Abstract
We investigated the sensitivities of 2-dimensional (2D) magnetic resonance sialography (MR-S) and unilateral sagittal and axial 3-dimensional (3D) MR-S using a surface coil and their combination in diagnosing patients with Sjögren's syndrome (SS). We retrospectively analyzed the 3D and 2D MR-S results of 78 patients with SS. We evaluated the sensitivities of multiple high-signal-intensity spots and staging on MR sialograms and analyzed the efficient imaging methods and cross section for diagnosing patients with SS. The sensitivities of MR-S for detecting abnormal findings (i.e., MR-S stage 1 or higher) were as follows: 65 cases (83.3% [95% confidence interval (CI): 73.2–90.8]) for unilateral sagittal 3D MR-S; 62 cases (79.4% [95% CI: 68.8–87.8]) for axial 3D MR-S; 66 cases (84.6% [95% CI: 74.7–91.8]) for combined unilateral sagittal and axial 3D MR-S; and 32 cases (41.0% [95% CI: 30.0–52.7]) for bilateral sagittal 2D MR-S. The ratio of the abnormal finding of MR-S was tested using the two-tailed Fisher's exact test. Unilateral sagittal, axial, and combined unilateral sagittal and axial 3D MR-S showed significantly higher sensitivity than bilateral sagittal 2D MR-S, respectively (P < 0.001). Most cases upstaged by 3D MR-S were those positive (stage 1 or higher) among the stage 0 cases detected by 2D MR-S. Axial 3D MR-S, compared with 2D MR-S, understaged four cases, which was due to the imaging range of the axial 3D MR-S. We concluded that a single unilateral sagittal 3D MR-S was sufficient and axial 3D MR-S was unnecessary for SS staging. T1- and T2-weighted images are essential for investigating the salivary glands in patients with SS. Therefore, we also concluded that bilateral sagittal 3D MR-S of the parotid glands in addition to T1- and T2-weighted imaging is necessary, sufficient, and most efficient for precise MR imaging examination of the salivary glands, including diagnosing SS.
Highlights
Magnetic resonance (MR) imaging has become widely used for assessing salivary gland diseases and is useful for the diagnosis of Sjogren’s syndrome (SS)
In the imaging analysis for the staging of MR-S, which indicates the detection of the multiple high-signal-intensity spots (MHS) and measurement of the diameter of the MHS, the kappa values for the interobserver agreement of the sagittal 3D MR-S, axial 3D MR-S, and sagittal 2D MR-S were 0.92 (95% confidence interval [CI], 0.808–1.02), 0.96, and 0.85, respectively
Most cases designated as stage 2 or higher based on 3D MR sialography (MRS) could be designated as stage 1 or higher by 2D MR-S (Figure 3)
Summary
Magnetic resonance (MR) imaging has become widely used for assessing salivary gland diseases and is useful for the diagnosis of Sjogren’s syndrome (SS). MR-S was performed using a high-resolution technique and a heavily T2-weighted 3D fast-spin-echo sequence (TR/TE/number of signal-intensity acquisitions, 5000/602–675 ms/2) according to a previous report that a heavily T2-weighted 3D fast-spin-echo sequence is the most suitable for the evaluation of thin salivary gland ducts (section thickness: 1 mm, gapless image, number of slices: 20, pixel size: 0.45–0.55 mm × 0.55–0.79 mm, FOV: 200 mm; scan time: 185 s) [21]. Two oral and maxillofacial radiologists with 11 and 19 years of experience, respectively, evaluated the coded and randomly presented unilateral sagittal 3D MR-S, axial 3D MR-S, and bilateral sagittal 2D MR-S for the presence or absence of MHS based on a previous report [6] Both radiologists were blinded to the histopathological grading and T1- and T2weighted imaging findings. EZR software (Saitama Medical Center, Jichi Medical University, Saitama, Japan), providing a graphical interface for R (v3.2.2; e R Foundation for Statistical Computing, Vienna, Austria), was used for statistical analyses
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