الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 128 |  |  |
| | | from | 128 | | |
Abstract
Being a highly prevalent condition, and relatively complicated in its diagnosis and management, temporomandibular joint internal derangement requires additional care for proper diagnosis and accurate treatment planning. Although MRI is considered the gold standard for imaging of the soft tissue components of the temporomandibular joint, CBCT is the modality of choice for evaluation of the osseous structures, combining the two modalities together by image fusion for simultaneous evaluation of the TMJ is considered an unexplored territory.
In this study we aimed to evaluate the reliability of MRI-CBCT fused images in assessment of clinically diagnosed internal derangement of the TMJ. We did so by including 10 patients with 2 or more signs of TMDs. MRI images with the sequences (T1, T2 and Proton Density Turbin spin echo) where acquired for these patients, as well as CBCT images for the TMJ. Image fusion was performed afterwards using the Amira 3D Thermofisher Software, by utilizing normalized mutual information theory algorithm for image registrations.
Two oral and maxillofacial radiologists with 5+ years of experience evaluated each kind of datasets, MRI for disc displacement and joint effusion, CBCT for osseous changes & the fused image for both findings simultaneously. The overall accuracy and inter-examiner reliability where then calculated.
Regarding the overall diagnostic accuracy, there was no significant difference between the diagnosis made based on the index and the actual diagnosis (p = 1). The sensitivity value was 90.91% (indicating the probability of detecting a true positive), and the specificity value was 75.00% (indicating the probability of detecting a true negative). The area under the curve value was 0.830(i.e., indicating the probability of true diagnosis) which was significantly different from the null hypothesis value of 0.5 (i.e. indicating good diagnostic ability) (p < 0.001).
Regarding inter examiner reliability, our study showed a strong agreement between measurements made by different observers that was statistically significant (k = 0.870, p < 0.001).
Image fusion therefore proved to be a promising method for simultaneous evaluation of the osseous structures and the soft tissue components of the TMJ complex, this was proved by improved overall accuracy and high inter-examiner reliability.