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

Abstract

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.

Diagnostic Value of Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging for Multilocular Ameloblastoma

“…Some studies have reported that FLAIR improved tissue contrast in the presence of degenerative disease of the cervical spine area and brain lesions [10][11][12] . It has also been reported that there is a potential use for FLAIR imaging in patients with vascular malformations and to assess condylar bone marrow changes in temporomandibular joint disorders 14,15) . The FLAIR sequence, however, has not come into common use in the oral and maxillofacial region.…”

“…FLAIR, an MRI sequence, has important roles in brain imaging [10][11][12] and has recently been used to examine pathological areas in the eye 13) . There are few reports, however, of the potential use of FLAIR in the oral and maxillofacial region 14,15) . In the present retrospective study, we qualitatively and quantitatively evaluated MRI sequences, including FLAIR, for their value in identifying multilocular ameloblastoma.…”

The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders

“…Furthermore, Kodama et al [77] referred to the usefulness of fluid-attenuated inversion recovery (FLAIR)-sequence MRI to detect such minimal bone marrow changes. Signal intensity on FLAIR images is significantly higher in painful than in non-painful TMJs [77].…”

“…It has been stated that fat-suppressed T2-weighted MR imaging is useful for the detection of the marrow edema pattern in the mandibular condyle associated with TMJ-related pain [75] , [76] . Furthermore, Kodama et al [77] referred to the usefulness of fluid-attenuated inversion recovery (FLAIR)-sequence MRI to detect such minimal bone marrow changes. Signal intensity on FLAIR images is significantly higher in painful than in non-painful TMJs [77] .…”

“…Furthermore, Kodama et al [77] referred to the usefulness of fluid-attenuated inversion recovery (FLAIR)-sequence MRI to detect such minimal bone marrow changes. Signal intensity on FLAIR images is significantly higher in painful than in non-painful TMJs [77] . A significant and positive association between TMJ pain, joint effusion, and bone marrow abnormalities has also been reported [32] , [78] .…”