Background/Purpose: Imaging techniques such as salivary gland ultrasound and magnetic resonance imaging (MRI) are able to diagnose primary Sjögren syndrome (pSS) patients with high sensitivity and specificity. Recently, the OMERACT ultrasound novel scoring system for major salivary gland (SG) lesions in patients with pSS was developed showing good inter-reader and excellent intra-reader reliability. The aim of the OMERACT Sjögren ultrasound subtask group exercise was to assess the validity of the OMERACT ultrasound novel scoring system for major salivary gland (SG) lesions compared with MRI of parotid (PGs)/submandibular glands(SMGs) and salivary flow rates (SFRs) in patients with pSS.

Methods: Nine sonographers and two radiologists participated in the validity exercise, evaluating the parenchymal changes of bilateral PGs and SMGs in 11 pSS patients using greyscale ultrasound and MRI. Nine sonographers examined the superficial lobe of the PGs in both longitudinal and transverse plane, while the SMGs were evaluated in longitudinal plane only. Machine settings were not allowed to modify during scanning. The OMERACT novel four grade semiquantitative ultrasound score was applied: Grade 0, normal parenchyma; Grade 1: minimal change: mild inhomogeneity without anechoic/hypoechoic areas; Grade 2: moderate change: moderate inhomogeneity with focal anechoic/hypoechoic areas; Grade 3: severe change: diffuse inhomogeneity with anechoic/hypoechoic areas occupying the entire gland surface or fibrous gland. MRI images were evaluated by two radiologists with at least ten years of expertise in head and neck practice. The PGs parenchyma were graded by modifying the protocol as proposed by Kojima et al., i.e. , grade 0 definitely normal, grade 1 slightly heterogeneous, grade 2 clearly abnormal, and grade 3 severely heterogeneous destroyed parenchyma. Differences in opinion between radiologists, if any, were resolved by reevaluating those cases. Furthermore, both stimulated and unstimulated salivary flow rates (SFRs) were assessed in 11 pSS patients.

Results: OMERACT novel ultrasound score was strongly correlated with MRI score for the PGs and for the SMGs (Table 1). Correlation was similar for both the PGs and the SMGs combined (r:0,8 p=0.002). Moreover, both unstimulated and stimulated SFRs as objective criteria were associated with total OMERACT novel ultrasound score (r:0,7 p=0.04; r: 0,7 p=0.027) and total MRI score (r:0,8 p=0.004; r: 0,8 p=0.013). Similar trend was observed in PGs and SMGs (Table 2).

Conclusion: The OMERACT novel ultrasound scoring system for the evaluation of SG in pSS showed strong correlation with MRI assessment. Furthermore, both imaging methods strongly correlate with unstimulated and stimulated SFRs.

Table 1. Spearman’s rho correlation coefficients for salivary gland target lesions scored by ultrasound and MRI.

Tablo 2. Spearman’s rho correlation coefficients of MRI and US scores of salivary glands with salivary flow rates (SFR).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-the-construct-validity-of-the-novel-omeract-ultrasound-scoring-system-for-salivary-glands-target-lesions-by-comparison-with-mri-in-patients-with-sjogrens-syndrome-an-omeract-ultrasound-w/