Salaffi F, Carotti M, Iagnocco A, Luccioli F, Ramonda R, Sabatini E, De Nicola M, Maggi M, Priori R, Valesini G, Gerli R, Punzi L, Giuseppetti G M, Salvolini U, Grassi W
Department of Rheumatology, Polytechnic University of the Marche Region, Ancona, Italy.
Rheumatology (Oxford). 2008 Aug;47(8):1244-9. doi: 10.1093/rheumatology/ken222. Epub 2008 Jun 19.
To compare ultrasonography (US) of salivary glands with contrast sialography and scintigraphy, in order to evaluate the diagnostic value of this method in primary SS (pSS).
The diagnostic value of parotid gland US was studied in 77 patients with pSS (male/female ratio 3/74; mean age 54 yrs) and in 79 with sicca symptoms but without SS. The two groups were matched for sex and age. Imaging findings of US were graded using an ultrasonographic score ranging from 0 to 16, which was obtained by the sum of the scores for each parotid and submandibular gland. The sialographic and scintigraphic patterns were classified in four different stages. The area under receiver operating characteristic curve (AUC-ROC) was employed to evaluate the screening method's performance.
Of the 77 patients with pSS, 66 had abnormal US findings. Mean US score in pSS patients was 9.0 (range from 3 to 16). Subjects without confirmed pSS had the mean US score 3.9 (range from 0 to 9) (P < 0.0001). Results of sialography showed that 59 pSS patients had abnormal findings at Stage 1 (n = 4), Stage 2 (n = 8), Stage 3 (n = 33) or Stage 4 (n = 14), and 58 patients had abnormal scintigraphic findings at Stage 1 (n = 11), Stage 2 (n = 18), Stage 3 (n = 25) or Stage 4 (n = 4). Through ROC curves US arose as the best performer (AUC = 0.863 +/- 0.030), followed by sialography (AUC = 0.804 +/- 0.035) and by salivary gland scintigraphy (AUC = 0.783 +/- 0.037). The difference between AUC-ROC curve of salivary gland US and scintigraphy was significant (P = 0.034). Setting the cut-off score >6 US resulted in the best ratio of sensitivity (75.3%) to specificity (83.5%), with a likelihood ratio of 4.58. If a threshold >8.0 was applied the test gained specificity, at the cost of a serious loss of sensitivity (sensitivity 54.5%, specificity 97.5%, likelihood ratio 21.5).
Salivary gland US is a useful method in visualizing glandular structural changes in patients suspected of having pSS and it may represent a good option as a first-line imaging tool in the diagnostics of the disease.
比较唾液腺超声检查（US）与造影涎管造影及闪烁扫描法，以评估该方法在原发性干燥综合征（pSS）中的诊断价值。
对77例pSS患者（男/女比例为3/74；平均年龄54岁）和79例有干燥症状但无干燥综合征的患者进行腮腺超声诊断价值的研究。两组在性别和年龄上相匹配。超声检查结果采用0至16分的超声评分进行分级，该评分通过每个腮腺和颌下腺的得分总和获得。涎管造影和闪烁扫描模式分为四个不同阶段。采用受试者操作特征曲线下面积（AUC-ROC）评估筛查方法的性能。
77例pSS患者中，66例超声检查结果异常。pSS患者的平均超声评分为9.0（范围为3至16）。未确诊为pSS的受试者平均超声评分为3.9（范围为0至9）（P<0.0001）。涎管造影结果显示，59例pSS患者在第1阶段（n = 4）、第2阶段（n = 8）、第3阶段（n = 33）或第4阶段（n = 14）有异常发现，58例患者在第1阶段（n = 11）、第2阶段（n = 18）、第3阶段（n = 25）或第4阶段（n = 4）有闪烁扫描异常发现。通过ROC曲线，超声检查表现最佳（AUC = 0.863±0.030），其次是涎管造影（AUC = 0.804±0.035）和唾液腺闪烁扫描（AUC = 0.783±0.037）。唾液腺超声与闪烁扫描的AUC-ROC曲线差异有统计学意义（P = 0.034）。将超声评分临界值设为>6时，敏感性（75.3%）与特异性（83.5%）的比例最佳，似然比为4.58。如果应用阈值>8.0，该测试可提高特异性，但敏感性会严重降低（敏感性54.5%，特异性97.5%，似然比21.5）。
唾液腺超声是一种有用的方法，可用于观察疑似pSS患者的腺体结构变化，它可能是该疾病诊断中作为一线成像工具的良好选择。
