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

Technique d’échographie des glandes salivaires Examen du syndrome 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.

Pleins feux sur l’auteur : Un regard sur le protocole normalisé d’échographie des glandes salivaires dans la recherche sur les maladies du tissu conjonctif

Évaluation échographique des glandes salivaires pour le syndrome de Sjögren : perspectives de diagnostic et de surveillance

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.

Échographie de la glande sous-mandibulaire pour l&#39;examen du syndrome de Sjögren

Positionnez le patient en position couchée avec la tête inclinée au maximum vers l’arrière. Pour obtenir la vue transversale de la glande sous-mandibulaire, placez le transducteur juste en dessous de l’angle de la mandibule au niveau de la zone sous-mandibulaire. Examinez toute la glande sous-mandibulaire de l’avant à l’arrière, la mandibule, les muscles mylohyoïdiens et le ventre antérieur des muscles digastriques la relient.Obtenez la vue longitudinale en plaçant la sonde médialement par rapport au corps horizontal de la mandibule. Visualisez l’artère faciale dans ce plan. Enregistrez et étiquetez les images dans des vues transversales et longitudinales de la glande sous-mandibulaire.Évaluez la taille de la glande sous-maxillaire. Examinez l’échogénicité de la glande sous-mandibulaire, qui est généralement moins échogène que la glande parotide. Évaluer le degré d’inhomogénéité, la clarté du bord de la glande et la présence de zones hypo ou anéchoïques à l’intérieur des glandes.Notez la présence de lésions focales. Évaluez le degré d’inhomogénéité à l’aide du score OMERACT. Si l’évaluation du presse-étoupe n’est pas possible en raison de paramètres qualitatifs, suivez les autres paramètres de classement.Mesurer la taille des ganglions lymphatiques sous-mandibulaires, évaluer les hiles adipeux, la forme, l’échogénicité et la préservation. Répétez le balayage au niveau de la glande sous-mandibulaire controlatérale et comparez la taille et la texture de l’écho entre les deux glandes sous-mandibulaires. Les glandes sous-mandibulaires normales ont montré une démarcation claire avec les structures sus-jacentes.

Research

JoVE Journal

Medicine

Ultrasound Scanning of the Submandibular 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 ...

Recherche

Médecine

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

Réglage de l&#39;échographie et balayage de la glande thyroïde pour l&#39;examen du syndrome de Sjögren

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

Échographie de la glande parotide pour l&#39;examen du syndrome de Sjögren