Retrospective study on the evaluation of the TMJ by MRI using a newly developed standardized evaluation form.

The objectives of this retrospective study were to systematically assess the temporomandibular joint (TMJ) using a newly developed standardized evaluation form with 16 parameters based on MRI diagnostics and to verify the reliability of the MRI diagnoses. One hundred fifty-four (154) TMJs of 77 patients with arthrogenic complaints were evaluated using MRI on two planes (parasagittal, paracoronal), in both closed-mouth and open-mouth positions. The sequences used were intermediary FLASH and spin echo sequences using T1 or T2 weighting with fat suppression. Examination of the reliability of the MRI evaluations of three independent observers evaluating 60 randomly selected TMJ from among the overall sample using the new evaluation form yielded an average Pearson contingency coefficient of between 0.64 and 0.70 with regard to the 16 parameters studied. In the evaluation of the 77 left (L) and 77 right (R) joints, the biplanar morphology of the disk was the most frequent with 24.7% (L) and 32.5% (R). In paracoronal projection, medial displacement of the disk was seen in 7.9% (L, R) of the cases and lateral displacement in 6.4% (L) and 3.2% (R). The use of the new evaluation form, in combination with MRI of the TMJ, demonstrated a substantial reliability of the diagnoses. In TMD patients, the biconcave disk shape cannot be considered the sole normal, standard situation. The presence of lateral and medial disk displacement should be given more diagnostic consideration.

Proton 1H- and Phosphorus 31P-MR spectroscopy (MRS) in asymptomatic HIV-positive patients.

INTRODUCTION: HIV infection is accompanied by a variety of neurological disorders. Depression of cell-mediated immunity is followed by the development of central nervous system opportunistic infections/tumours, and frequently by the occurrence of the AIDS dementia complex (ADC). However, the pathophysiology of the emergence of neuro-AIDS is still unknown. Despite the development of cognitive impairments, the early diagnosis, objectification and quantification of the existence and extent of this impairment during infection are difficult to recognize in each individual case. To support the early diagnosis of ADC, there is a need for additional, non-invasive diagnostic methods. In this study, it is of interest to answer the clinically relevant question of whether magnetic resonance spectroscopy can detect changes in the cerebral metabolism of asymptomatic HIV-positive patients and is possibly suitable for the early diagnosis and prevention of HIV encephalopathy. METHODS: A group of 13 asymptomatic, HIV-positive patients with combined antiretroviral therapy (cART) and 13 healthy controls were examined with 2D 1H-MRS and 3D 31P-MRS at 3T. The patients were treated with cART for at least 12 months. Changes in the absolute concentrations of phosphorylated metabolites (ATP), N-acetyl-aspartate, creatine, myo-Isonitol, glutamate/glutamine and choline-containing compounds were compared with that of control subjects. RESULTS: Asymptomatic HIV-positive patients had significantly lower N-acetyl-aspartate in the white matter in a frontal and parietal target region. The other evaluated metabolites in the 1H MRS showed no significant difference between the HIV-positive patients and healthy controls. The 31P-MRS detected significant elevated values regarding the choline-containing compounds PEth, GPE and PCho. CONCLUSIONS: This spectroscopic study revealed a significantly lower N-acetyl-aspartate in the white matter in a frontal and parietal cerebral target region in asymptomatic, HIV-positive patients as an early sign of neuronal disintegration. The 31P-MRS detected significant elevated values regarding the choline-containing compounds PEth, GPE and PCho as an early sign of gliosis. Furthermore we could show that with the use of 1H-MRS and 31P-MRS cerebral metabolites can be reliably detected and measured in HIV-positive patients. The 1H-MRS and 31P-MRS is therefore suited as a diagnostic tool for early cerebral metabolic changes in HIV-positive patients.