Parotid MRI for the evaluation of primary Sjögren's syndrome: A meta‑analysis

Objectives This study aims to assess the diagnostic utility of parotid gland magnetic resonance imaging (MRI) in patients with primary Sjögren’s syndrome (pSS). Methods This meta‑analysis adhered to the PICOS principles and was registered in PROSPERO (CRD420261369735). The study involved a systematic search of domestic and international databases for studies concerning parotid MRI and pSS, covering the period from database inception to February 28, 2026. After selecting studies according to the inclusion and exclusion criteria, this study assessed the quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Data were extracted from the included studies, after which meta-analysis and subgroup analysis were carried out using R software. Study heterogeneity was also assessed, aiming to comprehensively evaluate the diagnostic value of parotid MRI in pSS. Results A total of 599 relevant studies were retrieved, of which 16 met the inclusion criteria. For most of the included studies, the domains of "patient selection" and "index test" were rated as "high risk" or "unclear", while both the "gold standard" and "disease process and progression" domains were rated as "unclear". Regarding applicability, all included studies were rated as low risk. Across the 16 included studies, the total number of participants was 1358. Combined sensitivity of MRI of parotid gland in diagnosing pSS was 0.87 (95%CI: 0.82～0.91), the combined specificity was 0.82 (95%CI: 0.69～0.91), PLR was 5.23 (95%CI: 3.00～9.14), NLR was 0.15 (95%CI: 0.08～0.27), and the diagnostic odds ratio (DOR) was 53.70 (95%CI: 17.08～168.88), all with statistical significance ( P < 0.001). Heterogeneity was moderate to high, with SROC AUC 0.903 ( P < 0.05). Subgroup analysis categorized studies by different MRI diagnostic methods into three types: “MRI”, “magnetic resonance sialography (MRS)” and “MRI + MRS”. There was no significant difference in diagnostic sensitivity among MRI technique types ( P > 0.05). Pooled sensitivities were 0.91 (95% CI: 0.84～0.95) for MRI, 0.81 (95% CI: 0.72～0.88) for MRS, and 0.90 (95% CI: 0.76～0.96) for combine. Funnel plot asymmetry was obvious on publication bias assessment ( P > 0.05). Conclusions Parotid MRI shows high diagnostic performance for pSS and serves as a valuable non‑invasive adjunctive tool, but its clinical value requires further high‑quality prospective validation.