Ultrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy

Ultrasonography of salivary glands in primary Sjogren's syndrome: a comparison with contrast sialography and scintigraphy Author(s): Salaffi, F (Salaffi, F.)1; Carotti, M (Carotti, M.)2; Iagnocco, A (Iagnocco, A.)3; Luccioli, F (Luccioli, F.)4; Ramonda, R (Ramonda, R.)5; Sabatini, E (Sabatini, E.)3; De Nicola, M (De Nicola, M.)6; Maggi, M (Maggi, M.)6; Priori, R (Priori, R.)3; Valesini, G (Valesini, G.)3; Gerli, R (Gerli, R.)4; Punzi, L (Punzi, L.)5; Giuseppetti, GM (Giuseppetti, G. M.)2; Salvolini, U (Salvolini, U.)6; Grassi, W (Grassi, W.)1 Source: RHEUMATOLOGY Volume: 47 Issue: 8 Pages: 1244-1249 DOI: 0.1093/rheumatology/ken222 Published: AUG 2008 Times Cited: 10 (from Web of Science) Cited References: 40 [ view related records ] Citation Map Abstract: 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 methods 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. Accession Number: WOS:000257787200026 Document Type: Article Language: English Author Keywords: Sjogren's syndrome; salivary glands; ultrasonography; sialography; salivary gland scintigraphy; diagnosis KeyWords Plus: COLOR DOPPLER SONOGRAPHY; PAROTID SIALOGRAPHY; CLASSIFICATION CRITERIA; DIAGNOSTIC-CRITERIA; SICCA SYNDROME; BIOPSY; ECHOGRAPHY Reprint Address: Salaffi, F (reprint author), Univ Politecn Marche, Cattedra Reumatol, Via Colli 52, Ancona, Italy Addresses: 1. Polytechn Univ Marche Reg, Dept Rheumatol, Ancona, Italy 2. Polytechn Univ Marche Reg, Dept Radiol, Ancona, Italy 3. Univ Rome, Rheumatol Unit Sapienza, Rome, Italy 4. Univ Perugia, Dept Clin & Expt Med, Rheumatol Unit, I-06100 Perugia, Italy 5. Univ Padua, Dept Clin & Expt Med, Rheumatol Unit, Padua, Italy 6. Polytechn Univ Marche Reg, Dept Neuroradiol, Ancona, Italy E-mail Address: fsalaff@tin.it Publisher: OXFORD UNIV PRESS, GREAT CLARENDON ST, OXFORD OX2 6DP, ENGLAND Web of Science Category: Rheumatology Subject Area: Rheumatology IDS Number: 328GU ISSN: 1462-0324