Contrast enhanced magnetic resonance imaging as a method to diagnose early inflammatory changes in the temporomandibular joint in children with juvenile chronic arthritis

OBJECTIVE: Recent studies have stressed early diagnosis of temporomandibular joint (TMJ) involvement in children with juvenile chronic arthritis (JCA) to initiate treatment before destruction of the condylar head and growth alterations take place. TMJ involvement is often asymptomatic, but studies with contrast enhanced magnetic resonance imaging (MRI) in other joints have shown that it is possible to detect the early inflammatory changes. METHODS: Thirty TMJ in 15 children with newly diagnosed JCA (mean age 12.0 years) were examined clinically, with radiographs and with MRI enhanced with gadolinium diethylene thiamine pentaacetic acid (Gd-DTPA). A control group of 10 healthy children (mean age 11.5 yrs) were examined clinically and with MRI. The MRI variables included T1 weighted images before and after administration of Gd-DTPA with and without fat suppression. RESULTS: MRI enhanced with Gd-DTPA indicated inflammatory activity in 87% of the patients. Conventional MRI without contrast medium proved to be insignificant in diagnosing early inflammatory changes. CONCLUSION: Enhanced MRI is very efficient in diagnosing early inflammatory changes of the TMJ and is a more sensitive method than the clinical examination and radiographs.