Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis.
OBJECTIVE
As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT).


METHODS
Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA).


RESULTS
For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA.


CONCLUSIONS
Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
Ahmad
Mansur
M
Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, Minnesota 55455, USA. ahmad005@umn.edu
Hollender
Lars
L
Anderson
Quentin
Q
Kartha
Krishnan
K
Ohrbach
Richard
R
Truelove
Edmond L
EL
John
Mike T
MT
Schiffman
Eric L
EL
D018865:Dental Research / Q000592:standards; D003937:Diagnosis, Differential; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards*; D008279:Magnetic Resonance Imaging / Q000592:standards; D015588:Observer Variation; D010003:Osteoarthritis / Q000000981:diagnostic imaging*; D011861:Radiography, Dental / Q000295:instrumentation / Q000592:standards*; D011862:Radiography, Panoramic / Q000592:standards; D011871:Radiology / Q000592:standards*; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000592:standards