| Objective:To evaluate the value of shear wave elastography(SWE)and(SGUS)scoring system in the diagnosis of salivary glands lesions in patients with Sj(?)gren’s syndrome(SS)and to compare the diagnostic efficiency of the two methods.Method:From June 2019 to November 2020,58 patients with suspected SS were selected from the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University.According to the 2002 American-European Consensus Group(AECG)classification standard,the enrolled patients were divided into two groups: SS group(47cases)who aged among 19 to 75 years and whose mean age was(51.13±14.69);non-SS group(11 cases)who aged among 38 to 76 years and whose mean age was(55.36±12.30).According to symptom duration,SS group was divided into the ≤5 years group(29 cases)and the > 5 years group(18 cases).Meanwhile,40 healthy volunteers were enrolled in this study as normal control group who aged among 25 to 67 years and whose age was(42.23±11.92).Patients with a history of previous head and neck radiation treatment,hepatitis C infection,graft versus host disease,sarcoidosis,acute or chronic inflammation of parotid or submandibular gland,space occupying lesions of parotid or submandibular gland,metabolic diseases(such as diabetes)or lymphoma,and current use of anticholinergic or other drugs that might affect salivary gland function were excluded from the study.The morphology and hardness of bilateral parotid glands and submandibular glands were examined by Aix Plorer real-time shear wave elastic diagnostic instrument produced by France Supersonic Image company.The examination method is in accordance with the user’s manual and previous studies: all study participants were scanned in a supine position with their necks hyperextended.In the first,the transverse and longitudinal B-mode ultrasound images of the parotid and submandibular glands were acquired.The 0-16 scoring systems was employed to assess the echo structure of each gland.The grades for each of the four salivary glands were summed,then color Doppler mode was switched to observe the blood flow of the parotid and submandibular glands,and finally it was converted to SWE mode.The probe was gently placed on the surface of the tested site without pressure.After avoiding the main blood vessels,the SWE sampling frame was placed in the middle of the parotid gland and submandibular gland parenchyma.And it was measured when the color filling in the SWE sampling frame was complete and stable for 3 seconds and the Q-Box diameter was taken as 3mm.The mean Young’s modulus of bilateral parotid gland and submandibular gland was measured and recorded,and the average value was measured for three consecutive times.The differences of SGUS scores and SWE Young’s modulus among the groups were compared,and the receiver operating characteristic(ROC)curve was drawn to analyze the efficiency of parotid gland,submandibular gland Young’s modulus and SGUS scores in the diagnosis of salivary gland lesions in SS.Results:1.Comparison of SGUS scores in the SS group,non-SS group and healthy control group: The SGUS scores of the SS group,non-SS group and healthy control group were(7.81±3.06)points,(5.64±2.01)points,(6.15±2.37)points,respectively.The SGUS scores of SS group were significantly higher than those of non-SS group and control group,and the difference was statistically significant(P<0.05).2.Comparison of Young’s modulus of salivary glands in SS group,non-SS group and healthy control group: The mean Young’s modulus of the SS left,right parotid and submandibular gland were(11.95 ±2.30)k Pa,(11.62 ±2.52)k Pa,(12.16 ±1.97)k Pa,(12.20 ±2.05)k Pa,respectively.The mean Young’s modulus of the non-SS left,right parotid and submandibular gland were(8.95±2.29)k Pa,(8.98±3.15)k Pa,(10.73±2.82)k Pa,(9.86±2.60)k Pa,respectively.The mean Young’s modulus of the healthy volunteers left,right parotid and submandibular gland were(9.18±1.85)k Pa,(8.77±2.56)k Pa,(9.14±1.70)k Pa,(8.99±2.13)k Pa,respectively.There was no significant difference in Young’s modulus between left and right parotid gland and submandibular gland in the SS group,non-SS group and healthy control group(P>0.05).The Young’s modulus of parotid gland and submandibular gland in SS group was higher than that in non-SS group and healthy control group,and the difference was statistically significant(P<0.05).3.The diagnostic value of SGUS scoring system and SWE in different courses of SS salivary gland lesions: There were no significant differences in SGUS scores,parotid and submandibular gland Young’s modulus between the ≤5 years group and the >5years group(P>0.05).4.ROC curves of parotid gland,submandibular gland Young’s modulus and SGUS scoring system for the diagnosis of SS: Taking 10.2 k Pa as the cut-off value,the sensitivity of SS diagnosis in the parotid gland was 77.7% by using SWE imaging,the specificity was 78.4% and the area under the curve was 0.801.Taking 10.4 k Pa as the cut-off value,the sensitivity of SS diagnosis in the submandibular gland was 80.9% by using SWE imaging,the specificity was 78.4% and the area under the curve was 0.829.By using SGUS scoring system,the sensitivity of SS diagnosis in the salivary gland was70.2%,the specificity was 67.4%,and the area under the curve was 0.676 when the cut-off value was >6.The areas under the curve of parotid gland Young’s modulus and submandibular gland Young’s modulus were higher than those of ultrasound score.There was no significant difference in the area under the curve of the Young’s modulus between the parotid and submandibular glands(P>0.05);and the comparison of the area under the curve between the Young’s modulus of the parotid and submandibular glands and the ultrasound score was statistically significant(P<0.05).Conclusions:1.SGUS scoring system can objectively evaluate the morphology and structure of glands by semi-quantitative parameter,and SWE can quantitatively analyze the hardness of salivary glands in patients with SS by measuring Young’s modulus.The two imaging methods can provide important reference information for the diagnosis of salivary gland lesions in SS from different perspectives.2.The diagnostic efficiency of SWE for salivary glands lesions in patients with SS is better than that of SGUS scoring system. |
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