title: Is salivary gland ultrasonography a useful tool in Sjögren's syndrome? A systematic review.
abstract: OBJECTIVE
  Ultrasonography (US) is a sensitive tool in the diagnosis of major salivary gland abnormalities in primary Sjögren's syndrome (pSS). The aim of this systematic review was to assess the metric properties of this technique.
  
  
  METHODS
  PUBMED and EMBASE databases were searched. All publications between January 1988 and January 2013 were considered. Data were extracted from the articles meeting the inclusion criteria according to US definition of salivary gland scoring system and metric properties studied. The type and number of glands tested, study design and metric properties according to OMERACT filter (truth, discrimination, feasibility) were assessed.
  
  
  RESULTS
  Of 167 publications identified initially with PUBMED and EMBASE, 31 met the inclusion criteria. The number of pSS patients varied among the studies from 16 to 140. The diagnosis of pSS was in line in most of the cases with the American-European Consensus Group (AECG) classification criteria for Sjögren's syndrome. The US examination was performed in suspected pSS only in studies in which the sensitivity ranged from 45.8 to 91.6% and specificity from 73 to 98.1%. There was heterogeneity in regard to the definition of US in B-mode and few studies used US in colour Doppler. Few studies reported reliability of US and sensitivity to change in pSS.
  
  
  CONCLUSIONS
  US is a valuable tool for detecting salivary gland abnormalities in pSS. Its reliability has been poorly investigated and there is considerable variation in the definition of US abnormalities. Further studies are required to validate and standardize the US definition of salivary gland in pSS.
authors.affiliation: Department of Rheumatology, La Cavale Blanche University Hospital, Department of Rheumatology-ERI 29, Brittany University, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.affiliation: Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Vera
authors.initials: V
authors.lastname: Milic
authors.affiliation: Department of Clinical Dentistry, Section for Oral and Maxillofacial Radiology, University of Bergen, Bergen, Norway.
authors.forename: Malin V
authors.initials: MV
authors.lastname: Jonsson
authors.affiliation: Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece.
authors.forename: Athena
authors.initials: A
authors.lastname: Plagou
authors.affiliation: Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Elke
authors.initials: E
authors.lastname: Theander
authors.affiliation: Department of Diagnostic and Interventional Radiology.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Luciano
authors.affiliation: Department of Diagnostic and Interventional Radiology.
authors.forename: Pascale
authors.initials: P
authors.lastname: Rachele
authors.affiliation: Rheumatology Unit, University of Pisa, Pisa, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Baldini
authors.affiliation: Department of Rheumatology and Clinical Immunology.
authors.forename: Hendrika
authors.initials: H
authors.lastname: Bootsma
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: Vissink
authors.affiliation: Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Alojzija
authors.initials: A
authors.lastname: Hocevar
authors.affiliation: Rheumatology Clinic, DSMB, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: De Vita
authors.affiliation: Department of Pathophysiology, School of Medicine, National University of Athens, Athens, Greece.
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Tzioufas
authors.affiliation: INSERM, CIC 1412, Brest Medical University Hospital, Brest, France and.
authors.forename: Zarin
authors.initials: Z
authors.lastname: Alavi
authors.affiliation: New Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Bowman
authors.affiliation: Department of Rheumatology, La Cavale Blanche University Hospital, Department of Rheumatology-ERI 29, Brittany University, Brest, France, valerie.devauchelle-pensec@chu-brest.fr.
authors.forename: Valerie
authors.initials: V
authors.lastname: Devauchelle-Pensec
mesh_terms: D006801:Humans; D015203:Reproducibility of Results; D012107:Research Design; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D012859:Sjogren's Syndrome / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: primary Sjögren’s syndrome; reliability; reproducibility; salivary gland; ultrasonography; validity