- Email: [email protected]
Gamma camera images of the salivary gland using 99mTc
dental radiology Editor: LINCOLN R. MANSON-HING, D.M.D., American Academy of Dental Radiology School of Dentistry, University 1919 Seventh Avenue South Birmingham, Alabama 35233
M.S.
of Alabama
Gamma camera images of the salivary gland using 99mT~ Report
of
four
cases
1’omomit.w Ilignshi, X.D., Ph.D.,* Tadclshi Fujirn~lra, D.D.cs’.,*” Wataru Aoya?)la, D.D.S., D.M.Sc.,*** crnd Eiichi Aknmatnc, D.D.S., D.M.Sc.,**** Yokosuka, Japan KAiVX(;.\\V;\
DESTAL
COLLEGE
pertechnetate, the gamma Following the intrarrnous injection of 3 to 4 mCi <~gmTe . camera enal)lcd us to define the dynamic characteristics of salivary gland function as 1~11 as morphologic characteristics in a normal patient and in thrw patients with diseased parotid glands.
R
adioactivc iodine ( 1311) has long been used in the examination of the salivary glands. Reports from Japan have been made on the morphologic or functional characteristics of the salivary glands using 1311.1-”In 1968, Cirove and DiChiro” and Lindenbraten and Judin” were the first to study the salivary glands using technetium (!jPmTc), which has shorter half-life than 1311. This radioisotope is an excellent scanning agent. because the short 6-hour half-life and the absence of beta emissions make possible the administration of large doses with less radiation to the patient’s tissue. In addition, its low-energy gamma (140 kev.) simplifies collimator design and increases detector efficiency. Since then, many reports on the scintigram of the salivary glands using *Professor and Chairman, Department of Radiology. **Resident, Department of Radiology. ***Assistant professor, Department of Radiology. ****Professor and Chairman, Department of Oral Diagnosis.
804
Volume 40 Number 6
Gamma camera images of salivary
gland using
ggmTc 805
Fig. 1. Case 1. Anterior gamma camera images with Polaroid film of salivary glands in a normal control. Both parotid glands (P), both submandibular glands (S), and nasal region (NJ are shown. 8, five minutes after intravenous injection. B, fifteen minutes after intravenous injection. C, forty minutes after intravenous injection.
g9mTc have been published.7-10 However, most of those studies were based on the static morphologic examination with a scintiscan. In this study, we have developed a functional and morphologic examination of the salivary glands simultaneously using a gamma camera and ssmTc. METHOD
AND
MATERIALS
Immediately after intravenous injection of 3 to 4 mCi 99mTc pertechnetate, anterior and lateral images of the salivary glands are obtained with Polaroid film and life-size film by means of the gamma camera. Counts of 150,000 are obtained in 3 or 4 minutes. Additional anterior and lateral examinations are performed at 5- or lo-minute intervals for 10 minutes to 6 hours. The detector is positioned so that its face is 3 to 5 cm. from the skin. The image obtained includes the parotid and submandibular glands. sgmTc images were obtained in four cases. These included one patient with normal salivary glands, one patient with chronic parotitis, one patient with metastatic parotid tumor from Grawitz’s tumor, and one patient whose parotid gland had been previously subjected to radiotherapy. Resultant gamma camera images were compared with the clinical picture, laboratory data, sialogram results, operative findings, and histologic findings, respectively.
Oral Slug. December, 1975
Fiq. 8. Case 2. Anterior and lateral gamma camera images with life-size film glands in aatient with left chronic: sialoadenitis. Note diminished uptake of ‘gland as co’mpared to the right parotid gland (a, R, and C). a, ten minutes after injection. H, thirtv minutes after intravenous injection. C, forty minutes after injection.
CASE
of salivary left parotid intravenous intravenous
REPORTS
CASE 1
The patient was H. M., a healthy 6%year-old man. About 3 mCi of ssmTc was administered by intravenous injection. Following the injection, t,he anterior images were obtained by gamma camera at 5, 15, and 40 minutes, respectively. “9mTc was already taken into the parotid gland (P), the submandibular gland (S), and nasal region (N) at 5 minutes (Fig. 1, A). A small amount of ssmTc was already secreted from the parotid gland and the submandibular gland at 15 minutes (Fig. 1, B). The anterior image of the salivary glands became clear and Stensen’s duct and Warton’s duct were visualized (Fig. 1, C). CASE 2
Patient M. M. was a 40.year-old woman with chronic left sialoadenitis. This patient had noted a swelling the size of a pigeon’s egg in the left parotid gland about 5 years previously. She had experienced occasional pains in that region since then. About 3 mCi of a9slTc was administered intravenously, and uptake of ssmTc into the diseased parotid gland was clearly decreased relative to the normal parotid gland 10 minutes after
T’olulne 40 Number 6
Gamma
cnmera
images
of salivnry
gland
wisg
99mTc
807
Fig. 5. Case 2. Anterior and lateral gamma camera images with life-size film of salivary glands in Case 2 (chronic sialoadenitis) 6 hours after injection. Radioactivity of salivary glands was completely discharged into the oral cavity. injection (Fig. 2, a). The lateral view showed decreased uptake into the diseased parotid gland compared to the submandibular gland on the same side at 30 minutes (Fig. 2, B). This is in contrast to the normal side, in which the activity in the parotid gland was greater than the activity of the submandibular gland (Fig. 2, G). somTc was completely secreted from the salivary glands, and was found to be retained in the floor of the oral cavity and in the palate at 6 hours (Fig. 3). CASE 3
Patient T. E.,-a G&year-old man, had a left parotid tumor. This patient underwent an operation for carcinoma of the left kidney (Grawitz’s tumor) about 2 years previous to this study. Recently, he had noted a swelling of the left parotid gland. At operation, this swelling was found to be metastatic Grawitz’s tumor. Prior to surgery he was examined with semTc. Uptake of osmTc was barely detectable in the left parotid gland 15 minutes following the intravenous injection of about 3 mCi of esmTc. However, uptake was present in the normal parotid gland and submandibular gland (Fig. 4, a). The gamma camera image showed the upward displacement of the diseased left parotid gland at 30 minutes and a region of decreased activity in its lower part. The radioactive technetium already had been secreted from one Stensen’s duct of the normal parotid gland into the oral cavity (Fig. 4, B). A large amount of ssmTc was secreted into the palate at 60 minutes (Fig. 4, C). This is probably related to the deposition of the saliva in the palate because of the patient’s supine position. CASE 4
Patient T. H. was a 72-year-old man with right tonsillar sarcoma. A thumb-tip-sized tumor was seen in the right tonsillar region; this was proved by histologic examination to be reticulosarcoma. Radiation therapy using eoCo was administered in the right cervical region (field 8 by 13 cm). The radiation dose was 4,000 r over a period of 30 days. As a result, the tumor in the tonsillar region was reduced. The isotopic examination was performed with osmTc 7 days following completion of radiation therapy. The anterior image clearly showed the concentration in both parotid glands and the submandibular glands 15 minutes following intravenous injection of about 4 mCi of semTc (Fig. 5). The secretion of ssmTc from the diseased side was slightly reduced in comparison with that from the normal side (Fig. 5, ~4). Forty minutes following injection, ssmTc was secreted from the normal side (arrow) but was smaller on the diseased side (Fig. 5, B) .
808
/Ii{ttrshi
P( trl.
Fig. 4. Cnso 3. Anterior ~&mma camer:L images with life-size film of salivary glands in patient with left, parotid tumor. Note decreased actirity in left parotid gland compaw~l to the normal right parotid gkrnd. -4, fifteen minutes after intravenous injection. B, thirty minutes after intravenous injwtion. (‘, sixty minutes after intravenous injection.
DISCUSSION
In 1968, Grove and 1)iChiro” and Lindcnbraten and Judin” studied the scintiscan of the salivary glands using nnmTc, which is taken up into not only the t,hyroid gland but also into the salivary glands. Since then there have been many reports on the examination of the salivary glands with !19r1’Tc.However, all of these reports have been concerned with the use of a scintiscannrr, obtaining a single scintigram. It takes about 20 to 30 minutes to obtain this type of scan, and, therefore, it is impossible to record the movement of !‘nmT~ with time. In this study, the gamma camera enabled us to obtain an image in about 3 to 3 minutes. Therefore, the dynamic examination of the uptake of 09mTc into the salivary gland and its secretion is possible. In the examination of a normal patient (Cast l), the radioactivity was taken up into the parotid gland and the submandibular gland 5 minutes following the intravenous injection of nnmTc and had already been secreted into the oral cavity at 1% minutes. In addition, the same amount of !IymTc uptake was
Volume 40 Number 6
Gamma camera images of salivary
gland using 99*Tc
809
Pig. 5. Case 4. Anterior gamma camera images of salivary glands in patient with right tonsillar sarcoma. Note diminished salivary secretion from right Stensen’s duct as compared to the normal left Stensen’s duct (B). 9, fifteen minutes after intravenous injection. B, forty minutes after intravenous injection.
seen in the parotid gland and the submandibular gland. 99mTc was taken up into not only the salivary glands but also the nasal region. In the patient with chronic sialoadenitis (Case 2), the uptake of 99mTc was reduced in the diseased side relative to the normal side. This finding is in agreement with the reports by Mlatchkov and KrumovQ and Furumoto and Seki.‘l 99mTc was completely secreted from the salivary glands, and it was found to be retained in the hard palate and the floor of the oral cavity at 6 hours. In the patient with metastatic tumor in the parotid glands (Case 3), the sialogram showed a defect which corresponded to the tumor and suggested decreased function in the diseased gland. However, uptake into the submandibular gland was found to be smaller in this patient than in other patients, and the reason is unknown. This may indicate that there are differences among individuals in the function of the salivary glands. In the patient who had undergone radiation therapy (Case 4), the uptake and the secretion of 99mTc were slightly reduced in the parotid gland which had been treated with radiation. In 1967 Higashi and Tutumi12 studied the function of the salivary glands using 1311 in patients with cancer of the upper jaw who had been treated with ““Co radiation and described the decreased parotid gland uptake of radioactivity secondary to radiation therapy. We have been able to define the patterns of function of salivary glands which have been altered by radiation therapy. CONCLUSION
Following the intravenous injection of QQ1”T~pertechnetate, the gamma camera enabled us to define the dynamic characteristics of salivary gland function as well as morphologic characteristics in a normal patient and in three patients with diseased parotid glands. We will continue this study in an attempt to define further the functional and morphologic characteristics of abnormal salivary glands. The authors wish to express their appreciation to Dr. F. R. Everhart, United States Naval
REFERENCES
3. Hipshi, T., Yoshid:r, K., and Nakalmra, S.: A Possil)ility of tllc, SalivqGland Function Teat by IJw of l:t11, Nippon Acta Rndiol. 25: Z-29, 1965. 4. Misakn, .%: F’unctibn ?&t of Salivary Gland I&asr With Xadioactivv Iodiw, Xadiol. ( Kanazawa, Japan) 83: l-24, 1968. 3. Grove, A. S., Jr., and DiChiro, G. : Salivary Gland Hv:nming With Technetium H9m Prrtt~c+nceltt~, zYnL J. Roc~ntgrnol. 102: 109-l 16, 1968. 6. Lindenl)ratrn, I,. n., and Judin, L. A.: Koml~lesc Untcrsuchung der Speicl~rldriisen mittclr radioaktivcr Isotope und Kiintgenst~:~hlrn, Fortshr. Roentgcnstr. 108: 23-32, 196X. 7. Abramwon, A. L., Levy, I,. M., Goodmam, M., and Attic., J. N.: Salivary Gland ScintiScanninsz \Vitll Technetium 99m Pertrclmetatr. 1,arvneoscorw 79: 1105-1117. 1969. X. Stel,ncr,-F. C., Fylw, W. H., Du Sault, I,. A.; Slack,-M. h., Kelly, A. I,.,: and Nichols, R.: 3glnTc P(~rtcclmctnte Scanning of Salivary Glands, Radiology 90: 5X3-583, 1968. 9. Mhtchkov, C., and Krumov, N. : Diagnostic Potentmlities of Scintillation Scanning of the Salivary G1n11d.s Using Tc, ssnl-PI~rt~llnetatr, Dento-Maxilla-Facial Radiol. 1: 38-41, 1973 _-.-. dcs ggnlTcO,-Speiclwl driisenszinti10. Breunsbach, J., and Dvorak, K.: Zur Interpretation gramms, Fortwhr. Rocwtgenstr. 121: 500-506, 1974. 11. Furumoto, K., and Seki, K.: Evaluation of Salivary Gland Scanning With ~~!~nlTc,Jap. J. Nucl. Med. 6: 19-20, 1969. 12. Higashi, I’., and Tutumi, T.: Studies on the Changes of Salivary Gland Function Followving Tclecobalt Therapy of Maxillary Cancer, Nippon Acta Radial. 26: 127-133, 1967. Ileprint
Iquests
to:
Dr. Tomomitsu Higashi Department of Radiology Knn:ig:~wa Dental College 82, Inaoka-c-110 Yokosuka, .Jwpan
M.S.
of Alabama
Gamma camera images of the salivary gland using 99mT~ Report
of
four
cases
1’omomit.w Ilignshi, X.D., Ph.D.,* Tadclshi Fujirn~lra, D.D.cs’.,*” Wataru Aoya?)la, D.D.S., D.M.Sc.,*** crnd Eiichi Aknmatnc, D.D.S., D.M.Sc.,**** Yokosuka, Japan KAiVX(;.\\V;\
DESTAL
COLLEGE
pertechnetate, the gamma Following the intrarrnous injection of 3 to 4 mCi <~gmTe . camera enal)lcd us to define the dynamic characteristics of salivary gland function as 1~11 as morphologic characteristics in a normal patient and in thrw patients with diseased parotid glands.
R
adioactivc iodine ( 1311) has long been used in the examination of the salivary glands. Reports from Japan have been made on the morphologic or functional characteristics of the salivary glands using 1311.1-”In 1968, Cirove and DiChiro” and Lindenbraten and Judin” were the first to study the salivary glands using technetium (!jPmTc), which has shorter half-life than 1311. This radioisotope is an excellent scanning agent. because the short 6-hour half-life and the absence of beta emissions make possible the administration of large doses with less radiation to the patient’s tissue. In addition, its low-energy gamma (140 kev.) simplifies collimator design and increases detector efficiency. Since then, many reports on the scintigram of the salivary glands using *Professor and Chairman, Department of Radiology. **Resident, Department of Radiology. ***Assistant professor, Department of Radiology. ****Professor and Chairman, Department of Oral Diagnosis.
804
Volume 40 Number 6
Gamma camera images of salivary
gland using
ggmTc 805
Fig. 1. Case 1. Anterior gamma camera images with Polaroid film of salivary glands in a normal control. Both parotid glands (P), both submandibular glands (S), and nasal region (NJ are shown. 8, five minutes after intravenous injection. B, fifteen minutes after intravenous injection. C, forty minutes after intravenous injection.
g9mTc have been published.7-10 However, most of those studies were based on the static morphologic examination with a scintiscan. In this study, we have developed a functional and morphologic examination of the salivary glands simultaneously using a gamma camera and ssmTc. METHOD
AND
MATERIALS
Immediately after intravenous injection of 3 to 4 mCi 99mTc pertechnetate, anterior and lateral images of the salivary glands are obtained with Polaroid film and life-size film by means of the gamma camera. Counts of 150,000 are obtained in 3 or 4 minutes. Additional anterior and lateral examinations are performed at 5- or lo-minute intervals for 10 minutes to 6 hours. The detector is positioned so that its face is 3 to 5 cm. from the skin. The image obtained includes the parotid and submandibular glands. sgmTc images were obtained in four cases. These included one patient with normal salivary glands, one patient with chronic parotitis, one patient with metastatic parotid tumor from Grawitz’s tumor, and one patient whose parotid gland had been previously subjected to radiotherapy. Resultant gamma camera images were compared with the clinical picture, laboratory data, sialogram results, operative findings, and histologic findings, respectively.
Oral Slug. December, 1975
Fiq. 8. Case 2. Anterior and lateral gamma camera images with life-size film glands in aatient with left chronic: sialoadenitis. Note diminished uptake of ‘gland as co’mpared to the right parotid gland (a, R, and C). a, ten minutes after injection. H, thirtv minutes after intravenous injection. C, forty minutes after injection.
CASE
of salivary left parotid intravenous intravenous
REPORTS
CASE 1
The patient was H. M., a healthy 6%year-old man. About 3 mCi of ssmTc was administered by intravenous injection. Following the injection, t,he anterior images were obtained by gamma camera at 5, 15, and 40 minutes, respectively. “9mTc was already taken into the parotid gland (P), the submandibular gland (S), and nasal region (N) at 5 minutes (Fig. 1, A). A small amount of ssmTc was already secreted from the parotid gland and the submandibular gland at 15 minutes (Fig. 1, B). The anterior image of the salivary glands became clear and Stensen’s duct and Warton’s duct were visualized (Fig. 1, C). CASE 2
Patient M. M. was a 40.year-old woman with chronic left sialoadenitis. This patient had noted a swelling the size of a pigeon’s egg in the left parotid gland about 5 years previously. She had experienced occasional pains in that region since then. About 3 mCi of a9slTc was administered intravenously, and uptake of ssmTc into the diseased parotid gland was clearly decreased relative to the normal parotid gland 10 minutes after
T’olulne 40 Number 6
Gamma
cnmera
images
of salivnry
gland
wisg
99mTc
807
Fig. 5. Case 2. Anterior and lateral gamma camera images with life-size film of salivary glands in Case 2 (chronic sialoadenitis) 6 hours after injection. Radioactivity of salivary glands was completely discharged into the oral cavity. injection (Fig. 2, a). The lateral view showed decreased uptake into the diseased parotid gland compared to the submandibular gland on the same side at 30 minutes (Fig. 2, B). This is in contrast to the normal side, in which the activity in the parotid gland was greater than the activity of the submandibular gland (Fig. 2, G). somTc was completely secreted from the salivary glands, and was found to be retained in the floor of the oral cavity and in the palate at 6 hours (Fig. 3). CASE 3
Patient T. E.,-a G&year-old man, had a left parotid tumor. This patient underwent an operation for carcinoma of the left kidney (Grawitz’s tumor) about 2 years previous to this study. Recently, he had noted a swelling of the left parotid gland. At operation, this swelling was found to be metastatic Grawitz’s tumor. Prior to surgery he was examined with semTc. Uptake of osmTc was barely detectable in the left parotid gland 15 minutes following the intravenous injection of about 3 mCi of esmTc. However, uptake was present in the normal parotid gland and submandibular gland (Fig. 4, a). The gamma camera image showed the upward displacement of the diseased left parotid gland at 30 minutes and a region of decreased activity in its lower part. The radioactive technetium already had been secreted from one Stensen’s duct of the normal parotid gland into the oral cavity (Fig. 4, B). A large amount of ssmTc was secreted into the palate at 60 minutes (Fig. 4, C). This is probably related to the deposition of the saliva in the palate because of the patient’s supine position. CASE 4
Patient T. H. was a 72-year-old man with right tonsillar sarcoma. A thumb-tip-sized tumor was seen in the right tonsillar region; this was proved by histologic examination to be reticulosarcoma. Radiation therapy using eoCo was administered in the right cervical region (field 8 by 13 cm). The radiation dose was 4,000 r over a period of 30 days. As a result, the tumor in the tonsillar region was reduced. The isotopic examination was performed with osmTc 7 days following completion of radiation therapy. The anterior image clearly showed the concentration in both parotid glands and the submandibular glands 15 minutes following intravenous injection of about 4 mCi of semTc (Fig. 5). The secretion of ssmTc from the diseased side was slightly reduced in comparison with that from the normal side (Fig. 5, ~4). Forty minutes following injection, ssmTc was secreted from the normal side (arrow) but was smaller on the diseased side (Fig. 5, B) .
808
/Ii{ttrshi
P( trl.
Fig. 4. Cnso 3. Anterior ~&mma camer:L images with life-size film of salivary glands in patient with left, parotid tumor. Note decreased actirity in left parotid gland compaw~l to the normal right parotid gkrnd. -4, fifteen minutes after intravenous injection. B, thirty minutes after intravenous injwtion. (‘, sixty minutes after intravenous injection.
DISCUSSION
In 1968, Grove and 1)iChiro” and Lindcnbraten and Judin” studied the scintiscan of the salivary glands using nnmTc, which is taken up into not only the t,hyroid gland but also into the salivary glands. Since then there have been many reports on the examination of the salivary glands with !19r1’Tc.However, all of these reports have been concerned with the use of a scintiscannrr, obtaining a single scintigram. It takes about 20 to 30 minutes to obtain this type of scan, and, therefore, it is impossible to record the movement of !‘nmT~ with time. In this study, the gamma camera enabled us to obtain an image in about 3 to 3 minutes. Therefore, the dynamic examination of the uptake of 09mTc into the salivary gland and its secretion is possible. In the examination of a normal patient (Cast l), the radioactivity was taken up into the parotid gland and the submandibular gland 5 minutes following the intravenous injection of nnmTc and had already been secreted into the oral cavity at 1% minutes. In addition, the same amount of !IymTc uptake was
Volume 40 Number 6
Gamma camera images of salivary
gland using 99*Tc
809
Pig. 5. Case 4. Anterior gamma camera images of salivary glands in patient with right tonsillar sarcoma. Note diminished salivary secretion from right Stensen’s duct as compared to the normal left Stensen’s duct (B). 9, fifteen minutes after intravenous injection. B, forty minutes after intravenous injection.
seen in the parotid gland and the submandibular gland. 99mTc was taken up into not only the salivary glands but also the nasal region. In the patient with chronic sialoadenitis (Case 2), the uptake of 99mTc was reduced in the diseased side relative to the normal side. This finding is in agreement with the reports by Mlatchkov and KrumovQ and Furumoto and Seki.‘l 99mTc was completely secreted from the salivary glands, and it was found to be retained in the hard palate and the floor of the oral cavity at 6 hours. In the patient with metastatic tumor in the parotid glands (Case 3), the sialogram showed a defect which corresponded to the tumor and suggested decreased function in the diseased gland. However, uptake into the submandibular gland was found to be smaller in this patient than in other patients, and the reason is unknown. This may indicate that there are differences among individuals in the function of the salivary glands. In the patient who had undergone radiation therapy (Case 4), the uptake and the secretion of 99mTc were slightly reduced in the parotid gland which had been treated with radiation. In 1967 Higashi and Tutumi12 studied the function of the salivary glands using 1311 in patients with cancer of the upper jaw who had been treated with ““Co radiation and described the decreased parotid gland uptake of radioactivity secondary to radiation therapy. We have been able to define the patterns of function of salivary glands which have been altered by radiation therapy. CONCLUSION
Following the intravenous injection of QQ1”T~pertechnetate, the gamma camera enabled us to define the dynamic characteristics of salivary gland function as well as morphologic characteristics in a normal patient and in three patients with diseased parotid glands. We will continue this study in an attempt to define further the functional and morphologic characteristics of abnormal salivary glands. The authors wish to express their appreciation to Dr. F. R. Everhart, United States Naval
REFERENCES
3. Hipshi, T., Yoshid:r, K., and Nakalmra, S.: A Possil)ility of tllc, SalivqGland Function Teat by IJw of l:t11, Nippon Acta Rndiol. 25: Z-29, 1965. 4. Misakn, .%: F’unctibn ?&t of Salivary Gland I&asr With Xadioactivv Iodiw, Xadiol. ( Kanazawa, Japan) 83: l-24, 1968. 3. Grove, A. S., Jr., and DiChiro, G. : Salivary Gland Hv:nming With Technetium H9m Prrtt~c+nceltt~, zYnL J. Roc~ntgrnol. 102: 109-l 16, 1968. 6. Lindenl)ratrn, I,. n., and Judin, L. A.: Koml~lesc Untcrsuchung der Speicl~rldriisen mittclr radioaktivcr Isotope und Kiintgenst~:~hlrn, Fortshr. Roentgcnstr. 108: 23-32, 196X. 7. Abramwon, A. L., Levy, I,. M., Goodmam, M., and Attic., J. N.: Salivary Gland ScintiScanninsz \Vitll Technetium 99m Pertrclmetatr. 1,arvneoscorw 79: 1105-1117. 1969. X. Stel,ncr,-F. C., Fylw, W. H., Du Sault, I,. A.; Slack,-M. h., Kelly, A. I,.,: and Nichols, R.: 3glnTc P(~rtcclmctnte Scanning of Salivary Glands, Radiology 90: 5X3-583, 1968. 9. Mhtchkov, C., and Krumov, N. : Diagnostic Potentmlities of Scintillation Scanning of the Salivary G1n11d.s Using Tc, ssnl-PI~rt~llnetatr, Dento-Maxilla-Facial Radiol. 1: 38-41, 1973 _-.-. dcs ggnlTcO,-Speiclwl driisenszinti10. Breunsbach, J., and Dvorak, K.: Zur Interpretation gramms, Fortwhr. Rocwtgenstr. 121: 500-506, 1974. 11. Furumoto, K., and Seki, K.: Evaluation of Salivary Gland Scanning With ~~!~nlTc,Jap. J. Nucl. Med. 6: 19-20, 1969. 12. Higashi, I’., and Tutumi, T.: Studies on the Changes of Salivary Gland Function Followving Tclecobalt Therapy of Maxillary Cancer, Nippon Acta Radial. 26: 127-133, 1967. Ileprint
Iquests
to:
Dr. Tomomitsu Higashi Department of Radiology Knn:ig:~wa Dental College 82, Inaoka-c-110 Yokosuka, .Jwpan