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

Teknikk for ultralydundersøkelse av spyttkjertelen ved Sjøgrens 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.

Forfatter Spotlight: Et fokus på standardisert ultralydprotokoll for spyttkjertelen i forskning på bindevevssykdommer

Ultrasonografisk evaluering av spyttkjertler for Sjøgrens syndrom: diagnostisk og overvåkingsinnsikt

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.

Ultralydskanning av submandibulære kjertelen for undersøkelse av Sjögrens syndrom

Plasser pasienten i liggende stilling med hodet maksimalt vippet bakover. For å få den tverrgående visningen av den submandibulære kjertelen, plasser transduseren rett under vinkelen til underkjeven i det submandibulære området. Undersøk hele den submandibulære kjertelen fra fremre til bakre, underkjeven, mylohyoidmusklene og den fremre magen til de digastriske musklene bandt den.Få den langsgående visningen ved å plassere sonden medialt til den horisontale kroppen til underkjeven. Visualiser ansiktsarterien i dette planet. Lagre og merk bildene i både tverrgående og langsgående visninger av den submandibulære kjertelen.Vurder størrelsen på den submandibulære kjertelen. Undersøk ekkogenisiteten til den submandibulære kjertelen, som vanligvis er mindre ekkogen enn parotiskjertelen. Vurder graden av inhomogenitet, klarheten i kjertelmarginen og tilstedeværelsen av hypo- eller an-ekkoiske områder i kjertlene.Legg merke til tilstedeværelsen av fokale lesjoner. Vurder graden av inhomogenitet ved å bruke OMERACT-poengsummen. Hvis evalueringen av kjertelen ikke er mulig på grunn av kvalitative parametere, følg de alternative graderingsparametrene.Mål størrelsen på de submandibulære lymfeknuter, vurder fetthilum, form, ekkogenisitet og konservering. Gjenta skanningen ved den kontralaterale submandibulære kjertelen og sammenlign størrelsen og ekkoteksturen mellom de to submandibulære kjertlene. Normale submandibulære kjertler viste en klar avgrensning med de overliggende strukturene.

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 ...

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

Ultralydinnstilling og skanning av skjoldbruskkjertelen for undersøkelse av Sjøgrens syndrom

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

Ultralydundersøkelse av parotiskjertelen for undersøkelse av Sjøgrens syndrom