Temporomandibular joint involvement in childhood arthritis: comparison of ultrasonography-assessed capsular width and MRI-assessed synovitis

Abstract

Objectives: Ultrasonography is an effective, low-cost, low-threshold and convenient diagnostic tool in childhood arthritis, but its value in temporomandibular joint (TMJ) involvement is not clear. The purpose of our study was to explore the reliability of ultrasonography to assess TMJ inflammation using contrast-enhanced MRI as reference standard, in order to deduce cut-off values for TMJ capsular width to detect enhanced synovial thickening (synovitis). Methods: 124 ultrasonography and MRI examinations in 55 patients [mean age 12.4 ± 3.5 years (±standard deviation)], the majority obtained within 1 day, were scored for subcondylar and condylar capsular width (ultrasonography images) and amount of synovitis (MR images). The correlations of these findings were calculated. A receiver operating characteristic (ROC) curve analysis, with MRI findings as reference standard, was obtained. Results:The correlation between ultrasonography-assessed capsular width and MRIassessed amount of synovitis was moderate both at the subcondylar and condylar level [Spearman's rho (r): 0.483; p , 0.001 and 0.347; p , 0.001 respectively]. The ROC curve indicated the best discriminatory ability at the subcondylar level with an area under the curve of 0.77 (95% confidence interval 0.69-0.85) and a cut-off value of 1.2 mm (sensitivity 72%, specificity 70%) for the capsular width. Conclusions: A moderate correlation between ultrasonography-assessed capsular width and MRI-assessed synovitis was found in childhood arthritis with the best discriminatory ability at the subcondylar level. This indicates that ultrasonography may be a valuable diagnostic tool in the initial assessment of TMJ inflammation.

Temporomandibular joint arthritis in juvenile idiopathic arthritis, now what?

“…Likewise, Muller et al reported that MRI and even physical examination were both more sensitive at the detection of active inflammatory changes and arthritic sequelae as compared to US [ 18 ]. More recently, Kirkhus et al compared the correlation between ultrasonography-assessed capsular width and MRI assessment of synovitis (T1 weighted [T1W] signal increase at the synovium following administration of contrast), finding a correlation of 0.483 ( p < 0.001) at the subcondylar level, concluding in contrast to the previous studies that US may in fact be a useful screening tool for arthritis of the TMJ [ 23 ]. In support, several other studies that did not constitute direct comparisons with MRI did show that US frequently detected findings of active arthritis in children with JIA [ 24 – 26 ].…”

Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis

“…This process led to the exclusion of 19 studies presented in Supplementary Material 2. Finally, 28 studies satisfied the inclusion criteria of this review and were selected for the qualitative synthesis.. [9][10][11][12][13][14] 22 studies were quantitatively divided in groups and analyzed by a meta-analysis. [10][11][12][13][14]27,28,[30][31][32][33][34][35][36][37][38][39][40]43,[46][47][48]…”

“…7,8 Several studies have assessed ultrasound (US) to evaluate TMJ alterations. [9][10][11][12][13] The high-frequency source pulse emitted, and the echoes detected are accomplished by a transducer placed in contact to the patient skin acquiring the image in real time. The ultrasound frequency usually ranges from 2 MHz to 15 MHz depending on the anatomic region depth to be evaluated.…”

Dynamic Weight-bearing Magnetic Resonance in the Clinical Diagnosis of Internal Temporomandibular Joint Disorders

“…14 One of the first articles that described this technique stressed the possibility of identifying the position of the articular disk and capsule distension in some disorders, 32 especially in juvenile arthritis. 15 More specifically, ultrasound is a good screening technique to identify lesions of the capsule-ligament and disk-articular units. Furthermore, as stated by different authors, it can identify bone erosions, marginal osteophytes, and condylar deformities.…”

“…Its usefulness has been validated in the international literature for its capability in detecting joint range of motion, the relation of the condyledisk complex, and the identification of structural changes in different disorders. [14][15][16] The knowledge of joint dynamics applied to ultrasound functional studies in orthostasis showed good correlation with MRI studies in a supine position 16 and with the joint pseudo-dynamic MRI. 5 The use of WBMRI for the evaluation of TMJ movement has not yet found official validation because it is considered an innovative technique, but it can still provide useful clinical information compared with other functional dynamic techniques, such as condylography and dynamic ultrasound.…”