Please be upstanding – A narrative review of evidence comparing upright to supine lumbar spine MRI

Abstract

Objectives: The objective of the review was to examine the evidence comparing upright to supine MRI of the lumbar spine. Key findings: A literature search identified 14 articles comparing data where subjects had been scanned in both supine and upright positions on the same scanner. Lumbar spine anatomy is dynamic and therefore subject to morphological changes when transitioning from the supine to the upright position. There is strong evidence to suggest structural changes in spinal morphology due to radiographic positioning, and that upright positioning is better for evaluating spondylolisthesis. Conclusion:It has been demonstrated that the scanning position is important in the outcome of the MRI examination of the lumbar spine. With this in mind, it would be beneficial for guidance to be written and adopted to improve the consistency and quality of scanning. Implications for practice: As upright MRI occupies a niche in the scanning sector, many professionals are unaware of its capabilities. This article aims to increase awareness of the use of upright MRI in evaluating the lumbar spine.

Low‐field MRI: Clinical promise and challenges

“…Low‐field scanners are particularly attractive to orthopedics were metal implants are common and unique scanner designs (eg open bores, extremity specific scanners, and vertical scanners for weight‐bearing studies) offer more clinically tailored imaging 154 . Several manufacturers, including FONAR, Esaote, and Paramed currently offer low‐field MRI scanners targeted at orthopedic and spinal applications 155 . These devices focus on minimizing imaging costs or feature rotating tables which permit weight‐bearing and kinematic imaging.…”

“…Unlike conventional closed‐bore systems, extremity specific and open bore scanner configurations permit central positioning of limbs in the magnetic field, which increases image quality 154 . Although these advantages have given low‐field scanners some traction in orthopedics, due to their lower resolution they are predominantly used for niche applications 155 …”

“…154 Although these advantages have given low-field scanners some traction in orthopedics, due to their lower resolution they are predominantly used for niche applications. 155 While low-field MRI offers a cost-effective method for orthopedic imaging, 156 there remain significant challenges that must be overcome before scanners become more widely adopted. The three primary obstacles are user perceptions of low-field image quality, developing the full range of clinically necessary sequences, and loss of quality control by radiologists.…”

“… 154 Several manufacturers, including FONAR, Esaote, and Paramed currently offer low‐field MRI scanners targeted at orthopedic and spinal applications. 155 These devices focus on minimizing imaging costs or feature rotating tables which permit weight‐bearing and kinematic imaging. Unlike conventional closed‐bore systems, extremity specific and open bore scanner configurations permit central positioning of limbs in the magnetic field, which increases image quality.…”

“… 154 Although these advantages have given low‐field scanners some traction in orthopedics, due to their lower resolution they are predominantly used for niche applications. 155 …”