Gradient-echo MR imaging of the temporomandibular joint: diagnostic pitfall caused by the superficial temporal artery

In routine MR imaging of the temporomandibular joints, a low-signal structure posterosuperior to the mandibular condyle is occasionally seen on the two-dimensional gradient-echo sequence. The structure is ovoid and may have a higher-signal core, simulating a loose body within the joint. We undertook a clinical and cadaveric study to determine the cause of this finding.

In a clinical study, we reviewed the MR images of 100 temporomandibular joints. We scored each joint for the presence and appearance of a low-signal structure posterosuperior to the mandibular condyle: type 1 was ovoid with a low-signal rim and a higher-signal core, type 2 was ovoid with uniformly low signal, type 3 was a low-signal structure inseparable from the posterior wall of the glenoid fossa, and type 4 was normal. Using this scoring system, we determined the appearance and frequency of the finding on two-dimensional gradient-echo, T1-, T2-, and proton density-weighted images. To determine the cause of the finding, we correlated the imaging and anatomic findings in a cadaveric specimen.

Of the 100 MR images of joints reviewed, 22 showed a type 1 structure, 24 a type 2 structure, 11 a type 3 structure, and 43 were normal. The finding was seen only on the two-dimensional gradient-echo sequences, never on the spin-echo sequences. Correlation between the imaging and anatomic findings in the cadaveric specimen showed that the finding was caused by the superficial temporal artery. The variability in its appearance is thought to result from the complex manifestations of flowing blood within this artery.

The finding posterosuperior to the mandibular condyle seen on two-dimensional gradient-echo MR images is a flow phenomenon within the superficial temporal artery. Recognition of the nature of this finding will avoid mistaking it for disease, such as an intraarticular loose body.