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Assessment of lacrimal gland involvement in primary Sjögren’s syndrome using gray-scale ultrasonography and shear wave elastography

European Radiology volume 33, pages 9368–9377 (2023)Cite this article

Abstract

Objectives

The aim of this study was to assess lacrimal gland involvement in primary Sjögren’s syndrome (pSS) using lacrimal gland gray-scale ultrasound (LGUS) and two-dimensional shear wave elastography (2D-SWE).

Methods

Eighty-five pSS patients with a mean age of 51.16 ± 10.61 years and 84 sex- and age-matched healthy subjects with a mean age of 50.94 ± 11.05 years were included in the study. Lacrimal gland parenchymal findings and 2D-SWE values were compared between the two groups and the correlations of LGUS parameters with clinical findings, dry eye tests, and minor salivary gland biopsy (MSGB) were further investigated.

Results

LGUS parenchymal grade was 0 in 14 (16.5%), 1 in 45 (52.9%), 2 in 23 (27.1%), and 3 in 3 patients (3.5%) in the pSS group, while in the control group, parenchymal grades were 0 (57.1%) and 1 (42.9%). The mean 2D-SWE value of pSS patients was significantly higher than the control group (p < 0.05) and increased parallel with lacrimal parenchymal grade. The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in pSS patients (AUC 0.901, sensitivity 70.6%, specificity 97.6%), while the diagnostic performance of LGUS was much lower (AUC 0.769, sensitivity 83.5%, specificity 57.1%). LGUS and 2D-SWE values were found to be correlated with dry eye tests and MSGB results (p < 0.05).

Conclusions

LGUS and 2D-SWE are both useful for assessing the lacrimal gland involvement in pSS patients; however, 2D-SWE has a better diagnostic performance than LGUS and found to be correlated with dry eye tests.

Clinical relevance statement

Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are imaging modalities that can be used to demonstrate parenchymal involvement of the lacrimal gland in primary Sjögren’s syndrome (pSS).

Key Points

• Gray-scale US and two-dimensional shear wave elastography (2D-SWE) have been widely used in the recent decade to assess gland involvement in patients with primary Sjögren’s syndrome (pSS).

• The elasticity modulus had a high diagnostic performance in detecting lacrimal gland involvement in primary Sjögren’s syndrome (pSS) patients.

• Lacrimal gland US and two-dimensional shear wave elastography (2D-SWE) are both useful for assessing the lacrimal gland in primary Sjögren’s syndrome (pSS) patients; however, two-dimensional shear wave elastography (2D-SWE) has a better diagnostic performance than lacrimal gland ultrasound (LGUS).

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Abbreviations

2D-SWE:

Two-dimensional shear wave elastography

ACR/EULAR:

American College of Rheumatology/European League Against Rheumatism

ANA:

Antinuclear antibodies

ESSDAI:

EULAR Sjögren’s syndrome disease activity index

kPa:

Kilopascals

LGUS:

Lacrimal gland ultrasound

m/s:

Meters per second

MSGB:

Minor salivary gland biopsy

OSS:

Ocular surface staining

pSS:

Primary Sjögren’s syndrome

RF:

Rheumatoid factor

SGUS:

Salivary gland ultrasound

TBUT:

Tear break-up time

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Selçuk University, Konya, 42131, Turkey

    Halil Özer, Ömer Faruk Topaloğlu & Mehmet Sedat Durmaz

  2. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Selçuk University, Konya, Turkey

    Sema Yılmaz, Dilek Tezcan & Selda Hakbilen

  3. Department of Ophthalmology, Faculty of Medicine, Selçuk University, Konya, Turkey

    Banu Bozkurt

  4. Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey

    Merve Yazol

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  1. Halil Özer
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Correspondence to Halil Özer.

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The scientific guarantor of this publication is Mehmet Sedat Durmaz.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors, Halil Özer, has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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  • cross-sectional study

  • performed at one institution

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Özer, H., Yılmaz, S., Bozkurt, B. et al. Assessment of lacrimal gland involvement in primary Sjögren’s syndrome using gray-scale ultrasonography and shear wave elastography. Eur Radiol 33, 9368–9377 (2023). https://doi.org/10.1007/s00330-023-09943-z

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