Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects

Dullerud, R.; Gjertsen, Øivind; Server, Andrés

doi:10.3109/02841850903321617

Cited by 41 publications

(57 citation statements)

References 21 publications

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“…Because MRI scan protocol and evaluation criteria for ligament changes used in the paper by Lindgren et al [24] (1.5 T dynamic kine MRI and two-point grading scale and movement) was completely different from other six papers (1.5 T fast spin-echo proton density-weighted sequences and four-point grading scale), this paper was excluded in order to minimize clinical bias. In total, data from six retrospective case-control studies involving 622 patients were included in our analyses [20,22,23,[25][26][27]33] (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Patients were classified according to Québec Task Force WAD Grade [29]. Ligaments were considered to be injured with grade 2 or 3, according to a four-point grading scale based on maximal cross-section involvement in proton density-weighted images (0, low signal throughout the entire cross-section area of the alar ligaments; 1, high-signal in less than one-third of the crosssection; 2, high-signal in one-third-two-third of the crosssection; 3, high-signal in more than two-third of the crosssection) [20,22,23,25,26,33], with grade 3 or 4 according to another four-point grading scale based on unilateral thinning or interruption of the ligament (1, clearly normal; 2, probably normal; 3, probably abnormal; 4, clearly abnormal) [27]. …”

Section: Resultsmentioning

confidence: 99%

“…These structures could be well visualized by magnetic resonance imaging (MRI) [17][18][19]. In recent years, with the development of more detailed MRI techniques morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed [18,[20][21][22][23][24][25][26][27]. However, most of these studies include relatively small samples of patients and thus their results were inconsistent and lacked statistical strength.…”

Section: Introductionmentioning

confidence: 99%

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Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Shen

2012

Eur Spine J

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Purpose Hypothesis that loss of integrity of the membranes in the craniocervical junction might be the cause of neck pain in patients with whiplash-associated disorders (WADs) has been proposed. In recent years, with development of more detailed magnetic resonance imaging (MRI) techniques, morphologic changes of the ligaments and membranes in the craniocervical junction, especially alar and transverse ligaments have been discussed. A metaanalysis was performed to evaluate the relationship of MRI signal changes of alar and transverse ligaments and WADs. Methods A systematic search of EMBASE, PUBMED, and Cochrane Library and references from eligible articles were conducted. Comparative studies reporting on evaluating the relationship between MRI high-signal changes of alar and transverse ligaments and WADs were regarded eligible. A pooled estimate of effect size was produced. Results Alar ligaments: Six studies (total n = 622) were included. MRI signal changes of alar ligaments did not appear to be related with WADs (P = 0.20, OR = 1.54, 95 % CI = 0.80-2.94). Heterogeneity was present (I 2 = 46 %, P = 0.10), which was eliminated upon sensitivity analysis bringing the OR to 1.27 (95 % CI = 0.87-1.86, I 2 = 0 %). Transverse ligaments: Four studies (total n = 489) were included. MRI signal changes of transverse ligament did not appear to be related with WADs (P = 0.51, OR = 1.44, 95 % CI = 0.49-4.21). Heterogeneity was present (I 2 = 77 %, P = 0.005), which was eliminated upon sensitivity analysis bringing the OR to 0.79 (95 % CI = 0.49-1.28, I 2 = 0 %). Conclusion MRI signal changes of alar and transverse ligaments are not supposed to be caused by whiplash injury, and MRI examination of alar and transverse ligaments should not be used as the routine workup of patients with WADs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Shen

2012

Eur Spine J

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“…It has been reported in patients with chronic WAD 6,9,10 but also in noninjured controls. 4,5,7,8 In the only study of alar and transverse ligament high signal intensity in acute WAD, such high signal intensity was not related to crash factors, was not more frequent when compared with noninjured controls without neck pain, and did not influence clinical outcome after 12 months. 8,11 Traumarelated high signal intensity can appear in ligaments some time after an acute injury due to repair processes of scarring and fibrosis or fat replacement.…”

mentioning

confidence: 99%

“…[1][2][3] These ligaments can show high signal intensity on proton attenuation-weighted high-resolution MR imaging. [4][5][6][7][8][9] The high signal intensity has an unknown etiology, a debated relation to trauma, and uncertain clinical relevance. It has been reported in patients with chronic WAD 6,9,10 but also in noninjured controls.…”

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confidence: 99%

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury: A Prospective Controlled Study

Vetti¹,

Kråkenes²,

Ask³

et al. 2011

AJNR Am J Neuroradiol

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Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis

Farrell

Smith

Hancock

et al. 2019

Magnetic Resonance Imaging

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Background There is uncertainty regarding the clinical significance of findings on MRI in patients with whiplash associated disorder (WAD) or nonspecific neck pain (NSNP). Purpose To compare the presence of cervical spine MRI findings in people with WAD or NSNP with pain‐free controls. Study Type Systematic review and meta‐analysis. Population Adults with WAD (n = 994), NSNP (n = 715), or pain‐free controls (n = 2323). Field Strength 0.5T, 1.5T, and 3.0T. Assessment Medline, EMBASE, CINAHL, Web of Science, SCOPUS, and Cochrane CENTRAL databases were searched. Two independent reviewers identified studies for inclusion and extracted data. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. Overall quality of the evidence from meta‐analysis was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. Statistical Tests Meta‐analysis was performed using a random‐effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data. Results In total, 31 studies were included (eight comparing acute WAD to controls, 14 comparing chronic WAD to controls, 12 comparing chronic NSNP to controls) comprising 4032 participants. Rectus capitis posterior major cross‐sectional area was smaller in people with chronic NSNP than controls (two studies: SMD –1.18 [95% confidence interval [CI] –1.65, –0.71]). The remaining meta‐analysis comparisons showed no group differences in MRI findings. The quality of evidence was mostly low due to small sample sizes and high heterogeneity. Data Conclusion Given the typically low‐quality evidence, definitive conclusions cannot be drawn on the presence of MRI findings in individuals with WAD or NSNP compared with pain‐free controls. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018.

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Magnetic resonance imaging of ligaments and membranes in the craniocervical junction in whiplash-associated injury and in healthy control subjects

Abstract: Due to lack of significant differences between patients with WAD and healthy control subjects, it is not recommended that MRI with the current technique and classification system be used in the routine workup of patients with WAD.

Cited by 41 publications

References 21 publications

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Magnetic resonance imaging signal changes of alar and transverse ligaments not correlated with whiplash-associated disorders

Follow-Up MR Imaging of the Alar and Transverse Ligaments after Whiplash Injury: A Prospective Controlled Study

Cervical spine findings on MRI in people with neck pain compared with pain‐free controls: A systematic review and meta‐analysis

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