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Table 5 Scoring systems for salivary gland ultrasound findings in patients with Sjögren’s syndrome, considering the bilateral submandibular glands and parotid glands

From: Recommendations from the Brazilian society of rheumatology for the diagnosis of Sjögren’s syndrome (Part I): glandular manifestations (systematic review)

Author (year)ScoringCalculation
De Vita (1992) [34]0–normalRange 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 individual gland (or 4 points total)
1–Mild: small localized 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
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) [42]Parenchymal echogenicityRange 0–48 points
The scores for the 5 parameters in the 4 glands are added.
Cut-off ≥17 points
0–comparable to the thyroid
1–decreased compared to the thyroid
Homogeneity
0–homogeneous gland
1–mild inhomogeneity
2– evident inhomogeneity
3–grossly inhomogeneous gland
Presence of hypoechogenic areas
0–absent
1–a few, scattered
2–several
3–numerous
Hyperechogenic reflections
Parotids
0–absent
1–a few, scattered
2–several
3–numerous
Submandibular glands
0–absent
1–present
Clearness of salivary gland borders
0–clear, regular defined borders
1–partially defined borders
2–ill-defined borders
3–borders not visible
Cornec (modified De Vita) (2013) [44]0–normalRange 0–16 points
Maximum score of 4 points for each individual gland
The final score is calculated by adding the highest score for each gland.
Cut-off ≥2 points for individual gland (or 8 points total)
1–small hypoechogenic areas without echogenic bands
2–multiple hypoechogenic areas measuring < 2 mm with echogenic bands
3–multiple hypoechogenic areas measuring 2–6 mm with hyperechogenic bands
4–multiple hypoechogenic areas measuring > 6 mm or multiple calcifications with echogenic bands
Theander (2014) [45]0–the parenchyma is completely homogeneousRange 0–3 points
The highest score among the 4 glands is considered.
Score of 0–1 points: normal or unspecific
Score of 2–3 points: abnormal, typical of Sjögren’s syndrome
1–mildly inhomogeneous
2–several rounded hypoechoic lesions
3–rounded hypoechoic lesions are numerous or confluent
aHammenfors (2015) [46]0–normalRange 0–3 points
The highest score among the 4 glands is considered.
Score of 0–1 points: normal or nonspecific
Score of 2–3 points: abnormal and typical of Sjögren’s syndrome
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
3–severe generalized effects on at least 2 of the glands, with minimal normal-appearing glandular tissue remaining, as well as at least a grade 2 effects on the remaining gland(s).
Jousse-Joulin (2019) [43]0–normalScore of 2–3 points: abnormal and typical of Sjögren’s syndrome
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 normal appearence areas salivary gland tissue.
  1. aAdapted from reference [47]