表面擴散係數分析在修格連氏症候群腮腺Cevimeline 治療前後之研究

背景:修格連氏症候群(Sjögren''s syndrome) 是種自體免疫性疾病，主要受影響的器官以淚腺及唾液腺等分泌腺體為主。本研究目的為分析表面擴散係數在修格連氏症候群腮腺cevimeline治療前後的變化。研究材料與方法: 所有受試者先接受一次常規磁振照影與兩次擴散加權影像檢查後，口服cevimeline治療四週後，再接受第二次常規磁振照影與兩次擴散加權影像檢查。結果:口含酸檸檬糖刺激唾液分泌前後腮腺平均ADC值的比較結果，顯示平均ADC值有明顯的增加。給予cevimeline治療後在酸檸檬糖刺激唾液分泌前後腮腺平均ADC的比較結果亦有明顯的增加。在四週cevimeline治療後腮腺對酸檸檬糖刺激唾液分泌的反應由5.3%增加至11.3% 在統計上具有明顯差異。討論:研究結果顯示給予刺激唾液分泌會明顯增加腮腺ADC值，此結果意味著ADC值分析方法可用來監測唾液分泌功能。四週cevimeline治療後，腮腺對酸檸檬糖刺激唾液分泌的反應ADC值亦有明顯增加。ADC分析可觀察到cevimeline治療後增加腮腺對刺激唾液分泌敏感度。結論:擴散磁振造影提供可重覆非侵入性檢查且可用量化ADC分析來觀察修格連氏症候群腮腺對酸檸檬糖刺激唾液分泌後變化及cevimeline治療後的變化。

Background and Purpose: Sjögren''s Syndrome (SS) is considered a systemic autoimmune disease with the exocrine glands as main target organs. The purpose of this study is using ADC to analysis of the parotid gland of Sjögren''s syndrome response to cevimeline treatment.Material and Method: Total 36 subjects with Sjögren’s syndrome presented with xerostomia were enrolled. Initial MR imaging was performed before treatment, and perofromed 2nd MR study after 4 weeks of proper cevimeline treatment. Result: Regarding response to salivary stimulation, there was a significant increase the mean ADC values on pre-cevimeline treatment. Also significant increase the mean ADC values on post-cevimeline treatment. After 4 weeks cevimeline treatment, the salivary secretion respone revealing significant increase from 5.3% increase to 11.3%. Discussion : Our results show that significant increase ADC values after salivary stimulation, which suggest that ADC values can be a monitor of salivary secretion. The salivary secretion respone revealing significant increase, which suggest that cevimeline treatment can increase sensitivity of salivary secretion stimulation in Sjogren patient even only 4 weeks follow up. However, this increase in secretion may be transient. Conclusion: ADC values can be a monitor of salivary secretion. DWI able to evaluate response sensitivity of salivary flow of the Sjogren syndrome in post cevimeline treatment.