Ultrasound elastography in assessment of salivary glands involvement in primary Sjögren's syndrome

Cındıl, Emetullah; Oktar, Suna Özhan; Akkan, Koray; Şendur, Halit Nahit; Mercan, Rıdvan; Tufan, Abdurrahman; Öztürk, Mehmet Akif

doi:10.1016/j.clinimag.2018.04.011

Cited by 30 publications

(17 citation statements)

References 26 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, elastography has been used to detect tissue elasticity and glandular fibrosis ( 11 – 13 ); there is scarce information in elderly pSS patients in which MSG US is associated with glandular atrophy ( 14 ). There is no valid scoring system to interpret elastography in MSG, however, a four-grade score has been used, which gives an interpretation related to the main color in the area of interest.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Ultrasound (US) of major salivary glands (MSG) evaluates echogenicity, border features and vascularization, with elastography, it can detect tissue elasticity and glandular fibrosis, related to inflammation in Primary Sjögren’s syndrome (pSS). This study aimed to develop a novel technique by pixel analysis for evaluation and interpretation of elastography in MSG in pSS. A cross-sectional and observational multicenter study was conducted. The US of MSG performed in orthogonal planes in grayscale, Doppler, and shear-wave elastography. For elastography images of each gland were analyzed with the open-source program ImageJ to perform a pixel analysis. Statistical analysis was performed with the IBM-SPSS v25 program. Fifty-nine women with a mean age of 57.69 (23–83) years were recruited; pSS mean duration of 87 (5–275) months, and 12 healthy women without sicca symptoms as a control group with a mean age of 50.67 (42–60) years. Intragroup analysis showed p-values >0.05 between sicca symptoms, ocular/dryness tests, biopsy, US, and pixel analysis; correlation between Hocevar and pixel analysis was not found (rho < 0.1, p >0.5). MSG anatomical size was 41.7 ± 28.2 mm vs. 67.6 ± 8.8 mm (p ≤ 0.0001); unstimulated whole saliva flow rate was 0.80 ± 0.80 ml/5 min vs. 1.85 ± 1.27 ml/5 min (p = 0.016). The elastography values (absolute number of pixels) were 572.38 ± 99.21 vs. 539.69 ± 93.12 (p = 0.290). A cut-off point risk for pSS identified with less than 54% of red pixels in the global MSG mass [OR of 3.8 95% CI (1.01–15.00)]. Pixel analysis is a new tool that could lead to a better understanding of the MSG chronic inflammatory process in pSS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…The role of SGUS in pSS diagnosis is described below (see section ‘The role of SGUS in pSS diagnosis’). Other promising innovations are ultrasound elastography, 66 the application of artificial intelligence to automatically score SGUS, 67 and the major SG biopsy, which is now reserved for cases of suspected SG lymphoma. 68 , 69 Nevertheless, according to Pijpe et al , 70 a surgical major SG biopsy has a diagnostic performance comparable to MSGB in pSS, with 93% sensitivity and 95% specificity, and is repeatable, allowing treatment response evaluation.…”

Section: Established Pssmentioning

confidence: 99%

Sjögren syndrome: looking forward to the future

Callegher

Giovannini

Zenz

et al. 2022

Therapeutic Advances in Musculoskeletal

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Primary Sjögren’s syndrome (pSS) is a heterogeneous disease characterised by a wide spectrum of manifestations that vary according to the different stages of the disease and among different subsets of patients. The aim of this qualitative literature review is to summarise the recent advances that have been reported in pSS, ranging from the early phases to the established disease and its complications. We analysed the diagnostic, prognostic, and management aspects of pSS, with a look into future clinical and research developments. The early phases of pSS, usually antedating diagnosis, allow us to investigate the pathophysiology and risk factors of the overt disease, thus allowing better and timely patient stratification. Salivary gland ultrasound (SGUS) is emerging as a valid complementary, or even alternative, tool for histopathology in the diagnosis of pSS, due to a standardised scoring system with good agreement and performance. Other promising innovations include the application of artificial intelligence to SGUS, ultrasound-guided core needle biopsy, and a wide array of novel diagnostic and prognostic biomarkers. Stratifying pSS patients through the integration of clinical, laboratory, imaging, and histopathological data; differentiating between activity-related and damage-related manifestations; and identifying patients at higher risk of lymphoma development are essential steps for an optimal management and individualised treatment approach. As new treatment options are emerging for both glandular and systemic manifestations, there is a need for a more reliable treatment response evaluation. pSS is a complex and heterogeneous disease, and many distinct aspects should be considered in the different stages of the disease and subsets of patients. In recent years, efforts have been made to improve our understanding of the disease, and certainly in the coming years, some of these novelties will become part of our routine clinical practice, thus improving the management of pSS patients.

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“…Information, such as size, echogenicity, echogenicity margin sharpness, and echotexture, can be obtained from ultrasound scan for more in-depth analysis of the glands (23). Furthermore, shear wave ultrasound elastography provided easy assessment method of parotid and submandibular gland morphology (24, 25). Regarding the echogenicity of the gland tissue in UI image, it can be classified as hypoechoic, isoechoic, and hyperechoic by comparing with a reference which could be the nearby muscle outside the radiation field.…”

Section: Assessing Xerostomia For Post-radiotherapy Patientsmentioning

confidence: 99%

A Review on the Assessment of Radiation Induced Salivary Gland Damage After Radiotherapy

Leung

2019

Front. Oncol.

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Head and neck cancers are common in Southern China including Hong Kong. Intensity modulated radiotherapy has been the treatment of choice for these patients. Although radiotherapy provides good local control, radiotherapy treatment side-effects are still inevitable due to close proximity of the organs at risk from the target volume. Xerostomia, which is caused due to the damage of salivary glands, is one of the main radiation induced toxicities in post-radiotherapy head and neck patients. This review article discusses the methods for the assessing of radiation induced salivary gland changes including the gland morphology and saliva flow rate. The discussion also includes the recovery of the salivary gland after radiotherapy and how it is affected by the dose. It is expected that the future direction in monitoring the recovery of salivary glands will focus in cellular or molecular levels, and the development of imaging biomarker.

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Ultrasound elastography in assessment of salivary glands involvement in primary Sjögren's syndrome

Cited by 30 publications

References 26 publications

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

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

Sjögren syndrome: looking forward to the future

A Review on the Assessment of Radiation Induced Salivary Gland Damage After Radiotherapy

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