Gadolinium-enhanced MR imaging of temporomandibular disorders: improved lesion detection of the posterior disk attachment on T1-weighted images obtained with fat suppression

OBJECTIVE: The purpose of this study was to assess the potential for improved lesion detection in the posterior disk attachment and its surrounding tissue in temporomandibular disorders when gadolinium-enhanced MR imaging performed with fat suppression is used. MATERIALS AND METHODS: Forty-five patients underwent MR imaging with conventional T1- and T2-weighted, gadolinium-enhanced T1-weighted, and gadolinium-enhanced fat-suppressed spin-echo imaging sequences. Qualitative and quantitative assessments of the contrast enhancement of each type of imaging were also performed. RESULTS: The contrast-enhanced fat-suppressed T1-weighted imaging sequence had several advantages over the other imaging techniques in detecting abnormalities of the posterior disk attachment and in detecting bone marrow lesions in the mandibular condyle. The most significant advantage was better enhancement of lesion conspicuity. The diagnostic accuracy of contrast-enhanced fat-suppressed imaging was 77% versus 70% for conventional contrast-enhanced imaging. The kappa value for interobserver agreement was .95 for contrast-enhanced fat-suppressed imaging and .72 for conventional contrast-enhanced imaging. CONCLUSION: Contrast-enhanced fat-suppressed T1-weighted spin-echo MR imaging is a valuable technique for visualizing the extent and degree of lesions in the posterior disk attachment and bone marrow lesions in the mandibular condyle.