超声弹性成像技术在IgG4相关唾液腺炎诊断和随访中的应用
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摘要
目的:探讨超声弹性成像技术在IgG4相关唾液腺炎诊断和随访中的应用价值。方法:回顾分析2018年5月—10月就诊于上海交通大学医学院附属第九人民医院口腔外科,诊断为IgG4相关唾液腺炎3例患者的临床资料。所有患者均接受口服小剂量糖皮质激素治疗,采用超声弹性成像技术应变率比值法和声辐射力脉冲成像法,对治疗前、后患者下颌下腺进行弹性超声检查,观察超声影像学特点及疗效。结果:3例患者临床表现均为双侧下颌下腺无痛性肿大超过3个月,血清IgG和IgG4浓度均异常升高,下颌下腺活检病理及免疫组织化学染色结果提示符合IgG4相关唾液腺炎。治疗前弹性超声成像显示腺内大范围蓝色区域对应低回声区,应变率比值(SR)较正常腺体减小而剪切波速值(SWV)较正常腺体增大,表示该区域腺体质地比正常腺体明显较硬。所有患者经小剂量糖皮质激素治疗1个月后随访,临床表现原本肿大的下颌下腺明显消退,触诊质地软化,血清IgG和IgG4浓度明显下降,弹性超声显示蓝色区域范围明显缩小,黄色和绿色区域范围增大,对应SR增大而SWV减小,客观且半量化地反映腺体质地较治疗前软化。结论:超声弹性成像技术通过测量SR或SWV,可以客观半量化地反映病变唾液腺质地。结合患者的临床表现、血清学指标和组织病理学表现,可以辅助IgG4相关唾液腺炎的诊断,并初步评价疾病的严重性和进展程度。
PURPOSE: This study was aimed to explore the utility of ultrasound elastography in diagnosis and follow-up of IgG4-related sclerosing sialadenitis. METHODS: We retrospectively studied IgG4-related sclerosing sialadenitis patients based on clinical examination, serology, pathology and ultrasound elastography features. The bilateral submandibular glands were examined by strain ratio(SR) and acoustic radiation force impulse(ARFI) imaging, and the SR and shear wave velocity(SWV) value were obtained. All the patients were treated by corticosteroids and followed up for at least one month. RESULTS: Three patients with IgG4-related sclerosing sialadenitis were involved in the study. The patients presented persistent bilateral and painless submandibular glands swelling, elevated levels of serum IgG4 and IgG4-positive plasmacytes infiltration with tissue fibrosis. Elastography revealed ''blue'' area meaning to be hard tissue matched the hypoechoic areas within the enlarged submandibular glands before treatment. The SR value was lower and the SWV value was higher than normal controls, which meant the gland tissue was stiffer than normal. After one month's steroids treatment, obvious regression of gland swelling and decrease of serum IgG/IgG4 level were observed. Elastography showed ''blue'' area was shrinking and "yellow/green" area was expanding. The SR value was higher and the SWV value was lower, which meant the gland tissue was softer than before. CONCLUSIONS: Ultrasound elastography provides an easy, quick and non-invasively safe method for objective and semi-quantitative assessment of salivary gland involvement in the diagnosis and follow-up of IgG4-related sclerosing sialadenitis. A comprehensive understanding of ultrasound elastography, clinical condition, serum IgG/IgG4 level change and histopathologic manifestation can assist the diagnosis and lead to the preliminary assessment of disease severity and progression in patients with IgG4-related sclerosing sialadenitis.
PURPOSE: This study was aimed to explore the utility of ultrasound elastography in diagnosis and follow-up of IgG4-related sclerosing sialadenitis. METHODS: We retrospectively studied IgG4-related sclerosing sialadenitis patients based on clinical examination, serology, pathology and ultrasound elastography features. The bilateral submandibular glands were examined by strain ratio(SR) and acoustic radiation force impulse(ARFI) imaging, and the SR and shear wave velocity(SWV) value were obtained. All the patients were treated by corticosteroids and followed up for at least one month. RESULTS: Three patients with IgG4-related sclerosing sialadenitis were involved in the study. The patients presented persistent bilateral and painless submandibular glands swelling, elevated levels of serum IgG4 and IgG4-positive plasmacytes infiltration with tissue fibrosis. Elastography revealed ''blue'' area meaning to be hard tissue matched the hypoechoic areas within the enlarged submandibular glands before treatment. The SR value was lower and the SWV value was higher than normal controls, which meant the gland tissue was stiffer than normal. After one month's steroids treatment, obvious regression of gland swelling and decrease of serum IgG/IgG4 level were observed. Elastography showed ''blue'' area was shrinking and "yellow/green" area was expanding. The SR value was higher and the SWV value was lower, which meant the gland tissue was softer than before. CONCLUSIONS: Ultrasound elastography provides an easy, quick and non-invasively safe method for objective and semi-quantitative assessment of salivary gland involvement in the diagnosis and follow-up of IgG4-related sclerosing sialadenitis. A comprehensive understanding of ultrasound elastography, clinical condition, serum IgG/IgG4 level change and histopathologic manifestation can assist the diagnosis and lead to the preliminary assessment of disease severity and progression in patients with IgG4-related sclerosing sialadenitis.
引文
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[9]Zengel P,Reichel CA,Vincek T,et al.Ultrasound elastography in diagnosis and follow-up for patients with chronic recurrent parotitis[J].Clin Hemorheol Microcirc,2017,67(3-4):389-397.
[10]Reichel CA,Vincek T,Gellrich D,et al.Ultrasound elastography in diagnosis and follow-up for patients with sialolithiasis[J].Dentomaxillofac Radiol,2018,47(7):20170424.
[11]Kimura-Hayama E,Criales-Vera S,Azpeitia-Espinosa L,et al.Elastographic ultrasound:an additional image tool in Sjogren's syndrome[J].Int J Rheum Dis,2018,21(6):1293-1300.
[12]王知俊,郑凌艳,浦益萍,等.Ig G4相关唾液腺炎25例临床分析[J].中国口腔颌面外科杂志,2016,14(2):128-133.
[13]Kawashiri SY,Nishino A,Nakamura H,et al.The stiff elastographic change of submandibular glands rapidly improves after the introduction of glucocorticoid treatment in patients with Ig G4-related dacryoadenitis and sialoadenitis[J].Mod Rheumatol,2016,26(3):463-464.
[2]张蔚蒨,龚霞,熊屏.超声弹性成像在干燥综合征唾液腺病变中的应用价值[J].上海口腔医学,2018,27(1):73-78.
[3]Umehara H,Okazaki K,Masaki Y,et al.Comprehensive diagnostic criteria for Ig G4-related disease(IgG4-RD),2011[J].Mod Rheumatol,2012,22(1):21-30.
[4]Barr RG,Ferraioli G,Palmeri ML,et al.Elastography assessment of liver fibrosis:society of radiologists in ultrasound consensus conference statement[J].Radiology,2015,276(3):845-861.
[5]Brener S.Transient elastography for assessment of liver fibrosis and steatosis:an evidence-based analysis[J].Ont Health Technol Assess Ser,2015,15(18):1-45.
[6]Ma X,Zhan W,Zhang B,et al.Elastography for the differentiation of benign and malignant liver lesions:a metaanalysis[J].Tumour Biol,2014,35(5):4489-4497.
[7]Sigrist RMS,Liau J,Kaffas AE,et al.Ultrasound elastography:review of techniques and clinical applications[J].Theranostics,2017,7(5):1303-1329.
[8]Cindil E,Oktar SO,Akkan K,et al.Ultrasound elastography in assessment of salivary glands involvement in primary Sjogren's syndrome[J].Clin Imaging,2018,50:229-234.
[9]Zengel P,Reichel CA,Vincek T,et al.Ultrasound elastography in diagnosis and follow-up for patients with chronic recurrent parotitis[J].Clin Hemorheol Microcirc,2017,67(3-4):389-397.
[10]Reichel CA,Vincek T,Gellrich D,et al.Ultrasound elastography in diagnosis and follow-up for patients with sialolithiasis[J].Dentomaxillofac Radiol,2018,47(7):20170424.
[11]Kimura-Hayama E,Criales-Vera S,Azpeitia-Espinosa L,et al.Elastographic ultrasound:an additional image tool in Sjogren's syndrome[J].Int J Rheum Dis,2018,21(6):1293-1300.
[12]王知俊,郑凌艳,浦益萍,等.Ig G4相关唾液腺炎25例临床分析[J].中国口腔颌面外科杂志,2016,14(2):128-133.
[13]Kawashiri SY,Nishino A,Nakamura H,et al.The stiff elastographic change of submandibular glands rapidly improves after the introduction of glucocorticoid treatment in patients with Ig G4-related dacryoadenitis and sialoadenitis[J].Mod Rheumatol,2016,26(3):463-464.
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