Tiziana Angusti1, Emanuela Pilati1, Antonella Parente1, Renato Carignola2, Matteo Manfredi1, Simona Cauda3, Elena Pizzigati1, Julien Dubreuil4,5, Francesco Giammarile4,5, Valerio Podio1, Andrea Skanjeti6,7,8. 1. Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy. 2. Medical Division, San Luigi Gonzaga University Hospital, Orbassano, Italy. 3. Service of Nuclear Medicine, Institute for Cancer Research and Treatment, Candiolo, Italy. 4. Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France. 5. Equipe Mixte de Recherche 3738, Université Claude Bernard Lyon 1, Lyon, France. 6. Nuclear Medicine Unit, San Luigi Gonzaga University Hospital, Orbassano, Italy. askanjeti@gmail.com. 7. Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France. askanjeti@gmail.com. 8. Equipe Mixte de Recherche 3738, Université Claude Bernard Lyon 1, Lyon, France. askanjeti@gmail.com.
Abstract
OBJECTIVE: The aim of this study was the assessment of semi-quantified salivary gland dynamic scintigraphy (SGdS) parameters independently and in an integrated way in order to predict primary Sjögren's syndrome (pSS). MATERIALS AND METHODS: Forty-six consecutive patients (41 females; age 61 ± 11 years) with sicca syndrome were studied by SGdS after injection of 200 MBq of pertechnetate. In sixteen 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-quantitative analysis. 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 diagnosis (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.
OBJECTIVE: The aim of this study was the assessment of semi-quantified salivary gland dynamic scintigraphy (SGdS) parameters independently and in an integrated way in order to predict primary Sjögren's syndrome (pSS). MATERIALS AND METHODS: Forty-six consecutive patients (41 females; age 61 ± 11 years) with sicca syndrome were studied by SGdS after injection of 200 MBq of pertechnetate. In sixteen 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-quantitative analysis. 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 pSSpatients 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 diagnosis (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.
Authors: C Vitali; S Bombardieri; R Jonsson; H M Moutsopoulos; E L Alexander; S E Carsons; T E Daniels; P C Fox; R I Fox; S S Kassan; S R Pillemer; N Talal; M H Weisman Journal: Ann Rheum Dis Date: 2002-06 Impact factor: 19.103