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Oral Radiology

, Volume 34, Issue 3, pp 245–250 | Cite as

Differences in signal intensities of temporomandibular joint (TMJ) effusion on fluid-attenuated inversion recovery (FLAIR) images

  • Mika Otonari-Yamamoto
  • Kenichi Imoto
Original Article

Abstract

Objectives

Joint effusion is demonstrated by high signal intensity in the upper and lower temporomandibular joint (TMJ) spaces on T2-weighted images. The fluid-attenuated inversion recovery (FLAIR) technique can be applied to analyze joint effusion in the TMJ. FLAIR signal intensity can be more sensitively influenced by the contents of joint effusion than T2-weighted signal intensity. The purpose of this study was to analyze the signal intensity of joint effusion on FLAIR images and to investigate the changes in joint effusion contents according to the status of TMJ disorders.

Methods

A total of 48 joints (45 patients) with joint effusion were investigated by magnetic resonance (MR) imaging. Regions of interest were placed over the joint effusion and gray matter on FLAIR images. The joints were categorized as normal disk position (NL), disk displacement with reduction (DWR), disk displacement without reduction (DWOR), and osteoarthritis (OA). The signal intensity ratio of joint effusion was calculated using gray matter as the reference point. The Kruskal–Wallis test and Steel test were applied. A probability of less than 0.05 was considered statistically significant.

Results

The median signal intensity ratios of joint effusion differed significantly among the four joint categories (p = 0.02, Kruskal–Wallis test). The median signal intensity ratio of joint effusion in the OA category was significantly higher than that in the NL category (p = 0.04, Steel test).

Conclusions

The present findings suggest that FLAIR images can demonstrate the changes in joint effusion contents according to the status of TMJ disorders.

Keywords

TMJ MRI FLAIR Joint effusion 

Notes

Acknowledgements

We would like to express our appreciation to Associate professor Mutsumi Takagiwa of the Laboratory of Mathematics of the Tokyo Dental College for advice regarding the statistical analysis of the data.

Compliance with ethical standards

Conflict of interest

Mika Otonari-Yamamoto and Kenichi Imoto declare that they have no conflict of interest.

Human rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Harms SE, Wilk RM, Wolford LM, Chiles DG, Milam SB. The temporomandibular joint: magnetic resonance imaging using surface coils. Radiology. 1985;157:133–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Westesson PL, Brooks SL. Temporomandibular joint: relationship between MR evidence of effusion and the presence of pain and disk displacement. AJR Am J Roentgenol. 1992;159:559–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Larheim TA. Current trends in temporomandibular joint imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;80:555–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Murakami K, Nishida M, Bessho K, Iizuka T, Tsuda Y, Konishi J. MRI evidence of high signal intensity and temporomandibular arthralgia and relating pain. Does the high signal correlate to the pain? Br J Oral Maxillofac Surg. 1996;34:220–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Kaneyama K, Segami N, Yoshimura H, Honjo M, Demura N. Increased levels of soluble cytokine receptors in the synovial fluid of temporomandibular joint disorders in relation to joint effusion on magnetic resonance images. J Oral Maxillofac Surg. 2010;68:1088–93.CrossRefPubMedGoogle Scholar
  6. 6.
    Kaneyama K, Segami N, Nishimura M, Suzuki T, Sato J. Importance of proinflammatory cytokines in synovial fluid from 121 joints with temporomandibular disorders. Br J Oral Maxillofac Surg. 2002;40:418–23.CrossRefPubMedGoogle Scholar
  7. 7.
    Takahashi T, Kondoh T, Fukuda M, Yamazaki Y, Toyosaki T, Suzuki R. Proinflammatory cytokines detectable in synovial fluids from patients with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:135–41.CrossRefPubMedGoogle Scholar
  8. 8.
    Kubota E, Imamura H, Kubota T, Shibata T, Murakami K. Interleukin 1 beta and stromelysin (MMP3) activity of synovial fluid as possible markers of osteoarthritis in the temporomandibular joint. J Oral Maxillofac Surg. 1997;55:20–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Shafer DM, Assael L, White LB, Rossomando EF. Tumor necrosis factor-alpha as a biochemical marker of pain and outcome in temporomandibular joints with internal derangements. J Oral Maxillofac Surg. 1994;52:786–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Sandler NA, Buckley MJ, Cillo JE, Braun TW. Correlation of inflammatory cytokines with arthroscopic findings in patients with temporomandibular joint internal derangements. J Oral Maxillofac Surg. 1998;56:534–43.CrossRefPubMedGoogle Scholar
  11. 11.
    Imoto K, Otonari-Yamamoto M, Nishikawa K, Sano T, Yamamoto A. Potential of fluid-attenuated inversion recovery (FLAIR) in identification of temporomandibular joint effusion compared with T2-weighted images. Oral Surg Oral Med Oral Pathol. Oral Radiol Endod. 2011;112:243–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Melhem ER, Jara H, Eustace S. Fluid-attenuated inversion recovery MR imaging: identification of protein concentration thresholds for CSF hyperintensity. AJR Am J Roentgenol. 1997;169:859–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg. 1989;115:469–77.CrossRefPubMedGoogle Scholar
  14. 14.
    Oliveira JX, Rosa JA, Dutra MEP, Santos KCP, Gil C. Assessing joint effusion and bone changes of the head of the mandible in MR images of symptomatic patients. Braz Oral Res. 2013;27:37–41.CrossRefPubMedGoogle Scholar
  15. 15.
    Chang H, Israel H. Analysis of inflammatory mediators in temporomandibular joint synovial fluid lavage samples of symptomatic patients and asymptomatic controls. J Oral Maxillofac Surg. 2005;63:761–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Larheim TA, Westesson PL, Sano T. MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain. Int J Oral Maxillofac Surg. 2001;30:104–12.CrossRefPubMedGoogle Scholar
  17. 17.
    Schellhas KP, Wilkes CH. Temporomandibular joint inflammation: comparison of MR fast scanning with T1- and T2-weighted imaging techniques. Am J Neuroradiol. 1989;153:93–8.Google Scholar
  18. 18.
    Adame CG, Monje F, Offnoz M, Martin-Granizo R. Effusion in magnetic resonance imaging of the temporomandibular joint: a study of 123 joints. J Oral Maxillofac Surg. 1998;56:314–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc. 2001;132:476–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Rudisch A, Innerhofer K, Bertram S, Emshoff R. Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:566–71.CrossRefPubMedGoogle Scholar
  21. 21.
    Yamamoto M, Sano T, Okano T. Magnetic resonance evidence of joint fluid with temporomandibular joint disorders. J Comput Assist Tomogr. 2003;27:694–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Segami N, Nishimura M, Kaneyama K, Miyamaru M, Sato J, Murakami KI. Does joint effusion on T2 magnetic resonance imaging reflect synovitis? Comparison of arthroscopic findings in internal derangements of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:341–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Segami N, Miyamaru M, Nishimura M, Suzuki T, Kaneyama K, Murakami K. Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 2. Comparison of concentration levels of proinflammatory cytokines and total protein in synovial fluid of the temporomandibular joint with internal derangements and osteoarthrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94:515–21.CrossRefPubMedGoogle Scholar
  24. 24.
    Segami N, Suzuki T, Sato J, Miyamaru M, Nishimura M, Yoshimura H. Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 3. Comparison of histologic findings of arthroscopically obtained synovium in internal derangements of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:761–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Hanyuda H, Otonari-Yamamoto M, Imoto K, Sakamoto J, Kodama S, Kamio T, et al. Analysis of elements in a minimal amount of temporomandibular joint fluid on fluid-attenuated inversion recovery magnetic resonance images. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115:114–20.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial RadiologyTokyo Dental CollegeTokyoJapan

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