Jeon Kug Jin, Lee Chena, Choi Yoon Joo, Han Sang-Sun
Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Republic of Korea.
Quant Imaging Med Surg. 2021 May;11(5):1921-1931. doi: 10.21037/qims-20-857.
The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms.
A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test.
TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85).
CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.
本研究的目的是分析颞下颌关节紊乱病（TMD）患者的锥束计算机断层扫描（CBCT）和磁共振成像（MRI）结果，并全面评估这些影像学结果与临床症状之间的关系。
回顾性分析了377例有TMD临床症状且同时接受CBCT和MRI检查的患者的754个颞下颌关节（TMJ）。临床症状包括TMJ疼痛、TMJ弹响和张口受限。口腔放射科医生评估CBCT上髁突头部的骨质变化，以及MRI上的盘状结构、关节内紊乱和关节积液。分析CBCT和MRI结果的频率以及年龄的均值和标准差。使用适用于Windows的SPSS 25.0版（美国纽约州阿蒙克市IBM公司）进行逻辑回归分析，以确定这些影像学结果与临床症状之间的关联。使用Hosmer和Lemeshow检验评估模型拟合情况。
TMD患者包括294名女性和83名男性，20 - 39岁年龄组占患者的47.2%。65.1%的患者CBCT上髁突头部骨质变化结果正常。在MRI上，54.9%的患者发现盘状结构改变，62.6%有关节内紊乱，46.0%有关节积液。TMJ疼痛与骨质硬化[比值比（OR）：3.81]、不可复性盘移位（DDWOR）（OR：3.22）、2级关节积液（OR：2.33）和3级关节积液（OR：5.54）显著相关。TMJ弹响与可复性盘移位（DDWR）（OR：3.04）、DDWOR（OR：2.50）、2级关节积液（OR：2.37）和3级关节积液（OR：3.23）显著相关。张口受限与盘状结构扁平（OR：2.08）、盘状结构折叠（OR：2.30）和3级关节积液（OR：2.85）显著相关。
CBCT结果与临床症状关系不大。相比之下，MRI结果，包括盘状结构、关节内紊乱和关节积液，与临床症状相关。这些结果表明，对于TMD患者的正确诊断，应推荐使用MRI而非CBCT。
