Is MRI still the gold standard for assessing disc position in Temporomandibular joint disorders? A clinical–Imaging agreement study

Background: Temporomandibular disorders (TMDs) are primarily diagnosed clinically using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), while the role of magnetic resonance imaging (MRI) remains selective. This study evaluated agreement between DC/TMD-based clinical diagnoses and MRI findings in symptomatic patients. Methods: In this prospective diagnostic agreement study, 85 symptomatic patients diagnosed with TMJ internal derangement using DC/TMD criteria underwent standardized bilateral TMJ MRI. Clinical and imaging findings were compared using sensitivity, specificity, diagnostic accuracy, and Cohen’s kappa statistics. Inter-observer reliability for MRI interpretation was also assessed. Results: MRI identified no disc displacement in 30.6%, anterior disc displacement with reduction in 37.6%, anterior disc displacement without reduction in 20.0%, and other findings in 11.8%. Clinical assessment showed sensitivity of 88.6%, specificity of 70.9%, and diagnostic accuracy of 85.9%. Inter-observer MRI agreement was substantial (κ = 0.71). Conclusion: DC/TMD clinical assessment demonstrates good agreement with MRI findings; however, MRI provides complementary anatomical information and is best reserved for selected clinical scenarios.