1
|
Liu J, Xia G, Dai Z, Wang R, Feng Z, Ma G, Zeng L, He X. Accuracy of two-dimensional transverse wave elastography of salivary glands in diagnosis of Sjögren's disease: a systematic review and meta-analysis. BMJ Open 2024; 14:e081015. [PMID: 39153789 PMCID: PMC11331836 DOI: 10.1136/bmjopen-2023-081015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 07/16/2024] [Indexed: 08/19/2024] Open
Abstract
OBJECTIVES Two-dimensional shear wave elastography (2D-SWE) is a non-invasive technique for the evaluation of Sjögren's disease (SjD). This study investigated the diagnostic accuracy of 2D-SWE in assessing major salivary gland involvement in SjD. DESIGN A systematic review and meta-analysis. DATA SOURCES Data were obtained by searching PubMed, MEDLINE, EMBASE, Scopus, Cochrane library and CNKI from 1999 to 26 September 2022, which includes randomised clinical trial of 2D-SWE for the diagnosis of SjD. ELIGIBILITY CRITERIA (1) Patients (≥18 years old) diagnosed with SjD following the international classification in 2002 or 2016 American College of Rheumatology-European League Against Rheumatism classification criteria for SjD; (2) The purpose of this study was to evaluate the diagnostic value of 2D-SWE in SjD; (3) The evaluation parameters for the diagnosis of SjD can be extracted or indirectly obtained in this article, including sensitivity, specificity, true positive, false positive, false negative, true negative, diagnostic point (Young's modulus) and other data. DATA EXTRACTION AND SYNTHESIS Four authors independently screened and assessed the literature and extracted the data. RevMan V.5.3 and StataMP V.18 software were used for quality assessment and meta-analysis. RESULTS We included 8 studies with a total of 912 cases, including 509 patients with SjD. The high-risk bias in the quality evaluation focused on patient selection and index test. The pooled sensitivity, specificity and summary area under the curve of 2D-SWE were 0.75 (95% CI 0.62 to 0.84), 0.89 (95% CI 0.80 to 0.94) and 0.90 (95% CI 0.87 to 0.92), respectively. CONCLUSIONS 2D-SWE has an acceptable diagnostic accuracy for SjD patients and is an effective tool for auxiliary diagnosis of SjD. PROSPERO REGISTRATION NUMBER CRD42022365766.
Collapse
Affiliation(s)
- Jie Liu
- Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Guangsha Xia
- Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhaoqiu Dai
- Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Ruirui Wang
- Department of Rheumatology and Immunology, Nanjing General Hospital of Nanjing Military Command, Nanjing, Jiangsu, China
| | - Zhe Feng
- Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Guquan Ma
- Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Liang Zeng
- Department of Imaging, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xiaojin He
- Department of Rheumatology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| |
Collapse
|
2
|
Kise Y, Møystad A, Kuwada C, Ariji E, Bjørnland T. Does ultrasound elastography have a role as a diagnostic method for Sjögren's syndrome in the salivary glands? A systematic review. Oral Radiol 2024; 40:329-341. [PMID: 38308723 DOI: 10.1007/s11282-024-00740-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE This systematic review was performed to examine the usefulness of salivary gland ultrasound elastography (USE) as a diagnostic tool for Sjögren's syndrome (SjS). METHODS Electronic databases (MEDLINE, EMBASE, the Cochrane Library, and Web of Science: Science Citation Index) were searched to identify studies using USE to diagnose SjS from database inception to 15 July 2022. The primary outcome was improved diagnostic accuracy for SjS with the use of USE. Risk of bias and applicability concerns were assessed using the GRADE system, which is continuously developed by the GRADE Working Group. RESULTS Among 4550 screened studies, 24 full-text articles describing the applications of USE to diagnose SjS were reviewed. The overall risk of bias was determined to be low for 17 of the 24 articles, medium for 5, and high for 2. Articles comparing patients with SjS and healthy subjects reported high diagnostic accuracy of USE, with most results showed statistically significant differences (parotid glands: 15 of the 16 articles, submandibular glands: 11 of the 14 articles). CONCLUSIONS This systematic review suggests that the assessment of salivary glands using USE is a useful diagnostic tool for SjS.
Collapse
Affiliation(s)
- Yoshitaka Kise
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-Ku, Nagoya, 464-8651, Japan.
| | - Anne Møystad
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Chiaki Kuwada
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-Ku, Nagoya, 464-8651, Japan
| | - Eiichiro Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi Gakuin University, 2-11 Suemori-dori, Chikusa-Ku, Nagoya, 464-8651, Japan
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| |
Collapse
|
3
|
Pillai S, Munguia-Lopez JG, Tran SD. Bioengineered Salivary Gland Microtissues─A Review of 3D Cellular Models and their Applications. ACS APPLIED BIO MATERIALS 2024; 7:2620-2636. [PMID: 38591955 DOI: 10.1021/acsabm.4c00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Salivary glands (SGs) play a vital role in maintaining oral health through the production and release of saliva. Injury to SGs can lead to gland hypofunction and a decrease in saliva secretion manifesting as xerostomia. While symptomatic treatments for xerostomia exist, effective permanent solutions are still lacking, emphasizing the need for innovative approaches. Significant progress has been made in the field of three-dimensional (3D) SG bioengineering for applications in gland regeneration. This has been achieved through a major focus on cell culture techniques, including soluble cues and biomaterial components of the 3D niche. Cells derived from both adult and embryonic SGs have highlighted key in vitro characteristics of SG 3D models. While still in its first decade of exploration, SG spheroids and organoids have so far served as crucial tools to study SG pathophysiology. This review, based on a literature search over the past decade, covers the importance of SG cell types in the realm of their isolation, sourcing, and culture conditions that modulate the 3D microenvironment. We discuss different biomaterials employed for SG culture and the current advances made in bioengineering SG models using them. The success of these 3D cellular models are further evaluated in the context of their applications in organ transplantation and in vitro disease modeling.
Collapse
Affiliation(s)
- Sangeeth Pillai
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dental Medicine and Oral Health Sciences, McGill University, 3640 Rue University, Montreal, QC H3A 0C7, Canada
| | - Jose G Munguia-Lopez
- Department of Mining and Materials Engineering, McGill University, 3610 University Street, Montreal, QC H3A 0C5, Canada
| | - Simon D Tran
- McGill Craniofacial Tissue Engineering and Stem Cells Laboratory, Faculty of Dental Medicine and Oral Health Sciences, McGill University, 3640 Rue University, Montreal, QC H3A 0C7, Canada
| |
Collapse
|
4
|
Dai X, Sui X, Chen S, Zhao B, Liu Z, Wang X. The diagnostic performance of salivary gland ultrasound elastography in Sjögren's syndrome and sicca symptoms: a systematic review and meta-analysis. Eur Radiol 2024; 34:1545-1555. [PMID: 37658892 DOI: 10.1007/s00330-023-10166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To systematically evaluate the diagnostic performance of ultrasound elastography (USE) in distinguishing primary Sjögren's syndrome (pSS) from healthy/disease controls. METHODS We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for published literature on USE for diagnosing pSS. Bivariate random effects models were used to calculate the pooled sensitivity and specificity of USE. To determine the factors influencing heterogeneity, meta-regression and subgroup analyses were performed to assess country, diagnostic criteria, imaging mechanisms, shear wave elastography techniques, measurement location, control group category, and patient age. Publication bias was assessed using the asymmetry of the Deeks funnel plot. RESULTS Fifteen articles covering 816 patients and 735 control participants were included. USE showed a pooled sensitivity of 0.80 (95% CI: 0.71-0.87) and specificity of 0.87 (95% CI: 0.78-0.92). Meta-regression and subgroup analyses revealed that shear wave elastography techniques, measurement location, and patient age were significant factors that affected study heterogeneity (p < 0.05). Elastography performs better in diagnosing patients aged ≤ 51 years compared to patients aged > 51 years. There was no significant publication bias. CONCLUSION USE demonstrates high accuracy in differentiating between pSS and healthy/disease control groups. CLINICAL RELEVANCE STATEMENT Ultrasound elastography, as a non-invasive and cost-effective technique, can be used to distinguish primary Sjögren's syndrome from disease/healthy control groups by measuring the stiffness of salivary glands. KEY POINTS • Ultrasound elastography is an acceptable technique for the diagnosis of primary Sjögren's syndrome. • The pooled sensitivity and specificity of ultrasound elastography for diagnosing primary Sjögren's syndrome were 0.80 and 0.87, respectively. • In patients aged ≤ 51 years with primary Sjögren's syndrome, ultrasound elastography showed good diagnostic performance.
Collapse
Affiliation(s)
- Xinpeng Dai
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Xin Sui
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China.
| | - Simei Chen
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Bingxin Zhao
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Zongjie Liu
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Xiaoyan Wang
- Department of Ultrasound, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, China
| |
Collapse
|
5
|
Özer H, Yılmaz S, Bozkurt B, Tezcan D, Yazol M, Hakbilen S, Topaloğlu ÖF, Durmaz MS. Assessment of lacrimal gland involvement in primary Sjögren's syndrome using gray-scale ultrasonography and shear wave elastography. Eur Radiol 2023; 33:9368-9377. [PMID: 37474658 DOI: 10.1007/s00330-023-09943-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/30/2023] [Accepted: 05/16/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The aim of this study was to assess lacrimal gland involvement in primary Sjögren's syndrome (pSS) using lacrimal gland gray-scale ultrasound (LGUS) and two-dimensional shear wave elastography (2D-SWE). METHODS Eighty-five pSS patients with a mean age of 51.16 ± 10.61 years and 84 sex- and age-matched healthy subjects with a mean age of 50.94 ± 11.05 years were included in the study. Lacrimal gland parenchymal findings and 2D-SWE values were compared between the two groups and the correlations of LGUS parameters with clinical findings, dry eye tests, and minor salivary gland biopsy (MSGB) were further investigated. RESULTS LGUS parenchymal grade was 0 in 14 (16.5%), 1 in 45 (52.9%), 2 in 23 (27.1%), and 3 in 3 patients (3.5%) in the pSS group, while in the control group, parenchymal grades were 0 (57.1%) and 1 (42.9%). The mean 2D-SWE value of pSS patients was significantly higher than the control group (p < 0.05) and increased parallel with lacrimal parenchymal grade. The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in pSS patients (AUC 0.901, sensitivity 70.6%, specificity 97.6%), while the diagnostic performance of LGUS was much lower (AUC 0.769, sensitivity 83.5%, specificity 57.1%). LGUS and 2D-SWE values were found to be correlated with dry eye tests and MSGB results (p < 0.05). CONCLUSIONS LGUS and 2D-SWE are both useful for assessing the lacrimal gland involvement in pSS patients; however, 2D-SWE has a better diagnostic performance than LGUS and found to be correlated with dry eye tests. CLINICAL RELEVANCE STATEMENT Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are imaging modalities that can be used to demonstrate parenchymal involvement of the lacrimal gland in primary Sjögren's syndrome (pSS). KEY POINTS • Gray-scale US and two-dimensional shear wave elastography (2D-SWE) have been widely used in the recent decade to assess gland involvement in patients with primary Sjögren's syndrome (pSS). • The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in primary Sjögren's syndrome (pSS) patients. • Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are both useful for assessing the lacrimal gland in primary Sjögren's syndrome (pSS) patients; however, two-dimensional shear wave elastography (2D-SWE) has a better diagnostic performance than lacrimal gland ultrasound (LGUS).
Collapse
Affiliation(s)
- Halil Özer
- Department of Radiology, Faculty of Medicine, Selçuk University, Konya, 42131, Turkey.
| | - Sema Yılmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Banu Bozkurt
- Department of Ophthalmology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Dilek Tezcan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Merve Yazol
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Selda Hakbilen
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Ömer Faruk Topaloğlu
- Department of Radiology, Faculty of Medicine, Selçuk University, Konya, 42131, Turkey
| | - Mehmet Sedat Durmaz
- Department of Radiology, Faculty of Medicine, Selçuk University, Konya, 42131, Turkey
| |
Collapse
|
6
|
Ike RW, McCoy SS, Kalunian KC. What Bedside Skills Could the Modern Rheumatologist Possess? Part II. "Certain Technical Procedures". J Clin Rheumatol 2023:00124743-990000000-00172. [PMID: 37983677 DOI: 10.1097/rhu.0000000000002022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT Rheumatologists have never been reluctant to adopt procedures that might enhance their diagnostic or therapeutic powers. Their propensity to penetrate the joints of the patients they were treating set them apart from the general internist. Since the 1980s, when a chance to look inside the joints they were treating attracted a few rheumatologists, other things that could be done at the bedside emerged with now an array of bedside procedures that could be part of a rheumatologist's skill set. Besides gains in diagnosis and/or therapy, each constitutes a chance to restore the physical contact between physician and patient, riven by factors of the last decade, such as electronic medical records and COVID. With such contact so important to satisfaction of the patient and physician alike, acquisition of proficiency in certain technical procedures described herein offers one path to begin restoring rheumatology to the richly fulfilling practice it once was.
Collapse
Affiliation(s)
- Robert W Ike
- From the Department of Internal Medicine, Division of Rheumatology, University of Michigan Health System, Ann Arbor, MI
| | - Sara S McCoy
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison, Madison, WI
| | - Kenneth C Kalunian
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of California at San Diego, San Diego, CA
| |
Collapse
|
7
|
Kayadibi Y, Deger E, Kurt SA, Ucar AK, Adaletli I, Ozturk T, Kocael CP, Velidedeoglu M, Icten GE. The Diagnostic Role of Shear Wave Elastography and Superb Microvascular Imaging in the Evaluation of Suspicious Microcalcifications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2295-2306. [PMID: 37146224 DOI: 10.1002/jum.16252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the role of superb microvascular imaging (SMI) and shear wave elastography (SWE) in the prediction of malignancy and invasiveness of isolated microcalcifications (MC) that can be visualized by ultrasonography (US). MATERIAL AND METHODS Sixty-seven women with MC, who were considered suspicious on mammography were evaluated. Only those lesions that could be visualized by US and presented as non-mass lesion were included. They were evaluated by B-mode US, SMI, and SWE before US-guided core-needle biopsy. B-mode US, SMI (vascular index (SMIvi)), and SWE (E-mean, E-ratio) findings were compared with histopathologic features. RESULTS Pathology confirmed 45 malignant (21 invasive and 24 in situ carcinomas) and 22 benign lesions. There was a statistically significant difference between malignant and benign groups in terms of size (P = .015), distortion (P = .028), cystic component (P < .001), E-mean (P < .001), E-ratio (P < .001), and SMIvi (P = .006). For differentiation of invasiveness E-mean (P = .002), E-ratio (P = .002), and SMIvi (P = .030) were statistically significant. According to ROC analysis E-mean (cut-off point at 38 kPa) was the most sensitive (78%) and the most specific (95%) value among four numeric parameters (size, SMI, E-mean, and E-ratio) with AUC = 0.895, PPV = 97%, and NPV = 68% in detecting malignancy. In the evaluation of invasiveness, the most sensitive (71.4%) method was SMI (cut-off point at 3.4) and the most specific (72%) method was E-mean (cut-off point at 91.5 kPa). CONCLUSION Our study shows that adding SWE and SMI to the sonographic evaluation of MC would be an advantage for US-guided biopsy. Including suspicious areas according to SMI and SWE in the sampling area can help target the invasive part of the lesion and avoid underestimation of core biopsy.
Collapse
Affiliation(s)
- Yasemin Kayadibi
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Enes Deger
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Seda Aladag Kurt
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ayse Kalyoncu Ucar
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim Adaletli
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Tulin Ozturk
- Cerrahpasa Medical Faculty, Department of Pathology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Pinar Kocael
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| |
Collapse
|
8
|
Fulvio G, Izzetti R, Aringhieri G, Donati V, Ferro F, Gabbriellini G, Mosca M, Baldini C. UHFUS: A Valuable Tool in Evaluating Exocrine Gland Abnormalities in Sjögren's Disease. Diagnostics (Basel) 2023; 13:2771. [PMID: 37685309 PMCID: PMC10486364 DOI: 10.3390/diagnostics13172771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Sjögren's Disease (SjD) is a chronic autoimmune disorder that affects the salivary and lacrimal glands, leading to xerostomia and xerophthalmia. Ultrasonography of Major Salivary Glands (SGUS) is a well-established tool for the identification of the salivary glands' abnormalities in SjD. Recently, a growing interest has arisen in the assessment of the other exocrine glands with ultrasonography: lacrimal glands (LGUS) and labial salivary glands (LSGUS). The objective of this study is to explore the practical applications of ultra-high frequency ultrasound (UHFUS) in the assessment of lacrimal glands and labial salivary glands. Indeed, UHFUS, with its improved spatial resolution compared to conventional ultrasonography, allows for the evaluation of microscopic structures and has been successfully applied in various medical fields. In lacrimal glands, conventional high-frequency ultrasound (HFUS) can detect characteristic inflammatory changes, atrophic alterations, blood flow patterns, and neoplastic lesions associated with SjD. However, sometimes it is challenging to identify lacrimal glands characteristics, thus making UHFUS a promising tool. Regarding labial salivary glands, limited research is available with conventional HFUS, but UHFUS proves to be a good tool to evaluate glandular inhomogeneity and to guide labial salivary glands biopsy. The comprehensive understanding of organ involvement facilitated by UHFUS may significantly improve the management of SjD patients.
Collapse
Affiliation(s)
- Giovanni Fulvio
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Clinical and Translational Science, University of Pisa, 56126 Pisa, Italy
| | - Rossana Izzetti
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giacomo Aringhieri
- Academic Radiology, Department of Clinical and Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Valentina Donati
- Unit of Pathological Anatomy 2, Department of Laboratory Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Giovanna Gabbriellini
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Baldini
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
9
|
Park Y, Oh M, Lee YS, Kim WU. Salivary ultrasonography and histopathologic evaluation of secondary Sjögren's syndrome in rheumatoid arthritis patients. Sci Rep 2023; 13:11339. [PMID: 37443200 PMCID: PMC10344871 DOI: 10.1038/s41598-023-38469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/08/2023] [Indexed: 07/15/2023] Open
Abstract
Novel modalities, such as salivary ultrasonography (SGUS) and shear wave elastography (SWE), have previously been introduced to evaluate Sjögren's syndrome (SS). However, in secondary SS (sSS), the diagnostic performance of SGUS and its relationship with clinicopathological characteristics have not yet been clearly defined. In this study, we aimed to investigate sSS in RA patients using SGUS and SWE and sought to determine its pathological correlations. Thirty-one RA patients who presented with sicca symptoms were included to be evaluated on SS, and were compared with 18 primary SS (pSS) patients. All subjects were assessed through SGUS, SWE, and conventional diagnostic approaches for SS, including minor salivary gland biopsy (MSGB). In SGUS evaluation, two separate scoring systems, suggested by Hocevar and OMERACT, were used. Among 31 RA patients with sicca symptoms, 19 (61.2%) were diagnosed as sSS. Similar to pSS, SGUS showed good diagnostic performance (sensitivity 68.4% and 78.9%, and specificity 91.7% and 75.0% for Hocever and OMERACT, respectively) in differentiating sSS from RA patients with simple sicca symptoms. The sSS and pSS patients exhibited significantly higher lymphoid infiltration areas in MSGB than RA patients without SS. Focus score and lymphoid infiltration areas correlated well with sonographic severity. Severity of fibrosis in MSGB showed better positive correlation with SWE than with SGUS. Similar to pSS, SGUS shows good diagnostic performance for sSS in RA patients. SWE reflects histopathologic chronicity of MSGB well in both pSS and sSS.
Collapse
Affiliation(s)
- Youngjae Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minae Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youn Soo Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Wan-Uk Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Center for Integrative Rheumatoid Transcriptomics and Dynamics, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
10
|
Karadeniz H, Cerit M, Güler AA, Salman RB, Satış H, Yıldırım D, Göker B, Küçük H, Öztürk MA, Tufan A. Lacrimal gland ultrasonography and elastography as a diagnostic and activity tool for primary Sjögren's syndrome. Int J Rheum Dis 2023. [PMID: 37137730 DOI: 10.1111/1756-185x.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To investigate the effectiveness of 2-dimensional shear wave elastography (2D-SWE) in the assessment of lacrimal gland involvement in primary Sjögren's syndrome (pSS) and to determine the association between ultrasonographic findings and clinical activity measures. METHOD Forty-six patients who fulfilled the 2016 American College of Rheumatology/European League Against Rheumatism (EULAR) classification criteria of pSS and 23 age and gender-matched healthy control subjects were enrolled. Clinical, laboratory and labial biopsy histopathologic characteristics of patients were recorded. Disease activity of pSS and severity of ocular dryness were evaluated with EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Ocular Surface Disease Index (OSDI), respectively. Parotid and lacrimal gland architectures were assessed by B-mode ultrasound and 2D-SWE techniques. RESULTS Mean shear wave elastography measurements, reflecting loss of elasticity, were remarkably higher in pSS patients compared to healthy subjects both in the lacrimal and parotid glands (8.99 ± 3.45 vs 3.68 ± 1.76 in lacrimal glands and 14.14 ± 4.39 vs 7.83 ± 1.69 in parotid glands, all P < 0.001). Shear wave elasticity of lacrimal glands was correlated with OSDI and ESSPRI scores (r = 0.69; P = 0.001 and r = 0.58; P = 0.001, respectively). A cut-off value of 4.6 kPa in the lacrimal gland elasticity discriminated pSS patients from healthy subjects with a sensitivity of 94% and specificity of 87%. CONCLUSION Results of our study suggest that lacrimal glands lose elasticity in patients with pSS and the assessment of elasticity with 2D-SWE might help to classify patients as having pSS. Further studies are needed to validate the diagnostic utility of lacrimal 2D-SWE by including diseases other than pSS.
Collapse
Affiliation(s)
- Hazan Karadeniz
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mahinur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | | | - Hasan Satış
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Derya Yıldırım
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hamit Küçük
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
11
|
Chang C, Wang H. Ultrasound shear wave elastography for patients with sialolithiasis undergoing interventional sialendoscopy. Laryngoscope Investig Otolaryngol 2023; 8:76-81. [PMID: 36846401 PMCID: PMC9948575 DOI: 10.1002/lio2.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Ultrasound shear wave elastography is an objective tool to evaluate the stiffness of human tissues. Patients with sialolithiasis could be treated by interventional sialendoscopy with a high success rate. Sialolithiasis could be extracted, and the diseased gland could be preserved and evaluated after treatment. Whether ultrasound shear wave elastography could be used for objective outcome measurement and short-term follow-up of the parenchyma of gland in patients with sialolithiasis remains unclear. Methods This retrospective self-controlled study was conducted. Patients with sialolithiasis treated by interventional sialendoscopy and followed by high-resolution ultrasound shear wave elastography were selected between January and September 2017. Results Seventeen patients with sialolithiasis (mean age: 39.63 ± 12.49 years), including 10 women and 7 men, were enrolled. Fifteen patients had sialolithiasis in the submandibular gland and two in the parotid gland. The preoperative value of shear wave velocity was significantly higher in the diseased gland than in the contralateral normal gland (p < .001; 95% confidence interval [CI], 0.3915-0.6046). After successful treatment by interventional sialendoscopy surgery, the shear wave velocity of the diseased gland decreased significantly (p = 0.001; 95% CI, -0.38792 to -0.20474). However, there was a significant difference between the diseased and contralateral normal glands (p = 0.001; 95% CI, 0.0423-0.2895) after 1.55 months of surgery. Conclusion Ultrasound shear wave elastography could be an adjuvant tool to distinguish sialolithiasis-affected diseased glands from contralateral normal glands and assess the short-term treatment outcome objectively. The changing trend of shear wave velocity could help monitor the healing process of the parenchyma in the diseased gland after treatment. Level of Evidence 4.
Collapse
Affiliation(s)
- Chia‐Fan Chang
- Department of Otolaryngology‐Head and Neck SurgeryTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Hsin‐Kai Wang
- Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
- Department of Medical Imaging and Radiological TechnologyYuanpei University of Medical TechnologyHsinchuTaiwan
| |
Collapse
|
12
|
Özer H, Tezcan D, Hakbilen S, Gülcemal S, Topaloğlu ÖF, Yazol M, Yılmaz S. Diagnostic performance of gray-scale ultrasound and shear wave elastography in assessing salivary gland involvement in patients with primary Sjögren's syndrome. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:187-194. [PMID: 36285880 DOI: 10.1002/jcu.23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate the diagnostic performance of gray-scale ultrasound (US) and shear wave elastography (SWE) for determining salivary gland involvement primary Sjögren's syndrome (pSS). METHODS In this prospective study, the salivary glands of 72 healthy volunteers and 74 participants with pSS were examined by two blinded radiologists with consensus using gray-scale US and SWE. SWE parameters were compared between groups. The area under the curve (AUC), sensitivity, and specificity of gray-scale US and SWE was analyzed. The correlation between SWE and clinical findings was investigated. RESULT The SWE parameters of the parotid and submandibular glands were significantly higher in the pSS group, but did not differ significantly based on serologic assays, Schirmer test, minor salivary gland biopsy, and comorbidities. The AUC values for gray-scale US of the salivary glands were significantly lower than the AUC values for SWE. The elasticity modulus (kPa) of parotid gland had the highest AUC value (0.937; 95% CI, 0.901-0.973), with a sensitivity of 93.2% and a specificity of 83.3%. SWE had no correlation with age, disease duration, laboratory values, or disease activity. CONCLUSION SWE provides excellent diagnostic performance for submandibular and parotid gland involvement in pSS and can be used to complement gray-scale US.
Collapse
Affiliation(s)
- Halil Özer
- Department of Radiology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Dilek Tezcan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Selda Hakbilen
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Semral Gülcemal
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | | | - Merve Yazol
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sema Yılmaz
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Selçuk University, Konya, Turkey
| |
Collapse
|
13
|
Shear wave elastography as a potential additional diagnostic tool in primary Sjögren's syndrome: an observational study. Rheumatol Int 2022; 42:1579-1587. [PMID: 35507104 DOI: 10.1007/s00296-022-05120-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
The primary aim of this study was to verify if shear wave elastography can be used to evaluate salivary gland involvement in primary Sjögren's syndrome (pSS). The secondary objective was to establish an accurate cut-off value for parotid and submandibular salivary gland stiffness and to verify whether there are any distinctions among pSS patients with or without subjective mouth dryness. This prospective study included 45 patients with pSS (2016 ACR/EULAR classification criteria) and 108 healthy controls. All subjects underwent bilateral shear wave elastography of the parotid and submandibular salivary glands. Clinical data of pSS patients were collected and compared to elastography results. Patients with pSS had significantly higher shear wave elastography values for the parotid and submandibular salivary glands than the controls. There were no statistical differences in SWE values between patients with or without mouth dryness. The optimal cut-off value (mean value of 4 salivary glands shear wave elastography results) to distinguish patients with or without pSS was 13.19 kPa with sensitivity = 97.8% and specificity = 100.0%. It was, therefore, confirmed that shear wave elastography measurement of salivary glands has strong predictive ability in pSS detection (AUC 97.8%, 95% CI 93.4-100.0%). Shear wave elastography seems to be a promising, non-invasive and simple quantitative adjunct test to support the diagnosis of pSS with good sensitivity and specificity. More extensive prospective studies are needed to standardize a study protocol.
Collapse
|
14
|
Kayadibi Y, Bulut IN, Aladag Kurt S, Erginöz E, Ozturk T, Velidedeoglu M, Taskin F, Esen Icten G. The Role of Superb Microvascular Imaging and Shearwave Elastography in the Evaluation of Intraductal Papilloma-Like Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:995-1008. [PMID: 34862641 DOI: 10.1002/jum.15907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the role of quantitative values obtained by superb microvascular imaging (SMI) and shearwave elastography (SWE) in the prediction of malignancy in intraductal papilloma-like lesions (IDPL). METHODS In the study, 61 patients between the ages of 14 to 73 years (mean age 44) diagnosed with IDPL on ultrasound (US) examination between the years 2020 and 2021 were included. The B-Mode US findings (shape, margins, size, echo pattern, and accompanying ductal dilatation), SMI vascular index (SMIvi), E-mean, and SWE-ratio values were recorded. RESULTS There was a statistically significant difference between malignant (n = 14) and benign (n = 47) groups in terms of symptoms (P = .005), size (P = .042), shape (P = .002), margins (P = .001), echogenicity (P = .023), microcalcifications (P = .009), SMIvi (P = .031), E-mean (P < .005), and SWE-ratio (P = .007). According to receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, accuracy, area under the curve (AUC), positive predictive values (PPV), and negative predictive values (NPV) were 57.1%, 87.2%, 80%, 0.722, 57.1%, 87.2% for US; 71.4%, 49%, 55.7%, 0.692, 30.3%, 85.7% for SMIvi; 85.7%, 71%, 74%, 0.864, 46%, 94.3% for E-mean, and 50%, 75.4%, 83%, 0.707, 91.5%, and 50% for SWE-ratio, respectively. Best results were obtained when SMI and SWE values were used together, achieving a sensitivity, specificity, accuracy, AUC, PPD, NPD of 78.6%, 93.6%, 93.4%, 0.872, 91.7%, and 93.9%, respectively. CONCLUSIONS The SMI and SWE examinations are successful in the differentiation of benign and malignant intraductal lesions. They complement each other and contribute to B-mode US in managing IDPLs especially when used together. Our study is the first to compare the quantitative data of SWE and SMI in the differentiation of IDPLs.
Collapse
Affiliation(s)
- Yasemin Kayadibi
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Iclal Nur Bulut
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Seda Aladag Kurt
- Department of Radiology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ergin Erginöz
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Tulin Ozturk
- Department of Pathology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fusun Taskin
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Gul Esen Icten
- Senology Research Institute, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| |
Collapse
|
15
|
Elsholtz FHJ, Reiter R, Marticorena Garcia SR, Braun J, Sack I, Hamm B, Schaafs LA. Multifrequency magnetic resonance elastography-based tomoelastography of the parotid glands-feasibility and reference values. Dentomaxillofac Radiol 2022; 51:20210337. [PMID: 34558305 PMCID: PMC8693321 DOI: 10.1259/dmfr.20210337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Accurate radiological differentiation of parotid tumors remains challenging despite recent technical advances in quantitative medical imaging. Multifrequency magnetic resonance elastography (MRE) could provide additional information on viscoelastic properties of normal and abnormal biological tissues. This study investigates the feasibility of MRE of the parotid glands in healthy participants and provides first reference values. METHODS 20 healthy participants underwent multifrequency MRE of both parotid glands at 3 Tesla. Shear waves at frequencies of 25, 30, 40, and 50 Hz were introduced into the participants' heads through the occiput using pressurized-air actuators. Shear wave speed (SWS) and loss angle of the shear modulus (φ) were reconstructed by tomoelastography post-processing as surrogate parameters for tissue stiffness and viscosity or fluidity. 10 participants underwent repeated MRE to determine test-retest reliability based on intraclass correlation coefficients. RESULTS All MRE datasets acquired could be included in the analysis. Mean SWS was 0.97 ± 0.13 m/s, and mean φ was 0.59 ± 0.05 rad, each for both sides combined and without notable lateral difference (p = 0.88/0.87). Test-retest reliability was good for SWS (ICC = 0.84 for both sides/ICC = 0.77 for the right side/ICC = 0.79 for the left side) and good to excellent for φ(ICC = 0.94/0.86/0.90). CONCLUSIONS Multifrequency MRE of the parotid glands is feasible and reliable. This technique, therefore, is a promising method for investigating the viscoelastic properties of salivary gland tumors in future studies.
Collapse
Affiliation(s)
- Fabian Henry Jürgen Elsholtz
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | - Stephan Rodrigo Marticorena Garcia
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Jürgen Braun
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Campus Charité Mitte, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Berlin, Germany
| |
Collapse
|
16
|
Kayadibi Y, Ucar N, Kaya MF, Yildirim E, Bektas S. Characterization of Suspicious Microcalcifications on Mammography Using 2D Shear-Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2532-2542. [PMID: 34127332 DOI: 10.1016/j.ultrasmedbio.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
Our aim was to investigate the correlations between the findings of two-dimensional shear-wave elastography (2D-SWE) and the histopathologic results of microcalcifications (MCs) visualized using ultrasonography (USG). Fifty people with suspicious MCs without accompanying mass were evaluated. They underwent USG and 2D-SWE before USG-guided tru-cut biopsy. SWE values and histopathologic features were compared statistically. The variables between groups were analyzed using the Mann-Whitney U test. Receiver operating characteristic analysis was performed and cut-off values determined to discriminate malignancy, invasiveness and high grade. Pathology confirmed 27 malignant lesions (18 invasive ductal carcinomas, one invasive lobular and eight ductal carcinomas in situ) and 23 benign ones. There was a statistically significant difference between the SWE values of malignant and benign MCs (p < 0.001). The diagnostic performance of SWE for malignancy, invasiveness and high grade were as follows, repectively: sensitivity (93%, 83%, 88%), specificity (91%, 88%, 53%), positive predictive value (93%, 94%, 44%), negative predictive value (91%, 70%, 90%) and area under the curve (0.952, 0.885, 0.776). Cut-off values were determined as 57 kPa for malignancy, 124 kPa for invasiveness and 124.5 kPa for high grade. In conclusion, SWE is a useful method in clinical practice for characterizing MCs that can be visualized with USG.
Collapse
Affiliation(s)
- Yasemin Kayadibi
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul Universitesi-Cerrahpasa, Kocamustafapasa, Istanbul, Turkey.
| | - Nese Ucar
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Mehmet Fatih Kaya
- Department of Radiology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Emine Yildirim
- Department of General Surgery, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| | - Sibel Bektas
- Department of Pathology, Gaziosmanspasa Education and Research Hospital, Gaziosmanpasa, Istanbul, Turkey
| |
Collapse
|
17
|
Mo YQ, Hao SY, Li QH, Liang JJ, Luo Y, Lan YQ, Zhong JL, Wang JW, Zhang XP, Huang WK, Dai L. Ultrasonography predicts the results of labial salivary gland biopsy in patients with suspected Sjögren's syndrome: a matrix risk model. Ther Adv Musculoskelet Dis 2021; 13:1759720X211010592. [PMID: 33995602 PMCID: PMC8071977 DOI: 10.1177/1759720x211010592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Although a positive result of labial salivary gland biopsy (LSGB) is critical for the diagnosis of Sjögren’s syndrome, rheumatologists prefer assessing the non-invasive objective items and hope to learn the predicted probability of positive LSGB before referring patients with suspected Sjögren’s syndrome to receive biopsy. This study aimed to explore the predictive value of combined B-mode ultrasonography (US) and shear-wave elastography (SWE) examination on LSGB results. Methods: A derivation cohort and later a validation cohort of patients with suspected Sjögren’s syndrome were recruited. All participants received clinical assessments, B-mode US and SWE examination on bilateral parotid and submandibular glands before LSGB. Positive LSGB was defined by a focus score ⩾1 per 4 mm2 of glandular tissue. Results: In the derivation cohort of 91 participants, either the total US scores or the total SWE values of four glands significantly distinguished patients with positive LSGB from those with negative results (area under the curve (AUC) = 0.956, 0.825, both p < 0.001). The positive predictive value (PPV) was 100% in patients with total US scores ⩾9 or with total SWE values ⩾33 kPa. The negative predictive value (NPV) was 100% in patients with total US scores <5, but 68% in patients with total SWE values <27 kPa. A matrix risk model was derived based on the combination of total US scores and total SWE values. Patients can be stratified into high, moderate, and low risk of positive LSGB. In the validation cohort of 52 participants, the PPV was 94% in the high-risk subpopulation and the NPV was 93% in the low-risk subpopulation. Conclusion: A novel matrix risk model based on the combined B-mode US and SWE examination can help rheumatologists to make a shared decision with suspected Sjögren’s syndrome patients on whether the invasive procedure of LSGB should be performed.
Collapse
Affiliation(s)
- Ying-Qian Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Shao-Yun Hao
- Department of Ultrasonography, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Qian-Hua Li
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jin-Jian Liang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yi Luo
- Department of Ultrasonography, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yu-Qing Lan
- Department of Ophthalmology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jiang-Long Zhong
- Department of Oral & Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jun-Wei Wang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Xue-Pei Zhang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Wen-Ke Huang
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, P.R. China
| | - Lie Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, P.R. China
| |
Collapse
|
18
|
Bedewi MA, Elsifey AA, Nassir EM, Elgazzar HM, Alfawaz AF, Hussein RS, Moawad K, Bediwy AM, Swify SM. Shear wave elastography of the submandibular gland in healthy individuals. J Int Med Res 2020; 48:300060520979445. [PMID: 33356715 PMCID: PMC7768579 DOI: 10.1177/0300060520979445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Shear wave elastography is a rapidly evolving new technique. The purpose of the present study was to determine the sonoelastographic features of the submandibular glands in healthy individuals. METHODS We conducted a cross-sectional study of 45 healthy individuals, whose submandibular glands were studied using shear wave elastography. The stiffness of both submandibular glands was measured and its relationships with the age, sex, body mass, body mass index (BMI), and height of the participants were assessed. RESULTS The participants had a mean age of 31.82 ± 5.53 years, a mean height of 158.30 ± 7.16 cm, a mean body mass of 57.83 ± 8.84 kg, and a mean BMI of 22.99 ± 2.72 kg/m2. The mean shear elastic modulus of the right and left submandibular glands were 18.02 kPa and 19.09 kPa, respectively. Positive correlations were found between the elasticity of the right submandibular gland and the anthropometric parameters. CONCLUSION The elastic modulus of the submandibular glands has been determined in healthy individuals and the data generated can serve as a reference for future studies of pathological conditions of these structures.
Collapse
Affiliation(s)
- Mohamed A Bedewi
- Department of Internal Medicine, Prince Sattam bin Abdulaziz University, College of Medicine, Al-kharj, Saudi Arabia
| | - Ayman A Elsifey
- Department of Internal Medicine, Prince Sattam bin Abdulaziz University, College of Medicine, Al-kharj, Saudi Arabia
| | - Elbagir Mohammed Nassir
- Department of Internal Medicine, Prince Sattam bin Abdulaziz University, College of Medicine, Al-kharj, Saudi Arabia
| | - Hala Mohamed Elgazzar
- Department of Internal Medicine, Prince Sattam bin Abdulaziz University, College of Medicine, Al-kharj, Saudi Arabia
| | - Abdullah Fahad Alfawaz
- Department of Internal Medicine, Prince Sattam bin Abdulaziz University, College of Medicine, Al-kharj, Saudi Arabia
| | - Ramadan S Hussein
- Department of Internal Medicine, Prince Sattam bin Abdulaziz University, College of Medicine, Al-kharj, Saudi Arabia
| | - Karim Moawad
- Department of Biological Sciences, University of California Irvine, California, United States of America
| | | | | |
Collapse
|
19
|
Martino M, Fodor D, Fresilli D, Guiban O, Rubini A, Cassoni A, Ralli M, De Vincentiis C, Arduini F, Celletti I, Pacini P, Polti G, Polito E, Greco A, Valentini V, Sorrenti S, D'Andrea V, Masciocchi C, Barile A, Cantisani V. Narrative review of multiparametric ultrasound in parotid gland evaluation. Gland Surg 2020; 9:2295-2311. [PMID: 33447581 DOI: 10.21037/gs-20-530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Disorders affecting parotid gland represent a heterogeneous group comprising congenital, inflammatory and neoplastic diseases which show a focal or diffuse pattern of appearance. The differentiation of neoplastic from non-neoplastic conditions of parotid glands is pivotal for the diagnostic imaging. Frequently there is evidence of overlapping between the clinical and the imaging appearance of the various pathologies. The parotid gland is also often object of study with the combination of different techniques [ultrasound-computed tomography-magnetic resonance imaging (US-CT-MRI), ex.]. Compared to other dominant methods of medical imaging, US has several advantages providing images in real-time at lower cost, and without harmful use of ionizing radiation and of contrast enhancement. B-mode US, and the microvascular pattern color Doppler are usually used as first step evaluation of parotid lesions. Elastography and contrast-enhanced US (CEUS) has opened further possible perspectives to improve the differentiation between benign and malignant parotid lesions. The characterization of the parotid tumors plays a crucial role for their treatment planning and for the prediction of possible surgical complications. We present, here an updated review of the most recurrent pathologies of parotid gland focusing on the diagnostic power of multiparametric US including CEUS and ultrasound elastography (USE); limitations, advantages and the main key-points will be presented.
Collapse
Affiliation(s)
- Milvia Martino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | | | - Andrea Cassoni
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Federico Arduini
- Department of Radiology, Ospedale Santa Maria del Carmine, Rovereto, Italy
| | - Ilaria Celletti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Valentino Valentini
- Department of Maxillofacial Surgery, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
20
|
Durmaz MS, Kesimal U, Ünal HA, Özbakır B. Evaluation of perforating venous insufficiency with shear wave elastography: a preliminary study. J Ultrasound 2020; 24:463-470. [PMID: 32902811 DOI: 10.1007/s40477-020-00527-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the efficacy of shear wave elastography (SWE) in the diagnosis of perforating vein insufficiency, and to determine the applicability of these measurements. METHODS A total of 140 symptomatic patients with a total of 280 lower extremities were investigated. All patients presented with venous insufficiency (VI) symptoms, and received Doppler ultrasound assessment to determine VI and SWE measurements. The SWE values were measured in the adjacent perivenous tissue of the largest Cockett's perforating vein (PV) of both lower extremities, at the level where they pass the fascia. The Cockett's PV diameter and the presence of reflux in Cockett's PV and the great saphenous vein were compared with SWE values in perivenous tissue of PVs. RESULTS The SWE values of the perforating vein insufficiency group were significantly higher than those of the normal PV without insufficiency group (P < 0.001). A significant and positive relation was seen between increased PV diameter and SWE values (P < 0.001) and there was a significant relationship between the presence of perforating vein insufficiency and increase in PV diameter. A statistically significant increase was detected in SWE values for the PV for those with reflux in the great saphenous vein (P < 0.001). The best cut-off values that can be used to detect perforating vein insufficiency were found 34.600 for kPa and 3.375 for m/s. CONCLUSION SWE may be used effectively in addition to conventional Doppler ultrasound examination in diagnosing and following perforating vein insufficiency.
Collapse
Affiliation(s)
- Mehmet Sedat Durmaz
- Department of Radiology, Medicine Faculty, Selçuk University, Ardıclı Mahallesi, Celal Bayar Cad. No: 313, Selçuklu, 42250, Konya, Turkey.
| | - Uğur Kesimal
- Department of Radiology, Kepez State Hospital, Antalya, Turkey
| | - Hasan Ali Ünal
- Department of Radiology, Manavgat State Hospital, Antalya, Turkey
| | - Bora Özbakır
- Department of Radiology, Isparta City Hospital, Isparta, Turkey
| |
Collapse
|
21
|
Jung JW, Je H, Lee SK, Jang Y, Choi J. Two-Dimensional Shear Wave Elastography of Normal Soft Tissue Organs in Adult Beagle Dogs; Interobserver Agreement and Sources of Variability. Front Bioeng Biotechnol 2020; 8:979. [PMID: 32974311 PMCID: PMC7466577 DOI: 10.3389/fbioe.2020.00979] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/27/2020] [Indexed: 12/21/2022] Open
Abstract
Shear wave elastography (SWE) induces lateral shear wave through acoustic pulses of the transducer and evaluates tissue stiffness quantitatively. This study was performed to evaluate feasibility and reproducibility of two-dimensional shear wave elastography (2D SWE) for evaluation of tissue stiffness and to examine technical factors that affect shear wave speed (SWS) measurements in adult dogs. Nine healthy, 2 year-old, adult beagles with the median weight of 9.8 kg were included. In this prospective, experimental, exploratory study, 2D SWE (Aplio 600) from the liver, spleen, kidneys, pancreas, prostate, lymph nodes (submandibular, retropharyngeal, axillary, medial iliac, and inguinal), submandibular salivary gland, and thyroid was performed in anesthetized beagles. Color map was drawn and SWS of each SWE were measured as Young’s modulus (kPa) and shear wave velocity (m/s). The effect of measuring site, scan approach, depth, and anesthesia on SWE was assessed in abdominal organs by two observers independently. A total of 27 SWE examinations were performed in 12 organs by each observer. All SWS measurements were preformed successfully; however, SWE in the renal medulla could not be successfully conducted, and it was excluded from further analysis. Interobserver agreement of SWE was moderate to excellent in all organs, except for the left liver lobe at 10–15 mm depth with the intercostal scan. In the liver, there was no significant effect of the measuring site and scan approach on SWE. SWS of the liver and spleen tended to be higher with increasing the depth, but no significant difference. However, anesthesia significantly increased tissue stiffness in the spleen compared to awake dog regardless of the depth (P < 0.05). There was a significant difference in SWS according to the measuring site in the kidneys and pancreas (P < 0.001). 2D SWE was feasible and highly reproducible for the estimation of tissue stiffness in dogs. Measuring site and anesthesia are sources of variability affecting SWE in abdominal organs. Therefore, these factors should be considered during SWS measurement in 2D SWE. This study provides basic data for further studies on 2D SWE on pathological conditions that may increase tissue stiffness in dogs.
Collapse
Affiliation(s)
- Jin-Woo Jung
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Hyejin Je
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Sang-Kwon Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Youjung Jang
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| |
Collapse
|
22
|
Shear wave elastography as a new method to identify parotid lymphoma in primary Sjögren Syndrome patients: an observational study. Rheumatol Int 2020; 40:1275-1281. [PMID: 32200426 DOI: 10.1007/s00296-020-04548-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/06/2020] [Indexed: 02/07/2023]
Abstract
Parotid non-Hodgkin lymphoma (NHL) in primary Sjögren syndrome (pSS) has no specific biomarker for diagnosis. Salivary glands ultrasound (US) is largely used, but its contribution in detecting parotid NHL has not been established. The aim of our study was to determine the added value of bidimensional shear wave elastography (2D-SWE) in pSS diagnosis and to determine its accuracy in identifying parotid NHL. Grey-scale US (GSUS) and 2D-SWE of salivary glands were performed in 35 patients with pSS and 35 healthy controls. The GSUS scores were calculated and the mean of three SWE consecutive measurements was used to appreciate the gland stiffness. SWE increase the diagnostic rate at a cut-off of 6.45 kPa (from 88.6 to 94.2%, p < 0.001) only if applied in patients with insufficient GSUS criteria for pSS diagnosis. The parotid glands with NHL (8 patients, all mucosa-associated lymphoid tissue type) had hyperechoic bands in more than half of the glandular parenchyma (in 68.75% of the glands), large hypoechoic area > 20 mm (all glands), traced gland area over 5 cm2 (all glands), parotid US score greater than 13 (in 68.75% of the glands), and high stiffness (elasticity modulus 13.9 ± 4.08 vs 6.32 ± 2.24) (all p < 0.001). These findings give high sensitivity (92.3%), specificity (100%), and positive (100%) and negative predictive values (98.3%) for NHL identification. The rest of GSUS findings did not correlate with the classic risk factors for lymphoma development (all p > 0.05). 2D-SWE had added value for pSS diagnosis in cases where GSUS aspect is normal or nonspecific. The higher stiffness of parotid NHL can be used for early diagnosis, biopsy guidance, and, possible, for treatment monitoring.
Collapse
|