The imaging appearance of the parotid glands in Sjogren’s syndrome depends on the stage of the disease.
In the early stages, the parotid glands may appear normal. Multiple small cysts in both parotids can be seen in the intermediate form of the disease. Late stage Sjogren’s syndrome of the parotids involves large cystic and solid masses. The cystic components represent areas of destroyed gland or collections of saliva while the solid masses represent lymphoid aggregates which actively destroy the gland.
Contrast-enhanced CT typically demonstrates bilateral parotid enlargement, heterogeneous enhancement of solid and mixed cystic lesions and punctate calcifications.
MR sialography is the best imaging test if Sjogren’s syndrome is suspected because of its ability to accurately stage the severity of the disease.