Schellhas K P, Wilkes C H, Omlie M R, Peterson C M, Johnson S D, Keck R J, Block J C, Fritts H M, Heithoff K B
Center for Diagnostic Imaging, St. Louis Park, MN 55416.
AJR Am J Roentgenol. 1988 Aug;151(2):341-50. doi: 10.2214/ajr.151.2.341.
The reliability and accuracy of two-compartment temporomandibular joint (TMJ) arthrography was compared with MR imaging on the basis of an analysis of surgical findings obtained from joints that had been studied preoperatively with arthrography or MR or, in some cases, both procedures. Seven hundred forty-three consecutive TMJ arthrograms were successfully obtained in a total of 443 patients by using a single 27-gauge needle and a two-compartment technique in each joint. There was a 100% correlation with surgical findings in 218 radiologically abnormal joints operated on within 90 days of arthrography with respect to the presence or degree of meniscus displacement and normal or abnormal disk morphology and function. In 604 patients 1052 TMJs were studied with high-field-strength surface-coil MR. Surgical findings were available for correlation in 170 of the joints studied. Forty-three joints were studied with both two-compartment arthrography and MR. Eight operated joints had been imaged successfully with both two-compartment arthrography and MR. Both methods of evaluation provided highly reliable and accurate information regarding meniscus position and shape. Arthrography was superior to MR in detecting capsular adhesions and the presence or absence of perforation of the disk or meniscus attachments. Simple meniscectomy (with or without insertion of a temporary Silastic TMJ implant) was the most frequently performed surgical procedure in the series, followed by meniscus repositioning procedures. Joint effusions, failed TMJ implants, and avascular necrosis were demonstrated best with MR. Soft-tissue lesions, including intrinsic degeneration of the meniscus, anomalous muscle development, muscle atrophy, tendinitis, and injuries such as contusions and hematomas, were demonstrated only with MR. Partial-flip-angle GRASS (gradient-recalled acquisition in the steady state) techniques permit both fast scanning and study of functional joint dynamic. Joint fluid may appear as high signal intensity on GRASS images because of T2*-weighting. We recommend MR as the procedure of choice for diagnosis of uncomplicated internal derangements of the TMJ. Two-compartment arthrography with videofluoroscopy is an important ancillary procedure that should be performed whenever capsular adhesions or perforations are suspected and not demonstrated with MR and whenever MR is inconclusive.
在对术前接受关节造影或磁共振成像（MR）检查，或在某些情况下同时接受这两种检查的关节手术结果进行分析的基础上，比较了双腔颞下颌关节（TMJ）造影与MR成像的可靠性和准确性。通过在每个关节使用一根27号针和双腔技术，共443例患者成功获得了743例连续的TMJ关节造影。在造影后90天内接受手术的218个放射学异常关节中，半月板移位的存在或程度以及盘形态和功能正常或异常方面，与手术结果的相关性为100%。604例患者的1052个TMJ接受了高场强表面线圈MR检查。其中170个关节有可供对比的手术结果。43个关节同时接受了双腔关节造影和MR检查。8个接受手术的关节同时成功进行了双腔关节造影和MR成像。两种评估方法在半月板位置和形状方面均提供了高度可靠和准确的信息。关节造影在检测关节囊粘连以及盘或半月板附着处有无穿孔方面优于MR。单纯半月板切除术（有或无临时硅橡胶TMJ植入物）是该系列中最常施行的手术，其次是半月板复位手术。MR对关节积液、TMJ植入物失败和缺血性坏死的显示最佳。软组织病变，包括半月板的内在退变、异常肌肉发育、肌肉萎缩、肌腱炎以及挫伤和血肿等损伤，仅能通过MR显示。部分翻转角GRASS（稳态梯度回波采集）技术既能实现快速扫描，又能研究关节功能动态。由于T2*加权，关节液在GRASS图像上可能表现为高信号强度。我们推荐MR作为诊断TMJ单纯性内部紊乱的首选检查方法。当怀疑有未被MR显示的关节囊粘连或穿孔，以及MR结果不明确时，带视频透视的双腔关节造影是一项重要的辅助检查。
