Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Salivary gland ultrasonography is a highly specific tool for the diagnosis of primary Sjögren´s syndrome (PSS). Real time sonoelastography (RTS) is a novel imaging option involving tissue stiffness assessment. Previous works have reported higher RTS values in PSS vs healthy and sicca controls. Herein we evaluated the stiffness of parotid and submandibular glands using RTS and correlated it with a multiparametric approach including morphologic ultrasonographic parameters, profibrotic chemokines and cytokines levels, serology and the presence of minor salivary gland fibrosis.
Methods: We included 26 patients with PSS according to the AECG criteria, who had a salivary gland biopsy with no more than 5 years previous the ultrasonographic evaluation. B-Mode ultrasonography and RTS (ARFI methodology) were performed by a trained radiologist. Parotid and submandibular glands were individually rated for parenchymal echogenicity, homogeneity, hypo-echogenic areas, hyper-echogenic reflections and clearness of borders using the Hocevar scale (global B-mode sum score 0-48 points). RTS was also conducted at both parotid and submandibular glands (8 areas of each gland to obtain a median value) and we registered the median value of shear wave velocity (SVV) expressed in m/s. We assessed the ESSDAI, ESSPRI, non-stimulated whole salivary flow rate (NSWSF), C3 and C4 levels, rheumatoid factor, anti-Ro/La antibodies and salivary levels of CXCL14, CCL28, TRAIL and TGb by ELISA. We also evaluated salivary gland fibrosis with the Masson’s trichrome staining.
Results: The mean age was 51.1±11 years, median disease duration 6.1 years, 92.8% females, 92.8% had oral symptoms and 26.9% fibrosis at the minor salivary gland. The global B mode score was of 22.2 points (13-44) and the SVV 2.5 (1.64-3.28) m/seg. We found a correlation between SVV and the global B mode score (t=0.53, p=0.001), SVV between both parotids (t=0.58, p=0.0001) and both submandibulars (t=0.50, p=0.0001); but not between parotids and submandibular glands. The SVV correlated with the NSWSF (t=-0.53, p=0.001), ESSDAI (t=0.31, p=0.03), glandular ESDDAI domain (t=0.36, p=0.02), C4 levels (t=-0.32, p=0.04), but not with age or any other variable including fibrosis and salivary chemokines/cytokines. At the linear regression analysis, the glandular ESSDAI domain (B=0.49, p=0.04), the C4 level (B=-0.02, p=0.05) and the disease duration (B=0.04, p=0.04) correlated with the SVV.
Conclusion: SVV correlated with the ultrasonography morphologic score and glandular activity but not with fibrosis, suggesting that it rather represents glandular inflammation. Further prospective studies are needed to evaluate its sensitivity to change over time.
To cite this abstract in AMA style:Hernandez-Molina G, Azpeitia L, Criales-Vera S, Pacheco C, Reyes E, Lima G, Llorente L, Kimura-Hayama E. Real Time Sonoelastography in Primary Sjögren’s Syndrome Correlates with Morphological Ultrasonographic Features and Glandular Activity but Not with Glandular Fibrosis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/real-time-sonoelastography-in-primary-sjogrens-syndrome-correlates-with-morphological-ultrasonographic-features-and-glandular-activity-but-not-with-glandular-fibrosis/. Accessed March 25, 2019.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/real-time-sonoelastography-in-primary-sjogrens-syndrome-correlates-with-morphological-ultrasonographic-features-and-glandular-activity-but-not-with-glandular-fibrosis/