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: ACR/ARHP Annual Meeting 2017

Date of first publication: September 18, 2017

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

Session Information

Date: Monday, November 6, 2017

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 .

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