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SAT0395 Sonoelastography detects salivary gland dysfunction in patients with primary sjögren’s syndrome
  1. C. Dejaco1,
  2. T. DeZordo2,
  3. D. Heber3,
  4. R. Lipp3,
  5. A. Lutfi4,
  6. M. Magyar4,
  7. D. Zauner1,
  8. W.B. Graninger1,
  9. J. Hermann1
  1. 1Rheumatology, Medical University Graz, Graz
  2. 2Radiology, Medical University Innsbruck, Innsbruck
  3. 3Nuclear Medicine
  4. 4Radiology, Medical University Graz, Graz, Austria


Background Sialoscintigraphy (Szinti) is used to investigate salivary gland function in patients with primary Sjögren’s syndrome (pSS). Real-time sonoelastography (SElasto) indicates tissue rigidity of salivary glands and correlates with an impaired saliva production.

Objectives To investigate the value of SElasto and B-mode sonography to identify pSS patients with dysfunctional salivary glands.

Methods Prospective study on 37 pSS patients fulfilling the American-European consensus group criteria [mean age 59 years; 92% female; median disease duration 3.1 years]. Szinti was conducted according to a routine protocol and semiquantitative scoring was performed (1): each gland was graded into 3= severe dysfunction, 2= moderate dysfunction, 1= mild dysfunction or 0= normal function. B-mode sonography and SElasto of parotid and submandibular glands was performed using a GE Logiq E9 ultrasound device. Parenchymal homogenicity, echogenicity, hypoechogenic areals, hyperechoic reflections and clearness of glandular borders were also semiquantitatively scored (total score 0-48) (2). SElasto was used to examine the elasticity of glandular parenchyma and a semiquantitative rating was performed with 0=no, 1=up to 25%, 2=up to 50%, 3=up to 75% and 4=more than 75% hardened areas within the salivary gland (total score 0-16). Interobserver variability of sonography and Szinti were tested in 30% of pSS patients.

Results The mean Szinti score of pSS patients was 6.0 (±4.3). Loss function of 1,2 or 4 salivary glands was present in 5.3%, 17.5% and 19.3% of patients, respectively. B-mode (corrcoeff 0.65, p<0.001) as well as SElasto scores (corrcoeff 0.39, p=0.02) correlated with the Szinti score. Patients with at least one dysfunctional salivary gland had higher B-mode [median 27.5 (range 10.0-44.0) vs. 12.0 (2.0-6.9) p<0.001] and SElasto scores [median 7.0 (range 3.0-12.0) vs. 6.0 (2.0-7.0) p=0.032] than patients with normal salivary gland function. In ROC curve analysis we found an area under the curve (AUC) of 0.91 (95%CI 0.8-1.0, p<0.001) and 0.73 (0.56-0.89, p=0.03) for B-mode sonography and SElasto, respectively, to detect patients with salivary gland dysfunction.

A good reproducibility of B-mode and SElasto results was found as indicated by an ICC of 0.926 (95%CI 0.565-0.983) and 0.934 (0.787-0.981), respectively. Reproducibility of Szinti results was also good (kappa 0.871).

Conclusions Structural changes and increased rigidity of major salivary glands as demonstrated by B-mode sonography and SElasto, respectively correlates closely withsalivary gland dysfunction in patients with pSS.

  1. Shizukuishi K, Nagaoka S, Kinno Y, Saito M, Takahashi N, Kawamoto M et al. Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome. Ann Nucl Med 2003;17:627-31.

  2. Shizukuishi K, Nagaoka S, Kinno Y, Saito M, Takahashi N, Kawamoto M et al. Ultrasonographic changes of major salivary glands in primary Sjogren’s syndrome. Diagnostic value of a novel scoring system. Rheumatology 2005;44:768-72

Disclosure of Interest None Declared

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