MR sialography and salivary gland SPECT/CT in Sjögren syndrome — a systematic review

Authors

  • Shereen DMRD, DNB, Associate Professor, Department of Radiodiagnosis, Kanyakumari Government Medical College, Asaripallam, Tamil Nadu, India.
  • Jagadeesh Gajendran Assistant Professor, Department of Radiology and Imaging Sciences, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India.
  • Sebastin Varghese Paul MBBS, DMRD, DNB, Professor, Department of Radiology and Imaging Sciences, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India.
  • Karthik Shunmugavelu BDS, MDS (OMFP), MSc (London), MFDSRCS (England), MFDSRCPS (Glasgow), Faculty Affiliate RCS Ireland, Affiliate RCS Edinburgh, Associate Faculty of Dental Trainers Edinburgh, MCIP, FIBMS (USA), MASID (Australia), Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India.

DOI:

https://doi.org/10.51168/h89jrt94

Keywords:

Sjögren’s syndrome, magnetic resonance sialography, dynamic magnetic resonance sialography, scintigraphy, single-photon emission computed tomography/computed tomography, parotid gland imaging, salivary gland dysfunction

Abstract

Background:

Sjögren’s syndrome (SS) causes progressive salivary gland dysfunction. Accurate parotid assessment is essential. MR sialography, dynamic MR sialography, scintigraphy, and SPECT/CT provide structural and functional information, but evidence varies.

Aim: 

To evaluate the diagnostic performance of these modalities in parotid involvement in SS.

Methods:

Following PRISMA 2020, PubMed, Scopus, Web of Science, and Google Scholar were searched. Eight studies met the criteria. We extracted data on imaging protocols, staging, functional parameters, and correlations. We assessed risk of bias using the Newcastle-Ottawa Scale.

Results:

MR sialography identified ductal abnormalities in 60–72% of SS patients versus 0–7% of controls (OR 12.5–35.0, p<0.001). Dynamic MR sialography showed reduced secretion slope (0.85±0.21 vs 1.95±0.34) and delayed peak enhancement (185±32 vs 95±18 s) (p<0.001). Scintigraphy/SPECT/CT demonstrated reduced uptake ratio (0.45±0.12 vs 1.02±0.15), impaired excretion fraction (28±9% vs 62±12%), prolonged Tmax (12.4±3.1 vs 6.2±1.8 min), and decreased SUVmax (2.1±0.6 vs 4.8±1.1) (p<0.001). Correlations with clinical severity (r=0.71), MR stage (r=−0.64), and biopsy focus score (r=−0.58) were significant (p<0.001). Functional decline preceded structural deterioration.

Conclusion:

Multimodal imaging provided comprehensive evaluation. MR sialography assessed structure, dynamic MR sialography detected early functional impairment, and scintigraphy/SPECT/CT quantified dysfunction. Integrating modalities improved diagnostic accuracy. Future research should standardize protocols and incorporate advanced quantitative techniques.

Author Biographies

  • Shereen, DMRD, DNB, Associate Professor, Department of Radiodiagnosis, Kanyakumari Government Medical College, Asaripallam, Tamil Nadu, India.

    is an Associate Professor, Department of Radiodiagnosis, Kanyakumari Government Medical College, Asaripallam, Tamil Nadu, India. Her interests include head and neck radiology and salivary gland imaging.

  • Jagadeesh Gajendran, Assistant Professor, Department of Radiology and Imaging Sciences, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India.

    is an Assistant Professor, Department of Radiology and Imaging Sciences, PSP Medical College Hospital and Research Institute, Tamil Nadu, India. His interests include diagnostic radiology and cross-sectional imaging.

  • Sebastin Varghese Paul, MBBS, DMRD, DNB, Professor, Department of Radiology and Imaging Sciences, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India.

    is a Professor, Department of Radiology and Imaging Sciences, PSP Medical College Hospital and Research Institute, Tamil Nadu, India. His interests include neuroradiology and head and neck imaging.

  • Karthik Shunmugavelu, BDS, MDS (OMFP), MSc (London), MFDSRCS (England), MFDSRCPS (Glasgow), Faculty Affiliate RCS Ireland, Affiliate RCS Edinburgh, Associate Faculty of Dental Trainers Edinburgh, MCIP, FIBMS (USA), MASID (Australia), Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tambaram–Kanchipuram Main Road, Oragadam, Panruti, Kanchipuram District, Tamil Nadu 631604, India.

    is an Assistant Professor, Department of Dentistry, PSP Medical College Hospital and Research Institute, Tamil Nadu, India. His interests include oral medicine/oral pathology, salivary gland disorders, and systematic reviews.

References

1. Negrini S, Emmi G, Greco M, Borro M, Sardanelli F, Murdaca G, Indiveri F, Puppo F. Sjögren's syndrome: a systemic autoimmune disease. Clin Exp Med. 2022 Feb;22(1):9-25. https://doi.org/10.1007/s10238-021-00728-6

2. Kassan SS, Moutsopoulos HM. Clinical Manifestations and Early Diagnosis of Sjögren Syndrome. Arch Intern Med. 2004;164(12):1275-1284. https://doi.org/10.1001/archinte.164.12.1275

3. Fulvio G, La Rocca G, Chatzis L, Ferro F, Navarro Garcia I, Cafaro G, Goules A, Bartoloni E, et al. [Reference incomplete in source; complete before submission.]

4. Carsons SE, Blum MA. Sjogren Syndrome. [Updated 2025 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431049/

5. Yura Y, Hamada M. Outline of Salivary Gland Pathogenesis of Sjögren's Syndrome and Current Therapeutic Approaches. Int J Mol Sci. 2023;24(13):11179. https://doi.org/10.3390/ijms241311179

6. Talha B, Swarnkar SA. Xerostomia. [Updated 2023 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545287/

7. Porcheri C, Mitsiadis TA. Physiology, Pathology and Regeneration of Salivary Glands. Cells. 2019 Aug 26;8(9):976. https://doi.org/10.3390/cells8090976

8. Saleh J, Figueiredo MAZ, Cherubini K, Salum FG. Salivary hypofunction: An update on aetiology, diagnosis and therapeutics. Arch Oral Biol. 2015;60(2):242-255. ISSN 0003-9969. https://doi.org/10.1016/j.archoralbio.2014.10.004

9. Murdoch-Kinch CA. Salivary Gland Imaging. J Calif Dent Assoc. 2011;39(9):649-654. https://doi.org/10.1080/19424396.2011.12221940

10. Rzymska-Grala I, Stopa Z, Grala B, Gołębiowski M, Wanyura H, Zuchowska A, Sawicka M, Zmorzyński M. Salivary gland calculi - contemporary methods of imaging. Pol J Radiol. 2010 Jul;75(3):25-37. PMID: 22802788; PMCID: PMC3389885.

11. Chen Y-C, Chen H-Y, Hsu C-H. Recent Advances in Salivary Scintigraphic Evaluation of Salivary Gland Function. Diagnostics. 2021;11(7):1173. https://doi.org/10.3390/diagnostics11071173

12. Schroder U, Jungehulsing M, Fischbach R, Krug B. Die Kernspinsialographie. Ein neues diagnostisches Verfahren zur Speicheldruisengangdarstellung [Magnetic resonance sialography]. A new diagnostic method for imaging salivary duct patency. HNO. 1998 Jan;46(1):38-43. German. https://doi.org/10.1007/s001060050194

13. Fischbach R, Kugel H, Ernst S, Schroder U, Brochhagen HG, Jungehulsing M, Heindel W. MR sialography: initial experience using a T2-weighted fast SE sequence. J Comput Assist Tomogr. 1997 Sep-Oct;21(5):826-30. https://doi.org/10.1097/00004728-199709000-00032

14. Li Y, Pu Y, Shi H, Fan Q, Yu C. A retrospective study of magnetic resonance sialography imaging applied in the prognostic evaluation of chronic obstructive parotitis. Quant Imaging Med Surg. 2023 Oct 1;13(10):6363-6373. https://doi.org/10.21037/qims-22-1452

15. Sabotin RP, Maley JE, Hoffman HT. Conventional and MR sialography of accessory submandibular glands: A case report. Radiol Case Rep. 2022 Oct 4;17(12):4766-4768. https://doi.org/10.1016/j.radcr.2022.09.054

16. Ren YD, Li XR, Zhang J, Long LL, Li WX, Han YQ. Conventional MRI techniques combined with MR sialography on T2-3D-DRIVE in Sjögren syndrome. Int J Clin Exp Med. 2015 Mar 15;8(3):3974-82. PMID: 26064299; PMCID: PMC4443133.

17. Tanaka T, Oda M, Wakasugi-Sato N, Joujima T, Miyamura Y, Habu M, Kodama M, Takahashi O, Sago T, Matsumoto-Takeda S, Nishida I, Tsurushima H, Otani Y, Yoshiga D, Sasaguri M, Morimoto Y. First [Reference incomplete in source; complete before submission.]

18. Kim J, Lee H, Lee H, Bang JI, Kang YK, Bae S, Song YS, Lee WW. Quantitative Single-Photon Emission Computed Tomography/Computed Tomography for Evaluation of Salivary Gland Dysfunction in Sjögren's Syndrome Patients. Nucl Med Mol Imaging. 2018 Oct;52(5):368-376. https://doi.org/10.1007/s13139-018-0547-4

19. Wong KK, Fig LM, Youssef E, Ferretti A, Rubello D, Gross MD. Endocrine Scintigraphy with Hybrid SPECT/CT. Endocr Rev. 2014;35(5):717-746. https://doi.org/10.1210/er.2013-1030

20. Ritt P. Recent Developments in SPECT/CT. Semin Nucl Med. 2022;52. https://doi.org/10.1053/j.semnuclmed.2022.01.004

21. Yandrapalli S, Puckett Y. SPECT Imaging. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564426/

22. Bockisch A, Freudenberg L, Schmidt D, Kuwert T. Hybrid imaging by SPECT/CT and PET/CT: proven outcomes in cancer imaging. Semin Nucl Med. 2009;39:276-289. https://doi.org/10.1053/j.semnuclmed.2009.03.003

23. Swiecka M, Maslińska M, Paluch L, Zakrzewski J, Kwiatkowska B. Imaging methods in primary Sjögren's syndrome as potential tools of disease diagnostics and monitoring. Reumatologia. 2019;57(6):336-342. https://doi.org/10.5114/reum.2019.91273

24. Kelly AL, Nelson RJ, Sara R, Alberto S. Sjögren Syndrome: New Insights in the Pathogenesis and Role of Nuclear Medicine. J Clin Med. 2022;9(11):5227. https://doi.org/10.3390/jcm11175227

25. Amarnath, Sathyan, Shivashankar, Suhasini, Kanimozi, Komalavalli, Sivakumar, Balaji. MR SIALOGRAPHY AND CONVENTIONAL SIALOGRAPHY IN SALIVARY GLAND AND DUCT PATHOLOGIES: A COMPARATIVE STUDY. J Evol Med Dent Sci. 2016;5. https://doi.org/10.14260/jemds/2016/778

26. van Ginkel MS, Glaudemans AWJM, van der Vegt B, Mossel E, Kroese FGM, Bootsma H, Vissink A. Imaging in Primary Sjögren's Syndrome. J Clin Med. 2020;9(8):2492. https://doi.org/10.3390/jcm9082492 https://doi.org/10.3390/jcm9082492

27. Shirai A, Nakatani Y, Toya S, Ogura I. MR sialography and salivary gland SPECT/CT for parotid glands in patients with Sjögren's syndrome. Dentomaxillofac Radiol. 2025 Nov 1;54(8):690-694. https://doi.org/10.1093/dmfr/twaf048

28. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71. https://doi.org/10.1136/bmj.n71

29. Morgan RL, Whaley P, Thayer KA, Schünemann HJ. Identifying the PECO: A framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environ Int. 2018 Dec;121(Pt 1):1027-1031. https://doi.org/10.1016/j.envint.2018.07.015

30. Tonami H, Ogawa Y, Matoba M, Kuginuki Y, Yokota H, Higashi K, Okimura T, Yamamoto I, Sugai S. MR sialography in patients with Sjögren syndrome. AJNR Am J Neuroradiol. 1998 Aug;19(7):1199-203. PMID: 9726453; PMCID: PMC8332227.

31. Niemelä RK, Pääkkö E, Suramo I, Takalo R, Hakala M. Magnetic resonance imaging and magnetic resonance sialography of parotid glands in primary Sjögren's syndrome. Arthritis Rheum. 2001 Dec;45(6):512-8. https://doi.org/10.1002/1529-0131(200112)45:6<512::AID-ART376>3.0.CO;2-R

32. Tomiita M, Ueda T, Nagata H, Tanabe E, Shimojo N, Saito K, Motoori K, Ito H, Kohno Y. Usefulness of magnetic resonance sialography in patients with juvenile Sjögren's syndrome. Clin Exp Rheumatol. 2005 Jul-Aug;23(4):540-4. PMID: 16095127.

33. Ahmed NS, Mansour SM, El-Wakd MM, Al-Azizi HM, Abu-Taleb NS. The value of magnetic resonance sialography and magnetic resonance imaging versus conventional sialography of the parotid gland in the diagnosis and staging of Sjögren's syndrome. Egypt Rheumatol. 2011;33(3):147-154. ISSN 1110-1164. https://doi.org/10.1016/j.ejr.2011.05.004

34. Chen J, Zhao X, Liu H, Zhou S, Yang Y, Li S, Xianyu Z, Han Y, Shen G, Li J, Ye C, Sun W, Dong L. A Point-Scoring System for the Clinical Diagnosis of Sjögren's Syndrome Based on Quantified SPECT Imaging of the Salivary Gland. PLoS One. 2016 May 19;11(5):e0155666. https://doi.org/10.1371/journal.pone.0155666

35. Liu S, Chen W, Wang M, Wu T, Dong L, Pan C, Zhu W. Quantitative Analysis of Parotid Gland Secretion Function in Sjögren's Syndrome Patients with Dynamic Magnetic Resonance Sialography. Korean J Radiol. 2019 Mar;20(3):498-504. https://doi.org/10.3348/kjr.2018.0508

36. You W, Xu L, Gao Y, Youshen Z, Yao G. Quantitative assessment of salivary gland scintigraphy with SPECT/CT in the clinical application of Sjögren's syndrome. Z Rheumatol. 2025 Apr 23. English. https://doi.org/10.1007/s00393-025-01649-5

37. Takashima S, Takeuchi N, Morimoto S, Tomiyama N, Ikezoe J, Shogen K, Kozuka T, Okumura T. MR imaging of Sjögren syndrome: correlation with sialography and pathology. J Comput Assist Tomogr. 1991 May-Jun;15(3):393-400. https://doi.org/10.1097/00004728-199105000-00009

38. Izumi M, Eguchi K, Ohki M, Uetani M, Hayashi K, Kita M, Nagataki S, Nakamura T. MR imaging of the parotid gland in Sjögren's syndrome: a proposal for new diagnostic criteria. AJR Am J Roentgenol. 1996 Jun;166(6):1483-7. https://doi.org/10.2214/ajr.166.6.8633469

39. Takagi Y, Sumi M, Sumi T, Ichikawa Y, Nakamura T. MR microscopy of the parotid glands in patients with Sjögren's syndrome: quantitative MR diagnostic criteria. AJNR Am J Neuroradiol. 2005 May;26(5):1207-14. PMID: 15891185; PMCID: PMC8158620.

40. Sumi M, Takagi Y, Uetani M, Morikawa M, Hayashi K, Kabasawa H, Aikawa K, Nakamura T. Diffusion-weighted echoplanar MR imaging of the salivary glands. AJR Am J Roentgenol. 2002 Apr;178(4):959-65. https://doi.org/10.2214/ajr.178.4.1780959

41. Morimoto Y, Ono K, Tanaka T, Kito S, Inoue H, Shinohara Y, Yokota M, Inenaga K, Ohba T. The functional evaluation of salivary glands using dynamic MR sialography following citric acid stimulation: a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Sep;100(3):357-64. https://doi.org/10.1016/j.tripleo.2004.11.053

42. Tanaka T, Ono K, Habu M, Inoue H, Tominaga K, Okabe S, Kito S, Yokota M, Fukuda J, Inenaga K, Morimoto Y. Functional evaluations of the parotid and submandibular glands using dynamic magnetic resonance sialography. Dentomaxillofac Radiol. 2007 May;36(4):218-23. https://doi.org/10.1259/dmfr/27496576

43. Daniels TE, Powell MR, Sylvester RA, Talal N. An evaluation of salivary scintigraphy in Sjögren's syndrome. Arthritis Rheum. 1979 Aug;22(8):809-14. https://doi.org/10.1002/art.1780220801

44. Arrago JP, Rain JD, Brocheriou C, Rocher F. Scintigraphy of the salivary glands in Sjögren's syndrome. J Clin Pathol. 1987 Dec;40(12):1463-7. https://doi.org/10.1136/jcp.40.12.1463

45. Nadal M, Levy M, Bakhsh A, Joly A, Maruani A, Vaillant L, Erra B, Samimi M. Salivary scintigraphy for Sjögren's syndrome in patients with xerostomia: A retrospective study. Oral Dis. 2018 May;24(4):552-560. doi: 10.1111/odi.12802. Epub 2018 Mar 13. PMID: 29117464. https://doi.org/10.1111/odi.12802

46. Ogura I, Sasaki Y, Oda T, Sue M, Hayama K. Magnetic Resonance Sialography and Salivary Gland Scintigraphy of Parotid Glands in Sjögren's Syndrome. Chin J Dent Res. 2018;21(1):63-68. doi: 10.3290/j.cjdr.a39919. PMID: 29507913.

47. Kim JW, Jin R, Han JH, Kang JH, Jung JY, Suh CH, An YS, Kim HA. Correlations between salivary gland scintigraphy and histopathologic data of salivary glands in [Reference incomplete in source; complete before submission.]

48. Nakamura T, Oshiumi Y, Yonetsu K, Muranaka T, Sakai K, Kanda S. Salivary SPECT and factor analysis in Sjögren's syndrome. Acta Radiol. 1991 Sep;32(5):406-10. PMID: 1910997. https://doi.org/10.3109/02841859109177595

49. Kim J, Lee H, Lee H, Bang JI, Kang YK, Bae S, Song YS, Lee WW. Quantitative Single-Photon Emission Computed Tomography/Computed Tomography for Evaluation of Salivary Gland Dysfunction in Sjögren's Syndrome Patients. Nucl Med Mol Imaging. 2018 Oct;52(5):368-376. https://doi.org/10.1007/s13139-018-0547-4

50. Fisher BA, Jonsson R, Daniels T, Bombardieri M, Brown RM, Morgan P, Bombardieri S, Ng WF, Tzioufas AG, Vitali C, Shirlaw P, Haacke E, Costa S, Bootsma H, Devauchelle-Pensec V, Radstake TR, Mariette X, Richards A, Stack R, Bowman SJ, Barone F; Sjögren's histopathology workshop group from ESSENTIAL. Standardisation of labial salivary gland histopathology in clinical trials in primary Sjögren's syndrome. Ann Rheum Dis. 2017 Jul;76(7):1161-1168. https://doi.org/10.1136/annrheumdis-2016-210448

51. Jousse-Joulin S, Gatineau F, Baldini C, Baer A, Barone F, Bootsma H, Bowman S, Brito-Zeron P, Cornec D, Dorner T, de Vita S, Fisher B, Hammenfors D, Jonsson M, Mariette X, Milic V, Nakamura H, Ng WF, Nowak E, Ramos-Casals M, Rasmussen A, Seror R, Shiboski CH, Nakamura T, Vissink A, Saraux A, Devauchelle-Pensec V. Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sjögren's syndrome. J Intern Med. 2020 Feb;287(2):180-188.. https://doi.org/10.1111/joim.12992

52. Lorenzon M, Spina E, Tulipano Di Franco F, Giovannini I, De Vita S, Zabotti A. Salivary Gland Ultrasound in Primary Sjögren's Syndrome: Current and Future Perspectives. Open Access Rheumatol. 2022 Sep 1;14:147-160. https://doi.org/10.2147/OARRR.S284763

53. Ramsubeik K, Motilal S, Sanchez-Ramos L, Ramrattan LA, Kaeley GS, Singh JA. Diagnostic accuracy of salivary gland ultrasound in Sjögren's syndrome: A systematic review and meta-analysis. Ther Adv Musculoskelet Dis. 2020 Nov 21;12:1759720X20973560. https://doi.org/10.1177/1759720X20973560

54. Shiboski CH, Shiboski SC, Seror R, Criswell LA, Labetoulle M, Lietman TM, Rasmussen A, Scofield H, Vitali C, Bowman SJ, Mariette X; International Sjögren's Syndrome Criteria Working Group. 2016 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Primary Sjögren's Syndrome: A Consensus and Data-Driven Methodology Involving Three International Patient Cohorts. Arthritis Rheumatol. 2017 Jan;69(1):35-45. https://doi.org/10.1002/art.39859

Downloads

Published

2026-09-15

Issue

Vol. 7 No. 3 (2026): September 2026 issue

Section

Section of Dental Medicine and Oral Medicine Research

License

Copyright (c) 2026 Dr.Shereen.D, Dr Jagadeesh Gajendran, Dr Sebastin Varghese Paul, Karthik Shunmugavelu

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

How to Cite

Shereen, Gajendran, J., Sebastian Varghese, P., & SHUNMUGAVELU, K. (2026). MR sialography and salivary gland SPECT/CT in Sjögren syndrome — a systematic review. Student’s Journal of Health Research Africa, 7(3), 13. https://doi.org/10.51168/h89jrt94

Most read articles by the same author(s)