Quantitative ultrasonography and magnetic resonance imaging of the parotid gland: can they replace the histopathologic studies in patients with Sjogren's syndrome?
OBJECTIVE
To assess the diagnostic value of parotid gland quantitative assessment using ultrasound (US) as well as magnetic resonance imaging (MRI) in patients with Sjogren's syndrome (SS) and to evaluate the possibility of using such modalities as a predictor of the histopathologic score of salivary gland biopsy in this group of patients.


METHODS
Sonographic and MRI studies were performed on the parotid glands of 47 patients diagnosed to have primary SS, 20 healthy control subjects of matched sex and age, and 20 subjects with sicca symptoms but without any evidence of SS. The patients and the control subjects were scored according to the structural changes seen in both radiologic modalities. In addition, sialography and labial gland biopsy were done for all patients as well as the control subjects and scored according to the degree of affection.


RESULTS
Parenchymal inhomogenity (PIH) was seen in 93.6% of the patients studied by US, while nodular pattern was seen in 97.8% in the MRI study. The US and MRI results correlated significantly with the histopathologic score of the minor salivary glands (r = 0.82, 0.84, respectively) as well as sialography score (r = 0.69, 0.60, respectively). There was good agreement between US and MRI findings (r = 0.87) in both SS cases and control subjects.


CONCLUSIONS
US and MRI are equally sensitive tools for the diagnosis of salivary involvement in patients with SS. Quantitative assessment of US and MRI images seem to represent an advance in the diagnosis of SS as they offer a good prediction of the pathology score of the salivary gland. MRI seems unnecessary as a routine diagnostic tool and should be considered as the second option in case of normal US.
El Miedany
Yasser M
YM
Rheumatology and Rehabilitation Department, Ain Shams University, 2 Italian Hospital Street, Abbassia, Cairo 11381, Egypt. miedanycrd@yahoo.com
Ahmed
Ihab
I
Mourad
Hassan G
HG
Mehanna
Annie N
AN
Aty
Soheir Abdel
SA
Gamal
Hamed M
HM
El Baddini
Mohammed
M
Smith
Phillip
P
El Gafaary
Maha
M
D000368:Aged; D001706:Biopsy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010306:Parotid Gland / Q000000981:diagnostic imaging* / Q000473:pathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012470:Salivary Glands, Minor / Q000473:pathology; D012680:Sensitivity and Specificity; D012796:Sialography; D012859:Sjogren's Syndrome / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography