Landes Constantin A, Goral Wojciech A, Sader Robert, Mack Martin G
Oral, Maxillofacial & Plastic Facial Surgery, The Frankfurt University Medical Centre, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
Eur J Radiol. 2007 Feb;61(2):235-44. doi: 10.1016/j.ejrad.2006.09.015. Epub 2006 Oct 27.
To compare clinical feasibility of static two-dimensional (2D) to three-dimensional (3D) sonography of the temporomandibular joint (TMJ) in assessment of disk dislocation and joint degeneration compared to magnetic resonance imaging (MRI).
Thirty-three patients, 66 TMJ were prospectively sonographed 2D and 3D (8-12.5MHz step motor scan), in occlusion and maximum opening with a probe position parallel inferior to the zygomatic arch. Axial 2D images were judged independent from the 3D scans; 3D volumes were cut axial, sagittal, frontal and rotated in real-time. Disk position and joint degeneration were assessed and compared to a subsequent MRI examination.
The specific appearance of the disk was hypoechogenic overlying a hyperechogenic condyle in axial (2D) or sagittal and frontal (3D) viewing. Specificity of 2D sonography for disk dislocation was 63%, sensitivity 58%, accuracy 64%, positive predictive value 46%, negative predictive value 73%; for joint degeneration synonymously 59/68/61/38/83%. 3D sonography for disk displacement reached synonymously 68/60/69/51/76%, for joint degeneration 75/65/73/48/86%. 2D sonographic diagnoses of disk dislocation in the closed mouth position and of joint degeneration showed significantly different results from the expected values (MRI) in chi(2) testing; 3D diagnoses of disk dislocation in closed mouth position, of joint degeneration, 2D and 3D diagnoses in open mouth position were nonsignificant.
Acceptable was the overall negative predictive value, as specificity and accuracy for joint degeneration in 3D. 3D appears superior diagnosing disk dislocation in closed mouth position as for overall joint degeneration. Sensitivity, accuracy and positive predictive value will have to ameliorate with future equipment of higher resolution in real-time 2D and 3D, if sonographic screening shall be clinically applied prior to MRI.
与磁共振成像（MRI）相比，比较颞下颌关节（TMJ）静态二维（2D）超声与三维（3D）超声在评估盘状移位和关节退变方面的临床可行性。
对33例患者的66个颞下颌关节进行前瞻性2D和3D超声检查（8 - 12.5MHz步进电机扫描），检查时处于咬合位和最大开口位，探头平行置于颧弓下方。轴向2D图像独立于3D扫描进行判断；3D容积数据进行轴向、矢状、冠状切割并实时旋转。评估盘状位置和关节退变情况，并与随后的MRI检查结果进行比较。
在轴向（2D）或矢状和冠状（3D）视图中，盘状结构表现为低回声覆盖在高回声髁突上。2D超声诊断盘状移位的特异性为63%，敏感性为58%，准确性为64%，阳性预测值为46%，阴性预测值为73%；诊断关节退变的相应数值为59/68/61/38/83%。3D超声诊断盘状移位的相应数值为68/60/69/51/76%，诊断关节退变的相应数值为75/65/73/48/86%。2D超声诊断闭口位盘状移位和关节退变的结果与预期值（MRI）在卡方检验中有显著差异；3D诊断闭口位盘状移位、关节退变以及2D和3D诊断开口位情况均无显著差异。
总体阴性预测值尚可，3D诊断关节退变的特异性和准确性也较好。3D在诊断闭口位盘状移位和总体关节退变方面似乎更具优势。如果在MRI之前进行超声筛查，随着未来实时2D和3D更高分辨率设备的出现，敏感性、准确性和阳性预测值将得到改善。
