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. 2007 Sep;1(3):311-9.

Ultrasound assessment of salivary glands in patients with primary Sjögren's syndrome treated with rituximab: Quantitative and Doppler waveform analysis

Sandrine Jousse-Joulin  1 , Valérie Devauchelle-Pensec, Johanne Morvan, Bruno Guias, Yvon Pennec, Jacques-Olivier Pers, Capucine Daridon, Christophe Jamin, Yves Renaudineau, Isabelle Quintin Roué, Béatrice Cochener, Luc Bressollette, Pierre Youinou, Alain Saraux
Affiliations

Ultrasound assessment of salivary glands in patients with primary Sjögren's syndrome treated with rituximab: Quantitative and Doppler waveform analysis

Sandrine Jousse-Joulin et al. Biologics. 2007 Sep.

Abstract

Objectives: Noninvasive objective tests are needed to diagnose primary Sjogren's syndrome (pSS) and to evaluate treatment responses. Ultrasound imaging of the salivary glands is rapid and noninvasive. Recent open-label studies suggested that anti-CD20 (rituximab) may be effective in pSS. The purpose of this study was to look for ultrasound evidence of the effects of rituximab in pSS.

Methods: We compared 16 patients fulfilling the new American-European consensus group criteria for pSS to 9 controls, using B-mode ultrasound features (parenchymal homogeneity and gland size) and Doppler waveform analysis of the transverse facial artery of parotid glands. We compared the same parameters in the patients before and after 12 weeks of intravenous rituximab therapy.

Results: Compared to controls, untreated patients had significant abnormalities in salivary gland structure (p < 0.0001) and parotid size (2.05 +/- 0.33 cm versus 1.70 +/- 0.28 cm; p = 0.001). Doppler waveform analysis showed significant differences before, but not after, lemon stimulation between untreated patients and controls. After rituximab treatment, significant size reductions were noted in the parotids (2.05 +/- 0.3 cm at baseline and 1.86 +/- 0.27 cm at week 12; p = 0.002) and submandibular glands (2.02 +/- 0.54 cm at baseline and 1.66 +/- 0.34 cm at week 12; p = 0.001). Doppler resistive indices after lemon stimulation were significantly increased after rituximab treatment.

Conclusion: Salivary gland measurements and blood inflow responses to salivary stimulation as assessed by ultrasound hold promise as objective noninvasive tools for evaluating rituximab effects in patients with pSS.

Keywords: primary Sjögren’s syndrome; rituximab; ultrasonography.

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Figures

Figure 1
Figure 1
High-resolution, 10 MHz, axial sonograms of parotid gland. Parenchymal pattern of the parotid gland in control (a) and patients (b, c).
Figure 2
Figure 2
B-mode image of submandibular gland. (a) Homogenous parenchyma. (b) heterogenous parenchyma.
Figure 3
Figure 3
At baseline. (a) Doppler waveform without lemon stimulation: control population. High systolic peak and a prominent following compliance peak, followed by a low diastolic flow (RI = 0.88). (b) Doppler waveform with lemon stimulation: control population. Physiologic changes in vasculature when parotid gland is stimulated in controls. Level of systolic and diastolic flow is increased (RI = 0.91). (c) Doppler waveform in patient population without stimulation. We noted a decreased impedance in parotid vessels with a decrease RI (RI = 0.77). (d) Doppler waveform with lemon stimulation: patients. The waveform profile is the same before and after stimulation.
Figure 4
Figure 4
Patient population treated by anti-CD20. (a) Pss patient population without stimulation: the resistive indice is clearly decreased (b) Pss patient population with lemon stimulation: the resistive indice is increased.
Figure 5
Figure 5
Individual evolution of the parotid size of the patients before (W0) and after (W12) rituximab treatment.
See this image and copyright information in PMC

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