title: Alterations of the transverse ligament: an MRI study comparing patients with acute whiplash and matched control subjects.
abstract: OBJECTIVE
  The objective of our study was to evaluate whether there is injury to the transverse ligament of the atlas in patients with acute whiplash.
  
  
  METHODS
  Ninety patients with an acute (< 48 hours) symptomatic whiplash-associated injury and 90 healthy age- and sex-matched asymptomatic control subjects (mean age of patients and control subjects, 36 years) were included. The maximal sagittal thickness of the transverse ligament was measured on midsagittal T1 volumetric interpolated breath-hold examination (VIBE) images and transverse reformatted VIBE images. The signal intensity of the transverse ligament was measured on transverse STIR images and on transverse reformatted T1 VIBE images before and after IV administration of gadoterate. Contrast between the transverse ligament and CSF and alterations of contrast after gadoterate injection were calculated.
  
  
  RESULTS
  Patients had a minimally thicker transverse ligament (posttraumatic swelling) than control subjects, and the difference in thickness was significant in men only (p = 0.03). In patients, a significant signal alteration of the transverse ligament (p = 0.03) was seen on STIR (posttraumatic edema) and native VIBE sequences. The contrast between the transverse ligament and the CSF on VIBE images was significantly (p = 0.005) lower in patients than in control subjects. With the application of a contrast agent, the contrast difference between the transverse ligament and CSF in patients and control subjects was less pronounced (p = 0.038). There was no abnormal uptake of contrast agent by the transverse ligament or CSF.
  
  
  CONCLUSIONS
  The results of our study indicate possible involvement of the transverse ligament in whiplash injury. Although MRI may be helpful to study injury-related changes of anatomic structures in cohorts, it is not suited for individual diagnosis because the alterations are too small.
authors.affiliation: Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital and University of Bern, Inselspital, Switzerland. erikajulbrich@googlemail.com
authors.forename: Erika Jasmin
authors.initials: EJ
authors.lastname: Ulbrich
authors.forename: Sandra
authors.initials: S
authors.lastname: Eigenheer
authors.forename: Chris
authors.initials: C
authors.lastname: Boesch
authors.forename: Juerg
authors.initials: J
authors.lastname: Hodler
authors.forename: André
authors.initials: A
authors.lastname: Busato
authors.forename: Christian
authors.initials: C
authors.lastname: Schraner
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Anderson
authors.forename: Harald
authors.initials: H
authors.lastname: Bonel
authors.forename: Heinz
authors.initials: H
authors.lastname: Zimmermann
authors.forename: Matthias
authors.initials: M
authors.lastname: Sturzenegger
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D016022:Case-Control Studies; D003287:Contrast Media; D005260:Female; D006571:Heterocyclic Compounds; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008022:Ligaments / Q000293:injuries*; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D012372:ROC Curve; D014911:Whiplash Injuries / Q000473:pathology*
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C050823:gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate