Which statement about whiplash imaging is true?

• A. Red flags or persistent neurologic symptoms prompt imaging; otherwise management is conservative
• B. All patients with whiplash should have immediate MRI
• C. Imaging is never helpful
• D. Imaging should only be done after 3 months

Answer: (A)

Imaging after whiplash is used selectively and guided by signs that suggest a more serious injury. The best approach is to image when red flags or persistent neurologic symptoms are present, because these raise concern for fracture, nerve compression, or spinal cord involvement. If there are no red flags, most whiplash injuries are soft-tissue strains and will improve with conservative care, so routine imaging isn’t helpful and can expose patients to unnecessary radiation and incidental findings. When imaging is needed, plain X-rays are typically first to check for alignment or fracture; MRI is reserved for suspected soft-tissue, nerve, or cord problems, and CT is useful when a fracture is strongly suspected or detailed bone anatomy is required.