颞下颌关节上腔囊内粘连的磁共振诊断

目的:评价磁共振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27例(33侧)患 者,进行颞下颌关节磁共振检查及关节镜诊治。按照磁共振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;并与关节镜诊断结果对比,得出真、假阳性及真、假阴性关节数,应用SPSS软件 制作ROC曲线,计算ROC曲线下面积,评价磁共振诊断囊内粘连的整体准确性。结果:关节镜诊断囊内粘连为 54.55％(18／33)。磁共振诊断结果经与关节镜诊断对照后得出:阳性组11侧,其中7侧真阳性,4侧假阳性;可疑 组4侧,其中3侧真阳性,1侧假阳性;阴性组18侧,其中10侧真阴性,8侧假阴性。ROC曲线下面积=0.60 (0.41,0.80),P<0.05。结论:磁共振诊断关节囊内粘连的整体准确性较低,对大部分囊内粘连不能作出肯定的 诊断;若有关节腔积液,T2加权像可诊断囊内粘连。

MRI Applied to the Diagnosis of Intraarticular Adhesions of TMJ

Objective: To evaluate the value of MRI on the diagnosis of intraarticular adhesions of the temporomandibular joint (TMJ). Methods: Consecutive 27 patients (33 TMJs) diagnosed as internal derangement of TMJ were collected from December 1st, 2001 to July 31st, 2003 in our department. All the patients were examined by MRI and arthroscopy. The findings of interpreting MRI were recorded as positive, suspicious and negative according to the radiographic criteria. After comparing the findings of MRI with those of arthroscopy, the numbers of true positive, true negative, false positive and false negative were obtained. Through software SPSS 11.0, receiver operator characteristic curve (ROC curve) was made with 1-specificity as abscissa and the sensitivity as ordinate, and the area under the ROC curve was calculated. Results: Arthroscopic findings confirm that 18 in 33 TMJs have adhesions. According to the criteria above, we found 11 TMJs were positive, 4 TMJs were suspicious, and 18 TMJs were negative. After comparing the findings of MRI with those of arthroscopy , true positive in 7 TMJs and false positive in 4 TMJs were detected among 11 positive TMJs, adhesion in 3 TMJs and no adhesion in 1 TMJs were detected among 4 suspicious TMJs, and true negative in 10 TMJs and false negative in 8 TMJs weredetected among 18 negative TMJs. The area under ROC curve was 0.60 (0.41, 0. 80) , P <0.05. Conclusion: It is concluded that ①The diagnostic accuracy of MRI for intraarticular adhesions was poor, the major part of adhesions could not be diagnosed through MRI; ②Intracapular adhesions could be detected on T2 weight-image with existing synovial fluid.