Whiplash-associated injuries in medicolegal contexts: a review of imaging findings and a pictorial essay.

Abstract

Whiplash-associated disorder (WAD) can lead to a range of acute and chronic symptoms, posing significant diagnostic and legal challenges. Diagnosing WAD is complicated by non-specific imaging findings, particularly in cases involving compensation claims. MRI can detect ligamentous injuries involving craniovertebral junction structures such as the alar and transverse ligaments. However, the reliability of these findings remains debated due to the overlap with age-related changes. Muscle injuries, such as strains, tears, and fatty infiltration, are common in WAD and can contribute to chronic disability. MRI also identifies Modic changes in the vertebral endplates, which may indicate inflammation or degeneration but are frequently observed in asymptomatic individuals as well. The timing of MRI plays a crucial role; delays in imaging can result in lower sensitivity, as inflammatory changes may resolve over time. Comparison with prior imaging studies, when available, is essential for distinguishing trauma-related changes from pre-existing degenerative findings. Other modalities, such as videofluoroscopy for detecting vertebral instability, positron emission tomography for identifying inflammation, and ultrasound for assessing muscle function, can provide complementary information. Differentiating trauma-induced injuries from pre-existing degenerative changes remains essential, particularly in medicolegal contexts where compensation claims are evaluated. A careful interpretation of imaging findings, supported by clinical and legal perspectives, helps avoid misattributing symptoms to either trauma or natural aging processes.