7 Imaging Technology in Sjögren’s Syndrome: Non-invasive Evaluation of the Salivary Glands |
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To the authorsÕ knowledge, studies regarding the function of salivary glands in SjšgrenÕs syndrome, with positron emission tomography (PET), have not yet been performed. PET has a potential for functional imaging that in the future may give information not obtainable by other methods.
The resolution of scintigraphy is not comparable to the other imaging methods previously mentioned. However, functional studies providing a quantitative evaluation of parotid function still make scintigraphy a frequently used imaging method for SjšgrenÕs syndrome [1, 25, 26]. Reported sensitivity of scintigraphy ranges from 75 to 87%, but has low speciÞcity [27Ð29]. In addition, scintigraphy may only be performed in a hospital setting, thus limiting the accessibility and applicability. Furthermore, there may be difÞculties in the ability of the procedures to differentiate between uptake and secretory failure. Scintigraphy is, as sialography, unsuited for repetition [30]. Nonetheless, one study indicates that scintigraphy still is better than ultrasound as a diagnostic tool for SjšgrenÕs syndrome [29]. Scintigraphy is an accepted imaging method in overall approaches for diagnosing SjšgrenÕs syndrome [30, 31].
Table 7.1 A review of current methods
7.6Comparison of Nuclear Medicine, Ultrasound, and MRI
MRI and US may detect small amounts of Þbrotic tissue or edema in glands. With contrast media they may also provide information regarding function of the salivary glands, more so MRI than US. MRI may also give an excellent anatomic overview. Both MRI and US have excellent spatial and tissue resolution.
Nuclear medicine provides a dynamic examination, making it possible to quantify function. The impression, however, is that MRI is the better method, but both availability and the need of expertise may have limited the application and use of this method. In addition, so may also costs and time consumption.
Scintigraphy, on the other hand, is a well-established method and incorporated in diagnostic approaches. One may expect ultrasound to challenge that position as it is becoming more easily available and has proven to be of equal diagnostic value. However, ultrasound is more user-dependent than the other methods and is not as easily documented as compared to scintigraphy.
An overview of current methods is provided in Table 7.1.
Topic |
Scintigraphy |
MRI |
US |
Clinical comparisons |
Functional |
+++ |
+(+) |
+ |
Scintigraphy |
information |
Detection of isotopes |
Examination of |
Perfusion |
superior |
|
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perfusion and |
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diffusion |
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|
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Morphological |
+ |
+++ |
++ |
MRI superior in |
information |
Low resolution |
Excellent both tissue |
Excellent tissue |
resolution and in |
|
|
and spatial |
resolution but |
making anatomical |
|
|
resolution |
problems with |
ÒmapsÓ |
|
|
|
anatomic overview |
|
|
|
|
|
|
Existing experience |
+++ |
+ |
++ |
Scintigraphy is a |
|
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|
|
well-established |
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|
|
method. Ultrasound |
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|
|
is also widely used, |
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whereas the use of |
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MRI most likely will |
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increase |
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Seeing the ducts |
− |
+++ |
(+) |
MRI is the only one |
|
|
MRI sialography |
|
of these methods |
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showing the ductal |
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|
structures |
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J.T. Geitung and M.V. Jonsson |
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References
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Schmidt WA. Ultrasonography of salivary glandsÑa highly speciÞc imaging procedure for diagnosis of SjšgrenÕs syndrome. J Rheumatol. 2008;35: 285Ð93.
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magnetic resonance sialography as a new diagnostic technique for patients with SjšgrenÕs syndrome. Oral Dis. 2006;12:408Ð14.
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Part III
Mechanisms of Pathogenesis
Genomics and Viruses in Sjögren’s |
8 |
Syndrome |
Kathy L. Moser and John B. Harley
Abstract
Contributions from both genetic and environmental factors to the etiology of SjšgrenÕs syndrome (SS) are being discovered, though their roles in disease pathogenesis remain obscure. An important key to fully understand how genetic variation leads to disease is to comprehensively test all potential variation for association. Extraordinary developments in our understanding of the inherent variation present in the human genome and rapid advances in the technical capacity to evaluate this variation are moving us closer to understanding the genetic etiology for numerous complex diseases. In particular, major shifts in the past few years from small candidate gene studies to large genome-wide screens for association of human variation with disease have been remarkably successful. Dozens of new disease associations previously thought intractable to discovery have now been identiÞed in complex diseases. Although the genetics of SS remains vastly unexplored, rapid advances in our understanding of related autoimmune diseases illustrate the potential complexity of the expected genetic landscape for SS with several emerging themes. First, multiple genes contribute to increasing disease risk. Second, many genes have now been associated with multiple autoimmune disorders. Third, the frequencies of some disease-associated variants are relatively common while others are rare within populations. In addition, the frequency of any given disease risk allele often varies between different racial groups. Fourth, certain disease variants are more strongly associated with clinically recognizable disease subgroups or manifestations as opposed to more general susceptibility risk to disease. Overall, studies in autoimmune diseases related to SS provide an encouraging glimpse into the potential for success in establishing the genetic basis for SS. We discuss how genetics is transforming our understanding of autoimmunity with relevance to SS and review evidence
K.L. Moser ( )
Arthritis and Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA e-mail: moserk@omrf.org
R.I. Fox, C.M. Fox (eds.), Sjögren’s Syndrome, DOI 10.1007/978-1-60327-957-4_8, |
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