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

Tecnica per l'esame ecografico delle ghiandole salivari della sindrome di Sjogren

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.

Autore in primo piano: Un focus sul protocollo ecografico standardizzato delle ghiandole salivari nella ricerca sulle malattie del tessuto connettivo

Valutazione ecografica delle ghiandole salivari per la sindrome di Sjogren: approfondimenti diagnostici e di monitoraggio

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.

Ecografia della ghiandola sottomandibolare per l&#39;esame della sindrome di Sjogren

Posizionare il paziente in posizione supina con la testa inclinata al massimo all'indietro. Per ottenere la vista trasversale della ghiandola sottomandibolare, posizionare il trasduttore appena sotto l'angolo della mandibola nella zona sottomandibolare. Esamina l'intera ghiandola sottomandibolare dalla parte anteriore a quella posteriore, la mandibola, i muscoli miloioidei e il ventre anteriore dei muscoli digastrici la legano.Ottenere la vista longitudinale posizionando la sonda medialmente al corpo orizzontale della mandibola. Visualizza l'arteria facciale in questo piano. Salva ed etichetta le immagini sia in vista trasversale che longitudinale della ghiandola sottomandibolare.Valutare le dimensioni della ghiandola sottomandibolare. Esaminare l'ecogenicità della ghiandola sottomandibolare, che di solito è meno ecogena della ghiandola parotide. Valutare il grado di disomogeneità, la chiarezza del margine ghiandolare e la presenza di aree ipo o anecoiche all'interno delle ghiandole.Notare la presenza di lesioni focali. Valutare il grado di disomogeneità utilizzando il punteggio OMERACT. Se la valutazione della ghiandola non è possibile a causa di parametri qualitativi, seguire i parametri di classificazione alternativi.Misurare le dimensioni dei linfonodi sottomandibolari, valutare gli ili adiposi, la forma, l'ecogenicità e la conservazione. Ripetere la scansione alla ghiandola sottomandibolare controlaterale e confrontare le dimensioni e la consistenza dell'eco tra le due ghiandole sottomandibolari. Le ghiandole sottomandibolari normali hanno dimostrato una chiara demarcazione con le strutture sovrastanti.

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 ...

Ricerca

Medicina

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

Impostazione ecografica e scansione della ghiandola tiroidea per l&#39;esame della sindrome di Sjogren

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

Ecografia della ghiandola parotide per l&#39;esame della sindrome di Sjogren