Rheumatology Advance Access originally published online on June 19, 2008
Rheumatology 2008 47(8):1244-1249; doi:10.1093/rheumatology/ken222
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Ultrasonography of salivary glands in primary Sjögren's syndrome: a comparison with contrast sialography and scintigraphy
1Department of Rheumatology, 2Department of Radiology, Polytechnic University of the Marche Region, Ancona, 3Rheumatology Unit Sapienza, University of Rome, Rome, 4Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, 5Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova and 6Department of Neuroradiology, Polytechnic University of the Marche Region, Ancona, Italy.
Correspondence to: F. Salaffi, Cattedra di Reumatologia, Università Politecnica delle Marche, Ancona, Ospedale A. Murri, Via dei Colli, 52, 60035 - Jesi (Ancona), Italy. E-mail: fsalaff{at}tin.it
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Abstract |
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Objective. To compare ultrasonography (US) of salivary glands with contrast sialography and scintigraphy, in order to evaluate the diagnostic value of this method in primary SS (pSS).
Methods. The diagnostic value of parotid gland US was studied in 77 patients with pSS (male/female ratio 3/74; mean age 54 yrs) and in 79 with sicca symptoms but without SS. The two groups were matched for sex and age. Imaging findings of US were graded using an ultrasonographic score ranging from 0 to 16, which was obtained by the sum of the scores for each parotid and submandibular gland. The sialographic and scintigraphic patterns were classified in four different stages. The area under receiver operating characteristic curve (AUC-ROC) was employed to evaluate the screening method's performance.
Results. Of the 77 patients with pSS, 66 had abnormal US findings. Mean US score in pSS patients was 9.0 (range from 3 to 16). Subjects without confirmed pSS had the mean US score 3.9 (range from 0 to 9) (P < 0.0001). Results of sialography showed that 59 pSS patients had abnormal findings at Stage 1 (n = 4), Stage 2 (n = 8), Stage 3 (n = 33) or Stage 4 (n = 14), and 58 patients had abnormal scintigraphic findings at Stage 1 (n = 11), Stage 2 (n = 18), Stage 3 (n = 25) or Stage 4 (n = 4). Through ROC curves US arose as the best performer (AUC = 0.863 ± 0.030), followed by sialography (AUC = 0.804 ± 0.035) and by salivary gland scintigraphy (AUC = 0.783 ± 0.037). The difference between AUC-ROC curve of salivary gland US and scintigraphy was significant (P = 0.034). Setting the cut-off score >6 US resulted in the best ratio of sensitivity (75.3%) to specificity (83.5%), with a likelihood ratio of 4.58. If a threshold >8.0 was applied the test gained specificity, at the cost of a serious loss of sensitivity (sensitivity 54.5%, specificity 97.5%, likelihood ratio 21.5).
Conclusions. Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease.
KEY WORDS: Sjögren's syndrome, Salivary glands, Ultrasonography, Sialography, Salivary gland scintigraphy, Diagnosis
Submitted 18 December 2007;
revised version accepted 12 May 2008.
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