Elastographic ultrasound: an additional image tool in
and Gabriela HERNANDEZ-MOLINA
Department of Radiology, Instituto Nacional de Cardiolog
ıa Ignacio Ch
avez, Departments of
Immunology and Rheumatology and
Pathology, Instituto Nacional de Ciencias M
edicas y Nutrici
on Salvador Zubir
an, Mexico City, Mexico
Aim: To evaluate the stiffness of parotid and submandibular glands using elastography ultrasound and to corre-
late it with B-mode ultrasonographical, clinical and serological features, salivary proﬁbrotic and inﬂammatory
chemokines, and salivary gland ﬁbrosis.
Methods: We performed B-mode and elastography ultrasound of major salivary glands of 26 patients with primary
ogren’s syndrome. We registered the shear wave velocity (SWV) and correlated it with the morphologic ultrasono-
graphic changes assessed by the Hocevar scale. We assessed the European League Against Rheumatism (EULAR)
ogren’s Syndrome Disease Activity Index (ESSDAI), EULAR Sj
ogren’s Syndrome Patient Reported Index (ESSPRI),
non-stimulated whole salivary ﬂow rate (NSWSF), C3 and C4 levels, anti-Ro/La antibodies, salivary inﬂammatory
(C-X-C motif ligand 13 [CXCL13], CXCL10, CXCL8, C-C motif ligand 2 [CCL2], interleukin 10 [IL-10] and IL-6)
and pro-ﬁbrotic (CXCL14, CCL28, tumor necrosis factor-related apoptosis-inducing ligand and transforming
growth factor b) chemokines and cytokines and evaluated the presence of ﬁbrosis in the minor salivary gland.
Results: Ninety-two percent of patients were women; mean age was 51.1 Æ 11 years; median disease duration
was 6.1 years; 92.3% had oral symptoms and 26.9% ﬁbrosis. The median B-mode score was 22.2 points and the
median SWV 2.5 m/s (s = 0.53, P = 0.001). The SWV correlated with the NSWSF (s = –0.53, P = 0.001), ESS-
DAI (s = 0.31, P = 0.03), glandular ESDDAI domain (s = 0.36, P = 0.02), C4 levels (s = –0.32, P = 0.04), sali-
vary CXCL13 (s = 0.29, P = 0.03) and CXCL10 (s = 0.30, P = 0.003), but not with age and ﬁbrosis.
Conclusion: WV correlated with the B-mode ultrasound score, systemic and glandular activity and in a large
degree with CXCL10, an inﬂammatory chemokine, but not with ﬁbrosis. An increased SWV might represent
chronic glandular inﬂammation rather than ﬁbrotic changes in these patients.
Key words: elastography, salivary gland, Sj
ogren’s syndrome, ultrasonography.
ogren’s syndrome (SS) is a chronic autoimmune dis-
ease affecting the exocrine glands for which the main
histological feature is the presence of lymphocytic inﬁl-
however, other lesions, such as myoepithelial
islets, germinal centers and ﬁbrosis may be present.
Salivary gland ultrasound is a simple, non-invasive
and widely available method, with no ionizing radia-
tion exposure, that has gained an increasing role in SS
assessment. The method has diagnostic properties simi-
lar to sialography, is better than parotid gammagraphy,
and has a sensitivity similar to magnetic resonance.
Correspondence: Gabriela Hern
andez-Molina, Department of
Immunology and Rheumatology, Vasco de Quiroga 15, Col.
on XVI, CP 14080 Mexico City,
Mexico. Email: firstname.lastname@example.org
© 2018 Asia Paciﬁc League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd
International Journal of Rheumatic Diseases 2018; 21: 1293–1300