Rheumatic and nonrheumatic disease in the temporomandibular joint: gadolinium-enhanced MR imaging.

Abstract

Magnetic resonance (MR) imaging of 36 temporomandibular joints (TMJs) in 27 patients and six healthy volunteers was performed before and after injection of gadopentetate dimeglumine. Twelve asymptomatic joints were used as controls, 12 TMJs had symptomatic internal derangement, and 12 TMJs had rheumatic inflammatory disease. A small or moderate joint effusion was seen in one asymptomatic joint, four joints with internal derangement, and one joint with rheumatic involvement; in all of these, contrast enhancement of the effusion was observed. A large effusion in one rheumatic joint was enhanced only after delayed imaging. In healthy controls and patients with internal derangement, no or only minimal enhancement of intraarticular tissues was seen. Eleven of the 12 rheumatic TMJs showed moderate or intense soft-tissue enhancement along the disk and articular surfaces (ie, in areas normally devoid of synovial membrane). The one rheumatic joint without enhancement had bony ankylosis and no remaining soft tissue within the joint space. Gadolinium-enhanced MR imaging of the TMJ may effectively depict the proliferating synovium of rheumatic inflammatory joint disease.

Dynamic magnetic resonance imaging for the evaluation of synovitis in patients with rheumatoid arthritis

“…Winalski et a1 (17) described joint fluid enhancement in posttraumatic joint effusions within 1.75-3 minutes after intravenous contrast injection. Smith et a1 (18) showed intense joint fluid enhancement in small effusions within the temporomandibular joint with images begun within 1-2 minutes postinjection. It appears that the E ratio measured in this study would actually be an average of the synovium and the joint fluid, as described in our previous report (19).…”

Tempomandibular Joint Evaluation in Rheumatoid Arthritis Patients Using Magnetic Resonance Imaging.

“…These changes were erosion, flattening, osteophyte formation, condylar deformity, sclerosis, subchondral cyst, and condylar irregularities. These are the typical and most common radiographic osseous changes in the TMJ of RA patients ( As stated by (Smith et al, 1992) and (Sommer et al, 2003) the synovial proliferation that occurs in RA can affect the joint disc. Also, joint effusion and bone marrow edema may occur in the active phase of the disease.…”

Potential of fluid-attenuated inversion recovery (FLAIR) in identification of temporomandibular joint effusion compared with T2-weighted images

“…[21][22][23] Hypertrophic synovium is a characteristic of synovitis seen in the patients with internal derangement. 16 Synovitis has been observed arthroscopically and studied to clarify histological changes in disorders of the TMJ.…”