Magnetic resonance arthrography of the temporomandibular joint.

PURPOSE: This study evaluated the usefulness of magnetic resonance arthrography (MRAr) in imaging the pathologic temporomandibular joint (TMJ). PATIENTS AND METHODS: Thirteen TMJs of 11 patients with chronic TMJ pain and disability were examined with MRAr. T1-weighted and T2-weighted first spin-echo sequence with fat suppression images were obtained after the intra-articular injection of gadopentetate dimeglumine. RESULTS: The disc, the posterior attachment, and the presence of perforations and adhesions were evaluated in each image. All of these anatomic and pathologic structures were clearly detected. CONCLUSION: MRAr appears to be a promising imaging modality in detecting adhesions and perforations in the TMJ. The MRAr findings simplified the decision of whether a patient should undergo surgery.     

Magnetic resonance evaluation of the disk before and after arthroscopic surgery for temporomandibular joint disorders

OBJECTIVE: The purposes of this study were (1) to assess functional and pain outcomes after arthroscopic surgery on patients with temporomandibular joint disorders (TMD); (2) to evaluate postsurgical changes in disk position, mobility, and morphology on magnetic resonance imaging (MRI); and (3) to measure the association between changes in disk position, mobility, and morphology on MRI and clinical outcomes. STUDY DESIGN: A retrospective analysis was conducted of temporomandibular joints with internal derangement and osteoarthritis that were refractory to nonsurgical treatments and underwent arthroscopic surgery and on which MRI was performed within 1 month after the initial visit and 1 year after arthroscopic surgery. Clinical findings were assessed on the basis of mandibular range of motion and joint pain level on a visual analog scale at the initial visit and 1 year after arthroscopic surgery. The disk position, mobility, and morphology on MRI were compared with clinical findings and were statistically analyzed before and after arthroscopic surgery. The treatment outcome was judged according to our success criteria. The associations between changes in disk position, mobility, and morphology and clinical outcomes after arthroscopic surgery were statistically analyzed. RESULTS: Forty-three joints of 43 patients who underwent arthroscopic surgery were assessed in this study. After arthroscopic surgery, mandibular range of motion and visual analog scale results improved statistically. According to the criteria for clinical resolution, 32 surgeries were successful and 11 were unsuccessful. Preoperative and postoperative MRI showed that most joints had anterior disk displacement (ADD) without reduction. Postoperative MRI revealed that, statistically, the number of mobile disks had increased and deformity of the disks had progressed. In the successful group, postoperative MRI revealed that all joints had mobile disks. In both groups, most joints had ADD without reduction before and after arthroscopic surgery, and, statistically, deformity of the disks progressed after arthroscopic surgery. CONCLUSIONS: Arthroscopic surgery was an effective treatment for TMD refractory to nonsurgical treatments. This study provides important information of clinical significance. Disk position remained ADD without reduction, disk mobility increased, and deformity of the disks progressed after arthroscopic surgery.     

Magnetic resonance imaging of the temporomandibular joint

Correct diagnosis of internal derangements of the temporomandibular joint requires both a comprehensive clinical and radiographic evaluation. Plain film tomography, transcranial radiography, arthrography and computed tomography have all been used to assess the status of the joint structures. Magnetic resonance imaging is a relatively new modality used for imaging many different organ systems. Magnetic resonance imaging of the temporomandibular joint has certain distinct advantages over previously used techniques in evaluating patients for internal joint derangements. The applicability of magnetic resonance imaging in the diagnosis of internal derangements will be discussed.     

Magnetic resonance imaging of temporomandibular joint after surgical treatment of internal derangement

Sagittal and coronal surface coil magnetic resonance imaging was performed on 21 patients who about 2 years earlier had surgery for temporomandibular joint internal derangement. Surgical procedure included disk repositioning (23 joints) and diskectomy (seven joints). At the time of reimaging, 20 joints showed recurrence of pain and 10 joints were asymptomatic. Extensive fibrous tissue was seen in the joint space and in the joint capsule in 13 of the 20 painful joints, whereas minimal fibrous tissue in the lateral capsule wall was seen in 3 of the 10 nonpainful joints. Fibrous tissue was surgically confirmed in 10 of the painful joints. Disk displacement was seen in 11 of the 23 joints that had surgical disk repositioning. Disk displacement was seen in both painful (9/17) and nonpainful joints (2/6). It was concluded that magnetic resonance imaging is an excellent method for postoperative imaging of the temporomandibular joint and that attention should be directed to the presence or absence and extension of the fibrous tissue in the joint space and in the joint capsule.     

Magnetic resonance imaging predictors of temporomandibular joint pain

BACKGROUND: The authors conducted a study to evaluate whether temporomandibular joint, or TMJ, disorder subgroups are related to magnetic resonance imaging, or MRI, diagnoses of TMJ internal derangement, or ID; osteoarthrosis, or OA; effusion; and bone marrow edema. METHODS: The TMJ disorder group was composed of 118 subjects with TMJ pain who were assigned a clinical unilateral single diagnosis of a specific TMJ disorder. The control group consisted of 46 subjects who did not have TMJ pain. Sagittal and coronal magnetic resonance images were obtained to establish the prevalence of ID, OA, effusion and bone marrow edema. The authors used a multiple logistic regression analysis to compute the odds ratios, or OR, for MRI features for control subjects versus four groups of subjects who had TMJ pain: ID type I (n = 35), ID type III (n = 39), capsulitis/synovitis (n = 26) and degenerative joint disease, or DJD, (n = 18). RESULTS: MRI diagnoses that did not contribute to the risk of TMJ pain included disk displacement, or DD, with reduction and effusion. Significant increases in the risk of experiencing TMJ pain occurred selectively with DD without reduction (OR = 10.2:1; P = .007) and bone marrow edema (OR = 15.6:1, P = .003) for the ID type III group and with DD without reduction (OR = 11.7:1, P = .054) for the DJD group. Subjects in the group with ID type I were less likely to be associated with an MRI finding of OA than were control subjects (OR = 1:5.6). CONCLUSIONS: While the contribution of MRI variables to the TMJ pain subgroups was not zero, most of the variation in each TMJ pain population was not explained by MRI parameters. Thus, MRI diagnoses may not be considered the unique or dominant factor in defining TMJ disorder populations. CLINICAL IMPLICATIONS: Therapy for subjects with TMJ based on the evaluation of concomitant morphological abnormalities, whether prophylactically or as treatment for TMJ disorders, may be unwarranted.     

Magnetic resonance imaging of the temporomandibular joint meniscus

This report describes early experience with magnetic resonance imaging (MRI) of the temporomandibular joint meniscus in which surface coil technology was used. The results suggest remarkable imaging capabilities and speed with noninvasive methods.     

Magnetic resonance spectroscopy of inflammation associated with the temporomandibular joint.

Noninvasive early recognition and treatment of temporomandibular joint dysfunction remains a diagnostic challenge. This pilot study evaluated the use of phosphorus 31 magnetic resonance spectroscopy with magnetic resonance imaging to measure alterations in pH and high-energy phosphate metabolite ratios of muscle that is adjacent to an inflamed temporomandibular joint. Ten New Zealand white rabbits were used in this study. Two animals were used to develop signal acquisition protocols and to ensure that stable baseline data could be measured. In each of the eight animals used in the experiment, one temporomandibular joint was injected with a suspension of silica particles and the contralateral joint served as a control. Data were collected from control and experimental joints on days 0, 7, 14, 21, and 28, after the injection. At the end of the study, temporomandibular joints were block resected and histologically examined to confirm the presence of an inflammatory response. Results indicated that pH and metabolite ratios could be obtained by 31P-magnetic resonance spectroscopy. Changes in pH and some metabolite ratios in experimental joints showed statistical significance (p < 0.001). Differences were seen on day 2 and day 7 (p = 0.040 and p = 0.008, respectively) in the phosphocreatine/alpha-adenosine triphosphate ratios. This contrasts with phosphocreatine/beta adenosine triphosphate ratios that showed significance that began at day 7 (p = 0.022) and continued to day 14 (p = 0.025). Histologic examination indicated that the tissue response within the joint capsule was less than the granulomatous reaction expected.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnetic resonance imaging of partial temporomandibular joint disc displacement

Unilateral magnetic resonance imaging (MRI) of the symptomatic temporomandibular joint (TMJ) was performed on 55 patients. The position of the articular disc in relation to the condyle was established on sagittal images. Particular attention was paid to partial or complete anterior positioning of the disc. MRI was correlated with clinical and, in 33 cases, surgical findings. The concept of partial anterior displacement may be useful in relation to treatment planning.     

Magnetic resonance imaging evaluation of temporomandibular joint disc deformities in relation to type of disc displacement.

PURPOSE: This study was undertaken to assess the relationship between the temporomandibular joint (TMJ) disc deformity and the type of internal derangement. PATIENTS AND METHODS: One hundred thirty-three TMJs of 72 patients (53 female and 19 male) with intracapsular dysfunction were studied using clinical and magnetic resonance imaging examinations. RESULTS: Of the 133 TMJ discs, 41.35% had no deformity, whereas 18% of the discs were folded, 19.55% were lengthened, 9.77% were round, 7.51% were biconvex, and 3.75% had thick posterior bands. The frequency of disc deformity was greater with anterior disc displacement without reduction than in cases of anterior disc displacement with reduction (P <.001). Folded and round discs were most common in cases with TMJ anterior disc displacement without reduction (P <.0001). An increase in length was seen in 56.75% of the cases with anterior disc displacement with reduction, whereas 100% of nonreducing discs were mainly folded or rounded. Crepitation was correlated with folded and round disc deformities, whereas lengthening was the feature of reducing discs associated with early and intermediate clicking. CONCLUSIONS: The results show that the degenerative changes in the TMJ disc are influenced by the degree and the type of disc displacement. The more advanced the internal derangement, the more deteriorated the disc configuration.     

Magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement--a review of 144 cases

One hundred and forty four patients underwent magnetic resonance imaging (MRI) for evaluation of suspected internal derangement (ID) of the temporomandibular joint (TMJ). All scans were performed on a state-of-the-art scanner by highly experienced technologists and evaluated by a single Head and Neck/Maxillofacial radiologist. Seventy-nine percent of patients were female and 21% male. Age distribution of the cases was bi-modal with first peak at 20-30 years of age and second peak at 50-60 years of age. Of the 82.5% of cases with disc displacement, 59.5% demonstrated reduction with opening and 40.5% did not reduce. Anterior disc displacement is common (44%) and sideways displacement rare (4%). Antero-lateral displacement was the second commonest type of displacement (29%) probably related to the weakness of the lateral disc attachment.     

Long-term magnetic resonance imaging after temporomandibular joint discectomy without replacement.

PURPOSE: The intracapsular changes in patients who underwent discectomy without disc replacement were evaluated by magnetic resonance imaging (MRI) to determine the long-term outcome of this procedure. PATIENTS AND METHODS: Thirty-three patients observed for an average of 9 years 4 months (5 to 24 years) and 10 asymptomatic volunteers underwent MRI using T1- and T2-weighted images and 3-dimensional fast imaging with a steady precession sequence (FISP-3D) technique. The intracapsular changes, especially those in the joint space, were compared with the postoperative clinical findings. RESULTS: MRI examination of the temporomandibular joint in the 33 patients (35 joints) indicated the presence of tissue with an intermediate or high signal intensity in the joint space. This tissue covered the articular surface of the condyle and fossa. Thirty-two joints had no pain or only occasional, mild pain (3 joints). No patient had severe joint pain or a low signal intensity in the joint space on MRI examination. There was no correlation between joint noise and the presence of a tissue deformity in the joint space. MRI of 2 patients with limited mouth opening showed tissue with high signal intensity in the joint space as well as an exostosis on the eminence and hypertrophy of the condyle. CONCLUSION: Long-term success is possible with discectomy without replacement. This appears to be attributable to the formation of new tissue between the condyle and fossa that acts as a pseudodisc.     

颞下颌关节盘穿孔的MRI诊断

目的 评价磁共振(magnetic resonance image,MRI)检查对颞下颌关节（temporomandibular joint,TMJ)盘穿孔的诊断价值。方法 对2003年4月—2010年3月期间临床诊断为TMJ结构紊乱（internal derangement,ID）的1845例（2524侧）患者行TMJ MRI检查。所有患者均行关节镜或开放性手术治疗,确定有无盘穿孔。按照我们制定的MRI诊断标准,确定有无穿孔,分为阳性组、可疑组及阴性组;并以关节镜或开放性手术结果为金标准,得出真、假阳性及真、假阴性关节例数,应用SPSS16.0软件包制作ROC曲线,计算ROC曲线下面积,评价MRI诊断TMJ盘穿孔的整体准确性,并结合其优点,评价其对TMJ盘穿孔的应用价值。结果 磁共振检查诊断结果与关节镜及开放性手术结果相比,阳性组189侧,其中102侧真阳性,87侧假阳性;可疑组197侧, 其中42侧真阳性,155侧假阳性;阴性组2138侧,其中63侧假阴性,2075侧真阴性。ROC曲线下面积=0.808(0.77,0.85)（P<0.05）。结论 MRI对TMJ盘穿孔具有较好的诊断价值,但其诊断的准确性依赖于有无关节液和临床经验。     

Magnetic resonance imaging of the temporomandibular joint using a surface coil

Magnetic resonance imaging (MRI) was done in 454 temporomandibular joints of 240 patients and the images produced were correlated with arthrographic, tomographic, and, in the 85 patients who were operated on, surgical findings. The MRI was found to be more accurate than arthrography in demonstrating soft tissue changes. In addition, the technique does not expose the patient to ionizing radiation and has no known biological hazard.