Giuseppetti Gian Marco, Argalia Giulio, Salera Diego, Ranaldi Roberto, Danieli Giovanna, Cappelli Marida
Institute of Radiology, University School of Medicine, Umberto I Hospital, Via Conca 1, Ancona, Italy.
Eur J Radiol. 2005 May;54(2):225-32. doi: 10.1016/j.ejrad.2004.04.018.
To assess the ability of US contrast-enhanced time-intensity curves to depict the changes connected with sicca syndrome, a fairly common condition that is often associated with autoimmune disorders such as Sjogren's syndrome or other diseases. Diagnostic criteria are complex and controversial and although no single test can be considered the gold standard, salivary gland scintigraphy and biopsy are reliable diagnostic methods.
Sixty consecutive patients with sicca syndrome, 40 of whom had primary (n = 23) or secondary (n = 17) Sjogren's syndrome and 20 had non-Sjogren's sicca syndrome, selected according to European Community Study Group diagnostic criteria for Sjogren's syndrome and subjected to contrast-enhanced US imaging of the parotids using a second-generation contrast agent with analysis of time-intensity curves at rest and during salivary stimulation, Tc99m salivary gland scintigraphy and labial gland biopsy.
In the 40 Sjogren's patients, US enhancement values were significantly lower (P < 0.0001 and P < 0.00003, respectively) than in the 20 non-Sjogren's patients both at rest and during stimulation. In the 23 subjects with the primary syndrome, values during stimulation were significantly lower than in the 17 subjects with the secondary syndrome (P < 0.0006), whereas at rest differences were not significant. Contrast-enhanced US imaging allowed to discriminate Sjogren's from non-Sjogren's sicca patients with 87.5% sensitivity, 85% specificity and 86.7% accuracy and the primary from the secondary syndrome with 78.2% sensitivity, 70.5% specificity and 75% accuracy. Interestingly, in eight patients with the primary syndrome, i.e. those with the more severe gland involvement, enhancement values were lower during stimulation than at rest.
Preliminary results indicate that contrast-enhanced US imaging can provide useful information on sicca characterisation and severity.
评估超声造影时间-强度曲线描绘与干燥综合征相关变化的能力。干燥综合征是一种相当常见的病症，常与自身免疫性疾病如舍格伦综合征或其他疾病相关。其诊断标准复杂且存在争议，尽管没有单一测试可被视为金标准，但唾液腺闪烁扫描和活检是可靠的诊断方法。
根据欧洲共同体舍格伦综合征研究组的诊断标准，连续选取60例干燥综合征患者，其中40例患有原发性（n = 23）或继发性（n = 17）舍格伦综合征，20例患有非舍格伦干燥综合征。使用第二代造影剂对腮腺进行超声造影成像，并分析静息状态和唾液刺激时的时间-强度曲线，同时进行Tc99m唾液腺闪烁扫描和唇腺活检。
在40例舍格伦综合征患者中，无论是静息状态还是刺激状态下，超声增强值均显著低于20例非舍格伦综合征患者（分别为P < 0.0001和P < 0.00003）。在23例原发性综合征患者中，刺激状态下的值显著低于17例继发性综合征患者（P < 0.0006），而静息状态下差异不显著。超声造影成像能够鉴别舍格伦综合征与非舍格伦干燥综合征患者，敏感性为87.5%，特异性为85%，准确性为86.7%；鉴别原发性综合征与继发性综合征，敏感性为78.2%，特异性为70.5%，准确性为75%。有趣的是，在8例原发性综合征患者中，即腺体受累更严重的患者，刺激状态下的增强值低于静息状态。
初步结果表明，超声造影成像可为干燥综合征的特征描述和严重程度提供有用信息。
