The diagnostic performance of salivary gland ultrasound elastography in Sjogren's syndrome and sicca symptoms: a systematic review and meta-analysis

Objective To systematically evaluate the diagnostic performance of ultrasound elastography (USE) in distinguishing primary Sjogren's syndrome (pSS) from healthy/disease controls. Methods We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for published literature on USE for diagnosing pSS. Bivariate random effects models were used to calculate the pooled sensitivity and specificity of USE. To determine the factors influencing heterogeneity, meta-regression and subgroup analyses were performed to assess country, diagnostic criteria, imaging mechanisms, shear wave elastography techniques, measurement location, control group category, and patient age. Publication bias was assessed using the asymmetry of the Deeks funnel plot. Results Fifteen articles covering 816 patients and 735 control participants were included. USE showed a pooled sensitivity of 0.80 (95% CI: 0.71-0.87) and specificity of 0.87 (95% CI: 0.78-0.92). Meta-regression and subgroup analyses revealed that shear wave elastography techniques, measurement location, and patient age were significant factors that affected study heterogeneity (p < 0.05). Elastography performs better in diagnosing patients aged = 51 years compared to patients aged > 51 years. There was no significant publication bias. Conclusion USE demonstrates high accuracy in differentiating between pSS and healthy/ disease control groups. Clinical relevance statement Ultrasound elastography, as a non-invasive and cost-effective technique, can be used to distinguish primary Sjogren's syndrome from disease/healthy control groups by measuring the stiffness of salivary glands. Key Points center dot Ultrasound elastography is an acceptable technique for the diagnosis of primary Sjogren's syndrome. center dot The pooled sensitivity and specificity of ultrasound elastography for diagnosing primary Sjogren's syndrome were 0.80 and 0.87, respectively. center dot In patients aged = 51 years with primary Sjogren's syndrome, ultrasound elastography showed good diagnostic performance.