Can MRI-based FRACTURE (fast field echo resembling a CT using restricted echo-spacing) serve as an alternative to CT for diagnosing degenerative joint disease of the temporomandibular joint?

PURPOSE: To compare the evaluation of temporomandibular joint bone changes and diagnosis of degenerative joint disease (DJD) using fast field echo resembling a CT using restricted echo-spacing (FRACTURE) magnetic resonance imaging (MRI) sequence, with that using computed tomography (CT).

METHODS

This study included 28 temporomandibular joints from 14 patients who underwent MRI, including FRACTURE sequence, and CT of the temporomandibular joint region. Three-axis cross-sectional images were prepared for both FRACTURE and CT. Two radiologists independently assessed temporomandibular joint bone changes across nine categories. The proportion of agreement between FRACTURE and CT assessments for bone changes was calculated separately for each observer using CT as the reference standard. Diagnostic agreement for detecting DJD was also assessed, and interobserver agreement for DJD diagnosis was measured using kappa statistics.

RESULTS

The proportion of agreement between FRACTURE and CT assessments for bone changes ranged from 0.750 to 1.000 for Observer 1, and from 0.786 to 1.000 for Observer 2. For DJD diagnosis, the FRACTURE technique demonstrated high agreement with CT assessments, with proportions of agreement of 1.000 for Observer 1 and 0.893 for Observer 2. The kappa statistic for interobserver agreement for DJD diagnosis was substantial with FRACTURE and almost perfect with CT.

CONCLUSION

The FRACTURE technique may provide information comparable to CT assessments for evaluating temporomandibular joint bone changes and diagnosing DJD. Adding FRACTURE, a widely available sequence, to conventional MRI sequences may enable many institutions to diagnose both disc displacement and DJD without requiring CT.