Diagnostic accuracy of 2 cone-beam computed tomography protocols for detecting arthritic changes in temporomandibular joints

Abstract

The temporomandibular joint (TMJ) is a complex joint that often develops degenerative joint disease. Clinical examination alone cannot usually diagnose this accurately, and a radiographic examination complements and aids in diagnosis and treatment. The osseous components of the TMJ complex are best imaged using computed tomography. The evolution of cone-beam computed tomography (CBCT) offers a low radiation dose and a high spatial resolution alternative and is becoming the imaging modality of choice for the TMJ. To further reduce the dose and yet not compromise the diagnostic task at hand, some alternative rotation acquisition protocols are available but have not been adequately evaluated. The aim of this study was to evaluate the diagnostic efficacy of 2 CBCT acquisition protocols to detect degenerative changes associated with the TMJ complex. Thirty-four TMJs, from 17 dry human skulls, were obtained from the anatomy department at the School of Dental Medicine of the University of Connecticut. The sample consisted of complete dentate and partially dentate skulls with no identifiable markers such as age, sex, or ethnicity. Small and large lesions simulating early and established arthritic changes were created on the mandibular condyle. Each defect was randomly created on the medial pole, articulating surface, or lateral pole. After simulating the articular disc with rubber dam material, the condyle and the glenoid fossa were articulated and positioned in place by a rubber band. The skulls were scanned by using an Accuitomo CBCT scanner (J. Morita Corp, Kyoto, Japan) with 180° and 360° rotation protocols. Two operators scored the lesions and compared the results to the gold standard, which was the master list of where the lesions were made on the condyles. On the 102 randomly selected sites, 39 large and 33 small lesions were made, and the rest of the sites had no lesions. The detection rates for areas with large lesions and areas with no lesions were 100% between the examiners. However, of the 33 small lesions, each examiner was able to identify 32 of them with the 360° scans: a 97.4% detection rate when compared with the gold standard. With the 180° scan, 94.9% of the small lesions were detected when compared with the gold standard, and 96.9% were detected with the 360° scan. The overall interexaminer reliability was over 90% for both imaging protocols (Cronbach's alpha, 92.4% for 180° and 97% for 360°). Based on the results of this study, the 180° CBCT acquisition protocol can detect small and large arthritic lesions with high reliability and is comparable with the 360° spin acquisition.