Evaluation of the reproducibility in the interpretation of magnetic resonance images of the temporomandibular joint

Abstract

Objectives: The aim was to determine the intra-and interexaminer reproducibility in the interpretation of MRI of the temporomandibular joint among independent observers, with respect to six specific articular characteristics, and to discover which of these had greater and lesser agreement. Methods: 30 magnetic resonance examinations of temporomandibular joints of adults were independently interpreted by 9 experienced and trained observers at 2 different times. Observers were divided into three groups according to their specialties: surgeon dentists specialized in temporomandibular dysfunction and orofacial pain, surgeon dentists specialized in radiology and medical doctors specialized in radiology. The reproducibility analysis was carried out using Cohen's kappa coefficient. Results: The interexaminer reproducibility ranged from slight to fair. The intraexaminer reproducibility ranged from slight to no agreement. In the interexaminer evaluation, anterior disc displacement without reduction presented greater agreement, whereas change in condylar head shape showed the poorest agreement. In the intraexaminer evaluation, anterior disc displacement without reduction presented slight agreement, whereas, for the other characteristics, no agreement was observed. Conclusion: Examiners do not demonstrate reproducibility in the interpretation of MRI of temporomandibular joints. Therefore, more efforts are necessary with respect to understanding the changes that may be detected in these images in terms of diagnosis and appropriate treatment approaches.

Web-based calibration of observers using MRI of the temporomandibular joint

“…This is consistent with the findings of Takano et al, 15 Widmalm et al, 16 Butzke et al 17 and Schmitter et al 8 However, better agreement of the disc shape was found by Tasaki et al 10 One way of increasing the agreement between observers is to reduce the number of categories. This was proposed by Takano et al 15 regarding the finding of joint effusion, and in our study, if the finding of joint fluid was dichotomized to ''yes'' or ''no'', the observer agreement would increase to 80%.…”

“…A recent publication concluded that examiners do not demonstrate reproducibility in the interpretation of MRI of the TMJ. 17 It seems that the diagnosis ''anterior disc displacement without reduction'' reached the highest kappa values and agreements between observers in different publications. 8,13,[15][16][17] In 80% of the cases the five observers agreed on the diagnosis of the disc in the sagittal plane, a finding that is similar to our results.…”

“…In the axially corrected coronal plane, the disc is not centred between the condyle and eminence in either the medial or the lateral parts Disc not visible: Neither signal intensity nor outline make it possible to define a structure as the disc Several studies of observer agreement at MRI of the TMJ have been published. [10][11][12][13][14][15][16][17] It is difficult to compare the studies as different criteria were used, for instance for disc position. Widmalm et al 16 concluded that a diagnosis of TMD based on MRI examination protocols made by a single examiner should not be accepted, as the diagnosis may be misleading.…”

Diagnostic reproducibility of temporomandibular joint using magnetic resonance imaging at 0.5 and 1.5 Tesla

“…Even though MRI is considered appropriate to examine the TMJ, research has reported discrepancies between MRI-based and clinical diagnoses 1,[16][17][18][19][20][21][22] . Additionally, studies that evaluated the reproducibility of this method indicate the occurrence of conflicting values [23][24][25][26][27][28][29] . This may be due to two main factors: image quality and observer skills.…”

“…In this sense, some authors have reported that training sessions and the definition of clear diagnosis criteria increase MRI reproducibility 24,26,34,35 . Furthermore, lower reproducibility values were detected in studies that assessed the performance of observers from different clinical centers who had not been trained 23,25 . For Nebbe et al 25 (2000), agreement ranged from slight to substantial for the diagnosis of anterior disc displacement with reduction (DDR) and normal disc position (κ ranging between 0.15 and 0.67), while the agreement for DDWR was excellent (κ = 0.91).…”