Effectiveness of ultrasonography and shear wave sonoelastography in Sjögren syndrome with salivary gland involvement

Abstract

The purpose of this study was to investigate the effectiveness of major salivary gland ultrasonography (MSGUS) by using new grading system and shear wave elastography (SWE) in evaluating the major salivary glands of patients with Sjögren's Syndrome (SjS). Material and Methods:This prospective designed cross sectional study included 49 SjS patients and 49 healthy controls. Major salivary glands were examined by gray scale ultrasonography and SWE. A new grading system for salivary glands was made by using MSGUS findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MSGUS and shear wave velocity (SWV) values was investigated. Also, MSGUS grading system and SWV values were evaluated together by logistic regression modeling. A cutoff value of SWE for salivary glands was determined. Results:The sensitivity, specificity, PPV, and NPV of MSGUS for submandibular gland were 69.4%, 73.5%, 72.3%, 70.6% and for parotid gland were 69.4%, 65.3%, 66.7%, 68.1%, respectively. The mean SWV values of parotid and submandibular glands were significantly higher in SjS patients than control group (p<0.05). The sensitivity, specificity, PPV, and NPV for submandibular gland (the cutoff value: 1.95 m/s) and for parotid gland (the cutoff value:2.39 m/sn) were 69.4%,52%,59.1%,63% and 82.7%,83.7%,83.5%,82.8%, respectively.Sensitivity and specificity increased when SWE was added to grading system in parotid gland (sensitivity:82.7%, specifity:83.7%). Conclusion:This study demonstrated that the evaluation of the salivary gland by MSGUS with new grading system and SWE may contribute to the diagnosis of SjS. Also the combination of MSGUS and SWE were found a promising tool in diagnosis of SjS.

A Novel Technique for the Evaluation and Interpretation of Elastography in Salivary Gland Involvement in Primary Sjögren Syndrome

“…In our study, we found by elastography stiffer tissue in both parotid and submandibular glands by pixel analysis, the finding was associated significantly with minor glands and low unstimulated whole saliva flow rate; it can translate as chronic damage or its consequences; differing to what Zhang et al found in their study in which the parotid was the most involved gland ( 20 , 21 ).…”

“…Additionally, it accompanies the initial inflammatory and fibrotic process, which is not evaluated adequately since parotid or submandibular biopsies are not recommended ( 22 ). However, fatty tissue is an inflammatory tissue, so detecting initial changes with elastography, especially with pixel analysis leads to early diagnosis of inflammation or fibrosis and fatty infiltrate in the gland; as has been done in other studies in which elasticity index has been used ( 13 , 20 ), but not this novel pixel analysis technique. Our finding suggests a path, possibly related to fatty tissue inflammation, to evaluate early damage, as Skarstein et al ( 22 ) previously showed.…”

Salivary Gland Ultrasound in Primary Sjögren’s Syndrome: Current and Future Perspectives

“…22 Some studies have shown that elastography combined with SGUS may be useful for the diagnosis of pSS. [109][110][111] pSS is associated with inflammation and fibrosis. Thus, patients with pSS can present with increased SG stiffness, mainly because of structural changes of glandular parenchima.…”

“…[113][114][115] Thus far, elastography studies of SGs of pSS patients have been conducted in small cohorts of patients. [111][112][113][114][115] Moreover, there are substantial differences among the three aforementioned modalities to obtain elastography. 108 Therefore, it is not possible to make a final statement about the usefulness of elastography in diagnosing and monitoring pSS.…”

Diagnostic performance of gray‐scale ultrasound and shear wave elastography in assessing salivary gland involvement in patients with primary Sjögren's syndrome

“…Salivary gland US has gained increased attention over the last decade, and some studies have demonstrated that the addition of US increases the performance of the ACR‐EULAR criteria 5,9,10 . The sensitivity and specificity of gray‐scale US studies assessing the salivary gland parenchyma in the literature are 46%–92% and 65%–98%, respectively, with substantial variation between studies 11–14 . However, in the majority of these studies, US is dependent on the user and subjective.…”