Reliability of ultrasonography and sialography in the diagnosis of sjögren's syndrome

doi:10.1016/S1079-2104(97)90249-3

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 83, Issue 3, March 1997, Pages 400-407

https://doi.org/10.1016/S1079-2104(97)90249-3 Get rights and content

Abstract

Objectives. The purpose of this study was to evaluate quantitatively observer performance with ultrasonography and sialography in the diagnosis of parotid gland involvement of Sjögren's syndrome.

Study design. Sixty-four parotid gland sialograms and 65 ultrasonograms were prepared for observer performance experiments. They included both modalities in 24 Sjögren's syndrome and 19 nonspecific parotitis cases, 21 normal parotid gland sialograms, and 22 normal ultrasonograms in healthy volunteers. The images were randomly sequenced and presented to five observers who were asked to describe several findings and finally to determine the imaging diagnosis by ranking the abnormal features and the diagnosis on a five-point-rating scale. Observer performance was evaluated on the basis of the reliability of findings interpreted and the diagnostic accuracy of each modality from observers' rating scores.

Results. The diagnostic accuracy of sialography was very high, nearly perfect. The diagnostic accuracy of ultrasonography was lower than that of sialography; resulting from the lower incidence of characteristic findings in the disease groups and lower sensitivity on ultrasonography. In the differentiation of Sjögren's syndrome from the normal, however, the diagnostic accuracy of ultrasonography increased to 80% for all cases, and up to nearly 90% in the advanced sialographic stages.

Conclusion. Ultrasonography is useful for the diagnosis of Sjögren's syndrome in the advanced stages. Taking the noninvasiveness of this technique into account, we recommend first applying ultrasonography to the diagnosis of Sjögren's syndrome and performing sialography when no positive findings are detected on ultrasonography.

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Ag₂O–Ag-porous silicon Bragg mirror (PSB) composite SERS substrates were successfully synthesized by using a combination of electrochemical and thermochemical methods. Test results showed that the SERS signal increased and decreased as the annealing temperature used for the substrate increased, where the most intense SERS signal was obtained using a substrate annealed at 300 °C. Stability test results showed substantial enhancement of the SERS signal intensity of the Ag₂O-Ag-PSB composite one month after preparation compared with that of conventional Ag-PSB. We conclude that Ag₂O nanoshells play an essential role in SERS signal enhancement. Ag₂O prevents natural oxidation of Ag nanoparticles (AgNPs) and has a solid localized surface plasmon resonance (LSPR). SERS signal enhancement was tested using this substrate for serum from patients with Sjögren's syndrome (SS) and Diabetic nephropathy (DN), as well as from healthy controls (HC). SERS feature extraction was performed using principal component analysis (PCA). The extracted features were analyzed by a support vector machine (SVM) algorithm. Finally, a rapid screening model for SS and HC, as well as DN and HC, was developed and used to perform controlled experiments. The results showed that the diagnostic accuracy, sensitivity and selectivity for SERS technology combined with machine learning algorithms reached 90.7%, 93.4% and 86.7% for SS/HC and 89.3%, 95.6% and 80% for DN/HC, respectively. The results of this study show that the composite substrate has excellent potential to be developed into a commercially available SERS chip for medical testing.
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L’échographie des glandes salivaires va devenir un outil presque incontournable dans le diagnostic et le suivi des patients porteurs d’un syndrome de Gougerot-Sjögren primitif (SSp). En effet, de récents articles montrent son utilité de part son caractère non invasif dans le dépistage de patients porteurs de syndrome sec et susceptible de développer une maladie auto-immune telle que le SSp. Un de ces principaux atouts est aussi de pouvoir suivre de manière simple l’évolution naturelle et sous traitement de ces patients.
Ultrasound of the salivary glands will become an almost indispensable tool in the diagnosis and monitoring of patients with Sjögren's syndrome. Indeed, recent articles demonstrate its usefulness due to its noninvasive nature in screening dry syndrome patients and autoimmune likely to develop diseases such as Sjögren's syndrome. One of its main advantages is also to be able to follow simple natural evolution and in treating these patients.
Ultrasonography of salivary gland: A pictorial review
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Finally, gland atrophy and fibrosis supervene. Persons with Sjögren's syndrome are at significantly increased risk of lymphoma development [12] (Figs. 5 and 6). Sarcoidosis involves the parotid glands in 6% of cases and may be associated with uveitis and facial paralysis (Heerfordt's disease).
Ultrasound has been introduced into the medical field around 1940s, since than it has been widely used. It has been found many adherents in the fields of ophthalmology and obstetrics and gynecology. It has proved invaluable in cardiology and abdominal diseases. In recent years, the role of ultrasonography in the head and neck has expanded dramatically. It is used in establishing differential diagnosis of cystic neck masses, solid masses and lymphadenopathies. It not only serves for the differentiation between benign and malignant lymphadenopathy and also between intraglandular and extraglandular abnormalities of the salivary glands, with 90–95% accuracy.
A comparison of diagnostic tools for Sjögren syndrome, with emphasis on sialography, histopathology, and ultrasonography
2010, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
The present study examined the reliability and correlation of sialography, salivary gland biopsy, and ultrasonography for Sjögren syndrome (SS) and evaluated the usefulness of ultrasonography as a diagnostic tool for SS compared with sialography and histopathology.
Seventy-three patients who underwent sialography, ultrasonography, and salivary gland biopsy were included in this study. The study evaluated the diagnostic reliability and correlation of each kind of examination with SS.
There was a statistically significant difference in the sensitivities of sialography and histopathology, in the specificities of sialography and ultrasonography, and in the accuracies of sialography and both ultrasonography and histopathology. The correlation coefficient (r) between sialography and ultrasonography was significantly higher than the others and indicated a good correlation.
Ultrasonography can be used as a diagnostic tool for SS, with its advantage of noninvasiveness and ease of use.
A Quantitative Analysis of Sonographic Images of the Salivary Gland: A Comparison Between Sonographic and Sialographic Findings
2009, Ultrasound in Medicine and Biology
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A quite high incidence of the category ± (probably present) demonstrated this interpretation to sometimes be difficult. These results were closely similar to the results of a previous study (Yoshiura et al. 1997). The qualitative findings (presence of HA, presence of EL) of the PGs were thus found to be useful predictors according to a univariable analysis.
We performed three quantitative analyses (particle analysis, fractional Brownian motion [fBM] model analysis, two-dimensional [2-D] fractal analysis) of the ultrasonographic (US) images of the salivary gland and evaluated whether the obtained indices correlated with the sialographic stage of Rubin-Holt. Our study included 192 patients suspected of having Sjögren's syndrome (SS). In 89 patients, sialography demonstrated abnormal findings. Based on a particle analysis, we calculated both the average size of the particles (avg-area) and the area ratio to evaluate the presence of hypoechoic areas and echogenic lines, which are characteristic of SS. According to the fBM model, we calculated the Hurst index of the original image (Hurst-ori) and the background-subtracted image (Hurst-bs) to evaluate the complexity of the pixel value distribution. We also obtained the 2-D fractal dimension (2-D-FD) to evaluate the complexity of the contour lines. We entered these indices of the parotid glands (PG) into a logistic regression analysis and evaluated which indices were useful predictors for detecting an abnormal sialographic stage. Significant differences were observed between the normal and abnormal groups in all five indices of the PG (Mann-Whitney U test) and all five indices were correlated with the Rubin-Holt stage (Spearman's Rank Correlation Test). As the Rubin-Holt stage became more severe, both the Hurst-ori and 2-D-FD became smaller. Alternatively, the Hurst-bs, avg-area, and area ratio became higher. Three indices (avg-area, area ratio and Hurst-ori) were selected as useful predictors for detecting abnormal sialographic stages. This quantitative analysis system is therefore considered to have potentially useful clinical applications for the detection of abnormal sialographic findings. (Email: [email protected])
Sonographic diagnosis of Sjögren syndrome: evaluation of parotid gland vascularity as a diagnostic tool
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To evaluate the usefulness of the vascularity in parotid glands in sonographic diagnosis for Sjögren syndrome.
Sonographic images of 72 cases of previously suspected Sjögren syndrome (including 43 actual cases) were analyzed retrospectively for the abnormal vascularity in the parotid gland parenchyma. The relationships between the vascularity and the results of sialographic, serologic, and histopathologic examinations were analyzed. We also compared the diagnostic accuracy of B-mode only with that of B-mode plus Doppler-mode.
Sjögren-positive cases showed significantly higher vascularity. As the grade of vascularity became higher, the rate of the Sjögren-negative cases became lower. The highest mean vascular score could be observed both in the initial stage and in the cavitary-destructive stage in the sialographic grades. Sensitivity and accuracy were markedly improved with vascular information.
By using vascular information, sonographic diagnosis for Sjögren syndrome can be improved.

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Reliability of ultrasonography and sialography in the diagnosis of sjögren's syndrome

Abstract

Clin Radiol

Secretory sialography in disease of major salivary gland

Am J Roentogen

Sialographic study of diseases of the major salivary gland

Acta Radiol

Manifestations of parotid gland enlargement: radiographic, pathologic, and clinical correlations. part 1: the autoimmune pseudosialectasias

Radiology

Annual report of the Ministry of Health and Welfare: Sjögren's Disease Research Committee

Texture analysis of sonographic features of the parotid gland in Sjögren's syndrome

AJR

Ultrasonography and computer tomography of the salivary glands in the evaluation of Sjögren's syndrome: comparison with parotid sialography

J Rheumatol

Salivary gland echography in patients with Sjögren's syndrome

Arthritis Rheum

Sjögren's syndrome: comparison of sialography and ultrasonography

J Clin Ultrasound