title: Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjögren Syndrome.
abstract: To evaluate the multiobserver reliability of salivary gland ultrasonography (SGUS) for scoring greyscale (GS) parenchymal inhomogeneity and parenchymal color Doppler (CD) signal in patients with established primary Sjögren syndrome (pSS).
  
  
  
  The study comprised 2 multiobserver reliability assessments in patients with pSS in 2 European centers. The first reliability exercise was performed on 24 patients with pSS and 8 controls who were independently evaluated with GS and CD US by 5 observers at the Institute of Rheumatology, Belgrade, Serbia. The second reliability exercise was carried out on 10 patients with pSS who were independently assessed with GS and CD US by 8 observers at the Hospital G.U. Gregorio Marañón, Madrid, Spain. SGUS parenchymal inhomogeneity and parenchymal CD signal were semiquantitatively scored using a 4-grade scoring system. The multiobserver agreement was calculated by the overall agreement and Light's κ statistics.
  
  
  
  A total of 640 SGUS examinations were performed in the first reliability exercise and a total of 320 examinations in the second reliability exercise. Multiobserver reliability was good (κ = 0.71-0.79) to excellent (κ = 0.81-0.82) for GS parenchymal inhomogeneity in both exercises. There was a moderate (κ = 0.53-0.58) to good (κ = 0.70) multiobserver reliability for parenchymal CD signal in the first exercise. However, there was no agreement or only a fair agreement (κ = 0.03-0.29) for parenchymal CD signal in the second exercise.
  
  
  
  US may be a reliable technique in the multiobserver scoring of GS parenchymal inhomogeneity of major SG in patients with established pSS. CD scoring of SG needs further standardization to be used in multicenter studies.
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Nemanja
authors.initials: N
authors.lastname: Damjanov
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón. veramilic@ptt.rs.
authors.forename: Vera
authors.initials: V
authors.lastname: Milic
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto-González
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Iustina
authors.initials: I
authors.lastname: Janta
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Lina
authors.initials: L
authors.lastname: Martínez-Estupiñan
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Belén
authors.initials: B
authors.lastname: Serrano
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mata
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: María
authors.initials: M
authors.lastname: Montoro
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Denisa
authors.initials: D
authors.lastname: Stanciu
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinković-Erić
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: López-Longo
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
authors.affiliation: From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D055771:Serbia; D012859:Sjogren's Syndrome / Q000000981:diagnostic imaging*; D013030:Spain; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
keywords: DOPPLER; SALIVARY GLANDS; SJÖGREN SYNDROME; ULTRASONOGRAPHY