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Advanced imaging for quantification of abnormalities in the salivary glands of patients with primary Sjögren's syndrome

Jimenez-Royo, Pilar; Bombardieri, Michele; Ciurtin, Coziana; Kostapanos, Michalis; Tappuni, Anwar R; Jordan, Natasha; Saleem, Azeem; Fuller, Teresa; Port, Kathleen; Pontarini, Elena; Lucchesi, Davide; Janiczek, Robert; Galette, Paul; Searle, Graham; Patel, Neel; Kershaw, Lucy; Gray, Calum; Ratia, Nirav; van Maurik, André; de Groot, Marius; Wisniacki, Nicolas; Bergstrom, Mats; Tarzi, Ruth


Pilar Jimenez-Royo

Michele Bombardieri

Coziana Ciurtin

Michalis Kostapanos

Anwar R Tappuni

Natasha Jordan

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Dr Azeem Saleem
Reader and Honorary Consultant in Clinical Oncology

Teresa Fuller

Kathleen Port

Elena Pontarini

Davide Lucchesi

Robert Janiczek

Paul Galette

Graham Searle

Neel Patel

Lucy Kershaw

Calum Gray

Nirav Ratia

André van Maurik

Marius de Groot

Nicolas Wisniacki

Mats Bergstrom

Ruth Tarzi


OBJECTIVES: To assess non-invasive imaging for detection and quantification of gland structure, inflammation and function in patients with primary Sjogren's syndrome (pSS) using PET-CT with 11C-Methionine (11C-MET; radiolabelled amino acid), and 18F-fluorodeoxyglucose (18F-FDG; glucose uptake marker), to assess protein synthesis and inflammation, respectively; multiparametric MRI evaluated salivary gland structural and physiological changes. METHODS: In this imaging/clinical/histology comparative study (GSK study 203818; NCT02899377) patients with pSS and age- and sex-matched healthy volunteers underwent MRI of the salivary glands and 11C-MET PET-CT. Patients also underwent 18F-FDG PET-CT and labial salivary gland biopsies. Clinical and biomarker assessments were performed. Primary endpoints were semi-quantitative parameters of 11C-MET and 18F-FDG uptake in submandibular and parotid salivary glands and quantitative MRI measures of structure and inflammation. Clinical and minor salivary gland histological parameter correlations were explored. RESULTS: Twelve patients with pSS and 13 healthy volunteers were included. Lower 11C-MET uptake in parotid, submandibular and lacrimal glands, lower submandibular gland volume, higher MRI fat fraction, and lower pure diffusion in parotid and submandibular glands were observed in patients vs healthy volunteer, consistent with reduced synthetic function. Disease duration correlated positively with fat fraction and negatively with 11C-MET and 18F-FDG uptake, consistent with impaired function, inflammation and fatty replacement over time. Lacrimal gland 11C-MET uptake positively correlated with tear flow in patients, and parotid gland 18F-FDG uptake positively correlated with salivary gland CD20+ B-cell infiltration. CONCLUSION: Molecular imaging and MRI may be useful tools to non-invasively assess loss of glandular function, increased glandular inflammation and fat accumulation in pSS.


Jimenez-Royo, P., Bombardieri, M., Ciurtin, C., Kostapanos, M., Tappuni, A. R., Jordan, N., …Tarzi, R. (2021). Advanced imaging for quantification of abnormalities in the salivary glands of patients with primary Sjögren's syndrome. Rheumatology, 60(5), 2396-2408.

Journal Article Type Article
Acceptance Date Aug 21, 2020
Online Publication Date Nov 21, 2020
Publication Date May 14, 2021
Deposit Date Feb 10, 2021
Publicly Available Date Feb 11, 2021
Journal Rheumatology (Oxford, England)
Print ISSN 1462-0324
Electronic ISSN 1462-0332
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 60
Issue 5
Article Number keaa624
Pages 2396-2408
Keywords SS; MRI; CT scanning; Radionuclide imaging; Diagnostic imaging; Outcome measures and histopathology
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Published article (945 Kb)

Copyright Statement
© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact

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