Lacrimal gland ultrasonography and elastography as a diagnostic and activity tool for primary Sjögren's syndrome

Abstract

AbstractObjectiveTo investigate the effectiveness of 2‐dimensional shear wave elastography (2D‐SWE) in the assessment of lacrimal gland involvement in primary Sjögren's syndrome (pSS) and to determine the association between ultrasonographic findings and clinical activity measures.MethodForty‐six patients who fulfilled the 2016 American College of Rheumatology/European League Against Rheumatism (EULAR) classification criteria of pSS and 23 age and gender‐matched healthy control subjects were enrolled. Clinical, laboratory and labial biopsy histopathologic characteristics of patients were recorded. Disease activity of pSS and severity of ocular dryness were evaluated with EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Ocular Surface Disease Index (OSDI), respectively. Parotid and lacrimal gland architectures were assessed by B‐mode ultrasound and 2D‐SWE techniques.ResultsMean shear wave elastography measurements, reflecting loss of elasticity, were remarkably higher in pSS patients compared to healthy subjects both in the lacrimal and parotid glands (8.99 ± 3.45 vs 3.68 ± 1.76 in lacrimal glands and 14.14 ± 4.39 vs 7.83 ± 1.69 in parotid glands, all P < 0.001). Shear wave elasticity of lacrimal glands was correlated with OSDI and ESSPRI scores (r = 0.69; P = 0.001 and r = 0.58; P = 0.001, respectively). A cut‐off value of 4.6 kPa in the lacrimal gland elasticity discriminated pSS patients from healthy subjects with a sensitivity of 94% and specificity of 87%.ConclusionResults of our study suggest that lacrimal glands lose elasticity in patients with pSS and the assessment of elasticity with 2D‐SWE might help to classify patients as having pSS. Further studies are needed to validate the diagnostic utility of lacrimal 2D‐SWE by including diseases other than pSS.