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. 2017 Jul;46(5):20160424.
doi: 10.1259/dmfr.20160424. Epub 2017 Mar 23.

The intravoxel incoherent motion MRI of lateral pterygoid muscle: a quantitative analysis in patients with temporomandibular joint disorders

Supak Ngamsom  1   2 , Shin Nakamura  1 , Junichiro Sakamoto  1 , Shinya Kotaki  1 , Akemi Tetsumura  1 , Tohru Kurabayashi  1
Affiliations

The intravoxel incoherent motion MRI of lateral pterygoid muscle: a quantitative analysis in patients with temporomandibular joint disorders

Supak Ngamsom et al. Dentomaxillofac Radiol. 2017 Jul.

Abstract

Objectives: To quantitatively evaluate diffusion and perfusion status of lateral pterygoid muscle (LPM) in patients with temporomandibular joint disorder (TMD) by intravoxel incoherent motion (IVIM) imaging and to correlate with findings on temporomandibular joints (TMJs) by conventional MRI.

Methods: 42 patients with TMD underwent MRI. To assess IVIM parameters, diffusion-weighted imaging was obtained by spin-echo-based single-shot echoplanar imaging. Regions of interest were created on all diffusion-weighted images of the superior belly of the lateral pterygoid (SLP) and inferior belly of the lateral pterygoid (ILP) at b-values 0-500 s mm-2. Then, IVIM parameters, diffusion (D) and perfusion (f) were calculated using biexponential fittings. The correlation of these values with conventional MRI findings on TMJs was investigated.

Results: For SLP, the f parameter in TMJs with anterior disc displacement without reduction was significantly higher than that in normal ones (p = 0.015). It was also significantly higher in TMJs with joint effusion than in those without (p = 0.016). On the other hand, for both SLP and ILP, the D parameter significantly increased in TMJs with osteoarthritis compared with those without (p = 0.015 and p = 0.022, respectively).

Conclusions: Pathological changes of LPM in patients with TMD may be quantitatively evaluated by IVIM parameters.

Keywords: diagnostic imaging; diffusion-weighted MRI; masticatory muscles; pterygoid muscle; temporomandibular joint disorders.

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Figures

Figure 1
Figure 1
A 33-year-old female: on the axial three-dimensional (3D) T1 weighted image (T1WI) showing the maximal area of the superior belly of the lateral pterygoid muscle (SLP), the region of interest (ROI) including the whole SLP was drawn (a: upper left image). The ROI was superimposed on eight diffusion-weighted images of the same level with different b-values, and signal intensity was measured on each image (a: the other images). Parasagittal (b) and paracoronal (c) proton density-weighted images (PDWIs) were used to confirm the location of SLP (dashed lines).
Figure 2
Figure 2
The same patient as in Figure 1: on the axial three-dimensional (3D) T1 weighted image (T1WI) showing the maximal area of the inferior belly of the lateral pterygoid (ILP), the region of interest (ROI) including the whole ILP was drawn (a: upper left image). The ROI was superimposed on eight diffusion-weighted images of the same level with different b-values, and signal intensity was measured on each image (a: the other images). Parasagittal (b) and paracoronal (c) proton density-weighted images (PDWIs) were used to confirm the location of ILP (dashed lines).
Figure 3
Figure 3
Box plots demonstrating the relationship between the intravoxel incoherent motion parameters (D and f) of the superior lateral pterygoid muscle and the MRI findings of the temporomandibular joints for the articular disc position, joint effusion and osteoarthritis (*p < 0.05). ADWOR, anterior disc displacement without reduction; ADWR, anterior disc displacement with reduction ND, normal disc.
Figure 4
Figure 4
Box plots demonstrating the relationship between the intravoxel incoherent motion parameters (D and f) of the inferior lateral pterygoid muscle and the MRI findings of the temporomandibular joints for the articular disc position, joint effusion and osteoarthritis (*p < 0.05). ADWOR, anterior disc displacement without reduction; ADWR, anterior disc displacement with reduction ND, normal disc.
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