Comparison of Ultrasonography and MRI in diagnosing TMD in common dental settings

Han, June1, Kim, Joshua JH1, Kim, Justin JY2
Faculty / Advisor: Ford, Brian P.1
1University of Pennsylvania School of Dental Medicine, Department of Oral & Maxillofacial Surgery/Pharmacology
2University of Alberta, Department of Biological Sciences


Temporomandibular joint disorders (TMD) are often diagnosed with a panoramic x-ray and confirmed with magnetic resonance imaging (MRI).3 Although commonly used in assessing TMD, MRI can be precluded due to limitations such as high cost, patient accessibility, and patient’s medical conditions.3 In contrast, ultrasonography (USG) is an alternative cost-efficient diagnostic method widely available in temporomandibular joint (TMJ) imaging.2 This literature review aims to highlight the efficacy of ultrasound imaging compared to MRI.


We performed a review using various databases, including PubMed and Google Scholar, to compare ultrasound and MRI efficacy in diagnosing TMD. We analyzed three studies and discussed their findings.


Cakir-Ozkan et al. evaluated 28 patients with TMD, and the study attempted to distinguish the accuracy of MRI and USG as diagnostic tools by using the receiver operating characteristic (ROC) curve. The USG of anterior capsule condyle distance in open mouth position was more reliable for disc displacement assessment.1 Landes et al. sampled 55 patients and used paired T-tests to distinguish the differences between sonography and axiography between mouth opening, protrusion, and lateral excursions: where no statistical significance was found when comparing the ranges of motion for mediotrusion.2 Using MRI, the study found 83% concordance in the diagnosis of disc displacement and perforation, hypermobility, and impaired range of motion compared to sonographic results.2 Yılmaz et al. examined disc displacement and joint effusion of 50 patients using a high-resolution ultrasound and 1.5 Tesla MR. The results showed that USG is best used in closed disc position compared to open disc position and detecting effusion.3 Intraclass correlation values ranged between 0.964 and 0.995, indicating an excellent correlation between the two modalities.3


Accuracy of USG compared with MRI was reported to be 83%-95%.1 Differences in the two imaging modalities occurred when disc displacements were evaluated at different mouth opening positions.1-3 USG had difficulty assessing the disc, and lateral capsule-condyle distance in open or closed-mouth position was not reliable for disc displacement assessment.1 Diagnostic accuracy of USG anterior capsule-condyle distance in closed-mouth position was the highest.1,3 Ultimately, USG measurement of the anterior capsule-condyle distance can be used to assess disc displacement in diseased joints.1 USG can be suggested as an adjunct to common imaging modalities in assessment of TMJ for standard dental practices due to its advantages such as availability and low cost.3