1
|
Navallas M, Tolend M, Otobo TM, Panwar J, Clemente EJI, Hemke R, van Rossum MA, Doria AS. Developing standards for MRI evaluation of joints in children with juvenile idiopathic arthritis utilizing the temporomandibular joint as a model. Jpn J Radiol 2024; 42:56-68. [PMID: 37626169 DOI: 10.1007/s11604-023-01479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
The treatment of a patient with juvenile idiopathic arthritis (JIA) is best monitored with standardized and validated tools to measure joint changes over time. Treatment approaches are best indicated if the clinicians are aware of the structural status of the joint at a given time, especially in anatomically deep joints for which clinical assessment is limited. Magnetic resonance imaging (MRI) is of utmost importance for assessment of deep joints and extra-articular soft tissue of the entire body for which ultrasound may be suboptimal. Because the distinction between pathologic and physiologic joint changes on MRI is key for proper diagnosis and treatment of patients with arthropathies, a comprehensive standardized approach is needed to effectively measure outcomes of growing joints of children with JIA. Such an approach is essential for both clinical assessment and to conduct clinical trials in patients with JIA treated in different centers around the world. To meet this need, several international imaging collaborative research groups have been developing MRI scales over the past years, including the MRI in JIA (JAMRI) special interest group within the Outcome Measures in Rheumatology (OMERACT) research network. This manuscript reviews the efforts of the OMERACT JAMRI working group to generate and validate pediatric MRI scoring systems for different joints in children with JIA that can have ubiquitous utilization anywhere in the world. In particular, it describes the different steps of development and validation of an MRI scale using the TMJ as a model.
Collapse
Affiliation(s)
- Maria Navallas
- Department of Diagnostic Imaging. Hospital 12 de Octubre, Madrid, Spain
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Tarimobo M Otobo
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Jyoti Panwar
- Department of Medical Imaging, The Tweed Hospital, Lumus Imaging, Tweed Heads, NSW, Australia
| | - Emilio J Inarejos Clemente
- Department of Diagnostic Imaging. Sant Joan de Deu Barcelona Children Hospital, University of Barcelona, Barcelona, Spain
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marion A van Rossum
- Department of Pediatrics, Emma Children's Hospital Amsterdam University Medical Centers and Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, The Netherlands
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| |
Collapse
|
2
|
Tonni I, Fossati G, Garo ML, Piancino MG, Cattalini M, Visconti L, Borghesi A. Temporomandibular joint involvement in patients with Juvenile Idiopathic Arthritis: comparison of ultrasonography and magnetic resonance imaging in assessing the periarticular space width. Oral Radiol 2023; 39:750-758. [PMID: 37400736 PMCID: PMC10504125 DOI: 10.1007/s11282-023-00696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES This study aimed to compare the performance of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) in assessing the Lateral Periarticular Space (LPAS) of Temporomandibular Joints (TMJs) in patients with Juvenile Idiopathic Arthritis (JIA). METHODS The LPAS width was evaluated in two different patient groups. In the JIA group, including 29 children (13 ± 2.8 years) with JIA, the LPAS width was measured with both MRI and US. In the healthy group, including 28 healthy children (12.6 ± 2.5 years), the LPAS width was measured only with US. Comparisons of LPAS width based on patient groups and TMJ contrast enhancement in MRI were evaluated by applying the Mann-Whitney U test. Correlation and agreement between MRI and US measurements in JIA group were tested using Spearman rank correlation and Bland-Altman method. RESULTS The LPAS width was significantly greater in the JIA group than in the healthy group. In the JIA group, the LPAS width was significantly greater in TMJs with moderate/severe enhancement than those with mild enhancement. A positive significant correlation between MRI and US measurements of LPAS width was found in the JIA group. In the same group, Bland-Altman method showed a good level of agreement between MRI and US measurements. CONCLUSION Although, US cannot replace MRI in the evaluation of TMJ in patients with JIA, US could be used as a supplementary imaging method to MRI in assessing the TMJ disease.
Collapse
Affiliation(s)
- Ingrid Tonni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy.
| | - Giulia Fossati
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Luisa Garo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Grazia Piancino
- Department of Surgical Sciences, C.I.R. Dental School, Orthodontic Division, Dental School, University of Turin-Italy, Via Nizza 230, 10126, Turin, Italy
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luca Visconti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
- Operational Unit 2nd Diagnostic Radiology, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| |
Collapse
|
3
|
Inarejos Clemente EJ, Tolend M, Navallas M, Doria AS, Meyers AB. MRI of the temporomandibular joint in children with juvenile idiopathic arthritis: protocol and findings. Pediatr Radiol 2023; 53:1498-1512. [PMID: 36944679 DOI: 10.1007/s00247-023-05616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/23/2023]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) is the technique of choice for diagnosis and monitoring of temporomandibular joint (TMJ) disorders in patients with juvenile idiopathic arthritis (JIA), as it is able to visualize both soft tissue and osteochondral changes. Approximately 40% of children with JIA develop inflammatory and chronic osteochondral changes observable on imaging, which if left untreated can lead to significant facial growth impairment, including facial asymmetry and retrognathia. MRI of the TMJ plays a paramount role in diagnosis and treatment monitoring in JIA since early signs of TMJ involvement are difficult to detect clinically and with physical examination. Findings of TMJ arthritis may be classified into acute and chronic domains. Early or acute manifestations include joint effusion, bone marrow edema, synovial thickening, and increased joint enhancement. With disease progression, there are characteristic osteochondral changes, including deformity of the mandibular condyle with shortening of the mandibular ramus, bone erosions, and disk abnormalities. In this pictorial essay, we describe a consensus MRI protocol for the study of the TMJ and illustrate the degree of normal and pathological MRI findings using currently available MRI scoring systems of the TMJ developed for JIA.
Collapse
Affiliation(s)
- Emilio J Inarejos Clemente
- Department of Diagnostic Imaging, Hospital Sant Joan de Déu, Av. Sant Joan de Déu, 2, CP: 08950, Esplugues de Llobregat, Barcelona, Spain.
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Institute of Medical Science, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Maria Navallas
- Department of Diagnostic Imaging, Hospital Universitario, 12 de Octubre, Av. de Córdoba, s/n, Madrid, Spain
| | - Andrea S Doria
- Department of Diagnostic Imaging and Research Institute, The Hospital for Sick Children and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, Canada
| | - Arthur B Meyers
- Department of Diagnostic Imaging, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, USA
| |
Collapse
|
4
|
Augdal TA, Angenete OW, Shi XQ, Säll M, Fischer JM, Nordal E, Rosendahl K. Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system. BMC Oral Health 2023; 23:12. [PMID: 36627622 PMCID: PMC9830735 DOI: 10.1186/s12903-022-02701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The temporomandibular joint (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA). Diagnostic imaging is necessary to correctly diagnose and evaluate TMJ involvement, however, hitherto little has been published on the accuracy of the applied scoring systems and measurements. The present study aims to investigate the precision of 20 imaging features and five measurements based on cone beam computed tomography (CBCT). METHODS Imaging and clinical data from 84 participants in the Norwegian study on juvenile idiopathic arthritis, the NorJIA study, were collected. Altogether 20 imaging features and five measurements were evaluated independently by three experienced radiologists for intra- and interobserver agreement. Agreement of categorical variables was assessed by Fleiss', Cohen's simple or weighted Kappa as appropriate. Agreement of continuous variables was assessed with 95% limits of agreement as advised by Bland and Altman. RESULTS "Overall impression of TMJ deformity" showed almost perfect intraobserver agreement with a kappa coefficient of 0.81 (95% CI 0.69-0.92), and substantial interobserver agreement (Fleiss' kappa 0.70 (0.61-0.78)). Moreover, both "flattening" and "irregularities" of the eminence/fossa and condyle performed well, with intra- and interobserver agreements of 0.66-0.82 and 0.55-0.76, respectively. "Reduced condylar volume" and "continuity" of the fossa/eminence had moderate intra- and interobserver Kappa values, whereas continuity of the condyle had Kappa values above 0.55. Measurements of distances and angles had limits of agreement of more than 15% of the sample mean. CONCLUSIONS We propose a CBCT-based scoring system of nine precise imaging features suggestive of TMJ deformity in JIA. Their clinical validity must be tested.
Collapse
Affiliation(s)
- Thomas A. Augdal
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskar W. Angenete
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Institute for Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xie-Qi Shi
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.32995.340000 0000 9961 9487Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Mats Säll
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Johannes M. Fischer
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ellen Nordal
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
5
|
MRI in the Assessment of TMJ-Arthritis in Children with JIA; Repeatability of a Newly Devised Scoring System. Acad Radiol 2021; 29:1362-1377. [PMID: 34802906 DOI: 10.1016/j.acra.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES The temporomandibular joint (TMJ) is commonly involved in children with juvenile idiopathic arthritis. The diagnosis and evaluation of the disease progression is dependent on medical imaging. The precision of this imaging is under debate. Several scoring systems have been proposed but transparent testing of the precision of the constituents of the scoring systems is lacking. The present study aims to test the precision of 25 imaging features based on magnetic resonance imaging (MRI). MATERIALS AND METHODS Clinical data and imaging were obtained from the Norwegian juvenile idiopathic arthritis study, The NorJIA study. Twenty-five imaging features of the TMJ in MRI datasets from 86 study participants were evaluated by two experienced radiologists for inter- and intraobserver agreement. Agreement of ordinal variables was measured with Cohen´s linear or weighted Kappa as appropriate. Agreement of continuous measurements was assessed with 95% limit of agreement according to Bland-Altman. RESULTS In the osteochondral domain, the ordinal imaging variables "loss of condylar volume," "condylar shape," "condylar irregularities," "shape of the eminence/fossa," "disk abnormalities," and "condylar inclination" showed inter- and intraobserver agreement above Kappa 0.5. In the inflammatory domain, the ordinal imaging variables "joint fluid," "overall impression of inflammation," "synovial enhancement" and "bone marrow oedema" showed inter- and intraobserver agreement above Kappa 0.5. Continuous measurements performed poorly with wide limits of agreement. CONCLUSION A precise MRI-based scoring system for assessment of TMJ in JIA is proposed consisting of seven variables in the osteochondral domain and four variables in the inflammatory domain. Further testing of the clinical validity of the variables is needed.
Collapse
|
6
|
Fischer J, Augdal TA, Angenete O, Gil EG, Skeie MS, Åstrøm AN, Tylleskär K, Rosendahl K, Shi XQ, Rosén A. In children and adolescents with temporomandibular disorder assembled with juvenile idiopathic arthritis - no association were found between pain and TMJ deformities using CBCT. BMC Oral Health 2021; 21:518. [PMID: 34641860 PMCID: PMC8513178 DOI: 10.1186/s12903-021-01870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. Methods This cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT. Results Of 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031). Conclusions There was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01870-z.
Collapse
Affiliation(s)
- J Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
| | - T A Augdal
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - O Angenete
- Department of Radiology and Nuclear Medicine, St. Olav Hospital HF, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - E G Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - M S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - A N Åstrøm
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Public Dental Service Competence Centre of Western-Norway (TkVest), Bergen, Norway
| | - K Tylleskär
- Paediatric Clinic at Haukeland University Hospital, Bergen, Norway
| | - K Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway.,UiT Arctic University of North Norway, Tromsø, Norway
| | - X-Q Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | | |
Collapse
|
7
|
Arif CA, Randy C, Matthew S, Serhat S, Brian K, Peter W, Jue W, Viet V, Linh T, How KC. Comparison of the condyle-fossa relationship and resorption between patients with and without Juvenile Idiopathic Arthritis (JIA). J Oral Maxillofac Surg 2021; 80:422-430. [PMID: 34627744 DOI: 10.1016/j.joms.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The most common disease in pediatric rheumatology is juvenile idiopathic arthritis (JIA). JIA is considered to be an autoimmune disease with an onset before the age of 16. The temporal mandibular joint (TMJ) has been reported to be involved in up to 87% of patients with JIA. Even though substantial research has been conducted on JIA, limited research has studied to understand its effect on the condyle-fossa relationship and to evaluate resorption amount on condyle by using a scoring system. AIM The purpose of this study was 1) to compare condyle - fossa relationships in the temporomandibular joint (TMJ), 2) was to score condylar resorption by using a TMJ indexing system in patients with JIA and without JIA. METHODS The present retrospective cross-sectional study included cone-beam computed tomography (CBCT) images obtained from the sagittal, coronal, and axial slices. In the multidisciplinary Pediatric Rheumatology Outpatient Clinic at The University of Alabama at Birmingham (UAB) children with JIA are also examined by a group of orthodontists working in the same institute from October 2018 to July 2019. The predictor variable consists of patients with JIA and without JIA. The primary outcome variables are the depth of the mandibular fossa, joint spaces, axial angles, medio-lateral width, and condyle resorption. Other study variables were age and sex. In this study, the measurements obtained from 2 different groups (with JIA and without JIA) are compared using a t-test, where Tukey is utilized to adjust for multiple comparisons. The left and right joints are analyzed separately as the paired t test conducted showed a significant difference between the 2 joints (P < .05). RESULTS The study was comprised of 34 patients diagnosed with JIA and 34 healthy subjects. The depth of the mandibular fossa, the anterior joint spaces, the axial angles, and the resorption index showed statistically significant differences between the JIA and healthy groups in both left and right sides (P < .05). However, there was no statistically significant difference in the posterior joint spaces and mediolateral width between JIA and healthy groups in both sides (P > .05). CONCLUSIONS The results of our study presented the destructive potential of juvenile idiopathic arthritis by using CBCT. CBCT scanning is a helpful tool in the evaluation of the radiographic result of TMJ.
Collapse
Affiliation(s)
- Celebi Ahmet Arif
- Department of Orthodontics, School of Dentistry, University of Alabama Birmingham, Birmingham
| | - Cron Randy
- Department of Pediatric Rheumatology, University of Alabama Birmingham, Birmingham
| | - Stoll Matthew
- Department of Pediatric Rheumatology, University of Alabama Birmingham, Birmingham
| | - Simsek Serhat
- Feliciano School of Business, Montclair State University, New Jersey
| | - Kinard Brian
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama, Birmingham
| | - Waite Peter
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Alabama, Birmingham
| | - Wang Jue
- Department of Orthodontics, School of Dentistry, University of Alabama Birmingham, Birmingham
| | - Vo Viet
- School of Dentistry, University of Alabama, Birmingham
| | - Tran Linh
- School of Dentistry, University of Alabama, Birmingham
| | - Kau Chung How
- Department of Orthodontics, School of Dentistry, University of Alabama Birmingham, Birmingham.
| |
Collapse
|
8
|
Tolend M, Doria AS, Meyers AB, Larheim TA, Abramowicz S, Aguet J, Appenzeller S, Arvidsson LZ, Averill LW, Feldman BM, Guleria S, Inarejos Clemente EJ, Jaremko JL, Junhasavasdikul T, von Kalle T, Kirkhus E, Koos B, Miller E, Moineddin R, Panwar J, Peacock ZS, Resnick CM, van Rossum MA, Stimec J, Tomlinson G, Tzaribachev N, Kellenberger CJ. Assessing the Reliability of the OMERACT Juvenile Idiopathic Arthritis Magnetic Resonance Scoring System for Temporomandibular Joints (JAMRIS-TMJ). J Clin Med 2021; 10:jcm10184047. [PMID: 34575158 PMCID: PMC8467699 DOI: 10.3390/jcm10184047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) remains the most comprehensive modality to assess juvenile idiopathic arthritis (JIA)-related inflammation and osteochondral damage in the temporomandibular joints (TMJ). This study tested the reliability of a new JIA MRI scoring system for TMJ (JAMRIS-TMJ) and the impact of variations in calibration and reader specialty. Thirty-one MRI exams of bilateral TMJs were scored independently using the JAMRIS-TMJ by 20 readers consisting of radiologists and non-radiologist clinicians in three reading groups, with or without a calibrating atlas and/or tutorial. The inter-reader reliability in the multidisciplinary cohort assessed by the generalizability coefficient was 0.61–0.67 for the inflammatory and 0.66–0.74 for the damage domain. The atlas and tutorial did not improve agreement within radiologists, but improved the agreement between radiologist and non-radiologist groups. Agreements between different calibration levels were 0.02 to 0.08 lower by the generalizability coefficient compared to agreement within calibration levels; agreement between specialty groups was 0.04 to 0.10 lower than within specialty groups. Averaging two radiologists raised the reliability above 0.8 for both domains. Therefore, the reliability of JAMRIS-TMJ was moderate-to-good depending on the presence of specialty and calibration differences. The atlas and tutorial are necessary to improve reliability when the reader cohort consists of multiple specialties.
Collapse
Affiliation(s)
- Mirkamal Tolend
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
| | - Andrea S. Doria
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
- Correspondence: ; Tel.: +1-416-813-6079
| | - Arthur B. Meyers
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Tore A. Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, 0317 Oslo, Norway; (T.A.L.); (L.Z.A.)
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA;
- Oral and Maxillofacial Surgery, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Julien Aguet
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13083-970, Brazil;
| | - Linda Z. Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, 0317 Oslo, Norway; (T.A.L.); (L.Z.A.)
| | - Lauren W. Averill
- Department of Medical Imaging, Nemours Children’s Health System, Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA;
| | - Brian M. Feldman
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada; (M.T.); (B.M.F.)
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | | | | | - Jacob L. Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB T6G 2B7, Canada;
| | | | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, 70174 Stuttgart, Germany;
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, 0424 Oslo, Norway;
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Elka Miller
- Department of Medical Imaging, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada;
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India;
| | - Zachary S. Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Cory M. Resnick
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Marion A. van Rossum
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
- Amsterdam Rheumatology and Immunology Center, Reade, 1007 MB Amsterdam, The Netherlands
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.A.); (J.S.)
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada;
| | | | | |
Collapse
|
9
|
Tonni I, Borghesi A, Tonesi S, Fossati G, Ricci F, Visconti L. An ultrasound protocol for temporomandibular joint in juvenile idiopathic arthritis: a pilot study. Dentomaxillofac Radiol 2021; 50:20200399. [PMID: 34233508 DOI: 10.1259/dmfr.20200399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES As it is well known, the diagnosis of temporomandibular joint (TMJ) involvement in patients affected by Juvenile Idiopathic Arthritis (JIA) is important to avoid the impairment of mandibular growth. In this context, Magnetic Resonance Imaging (MRI) is the gold-standard for detection of TMJ involvement, however it is expensive and requires patients' collaboration. The aim of this study was to evaluate if ultrasound may be used as an alternative tool to investigate the acute signs of TMJ involvement in JIA patients. METHODS Lateral periarticular space (LPAS) and joint effusion were evaluated by ultrasound in a study Group A of 8 JIA children (11.6±3.5 years old) with 14 TMJs involved, as confirmed by MRI, and in a control Group B of 7 healthy children (9.3±1.2 years old) without temporomandibular disorders (TMD). The LPAS width values were compared between the two groups using the Mann-Whitney test. The ultrasound images of the JIA group were then matched with the corresponding MR images; the Spearman Rank Correlation test and the Bland-Altman test were used to evaluate the differences. RESULTS The LPAS values in Group A were statistically significantly higher than those in Group B (p < 0.001). There was no overlap of the LPAS values confidence intervals (CIs) between the two groups. No signs of joint effusion were identified in groups A and B. The Spearman test applied to the values of LPAS measured in ultrasound and the corresponding MR images showed a proportional positive correlation with a ρ of 0.623 and a p < 0.05. CONCLUSIONS Ultrasound can detect differences in the TMJ features between JIA patients and healthy patients and it might be used as a follow-up tool in the assessment of TMJ involvement in subject affected by JIA.
Collapse
Affiliation(s)
- Ingrid Tonni
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Borghesi
- Department of Radiology, Medical School, University of Brescia, Brescia, Italy
| | - Silvia Tonesi
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Fossati
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Ricci
- Paediatric Immunology and Rheumatology Unit, University of Brescia, Brescia, Italy
| | - Luca Visconti
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| |
Collapse
|
10
|
Tolend M, Junhasavasdikul T, Cron RQ, Inarejos Clemente EJ, von Kalle T, Kellenberger CJ, Koos B, Miller E, van Rossum MA, Saurenmann RK, Spiegel L, Stimec J, Twilt M, Tzaribachev N, Abramowicz S, Appenzeller S, Arvidsson LZ, Guleria S, Jaremko JL, Kirkhus E, Larheim TA, Meyers AB, Panwar J, Resnick CM, Shelmerdine SC, Feldman BM, Doria AS. Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:308-316. [PMID: 33555146 DOI: 10.1002/acr.24577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for temporomandibular joints (TMJ, JAMRIS-TMJ). METHODS An adaptive partial-profile discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank-ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts. RESULTS Nineteen experts completed the DCE survey and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed non-linear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's rho of 0.92 (intra-quartile range: 0.87-0.95) for the inflammation and 0.93 (0.90-0.94) for the damage domain. CONCLUSIONS A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.
Collapse
Affiliation(s)
- Mirkamal Tolend
- The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Randy Q Cron
- Children's of Alabama, Birmingham, AL, United States
| | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, and University of Calgary, Calgary, Alberta, Canada
| | | | - Shelly Abramowicz
- Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | | | | | | | | | | | - Arthur B Meyers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jyoti Panwar
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
11
|
Malattia C, Tolend M, Mazzoni M, Panwar J, Zlotnik M, Otobo T, Vidarsson L, Doria AS. Current status of MR imaging of juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2020; 34:101629. [PMID: 33281052 DOI: 10.1016/j.berh.2020.101629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic arthropathy in the pediatric population. Although the diagnosis is essentially clinical for many affected joints, MR imaging has become an important tool for the assessment of joints that are difficult to evaluate clinically, such as temporomandibular and sacroiliac joints, and for screening of inflammatory changes in the entire body by whole body MRI (WBMRI) assessment. The utilization of MR imaging is challenging in the pediatric population given the need for discrimination between pathological and physiological changes in the growing skeleton. Several multicentric multidisciplinary organizations have made major efforts over the past decades to standardize, quantify, and validate scoring systems to measure joint changes both cross-sectionally and longitudinally according to rigorous methodological standards. In this paper, we (1) discuss current trends for the diagnosis and management of JIA, (2) review challenges for detecting real pathological changes in growing joints, (3) summarize the current status of standardization of MRI protocols for data acquisition and the quantification of joint pathology in JIA by means of scoring systems, and (4) outline novel MR imaging techniques for the evaluation of anatomy and function of joints in JIA. Optimizing the role of MRI as a robust biomarker and outcome measure remains a priority of future research in this field.
Collapse
Affiliation(s)
- Clara Malattia
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marta Mazzoni
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Italy
| | - Jyoti Panwar
- Department of Radiology, Christian Medical College, Vellore, India
| | - Margalit Zlotnik
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Tarimobo Otobo
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Logi Vidarsson
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
12
|
Hemke R, Herregods N, Jaremko JL, Åström G, Avenarius D, Becce F, Bielecki DK, Boesen M, Dalili D, Giraudo C, Hermann KG, Humphries P, Isaac A, Jurik AG, Klauser AS, Kvist O, Laloo F, Maas M, Mester A, Oei E, Offiah AC, Omoumi P, Papakonstantinou O, Plagou A, Shelmerdine S, Simoni P, Sudoł-Szopińska I, Tanturri de Horatio L, Teh J, Jans L, Rosendahl K. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30:5237-5249. [PMID: 32399709 PMCID: PMC7476913 DOI: 10.1007/s00330-020-06807-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.
Collapse
Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gunnar Åström
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Dennis K Bielecki
- Department of Diagnostic Imaging, Kings College Hospital, London, UK
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Danoob Dalili
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, Padova University, Padua, Italy
| | - Kay-Geert Hermann
- Department of Radiology, University Hospital Charité, Berlin, Germany
| | - Paul Humphries
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Amanda Isaac
- Department of Radiology, Guy's & St Thomas Hospitals, London, UK
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea S Klauser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Adam Mester
- Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Edwin Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Amaka C Offiah
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, UK
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | - Paolo Simoni
- Department of Radiology, Reine Fabiola Children's University Hospital of Bruxelles, University of Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation and Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
| | | | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| |
Collapse
|
13
|
Condylar alterations and facial growth in children with juvenile idiopathic arthritis. J Orofac Orthop 2020; 81:163-171. [PMID: 32077980 PMCID: PMC7186245 DOI: 10.1007/s00056-020-00216-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/23/2019] [Indexed: 12/27/2022]
Abstract
Purpose The aim of this retrospective study was to evaluate facial growth in children with juvenile idiopathic arthritis (JIA) by means of lateral head cephalometric radiographs and relate the findings to temporomandibular joint (TMJ) condylar changes on panoramic radiographs. Methods Radiographic and medical records were evaluated in 65 children with JIA. Cephalometric and panoramic analyses were performed for the impact of condylar changes on facial growth. We compared children with condylar alterations, minor or major, with those without condylar alterations. Results Based on panoramic radiographs, no condylar alterations were seen in 27 of the 65 children and condylar alterations were seen in 38 children (i.e., 23 had minor and 15 major condylar alterations). The cephalometric analyses of the children with condylar changes showed significant growth disturbances with a more retrognathic mandible (SNB; p = 0.03), retruded chin position (SNPog; p = 0.02), larger mandibular angulation (ML/NSL; p = 0.009) and maxillary angulation (NL/NSL; p = 0.03) compared with children without condylar alterations. Children with minor condylar alterations had a significantly more retruded chin position (SNPog) than those with no condylar changes (p = 0.04). Conclusions Condylar changes in the TMJ, judged on panoramic radiography, in children with JIA, have impact on craniofacial growth. Even minor alterations seem to have an impact.
Collapse
|
14
|
Mitra S, Samui PP, Samanta M, Mondal RK, Hazra A, Mandal K, Sabui TK. Ultrasound detected changes in joint cartilage thickness in juvenile idiopathic arthritis. Int J Rheum Dis 2019; 22:1263-1270. [PMID: 31117159 DOI: 10.1111/1756-185x.13584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to investigate the changes in joint cartilage thickness in different subtypes of juvenile idiopathic arthritis (JIA) using ultrasound, comparing them with healthy children and to evaluate the relationship with disease duration and inflammatory markers. METHODS We conducted a cross-sectional study comprising of 27 cases of JIA and 54 age- and sex-matched healthy children. Bilateral wrist, knee and ankle joint cartilage thicknesses were measured by ultrasound as per European League Against Rheumatism standard guidelines and compared them between JIA subtypes as well as between cases and control. RESULTS Descriptive analysis of the whole cohort revealed the mean age of the study population was 8.3 ± 3.2 years with mean cartilage thicknesses at the wrist, knee and ankle being 1.40 ± 0.89 mm, 1.57 ± 0.78 mm and 1.41 ± 0.85 mm, respectively. The median cartilage thicknesses of wrist, knee and ankle joints of JIA cases (n = 27) and healthy controls (n = 54) were 1.01, 1.35, 1.05 and 1.95, 2.00, 1.95, respectively. The joint cartilage thickness was significantly reduced in JIA in comparison to the healthy cohort (P < 0.01). Diseased boys suffered greater cartilage damage in knee joints compared to girls; the polyarticular variety of cases had thinner knee cartilage in comparison to the oligoarticular subtype. Further, it was found that joint cartilage destruction is independent of inflammatory markers and disease duration. CONCLUSION Significant cartilage thinning in addition was found in JIA children, particularly in the polyarticular subtype, and more in boys than girls, which is independent of disease duration and inflammatory markers, using ultrasound as a primary investigative tool.
Collapse
Affiliation(s)
- Sonali Mitra
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | | | - Moumita Samanta
- Department of Pediatrics, NRS Medical College, Kolkata, India
| | | | - Avijit Hazra
- Department of Pharmacology, IPGME&R SSKM Hospital, Kolkata, India
| | | | | |
Collapse
|
15
|
Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2018; 14:681-694. [PMID: 29972659 DOI: 10.1080/1744666x.2018.1496019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prognosis of juvenile idiopathic arthritis (JIA) has changed dramatically due to the availability of novel drugs. Prompt diagnosis and treatment are essential to prevent permanent joint damage. As a result, methods to improve JIA diagnosis and prognosis are of high priority to tailor treatment strategies and maximize their efficacy. Musculoskeletal ultrasound and magnetic resonance imaging are more sensitive than clinical examination and radiography in the detection of joint involvement and might play a substantial role to optimize the management of JIA. Areas covered: This review compiles an inventory of potential uses of imaging studies in the modern practice of pediatric rheumatology, together with a critical analysis of the major challenges that are still to be addressed. Imaging appearance of normal growth-related changes of the musculoskeletal system will be discussed. Expert commentary: Knowledge of the evolving patterns of skeletal maturity is paramount to define pathological findings and avoid misinterpretations. Establishing a novel radiological algorithm for a rational use of imaging in JIA is of high priority to allow a speedier integration of imaging into the clinical workflow and decision-making process.
Collapse
Affiliation(s)
- Clara Malattia
- a Clinica Pediatrica e Reumatologia , Istituto Giannina Gaslini , Genova , Italy.,b Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili , Università degli studi di Genova , Italy
| | - Mariangela Rinaldi
- a Clinica Pediatrica e Reumatologia , Istituto Giannina Gaslini , Genova , Italy
| | - Alberto Martini
- c Direzione Scientifica Istituto Giannina Gaslini , Genova Italy
| |
Collapse
|
16
|
Miller E, Inarejos Clemente EJ, Tzaribachev N, Guleria S, Tolend M, Meyers AB, von Kalle T, Stimec J, Koos B, Appenzeller S, Arvidsson LZ, Kirkhus E, Doria AS, Kellenberger CJ, Larheim TA. Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol. Pediatr Radiol 2018; 48:792-800. [PMID: 29766249 DOI: 10.1007/s00247-017-4005-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Abstract
Inflammation and damage in the temporomandibular joint (TMJ) often develop without clinical symptoms but can lead to severe facial growth abnormalities and impaired health-related quality of life, making early diagnosis of TMJ changes crucial to identify. Inflammatory and osteochondral changes detectable through magnetic resonance imaging (MRI) occur in TMJs of approximately 40% of children with juvenile idiopathic arthritis (JIA), and no other imaging modality or physical method of examination can reliably detect these changes. Therefore contrast-enhanced MRI is the diagnostic standard for diagnosis and interval monitoring of JIA. However the specific usage of MRI for TMJ arthritis is not standardized at present. There is a recognized need for a consensus effort toward standardization of an imaging protocol with required and optional sequences to improve detection of pathological changes and shorten study time. Such a consensus imaging protocol is important for providing maximum information with minimally necessary sequences in a way that allows inter-site comparison of results of clinical trials and improved clinical management. In this paper we describe the challenges of TMJ imaging and present expert-panel consensus suggestions for a standardized TMJ MRI protocol.
Collapse
Affiliation(s)
- Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 08.9840-L4, Toronto, ON, M5G 1A4, Canada.
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Health System, Orlando, FL, USA
| | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany
| | | | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Tore A Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| |
Collapse
|
17
|
Tolend MA, Twilt M, Cron RQ, Tzaribachev N, Guleria S, von Kalle T, Koos B, Miller E, Stimec J, Vaid Y, Larheim TA, Herlin T, Spiegel L, Inarejos Clemente EJ, Moineddin R, van Rossum MA, Saurenmann RK, Doria AS, Kellenberger CJ. Toward Establishing a Standardized Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2018; 70:758-767. [PMID: 28805021 DOI: 10.1002/acr.23340] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 08/08/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The temporomandibular joints (TMJs) are frequently affected in children with juvenile idiopathic arthritis (JIA). Early detection is challenging, as major variation is present in scoring TMJ pathology on magnetic resonance imaging (MRI). Consensus-driven development and validation of an MRI scoring system for TMJs has important clinical utility in timely improvement of diagnosis and serving as an outcome measure. We report on a multi-institutional collaboration toward developing a TMJ MRI scoring system for JIA. METHODS Seven readers independently assessed MRI scans from 21 patients (42 TMJs, from patients ages 6-16 years) using 3 existing MRI scoring systems from American, German, and Swiss institutions. Reliability scores, scoring system definitions, and items were discussed among 10 JIA experts through 2 rounds of Delphi surveys, nominal group voting, and subsequent consensus meetings to create a novel TMJ MRI scoring system. RESULTS Average-measure absolute agreement intraclass correlation coefficients (avICCs) for the total scores of all 3 scoring systems were highly reliable at 0.96 each. Osteochondral items showed higher reliability than inflammatory items. An additive system was deemed preferable for assessing minor joint changes over time. Eight items were considered sufficiently reliable and/or important for integration into the consensus scoring system: bone marrow edema and enhancement (avICC 0.57-0.61, smallest detectable difference [SDD] ± 45-63% prior to redefining), condylar flattening (avICC 0.95-0.96, SDD ± 23-28%), effusions (avICC 0.85-0.88, SDD ± 25-26%), erosions (avICC 0.94, SDD ± 20%), synovial enhancement and thickening (previously combined, avICC 0.90-0.91, SDD ± 33%), and disk abnormalities (avICC 0.90, SDD ± 19%). CONCLUSION A novel TMJ MRI scoring system was developed by consensus. Further iterative refinements and reliability testing are warranted in upcoming studies.
Collapse
Affiliation(s)
| | - Marinka Twilt
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | | | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | - Elka Miller
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | | | | | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Andrea S Doria
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | |
Collapse
|
18
|
Kellenberger CJ, Junhasavasdikul T, Tolend M, Doria AS. Temporomandibular joint atlas for detection and grading of juvenile idiopathic arthritis involvement by magnetic resonance imaging. Pediatr Radiol 2018; 48:411-426. [PMID: 29134239 PMCID: PMC5823950 DOI: 10.1007/s00247-017-4000-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/05/2017] [Accepted: 09/26/2017] [Indexed: 11/17/2022]
Abstract
Contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic standard for identifying involvement of the temporomandibular joint by juvenile idiopathic arthritis. Early or active arthritis is shown as bone marrow oedema, joint effusion, synovial thickening and increased joint enhancement. Subsequent joint damage includes characteristic deformity of the mandibular condyle, bone erosion, disk abnormalities and short mandibular ramus due to impaired growth. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the temporomandibular joint in children. The rationale and practical application of semiquantitative MRI assessment of joint inflammation and damage are discussed and presented. This atlas can serve as a reference for grading temporomandibular joint arthritis according to the scoring systems proposed by working groups of OMERACT (Outcome Measures in Rheumatology and Clinical Trials) and the EuroTMjoint research network. Systematic assessment of the level of inflammation, degree of osteochondral deformation, and growth of the mandibular ramus by MRI may aid in monitoring the course of temporomandibular joint arthritis and evaluating treatment options.
Collapse
Affiliation(s)
- Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
- Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.
| | - Thitiporn Junhasavasdikul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| |
Collapse
|
19
|
No association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis. Am J Orthod Dentofacial Orthop 2018; 153:214-223. [DOI: 10.1016/j.ajodo.2017.05.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
|
20
|
Kovalko I, Stoustrup P, Twilt M. Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: Challenges in Diagnosis, Treatment, and Outcomes. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0086-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
21
|
Frequency and Morbidity of Temporomandibular Joint Involvement in Adult Patients With a History of Juvenile Idiopathic Arthritis. J Oral Maxillofac Surg 2017; 75:1191-1200. [DOI: 10.1016/j.joms.2016.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022]
|
22
|
Navallas M, Inarejos EJ, Iglesias E, Cho Lee GY, Rodríguez N, Antón J. MR Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis: Technique and Findings. Radiographics 2017; 37:595-612. [DOI: 10.1148/rg.2017160078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- María Navallas
- From the Departments of Radiology (M.N., E.J.I.), Rheumatology (E.I., J.A.), and Rehabilitation (N.R.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital of Torrejón, Madrid, Spain (G.Y.C.L.)
| | - Emilio J. Inarejos
- From the Departments of Radiology (M.N., E.J.I.), Rheumatology (E.I., J.A.), and Rehabilitation (N.R.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital of Torrejón, Madrid, Spain (G.Y.C.L.)
| | - Estíbaliz Iglesias
- From the Departments of Radiology (M.N., E.J.I.), Rheumatology (E.I., J.A.), and Rehabilitation (N.R.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital of Torrejón, Madrid, Spain (G.Y.C.L.)
| | - Gui Youn Cho Lee
- From the Departments of Radiology (M.N., E.J.I.), Rheumatology (E.I., J.A.), and Rehabilitation (N.R.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital of Torrejón, Madrid, Spain (G.Y.C.L.)
| | - Natalia Rodríguez
- From the Departments of Radiology (M.N., E.J.I.), Rheumatology (E.I., J.A.), and Rehabilitation (N.R.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital of Torrejón, Madrid, Spain (G.Y.C.L.)
| | - Jordi Antón
- From the Departments of Radiology (M.N., E.J.I.), Rheumatology (E.I., J.A.), and Rehabilitation (N.R.), Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08950 Esplugues de Llobregat, Barcelona, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital of Torrejón, Madrid, Spain (G.Y.C.L.)
| |
Collapse
|
23
|
Clinical predictors of temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic literature review. Semin Arthritis Rheum 2015; 45:717-32. [PMID: 26708936 DOI: 10.1016/j.semarthrit.2015.11.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/25/2015] [Accepted: 11/18/2015] [Indexed: 12/30/2022]
Abstract
AIM To assess the level of evidence for subjective and objective parameters in clinical orofacial examination and determine if predictors for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) patients exist in the current literature. METHOD A comprehensive systematic electronic search strategy was performed in all major medical databases in June 2015. Studies were selected independently by two reviewers in accordance with a prespecified protocol and a risk of bias assessment for all included studies. Subjective examination outcome measures assessed were pain, decreased TMJ function, and TMJ sounds. The objective outcome measures assessed were maximal incisor opening, mandibular asymmetric opening, condylar translation, protrusion, myofascial pain on palpation, facial asymmetry, and micro- or retrognathism. RESULTS The electronic database search identified 345 unique citations. After application of our strict, predefined inclusion and exclusion criteria, 21 articles were included and data extracted. The study heterogeneity did not allow for meta-analyses. No singular outcome measure can be suggested as a predictor of TMJ involvement in JIA, as sensitivity and/or specificity is too low compared to contrast-enhanced magnetic resonance imaging. CONCLUSION The current low level of evidence and study heterogeneity do not allow us to conclude on singular clinical outcome measures. To increase study comparability, we call for a standardized terminology and evidence-based guidelines for clinical orofacial examination parameters in JIA patients.
Collapse
|
24
|
Olsen-Bergem H, Kristoffersen AK, Bjørnland T, Reseland JE, Aas JA. Juvenile idiopathic arthritis and rheumatoid arthritis: bacterial diversity in temporomandibular joint synovial fluid in comparison with immunological and clinical findings. Int J Oral Maxillofac Surg 2015; 45:318-22. [PMID: 26554824 DOI: 10.1016/j.ijom.2015.08.986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/27/2015] [Accepted: 08/20/2015] [Indexed: 10/22/2022]
Abstract
Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) occurs in up to 80% of affected children. The purpose of this study was to investigate the presence of bacterial DNA in synovial fluid, and to compare this with clinical and immunological findings in children with JIA, adults with persistent JIA, and adults with rheumatoid arthritis, in order to detect whether bacteria contribute to inflammation in TMJ arthritis. Synovial fluid and skin swab samples were collected from 30 patients (54 TMJs). Bacterial detection was performed using 16S rRNA pyrosequencing. Bacterial DNA was detected in 31 TMJs (57%) in 19 patients (63%). A positive statistically significant correlation was registered between bacterial DNA detected in TMJ synovial fluid and the following factors: total protein concentration in synovial fluid, interleukin 1β, tumour necrosis factor alpha, adrenocorticotropic hormone, and adiponectin, as well as the duration of the general medical disease. Fourteen different bacterial species were detected in synovial fluid. Bacterial DNA in TMJ synovial fluid without contamination was detected in more than 50% of the patients. Studies are needed to evaluate the consequences of this bacterial DNA in synovial fluid with regard to TMJ arthritis.
Collapse
Affiliation(s)
- H Olsen-Bergem
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
| | | | - T Bjørnland
- Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - J E Reseland
- Department of Biomaterials, Institute for Clinical Dentistry, University of Oslo, Oslo, Norway
| | - J A Aas
- Department of Prosthodontics, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| |
Collapse
|
25
|
SAURENMANN ROTRAUDK, KELLENBERGER CHRISTIANJ. Assessing Arthritis in the Temporomandibular Joint. J Rheumatol 2015; 42:2000-2. [DOI: 10.3899/jrheum.151088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
26
|
Abstract
Temporomandibular disorders (TMD) affect 5% to 12% of the United States population. This article discusses common conditions related to temporomandibular joints, including disc displacements, inflammatory disturbances, loose joint bodies, traumatic disturbances, and developmental conditions. Also addressed are the appropriate imaging modalities and diagnostic criteria for TMD.
Collapse
Affiliation(s)
- Mansur Ahmad
- University of Minnesota School of Dentistry, 515 Delaware Street Southeast, Minneapolis, MN 55455, USA.
| | - Eric L Schiffman
- University of Minnesota School of Dentistry, 515 Delaware Street Southeast, Minneapolis, MN 55455, USA
| |
Collapse
|
27
|
Larheim TA, Abrahamsson AK, Kristensen M, Arvidsson LZ. Temporomandibular joint diagnostics using CBCT. Dentomaxillofac Radiol 2015; 44:20140235. [PMID: 25369205 DOI: 10.1259/dmfr.20140235] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The present review will give an update on temporomandibular joint (TMJ) imaging using CBCT. It will focus on diagnostic accuracy and the value of CBCT compared with other imaging modalities for the evaluation of TMJs in different categories of patients; osteoarthritis (OA), juvenile OA, rheumatoid arthritis and related joint diseases, juvenile idiopathic arthritis and other intra-articular conditions. Finally, sections on other aspects of CBCT research related to the TMJ, clinical decision-making and concluding remarks are added. CBCT has emerged as a cost- and dose-effective imaging modality for the diagnostic assessment of a variety of TMJ conditions. The imaging modality has been found to be superior to conventional radiographical examinations as well as MRI in assessment of the TMJ. However, it should be emphasized that the diagnostic information obtained is limited to the morphology of the osseous joint components, cortical bone integrity and subcortical bone destruction/production. For evaluation of soft-tissue abnormalities, MRI is mandatory. There is an obvious need for research on the impact of CBCT examinations on patient outcome.
Collapse
Affiliation(s)
- T A Larheim
- 1 Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | | | | | | |
Collapse
|
28
|
Kellenberger CJ, Arvidsson LZ, Larheim TA. Magnetic resonance imaging of temporomandibular joints in juvenile idiopathic arthritis. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
29
|
Larheim TA, Doria AS, Kirkhus E, Parra DA, Kellenberger CJ, Arvidsson LZ. TMJ imaging in JIA patients—An overview. Semin Orthod 2015. [DOI: 10.1053/j.sodo.2015.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
30
|
Ording Muller LS, Humphries P, Rosendahl K. The joints in juvenile idiopathic arthritis. Insights Imaging 2015; 6:275-84. [PMID: 25903287 PMCID: PMC4444796 DOI: 10.1007/s13244-015-0406-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/19/2015] [Accepted: 03/25/2015] [Indexed: 11/25/2022] Open
Abstract
Abstract Juvenile idiopathic arthritis is the most common rheumatic entity in childhood. Imaging has become an important supplement to the clinical assessment of children with JIA. Radiographs still play an important role in the workup, and long-term follow-up in children with JIA, but are not sensitive to findings in the early disease stage. Both ultrasound and MRI are more sensitive to inflammatory changes than clinical assessment alone. However, the differentiation between normal findings and pathology can be challenging, particularly in early disease. The objective of this review is to discuss the role of imaging in JIA, describe the typical findings on different modalities and highlight the challenges we face regarding the reliability and accuracy of the different methods for imaging the joints in children with JIA. Key Points • Imaging is an important supplement to the clinical examination in JIA. • Ultrasound is more sensitive for detecting synovitis than clinical examination alone. • MRI can depict all relevant structures in joint inflammation. • The differentiation between normal variants and pathology is difficult in children.
Collapse
Affiliation(s)
| | - Paul Humphries
- />Institute of Child Health, UCL, University College London Hospital NHS Trust and Great Ormond Street Hospital for Children, London, UK
| | - Karen Rosendahl
- />Department of Radiology, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
31
|
Yadav S, Palo L, Mahdian M, Upadhyay M, Tadinada A. Diagnostic accuracy of 2 cone-beam computed tomography protocols for detecting arthritic changes in temporomandibular joints. Am J Orthod Dentofacial Orthop 2015; 147:339-44. [DOI: 10.1016/j.ajodo.2014.11.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/01/2014] [Accepted: 11/01/2014] [Indexed: 11/29/2022]
|
32
|
Zhong Y, Wang Y, Guo J, Chu H, Gao Y, Pang L. Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study. TOHOKU J EXP MED 2015; 237:183-91. [PMID: 26477692 DOI: 10.1620/tjem.237.183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yingjie Zhong
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Ye Wang
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Jun Guo
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Haifeng Chu
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| | - Yong Gao
- Department of Emergency Internal, China-Japan Union Hospital of Jilin University
| | - Limin Pang
- Department of Pediatrics, China-Japan Union Hospital of Jilin University
| |
Collapse
|
33
|
Koos B, Twilt M, Kyank U, Fischer-Brandies H, Gassling V, Tzaribachev N. Reliability of clinical symptoms in diagnosing temporomandibular joint arthritis in juvenile idiopathic arthritis. J Rheumatol 2014; 41:1871-7. [PMID: 24986847 DOI: 10.3899/jrheum.131337] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Temporomandibular joint (TMJ) arthritis, commonly considered oligoarthritic/asymptomatic, occurs frequently in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) has proved to be a sensitive diagnostic tool in this context. We compared the reliability of clinical examinations to Gd-MRI results in diagnosing the condition. METHODS Patients with JIA (134 consecutive) underwent routine clinical and Gd-MRI examinations. The clinical items examined were clicking, tenderness (TMJ/adjacent muscles), and mouth-opening capacity. Blinded MRI reading focused on inflammation (synovitis/hypertrophy). After statistical power analysis, the clinical findings for 134 healthy controls were included. Contingency analysis was used to determine the sensitivity, specificity, and frequency of clinical symptoms (JIA/healthy controls); Cohen's κ was used to establish the interrater reliability. RESULTS Statistically significant differences were observed between JIA and healthy control groups with regard to the concise screening items (power analysis > 0.95), whereas no differences in mouth-opening capacity were noted. In 80% of the patients with JIA, Gd-MRI revealed signs of TMJ arthritis, with positive correlations between concise screening items and Gd-MRI results. The average specificity was 0.81, but the sensitivity was low, at 0.42. Combining items led to a marked increase in the sensitivity (0.73). There was a high rate of both false-negative and false-positive results (corresponding to clinical underdiagnosis or overdiagnosis of TMJ arthritis). CONCLUSION Despite a relatively high specificity, clinical examination alone does not seem sufficiently sensitive to adequately detect TMJ arthritis. Thus, a relatively high number of cases will be missed or overdiagnosed, potentially leading to undertreatment or overtreatment. Gd-MRI may support correct diagnosis, thereby helping to prevent undertreatment or overtreatment.
Collapse
Affiliation(s)
- Bernd Koos
- From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI.
| | - Marinka Twilt
- From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI
| | - Ullrike Kyank
- From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI
| | - Helge Fischer-Brandies
- From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI
| | - Volker Gassling
- From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI
| | - Nikolay Tzaribachev
- From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI
| |
Collapse
|
34
|
Vaid YN, Dunnavant FD, Royal SA, Beukelman T, Stoll ML, Cron RQ. Imaging of the temporomandibular joint in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2014; 66:47-54. [PMID: 24106204 DOI: 10.1002/acr.22177] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/10/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Temporomandibular joint (TMJ) arthritis in children with juvenile idiopathic arthritis (JIA) is extremely common but frequently asymptomatic. Magnetic resonance imaging (MRI) with contrast remains the gold standard for identifying TMJ arthritis in JIA. A reliable scoring system with published MRI examples of typical acute and chronic TMJ arthritis changes will be invaluable for future prospective treatment trials of TMJ arthritis in JIA. METHODS MRIs were collected from routine clinical studies assessing TMJ arthritis in JIA. Representative images were selected for publication to depict acute (synovial fluid, bone marrow edema, and synovial enhancement) and chronic (pannus, disc derangement, and condylar head flattening and erosions) TMJ arthritis findings. A preliminary MRI-based scoring system for assessing degrees of acute and chronic TMJ arthritis was developed and tested for inter- and intrareader reliability. RESULTS TMJ MRIs representative of acute and chronic TMJ arthritis in JIA were selected from among thousands taken (>500 TMJ MRI studies annually at Children's of Alabama) since September 2007. Moreover, computed tomography scans depicting select bony changes (osteophyte formation, micrognathia) were chosen for publication. A description of the MRI protocol for assessing TMJ arthritis is included. A preliminary scoring system weighted for degree of acute and chronic TMJ arthritis MRI findings was found to have substantial inter- and intrareader reliability. CONCLUSION A published set of MRIs depicting representative acute and chronic changes will help establish a standardized scoring system to assess TMJ arthritis in children with JIA. Future validation will aid in assessing improvement during treatment trials of TMJ arthritis.
Collapse
|