MR Imaging of the TMJ: A Pictorial Essay

Chris Roth, MD; Robert J. Ward, MD; Scott Tsai, MD; Wendy Zolotor, MD; Richard Tello, MD, MSME, MPH

Disclosures

Appl Radiol. 2005;34(5):9-16. 

In This Article

Imaging the TMJ

A small surface coil is placed over the TMJ; a bilateral examination can be performed with coupled coils. Images are obtained in the open-and closed-mouth positions to assess the position and reducibility (or recapture) of the articular disk. This is facilitated by placing a specialized device in the patient's mouth to keep it open and by instructing the patient to bite down on it for the closed-mouth views.

From axial localizing images, sagittal and coronal planes are prescribed. Imaging is most commonly performed in these planes in order to document the position of the disk. Oblique sagittal and coronal images can be oriented to the condyle, but are unnecessary to demonstrate internal derrangements.

T1-weighted sagittal images are the cornerstone of the TMJ examination; the anatomy is clearly depicted, and the imaging plane is optimal for assessing articular disk position. T2-weighted images are useful for detecting degenerative periarticular changes and the presence of a joint effusion.[4] Fat saturation or inversion recovery renders these findings more conspicuous.

Gradient-echo techniques have been implemented to obtain cine-loop motion studies. Three-dimensional volume acquisitions allow a volume of tissue to be imaged rapidly and subsequently viewed in any plane. The use of intra-articular and intravenous gadolinium may provide utility in certain clinical instances—for instance, the inflamed synovium or an inflamed arthropathy will avidly enhance after the administration of intravenous gadolinium.[5—7]

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