EVALUATION OF MRI FOR DIAGNOSIS OF TMJ DISC DISPLACEMENT

确定病理形态学存在的现有技术 在TMJ中，特别是盘紊乱病症，包括常规的 X光片关节造影和CT 大多数人认为关节造影术 临床医生提供最佳的软组织诊断信息 病理学，并显示出与手术结果高度相关。 然而，在这方面， 它是痛苦的，侵入性的，并使用中等水平的电离辐射。 MRI是一种非侵入性的替代技术， 对健康的不良影响。 它展示了大多数身体组织的解剖结构， 与X射线技术相比，在软成像方面特别有效 组织结构 此外，MR信号的变化可能 可能与组织特征的差异有关。 我们试图验证这样一个假设，即MRI至少和 关节造影在鉴别椎间盘紊乱中的作用。 观察员 将利用2个专家阅片小组进行性能研究， 独立解释关节造影和MR图像， 有椎间盘紊乱症状的患者人群。 观察员 诊断将与直接验证患者进行比较， 去做手术 为了避免样本偏差对观测器性能的影响， 数据集将包括大致相等比例的“正常”和 异常情况 这项调查将提供定量证据， 比较准确性、灵敏度、特异性以及间和内 每种方法的观察者可靠性。 进一步分析对一个问题的答复 一系列诊断功能将识别特定信息， 是从每种技术中单独或共同得出的。 磁共振成像参数对观察者检测和 TMJ病理学的表征将在以下相等的子集中进行研究： 正常和异常受试者将使用4组不同的 脉冲序列 随机序列图像将由MRI读取两次 面板 将比较准确性和阅片员间和阅片员内的可靠性 跨成像协议。 最后，研究了MR信号特征与 将在切除的TMJ组织样本中进行组织病理学研究 来自于手术病人。 组织弛豫时间（T1和T2） 将与观察到的病理变化的类型和程度相关 通过组织的组织学检查。 结果将决定 弛豫时间可用于推断关于神经病理学的信息。

Current techniques for determining the existence of pathologic morphology in the TMJ, particularly disc derangement disorders, include conventional radiographs, arthrography, and CT. Arthrography is considered by most clinicians to provide the best diagnostic information on soft tissue pathology and has shown high correlation with surgical findings. However, it is painful, invasive and uses moderate levels of ionizing radiation. MRI is an alternative technique which is non-invasive and has no known adverse health effects. It displays the anatomy of most body tissues, but in contrast to x-ray techniques, is particularly effective in imaging soft tissue structures. Further, it is possible that variations in MR signals may be associated with differences in tissue characteristics. We seek to test the hypothesis that MRI is at least as accurate as arthrography in identification of disc derangement. An observer performance study will be conducted utilizing 2 panel of expert readers to independently interpret arthrographic and MR images derived from a population of patients with symptoms of disc derangement. Observer diagnoses will be compared to direct verification in patients who proceed to surgery. To avoid the effects of sample bias on observer performance, data sets will consist of roughly equal proportions of 'normal' and abnormal cases. This investigation will provide quantitative evidence of comparative accuracy, sensitivity, specificity, and inter and intra observer reliability for each method. Further analysis of responses on a range of diagnostic features will identify the specific information which is uniquely or jointly derived from each technique. The effect of MR imaging parameters on observer detection and characterization of TMJ pathology will be studied in equal subsets of normal and abnormal subjects who will be scanned using 4 different sets of pulse sequences. Randomly sequenced images will be read twice by the MRI panel. Accuracy and inter and intra reader reliability will be compared across imaging protocols. Finally, the relationship between MR signal characteristics and histopathology will be studied in a sample of excised TMJ tissue specimens derived from the surgery patients. Tissue relaxation times (T1 and T2) will be correlated with the type and degree of pathologic change observed via histologic examination of the tissue. The results will determine if relaxation time can be used to infer information about meniscal pathology.