Learning objectives
To review the pathogenesis and clinical features of Sjögren's syndrome (SS).
To identify the main imaging features of Sjögren's syndrome in the different glands
to delineate the role of radiology in the follow up of SS and its potential complications
To be familiar with the imaging clues of other disorders associated with Sjögren's syndrome.
Background
Background
Sjögren's syndrome is a chronic autoimmune disorder with a higher incidence in middle aged and menopausal females.
It predominantly affects the salivary and lacrimal glands as a primary manifestation.
It may be primary or secondary being associated with other connective tissue disorders like rheumatoid arthritis.
SS shows a 44 fold increased risk of Lymphoma as well as the affection of multiple glandular and extra-glandular tissues,
necessitating proper radiological follow up.
The diagnosis of SS is based on the classification criteria proposed by the American–European...
Findings and procedure details
Glandular abnormalities:
1) Contrast sialography:(Fig.1)
Sialography is a first radiographic method that can detect anatomic and architectural changes in the salivary gland duct system.
However its drawbacks are due to its invasiveness and the use of contrast media.
The sialographic changes are classified as punctate,
globular,
cavitary,
and destructive dilatation (sialectasia) of the acinar system.
It is the reference standard for staging and appears as alternating areas of ductal stenosis and dilatation (string of beads pattern).
2) Scintigraphy:(Fig.2)
It is a functional method that allows...
Conclusion
Multiple imaging modalities can aid in the proper diagnosis and management of SS.
Imaging is directed to the major salivary glands starting from Plain Radiography in detecting ductal calculi,
calcifications and adjacent osseous lesions.
Sialography for the evaluation of the ductal system.
US for differentiating solid fromcystic lesions and obtaining biopsies.
CT and MRI allow the complete imaging of the glands,
extensions and complications.
SS may show reliable imaging features of the glandulartissues aiding in its diagnosis,
proper management plan as well as the early...
References
El Miedany YM,
Ahmed I,
Mourad HGet al.: Quantitative ultrasonography and magnetic resonance imaging of the parotid gland: can they replace the histopathologic studies in patients with Sjogren’s syndrome?Joint Bone Spine71,
29–38 (2004).
Ariji Y,
Ohki M,
Eguchi Ket al.: Texture analysis of sonographic features of the parotid gland in Sjögren’s syndrome.AJR Am.J.
Roentgenol.166,
935–941 (1996).
Hermann GA,
Vivino FB,
Goin JE: Scintigraphic features of chronic sialadenitis and Sjögren’s syndrome: a comparison.Nucl.
Med.
Commun.20,
1123–1132 (1999).
Vinagre F,
Santos MJ,
Prata A,
da Silva JC,...