颞下颌关节上腔囊内粘连的磁共振造影诊断

目的:评价磁共振造影对颞下颌关节上腔囊内粘连的诊断价值。方法:临床诊断为内错乱的连续33例(36侧)患者,进行颞下颌关节上腔磁共振造影检查,其中30例(31侧)进行关节镜检查并同期治疗,按照磁共振造影对颞下颌关节囊内粘连诊断的影像学标准,确定有无粘连,分阳性组、可疑组及阴性组;并以关节镜诊断结果为金标准,得出真、假阳性及真、假阴性关节例数。应用SPSS软件制作ROC曲线,计算ROC曲线下面积,从而评价磁共振造影诊断囊内粘连的整体准确性。结果:关节镜诊断囊内粘连为70.97%(22/31)。磁共振造影诊断结果与关节镜诊断对照后得出:阳性组20侧,其中19侧真阳性,1侧为单个游离体;可疑组3侧,其中1侧假阳性,2侧真阳性;阴性组8侧,其中1侧假阴性,7侧真阴性。ROC曲线下面积=0.91(0.86,0.95),P<0.05。结论:磁共振造影兼具平片造影和MRI的优点,诊断准确率高,而且能对囊内粘连作定位诊断,是一种诊断囊内粘连的理想方法。

Magnetic resonance arthrography for the diagnosis of intraarticular adhesions of TMJ adhesions

PURPOSE:To evaluate the value of magnetic resonance arthrography (MRAr) on the diagnosis of intraarticular adhesions of the temporomandibular joint(TMJ). METHODS:30 consecutive patients (31 TMJs) diagnosed as internal derangement of TMJ were examined by MRAr and arthroscopy. The findings of interpreting MRAr were recorded as positive, suspicious and negative according to the MRAr radiographic criteria. After comparing the findings of MRAr with those of arthroscopy, the numbers of true positive, true negative,false positive and false negative were obtained. Through SPSS11.0, receiver operator characteristic curve(ROC curve) was made, and the area under the ROC curve was calculated. According to the area, the diagnostic accuracy of MRAr was evaluated. RESULTS:Surgery results confirmed that 22 TMJs in 31 TMJs had adhesions. According to the above criteria , we found 20 TMJs were positive, 3 TMJs were suspicious, and 8 TMJs were negative. After comparing the findings of MRI with those of arthroscopy, true positive in 19 TMJs and false positive in 1 TMJs were detected among 20 positive TMJs, adhesion in 2 TMJs and no adhesion in 1 TMJs were detected among 3 suspicious TMJs, and true negative in 7 TMJs and false negative in 1 TMJs were detected among 8 negative TMJs. The area under ROC curve was 0.91(0.86,0.95), P<0.05. CONCLUSION:It is concluded that:(1)The diagnostic accuracy of MRAr is excellent, much better than that of PFA and MRI.(2)MRAr is an ideal method to diagnose intraarticular adhesions of TMJ.