Department of Radiology, Haukeland University Hospital, Bergen, Norway.
Spine (Phila Pa 1976). 2011 Mar 15;36(6):E434-40. doi: 10.1097/BRS.0b013e3181da21a9.
Cross-sectional.
To describe alar- and transverse-ligament magnetic resonance imaging (MRI) high-signal changes in acute whiplash-associated disorders (WAD) grades 1 and 2 in relation to the severity and mechanics of trauma, and to compare them with controls.
The alar and transverse ligaments are important stabilizers at the craniovertebral junction. Acute injury of these ligaments should be detected as high-signal changes on high-resolution MRI.
In the study, 114 consecutive acute WAD 1-2 patients and 157 noninjured controls underwent upper-neck high-resolution MRI, using proton-weighted sequences and Short Tau Inversion Recovery (STIR). Two blinded radiologists independently graded high-signal changes 0 to 3 on proton images and assessed ligament high-signal intensity on STIR. Image quality was evaluated as good, reduced, or poor (not interpretable). Multiple logistic regression was used for both within- and between-groups analyses.
All proton and STIR images were interpretable. Interobserver agreement for grades 2 to 3 versus grades 0 to 1 changes was moderate to good (κ = 0.71 alar; and 0.54 transverse). MRI showed grades 2 to 3 alar ligament changes in 40 (35.1%) and grades 2 to 3 transverse ligament changes in 27 (23.7%) of the patients. Such changes were related to contemporary head injury (P = 0.041 alar), neck pain (P = 0.042 transverse), and sex (P = 0.033 transverse) but did not differ between patients and controls (P = 0.433 alar; and 0.254 transverse). STIR ligament signal intensity, higher than bone marrow, was found in only three patients and one control.
This first study on high-resolution MRI of craniovertebral ligaments in acute WAD 1-2 indicates that such trauma does not induce high-signal changes. Follow-up studies are needed to find out whether pretraumatic high-signal changes imply reduced ligament strength and can predict chronic WAD.
横断面研究。
描述急性颈挥鞭伤（WAD）1 级和 2 级患者寰枢外侧和横韧带磁共振成像（MRI）高信号改变与损伤严重程度和机制的关系，并与对照组进行比较。
寰枢外侧和横韧带是颅颈交界处的重要稳定结构。这些韧带的急性损伤应在高分辨率 MRI 上表现为高信号改变。
在这项研究中，114 例连续的急性 WAD 1-2 患者和 157 例非损伤对照组接受了上颈部高分辨率 MRI 检查，使用质子加权序列和短反转时间反转恢复（STIR）序列。两名盲法放射科医生分别对质子图像上的 0 到 3 级高信号改变和 STIR 上的韧带高信号强度进行分级。图像质量评估为好、差或差（无法解释）。采用多变量逻辑回归进行组内和组间分析。
所有质子和 STIR 图像均可解释。2 到 3 级与 0 到 1 级改变的观察者间一致性为中等至良好（κ=0.71 为寰枢外侧韧带，0.54 为横韧带）。MRI 显示 40 例（35.1%）患者存在 2 到 3 级寰枢外侧韧带改变，27 例（23.7%）患者存在 2 到 3 级横韧带改变。这些改变与同时发生的头部损伤（P=0.041，寰枢外侧韧带）、颈部疼痛（P=0.042，横韧带）和性别（P=0.033，横韧带）有关，但在患者与对照组之间无差异（P=0.433，寰枢外侧韧带；P=0.254，横韧带）。仅在 3 例患者和 1 例对照中发现韧带信号强度高于骨髓的 STIR 高信号。
这是首次关于急性 WAD 1-2 颅颈韧带高分辨率 MRI 的研究表明，此类创伤不会引起高信号改变。需要进一步的随访研究来确定先前的高信号改变是否意味着韧带强度降低，并能预测慢性 WAD。
