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Ohshima M, Suzuki T, Suzuki A. Case Series of Changes in Greyscale and Power Doppler Signals on Salivary Gland Ultrasonography after Treatment in Patients with Sjögren's Syndrome. Intern Med 2024; 63:2203-2208. [PMID: 38104991 DOI: 10.2169/internalmedicine.2812-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
The usefulness of greyscale (GS) in salivary gland ultrasonography for Sjögren's syndrome (SS) has been established; however, limited information is currently available on power Doppler signals (PDs), and changes after treatment remain unknown. PDs are considered to represent glandular inflammation, which indicates the worsening of GS in later years. We examined the changes in PDs in three immunosuppressant-treated SS patients. PDs decreased, along with GS and markers of disease activity, after treatment. PDs have the potential to provide insights into glandular inflammation in real time; however, large-scale studies on their clinical usefulness are needed.
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Affiliation(s)
- Miho Ohshima
- Department of Rheumatology, Mitsui Memorial Hospital, Japan
| | - Takeshi Suzuki
- Department of Rheumatology, Mitsui Memorial Hospital, Japan
| | - Akitake Suzuki
- Department of Rheumatology, Mitsui Memorial Hospital, Japan
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Cheng L, Yang Y, Ma AJ. Performance of salivary glands ultrasonography, shear wave elastography and their combined use for the diagnosis of primary and secondary Sjögren's syndrome. J Appl Clin Med Phys 2024:e14441. [PMID: 38980059 DOI: 10.1002/acm2.14441] [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: 01/30/2024] [Accepted: 05/15/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Sjögren's syndrome (SS) is a common rheumatic disease for which finding the right imaging tool remains a challenge. PURPOSE This study aimed to evaluate the performance of salivary gland ultrasonography (SGUS), shear wave elastography (SWE) and their combined use for the diagnosis of primary and secondary SS (pSS and sSS). METHODS This retrospective study included patients with dry symptoms who underwent routine examinations between May 2019 and December 2023. Patients were categorized into the pSS (n = 41), sSS (n = 26), and control (n = 27) groups based on the American College of Rheumatology/European League Against Rheumatism classification criteria (2016). A comparison of SGUS and shear wave velocity (SWV) results was conducted among the three groups. The diagnostic capabilities of different ultrasound methods for SS were evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC) for specificity. RESULTS Compared to the control group, both the pSS (1.80 ± 1.03 vs. 0.67 ± 0.48, p < 0.001) and the sSS (1.85 ± 0.88 vs. 0.67 ± 0.48, p < 0.001) groups exhibited significantly elevated SGUS scores. However, there was no statistically significant difference between the pSS and sSS groups (p = 0.849). The SWV values in both the pSS and sSS groups were significantly higher than those in the control group (all p < 0.001). The AUC for diagnosing SS using only SGUS scores was 0.823 (95% confidence interval [CI]: 0.731-0.894). Combining SGUS scores and SWV values resulted in improved diagnostic accuracy (AUC: 0.883, 95% CI: 0.801-0.940). CONCLUSIONS SGUS and SWE are pivotal in the diagnosis of Sjögren's syndrome, with their synergistic application poised to bolster diagnostic precision. This combined approach also furnishes substantial backing for the clinical assessment and management of Sjögren's syndrome.
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Affiliation(s)
- Lian Cheng
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Yan Yang
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Ai-Ju Ma
- Department of Computed Tomography and Magnetic Resonance Imaging, Langfang Traditional Chinese Medicine Hospital, Langfang, Hebei, China
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Martins FB, Oliveira MB, Oliveira LM, Lourenço AG, Paranhos LR, Motta ACF. Diagnostic accuracy of ultrasonography in relation to salivary gland biopsy in Sjögren's syndrome: a systematic review with meta-analysis. Dentomaxillofac Radiol 2024; 53:91-102. [PMID: 38177085 DOI: 10.1093/dmfr/twad007] [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: 07/02/2023] [Revised: 10/17/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES To evaluate the accuracy of major salivary gland ultrasonography (SGUS) in relation to minor salivary gland biopsy (mSGB) in the diagnosis of Sjögren's syndrome (SS). METHODS A systematic review and meta-analysis were performed. Ten databases were searched to identify studies that compared the accuracy of SGUS and mSGB. The risk of bias was assessed, data were extracted, and univariate and bivariate random-effects meta-analyses were done. RESULTS A total of 5000 records were identified; 13 studies were included in the qualitative synthesis and 10 in the quantitative synthesis. The first meta-analysis found a sensitivity of 0.86 (95% CI: 0.74-0.92) and specificity of 0.87 (95% CI: 0.81-0.92) for the predictive value of SGUS scoring in relation to the result of mSGB. In the second meta-analysis, mSGB showed higher sensitivity and specificity than SGUS. Sensitivity was 0.80 (95% CI: 0.74-0.85) for mSGB and 0.71 (95% CI: 0.58-0.81) for SGUS, and specificity was 0.94 (95% CI: 0.87-0.97) for mSGB and 0.89 (95% CI: 0.82-0.94) for SGUS. CONCLUSIONS The diagnostic accuracy of SGUS was similar to that of mSGB. SGUS is an effective diagnostic test that shows good sensitivity and high specificity, in addition to being a good tool for prognosis and for avoiding unnecessary biopsies. More studies using similar methodologies are needed to assess the accuracy of SGUS in predicting the result of mSGB. Our results will contribute to decision-making for the implementation of SGUS as a diagnostic tool for SS, considering the advantages of this method.
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Affiliation(s)
- Fernanda B Martins
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, 05508-000, Brazil
| | - Millena B Oliveira
- Postgraduate Program in Dentistry, Dental School, Federal University of Uberlândia, Uberlândia, 38405-320, Brazil
| | - Leandro M Oliveira
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, 97105-900, Brazil
| | - Alan Grupioni Lourenço
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, 14040-904, Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Social Dentistry, Dental School, Federal University of Uberlandia, Uberlandia, 38405-320, Brazil
| | - Ana Carolina F Motta
- Department of Stomatology, Public Health and Forensic Dentistry, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto, 14040-904, Brazil
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Xu J, Huang B, Chai J, Wang B, Xu S. The diagnostic insights of immunoglobin G4-related Mikulicz disease: a case description and literature analysis. Quant Imaging Med Surg 2023; 13:8824-8831. [PMID: 38106322 PMCID: PMC10722000 DOI: 10.21037/qims-23-563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/28/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Jie Xu
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Bin Huang
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Jiayuan Chai
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Boyi Wang
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
| | - Senyin Xu
- Department of Ultrasound, Zhejiang Hospital, Hangzhou, China
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Xu S, Zhu C, Jiang J, Cheng H, Wang P, Hong J, Yang S, Li Z, Wang X. Non-invasive diagnosis of primary Sjögren's syndrome using ultrasonography and transcriptome biomarkers. Clin Immunol 2023; 255:109739. [PMID: 37586671 DOI: 10.1016/j.clim.2023.109739] [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: 05/06/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
Diagnosing primary Sjögren's syndrome (pSS) is difficult due to clinical heterogeneity and the absence of non-invasive specific biomarkers. To develop non-invasive pSS diagnosis methods that integrate classic clinical indexes, major salivary gland ultrasonography (SGUS), and gene expression profiles shared by labial gland and peripheral blood, we conducted a study on a cohort of 358 subjects. We identified differentially expressed genes (DEGs) in glands and blood that were enriched in defense response to virus and type I interferon production pathways. Four upregulated DEGs common in glands and blood were identified as hub genes based on the protein-protein interaction networks. A random forest model was trained using features, including SGUS, anti-SSA/Ro60, keratoconjunctivitis sicca tests, and gene expression levels of MX1 and RSAD2. The model achieved comparable pSS diagnosis accuracy to the golden standard method based on labial gland biopsy. Our findings implicate this novel model as a promising diagnosis technique of pSS.
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Affiliation(s)
- Shihao Xu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| | - Chengwei Zhu
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jiachun Jiang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Hui Cheng
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ping Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jingwei Hong
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shiping Yang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhongshan Li
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China.
| | - Xiaobing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai 200001, China.
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Xu Z, Li R, Xia B, Jiang M, Wu X, Zhang X, Pan J, Chen J. Combination of ultra-micro angiography and sound touch elastography for diagnosis of primary Sjögren's syndrome: a diagnostic test. Quant Imaging Med Surg 2023; 13:7170-7179. [PMID: 37869334 PMCID: PMC10585522 DOI: 10.21037/qims-23-711] [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: 05/21/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023]
Abstract
Background Primary Sjogren's syndrome (PSS) is a prevalent systemic autoimmune disease. However, the current gold standard diagnostic method is invasive, increasing the difficulty of patient acceptance and then delaying treatment. Therefore, a non-invasive, convenient, and effective diagnostic method is required. Although salivary gland ultrasonography (SGUS) is a good choice, previous studies have not found suitable parameters to diagnose PSS. Salivary gland involvement in patients with PSS leads to changes in gland stiffness and vascularization, so we combined sound touch elastography (STE) and ultra-microangiography (UMA) to demonstrate the diagnostic effectiveness of ultrasonography in PSS. Methods This prospective study included 27 patients with PSS and 20 healthy controls, with all participants forming a random series. Major salivary glands were examined with UMA and STE. Color pixel percentage (CPP), shear wave velocity (SWV), and Young's modulus values were investigated, and the combination of these parameters was evaluated by logistic regression analysis. Results For Young's modulus and SWV in the elasticity index, combined evaluation of both parotid glands and submandibular glands yielded an area under the receiver operating characteristic (ROC) curve (AUC) and confidence interval (CI) of 0.819, 0.699-0.938 and 0.801, 0.677-0.925, respectively. The levels of CPP in the parotid glands were significantly elevated (P<0.003) among patients compared to those in the control group, whereas the CPP values in the submandibular glands were not statistically different (P>0.086). We evaluated the elasticity values of the total 4 glands and the CPP of parotid glands together by logistic regression modeling. The ROC curve yielded an AUC of 0.954 (95% CI: specificity 0.849-0.994) which showed the best accuracy, with 92.6% sensitivity and 85.0% specificity. Conclusions The use of STE and UMA to examine the salivary glands may aid in the diagnosis of PSS, and their combination may be a promising method. This is good news for patients with PSS who are not suitable or unwilling to undergo labial gland biopsy.
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Affiliation(s)
- Zhikang Xu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Rumei Li
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Bin Xia
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Meijuan Jiang
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojin Wu
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xuanxuan Zhang
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Jianlian Pan
- Department of Clinical and Research, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Jian Chen
- Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
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Barrio-Nogal L, Novella-Navarro M, Heras CB, Sala-Icardo L, Calvo-Aranda E, Gómez AP. Ultrasonography in the diagnosis of suspected primary Sjögren's syndrome and concordance with salivary gland biopsy: a Spanish single-center study. Clin Rheumatol 2023; 42:2409-2417. [PMID: 37225928 DOI: 10.1007/s10067-023-06618-4] [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: 02/20/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The study aims to evaluate the utility of major salivary gland ultrasonography for diagnosis of primary Sjögren's syndrome (pSS) and to assess its concordance with minor salivary gland biopsy (MSGB). METHODS A cross-sectional study of 72 patients with suspected pSS was performed. Demographic, clinical, and serological data were collected. MSGB was performed, as was ultrasonography. The ultrasound technician was blind to clinical, serological, and histological data. The validity of ultrasonography compared with MSGB, the American-European Consensus Group (AECG), and American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) criteria was assessed by calculating the percentage of agreement, sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC). RESULTS Based on MSGB as the gold standard, the percentage of agreement between both tests was 78% (AUC 0.75). Based on the ACR/EULAR criteria, the percentage of agreement was 83% (AUC 0.78) for ultrasonography and 81% (AUC 0.83) for biopsy. Sensitivity and specificity were 90% and 67%, respectively, for ultrasonography and 76% and 90% for biopsy. The results were similar with the AECG criteria. The intra- and inter-observer variability was good (κ > 0.7). Significant differences were observed for positive anti-Ro52 values and hypergammaglobulinemia in pathological ultrasound scans. CONCLUSION Diagnostic ultrasonography is as useful as MSGB in pSS. Therefore, it could be included in the classification criteria. In this cohort, it proved more sensitive than MSGB and could be used as an initial test for patients suspected of having pSS. MSGB could be used in cases where clinical and serological results are inconclusive. Key Points • Major salivary gland ultrasonography adds diagnostic value similar to that of MSGB, thus potentially enabling this invasive procedure to be avoided. • Ultrasonography could be included in the classification criteria for primary Sjögren's syndrome. • Given that ultrasonography is more sensitive and less specific than MSGB, it could be used as an initial diagnostic test in patients with suspected Sjögren's syndrome. • Biopsy should be performed in those cases where ultrasonography, clinical, and serological data are inconclusive.
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Affiliation(s)
- Laura Barrio-Nogal
- Rheumatology Department, Hospital Universitario de Torrejón, Madrid, Spain.
| | | | | | - Luis Sala-Icardo
- Rheumatology Department, Hospital Universitario de Torrejón, Madrid, Spain
| | | | - Ana Pérez Gómez
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
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Rink M, Krassler J, Symeou L, Fischer R, Jung EM, Künzel J. [Use of Contrast enhanced Ultrasound (CEUS) in the Head and Neck Area: Update]. Laryngorhinootologie 2023; 102:450-463. [PMID: 37267968 DOI: 10.1055/a-1994-5141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the help of contrast enhanced ultrasound, the diagnostic accuracy of conventional sonography can be increased in many areas of otorhinolaryngology. Vascularisation and tissue perfusion can be objectified through the examination. This offers promising approaches for example to monitor the therapy of metastatic cervical lymph nodes or in the treatment of vascular malformations. Contrast Enhanced Ultrasound (CEUS) also offers great potential for differential diagnosis, for example of thyroid nodules. Valid threshold values for the quantitative time intensity curve (TIC) analysis of cervical pathologies are currently still not available. Further studies are necessary. As there is currently no license for the use of contrast enhanced ultrasound in otorhinolaryngology patients must be informed about its off-label use before the examination. This article is intended to provide an overview of the current possibilities and to serve as an introduction to the topic.
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