Real-Time Sonoelastography of Salivary Glands for Diagnosis and Functional Assessment of Primary Sjögren’s Syndrome

Elastographic ultrasound: an additional image tool in Sjögren's syndrome

“…3 On the other hand, EU is a technique used in the assessment of tissue elasticity and/or stiffness. 10,11,[19][20][21] A former study that evaluated different non-malignant parotid gland pathologies, detected higher elastography scores in patients with sialolithiasis, Stenon's duct stenosis, chronic sialoadenitis and pSS when compared with healthy controls; however, the highest scores corresponded to SS, 20 a finding that was further corroborated in other studies. Wave propagation is faster in stiffer tissues such as those seen in some tumors or chronic liver disease (e.g., cirrhosis).…”

“…18 Information about this novel technique in pSS is emerging. 10 In addition, Chen and colleaguess found an AUC of 0.95% to distinguish pSS patients (fulfilling the AECG criteria 12 ) from healthy controls, using a SWV cutoff value of 2.1 m/s; and when combining B-mode ultrasound score and SWV values, the ROC curve yielded an AUC of 0.94 and a mean accuracy of 91.9%. 11,19 In a study that included 157 patients with sicca symptoms and/or salivary swelling, and used the AECG SS classification criteria 12 as the gold standard, the sensitivity and specificity of the elastographic ultrasound was 81% and 67%, respectively.…”

“…6 The hypoechoic zones are typically 2-5 mm in size and their histological meaning might be lymphocytic infiltration, 7 whereas echogenic lines could represent fibrosis and fatty infiltration. 10 Moreover, the sensitivity and specificity of the method to distinguish pSS from patients with sicca symptoms and/or salivary swelling, ranges 81% and 67%, respectively. This is a velocity parameter, and it is integrated in images presented in a color-coded map, and analyzed in a workstation with qualitative, semiquantitative or quantitative results.…”

“…9 A study that compared the salivary gland stiffness measured by EU among patients with primary SS (pSS), normal subjects and patients with sicca symptoms found that patients with pSS had higher values of elastography (i.e., increased stiffness) with an excellent intraclass correlation (0.93, range 0.79-0.98). 10 Moreover, the sensitivity and specificity of the method to distinguish pSS from patients with sicca symptoms and/or salivary swelling, ranges 81% and 67%, respectively. 11 The aim of this study was to assess the elastographic characteristics of major salivary glands of pSS patients and correlate it with a B-mode ultrasound morphological score, glandular activity, sicca symptoms, nonstimulated whole salivary flow rate (NSWSF), the presence of salivary inflammatory (C-X-C motif ligand 13 [CXCL13], CXCL10, CXCL8, C-C motif ligand 2 [CCL2], interleukin 10 [IL-10] and IL-6) and pro-fibrotic chemokines and cytokines (CXCL14, CCL28, tumor necrosis factor-related apoptosis-inducing ligand, transforming growth factor [TGF]-b, CCL18), as well as with fibrosis at minor salivary gland biopsy.…”

Virtual Touch Quantification of the Salivary Glands for Diagnosis of Primary Sjögren Syndrome

“…Currently, there are very few articles reporting the stiffness of salivary glands in patients with primary Sjögren syndrome. Using strain elastography, Dejaco et al 15 showed that salivary glands of patients with primary Sjögren syndrome were significantly stiffer than those of healthy participants. On strain elastography, tissue deformation (strain) due to manual transducer compression is used for relative mapping of tissue stiffness: stiff regions have less deformation compared to softer regions.…”