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Kıranatlı M, Yurttaş M, Güngör M, Canbaz Kabay S. Evaluation of major salivary glands with ultrasonography in multiple sclerosis patients. BMC Oral Health 2024; 24:245. [PMID: 38365725 PMCID: PMC10873994 DOI: 10.1186/s12903-024-04007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND This study aimed to investigate the homogeneity of the major salivary glands in multiple sclerosis (MS) patients using ultrasonography (USG), assess DMFT indices, measure resting salivary flow rates, and compare these values with healthy individuals. METHODS In this study, 20 individuals diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) (mean age 36.15 ± 8.51) and 20 systemically healthy individuals (mean age 35.7 ± 9.22) were included. Oral and radiologic examinations were performed in all individuals. The parotid and submandibular salivary glands were examined using USG, and their homogeneity was assessed based on the scoring system recommended by the Outcome Measures in Rheumatology Clinical Trials (OMERACT) study group. Resting salivary flow rates and DMFT indices were measured, and the obtained data were subjected to statistical analysis. RESULTS The parotid glands exhibited more heterogeneity on USG within the MS patient group than the control group, with a statistically significant difference between the two groups (p = 0.015). A statistically significant correlation was observed in total homogeneity values between the patient and control groups (p = 0.021). Furthermore, the MS patient group exhibited higher DMFT indices and lower salivary flow rates than the control group. The difference between the DMFT indices and salivary flow rate between the patient groups was statistically significant (p = 0.004 and p = 0.002 respectively). CONCLUSIONS The parenchyma of the major salivary glands in MS patients exhibited decreased homogeneity than the healthy controls. Additionally, the MS group showed a decrease in salivary flow rate and an increase in the DMFT index. Autonomic dysfunction and medications used for MS are thought to cause salivary gland hypofunction and dry mouth. It can be interpreted that hyposalivation and motor skill losses in MS patients lead to an increase in DMFT index.
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Affiliation(s)
- Mustafa Kıranatlı
- Faculty of Dentistry, Oral and Maxillofacial Radiology, Afyon Health Sciences University, Afyon, Turkey
| | - Melike Yurttaş
- Faculty of Dentistry, Oral and Maxillofacial Radiology, Kütahya Health Sciences University, Kütahya, Turkey.
| | - Müjgan Güngör
- Faculty of Dentistry, Oral and Maxillofacial Radiology, Lokman Hekim University, Ankara, Turkey
| | - Sibel Canbaz Kabay
- Faculty of Medicine, Neurology Department, Dokuz Eylul University, İzmir, Turkey
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Sebastian A, Woytala P, Madej M, Proc K, Czesak-Woytala K, Sebastian M, Zub K, Wiland P. Is it possible to not perform salivary gland biopsy in targeted patients according to unstimulated salivary flow results in patients with suspected Sjögren's syndrome? Rheumatol Int 2021; 41:1125-1131. [PMID: 33844038 PMCID: PMC8079304 DOI: 10.1007/s00296-021-04840-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION/OBJECTIVE Xerostomia is one of the main symptoms of primary Sjögren's syndrome (pSS). The unstimulated salivary flow (UWS) test is one of the objective Sjögren's syndrome classification criteria used to assess xerostomia's severity. The study's objective was to evaluate UWS rate measurements (with a threshold rate of 0.1 mL/min) in the screening of patients suspected with pSS, presenting with xerostomia in whom labial salivary gland biopsy (LSGB) should be performed. We will try to answer whether it is possible not to perform LSGB in targeted patients according to UWS results? We analyze the correlation between UWS value and focus score (FS) and anti-SSA antibodies. METHODS The study group consisted of subjects above 18 years of age with a subjective feeling of oral dryness. RESULTS A total of 105 subjects were qualified for the study. The final diagnosis of pSS was made in 44 patients according to the classification criteria from 2016. No age differences were identified between pSS patients and control group subjects (patients with dry mouth without autoimmune background). UWS rates were significantly lower in pSS patients than in the control group. No association was identified between UWS and focus score (FS) ≥ 1 in LSGB. No differences were observed between anti-SSA-positive and anti-SSA-negative patients in terms of age, UWS rates, FS. CONCLUSION LSGB should be performed in all suspected pSS cases regardless of the UWS rate value, particularly in subjects without specific anti-SSA antibodies. In patients with suspected pSS, only less than one-half of the UWS measurements are below the value of 0.1 mL/min adopted as the threshold in the classification criteria for pSS.
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Affiliation(s)
- Agata Sebastian
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland.
| | - Patryk Woytala
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Marta Madej
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Proc
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
| | | | - Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Medical University of Wroclaw, Wroclaw, Poland
| | - Krzysztof Zub
- Department and Clinic of Otolaryngology-Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Medical University of Wroclaw, Borowska 213, 50-556, Wroclaw, Poland
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High prevalence of salivary gland ultrasound abnormalities in systemic sclerosis. Joint Bone Spine 2020; 88:105113. [PMID: 33278589 DOI: 10.1016/j.jbspin.2020.105113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate salivary gland (SG) involvement in patients with systemic sclerosis (SSc) using SG ultrasound (SGUS). METHODS Patients with SSc (n=62), primary Sjögren's syndrome (pSS) (n=59), and idiopathic Sicca syndrome (n=43) were evaluated using the outcome measures in rheumatology clinical trial (OMERACT) definitions of the SGUS scoring system. The hyperechogenic bands using the 0-3 scoring system, intraglandular power Doppler signal (PDS), and SG volumes were also assessed. RESULTS The proportion of patients with OMERACT grades (≥2) among the four SGs was significantly higher in SSc (51.6%) and pSS (62.7%) groups than those in the idiopathic Sicca syndrome group (4.7%). Patients with SSc and pSS had significantly higher total fibrosis grades than controls. No difference in fibrosis grades was observed between SSc and pSS groups. The PDS scores of SGs were higher in the SSc group than in the idiopathic Sicca syndrome group. SG volumes did not differ between the groups. SSc patients with SGUS grades ≥2 had more anti-centromere antibodies (ACA) (65.6% vs. 30.0%) than individuals with grades 0-1. SSc patients with fibrosis grades ≥2 reported more Sicca symptoms than those with grades 0-1. Inhomogeneity and hyperechogenic bands within the SGs were not associated with organ involvement in SSc. CONCLUSIONS More than half of patients with SSc, specifically with ACA, showed SG involvement. SG fibrosis was more prominent in SSc than in idiopathic Sicca syndrome and was associated with subjective Sicca symptoms. However, hyperechoic bands within the SGs are not features that can differentiate between SSc and pSS.
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Ramsubeik K, Motilal S, Sanchez-Ramos L, Ramrattan LA, Kaeley GS, Singh JA. Diagnostic accuracy of salivary gland ultrasound in Sjögren's syndrome: A systematic review and meta-analysis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20973560. [PMID: 33281953 PMCID: PMC7682247 DOI: 10.1177/1759720x20973560] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren's syndrome (pSS). METHODS PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. RESULTS Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77-83%; I 2 = 78%], and specificity was 90% (95% CI: 87-92%; I 2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4-10) and 0.22 (95% CI: 0.19-0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28-48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77-84%; I 2 = 99%) and specificity 90% (95% CI: 87-93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72-84%; I 2 = 99%), and specificity 90% (89-94%; I 2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. CONCLUSION Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren's syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.
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Affiliation(s)
- Karishma Ramsubeik
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Shastri Motilal
- Department of Para Clinical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Luis Sanchez-Ramos
- Division of Maternal and Fetal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Laurie Ann Ramrattan
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gurjit S. Kaeley
- Division of Rheumatology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Jasvinder A. Singh
- Department of Medicine, Birmingham VA Medical Center, Faculty Office Tower 805B, 510, 20th Street South, Birmingham, AL 35233, USA
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Iordanis K, Panagiotis D, Angelos C, Antonios M, Alexander D, Sofia A, Efimia PA. Unilateral Sialendoscopy for Juvenile Recurrent Parotitis: What Happens to the Other Side? Laryngoscope 2020; 131:1404-1409. [PMID: 33098313 DOI: 10.1002/lary.29187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE/HYPOTHESIS Current literature has confirmed the benefits of sialendoscopy for the treatment of juvenile recurrent parotitis (JRP). However, this procedure is often performed unilaterally, although the disease can affect both sides. This article investigated the clinical course of the contralateral parotid (CL) gland in children requiring unilateral sialendoscopy with the goal of clarifying the necessity of primary bilateral sialendoscopy. STUDY DESIGN Prospective cohort study in a tertiary center. METHODS Over an eight-year period, 77 children with JRP underwent unilateral sialendoscopy. We observed the clinical course of the CL parotid over a minimum follow-up period of 24 months. New episodes of sialadenitis were recorded on both sides along with the need for a second sialendoscopy. These data were correlated with the preoperative symptoms of the contralateral side as well as ultrasound (U/S) findings at baseline assessment. RESULTS In total, six children required sialendoscopy on the CL side (7.8%), 62 children remained asymptomatic or with scarce swellings (80.5%), and nine children improved (11.7%). The preoperative U/S findings on the CL side positively correlated with the number of postoperative swellings. The proportion of children needing CL sialendoscopy was higher (21.4%) among children needing a second sialendoscopy on the operated side. CONCLUSIONS In the long term, the vast majority of children needing unilateral sialendoscopy do not require similar treatment of the CL parotid gland. However, a history of bilateral swellings along with U/S findings of parenchymal disorganization on the CL side significantly increases the risk of needing further sialendoscopy at a later time. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1404-1409, 2021.
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Affiliation(s)
- Konstantinidis Iordanis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Dogantzis Panagiotis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Chatziavramidis Angelos
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Metzikofis Antonios
- 4th Department of Pediatrics, Aristotle University, School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Delides Alexander
- 2nd Academic ORL Department, Attikon Hospital, School of Medicine, National and Kapodistrian University, Athens, Greece
| | - Alataki Sofia
- 4th Department of Pediatrics, Aristotle University, School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Papadopoulou-Alataki Efimia
- 4th Department of Pediatrics, Aristotle University, School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
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Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease, which involves salivary glands (SG) and extra glandular organs. Today, Sjögren's patients' diagnosis is based on classification criteria taking into account five objective tests, including histology, immunology, two ophthalmological tests, and salivary flow evaluation. To date, the challenge is to find the right imaging tool for diagnosis, follow up, and prognosis of pSS. The objective of this review is to describe as to what are these imaging modalities and particularly the place and validity of salivary glands ultrasonography (SGUS) in the diagnosis and follow-up strategy of patients with suspected pSS. Moreover, new noninvasive tools are emerging, including elastography, a new ultrasonography technique that provides an estimate of tissue elasticity, MRI, MR sialography, and 18 fluorodeoxyglucose-positron emission tomography. Although new imaging opportunities are available, SGUS should be the first-line choice in pSS because of its accessibility, feasibility over time, and sensitivity to change.
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James-Goulbourne T, Murugesan V, Kissin EY. Sonographic Features of Salivary Glands in Sjögren's Syndrome and its Mimics. Curr Rheumatol Rep 2020; 22:36. [PMID: 32562049 DOI: 10.1007/s11926-020-00914-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW For 30 years, ultrasound has been investigated as a means to evaluate salivary gland abnormalities in patients with autoimmune disease. We aim to review the test characteristics of ultrasound for diagnosing Sjögren's syndrome, the scoring systems used for this purpose, and the ultrasound similarities and differences between Sjögren's syndrome and some of its potential salivary gland mimics. RECENT FINDINGS Hypo/anechoic glandular lesions are the major ultrasound characteristic found in Sjögren's syndrome. Most studies have reported such ultrasound abnormalities to have a sensitivity and specificity in the range of 65-85% and 85-95%, respectively, as well as a positive likelihood ratio between 4 and 12. However, similar findings can also be seen in sarcoidosis, amyloidosis, IgG4-related disease, HIV, and lymphoma. A "nodal" pattern of involvement or the ultrasound artifact of "through transmission" can help distinguish some of these mimics from Sjogren's syndrome. Ultrasound can substantially influence the diagnosis of Sjögren's syndrome.
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Affiliation(s)
| | | | - Eugene Y Kissin
- Section of Rheumatology, 72 East Concord Str, Evans 501, Boston, MA, 02118, USA.
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Carotti M, Salaffi F, Di Carlo M, Barile A, Giovagnoni A. Diagnostic value of major salivary gland ultrasonography in primary Sjögren's syndrome: the role of grey-scale and colour/power Doppler sonography. Gland Surg 2019; 8:S159-S167. [PMID: 31559183 DOI: 10.21037/gs.2019.05.03] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune connective tissue disease characterized primarily by chronic inflammatory involvement of the exocrine glands, particularly the salivary glands. The use of ultrasound in the study of salivary glands (SGUS) has expanded considerably in recent years. The ultrasound can document structural alterations that can be visualized as hyperechogenic and hypoechogenic areas, or as areas with non-homogeneous echogenicity. To date, several systems of SGUS scoring systems of abnormalities during pSS are available. From the studies published in recent decades, it has been possible to document the high sensitivity and specificity of the pathological findings that can be documented by SGUS. SGUS can also provide added value in identifying patients at risk for developing disease complications such as lymphoma. The Doppler technique can also supply information about glandular tissue vascularization, which is very useful for diagnostic and differential purposes. In this review we will present the state of the art of SGUS, with a prevailing focus on diagnostic use and possible future developments.
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Affiliation(s)
- Marina Carotti
- Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Dipartimento di Scienze Radiologiche S. O. D. Radiologia Pediatrica e Specialistica, Ancona (AN), Italy
| | - Fausto Salaffi
- Clinica Reumatologica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona (AN), Italy
| | - Marco Di Carlo
- Clinica Reumatologica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona (AN), Italy
| | - Antonio Barile
- Dipartimento di Radiodiagnostica, Ospedale S. Salvatore, Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università degli Studi dell'Aquila, L'Aquila (AQ), Italy
| | - Andrea Giovagnoni
- Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Dipartimento di Scienze Radiologiche S. O. D. Radiologia Pediatrica e Specialistica, Ancona (AN), Italy
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Diagnostic accuracy of salivary gland ultrasonography with different scoring systems in Sjögren's syndrome: a systematic review and meta-analysis. Sci Rep 2018; 8:17128. [PMID: 30459471 PMCID: PMC6244082 DOI: 10.1038/s41598-018-35288-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 11/01/2018] [Indexed: 11/12/2022] Open
Abstract
Noninvasive objective salivary gland ultrasonography (SGU) had been widely used to evaluate major salivary gland involvement in primary Sjögren’s syndrome (pSS) and treatment responses. However, the evaluation score, diagnostic sensitivity, and diagnostic specificity significantly varied among clinical studies. We conducted this meta-analysis to assess the diagnostic accuracy of different SGU scoring systems using the American-European Consensus Group criteria. Of the 1301 articles retrieved from six databases, 24 met the criteria for quality assessment and 14 for meta-analyses. The pooled sensitivities were 75% (0–4) with I2 = 92.0%, 84% (0–16) with I2 = 63.6%, and 75% (0–48) with I2 = 90.9%; the pooled specificities were 93% (0–4) with I2 = 71.5%, 88% (0–16) with I2 = 65.4%, and 95% (0–48) with I2 = 83.9%; the pooled diagnostic odds ratios were 71.26 (0–4) with I2 = 0%, 46.3 (0–16) with I2 = 73.8%, and 66.07 (0–48) I2 = 0%; the areas under the SROC curves were 0.95 (0–4), 0.93 (0–16), and 0.94 (0–48). These results indicated that the 0–4 scoring system has a higher specificity and a less heterogeneity than other systems, and could be used as a universal SGU diagnostic standard.
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Aframian DJ, Keshet N, Nadler C. Cone beam computerized tomography sialography-An emerging novel diagnostic tool for Sjogren's syndrome. Oral Dis 2018; 24:191-193. [DOI: 10.1111/odi.12736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022]
Affiliation(s)
- DJ Aframian
- Department of Oral Medicine, Sedation and Maxillofacial Imaging; Sjogren's Syndrome Center; Hebrew University Hadassah School of Dental Medicine; Jerusalem Israel
| | - N Keshet
- Department of Oral Medicine, Sedation and Maxillofacial Imaging; Sjogren's Syndrome Center; Hebrew University Hadassah School of Dental Medicine; Jerusalem Israel
| | - C Nadler
- Department of Oral Medicine, Sedation and Maxillofacial Imaging; Sjogren's Syndrome Center; Hebrew University Hadassah School of Dental Medicine; Jerusalem Israel
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Mossel E, Arends S, van Nimwegen JF, Delli K, Stel AJ, Kroese FGM, Spijkervet FKL, Vissink A, Bootsma H. Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary Sjögren's syndrome. Ann Rheum Dis 2017; 77:556-562. [PMID: 29233833 DOI: 10.1136/annrheumdis-2017-211992] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/23/2017] [Accepted: 11/19/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess whether ultrasonographic scoring of (i) both parotid and submandibular salivary glands and (ii) all individual components of the Hocevar scoring system, is needed for classifying patients as primary Sjögren's syndrome (pSS). METHODS Ultrasound examination of the major salivary glands (sUS) was performed in 204 consecutive patients clinically suspected (n=171) or diagnosed (n=33) with pSS.Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and salivary gland posterior border were scored in left and right parotid and submandibular glands. Logistic regression analyses were performed to assess which glands and sUS components contributed significantly to classification as pSS or non-pSS according to the 2016 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) criteria. RESULTS 116 (57%) patients were classified as pSS, the remaining as non-pSS. Instead of scoring both sides (area under the curve; AUC=0.856, Nagelkerke R2=0.526), multivariate analysis showed that sUS scoring of only right (AUC=0.850; R2=0.518) or left (AUC=0.852; R2=0.511) parotid and submandibular glands is sufficient to predict ACR-EULAR classification. Moreover, all individual components of the Hocevar scoring system significantly predicted classification. Multivariate analysis showed that parenchymal echogenicity and hypoechogenic areas contributed independently to ACR-EULAR classification (AUC=0.857; R2=0.539). Scoring these components in one parotid and one submandibular gland highly predicted ACR-EULAR classification (AUC=0.855; R2=0.539). Scoring only hypoechogenic areas on one side showed almost similar results (AUC=0.846; R2=0.498). CONCLUSION sUS examination of parotid and submandibular glands on one side is sufficient to predict classification of patients according to the ACR-EULAR criteria. To further increase feasibility of sUS in outpatient clinics worldwide, only hypoechogenic areas can be scored.
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Affiliation(s)
- Esther Mossel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jolien F van Nimwegen
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alja J Stel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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