The Role of Real-Time Tissue Elastography and Gray-Scale Ultrasound Histogram Analysis in the Diagnosis of Patients With Sjögren’s Syndrome

Abstract

Objectives: This study aims to evaluate gray-scale histogram analysis of B-mode ultrasound (US) images and US elastographic features of the parotid glands in patients with Sjögren's syndrome (SS) and to explore relationships with the ultrasonographic and disease activity scores in the light of histopathological findings. Patients and methods: A total of 57 consecutive female patients (mean age 47.9±10.4 years; range 25 to 76 years) with a diagnosis of SS and 48 healthy female individuals (mean age 51.1±10.8 years; range 20 to 70 years) underwent parotid ultrasonography and real-time tissue elastography imaging. Quantitative measurements of gray-scale US images were performed using the histogram software of the scanner. The histogram ratios of the parotid glands from both sides were obtained (histogram ratio; mean gray-scale histogram parotid/mean gray-scale histogram fat). Strain ratio (SR; ratio of fat to gland parenchyma) was calculated from the color-coded images. Subjective B-mode US scoring of electronically recorded grayscale US images was performed by two radiologists independently for intra-and inter-observer agreement. Subjective assessments, quantitative measurements, and clinical parameters were compared. Results: The SR of the patient group (1.4±0.8 right side, 1.5±0.9 left side) was significantly higher than that of the control group (1.0±0.3 right side, 1.1±0.3 left side) (p<0.05). The gray-scale histogram ratio of the patient group (1.3±0.5 right side, 1.4±0.9 left side) was lower than that of the control group (1.8±0.7 right side, 1.9±0.7 left side) (p<0.05). Receiver-operating-characteristics curve yielded 66% sensitivity for both sides and 50% and 52% specificity for the right and left sides, respectively, for a cut-off SR of 1.02; 76% and 86% sensitivity for the right and left sides, respectively, and 63% specificity for both sides for a cut-off histogram ratio of 1.35. The quantitative histogram ratio method had a higher positivity rate for the diagnosis of abnormal parotid glands than subjective assessments of US images. Conclusion: Sonoelastography and gray-scale histogram analysis of the parotid glands may be used as auxiliary tools to detect parotid gland sonographic abnormalities in patients with SS.

Value of Histogram of Gray-Scale Ultrasound Image in Differential Diagnosis of Small Triple Negative Breast Invasive Ductal Carcinoma and Fibroadenoma

“…Gray-scale histogram analysis of US images is a more objective method, 39 which can quantitatively provide echogenicity information of lesions according to the echo intensity level in the gray range of 0 to 255. 16 , 39 , 40 Thus, some subjective or operator-dependent features in conventional US evaluation can be effectively eliminated. 39 , 40 To date, many literatures have reported that gray-scale ultrasound histogram is helpful to evaluate different lesions.…”

“… 16 , 39 , 40 Thus, some subjective or operator-dependent features in conventional US evaluation can be effectively eliminated. 39 , 40 To date, many literatures have reported that gray-scale ultrasound histogram is helpful to evaluate different lesions. 11 , 15 , 16 , 39–41 For example, Kwon et al 16 proposed that grey-scale US was an easily applicable and standard imaging modality used to evaluate thyroid nodules, and some grey-scale histogram parameters could be helpful for the discrimination between the subtypes of follicular variant of papillary thyroid carcinoma (FVPTC).…”

Evaluation of the Achilles Tendon Using B‐Mode Ultrasound and Strain Elastography in Patients With Chronic Kidney Disease

“…Another limitation of our study was that although we used the Kager fat pad as a reference tissue, we do not have clear information about the effects of CKD on the Kager fat pad. Nevertheless, we picked fat tissue as a reference because it was considered relatively constant, similar to several past studies using fat tissue as a reference, including those with Achilles tendons as well as other subjects, including breast and parotid studies 6,21 . The use of external reference material could have excluded this limitation, as used by some investigators in their past studies 22,23 .…”

Narrative review of multiparametric ultrasound in parotid gland evaluation

“…In addition to the traditional and high-resolution US evaluation (36)(37)(38), recently quantitative evaluation of parotid gland echogenicity by means of grey-scale histogram measurements (ROI) was also reported. The gland histogram ratio (mean grey-scale histogram parotid/ mean grey-scale histogram subcutaneous fat) on healthy subjects and patients with parotid abnormalities can be also determined (39)(40)(41).…”