Ultrasonographic Evaluation of Salivary Glands for Sjogren's Syndrome: Diagnostic and Monitoring Insights
October 13th, 2023
Salivary gland ultrasonography is a promising tool for the diagnosis and evaluation of disease activity and complications in Sjogren's syndrome (SS). The scanning technique for salivary gland ultrasound examination relevant to SS is described in the article.
Our research focus is connective tissue diseases, including Sjogren's syndrome, and we will describe a standardized approach to salivary gland ultrasound in diagnosing Sjogren's syndrome. We hope the protocol will be useful for clinicians unfamiliar with doing ultrasound to enhance its application In clinical practice, Ultrasound is a powerful tool in evaluating various rheumatological conditions, including arthritis, Sjogren's syndrome, and interstitial lung disease. It is helpful in diagnosis, monitoring, and prognostication.
It can be applied as an outcome measure in clinical studies, such as detecting subclinical synovitis to assess the risk of rheumatoid arthritis progression. Ultrasound is an operator-dependent procedure, and the result may be unreliable if inexperienced hands perform it. Well-validated and quantitative measurements are often needed to standardize the description and reporting of pathological sonographic findings before they can be applied in clinical practice and research.
In this procedure, we will describe how to conduct a salivary gland ultrasound in patients with sicker symptoms. This approach is easy to perform and can usually be completed within 10 to 15 minutes. We will also demonstrate techniques to perform reliable and reproducible results to ensure the quality of the ultrasound scanning.
Our center will continue to research on applying ultrasound in diagnosis and monitoring in rheumatology. We will research utilizing lung ultrasound for screening of interstitial lung disease associated with connective tissue diseases, hoping to improve the current screening strategy for lung fibrosis in rheumatology patients. To begin, select a high frequency linear transducer of 10 megahertz.
Set the ultrasound to B mode, and use the highest frequency of the probe. Adjust the depth to three centimeters and gain 50%to 60%Position the patient in the supine position with the neck slightly extended. Use a pillow to support the patient's head.
For transverse images, orient the probe with the marker pointing towards the patient's right side. For longitudinal scanning, orient the marker at the cephalic side. Apply gel to the probe's surface.
Place the probe below the thyroid cartilage to scan the thyroid gland. Save the obtained images, the isthmus connects the right and left lobes of the thyroid gland. Consider the echogenicity of a normal thyroid gland as a reference.
For any concomitant thyroid disease, compare the echogenicity to that of the surrounding muscles. To begin, turn the patient's head to the opposite side of the gland being examined. Place the transducer longitudinally along the anterior border of the parotid gland, just anterior to the ear and parallel to the tragus, and move it from the superior to the inferior pole of the gland to obtain the standard view.
Place the probe transversely at the angle of the mandible to obtain the transverse scan. Ideally, the parotid gland is located between the mastoid and mandible ramus in a transverse view. Scan the parotid gland transversely from the superior to the inferior pole.
Slide the probe below the mandible's ramus to visualize the parotid gland's deep part, which the mandible could partially obscure. Place the probe between the mastoid process and the angle of the mandible. Save and label the images in both the longitudinal and transverse views.
Assess the size of the parotid gland. Compare the echogenicity with that of the thyroid gland, which is similar to the normal parotid gland. Turn on the color doppler to differentiate blood vessels from the dilated intraglandular duct.
The retromandibular vein and external carotid artery divide the superficial and deep parotid lobes. Capture the degree of inhomogeneity, the clearness of the gland margin, and the presence of hypo or anechoic areas. Note the presence of focal lesions and document the size, location, shape, and echogenicity.
Turn on the color doppler to look for vascularity. Score the degree of sonographic involvement on a scale of zero to three as defined on the screen. The presence of lymph nodes within the parotid gland could be normal and common, especially when located in the superficial lobe.
Measure the diameter of the lymph nodes. Evaluate the shape, echogenicity, and preservation of fatty hilum. Repeat the scanning at the contralateral parotid gland and compare the size and echo texture between the two parotid glands.
Normal parotid glands appeared homogenous with clear demarcation with overlying tissues and muscles. Position the patient in the supine position with the head maximally tilted to the back. To obtain the transverse view of the submandibular gland, position the transducer just below the angle of the mandible at the submandibular area.
Examine the entire submandibular gland from anterior to posterior. The mandible, mylohyoid muscles, and the anterior belly of the digastric muscles bound it. Obtain the longitudinal view by placing the probe medial to the horizontal body of the mandible.
Visualize the facial artery in this plane. Save and label the images in both transverse and longitudinal views of the submandibular gland. Assess the size of the submandibular gland.
Examine the echogenicity of the submandibular gland, which is usually less echogenic than the parotid gland. Assess the degree of inhomogeneity, the clearness of the gland margin, and the presence of hypo or anechoic areas within the glands. Note the presence of focal lesions.
Grade the degree of inhomogeneity using the OMERACT score. If the evaluation of the gland is not possible due to qualitative parameters, follow the alternate grading parameters. Measure the size of the submandibular lymph nodes.
Evaluate fatty hilum's shape, echogenicity, and preservation. Repeat the scanning at the contralateral submandibular gland and compare the size and echo texture between the two submandibular glands. Normal submandibular glands demonstrated a clear demarcation with the overlying structures.
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Overview
Salivary gland ultrasonography is an effective diagnostic tool for Sjogren's syndrome (SS), aiding in the evaluation of disease activity and complications. This article outlines a standardized approach for clinicians to enhance the application of ultrasound in clinical practice.
Key Study Components
Area of Science
- Connective tissue diseases
- Rheumatology
- Ultrasound diagnostics
Background
- Ultrasound is valuable in diagnosing rheumatological conditions.
- It assists in monitoring and prognostication of diseases.
- Operator experience significantly impacts the reliability of ultrasound results.
- Standardized measurements are crucial for clinical application.
Purpose of Study
- To describe a standardized approach to salivary gland ultrasound for SS diagnosis.
- To provide a protocol for clinicians unfamiliar with ultrasound.
- To enhance the application of ultrasound in clinical practice.
Methods Used
- Standardized ultrasound scanning technique for salivary glands.
- Evaluation of disease activity in Sjogren's syndrome.
- Assessment of complications related to SS.
- Quantitative measurements for standardized reporting.
Main Results
- Ultrasound effectively evaluates various rheumatological conditions.
- Standardized protocols improve diagnostic reliability.
- Ultrasound can detect subclinical conditions, aiding in prognosis.
- Operator-dependent variability can affect outcomes.
Conclusions
- Salivary gland ultrasonography is a promising diagnostic tool for SS.
- Standardized approaches are necessary for effective clinical application.
- Further validation of techniques is needed for widespread use.
Frequently Asked Questions
Executive Industry Relevance
Standardized salivary gland ultrasonography (SGUS) offers a non-invasive, reproducible imaging modality to support early diagnostic and monitoring decisions in Sjogren's syndrome (SS) and related autoimmune conditions. By enabling quantitative assessment of glandular structure and pathology, SGUS enhances predictive confidence and informs risk-adjusted portfolio advancement in autoimmune disease research. Integration of SGUS into discovery and translational workflows addresses the need for scalable, operator-independent diagnostic tools in biopharma R&D.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Supports objective evaluation of glandular pathology for target validation in autoimmune disease models.
- Enables biological de-risking by providing quantitative imaging endpoints for hypothesis testing.
- Facilitates portfolio triage by distinguishing disease-relevant glandular changes from non-specific findings.
Screening & Assay Development
- Prepares validated imaging protocols for downstream clinical and preclinical studies.
- Standardizes assessment of glandular echogenicity and inhomogeneity for reproducible data generation.
- Enables quantitative scoring systems (e.g., OMERACT) to support assay comparability and scalability.
Translational & Preclinical Research
- Aligns imaging biomarkers with disease progression and therapeutic response in preclinical models.
- Provides continuity from discovery-stage imaging to clinical trial endpoints in autoimmune indications.
- Reduces translational risk by enabling non-invasive, repeatable monitoring of glandular pathology.
Pipeline & Workflow Integration
SGUS fits within the autoimmune discovery continuum, bridging early target validation, preclinical model assessment, and translational biomarker development for SS and related diseases.
- Discovery Biology: Enables hypothesis-driven evaluation of glandular changes and mechanistic de-risking.
- Screening: Provides standardized, reproducible imaging outputs for assay development and compound evaluation.
- Analytics: Delivers quantitative measurements (e.g., echogenicity, inhomogeneity scores) to compare disease and control conditions.
- Translational Research: Supports biomarker alignment and continuity from preclinical to clinical research phases.
- Enterprise Reuse: Establishes a reusable imaging platform for autoimmune and connective tissue disease portfolios.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in autoimmune target validation.
- Operational Value: Promotes standardization, reproducibility, and scalability of imaging assessments.
- Strategic Value: Informs go/no-go decisions and enhances capital efficiency by reducing reliance on invasive diagnostics.
- Portfolio Impact: Enables risk-adjusted prioritization and advancement of autoimmune disease programs.
Implementation Considerations
- Requires expertise in ultrasonography and autoimmune disease imaging interpretation.
- Needs access to high-frequency linear transducers and standardized imaging protocols.
- Demands cross-team agreement on scoring systems and reporting standards.
- May require adaptation for different anatomical or disease contexts within autoimmune research.
- Operator dependency and training are critical for reproducibility and data quality.
Biopharma FAQs
Chapters in this video
0:00
Introduction
2:09
Ultrasound Setting and Scanning of the Thyroid Gland for Examining Sjogren s Syndrome
3:10
Ultrasound Scanning of the Parotid Gland for Examining Sjogren's Syndrome
5:34
Ultrasound Scanning of the Submandibular Gland for Examining Sjogren s Syndrome
