Korean J Radiol.  2019 Mar;20(3):498-504. 10.3348/kjr.2018.0508.

Quantitative Analysis of Parotid Gland Secretion Function in Sjögren's Syndrome Patients with Dynamic Magnetic Resonance Sialography

• Liu S
• Chen W
• Wang M
• Wu T
• Dong L
• Pan C
• Zhu W

• KMID: 2438280
• DOI: http://doi.org/10.3348/kjr.2018.0508

Abstract

OBJECTIVE
To evaluate the secretory function of parotid glands by dynamic magnetic resonance (MR) sialography and determine the clinical performance of this technique in diagnosing and evaluating Sjögren's syndrome (SS) patients.
MATERIALS AND METHODS
This study enrolled 29 healthy volunteers (25 women and 4 men; mean age, 34.8 ± 6.3 years; age range, 26-47 years) and 25 primary SS (pSS) patients (23 women and 2 men; mean age, 37.7 ± 7.9 years; age range, 25-50 years) with decreased secretory function. The volume of the parotid gland ducts was precisely measured for both groups at single pre- and 6 post-gustatory-stimulated phases. Time-dependent volume change ratio curves were generated, four parameters were derived from the curves: the slope of the increase in the first post-stimulation phase (slope(1st)), the peak value, the time-to-peak, the total saliva secretion post-stimulation. All values were used to quantitatively evaluate the secretory function of the parotid gland. The repeated measurement analysis, Mann-Whitney U test and receiver operating characteristic curve were applied.
RESULTS
Time-dependent volume change ratio curves demonstrated that there is a statistically significant difference between the two groups (F = 8.750; p = 0.005). A quickly increasing curve was shown in the volunteer group, whereas a slowly increasing curve was shown in the pSS patient group. The slope(1st), peak value and total saliva secretion post-stimulation of the patient group were significantly lower than those of the volunteer group (p = 0.005, p = 0.003, and p = 0.002, respectively). The time-to-peak between the two groups was not significantly different (p = 0.383). The slope(1st) can be used as a discriminator to diagnose SS patients (p = 0.015; odds ratio = 4.234; area under the curve = 0.726).
CONCLUSION
Dynamic MR sialography is proven to be an effective method in evaluating salivary gland function and has a great potential in diagnosing and evaluating pSS patients.

Keyword

Magnetic resonance; Quantification; Secretary function; Salivary gland; Salivation; Autoimmune disease; Sialadenitis; Sialosis

MeSH Terms

Autoimmune Diseases
Female
Healthy Volunteers
Humans
Male
Methods
Odds Ratio
Parotid Gland*
ROC Curve
Saliva
Salivary Glands
Salivation
Sialadenitis
Sialography*
Volunteers

Figure

• 

  Fig. 1 Volume CR of parotid gland for each post-gustatory stimulation phase.There were very good agreements for CR1–6 both in volunteer and pSS patient group. CR = changing-ratio, ICC = intraclass correlation coefficient, pSS = primary Sjögren's syndrome

• 

  Fig. 2 Dynamic magnetic resonance sialographic maximum intensity projection images of 37-year-old male healthy volunteer (A) and 44-year-old female pSS patient (B).Main duct and its branches of healthy volunteer become rapidly brighter and thicker in first post-stimulation phase and retain higher signal intensity during rest phases, despite slight fluctuations. Parotid gland duct of pSS patient became brighter in slower and more subtle manner.

• 

  Fig. 3 Time-dependent volume change ratio curves of parotid gland duct in volunteers and pSS patients.

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  Fig. 4 ROC curve of slope1st.slope1st exhibited high accuracy in diagnosing impaired secretory function in pSS patients. AUC = area under curve, ROC = receiver operating characteristic, slope1st = slope of increase in first post-stimulation phase

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