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

쇼그렌 증후군의 타액선 초음파 검사 기법

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.

저자 스포트라이트: 결합 조직 질환 연구에서 표준화된 타액선 초음파 프로토콜에 초점

쇼그렌 증후군에 대한 타액선의 초음파 평가: 진단 및 모니터링 통찰력

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.

쇼그렌 증후군을 검사하기 위한 귀밑샘의 초음파 검사

먼저 환자의 머리를 검사 중인 분비샘의 반대쪽으로 돌립니다. 귀밑샘의 앞쪽 경계를 따라 변환기를 세로로 배치하고 귀 바로 앞쪽에 놓고 트래거스와 평행하게 놓고 귀밑샘의 위쪽 극에서 아래쪽 극으로 이동합니다. 표준 보기를 얻으려면 프로브를 하악 각도에 가로로 배치하여 가로 스캔을 얻습니다.이상적으로, 이하선은 유양돌기와 하악골 사이에 가로로 위치합니다. 귀밑샘을 상극에서 하극까지 가로로 스캔합니다. 프로브를 하악골 라무스 아래로 밀어 하악골이 부분적으로 가릴 수 있는 귀밑샘 깊은 부분을 시각화합니다.유양돌기와 하악골 각도 사이에 프로브를 놓습니다. 이미지를 longitudinal 및 transverse views 모두에서 저장하고 레이블을 지정합니다. 이하선의 크기를 평가합니다.정상 이하선과 유사한 갑상선의 초음파감과 비교해 보십시오. 컬러 도플러를 켜서 혈관을 확장된 선내관, 후악정맥 및 외경동맥에서 구별하여 표재성 이하엽과 깊은 이하선엽을 나눕니다. 균질성의 정도, 땀샘 가장자리의 선명도, 저반향 또는 무반향 영역의 존재를 포착합니다.국소 병변의 존재에 유의하고 크기, 위치, 모양 및 초음파성을 문서화합니다. 컬러 도플러를 켜서 혈관성을 찾습니다. 화면에 정의된 대로 0에서 3까지의 척도로 초음파 관여 정도를 점수화합니다.이하선 내에 림프절이 있는 것은 정상적이고 흔한 현상일 수 있으며, 특히 표재성 엽에 위치할 때 더욱 그렇습니다. 림프절의 직경을 측정합니다. 지방 힐람의 모양, 에코원성 및 보존을 평가합니다.반대쪽 이하선에서 스캔을 반복하고 두 이하선 사이의 크기와 반향 질감을 비교합니다. 정상적인 이하선 땀샘은 위에 놓인 조직과 근육과 명확한 경계로 균질하게 보였다.

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 ...

연구

의학

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

쇼그렌 증후군을 검사하기 위한 갑상선의 초음파 설정 및 스캔

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

쇼그렌 증후군을 검사하기 위한 턱밑샘의 초음파 스캔