Clinical Study on T2 Mapping Evaluation of Joint Disc Characteristics in Patients with Temporomandibular Joint Dysfunction Syndrome
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摘要:
目的 运用磁共振T2 mapping技术，分别在开、闭口位定量评估TMD关节盘结构损伤的变化及意义。 方法 前瞻性收集2023年6月至2024年1月期间在云南大学附属医院口腔外科初诊为TMD的患者127例以及对照组51例。所试对象均行颞颌常规序列及T2 Mapping序列扫描。扫描后利用后处理获得伪彩图，分别在开、闭口位伪彩图上测量关节盘（前带、后带）的T2值，分析其与TMD前移程度的相关性。 结果 病例组开、闭口位关节盘后带T2值均大于关节盘前带T2值（P < 0.05）；关节盘不同前移程度组，正常上位组、轻度前移组、中度前移组的T2值整体呈依次增高趋势，而重度前移组的T2值呈现下降的趋势（P < 0.01）；弹响、咬合异常是TMD患者关节盘不可复前移的独立危险因素。 结论 开口位、闭口位扫描均可以作为评估TMD关节盘损伤的检查方法；T2 mapping技术可以定量、敏感地反映关节盘微结构生化成分变化规律。 -
关键词:
- 颞下颌关节紊乱综合征 /
- 磁共振 /
- T2 mapping /
- 关节盘 /
- 颞下颌关节
Abstract:Objective To quantitatively evaluate structural changes in the TMD disc using magnetic resonance T2 mapping technology at open and closed mouth positions, and assess its significance. Methods 127 newly diagnosed patients with TMD and 51 controls in the Department of Oral and Maxillofacial Surgery of the Affiliated Hospital of Yunnan University from June 2023 to January 2024 were prospectively collected. All subjects underwent routine TMJ sequence and T2 mapping sequence scans. After scanning, the pseudo-color images were processed, and T2 values of the joint disc （anterior and posterior bands） were measured at open and closed mouth positions to analyze their correlation with TMD disc displacement. Results The T2 values of the posterior zone of the joint disc in both open and closed positions were higher than those in the anterior zone of the joint disc in the case group （P < 0.05）; for different anterior displacement degrees of the joint disc, T2 values showed a progressive increase from the normal position group to the mild and moderate anterior displacement groups, while the severely displaced group demonstrated a decreasing trend （P < 0.01）; joint clicking and occlusal abnormalities were independent risk factors for non-reducible anterior joint disc displacement in TMD patients. Conclusion Scans during both mouth-opening and closing positions can be used to assess joint disc injury in TMD; T2 mapping technology can quantitatively and sensitively reflect changes in the biochemical composition of joint disc microstructure. -
表 1 病例组、对照组性别及年龄比较（$\bar x \pm s $）
Table 1. Comparison of gender and age between case group and control group（$ \bar x \pm s$）
指标 病例组（n=127） 对照组（n=52） Z/χ2 P 性别（男/女） 127（23/104） 52（9/43） −0.776 0.438 年龄（岁） 23.67±6.31 23.75±4.44 0.016 0.899 
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表 2 A、B两名医师对病例组闭口位不同ROI测量T2值的一致性检验
Table 2. Consistency test of T2 values measured by different ROIs in the closed mouth position in case group by two physicians A and B
部位 ROI ICC 95%CI P 关节盘 前带 0.927 0.906～0.943 <0.001* 后带 0.892 0.862～0.915 <0.001* *P < 0.05。
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表 3 病例组、对照组分别对关节盘前带及后带T2值比较[M（P25，P75）/（$ \bar x \pm s $），ms]
Table 3. Comparison of T2 values in the anterior and posterior bands of the articular disc between the case group and the control group[M（P25，P75）/（$ \bar x \pm s $），ms]
分组 体位 前带 后带 Z/t P 病例组（n=232） 闭口位 19.7800 （17.6150 ，22.7250 ）21.0100 （18.2675 ，23.5200 ）−2.341 0.019* 开口位 20.5200 （18.5200 ，23.6625 ）21.9150 （18.9150 ，24.6175 ）−2.031 0.042* 对照组（n=104） 闭口位 20.0750 （17.1375 ，22.4575 ）21.0450 （18.6425 ，23.7125 ）−2.488 0.013* 开口位 20.8979 ±3.6486 20.4733 ±3.31639 0.878 0.299 *P < 0.05。
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表 4 关节盘闭口位与开口位T2值比较[M（P25，P75）/（$ \bar x \pm s $），ms]
Table 4. Comparison of T2 values between closed and open positions of joint discs$ [ $M（P25，P75）/（$ \bar x \pm s $），ms]
分组 闭口位 开口位 Z/t P 病例组（n=232） 21.3625 （19.5638 ，23.6163 ）21.2825 （19.3863 ，23.4025 ）−0.387 0.699 对照组（n=104） 20.7094 ±2.9472 20.6856 ±2.5271 0.068 0.946
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表 5 关节盘病例组与对照组T2值[M（P25，P75），ms]
Table 5. Comparison of T2 values between the joint disc case group and the control group [M（P25，P75），ms]
部位 体位 病例组（n=232） 对照组（n=104） Z P 关节盘 闭口位 21.3625 （19.5638 ，23.6163 ）20.8350 （18.3250 ，22.7425 ）−2.761 0.006* 开口位 21.2825 （19.3863 ，23.4025 ）20.7100 （18.9525 ，27.8750 ）−2.328 0.020* *P < 0.05。
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表 6 关节盘不同前移程度分组病例组与正常上位组T2值比较[M（P25，P75），ms]
Table 6. Comparison of T2 values between case and control groups with different degrees of anterior disc displacement [M（P25，P75），ms]
位 体位 正常上位（n=104） 轻度前移（n=41） 中度前移（n=44） 重度前移（n=110） H P 关节盘 闭口位 20.8350
（18.3250 ，22.7425 ）19.9050
（18.2400 ，22.8950 ）21.7825
（19.3038 ，24.1088 ）20.1025
（18.0100 ，21.7200 ）9.147 0.027* 开口位 20.7100
（18.9525 ，22.2788 ）20.5700
（18.2525 ，21.8075 ）21.9650
（20.2613 ，23.8663 ）21.3650
（18.9388 ，23.5575 ）13.044 0.005* *P < 0.05。
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表 7 TMD患者关节盘不可复前移影响因素的Logistic回归分析
Table 7. Logistic regression analysis of factors affecting irreversible disc displacement in TMD patients
变量 赋值 B S.E Wald P OR 95%CI 弹响 1=是，0=否 1.086 0.533 4.155 0.042 2.961 1.043～8.411 咬合异常 1=是，0=否 0.899 0.352 6.522 0.011 2.457 1.233～4.899
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