Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol

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.

Digital image filters are not necessarily related to improvement in diagnostic of degenerative bone changes in the temporomandibular joint on cone beam computed tomography

“…Studies have assessed the prevalence of bone changes in the TMJ by using several parameters: different CBCT devices, application or not of image filters, voxels of different sizes, different image re-construction software, and different image assessment methods (Al-Ekrish et al, 2017;Choudhary et al, 2020;Derwich, Mitus-Kenig & Pawlowska, 2020;Hou et al, 2020;Miller et al, 2018;Oliveira et al, 2020;Sun et al, 2018;Urtane et al, 2018). Even so, it is possible to state that the majority of these studies found that faceting was the most prevalent change.…”

Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis—Review of the Literature

“…These images were considered to be complementary, more detailed, providing more information on joint disc morphology. Miller et al [44] divided MRI protocols into two groups: "the minimal required protocol" and "the ideal protocol". The former is recommended for routine TMJ diagnosis and for retrospective research studies, whereas the latter provides further information in prospective imaging studies.…”

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

“…The main growth centre of the mandible is located in the condyle, and mandibular growth is therefore vulnerable to arthritic changes [8]. Early detection and treatment of TMJ arthritis is important to preserve mobility and to prevent growth abnormalities and deformities which have been found to be associated with impaired health-related quality of life [9]. Conventional radiography and cone beam computed tomography (CT) are used to detect condylar bony abnormalities (Fig.…”

“…1 ). Compared to conventional radiography, CT and cone beam CT avoid difficulties of superimposition and offer unsurpassed resolution of cortical surfaces, but soft tissue changes such as those related to the disc and joint capsule as well as bone marrow oedema cannot accurately be assessed [ 9 , 10 ].

Fig.

…”

“…Small dots or lines of high signal intensity on T2-weighted sequences within the joint recesses are considered physiological joint fluid [ 15 ]. Synovial thickness is difficult to measure due to rapid diffusion of contrast to the synovial fluid, but comparing post-contrast T1-weighted fat-saturated images to pre-contrast T2-weighted fat-saturated images which demonstrates the extent of joint effusion can be helpful [ 9 , 16 ]. Figure 2 depicts an example of active TMJ arthritis on MRI.…”