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Salivagram revisited: justifying its routine use for the evaluation of persistent/recurrent lower respiratory tract
Vijay Harish Somasundaram1, Padma Subramanyam, Shanmugasundaram Palaniswamy
1Department of Nuclear Medicine and PET-CT, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Lane, Ponekkara P.O., Kochi, 682041, India. vijayharishs@yahoo.co.in
Insights
Radionuclide salivagram and milk scan effectively detect pulmonary aspiration in children with recurrent respiratory infections. Combining these tests improves diagnostic accuracy for aspiration, a key cause of lung pathology.
Area of Science:
- Pediatric Pulmonology
- Nuclear Medicine Imaging
- Diagnostic Radiology
Background:
- Persistent/recurrent lower respiratory tract infections (LRTI) in children often stem from pulmonary aspiration.
- Accurate diagnosis of aspiration is crucial for effective management in pediatric LRTI.
- Evaluating aspiration in neurodevelopmentally normal children requires reliable imaging techniques.
Purpose of the Study:
- To evaluate the diagnostic utility of radionuclide salivagram for pulmonary aspiration in children with recurrent LRTI.
- To compare the detection rates of salivagram and milk scan individually and in combination.
- To assess the agreement between salivagram and milk scan in identifying aspiration.
Main Methods:
- 113 neurodevelopmentally normal children with persistent/recurrent LRTI underwent both salivagram and milk scan.
- Pulmonary aspiration and gastroesophageal reflux were assessed using radionuclide imaging.
- Detection rates and inter-test agreement (kappa statistic) were analyzed.
Main Results:
- Salivagram detected antegrade pulmonary aspiration in 39.2% of infants and 16.1% of children aged 1-2 years; none above 2 years.
- Milk scan identified gastroesophageal reflux in 38% of children, primarily those over 2 years.
- Combined imaging increased the diagnosis of aspiration as a cause of LRTI from 38% to 53.9% (poor agreement: kappa -0.103).
Conclusions:
- Antegrade pulmonary aspiration is a significant cause of recurrent LRTI in children, with age as a predictor.
- Combined use of salivagram and milk scan offers a comprehensive approach to evaluating pulmonary aspiration.
- These radionuclide studies are valuable tools for objective assessment in pediatric respiratory conditions.
Purpose:
To assess and establish the utility of radionuclide salivagram in the routine evaluation of developmentally normal children with persistent/recurrent lower respiratory tract infection.
Methods:
113 neurodevelopmentally normal children diagnosed with persistent/recurrent lower respiratory tract infection underwent a salivagram and a milk scan on two consecutive days. Frequency of detection of pulmonary aspiration by either procedure individually and increment in detection rates on combining the two were assessed. The agreement between the tests was also studied.
Results:
Antegrade pulmonary aspiration was demonstrated using the salivagram in 39.2 % of infants and 16.1 % of children between the ages of 1 and 2 years. No antegrade aspiration was seen in children above the age of 2 years. 44 % of all antegrade aspirations identified were bilateral, while remaining 66 % were into the right lung. Milk scan revealed gastroesophageal reflux in 38 % of children and most commonly in those above the age of 2 years. Diagnosis of pulmonary aspiration as an underlying cause of the lung pathology increased from 38 % with the use of milk scan alone to 53.9 % on combining the procedures. There was a poor agreement between the two procedures (kappa -0.103).
Conclusion:
Antegrade pulmonary aspiration can be demonstrated as an underlying cause for persistent/recurrent lower respiratory tract infection in developmentally normal children, with age being an important clinical predictor. Combined use of salivagram and milk scan is warranted to objectively evaluate pulmonary aspiration in children.
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