Objective To assess whether ultrasonographic scoring of (i) both parotid and submandibular salivary glands and (ii) all individual components of the Hocevar scoring system, is needed for classifying patients as primary Sjögren’s syndrome (pSS). Methods Ultrasound examination of the major salivary glands (sUS) was performed in 204 consecutive patients clinically suspected (n=171) or diagnosed (n=33) with pSS. Parenchymal echogenicity, homogeneity, hypoechogenic areas, hyperechogenic reflections and salivary gland posterior border were scored in left and right parotid and submandibular glands. Logistic regression analyses were performed to assess which glands and sUS components contributed significantly to classification as pSS or non-pSS according to the 2016 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) criteria. Results 116 (57%) patients were classified as pSS, the remaining as non-pSS. Instead of scoring both sides (area under the curve; AUC=0.856, Nagelkerke R2=0.526), multivariate analysis showed that sUS scoring of only right (AUC=0.850; R2=0.518) or left (AUC=0.852; R2=0.511) parotid and submandibular glands is sufficient to predict ACR-EULAR classification. Moreover, all individual components of the Hocevar scoring system significantly predicted classification. Multivariate analysis showed that parenchymal echogenicity and hypoechogenic areas contributed independently to ACR-EULAR classification (AUC=0.857; R2=0.539). Scoring these components in one parotid and one submandibular gland highly predicted ACR-EULAR classification (AUC=0.855; R2=0.539). Scoring only hypoechogenic areas on one side showed almost similar results (AUC=0.846; R2=0.498). Conclusion sUS examination of parotid and submandibular glands on one side is sufficient to predict classification of patients according to the ACR-EULAR criteria. To further increase feasibility of sUS in outpatient clinics worldwide, only hypoechogenic areas can be scored.

中文翻译：

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对一个腮腺和一个下颌下腺的低回声区域进行评分增加了超声在原发性干燥综合征中的可行性

目的 评估是否需要对 (i) 腮腺和下颌下唾液腺以及 (ii) Hocevar 评分系统的所有单个组成部分进行超声评分，以将患者分类为原发性干燥综合征 (pSS)。方法 对 204 名临床疑似（n=171）或诊断（n=33）pSS 的连续患者进行大唾液腺 (sUS) 超声检查。对左右腮腺和下颌下腺的实质回声、均匀性、低回声区域、高回声反射和唾液腺后缘进行评分。根据 2016 年美国风湿病学会-欧洲抗风湿病联盟 (ACR-EULAR) 标准，进行逻辑回归分析以评估哪些腺体和 sUS 成分对分类为 pSS 或非 pSS 有显着影响。结果 116 名 (57%) 患者被归类为 pSS，其余为非 pSS。不是对两侧进行评分（曲线下面积；AUC=0.856，Nagelkerke R2=0.526），多变量分析显示 sUS 评分仅为右侧（AUC=0.850；R2=0.518）或左侧（AUC=0.852；R2=0.511）腮腺和下颌下腺足以预测 ACR-EULAR 分类。此外，Hocevar 评分系统的所有单个组件都显着预测了分类。多变量分析表明，实质回声区和低回声区对 ACR-EULAR 分类有独立贡献（AUC=0.857；R2=0.539）。在一个腮腺和一个下颌下腺中对这些成分进行评分可高度预测 ACR-EULAR 分类（AUC=0.855；R2=0.539）。仅对一侧的低回声区域进行评分显示出几乎相似的结果（AUC=0.846；R2=0.498）。结论 一侧腮腺和下颌下腺的 sUS 检查足以根据 ACR-EULAR 标准预测患者的分类。为了进一步提高 sUS 在全球门诊的可行性，只能对低回声区域进行评分。