Oral and maxillofacial radiology
Sonographic diagnostic criteria for screening Sjögren’s syndrome

https://doi.org/10.1016/j.tripleo.2005.09.012Get rights and content

Objective

The objective of this study is to establish readily applied sonographic diagnostic criteria for Sjögren’s syndrome.

Study design

Sonographic images of 79 cases of previously suspected Sjögren’s syndrome (including 43 actual cases) were analyzed retrospectively for the following characteristic features: (1) multiple hypoechoic areas, (2) multiple hyperechoic lines or spots, (3) multiple hypoechoic areas surrounded with hyperechoic lines or spots, and (4) obscuration of the gland configuration. Logistic regression analysis was used to extract valuable sonographic findings. Sonographic images of 80 prospective patients (of whom 48 proved to have Sjögren’s syndrome) were scored prospectively using selected features to verify the usefulness of the established criteria.

Results

Three sonographic findings in parotid and submandibular glands were selected by logistic regression analysis and retrospective and prospective patients compared. Experienced observers could differentiate positive cases of Sjögren’s syndrome from negative controls to a highly significant degree. Findings correlated very well with sialographic grading.

Conclusion

Sonography can be substituted for sialography when applying the selected criteria in screening for Sjögren’s syndrome.

Section snippets

Patients

Patients who visited our hospital with suspicions of Sjögren’s syndrome and who were examined both by sonography and by sialography constituted the study population. Two groups of patients were studied:

  • Group 1: Seventy-nine subjects observed for possible Sjögren’s syndrome from January 1999 to October 2001. Subjects comprised 7 males and 72 females with a mean age of 50.8 years. Sonographic criteria were established using images from this group of patients who were determined to have Sjögren’s

Results

Forty-three of 79 Group 1 subjects were positive for Sjögren’s based on the revised Japanese criteria.3 Table III shows sensitivity, specificity, and accuracy for each sonographic finding in this Group. Those classified as “probable” were included in the “negative” set for data analysis purposes. The finding of “multiple hyperechoic lines and/or spots” in parotid glands (P2 in Table III) showed high sensitivity, specificity, and accuracy. The findings of “multiple hypoechoic areas surrounded

Discussion

This study was carried out to establish easily applied sonographic criteria for Sjögren’s syndrome. Inhomogeneity had previously been reported to be the most important sonographic finding; however, it is sometimes difficult to detect whether the gland is homogeneous or not. Hence, we determined more concrete findings of inhomogeneity that are relatively easy to perceive: (1) multiple hypoechoic areas, (2) multiple hyperechoic lines and/or spots, and (3) multiple hypoechoic areas surrounded by

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