Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2025; 35(01): 050-058
DOI: 10.1055/s-0044-1788608
Original Article

Evaluation of the Articular Disc Using the Magnetic Resonance Cartigram in Asymptomatic and Symptomatic Temporomandibular Disorders

Aparna Sivakumar 
1   Department of Oral Medicine and Radiology, SRM Dental College, Bharathi Salai, Chennai, Tamil Nadu, India
,
Anuradha Ganesan
1   Department of Oral Medicine and Radiology, SRM Dental College, Bharathi Salai, Chennai, Tamil Nadu, India
,
Krithika Chandrasekar Lakshmi
1   Department of Oral Medicine and Radiology, SRM Dental College, Bharathi Salai, Chennai, Tamil Nadu, India
,
Yesoda Aniyan
1   Department of Oral Medicine and Radiology, SRM Dental College, Bharathi Salai, Chennai, Tamil Nadu, India
,
Saravanan Kannan
2   Department of Radiology in Saravana Imaging and Research Centre, Nandanam, Chennai, Tamil Nadu, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objectives The study is aimed to perform magnetic resonance (MR) cartigram of the articular disc in patients with asymptomatic and symptomatic temporomandibular disorders (TMD).

Materials and Methods Thirty-nine volunteers were divided into three groups: 16 symptomatic TMD, 16 asymptomatic TMD, and 7 controls. The articular disc was divided into three segments (anterior, middle, and posterior) and analyzed using morphological magnetic resonance imaging (MRI) and T2 mapping sequences. T2 relaxation values were measured and assessed by an experienced radiologist and two observers. The T2 values in the discs were compared between the control, asymptomatic, and symptomatic groups using the Kruskal–Wallis test. The right and left discs were compared using the Wilcoxon signed rank test. Inter-examiner reliability among different examiners was evaluated.

Results The controls had the highest T2 values compared with the other groups. The comparison among the right and left sides of all the groups revealed statistically significant results in the anterior portion in the asymptomatic group and the middle portion in the symptomatic group (p < 0.05). The inter-examiner reliability coefficients among the three examiners were consistently high, with values of 0.921, 0.920, and 0.930.

Conclusion Our study found the T2 relaxation time span was shorter than that reported in previous studies, which could be attributed to the early stage of cartilage deterioration in the individuals with TMD inferring treatment at this phase may be eventually effective with a good prognosis.

Keywords

temporomandibular joint - temporomandibular disorders - magnetic resonance imaging - articular disc - T2 mapping - collagen fiber network

Ethical Approval

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).


Patient Consent

Additional informed consent was obtained from all patients for which identifying information is included in this article. This article does not contain any studies with human or animal subjects performed by the any of the authors.




Publication History

Article published online:
01 August 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Maini K, Dua A. Temporomandibular Syndrome. Treasure Island, FL: StatPearls Publishing; 2023
    Search in Google Scholar
  • 2 Li DTS, Leung YY. Temporomandibular disorders: current concepts and controversies in diagnosis and management. Diagnostics (Basel) 2021; 11 (03) 459
    CrossrefPubMedSearch in Google Scholar
  • 3 Bag AK, Gaddikeri S, Singhal A. et al. Imaging of the temporomandibular joint: an update. World J Radiol 2014; 6 (08) 567-582
    CrossrefPubMedSearch in Google Scholar
  • 4 Tomas X, Pomes J, Berenguer J. et al. MR imaging of temporomandibular joint dysfunction: a pictorial review. Radiographics 2006; 26 (03) 765-781
    CrossrefPubMedSearch in Google Scholar
  • 5 Tresoldi M, Dias R, Bracci A, Segù M, Guarda-Nardini L, Manfredini D. Magnetic resonance imaging evaluation of closed-mouth TMJ disc-condyle relationship in a population of patients seeking for temporomandibular disorders advice. Pain Res Manag 2021; 2021: 5565747
    CrossrefPubMedSearch in Google Scholar
  • 6 Stehling C, Vieth V, Bachmann R. et al. High-resolution magnetic resonance imaging of the temporomandibular joint: image quality at 1.5 and 3.0 tesla in volunteers. Invest Radiol 2007; 42 (06) 428-434
    CrossrefPubMedSearch in Google Scholar
  • 7 Safna MA, Sunil M, Keshav Kumar ADT. T2 mapping [cartigram] in the evaluation of the articular cartilage in traumatic knee injury. MedPulse – International. J Radiol 2019; 9 (02) 59-62
    Search in Google Scholar
  • 8 Cha JG, Lee JC, Kim HJ. et al. Comparison of MRI T2 relaxation changes of knee articular cartilage before and after running between young and old amateur athletes. Korean J Radiol 2012; 13 (05) 594-601
    CrossrefPubMedSearch in Google Scholar
  • 9 Welsch GH, Trattnig S, Paternostro-Sluga T. et al. Parametric T2 and T2* mapping techniques to visualize intervertebral disc degeneration in patients with low back pain: initial results on the clinical use of 3.0 Tesla MRI. Skeletal Radiol 2011; 40 (05) 543-551
    CrossrefPubMedSearch in Google Scholar
  • 10 Apprich S, Mamisch TC, Welsch GH. et al. Evaluation of articular cartilage in patients with femoroacetabular impingement (FAI) using T2* mapping at different time points at 3.0 tesla MRI: a feasibility study. Skeletal Radiol 2012; 41 (08) 987-995
    CrossrefPubMedSearch in Google Scholar
  • 11 Hesper T, Hosalkar HS, Schleich C. et al. T2* mapping for hip joint cartilage assessment: pre-MRI exercise and time of imaging do not bias the T2* measurement in asymptomatic volunteers. Cartilage 2017; 8 (04) 400-405
    CrossrefPubMedSearch in Google Scholar
  • 12 Schmid-Schwap M, Bristela M, Pittschieler E. et al. Biochemical analysis of the articular disc of the temporomandibular joint with magnetic resonance T2 mapping: a feasibility study. Clin Oral Investig 2014; 18 (07) 1865-1871
    CrossrefPubMedSearch in Google Scholar
  • 13 Mosher TJ, Dardzinski BJ. Cartilage MRI T2 relaxation time mapping: overview and applications. Semin Musculoskelet Radiol 2004; 8 (04) 355-368
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Cao Y, Xia C, Wang S, He S, Wamalwa P, Chen S. Application of magnetic resonance T2 mapping in the temporomandibular joints. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114 (05) 644-649
    CrossrefPubMedSearch in Google Scholar
  • 15 Zhao Z, Ge H, Xiang W, Bai G. Exploration of MRI T2 mapping image application in articular disc displacement of the temporomandibular joint in adolescents. Int J Gen Med 2021; 14: 6077-6084
    CrossrefPubMedSearch in Google Scholar
  • 16 Bristela M, Skolka A, Eder J. et al. T2 mapping with 3.0 T MRI of the temporomandibular joint disc of patients with disc dislocation. Magn Reson Imaging 2019; 58 (58) 125-134
    CrossrefPubMedSearch in Google Scholar
  • 17 Kakimoto N, Shimamoto H, Chindasombatjaroen J. et al. Comparison of the T2 relaxation time of the temporomandibular joint articular disk between patients with temporomandibular disorders and asymptomatic volunteers. AJNR Am J Neuroradiol 2014; 35 (07) 1412-1417
    CrossrefPubMedSearch in Google Scholar
  • 18 Schiffman E, Ohrbach R, Truelove E. et al; International RDC/TMD Consortium Network, International association for Dental Research, Orofacial Pain Special Interest Group, International Association for the Study of Pain. 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 Facial Pain Headache 2014; 28 (01) 6-27
    CrossrefPubMedSearch in Google Scholar
  • 19 Tasaki MM, Westesson PL, Isberg AM, Ren YF, Tallents RH. Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers. Am J Orthod Dentofacial Orthop 1996; 109 (03) 249-262
    CrossrefPubMedSearch in Google Scholar
  • 20 Murakami S, Takahashi A, Nishiyama H, Fujishita M, Fuchihata H. Magnetic resonance evaluation of the temporomandibular joint disc position and configuration. Dentomaxillofac Radiol 1993; 22 (04) 205-207
    CrossrefPubMedSearch in Google Scholar
  • 21 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 (02) 104-112
    CrossrefPubMedSearch in Google Scholar
  • 22 Kirk Jr WS. Sagittal magnetic resonance image characteristics and surgical findings of mandibular condyle surface disease in staged internal derangements. J Oral Maxillofac Surg 1994; 52 (01) 64-68
    CrossrefPubMedSearch in Google Scholar
  • 23 Larheim TA, Westesson PL, Hicks DG, Eriksson L, Brown DA. Osteonecrosis of the temporomandibular joint: correlation of magnetic resonance imaging and histology. J Oral Maxillofac Surg 1999; 57 (08) 888-898 , discussion 899
    CrossrefPubMedSearch in Google Scholar
  • 24 Dhanasekaran SM, Kannan A, Lakshmi KC, Anuradha G, Aniyan KY. Efficacy of pulsed shortwave therapy in symptomatic TMD patients: randomized control trial. J Indian Acad Oral Med Radiol 2022; 34 (02) 146-149
    CrossrefSearch in Google Scholar
  • 25 Wongratwanich P, Nagasaki T, Shimabukuro K. et al. Intra- and inter-examination reproducibility of T2 mapping for temporomandibular joint assessment at 3.0 T. Sci Rep 2022; 12 (01) 10993
    CrossrefPubMedSearch in Google Scholar
  • 26 Radha R, Yesodha AK, Kannan A, Krithika CL, Anuradha G. Magnetic resonance T2 mapping in temporomandibular joints: comparison among different age groups—an observational study. Innovations 2022; 68: 246-254
    Search in Google Scholar
  • 27 Meera R, Kannan A, Krithika CL, Aniyan KY. Correlation between clinical pain in temporomandibular disorders and signal intensity of the retrodiscal tissue using fluid attenuation inversion recovery MRI: a cross sectional study. Matrix 2022; 8 (01) 20-25
    Search in Google Scholar
  • 28 Nikkuni Y, Nishiyama H, Hyayashi T. The relationship between masseter muscle pain and T2 values in temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126 (04) 349-354
    CrossrefPubMedSearch in Google Scholar
  • 29 Xia Y. Magic-angle effect in magnetic resonance imaging of articular cartilage: a review. Invest Radiol 2000; 35 (10) 602-621
    CrossrefPubMedSearch in Google Scholar
  • 30 Bittersohl B, Miese FR, Hosalkar HS. et al. T2* mapping of acetabular and femoral hip joint cartilage at 3 T: a prospective controlled study. Invest Radiol 2012; 47 (07) 392-397
    CrossrefPubMedSearch in Google Scholar
  • 31 Mingjun YE, Mingle WU, Shan SHEN. Application value of magnetic resonance T2 mapping imaging in anterior disc displacement of temporomandibular joint. Int J Applied Science Research 2022; 1 (05) 1-9
    Search in Google Scholar