Variability of Morphology and Signal Intensity of Alar Ligaments in Healthy Volunteers Using MR Imaging

Lummel, Nina; Zeif, Christian; Kloetzer, A.; Linn, Jennifer; Brückmann, H.; Bitterling, H.

doi:10.3174/ajnr.a2255

Cited by 17 publications

(23 citation statements)

References 31 publications

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“…However, alar and transverse ligament high signal intensity is reported to be frequent also in healthy noninjured persons without neck pain. 4,5,7,8 The high signal intensity is unlikely to be caused by pain-induced neck immobility.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…17,19 However, these findings have been contradicted by several investigators who found no direct correlation to trauma or clinical symptoms. 2,21,24,25,29,30 Instead, as an alternative explanation, degeneration has been put forward as the source of these high signal changes. 37 This hypothesis was put to the test.…”

mentioning

confidence: 99%

“…4,8,9,13,22,28 Substantial variability in the morphology of the upper cervical ligaments has been shown in various studies using MRI. 16,20,24,29,32,35 Dark signals on proton-density (PD)-weighted images of the ALs are generally considered the norm. 19 However, high signal alterations of the ALs have frequently been reported in patients with (chronic) whiplash-associated disorder (WAD), 1,5,11,26,28,31 and also in uninjured individuals.…”

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confidence: 99%

Signal changes of the alar ligament in a healthy population: a dispositional or degenerative consequence?

Wenz¹,

Kerl²,

Maros³

et al. 2015

SPI

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OBJECT The alar ligaments (ALs) are vital for stabilizing the craniocervical junction. In terms of morphology, their appearance varies and is visible on MRI. Dark signal of the AL on proton-density (PD)-weighted images is generally considered the norm, but the etiology of frequently observed signal hyperintensities is poorly understood. Using spectral fat suppression, signal hyperintensities can be differentiated into fat- and nonfat-related hyperintensities (NFH). Although signal hyperintensities have no evident association with whiplash-associated disorder, age-related degeneration has often been theorized. Therefore, this study investigates the signal intensities of the ALs on 3.0-T MRI with special reference to age. Expanding thereon, the authors investigated the relationship between signal hyperintensities and patient characteristics, such as height, weight, and sex. METHODS Sixty-six healthy volunteers were scanned using 3.0-T PD-weighted MRI, including spectral fat suppression of the craniocervical junction. The study population was separated into 2 groups (old vs young) using 2 approaches: dichotomization at the median age (40.0 years) and the calculated threshold (28.5 years) using receiver operating characteristics (ROC). The AL was independently characterized with respect to continuity, course, shape, signal intensity, and graduation of homogeneity by 2 experienced neuroradiologists. Signal intensity was differentiated into fat-related hyperintensity and NFH. Univariate and multivariate logistic regression models were employed to investigate the relationship between patient characteristics and signal intensities. RESULTS Two different AL patterns were observed: inhomogeneous (33.3%) and homogeneous (66.7%). The latter pattern was mostly surrounded by a small dark rim (56.8%). Fat could be identified in 15.9% of all ALs (21 of 132 patients), and NFH was identified in 17.4% of all ALs (23 of 132 patients). Here, 28.5 years was the preferred threshold, demonstrating a relatively high sensitivity for dichotomizing the population based on the ROC of NFH. The most relevant factor for having NFH was being older than the calculated threshold (odds ratio [OR] 3.420, p = 0.051). Fat-related hyperintensities occurred significantly more frequently in men than women (OR 0.110 and p = 0.007 for women; OR 9.075 and p = 0.007 for men). Height was the second most significant factor: for every 1-cm increase, the odds of having fat lesions increased by approximately 10% (OR 1.102; p = 0.017). CONCLUSIONS This study shows that AL signal hyperintensities are substantially influenced by age, sex, and height in healthy individuals. Regarding fat-related hyperintensities, the most relevant factors proved to be sex and height. The odds of detecting NFH increased almost significantly after a relatively young age (> 28.5 years) and were remarkably more frequent in individuals older than 28.5 years. The authors caution presumptions equating signal alterations with age-related deterioration. Instead, they suggest that dispositional factors such as sex and height are more relevant in the AL constitution. Signal alterations in ALs naturally occur in healthy symptom-free individuals, underscoring the importance of cautiously interpreting such lesions on posttraumatic MRI scans.

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Age-related changes to the craniocervical ligaments in asymptomatic subjects: a prospective MR study

2020

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Variability of Morphology and Signal Intensity of Alar Ligaments in Healthy Volunteers Using MR Imaging

Abstract: BACKGROUND AND PURPOSE:Evaluation of alar traumatic injuries by using MR imaging is frequently performed. This study investigates the variability of morphology and signal intensity of alar ligaments in healthy volunteers so that pathology can be more accurately defined.

Cited by 17 publications

References 31 publications

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

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

Signal changes of the alar ligament in a healthy population: a dispositional or degenerative consequence?

Age-related changes to the craniocervical ligaments in asymptomatic subjects: a prospective MR study

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