The Use of PET/CT to Evaluate Synovitis in the Temporomandibular Joint (TMJ)
Status:
Withdrawn
Trial end date:
2012-10-01
Target enrollment:
Participant gender:
Summary
Temporomandibular joint disorders (TMD) are a common musculoskeletal problem with an
estimated 40-75 percent of the population reporting at least one sign. Up to fifteen percent
of the patients who seek care for one of these conditions, will go on to develop chronic
pain. The two most common TMD conditions include myofascial pain disorder and internal
derangement of the Temporomandibular Joint (TMJ). These two conditions have similar clinical
presentations, making an accurate diagnosis difficult. Currently, there is no accurate exam
or test to differentiate between these two conditions.
Internal derangement of the TMJ is a condition with disk displacement, pain, and dysfunction,
which may progress to localized osteoarthritis. Fortunately, this condition is self-limiting
for the majority of the patients afflicted, with a small minority progressing to advanced
joint destruction, disability and chronic pain.18 Currently there are no prognostic
indicators to identify these individuals. There are three hypothesis of degenerative TMJ
disease, they include: direct mechanical trauma, hypoxia reperfusion injuries, and neurogenic
inflammation. All involve parafunctional habits such as clenching or grinding by the patient
and a low-grade inflammatory response/synovitis. 18-fluorodeoxyglucose (18-FDG), a
radioisotope used with positron emission tomography (PET) and paired with a CT scan (PET/CT),
may have a role in imaging inflammation in arthritis as recently demonstrated in several
pilot studies involving osteoarthritis of the knee and shoulder. 18-FDG accumulates in areas
of increased metabolism, particularly activated leukocytes, as measured by increased
standardized uptake value.2 PET/CT offers the unique advantage of showing active disease
before anatomic damage is evident. Our hypothesis is that there is an increased uptake of
18-FDG on PET/CT in synovitis of the TMJ.