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

De Vita (1992) [34]

0–normal

Range 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 echogenicity

Range 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–normal

Range 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 homogeneous

Range 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–normal

Range 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–normal

Score 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.