Background/Purpose:

Salivary gland enlargement occurs in conditions such as Sjögren’s syndrome (SS), sarcoidosis (SAR), and AL amyloidosis (AL). Salivary gland ultrasound (US) has been shown to be useful in diagnosing SS. Our purpose is to compare salivary gland ultrasound features in SAR and AL with those in patients with SS, and controls (C) without known salivary gland disease.

Methods:

In this 1 year cross-sectional study, we enrolled consecutive adult clinic out patients. Enrollment inclusion criteria include: clinical diagnosis of either primary or secondary SS fulfilling American-European Consensus 2002 classification criteria; clinical diagnosis of SAC or AL with histological confirmation from any tissue; and rheumatology outpatients without these diagnoses or other autoimmune rheumatic disease.

Subjects underwent clinical examination including Schirmer testing, and unstimulated salivary flow measurement, and bilateral parotid and submandibular salivary gland ultrasound by single unblinded investigator, using an ultrasound machine with an 18-6 MHz ultrasound probe. Another investigator, blinded to underlying diagnosis, analyzed ultrasound images for salivary gland ultrasound score (SGUS) per Hocevar protocol (parenchymal echogenicity, homogeneity, hypoechoic areas, hyperechoic foci, border visibility, and color Doppler signals), lymph nodes, and hyperechoic septae. US findings are compared between the groups using T test and Mann Whitney test as appropriate with P-value of < 0.05 as being statistically significant.

Results:

Subjects enrolled, with mean age (A), % abnormal Schirmer (Sch), and % abnormal salivary flow (Sf) as follows: 27 SAC (A 55, Sch 65, Sf 4), 22 AL (A 66, Sch 86, Sf 32), 21 SS (A 49, Sch 57, Sf 62), and 16 C (A 58, Sch 38, Sf 25). In the control group, there was no correlation between age and SGUS score. By Shapiro-Wilk test of normality, only the AL group violated the assumption of normality. ANOVA of the mean SGUS showed significant difference among the four groups (p < 0.00008). SS SGUS was significantly higher than SAC, AL, and C groups (20 vs. 11, 14, 9 respectively all with p <0.05). AL SGUS was higher than C (14 vs. 9, p<0.05), but SAC was not different from C (11 vs. 9, p=NS). Intraglandular lymph node number, size, shape, and Doppler flow did not differ between the groups (p=NS). Gland septae score was greater for SS and AL groups than SAC and C groups (0.39 and 0.44 vs. 0.18 and 0.16, p=0.0040). Hypoechoic area score was higher for SS and AL than SAC and C groups (1.6 and 1.2 vs. 0.95 and 0.77, p=0.0039). There was a trend towards greater difference between groups in the percentage of subjects with hyperechoic area scores for the SS and AL groups than SAC and C groups (0.37 and 0.35 vs. 0.19 and 0.063, p=0.051).

Conclusion:

While SGUS was highest in SS, US abnormalities of SS were more similar to those of AL than those of SAC. Hyperechoic foci and septae, may be most helpful in distinguishing patients with SS and AL from those with SAC and patients without a systemic disease of the salivary glands.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-ultrasound-features-of-major-salivary-glands-in-sarcoidosis-amyloidosis-and-sjogrens-syndrome/