• Scott F Farrell, Ashley D Smith, Mark J Hancock, Alexandra L Webb, and Michele Sterling.
• RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries, University of Queensland, Brisbane, Australia.
• J Magn Reson Imaging. 2019 Jun 1; 49 (6): 1638-1654.

BackgroundThere is uncertainty regarding the clinical significance of findings on MRI in patients with whiplash associated disorder (WAD) or nonspecific neck pain (NSNP).PurposeTo compare the presence of cervical spine MRI findings in people with WAD or NSNP with pain-free controls.Study TypeSystematic review and meta-analysis.PopulationAdults with WAD (n = 994), NSNP (n = 715), or pain-free controls (n = 2323).Field Strength0.5T, 1.5T, and 3.0T.AssessmentMedline, EMBASE, CINAHL, Web of Science, SCOPUS, and Cochrane CENTRAL databases were searched. Two independent reviewers identified studies for inclusion and extracted data. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Overall quality of the evidence from meta-analysis was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation approach.Statistical TestsMeta-analysis was performed using a random-effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data.ResultsIn total, 31 studies were included (eight comparing acute WAD to controls, 14 comparing chronic WAD to controls, 12 comparing chronic NSNP to controls) comprising 4032 participants. Rectus capitis posterior major cross-sectional area was smaller in people with chronic NSNP than controls (two studies: SMD -1.18 [95% confidence interval [CI] -1.65, -0.71]). The remaining meta-analysis comparisons showed no group differences in MRI findings. The quality of evidence was mostly low due to small sample sizes and high heterogeneity.Data ConclusionGiven the typically low-quality evidence, definitive conclusions cannot be drawn on the presence of MRI findings in individuals with WAD or NSNP compared with pain-free controls.Level Of Evidence3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018.© 2018 International Society for Magnetic Resonance in Medicine.

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