Abstract:Objective: To explore the diagnostic value of Young’s modulus by real-time shear wave elastography(RT-SWE) combined with sonographic score in parotid gland with primary Sjogren’s syndrome(pSS). Methods: One hundred and forty suspected Sjogren’s syndrome patients were enrolled in this study. The bilateral parotid gland was examined by ultrasonography and RT-SWE. Semiquantitative scores and the Young’s modulus were obtained. The differences of sonographic scores and Young’s modulus between two sides of parotid glands in pSS group and the non-pSS group were analyzed. And the diagnostic efficacy of sonographic scores combined with Emean in parotid gland damage of pSS was also analyzed, the ROC curve was plotted. Results: ①Sonographic score in pSS group was higher than non-pSS group(P<0.001). The ROC curve showed that the best cut-off value was 2, the sensitivity and specificity was 81.6% and 93.7%, respectively, and the area under the curve(AUC) was 0.906. ②The Young’s modulus between two sides of parotid glands in pSS group or non-pSS group showed no significant difference(P>0.05). The difference of Young’s modulus between the two groups was statistically significant(P<0.001). The ROC curve showed that the optimal cut-off value of Emean was 9.9 kPa, the sensitivity and specificity was 75.0% and 95.3%, respectively, and the AUC was 0.876. ③The sensitivity and specificity of parotid ultrasonography scores combined with RT-SWE for diagnosis of pSS was 88.2% and 90.6%, respectively, and the AUC was 0.950. The AUC of the combined score was greater than the AUC of the sonographic scores or Young’s modulus(P value was 0.033 and 0.001, respectively). Conclusion: The parotid sonographic scores can provide a semi-quantitative index for the uniformity of glandular echo. RT-SWE can measure the hardness of parotid gland. The combination of these two is highly accurate in the evaluation of parotid gland with pSS, which is worthy of clinical promotion.
王娇娇,张 磊,刘升云,马 笑,齐清华,董 刚. 实时剪切波弹性成像联合超声评分在原发性干燥综合征
腮腺受损诊断中的价值[J]. 中国临床医学影像杂志, 2019, 30(11): 773-777.
WANG Jiao-jiao, ZHANG Lei, LIU Sheng-yun, MA Xiao, QI Qing-hua, DONG Gang. The diagnosis value of RT-SWE combined with sonographic score in
parotid gland damage of primary Sjogren’s syndrome. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(11): 773-777.
[1]Srinivasan S, Slomovic AR. Sjogren syndrome[J]. Comprehensive Ophthalmol Update, 2007, 8(4): 205-212.
[2]中华医学会风湿病学分会. 干燥综合征诊断及治疗指南[J]. 中华风湿病学杂志,2010,11(14):766-768.
[3]Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group[J]. Ann Rheum Dis, 2002, 61(6): 554-558.
[4]Mossel E, Arends S, van Nimwegen JF, et al. Scoring hypoechogenic areas in one parotid and one submandibular gland increases feasibility of ultrasound in primary Sjogren’s syndrome[J]. Ann Rheum Dis, 2018, 77(4): 556-562.
[5]Ienopoli S, Carsons SE. Extraglandular manifestations of primary Sjogren’s syndrome[J]. Oral Maxillofac Surg Clin North Am, 2014, 26(1): 91-99.
[6]Jonsson MV, Baldini C. Major salivary gland ultrasonography in the diagnosis of Sjogren’s syndrome: a place in the diagnostic criteria?[J]. Rheum Dis Clin North Am, 2016, 42(3): 501-517.
[7]Yang Z, Zhang H, Wang K, et al. Assessment of diffuse thyroid disease by strain ratio in ultrasound elastography[J]. Ultrasound Med Biol, 2015, 41(11): 2884-2889.
[8]Li Y, Wang Y, Wu Q, et al. Papillary thyroid microcarcinoma co-exists with Hashimoto’s thyroiditis: is strain elastography still useful?[J]. Ultrasonics, 2016, 68(2): 127-133.
[9]Takagi Y, Sumi M, Nakamura H, et al. Ultrasonography as an additional item in the American College of Rheumatology classification of Sjogren’s syndrome[J]. Rheumatology(Oxford), 2014, 53(11): 1977-1983.
[10]Milic V, Petrovic R, Boricic I, et al. Ultrasonography of major salivary glands could be an alternative tool to sialoscintigraphy in the American-European classification criteria for primary Sjogren’s syndrome[J]. Rheumatology(Oxford), 2012, 51(6): 1081-1085.
[11]Zhang X, Zhang S, He J, et al. Ultrasonographic evaluation of major salivary glands in primary Sjogren’s syndrome: comparison of two scoring systems[J]. Rheumatology(Oxford), 2015, 54(9): 1680-1687.
[12]张霞,何菁. 涎腺超声对干燥综合征诊断的贡献:是否作为新的诊断标准[J]. 中华风湿病学杂志,2013,17(10):713.
[13]Cornec D, Jousse-Joulin S, Pers JO, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjogren’s syndrome: toward new diagnostic criteria?[J]. Arthritis Rheum, 2013, 65(1): 216-225.
[14]Cindil E, Oktar SO, Akkan K, et al. Ultrasound elastography in assessment of salivary glands involvement in primary Sjogren’s syndrome[J]. Clin Imaging, 2018, 50: 229-234.
[15]陈娟,谢明星,王静,等. 实时剪切波弹性成像评价干燥综合征患者涎腺弹性模量的初步临床研究[J]. 中华超声影像学杂志,2018,27(3):220-225.
[16]Westerland O, Howlett D. Sonoelastography techniques in the evaluation and diagnosis of parotid neoplasms[J]. Eur Radiol, 2012, 22(5): 966-969.
[17]Gunes Tatar I, Altunoglu H, Kurt A, et al. The role of salivary gland elastosonography in Sjogren’s syndrome: preliminary results[J]. Int J Rheum Dis, 2014, 17(8): 904-909.
[18]刘芳,任卫东. 实时剪切波弹性成像对原发性干燥综合征患者腮腺病变的诊断价值[J]. 中国临床医学影像杂志,2018,29(8):564-567.