Incidental findings during head and neck MRI screening in 1717 patients with temporomandibular disorders

  • Takashi Kamio
  • Takashi Yakushiji
  • Takashi Takaki
  • Takahiko Shibahara
  • Kenichi Imoto
  • Mamoru Wakoh
Original Article
  • 28 Downloads

Abstract

Objective

Magnetic resonance imaging (MRI) plays an important role in the evaluation of temporomandibular disorders (TMDs). At our institution, we perform additional head and neck screening using head coils when performing MRI screening of the temporomandibular joint (TMJ) to detect lesions in areas other than the TMJ (lesions discovered by chance, or incidental findings; IFs) and to conduct a diagnosis of exclusion. The objective of this study was to determine the number and frequency of IFs detected during head and neck screening, according to sites and diseases.

Materials and methods

The study evaluated 1717 patients with clinically suspected TMDs who underwent MRI of the TMJ. IFs were assessed on horizontal sections of images of the craniofacial region obtained by the short tau inversion recovery imaging technique.

Results

The patients undergoing MRI of the TMJ comprised 433 males and 1284 females. Among the patients, at least one IF was detected on images in 461 patients. The most common IF site was the maxillary sinus. Based on diagnostic imaging, there were 21 IFs (1.2%) associated with TMD symptoms, or for which an association with TMD symptoms could not be ruled out.

Conclusions

Combination of conventional MRI imaging of the TMJ with craniofacial MRI screening may allow detection of lesions other than TMDs, thereby confirming the usefulness of MRI. Detection of IFs may require development of different therapeutic strategies than those for TMDs.

Keywords

Temporomandibular disorders MRI Screening Incidental findings 

Notes

Compliance with ethical standards

Conflict of interest

Takashi Kamio, Takashi Yakushiji, Takashi Takaki, Takahiko Shibahara, Kenichi Imoto, and Mamoru Wakoh declare that they have no conflict of interest.

Human rights statement

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

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Iizuka T, Kakudo K, Kino K, Kawano M, Kobayashi K, Koyano K, et al. Concept and differential diagnosis for temporomandibular joint disorders. In: Iizuka T, editor. Tokyo: Japanese Society for the Temporomandibular Joint; 2001. p. 1–5 (in Japanese).Google Scholar
  2. 2.
    Roberts D, Schenck J, Joseph P, Foster T, Hart H, Pettigrew J, et al. Temporomandibular joint: magnetic resonance imaging. Radiology. 1985;154:829–30.CrossRefPubMedGoogle Scholar
  3. 3.
    Katzberg RW. Temporomandibular joint imaging. Anesth Prog. 1990;37:121–6.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Tasaki MM, Westesson PL. Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR imaging. Radiology. 1993;186:723–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Brooks SL, Brand JW, Gibbs SJ, Hollender L, Lurie AG, Omnell KA, et al. Imaging of the temporomandibular joint. A position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83:609–18.CrossRefPubMedGoogle Scholar
  6. 6.
    Harms SE, Wilk RM, Wolford LM, Chiles DG, Milam SB. The temporomandibular joint: magnetic resonance imaging using surface coils. Radiology. 1985;157:133–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Katzberg RW, Bessette RW, Tallents RH, Plewes DB, Manzione JV, Schenck JF, et al. Normal and abnormal temporomandibular joint: MR imaging with surface coil. Radiology. 1986;158:183–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Wolf SM, Lawrenz FP, Nelson CA, Kahn JP, Cho MK, Clayton EW, et al. Managing incidental findings in human subjects research: analysis and recommendations. J Law Med Ethics. 2008;36:219–48.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    ICD-10 Volume-2 Instruction Manual. World Health Organization, International Classification of Diseases, 10th Revision (ICD-10). Geneva: World Health Organization. http://www.who.int/classifications/icd/ICD-10_2nd_ed_volume2.pdf (2010). Accessed 14 Nov 2014.
  10. 10.
    R Development Core Team. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. http://www.R-project.org/ (2013).
  11. 11.
    Morin SH, Cobbold JF, Lim AK, Eliahoo J, Thomas EL, Mehta SR, et al. Incidental findings in healthy control research subjects using whole-body MRI. Eur J Radiol. 2009;72:529–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Orme NM, Fletcher JG, Siddiki HA, Harmsen WS, O’Byrne MM, Port JD, et al. Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med. 2010;170:1525–32.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lumbreras B, González-Alvárez I, Lorente MF, Calbo J, Aranaz J, Hernández-Aguado I. Unexpected findings at imaging: predicting frequency in various types of studies. Eur J Radiol. 2010;74:269–74.CrossRefPubMedGoogle Scholar
  14. 14.
    Morris Z, Whiteley WN, Longstreth WT Jr, Weber F, Lee YC, Tsushima Y, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ. 2009;339:b3016.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Radhamma A, Halligan S, Bloom S, McCartney S, Taylor SA. MRI enterography: what is the clinical impact of unsuspected extra-enteric findings? Br J Radiol. 2012;85:e766–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Allareddy V, Vincent SD, Hellstein JW, Qian F, Smoker WR, Ruprecht A. Incidental findings on cone beam computed tomography images. Int J Dent. 2012;2012:871532.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Cha JY, Mah J, Sinclair P. Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging. Am J Orthod Dentofac Orthop. 2007;132:7–14.CrossRefGoogle Scholar
  18. 18.
    Edwards R, Altalibi M, Flores-Mir C. The frequency and nature of incidental findings in cone-beam computed tomographic scans of the oral and maxillofacial region: a systematic review. J Am Dent Assoc. 2013;144:161–70.CrossRefPubMedGoogle Scholar
  19. 19.
    Price JB, Thaw KL, Tyndall DA, Ludlow JB, Padilla RJ. Incidental findings from cone beam computed tomography of the maxillofacial region: a descriptive retrospective study. Clin Oral Implants Res. 2012;23:1261–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Kaneda T, Minami M, Ozawa K, Akimoto Y, Utsunomiya T, Yamamoto H, et al. Magnetic resonance imaging of osteomyelitis in the mandible. Comparative study with other radiologic modalities. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:634–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Lee K, Kaneda T, Mori S, Minami M, Motohashi J, Yamashiro M. Magnetic resonance imaging of normal and osteomyelitis in the mandible: assessment of short inversion time inversion recovery sequence. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:499–507.CrossRefPubMedGoogle Scholar
  22. 22.
    Orhan K, Avsever H, Aksoy S, Seki U, Bozkurt P. Temporomandibular joint MR images: incidental head and neck findings and pathologies. Cranio. 2017;17:1–8.CrossRefGoogle Scholar
  23. 23.
    Panelli SKC, Fujita M, Oliveira JX, Yanagi Y, Asaumi J. Should incidental findings in diagnostic imaging be reported? Minerva Stomatol. 2017;66:75–80.Google Scholar
  24. 24.
    Makdissi J, Pawar RR, Radon M, Holmes SB. Incidental findings on MRI of the temporomandibular joint. Dentomaxillofac Radiol. 2013;42:20130175.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ariji Y, Izumi M, Gotoh M, Naitoh M, Katoh M, Kuroiwa Y, et al. MRI features of mandibular osteomyelitis: practical criteria based on an association with conventional radiography features and clinical classification. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;105:503–11.CrossRefPubMedGoogle Scholar
  26. 26.
    Chaudhuri R, Bingham JB, Crossman JE, Gleeson MJ. Magnetic resonance imaging of the parotid gland using the STIR sequence. Clin Otolaryngol Allied Sci. 1992;17:211–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Müller-Lisse GU, Kretschmar UL, Jäger L, Dreher A, Grevers G, Reiser M. Value of fat signal suppression MRI pulse sequences for diagnosis of malignant tumors in the area of the head-neck. Radiologe. 1996;36:199–206. (German).CrossRefPubMedGoogle Scholar
  28. 28.
    Cimino R, Steenks MH, Michelotti A, Farella M, PierFrancesco N. Mandibular condyle osteochondroma. Review of the literature and report of a misdiagnosed case. J Orofac Pain. 2003;17:254–61.PubMedGoogle Scholar
  29. 29.
    Karasu HA, Ortakoglu K, Okcu KM, Gunhan O. Osteochondroma of the mandibular condyle: report of a case and review of the literature. Mil Med. 2005;170:797–801.CrossRefPubMedGoogle Scholar
  30. 30.
    Orhan K, Orhan AI, Oz U, Pekiner FN, Delilbasi C. Misdiagnosed fibrosarcoma of the mandible mimicking temporomandibular disorder: a rare condition. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e26–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Yanagi Y, Asaumi J, Maki Y, Murakami J, Hisatomi M, Matsuzaki H, et al. Incidentally found and unexpected tumors discovered by MRI examination for temporomandibular joint arthrosis. Eur J Radiol. 2003;47:6–9.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryTokyo Dental CollegeChibaJapan

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