63 Longitudinal scintigraphic study of parotid and submandibular by fanzhongqing

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									     Longitudinal scintigraphic study of
        parotid and submandibular
               gland function
       after total body irradiation at
       bone marrow transplantation
                     Mats Bågesund 1,2
                           Sven Richter 3
                          Göran Dahllöf 2
       1 Center for Orthodontics and Pedodontics, Linköping

2 Department of Pediatric Dentistry, Karolinska Institutet, Stockholm

                 3 Department of Nuclear Medicine,

    Huddinge University Hospital, Karolinska Institutet, Sweden
© Copyright: Mats Bågesund, DDS, PhD.

No material published in this file may be
reproduced in any way without written
permission from the author !
Address:
Mats Bågesund DDS PhD
Center for Orthodontics and Pedodontics
SE-581 85 Linköping
SWEDEN

Phone: +46 13 22 88 30
Fax: +46 13 22 88 36
E-mail: mats.bagesund@lio.se
Regions of interest




                      © Mats Bågesund
                     Time-activity curve showing
                       scintigraphic variables
                                     Ma
% of dose injected




                                                         Fu
                                S%
                         US               DS
                                                         RS




                                                              © Mats Bågesund
                          TMa                    Mi

                     0      15        30        45       60
                         Time from injection (minutes)
                      Percentage secretion
                     S%=100% x (Ma-Mi) / Ma
                               Ma
% of dose injected




                          S%




                                                 © Mats Bågesund
                                            Mi


                           Time from injection
              Objective
                  To study

the scintigraphic functional changes over time

  of the parotid and submandibular glands

in children and young adults during one year




                                                 © Mats Bågesund
       after total body irradiation (TBI)

   at bone marrow transplantation (BMT)
            Patients examined

                   Before    After      After
                   TBI/BMT   3 months   12 months
                   n=9       n=5        n=3

Sex                1F, 8M    1F, 4M     3M




                                               © Mats Bågesund
Mean age (years)   13.9      15.4       17.3
 Range             8-28      8-28       9-29
               Patients examined

                Before  After      After
                TBI/BMT 3 months   12 months
    Diagnose    n=9     n=5        n=3

   Lymphoma    2       2          2
   AML         1       1          1





                                               © Mats Bågesund
    CML         1       1
   ALL         4       1
   SAA         1
Conditioning
 Cyclophosphamide
 10 Gy TBI

GVH-prophylaxis
 Methotrexate




                     © Mats Bågesund
 Cyclosporine A
                  Method

Whole salivary secretion rate
 Unstimulated (USSR)         15 minutes
 Chewing stimulated (SSSR) 5 minutes


Salivary gland scintigraphy   60 minutes




                                           © Mats Bågesund
Subtraction of background radiation




                                                           © Mats Bågesund
Bågesund et al. Dentomaxillofac Radiol 2000; 29: 264-71.
  Statistical method


Wilcoxon Signed Rank Test




                            © Mats Bågesund
Unstimulated (USSR) and stimulated (SSSR)
        salivary secretion rate (n=5)

   ml/min
                                USSR
       2
                                SSSR

       1




                                             © Mats Bågesund
       0                      months after
             0     3     12
                               TBI / BMT
Changes in salivary secretion rate
         after TBI/BMT
                   0 vs. 3 months after
USSR (n=7)         P=0.018
SSSR (n=7)         P=0.018

                   0 vs. 12 months after
USSR (n=5)         P=0.043




                                           © Mats Bågesund
SSSR (n=5)         P=0.043

                   3 vs. 12 months after
SSSR (n=5)         P=0.043
                          Scintigraphic differences in
                                 parotid glands
                       before vs. 3 months after TBI/BMT

                                                            P=0.043
  % of dose injected




                                  S%




                                                                      © Mats Bågesund
                            TMa

                       0       15        30        45         60
n=5                         Time from injection (minutes)
                            Parotid secretion (S%Par)

                                         P=0.043
% of maximal uptake



                      100


                                 79%




                                                               © Mats Bågesund
                                                   51%
                       0
                             Before TBI/BMT   3 months after
                      n=5
% of maximal uptake
                        Parotid secretion (S%Par)

                      100


                                                             0%




                                                                  © Mats Bågesund
                       0
                             0            3             12
                      n=3
                                 Months after TBI/BMT
                          Scintigraphic differences in
                             submandibular glands
                       before vs. 3 months after TBI/BMT

                                      Ma                    P=0.043
  % of dose injected




                                                              Fu
                                 S%




                                                                      © Mats Bågesund
                                                    Mi

                       0       15        30        45         60
n=5                         Time from injection (minutes)
                      Submandibular secretion (S%Sub)

                                       P=0.043
                      100
% of maximal uptake




                                 95%


                                                  44%




                                                              © Mats Bågesund
                       0
                            Before TBI/BMT   3 months after
                      n=5
               Submandibular secretion (S%Sub)
                      100
% of maximal uptake




                                                            93%




                                                              © Mats Bågesund
                       0
                            0            3             12
                      n=3
                                Months after TBI/BMT
                  Conclusion
The excretion capacity (S%) is reduced three
months after TBI/BMT in both parotid and
submandibular glands.

The capacity to recover function is obvious in the
submandibular glands, but is hardly present in the
parotid glands one year after TBI/BMT.

A reduced recovering capacity of the parotid




                                                       © Mats Bågesund
glands is a contributing factor to the reduced whole
salivary secretion rate seen one year after
TBI/BMT.
                     Sponsors
Swedish Children’s Cancer Foundation


Swedish Society of Pediatric Dentistry




                                            © Mats Bågesund
ACTA research and travel foundation
Mölnlycke Toiletries AB / Cederroth


Public Dental Health Service Östergötland
                                     References:

Bågesund M, Richter S, Ågren B, Dahllöf G. Correlation between quantitative
   salivary gland scintigraphy and salivary secretion rates in children and young
   adults treated for hematological, malignant and metabolic diseases.
   Dentomaxillofac Radiol 2000; 29: 264-271.
Bågesund M, Richter S, Ågren B, Ringdén O, Dahllöf G. Scintigraphic study of the
   major salivary glands in pediatric bone marrow transplant recipients. Bone Marrow
   Transplant 2000; 26: 775-779.
Bågesund M, Winiarski J, Dahllöf G. Subjective xerostomia in long-term surviving
   children and adolescents after pediatric bone marrow transplantation.
   Transplantation 2000; 69: 822-826.
Dahllöf G, Bågesund M, Ringdén O. Impact of conditioning regimens on salivary
   function, caries associated microorganisms and dental caries in children treated




                                                                                       © Mats Bågesund
   with bone marrow transplantation. A four-year longitudinal study. Bone Marrow
   Transplant 1997; 20: 479-483.
Dahllöf G, Bågesund M, Remberger M, Ringdén O. Risk factors for salivary gland
   dysfunction in children 1 year after bone marrow transplantation. Eur J Cancer
   Oral Oncol 1997; 33: 327-331.

								
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