磁共振成像在颞下颌关节内紊乱症诊断中的价值

目的：评价磁共振成像（MRI）诊断颞下颌关节内紊乱症（TMJID）的价值.方法：20例（40侧颞下颌关节）颞下颌关节紊乱病（TMD）患者,使用GE Signa ExciteⅡ 1.5T超导型MR扫描仪,采用颞下颌关节表面线圈,在斜矢状闭口位、开口位和斜冠状闭口位上应用自旋回波（SE）T1WI、T2WI、PDWI及快速梯度回波（FSPGR）序列进行扫描,确定有无TMJID.结果：40侧关节均获得清晰的MR图像,其中13侧（32.5%）关节盘的位置和形态表现正常,21侧（52.5%）关节盘有前移位,6侧（15.0%）关节盘有旋转移位.15侧关节盘在移位的同时存在变形改变,4侧关节髁状突存在退行性骨关节病改变;SE T1WI、T2WI能清晰地显示关节盘的位置、形态和关节的骨性结构及翼外肌结构,可作为TMJ检查的常规扫描序列.PDWI和FSPGR序列可作为辅助扫描序列,斜矢状闭口位能清晰地显示盘前移位和后移位,斜矢状开口位能清晰地显示可复性和不可复性盘前、后移位,斜冠状闭口位能清晰地显示关节盘侧方移位.结论：MRI是诊断关节内紊乱症理想的方法.

Diagnostic values of magnetic resonance imaging in internal derangement in temporo-mandibular joints

Objective: To evalvate the value of MR imaging on the diagnosis of internal derangement(ID) in temporomandibular joints(TMJ).Methods: The study comprised 40 TMJs in 20 patients,who were assigned a clinical TMJ-related diagnosis of TMD in at least one TMJ.Bilateral oblique sagittal,of close mouth and open mouth and oblique coronal of close mouth MR images were obtained subsequently.Joints were studied in SE T_1WI,T_2WI PDWI and FSPGR series to establish the presence or absence of TMJID.Results: Forty sides joint equally to obtain limpid MR image,among the total,13 sides articular disk positions and shapes displayed for normal account for 32.5%,about 52.5% of the closed mouth-related TMJ positions characterized by disc displacement preseated with anterior disc displacement,15% had rotational,while 15 sides had disc deformation and 4 sides athrosis of the condylar head.SE T_1 WI,T_2 WI optimally visualized disk positions,shapes and structures of correlate tissues,hence,can conduct and actions routine sequence of TMJ exam.SE PDWI and FSPGR series may conduct and actions adjuvanticity sequence of TMJ exam.Oblique sagittal of close mouth positions optimally visualized anterior and posterior disc displacement.Oblique sagittal of open mouth positions optimally visualized anterior and posterior disc displacement with and without reduction.Oblique coronal of close mouth positions optimally visualizes lateral and medial disc displacement.Conclusion: MRI is an ideal method to diagnose internal derangement of TMJ.