螺旋CT、锥形束CT与MRI在颞下颌关节紊乱病成像中的应用比较

目的 探讨螺旋CT（spiral CT）、锥形束CT(cone-beam CT, CBCT)与磁共振成像(magnetic resonance imaging,MRI)在颞下颌关节紊乱病（temporomandibular joint disorders, TMD）成像中的应用价值。方法 回顾分析104例208侧行螺旋CT、CBCT或MRI检查的临床怀疑TMD的患者。由2名放射科医师分别对每侧TMJ关节的关节间隙、关节盘的显示、髁突的骨质改变和关节腔积液情况进行评估,并将3组显示结果进行比较。采用SPSS19.0软件包对数据进行统计学分析。结果 除螺旋CT组与CBCT组右侧前间隙（P<0.05）及左侧上间隙有统计学差异（P<0.05）外,其余组比较均无统计学差异（P>0.05）。CBCT及螺旋CT无法清晰显示关节盘,而MRI对关节盘的显示率为100%。104例208侧TMJ中,通过同一样本资料不同检查的比较所示,螺旋CT与CBCT在显示髁突骨质改变上无统计学差异（P>0.05）,而螺旋CT、CBCT分别与MRI组比较均有统计学差异（P<0.05）。仅CBCT可清晰显示骨小梁结构。螺旋CT及CBCT均无法清晰显示关节腔积液,仅MRI可清晰观察,显示率为18.27%。结论 螺旋CT、CBCT及MRI对TMD都有一定的诊断价值。其中,MRI对关节盘的显示最好,并可显示骨髓的异常改变;CBCT、螺旋CT及MRI均可测量关节间隙,且螺旋CT、CBCT与MRI三者重建的关节各间隙影像基本一致;仅CBCT可以清晰显示髁突内骨小梁的结构及走行。

Comparison among spiral CT,cone-beam CT and MRI in the diagnosis of temporomandibular joint disorders

PURPOSE: To investigate the difference between spiral CT, cone-beam CT (CBCT) and MRI in radiologic examination of temporomandibular joint disorder (TMD). METHODS: A retrospective analysis of 208 TMJs from 104 patients was obtained by using spiral CT, CBCT or MRI examination of TMDs. Each side of the joint space,articular disc,bone change of the condyle and joint effusion were evaluated and compared among the 3 groups by 2 independent radiologists. The data was analyzed with SPSS 19.0 software package. RESULTS: Except significant difference in the right-anterior and left-superior joint space between spiral CT group and CBCT group (P<0.05), the other groups had no statistically significant difference (P>0.05). The articular disc can not be clearly shown by CBCT and spiral CT, but it can be displayed completely by MRI scanner. In 208 TMJs from 104 patients, there was no significant difference in the bone changes of condyle between spiral CT and CBCT group (P>0.05), but there was significant difference between spiral CT and MRI group, CBCT and MRI group, respectively. The structure of the bone trabeculae was displayed clearly only by CBCT. Meanwhile, only MRI scanner revealed the joint effusion clearly and the rate of display was 18.27%. CONCLUSIONS: Spiral CT, CBCT and MRI are valuable in the diagnosis of TMD. Among them, MRI could displayed the disc more distinctly than spiral CT and CBCT. Spiral CT, CBCT and MRI can accurately display the joint space, and their reconstruction images of the joint space are the same. Only CBCT can display the structure of the condylar trabeculae clearly.