Magnetic resonance imaging findings of osteoarthrosis and effusion in patients with unilateral temporomandibular joint pain

Reconstructed magnetic resonance image-based effusion volume assessment for temporomandibular joint arthralgia

BACKGROUND

Joint effusion is often noticed in magnetic resonance image (MRI) and its diagnostic value for arthralgia of the temporomandibular joint (TMJ) remains obscure.

OBJECTIVE

To develop a method for quantitatively evaluating the joint effusion revealed in MRI and its diagnostic value for arthralgia of the TMJ.

METHODS

Two-hundreds and twenty-eight TMJs, 101 with arthralgia (Group P) and 105 without (Group NP) from 103 patients, and 22 TMJs (Group CON) from 11 asymptomatic volunteers were examined by using MRI. The effusion volume was measured after constructing a three-dimensional structure of the joint effusion revealed in MRI by using the ITK-SNAP software. The diagnostic capabilities of the effusion volume on arthralgia were evaluated with receiver operating characteristic (ROC) curve analysis.

RESULTS

Totally 146 joints showed MRI signs of joint effusion, including nine joints from Group CON. However, the medium volume was greater in Group P (66.65 mm3 ), but was much similar in Group CON (18.33 mm3 ) to Group NP (27.12 mm3 ). The effusion volume larger than 38.20 mm3 was validated to discriminate Group P from Group NP. The AUC value was 0.801 (95% CI 0.728 to 0.874), with a sensitivity of 75% and specificity of 78.9%. The median volume of the joint effusion was larger in those with than without bone marrow oedema, osteoarthritis, Type-III disc configurations, disc displacement and higher signal intensity of the retrodiscal tissue (all, p < .05).

CONCLUSION

The present method for evaluate joint effusion volume well discriminated painful TMJs from non-pain ones.

Case report: Electroacupuncture for acute pain flare-up of knee osteoarthritis

Acute pain flare-up of knee osteoarthritis (KOA) is a common disease in orthopedics and is mainly treated with analgesic drugs. Patients usually refuse to take western medicines orally owing to gastrointestinal side effects or unsatisfactory treatment results. We report the case of a 69-year-old woman who had an acute pain flare-up of right KOA induced by long-distance walking. As the patient refused medication, we used electroacupuncture (EA) to relieve her symptoms. EA with a 2-Hz frequency and a 1–2-mA intensity had an analgesic effect on the acute pain flare-up of KOA. After 12 weeks of EA intervention, the bone marrow edema-like lesions (BMLs) improved significantly, as depicted on magnetic resonance imaging of the knee joint. However, more powerful evidence is needed to understand the mechanism of the EA technique that alleviates BMLs of KOA.

Electroacupuncture on Hemifacial Spasm and Temporomandibular Joint Pain Co-Morbidity: A Case Report

Hemifacial spasm (HFS) and temporomandibular joint (TMJ) pain are common facial diseases which cause depression, anxiety, insomnia, and poor quality of life. However, currently there are still no effective therapies to treat HFS and TMJ. Electroacupuncture (EA) has advantages of safety, rapid work, easy operation and convenience. Here, we reported a case of a 50-year-old woman who presented with irregular spasm of eyelids and facial muscles on the left side, and TMJ pain on the right side. The patient had been treated with carbamazepine (20mg per day) and alternative therapies for a year, but still not much improvement in the symptoms. The scores of the Jankovic Rating Scale (JRS), global rating scale (GRS), and visual analog scale (VAS) were 7, 60, and 7 points, respectively. The EMG test showed that the spastic side had higher R1 amplitude, longer R2 duration, and larger R2 area than the non-spasmodic side, and the occurrence rate of the lateral spread responses (LSR) in the Orbicularis oris and the Orbicularis oculi muscle was 60% and 40%, respectively. We considered this patient had left HFS and right TMJ pain. EA was successfully undertaken for two periods over 30 weeks. After EA, JRS and VAS were reduced sharply, and the symptoms of HFS were stable without recurrence. However, the frequency of the lower eyelid increased gradually during the 6-month follow-up. These findings reveal that EA with the frequency of 2 Hz and intensity of ~ 1–2 mA may be a benefit for alleviating symptoms of HFS and TMJ pain without adverse reaction. The potential mechanisms of EA in HFS and TMJ pain co-morbidity involve brain stem mechanism and DNIC mechanism for distal acupuncture and segmental mechanism for local acupuncture analgesia.

Diagnostic correlation between clinical protocols and magnetic resonance findings in temporomandibular disorders: A systematic review and meta-analysis

BACKGROUND

Our aim was to assess the diagnostic correlation between clinical protocols and magnetic resonance (MRI) findings in temporomandibular disorders (TMDs), including disc displacement with and without reduction (DDwR; DDwoR) and arthralgia.

METHODS

A systematic review performed in two phases according to the PRISMA checklist. Specific indexing terms were used for search of studies assessing TMDs through clinical diagnostic protocols with the aid of Research Diagnostic Criteria for TMDs or Diagnostic Criteria for TMDs. Quality assessment performed using QUADAS-2. Heterogeneity was assessed using I² . Publication bias was assessed using funnel plots. For meta-analysis, we used random effect model or fixed effect. The main outcomes were sensitivity and specificity of clinical protocols.

RESULTS

Fourteen studies included in the qualitative analysis and 11 studies in the meta-analysis. None of the studies fulfilled all criteria of QUADAS-2. High heterogeneity and high publication bias were found among the studies. Clinical protocols for assessing DDwR compared with MRI showed pooled sensitivity of 66% and specificity of 72%. For DDwoR, sensitivity was 61% and specificity 98%. For arthralgia, sensitivity was 43% and specificity 68% for the presence of effusion.

CONCLUSIONS

This review reveals the need for studies with improved quality. Clinical protocols show poor to moderate validity in diagnosis of DDwR and DDwoR compared with MRI. No correlation was found between a clinical diagnosis of arthralgia and MRI effusion. Clinical diagnostic protocols can be used as screening tools, reserving the use of MRI for a more accurate diagnosis in patients with symptoms or dysfunction.

Internal derangement as a predictor of provoked pain on mouth opening: A magnetic resonance imaging study

Purpose

This study investigated the relationship between pain and internal derangement in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI).

Materials and Methods

This study analyzed 356 TMD patients (712 temporomandibular joints [TMJs]). The inclusion criteria were the presence of spontaneous or provoked pain on one or both TMJs and having undergone MRI. The patients with provoked pain were divided into 3 groups: pain on palpation, pain on mouth opening, and pain on mastication. MRI was performed using a 1.5-T scanner. T1- and T2-weighted parasagittal and paracoronal images were obtained. According to the findings on the T1-weighted images, another 3 groups were created based on internal derangement: normal, disc displacement with reduction, and disc displacement without reduction. The MRI findings were independently interpreted by 2 experienced oral and maxillofacial radiologists at 2 different times. Statistical analysis was performed by the chi-square test using SPSS (version 12.0; SPSS Inc., Chicago, IL, USA).

Results

Provoked pain on mouth opening was found to be correlated with internal derangement in TMD patients (P<.05). However, spontaneous pain and provoked pain on palpation or mastication were not associated with internal derangement (P>.05).

Conclusion

These results suggest that internal derangement was a significant predictor of provoked pain on mouth opening.

Relationship between pain and effusion on magnetic resonance imaging in temporomandibular disorder patients

Purpose

This study was performed to find the relationship between pain and joint effusion using magnetic resonance imaging (MRI) in temporomandibular disorder (TMD) patients.

Materials and Methods

The study subjects included 232 TMD patients. The inclusion criteria in this study were the presence of spontaneous pain or provoked pain on one or both temporomandibular joints (TMJs). The provoked pain was divided into three groups: pain on palpation (G1), pain on mouth opening (G2), and pain on mastication (G3). MRI examinations were performed using a 1.5-T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the T2-weighted image findings, the cases of effusions were divided into four groups: normal, mild (E1), moderate (E2), and marked effusion (E3). A statistical analysis was carried out using the χ² test with SPSS (version 12.0, SPSS Inc., Chicago, IL, USA).

Results

Spontaneous pain, provoked pain, and both spontaneous and provoked pain were significantly related to joint effusion in TMD patients (p<0.05). However, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ (G1) was not related to joint effusion in TMD patients (p>0.05).

Conclusion

Spontaneous pain was related to the MRI findings of joint effusion; however, among the various types of provoked pain, pain on palpation of the masticatory muscles and TMJ was not related to the MRI findings of joint effusion. These results suggest that joint effusion has a significant influence on the prediction of TMJ pain.

Evaluation of the correlation between disc displacements and degenerative bone changes of the temporomandibular joint by means of magnetic resonance images

The aim was to evaluate the correlation between disc displacements and degenerative bone changes in magnetic resonance images (MRI) of 112 patients of both genders, with signs and symptoms of temporomandibular disorder. For this purpose, a calibrated examiner evaluated 224 MRI by assigning scores for the displacement of the disc and degenerative bone changes. Disc displacement was found in 58.42% of the temporomandibular joints (TMJs) evaluated. Anterior displacement of the disc with reduction was the most common, occurring in 67.18% cases of joints with disc displacement. Degenerative bone changes were observed in 53.94% of the TMJs analysed. There was significant correlation between disc displacement with reduction and condylar flattening, disc displacement without reduction and condylar flattening, disc displacement without reduction, and associated degenerative bone changes (flattening and erosion, flattening, osteophyte and erosion; flattening and osteophytes, erosion and sclerosis, flattening and sclerosis, flattening, osteophytes and sclerosis). The correlation between advanced cases of disc displacement and the occurrence of degenerative bone changes emphasises the importance of MRI for an accurate diagnosis and development of an appropriate treatment plan and in cases in which clinical examination is not sufficient for these purposes.

Psychosocial behaviour and health care utilization in patients suffering from temporomandibular disorders diagnosed on the basis of clinical findings and MRI examination

The aim of this study was to evaluate psychosocial behaviour and differences in health care utilization between subgroups of patients suffering from temporomandibular disorders, using both clinical examination and magnetic resonance imaging (MRI).

MATERIALS AND METHODS

70 patients were examined according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and were divided into groups according to their clinical diagnoses. MRIs were acquired and joint-related RDC/TMD diagnoses were modified on the basis of MRI findings. Group I suffered from joint pathology, group II from myofascial pain and group III from a combination. Non-parametric statistics were used to reveal group-related differences in psychosocial and behavioural aspects. Differences in group assignment based on clinical and MRI examination were assessed (kappa statistics).

RESULTS

MRI findings led to group assignments that were different from clinical assignments (k = 0.3). For both types of assignment, patients with myofascial pain displayed higher somatization scores, used more splints and consulted more physicians. For clinical assignment only, depression scores were higher in the myofascial pain group. For MRI based assignment, sex differences were significant between groups I and III.

CONCLUSION

Somatization-specific behaviour is more widespread in patients suffering from exclusively myofascial pain than in patients presenting joint pathology. Inconsistencies in differences of other psychosocial variables between groups of TMD patients seem to be related to differences in group assignment either with or without objective information on joint pathology.

Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis

OBJECTIVE

As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT).

STUDY DESIGN

Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA).

RESULTS

For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA.

CONCLUSION

Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.

Neuropathic pain in temporomandibular joint disorders: case-control analysis by MR imaging

BACKGROUND AND PURPOSE

Temporomandibular joint disorders (TMJ-D) may be associated with the onset of neuropathic pain. The purpose of this study was to prospectively assess if, at the open-mouth position, the distance between the temporomandibular joint (TMJ) disk and the mandibular nerve is shorter in patients with TMJ-D and neuropathic pain vs patients with TMJ-D without neuropathic pain or in healthy people.

MATERIALS AND METHODS

After ethical committee approval, we evaluated by MR imaging 16 TMJs with TMJ-D and neuropathic pain, 16 TMJs with TMJ-D without neuropathic pain, and 16 TMJs of healthy volunteers. All of the subjects were informed about the study procedure. We evaluated the distance between the TMJ disk and the mandibular nerve at the oval foramen level. Furthermore, the presence within the TMJs of internal derangement, osteoarthrosis, joint effusion, and bone marrow edema was evaluated.

RESULTS

At the maximal open-mouth position, the distance between the TMJ disk and the mandibular nerve is shorter in patients with TMJ-D and neuropathic pain than in patients with TMJ-D without neuropathic pain or in healthy volunteers (P < .05). The imaging findings of TMJ internal derangement, effusion, osteoarthrosis, and bone marrow edema were present both in patients with TMJ-D without neuropathic pain and in patients with TMJ-D and neuropathic pain.

CONCLUSIONS

We suggest that a closer proximity between the TMJ disk and the mandibular nerve could be one of the causes of the onset of neuropathic pain in patients with TMJ-D and neuropathic pain.

Osseous abnormalities related to the temporomandibular joint

With the arrival of arthrography, computed tomography, and magnetic resonance imaging, diagnostic imaging of the temporomandibular joint has improved tremendously over the last 20 years. In patients with temporomandibular joint pain and dysfunction, the main focus was on meniscal pathology. The purpose of this article is to discuss several osseous abnormalities and demonstrate their association with temporomandibular joint pain and dysfunction.

Clinical diagnoses and MRI findings in patients with TMD pain

The aim of this study was to compare the findings on magnetic resonance imaging (MRI) in temporomandibular disorders (TMD) pain patients with clinical diagnoses of myofascial pain or arthralgia/osteoarthritis in combination with myofascial pain according to the Research Diagnostic Criteria for TMD. The temporomandibular joints of 60 consecutive patients, 19 with myofascial pain and 41 patients with arthralgia/osteoarthritis in combination with myofascial pain were examined clinically and with MRI. Overall the most common MRI findings were different kinds of disc displacements and structural bone changes, which were found in both pain groups. However, disc displacements were found significantly (P=0.002) more often in the group arthralgia/osteoarthritis in combination with myofascial pain. One hundred and four joints were found to have no clinical diagnosis of disc displacements, but 64 of these joints had findings of disc displacements on MRI. Joint fluid was found in both pain groups. Patients having a combination of disc displacement and joint fluid were significantly (P=0.047) more common in the pain group arthralgia/osteoarthritis in combination with myofascial pain. In conclusion, the MRI findings of different kinds of disc displacement and structural bone changes were common in TMD patients. The clinical diagnoses for subdivision into myogenous only or combined arthrogenous and myogenous pain groups were not confirmed by MRI.

Magnetic resonance imaging characteristics of temporomandibular joint pain during opening and biting in patients with disc displacement

OBJECTIVE

The purpose of this study was to evaluate the magnetic resonance (MR) imaging characteristic of temporomandibular joint (TMJ) pain during opening and biting in patients with disk displacement.

STUDY DESIGN

MR images of 1252 TMJs in 640 patients with disk displacement were studied retrospectively. The relationship between TMJ pain and age, sex, and MR imaging findings, such as disk displacement with or without reduction, TMJ fluid, and osteoarthrosis, was analyzed using logistic regression analysis.

RESULTS

The resultant data showed a significant relationship between TMJ pain during maximum jaw opening and disk displacement without reduction (OR = 2.36). The resultant data also showed a significant relationship between TMJ pain during maximum biting and TMJ fluid (OR = 1.85).

CONCLUSION

The results suggest that TMJ pain during opening and biting is related to disk displacement without reduction and TMJ fluid on MR images.

[Temporomandibular joint: MRI diagnostics]

MRI of the temporomandibular joint (TMJ) requires 1.5 T. The radiologist must be familiar with the anatomy and pathology of the TMJ. This review gives a description of MRI protocols for the TMJ, and MRI anatomy and pathology of the TMJ (open and closed mouth) by means of MR images and drawings. Diagnosing of the TMJ related diseases depends on standardized clinical and MR examinations. Therefore close interdisciplinary cooperation between dentist and radiologist is necessary.