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

シェーグレン症候群の唾液腺超音波検査の技術

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.

著者スポットライト:結合組織疾患研究における標準化された唾液腺超音波プロトコルへの注目

シェーグレン症候群に対する唾液腺の超音波評価:診断とモニタリングの洞察

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.

シェーグレン症候群を検査するための耳下腺の超音波スキャン

まず、患者の頭を検査対象の腺の反対側に向けます。トランスデューサーを耳下腺の前方境界に沿って縦方向、耳のすぐ前、耳珠と平行に配置し、トランスデューサーを耳の下極から下極に移動します。標準ビューを取得するには、プローブを下顎骨の角度で横方向に配置して、横方向のスキャンを取得します。理想的には、耳下腺は横方向から見て乳様突起と下顎枝の間に位置しています。耳下腺を上極から下極まで横方向にスキャンします。プローブを下顎枝の下にスライドさせて、下顎骨が部分的に不明瞭になる可能性のある耳下腺の深い部分を視覚化します。乳様突起と下顎骨の角度の間にプローブを配置します。縦方向と横方向の両方のビューで画像を保存し、ラベルを付けます。耳下腺のサイズを評価します。エコー源性を甲状腺のエコー源性と比較しますが、これは正常な耳下腺に似ています。カラードップラーをオンにして血管を拡張した腺内管と区別し、顎後静脈と外頸動脈が表在性耳下腺葉と深部耳下腺葉を分割します。均質性の程度、腺縁の明瞭さ、および低音または無響領域の存在をキャプチャします。限局性病変の存在に注意し、サイズ、位置、形状、およびエコー源性を文書化します。カラードップラーをオンにして、血管を探します。超音波検査の関与の程度を、画面で定義されている 0 から 3 のスケールで採点します。耳下腺内のリンパ節の存在は、特に表在葉に位置する場合、正常で一般的である可能性があります。リンパ節の直径を測定します。脂肪質のヒラムの形状、エコー源性、および保存を評価します。反対側の耳下腺でスキャンを繰り返し、2つの耳下腺のサイズとエコーテクスチャを比較します。正常な耳下腺は均質に見え、その上にある組織や筋肉との明確な境界がありました。

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 ...

医学

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

シェーグレン症候群を検査するための甲状腺の超音波設定とスキャン

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

シェーグレン症候群を検査するための顎下腺の超音波スキャン