MRI of the Temporomandibular Joint Disk and Posterior Disk Attachment Before and After Nonsurgical Treatment

Suenaga, Shigeaki; Sonoda, Satoru; Oku, Teruo; Abeyama, Kazuhiro; Noikura, Takenori

doi:10.1097/00004728-199711000-00008

Cited by 33 publications

(9 citation statements)

References 14 publications

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“…A number of studies have investigated the causes of TMJ pain, including impingement and compression of the retrodiscal tissue [26, 27], inflammatory change in the retrodiscal tissue [28, 29], inflammatory change in the joint space resulting in joint effusion [30], capsulitis [31, 32], osteoarthritis [33–39], and alteration in the condylar bone marrow of the mandible [9, 11, 15]. Sano et al [9] showed an association between a marked increase in pain and alteration in the bone marrow of the mandibular condyle.…”

Section: Discussionmentioning

confidence: 99%

Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders

et al. 2014

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ObjectivesEdema and necrosis of the temporomandibular joint (TMJ) have been described in terms of bone marrow signal abnormalities in magnetic resonance imaging (MRI). However, painful joints often show no such signaling abnormalities, making the diagnosis of TMJ disorders difficult in the clinical setting. An association has been suggested between TMJ bone marrow change and TMJ pain, but even when such change results in slight pain, it may be too slight to be visually apparent on MR images. We hypothesized that fluid-attenuated inversion recovery (FLAIR) can be used to detect such minimal changes. The purpose of this study was to determine whether there is an association between signal intensity on FLAIR images and pain in the TMJ.MethodsThe study included 85 TMJs in 45 patients referred to our department for MRI. The signal intensity on FLAIR images was measured. Pain was evaluated based on the visual analog scale. An unpaired t test and Pearson’s product-moment correlation coefficient were used for the statistical analysis. A p value of <0.05 was considered statistically significant.ResultsSignal intensity on the FLAIR images was significantly higher in painful than in nonpainful TMJs, although a significant correlation was not observed between the signal intensity and the pain score.ConclusionsThe results of this study suggest an association between abnormalities in the marrow of the mandibular condyle and pain. They also indicate that FLAIR imaging is a useful tool in the clinical diagnosis of painful TMJs.

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Section: Discussionmentioning

confidence: 99%

Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders

et al. 2014

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“…Thus, we measured the permeability of the intact synovial membrane in a nonarthritic state. Because gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) is rapidly enhanced in the joint cavity of the TMJ, 5,15 Gd-DTPA (0.5 kDa) must be able to permeate the syno-vial membrane. We also selected 3 contrast reagents-an oligomer-based contrast reagent (CH3-DTPA-Gd; 2.1 kDa), gadolinium-labeled polylysine (Gd-polylysine; 10 kDa), and gadolinium-labeled albumin (Gd-albumin; 74 kDa)-and tried to measure the molecular weight dependency of the permeability of the synovial membrane.…”

Section: Introductionmentioning

confidence: 99%

Structure and Size-selective Permeability of the Synovial Membrane of the Temporomandibular Joint of the Mouse Measured by MR Imaging at 7T

2015

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Purpose: We analyzed the anatomical structure of the temporomandibular joint (TMJ) and molecular weight dependency of synovial membrane permeability in mice using 7-tesla magnetic resonance (MR) imaging.Methods: We obtained 3-dimensional (3D) T 1 -weighted gradient echo (3D-T 1 W) and 3D T 2 -weighted rapid acquisition with relaxation enhancement (3D-T 2 W RARE) MR images of the TMJ of male C57BL6 mice with voxel resolution of 65 µm. Two-dimensional (2D) T 1 w images were measured every 45 s before and after bolus intravenous (IV) injection of contrast reagents: gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA; 0.5 kDa); oligomer-based contrast agent (CH3-DTPA-Gd; 2.1 kDa); gadolinium-labeled polylysine (Gd-polylysine; 10 kDa); and gadolinium-labeled albumin (Gd-albumin; 74 kDa).Results: T 1 W images depicted the temporal bone and mandibular condyle as regions with lower signal intensity and the disc as a region of intermediate intensity. In the Gd-DTPA-enhanced T 1 W and T 2 W images, the articular disc could be identified as a region with lower signal intensity than that of the upper and lower joint cavities. After IV injection of Gd-DTPA or CH3-DTPA-Gd, the signal intensity of the joint cavities increased within 10 min, but this increase was not shown with Gd-polylysine and Gd-albumin.Conclusion: The structural findings obtained by MR imaging agreed with those obtained by hematoxylin-eosin staining under light microscopy. Contrast-enhanced MR imaging suggested that smaller (<2.1 kDa) but not larger (>10 kDa) molecules can permeate the synovial membrane. Our results suggest the utility of MR imaging for analyzing the structure of the TMJ as well as permeability of the synovial membrane.

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“…Dynamic contrast-enhanced MRI with closed mouth revealed that TMJs with pain or dysfunction had a higher signal intensity than those without pain or dysfunction 22,23) . On T2W images with mouth open, a slight increase in signal intensity in painful joints was observed in comparison with painfree joints 17) .…”

Section: Discussionmentioning

confidence: 98%

Magnetic Resonance Signal Intensity from Retrodiscal Tissue Related to Joint Effusion Status and Disc Displacement in Elderly Patients with Temporomandibular Joint Disorders

Ohkubo

Sano

Otonari-Yamamoto

et al. 2009

Bull. Tokyo Dent. Coll.

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Magnetic resonance imaging (MRI) on patients with temporomandibular joint disorders (TMD) has revealed that a decrease and/or increase in signal intensity from retrodiscal tissue, joint effusion (the excessive accumulation of joint fluid) and articular disc displacement are related to TMD. However, the effect of aging on these phenomena has yet to be clarified. This study was carried out to explore the relationship between changes in signal intensity from retrodiscal tissue, joint fluid status and pathological disc conditions in elderly patients with TMD. Twenty patients aged over 60 years were examined. They consisted of one man and 19 women, and ranged between 60 and 79 years in age (mean, 66.0 years). The relationships between decreased signal intensity on proton-density-weighted (PDW) images and increased signal intensity on T2-weighted (T2W) MR images from retrodiscal tissue, joint fluid status and state of articular disc were examined. Joint fluid status was classified into 5 levels by extent of high signal areas in upper and lower articular spaces on T2W images. Disc displacement status was evaluated by PDW images. The Wilcoxon test was applied for the statistical analysis. The group showing increased T2W signal intensities from the retrodiscal tissue consisted of 31 out of 40 joints (77.5%). This group showed a significant difference in comparison with the other groups in which no apparent joint fluid was shown (pϽ0.05). There were no statistically significant differences among other categories. The results suggest a negative relationship between joint fluid and increased signal intensity from retrodiscal tissue due to reflection of the inflammatory reaction in TM joints.

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MRI of the Temporomandibular Joint Disk and Posterior Disk Attachment Before and After Nonsurgical Treatment

Abstract: These results suggest an association between a decrease in contrast enhancement of the posterior disk attachment and resolution or reduction in joint pain. This association was much stronger than the association between the clinical findings and the anatomy of the disk.

Cited by 33 publications

References 14 publications

Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders

Signal intensity on fluid-attenuated inversion recovery images of condylar marrow changes correspond with slight pain in patients with temporomandibular joint disorders

Structure and Size-selective Permeability of the Synovial Membrane of the Temporomandibular Joint of the Mouse Measured by MR Imaging at 7T

Magnetic Resonance Signal Intensity from Retrodiscal Tissue Related to Joint Effusion Status and Disc Displacement in Elderly Patients with Temporomandibular Joint Disorders

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