Jousse-Joulin Sandrine, Nowak Emmanuel, Cornec Divi, Brown Jackie, Carr Andrew, Carotti Marina, Fisher Benjamin, Fradin Joel, Hocevar Alojzija, Jonsson Malin V, Luciano Nicoletta, Milic Vera, Rout John, Theander Elke, Stel Aaltje, Bootsma Hendrika, Vissink Arjan, Baldini Chiara, Baer Alan, Ng Wan Fai, Bowman Simon, Alavi Zarrin, Saraux Alain, Devauchelle-Pensec Valérie
Department of Rheumatology, Cavale Blanche Hospital and Brest Occidentale University, Brest, France.
INSERM CIC 1412, Brest Medical University Hospital, Brest, France.
RMD Open. 2017 Jun 9;3(1):e000364. doi: 10.1136/rmdopen-2016-000364. eCollection 2017.
Ultrasonography (US) is sensitive for detecting echostructural abnormalities of the major salivary glands (SGs) in primary Sjögren's syndrome (pSS). Our objectives were to define selected US-SG echostructural abnormalities in pSS, set up a preliminary atlas of these definitions and evaluate the consensual definitions reliability in both static and acquisition US-SG images.
International experts in SG US in pSS participated in consensus meetings to select and define echostructural abnormalities in pSS. The US reliability of detecting these abnormalities was assessed using a two-step method. First 12 experts used a web-based standardised form to evaluate 60 static US-SG images. Intra observer and interobserver reliabilities were expressed in κ values. Second, five experts, who participated all throughout the study, evaluated US-SG acquisition interobserver reliability in pSS patients.
Parotid glands (PGs) and submandibular glands (SMGs) intra observer US reliability on static images was substantial (κ > 0.60) for the two main reliable items (echogenicity and homogeneity) and for the advised pSS diagnosis. PG inter observer reliability was substantial for homogeneity. SMGs interobserver reliability was moderate for homogeneity (κ = 0.46) and fair for echogenicity (κ = 0.38). On acquisition images, PGs interobserver reliability was substantial (κ = 0.62) for echogenicity and moderate (κ = 0.52) for homogeneity. The advised pSS diagnosis reliability was substantial (κ = 0.66). SMGs interobserver reliability was fair (0.20< κ ≤ 0.40) for echogenicity and homogeneity and either slight or poor for all other US core items.
This work identified two most reliable US-SG items (echogenicity and homogeneity) to be used by US-SG trained experts. US-PG interobserver reliability result for echogenicity is in line with diagnosis of pSS.
超声检查（US）对检测原发性干燥综合征（pSS）中主要唾液腺（SGs）的回声结构异常具有敏感性。我们的目的是定义pSS中选定的US-SG回声结构异常，建立这些定义的初步图谱，并评估在静态和采集的US-SG图像中这些共识定义的可靠性。
pSS中SG US的国际专家参加了共识会议，以选择和定义pSS中的回声结构异常。使用两步法评估检测这些异常的US可靠性。首先，12名专家使用基于网络的标准化表格评估60张静态US-SG图像。观察者内和观察者间的可靠性用κ值表示。其次，五名全程参与研究的专家评估了pSS患者中US-SG采集的观察者间可靠性。
对于两个主要的可靠项目（回声性和均匀性）以及建议的pSS诊断，腮腺（PGs）和颌下腺（SMGs）在静态图像上的观察者内US可靠性较高（κ>0.60）。PGs在均匀性方面的观察者间可靠性较高。SMGs在均匀性方面的观察者间可靠性中等（κ=0.46），在回声性方面的可靠性一般（κ=0.38）。在采集图像上，PGs在回声性方面的观察者间可靠性较高（κ=0.62），在均匀性方面的可靠性中等（κ=0.52）。建议的pSS诊断可靠性较高（κ=0.66）。SMGs在回声性和均匀性方面的观察者间可靠性一般（0.20<κ≤0.40），对于所有其他US核心项目，可靠性为轻微或较差。
这项工作确定了两个最可靠的US-SG项目（回声性和均匀性）供经过US-SG培训的专家使用。PGs在回声性方面的观察者间可靠性结果与pSS的诊断一致。
