China Journal of Oral and Maxillofacial Surgery ›› 2019, Vol. 17 ›› Issue (3): 225-229.doi: 10.19438/j.cjoms.2019.03.007

• Original Articles • Previous Articles     Next Articles

Ultrasound elastography in diagnosis and follow-up for patients with IgG4-related sclerosing sialadenitis

WANG Zhi-jun1, ZHANG Wei-qian2, ZHENG Ling-yan1, CAO Ning-ning1, SHI Huan1, XIE Li-song1, YU Chuang-qi1   

  1. 1.Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine;National Clinical Research Center for Oral Diseases;Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology. Shanghai 200011;
    2.Department of Ultrasound, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China
  • Received:2018-11-30 Revised:2019-03-18 Online:2019-05-20 Published:2019-06-21

Abstract: 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.

Key words: Ultrasound elastography, Strain ratio, Acoustic radiation force impulse, IgG4-related sclerosing sialadenitis

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