Added value of the Alexandria preoperative imaging protocol combining noncontrast CT with MR sialography in sialolithiasis management.

OBJECTIVE

To assess the added value of the Alexandria sialography imaging protocol of noncontrast computed tomography (NCCT) plus magnetic resonance (MR) sialography in the assessment of suspected sialolithiasis.

STUDY

DESIGN

This prospective study included 59 consecutive patients (37 males, 22 females; mean age, 35.7 years) presenting with acute or recurrent postprandial salivary gland swelling and colicky pain with suspected salivary calculi referred from March 2021 to May 2022 to a tertiary referral center. NCCT and MR sialography were done in all cases to detect sialolithiasis and provide detailed information about calculus size and location as well as ductal changes. Results were compared with subsequent operative sialendoscopy findings.

RESULTS

NCCT provided 97.9% sensitivity and 83.3% specificity (P < 0.001*), while MR sialography had 79.6% sensitivity and 83.3% specificity (P = 0.003*). Combination of both NCCT and MR sialography gave higher sensitivity (97.9%) and specificity (100%) in stone detection (P < 0.001*). Details obtained regarding stone size, shape, number, and exact location in addition to ductal condition also provided an excellent road map for the surgeon before the procedure.

CONCLUSIONS

Combined NCCT plus MR sialography proved to be a valuable imaging protocol for preoperative planning of suspected sialolithiasis. It provided accurate assessment before surgery and, hence, facilitated minimally invasive salivary gland preservation.