Pediatric Radiology

, Volume 48, Issue 6, pp 792–800 | Cite as

Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol

  • Elka Miller
  • Emilio J. Inarejos Clemente
  • Nikolay Tzaribachev
  • Saurabh Guleria
  • Mirkamal TolendEmail author
  • Arthur B. Meyers
  • Thekla von Kalle
  • Jennifer Stimec
  • Bernd Koos
  • Simone Appenzeller
  • Linda Z. Arvidsson
  • Eva Kirkhus
  • Andrea S. Doria
  • Christian J. Kellenberger
  • Tore A. Larheim
Minisymposium: Juvenile Idiopathic Arthritis


Inflammation and damage in the temporomandibular joint (TMJ) often develop without clinical symptoms but can lead to severe facial growth abnormalities and impaired health-related quality of life, making early diagnosis of TMJ changes crucial to identify. Inflammatory and osteochondral changes detectable through magnetic resonance imaging (MRI) occur in TMJs of approximately 40% of children with juvenile idiopathic arthritis (JIA), and no other imaging modality or physical method of examination can reliably detect these changes. Therefore contrast-enhanced MRI is the diagnostic standard for diagnosis and interval monitoring of JIA. However the specific usage of MRI for TMJ arthritis is not standardized at present. There is a recognized need for a consensus effort toward standardization of an imaging protocol with required and optional sequences to improve detection of pathological changes and shorten study time. Such a consensus imaging protocol is important for providing maximum information with minimally necessary sequences in a way that allows inter-site comparison of results of clinical trials and improved clinical management. In this paper we describe the challenges of TMJ imaging and present expert-panel consensus suggestions for a standardized TMJ MRI protocol.


Children Imaging protocol Juvenile idiopathic arthritis Magnetic resonance imaging Synovitis Temporomandibular joint 



The authors thank Prof. Yoginder Vaid for his participation and valuable feedback in the initial stages of the consensus imaging protocol development meetings, and also Prof. Karen Rosendahl for her constructive comments to the manuscript. Profs. Kellenberger and Larheim contributed equally as senior authors of this article.

Compliance with ethical standards

Conflicts of interest



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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Elka Miller
    • 1
  • Emilio J. Inarejos Clemente
    • 2
  • Nikolay Tzaribachev
    • 3
  • Saurabh Guleria
    • 4
  • Mirkamal Tolend
    • 5
    • 6
    Email author
  • Arthur B. Meyers
    • 7
  • Thekla von Kalle
    • 8
  • Jennifer Stimec
    • 5
  • Bernd Koos
    • 9
  • Simone Appenzeller
    • 10
  • Linda Z. Arvidsson
    • 11
  • Eva Kirkhus
    • 12
  • Andrea S. Doria
    • 5
  • Christian J. Kellenberger
    • 13
  • Tore A. Larheim
    • 11
  1. 1.Department of Medical ImagingChildren’s Hospital of Eastern OntarioOttawaCanada
  2. 2.Department of Diagnostic ImagingHospital Sant Joan de DeuBarcelonaSpain
  3. 3.Pediatric Rheumatology Research InstituteBad BramstedtGermany
  4. 4.Austin Radiological AssociationAustinUSA
  5. 5.Department of Diagnostic ImagingThe Hospital for Sick ChildrenTorontoCanada
  6. 6.Peter Gilgan Centre for Research and LearningThe Hospital for Sick ChildrenTorontoCanada
  7. 7.Department of RadiologyNemours Children’s Health SystemOrlandoUSA
  8. 8.Department of Pediatric Radiology, Radiologisches InstitutOlgahospital Klinikum StuttgartStuttgartGermany
  9. 9.Department of OrthodonticsUniversity Hospital TübingenTübingenGermany
  10. 10.School of Medical ScienceUniversity of CampinasCampinasBrazil
  11. 11.Department of Maxillofacial Radiology, Institute of Clinical DentistryUniversity of OsloOsloNorway
  12. 12.Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  13. 13.Department of Diagnostic ImagingUniversity Children’s HospitalZürichSwitzerland

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