title: Semi-quantitative analysis of salivary gland scintigraphy in Sjögren's syndrome diagnosis: a first-line tool.
abstract: OBJECTIVE
  The aim of this study was the assessment of semi-quantified salivary gland dynamic scintigraphy (SGdS) parameters independently and in an integrated way in order to predict primary Sjögren's syndrome (pSS).
  
  
  METHODS
  Forty-six consecutive patients (41 females; age 61 ± 11 years) with sicca syndrome were studied by SGdS after injection of 200 MBq of pertechnetate. In sixteen patients, pSS was diagnosed, according to American-European Consensus Group criteria (AECGc). Semi-quantitative parameters (uptake (UP) and excretion fraction (EF)) were obtained for each gland. ROC curves were used to determine the best cut-off value. The area under the curve (AUC) was used to estimate the accuracy of each semi-quantitative analysis. To assess the correlation between scintigraphic results and disease severity, semi-quantitative parameters were plotted versus Sjögren's syndrome disease activity index (ESSDAI). A nomogram was built to perform an integrated evaluation of all the scintigraphic semi-quantitative data.
  
  
  RESULTS
  Both UP and EF of salivary glands were significantly lower in pSS patients compared to those in non-pSS (p < 0.001). ROC curve showed significantly large AUC for both the parameters (p < 0.05). Parotid UP and submandibular EF, assessed by univariated and multivariate logistic regression, showed a significant and independent correlation with pSS diagnosis (p value <0.05). No correlation was found between SGdS semi-quantitative parameters and ESSDAI. The proposed nomogram accuracy was 87%.
  
  
  CONCLUSIONS
  SGdS is an accurate and reproducible tool for the diagnosis of pSS. ESSDAI was not shown to be correlated with SGdS data.
  
  
  CONCLUSIONS
  SGdS should be the first-line imaging technique in patients with suspected pSS.
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Angusti
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pilati
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Parente
authors.affiliation: Medical Division, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Carignola
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Manfredi
authors.affiliation: Service of Nuclear Medicine, Institute for Cancer Research and Treatment, Candiolo, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Cauda
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Pizzigati
authors.affiliation: Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France.|Equipe Mixte de Recherche 3738, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Dubreuil
authors.affiliation: Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France.|Equipe Mixte de Recherche 3738, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Giammarile
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Podio
authors.affiliation: Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy. askanjeti@gmail.com.|Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France. askanjeti@gmail.com.|Equipe Mixte de Recherche 3738, Université Claude Bernard Lyon 1, Lyon, France. askanjeti@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Skanjeti
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012469:Salivary Glands / Q000000981:diagnostic imaging*; D012859:Sjogren's Syndrome / Q000000981:diagnostic imaging*; D013670:Sodium Pertechnetate Tc 99m
chemical_list: D019275:Radiopharmaceuticals; D013670:Sodium Pertechnetate Tc 99m
keywords: Differential diagnosis; Quantitative analysis; Salivary gland dynamic scintigraphy; Sicca syndrome; Sjögren’s syndrome