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Ultrasound assessment of increased capsular width as a predictor of temporomandibular joint effusion

¹ Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy; ² Department of Medical and Surgical Critical Care, Rheumatology Unit, University of Florence, Italy; ³ Division of Diagnostic and Interventional Radiology, Department of Oncology, University of Pisa, Italy

*Correspondence to: Dr Daniele Manfredini, Via Farini 22, 54031 Avenza-Carrara (MS), Italy; Email: daniele.manfredini{at}tin.it

Received 21 April 2003; accepted 5 December 2003

Objectives: The aim of this study was to evaluate whether an increased capsular width evidenced by ultrasound (US) could be an indirect marker of temporomandibular joint (TMJ) effusion.

Methods: 138 TMJs were evaluated by US and magnetic resonance imaging (MRI) by two blinded calibrated investigators. US measures of capsular width (in mm) and MRI diagnosis of TMJ effusion (presence/absence) were used to perform a receiver operating characteristic (ROC) curve analysis in order to assess the most accurate cut-off value of capsular width that was able to discriminate between joints with and without MRI effusion.

Results: Diagnostic accuracy of US to detect MRI-depicted TMJ effusion was good (area under the ROC curve=0.817). US sensitivity was high for values below the cut-off value of 1.950 mm (true positive rate (TPR)=83.9%; false positive rate (FPR)=26.3%), while specificity was high for values above the cut-off value of 2.150 mm (TPR=71.0%; FPR=11.8%).

Conclusions: Analysis of ROC curve appears to reveal that the critical area is around the 2 mm value for TMJ capsular width. These findings need to be refined by further studies assessing the smallest detectable difference in capsular width, with attention to reliability of interobserver observations.

Keywords: temporomandibular joint; effusion; ultrasonography; magnetic resonance imaging

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