T2 mapping在颞下颌关节紊乱病中的诊断价值

Diagnostic Value of T2 mapping in Patients with Temporomandibular Joint Disorders

目的 分析T2 mapping诊断颞下颌关节紊乱病(TMD)的效能和临床意义。资料与方法 回顾性选取2019年12月—2021年12月温州医科大学附属第二医院TMD患者100例为研究组,根据关节盘移位是否可复位分为关节盘移位伴复位组(可复位组38例)和关节盘移位不伴复位组(不可复位组62例),选取同期100名健康志愿者为对照组,所有研究对象均行颞下颌关节MRI常规序列平扫及T2 mapping成像,比较各组关节盘和盘后组织感兴趣区的T2值,采用单因素分析评价TMD患者关节盘移位不伴复位的影响因素,采用Logistic回归分析并绘制受试者工作特征曲线,分析其与关节盘移位不伴复位的关系及预测意义。结果 对照组、可复位组和不可复位组关节盘内的T2值依次升高[(22.31±3.06)ms、(24.05±3.47)ms、(26.31±4.06)ms;F=56.378,P<0.001],组间两两比较差异有统计学意义(P均<0.05)。3组T2值测量可重复性较好(ICC=0.774,95%CI 0.688~0.843)。单因素分析显示,可复位组与不可复位组年龄、关节盘形态、髁突形态比较,差异有统计学意义(P均<0.05)。非条件Logistic回归模型显示,高龄、关节盘形态(折叠形)、髁突形态(鸟嘴形)、T2值延长是不可复位的危险因素(OR>1,P<0.05)。T2值预测TMD的曲线下面积为0.746,敏感度为79.00%,特异度为82.00%。结论 T2 mapping可测量关节盘T2值的改变,对TMD有一定诊断意义,而组间值差异可以提高诊断TMD关节盘移位不伴复位及严重程度的准确度。

Purpose To observe the diagnostic efficacy and clinical significance of magnetic resonance T2 mapping imaging in the diagnosis of temporomandibular joint disorders.Materials and Methods A total of 100 patients with temporomandibular joint disorder in the Second Affiliated Hospital of Wenzhou Medical University from December 2019 to December 2021 were retrospectively selected as the study group,and were divided into joint disk displacement with reduction group(removable group)and joint disk displacement without reduction group(non-removable group)according to whether joint disk displacement was reconfigurable.A total of 100 healthy volunteers during the same period were selected as the control group.All subjects underwent temporomandibular joint MRI routine sequence plain scan and T2 mapping imaging to compare the T2 values of the area of interest of the articular disc and post-discoid tissue in each group.A univariate analysis was performed to analyze the influencing factors of articular disc displacement without reduction in patients with temporomandibular joint disorder,and Logistic regression analysis was used to plot the receiver operating characteristic curve.The relationship with disc displacement without reduction and its predictive significance were analyzed.Results T2 value in the joint disc of the control group,the reducible group and the non-reducible group increased successively[(22.31±3.06)ms,(24.05±3.47)ms,(26.31±4.06)ms;F=56.378,P<0.001],the difference between groups was statistically significant(all P<0.05).The reproducibility of T2 values in the three groups was all good[intraclass correlation coefficient(ICC)=0.774,95%CI 0.688-0.843].Univariate analysis showed that there were statistically significant differences in age,articular disk shape,condylar shape between the non-reducible group and the reducible group(all P<0.05).Unconditioned Logistic regression model showed that age(advanced age),articular disk shape(folded shape),condyle shape(beak shape)and prolonged T2 value were risk factors in the non-reducible group(OR>1,P<0.05).The area under the curve predicted by T2 value was 0.746,the sensitivity was 79.00%,and the specificity was 82.00%.Conclusion T2 mapping can measure the change of the T2 value of the articular disc,which has certain diagnostic significance for temporomandibular joint disorder,and the difference of the values between groups can improve the accuracy of the diagnosis of dislocation of the articular disc without reduction and the severity of temporomandibular joint disorder.