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Cho A, Lee YR, Jeon YT, Chang SH, Park YM, Ahn SJ, Lim JY. Correlations of MR Sialographic Gradings with the Clinical Measures of Sjögren's Syndrome. Laryngoscope 2023; 133:307-316. [PMID: 35546506 DOI: 10.1002/lary.30150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/08/2022] [Accepted: 04/09/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Sjögren syndrome (SS) features salivary gland architectural changes such as ductal deformities and fat deposition secondary to inflammatory cell infiltrates; however, the anatomical and pathophysiological correlations of SS remain to be determined. This study aimed to determine the correlations of imaging findings based on the magnetic resonance (MR) sialography with the clinical and laboratory aspects of SS patients. METHODS We evaluated the MR sialographic findings of two pairs of parotid glands (PGs) and submandibular glands (SMGs) from 41 SS patients. The distinct MR sialographic features were then compared with the clinical symptoms, biological (anti-SSA/Ro antibody positivity), histological (labial gland focus score), and functional (salivary flow and scintigraphy) data. RESULTS Ductal deformities such as sialectasis in the PG ducts were exclusively observed in SS, and fat replacement in SMGs was more distinct in patients with SS than in non-SS sicca patients. Of the 82 PGs and SMGs from 41 SS patients, the grade of sialectasis in PGs on MR sialographic images and fat stage in SMGs showed strong correlations with anti-SSA/Ro-positivity. PG sialectasis was found more frequently in patients with dry mouth and decreased salivary gland function. A significant correlation was found between fat deposition in PGs and SMGs and decreased salivary gland function. CONCLUSION These results suggest that MR sialography is a reliable, adjunctive anatomical and functional study to assess SS. Detail aspects of sialectasis and fat accumulation encountered on MR sialography in SS patients can help physicians assume the disease status in SS. LEVEL OF EVIDENCE 3 Laryngoscope, 133:307-316, 2023.
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Affiliation(s)
- Ara Cho
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ye Rin Lee
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yousei University College of Medicine, Seoul, Republic of Korea
| | - Yu Tae Jeon
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hyun Chang
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Min Park
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Jun Ahn
- Departments of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.,Yousei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Tanaka T, Oda M, Wakasugi-Sato N, Joujima T, Miyamura Y, Habu M, Kodama M, Takahashi O, Sago T, Matsumoto-Takeda S, Nishida I, Tsurushima H, Otani Y, Yoshiga D, Sasaguri M, Morimoto Y. First Report of Sublingual Gland Ducts: Visualization by Dynamic MR Sialography and Its Clinical Application. J Clin Med 2020; 9:jcm9113676. [PMID: 33207659 PMCID: PMC7698194 DOI: 10.3390/jcm9113676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/26/2023] Open
Abstract
This study was done to determine whether the sublingual gland ducts could be visualized and/or their function assessed by MR sialography and dynamic MR sialography and to elucidate the clinical significance of the visualization and/or evaluation of the function of sublingual gland ducts by clinical application of these techniques. In 20 adult volunteers, 19 elderly volunteers, and 7 patients with sublingual gland disease, morphological and functional evaluations were done by MR sialography and dynamic MR sialography. Next, four parameters, including the time-dependent changes (change ratio) in the maximum area of the detectable sublingual gland ducts in dynamic MR sialographic images and data were analyzed. Sublingual gland ducts could be accurately visualized in 16 adult volunteers, 12 elderly volunteers, and 5 patients. No significant differences in the four parameters in detectable duct areas of sublingual glands were found among the three groups. In one patient with a ranula, the lesion could be correctly diagnosed as a ranula by MR sialography because the mass was clearly derived from sublingual gland ducts. This is the first report of successful visualization of sublingual gland ducts. In addition, the present study suggests that MR sialography can be more useful in the diagnosis of patients with lesions of sublingual gland ducts.
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Affiliation(s)
- Tatsurou Tanaka
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
| | - Masafumi Oda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
| | - Nao Wakasugi-Sato
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
| | - Takaaki Joujima
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
| | - Yuichi Miyamura
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
| | - Manabu Habu
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu 803-8580, Japan; (M.H.); (O.T.); (M.S.)
| | - Masaaki Kodama
- Department of Oral and Maxillofacial Surgery, Japan Seafarers Relief Association Moji Ekisaikai Hospital, Kyushu 801-8550, Japan;
| | - Osamu Takahashi
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu 803-8580, Japan; (M.H.); (O.T.); (M.S.)
| | - Teppei Sago
- Division of Dental Anesthesiology, Kyushu Dental University, Kitakyushu 803-8580, Japan;
| | - Shinobu Matsumoto-Takeda
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
| | - Ikuko Nishida
- Division of Developmental Stomatognathic Function Science, Kyushu Dental University, Kitakyushu 803-8580, Japan;
| | - Hiroki Tsurushima
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (Y.O.); (D.Y.)
| | - Yasushi Otani
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (Y.O.); (D.Y.)
| | - Daigo Yoshiga
- Division of Oral Medicine, Kyushu Dental University, Kitakyushu 803-8580, Japan; (H.T.); (Y.O.); (D.Y.)
| | - Masaaki Sasaguri
- Division of Maxillofacial Surgery, Kyushu Dental University, Kitakyushu 803-8580, Japan; (M.H.); (O.T.); (M.S.)
| | - Yasuhiro Morimoto
- Division of Oral and Maxillofacial Radiology, Kyushu Dental University, Kitakyushu 803-8580, Japan; (T.T.); (M.O.); (N.W.-S.); (T.J.); (Y.M.); (S.M.-T.)
- Correspondence: ; Tel./Fax: +81-93-285-3094
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Świecka M, Maślińska M, Paluch Ł, Zakrzewski J, Kwiatkowska B. Imaging methods in primary Sjögren's syndrome as potential tools of disease diagnostics and monitoring. Reumatologia 2019; 57:336-342. [PMID: 32226167 PMCID: PMC7091478 DOI: 10.5114/reum.2019.91273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/28/2019] [Indexed: 01/06/2023] Open
Abstract
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease that affects exocrine glands, especially salivary and lacrimal glands, leading to their progressive destruction. With highly differentiated clinical course the approach to the definition of pSS is constantly evolving and the pSS classification criteria have been modified over the past years. In the past sialography and scintigraphy were frequently used in pSS diagnostics. Recently no imaging method has been included in the pSS classification criteria. That raises the question about the benefits of using novel imaging techniques such as ultrasonography, elastography and magnetic resonance imaging to diagnose and monitor pSS patients. The purpose of this review is to evaluate the advantages and limitations of widely used imaging methods in pSS and their possible future development.
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Affiliation(s)
- Marta Świecka
- Clinic of Early Arthritis, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Maria Maślińska
- Clinic of Early Arthritis, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Łukasz Paluch
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Jakub Zakrzewski
- Department of Radiology, Gruca Orthopedic and Trauma Teaching Hospital, Center of Postgraduate Medical Education, Otwock, Poland
| | - Brygida Kwiatkowska
- Clinic of Early Arthritis, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Liu S, Chen W, Wang M, Wu T, Dong L, Pan C, Zhu W. Quantitative Analysis of Parotid Gland Secretion Function in Sjögren's Syndrome Patients with Dynamic Magnetic Resonance Sialography. Korean J Radiol 2019; 20:498-504. [PMID: 30799581 PMCID: PMC6389808 DOI: 10.3348/kjr.2018.0508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/05/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the secretory function of parotid glands by dynamic magnetic resonance (MR) sialography and determine the clinical performance of this technique in diagnosing and evaluating Sjögren's syndrome (SS) patients. Materials and Methods This study enrolled 29 healthy volunteers (25 women and 4 men; mean age, 34.8 ± 6.3 years; age range, 26–47 years) and 25 primary SS (pSS) patients (23 women and 2 men; mean age, 37.7 ± 7.9 years; age range, 25–50 years) with decreased secretory function. The volume of the parotid gland ducts was precisely measured for both groups at single pre- and 6 post-gustatory-stimulated phases. Time-dependent volume change ratio curves were generated, four parameters were derived from the curves: the slope of the increase in the first post-stimulation phase (slope1st), the peak value, the time-to-peak, the total saliva secretion post-stimulation. All values were used to quantitatively evaluate the secretory function of the parotid gland. The repeated measurement analysis, Mann-Whitney U test and receiver operating characteristic curve were applied. Results Time-dependent volume change ratio curves demonstrated that there is a statistically significant difference between the two groups (F = 8.750; p = 0.005). A quickly increasing curve was shown in the volunteer group, whereas a slowly increasing curve was shown in the pSS patient group. The slope1st, peak value and total saliva secretion post-stimulation of the patient group were significantly lower than those of the volunteer group (p = 0.005, p = 0.003, and p = 0.002, respectively). The time-to-peak between the two groups was not significantly different (p = 0.383). The slope1st can be used as a discriminator to diagnose SS patients (p = 0.015; odds ratio = 4.234; area under the curve = 0.726). Conclusion Dynamic MR sialography is proven to be an effective method in evaluating salivary gland function and has a great potential in diagnosing and evaluating pSS patients.
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Affiliation(s)
- Simin Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tong Wu
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingli Dong
- Department of Rheumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chu Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xu X, Su G, Hu H, Wang Y, Hong X, Shi H, Wu F. Effects of regions of interest methods on apparent coefficient measurement of the parotid gland in early Sjögren's syndrome at 3T MRI. Acta Radiol 2017; 58:27-33. [PMID: 26987670 DOI: 10.1177/0284185116637245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/10/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The apparent diffusion coefficient (ADC) has been used to assess parotid gland abnormalities in Sjögren's syndrome (SS) patients; however, few data exist on the influence of region of interest (ROI) methods on ADC measurements. PURPOSE To assess the influence of ROI methods on ADC measurement, and their diagnostic ability in detecting parotid gland abnormalities in early SS patients. MATERIAL AND METHODS Thirteen early SS patients underwent parotid gland diffusion-weighted imaging scans at a 3.0 T MR unit. Two readers independently measured the parotid gland ADC value using three different ROIs (whole-gland [WG], single-slice [SS], and reader-based circular [RBC]). The ADC value based on three different ROIs (ADC-ROIWG, ADC-ROISS, ADC-ROIRBC) were compared between the SS group and a matched healthy control (HC) group (n = 19). Receiver operating characteristic (ROC) curves and intra-class correlation coefficients (ICC) were used to determine the diagnostic ability and reproducibility of the parameters. RESULTS The ADC-ROIWG, ADC-ROISS, and ADC-ROIRBC in the SS group were all significantly higher than those in HC group (all P < 0.05). The ADC-ROIWG showed better diagnostic ability than did ADC-ROIRBC (P = 0.0200), while no significant difference was found between ADC-ROIWG and ADC-ROISS (P = 0.4636). The ROIWG method showed the best inter- and intra-reader agreement (ICC, 0.902 and 0.928, respectively), followed by ROISS and ROIRBC. CONCLUSION The ROI methods can influence the parotid gland ADC measurements and their diagnostic ability. Considering our results, we suggest using in clinical practice single-slice ROIs to measure the ADC of the parotid gland.
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Affiliation(s)
- Xiaoquan Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Guoyi Su
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hao Hu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yanyan Wang
- Department of Rheumatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xunning Hong
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Haibin Shi
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Feiyun Wu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Kojima I, Sakamoto M, Iikubo M, Kumamoto H, Muroi A, Sugawara Y, Satoh-Kuriwada S, Sasano T. Diagnostic performance of MR imaging of three major salivary glands for Sjögren's syndrome. Oral Dis 2016; 23:84-90. [PMID: 27580143 DOI: 10.1111/odi.12577] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We analyzed the diagnostic performance of the MR imaging findings of the parotid, submandibular, and sublingual glands to discriminate between patients with and without Sjögren's syndrome. METHODS We retrospectively analyzed the correlation between the MR imaging and histopathological findings obtained from 69 patients with clinically suspected Sjögren's syndrome. We evaluated the heterogeneous signal intensity distribution on T1- and T2-weighted images, the multiple high-signal-intensity spots on MR sialograms, and the volume of the parotid, submandibular, and sublingual salivary glands. RESULTS The multiple high-signal-intensity spots in the parotid gland showed the highest sensitivity and diagnostic accuracy (82% and 83%, respectively). In addition, the multiple high-signal-intensity spots and the heterogeneous signal intensity distribution in the submandibular gland showed high specificity (100% and 88%, respectively). The volume of the submandibular gland, but not that of the parotid or sublingual gland, was smaller in patients with Sjögren's syndrome. CONCLUSIONS The presence of multiple high-signal-intensity spots on an MR sialogram in the parotid gland should be considered the best diagnostic indicator for Sjögren's syndrome. The presence of spots, heterogeneity, and the change to smaller volumes in the submandibular gland were also helpful because of their high specificity, particularly in advanced cases.
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Affiliation(s)
- I Kojima
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - M Sakamoto
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - M Iikubo
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - H Kumamoto
- Department of Oral Pathology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - A Muroi
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Y Sugawara
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - S Satoh-Kuriwada
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - T Sasano
- Department of Oral Diagnosis, Tohoku University Graduate School of Dentistry, Sendai, Japan
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Su GY, Xu XQ, Wang YY, Hu H, Shen J, Hong XN, Shi HB, Wu FY. Feasibility study of using intravoxel incoherent motion mri to detect parotid gland abnormalities in early-stage Sjögren syndrome patients. J Magn Reson Imaging 2015; 43:1455-61. [PMID: 26583877 DOI: 10.1002/jmri.25096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/02/2015] [Indexed: 12/20/2022] Open
Affiliation(s)
- Guo-Yi Su
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Xiao-Quan Xu
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Yan-Yan Wang
- Department of Rheumatology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Hao Hu
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Jie Shen
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Xun-Ning Hong
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Hai-Bin Shi
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
| | - Fei-Yun Wu
- Department of Radiology; First Affiliated Hospital of Nanjing Medical University; Nanjing China
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Yokosawa M, Tsuboi H, Nasu K, Hagiya C, Hagiwara S, Hirota T, Ebe H, Takahashi H, Asashima H, Kondo Y, Ogishima H, Suzuki T, Minami M, Bukawa H, Matsumoto I, Sumida T. Usefulness of MR imaging of the parotid glands in patients with secondary Sjögren's syndrome associated with rheumatoid arthritis. Mod Rheumatol 2014; 25:415-20. [DOI: 10.3109/14397595.2014.958892] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gomes PDS, Juodzbalys G, Fernandes MH, Guobis Z. Diagnostic Approaches to Sjögren's syndrome: a Literature Review and Own Clinical Experience. J Oral Maxillofac Res 2012; 3:e3. [PMID: 24422005 PMCID: PMC3886093 DOI: 10.5037/jomr.2012.3103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/20/2012] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of present paper is to critically address the recent advances on diagnostic procedures of Sjögren's syndrome, taking into account the attained local and systemic features of the disease. MATERIAL AND METHODS A comprehensive review of the available literature regarding to the diagnostic approaches to Sjögren's syndrome was conducted. Eligible studies were identified by searching the electronic literature PubMed, Medline, Embase, and ScienceDirect databases for relevant reports (last search update January 2012) combining the MESH heading term "Sjögren's syndrome", with the words "diagnosis, diagnostic procedures, salivary gland function, ocular tests, histopathology, salivary gland imaging, serology". The authors checked the references of the selected articles to identify additional eligible publications and contacted the authors, if necessary. RESULTS Presented article addresses the established diagnostic criteria for Sjögren's syndrome and critically evaluates the most commonly used diagnostic procedures, presenting data from author's own clinical experience. Diagnostic criteria for Sjögren's syndrome are required both by healthcare professionals and patients, namely in order to provide a rational basis for the assessment of the symptoms, establish an individual disease prognosis, and orientate the therapeutic intervention. CONCLUSIONS Sjögren's syndrome is quite a common autoimmune disease of which the diagnosis and treatment are not easily established. Due to its systemic involvement, it can exhibit a wide range of clinical manifestations that contribute to confusion and delay in diagnosis. The use of proper diagnostic modalities will help to reduce the time to diagnosis and preserve the health and quality of life of patients with Sjögren's syndrome.
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Affiliation(s)
- Pedro de Sousa Gomes
- Laboratory of Pharmacology and Cellular Biocompatibility, Faculty
of Dental Medicine, University of PortoPortoPortugal.
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Medical Academy, Lithuanian
University of Health SciencesKaunasLithuania.
| | - Maria Helena Fernandes
- Laboratory of Pharmacology and Cellular Biocompatibility, Faculty
of Dental Medicine, University of PortoPortoPortugal.
| | - Zygimantas Guobis
- Department of Dental and Oral Pathology, Medical Academy,
Lithuanian University of Health SciencesKaunasLithuania.
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Habu M, Tanaka T, Tomoyose T, Ono K, Anzai T, Ozaki Y, Yoshioka I, Yamashita Y, Kodama M, Yamamoto N, Oda M, Wakasugi N, Matsumoto S, Takahashi T, Inenaga K, Tominaga K, Morimoto Y. Significance of dynamic magnetic resonance sialography in prognostic evaluation of saline solution irrigation of the parotid gland for the treatment of xerostomia. J Oral Maxillofac Surg 2009; 68:768-76. [PMID: 19913967 DOI: 10.1016/j.joms.2009.04.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the clinical significance of dynamic magnetic resonance (MR) sialographic images in prognostic evaluation of saline solution irrigation of the parotid gland for the treatment of xerostomia. MATERIALS AND METHODS Morphologic findings and functional parameters were evaluated by use of dynamic MR sialography before saline solution irrigation of the parotid gland for the treatment of xerostomia in 17 patients. In addition, the MR sialographic data before the saline solution irrigation treatment in patients with improvement of salivary secretion and the sensation of dry mouth after irrigation treatment were compared with data in patients without improvement. RESULTS The maximum changing ratio in the group of patients with improvement after treatment was significantly higher (P = .042) than that in the group of patients without improvement. In addition, high correlations were found between the changing ratio and improvement on the visual analog scale for dry mouth sensation after treatment (Pearson r = 0.63, P = .001) and improvement of salivary flow rate (Pearson r = 0.77, P = .001). Moreover, in 12 patients with improvement of salivary flow rate after the saline solution irrigation treatment, the maximum changing ratio before the saline solution irrigation treatment was over 1.2. However, no significant differences in other parameters, including the detectable ductal area, were found between the group of patients with improvement after treatment and the group without improvement. CONCLUSIONS Our study suggests that dynamic MR sialography might be useful for the prognostic evaluation of saline solution irrigation of the parotid gland for the treatment of xerostomia.
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Affiliation(s)
- Manabu Habu
- Department of Oral and Maxillofacial Surgery, Division of Maxillofacial Diagnostic and Surgical Science, Kyushu Dental College, Kitakyushu, Japan
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Ono K, Tanaka T, Inoue H, Ansai T, Sato-Wakasugi N, Muraoka K, Yokota M, Takehara N, Morimoto Y, Inenaga K. Small salivary gland size in patients with xerostomia of unknown etiology. Arch Oral Biol 2009; 54:369-73. [PMID: 19185851 DOI: 10.1016/j.archoralbio.2008.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 12/16/2008] [Accepted: 12/23/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We have recently reported that flow rates of whole saliva in young healthy humans correlate positively with salivary gland sizes. The low rate of salivary secretion in xerostomia patients may be related to the small size of the salivary glands. To investigate this possibility, relationships between salivary secretions and salivary gland sizes were investigated in unknown-etiology xerostomia patients and healthy controls. DESIGN The sizes of the three major salivary glands in seven xerostomia patients and seven age- and gender-matched healthy controls who have no previous disease history and prescription medication related to xerostomia, were measured by use of a magnetic resonance imaging technique. The salivary glands of all subjects failed to show any pathological aspects in magnetic resonance images. The flow rates of unstimulated and chewing-stimulated whole saliva were also measured. RESULTS Flow rates of unstimulated and chewing-stimulated whole saliva and the sizes of the parotid and submandibular glands were significantly lower and smaller in xerostomia patients of unknown etiology when compared with healthy controls. In addition, salivary flow rates per size of the combined three major salivary glands were also significantly lower in the xerostomia patients of unknown etiology. CONCLUSIONS The smaller salivary gland size in xerostomia patients of unknown etiology may be one of the causes of the reduced salivary secretion. The secretion rates as a function of gland sizes were also lower, and so it is likely that functional impairments of the salivary gland are also present in patients with xerostomia of unknown etiology.
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Affiliation(s)
- K Ono
- Department of Biosciences, Kyushu Dental College, 2-6-1 Manazuru, Kokurakitaku, Kitakyushu, Fukuoka 803-8580, Japan
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Tanaka T, Ono K, Ansai T, Yoshioka I, Habu M, Tomoyose T, Yamashita Y, Nishida I, Oda M, Kuroiwa H, Wakasugi-Sato N, Okabe S, Kito S, Takahashi T, Tominaga K, Inenaga K, Morimoto Y. Dynamic magnetic resonance sialography for patients with xerostomia. ACTA ACUST UNITED AC 2008; 106:115-23. [DOI: 10.1016/j.tripleo.2008.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Revised: 03/07/2008] [Accepted: 03/13/2008] [Indexed: 11/27/2022]
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Hugill J, Sala E, Hollingsworth KG, Lomas DJ. MR sialography: the effect of a sialogogue and ductal occlusion in volunteers. Br J Radiol 2008; 81:583-6. [PMID: 18443015 DOI: 10.1259/bjr/29344975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
MR sialography using heavily T(2) weighted projection techniques relies upon saliva for image contrast, and the visualization of normal ducts is often limited. Methods used to increase the volume of intraductal saliva during imaging in order to improve duct visualization have not been previously evaluated. The effect of a sialogogue and passive ductal occlusion on the ability to visualize the main and intraglandular salivary gland ducts during MR sialography was investigated. Three-dimensional (3D) T(2) weighted MR sialograms were obtained from 12 healthy volunteers with and without the combined use of a sialogogue and passive ductal occlusion pad adjacent to the parotid duct orifice on one side. Two radiologists (in consensus) subjectively evaluated ductal visualization and image artefacts on the resulting blinded maximum intensity projections. The results demonstrate that main duct visualization was significantly improved (p<0.00001) by this technique, with no significant change seen in image artefacts. Although an improvement in intraglandular duct visualization was noted, this was not statistically significant (p = 0.05). Thus, the use of a sialogogue and passive ductal occlusion improves visualization of the main parotid duct in volunteers undergoing MR sialography. Further optimization and evaluation of this approach should lead to improvements in the MR sialography examination of patients.
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Affiliation(s)
- J Hugill
- Department of Radiology, University of Cambridge and Addenbrooke's Hospital, Box 219, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ UK
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Tzioufas AG, Voulgarelis M. Update on Sjögren's syndrome autoimmune epithelitis: from classification to increased neoplasias. Best Pract Res Clin Rheumatol 2008; 21:989-1010. [PMID: 18068857 DOI: 10.1016/j.berh.2007.09.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Sjögren's syndrome is a chronic inflammatory process that primarily involves the exocrine glands. Its clinical manifestations range from autoimmune exocrinopathy to extraglandular (systemic) involvement affecting the lungs, kidneys, blood vessels, and muscles; it can occur alone (primary Sjögren's syndrome) or in association with other autoimmune diseases (secondary Sjögren's syndrome). In recent years, clinical and laboratory observations have highlighted the central role of the epithelial cell and it has been suggested that the etiological name of the disease should be 'autoimmune epithelitis'. The extraglandular manifestations of the disease are divided in two groups: (1) lung, kidney (interstitial nephritis), and liver involvement as a result of lymphocytic invasion in epithelial tissues; and (2) skin vasculitis, peripheral neuropathy, and glomerulonephritis, with low C4 levels, which is the result of immune complex disease, are associated with increased morbidity and high risk for lymphoma. The diagnosis of the disease is based on the classification criteria, raised by the American-European Study Group and which have been built on the European preliminary classification criteria, developed in 1992. The association of Sjögren's syndrome with lymphoma is well documented as in approximately 5% of patients the benign autoimmune process is transformed into a lymphoid malignancy. The salivary extranodal marginal zone B-cell lymphomas of the mucosa-associated lymphoid tissue type are the most common lymphoma in Sjögren's syndrome. These tumors are antigen-stimulated B-cell lymphomas and are characterized by localized stage, indolent clinical course, and recurrence in other extranodal sites. Among the clinical and serological parameters that have been associated with lymphoma development in patients with Sjögren's syndrome, the presence of palpable purpura, low C4 and mixed monoclonal cryoglobulinemia constitute the main predictive markers; patients displaying these risk factors should be monitored closely. The purpose of this review is to discuss the clinical picture, the diagnostic procedure, and the malignant lymphoproliferation in the disease.
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Roberts C, Parker GJM, Rose CJ, Watson Y, O'Connor JP, Stivaros SM, Jackson A, Rushton VE. Glandular Function in Sjögren Syndrome: Assessment with Dynamic Contrast-enhanced MR Imaging and Tracer Kinetic Modeling—Initial Experience. Radiology 2008; 246:845-53. [DOI: 10.1148/radiol.2463070298] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Macan D, Hat J, Lukšić I. Lipiodol ultra-fluid – foreign body in the cheek. Dentomaxillofac Radiol 2008; 37:171-4. [DOI: 10.1259/dmfr/51096684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tanaka T, Ono K, Habu M, Inoue H, Tominaga K, Okabe S, Kito S, Yokota M, Fukuda J, Inenaga K, Morimoto Y. Functional evaluations of the parotid and submandibular glands using dynamic magnetic resonance sialography. Dentomaxillofac Radiol 2007; 36:218-23. [PMID: 17536089 DOI: 10.1259/dmfr/27496576] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To evaluate the functional differences between the parotid and submandibular glands using dynamic MR sialography. METHODS In 30 volunteers, the time-dependent changes (dynamic changes) in the maximum area of the detectable parotid and submandibular gland ducts on dynamic MR sialographic images were analysed. RESULTS Dynamic changes in the parotid gland ducts were detectable on MR sialographic images in all volunteers, but images of the submandibular gland ducts were detectable in only 23 volunteers. In addition, the dynamic changes in the submandibular gland ducts in these 23 subjects were less than those seen in the parotid gland ducts. A relationship was found between the changing ratio of parotid (Pearson r=0.448, P=0.013) or submandibular gland ducts (Pearson r=0.418, P=0.047) and the salivary flow rate during the stimulation period. CONCLUSIONS Dynamic MR sialography allows evaluation of rest and stimulated functioning and morphological evaluation of the parotid and submandibular glands. This technique appears to have many possible applications in the dental, medical and biological fields.
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Affiliation(s)
- T Tanaka
- Department of Oral Diagnostic Science, Kyushu Dental College, Kitakyushu, Japan
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