Jan Fritz MD, Presenter: Nothing to Disclose

Nicolay Tzaribachev, Abstract Co-Author: Nothing to Disclose

Stephan Clasen MD, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Jonathan Stuart Lewin MD, Abstract Co-Author: Consultant, Interventional Imaging, Inc Founder, Interventional Imaging, Inc

Philippe Lucien Pereira MD, Abstract Co-Author: Nothing to Disclose

To prospectively assess the therapeutic procedure and outcome of MR-guided steroid injection of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA).

15 children [8(3-16) years-of-age] with inflammatory arthropathy of the TMJ were enrolled. Procedures were performed at an open bore 1.5-T MR scanner (Magnetom Espree, Siemens) in endotracheal anesthesia. The path of a 21G needle (CH Ultra Somatex, Germany) to the superior recess was planned on axial, coronal and sagittal T1W MR images (TR/TE/SL=561/11/3mm). MR fluoroscopy (FLASH2D,TR/TE=9.3/3.1) facilitated real time navigated joint puncture. Injection was monitored by coronal T1W real time MRI (TrueFISP,TR/TE=4.8/2.4). Following injection of 0.1 mL of contrast-enhanced (ce) saline (Gd-DTPA 1:200) demonstrating intra-capsular accumulation, 1 mL of contrast-enhanced triamcinolone acetonide (Gd-DTPA 1:200) was intra-articularly injected. Finally, a sagittal T1W fatsat spin echo sequence (TR/TE=650/17) documented fluid distribution. Relative synovial enhancement and synovial thickness were assessed by ce MRI at 8-months follow up.

30 TMJ injections were technically successfully performed. During the intervention and at follow-up no complications occurred. MRI demonstrated intra-capsular fluid accumulation in all joints, proving successful puncture in all patients. FLASH2D MR Fluoroscopy provided real time MR imaging guidance at 1 frame/s and high contrast-to-noise ratios of 40 to 70. TrueFISP MR Fluoroscopy is highly sensitive for monitoring of intra-articular fluid accumulation with CNR of 25-35 to surrounding structures. Mean duration of procedures was 57(42-132) min with exponential shortening (p<0.01) over time. At follow-up, MRI demonstrated complete resolution of synovial enhancement in 13 joints, reduction of 75-50% in 6, 49-25% in 4 and <25% in 7 joints, respectively. Average synovial thickness decreased from 3.2 mm to 1.2 mm (p<0.01). MRI findings indicated reduced inflammatory activity.

Interventional MR imaging is highly accurate for intra-articular TMJ injections with promising short-term effect.

Local treatment of TMJ arthritis with use of non-ionizing radiation

Fritz, J, Tzaribachev, N, Clasen, S, Claussen, C, Lewin, J, Pereira, P, Magnetic Resonance-(MR)-Guided Percutaneous Steroid Injection of the Temporomandibular Joint for the Management of Inflammatory Arthropathy in Children: Technical and Clinical Outcome.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5007121.html