title: Real-time sonoelastography of salivary glands for diagnosis and functional assessment of primary Sjögren's syndrome.
abstract: The purpose of this study was to investigate the value of real-time sonoelastography (RTS) of salivary glands for the diagnosis and assessment of glandular damage in primary Sjögren's syndrome (pSS). After institutional review board approval, 45 pSS patients, 24 sicca patients and 11 healthy controls were investigated prospectively. Questionnaires were completed and Saxon and Schirmer tests and routine blood tests carried out in all patients. All patients underwent B-mode ultrasonography and RTS of parotid and submandibular glands. Abnormal findings were graded from 0 to 48 and from 0 to 16, respectively. Sialoscintigraphy was done according to a routine protocol; scoring ranged from 0 to 12. Statistical analysis comprised receiver operating characteristic curve and multivariate regression analysis. Patients with pSS had higher B-mode (median score = 25 [range: 2-44] vs. 9 [1-20], p < 0.001) and RTS (6.5 [2-13] versus 4 [1-9], p < 0.001) scores than controls with sicca syndrome, yielding areas under the curve of 0.83 and 0.85 (p < 0.05 each), respectively for pSS diagnosis. In cases with an inconclusive B-mode ultrasonography result, RTS (cutoff score: ≥ 6) led to a sensitive (66.7%) and specific (85.7%) classification of patients and sicca controls. In multivariate regression analysis, RTS (regression coefficient = -0.48, p = 0.005), but not B-mode ultrasonography, reflected impaired salivary gland function according to the Saxon test, whereas none of the subjective measures of dryness or discomfort were related to ultrasonography results. B-mode and RTS results were both associated with sialoscintigraphy scores (regression coefficient = 0.66, p < 0.001, and regression coefficient = 0.55, p = 0.001, respectively). Reproducibility of B-mode ultrasonography and RTS was good, with intra-class correlation coefficients of 0.93 (95% confidence interval: 0.57-0.98) and 0.93 (95% confidence interval: 0.79-0.98), respectively. In summary, RTS might be a useful adjunct to B-mode ultrasonography for diagnosis and assessment of salivary gland impairment in primary Sjögren's syndrome.
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Dejaco
authors.affiliation: Department of Radiology, Innsbruck Medical University, Innsbruck, Austria. Electronic address: Tobias.De-Zordo@i-med.ac.at.
authors.forename: Tobias
authors.initials: T
authors.lastname: De Zordo
authors.affiliation: Division of Nuclear Medicine, Medical University Graz, Graz, Austria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Heber
authors.affiliation: Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hartung
authors.affiliation: Division of Nuclear Medicine, Medical University Graz, Graz, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Lipp
authors.affiliation: Department of Radiology, Medical University Graz, Graz, Austria.
authors.forename: Andre
authors.initials: A
authors.lastname: Lutfi
authors.affiliation: Department of Radiology, Medical University Graz, Graz, Austria.
authors.forename: Marton
authors.initials: M
authors.lastname: Magyar
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Zauner
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria.
authors.forename: Angelika
authors.initials: A
authors.lastname: Lackner
authors.affiliation: Department of Internal Medicine VI, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Duftner
authors.affiliation: Department of Ophthalmology, Medical University Graz, Graz, Austria.
authors.forename: Jutta
authors.initials: J
authors.lastname: Horwath-Winter
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria.
authors.forename: Winfried B
authors.initials: WB
authors.lastname: Graninger
authors.affiliation: Department of Rheumatology, Medical University Graz, Graz, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Hermann
mesh_terms: D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014987:Xerostomia / Q000000981:diagnostic imaging*
keywords: Elasticity imaging techniques; Sjögren's syndrome; Ultrasonography; Xerophthalmia; Xerostomia