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Contrast-enhanced MRI compared to direct joint visualization at arthroscopy in pediatric patients with suspected
Jessica R Leschied1, Ethan A Smith2,3, Scott Baker2,4
1Section of Pediatric Radiology, C. S. Mott Children's Hospital, Department of Radiology, University of Michigan Health System, 1540 East Hospital Drive, Ann Arbor, MI, 48109-4252, USA. jleschi@med.umich.edu.
Background:
Contrast-enhanced magnetic resonance imaging (MRI) has become the gold standard when assessing the temporomandibular joint (TMJ) in children. To our knowledge, no previous pediatric study has compared findings of TMJ MRI with direct visualization of the joint using arthroscopy.
Objective:
To determine if subjective findings on contrast-enhanced MRI of the temporomandibular joint correlate with arthroscopic findings of acute and chronic inflammation of the TMJ in children.
Materials And Methods:
Patients who had temporally related TMJ arthroscopy and contrast-enhanced TMJ MRI between March 2014 and March 2016 were identified. Imaging was retrospectively reviewed by two radiologists for erosions, condyle shape, bone marrow edema, effusion, severity of synovitis, joint space width measured in the coronal plane and enhancement ratio of the synovium relative to ipsilateral temporal lobe white matter. Joint space width was included because synovial thickening could widen the joint space. TMJ arthroscopy findings assessed included indicators of acute inflammation (active synovitis, number of joint sites affected, presence of retrodiscitis) and markers of chronic inflammation (hyperplastic synovitis, adhesions, disc perforation, chondromalacia). A Total Synovitis Score was given to all patients on arthroscopy, which multiplied the severity of active synovitis (0-4) with the number of joint recesses affected. Data were compared using the Fisher exact test and a P-value <0.05 was considered significant.
Results:
There was no significant correlation between subjective synovitis on MRI and active synovitis on arthroscopy; however, there was a significant correlation between joint space width and hyperplastic synovitis (P=0.04, 3.7 mm±0.8 vs. 2.9 mm±0.6) and a trend toward significance between subjective synovitis (P=0.08) and enhancement ratio of synovium (P=0.06) on MRI and hyperplastic synovitis on arthroscopy.
Conclusion:
Joint space width and subjective synovitis on TMJ MRI correlate with arthroscopic findings of chronic synovitis. Increased joint space width may be useful when evaluating the TMJ with less time-intensive modalities, such as ultrasound. However, MRI findings did not correlate well with findings of acute inflammation on arthroscopy.
Insights
Contrast-enhanced MRI for pediatric temporomandibular joint (TMJ) inflammation shows correlation with chronic synovitis, particularly joint space width. However, MRI findings did not correlate well with acute inflammation indicators.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
- Rheumatology
Background:
- Contrast-enhanced MRI is the standard for pediatric temporomandibular joint (TMJ) assessment.
- No prior pediatric studies have compared TMJ MRI findings with direct arthroscopic visualization.
Purpose of the Study:
- To correlate subjective findings from contrast-enhanced TMJ MRI with arthroscopic findings of acute and chronic TMJ inflammation in children.
Main Methods:
- Retrospective review of temporally related TMJ arthroscopy and contrast-enhanced MRI in pediatric patients.
- Radiologists assessed MRI for erosions, condyle shape, edema, effusion, synovitis, joint space width, and synovial enhancement ratio.
- Arthroscopy evaluated acute inflammation (active synovitis, retrodiscitis) and chronic inflammation (hyperplastic synovitis, adhesions, disc perforation, chondromalacia).
Main Results:
- No significant correlation found between subjective synovitis on MRI and active synovitis on arthroscopy.
- Significant correlation observed between joint space width and hyperplastic synovitis (P=0.04).
- Trends toward significance noted between MRI synovitis/enhancement ratio and hyperplastic synovitis.
Conclusions:
- TMJ MRI joint space width and subjective synovitis correlate with arthroscopic findings of chronic synovitis.
- Increased joint space width may aid evaluation with less time-intensive modalities like ultrasound.
- MRI findings showed poor correlation with arthroscopic indicators of acute inflammation.
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