, Volume 51, Issue 4, pp 227–235 | Cite as

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

  • Nils VettiEmail author
  • Jostein Kråkenes
  • Geir Egil Eide
  • Jarle Rørvik
  • Nils Erik Gilhus
  • Ansgar Espeland
Diagnostic Neuroradiology



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.


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.


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.


Alar ligament Transverse ligament Whiplash-associated disorder (WAD) Magnetic resonance imaging Prevalence 



This study received funding from Grieg Foundation and the Norwegian Foundation for Health and Rehabilitation.

Conflict of interest statement

The MRI examinations used in this study were performed at a private institution. The MRI method applied is not generally accepted as a diagnostic tool in the investigation of WAD I–II patients.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Nils Vetti
    • 1
    • 2
    Email author
  • Jostein Kråkenes
    • 1
    • 2
  • Geir Egil Eide
    • 3
    • 4
  • Jarle Rørvik
    • 1
    • 2
  • Nils Erik Gilhus
    • 5
    • 6
  • Ansgar Espeland
    • 1
    • 2
  1. 1.Department of RadiologyHaukeland University HospitalBergenNorway
  2. 2.Section for Radiology, Department of Surgical SciencesUniversity of BergenBergenNorway
  3. 3.Centre for Clinical ResearchHaukeland University HospitalBergenNorway
  4. 4.Department of Public Health and Primary Health CareUniversity of BergenBergenNorway
  5. 5.Department of NeurologyHaukeland University HospitalBergenNorway
  6. 6.Section for Neurology, Department of Clinical MedicineUniversity of BergenBergenNorway

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