Clinical Study Of Ultrasonic Elastography In Salivary Gland Disease Of Sjogren's Syndrome

Objective: The purpose of this study is to analyze the diagnostic value of virtual touch tissue quantification(VTQ)in salivary gland lesions of patients with Sjogren's syndrome.Methods: There are 90 cases patient from June of 2017 to December of 2017 in the YijiShan Hospital affiliated to wannan Medical College with dry mouth,dry eye or clinically suspected Sjogren 's syndrome(SS).Exclusion criteria: Patients with salivary gland lesions or previous surgery history of salivary gland,salivary gland stones,with previous history of radiotherapy of head and facial salivary gland,acute and chronic inflammation,hepatitis C virus infection,AIDS,lymphoma,sarcoidosis,graft-versus-host disease,and patients with anti-cholinergic drugs.According to the American-European Consensus Group of 2002 SS(diagnostic)standard,all patients were divided into SS group and non SS group.Using SIEMENS S2000 ultrasonic instrument to examine bilateral submandibular gland and parotid gland of all patients with high-frequency ultrasound and ultrasonic elastic imaging.The patients were given comfortable supine position during the examination.The mandible was raised slightly and tilted to the other side during the examination of one salivary gland,The size,shape and internal echo of bilateral glands were observed by two dimensional ultrasound,and the images were saved.Then,analyzed and graded according to a 0-4 ultrasonographic scoring system.When performing ultrasound elastic imaging,the ultrasonic probe is coated with a suitable amount of coupling agent to gently place the skin on the selected salivary gland surface without any external force,avoiding calcification,blood vessels,ducts,lymph nodes,and obvious cystic areas,and after selecting the appropriate section,Ask assistant to turn on the VTQ mode in ARFI(Acoustic Radiation Force Impulse(ARFI).The elastic imaging sampling frame was placed on the upper and lower parts of parotid,and the anterior and posterior of the submandibular gland,The VTQ(shear wave velocity)were measured respectively.The same site measured 5 times and take the average.According to the diagnostic criteria of American-European Consensus Group of SS in 2002,patients were divided into SS group and non-SS group.The data of each group were analyzed by SPSS16 statistical analysis software.Metrological data were expressed by x±s.The SWV of elastic imaging in SS group and non SS group was tasted by paired-samples T Test.Case group analysis between groups using one-way analysis of variance.Analysis between pairing using least-significant different test.With P < 0.05,the different is statistically significant.With P < 0.01,the different is distinct statistically significant.The receiver operating characteristic(ROC)curves of SS patients with two dimensional ultrasound score and SWV were plotted.Result: 1.Characteristics of two-dimensional ultrasonography of salivary gland 1.1 There was no significant difference between different side of parotid gland and submandibular gland(P > 0.05).1.2 There was no significant difference between the score of parotid gland and submandibular gland in SS group(p > 0.05).1.3 There was significant difference in score of salivary as a whole in SS group and non SS group(p < 0.05).1.4 The area under ROC curve(AUC)of salivary gland ultrasound score for parotid gland,submandibular gland and overall salivary gland score was 0.85;0.91;0.91 respectively.2.Virtual touch tissue quantification(VTQ)results 2.1 There was no significant difference in SWV value between salivary gland and salivary gland in SS group(P > 0.05).2.2 There was no significant difference in SWV between the right and left salivary gland in SS group(P > 0.05).2.3.The SWV of parotid gland in SS group was higher than that in submandibular gland,and the difference was statistically significant(p < 0.01).2.4 The SWV value of different parts of bilateral salivary glands in SS group was higher than that in non-SS group,and the difference was statistically significant(P< 0.01).2.5 The SWV value of the whole parotid gland and submandibular gland in SS group was higher than that in the non SS group,and the difference was statistically significant(P< 0.01).2.6 The best threshold for the diagnosis of parotid gland lesions with VTQ technique is 2.29 m/s,the sensitivity is 100%,the specificity is 81%,The Youden index is 0.81 and the maximum area under ROC curve AUC is 0.90.The best threshold for the diagnosis of parotid gland lesions with VTQ technique is 2.03 m/s,the sensitivity is 100,the specificity is 71,The Youden index is 0.71 and the maximum area under ROC curve AUC is 0.83.Conclusion: Salivary gland acinar,ductal epithelial cells develop fatty degeneration,necrosis,lymphocytic infiltration,ductal dilatation,glandular cells replaced by fibrous tissue,finally glandular fibrosis,or even atrophy,The results showed that the salivary gland showed uneven low echo and increased SWV.The quantitative technique of acoustic palpation could accurately reflect the histological changes of salivary gland and provide more and more valuable information for clinical treatment and prognosis.