Xu Zhikang, Li Rumei, Xia Bin, Jiang Meijuan, Wu Xiaojin, Zhang Xuanxuan, Pan Jianlian, Chen Jian
Zhejiang University School of Medicine, Hangzhou, China.
Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China.
Quant Imaging Med Surg. 2023 Oct 1;13(10):7170-7179. doi: 10.21037/qims-23-711. Epub 2023 Aug 14.
Primary Sjogren's syndrome (PSS) is a prevalent systemic autoimmune disease. However, the current gold standard diagnostic method is invasive, increasing the difficulty of patient acceptance and then delaying treatment. Therefore, a non-invasive, convenient, and effective diagnostic method is required. Although salivary gland ultrasonography (SGUS) is a good choice, previous studies have not found suitable parameters to diagnose PSS. Salivary gland involvement in patients with PSS leads to changes in gland stiffness and vascularization, so we combined sound touch elastography (STE) and ultra-microangiography (UMA) to demonstrate the diagnostic effectiveness of ultrasonography in PSS.
This prospective study included 27 patients with PSS and 20 healthy controls, with all participants forming a random series. Major salivary glands were examined with UMA and STE. Color pixel percentage (CPP), shear wave velocity (SWV), and Young's modulus values were investigated, and the combination of these parameters was evaluated by logistic regression analysis.
For Young's modulus and SWV in the elasticity index, combined evaluation of both parotid glands and submandibular glands yielded an area under the receiver operating characteristic (ROC) curve (AUC) and confidence interval (CI) of 0.819, 0.699-0.938 and 0.801, 0.677-0.925, respectively. The levels of CPP in the parotid glands were significantly elevated (P<0.003) among patients compared to those in the control group, whereas the CPP values in the submandibular glands were not statistically different (P>0.086). We evaluated the elasticity values of the total 4 glands and the CPP of parotid glands together by logistic regression modeling. The ROC curve yielded an AUC of 0.954 (95% CI: specificity 0.849-0.994) which showed the best accuracy, with 92.6% sensitivity and 85.0% specificity.
The use of STE and UMA to examine the salivary glands may aid in the diagnosis of PSS, and their combination may be a promising method. This is good news for patients with PSS who are not suitable or unwilling to undergo labial gland biopsy.
原发性干燥综合征（PSS）是一种常见的系统性自身免疫性疾病。然而，目前的金标准诊断方法具有侵入性，增加了患者接受的难度，进而延误治疗。因此，需要一种非侵入性、便捷且有效的诊断方法。尽管唾液腺超声检查（SGUS）是一个不错的选择，但以往研究尚未找到适合诊断PSS的参数。PSS患者的唾液腺受累会导致腺体硬度和血管化改变，因此我们将声触诊组织弹性成像（STE）和超微血管成像（UMA）相结合，以证明超声检查在PSS中的诊断效能。
这项前瞻性研究纳入了27例PSS患者和20名健康对照者，所有参与者构成一个随机序列。使用UMA和STE对主要唾液腺进行检查。研究彩色像素百分比（CPP）、剪切波速度（SWV）和杨氏模量值，并通过逻辑回归分析评估这些参数的组合。
对于弹性指数中的杨氏模量和SWV，腮腺和下颌下腺联合评估的受试者操作特征（ROC）曲线下面积（AUC）及置信区间（CI）分别为0.819，0.699 - 0.938和0.801，0.677 - 0.925。与对照组相比，患者腮腺中的CPP水平显著升高（P < 0.003），而下颌下腺中的CPP值无统计学差异（P > 0.086）。我们通过逻辑回归建模共同评估了全部4个腺体的弹性值和腮腺的CPP。ROC曲线的AUC为0.954（95% CI：特异性0.849 - 0.994），显示出最佳准确性，敏感性为92.6%，特异性为85.0%。
使用STE和UMA检查唾液腺可能有助于PSS的诊断，二者结合可能是一种有前景的方法。这对于不适合或不愿意接受唇腺活检的PSS患者来说是个好消息。
