The Diagnostic Reliability of Various Magnetic Resonance Imaging sequences for the Early Diagnosis of Temporomandibular Disorders: A Systematic Review

The Diagnostic Reliability of Various Magnetic Resonance Imaging sequences for the Early Diagnosis of Temporomandibular Disorders: A Systematic Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Diagnostic Reliability of Various Magnetic Resonance Imaging sequences for the Early Diagnosis of Temporomandibular Disorders: A Systematic Review Aparna S, Anuradha Ganesan, Krithika Chandrasekar.Lakshmi, Swathi K V, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3848191/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This systematic study aimed to compare and evaluate the diagnostic accuracy of different MRI sequences for detecting internal TMJ dysfunction. Materials and methods In this search strategy, we employed Google Scholar, PubMed, PubMed Central, Science Direct, and the Cochrane Library. Articles from the last decade were included in the search. The potential for bias in the included studies was evaluated. The search yielded 48 papers. However, only 10 papers met the criteria for inclusion in the systematic review. Results Various sequences such as FIESTA, FLAIR, T2 mapping, MERGE, HASTE, and dGEMRIC, have been discussed in this systematic review. Conclusion Among the various MR sequences, T2 mapping and dGEMRIC sequences help in the quantitative evaluation and assessment of early changes in disc derangement. These sequences provide in-depth diagnostic information complementary to conventional MRI for diagnosing early changes in the TMJ disc Diagnostic Temporomandibular Disorders Magnetic resonance imaging Articular disc Figures Figure 1 Figure 2 Figure 3 Introduction Temporomandibular disorder (TMD) can occur when conditions affect the masticatory muscles, the temporomandibular joint (TMJ), or tissues around these areas [ 1 ]. Common signs and symptoms include difficulty chewing, difficulty swallowing, difficulty opening wide, and cracking or popping noises as the jaw moves [ 2 ]. Intra-articular abnormalities and trauma are the leading causes of temporomandibular joint (TMJ) pain [ 3 ]. “Internal derangement (ID) of the TMJ refers to a misalignment of the disc with respect to the condyle, articular eminence, or articular fossa [ 4 ].” Anterior motion of the disc is more prevalent than any other kind of motion (anterior, posterior, lateral, or medial) [ 5 ]. Disc displacement with reduction, disc displacement without reduction with limited mouth opening, and disc displacement without restricted mouth opening are the three categories of internal derangement recognized by the Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD) criteria. A misplaced disc may be reduced (or "recaptured") by expanding the mouth, but if the problem develops, the disc may become nonreducible, restricting mobility and causing an audible click [ 6 ]. Magnetic resonance imaging (MRI) is the gold standard for imaging TMJ components, including the articular disc, ligaments, and muscles, because of its high spatial resolution [ 7 ]. At first, an ID disc will seem normal, but as the illness advances, the disc will deform as the posterior band grows and the anterior band thins. The final form might be a rounded disc, teardrop, or biconvex shape [ 8 ]. Although MRI is a versatile diagnostic imaging modality, morphological imaging restricts ultrastructural imaging of the articular cartilage, which can be evaluated by biochemical analysis using modified MRI sequences. Among the various MRI methods available for evaluating TMJ articular cartilage, few such as FIESTA, CARTIGRAM, FLAIR, MEDIC, DESS, and HASTE, are available. The aim of this systematic review was to assess the diagnostic efficacy of MRI sequences for the early diagnosis of TMDs. The PRISMA standards were used to conduct the systematic review. Methods Research question This systematic study addressed the following question: Can different MRI modifications improve diagnostic reliability for early intervention in patients with TMJ internal derangement? The research question was formulated by using the PICO format. TMJ reduction in patients with and without intrinsic disc impairment, I- different MR imaging sequences, C- traditional MR imaging of the temporomandibular joint, O- Identifying internal abnormalities in the TMJ in its earliest stages. Materials and methods This systematic review was entered into the International Prospective Register of Systematic Reviews (PROSPERO) database with the identifier CRD42023444477. The search strategy for the identification of studies according to the selection criteria was as follows : The search approach adhered to the standards set out by Cochrane for systematic reviews. Articles on Google Scholar related to the search were originally found in databases such as PubMed, PubMed Central, ScienceDirect, and the Cochrane Library. After the article titles had been examined, any duplicates found in other search engines were deleted. Search Methodology The following terms were used to search the PubMed database: "diagnostic” OR "diagnostical" OR "diagnostically" OR "diagnostics AND ("reliabilities" OR "reliability" OR "reliable" OR "reliablity" OR "reliably" AND ("temporomandibular joint" OR ("temporomandibular" AND "joint" AND ("magnetic resonance imaging" OR ("magnetic" AND "resonance" AND "imaging" OR "magnetic resonance imaging" AND ("meniscus" OR ("articular" AND "disc" OR "articular disc" AND (("internal" OR "internally" AND "disc" AND ("derange OR "deranged" OR "derangement" OR "derangements" AND (("anterior" OR "anteriores" OR "anteriorization" OR "anteriors" AND "disc" AND ("displace" OR "displaced" OR "displacement, psychological"[MeSH Terms] OR ("displacement" OR "displacements" OR "displaces" OR "displacing" AND (("posterior" OR "posteriors" AND "disc" AND ("displace" OR "displaced" OR "displacement, psychological" OR ("displacement" OR "displacements" OR "displaces" OR "displacing” AND (("magnetic resonance imaging" [MeSH Terms] OR ("magnetic" AND "resonance" AND "imaging" OR "magnetic resonance imaging" OR "mri" AND ("base" AND "sequence" OR "base sequence" OR "sequence" OR "sequences" OR "sequence analysis"[MeSH Terms] OR "sequencing" OR "sequences" OR "sequenceable" OR "sequenced" Criteria for study selection The years 2013 through 2023 were used to find applicable research. Only research papers originally published in English were considered. Grey literature studies that have yet to be published will not be considered. “Modified sequencing of MRI for early diagnosis and intervention in patients with TMD/RDC criteria for internal disc derangement (with reduction, with reduction and intermittent locking, without reduction and limited opening, without reduction and limited opening).” Other temporomandibular disorders, a history of trauma or developmental problems of the TMJ, and individuals currently receiving therapy for TMDs are all reasons to rule out this diagnosis. Prospective and retrospective studies and other study types (such as clinical trials, cohort studies, case-control studies, and cross-sectional studies were included (Fig. 1 ). Reviews, editorials, letters, published errata, or historical pieces were not included. Results This systematic review closely examined ten separate studies. MRI sequences for TMD diagnosis employ a wide range of characteristics. Evaluation of the Studies' Quality : Studies were assessed for quality using the QUADAS 2 technique. The diagnostic accuracy tool may be evaluated in four broad domains: patient sampling, index test, reference standard, flow, and timing. Every category included anything from two to four questions, all of which could be answered "yes”, "no" or "unclear". Review Manager 5.4.1 (Fig. 2 ) received the data, and it was used to generate numerous color-coded diagrams showing bias and relevance risks. The applicability risk was low across all ten studies, and the risk of bias was uncertain across all ten investigations (Fig. 3 ). A pair of experts checked the evaluation quality. Risk of bias and applicability concern The risk of bias was ambiguous in the selected studies and the risk of generalizability concerns was low. Discussion Early diagnosis is important for managing the temporomandibular disorders [ 9 ]. MRI sensitivity, specificity, and diagnostic accuracy are the gold standards for articular disc imaging [ 10 , 11 ]. “TMJ MRIs commonly use T1-weighted (T1W) and proton-density-weighted (T2W) pulse sequences.” In contrast to the superiority of T1 and proton density-weighted images for distinguishing osseous from discal tissues, T2W images are often used for demonstrating inflammation and joint effusions. However, because the TMJ is much smaller than other joints, detecting early inflammatory changes in the joints might be challenging using conventional approaches before they lead to morphological alterations. New sequence applications have been attempted specifically for TMJ inflammation and bone marrow alterations in this context. In this review, ten articles, including several MRI sequences used for the diagnosis of internal derangement of the TMJ satisfied the inclusion criteria. To diagnose disc degeneration before morphological alterations occur and to monitor longitudinal changes in the TMJ structure over time, “Zhao Z (2021), [ 12 ] performed T2 mapping sequences in the articular disc displacement of the TMJ in young adults and stated that T2 mapping provides a more accurate quantitative evaluation of the temporomandibular disc than does conventional MRI by assessing the water content in the collagen of the disc.” TMJ derangement internally manifests with joint effusion. A high signal intensity in the upper and lower joint spaces on T2-weighted images indicates fluid collection in the temporomandibular joint (TMJ). Joint effusion marker expression was shown to be influenced by the quantity of protein cytokine receptors in synovial fluid. The FLAIR (fluid attenuated inversion recovery) sequence allows for the non-invasive study of variations in protein concentrations in the joint fluid by measuring increases in FLAIR signal intensity. Joint effusion signal intensity was analysed by Otonari (2018), [ 13 ] who concluded that FLAIR is a more sensitive approach than traditional MRI for assessing changes in effusion content in patients with TMJ problems [ 14 ]. Delayed gadolinium enhancement of magnetic resonance imaging of cartilage (dGEMRIC) provides quantitative imaging for the indirect assessment of glycosaminoglycan content, making it a clinically useful method for assessing the early stages of cartilage deterioration in various joints, such as the knee, ankle joint, and hip in individuals with risk factors for osteoarthritis. T1 mapping quantitatively revealed that contrast agent absorption was negatively linked with GAG concentration. More GAG is needed to replace degenerating cartilage. Hence, T1 relaxation times decrease with increasing contrast agent absorption. “Using inversion-recovery (IR), morphological proton-density (PD) weighted FSE, and 3D Dual- Echo Steady State (DESS) sequences, Eder J (2019), [ 15 ] investigated TMJ internal derangement using the d GEMRIC approach.” In recent years, dynamic magnetic resonance imaging (MRI) has been used in combination with other dynamic measures of joint function. Dynamic pictures taken as the patient opens and shuts his lips utilizing optimized sequences for image acquisition [ 16 – 18 ] are becoming more common in research. Using cinematic software, they could recreate the opening and shutting of the mouth. “It is only recently that optimized echo planar imaging, genuine Fast Imaging with Steady-State Precession, and Half-Fourier Acquisition Single-Shot Turbo Spin Echo (HASTE) sequences (Casetta M et al. (2014), FIESTA (Fast Imaging Employing Steady-State Acquisition) sequence (Sun Q. et al. By evaluating the TMJ's mobility in real-time, these sequences give more accurate imaging than pseudo-dynamic sequences.” Therefore, it is more challenging to diagnose TMD when a patient complains of pain without a systemic disease or the appearance of skeletal anomalies. MRI is essential for assessing the TMJ's intra-articular components [ 19 – 25 ]. Limitations This systematic review has few limitations, such as a small sample size, lack of standardization and heterogeneity, bias and confounding factors, and limited longitudinal studies. Future perspectives Various modified MRI sequences provide detailed images of the TMJ, both of soft tissue and of structures within the joint, and help to obtain real-time images of jaw movements and quantitative assessments of the joints. In the future, MRI biomarkers can be associated with different diseases and serve as indicators of disease progression and treatment response, leading to more personalized and targeted therapies. The AI algorithm can be used to analyse large datasets of TMJ MRI scans, assisting radiologists and clinicians in detecting early TMJ abnormalities. Ongoing research and clinical trials will validate these advancements in real-world medical practice. Conclusions Among various sequences discussed in this systematic review, T2 mapping and dGEMRIC sequences help in the quantitative evaluation and early identification of cartilage degeneration changes in the articular disc of the TMJ. Collaborative and standardization of imaging protocols can improve the quality and consistency of future research in this area. Abbreviations TMJ: Temporomandibular Joint MRI: Magnetic Resonance Imaging TMD: Temporomandibular Disorders RDC: Research Diagnostic Criteria ID: Internal derangement dGEMRIC: Delayed gadolinium enhancement of magnetic resonance imaging of cartilage GAG- Glycosaminoglycans FIESTA: Fast imaging employing steady-state acquisition FLAIR: Fluid Attenuated Inversion Recovery MEDIC: Multiple Echo Data Image Combination DESS: Double Echo Steady State HASTE: Half-Fourier Acquisition Single-Shot Turbo Spin Echo Declarations Author Contribution Aparna S- wrote the main manuscript text, prepared figures and reviewed the manuscriptAnuradha Ganesan- reviewed the manuscriptKrithika Chandrasekar Lakshmi- reviewed the manuscriptSwathi KV- prepared figures, reviewed the manuscriptYesoda Aniyan- reviewed the manuscript -Ethics approval and consent to participate: Not applicable since it is a systematic review -Consent for publication: Not applicable. -Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. -Competing interests: All the authors services are related to the subject of the article -Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. -Authors' contributions: S A wrote the main manuscript text, prepared figures and reviewed the manuscript, G A, C L K, K V S, A Y- reviewed the manuscript -Acknowledgements: Nil -Authors' information: All the authors are from the department of Oral Medicine and Radiology, SRM Dental College, Chennai-600089, Tamil Nadu, India References Leeuw R, Klasser G, editors. 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Ravanelli M, Bottoni L, Buffa I. Real-time assessment of temporomandibular joint using HASTE sequences: feasibility and comparison with standard static sequences. Dentomaxillofacial Radiol. 20211, 50:20200232. Barchetti F, Stagnitti A, Glorioso M. Static and dynamic MR imaging in evaluating temporomandibular disorders. Eur Rev Med Pharmacol Sci. 2014;1:18:2983–7. Kamel ZS, El-Shafey MH, Hassanien OA, Nagy HA. Can dynamic magnetic resonance imaging replace static magnetic resonance sequences in evaluation of temporomandibular joint dysfunction? Egypt J Radiol Nuclear Med. 2021;52:1. Yen P, Katzberg RW, Buonocore MH, Sonico J. Dynamic MR imaging of the temporomandibular joint using a balanced steady-state free precession sequence at 3T. Am J Neuroradiol. 20131, 34:24–6. Meera R, Kannan A, Krithika C, Aniyan K, Yesoda. Correlation between Clinical Pain in Temporomandibular Disorders and Signal Intensity of the Retrodiscal Tissue Using Fluid Attenuation Inversion Recovery MRI - A Cross-Sectional Study. J multidisciplinary Dent Res. 2022;8:20–5. Vogl TJ, Günther D, Weigl P, Scholtz JE. Diagnostic value of dynamic magnetic resonance imaging of temporomandibular joint dysfunction. Eur J Radiol Open. 2021;3:100390. Hegab AF, Hameed A, H.I., Karam KS. Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol. Sci Rep. 11:20917. Ismail R, Atta MM, Rafaat AE, Shalan. Role of magnetic resonance imaging in assessing temporomandibular joint internal derangement. BMFJ. 2020;37:369–81. Anuradha KSKA, Krithika G C. L. and, Yesoda A. Assessment of Condylar Osseous Changes in Patients with Bruxism Using Cone-Beam Computed Tomography-A Cross Sectional Observational Study. J Posit School Psychol. 2022;6(3):1189–203. Schmid-Schwap M, Bristela M, Pittschieler E, Skolka A, Szomolanyi P, Weber M, Piehslinger E, Trattnig S. Biochemical analysis of the articular disc of the temporomandibular joint with magnetic resonance T2 mapping: a feasibility study. Clin Oral Investig. 2014;18(7):1865–7. Table 1 Table 1. Author and year Design of the study Sample distribution MRI sequences Results Inference Zhao Z (2021) Case-control Control group n=57, Group DDWR 45, Group DDWoR- 63 Fat-suppressed T2-weighted image (T2WI), sagittal T1WI, coronal T2WI, (MERGE), and T2 mapping The mean T2 value of control group was- 39.284 ±5.634 ms for ADDwR- 33.634 ±4.235 ms, ADDw/oR- 30.982 ±3.205 ms T2 mapping gives an accurate quantitative evaluation of temporomandibular disc than conventional MRI. It can monitor the longitudinal changes in the TMJ structure for individuals with derangement Eder J (2019) Case-control Control group n= 6 Study group n= 11 (22 TMJs) inversion-recovery (IR), morphological (PD) weighted FSE, and 3D Dual- Echo Steady State (DESS) The dGEMRIC postcontrast T1 value dropped in both groups, 326.3ms in the patient group and 441.9ms in the control group. The dGEMRIC is a useful T1 quantitative biochemical protocol, which implies the early diagnosis of degenerative changes in the fibrocartilaginous disc of the TMJ in patients with TMD. Otonari (2018) Cross-sectional n= 45 (48 joints) PDWI, T2-weighted images, FLAIR images The median SIR of joint effusion was 0.97 in the NL category, 1.00 in the DWR category, 1.19 in the DWOR category, and 1.47 in the OA category FLAIR is a highly sensitive technique to evaluate joint effusion content changes compared to conventional MRI. The median SIR of joint effusion is increased in Disc displacement Without Reduction and Osteoarthritis categories Uchiyama Y (2022) Cross-sectional 23 patients (n= 46 joints) Oblique sagittal images acquired using PD-weighted, T1-weighted, T2-weighted, and MERGE sequences AD of the disc was seen in 22 joints (47.8%). Seeing the disc clearly and Alzheimer's disease, PD-weighted FSE is helpful for recognising a disc with Anterior Displacement, whereas MERGE is helpful for detecting a disc and cortex of the condylar head in their usual positions. Aksoy S (2021) Cross-sectional n= 60 patients Frequency-selected FS T2W (FS T2W), FSE T2W (3D), and 3D FIESTA-C Interobserver agreement on disc configuration closed and open mouth disc position was good for 3D FIESTA-C sequences High-resolution, dynamic MR images of the TMJ may be obtained using 3D FIESTA-C sequences, which can be integrated into standard MRI procedures. Sun Q (2015) Case-control n=20 in the control group TMJs were divided into two groups: group n = 92 (cyc;2300 = cycles of open-closed mouth = 3) and group 2 = 68 (cyc;2300 = cycles of open-closed mouth >= 3) The quality of each photograph was rated on a scale from one to three. Static MRI- PDWI AND T2WI Dynamic FIESTA sequence In a sample of 160 TMJs, 23.13 percent of the TMJs had joint effusions, and 79 TMJs had ADDw/oR. There was a statistically significant difference in the occurrence of the "jumping sign" in the ADDwR group and the DDw/Or group. The FIESTA-MRI can provide a better contrast between the TMJ disc and the joint effusion and helps in the evaluation of condyle and disc relationship in real-time Ravanelli M (2020) Cross-sectional N= 50 subjects (99 TMJs) Utilising Turbo-Spin-Echo (TSE)T2, Parasagittal Spin-Echo (SE)T1, and Fat-Saturated PD Sequences, together with a T2 HASTE sequence, we were able to obtain a dynamic rt MRI image. In a statistically significant comparison between static and rtMRI, the mean score for image quality analysis of 99 TMJs was 3.41 for static MRI and 3.82 for rtMRI. The real-time MRI with HASTE helps observe opening and closing movements and better evaluates internal disc derangement. Casetta M (2014) Cross-sectional 194 patients (388 TMJs) In addition to the dynamic PDWI/TSE T2 weighted sequences, the static half-Fourier single-shot turbo spin echo sequences are also used. In the evaluation of disc position, 25 (6.4%) normal disc positions, 274 (70.6%) DDwR and 89 (23.0%) DDw/oR were found on dynamic imaging. The HASTE sequence has smaller motion artefacts and a good spatial resolution achieved in a shorter acquisition time and evaluates the disc re-capture time in ADDR. Barchetti F (2014) Cross-sectional n=194 patients, 388 TMJs Static MRI- PD weighted/TSE T2-weighted sequences, Dynamic MRI- HASTE sequence The static and dynamic sequences are not concordant in evaluating disc position. Because of the lower quality of the images, dynamic sequences cannot be the only tool to evaluate TMD. Yen P (2013) Cross-sectional n= 12 subjects (24 volunteers) Static MRI- T1WI, T2WI, FSE PDWI, Dynamic MRI- EPI, HASTE, and true FISP pulse sequences Disk position and dynamics were best depicted in a sagittal plane of imaging that varied between subjects and often between joints in the same subject. Visualization of the TMJ was best in true FISP sequence as it has a very high spatial resolution. Additional Declarations No competing interests reported. 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06:10:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":784801,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3848191/v1/4b4ff161-5c3d-40b8-b14d-22f4de2bb36f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Diagnostic Reliability of Various Magnetic Resonance Imaging sequences for the Early Diagnosis of Temporomandibular Disorders: A Systematic Review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTemporomandibular disorder (TMD) can occur when conditions affect the masticatory muscles, the temporomandibular joint (TMJ), or tissues around these areas [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Common signs and symptoms include difficulty chewing, difficulty swallowing, difficulty opening wide, and cracking or popping noises as the jaw moves [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Intra-articular abnormalities and trauma are the leading causes of temporomandibular joint (TMJ) pain [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. \u0026ldquo;Internal derangement (ID) of the TMJ refers to a misalignment of the disc with respect to the condyle, articular eminence, or articular fossa [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u0026rdquo; Anterior motion of the disc is more prevalent than any other kind of motion (anterior, posterior, lateral, or medial) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Disc displacement with reduction, disc displacement without reduction with limited mouth opening, and disc displacement without restricted mouth opening are the three categories of internal derangement recognized by the Research Diagnostic Criteria/Temporomandibular Disorders (RDC/TMD) criteria. A misplaced disc may be reduced (or \"recaptured\") by expanding the mouth, but if the problem develops, the disc may become nonreducible, restricting mobility and causing an audible click [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMagnetic resonance imaging (MRI) is the gold standard for imaging TMJ components, including the articular disc, ligaments, and muscles, because of its high spatial resolution [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. At first, an ID disc will seem normal, but as the illness advances, the disc will deform as the posterior band grows and the anterior band thins. The final form might be a rounded disc, teardrop, or biconvex shape [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough MRI is a versatile diagnostic imaging modality, morphological imaging restricts ultrastructural imaging of the articular cartilage, which can be evaluated by biochemical analysis using modified MRI sequences. Among the various MRI methods available for evaluating TMJ articular cartilage, few such as FIESTA, CARTIGRAM, FLAIR, MEDIC, DESS, and HASTE, are available. The aim of this systematic review was to assess the diagnostic efficacy of MRI sequences for the early diagnosis of TMDs.\u003c/p\u003e \u003cp\u003eThe PRISMA standards were used to conduct the systematic review.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch question\u003c/h2\u003e \u003cp\u003eThis systematic study addressed the following question: Can different MRI modifications improve diagnostic reliability for early intervention in patients with TMJ internal derangement?\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe research question was formulated by using the PICO format.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTMJ reduction in patients with and without intrinsic disc impairment, I- different MR imaging sequences, C- traditional MR imaging of the temporomandibular joint, O- Identifying internal abnormalities in the TMJ in its earliest stages.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMaterials and methods\u003c/h3\u003e\n\u003cp\u003eThis systematic review was entered into the International Prospective Register of Systematic Reviews (PROSPERO) database with the identifier CRD42023444477.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe search strategy for the identification of studies according to the selection criteria was as follows\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eThe search approach adhered to the standards set out by Cochrane for systematic reviews. Articles on Google Scholar related to the search were originally found in databases such as PubMed, PubMed Central, ScienceDirect, and the Cochrane Library. After the article titles had been examined, any duplicates found in other search engines were deleted.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSearch Methodology\u003c/h2\u003e \u003cp\u003eThe following terms were used to search the PubMed database:\u003c/p\u003e \u003cp\u003e\"diagnostic\u0026rdquo; OR \"diagnostical\" OR \"diagnostically\" OR \"diagnostics AND (\"reliabilities\" OR \"reliability\" OR \"reliable\" OR \"reliablity\" OR \"reliably\" AND (\"temporomandibular joint\" OR (\"temporomandibular\" AND \"joint\" AND (\"magnetic resonance imaging\" OR (\"magnetic\" AND \"resonance\" AND \"imaging\" OR \"magnetic resonance imaging\" AND (\"meniscus\" OR (\"articular\" AND \"disc\" OR \"articular disc\" AND ((\"internal\" OR \"internally\" AND \"disc\" AND (\"derange OR \"deranged\" OR \"derangement\" OR \"derangements\" AND ((\"anterior\" OR \"anteriores\" OR \"anteriorization\" OR \"anteriors\" AND \"disc\" AND (\"displace\" OR \"displaced\" OR \"displacement, psychological\"[MeSH Terms] OR (\"displacement\" OR \"displacements\" OR \"displaces\" OR \"displacing\" AND ((\"posterior\" OR \"posteriors\" AND \"disc\" AND (\"displace\" OR \"displaced\" OR \"displacement, psychological\" OR (\"displacement\" OR \"displacements\" OR \"displaces\" OR \"displacing\u0026rdquo; AND ((\"magnetic resonance imaging\" [MeSH Terms] OR (\"magnetic\" AND \"resonance\" AND \"imaging\" OR \"magnetic resonance imaging\" OR \"mri\" AND (\"base\" AND \"sequence\" OR \"base sequence\" OR \"sequence\" OR \"sequences\" OR \"sequence analysis\"[MeSH Terms] OR \"sequencing\" OR \"sequences\" OR \"sequenceable\" OR \"sequenced\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCriteria for study selection\u003c/h2\u003e \u003cp\u003eThe years 2013 through 2023 were used to find applicable research. Only research papers originally published in English were considered. Grey literature studies that have yet to be published will not be considered. \u0026ldquo;Modified sequencing of MRI for early diagnosis and intervention in patients with TMD/RDC criteria for internal disc derangement (with reduction, with reduction and intermittent locking, without reduction and limited opening, without reduction and limited opening).\u0026rdquo; Other temporomandibular disorders, a history of trauma or developmental problems of the TMJ, and individuals currently receiving therapy for TMDs are all reasons to rule out this diagnosis.\u003c/p\u003e \u003cp\u003eProspective and retrospective studies and other study types (such as clinical trials, cohort studies, case-control studies, and cross-sectional studies were included (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Reviews, editorials, letters, published errata, or historical pieces were not included.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis systematic review closely examined ten separate studies. MRI sequences for TMD diagnosis employ a wide range of characteristics.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEvaluation of the Studies' Quality\u003c/b\u003e: Studies were assessed for quality using the QUADAS 2 technique. The diagnostic accuracy tool may be evaluated in four broad domains: patient sampling, index test, reference standard, flow, and timing. Every category included anything from two to four questions, all of which could be answered \"yes\u0026rdquo;, \"no\" or \"unclear\". Review Manager 5.4.1 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) received the data, and it was used to generate numerous color-coded diagrams showing bias and relevance risks. The applicability risk was low across all ten studies, and the risk of bias was uncertain across all ten investigations (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A pair of experts checked the evaluation quality.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eRisk of bias and applicability concern\u003c/h2\u003e \u003cp\u003eThe risk of bias was ambiguous in the selected studies and the risk of generalizability concerns was low.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEarly diagnosis is important for managing the temporomandibular disorders [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. MRI sensitivity, specificity, and diagnostic accuracy are the gold standards for articular disc imaging [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. \u0026ldquo;TMJ MRIs commonly use T1-weighted (T1W) and proton-density-weighted (T2W) pulse sequences.\u0026rdquo; In contrast to the superiority of T1 and proton density-weighted images for distinguishing osseous from discal tissues, T2W images are often used for demonstrating inflammation and joint effusions.\u003c/p\u003e \u003cp\u003eHowever, because the TMJ is much smaller than other joints, detecting early inflammatory changes in the joints might be challenging using conventional approaches before they lead to morphological alterations. New sequence applications have been attempted specifically for TMJ inflammation and bone marrow alterations in this context. In this review, ten articles, including several MRI sequences used for the diagnosis of internal derangement of the TMJ satisfied the inclusion criteria.\u003c/p\u003e \u003cp\u003eTo diagnose disc degeneration before morphological alterations occur and to monitor longitudinal changes in the TMJ structure over time, \u0026ldquo;Zhao Z (2021), [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] performed T2 mapping sequences in the articular disc displacement of the TMJ in young adults and stated that T2 mapping provides a more accurate quantitative evaluation of the temporomandibular disc than does conventional MRI by assessing the water content in the collagen of the disc.\u0026rdquo;\u003c/p\u003e \u003cp\u003eTMJ derangement internally manifests with joint effusion. A high signal intensity in the upper and lower joint spaces on T2-weighted images indicates fluid collection in the temporomandibular joint (TMJ). Joint effusion marker expression was shown to be influenced by the quantity of protein cytokine receptors in synovial fluid. The FLAIR (fluid attenuated inversion recovery) sequence allows for the non-invasive study of variations in protein concentrations in the joint fluid by measuring increases in FLAIR signal intensity. Joint effusion signal intensity was analysed by Otonari (2018), [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] who concluded that FLAIR is a more sensitive approach than traditional MRI for assessing changes in effusion content in patients with TMJ problems [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDelayed gadolinium enhancement of magnetic resonance imaging of cartilage (dGEMRIC) provides quantitative imaging for the indirect assessment of glycosaminoglycan content, making it a clinically useful method for assessing the early stages of cartilage deterioration in various joints, such as the knee, ankle joint, and hip in individuals with risk factors for osteoarthritis. T1 mapping quantitatively revealed that contrast agent absorption was negatively linked with GAG concentration. More GAG is needed to replace degenerating cartilage. Hence, T1 relaxation times decrease with increasing contrast agent absorption. \u0026ldquo;Using inversion-recovery (IR), morphological proton-density (PD) weighted FSE, and 3D Dual- Echo Steady State (DESS) sequences, Eder J (2019), [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] investigated TMJ internal derangement using the d GEMRIC approach.\u0026rdquo;\u003c/p\u003e \u003cp\u003eIn recent years, dynamic magnetic resonance imaging (MRI) has been used in combination with other dynamic measures of joint function. Dynamic pictures taken as the patient opens and shuts his lips utilizing optimized sequences for image acquisition [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] are becoming more common in research. Using cinematic software, they could recreate the opening and shutting of the mouth. \u0026ldquo;It is only recently that optimized echo planar imaging, genuine Fast Imaging with Steady-State Precession, and Half-Fourier Acquisition Single-Shot Turbo Spin Echo (HASTE) sequences (Casetta M et al. (2014), FIESTA (Fast Imaging Employing Steady-State Acquisition) sequence (Sun Q. et al. By evaluating the TMJ's mobility in real-time, these sequences give more accurate imaging than pseudo-dynamic sequences.\u0026rdquo; Therefore, it is more challenging to diagnose TMD when a patient complains of pain without a systemic disease or the appearance of skeletal anomalies. MRI is essential for assessing the TMJ's intra-articular components [\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23 CR24\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThis systematic review has few limitations, such as a small sample size, lack of standardization and heterogeneity, bias and confounding factors, and limited longitudinal studies.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFuture perspectives\u003c/h2\u003e \u003cp\u003eVarious modified MRI sequences provide detailed images of the TMJ, both of soft tissue and of structures within the joint, and help to obtain real-time images of jaw movements and quantitative assessments of the joints. In the future, MRI biomarkers can be associated with different diseases and serve as indicators of disease progression and treatment response, leading to more personalized and targeted therapies. The AI algorithm can be used to analyse large datasets of TMJ MRI scans, assisting radiologists and clinicians in detecting early TMJ abnormalities.\u003c/p\u003e \u003cp\u003eOngoing research and clinical trials will validate these advancements in real-world medical practice.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAmong various sequences discussed in this systematic review, T2 mapping and dGEMRIC sequences help in the quantitative evaluation and early identification of cartilage degeneration changes in the articular disc of the TMJ. Collaborative and standardization of imaging protocols can improve the quality and consistency of future research in this area.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTMJ: Temporomandibular Joint\u003c/p\u003e\n\u003cp\u003eMRI: Magnetic Resonance Imaging\u003c/p\u003e\n\u003cp\u003eTMD: Temporomandibular Disorders\u003c/p\u003e\n\u003cp\u003eRDC: Research Diagnostic Criteria\u003c/p\u003e\n\u003cp\u003eID:\u0026nbsp;Internal derangement\u003c/p\u003e\n\u003cp\u003edGEMRIC: Delayed gadolinium enhancement of magnetic resonance imaging of cartilage\u003c/p\u003e\n\u003cp\u003eGAG- Glycosaminoglycans\u003c/p\u003e\n\u003cp\u003eFIESTA: Fast imaging employing steady-state acquisition\u003c/p\u003e\n\u003cp\u003eFLAIR: Fluid Attenuated Inversion Recovery\u003c/p\u003e\n\u003cp\u003eMEDIC: Multiple Echo Data Image Combination\u003c/p\u003e\n\u003cp\u003eDESS: Double Echo Steady State\u003c/p\u003e\n\u003cp\u003eHASTE: Half-Fourier Acquisition Single-Shot Turbo Spin Echo\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAparna S- wrote the main manuscript text, prepared figures and reviewed the manuscriptAnuradha Ganesan- reviewed the manuscriptKrithika Chandrasekar Lakshmi- reviewed the manuscriptSwathi KV- prepared figures, reviewed the manuscriptYesoda Aniyan- reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e-Ethics approval and consent to participate: Not applicable since it is a systematic review\u003c/p\u003e\n\u003cp\u003e-Consent for publication:\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e-Availability of data and materials:\u0026nbsp;The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e-Competing interests: All the authors services are related to the subject of the article\u003c/p\u003e\n\u003cp\u003e-Funding:\u0026nbsp;This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e-Authors\u0026apos; contributions: S A\u0026nbsp;wrote the main manuscript text, prepared figures and reviewed the manuscript, G A, C L K, K V S, A Y- reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e-Acknowledgements: Nil\u003c/p\u003e\n\u003cp\u003e-Authors\u0026apos; information:\u003c/p\u003e\n\u003cp\u003eAll the authors are from the department of Oral Medicine and Radiology, SRM Dental College, Chennai-600089, Tamil Nadu, India\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLeeuw R, Klasser G, editors. 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Can dynamic magnetic resonance imaging replace static magnetic resonance sequences in evaluation of temporomandibular joint dysfunction? Egypt J Radiol Nuclear Med. 2021;52:1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYen P, Katzberg RW, Buonocore MH, Sonico J. Dynamic MR imaging of the temporomandibular joint using a balanced steady-state free precession sequence at 3T. Am J Neuroradiol. 20131, 34:24\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeera R, Kannan A, Krithika C, Aniyan K, Yesoda. Correlation between Clinical Pain in Temporomandibular Disorders and Signal Intensity of the Retrodiscal Tissue Using Fluid Attenuation Inversion Recovery MRI - A Cross-Sectional Study. J multidisciplinary Dent Res. 2022;8:20\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVogl TJ, G\u0026uuml;nther D, Weigl P, Scholtz JE. Diagnostic value of dynamic magnetic resonance imaging of temporomandibular joint dysfunction. Eur J Radiol Open. 2021;3:100390.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHegab AF, Hameed A, H.I., Karam KS. Classification of temporomandibular joint internal derangement based on magnetic resonance imaging and clinical findings of 435 patients contributing to a nonsurgical treatment protocol. Sci Rep. 11:20917.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsmail R, Atta MM, Rafaat AE, Shalan. Role of magnetic resonance imaging in assessing temporomandibular joint internal derangement. BMFJ. 2020;37:369\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnuradha KSKA, Krithika G C. L. and, Yesoda A. Assessment of Condylar Osseous Changes in Patients with Bruxism Using Cone-Beam Computed Tomography-A Cross Sectional Observational Study. J Posit School Psychol. 2022;6(3):1189\u0026ndash;203.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmid-Schwap M, Bristela M, Pittschieler E, Skolka A, Szomolanyi P, Weber M, Piehslinger E, Trattnig S. Biochemical analysis of the articular disc of the temporomandibular joint with magnetic resonance T2 mapping: a feasibility study. Clin Oral Investig. 2014;18(7):1865\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1.\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"996\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor and year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDesign of the study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample distribution\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMRI sequences\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003e\u003cstrong\u003eInference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eZhao Z (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCase-control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eControl group n=57, Group\u003c/p\u003e\n \u003cp\u003eDDWR 45, Group DDWoR- 63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eFat-suppressed\u003c/p\u003e\n \u003cp\u003eT2-weighted image (T2WI),\u003c/p\u003e\n \u003cp\u003esagittal T1WI, coronal T2WI,\u003c/p\u003e\n \u003cp\u003e(MERGE), and T2 mapping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eThe mean T2 value of control group was- 39.284 \u0026plusmn;5.634 ms for ADDwR- 33.634 \u0026plusmn;4.235 ms, ADDw/oR- 30.982 \u0026plusmn;3.205 ms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eT2 mapping gives an accurate quantitative evaluation of temporomandibular disc than conventional MRI. It can monitor the longitudinal changes in the TMJ structure for individuals with derangement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eEder J (2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCase-control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eControl group n= 6\u003c/p\u003e\n \u003cp\u003eStudy group n= 11 (22 TMJs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003einversion-recovery (IR), morphological (PD) weighted FSE, and 3D Dual- Echo Steady State (DESS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eThe dGEMRIC postcontrast T1 value dropped in both groups, 326.3ms in the patient group and 441.9ms in the control group.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eThe dGEMRIC is a useful T1 quantitative biochemical protocol, which implies the early diagnosis of degenerative changes in the fibrocartilaginous disc of the TMJ in patients with TMD.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eOtonari (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003en= 45 (48 joints)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003ePDWI, T2-weighted images, FLAIR images\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eThe median SIR of joint effusion was 0.97 in the NL category, 1.00 in the DWR category, 1.19 in the DWOR category, and 1.47 in the OA category\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eFLAIR is a highly sensitive technique to evaluate joint effusion content changes compared to conventional MRI. The median SIR of joint effusion is increased in Disc displacement Without Reduction and Osteoarthritis categories\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eUchiyama Y (2022)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003e23 patients (n= 46 joints)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eOblique sagittal images acquired using PD-weighted, T1-weighted, T2-weighted, and MERGE sequences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eAD of the disc was seen in 22 joints (47.8%). Seeing the disc clearly and Alzheimer\u0026apos;s disease,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003ePD-weighted FSE is helpful for recognising a disc with Anterior Displacement, whereas MERGE is helpful for detecting a disc and cortex of the condylar head in their usual positions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eAksoy S (2021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003en= 60 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eFrequency-selected FS T2W (FS T2W), FSE T2W (3D), and 3D FIESTA-C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eInterobserver agreement on disc configuration closed and open mouth disc position was good for 3D FIESTA-C sequences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eHigh-resolution, dynamic MR images of the TMJ may be obtained using 3D FIESTA-C sequences, which can be integrated into standard MRI procedures.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eSun Q (2015)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCase-control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003en=20 in the control group TMJs were divided into two groups: group n = 92 (cyc;2300 = cycles of open-closed mouth = 3) and group 2 = 68 (cyc;2300 = cycles of open-closed mouth \u0026gt;= 3) The quality of each photograph was rated on a scale from one to three.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eStatic MRI- PDWI AND T2WI Dynamic FIESTA sequence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eIn a sample of 160 TMJs, 23.13 percent of the TMJs had joint effusions, and 79 TMJs had ADDw/oR. There was a statistically significant difference in the occurrence of the \u0026quot;jumping sign\u0026quot; in the ADDwR group and the DDw/Or group.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eThe FIESTA-MRI can provide a better contrast between the TMJ disc and the joint effusion and helps in the evaluation of condyle and disc relationship in real-time\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eRavanelli M (2020)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eN= 50 subjects (99 TMJs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eUtilising Turbo-Spin-Echo (TSE)T2, Parasagittal Spin-Echo (SE)T1, and Fat-Saturated PD Sequences, together with a T2 HASTE sequence, we were able to obtain a dynamic rt MRI image.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eIn a statistically significant comparison between static and rtMRI, the mean score for image quality analysis of 99 TMJs was 3.41 for static MRI and 3.82 for rtMRI.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eThe real-time MRI with HASTE helps observe opening and closing movements and better evaluates internal disc derangement.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eCasetta M (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003e194 patients (388 TMJs)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eIn addition to the dynamic PDWI/TSE T2 weighted sequences, the static half-Fourier single-shot turbo spin echo sequences are also used.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eIn the evaluation of disc position, 25 (6.4%) normal disc positions, 274 (70.6%) DDwR and 89 (23.0%) DDw/oR were found on dynamic imaging.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eThe HASTE sequence has smaller motion artefacts and a good spatial resolution achieved in a shorter acquisition time and evaluates the disc re-capture time in ADDR.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eBarchetti F (2014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003en=194 patients, 388 TMJs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eStatic MRI- PD weighted/TSE T2-weighted sequences, Dynamic MRI- HASTE sequence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eThe static and dynamic sequences are not concordant in evaluating disc position.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eBecause of the lower quality of the images, dynamic sequences cannot be the only tool to evaluate TMD.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.943775100401606%\"\u003e\n \u003cp\u003eYen P (2013)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.843373493975903%\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003en= 12 subjects (24 volunteers)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.369477911646587%\"\u003e\n \u003cp\u003eStatic MRI- T1WI, T2WI, FSE PDWI, Dynamic MRI- EPI, HASTE, and true FISP pulse sequences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.674698795180724%\"\u003e\n \u003cp\u003eDisk position and dynamics were best depicted in a sagittal plane of imaging that varied between subjects and often between joints in the same subject.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08433734939759%\"\u003e\n \u003cp\u003eVisualization of the TMJ was best in true FISP sequence as it has a very high spatial resolution.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Diagnostic, Temporomandibular Disorders, Magnetic resonance imaging, Articular disc","lastPublishedDoi":"10.21203/rs.3.rs-3848191/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3848191/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis systematic study aimed to compare and evaluate the diagnostic accuracy of different MRI sequences for detecting internal TMJ dysfunction.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eIn this search strategy, we employed Google Scholar, PubMed, PubMed Central, Science Direct, and the Cochrane Library. Articles from the last decade were included in the search. The potential for bias in the included studies was evaluated. The search yielded 48 papers. However, only 10 papers met the criteria for inclusion in the systematic review.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eVarious sequences such as FIESTA, FLAIR, T2 mapping, MERGE, HASTE, and dGEMRIC, have been discussed in this systematic review.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAmong the various MR sequences, T2 mapping and dGEMRIC sequences help in the quantitative evaluation and assessment of early changes in disc derangement. These sequences provide in-depth diagnostic information complementary to conventional MRI for diagnosing early changes in the TMJ disc\u003c/p\u003e","manuscriptTitle":"The Diagnostic Reliability of Various Magnetic Resonance Imaging sequences for the Early Diagnosis of Temporomandibular Disorders: A Systematic Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-23 15:55:26","doi":"10.21203/rs.3.rs-3848191/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c6bb6f2c-c5dd-40ed-a6ee-e6547e808cb0","owner":[],"postedDate":"January 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-05T06:02:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-23 15:55:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3848191","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3848191","identity":"rs-3848191","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}