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Pediatr Radiol. 2018 Mar;48(3):411-426. doi: 10.1007/s00247-017-4000-0. Epub 2017 Nov 13.

Temporomandibular joint atlas for detection and grading of juvenile idiopathic arthritis involvement by magnetic resonance imaging.

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Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
Children's Research Centre, University Children's Hospital Zürich, Zürich, Switzerland.
Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.
Institute of Medical Science, University of Toronto, Toronto, Canada.
Department of Medical Imaging, University of Toronto, Toronto, Canada.


Contrast-enhanced magnetic resonance imaging (MRI) is considered the diagnostic standard for identifying involvement of the temporomandibular joint by juvenile idiopathic arthritis. Early or active arthritis is shown as bone marrow oedema, joint effusion, synovial thickening and increased joint enhancement. Subsequent joint damage includes characteristic deformity of the mandibular condyle, bone erosion, disk abnormalities and short mandibular ramus due to impaired growth. In this pictorial essay, we illustrate normal MRI findings and growth-related changes of the temporomandibular joint in children. The rationale and practical application of semiquantitative MRI assessment of joint inflammation and damage are discussed and presented. This atlas can serve as a reference for grading temporomandibular joint arthritis according to the scoring systems proposed by working groups of OMERACT (Outcome Measures in Rheumatology and Clinical Trials) and the EuroTMjoint research network. Systematic assessment of the level of inflammation, degree of osteochondral deformation, and growth of the mandibular ramus by MRI may aid in monitoring the course of temporomandibular joint arthritis and evaluating treatment options.


Children; Juvenile idiopathic arthritis; Magnetic resonance imaging; Synovitis; Temporomandibular joint

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