Elucidation of temporomandibular disorders using contrast-enhancement MRI and analysis of synovial fluid/tissue

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The purpose of the pilot study was to elucidate the association between changes in gadopentetate dimeglumine (Gd-DTPA) contrast-enhancement of the temporomandibular joint (TMJ) space in MR image and clinical outcomes before and after treatment in patients with temporomandibular disorders (TMD). Gd-DTPA enhanced T1-weighted MR images with fat suppression were taken in ten patients with twelve painful TMJs before and after treatment. One patient was treated with splint therapy, eight with pumping manipuration, and one with arthroscopic surgery. Clinical findings were assessed on the basis of the mouth opening and joint pain level on visual analog scale (VAS) before and after treatment (Ohnuki T, Fukuda M, et al. : Magnetic resonance evaluation of the disk before and after arthroscopic surgery for temporomandibular joint disorders. Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontics 96(2) : 141-148, 2003). After treatment, the mouth opening and joint pain level on VAS improved in all patients. The number of the enhanced joint spaces decreased from nine to three out of twelve TMJs after treatment. These results indicate that the contrast-enhancement in the joint space may be an index to improvement of clinical findings (particularly joint pain) after treatment. Level of the inflammatory mediators in synovial fluid of the TMD patients was higher than that of physically unimpaired persons. Therefore contrast-enhanced MRI may show inflammatory reaction of the TMJs. And most of TMD patients with high signal intensity in the mandibular condyle and/or the retrodiscal tissue in contrast-enhanced MRI have anterior disc displacement without reduction. In conclusion, high signal intensity of contrast-enhanced MRI might indicate the clinical stage of TMD.