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

Técnica para exame de ultrassom de glândulas salivares da síndrome de Sjögren

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.

Autor em destaque: um foco no protocolo padronizado de ultrassom da glândula salivar na pesquisa de doenças do tecido conjuntivo

Avaliação ultrassonográfica de glândulas salivares para síndrome de Sjögren: insights diagnósticos e de monitoramento

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.

Ultrassonografia da glândula parótida para exame da síndrome de Sjögren

Para começar, vire a cabeça do paciente para o lado oposto da glândula que está sendo examinada. Coloque o transdutor longitudinalmente ao longo da borda anterior da glândula parótida, logo anterior à orelha e paralela ao tragus, e mova-o do polo superior para o inferior da glândula. Para obter a visão padrão, coloque a sonda transversalmente no ângulo da mandíbula para obter a varredura transversal.Idealmente, a glândula parótida está localizada entre a mastóide e o ramo da mandíbula em uma visão transversal. Escaneie a glândula parótida transversalmente do polo superior ao inferior. Deslize a sonda abaixo do ramo das mandíbulas para visualizar a parte profunda das glândulas parótidas, que a mandíbula pode obscurecer parcialmente.Coloque a sonda entre o processo mastóideo e o ângulo da mandíbula. Salve e rotule as imagens nas visualizações longitudinal e transversal. Avalie o tamanho da glândula parótida.Compare a ecogenicidade com a da glândula tireoide, que é semelhante à glândula parótida normal. Ligue o doppler colorido para diferenciar os vasos sanguíneos do ducto intraglandular dilatado, a veia retromandibular e a artéria carótida externa dividem os lobos parótidas superficiais e profundos. Capture o grau de homogeneidade, a clareza da margem da glândula e a presença de áreas hipo ou anecóicas.Observe a presença de lesões focais e documente o tamanho, a localização, a forma e a ecogenicidade. Ligue o doppler colorido para procurar vascularização. Pontue o grau de envolvimento ultrassonográfico em uma escala de zero a três, conforme definido na tela.A presença de linfonodos dentro da glândula parótida pode ser normal e comum, especialmente quando localizada no lobo superficial. Meça o diâmetro dos gânglios linfáticos. Avalie a forma, ecogenicidade e preservação do hillam gorduroso.Repita a varredura na glândula parótida contralateral e compare o tamanho e a textura do eco entre as duas glândulas parótidas. As glândulas parótidas normais pareciam homogêneas com demarcação clara com tecidos e músculos sobrejacentes.

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 ...

Medicina

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

Configuração de ultrassom e varredura da glândula tireoide para examinar a síndrome de Sjögren

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

Ultrassonografia da glândula submandibular para exame da síndrome de Sjögren