Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.
Nortvig & Uhrenholt Kiropraktisk Klinik, 8200, Aarhus, Denmark.
Chiropr Man Therap. 2022 Jan 7;30(1):2. doi: 10.1186/s12998-022-00410-y.
Whiplash injury is common following road traffic crashes affecting millions worldwide, with up to 50% of the injured developing chronic symptoms and 15% having a reduced working capability due to ongoing disability. Many of these patients receive treatment in primary care settings based upon clinical and diagnostic imaging findings. Despite the identification of different types of injuries in the whiplash patients, clinically significant relationships between injuries and chronic symptoms remains to be fully established. This study investigated the feasibility of magnetic resonance imaging (MRI) techniques including quantitative diffusion weighted imaging and measurements of cerebrospinal fluid (CSF) flow as novel non-invasive biomarkers in a population of healthy volunteers and chronic whiplash patients recruited from a chiropractic clinic for the purpose of improving our understanding of whiplash injury.
Twenty chronic whiplash patients and 18 healthy age- and gender matched control subjects were included [mean age ± SD (sex ratio; females/males), case group: 37.8 years ± 9.1 (1.22), control group: 35.1 years ± 9.2 (1.25)]. Data was collected from May 2019 to July 2020. Data from questionnaires pertaining to the car crash, acute and current symptoms were retrieved and findings from clinical examination and MRI including morphologic, diffusion weighted and phase-contrast images were recorded. The apparent diffusion coefficient and fractional anisotropy were calculated, and measurement and analysis of CSF flow was conducted. Statistical analyses included Fisher's exact test, Mann Whitney U test and analysis of variance between groups.
The studied population was described in detail using readily available clinical tools. No statistically significant differences were found between the groups on MRI.
This study did not show that MRI-based measures of morphology, spinal cord and nerve root diffusion or cerebrospinal fluid flow are sensitive biomarkers to distinguish between chronic whiplash patients and healthy controls. The detailed description of the chronic whiplash patients using readily available clinical tools may be of great relevance to the clinician. In the context of feasibility, clinical practice-based advanced imaging studies with a technical setup similar to the presented can be expected to have a high likelihood of successful completion.
挥鞭伤是道路交通事故中常见的损伤，影响着全球数百万人，多达 50%的伤者会发展为慢性症状，15%的伤者因持续残疾而丧失工作能力。许多这些患者在初级保健机构中根据临床和诊断性影像学发现接受治疗。尽管在挥鞭伤患者中已经确定了不同类型的损伤，但损伤与慢性症状之间的临床显著相关性仍有待完全确定。本研究旨在通过磁共振成像（MRI）技术，包括定量扩散加权成像和测量脑脊液（CSF）流动，作为一种新的无创生物标志物，对来自脊椎按摩诊所的慢性挥鞭伤患者和健康志愿者人群进行研究，以提高我们对挥鞭伤的认识。
20 名慢性挥鞭伤患者和 18 名年龄和性别匹配的健康对照组被纳入研究[平均年龄±标准差（性别比；女性/男性），病例组：37.8 岁±9.1（1.22），对照组：35.1 岁±9.2（1.25）]。数据收集于 2019 年 5 月至 2020 年 7 月期间。从与车祸、急性和当前症状相关的问卷调查中检索数据，并记录临床检查和 MRI 的结果，包括形态学、扩散加权和相位对比图像。计算表观扩散系数和各向异性分数，并进行 CSF 流动的测量和分析。统计分析包括 Fisher 精确检验、Mann-Whitney U 检验和组间方差分析。
使用现成的临床工具详细描述了研究人群。两组在 MRI 上无统计学差异。
本研究未显示 MRI 形态学、脊髓和神经根扩散或脑脊液流动测量值是区分慢性挥鞭伤患者和健康对照组的敏感生物标志物。使用现成的临床工具详细描述慢性挥鞭伤患者可能对临床医生非常重要。在可行性方面，可以预期具有类似所提出的技术设置的基于临床实践的高级影像学研究很有可能成功完成。
