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).
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.
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).
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).
• 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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Two-dimensional shear wave elastography
American College of Rheumatology/European League Against Rheumatism
EULAR Sjögren’s syndrome disease activity index
Lacrimal gland ultrasound
Meters per second
Minor salivary gland biopsy
Ocular surface staining
Primary Sjögren’s syndrome
Salivary gland ultrasound
Tear break-up time
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The authors state that this work has not received any funding.
The scientific guarantor of this publication is Mehmet Sedat Durmaz.
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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.
Written informed consent was obtained from all subjects (patients) in this study.
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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