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Ultraschalldiagnostik beim Sjögren-Syndrom

Ultrasound diagnostics in Sjögren’s syndrome

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Zusammenfassung

Die Sonographie der Speicheldrüsen ist eine leicht erlernbare, schnell durchführbare, nichtinvasive, kostengünstige und spezifische Untersuchung zur Detektion pathologischer Veränderungen der Speicheldrüsen in der Diagnostik des Sjögren-Syndroms. Andere bildgebende Verfahren wie Sialographie und Szintigraphie werden nur noch selten eingesetzt. Zur Untersuchung eignen sich Linearschallköpfe mit einer Frequenz zwischen 7 und 12 MHz, die dem in der Sonographie der Bewegungsorgane geschulten Rheumatologen ohnehin zur Verfügung stehen. Standardmäßig werden Glandula parotis und submandibularis beidseits in Longitudinal- und Transversalschnitten durchgemustert.

Normale Speicheldrüsen sind echoreich und homogen. Sie lassen sich gut von der umgebenden Muskulatur abgrenzen. Speichel- und Schilddrüsengewebe haben eine ähnliche sonographische Morphologie. Beim Sjögren-Syndrom sind die Speicheldrüsen typischerweise echoarm und inhomogen. Es finden sich fokale oder diffuse echoarme oder echofreie Regionen. Die Glandulae submandibulares können atrophieren (sagittaler Durchmesser <8 mm). Die Glandulae parotidae können bei Krankheitsschüben anschwellen (sagittaler Durchmesser >20 mm). Die Sensitivität für die Diagnose wird mit 60 und 90 %, die Spezifität mit über 90 % angegeben. Eine zusätzliche farbkodierte Dopplersonographie führt nicht zu einer Verbesserung der diagnostischen Aussage. Damit ist die Sonografie ein wichtiger Baustein in der Diagnostik des Sjögren-Syndroms geworden.

Abstract

Ultrasound of the salivary glands is a specific examination for detecting pathology of salivary glands in the diagnosis of Sjögren’s syndrome. It is easy to learn, rapidly performed, non-invasive and inexpensive. Other imaging techniques, such as sialography and scintigraphy, are currently only rarely performed. For the examination, linear ultrasound probes with frequencies between 7 and 12 MHz are recommended. Such probes are already widely available to the rheumatologist performing musculoskeletal ultrasound. The parotid and submandibular glands are bilaterally scanned both in longitudinal and transverse planes as a standard.

Normal salivary glands have uniformly hyperechoic and homogeneous tissue. They can be clearly delineated from the surrounding muscles and soft tissue and appear similar to the thyroid gland. The salivary glands are typically hypoechoic and inhomogeneous in Sjögren’s syndrome. Focal or diffuse hypoechoic or anechoic foci are found in the glands. The submandibular glands may become atrophic (sagittal diameter <8 mm). Particularly in disease flares, the parotid glands may become enlarged (sagittal diameter >20 mm). The sensitivity for the diagnosis is 60 to 90% and the specificity is over 90%.

Doppler sonography does not further improve the diagnostic accuracy. Sonography has thus become an important tool in the diagnosis of Sjögren’s syndrome.

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Authors and Affiliations

  1. Innere Medizin, Rheumatologie und Klinische Immunologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Lindenberger Weg 19, 13125, Berlin, Deutschland

    V. S. Schäfer & W. A. Schmidt

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  1. V. S. Schäfer
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  2. W. A. Schmidt
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Correspondence to V. S. Schäfer.

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V.S. Schäfer und W.A. Schmidt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Schäfer, V.S., Schmidt, W.A. Ultraschalldiagnostik beim Sjögren-Syndrom. Z Rheumatol 76, 589–594 (2017). https://doi.org/10.1007/s00393-017-0305-5

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