Background/Purpose: Recently, Cornec D. et al. reported that salivary gland ultrasonography (SGUS) was characterized by a sensitivity of 65.8% and a specificity of 95.3%, in patients with primary Sjögren’s syndrome (pSS) and a disease duration of  ≤5 years, thus encouraging the use of SGUS for the early diagnosis of pSS. Aims of this study were:1) to validate SGUS diagnostic accuracy in a different cohort of patients with sicca symptoms duration of ≤5 years; 2) to correlate the SGUS score with minor salivary gland biopsy focus score (MSGB/FS) and unstimulated salivary flow rate measured by sialometry.

Methods: Patients with suspected pSS and symptoms duration of ≤5 years were consecutively enrolled in this study. The diagnosis of pSS was made according to the AECG criteria. SGUS was carried out by the same radiologist blinded to the diagnosis and the following US parameters were recorded: size, parenchymal echogenicity and inhomogeneity in the parotid and submandibular glands on both sides. A previously reported ultrasound scoring system (De Vita et al 1992, cut-off≥1) was used to grade the echostructure alterations of the salivary glands. Statistical analysis was performed using SPSS v16. 

Results: This study included 50 patients with pSS and 57 with no-SS sicca symptoms. The mean age of the pSS group was lower than non-SS group (47(13) vs 53(12) yrs, p=0.006).No further differences between the two groups were observed with respect to gender, frequency and duration of dry-mouth and dry-eye related symptoms. Patients with pSS showed a significantly higher SGUS score in comparison with controls (mean (SD)=2.1 (1.8) vs 0.0 (0.4), p=0.000). The SGUS cut-off≥1 showed a sensitivity (SE) of 66%, a specificity (SP) of 98%, a positive predictive value (PPV) of 97% and a negative predictive value (NPV) of 73% for pSS diagnosis. An inverse correlation was observed between the SGUS score and the age of the patients (r=-26, p=0.006) with younger patients frequently presenting multiple hypoechoic areas. The SGUS score was also correlated with both the MSGB/FS (r=55, p=0.000) and the salivary flow rate (r=-40, p=0.000).

Conclusion: This study confirmed the good performance that SGUS for the early non-invasive diagnosis of pSS. Further research in larger international cohort of patients is mandatory in order to assess the role of SGUS in the diagnostic algorithm of pSS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/salivary-gland-ultrasonography-a-highly-specific-tool-for-the-early-diagnosis-of-primary-sjogrens-syndrome/