Reliability of diagnostic imaging for degenerative diseases with osseous changes in the temporomandibular joint with special emphasis on subchondral cyst

  • Michihito NozawaEmail author
  • Nobumi Ogi
  • Yoshiko Ariji
  • Yoshitaka Kise
  • Miwa Nakayama
  • Masako Nishiyama
  • Munetaka Naitoh
  • Kenichi Kurita
  • Eiichiro Ariji
Original Article



The present study aimed to clarify the reliabilities of four characteristic appearances, subchondral cyst, erosion, generalized sclerosis, and osteophyte, for evaluation of degenerative diseases with osseous changes in the temporomandibular joint (TMJ) using panoramic TMJ projection imaging and computed tomography (CT), and to investigate the imaging features of these modalities for subchondral cyst with reference to its magnetic resonance imaging (MRI) features.


The reliabilities (κ values) of panoramic TMJ projection and CT images were determined by three radiologists for each characteristic appearance of TMJ osseous changes in 146 condyles. The features of cyst-like areas on CT images with agreement among the three radiologists were investigated for size, location, and continuity with the joint space together with MRI signal intensity and surrounding edema-like lesions.


Panoramic TMJ projection images showed moderate and substantial agreements for erosion and osteophyte evaluations, respectively; while CT images showed substantial agreements for subchondral cyst, erosion, and osteophyte evaluations. Cyst-like areas on CT images were predominantly located in the central parts and 69 of 86 (80.2%) areas showed no communication with the joint space. Cyst-like areas with diameters exceeding 2 mm showed high or moderate MRI signal intensities. Edema-like lesions were observed in 10 of 28 (29.4%) condyles.


The reliabilities of panoramic TMJ projection and CT images were clarified for each characteristic appearance. The results support the bone contusion theory for the formation of subchondral cysts in the TMJ. A possible improvement in reliability is suggested relative to MRI findings.


Temporomandibular joint disorder Osseous change Panoramic TMJ projection CT MRI Subchondral cyst 



The authors thank Alison Sherwin, PhD, from Edanz Group ( for editing a draft of this manuscript.

Compliance with ethical standards

Conflict of interest

Michihito Nozawa, Nobumi Ogi, Yoshiko Ariji, Yoshitaka Kise, Miwa Nakayama, Masako Nishiyama, Munetaka Naitoh, Kenichi Kurita, and Eiichiro Ariji declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Animal rights statement

This article does not contain any studies with animal subjects performed by any of the authors.

Informed consent

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


  1. 1.
    Uemura S, Nakamura M, Iwasaki Y, Fuchihata H. A roentgenological study on temporomandibular joint disorders. Morphological changes of TMJ in arthrosis (in Japanese). Dent Radiol. 1979;19:224–37.Google Scholar
  2. 2.
    Christentiansen EL, Thompson JR, Kopp S, Hasso AW, Hinshaw DB Jr. Radiographic signs of temporomandibular joint disease: an investigation utilizing x-ray computed tomography. Dentomaxillofac Radiol. 1985;14:83–91.CrossRefGoogle Scholar
  3. 3.
    Tanimoto K, Petersson A, Rohlin M, Hansson L-G, Johansen CC. Comparison of computed with conventional tomography in the evaluation of temporomandibular joint disease. A study of autopsy specimen. Dentomaxillofac Radiol. 1990;19:21–7.CrossRefGoogle Scholar
  4. 4.
    Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, John MT, Schiffman EL. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image nanalysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:844–60.CrossRefGoogle Scholar
  5. 5.
    Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group. J Oral Fac Pain Headache. 2014;28:6–27.CrossRefGoogle Scholar
  6. 6.
    Kudoh T, Maeda N, Kawaguchi S, Takeuchi T, Sugawara C, Shimomura M, Hosoki H, Iwasaki Y, Uemura S. Panoramic radiography of the temporomandibular joint part 4: detectability of outline of the temporomandibular joint in lateral panoramic temporomandibular joint projection (in Japanese). Dent Radiol. 2000;40:237–41.Google Scholar
  7. 7.
    Araki K, Honda K, Okano T, Endo A, Kaneko N, Funahashi I, Kataoka R. Diagnostic accuracy of the detection of bone change using panoramic TMJ projection: comparative study with limited cone-beam CT (in Japanese). Dent Radiol. 2007;47:121–5.Google Scholar
  8. 8.
    Igarashi C. Image diagnosis of osteoarthrrosis of the temporomandibular joint using the panoramic TMJ (temporomandibular joint) radiograph (in Japanese). J Jpn Soc TMJ. 2017;29:85–91.Google Scholar
  9. 9.
    Resnick D, Niwayama G, Coutts RD. Subchondral cyst (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint. Am J Roentgenol. 1977;128:799–806.CrossRefGoogle Scholar
  10. 10.
    Hayashi D, Xu L, Roemer FW, Hunter DJ, Li L, Katur AM, Guermazi A. Detection of osteophytes and subchondral cysts in the knee with use of tomosynthesis. Radiology. 2012;263:206–15.CrossRefGoogle Scholar
  11. 11.
    Carrino JA, Blum J, Parellada JA, Schweitzer ME, Morrison WB. MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Osteoarthr Cartil. 2006;14:1081–5.CrossRefGoogle Scholar
  12. 12.
    Pouders C, De Maeeneer M, Van Roy P, Gielen J, Goossens A, Shahabpour M. Prevalence of and MRI-anatomic correlation of bone cyst in osteoarthritic knees. Am J Roentgenol. 2008;190:17–211.CrossRefGoogle Scholar
  13. 13.
    Crema MD, Poemer FW, Zhu Y, Mara MD, Niu J, Zhang Y, Lynch JA, Javaid NK, El-Khoury GY, Felson DT, Guermazi A. Subchondral cystlike lesions develop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis: detection with MR imaging—The MOST study. Radiology. 2010;256:855–62.CrossRefGoogle Scholar
  14. 14.
    Roemer FW, Crema MD, Trattnig S, Guermazi A. Advances in imaging of oseteoarthritis and cartilage. Radiology. 2011;260:332–54.CrossRefGoogle Scholar
  15. 15.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefGoogle Scholar
  16. 16.
    Lim MJ, Lee JY. Computed tomographic study of the patterns of osteoarthritic change which occur on the mandibular condyle. J Craniomaxillofac Surg. 2014;42:1897–902.CrossRefGoogle Scholar
  17. 17.
    Larheim TA, Westesson PL, Hicks DG, Eriksson L, Brown DA. Oseteonecrosis of the temporomandibular joint: correlation of magnetic resonance imaging and histology. J Oral Maxillofac Surg. 1999;57:888–98.CrossRefGoogle Scholar
  18. 18.
    Larheim TA, Katzberg RW, Westesson PL, Tallents RH, Moss ME. MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients. Int J Oral Maxillofac Surg. 2001;30:113–7.CrossRefGoogle Scholar
  19. 19.
    Morimoto Y, Tanaka T, Masumi S, Tominaga K, Shibuya T, Kito S, Ohba T. Significance of frequency-selective fat saturation T2-weighted MR images for the detection of bone marrow edema in the temporomandibular condyle. Cranio. 2004;22:115–23.CrossRefGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial RadiologyAichi-Gakuin University School of DentistryNagoyaJapan
  2. 2.Department of Oral and Maxillofacial SurgeryAichi-Gakuin University School of DentistryNagoyaJapan

Personalised recommendations