Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

Abstract

Objective. The purpose of this study was to estimate the inter-and intraobserver agreement for interpreting magnetic resonance (MR) images of the temporomandibular joint (TMJ). Methods. The study was based on MR images of 30 TMJs. The images were interpreted by seven observers for disk configuration, disk position, joint fluid, bone marrow changes, and diagnosis. The observers were not calibrated. Kappa statistics were used. Results. The kappa values were, for interobserver agreement of disk configuration, 0.10; for disk position in the sagittal plane with closed mouth, 0.35; for a combination of closed mouth and open mouth, 0.44; for disk position in the coronal plane, 0.17; for joint fluid, 0.36; for bone marrow changes, 0.01; and for diagnosis, 0.39. Intraobserver agreement was generally higher than interobserver agreement. Conclusion. Agreement on disk position in the sagittal plane, on presence and amount of joint fluid, and on diagnosis was fair to moderate. Agreement on disk configuration, on disk position in the coronal plane, and on bone marrow changes was poor.

Web-based calibration of observers using MRI of the temporomandibular joint

“…17 It seems that the diagnosis ''anterior disc displacement without reduction'' reached the highest kappa values and agreements between observers in different publications. 8,13,[15][16][17] In 80% of the cases the five observers agreed on the diagnosis of the disc in the sagittal plane, a finding that is similar to our results.…”

“…This is consistent with the findings of Takano et al, 15 Widmalm et al, 16 Butzke et al 17 and Schmitter et al 8 However, better agreement of the disc shape was found by Tasaki et al 10 One way of increasing the agreement between observers is to reduce the number of categories. This was proposed by Takano et al 15 regarding the finding of joint effusion, and in our study, if the finding of joint fluid was dichotomized to ''yes'' or ''no'', the observer agreement would increase to 80%. Therefore, we propose that the criteria described by Ahmad et al 5 are changed for joint effusion to be stated as present or not.…”

“…In the axially corrected coronal plane, the disc is not centred between the condyle and eminence in either the medial or the lateral parts Disc not visible: Neither signal intensity nor outline make it possible to define a structure as the disc Several studies of observer agreement at MRI of the TMJ have been published. [10][11][12][13][14][15][16][17] It is difficult to compare the studies as different criteria were used, for instance for disc position. Widmalm et al 16 concluded that a diagnosis of TMD based on MRI examination protocols made by a single examiner should not be accepted, as the diagnosis may be misleading.…”

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

“…Another study has shown that when the examiners were not calibrated, the kappa values for inter-examiner agreement on TMJ disc position or configuration were poor. 77 These issues were addressed in our study, as the radiologists were calibrated and used clearly defined image analysis criteria. In detecting effusion, a study reported poor reliability (k = 0.36) for noncalibrated examiners; 77 however, the calibrated examiners in our study had good reliability (k =0.64).…”

“…77 These issues were addressed in our study, as the radiologists were calibrated and used clearly defined image analysis criteria. In detecting effusion, a study reported poor reliability (k = 0.36) for noncalibrated examiners; 77 however, the calibrated examiners in our study had good reliability (k =0.64). Our data suggest that the image analysis criteria developed for the RDC/TMD Validation Project and calibrated examiners led to more reliable interpretation than other reports.…”