. Role of gallium 67 in inflammatory disease. Semin Nucl Med.1978; 8(3): 219-34 .
7. Alarcon-Segovia D, Ibanez G, Hernandez-Ortiz, Cetina JA, Gonzalel-Jimenez Y, Diaz-Jouanen E. Salivary gland involvement in diseases associated with Sjogren’s syndrome. 1. Radionuclide and roentgenographic studies. J Rheumatol. 1974;1(2):159-65.
8. Schall GL, Anderson LG, Wolf RO, Herdt JR, Tarpley TM Jr, Cummings NA, et al. Xerostomia in Sjögren’s Syndrome. Evaluation by sequential salivary scintigraphy. JAMA. 1971;216(13):2109-16.
9. Fossaluzza V, De Vita S, Geatti O. Sequential salivary scintigraphy in Sjögren’s syndrome: proposal for a new method of evaluation. Clin Exp Rheumatol. 1990;8(5):469-74.
10. Shizukuishi K, Nagaoka S, Kinno Y, Saito M,Takahashi N, Kawamoto M, et al. Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome. Ann Nucl Med. 2003;17(8):627-31.
11. Kim HA, Yoon SH, Yoon JK, Lee SJ, Jo KS, Lee DH, et al. Salivary gland scintigraphy in Sjögren’s syndrome. Comparison of the diagnostic performance of visual and semiquantitative analysis. Nuklearmedizin. 2014;53(4):139-45.
12. Yoshimura M, Koizumi K, Satani K, Kakizaki D, Kawanishi Y, Ohyashiki K, et al. Gallium-67 scintigraphic findings in a patient with breast lymphoma complicated with Sjögren syndrome. Ann Nucl Med. 2000;14(3):227-9.
13. Parkin B, Chew JB, White VA, Garcia-Briones G, Chhanabhai M, Rootman J. Lymphocytic infiltration and enlargement of the lacrimal glands: a new subtype of primary Sjögren’s syndrome? Ophthalmology.2005;112(11):2040-7.
14. Weinreb RN, Yavitz EQ, O’Connor GR, Barth RA. Lacrimal gland uptake of gallium citrate Ga-67. Am J Ophthalmol. 1981;92(1):16-20.
15. Collins RD Jr, Ball GV, Logic JR. Gallium-67 scanning in Sjögren’s syndrome: concise communication. J Nucl Med. 1984;25(3):299-302.
16. Tanaka H, Onodera N, Ito R, Higuchi A, Suzuki Y, Monma N, et al. Subclinical Sjögren’s syndrome: a significant 67gallium accumulation in the orbits and parotid glands. Acta Paediatr Jpn. 1998;40(6):621-3.
17. Aung W, Yamada I, Umehara I, Ohbayashi N, Yoshino N, Shibuya H. Sjögren’s syndrome: comparison of assessments with quantitative salivary gland scintigraphy and contrast sialography. J Nucl Med.
18. Güne S, Yilmaz S, Karalezli A, Aktaş A. Quantitative and visual evaluation of salivary and thyroid glands in patients with primary Sjögren’s syndrome using salivary gland scintigraphy: relationship
with clinicopathological features of salivary, lacrimal and thyroid glands. Nucl Med Commun.2010;31(7):666-72.