Rheumatology Department, Centro Hospitalar e Universitário de Coimbra.
Rheumatology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho.
ARP Rheumatol. 2022 Nov 1;1(ARP Rheumatology, nº3 2022):197-204.
Salivary glands ultrasonography has recently been shown to be useful in the diagnosis of Primary Sjögren's Syndrome (pSS). Shear-wave elastography (SWE) is a promising tool for the quantitative assessment of tissues stiffness, but studies evaluating its role in pSS diagnosis are limited. This study aimed at investigating the diagnostic performance of SWE in pSS.
Cross-sectional study including patients fulfilling the 2016 ACR/EULAR classification criteria for pSS and healthy subjects. The four major salivary glands were assessed using SGUS. B-mode scans were rated using the Hočevar score, and shear-wave velocity (SWV) values were obtained using SWE. Intraclass-correlation coefficient (ICC) estimates were used to assess reliability. Cut-off values for differentiating pSS patients from healthy subjects were calculated using Receiver-Operating Characteristics (ROC) curves.
We included 50 pSS and 25 healthy subjects. Inter-rater reliability of SWE was moderate (ICC=0.64) and intra-rater reliability was moderate to good (ICC= 0.73 to 0.83). Total SWV (2.09 m/s (0.32); p < 0.001), parotid SWV (2.25 m/s (0.40)) and submandibular SWV (1.92 m/s (0.38)) were significantly higher in pSS patients. Total and parotid SWV presented good diagnostic performance for pSS diagnosis (AUROC= 0.80 and 0.81, respectively). The Hočevar score demonstrated excellent diagnostic performance (AUROC= 0.98) and combining it with total SWV did not result in statistically significant improvement (p=0.301).
SWE may contribute to the diagnosis of pSS. Large prospective studies including sicca and secondary SS patients, as well as the standardisation of SWE protocols, are warranted to assess the role of SWE in pSS management.
唾液腺超声检查最近已被证明对原发性干燥综合征（pSS）的诊断有用。剪切波弹性成像（SWE）是一种评估组织硬度的有前途的工具，但评估其在 pSS 诊断中作用的研究有限。本研究旨在探讨 SWE 在 pSS 诊断中的性能。
这项横断面研究纳入了符合 2016 年 ACR/EULAR pSS 分类标准的患者和健康受试者。使用 SGUS 评估四大唾液腺。使用 Hočevar 评分对 B 型扫描进行评分，并使用 SWE 获得剪切波速度（SWV）值。使用组内相关系数（ICC）评估可靠性。使用接收器工作特征（ROC）曲线计算区分 pSS 患者和健康受试者的截断值。
我们纳入了 50 名 pSS 患者和 25 名健康受试者。SWE 的观察者间可靠性为中度（ICC=0.64），观察者内可靠性为中度至良好（ICC=0.73 至 0.83）。pSS 患者的总 SWV（2.09 m/s（0.32）；p < 0.001）、腮腺 SWV（2.25 m/s（0.40））和颌下腺 SWV（1.92 m/s（0.38））明显较高。总 SWV 和腮腺 SWV 对 pSS 诊断具有良好的诊断性能（AUROC=0.80 和 0.81）。Hočevar 评分具有出色的诊断性能（AUROC=0.98），并且结合总 SWV 并没有显著提高（p=0.301）。
SWE 可能有助于 pSS 的诊断。需要进行包括干燥症和继发性 SS 患者的大型前瞻性研究，并标准化 SWE 方案，以评估 SWE 在 pSS 管理中的作用。
