Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjögren Syndrome

Nemanja Damjanov; Vera Milic; Juan Carlos Nieto-González; Iustina Janta; Lina Martínez-Estupiñan; Belén Serrano; Carmen Mata; María Montoro; Denisa Stanciu; Jelena Marinković-Erić; Francisco Javier López-Longo; Luis Carreño; Esperanza Naredo

doi:10.3899/jrheum.151220

Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjögren Syndrome

J Rheumatol. 2016 Oct;43(10):1858-1863. doi: 10.3899/jrheum.151220. Epub 2016 Aug 15.

Affiliations

¹ From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón.
² From the Rheumatology Department, Institute of Rheumatology and the Institute of Social Medicine and Informatics, University of Belgrade, Medical School, Belgrade, Serbia; Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.N. Damjanov, MD, PhD, Professor, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; V. Milic, MD, PhD, Rheumatology Department, Institute of Rheumatology, University of Belgrade, Medical School; J.C. Nieto-González, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; I. Janta, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Martínez-Estupiñan, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; B. Serrano, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; C. Mata, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; M. Montoro, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; D. Stanciu, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; J. Marinković-Erić, MD, PhD, Professor, Institute of Social Medicine and Informatics, University of Belgrade, Medical School; F.J. López-Longo, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; L. Carreño, MD, Rheumatology Department, Hospital General Universitario Gregorio Marañón; E. Naredo, MD, PhD, Rheumatology Department, Hospital General Universitario Gregorio Marañón. veramilic@ptt.rs.

PMID: 27528574
DOI: 10.3899/jrheum.151220

Abstract

Objective: To evaluate the multiobserver reliability of salivary gland ultrasonography (SGUS) for scoring greyscale (GS) parenchymal inhomogeneity and parenchymal color Doppler (CD) signal in patients with established primary Sjögren syndrome (pSS).

Methods: The study comprised 2 multiobserver reliability assessments in patients with pSS in 2 European centers. The first reliability exercise was performed on 24 patients with pSS and 8 controls who were independently evaluated with GS and CD US by 5 observers at the Institute of Rheumatology, Belgrade, Serbia. The second reliability exercise was carried out on 10 patients with pSS who were independently assessed with GS and CD US by 8 observers at the Hospital G.U. Gregorio Marañón, Madrid, Spain. SGUS parenchymal inhomogeneity and parenchymal CD signal were semiquantitatively scored using a 4-grade scoring system. The multiobserver agreement was calculated by the overall agreement and Light's κ statistics.

Results: A total of 640 SGUS examinations were performed in the first reliability exercise and a total of 320 examinations in the second reliability exercise. Multiobserver reliability was good (κ = 0.71-0.79) to excellent (κ = 0.81-0.82) for GS parenchymal inhomogeneity in both exercises. There was a moderate (κ = 0.53-0.58) to good (κ = 0.70) multiobserver reliability for parenchymal CD signal in the first exercise. However, there was no agreement or only a fair agreement (κ = 0.03-0.29) for parenchymal CD signal in the second exercise.

Conclusion: US may be a reliable technique in the multiobserver scoring of GS parenchymal inhomogeneity of major SG in patients with established pSS. CD scoring of SG needs further standardization to be used in multicenter studies.

Keywords: DOPPLER; SALIVARY GLANDS; SJÖGREN SYNDROME; ULTRASONOGRAPHY.

MeSH terms

Adult
Female
Humans
Male
Middle Aged
Observer Variation
Reproducibility of Results
Salivary Glands / diagnostic imaging*
Serbia
Sjogren's Syndrome / diagnostic imaging*
Spain
Ultrasonography, Doppler, Color*
Young Adult