Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis

Abstract

Introduction As a part of a multi-site RDC/TMD Validation Project, comprehensive TMJ diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computed tomography (CT). Methods Inter-examiner reliability was estimated using the kappa (k) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. CT was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). Results For the radiological diagnosis of OA, reliability of the three examiners was poor for panoramic radiography (k = 0.16), fair for MRI (k = 0.46), and close to the threshold for excellent for CT (k = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (k = 0.78) and for DD without reduction (k = 0.94), and was good for effusion (k = 0.64). Overall percent agreement for pair-wise ratings was ≥ 82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and for effusion was 81%. Negative percent agreement was ≥ 88% for all conditions. Compared to CT, panoramic radiography and MRI had poor to marginal sensitivity, respectively, but excellent specificity, in detecting OA. Conclusion Comprehensive image analysis criteria for RDC/TMD Validation Project were developed, which can reliably be employed for assessing OA using CT, and for disc position and effusion using MRI.

Assessment of articular disc displacement of temporomandibular joint with ultrasound

“…The disc position classified into normal when anterior border of the disc located superior to the condyle, anteriorly displaced when the anterior border of the disc presents anterior to the condyle, medially displaced when the disc boundary shifted medial to boundary of the condyle, laterally displaced when the disc boundary shifted lateral in comparison to the boundary of the condyle. On MR imaging, the normal and displaced disc position categorized according to previous criteria [30].…”

Usefulness of Dual Echo Volumetric Isotropic Turbo Spin Echo Acquisition (VISTA) in MR Imaging of the Temporomandibular Joint

“…[2][3][4] Another paper reports the 95z accuracy of MR imaging in assessing disk position and form and 93z accuracy in assessing osseous changes. 5 Proton density-weighted images (PDWI) are necessary to detect the position and deformity of the articular disk, [6][7][8] and T 2 -weighted images (T 2 WI) are necessary to detect the level of joint eŠusion, which is associated with pain. 8,9 A dual echo technique is generally used for 2-dimensional (2D)-PDWI and -T 2 WI scans.…”

Signs and symptoms of TMJ disorders in adults after adolescent Herbst therapy: A 6-year and 32-year radiographic and clinical follow-up study

“…8 The results showed that 1 of the 14 patients (7% of TMJs) had osteoarthritis at the 6-year follow-up and 3 of the 14 patients (18% of TMJs) at the 32-year follow-up. These results are in line with the frequencies of osteoarthritis found in a recent CBCT study on subjects without ongoing pain.…”

“…The TMJs (condylar head, mandibular fossa, and articular eminence) were interpreted for structural bone changes. The diagnosis of osteoarthritis was made according to Ahmad et al 8 ( Table 2). The interpretations of the radiographs were made by one observer (AP) at T3 6 and by two observers (Dr Petersson and Dr Salé ) at T4.…”