RESEARCH - Ultrasonography of salivary glands - a highly specific procedure for diagnosis of Sjögren's syndrome

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J Rheumatol. 2008 Feb;35(2):285-93. Epub 2008 Jan 15.

Ultrasonography of Salivary Glands -- A Highly Specific Imaging

Procedure for Diagnosis of Sjögren's Syndrome.

Wernicke D, Hess H, Gromnica-Ihle E, Krause A, Schmidt WA.

From the Clinic for Rheumatology Berlin-Buch, Berlin, Germany.

OBJECTIVE: To verify ultrasonographic criteria for examination of the

major salivary glands in diagnosis of primary and secondary Sjögren's

syndrome (SS). METHODS: Three hundred sixteen consecutive patients

with rheumatic diseases were selected according to the European

Consensus Study Group diagnostic criteria for SS. Fifty-seven had

primary SS, 33 had secondary SS, 78 had Sicca symptoms, and 148

patients served as asymptomatic controls. This cohort was analyzed for

size and parenchymal echogenicity of the major salivary glands by

ultrasonography. RESULTS: Evident parenchymal inhomogenicity in 2 or

more major salivary glands was detected by ultrasonography in patients

with primary and secondary SS with a sensitivity of 63.1% and 63.6%,

respectively. The specificity of this imaging approach in our cohort

was 98.7%. The volume of submandibular glands was reduced in patients

with primary and secondary SS by about 30% compared to patients with

sicca symptoms and asymptomatic controls. In receiver-operating

characteristic (ROC) curve analysis, the detection of reduced volumes

of both submandibular glands in patients with primary and secondary SS

had a specificity of 93% and a sensitivity of 48% at the cutoff point

of 3.0 ml. Of note, the volume of the parotid glands did not differ

between the groups of patients. In patients with primary SS,

parenchymal inhomogenicity of the salivary glands was strongly

associated with positivity for anti-Ro and/or anti-La antibodies.

CONCLUSION: Ultrasonographic detection of parenchymal inhomogenicity

of the major salivary glands and observation of reduced volume of the

submandibular glands resulted in high specificities for diagnosis of

primary and secondary SS. The data indicate that ultrasonography of

major salivary glands is a noninvasive imaging procedure with high

diagnostic value for the diagnosis of primary and secondary SS.

PMID: 18203316

http://www.ncbi.nlm.nih.gov/pubmed/18203316

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