Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Spine (Phila Pa 1976). 2011 Jun;36(13):E862-7. doi: 10.1097/BRS.0b013e3181ff1dde.
Cross-sectional study.
To evaluate the association between degree of signal changes in the alar ligaments on MRI with respect to pain and disability.
Conflicting evidence exists whether areas of high-signal intensity in the alar ligaments on MRI are associated with pain and disability.
A cross-sectional designed study of 173 subjects including a group with persistent whiplash associated disorder (WAD) Grade II after a car accident (n = 59), a group with chronic nontraumatic neck pain (n = 57) and a group without neck pain or previous neck trauma (n = 57). To assess pain and disability, all participants filled in the Brief Pain Inventory (BPI-intensity and BPI-interference), the European Quality of Life (EQ-5D and EQ VAS) and the Hospital Anxiety and Depression Rating Scale (HADS). High-resolution proton-weighted MR images in three planes were evaluated by two experienced neuroradiologists who were blinded to patient history and group allocation. The alar ligaments were evaluated according to a 4-point grading scale; 0 = low-signal intensity throughout the entire cross-section area, 1 = high-signal intensity in one third or less, 2 = high-signal intensity in one third to two thirds, and 3 = high-signal intensity in two thirds or more of the cross-section area.
With respect to BPI and HADS, the scores were highest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and lowest among controls. EuroQol scores were lowest in the WAD group, intermediate in the chronic nontraumatic neck pain group, and highest among controls (P < 0.001). There was, however, no significant correlation between the alar ligament changes and measures for pain and disability.
The previously reported assumption that changes in the alar ligaments detected on MRI are associated with pain and disability is not supported by this study. The diagnostic value and the clinical relevance of MR-detectable areas of high intensity in the alar ligaments remain questionable.
横断面研究。
评估 MRI 上翼状韧带信号改变程度与疼痛和残疾之间的关系。
MRI 上翼状韧带高信号区域是否与疼痛和残疾有关，目前证据相互矛盾。
对 173 例受试者进行横断面设计研究，包括车祸后持续存在的颈挥鞭伤相关障碍（WAD）Ⅱ级的一组（n=59）、慢性非创伤性颈痛的一组（n=57）和无颈痛或既往颈创伤的一组（n=57）。为了评估疼痛和残疾，所有参与者填写了简明疼痛量表（BPI-强度和 BPI-干扰）、欧洲生活质量（EQ-5D 和 EQ VAS）和医院焦虑抑郁量表（HADS）。由两位经验丰富的神经放射科医生在三个平面上评估高分辨率质子加权磁共振图像，他们对患者病史和组分配情况均不知情。翼状韧带根据 4 分分级量表进行评估；0=整个横截面区域低信号强度，1=三分之一或更少的高信号强度，2=三分之一至三分之二的高信号强度，3=三分之二或更多的横截面区域高信号强度。
就 BPI 和 HADS 而言，WAD 组的评分最高，慢性非创伤性颈痛组的评分居中，对照组的评分最低。EuroQol 评分在 WAD 组中最低，在慢性非创伤性颈痛组中居中，在对照组中最高（P<0.001）。然而，翼状韧带变化与疼痛和残疾测量之间没有显著相关性。
本研究不支持先前报道的 MRI 上检测到的翼状韧带变化与疼痛和残疾有关的假设。MR 检测到的翼状韧带高信号区域的诊断价值和临床相关性仍存在疑问。
