Biomedical subjects

Rüdiger Emshoff

Publications and source records attributed to Rüdiger Emshoff.

23 records · Page 2Linked to original sources

PubMed2002

Are high-resolution ultrasonographic signs of disc displacement valid?

PURPOSE: The study goal was to define the positive predictive value (PPV) for the diagnosis of disc displacement of the temporomandibular joint (TMJ) with the use of high-resolution ultrasonography (HR-US). MATERIALS AND METHODS: The HR-US reports for 29 patients aged 19 to 62 years who had a prospective clinical diagnosis of TMJ internal derangement were correlated with magnetic resonance results. RESULTS: For the prospective HR-US interpretation, the PPV for disc displacement was 97% at the closed-mouth position and 88% at the maximum-mouth opening position. CONCLUSION: The PPV for the HR-US diagnosis of disc displacement is high.

Adult↗

PubMed2002

The biological concept of "internal derangement and osteoarthrosis": a diagnostic approach in patients with temporomandibular joint pain?

OBJECTIVES: We sought to investigate whether the finding of temporomandibular joint (TMJ)-related pain may be linked to magnetic resonance (MR) imaging findings of TMJ internal derangement and TMJ osteoarthrosis. STUDY DESIGN: The study consisted of 194 consecutive TMJ patients. Criteria for including a patient with a painful TMJ were as follow: report of orofacial pain in the TMJ, with the presence of unilateral or bilateral TMJ pain during palpation, function, and unassisted or assisted mandibular opening. Criteria for including a patient with a nonpainful TMJ were as follow: absence of a TMJ with pain during palpation, function, and unassisted or assisted mandibular opening. Application of the criteria resulted in a study group of 150 patients with unilateral TMJ pain, 10 with bilateral TMJ pain, and 34 without TMJ pain. Bilateral sagittal and coronal MR images were obtained to establish the presence or absence of TMJ internal derangement or osteoarthrosis, or both. RESULTS: A comparison of the TMJ-related data showed a significant relationship between the clinical finding of TMJ pain and the MR imaging diagnoses of TMJ internal derangement (P =.002) and TMJ osteoarthrosis (P =.004). Significant increases in risk of pain occurred with "disk displacement without reduction and osteoarthrosis" (P =.000), "disk displacement without reduction and absence of osteoarthrosis" (P =.000), and "disk displacement with reduction and osteoarthrosis" (P =.036). CONCLUSIONS: The results suggest that TMJ-related pain is correlated with TMJ-related MR imaging diagnoses of internal derangement and osteoarthrosis. The data confirm the biological concept of "internal derangement and osteoarthrosis," yet re-emphasize that internal derangement and osteoarthrosis may not be regarded as the unique and dominant factors in the definition of TMJ pain.

Adolescent↗

PubMed2002

Error patterns and observer variations in the high-resolution ultrasonography imaging evaluation of the disk position of the temporomandibular joint.

OBJECTIVES: The purpose of this study was (1) to describe errors in the interpretation of high-resolution ultrasonography (HR-US) images of the temporomandibular joint (TMJ) and analyze the discrepancies between HR-US imaging and diagnostic magnetic resonance imaging findings, and (2) to measure interobserver and intraobserver variations with respect to reporting HR-US images of the TMJ. STUDY DESIGN: The sonographic reports of 208 patients aged 13 to 78 years who had a prospective clinical diagnosis of TMJ internal derangement were correlated with magnetic resonance imaging results. Prospective and retrospective readings were used to classify types of disk displacement. Assessment of observer variation was based on a set of 200 HR-US images in 50 randomly selected patients. The images were interpreted independently by 2 trained radiologists at 2 sessions, 1 to 2 weeks apart. RESULTS: Prospective interpretation of TMJ HR-US images at the closed-mouth position had a sensitivity of 80%, specificity of 87%, and accuracy of 82%. For images at the maximum mouth-opening position, the sensitivity was 68%, specificity 93%, and accuracy 82%. The number of diagnostic errors at retrospective analysis was 60.3% (n = 73) of the number at prospective analysis. The intraobserver agreement for reporting the disk position at the closed-mouth position was 93% and at the maximum mouth-opening position was 88%. The agreement between the 2 observers was 89% on the position of the disk at the closed-mouth position and 84% at the maximum mouth-opening position. CONCLUSIONS: The high diagnostic accuracy, together with the low observer variation reported in this study, suggest that HR-US of the TMJ is a valuable imaging technique for assessment of disk displacement. Many errors that occur at prospective analysis didn't occur at retrospective analysis.

Adolescent↗

PubMed2002

Comparing methods for diagnosing temporomandibular joint disk displacement without reduction.

BACKGROUND: Research is needed to assess the validity of the Clinical Diagnostic Criteria for Temporomandibular Disorders, or CDC/TMD. The authors conducted a prospective, double-blind study to determine whether applying the specific CDC/TMD diagnosis of TMJ internal derangement, or ID, type III would demonstrate good agreement with diagnoses obtained by MRI. METHODS: The study comprised 138 TMJs in 69 subjects who had a clinical diagnosis of unilateral TMJ ID type III (disk displacement without reduction). The authors obtained bilateral sagittal and coronal MRIs to establish the corresponding diagnosis of disk-condyle relationship. RESULTS: For the CDC/TMD interpretations, the positive predictive value of ID type III for disk displacement without reduction was 86 percent, and for the presence of an ID it was 91 percent. The overall diagnostic agreement for ID type III was 78.3 percent with a corresponding K value of 0.57. Most of the disagreement was due to false-positive interpretations of an absence of ID. CONCLUSIONS: The results suggest that using CDC/TMD for ID type III is predictive for the presence of an ID but is not sufficiently reliable for determining disk displacement without reduction. Parameters other than the functional disk-condyle relationship may need to be addressed to account for the biological plausibility of this entity. CLINICAL IMPLICATIONS: A clinical TMJ-related diagnosis of ID type III may need to be supplemented by evidence from an MRI to determine the functional disk-condyle relationship. Investigation of longitudinal evidence, including risk factors, history and response to treatment, appears to be warranted.

Adolescent↗

PubMed2002

Disk displacement of the temporomandibular joint: sonography versus MR imaging.

OBJECTIVE: The purpose of this study was to determine the value of dynamic sonography in the evaluation of internal derangements of a temporomandibular joint (TMJ) during maximal mandibular range of motion. SUBJECTS AND METHODS: Maximal mandibular range of motion was performed during high-resolution sonography of the TMJ in 64 consecutive patients (128 joints; nine males and 55 females; age range, 17-65 years; mean age, 35 years 6 months), all of whom subsequently underwent MR imaging. MR imaging confirmed disk displacement with reduction in 27 joints and disk displacement without reduction in 60 joints of the 128 examined. The high-resolution sonography and MR imaging findings for these 27 and 60 TMJs, respectively, were analyzed. RESULTS: Dynamic high-resolution sonography performed during the maximal range of motion helped to detect 81 instances (93%) of internal derangement, 22 instances (82%) of disk displacement with reduction, and 50 instances (83%) of disk displacement without reduction. There was one false-positive finding for internal derangement. The accuracy of prospective interpretation of high-resolution sonograms of internal derangement, disk displacement with reduction, and disk displacement without reduction was 95%, 92%, and 90%, respectively. CONCLUSION: When real-time images are interpreted by expert radiologists, dynamic sonography performed during maximal mandibular range of motion may provide valuable information about disk displacement of the TMJ.

Adolescent↗