Development of a new ultrasound scoring system to evaluate glandular inflammation in Sjögren’s syndrome: an OMERACT reliability exercise

• Published in: Rheumatology (Oxford, England) Vol. 61; no. 8; pp. 3341 - 3350
• Main Authors: Hočevar, Alojzija, Bruyn, George A, Terslev, Lene, De Agustin, Juan Jose, MacCarter, Daryl, Chrysidis, Stavros, Collado, Paz, Dejaco, Christian, Fana, Viktoria, Filippou, Georgios, Finzel, Stephanie, Gandjbakhch, Frederique, Hanova, Petra, Hammenfors, Daniel, Hernandez-Diaz, Cristina, Iagnocco, Annamaria, Mortada, Mohamed Atia, Inanc, Nevsun, Naredo, Esperanza, Ohrndorf, Sarah, Perko, Nejc, Schmidt, , Wolfgang A, Tamborrini, Giorgio, Tomšič, Matija, Chary-Valckenaere, Isabelle, Zabotti, Alen, Keen, Helen I, Pineda, Carlos, D’Agostino, Maria-Antonietta, Jousse-Joulin, Sandrine
• Format: Journal Article
• Language: English
• Published: 03.08.2022
• Subjects: Life Sciences; colour Doppler ultrasound; salivary gland vascularization; primary Sjögren’s syndrome; scoring system
• ISSN: 1462-0324; 1462-0332; 1462-0332
• DOI: 10.1093/rheumatology/keab876

Abstract Objective The aim of this exercise from the OMERACT Ultrasound subgroup on Sjögren’s syndrome was to develop and assess the reliability of a consensus-based semiquantitative colour Doppler US scoring system for pathologic salivary gland vascularization in patients with primary Sjögren's syndrome (pSS). Methods Using the Delphi method, a colour Doppler semiquantitative scoring system for vascularization of bilateral parotid and submandibular glands was developed and tested in static images and on patients (9 pSS patients and 9 sonographers). Intra-reader and inter-reader reliability of grading the salivary glands were computed by weighted Cohen and Light’s kappa analysis, respectively. Results The consensus-based semiquantitative score was: grade 0, no visible vascular signals; grade 1, focal, dispersed vascular signals; grade 2, diffuse vascular signals detected in <50% of the gland; grade 3, diffuse vascular signals in >50% of the gland. In static images, the intra- and inter-reader reliability showed excellent kappa values (95% CI) of 0.90 (0.87, 0.93) and 0.80 (0.74, 0.84), respectively, for all four salivary glands together. In patients, the intra- and inter-reader reliability for all four salivary glands together was kappa = 0.84 (0.73, 0.92) and 0.70 (0.64, 0.76), respectively. Conclusion The consensus-based colour Doppler US scoring for the evaluation of salivary gland vascularization in pSS showed a good inter-reader reliability and excellent intra-reader reliability in static images and in patients. The clinical application of the developed scoring system should be tested in clinical settings.