Skip to main content
Erschienen in: Neuroradiology 4/2009

01.04.2009 | Diagnostic Neuroradiology

MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1–2: high-signal changes by age, gender, event and time since trauma

verfasst von: Nils Vetti, Jostein Kråkenes, Geir Egil Eide, Jarle Rørvik, Nils Erik Gilhus, Ansgar Espeland

Erschienen in: Neuroradiology | Ausgabe 4/2009

Einloggen, um Zugang zu erhalten

Abstract

Introduction

This study describes the prevalence of high-signal changes at magnetic resonance imaging (MRI) of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1–2 in relation to age, gender, spinal degeneration, type of trauma event and time since trauma.

Materials and methods

In 1,266 consecutive WAD1–2 patients (779 women, 487 men; mean age 42 years) referred from clinicians, high-signal changes in the alar and transverse ligaments at high-resolution proton-weighted MRI were prospectively graded 0–3 based on a previously reported, reliable grading system. Type of event according to The International Statistical Classification of Diseases and Related Health Problems and time of trauma were obtained from referral letters.

Results

MRI showed grades 2–3 alar ligament changes in 449 (35.5%; 95% confidence interval (CI), 32.8 to 38.1%) and grades 2–3 transverse ligament changes in 311 (24.6%; 95% CI, 22.2% to 26.9%) of the 1,266 patients. Grades 2–3 changes were more common in men than women, odds ratio 1.9 (95% CI, 1.5 to 2.5) for alar and 1.5 (95% CI, 1.1 to 2.0) for transverse ligament changes. High-signal changes were not related to age, spinal degeneration, type of trauma event or time since trauma (median 5 years). Unilateral changes were more often left- than right-sided.

Conclusions

High-signal changes of the alar and transverse ligaments are common in WAD1-2 and unlikely to represent age-dependent degeneration. Their male and left-side preponderance cannot be explained by variation in ligament stretching or image artefacts. Further studies are needed to clarify whether such changes are caused by trauma.
Literatur
1.
2.
Zurück zum Zitat Dvorak J, Schneider E, Saldinger P et al (1988) Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 6:452–461PubMedCrossRef Dvorak J, Schneider E, Saldinger P et al (1988) Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res 6:452–461PubMedCrossRef
3.
Zurück zum Zitat Heller JG, Amrani J, Hutton WC (1993) Transverse ligament failure: a biomechanical study. J Spinal Disord 6:162–165PubMed Heller JG, Amrani J, Hutton WC (1993) Transverse ligament failure: a biomechanical study. J Spinal Disord 6:162–165PubMed
4.
Zurück zum Zitat Panjabi M, Dvorak J, Crisco J III et al (1991) Flexion, extension, and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord 4:157–167PubMedCrossRef Panjabi M, Dvorak J, Crisco J III et al (1991) Flexion, extension, and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord 4:157–167PubMedCrossRef
5.
Zurück zum Zitat Saldinger P, Dvorak J, Rahn BA et al (1990) Histology of the alar and transverse ligaments. Spine 15:257–261PubMedCrossRef Saldinger P, Dvorak J, Rahn BA et al (1990) Histology of the alar and transverse ligaments. Spine 15:257–261PubMedCrossRef
6.
Zurück zum Zitat Adams VI (1993) Neck injuries: III. Ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation. A pathologic study of 21 traffic fatalities. J Forensic Sci 38:1097–1104PubMed Adams VI (1993) Neck injuries: III. Ligamentous injuries of the craniocervical articulation without occipito-atlantal or atlanto-axial facet dislocation. A pathologic study of 21 traffic fatalities. J Forensic Sci 38:1097–1104PubMed
7.
Zurück zum Zitat Dickman CA, Greene KA, Sonntag VK (1996) Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 38:44–50PubMedCrossRef Dickman CA, Greene KA, Sonntag VK (1996) Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery 38:44–50PubMedCrossRef
8.
Zurück zum Zitat Fielding JW, Cochran GB, Lawsing JF III et al (1974) Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am 56:1683–1691PubMed Fielding JW, Cochran GB, Lawsing JF III et al (1974) Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am 56:1683–1691PubMed
9.
Zurück zum Zitat Saternus KS, Thrun C (1987) Traumatology of the alar ligaments. Aktuelle Traumatol 17:214–218PubMed Saternus KS, Thrun C (1987) Traumatology of the alar ligaments. Aktuelle Traumatol 17:214–218PubMed
10.
Zurück zum Zitat Krakenes J, Kaale BR (2006) Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine 31:2820–2826PubMedCrossRef Krakenes J, Kaale BR (2006) Magnetic resonance imaging assessment of craniovertebral ligaments and membranes after whiplash trauma. Spine 31:2820–2826PubMedCrossRef
11.
Zurück zum Zitat Pfirrmann CW, Binkert CA, Zanetti M et al (2001) MR morphology of alar ligaments and occipitoatlantoaxial joints: study in 50 asymptomatic subjects. Radiology 218:133–137PubMed Pfirrmann CW, Binkert CA, Zanetti M et al (2001) MR morphology of alar ligaments and occipitoatlantoaxial joints: study in 50 asymptomatic subjects. Radiology 218:133–137PubMed
12.
Zurück zum Zitat Willauschus WG, Kladny B, Beyer WF et al (1995) Lesions of the alar ligaments. In vivo and in vitro studies with magnetic resonance imaging. Spine 20:2493–2498PubMedCrossRef Willauschus WG, Kladny B, Beyer WF et al (1995) Lesions of the alar ligaments. In vivo and in vitro studies with magnetic resonance imaging. Spine 20:2493–2498PubMedCrossRef
13.
Zurück zum Zitat Spitzer WO, Skovron ML, Salmi LR et al (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine 20:1S–73SPubMedCrossRef Spitzer WO, Skovron ML, Salmi LR et al (1995) Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining “whiplash” and its management. Spine 20:1S–73SPubMedCrossRef
14.
Zurück zum Zitat Wilmink JT, Patijn J (2001) MR imaging of alar ligament in whiplash-associated disorders: an observer study. Neuroradiology 43:859–863PubMedCrossRef Wilmink JT, Patijn J (2001) MR imaging of alar ligament in whiplash-associated disorders: an observer study. Neuroradiology 43:859–863PubMedCrossRef
15.
Zurück zum Zitat Roy S, Hol PK, Laerum LT et al (2004) Pitfalls of magnetic resonance imaging of alar ligament. Neuroradiology 46:392–398PubMedCrossRef Roy S, Hol PK, Laerum LT et al (2004) Pitfalls of magnetic resonance imaging of alar ligament. Neuroradiology 46:392–398PubMedCrossRef
16.
Zurück zum Zitat Krakenes J, Kaale BR, Rorvik J et al (2001) MRI assessment of normal ligamentous structures in the craniovertebral junction. Neuroradiology 43:1089–1097PubMedCrossRef Krakenes J, Kaale BR, Rorvik J et al (2001) MRI assessment of normal ligamentous structures in the craniovertebral junction. Neuroradiology 43:1089–1097PubMedCrossRef
17.
Zurück zum Zitat Krakenes J, Kaale BR, Moen G et al (2002) MRI assessment of the alar ligaments in the late stage of whiplash injury—a study of structural abnormalities and observer agreement. Neuroradiology 44:617–624PubMedCrossRef Krakenes J, Kaale BR, Moen G et al (2002) MRI assessment of the alar ligaments in the late stage of whiplash injury—a study of structural abnormalities and observer agreement. Neuroradiology 44:617–624PubMedCrossRef
18.
Zurück zum Zitat Krakenes J, Kaale BR, Nordli H et al (2003) MR analysis of the transverse ligament in the late stage of whiplash injury. Acta Radiol 44:637–644PubMedCrossRef Krakenes J, Kaale BR, Nordli H et al (2003) MR analysis of the transverse ligament in the late stage of whiplash injury. Acta Radiol 44:637–644PubMedCrossRef
19.
Zurück zum Zitat Myran R, Kvistad KA, Nygaard OP et al (2008) Magnetic resonance imaging assessment of the alar ligaments in whiplash injuries: a case–control study. Spine 33:2012–2016PubMedCrossRef Myran R, Kvistad KA, Nygaard OP et al (2008) Magnetic resonance imaging assessment of the alar ligaments in whiplash injuries: a case–control study. Spine 33:2012–2016PubMedCrossRef
20.
Zurück zum Zitat Kaale BR, Krakenes J, Albrektsen G et al (2005) Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:1294–1302PubMedCrossRef Kaale BR, Krakenes J, Albrektsen G et al (2005) Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:1294–1302PubMedCrossRef
21.
Zurück zum Zitat el Khoury GY, Wira RL, Berbaum KS et al (1992) MR imaging of patellar tendinitis. Radiology 184:849–854PubMed el Khoury GY, Wira RL, Berbaum KS et al (1992) MR imaging of patellar tendinitis. Radiology 184:849–854PubMed
22.
Zurück zum Zitat Hodler J, Haghighi P, Trudell D et al (1992) The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens. AJR Am J Roentgenol 159:357–360PubMed Hodler J, Haghighi P, Trudell D et al (1992) The cruciate ligaments of the knee: correlation between MR appearance and gross and histologic findings in cadaveric specimens. AJR Am J Roentgenol 159:357–360PubMed
23.
Zurück zum Zitat Kjellin I, Ho CP, Cervilla V et al (1991) Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 181:837–841PubMed Kjellin I, Ho CP, Cervilla V et al (1991) Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers. Radiology 181:837–841PubMed
24.
Zurück zum Zitat Schweitzer ME, Mitchell DG, Ehrlich SM (1993) The patellar tendon: thickening, internal signal buckling, and other MR variants. Skeletal Radiol 22:411–416PubMedCrossRef Schweitzer ME, Mitchell DG, Ehrlich SM (1993) The patellar tendon: thickening, internal signal buckling, and other MR variants. Skeletal Radiol 22:411–416PubMedCrossRef
25.
Zurück zum Zitat Kaale BR, Krakenes J, Albrektsen G et al (2005) Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:466–475PubMedCrossRef Kaale BR, Krakenes J, Albrektsen G et al (2005) Whiplash-associated disorders impairment rating: neck disability index score according to severity of MRI findings of ligaments and membranes in the upper cervical spine. J Neurotrauma 22:466–475PubMedCrossRef
26.
Zurück zum Zitat Stemper BD, Yoganandan N, Pintar FA (2004) Gender- and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. Spine 29:1764–1771PubMedCrossRef Stemper BD, Yoganandan N, Pintar FA (2004) Gender- and region-dependent local facet joint kinematics in rear impact: implications in whiplash injury. Spine 29:1764–1771PubMedCrossRef
27.
Zurück zum Zitat World Health Organization (1992) International statistical classification of diseases and related health problems (10th revision). World Health Organization, Geneva World Health Organization (1992) International statistical classification of diseases and related health problems (10th revision). World Health Organization, Geneva
28.
Zurück zum Zitat Miettinen T, Leino E, Airaksinen O et al (2004) Whiplash injuries in Finland: the situation 3 years later. Eur Spine J 13:415–418PubMedCrossRef Miettinen T, Leino E, Airaksinen O et al (2004) Whiplash injuries in Finland: the situation 3 years later. Eur Spine J 13:415–418PubMedCrossRef
29.
Zurück zum Zitat Bunketorp L, Stener-Victorin E, Carlsson J (2005) Neck pain and disability following motor vehicle accidents—a cohort study. Eur Spine J 14:84–89PubMedCrossRef Bunketorp L, Stener-Victorin E, Carlsson J (2005) Neck pain and disability following motor vehicle accidents—a cohort study. Eur Spine J 14:84–89PubMedCrossRef
30.
Zurück zum Zitat Holm LW, Carroll LJ, Cassidy JD et al (2008) The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33:S52–S59PubMedCrossRef Holm LW, Carroll LJ, Cassidy JD et al (2008) The burden and determinants of neck pain in whiplash-associated disorders after traffic collisions: results of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. Spine 33:S52–S59PubMedCrossRef
31.
Zurück zum Zitat Bunketorp L, Nordholm L, Carlsson J (2002) A descriptive analysis of disorders in patients 17 years following motor vehicle accidents. Eur Spine J 11:227–234PubMedCrossRef Bunketorp L, Nordholm L, Carlsson J (2002) A descriptive analysis of disorders in patients 17 years following motor vehicle accidents. Eur Spine J 11:227–234PubMedCrossRef
32.
Zurück zum Zitat Hirsch SA, Hirsch PJ, Hiramoto H et al (1988) Whiplash syndrome. Fact or fiction? Orthop Clin North Am 19:791–795PubMed Hirsch SA, Hirsch PJ, Hiramoto H et al (1988) Whiplash syndrome. Fact or fiction? Orthop Clin North Am 19:791–795PubMed
33.
Zurück zum Zitat Jakobsson L, Norin H, Bunketorp O (2003) Whiplash-associated disorders in frontal impacts: influencing factors and consequences. Traffic Inj Prev 4:153–161PubMedCrossRef Jakobsson L, Norin H, Bunketorp O (2003) Whiplash-associated disorders in frontal impacts: influencing factors and consequences. Traffic Inj Prev 4:153–161PubMedCrossRef
34.
Zurück zum Zitat Berglund A, Alfredsson L, Jensen I et al (2003) Occupant- and crash-related factors associated with the risk of whiplash injury. Ann Epidemiol 13:66–72PubMedCrossRef Berglund A, Alfredsson L, Jensen I et al (2003) Occupant- and crash-related factors associated with the risk of whiplash injury. Ann Epidemiol 13:66–72PubMedCrossRef
35.
Zurück zum Zitat Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73:1507–1525PubMed Kannus P, Jozsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am 73:1507–1525PubMed
36.
Zurück zum Zitat Doherty ST, Andrey JC, MacGregor C (1998) The situational risks of young drivers: the influence of passengers, time of day and day of week on accident rates. Accid Anal Prev 30:45–52PubMedCrossRef Doherty ST, Andrey JC, MacGregor C (1998) The situational risks of young drivers: the influence of passengers, time of day and day of week on accident rates. Accid Anal Prev 30:45–52PubMedCrossRef
37.
Zurück zum Zitat Giannoudis PV, Mehta SS, Tsiridis E (2007) Incidence and outcome of whiplash injury after multiple trauma. Spine 32:776–781PubMedCrossRef Giannoudis PV, Mehta SS, Tsiridis E (2007) Incidence and outcome of whiplash injury after multiple trauma. Spine 32:776–781PubMedCrossRef
38.
Zurück zum Zitat Laapotti S, Keskinen E, Rajalin S (2003) Comparison of young male and female drivers’ attitude and self-reported traffic behaviour in Finland in 1978 and 2001. J Safety Res 34:579–587PubMedCrossRef Laapotti S, Keskinen E, Rajalin S (2003) Comparison of young male and female drivers’ attitude and self-reported traffic behaviour in Finland in 1978 and 2001. J Safety Res 34:579–587PubMedCrossRef
39.
Zurück zum Zitat Wiberg M (2006) Gender differences in the Swedish driving-license test. J Safety Res 37:285–291PubMedCrossRef Wiberg M (2006) Gender differences in the Swedish driving-license test. J Safety Res 37:285–291PubMedCrossRef
41.
Zurück zum Zitat Smith KL, Daniels JL, Arnoczky SP et al (1994) Effect of joint position and ligament tension on the MR signal intensity of the cruciate ligaments of the knee. J Magn Reson Imaging 4:819–822PubMedCrossRef Smith KL, Daniels JL, Arnoczky SP et al (1994) Effect of joint position and ligament tension on the MR signal intensity of the cruciate ligaments of the knee. J Magn Reson Imaging 4:819–822PubMedCrossRef
42.
Zurück zum Zitat Cattrysse E, Barbero M, Kool P et al (2007) 3D morphometry of the transverse and alar ligaments in the occipito–atlanto–axial complex: an in vitro analysis. Clin Anat 20:892–898PubMedCrossRef Cattrysse E, Barbero M, Kool P et al (2007) 3D morphometry of the transverse and alar ligaments in the occipito–atlanto–axial complex: an in vitro analysis. Clin Anat 20:892–898PubMedCrossRef
43.
Zurück zum Zitat Panjabi MM, Oxland TR, Parks EH (1991) Quantitative anatomy of cervical spine ligaments. Part I. Upper cervical spine. J Spinal Disord 4:270–276PubMed Panjabi MM, Oxland TR, Parks EH (1991) Quantitative anatomy of cervical spine ligaments. Part I. Upper cervical spine. J Spinal Disord 4:270–276PubMed
44.
Zurück zum Zitat Mengiardi B, Pfirrmann CW, Schottle PB et al (2006) Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons. Eur Radiol 16:2197–2206PubMedCrossRef Mengiardi B, Pfirrmann CW, Schottle PB et al (2006) Magic angle effect in MR imaging of ankle tendons: influence of foot positioning on prevalence and site in asymptomatic subjects and cadaveric tendons. Eur Radiol 16:2197–2206PubMedCrossRef
45.
Zurück zum Zitat Oatridge A, Herlihy A, Thomas RW et al (2003) Magic angle imaging of the achilles tendon in patients with chronic tendonopathy. Clin Radiol 58:384–388PubMedCrossRef Oatridge A, Herlihy A, Thomas RW et al (2003) Magic angle imaging of the achilles tendon in patients with chronic tendonopathy. Clin Radiol 58:384–388PubMedCrossRef
46.
Zurück zum Zitat Arena L, Morehouse HT, Safir J (1995) MR imaging artifacts that simulate disease: how to recognize and eliminate them. Radiographics 15:1373–1394PubMed Arena L, Morehouse HT, Safir J (1995) MR imaging artifacts that simulate disease: how to recognize and eliminate them. Radiographics 15:1373–1394PubMed
47.
Zurück zum Zitat Taber KH, Herrick RC, Weathers SW et al (1998) Pitfalls and artifacts encountered in clinical MR imaging of the spine. Radiographics 18:1499–1521PubMed Taber KH, Herrick RC, Weathers SW et al (1998) Pitfalls and artifacts encountered in clinical MR imaging of the spine. Radiographics 18:1499–1521PubMed
Metadaten
Titel
MRI of the alar and transverse ligaments in whiplash-associated disorders (WAD) grades 1–2: high-signal changes by age, gender, event and time since trauma
verfasst von
Nils Vetti
Jostein Kråkenes
Geir Egil Eide
Jarle Rørvik
Nils Erik Gilhus
Ansgar Espeland
Publikationsdatum
01.04.2009
Verlag
Springer-Verlag
Erschienen in
Neuroradiology / Ausgabe 4/2009
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-008-0482-7

Weitere Artikel der Ausgabe 4/2009

Neuroradiology 4/2009 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Hirnblutung unter DOAK und VKA ähnlich bedrohlich

17.05.2024 Direkte orale Antikoagulanzien Nachrichten

Kommt es zu einer nichttraumatischen Hirnblutung, spielt es keine große Rolle, ob die Betroffenen zuvor direkt wirksame orale Antikoagulanzien oder Marcumar bekommen haben: Die Prognose ist ähnlich schlecht.

Was nützt die Kraniektomie bei schwerer tiefer Hirnblutung?

17.05.2024 Hirnblutung Nachrichten

Eine Studie zum Nutzen der druckentlastenden Kraniektomie nach schwerer tiefer supratentorieller Hirnblutung deutet einen Nutzen der Operation an. Für überlebende Patienten ist das dennoch nur eine bedingt gute Nachricht.

Thrombektomie auch bei großen Infarkten von Vorteil

16.05.2024 Ischämischer Schlaganfall Nachrichten

Auch ein sehr ausgedehnter ischämischer Schlaganfall scheint an sich kein Grund zu sein, von einer mechanischen Thrombektomie abzusehen. Dafür spricht die LASTE-Studie, an der Patienten und Patientinnen mit einem ASPECTS von maximal 5 beteiligt waren.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.