Sjögren's syndrome is an autoimmune exocrinopathy which manifests itself with dryness of the eyes and the oral cavity. These symptoms comprise a so-called sicca syndrome (xerostomia and xerophthalmia). Two forms of this disease may be distinguished: primary Sjögren's syndrome which affects salivary glands and secondary Sjögren's syndrome with other autoimmune diseases present such as rheumatoid arthritis, systemic lupus erythematosus or systemic scleroderma. The diagnosis is based on the classification criteria established in 2002 by a group of American and European scientists (American-European Consensus Group), which involve the interview and physical examination as well as serological, histopathological and radiological tests. Most of these examinations show some limitations such as invasiveness, expensiveness or limited accessibility. The latest research suggests that ultrasound examination may appear promising in the diagnostics of the main salivary glands: submandibular and parotid glands. It is an accessible and relatively cheap examination with high sensitivity and specificity values which are comparable to those obtained via conventional means used in the diagnostics of this disease, i.e. biopsy of the minor salivary glands, sialography and scintigraphy, as well as superior to those obtained in sialometry and Schirmer's test. Additionally, ultrasonography correlates with the results of magnetic resonance imaging. Therefore, a number of authors claim that US examination should be included in the classification criteria of Sjögren's syndrome. The aim of this article is to present the diagnostic capacity of the US examination in Sjögren's syndrome using the current ultrasound classification systems based on the grey-scale, Doppler and contrast-enhanced examinations. The latest research confirms that the most valuable diagnostic criterion in Sjögren's syndrome is the heterogeneity of the glandular parenchyma. The outcome of the examination greatly depends on the examiner's experience.

SummaryBackgroundThe objective of this study was a comparative evaluation of radiography and MRI in the diagnostics of sacroiliitis in patients with a clinical diagnosis of spondyloartropathy, according to the current ASAS criteria.Material/MethodsSacroiliac joints radiograms and MRI were conducted in 101 consecutive patients, aged 19–71 yrs (mean age: 40.6 yrs). The patients were referred by a senior rheumatologist, with symptoms of the chronic back pain. The sacroiliac joints were assessed on AP radiograms of the pelvis according to the modified New York criteria for ankylosing spondylitis. MRI was performed to look for active and chronic inflammatory lesions.ResultsOf 14 patients with radiographic sacroiliitis according to modified New York criteria, only 50% had sacroiliitis on MRI. The sensitivity and specificity of conventional radiography were 22% and 94% and of MRI were 71% and 90%. Cohen’s kappa coefficient was κ=0.0187, agreement of radiograms and MRI was 58%. Among 86 patients displaying no sacroiliitis on radiograms, MRI showed sacroiliitis in 34 patients (39.5%). Positive predictive value was 0.429, negative predictive value was 0.605.ConclusionsMRI allowed to diagnose sacroiliitis in 39,5 % of patients in preradiographic stage. MRI ruled out the presence of active inflammatory lesions in 60.4% of patients with sacroiliitis on radiograms according to modified New York criteria.

SummaryBackgroundThe aim of the paper was to compare radiographs and MRI in assessment of active and chronic inflammatory changes in the sacroiliac joints in patients with chronic back pain and suspected axial spondyloarthritis.Moreover, the aim was to determine which of the two methods is more accurate in diagnosing individual inflammatory changes in the sacroiliac joints and whether there is a correlation between radiographs and MRI in their identification.Material/MethodsThe analysis was conducted in a group of 101 patients, including 61 women and 40 men, referred to radiographs and MR examinations by rheumatologists due to chronic back pain.AP images of the lumbar region of the spine were performed in each patient in the supine position. The images included the sacroiliac joints. Changes in the SIJs were assessed based on the New York criteria of 1966. In MR examination, the SIJs were assessed in terms of the presence of active and chronic inflammatory changes described by the ASAS. The statistical analysis of the variables tested was conducted in the Excel and Statistica systems.ResultsIn relation to the final clinical diagnosis of axSpA, MRI had higher sensitivity and specificity than radiography in diagnosing sacroiliitis (sensitivity: 71% vs. 22%, specificity: 90% vs. 94% on radiographs according to New York criteria. In relation to MRI, radiographs resulted in 40% of incorrect sacroiliitis diagnoses (both false positive and false negative results). In as many as 50% of cases (7/14), MRI failed to confirm the presence of inflammatory changes in the sacroiliac joints observed in radiography according to the modNY criteria (false positive results on radiographs).Both examinations are characterised by very low agreement, which is near to random, in assessing individual features of sacroiliitis, such as sclerosis, change in the joint space width, erosions and ankylosis.Conclusions1. Radiographs do not allow early inflammatory lesions indicating sacroiliitis to be diagnosed, which leads to diagnostic delay. MRI is the method of choice in diagnosing early sacroiliitis and detecting structural lesions, in particular sclerosis and erosions. 2. Radiographs and MRI are characterised by low, near to random, agreement in the detectability of the individual inflammatory changes in the sacroiliac joints.

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