Assessment of articular disc displacement of temporomandibular joint with ultrasound

Abstract

Purpose To assess pattern of articular disc displacement in patients with internal derangement (ID) of temporomandibular joint (TMJ) with ultrasound. Materials and methods Prospective study was conducted upon 40 TMJ of 20 patients (3 male, 17 female with mean age of 26.1 years) with ID of TMJ. They underwent highresolution ultrasound and MR imaging of TMJ. The MR images were used as the gold standard for calculating sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of ultrasound for diagnosis of anterior or sideway displacement of the disc. Results The anterior displaced disc was seen in 26 joints at MR and 22 joints at ultrasound. The diagnostic efficacy of ultrasound for anterior displacement has sensitivity of 79.3 %, specificity of 72.7 %, accuracy of 77.5 %, PPV of 88.5 %, NPV of 57.1 %, PLR of 2.9 and NLR of 0.34. The sideway displacement of disc was seen in four joints at MR and three joints at ultrasound. The diagnostic efficacy of ultrasound for sideway displacement has a sensitivity of 75 %, specificity of 63.6 %, accuracy of 66.7 %, PPV of 42.8, NPV of 87.5 %, PLR of 2.06, and NLR of 0.39. Conclusion We concluded that ultrasound is a non-invasive imaging modality used for assessment of anterior and sideway displacement of the articular disc in patients with ID of TMJ.Riassunto Scopo Valutare i pattern della dislocazione del disco articolare nei pazienti con squilibrio interno (ID) dell'articolazione temporo-mandibolare (ATM) con l'ecografia. Materiale e metodi E' stato condotto uno studio prospettico su 40 ATM di 20 pazienti (3 maschi, 17 femmine, con età media di 26,1 anni) con ID della TMJ. Tutti sono stati sottoposti ad ecografia ad alta risoluzione e RM della TMJ. La RM è stati utilizzata come il gold standard per il calcolo di sensibilità, specificità, accuratezza, valore predittivo positivo (PPV), valore predittivo negativo (NPV), rapporto di probabilità positivo (PLR) e rapporto di probabilità negativo (NLR) dell'ecografia nella la diagnosi di dislocazione anteriore o lateralmente del disco. Risultati Il disco appariva dislocato anteriormente in 26 ATM con la MR e in 22 con l'ecografia. L'efficacia diagnostica dell'ecografia nella diagnosi di dislocazione anteriore aveva sensibilità del 79,3 %, specificità del 72,7 %, accuratezza del 77,5 %, valore predittivo positivo del 88,5 %, NPV di 57,1 %, PLR di 2,9 e NLR di 0,34. Il dislocamento laterale del disco è stata osservato in 4 casi con MR e 3 con ecografia. L'efficacia diagnostica dell'ecografia per lo spostamento laterale aveva sensibilità del 75 %, specificità del 63,6 %, accuratezza del 66,7 %, PPV di 42,8, NPV di 87,5 %, PLR di 2.06 e NLR di 0,39. Conclusioni Abbiamo concluso che l'ecografia è una metodica di imaging non invasiva che può essere utilizzata per la valutazione delle dislocazioni anteriori e laterali del disco articolare nei pazienti con ID di TMJ.

Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis

“…MR imaging has a role in the assessment of knee joint but it is expensive [7][8][9][10]. Ultrasound is becoming more popular in the evaluation of different musculoskeletal abnormalities such as different rheumatic disease, soft tissue lesions, and joints [10][11][12][13][14]. Few studies discuss the role of ultrasound in knee joint [15][16][17] as well as ultrasound findings in patients with knee osteoarthritis [18][19][20][21][22][23][24][25].…”

Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis

“…For the reference standard domain, we consider the risk of bias high in one study [35], because the reference standard findings were interpreted without blinding of the index test results. The risk of bias in another four studies was considered unclear [24, 29, 32, 33], because we were unable to confirm whether the reference standard results were interpreted in a blinded manner of the index test findings. In the flow and timing domain, we considered the risk of bias high in three studies [23, 28, 35], because not all the patients included were in the final analysis in these studies.…”

“…For the index test domain, we consider the risk of bias high in one study [35], because the index test results were interpreted without blinding of the reference standard findings. Also, we consider the risk of bias unclear in another four studies [24, 29, 32, 33], because we were unable to confirm whether the index test results were interpreted in a blinded manner of the reference standard findings. For the reference standard domain, we consider the risk of bias high in one study [35], because the reference standard findings were interpreted without blinding of the index test results.…”

“…The interpretation of US imaging varied among these studies. Eight studies identified the disc as hypoechoic to isoechoic [23, 24, 26, 27, 29–31, 33] and another three studies as hyperechoic [17, 25, 32]. However, the remaining five studies did not report the radiographic features of disc in US.…”

Ultrasound in maxillofacial imaging: A review

“…[34,36] Razek et al (2015) assessed the pattern of articular disc displacement in patients with internal derangement using US and concluded that the diagnostic efficacy of US for anterior displacement has sensitivity of 79.3%, specificity of 72.7%. [37] Other applications of US Periapical and intraosseous lesions, maxillofacial trauma, detection of foreign bodies, US guided fine needle biopsy, submandibular gland injection of botulinum toxin for hypersalivation in cerebral palsy and in basket retrieval of salivary stones. [11] US has gained an importance for squamous cell carcinoma (SCC) involving the base of the tongue which is difficult to assess clinically.…”