Ultrasound Scoring of One Parotid and One Submandibular Gland in Primary Sjogren’s Syndrome – Further Increasing Feasibility in Outpatient Clinics

Esther Mossel¹, Suzanne Arends², Jolien F. van Nimwegen², Konstantina Delli³, Alja J. Stel¹, Frans G.M. Kroese², Fred K.L. Spijkervet⁴, Arjan Vissink⁵ and Hendrika Bootsma², ¹Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands, Groningen, Netherlands, ²Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, ³Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands, Groningen, Netherlands, ⁴Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, ⁵Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Sjogren's syndrome and ultrasound

Session Information

Date: Wednesday, November 8, 2017

Title: Imaging of Rheumatic Diseases II: Focus on Rheumatoid Arthritis and Systemic Sclerosis

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose:

To assess whether ultrasonographic scoring of (i) both parotid and submandibular salivary glands and (ii) all components of the Hocevar scoring system¹, is needed for classifying patients as primary Sjögren’s syndrome (pSS).

Methods:

Ultrasound examination of the major salivary glands (sUS) was performed in 204 consecutive outpatients, diagnosed or clinically suspected with pSS.

Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and salivary gland posterior border were scored in the right and left parotid and submandibular glands¹. Univariate and multivariate logistic regression analyses were performed to assess which salivary glands and sUS components significantly predicted classification as pSS or non-pSS according to the 2016 ACR-EULAR criteria².

Results:

116 (57%) patients were classified as pSS, the remaining 88 (43%) patients as non-pSS. The correlation between the sUS scores of both parotid glands (ρ=0.909), both submandibular glands (ρ=0.868) and between the left and right glands (ρ=0.926) was excellent. The correlation between the sUS scores of the left parotid and left submandibular gland (ρ=0.731) and between the right parotid and right submandibular gland (ρ=0.734) was slightly lower.

Multivariate analysis showed that sUS scores of one parotid gland and one submandibular gland contributed independently to ACR-EULAR classification. Instead of scoring both sides (area under the curve, AUC=0.856; Nagelkerke R²=0.527), sUS scoring of only the right (AUC=0.850; R²=0.518) or left (AUC=0.852; R²=0.511) parotid and submandibular glands is enough to significantly predict classification of patients according to the ACR-EULAR criteria.

In univariate analysis, all individual components of the Hocevar scoring system significantly predicted ACR-EULAR classification. Hypoechogenic areas showed the highest explained variance (R²=0.508). Multivariate analysis showed that only parenchymal echogenicity and hypoechogenic areas independently predicted ACR-EULAR classification (AUC=0.857; R²=0.539). Taking only the sUS scores of the right glands into account, multivariate analysis showed that only parenchymal echogenicity and hypoechogenic areas contributed independently to ACR-EULAR classification (AUC=0.855; R²=0.539). However, when scoring only hypoechogenic areas on one side, results were comparable (AUC=0.846; R²=0.498). Similar results were found when the analyses were repeated for the left glands.

Conclusion:

sUS examination of a parotid and submandibular gland on one side is enough to predict classification of patients according to the ACR-EULAR criteria.

Presence of hypoechogenic areas is the best predictor of ACR-EULAR classification. Although parenchymal echogenicity also independently predicted ACR-EULAR classification, its reliability is limited.³ Therefore, we conclude that sUS scoring of only hypoechogenic areas in one parotid and submandibular gland is enough to predict ACR-EULAR classification. These finding may increase the feasibility of sUS in outpatients clinics worldwide.

References:

1 Hocevar et al. Rheumatology 2005.

2 Shiboski et al. Ann Rheum Dis 2017.

3 Delli et al. Ultraschall Med 2017.

Disclosure: E. Mossel, None; S. Arends, None; J. F. van Nimwegen, None; K. Delli, None; A. J. Stel, None; F. G. M. Kroese, None; F. K. L. Spijkervet, None; A. Vissink, None; H. Bootsma, None.

To cite this abstract in AMA style:

Mossel E, Arends S, van Nimwegen JF, Delli K, Stel AJ, Kroese FGM, Spijkervet FKL, Vissink A, Bootsma H. Ultrasound Scoring of One Parotid and One Submandibular Gland in Primary Sjogren’s Syndrome – Further Increasing Feasibility in Outpatient Clinics [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/ultrasound-scoring-of-one-parotid-and-one-submandibular-gland-in-primary-sjogrens-syndrome-further-increasing-feasibility-in-outpatient-clinics/. Accessed .

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