BACKGROUND: To assess the reliability of the consensually agreed US definitions of major salivary gland lesions and the US scoring system for salivary gland assessment in patients with SS. METHODS: Nine experienced sonographers scanned and read the US images of both parotid glands (PGs) and submandibular glands (SMGs) in eight patients with primary and secondary SS in two rounds. A consensually agreed four-grade semi-quantitative scoring was applied in B-mode for morphological lesions: grade 0, normal; grade 1, mild inhomogeneity without anechoic or hypoechoic areas; grade 2, moderate inhomogeneity with focal anechoic or hypoechoic areas; grade 3, severe inhomogeneity with diffuse an- or hypoechoic areas occupying the entire gland or fibrous gland. The presence or absence of typical SS lesions, i.e. the Sjögren's signature, was scored binary. Intra- and interreader reliabilities were computed using weighted and unweighted Cohen's and Light's κ coefficients. RESULTS: The mean prevalence of grades 0-3 in PG were 43, 17, 23 and 31% and 28, 14, 33 and 32% for the SMGs, respectively. The weighted κ for intrareader reliability ranged from 0.44 to 1 for grading and 0.64 to 1 for the Sjögren's signature of PG and 0.59 to 1 and -0.09 to 0.6 for SMGs, respectively. The interreader reliability κ for grading in PG was 0.62 (95% CI 0.47, 0.74) and for Sjögren's signature it was 0.36 (95% CI 0, 0.43); in SMG it was 0.62 (95% CI 0.47, 0.72) and 0.03 (95% CI 0, 0.07) respectively. CONCLUSIONS: The consensually agreed novel US scoring system for major salivary gland lesions showed substantial intra- and interreader reliability in patients with SS. The reliability of the Sjögren's signature was moderate.

Academic Rheumatology Centre Università degli Studi di Torino Turin Italy

Centre for Rheumatology and Spinal Diseases Rigshospitalet Copenhagen Denmark

Department of Rheumatology and Clinical Immunology Charité Universitätsmedizin Berlin Berlin Germany

Department of Rheumatology and Clinical Immunology Faculty of Medicine University of Freiburg Freiburg Germany

Department of Rheumatology AP HP Ambroise Paré Hospital University of Versailles Saint Quentin en Yvelines Boulogne Billancourt France

Department of Rheumatology MC Groep Hospitals Lelystad The Netherlands

Institute of Rheumatology Prague Czech Republic

Medical Centre for Rheumatology Berlin Buch Immanuel Krankenhaus Berlin Berlin Germany

Rheumatology Department Chu de Brest University of Brest INSERM Brest France

Rheumatology Department Joint and Bone Research Unit Hospital Universitario Fundación Jiménez Díaz Universidad Autónoma Madrid Spain

Rheumatology Department Royal Perth Hospital Perth WA Australia

Rheumatology Department University Medical Centre Ljubljana Slovenia

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