Value Of Salivary Gland Ultrasonography And Shear Wave Elastography For Comparison Of Different Pathologies Of Labial Gland And Assessing Disease Activity In Sj?gren Syndrome

Part Ⅰ Value of salivary gland ultrasonography and shear wave elastography for comparison of different pathologies of labial gland in Sj?gren syndromeObjectivesTo investigate the difference on salivary gland ultrasonography(SGUS)score and shear wave elastography(SWE)on major salivary gland and labial gland in Sjogren syndrome(SS).MethodsA retrospective analysis of 97 SS patients admitted to The First Affiliated Hospital of Soochow University from June 2020 to December 2021 was performed.Labial gland biopsy was performed on 71 patients.Histopathologic results were recorded.Lymphocytic focus per 4 mm2≥1(1 lymphocytic focus for≥50 lymphocytes focal aggregation around ducts or vessels)were classified as focal lymphocytic sialadenitis,which was recorded as a positive result.Bilateral parotid gland,submandibular gland and bilateral lower lip labial gland ultrasonic examinations were performed on all patients.The SGUS score of parotid and submandibular glands of SS patients was performed using the ’four scores’,and the highest score of the four glands was taken as the final score.SWE imaging of the four glands was performed.And the average values of Young’s modulus[minimum(Emin),mean(Emean)and maximum(Emax)]of bilateral parotid and bilateral submandibular glands were measured,and the average values of Young’s modulus of bilateral parotid and bilateral submandibular glands(Emin,Emean and Emax)were summed as the final result.SWE imaging of the labial glands was performed.Emin,Emean and Emax were measured and recorded.The mean value was calculated for data analysis.The differences between the SGUS,Young’s modulus values(Emin,Emean and Emax)of major salivary gland and labial gland between the group with positive labial gland biopsy and the group with negative labial gland biopsy were analyzed.Results1.There was no difference in gender,duration of disease and age between the group with positive labial gland biopsy and negative labial gland biopsy.2.The Young’s modulus values(Emin,Emean and Emax)of labial gland were significantly higher in the group of positive labial gland biopsy compared with the group with negative labial gland biopsy,and the difference was statistically significant(P<0.05),while the SGUS score and Young’s modulus values(Emin,Emean and Emax)of major salivary glands were not significantly different between the two groups(P>0.05).2.ROC curves were plotted and AUCs were compared using the pathological results of labial gland biopsy as the gold standard.AUCs of Emin,Emean and Emax were 0.754,0.740 and 0.724,respectively,with the maximum AUC obtained for Emin with a cut-off value of 9.9 kPa(95%CI 0.636-0.850),with a sensitivity and specificity of 71.43%70.37%,respectively,but the differences on AUCs of Young’s modulus values(Emin,Emean and Emax)were not statistically significant(P>0.05).Conclusion1.There are significant differences in the Young’s modulus(Emin,Emean and Emax)of the labial glands between the group of the positive pathology and the negative group.The texture of the former group is obviously hard,which provides an auxiliary indirect basis for clinical diagnosis and evaluation of SS,especially for suspected SS patients who resist labial gland biopsy.2.In the ROC curves of labial gland biopsy pathology of SS evaluated by ultrasonic parameters,Emin obtaines the largest AUC value,which proves that its diagnostic efficiency is stronger and the result is more valuable for reference.Part Ⅱ Value of salivary gland ultrasonography and shear wave elastography for the assessment of disease activity in Sj?gren’s syndromeObjectivesTo investigate the value of salivary gland ultrasonography(SGUS)score and shear wave elastography(SWE)of on the assessment of disease activity in Sjogren’s syndrome(SS).MethodsA retrospective analysis of 97 SS patients admitted to The First Affiliated Hospital of Soochow University from June 2020 to December 2021 was performed.According to the European League Against Rheumatism SS Disease Activity Index(ESSDAI),the patients were divided into two groups:remission group(ESSDAI<5)and activity group(ESSDAI≥5).Serological markers(anti-Ro/SSA,anti-La/SSB,IgG,C3,C4)were collected.Bilateral parotid glands,submandibular glands,and bilateral lower lip labial glands ultrasonic examinations were performed on all patients.The SGUS score of parotid and submandibular glands of SS patients was performed using the ’four scores’,and the highest score of the four glands was taken as the final score.SWE imaging of the four glands was performed.And the average values of Young’s modulus[minimum(Emin),mean(Emean)and maximum(Emax)]of bilateral parotid and bilateral submandibular glands were measured,and the average values of Young’s modulus of bilateral parotid and bilateral submandibular glands(Emin,Emean and Emax)were summed as the final result.SWE imaging of the labial glands was performed.Emin,Emean and Emax were measured and recorded.The mean value was calculated for data analysis.The differences in SGUS scores,Young’s modulus(Emin,Emean and Emax)of the major salivary glands,labial glands and clinical parameters of the in SS patients with different disease activity groups were analyzed.ESSDAI(ESSDAI≥5 was recorded as 1,ESSDAI<5 was recored as 0)was used as dependent variable,SGUS score,Young’s modulus(Emin,Emean and Emax)of major salivary gland,labial gland and clinical parameters were used as independent variables for stepwise regression analysis.Receiver operating characteristic(ROC)curves were drawn and area under receiver operating curve(AUC),sensitivity and specificity was compared.Results1.There were no statistically significant differences in SGUS scores and Young’s modulus values(Emin,Emean and Emax)on bilateral parotid,submandibular glands and labial glands of both lower lips(Emin,Emean and Emax)in SS patients(P>0.05).2.The active group had higher SGUS scores and Young’s modulus values(Emin,Emean and Emax)of the major salivary glands compared with the remission group,and the Young’s modulus values(Emin,Emean and Emax)of labial gland were also significantly increased with statistically significant differences(P<0.05).Hypergammaglobulinemia and hypocomplementemia were more frequent in the active group(P<0.05).There was no significant difference in positive anti-Ro/SSA,anti-La/SSB,gender,duration of disease and age between the active group and the remission group(P>0.05).3.ROC curves were plotted and comparing the AUC using ESSDAI score as the gold standard,and the AUC values obtained by ultrasonic parameters[SGUS score,Young’s modulus values(Emin,Emean and Emax)]of the major salivary glands were significantly higher than Young’s modulus values(Emin,Emean and Emax)of labial gland(P<0.05),with the maximum AUC value obtained for Emax of the major salivary gland with a cut-off value of 30.07 kPa(95%CI 0.797-0.878),with a sensitivity of 88.52%and specificity of 80.56%.Stepwise regression was used to establish a Logistic regression model to evaluate the disease activity of patients.The AUC of the model was 0.923,which was significantly higher than that of individual evaluation indicators,and the difference was statistically significant(P<0.05).Conclusion1.SGUS score,SWE of major salivary gland and labial gland have the difference in patients with different ESSDAI,among which SGUS score combined with major salivary gland SWE show good evaluation efficacy,which provide imaging data for clinical evaluation of disease activity in SS.2.In the active stage of SS,the serological indicators also change significantly compared with the remission group,including the increase of serum immunoglobulin IgG level and the decrease of complement level,suggesting a poor prognosis of patients.