Emshoff Rüdiger, Jank Siegfried, Rudisch Ansgar, Walch Claudia, Bodner Gerd
Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Austria.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Mar;93(3):369-75. doi: 10.1067/moe.2002.121432.
The purpose of this study was (1) to describe errors in the interpretation of high-resolution ultrasonography (HR-US) images of the temporomandibular joint (TMJ) and analyze the discrepancies between HR-US imaging and diagnostic magnetic resonance imaging findings, and (2) to measure interobserver and intraobserver variations with respect to reporting HR-US images of the TMJ.
The sonographic reports of 208 patients aged 13 to 78 years who had a prospective clinical diagnosis of TMJ internal derangement were correlated with magnetic resonance imaging results. Prospective and retrospective readings were used to classify types of disk displacement. Assessment of observer variation was based on a set of 200 HR-US images in 50 randomly selected patients. The images were interpreted independently by 2 trained radiologists at 2 sessions, 1 to 2 weeks apart.
Prospective interpretation of TMJ HR-US images at the closed-mouth position had a sensitivity of 80%, specificity of 87%, and accuracy of 82%. For images at the maximum mouth-opening position, the sensitivity was 68%, specificity 93%, and accuracy 82%. The number of diagnostic errors at retrospective analysis was 60.3% (n = 73) of the number at prospective analysis. The intraobserver agreement for reporting the disk position at the closed-mouth position was 93% and at the maximum mouth-opening position was 88%. The agreement between the 2 observers was 89% on the position of the disk at the closed-mouth position and 84% at the maximum mouth-opening position.
The high diagnostic accuracy, together with the low observer variation reported in this study, suggest that HR-US of the TMJ is a valuable imaging technique for assessment of disk displacement. Many errors that occur at prospective analysis didn't occur at retrospective analysis.
本研究的目的是（1）描述颞下颌关节（TMJ）高分辨率超声（HR-US）图像解读中的错误，并分析HR-US成像与诊断性磁共振成像结果之间的差异，以及（2）测量观察者间和观察者内关于报告TMJ的HR-US图像的差异。
对208例年龄在13至78岁之间、临床前瞻性诊断为TMJ内部紊乱的患者的超声报告与磁共振成像结果进行相关性分析。采用前瞻性和回顾性解读来分类盘状移位的类型。观察者差异评估基于从50例随机选择的患者中选取的200幅HR-US图像。这些图像由2名经过培训的放射科医生在2次独立的会诊中进行解读，两次会诊间隔1至2周。
在闭口位时对TMJ的HR-US图像进行前瞻性解读，其敏感性为80%，特异性为87%，准确性为82%。对于最大开口位的图像，敏感性为68%，特异性为93%，准确性为82%。回顾性分析时的诊断错误数量是前瞻性分析时的60.3%（n = 73）。观察者内关于报告闭口位时盘状位置的一致性为93%，最大开口位时为88%。两位观察者之间关于闭口位时盘状位置的一致性为89%，最大开口位时为84%。
本研究报告的高诊断准确性以及低观察者差异表明，TMJ的HR-US是评估盘状移位的一种有价值的成像技术。许多在前瞻性分析中出现的错误在回顾性分析中并未出现。
