Validation of the effectiveness of ultrasonography as a diagnostic method for temporomandibular joint disorders and a comparison with MRI and CBCT

Abstract

Objective: The objective of this study was to compare findings from ultrasonography imaging (USI) of the temporomandibular joint (TMJ) with those from magnetic resonance imaging (MRI) and cone-beam computerized tomography (CBCT).

Methods: A total of 102 patients were included in this study. USI, MRI, and CBCT were performed in the TMJ area for all patients.

Results: USI showed 100% sensitivity (Se), 82.76% specificity (Sp), 93.15% positive predictive value (PPV), 100% negative predictive value (NPV) and 94.85% accuracy relative to MRI for identifying anterior disc displacement (ADD), while the Se, Sp, PPV, NPV, and accuracy were 100% for identifying joint effusion, relative to MRI. Moreover, USI showed a high agreement with CBCT, which had 98.08% Se, 94% Sp, 94.44% PPV, 97.92% NPV and 96.08% accuracy for identifying condylar irregularities, while MRI showed a 100% Se, 56.86% Sp, 69.86% PPV, 100% NPV, and 78.43% accuracy for detecting condylar irregularities, relative to CBCT.

Conclusions: High-resolution USI is a useful diagnostic method for detecting TMJ pathologies; USI can supplement clinical evaluations for patients with temporomandibular joint disorders (TMDs), and this imaging modality can be used as a diagnostic tool to identify internal derangement of the TMJ.

Keywords

• Temporomandibular joint,Ultrasonography,Articular disc,Disc displacement,Effusion

References

1. 1. Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. Temporomandibular joint disorders: A review of etiology, clinical management, and tissue engineering strategies. The International journal of oral & maxillofacial implants. 2013 Nov;28(6):e393.
2. 2. Keser G, Ulay G, Namdar Pekiner F, Borahan MO. Evaluation of Diagnostic Efficiency of Ultrasonography in Temporomandibular Joint Disorders: A Pilot Study. Marmara Dent J. 2018;2(1):7–12.
3. 3. Li C, Su N, Yang X, Yang X, Shi Z, Li L. Ultrasonography for detection of disc displacement of temporomandibular joint: A systematic review and meta-analysis. J Oral Maxillofac Surg. 2012;70(6):1300–9.
4. 4. Dong XY, He S, Zhu L, Dong TY, Pan SS, Tang LJ, et al. The diagnostic value of high-resolution ultrasonography for the detection of anterior disc displacement of the temporomandibular joint: A meta-analysis employing the HSROC statistical model. Int J Oral Maxillofac Surg. 2015;44(7):852–8.
5. 5. Bas B, Ylmaz N, Gkce E, Akan H. Diagnostic value of ultrasonography in temporomandibular disorders. J Oral Maxillofac Surg. 2011;69(5):1304–10.
6. 6. Razek AAKA, Al Mahdy Al Belasy F, Ahmed WMS, Haggag MA. Assessment of articular disc displacement of temporomandibular joint with ultrasound. J Ultrasound. 2015;18(2):159–63.
7. 7. Kundu H, Basavaraj P, Kote S, Singla A, Singh S. Assessment of TMJ disorders using ultrasonography as a diagnostic tool: A review. J Clin Diagnostic Res. 2013;7(12):3116–20.
8. 8. Osiewicz MA, Lobbezoo F, Loster BW, Loster JE, Manfredini D. Frequency of temporomandibular disorders diagnoses based on RDC/TMD in a Polish patient population. Cranio - J Craniomandib Pract. 2018;36(5):304–10.

9. 9. Klatkiewicz T, Gawriołek K, Pobudek Radzikowska M, Czajka-Jakubowska A. Ultrasonography in the Diagnosis of Temporomandibular Disorders: A Meta-Analysis. Med Sci Monit 2018;24:812–7.
10. 10. Emshoff R, Jank S, Rudisch A, Walch C, Bodner G. Error patterns and observer variations in the high-resolution ultrasonography imaging evaluation of the disk position of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(3):369–75.
11. 11. Emshoff R, Brandlmaier I, Bodner G, Rudisch A. Condylar erosion and disc displacement: Detection with high-resolution ultrasonography. J Oral Maxillofac Surg. 2003;61(8):877–81.
12. 12. Emshoff R, Bertram S, Rudisch A, Gaßner R. The diagnostic value of ultrasonography to determine the temporomandibular joint disk position. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84(6):688–96.
13. 13. Emshoff R, Jank S, Bertram S, Rudisch A, Bodner G. Disk displacement of the temporomandibular joint: Sonography versus MR imaging. Am J Roentgenol. 2002;178(6):1557–62.
14. 14. Kalyan US, Moturi K, Rayalu KP. The Role of Ultrasound in Diagnosis of Temporomandibular Joint Disc Displacement : A Case – Control Study. J Maxillofac Oral Surg. 2017
15. 15. Nabeih YB, Speculand B. Ultrasonography as a diagnostic aid in temporomandibular joint dysfunction. Int J Oral Maxillofac Surg. 1991;20(3):182–6.
16. 16. Thomas AE, Kurup S, Kumar SP, Chandy ML, Jose R. Diagnostic efficiency of high-resolution ultrasonography in patients with chronic temporomandibular disorders. Oral Radiol. 2016;32(3):160–6.
17. 17. Su N, van Wijk AJ, Visscher CM, Lobbezoo F, van der Heijden GJMG. Diagnostic value of ultrasonography for the detection of disc displacements in the temporomandibular joint: a systematic review and meta-analysis. Clin Oral Investig. 2018; 22(7):2599-2614
18. 18. Jank S, Emshoff R, Norer B, Missmann M, Nicasi A, Strobl H, et al. Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ - A pilot study. Int J Oral Maxillofac Surg. 2005;34(2):132–7.
19. 19. Markman TM, Halperin HR, Nazarian S. Update on MRI Safety in Patients with Cardiac Implantable Electronic Devices. Radiology. 2018;288(3):656–7.
20. 20. Manfredini D, Tognini F, Melchiorre D, Zampa V, Bosco M. Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion. Dentomaxillofacial Radiol. 2003;32(6):359–64.
21. 21. Jank S, Rudisch A, Bodner G, Brandlmaier I, Gerhard S, Emshoff R. High-resolution ultrasonography of the TMJ: Helpful diagnostic approach for patients with TMJ disorders? J Cranio-Maxillofacial Surg. 2001;29(6):366–71.
22. 22. Liao LJ, Lo WC. High-Resolution Sonographic Measurement of Normal Temporomandibular Joint and Masseter Muscle. J Med Ultrasound. 2012;20(2):96–100.
23. 23. Landes C, Walendzik H, Klein C. Sonography of the temporomandibular joint from 60 examinations and comparison with MRI and axiography. J Cranio-Maxillofacial Surg. 2000;28(6):352–61.
24. 24. Katzberg RW. Is ultrasonography of the temporomandibular joint ready for prime time? Is there a “window” of opportunity? J Oral Maxillofac Surg. 2012;70(6):1310–4.
25. 25. Manfredini D, Guarda-Nardini L. Ultrasonography of the temporomandibular joint: a literature review. Int J Oral Maxillofac Surg. 2009;38(12):1229–36.
26. 26. Hayashi T, Ito J, Koyama J, Yamada K. The accuracy of sonography for evaluation of internal derangement of the temporomandibular joint in asymptomatic elementary school children: comparison with MR and CT. AJNR Am J Neuroradiol. 2001;22(4):728–34.
27. 27. Kaya K, Dulgeroglu D, Unsal-Delialioglu S, Babadag M, Tacal T, Barlak A, et al. Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement. J Cranio-Maxillofacial Surg. 2010;38(5):391–5.
28. 28. Emshoff R, Jank S, Bertram S, Rudisch A, Bodner G. Disk Displacement of the Temporomandibular Joint Sonography Versus MR Imaging American Journal of Roentgenology Vol. 2002;(June 2000):1557–62.
29. 29. Alkhader M, Ohbayashi N, Tetsumura A, Nakamura S, Okochi K, Momin MA, et al. Diagnostic performance of magnetic resonance imaging for detecting osseous abnormalities of the temporomandibular joint and its correlation with cone beam computed tomography. Dentomaxillofacial Radiol. 2010;39(5):270–6.
30. 30. Sasaki J, Ariji Y, Sakuma S, Katsuno R, Kurita K, Ogi N, et al. Ultrasonography as a tool for evaluating treatment of the masseter muscle in temporomandibular disorder patients with myofascial pain. Oral Radiol. 2006;22(2):52–7.
31. 31. Yılmaz D, Kamburoğlu K. Comparison of the effectiveness of high resolution ultrasound with MRI in patients with temporomandibular joint dısorders. Dentomaxillofacial Radiol. 2019;20180349.