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。     

颞下颌关节区滑膜软骨瘤病的CT诊断

目的探讨颞下颌关节区滑膜软骨瘤病在CT上的表现特点.资料与方法搜集9例主诉为单侧颞下颌关节区肿胀患者的CT轴位和冠状位扫描,并对其CT表现进行评价.所有病例均经关节镜或手术病理证实为滑膜软骨瘤病.结果颞下颌关节滑膜软骨瘤病的CT表现为:(1)关节区软组织肿大(n=8);(2)病变内有散在钙化小体(n=8);(3)关节间隙增宽(n=4);(4)下颌髁突骨质异常改变(n=3);(5)颞骨关节面骨质异常改变(n=6),其中CT表现为颞骨关节面骨质硬化者4例,颞骨关节面骨质吸收者3例,颞骨关节面骨质变薄者1例.1例CT检查显示滑膜软骨瘤病向上经颞骨关节面侵犯颅内(大脑颞叶脑膜).结论颞下颌关节滑膜软骨瘤病的CT表现以该区软组织肿胀伴散在的钙化小体和周围骨质受侵犯为特征.后者可以引起中颅窝底的破坏和颅内侵犯,进而影响病变的预后.     

颞下颌关节滑膜软骨瘤病的MRI表现

目的 探讨颞下颌关节区滑膜软骨瘤病的MRI表现特点.资料与方法 搜集7例主诉为颞下颌关节区肿胀、疼痛、杂音或者张口受限患者的MRI影像资料,对其斜冠状面和斜矢状面的张闭口位T1WI、T2WI进行分析.所有病例均经关节镜手术或开放性手术病理证实为滑膜软骨瘤病.结果 颞下颌关节滑膜软骨瘤病的MRI表现为:(1)病变区有单个或多个散在软骨小体或钙化游离体(n=7);(2)关节腔大量积液(n=7);(3)关节区软组织肿大(n=5);(4)关节盘形态和位置异常(n=2);(5)下颌髁突骨质异常改变(n=3),表现为骨皮质连续性中断和/或骨髓腔减少;(6)颞骨关节面骨质异常改变(n=2),表现为骨质硬化.结论 颞下颌关节滑膜软骨瘤病的MRI表现多为单个或多个散在的软骨小体或钙化游离体伴关节腔大量积液;往往伴有关节区软组织肿胀;少数病例可侵犯邻近的骨质,引起髁突或颞骨关节窝等骨质的破坏或伴有关节盘形态或位置异常.     

颞下颌关节骨关节炎合并滑膜骨软骨瘤病一例

滑膜骨软骨瘤病为罕见疾病,现报道1例如下。     

滑膜软骨瘤病的MRI诊断

目的 探讨滑膜软骨瘤病的MRI特征.方法 搜集经病理证实的26例滑膜软骨瘤病MRI影像资料,分析其MRI表现.结果 滑膜软骨瘤病的MRI表现为关节滑膜肥厚、关节内悬垂体及游离体、关节腔积液和骨性关节炎改变.26例中,Milgram病理分期Ⅰ期5例,3例表现为关节滑膜的不规则结节状肥厚,2例滑膜均匀肥厚,2例增强扫描肥厚的滑膜及结节明显强化;Ⅱ期9例,Ⅲ期12例,表现为既有关节滑膜的结节状肥厚,又有关节内悬垂体和游离体的形成,悬垂体呈中等T1、中等T2信号,增强扫描呈明显强化或环形强化,游离体于T1WI及T2WI上呈低信号,表现为大小不一、数目不等、形态不同的圆形、卵圆形钙化或骨化结节影,其中11例游离体中央呈短T1信号,脂肪抑制序列PDWI上呈低信号,增强扫描无明显强化.10例继发骨性关节炎改变.结论 滑膜软骨瘤病具有典型的MRI特征,当游离体钙化或骨化时可明确诊断,对较早期病变的诊断亦具有重要价值.     

原发性滑膜骨软骨瘤病的影像诊断

目的分析原发性滑膜骨软骨瘤病的X线、CT和MRI表现。方法22例原发性滑膜骨软骨瘤病患者均行CT扫描,其中16例拍摄X线平片,2例做MRI检查。结果22例中男13例,女9例。20例为单关节发病,2例为双侧关节同时发病。20例表现为关节内或周围大小不一、数目不等的结节状钙化或骨化影,1例表现为髋关节内分叶状软组织块影伴有钙化,并有髋臼骨质破坏,另1例表现为膝关节内条状软组织密度伴有点状钙化。2例关节骨质破坏,手术证实为软骨结节压迫所致。结论X线平片和CT扫描能够显示钙化或骨化的软骨结节,对未钙化或骨化的软骨结节MRI能够清楚显示。     

滑膜骨软骨瘤病的影像诊断价值

目的 探讨影像检查对滑膜骨软骨瘤病的诊断价值.方法 回顾分析临床手术或关节镜病理确诊的滑膜骨软骨瘤病39例,分析其影像表现及其诊断价值.结果 发病关节为膝关节11例,髋关节10例,踝关节7例,肩关节8例,肘关节3例(其中5例多关节发病). X线表现主要见关节内或关节旁大小不等,形态不一,数目多少不等的游离钙化或骨化影;CT(25例)表现见比X线平片更清晰的关节内或关节旁游离钙化或骨化影,并可显示增厚的滑膜和关节积液;MRI(30例)能发现关节内未钙化软骨瘤结节,除可见关节游离体,还清晰显示软骨、滑膜、周围软组织的改变情况和关节积液等表现,并可作出分期诊断.结论 影像学检查对滑膜骨软骨瘤病有较高的诊断价值,同时对制订手术方案等方面有较高的临床应用价值.     

颞下颌关节内紊乱的影像学检查

颞下颌关节内紊乱（ID）是临床上常见病,引起的原因较多,随着影像诊断技术的发展,对其表现和病因的认识逐步深入。本文对ID的影像学检查包括颞下颌关节（TMJ）解剖及ID概述、X线平片、体层摄影、关节造影、CT、MR等进行综述。     

滑膜软骨瘤病影像学诊断

目的 探讨滑膜软骨瘤病的影像表现及诊断价值.方法 回顾性分析36例经手术病理证实的滑膜软骨瘤病.36例均行相应关节X线检查,其中13例行CT检查,10例行MR检查.结果 36例滑膜软骨瘤病患者中膝关节22例,髋关节5例,踝关节3例,肩关节2例,肘关节2例,腕关节及颞颌关节各1例;单关节发病31例,双关节发病5例均为膝关节.X线及CT表现为关节间隙及周围有钙化的骨小体,少的1个,多的达数百个,小如米粒,大的直径达2.7 cm.10例MRI检查中,8例钙化结节表现为T_1WI及T_2WI呈低信号,2例钙化结节中心T_1WI及T_2WI呈高信号,周边呈低信号.结论 X线、CT及MRI对本病诊断有重要作用.     

The use of arthrography in the diagnosis of temporomandibular joint synovial chondromatosis

Synovial chondromatosis (SC) involving the temporomandibular joint (TMJ) is very rare and can occur in either or both cavities. Differentiation of the affected cavity in SC is therefore as important as making the diagnosis. This report presents a case of SC in which both cavities were thought to be affected, but arthrography using cone beam CT (CBCT) allowed us to see that involvement was limited to the superior joint cavity. In addition, we describe the usefulness of arthrographic CBCT for diagnosis and treatment planning in SC of the TMJ.     

Synovial chondromatosis of the temporomandibular joint: MRI findings with pathological comparison

Objectives

The aim of this retrospective study was to characterize MRI findings of synovial chondromatosis in the temporomandibular joint (TMJ) by correlation with their pathological findings.

Methods

22 patients with synovial chondromatosis in unilateral TMJ were referred for plain MRI prior to surgical management and pathological examinations. Parasagittal and coronal proton density-weighted imaging and T₂ weighted imaging were performed for each case.

Results

MRI demonstrated multiple chondroid nodules and joint effusion in all patients (100%) and amorphous iso-intensity signal tissues within expanded joint space and capsule in 19 patients (86.4%). On T₂ weighted imaging, signs of low signal nodules within amorphous iso-intensity signal tissues were used to determine the presence of attached cartilaginous nodules in pathology, resulting in 100% sensitivity, 60% specificity and 90.9% accuracy. Signs of low and intermediate signal nodules within joint fluids were used to detect loose cartilaginous nodules and resulted in 80% sensitivity, 42.9% specificity and 68.2% accuracy.

Conclusions

MRI of synovial chondromatosis in TMJ was characterized by multiple chondroid nodules, joint effusion and amorphous iso-intensity signal tissues within the expanded space and capsule. The attached cartilaginous nodules in pathology were better recognized than the loose ones on MRI. Plain MRI was useful for clinical diagnosis of the disorder.     

Synovial chondromatosis of the temporomandibular joint with calcium pyrophosphate dihydrate crystal deposition disease (pseudogout)

This report describes a very rare case of synovial chondromatosis with deposition of calcium pyrophosphate dihydrate (CPPD) crystals (pseudogout) in the temporomandibular joint (TMJ) of a 46-year-old male patient. Synovial chondromatosis is a non-neoplastic disease characterized by metaplasia of the connective tissue leading to chondrogenesis in the synovial membrane. Pseudogout is an inflammatory disease of the joints caused by the deposition of CPPD, producing similar symptoms to those observed in gout but not hyperuricaemia. Both diseases commonly affect the knee, hip and elbow joints, but rarely affect the TMJ.     

Diagnostic performance of magnetic resonance imaging for detecting osseous abnormalities of the temporomandibular joint and its correlation with cone beam computed tomography

Objective

With cone beam CT (CBCT) as the reference standard, the objective of this study was to determine the diagnostic accuracy of MRI for assessing osseous abnormalities of the temporomandibular joint (TMJ).

Methods

106 TMJs from 55 patients with temporomandibular disorder were examined by CBCT and MRI. CBCT images were evaluated by two experienced oral radiologists with regard to the presence or absence of each of the following eight types of osseous abnormalities: Type 1, destructive and erosive osseous changes of the condyle; Type 2, flattening of the articular surface of the condyle; Type 3, deformity of the condyle; Type 4, sclerosis of the condyle; Type 5, osteophyte formation; Type 6, ankylosis; Type 7, erosion of the articular fossa and/or eminence; and Type 8, sclerosis of the articular fossa and/or eminence. For detection of these osseous abnormalities by MRI, proton density-weighted images and T₂ weighted images were evaluated independently by three observers. Using CBCT findings as the reference standard, the diagnostic performance of MRI for detecting various types of osseous abnormalities was evaluated by calculating its sensitivity and specificity.

Results

Out of 106 joints, CBCT revealed Types 1, 2, 3, 4, 5, 6, 7 and 8 abnormalities in 25, 19, 26, 20, 14, 5, 19 and 22 joints, respectively. The mean sensitivities of MRI among the three observers for detecting Types 1, 2, 3, 4, 5, 6, 7 and 8 abnormalities were 61%, 30%, 82%, 40%, 48%, 34%, 61% and 41%, respectively, whereas the mean specificities were 86%, 92%, 91%, 95%, 84%, 98%, 89% and 91%, respectively.

Conclusions

Although high specificity (84–98%) was obtained with MRI, this modality showed relatively low sensitivity (30–82%) for detecting osseous abnormalities of the TMJ. The value of MRI for the detection of TMJ osseous abnormalities is considered to be limited.     

12例原发性髋关节滑膜软骨瘤病临床病例分析

目的 探讨原发性髋关节滑膜软骨瘤病的临床、影像学、病理特点及术后疗效。方法 对1973年5月2004年5月解放军总医院收治的12例原发性髋关节滑膜软骨瘤病患者的术前临床表现、影像学资料及术后病理进行回顾性总结，同时对术后疗效进行追踪随访。结果 术前患者不同程度地存在间歇性髋关节疼痛、肿胀、活动受限，有些患者可触及包块、肌萎缩。术前X线片4例患者未见明显大片钙化影，仅见关节囊影外移，CT检查可见关节腔积液，关节内散在游离体，股骨头有骨侵蚀现象。其余8例患者术前X线片可见明显钙化影。所有患者术后均得到病理证实，8例属MilgramⅡ期，4例属MilgramⅢ期。术后8例获随访，时间1～7年，其中2例复发。结论 应结合临床特点、影像学资料及术后病理对本病进行诊断，并以病理结果为主要依据。为减少术后复发，建议术前行CT或MRI检查；对术前X线片游离体已钙化显影的患者，术中有必要进行X线监测。     

Indirect measurement of the temporomandibular joint disc elasticity with magnetic resonance imaging

Objectives

The radiological evaluation of the temporomandibular joint (TMJ) consists of demonstrating the morphological features of the disc and the condyle in closed and open mouth positions using MRI. We aimed to determine elasticity of the disc by measuring the amount of elongation during mouth opening.

Methods

The study population included 49 patients. Coronal T₁ and multiplane oblique T₂ weighted gradient recalled echo sequences were acquired in open and closed mouth positions. Biconcave TMJ disc lengths were measured on sagittal oblique images in both positions. Elongation ratio (ER) was calculated for each patient. According to the findings, TMJs are classified into subgroups: normal (N), dislocated with reduction (DWR), pure DWR (p-DWR), DWR with additional findings (DWR-a) and dislocated without reduction (DWOR). Statistical analysis was performed using the χ² test and receiver operating characteristic analysis.

Results

Out of 98 discs, 22 of them were evaluated as N, 60 as DWR (28 p-DWR, 32 DWR-a) and 16 as DWOR. There was no significant difference among the disc lengths in three subgroups at the closed mouth position (P = 0.15), whereas there was significant difference in the open mouth position (P = 0.0001). There was significant difference among subgroups as far as ER is concerned (P < 0.05).

Conclusions

ER is a strong indicator of elasticity. Compared with the N group, elasticity of the disc was not significantly different in the p-DWR group but the disc elasticity was very degraded in DWR-a and in DWOR. A negative conversion or one smaller than 1.4 mm means a compromised disc, although sometimes it will possess normal anatomical configurations or signal characteristics.     

Scintigraphic presentation of hip joint synovial chondromatosis

A case of hip joint synovial chondromatosis with an unusual scintigraphic pattern is described. This pattern was suggestive of a hip joint destructive reactive articular process or late manifestations of avascular necrosis of the femoral head. Concurrent radiographs were normal, as were laboratory investigations. Follow-up radiographs six months later showed radiolucencies and erosive bone changes in the diseased joint. Surgical and histopathological findings revealed well developed hip synovial chondromatosis (HSC) with thickened synovium and large, loose, cartilaginous bodies occupying and widening the tightened joint space, with destructive secondary juxta articular pressure and bone erosions. This and other scintigraphic patterns in HSC, and the differential diagnosis of the findings in patients with painful hip presentations are discussed.     

Correlation between temporomandibular joint morphology and disc displacement by MRI

Objectives:

The aim was to evaluate the morphology of the temporomandibular joint''s (TMJs) disc and condyle as well as its correlation with disc displacement, using MRI.

Methods:

190 TMJs were retrospectively analysed. The condyle morphology of each TMJ was evaluated by two observers using both axial and coronal views, as were their disc morphology and displacement, using sagittal view. Condyle morphology was classified as flat, convex, angled or rounded in the coronal sections and as anterior side flat/posterior side convex, biconvex, anterior side concave/posterior side convex, flat or biconcave in the axial view. Disc morphology was determined as biconcave, biplanar, biconvex, hemiconvex or folded. χ², Fisher exact and Bonferroni correction tests were used to evaluate the data. ANOVA followed by post hoc Tukey''s test was used to evaluate the interaction between age and disc displacement.

Results:

Anterior disc displacement with reduction; convex condyle morphology in the coronal view; anterior side concave/posterior side convex morphology in the axial view; and biconcave discs were found to be the most prevalent findings. An association was observed between disc morphology and disc displacement (p < 0.001). No correlation between condyle morphology and TMJ disc displacement was found (p = 0.291 for axial and p = 0.14 for coronal views).

Conclusions:

The results of this study suggest that TMJ disc morphology is associated with disc displacement.     

Radiographic manifestations of the temporomandibular joint in a case of Proteus syndrome

Proteus syndrome is a rare disorder with progressive asymmetrical and disproportionate overgrowth of various tissues of the body. The syndrome is characterized by a wide range of malformations, including craniofacial deformities. Extraoral examination revealed several of the classical craniofacial features of Proteus syndrome: pronounced hemifacial hypertrophy, macrodactyly and hyperostosis. Intraoral examination revealed a high arched palate and gingival hyperplasia. Other findings were unilateral enlargement of the tongue, alveolar growth and dilaceration of the roots of the teeth. There were severe degenerative changes and deformities in the left temporomandibular joint but the oversized condyle was asymptomatic; there was no pain, limitation and deviation at mouth opening. Treatment was not necessary owing to the asymptomatic situation but periodic follow-up with clinical and radiographic examination was considered. The aim of this article is to describe the radiographic manifestations of an asymptomatic condyle malformation and other craniofacial, oral and dental findings in a 33-year-old female patient with known Proteus syndrome.     

Advanced imaging findings and computer-assisted surgery of suspected synovial chondromatosis in the temporomandibular joint

Synovial chondromatosis of the joint occurs mainly in teenagers and young adults. Only 3% of these neoplasms are located in the head and neck region. Synovial chondromatosis of the temporomandibular joint is therefore a very rare disorder. Therefore, developing a working, histological confirmation is required for differential diagnosis. In this case series, the outcome of histological investigation and imaging techniques are compared. Based on clinical symptoms, five cases of suspected synovial chondromatosis of the temporomandibular joint are presented. In each of the subjects, the diagnosis was confirmed by histology. Specific imaging features for each case are described. The tomography images were compared with the histological findings. All patients demonstrated preauricular swelling, dental midline deviation, and limited mouth opening. Computer-assisted surgery was performed. Histology disclosed synovial chondromatosis of the temporomandibular joint in four cases. The other case was found to be a developmental disorder of the tympanic bone. The diagnosis of synovial chondromatosis of the temporomandibular joint can only be based on histology. Clinical symptoms are too general and the available imaging techniques only show nonspecific tumorous destruction, infiltration, and/or residual calcified bodies, they are only for advanced cases. A rare developmental disorder of the tympanic bone--persistence of foramen of Huschke--has to be differentiated.