OBJECTIVE: To correlate the signals and symptoms observed on clinical examination of patients with temporomandibular disorder with the results demonstrated by magnetic resonance imaging. MATERIALS AND METHODS: Thirty patients presenting with signs and symptoms of temporomandibular disorders underwent clinical evaluation and subsequent magnetic resonance imaging. The magnetic resonance imaging studies were independently evaluated by two experienced radiologists. Magnetic resonance imaging studies consisted of 12 images in coronal, T1-weighted sequences with 3 mm-thick slices with the mouth closed, sagittal, T1- and T2-weighted sequences with both open and closed mouth positions, and on progressive opening/closing movement at 5 mm intervals, in order to demonstrate the full mandibular movement. The statistical significance between the clinical findings in the evaluation of the patients and results found on the magnetic resonance imaging studies was analyzed by means the kappa test. RESULTS: Interobserver agreement was respectively 56.7% (kappa = 0.1) and 56.7 (kappa = 0) for the left and right sides. CONCLUSION: No correlation was found between the clinical and magnetic resonance imaging findings in the diagnoses of disc displacement.

Keywords: Magnetic resonance imaging, Temporomandibular joint, Disorders

Several diseases should be considered in the differential diagnosis of disorders affecting the temporomandibular joints. Internal derangement is the main condition responsible for pain related to this joint. Clinical signs may, though, be quite non-specific, and many other conditions present with similar and not infrequently indistinguishable signs and symptoms. In the present study, the authors describe several non-dysfunctional conditions affecting the temporomandibular joints through computed tomography and magnetic resonance imaging, emphasizing the importance of these imaging methods in the diagnosis of inflammatory, neoplastic and traumatic diseases of this region. Considering that clinical presentations are frequently non-specific, radiologists play a critical role in the differential diagnosis.

Keywords: Temporomandibular joint, Computed tomography, Magnetic resonance imaging

OBJECTIVE: The present study was aimed at identifying temporomandibular joint inflammatory processes employing technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled autonomous leukocytes. MATERIALS AND METHODS: We have utilized an experimental model of arthritis induction in ten adult male New Zealand rabbits by means of ovalbumin intra-articular injection into each left temporomandibular joint. For control purposes, saline solution was injected. After leukocytes radiolabelling with 99mTc-HMPAO and injection into rabbits, scintigraphic images were obtained. RESULTS: A higher 99mTcHMPAO-leukocytes uptake was observed in left temporomandibular joint in comparison with the contralateral joint. Wilcoxon non-parametric test was applied for statistical analysis. There was a statistically significant difference between counts of radioactivity per minute in the inflammed joint and the contralateral one (p = 0.0073). CONCLUSION: The method employing 99mTc-HMPAO-labelled autologous leukocytes allows an early and accurate detection of inflammatory processes, contributing to the adoption of a therapeutic conduct for patients before structural alterations have occurred.

Keywords: Temporomandibular joint disorder, Arthritis, 99mTc-HMPAO

OBJECTIVE: To assess radiographically the prevalence of morphological alterations of the styloid process in patients with temporomandibular joint disorders. MATERIALS AND METHODS: We have analyzed 1,500 panoramic x-ray films of temporomandibular joint from both male and female patients with no age limit, who were attended in the Service of Temporomandibular Joint Disorder of Faculty of Odontology at Universidade Federal de Juiz de Fora, MG, Brazil, in the period between 1997 and 2003. RESULTS: Eighty-three (5.53%) of the analyzed patients (74 female and 9 male), predominantly in the age range between 41 and 50 years (32.5%), presented with, at least, one of the joint sides with morphological alteration of the styloid process. As far as the type of styloid process in concerned, 113 elongated, 21 pseudoarticulated and 19 segmented were observed. Also, it was noticed that the morphological alterations of the styloid process develop in a symmetrical fashion. CONCLUSION: In individuals with temporomandibular joint disorder, styloid process alterations occur symmetrically and in a different way for each patient, independently from sex and age.

Keywords: Styloid process, Temporomandibular joint disorder, Radiography

OBJECTIVE: To use skeletal scintigraphy to detect mandibular growth through the analysis of bone metabolism in individuals with normal craniofacial growth, and to compare the findings with those seen in individuals with excessive craniofacial growth. MATERIALS AND METHODS: Forty-seven male and female patients between 18 to 28 years of age were divided in two groups - class I, control (n = 13), and class III, case (n = 34). Images were obtained two hours after intravenous injection of 99mTc-MDP (200 µCi/kg). Right and left side views of the mandible were obtained as well as a posterior view of the lumbar spine. The count rate was determined by the mean values of the count of the condyles and of the fourth lumbar vertebra, using a total of 300,000 counts. RESULTS: No asymmetrical condyle uptake was observed in both groups, and in spite of the absence of statistically significant differences, the mean condylar uptake values were higher in class III group. CONCLUSION: The increased mean uptake indicated higher condylar bone metabolism in class III individuals suggesting residual mandibular growth. Further studies are presently ongoing to increase our sample size.

Keywords: Bone scintigraphy, Mandibular condyle, Mandibular growth, Temporomandibular joint

OBJECTIVE: To implement a protocol for correction of images acquired by videofluoroscopy based on the mathematical model described by Baltzopoulos (1995) and to evaluate the magnitude of error in the linear and non-linear calibration methods. MATERIALS AND METHODS: The images were acquired using a Axion Siemens Iconos R100 videofluoroscope from one individual during knee extension exercise. A non-linear calibration pattern was used for the correction of the images. Data was processed using a Silicon Graphics 320 capture plate and subsequently analyzed using the Matlab software. RESULTS: In order to demonstrate the method's applicability, the deformation of the patellar ligament was evaluated. The use of a linear calibration pattern produced a maximum error of 0.086 mm, while the non-linear calibration pattern reached a maximum value of 0.019 mm. According to the mean error, the linear calibration was 0.024 mm, and the non-linear presented a value of 0.007 mm. CONCLUSION: The results show the need to use a non-linear calibration procedure.

Keywords: Videofluoroscopy, Images calibration, Patellar ligament, Knee

We present the preliminary results of testing and acceptance of a method for displaying medical images that employs simple computer freewares that can be run in unsophisticated computational platforms, which are commonly underutilized. This method allows easy and accessible visualization, printing, documenting, archiving, consulting and electronic transmission of a wide range of medical images without the need of expensive, complex and difficult to learn softwares.

Keywords: Medical images, Freeware, Ultrasound

OBJECTIVE: To present the process of implementation of toolkits for visualization of medical images using DICOM and to review the basis and characteristics of this protocol. In this paper we present a VDTApplication for visualization of local and remote images, and a VDTApplet that allows the visualization of images on a web browser. MATERIALS AND METHODS: The toolkits were implemented using Java programming language. For the development of this toolkit we considered the different version of the DICOM protocol, creating a generic system capable of reading and opening images generated by different modalities of different manufacturers. The tools were evaluated qualitatively by doctors taking into account the system's interface, image quality and image adjustment. RESULTS: The evaluation score ranged from 1 (very poor ) to 5 (very good) for each item, with the following results: 5 for system interface, 4 for image quality and 3 for the image adjustment. Based on the scores obtained we concluded that the tools can be considered good. CONCLUSION: These results allowed us to conclude that these tools are practical, user friendly and should be added to the PACS (picture archiving and communication system) of "Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo", Ribeirão Preto, SP, Brazil.

Keywords: Medical images, DICOM, Filmless radiology, Medical images visualization

Disc displacement of the temporomandibular joint has been defined as an abnormal relationship between the articular disc and the mandibular condyle, fossa and articular eminence. Disc displacements may occur without immediate interference in the function of the joint. Magnetic resonance imaging shows high diagnostic accuracy in the determination of articular disc position and has been indicated as the diagnostic method of choice for soft tissue abnormalities of the temporomandibular joint. The aim of this study is to review the literature including the normal features and different types of disc displacement of the temporomandibular joint as well as the imaging findings, emphasizing the role of magnetic resonance imaging.

Keywords: Temporomandibular joint, Magnetic resonance imaging, Diagnosis

In 2003, the National Committee of Medical Residency established new criteria for the accreditation of Radiology and Imaging Diagnosis Residency programs. Although these rules represent an advance to the resident's training, other specific abilities and skills should be developed in order to keep up with the technical and scientific advances and with the new requirements of the career. The authors' present the must important competencies and skills that complement the radiologist's education and suggest a change in current programs so that the resident can acquire these competencies and skills.

Keywords: Medical residency, Radiology, Image diagnostic, Resident; Education

Objetivo: A principal utilidade da tomografia por emissão de pósitrons com 18-fluordeoxiglicose (FDG-PET) está no estadiamento do câncer de pulmão. Porém, ela também pode ser utilizada para diferenciar lesões pulmonares indeterminadas, mas seu impacto na ressecção cirúrgica de lesões benignas é desconhecido. O objetivo deste estudo foi comparar a prevalência de lesões benignas em toracotomias feitas por suspeição de câncer de pulmão, antes e após a introdução do FDG-PET, em um centro de referência de cirurgia torácica. Materiais e Métodos: Os autores analisaram, prospectivamente, uma base de dados cirúrgicos de todos os pacientes consecutivos submetidos a toracotomia por câncer de pulmão suspeito ou comprovado e compararam a prevalência de lesões benignas em dois grupos ao longo de dois anos consecutivos, respectivamente antes (grupo I) e depois (grupo II) da introdução da FDG-PET. Resultados: Ressecção cirúrgica foi feita em 1.233 pacientes durante o período do estudo. A prevalência de lesões benignas na cirurgia nos grupos I e II foi similar (44/626 e 41/607, ambas correspondendo a 7%), e também no grupo II, entre aqueles submetidos a FDG-PET e os restantes (21/301 e 20/306 respectivamente, ambos correspondendo a 7%). No grupo II, dos 21 pacientes com lesões benignas submetidos a FDG-PET, 19 tiveram um estudo falso-positivo (valor médio padrão de captação 5.3 [faixa 2.6–12.7]). Desses, respectivamente 13 e 4 pacientes tiveram broncoscopia não diagnóstica e biópsia transtorácica percutânea de pulmão antes da toracotomia. Não houve diferença na proporção de lesões benignas diferentes ressecadas entre o grupo I e aqueles submetidos a FDG-PET no grupo II. Conclusão: A introdução da FDG-PET não alterou a proporção de pacientes submetidos a toracotomia por lesões benignas, principalmente devido à avidez pelo isótopo de algumas lesões não malignas. Tais resultados falsos-positivos devem ser considerados nos casos em que se contempla a possibilidade de ressecção cirúrgica em pacientes com câncer de pulmão não confirmado.

Keywords: Tomografia por emissão de pósitrons; Tomografia computadorizada; Pulmão – lesões benignas ou congênitas; Câncer de pulmão – diagnóstico e estadiamento; Câncer de pulmão – cirurgia.

Objetivo: Avaliar a percepção de médicos residentes em radiologia de 4º ano sobre as melhores modalidades de imagem na investigação de neoplasias e trauma. Materiais e Métodos: Vinte e sete médicos residentes de 4º ano de quatro programas de residência em radiologia americanos participaram do estudo. Aos participantes foi perguntado sobre a melhor modalidade de imagem para se avaliar o cérebro e a coluna vertebral, pulmões, abdome e o sistema musculoesquelético. As modalidades de imagem disponíveis foram: RM, TC, ultrassonografia, PET e radiografia simples. Todos os achados foram comparados com os Critérios de Adequação de Exames de Imagem e Radioterapia do ACR. Resultados: A RM foi escolhida como melhor modalidade de imagem para se avaliar neoplasias encefálicas, espinhais, abdominais e musculoesqueléticas por 96,3%, 100%, 70,4% e 63% dos residentes, respectivamente. A TC foi escolhida por 88,9% dos residentes para avaliar neoplasias pulmonares. A modalidade de imagem ótima para se avaliar trauma foi a TC para lesões encefálicas (100%), espinhais (92,6%), pulmonares (96,3%), abdominais (92,6%) e grandes lesões traumáticas musculoesqueléticas (74,1%); a RM foi escolhida para lesões esportivas (96,3%). Observou-se concordância com os critérios de adequação do ACR. Conclusão: Houve concordância entre a percepção dos residentes sobre as melhores modalidades de imagem para avaliação de neoplasias e trauma e os critérios de adequação do ACR.

Keywords: Formação de residentes; Educação médica; Modalidades de imagem.

Objective: To evaluate the sensitivity and specificity of high-resolution ultrasonography in the assessment of intra-capsular temporomandibular disorders. Materials and Methods: The authors have studied 38 patients (76 joints) with complaint of temporomandibular disorder. All the patients underwent ultrasonography and magnetic resonance imaging (gold standard for the evaluation) and the results were compared. Results: Among 24 joints demonstrating disc displacement at magnetic resonance imaging of patients at rest, 7 were confirmed at ultrasonography; in 13, the discs could not be visualized; and in 4, no sonographic abnormality was observed. In 48 joints, the articular discs could not be visualized at ultrasonography of patients at rest. Among them, 41 exhibited normal positioning at magnetic resonance imaging, and 7 exhibited anterior disc displacement. Morphological changes of the mandibular condyle were visualized in 13 joints at magnetic resonance imaging, and in 2 at ultrasonography. Conclusion: With the present study, the authors can conclude that ultrasonography offers high sensitivity and specificity in the diagnosis of the articular disc location with the patient at rest, either to analyze anatomical position or to analyze disc displacement. On the other hand, it does not offer significant results to analyze articular discs in patients with open mouth as well as to analyze disc/condyle morphological changes.

Keywords: Ultrasonography; Temporomandibular joint; Magnetic resonance imaging.

OBJECTIVE: To assess changes in the articular surfaces of the temporomandibular joint (TMJ) and in condylar translation, as detected by magnetic resonance imaging (MRI), determining whether such changes correlate with disc displacement. MATERIALS AND METHODS: We retrospectively analyzed the MRI scans of 2076 TMJs of 1038 patients with symptoms of temporomandibular disorder. We attempted to determine whether articular disc deformity and changes in condylar translation, as well as changes in the articular surfaces of the condyle, glenoid fossa, and articular eminence, correlated with disc displacement. RESULTS: Disc displacement with reduction was associated with changes in the shape of the articular eminence. Disc displacement without reduction was most strongly associated with disc deformity, condylar degeneration, glenoid fossa degeneration, and effusion. Neither decreases nor increases in condylar translation were associated with disc deformity, degenerative bone changes, or disc displacement. CONCLUSION: Changes in the shape of the articular eminence seem to predispose to progression of internal derangement of the TMJ.

Keywords: Magnetic resonance imaging; Temporomandibular joint; Temporomandibular joint disc; Temporomandibular joint disorders.

Os nervos cranianos representam extensões das estruturas funcionais do cérebro que cruzam a cabeça e o pescoço. Eles estão ligados a diferentes estruturas cranianas e se relacionam com diversas doenças. Uma compreensão profunda de sua complexa anatomia e aparência normal de imagem permite ao examinador identificar e caracterizar com mais precisão as anormalidades. A ressonância magnética com contraste é uma importante ferramenta para avaliar essas estruturas, especialmente as sequências tridimensionais de precessão livre de estado estacionário, que proporcionam alta resolução espacial e de partes moles, apesar da fina espessura dos nervos cranianos. Na maioria dos casos, os achados de imagem são inespecíficos, e uma anamnese completa, exame físico dirigido e testes laboratoriais são necessários para estreitar o diagnóstico diferencial. Este ensaio iconográfico ilustra e discute doenças congênitas, traumáticas e vasculares dos nervos cranianos, mostrando imagens em uma abordagem fisiopatológica.

Keywords: Neuroimagem/métodos; Radiologia/métodos; Ressonância magnética/métodos; Nervos cranianos/diagnóstico por imagem.