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The Proof is in The Picture™

Case Study #6
1.5T Recumbent vs. Erect MRI

Patient complains of radicular symptoms when sitting. When imaged recumbent on a 1.5T Philips Intera (left) there is a disc bulge at L3/4 level. Patient was then scanned in the seated position (right) which shows an L3/4 disc protrusion/herniation with corresponding compression on the thecal sac. Sometimes high-field MRI does not make the diagnosis.

Recumbent (1.5T image)

Seated (.6T image)

 

Case Study #7
Position Related Disc Herniation

Seated image (left) shows disc bulging at C4/5, 5/6 and 6/7. Placing the patient in the seated, extension position shows a C4/5 disc herniation with compression on the thecal sac and cervical cord.

Seated-Neutral

Seated – Extension

 

Case Study #8 (Images courtesy of Fonar)
Position Dependent Disc Herniation

Recumbent image (34A) shows degenerative disc disease at L5/S1 and an associated disc bulge at this level. The upright image (34B) reveals further narrowing of the disc space and a focal posterior disc herniation (arrow) at L5/S1. Mild instability (retrolisthesis) is present at this same level in the upright position.


 

Case Study #9 (Images courtesy of Fonar)
Postoperative Spinal Instability

Recumbent image (32A) shows laminectomies at L4 and L5 and a postoperative Grade II spondylolisthesis at L4/5. The upright flexion (32B) image reveals further anterolisthesis of L4 on L5 (arrow). Relative to the recumbent scan, extension (32C) reveals little reduction in the anterolisthesis of L4 on L5, indicating that instability is in the anterior direction.



 

Case Study #10 (Images courtesy of Fonar)
Instability and Central Spinal Canal Stenosis

These scans (18A-C) show how recumbent imaging can underestimate the maximum degree of pathology and miss its dynamic nature. The recumbent scan (18A) shows spondylolisthesis at L4/5. The flexion scan (18B) shows a further anterior shift of L4 on L5. The extension scan (18C) shows a comparative posterior shift of L4 on L5. Also note that the changes in central spinal canal stenosis are in part a function of position, the most severe degree occurring in flexion.



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