Background/Purpose: To assess the accuracy of ultrasonography of the salivary glands (US) in the diagnosis of primary Sjögren’s syndrome (pSS) and to verify whether US abnormalities can be correlated to patients’ clinical features, to the histopathological score of minor salivary gland biopsies and to the patients’ unstimulated sialometry of whole saliva.

Methods: Consecutive patients with a diagnosis of pSS made according to the AECG criteria were enrolled in the cross sectional prospective study. The control group consisted of subjects with suspected SS who did not fulfill the AECG criteria for pSS. US examination of the parotid and submandibular salivary glands was performed by a real-time US (Esaote Technos MPX) equipped with a 7.5/10 MHz linear transducer. The size, parenchymal echogenicity and fibrosis of major salivary glands were evaluated by the same observer who was not aware of the patients’ clinical diagnosis. Parenchymal inhomogeneity was assessed scoring as 0 = completely normal, 1 = slight abnormalities/few hypoechogenic areas, 2 = multiple hypoechogenic areas or 3 = many or confluent hypoechogenic lesions. US abnormalities were compared with patients’ clinico-serological data, sialometric findings and minor salivary gland focus score. For statistical comparisons, the t-test, the chi square test and logistic regression analysis were employed. P-values <0.05 were considered significant.

Results: Out of the 122 consecutive patients included in the study, 74/122 (71 F:3M, age 54.7±11.8 yrs) met the AECG criteria for pSS while the other 48/122 (45 F:3M, age 54.8±14.9 yrs) represented the control group. US abnormalities were found in 53/74 pSS patients vs 10/48 control group (p<0.0001); the grading values 2 and 3 resulted more frequent in the pSS group (36/74 vs 2/48; p<0.0001). Overall, the sensitivity of US was 71%, specificity 79% (96%, if we considered only parotid inhomogeneity), positive predictive value 84% and negative predictive value 64%. Parenchymal inhomogeneity of both parotid and submandibular glands correlated with antinuclear antibodies (ANA), anti-Ro/SSA, hypergammaglobulinemia and Rheumatoid Factor positivities. Patients with score 3 had significantly higher ESSDAI score (grade 3 vs 1, p=0.004; grade 3 vs 2, p=0.037) and showed trends towards lower salivary flow in comparison to other subgroups (grade 3 vs 1, p = 0.01; grade 3 vs grade 2, p= ns). When pSS patients where stratified according to parenchymal inhomogeneity, no difference was found in the presence of focal sialadenitis.

Conclusion: Major salivary glands US may be a specific tool in the diagnosis of pSS. US abnormalities should be investigated particularly in pSS patients with positive serological markers.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasonography-of-salivary-glands-diagnostic-and-prognostic-value-in-primary-sjogrens-syndrome/