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

Technik zur Ultraschalluntersuchung des Speicheldrüsensyndroms beim Sjögren-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.

Autor im Rampenlicht: Ein Fokus auf ein standardisiertes Speicheldrüsen-Ultraschallprotokoll in der Forschung zu Bindegewebserkrankungen

Ultraschalluntersuchung der Speicheldrüsen beim Sjögren-Syndrom: Diagnostische und überwachende Erkenntnisse

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.

Ultraschalluntersuchung der Untermandibulardrüse zur Untersuchung des Sjögren-Syndroms

Positionieren Sie den Patienten in Rückenlage, wobei der Kopf maximal nach hinten geneigt ist. Um die Queransicht der Unterkieferdrüse zu erhalten, positionieren Sie den Schallkopf knapp unterhalb des Winkels des Unterkiefers im Unterkieferbereich. Untersuchen Sie die gesamte submandibuläre Drüse von anterior nach posterior, den Unterkiefer, die Mylohyoideusmuskeln und den vorderen Bauch der Digastricusmuskeln, die sie gebunden haben.Die Längsansicht erhalten Sie, indem Sie die Sonde medial zum horizontalen Körper des Unterkiefers platzieren. Visualisieren Sie die Gesichtsarterie in dieser Ebene. Speichern und beschriften Sie die Bilder sowohl in der Quer- als auch in der Längsansicht der Unterkieferdrüse.Beurteile die Größe der Unterkieferdrüse. Untersuchen Sie die Echogenität der Unterkieferdrüse, die normalerweise weniger echogen ist als die Ohrspeicheldrüse. Beurteilen Sie den Grad der Inhomogenität, die Klarheit des Drüsenrandes und das Vorhandensein von hypo- oder echoischen Bereichen innerhalb der Drüsen.Beachten Sie das Vorhandensein von fokalen Läsionen. Benoten Sie den Grad der Inhomogenität mit dem OMERACT-Score. Wenn die Bewertung der Verschraubung aufgrund qualitativer Parameter nicht möglich ist, befolgen Sie die alternativen Sortierparameter.Messen Sie die Größe der submandibulären Lymphknoten, beurteilen Sie die Fettknochen, die Form, die Echogenität und die Konservierung. Wiederholen Sie den Scan an der kontralateralen submandibulären Drüse und vergleichen Sie die Größe und Echotextur zwischen den beiden submandibulären Drüsen. Normale submandibuläre Drüsen zeigten eine klare Abgrenzung zu den darüber liegenden Strukturen.

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 ...

Forschung

Medizin

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

Ultraschalleinstellung und Abtastung der Schilddrüse zur Untersuchung des Sjögren-Syndroms

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

Ultraschalluntersuchung der Ohrspeicheldrüse zur Untersuchung des Sjögren-Syndroms