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
|
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
|
4
|
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
|
5
|
Wu CH. A few considerations on strain sonoelastographic measurements of quadriceps and patellar tendons in knee osteoarthritis. Rheumatol Int 2022; 43:983-984. [PMID: 36520175 DOI: 10.1007/s00296-022-05259-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Zhongshan S. Rd, 100, Taipei, Taiwan.
| |
Collapse
|
6
|
The use of shear wave elastography to monitor changes in gingival elasticity associated with initial periodontal therapy in patients with advanced periodontitis: A prospective pilot study. J Dent Sci 2022. [DOI: 10.1016/j.jds.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|