ultrasound scanning of the submandibular 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 턱밑샘의 초음파 스캔

머리를 최대한 뒤로 기울여 환자를 앙와위 자세로 놓습니다. 턱밑샘의 횡단 시야를 얻으려면 턱밑 영역에서 하악의 각도 바로 아래에 변환기를 배치합니다. 턱밑샘 전체를 전방에서 후방까지 검사하고, 하악근, 골수설근, 그리고 이를 묶고 있는 이복근의 전배를 검사합니다.하악골의 수평체에 내측 프로브를 배치하여 종방향 view를 얻습니다. 이 평면에서 안면 동맥을 시각화합니다. submandibular gland의 transverse and longitudinal views(횡방향 및 종방향 보기)로 이미지를 저장하고 레이블을 지정합니다.턱밑샘의 크기를 평가합니다. 턱밑샘(submandibular gland)의 초음파원성(echogenicity)을 검사하는데, 보통 이하선(parotid gland)보다 초음파성(echogenic)이 적습니다. 불균일성의 정도, 땀샘 가장자리의 선명도, 땀샘 내 저반향 영역(hypo 또는 an-echoic area)의 존재를 평가합니다.국소 병변의 존재에 유의하십시오. OMERACT 점수를 사용하여 불균일성 정도를 등급화합니다. 정성적 매개변수로 인해 땀샘 평가가 불가능한 경우 대체 등급 매개변수를 따르십시오.턱밑 림프절의 크기를 측정하고 지방 림프절, 모양, 초음파성 및 보존을 평가합니다. 반대측 턱밑샘에서 스캔을 반복하고 두 턱밑샘 사이의 크기와 반향 질감을 비교합니다. 정상적인 턱밑샘은 위에 놓인 구조와 명확한 경계를 보여주었다.

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 ...

연구

의학

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