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Zachary S Peacock - One of the best experts on this subject based on the ideXlab platform.
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regional differences in temporomandibular joint inflammation in patients with juvenile idiopathic arthritis a dynamic post contrast magnetic resonance imaging study
International Journal of Oral and Maxillofacial Surgery, 2020Co-Authors: Karen Buch, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, H RothermelAbstract:Abstract The purpose was to determine whether there are regional differences in temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA). This was a retrospective study of all patients with dynamic, contrast-enhanced magnetic resonance imaging through the TMJs at Massachusetts General Hospital between January 2015 and July 2016. The patient cohort included those with a history of JIA and control patients who underwent MRI for other routine clinical purposes. TMJ inflammation was quantified as the difference between post-gadolinium and pre-gadolinium articular T1 signal intensity normalized to post-gadolinium signal intensity of the Longus Capitis Muscle. TMJ enhancement profiles were generated for the lateral, central, and medial portions of the TMJ. Regional differences in TMJ enhancement were investigated using basic descriptive statistics. Medial edge enhancement of the TMJs was highest in symptomatic JIA joints, followed by asymptomatic JIA, then control joints. Medial edge enhancement was a significant discriminator between symptomatic JIA TMJs and control joints (P = 0.0001), between symptomatic and asymptomatic JIA TMJs (P = 0.0003), and between asymptomatic JIA TMJs and controls (P = 0.0019). A shift in distribution of TMJ enhancement towards the medial edge that was seen uniquely in both asymptomatic and symptomatic JIA TMJs compared to control joints was found. This suggests a pattern of worsening medial edge inflammation with disease.
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imaging of the temporomandibular joint in juvenile idiopathic arthritis how does quantitative compare to semiquantitative mri scoring
Journal of Oral and Maxillofacial Surgery, 2019Co-Authors: Grace My, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, Carly E Calabrese, Timothy DonohueAbstract:Purpose Contrast-enhanced magnetic resonance imaging (MRI) is commonly used to evaluate temporomandibular joint (TMJ) disease in patients with juvenile idiopathic arthritis (JIA). However, MRI assessments have been limited by qualitative reporting, the presence of enhancement in normal joints, and a lack of standardized protocols. The purpose of the present study was to compare a quantitative MRI analysis using an enhancement ratio (ER) to a new semiquantitative system developed by Outcome Measures in Rheumatology and Clinical Trials (OMERACT). Materials and Methods We performed a retrospective cross-sectional study of children with JIA who had undergone TMJ MRI with gadolinium enhancement at Boston Children's Hospital. The predictor variables were demographic data (sex, age at MRI) and disease-related findings (JIA subtype and arthritis medication at MRI). The outcome variables were OMERACT scores and ER (ratio of TMJ synovium and Longus Capitis Muscle pixel intensities). The ER was compared with the OMERACT total, inflammatory, and damage scores using Pearson's correlation analysis and multivariable linear regression. Statistical significance was evaluated using the Student t test and analysis of variance with significance set at P Results The sample included 50 subjects (84% female) with a mean age of 12.7 ± 3.9 years and 124 MRI scans. The mean ER was 2.5 ± 0.9 (normal, Conclusions Quantitative evaluation of TMJ synovial enhancement using the ER is easier to score and has superior intra- and interrater agreement; however, it can only assess inflammation. Semiquantitative assessment of TMJ using the OMERACT adds data about chronic changes. Using both systems might provide the most accurate assessment of JIA status.
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quantifying temporomandibular joint synovitis in children with juvenile idiopathic arthritis
Arthritis Care and Research, 2016Co-Authors: Cory M Resnick, Pouya M Vakilian, Micheal Breen, David Zurakowski, Paul A Caruso, Lauren A Henderson, Peter A Nigrovic, Leonard B Kaban, Zachary S PeacockAbstract:Objective: Juvenile Idiopathic Arthritis (JIA) frequently affects the temporomandibular joints (TMJs) and is often undetected by history, examination and plain imaging. Qualitative assessment of gadolinium-enhanced magnetic resonance images (MRI) is currently the standard for diagnosis of TMJ synovitis associated with JIA. The purpose of this study is to apply a quantitative analysis of synovial enhancement to MRIs of patients with and without JIA to establish a disease threshold, sensitivity and specificity for the technique. Methods: This is a retrospective case-control study of children (≤16 years) who had MRIs with gadolinium including the TMJs. Subjects were divided into a “JIA group” and a “control group.” From a coronal T1-weighted image, a ratio (“enhancement ratio”, ER) of the average pixel intensity within three 0.2mm2 regions of interest (ROI) in the TMJ synovium to that of a 50mm2 ROI of the Longus Capitis Muscle was calculated. Receiver operating characteristic (ROC) curves were used to determine sensitivity and specificity. Inter- and intra-examiner reliabilities were evaluated with Bland-Altman plots and two-way mixed, absolute agreement intraclass correlation coefficients (ICC). Results: There were 187 and 142 TMJs included in the JIA and control groups, respectively. An ER threshold of 1.55 had a sensitivity and specificity for detecting synovitis of 91% and 96%, respectively. Inter- and intra-examiner reliability were excellent. Conclusion: Calculating a ratio of pixel intensity between TMJ synovium and the Longus Capitis Muscle is a reliable way to quantify synovial enhancement. An ER of 1.55 differentiates normal TMJs from those affected by inflammatory arthritis. This article is protected by copyright. All rights reserved.
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quantifying synovial enhancement of the pediatric temporomandibular joint
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Zachary S Peacock, Cory M Resnick, Pouya M Vakilian, Paul A Caruso, Mark Vangel, Leonard B KabanAbstract:Purpose The purposes of this study were to assess a novel method for quantifying temporomandibular joint (TMJ) synovial enhancement on gadolinium-enhanced magnetic resonance imaging (MRI) and to establish normative values to allow early detection of synovitis. Materials and Methods This is a retrospective cohort study of pediatric patients (aged 0 to 16 years) without jaw pathology who underwent MRI scans with contrast that included the TMJs. From a coronal T1-weighted image, the signal intensity within the superior and inferior joint spaces was divided by the signal intensity of the Longus Capitis Muscle to establish a ratio by age. Intrarater reliability and inter-rater reliability were assessed. A mixed-model regression analysis was used to determine the 95% specificity threshold for normal ratios. Results Temporal and optic nerve MRI scans of 158 patients were included. Normative synovial enhancement ratios (95% specificity) thresholds were established: 1.52, 1.68, and 1.55 for superior joint space, inferior joint space, and average of both joint spaces, respectively. Intrarater and inter-rater agreement was excellent. Conclusions A ratio of signal intensity of the TMJ synovium to the Longus Capitis is a reliable method to quantify enhancement controlling for time after contrast infusion and may be useful for diagnosis of TMJ synovitis.
Cory M Resnick - One of the best experts on this subject based on the ideXlab platform.
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regional differences in temporomandibular joint inflammation in patients with juvenile idiopathic arthritis a dynamic post contrast magnetic resonance imaging study
International Journal of Oral and Maxillofacial Surgery, 2020Co-Authors: Karen Buch, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, H RothermelAbstract:Abstract The purpose was to determine whether there are regional differences in temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA). This was a retrospective study of all patients with dynamic, contrast-enhanced magnetic resonance imaging through the TMJs at Massachusetts General Hospital between January 2015 and July 2016. The patient cohort included those with a history of JIA and control patients who underwent MRI for other routine clinical purposes. TMJ inflammation was quantified as the difference between post-gadolinium and pre-gadolinium articular T1 signal intensity normalized to post-gadolinium signal intensity of the Longus Capitis Muscle. TMJ enhancement profiles were generated for the lateral, central, and medial portions of the TMJ. Regional differences in TMJ enhancement were investigated using basic descriptive statistics. Medial edge enhancement of the TMJs was highest in symptomatic JIA joints, followed by asymptomatic JIA, then control joints. Medial edge enhancement was a significant discriminator between symptomatic JIA TMJs and control joints (P = 0.0001), between symptomatic and asymptomatic JIA TMJs (P = 0.0003), and between asymptomatic JIA TMJs and controls (P = 0.0019). A shift in distribution of TMJ enhancement towards the medial edge that was seen uniquely in both asymptomatic and symptomatic JIA TMJs compared to control joints was found. This suggests a pattern of worsening medial edge inflammation with disease.
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imaging of the temporomandibular joint in juvenile idiopathic arthritis how does quantitative compare to semiquantitative mri scoring
Journal of Oral and Maxillofacial Surgery, 2019Co-Authors: Grace My, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, Carly E Calabrese, Timothy DonohueAbstract:Purpose Contrast-enhanced magnetic resonance imaging (MRI) is commonly used to evaluate temporomandibular joint (TMJ) disease in patients with juvenile idiopathic arthritis (JIA). However, MRI assessments have been limited by qualitative reporting, the presence of enhancement in normal joints, and a lack of standardized protocols. The purpose of the present study was to compare a quantitative MRI analysis using an enhancement ratio (ER) to a new semiquantitative system developed by Outcome Measures in Rheumatology and Clinical Trials (OMERACT). Materials and Methods We performed a retrospective cross-sectional study of children with JIA who had undergone TMJ MRI with gadolinium enhancement at Boston Children's Hospital. The predictor variables were demographic data (sex, age at MRI) and disease-related findings (JIA subtype and arthritis medication at MRI). The outcome variables were OMERACT scores and ER (ratio of TMJ synovium and Longus Capitis Muscle pixel intensities). The ER was compared with the OMERACT total, inflammatory, and damage scores using Pearson's correlation analysis and multivariable linear regression. Statistical significance was evaluated using the Student t test and analysis of variance with significance set at P Results The sample included 50 subjects (84% female) with a mean age of 12.7 ± 3.9 years and 124 MRI scans. The mean ER was 2.5 ± 0.9 (normal, Conclusions Quantitative evaluation of TMJ synovial enhancement using the ER is easier to score and has superior intra- and interrater agreement; however, it can only assess inflammation. Semiquantitative assessment of TMJ using the OMERACT adds data about chronic changes. Using both systems might provide the most accurate assessment of JIA status.
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quantifying temporomandibular joint synovitis in children with juvenile idiopathic arthritis
Arthritis Care and Research, 2016Co-Authors: Cory M Resnick, Pouya M Vakilian, Micheal Breen, David Zurakowski, Paul A Caruso, Lauren A Henderson, Peter A Nigrovic, Leonard B Kaban, Zachary S PeacockAbstract:Objective: Juvenile Idiopathic Arthritis (JIA) frequently affects the temporomandibular joints (TMJs) and is often undetected by history, examination and plain imaging. Qualitative assessment of gadolinium-enhanced magnetic resonance images (MRI) is currently the standard for diagnosis of TMJ synovitis associated with JIA. The purpose of this study is to apply a quantitative analysis of synovial enhancement to MRIs of patients with and without JIA to establish a disease threshold, sensitivity and specificity for the technique. Methods: This is a retrospective case-control study of children (≤16 years) who had MRIs with gadolinium including the TMJs. Subjects were divided into a “JIA group” and a “control group.” From a coronal T1-weighted image, a ratio (“enhancement ratio”, ER) of the average pixel intensity within three 0.2mm2 regions of interest (ROI) in the TMJ synovium to that of a 50mm2 ROI of the Longus Capitis Muscle was calculated. Receiver operating characteristic (ROC) curves were used to determine sensitivity and specificity. Inter- and intra-examiner reliabilities were evaluated with Bland-Altman plots and two-way mixed, absolute agreement intraclass correlation coefficients (ICC). Results: There were 187 and 142 TMJs included in the JIA and control groups, respectively. An ER threshold of 1.55 had a sensitivity and specificity for detecting synovitis of 91% and 96%, respectively. Inter- and intra-examiner reliability were excellent. Conclusion: Calculating a ratio of pixel intensity between TMJ synovium and the Longus Capitis Muscle is a reliable way to quantify synovial enhancement. An ER of 1.55 differentiates normal TMJs from those affected by inflammatory arthritis. This article is protected by copyright. All rights reserved.
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quantifying synovial enhancement of the pediatric temporomandibular joint
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Zachary S Peacock, Cory M Resnick, Pouya M Vakilian, Paul A Caruso, Mark Vangel, Leonard B KabanAbstract:Purpose The purposes of this study were to assess a novel method for quantifying temporomandibular joint (TMJ) synovial enhancement on gadolinium-enhanced magnetic resonance imaging (MRI) and to establish normative values to allow early detection of synovitis. Materials and Methods This is a retrospective cohort study of pediatric patients (aged 0 to 16 years) without jaw pathology who underwent MRI scans with contrast that included the TMJs. From a coronal T1-weighted image, the signal intensity within the superior and inferior joint spaces was divided by the signal intensity of the Longus Capitis Muscle to establish a ratio by age. Intrarater reliability and inter-rater reliability were assessed. A mixed-model regression analysis was used to determine the 95% specificity threshold for normal ratios. Results Temporal and optic nerve MRI scans of 158 patients were included. Normative synovial enhancement ratios (95% specificity) thresholds were established: 1.52, 1.68, and 1.55 for superior joint space, inferior joint space, and average of both joint spaces, respectively. Intrarater and inter-rater agreement was excellent. Conclusions A ratio of signal intensity of the TMJ synovium to the Longus Capitis is a reliable method to quantify enhancement controlling for time after contrast infusion and may be useful for diagnosis of TMJ synovitis.
Paul A Caruso - One of the best experts on this subject based on the ideXlab platform.
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regional differences in temporomandibular joint inflammation in patients with juvenile idiopathic arthritis a dynamic post contrast magnetic resonance imaging study
International Journal of Oral and Maxillofacial Surgery, 2020Co-Authors: Karen Buch, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, H RothermelAbstract:Abstract The purpose was to determine whether there are regional differences in temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA). This was a retrospective study of all patients with dynamic, contrast-enhanced magnetic resonance imaging through the TMJs at Massachusetts General Hospital between January 2015 and July 2016. The patient cohort included those with a history of JIA and control patients who underwent MRI for other routine clinical purposes. TMJ inflammation was quantified as the difference between post-gadolinium and pre-gadolinium articular T1 signal intensity normalized to post-gadolinium signal intensity of the Longus Capitis Muscle. TMJ enhancement profiles were generated for the lateral, central, and medial portions of the TMJ. Regional differences in TMJ enhancement were investigated using basic descriptive statistics. Medial edge enhancement of the TMJs was highest in symptomatic JIA joints, followed by asymptomatic JIA, then control joints. Medial edge enhancement was a significant discriminator between symptomatic JIA TMJs and control joints (P = 0.0001), between symptomatic and asymptomatic JIA TMJs (P = 0.0003), and between asymptomatic JIA TMJs and controls (P = 0.0019). A shift in distribution of TMJ enhancement towards the medial edge that was seen uniquely in both asymptomatic and symptomatic JIA TMJs compared to control joints was found. This suggests a pattern of worsening medial edge inflammation with disease.
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imaging of the temporomandibular joint in juvenile idiopathic arthritis how does quantitative compare to semiquantitative mri scoring
Journal of Oral and Maxillofacial Surgery, 2019Co-Authors: Grace My, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, Carly E Calabrese, Timothy DonohueAbstract:Purpose Contrast-enhanced magnetic resonance imaging (MRI) is commonly used to evaluate temporomandibular joint (TMJ) disease in patients with juvenile idiopathic arthritis (JIA). However, MRI assessments have been limited by qualitative reporting, the presence of enhancement in normal joints, and a lack of standardized protocols. The purpose of the present study was to compare a quantitative MRI analysis using an enhancement ratio (ER) to a new semiquantitative system developed by Outcome Measures in Rheumatology and Clinical Trials (OMERACT). Materials and Methods We performed a retrospective cross-sectional study of children with JIA who had undergone TMJ MRI with gadolinium enhancement at Boston Children's Hospital. The predictor variables were demographic data (sex, age at MRI) and disease-related findings (JIA subtype and arthritis medication at MRI). The outcome variables were OMERACT scores and ER (ratio of TMJ synovium and Longus Capitis Muscle pixel intensities). The ER was compared with the OMERACT total, inflammatory, and damage scores using Pearson's correlation analysis and multivariable linear regression. Statistical significance was evaluated using the Student t test and analysis of variance with significance set at P Results The sample included 50 subjects (84% female) with a mean age of 12.7 ± 3.9 years and 124 MRI scans. The mean ER was 2.5 ± 0.9 (normal, Conclusions Quantitative evaluation of TMJ synovial enhancement using the ER is easier to score and has superior intra- and interrater agreement; however, it can only assess inflammation. Semiquantitative assessment of TMJ using the OMERACT adds data about chronic changes. Using both systems might provide the most accurate assessment of JIA status.
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quantifying temporomandibular joint synovitis in children with juvenile idiopathic arthritis
Arthritis Care and Research, 2016Co-Authors: Cory M Resnick, Pouya M Vakilian, Micheal Breen, David Zurakowski, Paul A Caruso, Lauren A Henderson, Peter A Nigrovic, Leonard B Kaban, Zachary S PeacockAbstract:Objective: Juvenile Idiopathic Arthritis (JIA) frequently affects the temporomandibular joints (TMJs) and is often undetected by history, examination and plain imaging. Qualitative assessment of gadolinium-enhanced magnetic resonance images (MRI) is currently the standard for diagnosis of TMJ synovitis associated with JIA. The purpose of this study is to apply a quantitative analysis of synovial enhancement to MRIs of patients with and without JIA to establish a disease threshold, sensitivity and specificity for the technique. Methods: This is a retrospective case-control study of children (≤16 years) who had MRIs with gadolinium including the TMJs. Subjects were divided into a “JIA group” and a “control group.” From a coronal T1-weighted image, a ratio (“enhancement ratio”, ER) of the average pixel intensity within three 0.2mm2 regions of interest (ROI) in the TMJ synovium to that of a 50mm2 ROI of the Longus Capitis Muscle was calculated. Receiver operating characteristic (ROC) curves were used to determine sensitivity and specificity. Inter- and intra-examiner reliabilities were evaluated with Bland-Altman plots and two-way mixed, absolute agreement intraclass correlation coefficients (ICC). Results: There were 187 and 142 TMJs included in the JIA and control groups, respectively. An ER threshold of 1.55 had a sensitivity and specificity for detecting synovitis of 91% and 96%, respectively. Inter- and intra-examiner reliability were excellent. Conclusion: Calculating a ratio of pixel intensity between TMJ synovium and the Longus Capitis Muscle is a reliable way to quantify synovial enhancement. An ER of 1.55 differentiates normal TMJs from those affected by inflammatory arthritis. This article is protected by copyright. All rights reserved.
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quantifying synovial enhancement of the pediatric temporomandibular joint
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Zachary S Peacock, Cory M Resnick, Pouya M Vakilian, Paul A Caruso, Mark Vangel, Leonard B KabanAbstract:Purpose The purposes of this study were to assess a novel method for quantifying temporomandibular joint (TMJ) synovial enhancement on gadolinium-enhanced magnetic resonance imaging (MRI) and to establish normative values to allow early detection of synovitis. Materials and Methods This is a retrospective cohort study of pediatric patients (aged 0 to 16 years) without jaw pathology who underwent MRI scans with contrast that included the TMJs. From a coronal T1-weighted image, the signal intensity within the superior and inferior joint spaces was divided by the signal intensity of the Longus Capitis Muscle to establish a ratio by age. Intrarater reliability and inter-rater reliability were assessed. A mixed-model regression analysis was used to determine the 95% specificity threshold for normal ratios. Results Temporal and optic nerve MRI scans of 158 patients were included. Normative synovial enhancement ratios (95% specificity) thresholds were established: 1.52, 1.68, and 1.55 for superior joint space, inferior joint space, and average of both joint spaces, respectively. Intrarater and inter-rater agreement was excellent. Conclusions A ratio of signal intensity of the TMJ synovium to the Longus Capitis is a reliable method to quantify enhancement controlling for time after contrast infusion and may be useful for diagnosis of TMJ synovitis.
Leonard B Kaban - One of the best experts on this subject based on the ideXlab platform.
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regional differences in temporomandibular joint inflammation in patients with juvenile idiopathic arthritis a dynamic post contrast magnetic resonance imaging study
International Journal of Oral and Maxillofacial Surgery, 2020Co-Authors: Karen Buch, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, H RothermelAbstract:Abstract The purpose was to determine whether there are regional differences in temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA). This was a retrospective study of all patients with dynamic, contrast-enhanced magnetic resonance imaging through the TMJs at Massachusetts General Hospital between January 2015 and July 2016. The patient cohort included those with a history of JIA and control patients who underwent MRI for other routine clinical purposes. TMJ inflammation was quantified as the difference between post-gadolinium and pre-gadolinium articular T1 signal intensity normalized to post-gadolinium signal intensity of the Longus Capitis Muscle. TMJ enhancement profiles were generated for the lateral, central, and medial portions of the TMJ. Regional differences in TMJ enhancement were investigated using basic descriptive statistics. Medial edge enhancement of the TMJs was highest in symptomatic JIA joints, followed by asymptomatic JIA, then control joints. Medial edge enhancement was a significant discriminator between symptomatic JIA TMJs and control joints (P = 0.0001), between symptomatic and asymptomatic JIA TMJs (P = 0.0003), and between asymptomatic JIA TMJs and controls (P = 0.0019). A shift in distribution of TMJ enhancement towards the medial edge that was seen uniquely in both asymptomatic and symptomatic JIA TMJs compared to control joints was found. This suggests a pattern of worsening medial edge inflammation with disease.
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imaging of the temporomandibular joint in juvenile idiopathic arthritis how does quantitative compare to semiquantitative mri scoring
Journal of Oral and Maxillofacial Surgery, 2019Co-Authors: Grace My, Cory M Resnick, Paul A Caruso, Leonard B Kaban, Zachary S Peacock, Carly E Calabrese, Timothy DonohueAbstract:Purpose Contrast-enhanced magnetic resonance imaging (MRI) is commonly used to evaluate temporomandibular joint (TMJ) disease in patients with juvenile idiopathic arthritis (JIA). However, MRI assessments have been limited by qualitative reporting, the presence of enhancement in normal joints, and a lack of standardized protocols. The purpose of the present study was to compare a quantitative MRI analysis using an enhancement ratio (ER) to a new semiquantitative system developed by Outcome Measures in Rheumatology and Clinical Trials (OMERACT). Materials and Methods We performed a retrospective cross-sectional study of children with JIA who had undergone TMJ MRI with gadolinium enhancement at Boston Children's Hospital. The predictor variables were demographic data (sex, age at MRI) and disease-related findings (JIA subtype and arthritis medication at MRI). The outcome variables were OMERACT scores and ER (ratio of TMJ synovium and Longus Capitis Muscle pixel intensities). The ER was compared with the OMERACT total, inflammatory, and damage scores using Pearson's correlation analysis and multivariable linear regression. Statistical significance was evaluated using the Student t test and analysis of variance with significance set at P Results The sample included 50 subjects (84% female) with a mean age of 12.7 ± 3.9 years and 124 MRI scans. The mean ER was 2.5 ± 0.9 (normal, Conclusions Quantitative evaluation of TMJ synovial enhancement using the ER is easier to score and has superior intra- and interrater agreement; however, it can only assess inflammation. Semiquantitative assessment of TMJ using the OMERACT adds data about chronic changes. Using both systems might provide the most accurate assessment of JIA status.
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quantifying temporomandibular joint synovitis in children with juvenile idiopathic arthritis
Arthritis Care and Research, 2016Co-Authors: Cory M Resnick, Pouya M Vakilian, Micheal Breen, David Zurakowski, Paul A Caruso, Lauren A Henderson, Peter A Nigrovic, Leonard B Kaban, Zachary S PeacockAbstract:Objective: Juvenile Idiopathic Arthritis (JIA) frequently affects the temporomandibular joints (TMJs) and is often undetected by history, examination and plain imaging. Qualitative assessment of gadolinium-enhanced magnetic resonance images (MRI) is currently the standard for diagnosis of TMJ synovitis associated with JIA. The purpose of this study is to apply a quantitative analysis of synovial enhancement to MRIs of patients with and without JIA to establish a disease threshold, sensitivity and specificity for the technique. Methods: This is a retrospective case-control study of children (≤16 years) who had MRIs with gadolinium including the TMJs. Subjects were divided into a “JIA group” and a “control group.” From a coronal T1-weighted image, a ratio (“enhancement ratio”, ER) of the average pixel intensity within three 0.2mm2 regions of interest (ROI) in the TMJ synovium to that of a 50mm2 ROI of the Longus Capitis Muscle was calculated. Receiver operating characteristic (ROC) curves were used to determine sensitivity and specificity. Inter- and intra-examiner reliabilities were evaluated with Bland-Altman plots and two-way mixed, absolute agreement intraclass correlation coefficients (ICC). Results: There were 187 and 142 TMJs included in the JIA and control groups, respectively. An ER threshold of 1.55 had a sensitivity and specificity for detecting synovitis of 91% and 96%, respectively. Inter- and intra-examiner reliability were excellent. Conclusion: Calculating a ratio of pixel intensity between TMJ synovium and the Longus Capitis Muscle is a reliable way to quantify synovial enhancement. An ER of 1.55 differentiates normal TMJs from those affected by inflammatory arthritis. This article is protected by copyright. All rights reserved.
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quantifying synovial enhancement of the pediatric temporomandibular joint
Journal of Oral and Maxillofacial Surgery, 2016Co-Authors: Zachary S Peacock, Cory M Resnick, Pouya M Vakilian, Paul A Caruso, Mark Vangel, Leonard B KabanAbstract:Purpose The purposes of this study were to assess a novel method for quantifying temporomandibular joint (TMJ) synovial enhancement on gadolinium-enhanced magnetic resonance imaging (MRI) and to establish normative values to allow early detection of synovitis. Materials and Methods This is a retrospective cohort study of pediatric patients (aged 0 to 16 years) without jaw pathology who underwent MRI scans with contrast that included the TMJs. From a coronal T1-weighted image, the signal intensity within the superior and inferior joint spaces was divided by the signal intensity of the Longus Capitis Muscle to establish a ratio by age. Intrarater reliability and inter-rater reliability were assessed. A mixed-model regression analysis was used to determine the 95% specificity threshold for normal ratios. Results Temporal and optic nerve MRI scans of 158 patients were included. Normative synovial enhancement ratios (95% specificity) thresholds were established: 1.52, 1.68, and 1.55 for superior joint space, inferior joint space, and average of both joint spaces, respectively. Intrarater and inter-rater agreement was excellent. Conclusions A ratio of signal intensity of the TMJ synovium to the Longus Capitis is a reliable method to quantify enhancement controlling for time after contrast infusion and may be useful for diagnosis of TMJ synovitis.
Patrik Pipkorn - One of the best experts on this subject based on the ideXlab platform.
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Longus Capitis reconstruction of the soft palate
Otolaryngology-Head and Neck Surgery, 2019Co-Authors: Jennifer Gross, Joseph Zenga, Jeffrey D Sharon, Ryan S Jackson, Patrik PipkornAbstract:Soft palate (SP) reconstruction remains a challenge for the head and neck reconstructive surgeon. One favorable local flap option is the Longus Capitis Muscle (LCM), a deep neck flexor with redunda...
