颞下颌关节盘穿孔的MRI诊断  

Magnetic resonance image for diagnosis of perforation of the temporomandibular joint

作　　者：沈佩[1] 霍亮[1] 张善勇[1] 杨驰[1] 恽白[1] 陈琢之[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2014年第6期498-502,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81371168);上海市自然科学基金(10ZR1418200);2011年上海市浦江人才计划;2013年上海交通大学医学院第七期大学生创新训练项目(2013052)~~

摘　　要：目的 :评价磁共振(magnetic resonance image,MRI)检查对颞下颌关节(temporomandibular joint,TMJ)盘穿孔的诊断价值。方法:对2003年4月—2010年3月期间临床诊断为TMJ结构紊乱(internal derangement,ID)的1845例(2524侧)患者行TMJ MRI检查。所有患者均行关节镜或开放性手术治疗,确定有无盘穿孔。按照我们制定的MRI诊断标准,确定有无穿孔,分为阳性组、可疑组及阴性组;并以关节镜或开放性手术结果为金标准,得出真、假阳性及真、假阴性关节例数,应用SPSS16.0软件包制作ROC曲线,计算ROC曲线下面积,评价MRI诊断TMJ盘穿孔的整体准确性,并结合其优点,评价其对TMJ盘穿孔的应用价值。结果:磁共振检查诊断结果与关节镜及开放性手术结果相比,阳性组189侧,其中102侧真阳性,87侧假阳性;可疑组197侧,其中42侧真阳性,155侧假阳性;阴性组2138侧,其中63侧假阴性,2075侧真阴性。ROC曲线下面积=0.808(0.77,0.85)(P<0.05)。结论 :MRI对TMJ盘穿孔具有较好的诊断价值,但其诊断的准确性依赖于有无关节液和临床经验。PURPOSE： To evaluate the value of magnetic resonance image （MRI） on the diagnosis of perforation of the temporomandibular joint （TMJ）. METHODS： Consecutive 1845 patients （2524 TMJs） diagnosed as temporomandibular disorders （TMD） were collected from April 1st, 2003 to March 1st, 2010 in our department. All the patients were examined by MRI and treated by arthroscopy or operation. The findings of interpreting MRI were recorded as positive, suspicious and negative according to the MRI radiographic criteria. After comparing the findings of MRI with those of arthroscopy or operation, the numbers of true positive, true negative, false positive and false negative were obtained. Through SPSS16.0 software package, receiver operator characteristic curve （ROC curve） was made with 1-specificity as abscissa and the sensitivity as ordinate, and the area under the ROC curve was calculated. According to the area, the diagnostic value of MRI was evaluated. RESULTS： According to the criteria above, we found 189 TMJs were positive, 197 TMJs were suspicious, and 2138 TMJs were negative. After comparing the findings of MRI with those of arthroscopy or operation, true positive in 102 TMJs and false positive in 87 TMJs were detected among 189 positive TMJs, perforation in 42 TMJs and no perforation in 155 TMJs were detected among 197 suspicious TMJs, and true negative in 2075 TMJs and false negative in 63 TMJs were detected among 2138 negative TMJs. The area under ROC curve was 0.808 （0.77,0.85）（P〈0.05）. CONCLUSIONS： It is concluded that the diagnostic accuracy of MRI was good, but the accuracy depends on both whether there was joint fluid and the experience of the doctors.

关 键 词：颞下颌关节 关节盘穿孔 磁共振检查 

分 类 号：R782.6[医药卫生—口腔医学]