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Donelli M, Lanteri V, Ugolini A, Bruni A, Cressoni P, Abate A, Maspero C. Cone-Beam Computed Tomography (CBCT) Analysis of Mandibular Condyles' Diameters in Patient with Juvenile Idiopathic Arthritis and Temporomandibular Joint Affection: A Cross-Sectional Investigation. J Clin Med 2024; 13:5104. [PMID: 39274322 PMCID: PMC11395992 DOI: 10.3390/jcm13175104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
Objectives: The aim of this study was to evaluate through analysis using CBCT the transverse and axial diameters of the mandibular condyles in subjects affected by juvenile idiopathic arthritis (JIA) and compare them with those of healthy subjects. Methods: The study was conducted on CBCT scans from the digital archive of the Department of Biomedical Surgical and Dental Sciences, University of Milan, including patients with JIA and using healthy subjects as controls. Inclusion criteria: aged between 7 and 25 years old at the time of the CBCT examination; Caucasian ethnicity; diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR) criteria documented in patients' records; TMJ involvement; good quality CBCTs covering our region of interest (ROI), from the glabella to the mandibular inferior border; no previous orthodontic/orthopedic treatment; no history of craniofacial trauma or congenital birth defects involving the craniofacial area. Each CBCT scan underwent examination using 3Diagnosys® software. Since data were normally distributed, parametric tests were used for analysis. The sample was divided into three groups: (1) bilateral JIA subjects, (2) unilateral JIA subjects, and (3) healthy controls. Results: We found a statistically significant reduction (p < 0.0001) in the transverse diameter (TR-Diam) of the affected condyles by an average of 1.7 mm, while the axial diameter (AX-Diam) again showed a slight reduction, on average by 0.1 mm, with a non-statistically significant value. Another comparison was made between the unaffected condyles of patients with unilateral JIA and the healthy condyles of the control group. The unilateral unaffected condyles were found to be slightly smaller than those of healthy patients, but without statistically significant differences. We found that in both JIA males and females, the condylar growth tends to stop earlier than the healthy ones. Conclusions: The transverse diameter was found to be more affected than the axial one, causing typical bone resorption and condylar shape. Moreover, we showed that the pathology, in the case of unilateral JIA, does not compromise only the affected condyles; the corresponding condyle that seems to be healthy is actually partially compromised. In addition, we observed that the growth of affected condyles of JIA subjects tends to stop earlier than the condyles of the healthy controls.
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Affiliation(s)
- Margherita Donelli
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valentina Lanteri
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16126 Genoa, Italy
| | - Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Paolo Cressoni
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16126 Genoa, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Ugolini A, Abate A, Donelli M, Gaffuri F, Bruni A, Maspero C, Lanteri V. Spontaneous Mandibular Dentoalveolar Changes after Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander-A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:501. [PMID: 38671718 PMCID: PMC11049362 DOI: 10.3390/children11040501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/13/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This systematic review aims to analyze the spontaneous dentoalveolar changes in the mandibular arch after maxillary expansion in growing patients obtained with different expansion protocols: Rapid Maxillary Expansion (RME), Slow Maxillary Expansion (SME), and Leaf Expander. METHODS The study adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria were established in the PICO format, involving patients who underwent slow, rapid, or leaf maxillary expansion during the mixed or early permanent dentitions. A comprehensive search of electronic databases and manual searches was conducted up to December 2023. The outcome measures included inter-mandibular first permanent molar width, inter-deciduous molar and canine width, arch perimeter, and arch length; both short- and long-term results were considered. The articles that met the inclusion criteria were included in this systematic review and were qualitatively evaluated using a methodological quality scoring system with a 13-point scale. To assess the inter-examiner agreement concerning the article selection and the qualitative assessment of the included studies, Kappa statistics were computed. RESULTS A total of 1184 articles were identified through electronic and manual searches. After the removal of duplicates and the initial examination of the titles and abstracts, 57 articles were considered for the full text analysis, and according to the eligibility and exclusion criteria, 22 studies were finally selected, composed of 8 randomized controlled trials (RCTs) and 14 retrospective/case-control studies. The qualitative assessment of the included studies showed the following scores: 6 papers have high research quality, 5 have moderate quality, and 11 have low quality. SME demonstrated negligible mandibular changes, with less than 1 mm variation on average (range 0.46-2.00 mm) in the selected parameters and relapses observed in the long term. RME induced more significant increases, particularly in intermolar width greater than 1 mm, which ranged between 0.93 and 3.3 mm, and good stability over the long term. Leaf Expander exhibited promising short-term lower intermolar width increases greater than 1 mm and ranged from 0.5 to 1.69 mm, but long-term stability was not thoroughly evaluated. CONCLUSIONS SME results in negligible short- and long-term effects, while RME, especially with Haas-type appliances, exhibits significant intermolar width increases that remain stable over the years. Leaf Expander shows short-term lower intermolar width increases, requiring further investigation into long-term stability.
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Affiliation(s)
- Alessandro Ugolini
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16145 Genova, Italy;
| | - Andrea Abate
- Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16145 Genova, Italy;
| | - Margherita Donelli
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142 Milan, Italy
| | - Francesca Gaffuri
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
| | - Alessandro Bruni
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.B.); (V.L.)
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20129 Milan, Italy; (M.D.); (F.G.); (C.M.)
| | - Valentina Lanteri
- Surgical, Medical and Dental Department, University of Modena and Reggio Emilia, 41125 Modena, Italy; (A.B.); (V.L.)
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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.
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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.
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Rotolo RP, d'Apuzzo F, Femiano F, Nucci L, Minervini G, Grassia V. Comparison between ultrasound and magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: A systematic review. J Oral Rehabil 2023; 50:1082-1092. [PMID: 37301975 DOI: 10.1111/joor.13529] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/03/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The objectives of this systematic review were to evaluate the correlation between Ultrasound (US) and Magnetic Resonance Imaging (MRI) in patients with JIA and to investigate the association with Temporomandibular Disorders (TMD). MATERIALS AND METHODS The protocol was registered in PROSPERO (CRD42022312734). Databases Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature were searched. Eligibility criteria were patients with JIA subjected to diagnostic evaluation using US and MRI. No language restrictions were applied. After duplicate study selection, data extraction and risk of bias assessment according to Cochrane were conducted. Data extraction of patients was conducted by two independent authors. RESULTS Five observational studies were included with 217 participants (153 females and 64 males; mean age 11.3 years). The quality of the studies was overall satisfactory. The correlation between US and MRI in children with JIA was 'moderate' in acute arthritis while the chronic arthritis correlated positively in two studies. CONCLUSIONS Even if MRI remains the more accurate imaging modality for the detection of TMJ of patients with JIA, US may be useful to early detect pathological conditions and to address the patient with JIA and putative TMJ involvement to a more accurate diagnosis with MRI and consequent appropriate treatment management. CLINICAL RELEVANCE MRI should be deemed necessary only secondary to less-invasive assessments with US just to confirm the diagnosis or to increase sensitivity, accuracy of positive predictive values detected.
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Affiliation(s)
- Rossana Patricia Rotolo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fabrizia d'Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Felice Femiano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
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Long AM, Marston B. Juvenile Idiopathic Arthritis. Pediatr Rev 2023; 44:565-577. [PMID: 37777651 DOI: 10.1542/pir.2022-005623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Juvenile idiopathic arthritis (JIA) comprises a group of heterogenous disorders characterized by childhood-onset chronic joint inflammation. It is the most common rheumatologic disease in the pediatric population and an important cause of chronic illness in children. Early recognition and treatment are vital to prevent sequelae of uncontrolled inflammation on the developing skeleton. JIA can have significant complications that general pediatricians should be aware of, especially uveitis, which can be insidious and asymptomatic in very young children, and macrophage activation syndrome, which can be life-threatening if not recognized and appropriately treated. Although advances have been made in the past few decades, the etiology of JIA remains incompletely understood. Efforts are underway to refine the classification of JIA. The currently accepted classification scheme identifies subsets of JIA that are important clinically in terms of prognosis and tailoring treatment approaches. However, it is limited in identifying homogenous groups of children with early childhood onset and antinuclear antibody positivity, which may have different pathogenic mechanisms that could be important in developing more targeted and effective treatment approaches in the future. Treatment strategies for JIA have changed significantly in recent years with the availability of multiple newer targeted therapies, often modeled after medications used in adult-onset forms of arthritis. These treatments, and likely many others to come, have markedly improved symptom control and reduced complications in patients with JIA.
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Affiliation(s)
- Andrew M Long
- Division of Pediatric Rheumatology, Golisano Children's Hospital, Rochester, NY
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Bethany Marston
- Division of Pediatric Rheumatology, Golisano Children's Hospital, Rochester, NY
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
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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.
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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
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What is the image appearance of juvenile idiopathic arthritis in MRI, CT, and CBCT of TMJ? A systematic review. Clin Oral Investig 2022; 27:2321-2333. [PMID: 36515761 DOI: 10.1007/s00784-022-04828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We performed a systematic review to investigate the appearance of imaging signs on magnetic resonance imaging (MRI), cone-beam computed tomography (CBCT), and conventional computed tomography (CT) scans of the temporomandibular joints (TMJs) of patients with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS We performed electronic searches of the PubMed, Embase, Web of Science, Scopus, Lilacs, and the Cochrane Library databases to identify studies investigating JIA and its related imaging findings. Inclusion criteria were as follows: original article studies based on humans and systematic reviews, studies enrolling patients under 18 years of age with a diagnostic of JIA, the use of International League of Associations for Rheumatology (ILAR) criteria and one type of medical imaging (MRI, CBCT, or CT), and papers published in the English language. RESULTS A total of six studies met the inclusion criteria, four involving MRI and two involving CBCT. Additionally, all six studies analyzed the imaging findings of pathological TMJ affected by JIA. The results showed that synovial membrane enhancement, condylar erosions, and condylar flattening were the most prevalent imaging findings in JIA. CONCLUSION MRI examinations are more specific for detecting anomalies in the TMJ than CBCT and CT. Additionally, these results must be correlated with clinical signs to verify the correct diagnosis. CLINICAL RELEVANCE This study identified the most prevalent imaging signs of JIA to provide an early and correct diagnosis of the disease.
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Berg S, Kuminack KF. [Acquired hip joint pathologies in childhood]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:789-802. [PMID: 35976403 DOI: 10.1007/s00117-022-01057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
A number of different acquired pathologies can affect the pediatric hip joint. The classical and relatively common reactive, inflammatory or traumatic entities have to be differentiated from each other. Rarer and very rare pathologies, such as neoplastic entities or tenosynovial giant cell tumor, must also be considered in the differential diagnostics. The correct diagnosis, treatment planning and follow-up monitoring require close coordination between the departments of pediatric radiology and pediatric orthopedics. Sonography often represents the initial diagnostic step, followed by conventional radiography. Further evaluation of hip joint pathologies requires magnetic resonance imaging. In selected cases computed tomography can also be indicated.
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Affiliation(s)
- Sebastian Berg
- Kinderradiologie, St. Josefskrankenhaus Freiburg, Sautierstr. 1, 79104, Freiburg, Deutschland.
| | - Kerstin F Kuminack
- Kinderorthopädie, Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg im Breisgau, Deutschland
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Maranini B, Ciancio G, Mandrioli S, Galiè M, Govoni M. The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives. Front Med (Lausanne) 2022; 9:926573. [PMID: 35795636 PMCID: PMC9251198 DOI: 10.3389/fmed.2022.926573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/24/2022] [Indexed: 12/11/2022] Open
Abstract
Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.
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Affiliation(s)
- Beatrice Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- *Correspondence: Beatrice Maranini
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Stefano Mandrioli
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy
| | - Manlio Galiè
- Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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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.
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Cavagnetto D, Abate A, Caprioglio A, Cressoni P, Maspero C. Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study. Prog Orthod 2021; 22:32. [PMID: 34595615 PMCID: PMC8484372 DOI: 10.1186/s40510-021-00380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is currently no information on how different mandibular segments are affected by juvenile idiopathic arthritis. The aim of this paper is to assess volumetric differences of different mandibular segments in subjects with unilateral and bilateral JIA and to compare them with non-JIA control volumes. MATERIALS AND METHODS Forty subjects with unilateral TMJ involvement and 48 with bilateral TMJ involvement were selected for the case group and 45 subjects with no known rheumatic comorbidities for the control group. The mandible of each subject was divided according to a validated method into different paired volumes (hemimandible, condyle, ramus and hemibody). RESULTS The ANOVA test revealed a statistically significant difference in all the groups for condylar and ramus volumes, and the pairwise comparison evidenced a statistically significant higher condylar and ramus volume in the control group (1444.47 mm3; 5715.44 mm3) than in the affected side in the unilateral JIA group (929.46 mm3; 4776.31 mm3) and the bilateral JIA group (1068.54 mm3; 5715.44 mm3). Moreover, there was also a higher condylar volume in the unaffected side in the unilateral JIA group (1419.39 mm3; 5566.24 mm3) than in the bilateral JIA group and the affected side in the unilateral JIA group. CONCLUSIONS The affected side of unilateral JIA patients showed statistically significant lower volumes in the hemimandible, in the condyle and in the ramus. The largest total mandibular volume was observed in the control group, followed by the unilateral JIA group and, lastly, by the bilateral JIA group.
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Affiliation(s)
- Davide Cavagnetto
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Andrea Abate
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Alberto Caprioglio
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Paolo Cressoni
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy.,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy
| | - Cinzia Maspero
- Department of Biomedical Surgical and Dental Sciences, University of Milan, 20142, Milan, Italy. .,Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20142, Milan, Italy.
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Panwar J, Patel H, Tolend M, Akikusa J, Herregods N, Highmore K, Inarejos Clemente EJ, Jans L, Jaremko JL, von Kalle T, Kirkhus E, Meyers AB, van Rossum MA, Rumsey DG, Stimec J, Tse SM, Twilt M, Tzaribachev N, Doria AS. Toward Developing a Semiquantitative Whole Body-MRI Scoring for Juvenile Idiopathic Arthritis: Critical Appraisal of the State of the Art, Challenges, and Opportunities. Acad Radiol 2021; 28:271-286. [PMID: 32139304 DOI: 10.1016/j.acra.2020.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/05/2020] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
With powerful new therapies available for management of juvenile idiopathic arthritis (JIA), early diagnosis leading to appropriate treatment may prevent long-term structural joint damage. Although magnetic resonance imaging (MRI) is typically used to assess individual body parts, indications for whole body (WB) MRI are increasing. Its utility as a diagnostic and monitoring tool has already been widely investigated in adult rheumatology patients, but less so in pediatric rheumatologic patients. This paper is a comprehensive review of scoring systems and a proposal for the conceptual development of a WB-MRI scoring system for the evaluation of JIA. In this review we identify, summarize, and critically appraise the available literature on the use of WB-MRI in inflammatory arthritis, addressing relevant considerations on components of a classification system that can lead to the development of a future pediatric WB-MRI scoring system for use in children with JIA. We also discuss advantages and challenges of developing such a WB-MRI scoring system for assessment of JIA and outline next steps toward the conceptual development of this scoring system.
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Affiliation(s)
- Jyoti Panwar
- Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Hiten Patel
- Department of Radiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jonathan Akikusa
- Department of Radiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nele Herregods
- Department of Radiology, Ghent University, Ghent, Belgium
| | - Kerri Highmore
- Department of Radiology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University, Ghent, Belgium
| | | | - Thekla von Kalle
- RadiologischesInstitut, Olga hospital Klinikum, Stuttgart, Germany
| | - Eva Kirkhus
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Hospital, Orlando, Florida, United States
| | - Marion A van Rossum
- Amsterdam Rheumatology and immunology Center, Reade, and Emma Children's Hospital Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Dax G Rumsey
- Division of Rheumatology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Shirley M Tse
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marinka Twilt
- Department of Pediatrics, Division of rheumatology, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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13
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von Schuckmann L, Klotsche J, Suling A, Kahl-Nieke B, Foeldvari I. Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review. Scand J Rheumatol 2020; 49:271-280. [PMID: 32757729 DOI: 10.1080/03009742.2020.1720282] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To study the proportion of patients with temporomandibular joint (TMJ) involvement among patients with juvenile idiopathic arthritis (JIA), as well as associated clinical characteristics and signs/symptoms. METHOD We performed a retrospective chart review on consecutive patients followed in the Hamburg Centre for Paediatric and Adolescent Rheumatology Eilbek between January 2010 and July 2012. TMJ involvement was diagnosed based on clinical examination; a subgroup of patients was also assessed by magnetic resonance imaging (MRI). RESULTS The study included 2413 patients with JIA (52.1% girls, mean age at JIA onset 9.5 years). The most frequent JIA category was oligoarthritis (46.6%), followed by enthesitis-related arthritis (ERA; 38.1%). TMJ involvement was diagnosed in 843/2413 patients (34.9%) (677 MRI-confirmed, four not MRI-confirmed, no MRI examination in 162). Female gender (p = 0.017), higher number of additional joints with active arthritis (p < 0.001), anti-nuclear antibody (ANA) positivity (p = 0.005), higher age (p = 0.020), and oligoarthritis (persistent and extended; p = 0.043) were significantly associated with TMJ involvement. Human leucocyte antigen-B27-positive patients were less likely to have TMJ involvement (p = 0.023). Pain on palpation and pain while chewing were statistically significantly associated with TMJ involvement (p = 0.008 and p = 0.020, respectively). CONCLUSIONS Based on our findings, to identify TMJ involvement special attention should be paid to JIA patients with female gender, ANA positivity, and oligoarthritis, as well as those with a higher number of additional joints with active arthritis; and regular examinations of the TMJ should be performed.
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Affiliation(s)
- L von Schuckmann
- Centre for Paediatric and Adolescent Rheumatology, Schöen Klinik Eilbek , Hamburg, Germany
| | - J Klotsche
- German Rheumatism Research Centre Berlin, A Leibniz Institute , Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine , Berlin, Germany
| | - A Suling
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - B Kahl-Nieke
- Department of Orthodontics, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - I Foeldvari
- Centre for Paediatric and Adolescent Rheumatology, Schöen Klinik Eilbek , Hamburg, Germany
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14
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Buch K, Peacock ZS, Resnick CM, Rothermel H, Kaban LB, Caruso P. Regional differences in temporomandibular joint inflammation in patients with juvenile idiopathic arthritis: a dynamic post-contrast magnetic resonance imaging study. Int J Oral Maxillofac Surg 2020; 49:1210-1216. [PMID: 32014316 DOI: 10.1016/j.ijom.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Abstract
The purpose was to determine whether there are regional differences in temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA). This was a retrospective study of all patients with dynamic, contrast-enhanced magnetic resonance imaging through the TMJs at Massachusetts General Hospital between January 2015 and July 2016. The patient cohort included those with a history of JIA and control patients who underwent MRI for other routine clinical purposes. TMJ inflammation was quantified as the difference between post-gadolinium and pre-gadolinium articular T1 signal intensity normalized to post-gadolinium signal intensity of the longus capitis muscle. TMJ enhancement profiles were generated for the lateral, central, and medial portions of the TMJ. Regional differences in TMJ enhancement were investigated using basic descriptive statistics. Medial edge enhancement of the TMJs was highest in symptomatic JIA joints, followed by asymptomatic JIA, then control joints. Medial edge enhancement was a significant discriminator between symptomatic JIA TMJs and control joints (P = 0.0001), between symptomatic and asymptomatic JIA TMJs (P = 0.0003), and between asymptomatic JIA TMJs and controls (P = 0.0019). A shift in distribution of TMJ enhancement towards the medial edge that was seen uniquely in both asymptomatic and symptomatic JIA TMJs compared to control joints was found. This suggests a pattern of worsening medial edge inflammation with disease.
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Affiliation(s)
- K Buch
- Department of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
| | - Z S Peacock
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - C M Resnick
- Department of Oral and Maxillofacial Surgery, Boston Children's Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - H Rothermel
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - L B Kaban
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - P Caruso
- Department of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, Massachusetts Eye & Ear Infirmary, Boston, MA, USA
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15
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Arthurs OJ, van Rijn RR, Granata C, Porto L, Hirsch FW, Rosendahl K. European Society of Paediatric Radiology 2019 strategic research agenda: improving imaging for tomorrow's children. Pediatr Radiol 2019; 49:983-989. [PMID: 31115616 PMCID: PMC6598945 DOI: 10.1007/s00247-019-04406-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/05/2019] [Indexed: 11/02/2022]
Abstract
The European Society of Paediatric Radiology (ESPR) research committee was established to initiate, drive forward and foster excellence in paediatric imaging, paediatric image-guided intervention and radiation protection research, by facilitating more evidence-based standards, protocols and multi-institutional collaborations. The ESPR Strategic Research Agenda outlines our current research approach, highlighting several areas of paediatric imaging where the society can help guide current and future research, and emphasizing those areas where early research ("seed") funding may need to be allocated by this and other societies as precursors to larger grant applications. The key aims are to evaluate normal variation in order to be able to confidently diagnose disease states, develop robust image-based classification systems to aid diagnosis and treatment monitoring, and help develop evidence-based clinical guidelines using current literature and experience to identify knowledge gaps. For this reason, the development of evidence-based imaging pipelines, broken down step-by-step to include diagnosis, classification and clinical effectiveness, should be the end goal for each disease entity for each affected child. Here, we outline the 2019 ESPR Strategic Research Agenda along three points in the clinical imaging pipeline: clinical referral, disease diagnosis and evolution, and clinical therapeutic evaluation and effectiveness. Through multicentre trials, using existing high-level experience and expertise, and nurturing the next generation of researchers, we will be able to achieve these aims.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital, London, UK. .,NIHR UCL Great Ormond Street Institute of Child Health Biomedical Research Centre, London, UK.
| | - Rick R van Rijn
- Department of Radiology, Emma Children's Hospital - Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Granata
- Service of Radiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Luciana Porto
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt am Main, Germany
| | - F Wolfgang Hirsch
- Department of Paediatric Radiology, University Leipzig, Leipzig, Germany
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, 5020, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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16
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Imaging of the Temporomandibular Joint in Juvenile Idiopathic Arthritis: How Does Quantitative Compare to Semiquantitative MRI Scoring? J Oral Maxillofac Surg 2019; 77:951-958. [DOI: 10.1016/j.joms.2018.11.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/05/2018] [Accepted: 11/28/2018] [Indexed: 11/19/2022]
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17
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Barendregt AM, van Gulik EC, Groot PFC, Dolman KM, van den Berg JM, Nassar-Sheikh Rashid A, Schonenberg-Meinema D, Lavini C, Rosendahl K, Hemke R, Kuijpers TW, Maas M, Nusman CM. Prolonged time between intravenous contrast administration and image acquisition results in increased synovial thickness at magnetic resonance imaging in patients with juvenile idiopathic arthritis. Pediatr Radiol 2019; 49:638-645. [PMID: 30707259 DOI: 10.1007/s00247-018-04332-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/07/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post-contrast synovial thickness measurement is necessary for scoring disease activity in juvenile idiopathic arthritis (JIA). However, the timing of post-contrast sequences varies widely among institutions. This variation in timing could influence thickness measurements. OBJECTIVE To measure thickness of the synovial membrane on early and late post-contrast knee magnetic resonance (MR) images of patients with JIA. MATERIALS AND METHODS Dynamic contrast-enhanced T1-weighted knee MR images of 53 children with JIA with current or past knee arthritis were used to study synovial thickness at time point 1 (about 1 min) and time point 2 (about 5 min after contrast administration). Two experienced readers, who were blinded for the time point, independently measured synovial thickness at a predefined, marked location in the patellofemoral compartment on randomized images. Synovial thickness at the two time points was compared using the Wilcoxon signed rank test. Repeatibility of the synovial thickness measurements was studied using intraclass correlation coefficients and Bland-Altman plots. RESULTS Median synovial thickness of the 53 patients (median age: 13.5 years, 59% female) increased with prolonged post-contrast interval with a synovial thickness of 1.4 mm at time point 1 and a synovial thickness of 1.5 mm at time point 2 (P<0.001). Repeated synovial thickness measurements showed an intraclass correlation coefficient (ICC) of 0.75, P<0.05 for time point 1 and an ICC of 0.91, P<0.05 for time point 2. CONCLUSION Post-contrast synovial membrane thickness measurements are time-dependent. Therefore, standardization of post-contrast image acquisition timing is important to achieve consistent grading of synovial inflammation.
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Affiliation(s)
- Anouk M Barendregt
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. .,Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - E Charlotte van Gulik
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul F C Groot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Koert M Dolman
- Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, the Netherlands.,Department of Pediatric Rheumatology, Onze Lieve Vrouwe Gasthuis West, Jan Tooropstraat, 164, Amsterdam, the Netherlands.,Department of Pediatric Rheumatology, Onze Lieve Vrouwe Gasthuis Oost, Oosterpark 9, Amsterdam, the Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amara Nassar-Sheikh Rashid
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristina Lavini
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Section of Pediatric Radiology, Haukeland University Hospital, Jonas Lies Vei 65, PB 1400, 5021, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Jonas Lies Vei 87, N-5021, Bergen, Norway
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Charlotte M Nusman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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18
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Abstract
Imaging of the temporomandibular joint in pediatric patients is a critical component in the evaluation and treatment of children with temporomandibular joint symptoms. MRI can provide detailed joint anatomy and identify inflammation, sometimes before symptom onset. Ultrasound scan is a convenient emerging modality to evaluate the joint and guide therapeutic injections. Radiography and computed tomography offer osseous detail to recognize early morphologic changes of the mandibular condyle and provide operative planning. Imaging promises to direct treatment to prevent future joint destruction and maintain function.
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19
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Junhasavasdikul T, Abadeh A, Tolend M, Doria AS. Developing a reference MRI database for temporomandibular joints in healthy children and adolescents. Pediatr Radiol 2018; 48:1113-1122. [PMID: 29789889 DOI: 10.1007/s00247-018-4142-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/16/2018] [Accepted: 04/16/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Recognition of normal temporomandibular joints (TMJs) is essential to assess arthropathic changes. Few, if any, prior studies have evaluated the morphological appearance of growing TMJs by magnetic resonance (MR) examinations in the pediatric population. OBJECTIVE This study aimed to determine normative osseous appearance of growing TMJs according to age and gender, both qualitatively and quantitatively, concerning structural and bone marrow changes. MATERIALS AND METHODS From 1,036 MR scans screened, one joint was included from each of 157 patients (76% female; 2-18 years) presenting with at least one normal-appearing TMJ was included. Quantitatively, mandibular condyle was characterized by measuring the following: (i) head-neck angle, (ii) anteversion angle, (iii) condylar dimensions (mediolateral, craniocaudal and anteroposterior [AP]) and (iv) condylar volume. Furthermore, qualitative categorization of condylar shape, into one of three types, and condylar bone marrow type was performed. RESULTS The head-neck angle significantly correlated with age (bivariable regression β =0.60, P<0.001), indicating an increase of 1.6 degrees per year. Except for AP diameter of condyles, all other mandibular dimensions and condylar volume increased with age (β =0.20-0.59, P≤0.001-0.004). Significant age difference was observed among the different condylar shapes (P<0.001), indicating a change from rounded head without anterior tilt to rectangular head with anterior tilt. Lastly, mandibular condylar size, measured by volume and by AP and mediolateral dimensions, appeared larger in males. CONCLUSION The morphology of the mandibular condyles changes with age. During development, the shape of the condyles changes from round to rectangular in contour with the development of the anterior condylar tilt, as measured by the head-neck angle.
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Affiliation(s)
- Thitiporn Junhasavasdikul
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada.,Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Aryan Abadeh
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada
| | - Mirkamal Tolend
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada
| | - Andrea S Doria
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., 2nd floor, Toronto, ON, M5G1X8, Canada. .,Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
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20
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Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S. Juvenile idiopathic arthritis - the role of imaging from a rheumatologist's perspective. Pediatr Radiol 2018; 48:785-791. [PMID: 29766250 DOI: 10.1007/s00247-017-4014-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/11/2017] [Indexed: 10/17/2022]
Abstract
Alongside recent advances in treatment strategies for juvenile idiopathic arthritis (JIA), paediatric rheumatologists have taken increasing interest in the use of imaging. Magnetic resonance imaging (MRI) and musculoskeletal ultrasound, by providing more detailed information on disease activity than clinical examination and conventional radiography (CR), have become helpful diagnostic and managerial tools. The growing skeleton, however, with changing appearances over time, is still challenging in the establishment of valid scoring systems for pathological changes. Defining child- and age-specific reference standards is therefore a highly prioritized issue. The aim of this article is to raise awareness among radiologists of the substantial role that imaging can play to optimize the management of JIA patients and to describe the state-of-the-art validation process of imaging as an outcome measure. A closer collaboration between radiologists and pediatric rheumatologists is crucial to define a scheduled workflow for imaging in JIA.
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Affiliation(s)
- Clara Malattia
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Largo Gaslini, 5, 16147, Genoa, Italy.
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genova, Genoa, Italy.
| | | | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital AMC University of Amsterdam, Amsterdam, The Netherlands
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21
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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.
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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
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22
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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.
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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
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23
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Stoll ML, Guleria S, Mannion ML, Young DW, Royal SA, Cron RQ, Vaid YN. Defining the normal appearance of the temporomandibular joints by magnetic resonance imaging with contrast: a comparative study of children with and without juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:8. [PMID: 29368603 PMCID: PMC5784616 DOI: 10.1186/s12969-018-0223-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Up to 80% of children with juvenile idiopathic arthritis (JIA) develop arthritis involving their temporomandibular joint (TMJ). Recent studies have questioned the sensitivity of an abnormal MRI in the diagnosis of active arthritis. METHODS 122 children without arthritis undergoing contrast MRI of the head were prospectively consented to undergo a simultaneous contrast MRI of their TMJs. As a comparison point, the initial MRI of the TMJ of 35 newly diagnosed children with JIA were retrospectively scored. The presence and size of effusion and contrast enhancement were measured in the left TMJ in all subjects. RESULTS 62/122 (51%) controls compared to only 10/35 JIA (29%) patients had an effusion (p = 0.022). Contrast enhancement was present in ≥97% of both groups, although the size of the enhancement was, on average, 0.2 mm larger in controls (1.1 ± 0.24 vs 0.88 ± 0.27 mm, p < 0.001). Among JIA patients, the size of the enhancement correlated inversely with disease duration (r = - 0.475, p = 0.005). Chronic changes were present in none of the controls versus 2/35 (5.5%) of the JIA patients (p = 0.049). CONCLUSION Findings consistent with minimally active TMJ arthritis appear to be equally likely in children with JIA as compared to non-inflamed controls, while this and other studies confirm that chronic changes are specific to JIA. Thus, small amounts of effusion or contrast enhancement, in the absence of chronic changes, should be interpreted with caution.
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Affiliation(s)
- Matthew L. Stoll
- 0000000106344187grid.265892.2Department of Pediatrics, University of Alabama at Birmingham, CPP N G10 / 1600 7th Avenue South, Birmingham, AL 35233 USA
| | - Saurabh Guleria
- Department of Radiology at Children’s of Alabama, CH 2 FL / 1600 7th Avenue South, Birmingham, AL 35233 USA ,Present affiliation: Austin Radiological Associates, Austin, TX USA
| | - Melissa L. Mannion
- 0000000106344187grid.265892.2Department of Pediatrics, University of Alabama at Birmingham, CPP N G10 / 1600 7th Avenue South, Birmingham, AL 35233 USA
| | - Daniel W. Young
- Department of Radiology at Children’s of Alabama, CH 2 FL / 1600 7th Avenue South, Birmingham, AL 35233 USA
| | - Stuart A. Royal
- Department of Radiology at Children’s of Alabama, CH 2 FL / 1600 7th Avenue South, Birmingham, AL 35233 USA
| | - Randy Q. Cron
- 0000000106344187grid.265892.2Department of Pediatrics, University of Alabama at Birmingham, CPP N G10 / 1600 7th Avenue South, Birmingham, AL 35233 USA
| | - Yoginder N. Vaid
- Department of Radiology at Children’s of Alabama, CH 2 FL / 1600 7th Avenue South, Birmingham, AL 35233 USA
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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]
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25
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Caruso P, Buch K, Rincon S, Hakimelahi R, Peacock ZS, Resnick CM, Foster C, Guidoboni L, Donahue T, Macdonald R, Rothermel H, Curtin HD, Kaban LB. Optimization of Quantitative Dynamic Postgadolinium MRI Technique Using Normalized Ratios for the Evaluation of Temporomandibular Joint Synovitis in Patients with Juvenile Idiopathic Arthritis. AJNR Am J Neuroradiol 2017; 38:2344-2350. [PMID: 29170273 DOI: 10.3174/ajnr.a5424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE MR imaging has been shown to be useful in the diagnosis of juvenile idiopathic arthritis of the temporomandibular joint. Prior MR imaging approaches have relied mainly on the subjective interpretation of synovial enhancement as a marker for synovial inflammation. Although, more recently, several attempts have been made to quantify synovial enhancement, these methods have not taken into account the dynamic enhancement characteristics of the temporomandibular joint and the effect of sampling time. Our aim was to develop a clinically feasible, reproducible, dynamic, contrast-enhanced MR imaging technique for the quantitative assessment of temporomandibular joint synovitis in patients with juvenile idiopathic arthritis and to study the effect of sampling time on the evaluation of synovitis. MATERIALS AND METHODS This was a retrospective study of all patients who had dynamic, contrast-enhanced coronal T1 3T MR imaging through the temporomandibular joint at our institution between January 1, 2015, and July 8, 2016. Patients in this cohort included those with a history of juvenile idiopathic arthritis and control patients who underwent MR imaging for other routine, clinical purposes. Synovial enhancement was calculated for each temporomandibular joint using 3 different types of equations termed normalization ratios. The enhancement profiles generated by each equation were studied to determine which provided the best discrimination between affected and unaffected joints, was the least susceptible to sampling errors, and was the most clinically feasible. RESULTS A ratio of synovial enhancement (defined as the difference between the postgadolinium and the pregadolinium T1 signal of the synovium) to the postgadolinium signal of the longus capitis provided the best discrimination between affected and unaffected joints, the least susceptibility to sampling error, and was thought to be the most clinically feasible method of quantification of synovial inflammation. Additional synovial enhancement ratios studied did not provide the same level rates of discrimination between the affected and unaffected joints and were thought to be too temporally variable to provide reliable clinical use. CONCLUSIONS We provide a robust, reproducible, dynamic gadolinium-enhanced MR imaging technique for the quantitative assessment of temporomandibular joint synovitis in patients with juvenile idiopathic arthritis.
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Affiliation(s)
- P Caruso
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - K Buch
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - S Rincon
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - R Hakimelahi
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - Z S Peacock
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital and Mass General Hospital for Children (Z.S.P., L.B.K.)
| | - C M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital (C.M.R.)
| | - C Foster
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - L Guidoboni
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - T Donahue
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - R Macdonald
- From the Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital (P.C., K.B., S.R., R.H., C.F., L.G., T.D., R.M.)
| | - H Rothermel
- Department of Pediatrics, Mass General Hospital for Children (H.R.)
| | - H D Curtin
- Department of Radiology, Massachusetts Eye and Ear Infirmary (H.D.C.), Harvard Medical School and Harvard School of Dental Medicine, Boston, Massachusetts
| | - L B Kaban
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital and Mass General Hospital for Children (Z.S.P., L.B.K.)
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Qualitative and semi-quantitative assessment of temporomandibular joint MRI protocols for juvenile idiopathic arthritis at 1.5 and 3.0T. Eur J Radiol 2017; 98:90-99. [PMID: 29279176 DOI: 10.1016/j.ejrad.2017.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Temporomandibular joints (TMJs) frequently develop silent inflammatory and osteochondral changes in children with juvenile idiopathic arthritis. Data-driven recommendations for TMJ imaging protocol are needed to reduce measurement error and scanning time. This study compares the impact of different protocols, imaging coils, and magnet strength on the reliability of image assessment and the subjective quality of images. MATERIALS AND METHODS Three groups of bilateral TMJ MR studies were retrospectively collected from two institutions, including 24 1.5T and 19 3.0T studies using dedicated TMJ surface coils, and 23 1.5T studies with head coil. Post-contrast sequences were re-compiled from the full protocol to create minimum protocol studies for the three groups. Two radiologists and two non-radiologists first scored the three minimum protocol images according to pre-specified definitions, then scored the full protocol images. Minimum-to-full protocol agreement, inter-reader agreement, and subjective item visibility scores were assessed. RESULTS With dedicated TMJ dual surface coils, minimum-vs-full protocol agreement was moderate to good (0.5-0.8 intraclass correlation coefficients or kappa) for most items, and was not influenced by the magnet strength. Inter-reader reliability was more significantly influenced by the imaging coil and reader's training background than by protocol length or magnet strength differences. Sagittal and coronal planes weighted on PD, T2 Fat Suppressed and T1 Fat Suppressed -postcontrast adequately visualized all the different features, whereas the axial plane was more limited to visualizing synovium. CONCLUSION Inter-reader reliability and qualitative measure of image quality improved more consistently with the coil offering the higher resolution, rather than increased magnet strength.
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Hechler BL, Phero JA, Van Mater H, Matthews NS. Ultrasound versus magnetic resonance imaging of the temporomandibular joint in juvenile idiopathic arthritis: a systematic review. Int J Oral Maxillofac Surg 2017; 47:83-89. [PMID: 28802761 DOI: 10.1016/j.ijom.2017.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/04/2017] [Accepted: 07/19/2017] [Indexed: 01/07/2023]
Abstract
A systematic review of published articles on ultrasound (US) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) was performed to answer the question "What is the sensitivity and specificity of US as compared to MRI in diagnosing acute and chronic joint changes in patients with JIA?" The most recent evidence was sought in published articles via a search of the PubMed, Ovid, and Embase databases. Article appraisal was performed by two reviewers. Nineteen articles reporting prospective or ambispective studies comparing US to MRI in TMJ imaging were found. Six of these articles were specific to JIA patients. The heterogeneity of these articles made comparison difficult. Of the acute and chronic changes assessed (disk displacement, joint effusion, bony deformity), only joint effusion was appropriately assessed by multiple authors, with US having a sensitivity of 0-72% and specificity of 70-83% as compared to MRI. There was a paucity of studies specific to JIA, with many studying adult, non-rheumatic patients. This systematic review found that dynamic imaging with high-resolution US improves sensitivity and specificity compared to static, low-resolution US. Additionally, there is evidence to suggest that US imaging following a baseline MRI can increase US sensitivity and specificity and may have a future role in disease surveillance.
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Affiliation(s)
- B L Hechler
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - J A Phero
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - H Van Mater
- Department of Rheumatology, Duke University Hospitals, Durham, North Carolina, USA
| | - N S Matthews
- Department of Oral and Maxillofacial Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.
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Frid P, Nordal E, Bovis F, Giancane G, Larheim TA, Rygg M, Pires Marafon D, De Angelis D, Palmisani E, Murray KJ, Oliveira S, Simonini G, Corona F, Davidson J, Foster H, Steenks MH, Flato B, Zulian F, Baildam E, Saurenmann RK, Lahdenne P, Ravelli A, Martini A, Pistorio A, Ruperto N. Temporomandibular Joint Involvement in Association With Quality of Life, Disability, and High Disease Activity in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2017; 69:677-686. [PMID: 27564918 DOI: 10.1002/acr.23003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants. METHODS This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression. RESULTS Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration >4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most important determinants for TMJ involvement. CONCLUSION Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.
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Affiliation(s)
- Paula Frid
- University Hospital of North Norway, UiT The Arctic University of Norway, and Public Dental Competence Center of Northern Norway, Tromsø, Norway
| | - Ellen Nordal
- University Hospital of North Norway, and UiT The Arctic University of Norway, Tromsø, Norway
| | - Francesca Bovis
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | | | - Tore A Larheim
- UiT The Arctic University of Norway, Tromsø, and University of Oslo, Oslo, Norway
| | - Marite Rygg
- Norwegian University of Science and Technology and St. Olavs University Hospital, Trondheim, Norway
| | | | - Donato De Angelis
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | - Elena Palmisani
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | - Kevin J Murray
- Princess Margaret Hospital for Children, Perth, Australia
| | - Sheila Oliveira
- Universidade Federal do Rio de Janeiro, and Instituto de Puericultura e Pediatria Martagao Gesteira, Rio de Janeiro, Brazil
| | | | - Fabrizia Corona
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Helen Foster
- Newcastle University, Newcastle Hospitals NHS Foundation Trust, and Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | - Berit Flato
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Eileen Baildam
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Pekka Lahdenne
- Children's Hospital and Helsinki University Central Hospital, Helsinki, Finland
| | - Angelo Ravelli
- Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy
| | - Alberto Martini
- Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy
| | | | - Nicolino Ruperto
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
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29
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Kinard BE, Abramowicz S. Juvenile Idiopathic Arthritis Practice Patterns Among Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg 2017; 75:2333.e1-2333.e8. [PMID: 28822720 DOI: 10.1016/j.joms.2017.07.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/12/2017] [Accepted: 07/11/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this investigation is to assess the current clinical practices by oral and maxillofacial surgeons (OMSs) in the United States regarding diagnosis and treatment of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS We implemented a cross-sectional survey of academic OMSs in the United States via an electronic survey. The survey included respondent demographic data, patient volumes, diagnostic methods, and management practices for children with JIA and TMJ involvement. The results of the survey were analyzed using descriptive statistics. RESULTS The study respondents were composed of 52 surgeons. Most respondents were men (n = 43, 87.8%), were aged 51 to 60 years (n = 20, 39.2%), were in full-time academics (n = 42, 84%), had more than 20 years of experience (n = 26, 50%), and were seeing 1 to 5 patients with JIA per month (n = 21, 46.7%). Most patients were aged 11 to 15 years (n = 22, 61.1%) and were managed with 1 to 2 systemic medications (n = 30, 81.1%). All OMSs reported evaluating TMJ involvement by reviewing patient history, clinical examination, and imaging. The most commonly used imaging modality was panoramic radiographs (n = 24, 63.2%) and magnetic resonance imaging (n = 22, 57.9%). OMSs decided to inject intra-articular medication based on history and symptoms (n = 36, 94.7%). Once in remission, patients were followed up at yearly (n = 12, 36.4%) or 6-month (n = 10, 30.3%) intervals. CONCLUSIONS Our study shows that, in general, there is consensus among US OMSs regarding diagnosis of TMJ involvement in children with JIA. There is less concordance among the respondents regarding treatment. Currently, management of TMJ involvement in children with JIA is mostly based on expert opinions and retrospective studies. This study further highlights the need for randomized clinical trials and multi-institution collaboration to allow for evidence-based diagnosis and treatment.
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Affiliation(s)
- Brian E Kinard
- Resident, Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shelly Abramowicz
- Assistant Professor, Departments of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
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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.)
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31
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Windschall D. [Imaging options in pediatric rheumatology]. Z Rheumatol 2016; 75:973-986. [PMID: 27796481 DOI: 10.1007/s00393-016-0216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There has been growing interest in the use of imaging modalities in pediatric rheumatology for the past 15 years. Nowadays, highly sensitive imaging techniques can be used to detect early stages of pediatric rheumatic diseases in addition to the physical examination. Magnetic resonance imaging and musculoskeletal ultrasound play the most important role. Moreover, these two techniques are of great value in differential diagnostics and therapy monitoring. The use of imaging methods with a high radiation exposure could therefore be greatly reduced over the last decade.
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Affiliation(s)
- D Windschall
- Klinik für Kinder und Jugendmedizin, Asklepios Klinik Weißenfels, Naumburgerstr. 76, 06667, Weißenfels, Deutschland.
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Collado P, Malattia C. Imaging in paediatric rheumatology: Is it time for imaging? Best Pract Res Clin Rheumatol 2016; 30:720-735. [PMID: 27931964 DOI: 10.1016/j.berh.2016.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/13/2016] [Accepted: 08/04/2016] [Indexed: 11/13/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of arthritides characterized by chronic synovial inflammation that can lead to structural damage. The main objective of JIA therapies is to induce disease control to avoid disability in childhood. The advances in therapeutic effectiveness have created a need to search for imaging tools that describe more precisely disease activity in children with JIA. Musculoskeletal ultrasound and magnetic resonance imaging have demonstrated to be more sensitive than clinical examination in early detection of synovitis. These modalities can detect both inflammatory and destructive changes. The unique characteristics of the growing skeleton and a scarce validation of imaging in children result in important challenges in evaluating paediatric population. This review describes indications and limitations of these imaging techniques and suggests some advices for a rational use in the management of JIA in clinical practice.
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Affiliation(s)
- Paz Collado
- Rheumatology/Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, C/Corazón de María 55, 2ºA, 28002 Madrid, Spain.
| | - Clara Malattia
- Pediatria 2-Reumatologia, Istituto Giannina Gaslini, Largo Gaslini 5, 16147 Genova, Italy; University of Genova, Italy
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Rieter JFMM, de Horatio LT, Nusman CM, Müller LSO, Hemke R, Avenarius DFM, van Rossum MAJ, Malattia C, Maas M, Rosendahl K. The many shades of enhancement: timing of post-gadolinium images strongly influences the scoring of juvenile idiopathic arthritis wrist involvement on MRI. Pediatr Radiol 2016; 46:1562-7. [PMID: 27406611 DOI: 10.1007/s00247-016-3657-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 05/12/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Potential long-term side effects of treatment for juvenile idiopathic arthritis are concerning. This has necessitated accurate tools, such as MRI, to monitor treatment response and allow for personalized therapy. OBJECTIVE To examine the extent to which timing of post-contrast MR images influences the scoring of inflammatory change in the wrist in children with juvenile idiopathic arthritis. MATERIALS AND METHODS We studied two sets of post-contrast 3-D gradient echo MRI series of the wrist in 34 children with juvenile idiopathic arthritis. These images were obtained immediately after administration of intravenous contrast material and again after approximately 10 min. The dataset was drawn from a prospective multicenter project conducted 2006-2010. We assessed five wrist locations for synovial enhancement, effusion and overall inflammation. Examinations were scored by one radiologist in two sessions - the first was based on the early post-contrast images, and the later session, for which the previous findings were masked, was based on the later post-contrast images. RESULTS Fifty-two of the 170 locations (30.6%) received a higher synovial enhancement score based on the late post-contrast images as compared to the early images. Sixty of the 170 (35%) locations received a higher total inflammation score. The mean scores of synovial enhancement and total inflammation were significantly higher when based on the late post-contrast images as compared to the early post-contrast images. CONCLUSION An MRI-based scoring system for the presence and degree of synovitis should be based on a standardized MR-protocol with a fixed interval between intravenous contrast injection and post-contrast images.
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Affiliation(s)
- Jasper F M M Rieter
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Charlotte M Nusman
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Robert Hemke
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Marion A J van Rossum
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam, The Netherlands
| | - Clara Malattia
- Department of Paediatrics, Ospedale Pediatrico Gaslini, Genoa, Italy
| | - Mario Maas
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Radiology Department, Section of Pediatric Radiology, Haukeland University Hospital, Pb 1400, 5021, Bergen, Norway. .,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway.
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Quantifying Synovial Enhancement of the Pediatric Temporomandibular Joint. J Oral Maxillofac Surg 2016; 74:1937-45. [PMID: 27067062 DOI: 10.1016/j.joms.2016.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The purposes of this study were to assess a novel method for quantifying temporomandibular joint (TMJ) synovial enhancement on gadolinium-enhanced magnetic resonance imaging (MRI) and to establish normative values to allow early detection of synovitis. MATERIALS AND METHODS This is a retrospective cohort study of pediatric patients (aged 0 to 16 years) without jaw pathology who underwent MRI scans with contrast that included the TMJs. From a coronal T1-weighted image, the signal intensity within the superior and inferior joint spaces was divided by the signal intensity of the longus capitis muscle to establish a ratio by age. Intrarater reliability and inter-rater reliability were assessed. A mixed-model regression analysis was used to determine the 95% specificity threshold for normal ratios. RESULTS Temporal and optic nerve MRI scans of 158 patients were included. Normative synovial enhancement ratios (95% specificity) thresholds were established: 1.52, 1.68, and 1.55 for superior joint space, inferior joint space, and average of both joint spaces, respectively. Intrarater and inter-rater agreement was excellent. CONCLUSIONS A ratio of signal intensity of the TMJ synovium to the longus capitis is a reliable method to quantify enhancement controlling for time after contrast infusion and may be useful for diagnosis of TMJ synovitis.
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El Assar de la Fuente S, Angenete O, Jellestad S, Tzaribachev N, Koos B, Rosendahl K. Juvenile idiopathic arthritis and the temporomandibular joint: A comprehensive review. J Craniomaxillofac Surg 2016; 44:597-607. [PMID: 26924432 DOI: 10.1016/j.jcms.2016.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/12/2015] [Accepted: 01/26/2016] [Indexed: 11/29/2022] Open
Abstract
Juvenile idiopathic arthritis is the most common inflammatory rheumatic disease of childhood and represents a series of chronic inflammatory arthritides of unknown cause. Involvement of the temporomandibular joint has been reported in up to 87% of children with juvenile idiopathic arthritis when based on magnetic tomography imaging; it can be asymptomatic and may lead to severe long term complications. In this review a summary of the contemporary literature of imaging of the temporomandibular joint in children with juvenile idiopathic arthritis will be provided, including ultrasound which is a valuable method for guided joint injections, but does not necessarily allow detection of acute inflammation, cone beam computed tomography, which has emerged as a feasible and accurate low-dose alternative as compared to conventional computed tomography to detect destructive change, and magnetic resonance imaging which is considered the method of choice for assessing acute, inflammatory change, although the lack of normative standards remains a challenge in children.
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Affiliation(s)
| | - O Angenete
- Department of Radiology, St Olav University Hospital, Norway
| | - S Jellestad
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - N Tzaribachev
- Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - B Koos
- Department of Orthodontics, University of Rostock, Germany
| | - K Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway; University of Bergen, Department of Clinical Medicine K1, Norway.
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Ma GMY, Amirabadi A, Inarejos E, Tolend M, Stimec J, Moineddin R, Spiegel L, Doria AS. MRI thresholds for discrimination between normal and mild temporomandibular joint involvement in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2015; 13:53. [PMID: 26626730 PMCID: PMC4665947 DOI: 10.1186/s12969-015-0051-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently there is no consensus agreement on the degree of enhancement in normal temporomandibular joints (TMJ) in children, which makes it difficult for clinicians to distinguish between the presence/absence of mild synovitis. Quantitative measurements of synovial and condylar enhancement may be useful additions to current qualitative methods on early MRI diagnosis and follow up of TMJ involvement in JIA. The purpose of the study is to establish thresholds/tendencies for quantitative measures that enable distinction between mild TMJ involvement and normal TMJ appearance based on the degree of synovial and bone marrow enhancement in JIA patients. METHODS TMJ MRI examinations in 67 children with JIA and in 24 non-rheumatologic children who underwent MRI for neurologic/orbit indications were retrospectively assessed. As a priori determined TMJs of JIA patients were categorized into three groups by experienced staff radiologists based on the degree of synovial and condylar enhancement: no active disease (rheumatologic control), mild and moderate/severe findings. The signal intensity (SI) of the synovial tissue around each condyle and of the bone marrow was measured to calculate the enhancement ratio (ER) and relative SI change. The ER was calculated using signal to noise ratios, while relative SI change was calculated using signal intensities alone. Quantitative measurements of synovial and condylar enhancement of TMJs with mild or moderate/severe findings were compared with the rheumatologic and non-rheumatologic controls. RESULTS Mean ER values were significantly different between the TMJs without active disease and those with mild and moderate/severe synovial enhancement, with highest values in the moderate/severe group (P < 0.0001). Similar findings were seen for condylar enhancement with P < 0.005. Relative SI change was unable to differentiate TMJs with mild synovitis from the two controls (P > 0.10). 27/60 (45%) TMJs without active disease had osteochondral changes. 8/40 (20%) TMJs in the mild group did not demonstrate any synovial thickening. CONCLUSIONS Quantitative signal to noise ratios of TMJ synovial and condylar enhancement generate thresholds/tendencies, which offer additional information to differentiate mild synovitis from normal TMJs in JIA patients. Osteochondral changes and synovial thickening may not be reliable indicators of active TMJ involvement and should be differentiated from synovial enhancement.
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Affiliation(s)
- Grace Mang Yuet Ma
- Department of Radiology, Ohio State University Wexner Medical Center, 410 West 10th Ave, Columbus, OH, 43210, USA.
| | - Afsaneh Amirabadi
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Emilio Inarejos
- Department of Diagnostic Imaging, Hospital Sant Joan de Deu, Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - Lynn Spiegel
- Department of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Andrea S. Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G1X8 Canada
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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.
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