“TRU-SCAN MRI” IN CLINICAL PRACTICE –
A RADIOLOGIST’S PERSPECTIVE

Case Study #3: Instability of L4-5 Vertebral Body in Weight Bearing
Clearly defined motion/instability of L4 with respect to L5 vertebral body with subluxation which worsens in weight bearing images. This indicates instability and possible need for surgical intervention. Note substantial change in disc heights at L2-3, L3-4, and L4-5.

	Recumbent	Seated
Case #3

Case Study #4: 1.5T Recumbent vs.TruSCAN 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 then scanned on TruScan MRI in the seated position (right) 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 #4

From my experience, about 20% of the cases that demonstrate a difference in pathology between supine and weight bearing views result in a surgical difference. Surgical findings include spinal instability, disc herniations and spinal stenosis. Non-surgical findings and differences that I see regularly include varying degrees of subluxation, degrees of neural foraminal compromise, scoliosis, and anterior disc protrusions. I present actual cases scanned in my practice showcasing these variances in this article.

Approximately 25% of the cases where I have witnessed a difference between positional MRI and traditional MRI are in the cervical spine. I have seen frank cervical herniations in the sitting position, made worse with head extension, that were not readily apparent on supine views. Remember, dependant upon the size of the individual, the human head can weigh between 10 and 20 pounds. This weight adds stress to the supporting structures of the neck and cervical spine.

Case Study #5: Upright Dynamic MRI Reveals Hidden Disc Herniation
The axial standing-extension gradient echo image (right) demonstrates a focal posterior disc Herniation at the C4/5 level not visible on the recumbent scan. Note associated spinal cord compression on the standing-extension scan.

	Recumbent	Stand-Ext.	Recumbent	Stand-Ext.
Case #5

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