Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis

Mansur Ahmad, Lars Hollender, Quentin Anderson, Krishnan Kartha, Richard Ohrbach, Edmond L. Truelove, Mike T. John, Eric L. Schiffman

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440 Scopus citations


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). Study design: Interexaminer reliability was estimated using the kappa (κ) 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 (κ = 0.16), fair for MRI (κ = 0.46), and close to the threshold for excellent for CT (κ = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (κ = 0.78) and for DD without reduction (κ = 0.94) and good for effusion (κ = 0.64). Overall percent agreement for pairwise ratings was ≥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 ≥88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)844-860
Number of pages17
JournalOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology
Issue number6
StatePublished - Jun 2009

Bibliographical note

Funding Information:
This study was supported by NIH/NIDCR U01-DE013331 to Dr. Eric L. Schiffman, the study principal investigator for the RDC/TMD Validation Project and for the research site at the University of Minnesota School of Dentistry, Minneapolis, MN. Drs. Edmond Truelove and Richard Ohrbach are the Validation Project site principal investigators at the University of Washington School of Dentistry, Seattle, WA, and the University at Buffalo, Buffalo, NY, respectively. Dr. David L. Berens, MD, University at Buffalo, provided valuable guidance in developing the criteria. We gratefully acknowledge Drs. Sharon Brooks and Samuel Dworkin, who were members of the NIDCR’s External Advisory Panel for this study, for critically reviewing our criteria.


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