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Open Access Research article

Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome?

Nils Vetti*, Jostein Kråkenes, Geir E Eide, Jarle Rørvik, Nils E Gilhus and Ansgar Espeland

BMC Musculoskeletal Disorders 2010, 11:260  doi:10.1186/1471-2474-11-260

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MRI imaging in acute whiplash has no value: is this a surprise?

Stephen Faulkner   (2011-01-25 10:15)  Centeno-Schultz Clinic/Authors: Christopher J. Centeno Dr., Michael D. Freeman Dr. and Stephen J. Faulkner Mr. email


We were interested to review the results reported in the recent publication by Vetti et al. [1] While we agree with these authors’ conclusion that upper cervical MRI is a poor screening tool for all patients with an acute whiplash injury, the paper may leave the reader with the impression that diagnostic MRI of the craniovertebral ligaments is not a useful modality in certain subpopulations of chronic whiplash-injured patients. It is important to note that the study design employed by the authors only allowed for the evaluation of upper cervical MRI as a screening tool of acutely injured patients (n = 114); there were too few patients in the study with significant chronic pain (n = 23) to draw any meaningful conclusions regarding the ability of the test to discriminate between possible pathologic causes of chronic pain among these patients. Given their reported 34% rate of Grade II-III findings among all of the acutely injured subjects, the authors would have needed more than 100 subjects in their chronically injured group to find a 33% greater rate of similar findings.

Like the use of MRI as a screening tool for cervical disk pathology in acutely injured patients [2], without clinical justification for the study, the false positive rate of upper cervical MRI combined with the relatively low rate of true upper cervical ligament injury makes it a poor screening test for such injuries among all patients with acute whiplash injury.

Additionally, we found it odd that the authors lumped together the unilateral and bilateral MRI findings as well as the Grades II and III findings, as reporting on the number of unilateral and highest grade findings versus symptom persistence may have yielded more meaningful results from their data.

The authors’ findings that chronically injured patients were most likely to have suffered from post-traumatic stress and to have low expectations of recovery are hardly surprising, as these are expected features of traumatically injured patients with refractory pain lasting for at least a year.

It is unfortunate that the efforts of these authors appear to have answered a question that no one was asking.

1. Vetti N, Kråkenes J, Eide GE, Rørvik J, Gilhus NE, Espeland A. Are MRI high-signal changes of alar and transverse ligaments in acute whiplash injury related to outcome? BMC Musculoskelet Disord. 2010 Nov 11;11:260.

2. Ronnen HR, de Korte PJ, Brink PR, van der Bijl HJ, Tonino AJ, Franke CL. Acute whiplash injury: is there a role for MR imaging?--a prospective study of 100 patients. Radiology. 1996 Oct;201(1):93-6.

Competing interests

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