Macromolecular changes in spinal cord white matter characterize whiplash outcome at 1-year post motor vehicle collision

Mark A Hoggarth,Kenneth A Weber,Marie Wasielewski,James M Elliott,Zachary A Smith,Mary J Kwasny,Todd B Parrish,Monica Paliwal

doi:10.1038/s41598-020-79190-5

Abstract

Each year, whiplash injuries from motor vehicle collisions (MVC) affect millions worldwide, with no strong evidence of pathology. While the majority recover soon after the injury, the same is not true for roughly 20% reporting higher levels of pain and distress, without diagnostic options. This study used magnetization transfer (MT) imaging to quantify white matter integrity in 78 subjects with varying levels of pain, 1 year after MVC. MT images of the cervical spinal cord were collected parallel to the intervertebral disks. MT ratios (MTR) were calculated in select white matter tracts along with MTR homogeneity (MTRh) at each level. Significant differences were observed between clinical outcome groups in the left and right spinothalamic tracts (p = 0.003 and 0.020) and MTRh (p = 0.009). MTRh was elevated in females with poor recovery versus females reporting recovery (p < 0.001) or milder symptoms (p < 0.001), and in males reporting recovery (p = 0.007) or no recovery (p < 0.001). There was a significant interaction between recovery status and sex (p = 0.015). MT imaging identified tract specific and regional changes in white matter integrity suggesting potential insults to the cord. Additionally, significant MTRh differences between sexes were observed, characterizing the heterogeneity of whiplash recovery and worse outcomes in females.

Highlights

Each year, whiplash injuries from motor vehicle collisions (MVC) affect millions worldwide, with no strong evidence of pathology
The purpose of this cross-sectional study was to investigate whether magnetization transfer (MT) imaging was able to identify those participants injured from an MVC whose persistent pain may be consistent with an insult to cervical spinal cord white matter, in general, and pathways
There was no significant difference in age or BMI between clinical outcome groups

Summary

Introduction

Whiplash injuries from motor vehicle collisions (MVC) affect millions worldwide, with no strong evidence of pathology. It is plausible MT imaging could provide an early and accurate quantification of an otherwise radiologically occult insult involving the spinal cord, which could (1) prove prognostic, (2) inform clinical trials, and (3) provide improved management schemas for patients left with little diagnostic options to explain their persistent pain and disability The purpose of this cross-sectional study was to investigate whether MT imaging was able to identify those participants injured from an MVC whose persistent pain may be consistent with an insult to cervical spinal cord white matter, in general, and pathways,

Methods

Results

Conclusion