• pleura
• interstiziopatia
• ecografia
• sindrome di Sjogren

Aim of the study: To explore the potential role of a new ultrasonography sign, pleural irregularity, for the diagnosis of lung involvement in primary Sjögren’s syndrome (pSS). To assess the performance of pleural irregularity ultrasonography in comparison with HRCT in detecting interstitial and non-interstitial lung manifestations in pSS
Materials and methods: We included patients with a diagnosis of pSS made according to the AECG. All the patients underwent HRCT and Chest ultrasonography. The latter was performed by the same operator with Esaote MyLab -25 Gold, using a 10-MHz, linear probe. Pleural irregularity (PI) was defined as the loss of the normal hyperechoic linear pleural contour. PI ultrasonography examination were performed with patients in supine position to record the anterior and anterolateral sonographic points and in sitting position for the posterior and posterolateral ones (up to 54 intercostal spaces). Interstitial changes with reticulation and/or ground glass (ILD) and non interstitial lesions (no-ILD) including cysts, and airway-related changes were defined by HRCT. Abnormal findings at HRCT were quantified by an expert radiologist according to a semiquantitative score (0-2: absent, moderate, severe).
Results: In this study we enrolled 35 (32 F: 3 M) pSS patients (mean age(SD) = 59 (14) yrs; mean follow-up (SD) = 9 (14) yrs). Out of them, 16/35 had a HRCT pattern suggestive for ILD, 13/35 for no-ILD and 6/35 presented a normal HRCT pattern. The global PI ultrasonography score strongly correlated with the HRCT total score (r=0.805, p<0.000). A strong positive correlation (Spearman r ranging from 0.60 to 0.84) was also observed between the scores assigned to each broncopulmonary segment by both PI ultrasonography score and HRCT. The PI ultrasonography score assigned to the inferior-posterior segments was independently associated to the diagnosis of ILD at the multivariate analysis (OR (95% IC) = 1.390 (1.089-1.774). An ultrasonographic score of the inferior-posterior segments ≥5 allowed to diagnose SS-related ILD with a sensitivity of 100% and a specificity of 63.2%.
Conclusions: PI ultrasonography appears as a promising tool for non-invasive diagnosis of SS-related ILD. The role of PI ultrasonography in the diagnostic algorithm of SS-related lung involvement warrants further investigations.