Early diagnosis of degenerative changes in the articular/fibrocartilaginous disc of the temporomandibular joint in patients with temporomandibular disorders using delayed gadolinium-enhanced MRI at 3 Tesla - preliminary results

Abstract

Background: Delayed gadolinium enhanced MRI of cartilage (dGEMRIC) is a quantitative method for assessment of glycosaminoglycan content in connective tissues. We hypothesize that the early diagnosis of degenerative changes in the temporomandibular joint could be diagnosed using dGEMRIC technique.

Purpose: To test the compositional MRI technique, dGEMRIC, at 3 Tesla to diagnosis early the degenerative changes in the fibrocartilaginous disc of the temporomandibular joint (TMJ) in patients with temporomandibular disorders (TMD) and to compare the dGEMRIC index of patients to the healthy volunteers.

Methods: Six volunteers (two men, four women; 20.8÷28.1 years) and eleven patients (22 TMJs, seven women, four men; 24÷54 years) were recruited for this prospective trial. Only patients with no morphological abnormality on MRI and without disc dislocations were included. Volunteers were used as a control group. The PD-weighted FSE sequence and the 3D GRE (DESS) sequence protocols were performed for morphological assessment. The Inversion recovery (IR) sequence was performed for T1 relaxation time measurements and intra-venous (IV) contrast agent administration was used according to the dGEMRIC protocol. T1 maps were calculated offline and ROIs were drawn on TMJ discs by a specialist trained in TMD disorders. Statistical evaluation was performed by ANOVA and correlations were calculated.

Results: The difference between the dGEMRIC values in the TMJ articular discs of the patients and the volunteers was statistically significant (P = .019). After contrast agent administration the T1 values dropped in both groups. In patient group was the T1 drop stronger (-54% from initial pre-contrast value), while in control group was the T1 drop less pronounced (-46% from initial pre-contrast value).

Conclusions: dGEMRIC seems to be a useful, compositional, quantitative method, suitable also for small joints, such as the articular disc of the TMJ. The results of the dGEMRIC index in the articular disc of the TMJ imply a lower GAG content in patients with TMJ disorders.

Keywords: 3 tTesla MRI; MRI of temporomandibular joint disc; dGEMRIC technique; early diagnosis of temporomandibular joint disc; glycosaminoglycan content at the temporomandibular joint disc.