全景X线摄影和MRI检测颞下颌关节退行性关节病体征的诊断准确性
Diagnostic accuracy of panoramic radiography and MRI for detecting signs of TMJ degenerative joint disease.
作者信息
Kaimal Shanti, Ahmad Mansur, Kang Wenjun, Nixdorf Donald, Schiffman Eric L
出版信息
Gen Dent. 2018 Jul-Aug;66(4):34-40.
The objective of this study was to determine the diagnostic accuracy of panoramic radiography and magnetic resonance imaging (MRI) for detection of signs of temporomandibular joint (TMJ) degenerative joint disease (DJD). Panoramic radiography and bilateral MRI and computed tomography (CT) of the TMJs were performed for 705 subjects. Three calibrated board-certified radiologists who were blinded to the clinical findings interpreted all images. The diagnoses of DJD established using the panoramic radiographs and MRIs were compared to the reference standard diagnoses derived from the CTs. DJD was defined as the presence of at least 1 of the following 4 signs: a subcortical cyst, surface erosion, osteophyte formation, or generalized sclerosis. The target values for sensitivity and specificity were 70% or greater and 95% or greater, respectively. Compared to the reference standard CTs, the panoramic radiographs had the following sensitivity and specificity values: subcortical cysts, 14% and 100%, respectively; erosion, 20% and 100%, respectively; osteophytes, 12% and 100%, respectively; and sclerosis, 33% and 100%, respectively. The MRIs achieved the following sensitivity and specificity values: subcortical cysts, 32% and 100% respectively; erosion, 35% and 99% respectively; osteophytes, 71% and 98%, respectively; and sclerosis, 50% and 100%, respectively. The radiologists' interexaminer reliability was slight (κ = 0.16) when using panoramic radiographs, moderate (κ = 0.47) when using MRIs, and substantial when using CTs (κ = 0.71) for diagnosis of signs of DJD. Panoramic radiographs and MRIs had below-target sensitivity but above-target specificity in detecting all CT-depicted signs of DJD with the exception of osteophytes, for which MRIs demonstrated adequate diagnostic accuracy. Use of CT for diagnosis of TMJ DJD is recommended to avoid the false-negative findings that can occur if panoramic radiographs and MRIs are used.
本研究的目的是确定全景X线片和磁共振成像（MRI）检测颞下颌关节（TMJ）退行性关节病（DJD）体征的诊断准确性。对705名受试者进行了全景X线片、双侧TMJ的MRI和计算机断层扫描（CT）检查。三名经过校准的、对临床结果不知情的获得委员会认证的放射科医生解读了所有图像。将使用全景X线片和MRI得出的DJD诊断结果与源自CT的参考标准诊断结果进行比较。DJD被定义为存在以下4种体征中的至少1种：皮质下囊肿、表面侵蚀、骨赘形成或广泛性硬化。敏感性和特异性的目标值分别为70%或更高和95%或更高。与参考标准CT相比，全景X线片的敏感性和特异性值如下：皮质下囊肿分别为14%和100%；侵蚀分别为20%和100%；骨赘分别为12%和100%；硬化分别为33%和100%。MRI的敏感性和特异性值如下：皮质下囊肿分别为32%和100%；侵蚀分别为35%和99%；骨赘分别为71%和98%；硬化分别为50%和100%。在诊断DJD体征时，放射科医生使用全景X线片时的检查者间可靠性较低（κ = 0.16），使用MRI时为中等（κ = 0.47），使用CT时为较高（κ = 0.71）。全景X线片和MRI在检测所有CT显示的DJD体征时，除骨赘外，敏感性低于目标值但特异性高于目标值，而MRI对骨赘具有足够的诊断准确性。建议使用CT诊断TMJ DJD，以避免使用全景X线片和MRI时可能出现的假阴性结果。
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