Comparison of medic and 3D DESS with routine MRI to assess the diagnostic efficacy in symptomatic temporomandibular disorders: a cross sectional observational study

Temporomandibular disorders (TMDs) involve functional and structural disturbances of the temporomandibular joint (TMJ), often requiring early imaging for effective management. This study compared the diagnostic performance of three MRI sequences-PDFSE, MEDIC, and 3D DESS-in evaluating early intra-articular changes in 108 TMJs of symptomatic patients. Key parameters assessed included disc morphology, joint effusion, bone marrow status, and image quality. PD-FSE showed the highest signal intensity ratios for the mandibular condyle, disc, and lateral pterygoid muscle, indicating superior contrast. MEDIC provided the best image quality and demonstrated the highest sensitivity for detecting bone marrow edema. Although PD-FSE detected moderate joint effusions most frequently, the difference was not statistically significant. Inter-observer agreement across all sequences was excellent. Overall, PD-FSE offered superior contrast, while MEDIC enhanced detection of subtle bone and fluid changes. A combined approach using both sequences may improve early diagnosis and clinical decision-making in TMD management.