Background Ultrasound (US) represents a non-invasive imaging method of the major salivary glands that may serve as a supplement to minor salivary gland biopsy. Minor salivary gland biopsy is part of the diagnostic process for primary Sjögren’s syndrome (pSS), but is not suitable for repeated follow-up.
Objectives To investigate if parotid and submandibular gland ultrasonography findings may contribute to pSS diagnosis and in the assessment of glandular function and disease activity.
Methods Ultrasound of the parotid and submandibular glands was performed with a GE Logiq E9 using a linear transducer with 6-15MHz. The parotid glands were evaluated in a longitudinal and cross-sectional plane and the submandibular glands in a longitudinal plane. Glandular homogeneity and presence of hypoechogenic areas was evaluated and scored (0-3) according to Hocevar et al 2005 (1). Scores 0-1 were considered “normal” and scores 2-3 “pathological”. Salivary gland functional capacity was evaluated by unstimulated and stimulated sialometry of whole saliva, in ml/15 minutes and ml/5 minutes, respectively (n=21). Ultrasound scores were compared to sialometric findings and minor salivary gland focus score where such data was available.
Results Results: Ultrasound was performed in 20 patients, with scores ranging 0-1 (n=10) and 2-3 (n=10). Mean unstimulated and stimulated saliva were 1.1 ml/15 min and 3.3 ml/5 min, respectively, and levels correlated (p<0.001, r=0.726, n=21). Ultrasound scores correlated with unstimulated (p<0.001, r=0.721, n=20) and stimulated saliva (p<0.05, r=0.546, n=20). Mean unstimulated and stimulated saliva levels were higher in patients with normal ultrasound findings compared to pathological (p<0.05). 10/14 patients with unstimulated saliva ≤1.5ml/15 min had pathological ultrasound changes compared to 0/6 with normal unstimulated saliva (p<0.01). 9/12 with stimulated saliva ≤3.5ml/5 min had pathological ultrasound compared to 1/8 with normal stimulated saliva (p<0.01). Focus score was available in 17/21 patients (mean 2.1, range 0-7), and was ≥1 in 14/17 patients. Focus score correlated with ultrasound score (p<0.05, r=0.516, n=16) and mean focus score was 3.3 in patients with ultrasound pathology and 1.2 in patients with normal ultrasound (p<0.05).
Conclusions In a small cohort of patients with pSS findings from non-invasive imaging method ultrasound correlate with glandular function and minor salivary gland inflammation. Ultrasound of major salivary glands may become a useful tool in both diagnostics and follow-up of patients with pSS.
Hocevar A, Ambrozic A, Rozman B, Kveder T, Tomsic M. Ultrasonographic changes of major salivary glands in primary Sjögren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford). 2005 Jun;44(6):768-72.
Disclosure of Interest None Declared
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