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Video clip assessment of a salivary gland ultrasound scoring system in Sjögren's syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise

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  • Sandrine Jousse-Joulin
  • Maria Antonietta D'Agostino
  • Celine Nicolas
  • Esperanza Naredo
  • Sarah Ohrndorf
  • Marina Backhaus
  • Giorgio Tamborrini
  • Isabelle Chary-Valckenaere
  • Lene Terslev
  • Annamaria Iagnocco
  • Paz Collado
  • Cristina Hernández-Díaz
  • Frederique Gandjbakhch
  • Wolfgang A Schmidt
  • Georgios Filippou
  • Christian Dejaco
  • Martin Helmut Stradner
  • Mohamed Atia Mortada
  • Alojzija Hočevar
  • Stavros Chrysidis
  • Ghada El Mardenly
  • Juan José de Agustín
  • Ralf Thiele
  • Daryl K MacCarter
  • Stephanie Finzel
  • Petra Hanova
  • Alen Zabotti
  • Cornelia Glaser
  • Zarrin Alavi
  • Daniel Sten Hammenfors
  • Florence Gatineau
  • George Aw Bruyn
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OBJECTIVE: To develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren's syndrome (pSS) and to test their intrareader and inter-reader reliability using US video clips.

METHODS: Twenty-five rheumatologists were subjected to a three-round, web-based Delphi process in order to agree on (1) definitions and scanning procedure of salivary gland ultrasonography (SGUS): parotid, submandibular and sublingual glands (PG, SMG and SLG); (2) definitions for the elementary SGUS lesions in patients with Sjögren's syndrome; (3) scoring system for grading changes. The experts rated the statements on a 1-5 Likert scale. In the second step, SGUS video clips of patients with pSS and non-pSS sicca cases were collected containing various spectrums of disease severity followed by an intrareader and inter-reader reliability exercise. Each video clip was evaluated according to the agreed definitions.

RESULTS: Consensual definitions were developed after three Delphi rounds. Among the three selected SGs, US assessment of PGs and SMGs was agreed on. Agreement was reached to score only greyscale lesions and to focus on anechoic/hypoechoic foci in a semiquantitative matter or, if not possible on a qualitatively (present/absent) evaluation of fatty or fibrous lesions. Intrareader reliability for detecting and scoring these lesions was excellent (Cohen's kappa 0.81) and inter-reader reliability was good (Light's kappa 0.66).

CONCLUSION: New definitions for developing a novel semiquantitative US score in patients with pSS were developed and tested on video clips. Inter-reader and intrareader reliabilities were good and excellent, respectively.

Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Issue number7
Pages (from-to)967-973
Number of pages7
Publication statusPublished - Jul 2019

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