The diagnostic accuracy of cone beam computed tomography in detecting temporomandibular joint bony disorders: a systematic review.

Computed tomography (CT) has been recognized as a robust and dependable technique for delineating osseous alterations and anomalies within hard tissues. The necessity for accurate diagnosis and management of patients with temporomandibular disorders in dental practices has increasingly come to the forefront. There is ongoing scholarly debate regarding the equivalence of diagnostic outcomes yielded by cone beam computed tomography (CBCT), which offers greater accessibility in dental settings than traditional CT, in identifying bony changes within the temporomandibular joint (TMJ). Our principal aim was to conduct a systematic review of studies that compare the efficacy of CT and CBCT in the detailed assessment of bone conditions affecting the TMJ. An electronic search was conducted across databases: PubMed, Medline, Web of Science, Cochrane and Scopus. Two independent reviewers screened titles and abstracts against predefined inclusion criteria. The included articles underwent rigorous critical appraisal, during which relevant data were extracted and systematically presented in a tabular format. This systematic review incorporates 5 studies published between 2006 and 2015. In 3 studies, CBCT demonstrated comparable outcomes to CT, while 2 investigations revealed significantly enhanced accuracy for CBCT compared to CT, with reported accuracies of 0.95 ± 0.04, 0.77 ± 0.17, and 89-91% for CBCT. The aggregated evidence from the included studies indicates that CBCT offers comparable or superior accuracy in detecting osseous changes within TMJ structures. Owing to its lower radiation exposure and increased accessibility, CBCT emerges as the preferred choice over conventional CT for evaluating bony structures of the TMJ.

Teaming up to overcome challenges toward translation of new therapeutics for osteoarthritis.

As a leading global cause of musculoskeletal-related disability, osteoarthritis (OA) represents a public health urgency. Understanding of disease pathogenesis has advanced substantially in the past decade, yet no disease-modifying therapeutics have advanced to the clinic. To address this challenge, the CARE-AP (Cartilage Repair strategies to alleviate Arthritis Pain) collaborative research team was convened to bring together relevant multidisciplinary expertise and perspectives from across the VA research community nationwide. The first CARE-AP Annual Research Symposium took place (virtually) in February 2022 with roughly 90 participants. A number of innovative and therapeutic strategies were discussed, including siRNA approaches coupled with novel nanoparticle-based delivery systems, cellular engineering approaches to develop reparative cells that can probe the joint environment and respond to disease-specific cues, and novel biofabrication techniques to improve tissue engineering and effect "biological joint replacement." In addition, challenges and advances in rehabilitation approaches, imaging outcomes, and clinical studies were presented, which were integrated into a framework of recommendations for running "preclinical trials" to improve successful clinical translation.

Electroarthrography: a novel method to assess articular cartilage and diagnose osteoarthritis by non-invasive measurement of load-induced electrical potentials at the surface of the knee.

OBJECTIVE: A new technique called electroarthrography (EAG) measures electrical potentials on the surface of the knee during joint loading. The objective of this study was to evaluate the effectiveness of EAG to assess joint cartilage degeneration. DESIGN: EAG recordings were performed on 20 asymptomatic subjects (Control group) and on 20 patients with bilateral knee osteoarthritis (OA) who had had a unilateral total knee replacement (TKR), both the TKR knee and the remaining knee were analyzed. EAG signals were recorded at eight electrode sites over one knee as the subjects shifted their weight from one leg to the other to achieve joint loading. The EAG signals were filtered, baseline-corrected and time-averaged. RESULTS: EAG repeatability was assessed with a test-retest protocol which showed statistically significant high intraclass correlation coefficients (ICC) for four electrode sites near the joint line. These sites also showed the highest mean EAG values. The mean EAG potentials of the Control group were significantly higher compared with the OA group for three sites overlying the joint line. The potentials overlying the TKR were statistically nul. In the Control group, no statistically significant correlation was found between the EAG amplitude and age, weight, height or body mass index (BMI); no statistical difference was found in mean EAG potentials between women and men. CONCLUSIONS: This study indicates that EAG signals arise from the streaming potentials in compressed articular cartilage which are known sensitive indicators of joint cartilage health. EAG is a promising new technique for the non-invasive assessment of cartilage degeneration and arthritis.

A microCT imaging protocol for reproducible and efficient quantitative morphometric analysis (QMA) of joint structures of the in situ mouse tibio-femoral joint.

Micro-computed tomography (microCT) offers a three-dimensional (3D), high-resolution technique for the visualisation and analysis of bone microstructure. Using contrast-enhanced microCT, this capability has been expanded in recent studies to include cartilage morphometry and whole joint measures, known together as quantitative morphometric analysis (QMA). However, one of the main challenges in quantitative analysis of joint images is sensitivity to joint pose and alignment, which may influence measures related to both joint space and joint biomechanics. Thus, this study proposes a novel microCT imaging protocol for reproducible and efficient QMA of in situ mouse tibio-femoral joint. This work consists of two parts: an in situ diffusion kinetics study for a known cationic iodinated contrast agent (CA4+) for QMA of the cartilage, and a joint positioning and image processing workflow for whole joint QMA. In the diffusion kinetics study, 8 mice were injected at both of their tibio-femoral joints with distinct CA4+ concentrations and diffusion times. The mice were scanned at different time points after injection, and evaluated using attenuation and cartilage QMA measures. Results show that cartilage segmentation and QMA could be performed for CA4+ solution at a concentration of 48 mg/ml, and that reliable measurement and quantification of cartilage were achieved after 5 min of diffusion following contrast agent injection. We established the joint positioning and image processing workflow by developing a novel positioning device to control joint pose during scanning, and a spherical harmonics-based image processing workflow to ensure consistent alignment during image processing. Both legs of seven mice were scanned 10 times, 5 prior to receiving CA4+ and 5 after, and evaluated using whole joint QMA parameters. Joint QMA evaluation of the workflow showed excellent reproducibility; intraclass correlation coefficients ranged from 0.794 to 0.930, confirming that the imaging protocol enables reproducible and efficient QMA of joint structures in preclinical models, and that contrast agent injection did not cause significant alteration to the measured parameters.

Osteoarthritis: Can We Do Better?

Osteoarthritis (OA) is the most common form of arthritis, affecting approximately 32.5 million adults in the United States. OA is characterized as a degenerative joint disease or "wear and tear" arthritis. Symptoms experienced by patients include, but are not limited to, swelling, stiffness, pain or aching, and decreased range of motion. The majority of individuals impacted by OA are over the age of 65. OA has long been thought of as an inevitable part of aging. Patients are typically diagnosed after the onset of symptoms once irreversible damage has occurred, such as the breakdown of bone and cartilage. Along with clinical presentations, medical professionals often relied on radiographic images to confirm the diagnosis of OA. Limited research has looked into how to catch OA early and stage patients in a pre-OA state, possibly preventing irreparable damage that is observable radiographically. This article presents the history, diagnosis, and classes of OA. In addition, we present multiple diagnostic tools currently used and others under investigation, including OA-specific biomarkers and electroarthrography (EAG). These tools show promise as aids in early OA diagnosis and intervention, ultimately slowing down or altogether stopping the progression of OA. In conjunction or individually, these techniques, if further developed, stand out as promising mechanisms that may decrease the current OA burden on the healthcare system.

Imaging, histopathological degree of degeneration and clinical findings - Do these correlate in patients with temporomandibular joint disorders.

The gold standard for temporomandibular joint imaging is magnetic resonance imaging, although there are still pathological findings that cannot be seen in MRI but in surgery and the subsequent histological analysis only. The main goal of this investigation was to validate the MRI score used by histopathological findings as well as clinical findings. In this retrospective study 39 patients were included; 38 of which underwent unilateral and 1 underwent bilateral discectomy. MRI findings were graded according to the score by Wurm. Histopathological analysis was performed in hematoxylin-eosin staining and graded in accordance with the scores by Krenn and by Leonardi. For valuation of preoperative pain values of the temporomandibular joint operated on the numeric rating scale was utilized. Correlations were verified by Spearman-Rho. The MRI scores on average showed significantly lower scores for the discs of the operated temporomandibular joint than for the discs of the non-operated side(p<.01). No significant correlations between MRI findings, histopathological findings and pain intensities could be observed. Thus unsuspicious morphology of the TMJ and the articular disc in MRI is no guarantee for the absence of cartilage-degeneration. Further investigations utilizing T2 cartilage mapping could possibly show better correlations between the temporomandibular joint's degree of degeneration and imaging results.

Bifid Mandibular Condyle With Associated Temporomandibular Joint Ankylosis: A Rare Skeletal Abnormality.

Bifid mandibular condyle (BMC) is splitting the mandibular condyle into two separate articular surfaces. The etiology is poorly understood, but trauma and developmental issues are currently the most cited causes. Though most often asymptomatic, occasionally, this condition may cause the development of jaw pain, clicking, and restriction of motion. We present a rare case of a patient who developed unilateral ankylosis of the temporomandibular joint (TMJ) secondary to BMC in the absence of trauma or infection. The ankylosis developed due to abnormal biomechanical forces and degenerative arthritis secondary to the abnormal articulation of the TMJ caused due to BMC. CT imaging is the best modality to evaluate the bony anatomy of the TMJ. It is essential to consider BMC as a cause of TMJ pathology, as management is primarily surgical in nature.

Three-dimensional intra- and extracranial arterial vessel wall joint imaging in patients with cerebrovascular disease.

PURPOSE: To evaluate the clinical performance of a newly developed three-dimensional (3D) intra- and extracranial arterial vessel wall joint imaging technique at 3T using T1-weighted 3D variable-flip-angle turbo spin-echo sequence with improved cerebrospinal fluid suppression in patients with cerebrovascular disease. MATERIALS AND METHODS: 122 consecutive patients (mean age 45.96 ± 12.16 years) with clinically confirmed cerebrovascular symptoms were imaged using a 3D intra- and extracranial arterial vessel wall joint imaging sequence with and without contrast enhancement on a 3 T MR system. The number of plaques and culprit plaques were evaluated. The image quality score, percent stenosis, remodeling ratio, and plaque burden were measured and compared between intracranial and carotid arterial plaques, and between non-culprit and culprit plaques. RESULTS: Except for 23 patients, there were 322 plaques (111 culprit plaques) detected in 96 patients with large artery atherosclerosis. Of the plaques, 278 (96 culprit plaques) and 44 (15 culprit plaques) plaques were identified in intracranial and extracranial arteries, respectively. Image quality did not differ significantly between pre- and post-contrast vessel wall magnetic resonance images. There were also no significant differences in the percent stenosis, remodeling ratio, and plaque burden between intracranial and carotid arteries, and between non-culprit and culprit plaques. The enhancement rate of culprit plaques was significantly higher than that of non-culprit plaques. CONCLUSIONS: The described joint imaging is a promising vessel wall magnetic resonance imaging method for comprehensive diagnosis of cerebrovascular symptoms and investigation of etiology. The imaging technique is a potentially valuable means to optimize treatment.

Acromioclavicular joint injuries: Imaging and management.

Acromioclavicular joint injuries are commonly encountered in the setting of shoulder trauma. Knowledge of the anatomy and biomechanics of the joint, grading of joint injuries, and understanding the capabilities and limitations of different radiological modalities will help in selecting the best management option and outcomes for affected patients.

A Comparative Study of High-Resolution Chemical-Shift-Eliminated Magnetic Resonance Imaging of Finger Specimens with Microcomputed Tomography.

OBJECTIVE: High-resolution images of finger joints with chemical-shift elimination can be obtained using an interleaved water-fat (IWF) sequence. This study assessed IWF imaging of finger joints in the delineation of bone structures by comparing images of cadaver fingers with those of microcomputed tomography (CT) that served as a standard reference. MATERIALS AND METHODS: IWF images with spatial resolution of 176 µ × 176 µ × 300 µ were obtained from the distal and proximal interphalangeal joints of two cadaver finger specimens using a custom-built radiofrequency receive coil at 1.5T. Regular three-dimensional gradient-echo (GRE) images were also acquired with similar parameters and compared with the IWF images to evaluate the effects of chemical shift. Micro-CT scans were obtained and served as the standard reference. The image data were reviewed by two experienced musculoskeletal radiologists in consensus. The delineation of normal joint structures and abnormalities in the finger specimens as revealed by the magnetic resonance imaging (MRI) and micro-CT images were compared. The IWF and regular GRE images were assigned scores 0-3 for the depiction of apparent marginal bone defects, with zero being the same in appearance to the micro-CT image and three as having minimal resemblance to it. Statistical analysis of the scoring results was conducted to compare the two MRI techniques. RESULTS: The high-resolution IWF images provided accurate delineation of bone and calcified structures as seen in micro-CT. The thickness of subchondral bone was depicted similarly on the IWF water + fat and the micro-CT images but not on the regular GRE images. The regular GRE sequence showed false marginal bone defects not observed with IWF and micro-CT. In addition, the IWF water-only images facilitated the identification of bone cyst by revealing its water content. CONCLUSION: High-resolution IWF imaging should be useful for the early diagnosis and treatment assessment of arthritis and should also benefit basic research in the pathophysiology of the disease.

Prevalence of Chondrocalcinosis in Patients above 50 Years and the Relationship with Osteoarthritis.

BACKGROUND: Some studies showed a relation between chondrocalcinosis and osteoarthritis (OA). Hence, considering the importance of chondrocalcinosis diagnosis andnecessity for its integration with OA, the current study aims at investigating prevalence of chondrocalcinosis in patients above 50 years admitted to Isfahan Al-Zahra Medical Center and its relationship with OA. MATERIALS AND METHODS: In a cross-sectional study, 600 patients who referred to the radiology units of Al-Zahra Hospital for radiography of different joints were studied during 2013-2014. The patients images were studied for chondrocalcinosis and OA by a radiologist and also examined clinically and results of imaging by an expert rheumatologist. The prevalence of chondrocalcinosis and it relation with OA was determined by Statistical Package for Social Sciences software and using of Chi-square and t-test. RESULTS: 23 patients under study had chondrocalcinosis (3.83%). patients with chondrocalcinosis had higher age average, and they were in age group of 70 years and older, but no significant difference was observed regarding the prevalence of the disease in both genders. Chondrocalcinosis prevalence in terms of body mass index showed significant differences (P = 0.001). All patients with chondrocalcinosis had a history of joint disease and prevalence of chondrocalcinosis in terms of joint disease history showed a significant difference (P < 0.001). CONCLUSION: Prevalence of chondrocalcinosis is relatively high in the Iranian population of 70 years and older. Hence, more investigation considering to the diagnosis of chondrocalcinosis among patients with OA is very important.

Association between mandibular condylar position and clinical dysfunction index.

OBJECTIVES: Condylar position in the glenoid fossa has been associated with temporomandibular disorders. The purpose of the present study was to investigate the correlation between clinical dysfunction index (Di) and mandibular condylar position in patients with temporomandibular joint dysfunction (TMD) using cone beam computed tomography (CBCT). METHODS: In this cross-sectional study, participants were recruited from the Department of Maxillofacial Radiology at Shiraz Dental University in Iran. The condylar position was assessed on the CBCT images of 120 temporomandibular joints in 60 patients with TMD. Patients were divided into 3 groups based on Helkimo's clinical Di. The chi-square test was used to correlate degree of the Helkimo's Di with the mandibular condylar position. The p value was set at 0.05. RESULTS: A total of 60 patients (42 women and 18 men; mean age, 33.4 years) participated in this study. Significant differences in condylar position were found among the 3 groups (Di I, II, and III) (p < 0.05). Patients with mild to moderate TMD were found to have anteriorly and concentric seated condyles. Posteriorly seated condyles were found in patients with severe TMD. CONCLUSION: Condylar position is associated with different severity of TMD.

TMJ imaging by CBCT: Current scenario.

Radiographic examination forms an integral component of the clinical assessment routine in patients with temporomandibular joint disorders (TMJ). There are several imaging modalities to visualize the TMJ. Cone beam computed tomography (CBCT) is a developing technique that is being increasingly used in dentomaxillofacial imaging due to its relatively low-dose high-spatial-resolution characteristics. Research in TMJ imaging has been greatly inspired by the advent of CBCT. In this paper we aim to discuss the present scenario of the role of CBCT in TMJ imaging.

The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part I: Ultrasound anatomy and examination technique.

The glenohumeral joint is a spherical articulation with a remarkable range of motion in several planes and decreased stability. The maintenance of joint stability is influenced by the functioning of specific muscle groups in the shoulder region, a complex system of ligaments reinforcing the joint capsule, and the labrum which augments the glenoid fossa. Lesions of the aforementioned structures require accurate diagnosis prior to a decision for operative treatment. Ultrasound is one of the imaging methods that has been widely used in the assessment of various shoulder pathologies. In the author opinion, this imaging modality may also be applied for the evaluation of labral tears. Being attached along the glenoid rim, the labrum forms a collar deepening the glenoid fossa thus increasing area of its contact with the head of the humerus. To better describe the location of lesions, the glenoid labrum is usually divided into certain zones. Most of them may be visualized sonographically. The US examination of the posterior labrum can be performed during evaluation of the infraspinatus and teres minor muscles. The anterior labrum along with capsulolabral complex is seen at the glenoid edge under the subscapularis tendon. Sonographic examination of the inferior labrum is best performed using axillar approach. The superior labrum is only partially available for US examination. A crucial part of the sonographic assessment of the labrum is the dynamic examination during rotation of the upper extremity. The paper presents normal sonographic anatomy of the glenoid labrum and technique of the examination.

Antibodies to citrullinated peptides are not associated with the rate of joint destruction in patients with a well-established diagnosis of rheumatoid arthritis

Antibodies to citrullinated peptides are highly specific for rheumatoid arthritis (RA) and represent a significant risk factor for undifferentiated polyarthritis. This prognostic ability may be related to the very diagnostic performance of these autoantibodies, since RA is a more erosive disease than other forms of arthritis. The present study evaluated an association of antibodies to citrullinated peptides and the rate of joint destruction in patients with a well-established diagnosis of RA. Seventy-one patients with RA were evaluated in 1994 and again in 2002 (functional class, joint count, Health Assessment Questionnaire score, hands X-ray). Autoantibodies (rheumatoid factor (RF), anti-perinuclear factor, anti-cyclic citrullinated peptide (CCP) antibodies) and Sharp's index were analyzed blindly. Delta Sharp was calculated as the difference in Sharp's index obtained in 1994 and 2002. During the follow-up the Health Assessment Questionnaire score increased from 0.91 ± 0.74 to 1.39 ± 0.72 (P < 0.001). Similarly, the number of swollen joints increased from 4.6 ± 5.71 to 6.4 ± 4.1 (P = 0.002). The frequency of autoantibodies and anti-CCP titer remained stable; however, serum RF concentration increased from 202.8 ± 357.6 to 416.6 ± 636.5 IU/mL (P = 0.003). Sharp's index increased from 56.7 ± 62.1 to 92.4 ± 80.9 (P < 0.001). No correlation was observed between Delta Sharp and the presence of RF, anti-perinuclear factor, and anti-CCP antibodies at baseline. Antibodies to citrullinated epitopes are specific and early markers for the diagnosis of RA but do not seem to be associated with the rate of joint destruction in patients with a well-established diagnosis of RA.