AbstractDiffusion weighted imaging (DWI) has proven to be sensitive for detecting early injury to the parotid gland in pSS (primary Sjögren’s syndrome). Here, we explored the application of ADC histogram and texture analyses for evaluating the disease activity of pSS. A total of 55 patients with pSS who met the classification criteria of the 2002 AECG criteria prospectively underwent 3.0-T magnetic resonance imaging (MRI) including DWI (b = 0 and 1000 s/mm²). According to the ESSDAI score, 35 patients were categorized into the low-activity group (ESSDAI < 5) and 20 into the moderate-high-activity group (ESSDAI ≥ 5). Via analysis of the whole-volume ADC histogram, the ADC_mean, skewness, kurtosis, and entropy values of the bilateral parotid glands were determined. Multivariate analysis was used to identify independent risk factors for predicting disease activity. The diagnostic performance of the indexes was evaluated via receiver operating characteristic (ROC) analysis. ROC analysis showed that the anti-SSB, lip biopsy, MRI morphology, ADC, ADC_mean, and entropy values were able to categorize the disease into two groups, particularly the entropy values. The multivariate model, which included anti-SSB, MRI morphology and entropy, had an area under the ROC curve of 0.923 (P < 0.001). The parotid entropy value distinguished disease activity in patients with pSS, especially combined with anti-SSB and MRI morphology.