正常人和偏侧咀嚼者颞下颌关节核素骨显像的比较

目的:比较放射性同位素骨三相显像技术对正常人及偏侧咀嚼者颞下颌关节影像检查的差异.材料和方法:正常男性志愿者15名和偏侧咀嚼者20名,接受放射性核素骨三相显像检查,以分析、比较不同咀嚼方式对颞下颌关节及骨的血流和骨代谢的影响.结果:正常人及偏侧咀嚼者两侧颞下颌关节形态对称,偏侧咀嚼者两侧髁状突运动不一致.正常人下颌骨不同部位的骨血流和骨代谢有特定差异.偏侧咀嚼者骨扫描示上述部位差异改变,非咀嚼侧关节区放射性强度稍高于咀嚼侧.结论:放射性同位素骨三相显像可以准确显示颞下颌关节的功能变化.     

99Tcm-MDP SPECT颞颌关节显像对髁突肥大的诊断价值

目的 探讨99Tcm-MDP SPECT颞颌关节显像对髁突肥大的诊断价值.方法 回顾性分析2009年至2010年行99Tcm-MDP SPECT颞颌关节显像的髁突肥大(临床确诊)患者56例(男22例,女34例,平均年龄21.5岁),其中31例接受了髁突高位切除术并有组织病理学结果.另收集10例因恶性肿瘤等其他疾病行骨显像的对照者,男女各5例,平均年龄22.6岁,加做颞颌关节显像.对所有研究对象进行SPECT图像分析及半定量分析,采用独立样本t检验比较髁突肥大组与对照组间患侧髁突/顶骨及患侧髁突/双侧髁突的摄取比差异,髁突肥大组患侧与健侧的摄取差异行配对t检验.对手术治疗患者的SPECT结果与其病理结果进行Pearson相关分析.结果 髁突肥大组患侧髁突/顶骨摄取比(1.66 ±0.63)及患侧髁突/双侧髁突摄取比(0.59±0.44)均明显高于对侧(1.34±0.34、0.41±0.04,t=3.687和6.590,均P＜0.01),并且明显高于对照组左侧髁突相应数据(1.12 ±0.07和0.50±0.01,t =6.459和4.750,均P＜0.001).SPECT检查诊断髁突生长活跃的灵敏度为95.2％(20/21),特异性为60.0％(6/10),阳性预测值为83.3％ (20/24),阴性预测值为6/7.患侧髁突/双侧髁突摄取比与软骨组织增生的厚度无明显相关[软骨膜、增殖层、肥大层的平均厚度分别为(150.5±94.9)、(185.2±113.6)、(167.7 ±76.9)μm,r=0.46、0.47、-0.12,均P＞0.05].结论 99Tcm-MDP SPECT颞颌关节显像能够有效评估髁突肥大患者的骨质生长活性,为手术方式的选择提供重要依据.     

下颌髁突脱位骨折后颞下颌关节软组织改变的MRI表现

目的 分析下颌髁突脱位骨折后颞下颌关节(TMJ)软组织改变的MRI表现.方法 应用矢状面和冠状面质子密度加权成像(PDWI)和T2WI连续检查103侧(77例)患有下颌髁突脱位骨折的颞下颌关节(TMJ).结果 MRI上,103侧髁突脱位骨折后的TMJ异常表现有:(1)髁突骨折断片向前下(102侧,99.0%)和前(1侧,10%)脱位;(2)关节盘移位(100侧,97.1%),其中矢状面MRI显示关节盘随脱位的髁突向前下移位者99侧,向前移位者1侧;(3)关节腔积液(103侧,100%);(4)关节盘后区信号异常(91侧,88.3%);(5)关节盘下后附着异常(89侧,86.4%);(6)关节囊异常(89侧,86.4%);(7)关节盘上后附着异常(37侧,35.9%);(8)关节盘变形(8侧,7.8%);(9)关节盘撕裂(8侧,7.8%);(10)颞骨关节窝骨折(4侧,3.9%).结论矢状面MRI上,多数下颌髁突脱位骨折以TMJ关节盘随脱位的髁突向前下移位,并伴有关节腔积液为特点.     

颞下颌关节紊乱综合征的MRI诊断价值

目的 探讨ＭＲＩ诊断颞下颌关节紊乱综合征（ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｉｎｔ ｄｅｒｅｎｇｍｅｎｔ ｓｙｎｄｒｏｍｅ,ＴＭＪＤｓ）的价值。材料与方法 回顾性分析３７例（７４侧）ＴＭＪＤｓ患者ＭＲＩ表现。７４侧均采用超导磁共振成像系统扫描。５０侧附加模拟动态扫描;关节腔造影３３侧,关节腔镜检查１９侧,手术１４侧,病理切片４侧,结果 （１）４４侧有症状关节中,３８侧关节盘病变,其中最多见为     

探讨MRI对颞下颌关节紊乱病中关节盘穿孔的诊断标准

目的 探讨MRI对颞下颌关节紊乱病中关节盘穿孔的诊断价值及方法,以期提高关节盘穿孔的诊断准确率.方法 回顾性分析100例颞下颌关节紊乱病患者的临床资料和MRI图像.由两位放射科医师按照标准共同判定图像:(1)关节盘连续性中断,伴有或不伴有关节腔上下关节腔相通;(2)关节盘形态尚可,但关节盘信号增高、模糊;(3)关节盘扭...     

颞下颌关节相关角度测量的磁共振影像分析

目的 通过对颞下颌关节相关角度测量来探讨颢下颌关节紊乱患者与正常者间有无差异,从而评价其磁共振影像价值.方法 设立病例组(颞下颌关节紊乱患者)及对照组(正常者),选取16例单侧闭口斜矢状位MR扫描图像进行相关角度测量,其中病例组:男5例,女11例,年龄分别为:病例组年龄18～42岁,平均年龄(26.94±5.25)岁,正常组年龄19～38岁,平均年龄(28.13±6.17)岁,测量角度包括前角(Anterior angle,Aa),中间角(Intermediate angle,Ma),后角(Posterior angle,Pa)及阿尔法角(α),径线包括髁线,颈线,下颌骨髁突线等.结果 正常组及病例组Aa角,Ma角,Pa角及α角分为(95.038士3.379)°(88.6～99.4)°,(101.031±3.607)°(97.5～108.3)°;(56.381±4.366)°(49.6～62.4)°,(62.838±3.469)°(58.4～66.4)°;(3.781±2.389)°(1.8～8.8)°,(10.363±3.215)°(5.6～16.6)°;(165.331±4.746)°(156.2～168.2)°,(165.013±4.708)°(158.4～172.2)°;其中α角P值＞0.05,两者间无显著性差异,Aa角,Ma角,Pa角间P值＜0.05,有显著性差异.结论 颞下颌关节多角度测量有助于颞下颌关节紊乱病影像学诊断,同时为该病临床诊断提供了较为可靠的依据.     

颞下颌关节盘移位的MRI表现及其临床诊断价值

目的:探讨颞下颌关节盘移位的MRI表现及其临床诊断价值。方法:23例共46侧关节盘行斜矢状面和冠状面T1WI、T2WI及T2*WI扫描,分析关节盘在开口位和闭口位上的位置变化和关节盘的形态等。结果:46侧关节盘中有17侧(17/46)正常;可复性关节盘前移位11侧(11/46),主要MRI表现为闭口位时关节盘在髁状突前方,关节结节前下方,开口位时,关节盘回到关节窝正常位置,关节盘可变形伸长,后带膨大,信号基本正常;不可复性关节盘前移位15侧(15/46),主要MRI表现为在闭口位和开口位时关节盘位置均位于髁突前方,关节结节前下方,不回到关节窝内,关节盘形态严重变形,出现圆形、折叠型、伸长型等,关节盘信号基本正常;关节盘内侧移位2侧(2/46),外侧移位1侧(1/46),这两种类型主要MRI表现为关节盘变形,呈低信号改变。结论:MRI可以清楚显示关节盘的位置、结构及盘突关系,对颞下颌关节盘移位有重要的临床诊断价值。     

MRI诊断颞下颌关节损伤的价值

目的:探讨MRI诊断颞下颌关节损伤的应用价值。材料和方法:对30例颞下颌关节损伤患者于外伤后3～20天内行颞下颌关节MRI检查,MRI扫描序列包括闭口斜矢状位T1WI、PDWI、斜冠状位T1WI、T2WI,张口斜矢状位T1WI、PDWI。由两位资深放射科医师分析MRI表现。结果:30例共60个颞下颌关节中发现18个髁状突骨折,9个骨损伤,29个关节盘移位,26个关节囊积液、积血。结论:MRI能很好的显示颞下颌关节的骨折、骨损伤以及关节盘与关节囊损伤情况,是颞下颌关节损伤的重要检查与评价手段,具有很高的临床应用价值。     

3.0 T MRI在颞下颌关节紊乱病诊断中的临床应用

目的：分析颞下颌关节紊乱病（TMD）的MRI表现,探讨3.0 T MRI在TMD诊断中的临床应用价值。方法：回顾性分析30例临床确诊为TMD患者的MRI资料,观察其关节盘、关节囊、髁突骨质及翼外肌异常影像,并进行统计。结果：TMD患者的关节盘、关节囊、髁突骨质、翼外肌异常影像概率与非TMD患者有显著差异。结论：3.0 T MRI能够全面评估TMD患者颞下颌关节情况,具有很高的临床应用价值。     

布洛芬皮肤贴敷治疗颞下颌关节紊乱病36例

颞下颌关节紊乱病（TMD）是口腔门诊常见病。自1999年以来,我们采用布洛芬局部皮肤贴敷治疗TMD36例,疗效满意。     

颞下颌紊乱病单侧关节疼痛盘后组织MRI信号强度的研究

目的　分析颞下颌关节疼痛及疼痛程度与MRI上盘后组织信号强度的关系。方法　对 2 0例单侧关节疼痛颞下颌紊乱病患者 40侧关节进行张口矢状位T2 WI成像 ,以非疼痛侧作为自身对照 ;利用VAS进行疼痛程度的判定 ,将疼痛分为轻、中、重度疼痛 3组 ,评价双板区信号强度与疼痛及疼痛程度的关系。结果　疼痛关节与非疼痛关节的盘后组织T2 信号强度平均值分别为170 .91± 3 9.0 6和 14 0 .74± 2 7.3 4,经配对t检验两者有显著性差异 (Ρ <0 .0 5 )。疼痛程度与盘后组织T2 信号强度关系的统计学分析发现 ,中度疼痛组和重度疼痛组其双板区信号强度均明显高于对照组 ,虽然轻度疼痛组与对照组双板区信号强度无显著性差异 ,但是双板区信号强度存在随疼痛程度加重而升高的趋势。结论　盘后组织T2 信号强度在疼痛关节高于非疼痛关节 ,这可能与疼痛关节盘后组织的血管分布增加有关     

Temporomandibular joint (TMJ) disc position in patients with TMJ pain assessed by coronal MRI

Objectives:

To assess the position of the temporomandibular joint (TMJ) disc in patients with TMJ pain and compare it with equivalent published data of asymptomatic volunteers.

Methods:

The oblique coronal closed- and open-jaw MR images from 66 patients with TMJ pain were evaluated. Clinical examination followed the research diagnostic criteria for temporomandibular disorders. In all coronal images, the transverse condylar axis and the medial and lateral edges of the disc were determined using special software. Inter-rater agreement was calculated [two raters; inter-rater correlation coefficient (ICC)]. The presence of osteoarthrosis (OA) was determined by two independent raters. The influence of OA was estimated in patients (generalized estimation equation model). The results were compared with those of healthy volunteers (t-test). Differences between closed and open jaw in patients were analysed with the Wilcoxon matched-pair test.

Results:

The ICC was good for the transverse condylar axis (0.987) and the medial edge of the disc (0.799) and fair for the lateral edge (0.355). On average, the disc projected 5.5% to the medial side; laterally, the condyle was partially uncovered by the disc (−16.6%). In the open-jaw position, both the medial and the lateral edges shifted medially (to 17.6% vs −23.6%, Wilcoxon matched-pair test, p < 0.001). OA had no significant influence (generalized estimation equation model, p = 0.952). The disc position differed significantly from asymptomatic individuals (t-test, p < 0.001) who showed a medial disc position and full coverage of the condyle.

Conclusions:

In patients with TMJ pain, the disc seems to be smaller and located less medially than in healthy volunteers. The extent of the medial shift on opening was similar.     

多排螺旋CT在颞颌关节形态研究中的应用

目的探讨多排螺旋CT(mu ltislice helical CT,MSCT)在颞颌关节(temporom and ibu lar joint,TM J)形态研究中的应用价值。方法MSCT对10具尸体,30名志愿者共80侧TM J扫描,在多层面后重建(mu ltip lanar reform ation,MPR)图像上,测量TM J骨性形态参数、关节盘厚度、关节间隙,对尸体TM J进行解剖测量,结果用SPSS软件分析。结果TM J MPR图像骨皮质边界清晰,关节间隙显示清楚,关节盘依稀可辨,TM J骨性形态参数2种测量结果间有显著的正相关关系,关节盘厚度2种方法间有较大的正相关关系,获得了正常TM J形态的参考值。结论MSCT配合MPR技术,可以全面、精确地测量TM J的骨性形态,准确地测量关节间隙,粗略地测量关节盘的厚度。     

+Gz重复作用对颞下颌关节的影响分析

现代高性能战斗机加速性能大幅度提高是引起空勤人员颞下颌关节疾病发生率较高原因之一,本文综合分析了近年来国内外航空医学中大量的研究成果,认为＋Gz重复作用对颞下颌关节的重要影响包括：1）造成颞下颌关节区组织缺血缺氧;2）引起颞下颌关节的微小创伤;3）导致口颌系统肌肉功能失调;4）精神紧张。这些因素均对颞下颌关节有不利影响。因此研究＋Gz重复作用对颞下颌关节的影响是很有意义的。     

肺癌脊柱骨转移的特点和规律的初步探讨

探讨肺癌脊柱骨转移的特点和规律。资料和方法回顾性分析190例病理证实为肺癌、核素骨显像诊断 脊柱骨转移病例的骨显像表现。结果(1)肺癌转移好发部位是胸椎,其次是腰椎。腺癌、早期肺癌及病程短者胸椎转移 率较高,晚期肺癌以腰椎转移为主;(2)腺癌、晚期肺癌及病程长的患者椎体转移范围广,手术较未手术患者椎体转移数 少;(3)病灶常呈圆形或类圆形;(4)肺癌常合并脊柱外骨转移,以胸部骨常见。结论肺癌患者尤其是腺癌,确诊后宜尽 早作骨显像检查,并注意定期随访,以早期发现脊柱骨转移病变,早期治疗,改善患者预后。     

Diffusion Tensor Imaging of the Lateral Pterygoid Muscle in Patients with Temporomandibular Joint Disorders and Healthy Volunteers

ObjectiveThis study aimed to explore the feasibility of functional evaluation of the lateral pterygoid muscle (LPM) using diffusion tensor imaging (DTI) in patients with temporomandibular joint disorders (TMDs).Materials and MethodsA total of 119 patients with TMD (23 male and 96 female; mean age ± standard deviation, 41 ± 15 years; 58 bilateral and 61 unilateral involvements for a total of 177 joints) and 20 healthy volunteers (9 male and 11 female; 40 ± 13 years; 40 joints) were included in this prospective study. Based on DTI of the jaw in the resting state, the diffusion parameters, apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ1, λ2, and λ3 of the superior and inferior heads of the LPM (SHLPM and IHLPM) were measured. Patients with TMD with normal disc position (ND), anterior disc displacement with reduction (ADWR), and anterior disc displacement without reduction (ADWOR) were compared.ResultsPatients with TMD overall, and ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 in both the SHLPM and IHLPM than those in volunteers (p < 0.05 for all), whereas the ND subgroup only had significantly higher ADC and λ1 (p < 0.001). Meanwhile, significant differences in FA in the SHLPM and IHLPM were found between volunteers and ADWOR (p = 0.014 and p = 0.037, respectively). Among the three TMD subgroups, except for λ3 and FA in the ADWR subgroup, ADWR and ADWOR subgroups had significantly higher ADC, λ1, λ2, and λ3 and lower FA than those in the ND group (p < 0.050). There was no significant difference in diffusion variables between ADWR and ADWOR. In ADWOR, the osteoarthritis group had significantly higher λ3 and lower FA values in the IHLPM than those in the non-osteoarthritis group.ConclusionDTI successfully detected functional changes in the LPM in patients with TMD. The unsynchronized diffusivity changes in the LPM in different subgroups of TMD signified the possibility of using diffusion parameters as indicators to identify the severity of LPM hyperfunction at various stages of TMD.     

颞下颌关节滑膜软骨瘤病的MRI表现

目的:探讨和描述颞下颌关节(TMJ)滑膜软骨瘤病的MRI表现特点。材料和方法:回顾性观察和分析13例经手术病理证实的TMJ区滑膜软骨瘤病的MRI表现。所有病例均在术前行闭口矢状面和冠状面PDWI、开口矢状面T_2WI检查。结果:所有滑膜软骨瘤病均发生于TMJ上腔。病变的MRI表现:关节上腔异常积液(13例,100%);关节囊明显扩张(11例,84.6%);关节腔内有多发软骨样小体的形成(11例,84.6%);关节囊或滑膜组织增厚(8例,61.5%)和颞骨关节面骨质破坏(4例,30.8%)。MRI未显示病变有下颌髁突侵蚀、关节囊外软组织侵犯、大脑颞叶脑膜和脑实质侵犯。结论:颞下颌关节滑膜软骨瘤病的MRI表现具有一定特点,主要表现为关节上腔异常积液,伴关节囊扩张、多发软骨样结节小体形成和滑膜组织增厚。     

颞下颌关节的开、闭口位计算机三维重建及测量

目的:探讨计算机三维重建技术在颞下颌关节开闭口运动研究中的应用。方法:利用生物塑化技术制作1.0mm厚的闭口位、大开口位的颞下颌关节的薄层断面标本,在SGI工作站上对关节盘、髁突等结构进行三维重建及相关测量。结果:计算机三维重建图像可显示闭口位、大开口位时颞下颌关节形态、位置变化及其三维解剖结构关系。重建结构均能单独显示、任意搭配显示或整体显示,并可绕任意轴进行旋转,任意径线及角度均可适时测量。结论:计算机三维重建技术对于颞下颌关节运动解剖研究具有重要应用价值。