Salivary gland ultrasound abnormalities in primary Sjögren's syndrome: consensual US-SG core items definition and reliability

Sandrine Jousse-Joulin, Emmanuel Nowak, Divi Cornec, Jackie Brown, Andrew Carr, Marina Carotti, Benjamin Fisher, Joel Fradin, Alojzija Hocevar, Malin V Jonsson, Nicoletta Luciano, Vera Milic, John Rout, Elke Theander, Aaltje Stel, Hendrika Bootsma, Arjan Vissink, Chiara Baldini, Alan Baer, Wan Fai NgSimon Bowman, Zarrin Alavi, Alain Saraux, Valérie Devauchelle-Pensec

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OBJECTIVES: Ultrasonography (US) is sensitive for detecting echostructural abnormalities of the major salivary glands (SGs) in primary Sjögren's syndrome (pSS). Our objectives were to define selected US-SG echostructural abnormalities in pSS, set up a preliminary atlas of these definitions and evaluate the consensual definitions reliability in both static and acquisition US-SG images.

METHODS: International experts in SG US in pSS participated in consensus meetings to select and define echostructural abnormalities in pSS. The US reliability of detecting these abnormalities was assessed using a two-step method. First 12 experts used a web-based standardised form to evaluate 60 static US-SG images. Intra observer and interobserver reliabilities were expressed in κ values. Second, five experts, who participated all throughout the study, evaluated US-SG acquisition interobserver reliability in pSS patients.

RESULTS: Parotid glands (PGs) and submandibular glands (SMGs) intra observer US reliability on static images was substantial (κ > 0.60) for the two main reliable items (echogenicity and homogeneity) and for the advised pSS diagnosis. PG inter observer reliability was substantial for homogeneity. SMGs interobserver reliability was moderate for homogeneity (κ = 0.46) and fair for echogenicity (κ = 0.38). On acquisition images, PGs interobserver reliability was substantial (κ = 0.62) for echogenicity and moderate (κ = 0.52) for homogeneity. The advised pSS diagnosis reliability was substantial (κ = 0.66). SMGs interobserver reliability was fair (0.20< κ ≤ 0.40) for echogenicity and homogeneity and either slight or poor for all other US core items.

CONCLUSION: This work identified two most reliable US-SG items (echogenicity and homogeneity) to be used by US-SG trained experts. US-PG interobserver reliability result for echogenicity is in line with diagnosis of pSS.

Original languageEnglish
Article numbere000364
JournalRMD Open
Issue number1
Publication statusPublished - 1 Jun 2017


  • Journal Article


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