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UPRIGHT DYNAMIC
MRI REVEALS OCCULT DISC HERNIATION
Professor J. Randy Jinkins, MD, FACR,
FEC
Department of Radiology
Downstate Medical Center
State University of New York
450 Clarkson Avenue
Brooklyn, NY 11203
USA
"This MRI unit is important in that
it enables the medical imaging specialist to uncover significant
occult disease that is not apparent on the recumbent MRI studies"
--J. Randy Jinkins, MD, FACR, FEC
Clinical Case Overview
37 year-old male with bilateral pain and tingling in hands
exacerbated upon flexion of the cervical spine.
Case Study
The images shown below were acquired on the Fonar Stand-Up™
MRI. The sagittal image in Figure 1 was acquired with the
patient in a conventional recumbent position; Figure 2 is
of the same patient, but in a standing position during extension.
The standing-extension image demonstrates marked stenosis
of the central spinal canal resulting from posterior disc
protrusions extending into the anterior aspect of the spinal
canal and focal ligamentous infolding posteriorly. Note that
the resulting compression of the underlying spinal cord is
not evident on the recumbent scan. (Scanning parameters for
sagittal scans: TR= 3000 msec; TE = 160 msec; ETL = 15; 4.0
mm slice; scan time: 2:55 min - recumbent, 3:19 min - standing
extension.)
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Figure 1: Sagittal T2-weighted fast spin echo
(FSE) image in recumbent position
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Figure 2: Sagittal T2-weighted FSE image in
standing position during extension
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The gradient recalled echo T2*-weighted axial images are from
the same patient. The standing extension image (Figure 4) demonstrates
a focal posterior disc herniation at C4/5 level that is not
visible on the recumbent scan (Figure 3). Patient positioning
and dynamic maneuvers clearly play a critical role in detecting
clinically significant spinal pathology. Note that a final diagnosis
based only on the recumbent scan would result in a missed pathologic
diagnosis. (Scanning parameters for axial scans: TR = 506 msec;
TE = 22 msec; FA = 20º; 4.0 mm slice; scan time: 5:04 min.)
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Figure 3: Axial T2*-weighted gradient recalled
echo (GRE) image of patient in recumbent position
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Figure 4: Axial T2*-weighted GRE image of
patient in standing-extension
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Diagnosis: Fluctuating
intervertebral disc herniation dependent upon patient position
and dynamic physical maneuver
Clinical Studies performed at:
Melville MRI - Long Island
FONAR Corporation, Melville, NY
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Back | End
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