Oral Radiology

, Volume 32, Issue 2, pp 87–97 | Cite as

Evaluation of the relationships between contrast-enhanced magnetic resonance characteristics and joint pain in patients with temporomandibular disorders

  • Shigeaki SuenagaEmail author
  • Kunihiro Nagayama
  • Taisuke Nagasawa
  • Yoshihiro Kawabata
  • Hiroko Indo
  • Hideyuki J. Majima
Original Article



To evaluate the correlations between temporomandibular joint (TMJ) pain and both conventional and gadolinium-enhanced magnetic resonance (MR) imaging characteristics in patients with temporomandibular disorders (TMDs).


T1-weighted, T2-weighted, and fat-suppressed contrast-enhanced T1-weighted MR imaging were performed in 80 TMD patients with the main complaint of TMJ pain. A kappa statistical analysis was performed to calculate the interobserver agreement between two of three radiologists. The relationships between TMJ pain and various MR findings were analyzed by multiple comparison test, Spearman’s rank correlation test, Chi-square test, Student’s t test, and multivariate logistic regression analysis.


Significant correlations were observed between anterior disk displacement without reduction, joint effusion, and TMJ pain (p < 0.01). The degree of contrast enhancement of the posterior disk attachment was correlated with the severity of TMJ pain, especially spontaneous pain (r = 0.725, p < 0.01), while no correlation was observed in the masticatory muscle pain group. The correlation tended to be higher in the latero-central portions than in the medial portion of the mandibular condyle, although no significant difference was seen.


It has been suggested that fat-suppressed contrast-enhanced MR imaging techniques facilitate better understanding of the sources of TMJ pain, but not masticatory muscle pain, and could reflect TMJ synovial inflammation. The severity of TMJ pain was closely correlated with the degree of contrast enhancement. The above-mentioned correlation had a tendency to be higher in the latero-central portions of the mandibular condyle.


Temporomandibular disorders Contrast-enhanced magnetic resonance imaging Synovitis Posterior disk attachment Temporomandibular joint pain 



The authors thank Mr. Seishi Hayahuchi for his help with the MR imaging.

Conflict of interest

Shigeaki Suenaga, Kunihiro Nagayama, Taisuke Nagasawa, Yoshihiro Kawabata, Hiroko Indo, and Hideyuki J. Majima declare that they have no conflict of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Limchaichana N, Nilsson H, Ekberg EC, Nilner M, Petersson A. Clinical diagnoses and MRI findings in patients with TMD pain. J Oral Rehabil. 2007;34:237–45.CrossRefPubMedGoogle Scholar
  2. 2.
    Emshoff R, Innerhofer K, Rudisch A, Bertram S. Clinical versus magnetic resonance imaging findings with internal derangement of the temporomandibular joint: an evaluation of anterior disc displacement without reduction. J Oral Maxillofac Surg. 2002;60:36–41.CrossRefPubMedGoogle Scholar
  3. 3.
    Manfredini D, Basso D, Arboretti R, Guarda-Nardini L. Association between magnetic resonance signs of temporomandibular joint effusion and disk displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:266–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Moen K, Hellem S, Geitung JT, Skartveit L. A practical approach to interpretation of MRI of the temporomandibular joint. Acta Radiol. 2010;9:1021–7.CrossRefGoogle Scholar
  5. 5.
    Ribeiro-Rotta RF, Marques KD, Pacheco MJ, Leles CR. Do computed tomography and magnetic resonance imaging add to temporomandibular joint disorder treatment? A systematic review of diagnostic efficacy. J Oral Rehabil. 2011;38:120–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Sano T, Westesson PL. Magnetic resonance imaging of the temporomandibular joint. Increased T2 signal in the retrodiskal tissue of painful joints. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:511–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Katzberg RW, Tallents RH. Normal and abnormal temporomandibular joint disc and posterior attachment as depicted by magnetic resonance imaging in symptomatic and asymptomatic subjects. J Oral Maxillofac Surg. 2005;63:1155–61.CrossRefPubMedGoogle Scholar
  8. 8.
    Chiba M, Kumagai M, Echigo S. Association between high signal intensity in the posterior disc attachment seen on T2 weighted fat-suppressed images and temporomandibular joint pain. Dentomaxillofac Radiol. 2007;36:187–91.CrossRefPubMedGoogle Scholar
  9. 9.
    Lee SH, Yoon HJ. The relationship between MRI findings and the relative signal intensity of retrodiscal tissue in patients with temporomandibular joint disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:113–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Larheim TA, Westesson PL, Sano T. MR grading of temporomandibular joint fluid: association with disk displacement categories, condyle marrow abnormalities and pain. Int J Oral Maxillofac Surg. 2001;30:104–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Emshoff R, Brandlmaier I, Gerhard S, Strobl H, Bertram S, Rudisch A. Magnetic resonance imaging predictors of temporomandibular joint pain. J Am Dent Assoc. 2003;134:705–14.CrossRefPubMedGoogle Scholar
  12. 12.
    Tomas X, Pomes J, Berenguer J, Quinto L, Nicolau C, Mercader JM, et al. MR imaging of temporomandibular joint dysfunction: a pictorial review. Radiographics. 2006;26:765–81.CrossRefPubMedGoogle Scholar
  13. 13.
    Larheim TA, Katzberg RW, Westesson PL, Tallents RH, Moss ME. MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients. Int J Oral Maxillofac Surg. 2001;30:113–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Tanaka T, Morimoto Y, Masumi S, Tominaga K, Ohba T. Utility of frequency-selective fat saturation T2-weighted MR images for the detection of joint effusion in the temporomandibular joint. Dentomaxillofac Radiol. 2002;31:305–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Morimoto Y, Tanaka T, Masumi S, Tominaga K, Shibuya T, Kito S, et al. Significance of frequency-selective fat saturation T2-weighted MR images for the detection of bone marrow edema in the mandibular condyle. Cranio. 2004;22:115–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Orhan K, Delilbasi C, Paksoy CS. Magnetic resonance imaging evaluation of mandibular condyle bone marrow and temporomandibular joint disc signal intensity in anaemia patients. Dentomaxillofac Radiol. 2009;38:247–54.CrossRefPubMedGoogle Scholar
  17. 17.
    Chen YJ, Gallo LM, Meier D, Palla S. Dynamic magnetic resonance imaging technique for the study of the temporomandibular joint. J Orofac Pain. 2000;14:65–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Wang EY, Mulholland TP, Pramanik BK, Nusbaum AO, Babb J, Pavone AG, et al. Dynamic sagittal half-Fourier acquired single-shot turbo spin-echo MR imaging of the temporomandibular joint: initial experience and comparison with sagittal oblique proton-attenuation images. AJNR Am J Neuroradiol. 2007;28:1126–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Shimazaki Y, Saito K, Matsukawa S, Onizawa R, Kotake F, Nishio R, et al. Image quality using dynamic MR imaging of the temporomandibular joint with True-FISP sequence. Magn Reson Med Sci. 2007;6:15–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Molinari F, Gentile L, Manicone P, Ursini R, Raffaelli L, Stefanetti M, et al. Interobserver variability of dynamic MR imaging of the temporomandibular joint. Radiol Med. 2011;116:1303–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Suenaga S, Hamamoto S, Kawano K, Higashida Y, Noikura T. Dynamic MR imaging of the temporomandibular joint in patients with arthrosis: relationship between contrast enhancement of the posterior disk attachment and joint pain. AJR Am J Roentgenol. 1996;166:1475–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Farina D, Bodin C, Gandolfi S, De Gasperi W, Borghesi A, Maroldi R. TMJ disorders and pain: assessment by contrast-enhanced MRI. Eur J Radiol. 2009;70:25–30.CrossRefPubMedGoogle Scholar
  23. 23.
    Tasali N, Cubuk R, Aricak M, Ozarar M, Saydam B, Nur H, et al. Temporomandibular (TMJ) pain revisited with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Eur J Radiol. 2012;81:603–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Gaffney K, Cookson J, Blades S, Coumbe A, Blake D. Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging. Ann Rheum Dis. 1998;57:152–7.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Matsumura Y, Nomura J, Murata T, Inui M, Nagai K, Yanase S, et al. Magnetic resonance imaging of synovial proliferation in temporomandibular disorders with pain. J Comput Assist Tomogr. 2004;28:73–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Magnusson T, Egermark I, Carlsson GE. A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age. J Orofac Pain. 2000;14:310–9.PubMedGoogle Scholar
  27. 27.
    Nagayama K, Suenaga S, Nagata J, Takada H, Majima HJ, Miyawaki S. Clinical significance of magnetization transfer contrast imaging for edematous changes in masticatory muscle. J Comput Assist Tomogr. 2010;34:233–41.CrossRefPubMedGoogle Scholar
  28. 28.
    Gambarota G, Philippens M, Cairns BE, Dong XD, Renema WK, Heerschap A. MRS assessment of glutamate clearance in a novel masticatory muscle pain model. NMR Biomed. 2005;18:345–51.CrossRefPubMedGoogle Scholar
  29. 29.
    Chikui T, Shiraishi T, Ichihara T, Kawazu T, Hatakenaka M, Kami Y, et al. Effect of clenching on T2 and diffusion parameters of the masseter muscle. Acta Radiol. 2010;51:58–63.CrossRefPubMedGoogle Scholar
  30. 30.
    Bertram S, Bodner G, Rudisch A, Brandlmaier I, Emshoff R. Effect of scanning level and muscle condition on ultrasonographic cross-sectional measurements of the anterior masseter muscle. J Oral Rehabil. 2003;30:430–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Stratmann U, Schaarschmidt K, Santamaria P. Morphometric investigation of condylar cartilage and disc thickness in the human temporomandibular joint: significance for the definition of osteoarthrotic changes. J Oral Pathol Med. 1996;25:200–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Gil IA, Barbosa CM, Pedro VM, Silverio KC, Goldfarb DP, Fusco V, et al. Multidisciplinary approach to chronic pain from myofascial pain dysfunction syndrome: a four-year experience at a Brazilian center. Cranio. 1998;16:17–25.PubMedGoogle Scholar
  33. 33.
    Hallgren KA. Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol. 2012;8:23–34.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301–55.PubMedGoogle Scholar
  35. 35.
    Kraus S. Temporomandibular disorders, head and orofacial pain: cervical spine considerations. Dent Clin North Am. 2007;51:161–93.CrossRefPubMedGoogle Scholar
  36. 36.
    Pedullà E, Meli GA, Garufi A, Mandalà ML, Blandino A, Cascone P. Neuropathic pain in temporomandibular joint disorders: case-control analysis by MR imaging. AJNR Am J Neuroradiol. 2009;30:1414–8.CrossRefPubMedGoogle Scholar
  37. 37.
    Jank S, Emshoff R, Norer B, Missmann M, Nicasi A, Strobl H, et al. Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ—a pilot study. Int J Oral Maxillofac Surg. 2005;34:132–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Emshoff R, Brandlmaier I, Bösch R, Gerhard S, Rudisch A, Bertram S. Validation of the clinical diagnostic criteria for temporomandibular disorders for the diagnostic subgroup—disc derangement with reduction. J Oral Rehabil. 2002;29:1139–45.CrossRefPubMedGoogle Scholar
  39. 39.
    Campos PS, Macedo Sobrinho JB, Crusoé-Rebello IM, Pena N, Dantas JA, Mariz AC, et al. Temporomandibular joint disc adhesion without mouth-opening limitation. J Oral Maxillofac Surg. 2008;66:551–4.CrossRefPubMedGoogle Scholar
  40. 40.
    Koh KJ, List T, Petersson A, Rohlin M. Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systematic literature review. J Orofac Pain. 2009;23:123–39.PubMedGoogle Scholar
  41. 41.
    Roh HS, Kim W, Kim YK, Lee JY. Relationships between disk displacement, joint effusion, and degenerative changes of the TMJ in TMD patients based on MRI findings. J Craniomaxillofac Surg. 2012;40:283–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Lin WC, Lo CP, Chiang IC, Hsu CC, Hsu WL, Liu DW, et al. The use of pseudo-dynamic magnetic resonance imaging for evaluating the relationship between temporomandibular joint anterior disc displacement and joint pain. Int J Oral Maxillofac Surg. 2012;41:1501–4.CrossRefPubMedGoogle Scholar
  43. 43.
    Molinari F, Manicone P, Raffaelli L, Raffaelli R, Pirronti T, Bonomo L. Temporomandibular joint soft-tissue pathology, I: disc abnormalities. Semin Ultrasound CT MR. 2007;28:192–204.CrossRefPubMedGoogle Scholar
  44. 44.
    Haley DP, Schiffman EL, Lindgren BR, Anderson Q, Andreasen K. The relationship between clinical and MRI findings in patients with unilateral temporomandibular joint pain. J Am Dent Assoc. 2001;132:476–81.CrossRefPubMedGoogle Scholar
  45. 45.
    Lopes SL, Costa AL, Cruz AD, Li LM, de Almeida SM. Clinical and MRI investigation of temporomandibular joint in major depressed patients. Dentomaxillofac Radiol. 2012;41:316–22.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Cholitgul W, Nishiyama H, Sasai T, Uchiyama Y, Fuchihata H, Rohlin M. Clinical and magnetic resonance imaging findings in temporomandibular joint disc displacement. Dentomaxillofac Radiol. 1997;26:183–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Eberhard L, Giannakopoulos NN, Rohde S, Schmitter M. Temporomandibular joint (TMJ) disc position in patients with TMJ pain assessed by coronal MRI. Dentomaxillofac Radiol. 2013;42:20120199.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Rudisch A, Innerhofer K, Bertram S, Emshoff R. Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:566–71.CrossRefPubMedGoogle Scholar
  49. 49.
    Emshoff R, Brandlmaier I, Bertram S, Rudisch A. Relative odds of temporomandibular joint pain as a function of magnetic resonance imaging findings of internal derangement, osteoarthrosis, effusion, and bone marrow edema. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:437–45.CrossRefPubMedGoogle Scholar
  50. 50.
    Segami N, Suzuki T, Sato J, Miyamaru M, Nishimura M, Yoshimura H. Does joint effusion on T2 magnetic resonance images reflect synovitis? Part 3. Comparison of histologic findings of arthroscopically obtained synovium in internal derangements of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:761–6.CrossRefPubMedGoogle Scholar
  51. 51.
    Ogura I. Magnetic resonance imaging characteristics of temporomandibular joint pain during opening and biting in patients with disc displacement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:669–72.CrossRefPubMedGoogle Scholar
  52. 52.
    Orlando B, Chiappe G, Landi N, Bosco M. Risk of temporomandibular joint effusion related to magnetic resonance imaging signs of disc displacement. Med Oral Patol Oral Cir Bucal. 2009;14:E188–93.PubMedGoogle Scholar
  53. 53.
    Güler N, Uçkan S, Imirzalioğlu P, Açikgözoğlu S. Temporomandibular joint internal derangement: relationship between joint pain and MR grading of effusion and total protein concentration in the joint fluid. Dentomaxillofac Radiol. 2005;34:175–81.CrossRefPubMedGoogle Scholar
  54. 54.
    Robinson de Senna B, Marques LS, Franca JP, Ramos-Jorge ML, Pereira LJ. Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:e117–24.Google Scholar
  55. 55.
    Adame CG, Monje F, Offnoz M, Martin-Granizo R. Effusion in magnetic resonance imaging of the temporomandibular joint: a study of 123 joints. J Oral Maxillofac Surg. 1998;56:314–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Yajima A, Sano T, Otonari-Yamamoto M, Otonari T, Ohkubo M, Harada T, et al. MR evidence of characteristics in symptomatic osteoarthritis of the temporomandibular joint: increased signal intensity ratio on proton density-weighted images of bone marrow in the mandibular condyle. Cranio. 2007;25:250–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Suenaga S, Abeyama K, Noikura T. Gadolinium-enhanced MR imaging of temporomandibular disorders: improved lesion detection of the posterior disk attachment on T1-weighted images obtained with fat suppression. AJR Am J Roentgenol. 1998;171:511–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Langendoen J, Müller J, Jull GA. Retrodiscal tissue of the temporomandibular joint: clinical anatomy and its role in diagnosis and treatment of arthropathies. Man Ther. 1997;2:191–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Westesson PL, Paesani D. MR imaging of the TMJ. Decreased signal from the retrodiskal tissue. Oral Surg Oral Med Oral Pathol. 1993;76:631–5.Google Scholar
  60. 60.
    Hirose M, Tanaka E, Tanaka M, Fujita R, Kuroda Y, Yamano E, et al. Three-dimensional finite-element model of the human temporomandibular joint disc during prolonged clenching. Eur J Oral Sci. 2006;114:441–8.CrossRefPubMedGoogle Scholar
  61. 61.
    Scapino RP, Obrez A, Greising D. Organization and function of the collagen fiber system in the human temporomandibular joint disk and its attachments. Cells Tissues Organs. 2006;182:201–25.CrossRefPubMedGoogle Scholar
  62. 62.
    Cevidanes LH, Walker D, Schilling J, Sugai J, Giannobile W, Paniagua B, et al. 3D osteoarthritic changes in TMJ condylar morphology correlates with specific systemic and local biomarkers of disease. Osteoarthritis Cartilage. 2014;22:1657–67.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Pérez Del Palomar A, Doblaré M. Finite element analysis of the temporomandibular joint during lateral excursions of the mandible. J Biomech. 2006;39:2153–63.CrossRefPubMedGoogle Scholar
  64. 64.
    Aoun M, Mesnard M, Monède-Hocquard L, Ramos A. Stress analysis of temporomandibular joint disc during maintained clenching using a viscohyperelastic finite element model. J Oral Maxillofac Surg. 2014;72:1070–7.CrossRefPubMedGoogle Scholar
  65. 65.
    Lim MJ, Lee JY. Computed tomographic study of the patterns of osteoarthritic change which occur on the mandibular condyle. J Craniomaxillofac Surg. 2014;42:1897–902.CrossRefPubMedGoogle Scholar
  66. 66.
    Kopp S. Neuroendocrine, immune, and local responses related to temporomandibular disorders. J Orofac Pain. 2001;15:9–28.PubMedGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Japan 2015

Authors and Affiliations

  • Shigeaki Suenaga
    • 1
    Email author
  • Kunihiro Nagayama
    • 2
  • Taisuke Nagasawa
    • 1
  • Yoshihiro Kawabata
    • 1
  • Hiroko Indo
    • 1
  • Hideyuki J. Majima
    • 1
  1. 1.Division of Oncology, Department of Maxillofacial RadiologyKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
  2. 2.Department of Orthodontics and Dentofacial OrthopedicsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan

Personalised recommendations