ultrasound scanning of the parotid gland for examining sjogren&#39;s syndrome

Teknik til spytkirtel ultralydsundersøgelse af Sjögrens syndrom

Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration in exocrine glands, including the salivary and lacrimal glands. Xerostomia, keratoconjunctivitis sicca, and extraglandular manifestations, including arthralgia, cytopenia, and lymphoma, are described in patients with SS. SS can be divided into primary and secondary types, in which the latter occurs in association with other connective tissue diseases. In the 2016 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for primary SS, anti-SSA/Ro positivity and lymphocytic infiltration in labial salivary gland biopsy contributed to the two major criteria, whereas Schirmer's test, ocular staining score, and unstimulated salivary flow represented the rest of the minor criteria1. The criteria are summarized in Table 1. Labial biopsy is an invasive procedure with potential complications, including sampling error, sensory loss, and hematoma formation2. Ocular staining tests and salivary flow assessment require specialized settings and might not be widely available. 
Salivary gland ultrasonography (SGUS) is a non-invasive imaging modality that provides a detailed examination of the superficial salivary gland structure, which is commonly affected in patients with SS. Lymphocytic infiltration and inflammation in the salivary glands often lead to fatty infiltration, fibrosis, and loss of parenchyma, resulting in parenchymal inhomogeneity detected in SGUS3. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) working group derived an ultrasound scoring system from grades 0 to 3 to semi-quantify inhomogeneity and the presence of hypoechoic areas within the parotid or submandibular glands4. A cutoff of grade 2 or above in at least one gland was found to correlate with positive labial biopsies, sialometry, and positive autoantibodies5. It demonstrated excellent specificity and good sensitivity in fulfilling the 2016 ACR/EULAR classification criteria for primary SS when given similar weight as the minor criteria. This protocol presents a standardized and practical approach for diagnosing SGUS in SS in clinical settings.

Forfatter Spotlight: Fokus på standardiseret spytkirtel ultralydsprotokol i forskning i bindevævssygdomme

Ultrasonografisk evaluering af spytkirtler for Sjögrens syndrom: Diagnostisk og overvågningsindsigt

Our research focus is connective tissue diseases, including Sjogren's syndrome, and we will describe a standardized approach to saliva and ultrasound in diagnosing Sjogren's syndrome. We hope the protocol will be useful for clinicians unfamiliar with doing ultrasound to enhance its application in clinical practice. Ultrasound is a powerful tool in evaluating various rheumatological conditions, including arthritis, sjogren syndrome, and interstitial lung disease.It is helpful in diagnosis, monitoring and prognostication. It can be applied as an outcome measure in clinical studies such as detecting subclinical synovitis to assess the risk of rheumatoid arthritis progression. Ultrasound is an operator-dependent procedure and the result may be unreliable if inexperienced, hence performed.Well validated and quantitative measurements are often needed to standardize the description and reporting of pathological sonographic findings before they can be applied in clinical practice and research. In this procedure, we will describe how to conduct a salivary gland ultrasound in patients with sicker symptoms. This approach is easy to perform and can usually be completed within 10 to 15 minutes.We'll also demonstrate techniques to perform reliable and reproducible results to ensure the quality of the ultrasound scanning. Our center will continue to research on applying ultrasound in diagnosis and monitoring in rheumatology. We will research utilizing lung ultrasound for screening of interstitial lung disease associated with connective tissue diseases, hoping to improve the current screening strategy for lung fibrosis in rheumatology patients.

Ultralydsscanning af parotiskirtlen til undersøgelse af Sjögrens syndrom

For at begynde skal du dreje patientens hoved til den modsatte side af kirtlen, der undersøges. Placer transduceren i længderetningen langs den forreste kant af øresnæverkirtlen, lige foran øret og parallelt med tragus, og flyt den fra den øvre til den nedre pol af kirtlen. For at opnå standardvisningen skal du placere sonden på tværs i vinklen på underkæben for at opnå den tværgående scanning.Ideelt set er parotiskirtlen placeret mellem mastoiden og underkæben ramus i en tværgående visning. Scan parotiskirtlen på tværs fra den øvre til den nedre pol. Skub sonden under underkæbernes ramus for at visualisere parotiskirtlernes dybe del, som underkæben delvist kunne skjule.Placer sonden mellem mastoidprocessen og underkæbens vinkel. Gem og mærk billederne i både længde- og tværgående visninger. Vurder størrelsen af parotiskirtlen.Sammenlign ekkogeniciteten med skjoldbruskkirtlen, som ligner den normale parotiskirtel. Tænd for farvedoppleren for at differentiere blodkar fra den udvidede intraglandulære kanal, den retromandibulære vene og den ydre halspulsåre deler de overfladiske og dybe parotislapper. Fang graden af homogenitet, klarheden af kirtelkanten og tilstedeværelsen af hypo- eller ekkofrie områder.Bemærk tilstedeværelsen af fokale læsioner og dokumenter størrelsen, placeringen, formen og ekkogeniciteten. Tænd for farvedoppleren for at se efter vaskularitet. Bedøm graden af sonografisk involvering på en skala fra nul til tre som defineret på skærmen.Tilstedeværelsen af lymfeknuder i parotiskirtlen kan være normal og almindelig, især når den er placeret i den overfladiske lap. Mål lymfeknudernes diameter. Vurder formen, ekkogeniciteten og bevarelsen af fed hillam.Gentag scanningen ved den kontralaterale parotiskirtel og sammenlign størrelsen og ekkoteksturen mellem de to parotiskirtler. Normale parotiskirtler syntes homogene med klar afgrænsning med overliggende væv og muskler.

Research

JoVE Journal

Medicine

Ultrasound Scanning of the Parotid Gland for Examining Sjogren&#39;s Syndrome

Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights

Sjogren's syndrome (SS) is a chronic autoimmune condition commonly affecting the exocrine glands, causing oral or ocular dryness and extraglandular ...

Ultrasound Setting and Scanning of the Thyroid Gland for Examining Sjogren&#39;s Syndrome

Ultralydsindstilling og scanning af skjoldbruskkirtlen til undersøgelse af Sjögrens syndrom

Ultrasound Scanning of the Submandibular Gland for Examining Sjogren&#39;s Syndrome

Ultralydsscanning af submandibulære kirtel til undersøgelse af Sjögrens syndrom