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MR Imaging of the Salivary Glands in Sicca Syndrome

Comparison of Lipid Profiles and Imaging in Patients with Hyperlipidemia and Patients with Sjögren's Syndrome

Masahiro Izumi1, Ayumi Hida2, Yukinori Takagi1, Yojiro Kawabe2, Katsumi Eguchi2 and Takashi Nakamura1

1 Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan.
2 First Department of Internal Medicine, Nagasaki University School of Medicine. 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.



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  		Fig. 1. —Graph shows impaired salivary flow in patients with hyperlipidemia. Dotted line indicates normal lower limit of salivary flow determined with Saxon test. HL = hyperlipidemia, SS = Sjögren's syndrome.

 


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  		Fig. 2A. —Sialography fails to reveal characteristic features of Sjögren's syndrome in patients with hyperlipidemia and sicca syndrome. Sialograph of parotid gland shows characteristic globular pattern of sialectasia in 50-year-old woman with Sjögren's syndrome.

 


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  		Fig. 2B. —Sialography fails to reveal characteristic features of Sjögren's syndrome in patients with hyperlipidemia and sicca syndrome. Sialograph of parotid gland shows normal staining pattern in 69-year-old woman with hyperlipidemia.

 


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  		Fig. 3A. —Enlargement and replacement of parotid gland by lipids in patients with hyperlipidemia. T1-weighted MR image shows normal parotid gland (arrows) in 51-year-old healthy woman.

 


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  		Fig. 3B. —Enlargement and replacement of parotid gland by lipids in patients with hyperlipidemia. T1-weighted MR image shows homogeneous high signal intensity of enlarged parotid gland (arrows) in 69-year-old woman with hyperlipidemia.

 


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  		Fig. 3C. —Enlargement and replacement of parotid gland by lipids in patients with hyperlipidemia. Fat-suppressed T1-weighted MR image shows low signal intensity of parotid gland (arrows) compared with that of same patient on T1-weighted MR image (B).

 


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  		Fig. 3D. —Enlargement and replacement of parotid gland by lipids in patients with hyperlipidemia. T1-weighted MR image shows normal-sized parotid gland (arrows) and normal level of gland signal intensity in 49-year-old woman with hyperlipidemia.

 


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  		Fig. 3E. —Enlargement and replacement of parotid gland by lipids in patients with hyperlipidemia. T1-weighted MR image shows irregularly distributed high signal intensities in normal-sized parotid gland (arrows) in 55-year-old woman with Sjögren's syndrome.

 


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  		Fig. 4A. —Submandibular gland is less severely affected in patients with hyperlipidemia. T1-weighted MR image shows normal submandibular gland (arrows) in 45-year-old healthy woman.

 


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  		Fig. 4B. —Submandibular gland is less severely affected in patients with hyperlipidemia. T1-weighted MR image shows moderately enlarged submandibular gland (arrows) with high signal intensity in 75-year-old man with hyperlipidemia.

 


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  		Fig. 4C. —Submandibular gland is less severely affected in patients with hyperlipidemia. T1-weighted MR image shows submandibular gland (arrows) with irregular distribution of high signal intensity in 50-year-old woman with Sjögren's syndrome.

 


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  		Fig. 5A. —Size of parotid gland is increased in patients with hyperlipidemia, but not in patients with Sjögren's syndrome. Graph shows age-related changes in size of parotid gland in nine men with hyperlipidemia and 109 healthy men. Curvilinear lines indicate ranges of means plus or minus two standard deviations for maximum gland area as determined on MR images from control subjects in each decade of life. Note maximum sizes of parotid gland on T1-weighted MR images of patients with hyperlipidemia ({blacksquare}) and control subjects ({circ}).

 


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  		Fig. 5B. —Size of parotid gland is increased in patients with hyperlipidemia, but not in patients with Sjögren's syndrome. Graph shows age-related changes in size of parotid gland in 15 women with hyperlipidemia and 100 healthy women. Curvilinear lines indicate ranges of means plus or minus two standard deviations for maximum gland area as determined on MR images from control subjects in each decade of life. Note maximum sizes of parotid gland on T1-weighted MR images of patients with hyperlipidemia ({blacksquare}), Sjögren's syndrome ({blacktriangleup}), and control subjects ({circ}).

 


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  		Fig. 6A. —Histopathologic differences of labial glands of the mouth in patients with hyperlipidemia and patients with Sjögren's syndrome. Photomicrograph shows extensive lipid infiltration in gland parenchyma with acinar cell loss in labial glands of mouth in 43-year-old man with hypertriglyceridemia. Mononuclear cell infiltration is minimal.

 


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  		Fig. 6B. —Histopathologic differences of labial glands of the mouth in patients with hyperlipidemia and patients with Sjögren's syndrome. Photomicrograph shows slight lipid infiltration in interlobular spaces and moderate acinar cell loss in labial glands of mouth in 63-year old man with hypercholesterolemia.

 


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  		Fig. 6C. —Histopathologic differences of labial glands of the mouth in patients with hyperlipidemia and patients with Sjögren's syndrome. Photomicrograph shows extensive mononuclear cell infiltration and aggregation in labial glands of mouth in 50-year-old woman with Sjögren's syndrome.

 


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  		Fig. 7. —Scatterplot of plasma levels of triglyceride and total cholesterol shows that triglyceride plays important role in development of swelling of parotid gland in patients with hyperlipidemia. Note differences in plasma levels between patients with ([UNK]) and without ({square}) parotid swelling. Dotted lines indicate normal thresholds for plasma levels of triglyceride (vertical) and total cholesterol (horizontal).

 

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