Dynamic MRI による顎関節症患者の円板後部組織の病態評価 : 炎症性変化と疼痛に関する研究
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The purpose of this study was to quantitatively evaluate inflammation in the temporomandibular joint (TMJ) by means of dynamic magnetic resonance imaging (MRI) in patients with TMJ arthrosis.<BR>Dynamic MRI was performed with a SPGR pulse sequence (TR, 35 ms; TE, 8 ms; flip angle, 60°) before and after administration of Gd-DTPA (0.1 mmol/kg). Signal intensity (SI) in the ROI was calculated in the region of the posterior disk attachment. The signal intensity ratio (SIR) at <I>t</I> minutes after Gd-DTPA administration was calculated by the following equation: SIR (<I>t</I>)={SI (<I>t</I>)-SI (<I>pre</I>)}/S1 (pre). The average SIR at 3.5, 4, 4.5, and 5 minutes was defined as the signal enhanced score (SES).<BR>1. To clarify the characteristics of dynamic MRI of the TMJ, a time-SIR curve was plotted every 30 seconds from just after until 8.5 minutes after Gd-DTPA administration in 20 painful and 28 painless TMJs. Painful TMJs had significantly higher SIR values than painless TMJs at all times. The time-SIR curves became stable 3.5 minutes after Gd-DTPA administration in both groups.<BR>2. Joint cavity pumping with a local anesthetic was performed after dynamic MRI in 42 painful TMJs. It proved that 31 TMJs had pain within the joint.<BR>3. As an index for distinguishing the group with pain within the joint (31 TMJs) from the normal TMJ group (32 TMJs), SES was most useful, and its discriminant value was 0.87.<BR>4. Analysis using this discriminant point (SES=0.87) revealed a significant difference between 189 painless and 167 painful TMJs.<BR>5. Among 52 painless TMJs with SES values over 0.87, 48 had painful TMJ on the opposite side. Thus, patients with unilateral painful TMJ may have inflammation in the opposite TMJ, even if it is asymptomatic.<BR>6. In 192 TMJs with SES values over 0.87, there was a positive correlation between pain and SES, suggesting that SES can be used as an index of morbidity and therapeutic efficacy. The results show that dynamic MRI is a useful, noninvasive method to diagnose inflammation within the TMJ.
- 社団法人 日本口腔外科学会の論文
- 1998-01-20
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