The usefulness of ultrasound in the diagnostics of Sjögren’s syndrome

Abstract

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.

Ultra-high frequency ultrasound (UHFUS) applications in Sjogren syndrome: narrative review and current concepts

“…It may be expected that the application of UHFUS to major SGs investigation may lead to an increase of the overall diagnostic accuracy in patient with pSS, particularly in the early phases. Indeed, the role of SGUS in the early diagnosis of pSS is still controversial (50). Although some authors stated that normal US findings in SGs have been observed in patients suffering from pSS for about 4.2 years (51), a recent study described the role of SGUS in the early diagnosis of pSS considering patients with symptoms duration inferior to 5 years (52).…”

Primary Sjögren's Syndrome

“…To obvykle začíná unilaterálně, později však dojde i k postižení druhostranné slinné žlázy [28]. Při sonografickém zobrazení bývají v slinných žlázách nacházeny typické změny ve smyslu hypoechogenit [31,41]. Rychlé zvětšení slinné žlázy může být předzvěstí vývoje maligního B-lymfomu.…”

A Non-Invasive Method for the Diagnosis of Sjogren's Syndrome with the Evaluation of the Capacity of Salivary Glands

“…(4) Additionally, the following examinations can be done: computed tomography, ultrasound scan, and MRI. (5) The most reliable methods recognized to detect typical changes in the glandular tissue during SS are salivary gland biopsy and sialograph. (6) However, performing a sialography is often impossible in patients with allergic reactions to the iodine medications and in cases of thyroid diseases, as the administration of the iodine-containing contrast agent is required to perform it.…”

“…This is shown on sonograms in the form of hypoechoic areas surrounded by a hyperechoic line or spot, resembling a reticulated image. (5) At the same time, this complex of symptoms can correspond either to the accumulation of the lymphoid cells or to the finefocal lymphomas and can be mistakenly interpreted. (8) The important data about structural changes of PSG and about the presence and distribution of the adipose tissue can be obtained with an MRI.…”