Parotid sialography for diagnosing Sjogren syndrome
Parotid sialography for diagnosing Sjogren syndrome
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DOI：
10.1067/moe.2002.126017
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发表时间：
2002-07-01
期刊：
影响因子：
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通讯作者：
Roodenburg, JLN
中科院分区：
文献类型：
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作者：
Kalk, WWI;Vissink, A;Roodenburg, JLN
Objective.尽管有许多新的成像方法，涎腺造影术，经过几十年的使用，保持其作为首选的成像程序评估干燥综合征（SS）的口腔组成部分的地位。在这项研究中，涎腺造影作为诊断工具在SS的临床价值进行了探讨，通过评估其诊断准确性，观察者的偏见，和分期的潜力。由2名经过培训的观察员和2名专家观察员以设盲方式独立解读100张腮腺唾液腺造影片。唾液腺造影片来自一组连续的SS诊断患者。根据修订的欧洲分类标准将患者分为SS和非SS。经过培训的观察员通过唾液腺造影对SS的敏感性为95%，特异性为33%，而专家观察员的敏感性为87%，特异性为84%。根据科恩的kappa，受过训练的观察者和专家观察者之间只有“公平”的观察者间一致性，而两位专家观察者之间的一致性都很好。所有观察员的观察员内一致性为“良好”至“非常好”。4种不同程度的唾液腺扩张，即点状、球状、空洞状和破坏性，与口腔黏膜扩张的持续时间呈弱但显著的相关性。这项研究明显表明，腮腺造影诊断SS的诊断价值在很大程度上取决于观察者的技能，这意味着涎腺造影缺乏普遍适用性作为诊断工具，在SS，需要特定的专业知识。尽管如此，鉴于其潜在的高敏感性和特异性诊断SS以及其有用的分期潜力，涎腺造影术仍然有其使用的SS的口腔组成部分的评估。
Objective. Despite the availability of many new imaging procedures, sialography has, after decades of use, maintained its status as the imaging procedure of choice for evaluating the oral component of Sjogren syndrome (SS). In this study, the clinical value of sialography as a diagnostic tool in SS was explored by assessing its diagnostic accuracy, observer bias, and staging potential.Methods. One hundred parotid sialograms were interpreted independently in a blinded fashion by 2 trained and 2 expert observers. Sialograms were derived from a group of consecutive patients referred for diagnostics of SS. Patients were categorized as SS and non-SS by the revised European classification criteria.Results. Trained observers reached a sensitivity of 95 and a specificity of 33% for SS by sialogram, whereas expert observers reached a sensitivity of 87 and a specificity of 84%. There was only "fair" interobserver agreement between trained and expert observers, whereas both expert observers showed "good" agreement with one another, according to Cohen's kappa. Intraobserver agreement was "good" to "very good" for all observers. The 4 different gradations of sialectasia, ie, punctate, globular, cavitary, and destructive, showed a weak but significant correlation with the duration of oral symptoms.Conclusions. This study markedly shows that the diagnostic value of parotid sialography for diagnosing SS greatly depends on the skills of the observer, implying that sialography lacks general applicability as a diagnostic tool in SS and requires specific expertise. Nevertheless, given its potentially high sensitivity and specificity in diagnosing SS as well as its useful staging potential, sialography still has its use in the evaluation of the oral component of SS.