Abstract
Diffusion weighted imaging (DWI) has proven to be sensitive for detecting early injury to the parotid gland in pSS (primary Sjögren’s syndrome). Here, we explored the application of ADC histogram and texture analyses for evaluating the disease activity of pSS. A total of 55 patients with pSS who met the classification criteria of the 2002 AECG criteria prospectively underwent 3.0-T magnetic resonance imaging (MRI) including DWI (b = 0 and 1000 s/mm2). According to the ESSDAI score, 35 patients were categorized into the low-activity group (ESSDAI < 5) and 20 into the moderate-high-activity group (ESSDAI ≥ 5). Via analysis of the whole-volume ADC histogram, the ADCmean, skewness, kurtosis, and entropy values of the bilateral parotid glands were determined. Multivariate analysis was used to identify independent risk factors for predicting disease activity. The diagnostic performance of the indexes was evaluated via receiver operating characteristic (ROC) analysis. ROC analysis showed that the anti-SSB, lip biopsy, MRI morphology, ADC, ADCmean, and entropy values were able to categorize the disease into two groups, particularly the entropy values. The multivariate model, which included anti-SSB, MRI morphology and entropy, had an area under the ROC curve of 0.923 (P < 0.001). The parotid entropy value distinguished disease activity in patients with pSS, especially combined with anti-SSB and MRI morphology.
Highlights
Primary Sjögren’s syndrome is a chronic autoimmune disease that results in direct injury to the exocrine glands[1,2]
Whole-volume apparent diffusion coefficient (ADC) histogram and texture analyses have been applied in the study of inflammation diseases[15,16], yet they have not been previously reported for evaluating parotid injury of Primary Sjögren’s syndrome (pSS) patients
The magnetic resonance imaging (MRI) morphology grades of bilateral parotid glands were consistent for each patient
Summary
Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disease that results in direct injury to the exocrine glands[1,2]. Cohen et al reported that the 18F-fluorodeoxyglucose positron emission tomography/computed tomography activity score was correlated with ESSDAI and could help to assess disease activity in patients with pSS, resulting in exposure to radionuclides[9]. Magnetic resonance imaging (MRI) is not included in the diagnostic criteria of the EULAR for pSS, it has be found to be superior to X-ray sialography for noninvasively evaluating the parotid parenchyma. Whole-volume ADC histogram and texture analyses have been applied in the study of inflammation diseases[15,16], yet they have not been previously reported for evaluating parotid injury of pSS patients. The purpose of this study was to compare the differences between whole-volume ADC histogram and texture analyses for parotid glands in pSS patients with different activities and to explore the potential of these indexes in predicting disease activity in pSS patients
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