颞下颌关节紊乱综合征的MRI诊断价值

The Value of MRI in Diagnosis of Temporomandibular Joint Derangement Syndrome

目的 探讨MRI诊断颞下颌关节紊乱综合征 (temporomandibularjointderengmentsyndrome ,TMJDs)的价值。材料与方法 回顾性分析 37例 (74侧 )TMJDs患者MRI表现。 74侧均采用超导磁共振成像系统扫描 ,5 0侧附加模拟动态扫描 ;关节腔造影 33侧 ,关节腔镜检查 19侧 ,手术 14侧 ,病理切片 4侧。结果 (1) 44侧有症状关节中 ,38侧关节盘病变 ,其中最多见为关节盘移位 ,占76 .4%。(2 )用Trace标准判断关节盘移位 (6 3 .6 % ,2 8/44 )与用胡氏标准判断关节盘移位 (70 % ,31/44 )无显著差异。(3) 14侧手术病例中 ,手术证实穿孔 7侧 ,MR平扫诊断穿孔 4侧 ,检出率为 5 7%。(4)MR检出髁突骨质增生 ,充血 ,水肿病变约为 85 .8%。(5 )模拟动态观察 ,髁突活动受限 15侧 ,其中 7侧关节盘穿孔 ,2侧关节盘粘连误为穿孔 ,5侧不可复性关节盘前移位。 (6 ) 44侧有症状的关节中 ,T2 WI见肌肉区有条片状高信号 ,为水肿渗出性病变 ,显示率为 6 3 .6 % (2 8/44 )。结论 MR能检出各种关节盘移位 ,是其他影像方法无法比拟的。能早期发现髁突骨髓内充血、水肿。模拟动态扫描对关节盘穿孔和粘连极为敏感 ,但不能区分。能准确区分可复性和不可复性关节盘移位。能显示翼外肌水肿渗出 。

Objective To evaluate MRI in diagnosing temporomandibular joint derangement syndrome (TMJDs).Materials and Methods MRI findings in 37 cases with TMJDs were retrospectively analyzed. MRI was performed in all patients (74 joints), while arthrography in 33 joints, arthroendoscopy in 19 joints, surgery in 14 joints and pathological examination in 4 joints.Results (1) Of 44 symptomatic joints, 38 had disk disorder. Displacement of the disk was the commonest (76.4%). (2) Disk displacement in 44 symptomatic joints was 70% (31/44) when Trace criteria used or 63.6% (28/44) when Hu's criteria used, no significant difference was found. (3) MRI displayed 4 disk perforation out of 7 proved on surgery, with the detecting rate of 57%. (4) 85.5% of sclerosis, edema and hyperemia of the condyle was demonstrated on MRI. (5) Pseudo dynamic MR scan with FFE sequences was performed in 50 joints. 15 condyles showed a decrease in motion range, of which 7 had perforation, 2 had adhesion and 5 had non reducible anterior displacement. (6) T 2WI in 44 symptomatic joints, abnormal stripe or patch high signal, indicating edema or effusion, was seen in pterygoid muscles in 63.6% joints.Conclusion MRI can display disk displacement, in this respect MRI is superior to any other imaging modality. Besides, MRI can demonstrate early bone marrow edema or hyperemia of the condyle. MR pseudo dynamic scanning is very sensitive to disk perforation and adhesion, though differentiation between the two is impossible. Pseudo dynamic scanning is helpful in distinguishing the reducible from non reducible anterior displacement. Moreover, MRI is able to reveal the pathological changes, such as edema and effusion, in lateral pterygoid muscles of the patients with TMJDs, which is very important for making an early diagnosis.