ULTRASOUND ELASTOGRAPHY FINDINGS IN SJÖGREN’S SYNDROME

Öz

Background/Aims: In Sjögren’s syndrome the basic histopathology in all affected organs is progressive lymphocyte infiltration This causes a change in tissue elasticity in the major salivary glands. The purpose of this study is to investigate salivary gland stiffness in primary Sjögren’s syndrome via shear wave elastography. Material and Methods: According to the 2016 American European Consensus Group criteria, 47 female cases were included in the study as the "patient group" by two rheumatologists. A total of 41 healthy female volunteers, who were in a similar age group and had no symptoms of dry mouth or sicca, and no diagnosis of salivary gland disease, constituted the "control group" of the study .The paired parotid and submandibular glands of all subjects were examined with shear wave elastography. The study was conducted between October 2018-October 2019 Results: In our study, there was a significant difference in both parotid glands' tissue elasticity values in both speed and kPA values in cases with pSS compared to the control group. However, when the submandibular glands were evaluated, no significant difference was found between the two groups. In our study, no relationship was found between the duration of symptoms and elasticity values. Conclusions :The fact that shear wave velocity (m / sec) and elasticity value (kPA) values are higher in the evaluation of the parotid gland by SWE technique in patients with pSS than the control group makes SWE an easy, non-invasive, and effective imaging method in Sjögren's Syndrome.

Anahtar Kelimeler

• Sjögren’s syndrome
• salivary glands
• shear wave elastography
• tissue elasticity

SJÖGREN SENDROMUNDA ULTRASON ELASTOGRAFİ BULGULARI

Öz

Amaç: Sjögren Sendromunda etkilenen tüm organlarda temel histopatalojik bulgu lenfosit infiltrasyonudur Bu durum tükrük bezlerinin doku esnekliğinde değişikliğe neden olur .Bu çalışmanın amacı primer Sjögren sendromunda tükrük bezlerinde oluşan doku sertliğindeki değişikliğin shear wave elastografi ile değerlendilirmesidir. Gereç ve Yöntemler: 2016 Amerika–Avrupa uzlaşı grubu kriterleri kullanılarak iki romatolog tarafından tanısı konan,47 kadın hasta çalışmaya dahil edildi. Kontrol grubu için 41 gönüllü; benzer yaş grubu ve cinsiyette (hepsi kadın) ağız kuruluğu veya sikka semptomu olmayan , ve tükrük bezi etkilenimi yapan hastalık tanısı bulunmayan gönüllü kişilerden seçilmiştir Bütün vakaların her iki parotis ve submandibular bezleri shear wave elastografi ile değerlendirildi. Çalışma Ekim 2018- Ekim 2019 tarihleri arasında yapıldı . Bulgular: Çalışmamızda her iki parotis bezinin doku elastisite değerlerinde kPA değerlerinde kontrol grubuna kıyasla anlamlı fark mevcuttu. Fakat submandibuler bezler değerlendirildiğinde hasta ve kontrol grubu arasında anlamlı fark saptanmadı. Bizim çalışmamızda semptom süresİ ile elastisite değerleri arasında ilişki bulunmamıştır Sonuç: Primer Sjögren Sendromlu olgularda parotis bezinin shear wave elastografi tekniği ile değerlendirilmesinde shear wav elastisite değeri (kPA) değerlerinin, kontrol grubuna göre daha yüksek olması Sjögren Sendromunda SWE kullanımını kolay ,noninvasiv ve efektif bir görüntüleme yöntemi yapmaktadır.

Anahtar Kelimeler

• Sjögren sendromu
• tükrük bezleri
• shear wave elastografi
• doku elastisititesi

Kaynakça

1. 1. Qin B, Wang J, Yang Z, et al. Epidemiology of primary Sjögren's syndrome: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(11):1983-9. doi:10.1136/annrheumdis-2014-205375
2. 2. Jonsson R, Vogelsang P, Volchenkov R, Espinosa A, Wahren-Herlenius M, Appel S.. The complexity of Sjögren's syndrome: novel aspects on pathogenesis. Immunol Lett. 2011;141(1):1-9. doi:10.1016/j.imlet.2011.06.007
3. 3. Shiboski CH, Shiboski SC, Seror R, et al. 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for primary Sjögren's syndrome: A consensus and data-driven methodology involving three international patient cohorts. Ann Rheum Dis. 2017;76(1):9-16. doi:10.1136/annrheumdis-2016-210571
4. 4. Salaffi F, Carotti M, Iagnocco A, et al. Ultrasonography of salivary glands in primary Sjögren's syndrome: a comparison with contrast sialography and scintigraphy. Rheumatology (Oxford).2008 Aug;47(8):1244-9. doi: 10.1093/rheumatology/ken222.
5. 5. Cornec D, Jousse-Joulin S, Pers JO, et al.Contribution of salivary gland ultrasonography to the diagnosis of Sjögren's syndrome:toward new diagnostşc criteria?. Arthritis Rheum.2013;65:216-25. doi: 10.1002/art.37698.
6. 6. Delli K, Dijkstra PU, Stel AJ, Bootsma H, Vissink A, Spijkervet FK. Diagnostic properties of ultrasound of major salivary glands in Sjögren's syndrome: a meta-analysis. Oral Dis. 2015 Sep;21(6):792-800. doi: 10.1111/odi.12349.
7. 7. Sezer İ, Toslak Eİ, Yağci B, et al The Role of Real-Time Tissue Elastography and Gray-Scale Ultrasound Histogram Analysis in the Diagnosis of Patients With Sjögren's Syndrome. Arch Rheumatol. 2019 Mar 28;34(4):371-9. doi: 10.5606/ArchRheumatol.2019.7120
8. 8. Dejaco C, De Zordo T, Heber D, et al. Real-time sonoelastography of salivary glands for diagnosis and functional assessment of primary Sjögren's syndrome. Ultrasound Med Biol. 2014; 40:2759–67. doi: 10.1016/j.ultrasmedbio.2014.06.023

9. 9. Arslan S, Durmaz MS, Erdogan H, Esmen SE, Turgut B, Iyisoy MS. Two-Dimensional Shear Wave Elastography in the Assessment of Salivary Gland Involvement in Primary Sjögren's Syndrome. J Ultrasound Med. 2020;39(5):949-56. doi:10.1002/jum.15179
10. 10. Zhang S, Zhu J, Zhang X, He J, Li J .Assessment of the Stiffness of Major Salivary Glands in Primary Sjögren's Syndrome through Quantitative Acoustic Radiation Force Impulse Imaging. Ultrasound Med Biol. 2016; 42:645–53. doi: 10.1016/j.ultrasmedbio.2015.11.009
11. 11. Samier-Guérin A, Saraux A, Gestin S, et al. Can ARFI elastometry of the salivary glands contribute to the diagnosis of Sjögren's syndrome?. Joint Bone Spine. 2016;83(3):301-6. doi:10.1016/j.jbspin.2015.11.002
12. 12. Wierzbicka M, Kałużny J, Ruchała M, Stajgis M, Kopeć T, Szyfter W. Sonoelastography--a useful adjunct for parotid gland ultrasound assessment in patients suffering from chronic inflammation. Med Sci Monit. 2014;20:2311-7. Published 2014 Nov 15. doi:10.12659/MSM.890678.
13. 13. Golder W, Stiller M. Distribution pattern of Sjögren's syndrome: a sialographical study. Z Rheumatol. 2014;73(10):928-33. doi:10.1007/s00393-014-1372-5. 14. Turnaoglu H, Kural Rahatli F, Pamukcu M, Haberal KM, Uslu N. Diagnostic value of acustic radiation force impulse imaging in the assessment of salivary gland involvement in primary Sjögren's sydrome. Med Ultrason. 2018 Aug 30;20(3):313-8. doi: 10.11152/mu-1397.
14. 15. Knopf, A., Hofauer, B., Thürmel, K. et al. Diagnostic utility of Acoustic Radiation Force Impulse (ARFI) imaging in primary Sjogren's syndrome. Eur Radiol 25, 3027–34 . doi: 10.1007/s00330-015-3705-4.
15. 16. Arslan S, Durmaz MS, Erdogan H, Esmen SE, Turgut B, Iyisoy MS. Two-Dimensional Shear Wave Elastography in the Assessment of Salivary Gland Involvement in Primary Sjögren's Syndrome. J Ultrasound Med. 2020;39(5):949-56. doi:10.1002/jum.15179.
16. 17. Gunes Tatar I, Altunoglu H, Kurt A, et al. The role of salivary gland elastosonography in Sjögren's syndrome: preliminary results. Int J Rheum Dis. 2014;17(8):904-9. doi:10.1111/1756-185X.12503.
17. 18. Cindil E, Oktar SO, Akkan K, Sendur HN, Mercan R, Tufan A, Ozturk MA. Ultrasound elastography in assessment of salivary glands involvement in primary Sjögren's syndrome. Clin Imaging. 2018 Jul-Aug;50:229-34. doi: 10.1016/j.clinimag.2018.04.011.
18. 19. Chen S, Wang Y, Zhang G, Chen S. Combination of Salivary Gland Ultrasonography and Virtual Touch Quantification for Diagnosis of Sjögren's Syndrome: A Preliminary Study. Biomed Res Int. 2016;2016:2793898. doi:10.1155/2016/2793898. 20. Hofauer B, Mansour N, Heiser C, et al. Sonoelastographic Modalities in the Evaluation of Salivary Gland Characteristics in Sjögren's Syndrome. Ultrasound Med Biol. 2016;42(9):2130-9. doi:10.1016/j.ultrasmedbio.2016.04.011.