De Vita (1992) [ 3434. De Vita S, Lorenzon G, Rossi G, Sabella M, Fossaluzza V. Salivary gland echography in primary and secondary Sjögren's syndrome. Clin Exp Rheumatol. 1992;10(4):351-6. ] |
0-normal |
Range 0-6 points Scores (0-3 points) are individually calculated for each pair of parotids and submandibular glands. When the degree of inhomogeneity differs between a pair of glands, the highest degree is considered. Cut-off ≥2 points for individualgland (or 4 points total) |
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1 —Mild: smalllocalized or diffuse hypoechoic areas |
2-Evident: multiple scattered hypoechoic areas of variable size with an inhomogeneous distribution and/or multiple or linear hyperechoic bands without an acoustic shadow |
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3-Gross: large rounded or confluent hypoechoic areas and/or gross linear hyperechoic bands and/or multiple cysts or multiple calcifications, resulting in severe damage to the gland architecture |
Hocevar (2005) [ 4242. Hocevar A, Ambrozic A, Rozman B, Kveder T, Tomsic M. Ultrasonographic changes of major salivary glands in primary Sjögren's syndrome. Diagnostic value of a novel scoring system. Rheumatology (Oxford). 2005;44(6):768-72. ] |
Parenchymalechogenicity |
Range 0-48 points The scores for the 5 parameters in the 4 glands are added. Cut-off ≥17 points |
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0-comparable to the thyroid |
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1-decreased compared to the thyroid |
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Homogeneity |
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0-homogeneous gland |
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1-mild inhomogeneity |
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2- evident inhomogeneity |
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3-grossly inhomogeneous gland |
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Presence of hypoechogenic areas |
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0-absent |
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1 -a few, scattered |
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2-several |
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3-numerous |
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Hyperechogenic reflections |
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Parotids |
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0-absent |
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1 -a few, scattered |
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2-several |
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3-numerous |
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Submandibular glands |
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0-absent |
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1-present |
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Clearness of salivary gland borders |
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0-clear, regular defined borders |
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1-partially defined borders |
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2-ill-defined borders |
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3-borders not visible |
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Cornec (modified De Vita) (2013) [ 4444. Cornec D, Jousse-Joulin S, Pers JO, Marhadour T, Cochener B, Boisrame-Gastrin S, et al. Contribution of salivary gland ultrasonography to the diagnosis of Sjögren's syndrome: toward new diagnostic criteria? Arthritis Rheum. 2013;65(1):216-25. ] |
0-normal |
Range 0-16 points Maximum score of 4 points for each individual gland The finalscore is calculated by adding the highest score for each gland. Cut-off ≥2 points for individualgland (or 8 points total) |
1-smallhypoechogenic areas without echogenic bands |
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2-multiple hypoechogenic areas measuring <2 mm with echogenic bands |
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3-multiple hypoechogenic areas measuring 2-6 mm with hyperechogenic bands |
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4-multiple hypoechogenic areas measuring >6 mm or multiple calcifications with echogenic bands |
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Theander (2014) [ 4545. Theander E, Mandl T. Primary Sjögren's syndrome: the diagnostic and prognostic value of salivary gland ultrasonography using a simplified scoring system. Arthritis Care Res (Hoboken). 2014;66(7):1102-7. ] |
0-the parenchyma is completely homogeneous |
Range 0-3 points |
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1-mildly inhomogeneous |
The highest score among the 4 glands is considered. Score of 0-1 points: normalor unspecific Score of 2-3 points: abnormal, typical of Sjögren's syndrome |
2-several rounded hypoechoic lesions |
3-rounded hypoechoic lesions are numerous or confluent |
Hammenfors (2015) [ 4646. Hammenfors DS, Brun JG, Jonsson R, Jonsson MV. Diagnostic utility of major salivary gland ultrasonography in primary Sjögren's syndrome. Clin Exp Rheumatol. 2015;33(1):56-62. ] |
0-normal |
Range 0-3 points The highest score among the 4 glands is considered. Score of 0-1 points: normalor nonspecific Score of 2-3 points: abnormaland typical of Sjögren's syndrome |
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1-a few minor focal hypo/anechoic areas |
2-at least one of the glands is more severely affected, with multiple focal hypo-/anechoic areas, but some homogeneous and normal-appearing salivary gland tissue remains |
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3-severe generalized effects on at least 2 of the glands, with minimalnormal-appearing glandular tissue remaining, as well as at least a grade 2 effects on the remaining gland(s). |
Jousse-Joulin (2019) [ 4343. Jousse-Joulin S, D’Agostino MA, Nicolas C, et al. Video clip assessment of a salivary gland ultrasound scoring system in Sjögren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise. Ann Rheum Dis. 2019;78:967-73. ] |
0-normal |
Score of 2-3 points: abnormaland typical of Sjögren's syndrome |
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1 -mild or unspecific and few hypoechoic areas. 2-multiple focal hypo-/anechoic areas, but some homogeneous and normal-appearing salivary gland tissue remains. Diffuse and multiple focal hypo-/anechoic. No normalappearence areas salivary gland tissue. |