Upright MRI - an article by Dr Ben Timmis October 2006                                            

In a paper presented to the European Society of Skeletal Radiology (ESSR) in July 2005, Smith and Siddiqui reported twenty-five patients referred for MRI of the lumbar spine  for sciatica following at least one prior, “normal” MRI examination within six months of referral. 14 men and 12 women aged between 38 and 67 years of age were scanned using an upright MRI Scanner. Each patient was scanned supine, standing erect and in the seated position. In the seated position, images were made with the back in neutral, flexed and extended. Sagittal T2 and Axial T2 weighted sections were made through the lower five intervertebral discs in each position.
In twelve cases, no significant abnormality was seen in any of the five postures. In thirteen, abnormalities were demonstrated in one or more of the seated postures that were not evident in the conventional supine examination. In three cases lateral disc herniation was only seen in the seated position. In six cases the presence of a hypermobile disc at one or more levels was demonstrated. In two cases previously unsuspected grade 1 spondylolisthesis was shown and in two cases significant spinal canal stenosis was seen in the seated extended position.
In 50%  (13/25) of these cases that had previously been investigated for sciatica, a surgically remediable lesion was found. Each of the thirteen patients has undergone appropriate surgery and six months post surgery remained symptom free.
Although LUMRIC has been open for just under 3 months their experience is consistent with the Smith and Siddiqui study, and they are detecting clinical findings which show the benefits of weight bearing imaging. The Centre has a research agreement with the Royal National Orthopaedic Hospital at Stanmore and it is their intention to publish these findings in the coming months.

LUMRIC’s experience to date suggests that patients who might be considered for upright MRI include:

1. Patients who are claustrophobic
2. Patients who are obese or exceptionally large (including some endocrine patients)
3. Patients who are unable to lie supine for whatever reason
4. Patients who need to be observed during their scan

For clinical applications, consideration might be given to using upright MRI in the following circumstances:
Cervical and Lumbar Spine:
1. As a problem-solving modality in those who have had a negative, or unhelpful ‘conventional’ MR examination
2. In patients with a ‘failed-back’ following previous surgery
3. In those whose symptoms are posture-specific (the patient is scanned in the position that causes the pain). Flexion, extension, rotation views are all achievable

Other Applications:
1. Other joints of the body that are symptomatic in specific weight-bearing positions
2. Assessment of bladder prolapse

Of course, the overall quality of any imaging service can only be as good as the quality of the imaging reports, so all images produced by the London Upright MRI Centre are reported by dedicated musculo-skeletal and neuro-radiologists.
Finally, Upright MRI should not be regarded as competitive to conventional MRI, but rather as complimentary, answering clinical problems not addressed by the conventional scan, and scanning those patients who are unable, for whatever reason, to benefit from the conventional approach to examining these patients. It is with these objectives in mind, that the centre has already established links with the NHS and Private Practice, in the hope and expectation that the amazing clinical powers of MRI are further expanded for the benefit of all patients.
SUMMARY:

• Upright MRI is now available in central London for the first time
• Image quality is exceptionally good, and all studies are reported by specialist radiologists
• Claustrophobia is not a problem with this scanner
• It can be used in a variety of clinical situations where conventional MRI is unsuitable
• It can sometimes reveal pathology not identified with conventional MRI