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ORIGINAL RESEARCH
Virtual Touch Quantification of the
Salivary Glands for Diagnosis of
Primary Sjögren Syndrome
Shaoqi Chen, MS, Yukai Wang, MD, Shaoxing Chen, MS, Qiulin Wu, MS, Shigao Chen, PhD
Received January 28, 2016, from the Departments
of Ultrasound (Shaoq.C.) and Community
Monitoring (Shaox.C.), First Affiliated Hospital
of Shantou University Medical College, Shantou,
China; Department of Rheumatism, Central
Hospital of Shantou, Shantou, China (Y.W.);
Guangdong Province Key Laboratory of Medical
Molecular Imaging, Shantou University, Shantou,
China (Q.W.); and Department of Radiology,
Mayo Clinic College of Medicine, Rochester,
Minnesota USA (Shi.C.). Revision requested
February 24, 2016. Revised manuscript accepted
for publication March 13, 2016.
This study was supported by the Bureau
of Shantou City Science and Technology (grant
2013-88-24), the Guangdong Province Medical
Science and Research Fund (grants A201566
and B2015128), the Foundation for Young
Talents in Higher Education of Guangdong,
China (grant 2015KQNCX048), and the
Natural Science Foundation of Guangdong
Province (grant 2014A030307003). Shaoqi
Chen and Yukai Wang contributed equally to
this work.
Address correspondence to Shaoqi Chen,
MS, Department of Ultrasound, First Affiliated
Hospital of Shantou University Medical College,
57 Changping Rd, 515041 Shantou, Guangdong
Province, China.
E-mail: csq1036587183@qq.com
Abbreviations
AUROC, area under the receiver operating
characteristic curve; CI, confidence interval;
SWV, shear wave velocity; VTQ, Virtual
Touch quantification
doi:10.7863/ultra.16.01085
©2016 by the American Institute of Ultrasound in Medicine | J Ultrasound Med 2016; 35:2607–2613 | 0278-4297 | www.aium.org
Objectives—To investigate the value of salivary gland stiffness measured by Virtual
Touch quantification (VTQ; Siemens Medical Solutions, Erlangen, Germany) for
assessment of primary Sjögren syndrome.
Methods—Fifty-four patients with primary Sjögren syndrome, 35 patients without pri-
mary Sjögren syndrome (patients with dry mouth and dry eye symptoms), and 52
healthy control volunteers were included in this study. Patients with primary Sjögren
syndrome were classified as early or advanced stage by labial gland biopsies. All partic-
ipants underwent B-mode sonography, on which the salivary glands (parotid and sub-
mandibular) were identified and VTQ measurements of shear wave velocity (SWV)
were obtained. The diagnostic performance of SWV was evaluated by sensitivity and
specificity at the optimum cutoff point and the area under the receiver operating char-
acteristic curve.
Results—For submandibular glands, the mean SWV ± SD values were 2.25 ± 0.34 m/s
in patients with early-stage primary Sjögren, 1.84 ± 0.20 m/s in patients without primary
Sjögren syndrome, and 1.82 ± 0.27 m/s in healthy controls (P < .001). With cutoff values
of 2.15 and 2.10 m/s to separate patients with early-stage primary Sjögren syndrome
from those without Sjögren syndrome and healthy controls, the sensitivity and speci-
ficity were 77.1% and 85.4% and 79.2% and 83.9%, respectively. For parotid glands, the
SWV values were 2.78 ± 0.82 m/s in patients with early-stage primary Sjögren syndrome,
1.93 ± 0.33 m/s, in patients without primary Sjögren syndrome, and 1.85 ± 0.31 m/s in
healthy controls (P < .001). With cutoff values of 2.18 and 2.10 m/s to separate patients
with early-stage primary Sjögren syndrome from those without Sjögren syndrome and
healthy controls, the sensitivity and specificity were 89.3 % and 75.3% and 91.4% and 80.0%.
Conclusions—The VTQ technique might be a useful noninvasive strategy for assess-
ment of salivary glands in the early stage of primary Sjögren syndrome.
Key Words—differentiation; head and neck ultrasound; primary Sjögren syndrome;
salivary gland; Virtual Touch quantification
P rimary Sjögren syndrome is a chronic autoimmune disease
characterized by lymphocytic infiltration of exocrine glands,
mostly salivary and lacrimal glands, resulting in a reduction
of salivary function. It may affect multiple organ systems but
typically manifests with xerostomia and keratoconjunctivitis sicca.1
In addition, about 5% of patients with primary Sjögren syndrome
develop B-cell lymphoma during follow-up.2
There is currently no single standard test for the diagnosis of pri-
mary Sjögren syndrome. The American College of Rheumatology3
classification criteria for primary Sjögren syndrome published in
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Chen et al—Virtual Touch Quantification in Primary Sjögren Syndrome
2012 and the criteria proposed by the American-European
Consensus Group4 in 2002 include serum tests, a corneal
fluorescence stain, and labial gland biopsy. Labial salivary
gland biopsy is an important test for diagnosing primary
Sjögren syndrome but is invasive. Other objective tests
such as sialography, scintigraphy, computed tomography,
magnetic resonance imaging, and sonography of salivary
glands are also used to evaluate patients with primary Sjö-
gren syndrome. Sialography, scintigraphy, and computed
tomography involve radiation exposure. Magnetic reso-
nance imaging is relatively expensive and contraindicated
in some clinical conditions; thus it plays a minor role in
diagnosis and follow-up for primary Sjögren syndrome.
In recent years, salivary gland sonography has emerged as
a simple noninvasive tool for identifying salivary gland
changes in patients with primary Sjögren syndrome. This
method has been shown to have value in the evaluation of
the salivary glands in patients with primary Sjögren syn-
drome and has higher accuracy compared with sialogra-
phy and isotopic examinations.5,6 Various salivary gland
sonographic scoring systems have been proposed to facil-
itate more objective evaluations, which include evaluating
the size of salivary glands, parenchymal echogenicity and
inhomogeneity, clearness of the borders, and others. Hoce-
var et al7 described a salivary gland sonographic scoring
system that ranged from 0 to 48, whereas Cornec et al8 sug-
gested a scoring system that ranged from 0 to 4 on sono-
grams of salivary glands. A simplified scoring system for
salivary gland sonography that ranged from 0 to 3 also has
been previously reported.9 However, these scoring systems
are only semiquantitative and somewhat operator depend-
ent, which may cause biased results. The lack of standard-
ized examination protocols and the high reliance on
physician expertise are reflected in a wide range of meas-
ured specificities (73%–99%) and sensitivities (59%–
94%), which limits their clinical applications.5,7–13
Therefore, there is still a need for noninvasive, safe, low-
cost, and accurate methods for diagnosing primary Sjögren
syndrome in salivary glands.
Ultrasound elasticity imaging is an emerging imaging
modality, which objectively evaluates tissue stiffness, a bio-
marker closely related to disease. This modality has shown
good promise for liver fibrosis staging and cancer diagno-
sis.14 Tissue stiffness has been shown to correlate with
fibrosis and inflammation.14 Since primary Sjögren syn-
drome is associated with inflammation and fibrosis, it is
expected that salivary glands of patients with primary
Sjögren syndrome will show higher stiffness, which may
be useful for diagnosis of this syndrome. Currently, there
are very few articles reporting the stiffness of salivary glands
2608
in patients with primary Sjögren syndrome. Using strain
elastography, Dejaco et al15 showed that salivary glands of
patients with primary Sjögren syndrome were significantly
stiffer than those of healthy participants. On strain elas-
tography, tissue deformation (strain) due to manual trans-
ducer compression is used for relative mapping of tissue
stiffness: stiff regions have less deformation compared to
softer regions. Therefore, strain elastography is only semi-
quantitative and generally operator dependent. A study by
Wierzbicka et al16 used shear wave elasticity imaging to
study patients with primary Sjögren syndrome. On shear
wave elasticity imaging, shear waves generated by an
ultrasound radiation force are detected by pulse-echo ultra-
sound and used to calculate the shear wave propagation
speed, which is quantitatively related to the tissue’s shear
modulus and Young modulus. Compared with strain elas-
tography, shear wave elasticity imaging is truly quantita-
tive and less operator dependent. However, Wierzbicka et
al16 only studied the parotid gland in a small group of 20
patients, and primary Sjögren syndrome was not confirmed
by biopsy.
The aim of our study was to investigate the value of shear
wave elasticity imaging as a complementary tool to traditional
sonography for assessing the parotid and submandibular
glands in patients with primary Sjögren syndrome. Patients
with advanced primary Sjögren syndrome usually have
marked parenchymal heterogeneity and thus are relatively
easy to detect with B-mode sonography. However, changes
in the B-mode image texture in patients with early-stage
primary Sjögren syndrome are more subtle and often over-
looked. Therefore, our study focused on evaluating the
performance of shear wave elasticity imaging for separating
patients with early-stage primary Sjögren syndrome from
healthy control participants and patients with dry eye and dry
mouth symptoms but without primary Sjögren syndrome.
Materials and Methods
Patients and Control Participants
The study was approved by the Ethics Committee of the
First Affiliated Hospital of Shantou University Medical
College and the Central Hospital of Shantou. From
January 2012 to July 2015, we consecutively enrolled a
total of 89 patients in our study. All of them were referred
by the Department of Rheumatology of the First Affiliated
Hospital of Shantou University Medical College and the
Central Hospital of Shantou. Inclusion criteria were
patients with symptoms of dry mouth and dry eye for 12
months or longer. Exclusion criteria were use of anti-
cholinergic drugs and other drugs known potentially to
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Chen et al—Virtual Touch Quantification in Primary Sjögren Syndrome
cause a reduction in salivary secretions, focal tumorous
lesions of major salivary glands, head and neck radiother-
apy, sialoadenitis, lymphoma, sarcoidosis, and human
immunodeficiency virus infection.
According to the criteria proposed by the American-
European Consensus Group4 in 2002 and pathologically
confirmed by labial gland biopsy, primary Sjögren syndrome
was diagnosed in 54 of the 89 patients. Thirty-five patients
who did not meet the criteria for primary Sjögren syndrome
were classified as the a non–primary Sjögren syndrome group
and used as control group A. All patients gave their informed
consent. Fifty-two healthy volunteers without salivary mass
lesions and sialoadenitis formed control group B. This
group had normal medical histories and physical examina-
tion findings, had no symptoms of xerostomia or kerato-
conjunctivitis sicca, had no sialoadenitis or mass lesions
in salivary glands, and were not using medications.
Sonographic Procedures
An Acuson S2000 ultrasound system (Siemens Medical
Solutions, Erlangen, Germany) equipped with a linear
4–9-MHz probe was used to perform Virtual Touch quan-
tification (VTQ) measurements in this study. The shear
wave velocity (SWV) measured by VTQ in meters per
second is quantitatively related to tissue stiffness. All par-
ticipants underwent VTQ imaging of the parotid and sub-
mandibular glands. When scanned, the participants were in
a supine position with the neck extended and the head
turned to the opposite side. The ultrasound transducer was
gently coupled to the body surface with a sufficient amount
of ultrasound gel. The parotid glands were evaluated in a
longitudinal plane, avoiding interference from both sur-
rounding bone structures and large salivary ducts. The sub-
mandibular glands were evaluated in a longitudinal plane,
where the gland was visualized entirely. The placement of
the VTQ measurement region of interest was selected to
avoid the main vascular branches, which were identified
by color Doppler imaging. Six VTQ measurements of the
SWV were obtained in the central, peripheral, and subcap-
sular areas without visible vessels of each salivary gland dur-
ing breath holding. These 6 nonoverlapping VTQ regions
of interest were selected to cover different areas of each sali-
vary gland to provide a more comprehensive evaluation.
Statistical Analysis
Continuous variables were expressed as mean ± standard
deviation. The data were analyzed with SPSS version 16
software (IBM Corporation, Armonk, NY). The optimal
cutoff values were determined from receiver operating char-
acteristic curves with Prism version 6.0 software (GraphPad
J Ultrasound Med 2016; 35:2607–2613
Software, Inc, La Jolla, CA), and the area under the receiver
operating characteristic curve (AUROC) was used to com-
pare the diagnostic performance. The optimal cutoff point
was chosen as the value giving the best combination of sen-
sitivity and specificity in the receiver operating character-
istic curve. P < .05 was considered statistically significant.
Histopathologic Analysis
All patients had labial salivary gland biopsies, which were
performed by an experienced stomatologist. Biopsy samples
were evaluated by the focus score.17 Patients with primary
Sjögren syndrome were further divided into 2 subgroups:
advanced stage (focus score ≥2 with the following patho-
logic features: almost complete acinar loss, ductal atrophy,
and a large increase in fibrous tissue) and early stage (those
not meeting the criteria of the advanced stage). Of the 54
patients with primary Sjögren syndrome, 26 belonged to
the advanced group, and 28 belonged to the early group.
Results
A total of 141 participants were studied. Fifty-four patients
had primary Sjögren syndrome according to the 2002
American-European Consensus Group criteria4 (age range,
23–77 years). Control group A consisted of 35 patients
with dry mouth and dry eye symptoms but not fulfilling
the American-European Consensus Group criteria4 (age
range, 24–73 years). Among this group, 22 patients had
sicca symptoms or swelling of major salivary glands with-
out known reasons; 5 patients had systemic lupus erythe-
matosus; 3 patients had hepatitis B or C and sicca syndrome;
and 5 had rheumatoid arthritis. Table 1 summarizes char-
acteristics of the patients with and without primary Sjö-
gren syndrome included in the study. Control group B
consisted of 52 healthy volunteers without salivary mass
lesions and sialoadenitis (48 female and 4 male; mean age
± SD, 46.0 ± 13.5 years; age range, 20–76 years). There
was no significant difference in mean age and sex distribu-
tion between patients with primary Sjögren syndrome and
controls. A total of 3384 VTQ values were obtained (141
participants, 4 glands per participant, and 6 measurements
per gland), ranging from 0.94 to 9.00 m/s.
Figure 1 shows some representative B-mode images
and VTQ measurements for the different groups. The B-
mode image of a healthy volunteer in Figure 1A showed
homogeneous gland parenchyma, compared with a subtle
inhomogeneous texture in a patient without Sjögren syn-
drome with dry eye and dry mouth symptoms in Figure
1B and markedly hypoechoic lesions in patients with pri-
mary Sjögren syndrome in Figure 1, C and D.
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Chen et al—Virtual Touch Quantification in Primary Sjögren Syndrome

Comparison of SWV Values Between Patients With
Early-Stage Primary Sjögren Syndrome and Control
Participants
For submandibular glands, the SWV values were 2.25 ±
0.34 m/s in patients with early-stage primary Sjögren
syndrome, 1.84 ± 0.20 m/s in patients without primary
Sjögren syndrome with dry eye and dry mouth symptoms,
and 1.82 ± 0.27 m/s in healthy volunteers (P < 0.001).
To separate patients with early-stage primary Sjögren syn-
drome from patients without primary Sjögren syndrome,
the AUROC was 0.805 (95% confidence interval [CI],
0.735–0.875). With a cutoff value of 2.15 m/s, the sensitivity
and specificity were 77.1% (95% CI, 67.4%–85.1%) and
85.4% (95% CI, 75.8%–92.2%), respectively. To separate
patients with early-stage primary Sjögren syndrome from
healthy controls, the AUROC was 0.812 (95% CI, 0.748–
0.876). With a cutoff value of 2.10 m/s, the sensitivity and
specificity were 79.2% (95% CI, 69.7%–86.8%) and 83.9%
(95% CI, 75.8%–90.2%).
For parotid glands, the SWV values were 2.78 ± 0.82
m/s in patients with early-stage primary Sjögren syndrome,
1.93 ± 0.33 m/s in patients without primary Sjögren syn-
drome, and 1.85 ± 0.31 m/s in healthy controls (P < 0.001).
To separate patients with early-stage primary Sjögren syn-
drome from patients without primary Sjögren syndrome,
the AUROC was 0.843 (95% CI, 0.782–0.904). With a
cutoff value of 2.18 m/s, the sensitivity and specificity
were 89.3 % (95% CI, 81.1%–94.7%) and 75.3% (95% CI,
64.8%–84.0%), respectively. To separate patients with
early-stage primary Sjögren syndrome from healthy
controls, the AUROC was 0.881 (95% CI, 0.833–0.929).
With a cutoff value of 2.10 m/s, the sensitivity and speci-
ficity were 91.4% (95% CI, 83.8%–96.2%) and 80.0% (95%
CI, 71.5%–86.9%). Receiver operating characteristic curves
of SWVs for separating glands of patients with early-stage
primary Sjögren syndrome from those of controls are
shown in Figure 2.
Comparison of SWV Values Between Patients With
Early- and Advanced-Stage Primary Sjögren Syndrome
For submandibular glands, the SWV values were 2.25 ± 0.34
m/s in patients with early-stage primary Sjögren syndrome
and 2.38 ± 0.49 m/s in those with advanced-stage primary
Sjögren syndrome. There was no significant difference
between these groups (P > .05). For parotid glands, the
SWV values were 2.78 ± 0.82 m/s in patients with early-stage
primary Sjögren syndrome and 2.92 ± 0.50 m/s in those
with advanced-stage primary Sjögren syndrome. There was
no significant difference between these groups (P > .05).
Discussion
Many studies have investigated the use of B-mode sonog-
raphy in salivary glands to differentiate patients with primary
Sjögren syndrome from those without primary Sjögren
syndrome with sicca symptoms.5–10 These studies showed
that, although sonography yielded a high specificity, it could
detect only about half of the patients with primary Sjögren
syndrome. We had similar findings in our study. Among
the 28 patients with advanced primary Sjögren syndrome,
26 had abnormal B-mode sonographic findings, with clearly
noticeable hypoechoic lesions in the parenchyma of the

Table 1. Baseline Characteristics of Patients With Primary Sjögren Syndrome and Patients Without Primary Sjögren Syndrome With Dry Eye
and Dry Mouth Symptoms

Primary Sjögren No Primary Sjögren

Characteristic Syndrome (n = 54) Syndrome (n = 35) Normal Values

Age, y 46.0 ± 12.9 52 ± 12.9

Female, n (%) 51 (94) 30 (86)
Schirmer tests, mm/5 min 4.6 ± 3.9 13.2 ± 4.7 >5
Disease duration, mo 47.4 ± 36.1 35.8 ± 21.7
Erythrocyte sedimentation rate, mm/h 48.6 ± 40.1 13.7 ± 10.8 0.0–20.0 (female) 0.0–15.0 (male)
C-reactive protein, mg/L 14.2 ± 12.3 5.3 ± 3.5 0.0–8.0
Rheumatoid factor, IU/L 226.8 ± 38.6 14.2 ± 8.9 0.0–20.0
Immunoglobulin G, g/L 20.9 ± 9.8 12.4 ± 8.1 7.51–15.6
Complement C3, g/L 0.56 ± 0.36 1.36 ± 0.49 0.79–1.52
Complement C4, g/L 0.15 ± 0.08 0.21 ± 0.16 0.16–0.38
γ-Globulin, % 25.9 ± 9.5 16.3 ± 7.4 9.2–18.2
Globulin, g/L 34.6 ± 9.2 29.6 ± 11.5 20.0–40.0
Anti-SSA/anti-SSB positive, n (%) 48 (88) 2 (6) Negative
Anti-nuclear antibody positive, n (%) 45 (84) 1 (3) Negative (<1:100)
Data are presented as mean ± SD where applicable.

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Chen et al—Virtual Touch Quantification in Primary Sjögren Syndrome

parotid and submandibular glands. The patients with early-
stage primary Sjögren syndrome had more subtle changes
in the B-mode texture, which were often difficult to differ-
entiate from those in patients without primary Sjögren syn-
drome with dry eye and dry mouth symptoms. In addition,
B-mode images of salivary glands in patients with hepatitis
C, human immunodeficiency virus infection, or sarcoido-
sis may show multiple hypoechoic foci or cystic areas,
mimicking the sonographic features of patients with pri-
mary Sjögren syndrome.18–20 Therefore, B-mode sonog-
raphy alone is not sufficient to differentiate early-stage
primary Sjögren syndrome from other diseases. The SWV
provides a quantitative evaluation of tissue stiffness, a bio-
marker that is potentially useful for characterizing inflam-
mation and fibrosis in primary Sjögren syndrome. In our
study, the healthy volunteers had SWV values of 1.85 ±
0.31 m/s in the parotid gland and 1.82 ± 0.27 m/s in the
submandibular gland. These results are consistent with
those reported by Matsuzuka et al,21 in which the SWV val-
ues of parotid and submandibular glands in the general
population were 1.98 ± 0.73 and 1.86 ± 0.37 m/s, respec-
tively. In another study with 124 healthy patients, parotid
gland tissue had an SWV of 1.87 ± 0.02 m/s, and sub-
mandibular gland tissue had an SWV of 1.81 ± 0.02 m/s.13
The relatively good agreement among different studies
suggests that the VTQ technique can provide valid meas-
urements in salivary glands.
The results of this study indicate that the SWV may
be useful for differentiating salivary glands of patients with
early-stage primary Sjögren syndrome from those of
patients without primary Sjögren syndrome with dry
mouth and dry eye symptoms (control group A) and
healthy individuals (control group B). The SWV values
in both salivary glands were significantly higher in patients
with early-stage primary Sjögren syndrome than in both
control groups. Lymphocytic infiltration, hyperplasia of
ductal epithelial cells, and fibrosis of salivary glands may
be conditions leading to increased stiffness and thus
higher SWV values in patients with primary Sjögren syn-
drome. To separate patients with early-stage primary

Figure 1. Representative images of parotid glands with SWV measurements using VTQ. Shear wave velocity values were 1.58 m/s in a healthy vol-
unteer (A), 1.84 m/s in a patient without primary Sjögren syndrome with dry eye and dry mouth symptoms (B), 2.88 m/s in a patient with early-stage
primary Sjögren syndrome (C), and 3.01 m/s in a patient with advanced-stage primary Sjögren syndrome (D).

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Chen et al—Virtual Touch Quantification in Primary Sjögren Syndrome

Sjögren syndrome from those without primary Sjögren
syndrome with dry eye and dry mouth symptoms and
healthy volunteers, the AUROC values were higher for
parotid glands than submandibular glands. Therefore,
the parotid gland appears to be the preferred salivary gland
for SWV evaluation of primary Sjögren syndrome. This
finding is not surprising because the serous parotid gland
is primarily affected by primary Sjögren syndrome,
whereas the mixed submandibular gland is impaired to a
lesser extent.22 Diagnosis of early-stage primary Sjögren
syndrome by B-mode imaging of salivary glands relies on
the presence of imaging features such as texture inhomo-
geneity, hypoechoic areas, and hyperechoic bands. How-
ever, this interpretation is subjective, and some of these
imaging features sometimes can present in inflammatory
or even normal salivary glands. Therefore, SWV meas-
urements may provide a valuable addition to sonographic
evaluation of the salivary glands in patients with early-
stage primary Sjögren syndrome.
Advanced-stage primary Sjögren syndrome showed
slightly higher SWV values in both submandibular and
parotid glands compared to early-stage primary Sjögren
syndrome, although there was no significant difference
between these groups. Therefore, SWV may have limited
value in monitoring the progression of primary Sjögren
syndrome. One possible reason may be the relative con-
tribution of inflammation and fibrosis because both
conditions are known to increase the SWV. Early-stage pri-
mary Sjögren syndrome often has more severe inflamma-
tion but less fibrosis, whereas advanced-stage primary
Sjögren syndrome has less inflammation but more fibrosis.
This combination of inflammation and fibrosis may lead to
relatively stable SWVs in different stages of primary Sjögren
syndrome.

Figure 2. Receiver operating characteristic curves of SWV measurements for separating patients with early-stage primary Sjögren syndrome from
control group B (healthy volunteers) in submandibular glands (A), patients with early-stage primary Sjögren syndrome from control group A (patients
without primary Sjögren syndrome with dry eye and dry mouth symptoms) in submandibular glands (B), patients with early-stage primary Sjögren
syndrome from control group B in parotid glands (C), and patients with early-stage primary Sjögren syndrome from control group A in parotid glands.

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Chen et al—Virtual Touch Quantification in Primary Sjögren Syndrome
This study had several limitations. First, the sample
size was relatively small. Larger studies are needed to vali-
date the findings of this preliminary investigation. Second,
the cohort with primary Sjögren syndrome had very few
male patients because primary Sjögren syndrome is much
more common among female patients. Our control cohort
was sex matched to the patient cohort and therefore had
the same distribution skewness. Third, this study only inves-
tigated the efficacy of the SWV of salivary glands alone for
diagnosis of primary Sjögren syndrome. A combination of
the SWV with B-mode features may improve the diagnos-
tic accuracy, which will be further evaluated in the future.
Finally, the participants in this study were scanned by a
single sonographer. To assess the inter-rater variation, 24
randomly selected participants were scanned by 2 experi-
enced sonographers, who were blinded to clinical findings.
A moderate correlation was found (r = 0.71). Future studies
with multiple sonographers are needed to confirm the find-
ings of this study.
In conclusion, we have used VTQ to measure the
SWV of the salivary glands of 54 patients with primary
Sjögren syndrome, 35 patients without primary Sjögren
syndrome, and 52 healthy volunteers. The results suggest
that the SWV is a promising parameter for assessing sali-
vary glands in primary Sjögren syndrome.
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