Salivary gland scintigraphy in Sjögren’s syndrome

Summary

The aim of this study was to compare the diagnostic utility of visual versus semiquantitative analysis of salivary gland scintigraphy in the diagnosis of Sjögren’s syndrome (SS). Patients, methods: ^99mTc-pertech- netate salivary gland scintigraphy was performed in 145 patients (133 women, 12 men) with clinically suspicious SS. The images were interpreted with visual and semiquantitative methods and the diagnostic performances for SS were compared using uptake and excretory functional parameters. Results: In total, 76 patients (52.4%) were finally diagnosed with SS. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of visual analysis for the diagnosis of SS were 88.2%, 48.6%, 65.1%, 79.1%, and 69.2%, respectively. Semiquantitative values, the area under the ROC curve for uptake ratio and percentage excretion in the right salivary glands were significantly greater than 0.5 (p < 0.05). However, the percentage excretion in the left salivary glands did not show a statistically significant diagnostic ability for SS. The diagnostic ability of visual assessment was greater than that of the semiquantitative method in terms of evaluating uptake and excretory function in the sub- mandibular glands. Conclusion: Visual analysis of salivary gland scintigraphy showed greater diagnostic utility than semiquantitative assessment in the diagnosis of SS, especially in the submandibular glands.

Zusammenfassung

Das Ziel dieser Studie war ein Vergleich des diagnostischen Nutzens der visuellen und semi-quantitativen Analyse der Speicheldrüsen- Szintigraphie bei diagnostiziertem Sjögren- Syndrom (SS). Patienten, Methoden: Die ^99mTc- Pertechnetat-Speicheldrüsen-Szintigraphie wurde bei 145 Patienten (133 Frauen, 12 Männer) mit klinischen Verdacht auf SS durchgeführt. Die Bilder wurden mit visuellen und semiquantitativen Methoden interpretiert, der diagnostische Wert für SS wurde mit Parametern der Aufnahme- und Ausscheidungsfunktion verglichen. Ergebnisse: Insgesamt wurden 76 Patienten (52,4%) mit SS diagnostiziert. Sensitivität, Spezifität, positiver und negativer prädiktiver Wert sowie die Genauigkeit der visuellen Analyse für die SS-Diagnose wurden mit 88,2%, 48,6%, 65,1%, 79,1% und 69,2% angegeben. Semiquantitative Werte, Aufnahmeverhältnis und prozentuale Ausscheidung in der rechten Speicheldrüsen waren signifikant höher als 0.5 (p < 0.05). Die prozentuale Ausscheidung in der linken Speicheldrüsen zeigte jedoch keine statistisch signifikante Diagnosefähigkeit für SS. Der diagnostische Wert der visuellen Beurteilung war größer als der des semiquantitativen Verfahrens bzgl. Evaluierung der Aufnahme- und Ausscheidungsfunktion in der submandibularen Speicheldrüse. Schlussfolgerungen: Die visuelle Analyse der Speicheldrüsenszintigraphie zeigte einen größeren diagnostischen Nutzen als die semiquantitative Evaluierung in Bezug auf die Diagnose von SS, insbesondere bei der submandibularen Speicheldrüse.

Keywords

Sjögren’s syndrome - salivary gland - salivary gland scintigraphy

Schlüsselwörter

Sjögren-Syndrom - Speicheldrüse - Speicheldrüsenszintigraphie

• References

• 1 Adams BK, Al Attia HM, Parkar S. Salivary gland scintigraphy in Sjogren’s syndrome: are quantitative indices the answer?. Nucl Med Commun 2003; 24: 1011-1016.
• 2 Anaya JM, Talal N. Sjogren’s syndrome comes of age. Semin Arthritis Rheum 1999; 28: 355-359.
• 3 Anjos DA, Etchebehere EC, Santos AO. et al. Normal values of [^99mTc]pertechnetate uptake and excretion fraction by major salivary glands. Nucl Med Commun 2006; 27: 395-403.
• 4 Arrago JP, Rain JD, Brocheriou C, Rocher F. Scintigraphy of the salivary glands in Sjogen’s syndrome. J Clin Pathol 1987; 40: 1463-1467.
• 5 Aung W, Yamada I, Umehara I. et al. Sjogren’s syndrome: comparison of assessments with quantitative salivary gland scintigraphy and contrast sialography. J Nucl Med 2000; 41: 257-262.
• 6 Aung W, Murata Y, Ishida R. et al. Study of quantitative oral radioactivity in salivary gland scintigraphy and determination of the clinical stage of Sjogren’s syndrome. J Nucl Med 2001; 42: 38-43.
• 7 Bohuslavizki K, Brenner W, Wolf H. et al. Value of quantitative salivary gland scintigraphy in the early stage of Sjorgen’s syndrome. Nucl Med Commun 1995; 16: 917.
• 8 Fossaluzza V, De Vita S, Geatti O. Sequential salivary scintigraphy in Sjogren’s syndrome: proposal for a new method of evaluation. Clin Exp Rheumatol 1990; 8: 469-474.
• 9 Fox RI. Sjogren’s syndrome. Lancet 2005; 366: 321-331.
• 10 Günel SE, Ylmaz S, Karalezli A, Aktas A. Quantitative and visual evaluation of salivary and thyroid glands in patients with primary Sjogren’s syndrome using salivary gland scintigraphy: relationship with clinicopathological features of salivary, lacrimal and thyroid glands. Nucl Med Commun 2010; 31: 666-672.
• 11 Hakansson U, Jacobsson L, Lilja B. et al. Salivary gland scintigraphy in subjects with and without symptoms of dry mouth and/or eyes, and in patients with primary Sjogren’s syndrome. Scand J Rheumatol 1994; 23: 326-333.
• 12 Hermann GA, Vivino FB, Shnier D. et al. Diagnostic accuracy of salivary scintigraphic indices in xerostomic populations. Clin Nucl Med 1999; 24: 167-172.
• 13 Jonsson R, Gordon TP, Konttinen YT. Recent advances in understanding molecular mechanisms in the pathogenesis and antibody profile of Sjogren’s syndrome. Curr Rheumatol Rep 2003; 5: 311-316.
• 14 Kalk WW, Vissink A, Spijkervet FK. et al. Sialometry and sialochemistry: diagnostic tools for Sjogren’s syndrome. Ann Rheum Dis 2001; 60: 1110-1116.
• 15 Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjogren syndrome. Arch Int Med 2004; 164: 1275-1284.
• 16 Klutmann S, Bohuslavizki K, Kröger S. et al. Quantitative salivary gland scintigraphy. J Nucl Med Technol 1999; 27: 20-26.
• 17 Kohn WG, Ship JA, Atkinson JC. et al. Salivary gland ^99mTc-scintigraphy: a grading scale and correlation with major salivary gland flow rates. J Oral Pathol Med 1992; 21: 70-74.
• 18 Kosuda S, Suzuki K, Kawakami R. et al. Reassessment of usefulness of salivary scintigraphy in diagnosis of Sjogren’s syndrome. Kaku igaku 1993; 30: 161-170.
• 19 Langerman AJ, Blair EA, Sweiss NJ, Taxy JB. Utility of lip biopsy in the diagnosis and treatment of Sjogren’s syndrome. Laryngoscope 2007; 117: 1004-1008.
• 20 Li M, Dai HJ, Wang ZC. et al. Evaluation of salivary gland scintigraphy, magnetic resonance and diffusion-weighted imaging in clinical diagnosis of Sjogren’s syndrome. African Journal of Microbiology Research 2010; 4: 722-729.
• 21 Loutfi I, Nair MK, Ebrahim AK. Salivary gland scintigraphy: the use of semiquantitative analysis for uptake and clearance. J Nucl Med Technol 2003; 31: 81-85.
• 22 Markusse HM, Pillay M, Breedveld FC. The diagnostic value of salivary gland scintigraphy in patients suspected of primary Sjogren’s syndrome. Br J Rheumatol 1993; 32: 231-235.
• 23 Mishkin FS. Radionuclide salivary gland imaging. Semin Nucl Med 1981; 11: 258-265.
• 24 Ramos-Casals M, Brito-Zerón P, Perez-De-Lis M. et al. Clinical and prognostic significance of parotid scintigraphy in 405 patients with primary Sjögren’s Syndrome. J Rheumatol 2010; 37: 585-590.
• 25 Saito T, Fukuda H, Horikawa M. et al. Salivary gland scintigraphy with ‘‘“TclXlpertechnetate in Sjögren’s syndrome: relationship to clinicopathologic features of salivary and lacrimal glands. J Oral Pathol Med 1997; 26: 46-50.
• 26 Santos LAN, Haiter Neto F, Boscolo FN. et al. Scintigraphy of the salivary gland in patients with Sjögren’s syndrome treated with pilocarpine; Cintigrafia da glándula salivar em pacientes com Síndrome de Sjogren tratados com pilocarpina. Rev clín pesq odontol (Impr) 2010; 6: 101-106.
• 27 Schall GL, Anderson LG, Wolf RO. et al. Xerostomia in Sjogren’s syndrome. Evaluation by sequential salivary scintigraphy. JAMA 1971; 216: 2109-2116.
• 28 Shizukuishi K, Nagaoka S, Kinno Y. et al. Scoring analysis of salivary gland scintigraphy in patients with Sjögren’s syndrome. Ann Nucl Med 2003; 17: 627-631.
• 29 Sugihara T, Yoshimura Y. Scintigraphic evaluation of the salivary glands in patients with Sjogren’s syndrome. Int J Oral Maxillofac Surg 1988; 17: 71-75.
• 30 Umehara I, Yamada I, Murata Y. et al. Quantitative evaluation of salivary gland scintigraphy in Sjorgen’s syndrome. J Nucl Med 1999; 40: 64-69.
• 31 Vinagre F, Santos M, Prata A. et al. Assessment of salivary gland function in Sjögren’s syndrome: the role of salivary gland scintigraphy. Autoimm Rev 2009; 8: 672-676.
• 32 Vissink A, Kalk WW, Mansour K. et al. Comparison of lacrimal and salivary gland involvement in Sjogren’s syndrome. Arch Otolaryngol Head Neck Surg 2003; 129: 966-971.
• 33 Vitali C, Moutsopoulos HM, Bombardieri S. The European Community Study Group on diagnostic criteria for Sjogren’s syndrome. Sensitivity and specificity of tests for ocular and oral involvement in Sjogren’s syndrome. Ann Rheum Dis 1994; 53: 637-647.
• 34 Vitali C, Bombardieri S, Jonsson R. et al. Classification criteria for Sjogren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis 2002; 61: 554-558.