MR Sialography: A Pictorial Review

MR sialography is a noninvasive method for evaluating the ductal structures of the major salivary glands. While the technique and its applications have evolved greatly from its initial description in the mid-1990s, it remains rooted in the simple concept that stationary fluid, such as saliva, has intrinsic high T2 signal intensity, obviating instillation of contrast material to “opacify” the salivary ducts. MR sialography offers several advantages over conventional or digital sialography, including its noninvasive technique, lack of the need for contrast media, lack of ionizing radiation, independence from an experienced operator, its concomitant evaluation of the salivary glandular parenchyma, and acute sialadenitis not being a contraindication for imaging. In this review, we describe the current state of MR sialographic imaging, including basic, adjuvant, and advanced techniques; salient anatomy germane to both radiologists and salivary endoscopists; MR sialographic considerations before sialoendoscopy; a suggested search pattern modeled after the clinical considerations of referring salivary endoscopists; disease-specific applications of MR sialography; and imaging alternatives.

Learning Objective: To recognize the current state of MR sialography, including its advantages, limitations, current applications in medical imaging, pertinent findings for salivary endoscopists, future directions, and imaging alternatives.