Diagnostic Value Of Salivary Gland Ultrasonography Scoring System And Elastography In Sjogren’s Syndrome

Objectives:1.To assess the diagnostic utility of ultrasonography in Sj?gren’s Syndrome(SS)by observing the ultrasonographic features of salivary glands in patients with SS.2.To assess the diagnostic utility of acoustic radiation force impulse(ARFI)imaging in SS by measuring the elasticity of salivary gland hardness in SS patients.Methods:We study 155 patients with suspected SS who were seen at the rheumatology outpatient clinic or inpatient,76 of them were divided to the SS group and the others non-SS group.Examine the bilateral parotid and submandibular gland of all patients with ultrasonography,then obtain the ultrasonographic features of bilateral salivary glands.The imaging features of salivary glands were evaluated by a new semi-quantitative scoring system.Then we performed the Acoustic Radiation Force Impulse(ARFI)imaging to both sides of their parotid glands and submandibular glands to get the shear wave velocity(SWV)value.We compared the differences of ultrasonography scores and SWV between in SS group and the non-SS group,then analysed the usefulness of salivary gland ultrasonography and ARFI imaging in diagnosis of SS.Results:1.Salivary gland ultrasonic manifestations of 64 patients(64/79,84.2%)in non-SS group were normal whose ultrasonography scores were 0,whereas salivary gland ultrasonography abnormalities were found 64 of 76(84.2%)in SS group,whose ultrasonography scores were≥1.SS group had higher ultrasonography scores than non-SS group(p <0.001).2.The area under the ROC curve of ultrasound scores was 0.883(95% confidence interval was 0.826 and 0.940,respectively).When the cut-off value of the scores was 2,the sensitivity,specificity,and accuracy were 73.7%,94.9%,84.5%,respectively.3.There was no significant difference in SWV value between both sides of parotid gland or submandibular gland in SS group and non SS group(p >0.05).Different groups of bilateral parotid gland or salivary gland were statistically significant differences in SWV values(p<0.05).4.The area under the ROC curve of ARFI imaging for the submandibular glands was 0.859(95% confidence interval was 0.767 and 0.950 respectively).When the cut-off value of the SWV was 2.14m/s,the sensitivity and specificity were 76.3% and 84.6%.The area under the ROC curve of ARFI imaging for the parotid glandswas 0.843(95% confidence interval was 0.741 and 0.945,respectively).When the cut-off value of the SWV was 1.98m/s,the sensitivity and specificity were 84.2% and 84.6%.The diagnostic efficiency value of ARFI imaging for the salivary glands were: the best cut-off value was 2.11m/s,sensitivity was 81.6%,specificity was 88.5%,accuracy was 85.2%,and Area under the ROC curve was 0.890,respectively.5.The diagnostic values of ultrasonography combined with ARFI imaging were: sensitivity 95.2%,specificity 84.0% and accuracy 89.0%.Conclusion:The salivary gland ultrasonography scoring can provide a semi-quantitative parameter for the inhomogeneity of the salivary glands,which has high specificity in the diagnoisis of SS.The ARFI imaging can provide the SWV value of salivary glands to quantify the elasticity of salivary glands in SS,the hardness of parotid gland and submandibular gland of SS patients was higher than that of non SS patients,which has great value in the diagnosis of SS.The diagnostic value of conventional ultrasonography combined with ARFI imaging in the diagnosis of SS is equivalent to that of single imaging.