Semi-quantitative analysis of salivary gland scintigraphy
in Sjögren’s syndrome diagnosis: a first-line tool
Received: 10 October 2016 /Accepted: 8 December 2016 / Published online: 3 January 2017
Springer-Verlag Berlin Heidelberg 2017
Objective The aim of this study was the assessment of semi-
quantified salivary gland dynamic scintigraphy (SGdS) pa-
rameters independently and in an integrated way in order to
predict primary Sjögren’s syndrome (pSS).
Materials and methods Forty-six consecutive patients (41 fe-
males; age 61 ± 11 years) with sicca syndrome were studied
by SGdS after injection of 200 MBq of pertechnetate. In six-
teen patients, pSS was diagnosed, according to American-
European Consensus Group criteria (AECGc).
Semi-quantitative parameters (uptake (UP) and excretion
fraction (EF)) were obtained for each gland. ROC curves were
used to determine the best cut-off value. The area under the
curve (AUC) was used to estimate the accuracy of each semi-
To assess the correlation between scintigraphic results and
disease severity, semi-quantitative parameters were plotted
versus Sjögren’s syndrome disease activity index (ESSDAI).
A nomogram was built to perform an integrated evaluation of
all the scintigraphic semi-quantitative data.
Results Both UP and EF of salivary glands were significantly
lower in pSS patients compared to those in non-pSS
(p < 0.001). ROC curve showed significantly large AUC for
both the parameters (p <0.05).
Parotid UP and submandibular EF, assessed by
univariated and multivariate logistic regression, showed
a significant and independent correlation with pSS diag-
nosis (p value <0.05). No correlation was found between
SGdS semi-quantitative parameters and ESSDAI. The
proposed nomogram accuracy was 87%.
Conclusion SGdS is an accurate and reproducible tool for the
diagnosis of pSS. ESSDAI was not shown to be correlated
with SGdS data.
Clinical relevance SGdS should be the first-line imaging
technique in patients with suspected pSS.
Keywords Sicca syndrome
gland dynamic scintigraphy
Sjögren’s syndrome (SS) is a chronic, progressive, autoim-
mune disease, of unknown aetiology, characterized by focal
lymphocytic infiltration of exocrine glands with a significant
functional impairment, leading to sicca symptoms [1–3].
These symptoms could be also associated with connective
tissue disorders, autoimmune diseases (rheumatoid arthritis,
systemic sclerosis or systemic lupus erythematosus) or other
causes (such as previous head and neck radiotherapy or anti-
depressant drugs). Therefore, it is important to identify prima-
ry Sjögren’s syndrome (pSS) among various aetiologies given
that clinical and therapeutic approaches are different .
* Andrea Skanjeti
Nuclear Medicine Unit, San Luigi Gonzaga University Hospital,
Medical Division, San Luigi Gonzaga University Hospital,
Service of Nuclear Medicine, Institute for Cancer Research and
Treatment, Candiolo, Italy
Nuclear Medicine Department, Hospices Civils de Lyon,
Equipe Mixte de Recherche 3738, Université Claude Bernard Lyon
1, Lyon, France
Clin Oral Invest (2017) 21:2389–2395