Assessment of MRI findings and clinical symptoms in patients with temporomandibular joint disorders

Abstract

Objectives: To investigate the correlations among various temporomandibular joint (TMJ) findings on MRI and the relationships between MRI findings and symptoms.

Methods: 425 patients (850 TMJs) with temporomandibular joint disorders (TMDs) who underwent MRI were enrolled. Oblique sagittal proton density-weighted and T2 weighted images in open- and closed-mouth positions were evaluated. MRI findings included disc configuration, disc position, condylar morphology, bone marrow pattern, and joint effusion. Symptoms included TMJ pain, TMJ noise, and limitation of mouth opening. For statistical analyses, Spearman's rank correlation coefficient and logistic regression analysis were applied.

Results: Folded disc, disc displacement without reduction (DDWOR), and osteophytes had significant negative correlations with other normal MRI findings (p < 0.01). DDWOR and marrow edema were associated with TMJ pain. Conversely, osteophytes [odds ratio (OR): 0.52; 95% CI (0.30-0.90)] and combination-type condylar degeneration [OR: 0.45; 95% CI (0.24-0.83)] were associated with decreased risk of TMJ pain. Condylar flattening was positively associated with TMJ noise [OR: 5.25; 95% CI (1.44-19.07)] and negatively associated with limitation of mouth opening [OR: 0.34; 95% CI (0.11-0.99)]. High-grade joint effusion was significantly associated with TMJ pain and noise.

Conclusions: DDWOR and high-grade joint effusion (an indicator of inflammation in the articular cavity) were associated with TMD symptoms. This finding suggests that treatment strategy for DDWOR and decreasing inflammation might lessen clinical TMD symptoms. Condylar degeneration was not associated with indicators of inflammation or TMJ symptoms. These results suggest that patients with TMD symptoms should undergo initial MRI to allow rapid selection of appropriate therapies.

Figures

Figure 1.

Types of disc configurations on proton density-weighted images. (a, e) Biconcave disc. (b, f) Flattened disc. (c, g) Concave disc. (d, h) Folded disc.

Figure 2.

Proton density-weighted images show condylar degenerative morphologies. (a) Erosion. (b) Sclerosis. (c) Flattening. (d) Osteophytes.

Figure 3.

Proton density-weighted images (left) and T2 weighted images (right) show condylar bone marrow abnormalities. (a) Bone marrow edema. (b) Bone marrow sclerosis. (c) Bone marrow edema with sclerosis.

Figure 4.

T2 weighted images show joint effusions. (a) Grade 0. (b) Grade 1. (c) Grade 2. (d) Grade 3.