Abstract
Weight-bearing magnetic resonance imaging (MRI) is a unique modality in diagnostic imaging that allows for the assessment of spinal pathology in ways considered previously inaccessible or insufficient with the conventional MRI technique. Due to limitations in positioning within the MRI machine itself, difficulties would be posed in determining the underlying cause of a patient’s pain or neurological symptoms, as the traditional supine position utilized can, in many cases, alleviate the severity of presented symptoms. Weight-bearing MRI addresses this concern by allowing a clinician to position a patient (to a certain degree) into flexion, extension, rotation, or side-bending with an axial load that can mimic physiologic conditions in order to replicate the conditions the patient experiences in order to give clinicians a clearer understanding of the anatomical relationship of the spine and surrounding tissues that may lead to a particular presentation of symptoms. These findings can then guide treatment approaches that are better tailored to a patient’s needs in order to initiate treatment earlier and shorten the duration of treatment necessary for patient benefit. The goal of this review is to describe and differentiate weight-bearing MRI from conventional MRI as well as examine the advantages and disadvantages of either imaging modality. This will include assessing cost-effectiveness and improvements in clinical outcomes. Further, the advancements of weight-bearing MRI will be discussed, including potentially unique clinical applications in development.
Highlights
BackgroundMagnetic resonance imaging (MRI) is an incredibly effective diagnostic tool for assessing spinal pathology [1]
Weight-bearing magnetic resonance imaging (MRI) allows for a range of testing possibilities that would not be possible with conventional MRI
Given the ability to dynamically position a patient into extension, flexion, rotation, or side-bending under axial load, a clinician is able to replicate the physiologic conditions that incite a patient’s symptoms and allows for the evaluation of the unique anatomical relationship between the spine and adjacent structures that underlies a patient’s specific clinical presentation
Summary
Magnetic resonance imaging (MRI) is an incredibly effective diagnostic tool for assessing spinal pathology [1]. Despite previously described limitations of the failure of the harness to induce true physiologic loading and increased lumbar lordosis, DCSA was still significantly reduced [20,21] Each of these changes was observed in the presence of pre-existing spinal pathology and, as such, these findings do not necessarily show that WBMRI is useful in identifying spinal stenosis in every patient. A clinician employing the use of WBMRI should have a high suspicion that changes observed in the spine during WBMRI, such as decreased DCSA, may or may not be the source of a patients’ symptoms and does not always indicate degenerative changes Based on these findings, the authors of this review believe WBMRI should be used primarily in conjunction with supine MRI only in symptomatic patients with known spinal pathology to rule in or rule out specific differential diagnoses. Chung et al estimated that, on average, the increased number of scans being billed per patient visit at upright MRI facilities in Washington State was 2.5 times higher than conventional, supine MRI facilities, concluding that diversification of MRI devices, in general, was potentially further magnifying the known problem of high cost in medical imaging [22]
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