A Point-Scoring System for the Clinical Diagnosis of Sjögren's Syndrome Based on Quantified SPECT Imaging of Salivary Gland.

Jing Chen,Guifen Shen,Yunfeng Han,Wei Sun,Haixia Liu,Yunqiang Yang,Jinming Li,Zhiqun Xianyu,Shouxin Li,Sheng Zhou,Xia Zhao,Cong Ye,Lingli Dong,Song Guo Zheng

doi:10.1371/journal.pone.0155666

Jing Chen, Guifen Shen + Show 12 more

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https://doi.org/10.1371/journal.pone.0155666

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Abstract

ObjectiveTo establish a point-scoring diagnostic system for Sjögren's syndrome (SS) based on quantified SPECT imaging of salivary gland, and evaluate its feasibility and performance compared with 2002 AECG criteria and 2012 ACR criteria.Methods213 patients with suspected SS enrolled in this study. The related clinical data of all patients were collected. All patients were evaluated and grouped on a clinical basis and posttreatment follow-up by rheumatology specialists as the unified standard (SS group with 149 cases and nSS group with 64 cases). From SPECT imaging of salivary gland, Tmax, UImax, Ts and EFs were derived for bilateral parotid and submandibular glands, and compared between the groups. A point-scoring diagnostic system for SS was established based on the quantified SPECT imaging of salivary gland. We estimated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for the new diagnostic system, compared with 2002 AECG criteria and 2012 ACR criteria.ResultsWhen 7.0 was used as the cut-off point, the sensitivity, specificity, PPV, NPV and accuracy for the new point-scoring system in diagnosing SS were 89.93% (134/149), 93.75% (60/64), 97.10% (134/138), 80.00% (60/75) and 91.08% (194/213), respectively. The new point-scoring diagnostic system based on quantified SPECT imaging of salivary gland keeps the specificity comparatively to 2002 AECG criteria and 2012 ACR criteria, but improves the sensitivity significantly (P<0.01).ConclusionThe new point-scoring diagnostic system for SS based on quantified SPECT imaging of salivary gland may be superior to 2002 AECG criteria and 2012 ACR criteria, with higher sensitivity and similar specificity in the diagnosis of SS. Additionally, it also has good feasibility in the clinical settings.

Highlights

Sjögren's syndrome (SS) is a systemic progressive autoimmune disease with external exocrine glands dysfunction and multiorgan involvement
The new pointscoring diagnostic system based on quantified SPECT imaging of salivary gland keeps the PLOS ONE | DOI:10.1371/journal.pone
The new point-scoring diagnostic system for SS based on quantified SPECT imaging of salivary gland may be superior to 2002 AECG criteria and 2012 ACR criteria, with higher sensitivity and similar specificity in the diagnosis of SS

Summary

Introduction

Sjögren's syndrome (SS) is a systemic progressive autoimmune disease with external exocrine glands dysfunction and multiorgan involvement. The classification criteria for SS issued in 2002 revised by the American-European Consensus Group (2002 AECG criteria) is the most widely used criteria in clinical studies over the last decade [2]. Another classification criteria for SS proposed in 2012 by the American College of Rheumatology (2012 ACR criteria) have recently been endorsed [8]. 38% of patients with a clinical diagnosis of SS were missing by 2002 AECG criteria or 2012 ACR criteria. Even if both criteria are applied in parallel, 20% of SS patients were still missing [5]

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