الفهرس 
Acknowledgement
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Abstract
The present study is a prospective cohort study aimed to evaluate the role of gray scale and Doppler ultrasound in characterizing parotid and submandibular gland lesions in comparison to biopsy as a gold stander in patients presented with neck swelling, pain or any complain related to major salivary gland as detected by the clinical examination who were referred to Radio-diagnosis department, Assuit University Hospitals, Egypt in the period from the first of January 2019 up to the first of January 2022. The study included 69 patients. The mean age of our studied participants was 35.86 ± 18.78 years. There is a male predominance among our studied participants; as we found that 58.0% were males versus 42% were females. Malignant salivary gland lesions were significantly higher among older aged patients, male sex, and in the parotid gland. Out of 69 studied cases, 59.4% had neoplastic lesions (41% have benign and 19% have malignant lesions) and 41% have inflammatory lesions. 94% had pleomorphic adenomas in parotid gland. By using US for the evaluation of inflammatory process affecting salivary glands, we found that most inflammatory lesions revealed predominantly low grade vascularity except the acute Sialodenitis revealed higher vascularity, benign tumours revealed predominantly low grade vascularity, except the infantile hemangioma showed high vascularity. Malignant tumours showed high grade vascularity except MALT lymphoma. Regarding to the pattern of vascularity among the SG tumors, our study shows that pleomorphic adenoma (which represents the most
common benign SG tumors) showed predominantly peripheral pattern of vascularity (75%). But Warthin’s tumours had hilar type of flow. Infantile hemangioma case show mixed pattern of vascularity. In malignant tumours 77% of showed mixed pattern of vascularity, mucoepidermoid carcinoma showed predominantly mixed pattern of vascularity (83%), adenoid cystic carcinoma and squamous cell carcinoma show mixed pattern of vascularity. By comparing the Pulse Wave Doppler findings between benign and malignant SG tumors patient we found that malignant SG tumors have higher mean of PSV, RI and PI. By using B-mode GSS, we found highly statistically significant difference between benign and malignant SG tumors as we found that malignant SG tumors were more likely to have ill-defined, inhomogeneous echo structure and with irregular shape than benign SG tumors (P<0.05, for all). The sensitivity, specificity and accuracy of the tumour border, homogeneity and shape for determining malignant tumours was 69.2%, 96.4% and 87.8% for tumor border, 69.2%, 78.6% and 75.6% for tumor homogeneity and 69.2%, 96.4% and 87.8% for tumor shape, respectively. The combination of the three GSS categories together has a sensitivity of 69.2%, specificity of 100 % and the accuracy was 90.2% for differentiating malignant from benign SG tumors. Malignant salivary gland lesions were significantly higher among older aged patients, male gender, and in the parotid gland. USG is the initial modality of choice for the evaluation of lesions of major salivary glands. USG is useful in detecting inflammatory and neoplastic lesions of salivary glands. Morphology of lesion is helpful in diagnosing and differentiating benign and malignant tumours. Color and pulse wave Doppler provides additional diagnostic information in detection of malignant tumours. Sometimes it might be difficult to differentiate benign and malignant tumours on USG and Doppler alone. In these cases pathological diagnosis by FNAC or biopsy is essential. Salivary gland ultrasonography should be used as a first diagnostic modality for evaluating patients with suspected salivary gland lesions. Larger prospective studies are needed to confirm our finding. After consensus on the threshold values of PSV, RI and PI in differentiating benign from malignant SG tumours, these numbers should be incorporated into the software of the ultrasound machines to guide the sonographer in his analysis