Let s talk about MRI

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Drusilla Wade
5 years ago
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1 Let s talk about MRI

2 Traditional High-Field Superconducting Magnet Classic Open MRI The patients are always lying down

3 If you think you might have a flat tire This position gives you the right diagnosis

4 `

5 The FONAR UPRIGHT Multi-Position MRI Why Settle for a Partial View of the Spine?

7 The FONAR UPRIGHT Multi-Position MRI

8 Recumbent Upright, Weight-Bearing

9 Scientific Data Disc pressure measurements demonstrate that the pressure on the disc is much greater when the patient is erect ANachemson, Spine 1, #1 (1976) Relative change in pressure in a disc Recumbent Upright, Weight-Bearing

10 What about Image Quality?

This is significant because of the rule in MRI that the axis of symmetry

11 The patient sits upright between 2 vertical magnetic poles so there is a horizontal transaxial magnetic field in the magnet. This is significant because of the rule in MRI that the axis of symmetry of the RF Receiver Coil should be perpendicular to the direction of the main magnetic field.

13 Excellent Image Quality

14 Advanced Applications Upright MR Scoliosis Evaluation 3-Pt Dixon Direct FatSat

15 Excellent Image Quality

16 Large Patient Scanning Capability 350 lbs. 425 lbs. The bed will accommodate patients up to 500 lbs

17 Exceptional Patient Comfort Patients watch a 42-inch flat screen TV during their scans

18 Pediatrics

19 Installations ALABAMA CALIFORNIA CONNECTICUT FLORIDA IDAHO INDIANA LOUISIANA MINNESOTA NEW MEXICO NEW YORK ORGEON TENNESSEE VIRGINIA SCOTLAND SPAIN GERMANY PUERTO RICO ARIZONA COLORADO DELAWARE GEORGIA ILLINOIS KENTUCKY MARYLAND NEVADA NEW JERSEY OHIO PENNSYLVANIA TEXAS WASHINGTON ENGLAND SWITZERLAND NETHERLANDS

20 Clinical Case Studies

21 Clinical Case Study: Upright Weight-Bearing Visualization of Postoperative Spinal Instability Recumbent Upright Case courtesy of M. Rose, MD, Rose Radiology Centers

22 Clinical Case Study: Position-Dependent Disc Herniation Recumbent Upright Case courtesy Stand-Up MRI of Orlando Orlando, Florida

23 Clinical Case Study: Chiari Malformation Visualization When Upright Recumbent Upright Case courtesy of J.P Elsig, MD, fmri Zentrum, Zurich Switzerland

24 Clinical Case Study: Unsuspected Disc Herniation on Extension Upright-Neutral Upright-Extension Case courtesy of R. Marks, MD, Up & Open Imaging, Dallas, Texas

25 Recumbent In EXTENSION, the anterior longitudinal ligament becomes taut, and the posterior longitudinal ligament becomes lax.

26 Clinical Case Study: Ligamentous Rupture & Associated Spinal Instability Recumbent Upright-Flexion Case courtesy of F. W. Smith, MD University of Aberdeen, Scotland

27 Recumbent (Static) Imaging Can Underestimate the Maximum Degree of Pathology and Miss its Dynamic Nature 18A Further anterior shift Comparative posterior shift 18C Recumbent Upright-Flexion Upright-Extension

28 Recumbent (Static) Imaging Can Underestimate the Maximum Degree of Pathology and Miss its Dynamic Nature Clinical Case Study: Hidden Nuclear Extrusion Recumbent Upright Recumbent Upright Case courtesy of F. W. Smith, MD University of Aberdeen, Scotland

29 Position Imaging TM in the Neural Foramen Flexion Neutral Extension

30 Clinical Case Study: Dynamic Fluctuation of Neural Foramen Stenosis Recumbent Flexion Extension

31 Position-Dependent Changes in the Pelvis Pelvic Floor Dysfunction (PFD) Recumbent Upright

32 Scientific Publications

33 Missed Spondylolisthesis in Static MRIs But Found in Dynamic MRIs in the Patients with Low Back Pain S.W. Hong, M.D. et al., UCLA School of Medicine, Albert Einstein College of Medicine & Hacettepe University The Spine Journal 7 (2007 ) p. 69S In the [510] patients with back pain, missed spondylolisthesis in neutral MRIs but found in flexion MRIs is 18.1% for all the levels in the condition that the spondylolisthesis is considered as more than 3 mm translation L3-4 was the most commonly missed at 38.7% followed by L4-5 at 35.1%

34 Positional MRI: A Valuable Tool in the Assessment of Cervical Disc Bulge P. Moazzaz, M.D. et al., UCLA School of Medicine, The Spine Journal 7 (2007) p. 39S In a study of 163 patients with radicular cervical spine symptoms: A significant increase in the degree of cervical disc bulge was found by examining flexion and extension views as compared to neutral views alone The study suggests that extension MRI views yield a higher detection rate of missed cervical disc bulges than flexion views Using 2.0 mm of disc bulge as a cutoff value, the false negative ratio for the neutral position alone compared to flexion and extension was 25.08%

35 Missed Lumbar Disc Herniations Diagnosed With Kinetic Magnetic Resonance Imaging J. Zou, M.D. et al., Department of Orthopedic Surgery, UCLA & Department of Orthopedic Surgery, Soochow University SPINE7 Volume 3, number 5 (2007) E140-E144 In a study of 553 patients with symptomatic back pain: A significant increase in the degree of lumbar disc herniation was found by examining flexion and extension views when compared with neutral views alone For patients with normal or < 3 mm bulge in neutral, 19.46% (15.29%) demonstrated an increase in herniation to > 3 mm in extension (flexion)

36 Positional Upright Imaging of the Lumbar Spine Modifies the Management of Low Back Pain & Sciatica F.W. Smith, M.D. et al., University of Aberdeen, Scotland Paper presented at the ESSR (2005) Oxford, England Published in Clinical MRI, Vol. 15, Issue 3 (2006) In a study of 25 patients with low back pain and sciatica referred to the Upright MRI for lumbar spine MRIs following at least one prior normal recumbent MRI within 6 months of referral: 13 patients [52%] demonstrated abnormalities in one or more of the seated postures that were not evident in the supine examination Each of the 13 patients has undergone appropriate surgery and 6 months post-surgery they remain symptom free

Dynamic MRI of the Lumbar Spine in the Upright Position Modifies Patient Management Francis W Smith, MD and Sandro Galea-Soler M.D. Department of Radiology, University of Aberdeen, MRI Centre, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, U.

37 Dynamic MRI of the Lumbar Spine in the Upright Position Modifies Patient Management Francis W Smith, MD and Sandro Galea-Soler M.D. Department of Radiology, University of Aberdeen, MRI Centre, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, U.K. Paper presented at SpineWeek2008 Geneva, Switzerland 30-May-2008 A study of 111 patients with a previous non-diagnostic supine MRI scan, or a scan with inconclusive findings Of the 111 patients, 47 [42%] demonstrated abnormalities, in one or more of the erect or seated positions, correlating with their symptoms and not evident on the supine scan. Abnormalities detected included 26 cases of spinal instability, 28 lateral disc prolapse and 10 circumferential disc prolapse with fluctuating spinal stenosis.

38 Dynamic Weight-bearing Cervical Magnetic Resonance Imaging: Technical Review and Preliminary Results T. Vitaz, M.D. et al., Southern Medical Journal (2004) Department of Neurological Surgery, University of Louisville School of Medicine 20 patients with neck pain and symptoms consistent with radiculopathy or myelopathy were scanned upright in a GE 0.5T Signa SP vertical gap MR imaging system designed for MR image-guided surgery. When only static supine MRI scanning is performed on these patients, the true abnormality may be overlooked and inappropriate surgical plans instituted because of a lack of illustration of the changes that occur with movement.

39 Positional MR Imaging of the Lumbar Spine: Does it Demonstrate Nerve Root Compromise not Visible at Conventional MR Imaging? D. Weishaupt, M.D. et al., RADIOLOGY (2000) 215: Institute of Diagnostic Radiology, University Hospital, Zurich 30 patients with chronic low back pain unresponsive to non-surgical treatment were studied in the GE 0.5T Signa SP vertical gap MR imaging system. They were scanned upright seated and their images compared with those of the same patients scanned supine in a Siemens 1.0T superconducting conventional MR imaging system. Positional MR imaging more frequently demonstrates minor neural compromise than does conventional MR imaging. Positional pain differences are related to position-dependent changes in foraminal size.

40 The FONAR UPRIGHT Multi-Position MRI Thank you for your attention

41 Clinical Images

42 Neuroimaging

46 Musculoskeletal Imaging (MSK)

51 Wrist Elbow

52 Hip

53 Body Imaging

MRI goes from the era of gas lights to the era of electric lights

MRI goes from the era of gas lights to the era of electric lights MRI goes from the era of gas lights to the era of electric lights Gas Light Recumbent Upright, Weight-Bearing g Electric Light Traditional