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Abstract Number: 1499

Major Salivary Gland Ultrasonography Bed-Side and Still Image Scoring – a Pilot Comparison in Juvenile Sjögren’s Syndrome

Daniel S. Hammenfors1, Valeria Valim2, Sandra Gofinet Pasoto3, Vibke Lilleby4, Juan Carlos Nieto5, Clovis Silva6, Rosa M R Pereira7, Blanca Bica8, Johan G. Brun9, Roland Jonsson9 and Malin V. Jonsson10, 1Department of Rheumatology, Haukeland University Hospital, University of Bergen, Bergen, Norway, 2Rheumatology, Department of Medicine, Universidade Federal do Espírito Santo, Vitória, Brazil, Vitória, Brazil, 3Internal Medicine, Division of Rheumatology - Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, São Paulo, Brazil, 4Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway, Oslo, Norway, 5Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain, 6Department of Pediatric Rheumatology, Federal University of São Paulo, São Paulo, Brazil, 7Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil, 8Istituto Giannina Gaslini - Pediatria II, Reumatologia - PRINTO, Genova, Italy, 9Department of Rheumatology, Haukeland University Hospital, Bergen, Bergen, Norway, 10Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway, Bergen, Norway

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Diagnostic imaging, salivary gland and ultrasonography, Sjogren's syndrome

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Session Information

Date: Monday, November 6, 2017

Session Title: Sjögren's Syndrome Poster II: Clinical Research

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Adding major salivary gland ultrasonography (SGUS) improves the diagnostics of primary Sjögren’s syndrome (pSS). Juvenile Sjögren’s syndrome (jSS) is a rare, poorly defined disease. With regard to the late onset of sicca-symptoms and current lack of diagnostic criteria, a non-invasive diagnostic method is warranted for jSS. The aim of this study was to evaluate SGUS bed-side scoring (realtime) and still/2D-image scoring, and to investigate whether imaging findings differ in the parotid and the submandibular glands.

Methods:

Patients were recruited from Brazil (n=40), Norway (n=11), and Spain (n=5) in the period 2016-2017. SGUS of the parotid and submandibular glands had been performed bed-side in all patients, using linear high-frequency transducers (6-15 MHz), and glands characterized as normal or SS-like. Still/2D-images from 26 patients were available for re-evaluation by the same experts (DSH and MVJ).

Results:

Mean age at diagnosis was 12.1 years (range 4-17), with first symptoms at 10.1 years (range 3-17). Time from onset of symptoms until diagnosis was 1.8 years (range -2-8). Oral and ocular symptoms were reported by 16/26 and 18/26 patients, respectively. Reduced tear-production was detected in 9/25 patients, and hyposalivation in 11/26 patients. Focus score was available in 19/20 cases. Anti-Ro/SSA-titer was elevated in 23/26, and anti-La/SSB in 12/26. AECG and ACR/EULAR diagnostic criteria was fulfilled by 21/26 patients. The female:male ratio was 23:3.

When comparing the total SGUS score, pathological changes were noted in 18/26 patients using realtime images, as compared to 24/26 using still/2D-images (p=0.027, ĸ=0.316).

In the realtime images SGUS pathological changes were detected in 16/26 parotid glands (15/16 in both right and left gland, p<0.001, ĸ=0.920), and 15/26 submandibular glands (14/15 in both right and left gland, p<0.001, ĸ=0.842). In four cases, pathological changes were detected only in the parotid glands (n=2) or only in the submandibular glands (n=2).

In the still/2D-images pathological changes were detected in 19/26 parotid glands (17/19 in both right and left gland, p<0.001, ĸ=0.821), and 21/26 submandibular glands (18/21 in both right and left gland, p=0.029, ĸ=0.425).

When comparing the glands separately, pathological changes were reported in 2D/still images of glands that had been diagnosed as normal using realtime images; 3/10 cases in the right parotid (p0.001, ĸ=0.742), 2/11 cases in the left parotid (p0.001, ĸ=0.839), 6/11 cases in the right submandibular (p=0.004), ĸ=0.490) and 5/11 cases in the left submandibular (p=0.001, ĸ=0.581).

Conclusion:

Although containing a limited number of patients, our study highlights important challenges in the clinical applications of SGUS. Notable differences were observed when comparing still/2D-images to realtime evaluation, especially in cases with normal-appearing glands or early pathological changes, and the submandibular glands as compared to the parotid glands. We speculate that bed-side or video scoring to evaluate the whole gland should be the preferred method, and SGUS evaluation using only one slide/gland should be performed with caution.


Disclosure: D. S. Hammenfors, None; V. Valim, None; S. G. Pasoto, None; V. Lilleby, None; J. C. Nieto, None; C. Silva, None; R. M. R. Pereira, None; B. Bica, None; J. G. Brun, None; R. Jonsson, None; M. V. Jonsson, None.

To cite this abstract in AMA style:

Hammenfors DS, Valim V, Pasoto SG, Lilleby V, Nieto JC, Silva C, Pereira RMR, Bica B, Brun JG, Jonsson R, Jonsson MV. Major Salivary Gland Ultrasonography Bed-Side and Still Image Scoring – a Pilot Comparison in Juvenile Sjögren’s Syndrome [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/major-salivary-gland-ultrasonography-bed-side-and-still-image-scoring-a-pilot-comparison-in-juvenile-sjogrens-syndrome/. Accessed February 25, 2021.
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