Author Title Year Journal/Proceedings Reftype DOI/URL
Alyas, F., Connell, D. and Saifuddin, A. Upright positional MRI of the lumbar spine 2008 Clinical Radiology
Vol. 63(9), pp. 1035-1048 
article URL 
Abstract: Supine magnetic resonance imaging (MRI) is routinely used in the assessment of low back pain and radiculopathy. However, imaging findings often correlate poorly with clinical findings. This is partly related to the positional dependence of spinal stenosis, which reflects dynamic changes in soft-tissue structures (ligaments, disc, dural sac, epidural fat, and nerve roots). Upright MRI in the flexed, extended, rotated, standing, and bending positions, allows patients to reproduce the positions that bring about their symptoms and may uncover MRI findings that were not visible with routine supine imaging. Assessment of the degree of spinal stability in the degenerate and postoperative lumbar spine is also possible. The aim of this review was to present the current literature concerning both the normal and symptomatic spine as imaged using upright MRI and to illustrate the above findings using clinical examples.
BibTeX:
@article{Alyas2008,
  author = {Alyas, F. and Connell, D. and Saifuddin, A.},
  title = {Upright positional MRI of the lumbar spine},
  journal = {Clinical Radiology},
  year = {2008},
  volume = {63},
  number = {9},
  pages = {1035--1048},
  note = {Upright MRI Fonar},
  url = {http://www.standupmrionthewestside.com/pdf/UprightPositionalMRI_ClinicalRad2008.pdf}
}
Alyas, F., Sutcliffe, J., Connell, D. and Saifuddin, A. Morphological change and development of high-intensity zones in the lumbar spine from neutral to extension positioning during upright MRI 2010 Clinical Radiology
Vol. 65(2), pp. 176-180 
article URL 
BibTeX:
@article{Alyas2010,
  author = {Alyas, F. and Sutcliffe, J. and Connell, D. and Saifuddin, A.},
  title = {Morphological change and development of high-intensity zones in the lumbar spine from neutral to extension positioning during upright MRI},
  journal = {Clinical Radiology},
  year = {2010},
  volume = {65},
  number = {2},
  pages = {176--180},
  note = {???????},
  url = {http://www.sciencedirect.com/science/article/pii/S0009926009003870}
}
Barile, A., Conti, L., Lanni, G., Calvisi, V. and Masciocchi, C. Evaluation of medial meniscus tears and meniscal stability: Weight-bearing MRI vs arthroscopy 2012 Eur J Radiol
Vol. -, pp. - 
article URL 
Abstract: To assess the role of dedicated low-field standard and weight-bearing MRI in the evaluation of stable or unstable tears of medial meniscus in comparison with arthroscopy. Our series included 1750 knee MRI scans performed with a high-field MRI scanner from July 2010 to August 2011. We retrospectively reviewed and analyzed 20 MRI exams of normal knee and 57 MRI exams of knee with clinical evidence of tears of the medial meniscus. In the same session, after conventional 1.5T and "dedicated" 0.25T supine MRI exam, the patients underwent weight-bearing examination with the same dedicated MRI unit. In all cases sagittal and coronal PD-W were used. All patients underwent arthroscopy 18–25 days after the weight-bearing MRI. In the first group, no statistically significant anatomical modifications of shape, intensity and position of the medial meniscus between standard 1.5T, dedicated supine and upright MRI were observed. In group A, the images acquired in the supine position (dedicated and 1.5T MRI) documented in 21 cases a traumatic tear (group 2A) and in 36 cases a degenerative tear (group 2B). In group 2A, weight-bearing MRI showed presence of unstable tear a degenerative unstable meniscal tear only in 19 out of 36 cases. In group 2B, weight-bearing MRI showed only in 9 out 21 cases. Arthroscopy confirmed weight-bearing MRI diagnosis in all cases. This new approach to meniscus pathology gives an important contribution to a better management of a diagnostic–therapeutic approach in which standard MRI has not played a key role, so far.
BibTeX:
@article{Barile2012,
  author = {Barile, Antonio and Conti, Laura and Lanni, Giuseppe and Calvisi, Vittorio and Masciocchi, Carlo},
  title = {Evaluation of medial meniscus tears and meniscal stability: Weight-bearing MRI vs arthroscopy},
  journal = {Eur J Radiol},
  publisher = {Elsevier Science Ireland Ltd},
  year = {2012},
  volume = {-},
  pages = {-},
  note = {G-scan Esaote},
  url = {http://linkinghub.elsevier.com/retrieve/pii/S0720048X12005293?showall=true}
}
Barile, A., Limbucci, N., Splendiani, A., Gallucci, M. and Masciocchi, C. Spinal injury in sport 2007 European Journal of Radiology
Vol. 62(1)Spinal Injury in Sport, pp. 68-78 
article URL 
Abstract: Spinal injuries are very common among professional or amateur athletes. Spinal sport lesions can be classified in overuse and acute injuries. Overuse injuries can be found after years of repetitive spinal load during sport activity; however specific overuse injuries can also be found in adolescents. Acute traumas are common in contact sports. Most of the acute injuries are minor and self-healing, but severe and catastrophic events are possible.
BibTeX:
@article{Barile2007,
  author = {Barile, Antonio and Limbucci, Nicola and Splendiani, Alessandra and Gallucci, Massimo and Masciocchi, Carlo},
  title = {Spinal injury in sport},
  booktitle = {Spinal Injury in Sport},
  journal = {European Journal of Radiology},
  year = {2007},
  volume = {62},
  number = {1},
  pages = {68--78},
  note = {G-scan Esaote},
  url = {http://www.sciencedirect.com/science/article/pii/S0720048X07000435}
}
Cimmino, M.A. and Grassi, W. What is new in ultrasound and magnetic resonance imaging for musculoskeletal disorders? 2008 Best Practice & Research Clinical Rheumatology
Vol. 22(6)Imaging and Musculoskeletal Conditions, pp. 1141-1148 
article URL 
Abstract: Imaging techniques are evolving continuously with refinements of existing machines and discovery of new techniques. Ultrasonography (US) is now able to achieve more detail in image definition through the use of very-high-frequency transducers. These can be coupled to US contrast agents to increase the sensitivity of Doppler in imaging synovial membrane perfusion. Three-dimensional US is the most promising advancement in US because it allows one to obtain cubes of echoes that can be explored on any plane. Fusion images are obtained between US and magnetic resonance imaging (MRI) or computed tomography, increasing the anatomical detail of US. Sono-elastography allows in-vivo assessment of the tissue's mechanical properties. New protein-binding MRI contrast agents can prolong the vascular phase and may permit examination of multiple joints. Weight-bearing MRI permits the imaging of joints in their natural, weight-bearing position and may disclose relevant biomechanical changes. Finally, whole-body MRI evaluates the entire body with a single acquisition.
BibTeX:
@article{Cimmino2008,
  author = {Cimmino, Marco A. and Grassi, Walter},
  title = {What is new in ultrasound and magnetic resonance imaging for musculoskeletal disorders?},
  booktitle = {Imaging and Musculoskeletal Conditions},
  journal = {Best Practice & Research Clinical Rheumatology},
  year = {2008},
  volume = {22},
  number = {6},
  pages = {1141--1148},
  note = {G-scan Esaote},
  url = {http://www.sciencedirect.com/science/article/pii/S1521694208001083}
}
Draper, C.E., Besier, T.F., Fredericson, M., Santos, J.M., Beaupre, G.S., Delp, S.L. and Gold, G.E. Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain 2011 Journal of Orthopaedic Research
Vol. 29(3), pp. 312-317 
article DOI URL 
Abstract: Patellar maltracking is thought to be one source of patellofemoral pain. Measurements of patellar tracking are frequently obtained during non-weight-bearing knee extension; however, pain typically arises during highly loaded activities, such as squatting, stair climbing, and running. It is unclear whether patellofemoral joint kinematics during lightly loaded tasks replicate patellofemoral joint motion during weight-bearing activities. The purpose of this study was to: evaluate differences between upright, weight-bearing and supine, non-weight-bearing joint kinematics in patients with patellofemoral pain; and evaluate whether the kinematics in subjects with maltracking respond differently to weight-bearing than those in nonmaltrackers. We used real-time magnetic resonance imaging to visualize the patellofemoral joint during dynamic knee extension from 30° to 0° of knee flexion during two conditions: upright, weight-bearing and supine, non-weight-bearing. We compared patellofemoral kinematics measured from the images. The patella translated more laterally during the supine task compared to the weight-bearing task for knee flexion angles between 0° and 5° (p=0.001). The kinematics of the maltrackers responded differently to joint loading than those of the non-maltrackers. In subjects with excessive lateral patellar translation, the patella translated more laterally during upright, weight-bearing knee extension for knee flexion angles between 25° and 30° (p=0.001). However, in subjects with normal patellar translation, the patella translated more laterally during supine, non-weight-bearing knee extension near full extension (p=0.001). These results suggest that patellofemoral kinematics measured during supine, unloaded tasks do not accurately represent the joint motion during weight-bearing activities.
BibTeX:
@article{Draper2011,
  author = {Draper, Christine E. and Besier, Thor F. and Fredericson, Michael and Santos, Juan M. and Beaupre, Gary S. and Delp, Scott L. and Gold, Garry E.},
  title = {Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain},
  journal = {Journal of Orthopaedic Research},
  publisher = {Wiley Subscription Services, Inc., A Wiley Company},
  year = {2011},
  volume = {29},
  number = {3},
  pages = {312--317},
  note = {Signa SP GE},
  url = {http://dx.doi.org/10.1002/jor.21253},
  doi = {http://dx.doi.org/10.1002/jor.21253}
}
Elsig, J.-P. and Kaech, D. Dynamic imaging of the spine with an open upright MRI: present results and future perspectives of fmri 2007 Eur J Orthop Surg Traumatol
Vol. 16(1)ArgoSpine News & Journal, pp. 42-45- 
article URL 
Abstract: This review illustrates the potential of a new upright MRI to reveal “occult” dynamic lesions within the spinal canal and the neural foramina, i.e., pathologic changes that were under-estimated or not seen using recumbent-only imaging.
“fmri” stands for functional MR imaging, mainly of the degenerative and postoperative spine, although it may also detect posttraumatic instabilities and malformations.
BibTeX:
@article{Elsig2007,
  author = {Elsig, Jean-PierreJ. and Kaech, DenisL.},
  title = {Dynamic imaging of the spine with an open upright MRI: present results and future perspectives of fmri},
  booktitle = {ArgoSpine News & Journal},
  journal = {Eur J Orthop Surg Traumatol},
  publisher = {Springer-Verlag},
  year = {2007},
  volume = {16},
  number = {1},
  pages = {42-45--},
  note = {Upright MRI Fonar},
  url = {http://dx.doi.org/10.1007/BF03041127}
}
Ferreiro Perez, A., Garcia Isidro, M., Ayerbe, E., Castedo, J. and Jinkins, J. Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines 2007 European Journal of Radiology
Vol. 62(3)Endocrine Tumor Abdomen, pp. 444-448 
article URL 
Abstract: Purpose The purpose of the study was to determine the difference in findings between recumbent and upright-sitting MRI of the cervical and lumbosacral spine in patients with related sign and symptoms. Materials and methods A total of 89 patients were studied (lumbosacral spine: 45 patients; cervical: 44 patients). T1-weighted (TR: 350, TE: 20) fast spin echo and T2-weighted (TR: 2500, TE: 160) fast spin echo images were acquired in the sagittal and axial planes in both the recumbent and sitting-neutral positions. The images were acquired on the Uprightâ„¢ MRI unit (Fonar Corporation, Melville, NY). Differences were sought between the recumbent and upright-sitting positions at all levels imaged, in both planes. Results The total number of cases of pathology was 68, including instances of posterior disc herniation and anterior and posterior spondylolisthesis. Focal posterior disc herniations were noted in 55 patients (cervical: 31, lumbosacral: 24) [62% of patients]. Six of these herniations (cervical: 4, lumbosacral: 2) [11%] were seen only on the upright-sitting study. Focal posterior disc herniations were seen to comparatively enlarge in size in 35 patients on the upright-seated examination (cervical: 21, lumbosacral: 14) [72%], and reduce in size in 9 patients (cervical: 5, lumbosacral: 4) [18%]. Degenerative anterior (n: 11) and posterior (n: 2) spondylolisthesis was seen in 13 patients (cervical: 0, lumbosacral: 13) [15% of patient total]. Anterior spondylolisthesis was only seen on the upright-seated examination in 4 patients (cervical: 0, lumbosacral: 4) [31%]. Anterior spondylolisthesis was comparatively greater in degree on the upright-seated study in 7 patients (cervical: 0, lumbosacral: 7) [54%]. Posterior spondylolisthesis was comparatively greater in degree on the recumbent examination in 2 patients (cervical: 0, lumbosacral: 2) [15%]. The overall combined recumbent miss rate in cases of pathology was 15% (10/68). The overall combined recumbent underestimation rate in cases of pathology was 62% (42/68). The overall combined upright-seated underestimation in cases of pathology was 16% (11/69). Conclusions Overall, upright-seated MRI was found to be superior to recumbent MRI of the spine in 52 patents (recumbent missed pathology [n: 10] + recumbent underestimated pathology [n: 42] = 52/89 total patients: 58%) in cases of posterior disc herniation and anterior spondylolisthesis. This seems to validate the importance of weight-bearing imaging in the spine that might be expected to unmask positional enlarging disc herniations and worsening spondylolisthesis. Overall, recumbent MRI was found to be superior to upright-seated MRI in 11 cases (11/89: 12%). The latter finding was possibly due to the fact that upright seated position is actually partial flexion that might be expected to reduce some cases of hypermobile posterior spondylolisthesis.
BibTeX:
@article{FerreiroPerez2007,
  author = {Ferreiro Perez, Antonio and Garcia Isidro, Millan and Ayerbe, Elena and Castedo, Julio and Jinkins, J.R.},
  title = {Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines},
  booktitle = {Endocrine Tumor Abdomen},
  journal = {European Journal of Radiology},
  year = {2007},
  volume = {62},
  number = {3},
  pages = {444--448},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0720048X06005523}
}
Fiaschetti, V., Squillaci, E., Pastorelli, D., Rascioni, M., Funel, V., Salimbeni, C., Fanucci, E. and Simonetti, G. Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders 2011 La radiologia medica
Vol. 116(4)La radiologia medica, pp. 620-633- 
article URL 
Abstract: Purpose. This study was undertaken to explore the capabilities of an open-confi guration, low-fi eld, tilting, magnetic resonance (MR) system for investigating pelvic fl oor disorders and to compare the results obtained with the patient in the semiorthostatic and supine positions.

Materials and methods. Eighteen female patients with a diagnosis of pelvic fl oor disorder (physical examination and conventional defecography) underwent dynamic MR defecography (MRD) with a 0.25-T tilting MR system (G-scan, Esaote). Images were obtained after administration of contrast agent into the rectum, bladder and vagina in both the orthostatic and supine positions. Three-dimensional T2-weighted hybrid contrast-enhanced (HYCE) sequences and dynamic T1-weighted gradient echo (GE) sequences were acquired at rest, during maximal contraction of the anal sphincter, straining and defecation.

Results. Good image quality was obtained in 15/18 patients; three presented severe artefacts due to motion, and three had incontinence, which hampered the functional studies. Better anatomical detail was obtained with MRD compared with conventional defecography. Three prolapses were observed in the semiorthostatic position only, and seven were found to be more severe in the orthostatic than in the supine position.

Conclusions. Dynamic MRD with an open-confi guration, low-field, tilting MR system is a feasible and promising tool for studying the pelvic fl oor. Larger series are necessary to assess its real diagnostic value.

BibTeX:
@article{Fiaschetti2011,
  author = {Fiaschetti, V. and Squillaci, E. and Pastorelli, D. and Rascioni, M. and Funel, V. and Salimbeni, C. and Fanucci, E. and Simonetti, G.},
  title = {Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders},
  booktitle = {La radiologia medica},
  journal = {La radiologia medica},
  publisher = {Springer Milan},
  year = {2011},
  volume = {116},
  number = {4},
  pages = {620-633--},
  note = {G-scan Esaote},
  url = {http://dx.doi.org/10.1007/s11547-011-0660-2}
}
Gallucci, M., Limbucci, N., Paonessa, A. and Splendiani, A. Degenerative Disease of the Spine 2007 Neuroimaging Clinics of North America
Vol. 17(1)Spinal Imaging: Overview and Update, pp. 87-103 
article URL 
Abstract: Degenerative disease of the spine is a definition that includes a wide spectrum of degenerative abnormalities. Degeneration involves bony structures and the intervertebral disk, although many aspects of spine degeneration are strictly linked because the main common pathogenic factor is identified in chronic overload. During life the spine undergoes continuous changes as a response to physiologic axial load. These age-related changes are similar to pathologic degenerative changes and are a common asymptomatic finding in adults and elderly persons. A mild degree of degenerative changes is paraphysiologic and should be considered pathologic only if abnormalities determine symptoms. Imaging allows complete evaluation of static and dynamic factors related to degenerative disease of the spine and is useful in diagnosing the different aspects of spine degeneration.
BibTeX:
@article{Gallucci2007,
  author = {Gallucci, Massimo and Limbucci, Nicola and Paonessa, Amalia and Splendiani, Alessandra},
  title = {Degenerative Disease of the Spine},
  booktitle = {Spinal Imaging: Overview and Update},
  journal = {Neuroimaging Clinics of North America},
  year = {2007},
  volume = {17},
  number = {1},
  pages = {87--103},
  note = {G-scan Esaote},
  url = {http://www.sciencedirect.com/science/article/pii/S1052514907000032}
}
Gilbert, J.W., Martin, J.C., Wheeler, G.R., Storey, B.B., Mick, G.E., Richardson, G.B., Herder, S.L. and Gyarteng-Dakwa, K. Lumbar Stenosis Rates in Symptomatic Patients Using Weight-Bearing and Recumbent Magnetic Resonance Imaging 2011 Journal of Manipulative and Physiological Therapeutics
Vol. 34(8)Focus on Cervical Spine, pp. 557-561 
article URL 
Abstract: Objective The purpose of this study was to determine the rate of lumbar stenosis detected via magnetic resonance imaging (MRI) in patients with symptomatic foraminal stenosis, lateral recess stenosis, or central stenosis. Methods A retrospective review was performed on 1983 MRI scans from a 2-year period on 1486 symptomatic patients. Of these patients, 761 were scanned in the recumbent position using low-field (0.3 T, Airis II; Hitachi, Twinsburg, Ohio) MRI, and 725 were scanned in an upright sitting position using midfield (0.6 T) open Upright MRI (Fonar Corp, Melville, NY). In total, 986 serial scans (recumbent) and 997 serial scans (weight-bearing) were performed. Results Of scans performed in the recumbent position, stenoses were identified in 382 scans (38.8%), central stenosis in 119 scans (12%), lateral recess stenosis in 91 scans (9.2%), and foraminal stenosis in 327 scans (33.2%). Of scans performed in a weight-bearing position, stenoses were identified in 565 scans (56.7%), central stenosis in 136 scans (13.6%), lateral recess stenosis in 206 scans (20.7%), and foraminal stenosis in 524 scans (52.6%). Conclusions The stenosis rates as indicated by MRI interpretation ranged between 38.5% (recumbent) and 56.7% (weight-bearing). These rates are higher than those reported in the medical literature for asymptomatic patients. Further study is needed to determine whether weight-bearing, compared with recumbent, MRI better informs the clinician in the diagnosis of spinal stenosis.
BibTeX:
@article{Gilbert2011,
  author = {Gilbert, John W. and Martin, J. Chad and Wheeler, Greg R. and Storey, Benjamin B. and Mick, Gregory E. and Richardson, Gay B. and Herder, Stephanie L. and Gyarteng-Dakwa, Kwadwo},
  title = {Lumbar Stenosis Rates in Symptomatic Patients Using Weight-Bearing and Recumbent Magnetic Resonance Imaging},
  booktitle = {Focus on Cervical Spine},
  journal = {Journal of Manipulative and Physiological Therapeutics},
  year = {2011},
  volume = {34},
  number = {8},
  pages = {557--561},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0161475411001849}
}
Gilbert, J.W., Martin, J.C., Wheeler, G.R., Storey, B.B., Mick, G.E., Richardson, G.B., Herder, S.L., Gyarteng-Dakwa, K. and Broughton, P.G. Lumbar Disk Protrusion Rates of Symptomatic Patients Using Magnetic Resonance Imaging 2010 Journal of Manipulative and Physiological Therapeutics
Vol. 33(8), pp. 626-629 
article URL 
Abstract: Objective The purpose of this study was to determine the rate of disk protrusions detected via magnetic resonance imaging (MRI) in patients symptomatic for spine pain, radiculopathy, or other spine-related pain. Methods A retrospective review of 1983 MRI scans was performed over a 2-year period on 1486 patients, each of whom was symptomatic for spine pain, radiculopathy, or other noncancer, spine-related pain. Of these patients, 761 were scanned in the recumbent position using low-field (0.3 T, Airis II, Hitachi, Twinsburg, Ohio) MRI, and 725 were scanned in an upright, sitting position using mid-field (0.6 T) open Upright MRI (Fonar, Melville, NY). In total, 986 serial scans were performed on patients in the recumbent position and 997 serial scans on patients in the weight-bearing position. Results One or more disk protrusions were identified in 73.3% of scans performed in the sitting position and in 50.1% of scans performed in the recumbent position. Most disk protrusions occurred at L5-S1 (52.3% and 29.8%), L4-L5 (42.6% and 26.7%), and L3-L4 (26.7% and 13.1%) in upright and recumbent positions, respectively. Conclusions The disk protrusion rate in this group of patients ranged between 50.1% (recumbent) and 73.3% (weight-bearing). These rates are higher than rates reported in the medical literature for asymptomatic patients, a finding that supports the decision to further evaluate patients with persistent spine-related pain.
BibTeX:
@article{Gilbert2010,
  author = {Gilbert, John W. and Martin, J. Chad and Wheeler, Greg R. and Storey, Benjamin B. and Mick, Gregory E. and Richardson, Gay B. and Herder, Stephanie L. and Gyarteng-Dakwa, Kwadwo and Broughton, Patricia G.},
  title = {Lumbar Disk Protrusion Rates of Symptomatic Patients Using Magnetic Resonance Imaging},
  journal = {Journal of Manipulative and Physiological Therapeutics},
  year = {2010},
  volume = {33},
  number = {8},
  pages = {626--629},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0161475410002083}
}
Gilbert, J.W., Wheeler, G.R., Kreft, M.P., Upadhyay, S.P., Storey, B.B., Spitalieri, J.R., Mick, G.E. and Gibbs, R.A. Repeat Upright Positional Magnetic Resonance Imaging for Diagnosis of Disorders Underlying Chronic Noncancer Lumbar Pain 2008 Journal of Manipulative and Physiological Therapeutics
Vol. 31(8), pp. 627-631 
article URL 
Abstract: Objective Cases of chronic noncancer pain are both the most frequent and the most difficult that the spine care professional is called upon to treat. We use this case to illustrate the potential effectiveness of repeat positional upright, weight-bearing magnetic resonance (MR) imaging to diagnose disorders and to detect changes in disorders. Clinical Features We present the case of a 35-year-old man referred to our neurosurgical clinic with complaints of chronic, noncancer lower back pain and right-greater-than-left sciatica. Traditional recumbent MR imaging had revealed degenerative disk disease at L5-S1 and a 2.2-mm (grade 1) degenerative spondylolisthesis. The patient had not improved after more than a year of conservative treatments and, moreover, had been prescribed opiates for pain management that were potentially masking changes in his condition. Intervention and Outcomes After referral to our clinic, we ordered repeat lumbar MR imaging in an upright weight-bearing position (sitting) 14 months after the patient's recumbent MR imaging. The weight-bearing MR imaging revealed a 9.13-mm (grade 1) degenerative spondylolisthesis at L5-S1. The patient underwent arthrodesis. His leg pain and back were significantly and clinically improved. Conclusion When patients with noncancer, lower back pain worsen, fail to improve, or require opiates to manage their pain, updated clinical diagnosis including repeat positional imaging may be an effective diagnostic strategy.
BibTeX:
@article{Gilbert2008,
  author = {Gilbert, John W. and Wheeler, Greg R. and Kreft, Martin P. and Upadhyay, Shailesh P. and Storey, Benjamin B. and Spitalieri, John R. and Mick, Gregory E. and Gibbs, Richard A.},
  title = {Repeat Upright Positional Magnetic Resonance Imaging for Diagnosis of Disorders Underlying Chronic Noncancer Lumbar Pain},
  journal = {Journal of Manipulative and Physiological Therapeutics},
  year = {2008},
  volume = {31},
  number = {8},
  pages = {627--631},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S016147540800239X}
}
Gilbert, J.W., Wheeler, G.R., Lingreen, R.A., Johnson, R.K., Scheiner, S.J., Gibbs, R.A., Upadhyay, S.P. and Gyarteng-Dakwa, K. Imaging in the position that causes pain 2008 Surgical Neurology
Vol. 69(5), pp. 463-465 
article URL 
Abstract: Background Magnetic resonance imaging has the diagnostic advantages of being noninvasive and able to visualize soft tissue. However, conventional recumbent MRI may underestimate a disease because the position of imaging takes stress off the spine. Case Description A 37-year-old woman presented with complaints of pain in the neck that radiated down her right arm when she turned her head to the right and increased with extension. She complained of paresthesias, numbness/tingling in the index and middle fingers and thumb, in the C6 and C7 nerve root dermatomes. Conventional conservative measures, including anti-inflammatories, muscle relaxants, opiates, and physical therapy, had been tried without positive results. Magnetic resonance imaging was performed in a weight-bearing upright neutral position, in the extended upright position, and in the extended upright position with the head turned to the right. The latter images showed a clear protrusion at C5-C6 and C6-C7. These protrusions were not clearly evident in the upright neutral position. A targeted epidural block at C5-C6 and C6-C7 relieved the patient's pain, and she has been able to continue work. Conclusions Magnetic resonance imaging of the cervical spine in the position that causes the patient's symptoms may increase the sensitivity and accuracy of the diagnostic study and thus provide the spine-care professional with a potentially more accurate diagnosis and a targeted treatment plan. Such MRIs may also decrease the need for myelography.
BibTeX:
@article{Gilbert2008a,
  author = {Gilbert, John W. and Wheeler, Greg R. and Lingreen, Richard A. and Johnson, Robert K. and Scheiner, Steven J. and Gibbs, Richard A. and Upadhyay, Shailesh P. and Gyarteng-Dakwa, Kwadwo},
  title = {Imaging in the position that causes pain},
  journal = {Surgical Neurology},
  year = {2008},
  volume = {69},
  number = {5},
  pages = {463--465},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0090301907003989}
}
Gilbert, J.W., Wheeler, G.R., Lingreen, R.A., Johnson, R.K., Scheiner, S.J. and Gibbs, R.D. Upright weight-bearing cervical flexion/extension dynamic magnetic resonance imaging: Case report and review of the literature 2006 European Journal of Radiology Extra
Vol. 60(3), pp. 121-124 
article URL 
Abstract: Conventional recumbent magnetic resonance imaging (MRI) of the cervical spine may underestimate disease because the imaging is performed in a non-dynamic, non-weight bearing position. The cervical myelogram may provide additional information but requires an invasive procedure and a post-myelogram computed tomography (CT) scan. We present a patient with cervical symptomatology imaged in an upright weight-bearing sitting position in the flexion, neutral, and extension positions. Measurements of the anterior to posterior midsagittal plane were obtained at several disc space levels. The T2 sagittal images are presented and compared. This case clearly shows a reduction in the anterior–posterior distance in the midsagittal plane progressively from flexion to neutral to extension with the extension position showing the greatest reduction in cervical central canal diameter. Images show a decrease in anterior and posterior subarachnoid space in the extension position. Upright weight bearing cervical flexion/extension dynamic magnetic resonance imaging provides an innovative noninvasive technique to see changes in midsagittal cervical spinal canal diameter and may provide for imaging of the dynamic nature of spinal cord compression.
BibTeX:
@article{Gilbert2006,
  author = {Gilbert, John W. and Wheeler, Greg R. and Lingreen, Richard A. and Johnson, Robert K. and Scheiner, Steven J. and Gibbs, Richard D.},
  title = {Upright weight-bearing cervical flexion/extension dynamic magnetic resonance imaging: Case report and review of the literature},
  journal = {European Journal of Radiology Extra},
  year = {2006},
  volume = {60},
  number = {3},
  pages = {121--124},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S1571467506000873}
}
Graber, O.P. and Oberthaler, W. Magnetresonanztomographie von Spitzentanz in aufrechtem Stand unter Belastung (Weight bearing upright Magnetic Resonance Imaging of pointe dancing) 2008 Rontgenpraxis
Vol. 56(5), pp. 195-198 
article URL 
Abstract: Zusammenfassung Magnetresonanztomographie (MRT) im aufrechten Stand "en pointe" unter voller Belastung ist die Methode der Wahl zum Studium der funktionellen Anatomie des Spitzentanzes und damit verbundener tanzmedizinischer Fragestellungen.
BibTeX:
@article{Graber2008,
  author = {Graber, Oliver Peter and Oberthaler, Wolfgang},
  title = {Magnetresonanztomographie von Spitzentanz in aufrechtem Stand unter Belastung (Weight bearing upright Magnetic Resonance Imaging of pointe dancing)},
  journal = {Rontgenpraxis},
  year = {2008},
  volume = {56},
  number = {5},
  pages = {195--198},
  note = {G-scan Esaote},
  url = {http://www.sciencedirect.com/science/article/pii/S0035782007000225}
}
Hadid, A., Epstein, Y., Shabshin, N. and Gefen, A. Modeling mechanical strains and stresses in soft tissues of the shoulder during load carriage based on load-bearing open MRI 2012 Journal of Applied Physiology
Vol. 112(4), pp. 597-606 
article DOI URL 
Abstract: Shoulder strain is a major limiting factor associated with load carriage. Despite advances in backpack designs, there are still reports of shoulder discomfort, loss of sensorimotor functions, and brachial plexus syndrome. The current study is aimed at characterizing mechanical loading conditions (strains and stresses) that develop within the shoulder's soft tissues when carrying a backpack. Open MRI scans were used for reconstructing a three-dimensional geometrical model of an unloaded shoulder and for measuring the soft tissue deformations caused by a 25-kg backpack; subsequently, a subject-specific finite element (FE) model for nonlinear, large-deformation stress-strain analyses was developed. Skin pressure distributions under the backpack strap were used as reference data and for verifying the numerical solutions. The parameters of the model were adjusted to fit the calculated tissue deformations to those obtained by MRI. The MRI scans revealed significant compression of the soft tissues of the shoulder, with substantial deformations in the area of the subclavian muscle and the brachial plexus. The maximal pressure values exerted by a 25-kg load were substantial and reached 90 kPa. In the muscle surrounding the brachial plexus, the model predicted maximal compressive strain of 0.14 and maximal tensile strain of 0.13, which might be injurious for the underlying neural tissue. In conclusion, the FE model provided some insights regarding the potential mechanisms underlying brachial plexus injuries related to load carriage. The large tissue deformations and pressure hotspots that were observed are likely to result in tissue damage, which may hamper neural function if sustained for long time exposures.
BibTeX:
@article{Hadid2012,
  author = {Hadid, Amir and Epstein, Yoram and Shabshin, Nogah and Gefen, Amit},
  title = {Modeling mechanical strains and stresses in soft tissues of the shoulder during load carriage based on load-bearing open MRI},
  journal = {Journal of Applied Physiology},
  year = {2012},
  volume = {112},
  number = {4},
  pages = {597-606},
  note = {Signa SP GE},
  url = {http://jap.physiology.org/content/112/4/597.abstract},
  doi = {http://dx.doi.org/10.1152/japplphysiol.00990.2011}
}
Hedberg, K., Alexander, L.A., Cooper, K., Hancock, E., Ross, J. and Smith, F.W. Low back pain: An assessment using positional MRI and MDT 2012 Manual Therapy
Vol. -(0), pp. 1-3 
article URL 
Abstract: Current guidelines advise against the use of routine imaging for low back pain. Positional MRI can provide enhanced assessment of the lumbar spine in functionally loaded positions which are often relevant to the presenting clinical symptoms. The purpose of this case report is to highlight the use of positional MRI in the assessment and classification of a subject with low back pain. A low back pain subject underwent a Mechanical Diagnosis and Therapy (MDT) assessment and positional MRI scan of the lumbar spine. The MDT assessment classified the subject as "other" since the subjective history indicated a possible posterior derangement whilst the objective assessment indicated a possible anterior derangement. Positional MRI scanning in flexed, upright and extended sitting postures confirmed the MDT assessment findings to reveal a dynamic spinal stenosis which reduced in flexion and increased in extension.
BibTeX:
@article{Hedberg,
  author = {Hedberg, Karen and Alexander, Lyndsay A. and Cooper, Kay and Hancock, Elizabeth and Ross, Jenny and Smith, Francis W.},
  title = {Low back pain: An assessment using positional MRI and MDT},
  journal = {Manual Therapy},
  year = {2012},
  volume = {-},
  number = {0},
  pages = {1-3},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S1356689X12001403}
}
Hong, S.-W., Alanay, A., Yoon, S.H., Miyazaki, M., Zou, J., Ashkan, M., Chen, M. and Wang, J. Missed Spondylolisthesis in Static MRIs but Found in Dynamic MRIs in the Patients with Low Back Pain 2007 Spine J
Vol. 7(5), pp. 69S-70S 
article URL 
BibTeX:
@article{Hong2007,
  author = {Hong, Soon-Woo and Alanay, Ahmet and Yoon, Seung Hwan and Miyazaki, Masashi and Zou, Jun and Ashkan, Mark and Chen, Marianne and Wang, Jeffrey},
  title = {Missed Spondylolisthesis in Static MRIs but Found in Dynamic MRIs in the Patients with Low Back Pain},
  journal = {Spine J},
  publisher = {Elsevier Science Inc.,},
  year = {2007},
  volume = {7},
  number = {5},
  pages = {69S--70S},
  note = {Upright MRI Fonar},
  url = {http://linkinghub.elsevier.com/retrieve/pii/S1529943007004809?showall=true}
}
Izadpanah, K., Weitzel, E., Honal, M., Winterer, J., Vicari, M., Maier, D., Jaeger, M., Kotter, E., Hennig, J., Weigel, M. and Südkamp, N.P. In Vivo Analysis of Coracoclavicular Ligament Kinematics During Shoulder Abduction 2012 The American Journal of Sports Medicine
Vol. 40(1), pp. 185-192 
article DOI URL 
Abstract: Background: Anatomic reconstruction of the coracoclavicular ligaments for the treatment of acromioclavicular joint separations provides superior biomechanical stability compared with other procedures. Clavicular and coracoidal footprints of the conoid ligament (CL) and the trapezoid ligament (TL) are well described. So far, little is known about their kinematics and the changes of the coracoclavicular distance during shoulder abduction. Hypothesis: The coracoclavicular distance along the coracoclavicular ligaments changes significantly with shoulder abduction and weightbearing. Study Design: Descriptive laboratory study. Methods: With use of an open magnetic resonance imaging scanner, the shoulders of 13 healthy volunteers were examined in supine and sitting positions. Three-dimensional magnetic resonance images of the shoulders were obtained in 30° increments of abduction (0°-120°). A manual segmentation of the scapula, the clavicle, and the coracoclavicular ligaments was performed. The insertion points of the coracoclavicular ligaments were identified, and automated measures along the ligamentous course were carried out. Results: During transfer from the lying to sitting position, the coracoclavicular distance showed significant lengthening of 3 mm along the center of the CL, which significantly increased another 3 mm during shoulder abduction to a total lengthening of 6 mm. In the supine position, the coracoclavicular distance along the TL did not elongate significantly. In the sitting position, the distance along the medial portion of the TL shortened significantly, whereas the distance along the center portion did not elongate significantly during shoulder abduction. Conclusion: The distances between the coracoclavicular insertion points depend on both patient and shoulder positioning. To prevent overconstraining of the graft, the CL should be fixated during 90° to 120° of shoulder abduction in a sitting position. Isometric reconstruction of the TL can be achieved if precise fixation of the graft at the centers of the conoidal and clavicular footprints is performed.
BibTeX:
@article{Izadpanah01012012,
  author = {Izadpanah, Kaywan and Weitzel, Elizabeth and Honal, Matthias and Winterer, Jan and Vicari, Marco and Maier, Dirk and Jaeger, Martin and Kotter, Elmar and Hennig, Jürgen and Weigel, Matthias and Südkamp, Norbert P.},
  title = {In Vivo Analysis of Coracoclavicular Ligament Kinematics During Shoulder Abduction},
  journal = {The American Journal of Sports Medicine},
  year = {2012},
  volume = {40},
  number = {1},
  pages = {185-192},
  note = {G-scan Esaote},
  url = {http://ajs.sagepub.com/content/40/1/185.abstract},
  doi = {http://dx.doi.org/10.1177/0363546511423015}
}
Jayakumar, P., Nnadi, C., Saifuddin, A., MacSweeney, E. and Casey, A. Dynamic Degenerative Lumbar Spondylolisthesis: Diagnosis With Axial Loaded Magnetic Resonance Imaging 2006 Spine
Vol. 31(10), pp. - 
article URL 
Abstract: Study Design. Retrospective review of case notes and imaging. Objective. To show the advantage of axial loaded magnetic resonance imaging (MRI) for identification of dynamic degenerative spondylolisthesis as a suspected cause of spinal claudication. Summary of Background Data. Degenerative spondylolisthesis typically occurs at L4/L5 and is usually evident on plain radiography. However, dynamic degenerative spondylolisthesis may become evident on erect radiographs when not shown on supine radiographs or MRI. Methods. The case notes and imaging (radiography, conventional MRI, and axial loaded MRI) in 2 patients with symptoms of spinal claudication were reviewed. Results. A 44-year-old female presented with a 3-year history of intermittent low back pain and right leg numbness after a fall. A 52-year-old female presented with a 4-year history of low back pain, bilateral leg weakness, and right leg numbness. In both cases, conventional MRI studies showed mild-to-moderate degenerative disc disease only with no evidence of abnormal spinal alignment or nerve root compression. Axial loaded MRI clearly showed the development of a degenerative spondylolisthesis with central canal stenosis and facet ganglion formation in 1 case. Conclusions. Axial loaded MRI identified occult dynamic degenerative spondylolisthesis, which correlated with the clinical picture but was not shown on initial conventional MRI or plain radiography.
BibTeX:
@article{Jayakumar2006,
  author = {Jayakumar, Prakash and Nnadi, Colin and Saifuddin, Asif and MacSweeney, Emer and Casey, Adrian},
  title = {Dynamic Degenerative Lumbar Spondylolisthesis: Diagnosis With Axial Loaded Magnetic Resonance Imaging},
  journal = {Spine},
  year = {2006},
  volume = {31},
  number = {10},
  pages = {--},
  note = {Axial loading device (Dynawell)},
  url = {http://journals.lww.com/spinejournal/Fulltext/2006/05010/Dynamic_Degenerative_Lumbar_Spondylolisthesis_.23.aspx}
}
Jinkins, J., Dworkin, J. and Damadian, R. Upright, weight-bearing, dynamic-kinetic MRI of the spine: initial results 2005 European Radiology
Vol. 15(9)European Radiology, pp. 1815-1825- 
article URL 
Abstract: The purpose of this study was to demonstrate the general utility of the first dedicated magnetic resonance imaging (MRI) unit enabling upright, weight-bearing positional evaluation of the spinal column (pMRI) during various dynamic-kinetic maneuvers (kMRI) in patients with degenerative
conditions of the soine. This study coniisted of a prospective analysis of cervical and lumbar imaging examinations. All studies were performed on a recently introduced whole body MRI system (Stand-Up"' MRI, Fonar Corp, Melville, NY). The system operates at 0.6T using an electromagnet with a horizontal field, transverse to the longitudinal axis of the patient's body. Depending upon spinal level, all examinations were acquired with either a cervical or lumbar solenoidal radiofrequency receiver coil. This unit is configured with a
top/front-open design. incorporating a patient-scanning table with tilt, translation and elevation functions.
The unique motorized patient handling system developed for the scanner allows for vertical (upright, weight bearing) and horizontal (recumbent) positioning of all patients. The top/front-open construction also allows dynamic-kinetic flexion and extension maneuvers of the spine. Patterns of bony and soft tissue change occurring among recumbent (/MRI) and upright neutral positions (pMRI), and dynamic-kinetic acquisitions (kMRI) were sought. Depending on the specific underlying pathologic degenerative condition, significant alterations observed on pMRI and kMRI that were either more or less pronounced than on rMRI included: fluctuating anterior and posterior disc herniations, hypermobile spinal instability, central spinal canal and spinal neural foramen stenosis and general sagittal spinal contour changes. No patient suffered from feelings of
claustrophobia that resulted in termination of the examination.
In conclusion, the potential relative beneficial aspects of upright, weight-bearing (pMRI), dynamickinetic (kMRI) spinal imaging on this system over that of recumbent MRI (rMRI) include: the revelation of occult disease dependent on true axial Ioading, the unmasking of kinetic-dependent disease, and the ability to scan the patient in the position of clinically relevant signs and symptoms. This imaging unit also demonstrated low claustrophobic potential and yielded relatively high-resolution images with little motion/chemical-shift artifact
BibTeX:
@article{Jinkins2005,
  author = {Jinkins, J.Randy and Dworkin, JayS. and Damadian, RaymondV.},
  title = {Upright, weight-bearing, dynamic-kinetic MRI of the spine: initial results},
  booktitle = {European Radiology},
  journal = {European Radiology},
  publisher = {Springer-Verlag},
  year = {2005},
  volume = {15},
  number = {9},
  pages = {1815-1825--},
  note = {Upright MRI Fonar},
  url = {http://www.fonar.com/pdf/revista_di_neuroradiologia.pdf}
}
Kaech, D.L. Comments about modern imaging techniques in spondylolisthesis and other dynamic spinal pathologies 2011 ArgoSpine
Vol. 23, pp. 129-130 
article URL 
BibTeX:
@article{Kaech2011,
  author = {D. L. Kaech},
  title = {Comments about modern imaging techniques in spondylolisthesis and other dynamic spinal pathologies},
  journal = {ArgoSpine},
  year = {2011},
  volume = {23},
  pages = {129-130},
  note = {Comments on WB MRI},
  url = {http://www.argospine.org/argos-spine-news/anj-23-3.pdf}
}
Kanno, H., Endo, T., Ozawa, H., Koizumi, Y., Morozumi, N., Itoi, E. and Ishii, Y. Axial Loading During Magnetic Resonance Imaging in Patients With Lumbar Spinal Canal Stenosis: Does It Reproduce the Positional Change of the Dural Sac Detected by Upright Myelography? 2012 Spine
Vol. 37(16), pp. - 
article URL 
Abstract: Study Design. We compared the sizes of the dural sac among conventional magnetic resonance imaging (MRI), axial loaded MRI, and upright myelography in patients with lumbar spinal canal stenosis (LSCS). Objective. To determine whether axial loaded MRI can demonstrate similar positional changes of the dural sac size as were detected by upright myelography in LSCS. Summary of Background Data. In patients with LSCS, constriction of the dural sac is worsened and symptoms are aggravated during standing or walking. To disclose such positional changes, upright myelography has been widely used. Recently, axial loaded MRI, which can simulate a standing position, has been developed. However, there has been no study to compare the dural sac size between axial loaded MRI and upright myelography. Methods. Forty-four patients underwent conventional MRI, axial loaded MRI, and myelography. Transverse and anteroposterior diameters and the cross-sectional areas of the dural sac from L2-L3 to L5-S1 were compared. Pearson correlations of the diameters between the MRIs and the myelograms were analyzed. On the basis of the myelograms, all disc levels were divided into severe and nonsevere constriction groups. In each group, the diameters and the cross-sectional areas were compared. Sensitivity and specificity to detect severe constriction were calculated for the conventional and axial loaded MRI. Results. Transverse and anteroposterior diameters at L4-L5 in the axial loaded MRI and myelogram were significantly smaller than those observed in the conventional MRI (P < 0.001). Cross-sectional areas in the axial loaded MRI were significantly smaller than those in the conventional MRI at L2-L3, L3-L4, and L4-L5 (P < 0.001). Between the axial loaded MRI and the myelography, Pearson correlation coefficients of the transverse and anteroposterior diameters were 0.85 and 0.87, respectively (P < 0.001), which were higher than those for conventional MRI. Reductions of the dural sac sizes in the axial loaded MRI were more evident in the severe constriction group. The axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98.2%) than the conventional MRI. Conclusion. The axial loaded MRI demonstrated a significant reduction in the dural sac size and significant correlations of the dural sac diameters with the upright myelogram. Furthermore, the axial loaded MRI had higher sensitivity and specificity than the conventional MRI for detecting the severe constriction observed in the myelogram. Therefore, the axial loaded MRI can be used to represent positional changes of the dural sac size detected by the upright myelography in patients with LSCS.
BibTeX:
@article{Kanno2012,
  author = {Kanno, Haruo and Endo, Toshiki and Ozawa, Hiroshi and Koizumi, Yutaka and Morozumi, Naoki and Itoi, Eiji and Ishii, Yushin},
  title = {Axial Loading During Magnetic Resonance Imaging in Patients With Lumbar Spinal Canal Stenosis: Does It Reproduce the Positional Change of the Dural Sac Detected by Upright Myelography?},
  journal = {Spine},
  year = {2012},
  volume = {37},
  number = {16},
  pages = {--},
  note = {Axial loading device},
  url = {http://journals.lww.com/spinejournal/Fulltext/2012/07150/Axial_Loading_During_Magnetic_Resonance_Imaging_in.19.aspx}
}
Karadimas, E.J., Siddiqui, M., Smith, F.W. and Wardlaw, D. Positional MRI Changes in Supine Versus Sitting Postures in Patients With Degenerative Lumbar Spine 2006 Journal of Spinal Disorders & Techniques
Vol. 19(7), pp. - 
article URL 
Abstract: Introduction: Back pain is associated with a degree of alteration in the alignment and movement of the lumbar spine. The purpose of this study is to investigate how the degree of lumbar segmental degeneration affects sagittal changes in the lumbar spine as it shifts from the supine to the sitting (load-bearing) posture. Materials and Methods: Thirty patients with chronic low back pain were enrolled (14 male and 16 female patients); mean age 44.5 years. Their lumbar spines were initially investigated by conventional supine magnetic resonance imaging (MRI) followed later by positional MRI in the seated posture. Of the 150 discs studied, 87 were classified as healthy grade 1, 16 as grade 2, 34 as grade 3, and 13 as grade 4. Results: As the lumbar spine was loaded from the supine to the sitting position, the end-plate angles were decreased significantly as the degeneration was increased. There were also significant changes in the anterior and middle disc heights between the supine and the sitting postures irrespective of the degree of degeneration. The overall lumbar lordosis did not significantly change between the two postures. Conclusions: We have found that the changes in the segmental motion were related to the degree of degeneration. With positional MRI, we were able to demonstrate changes in healthy and degenerative discs in the weight-bearing position. More similar studies are needed to understand the complex kinematics of the lumbar spine.
BibTeX:
@article{Karadimas2006,
  author = {Karadimas, Efthimios J. and Siddiqui, Manal and Smith, Francis W. and Wardlaw, Douglas},
  title = {Positional MRI Changes in Supine Versus Sitting Postures in Patients With Degenerative Lumbar Spine},
  journal = {Journal of Spinal Disorders & Techniques},
  year = {2006},
  volume = {19},
  number = {7},
  pages = {--},
  note = {???????},
  url = {http://journals.lww.com/jspinaldisorders/Fulltext/2006/10000/Positional_MRI_Changes_in_Supine_Versus_Sitting.6.aspx}
}
Khalil, J.G., Nassr, A. and Maus, T.P. Physiologic Imaging of the Spine 2012 Radiologic Clinics of North America
Vol. 50(4)Spine Imaging, pp. 599-611 
article URL 
Abstract: Spine imaging poses unique challenges to radiologist and clinician. The dynamic nature of the spine and its mobility across multiple segments is difficult to depict with any single imaging modality. Supine imaging fails to demonstrate the physiologic effects seen with axial load, physiologic posture or positional change. Physiologic imaging begins with standing radiographs. Advanced techniques include axial loading devices on conventional CT or MRI, dynamic (upright) MRI and stereoradiography (EOS). These techniques may unmask dynamic pathology that otherwise would be hidden on conventional supine imaging. Caution must be exercised where such techniques (upright MRI) reduce sensitivity to sinister disease.
BibTeX:
@article{Khalil2012,
  author = {Khalil, Jad G. and Nassr, Ahmad and Maus, Timothy P.},
  title = {Physiologic Imaging of the Spine},
  booktitle = {Spine Imaging},
  journal = {Radiologic Clinics of North America},
  year = {2012},
  volume = {50},
  number = {4},
  pages = {599--611},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0033838912000541}
}
Kimura, S., Garfin, S., Steinbach, G., Hesselink, J. and Hargens, A. Axial harness loads of the cervical spine in supine posture simulates the upright loads 2002 The Spine Journal
Vol. 2(5, Supplement), pp. 65- 
article URL 
Abstract: Purpose of study: Patients with cervical degenerative diseases often have pain or tingling in their upper extremities in upright posture. However, computed tomography or magnetic resonance imaging (MRI) is typically performed in a supine position. We reported that axial loading of 50% body weight in the lumbar spine stimulates upright loading conditions. The aim of our study was to simulate upright cervical spine loads using a new compression device and to examine the change of cervical spine alignment and dural tube before and during axial compression in healthy volunteers and in patients with cervical degenerative diseases.
BibTeX:
@article{Kimura2002,
  author = {Kimura, Shinji and Garfin, Steven and Steinbach, Gregory and Hesselink, John and Hargens, Alan},
  title = {Axial harness loads of the cervical spine in supine posture simulates the upright loads},
  journal = {The Spine Journal},
  year = {2002},
  volume = {2},
  number = {5, Supplement},
  pages = {65--},
  note = {Axial loading device},
  url = {http://www.sciencedirect.com/science/article/pii/S1529943002003066}
}
Kinder, A., Filho, F.P., Ribeiro, E., Domingues, R.C., Domingues, R.C., Marchiori, E. and Gasparetto, E. Magnetic resonance imaging of the lumbar spine with axial loading: A review of 120 cases 2012 European Journal of Radiology
Vol. 81(4), pp. e561-e564 
article URL 
Abstract: Purpose To evaluate the imaging findings of patients with clinical symptoms of lower back pain who underwent magnetic resonance imaging (MRI) of the lumbar spine with axial loading. Materials and methods We examined 120 patients by MRI, before and after axial loading, using a compression device that applied 50% of their body weight for a load time of 5 min. The dural sac cross area (DSCA) was examined by two experienced radiologists before and after axial load, and their findings were compared. Degenerative abnormalities within and adjacent to the spinal canal were also analyzed. Results A reduction in DSCA greater than 15 mm2 after axial load was defined as significant, and was found in 81 patients (67.5%) and 138 disc spaces (38.3%). Reduction was most frequent at L4-L5 (n = 55). For other disorders, a 9% increase in cases of bulging disc was seen during axial loading, and seven disc spaces showed protrusion/extrusion only after load. Facet joint synovial cysts, foraminal stenosis, and hypertrophy of the flavum ligaments showed almost no differences, pre- and post-load. Conclusion For adequate evaluation of lumbar symptoms, examination should be performed with axial loading, especially in cases of suspected spinal stenosis.
BibTeX:
@article{Kinder2012,
  author = {Kinder, Andre and Filho, Fernando Palma and Ribeiro, Elisio and Domingues, Romeu C. and Domingues, Roberto C. and Marchiori, Edson and Gasparetto, Emerson},
  title = {Magnetic resonance imaging of the lumbar spine with axial loading: A review of 120 cases},
  journal = {European Journal of Radiology},
  year = {2012},
  volume = {81},
  number = {4},
  pages = {e561--e564},
  note = {Axial loading device},
  url = {http://www.sciencedirect.com/science/article/pii/S0720048X11005687}
}
Lafon, Y., Smith, F. and Beillas, P. Combination of a model-deformation method and a positional MRI to quantify the effects of posture on the anatomical structures of the trunk 2010 Journal of Biomechanics
Vol. 43(7), pp. 1269-1278 
article URL 
Abstract: Understanding the postural effects on organs and skeleton could be crucial for several applications. This paper reports on a methodology to quantify the three-dimensional effects of postures on deformable anatomical structures. A positional MRI scanner was used to image the full trunk in four postures: supine, standing, seated and forward-flexed. The MRI stacks were processed with a custom toolbox, implemented using open source software. The semi-automated segmentation was based on the deformation of generic models of the pelvis, sternum, femoral heads, spine, liver, kidneys, spleen, skin, thoracic and abdominal cavities. The toolbox was designed to be easily extended by additional image filters, deformation schemes, or new generic models. Results obtained on one subject demonstrate that the method can be used to quantify the effects of postures on skeleton and organs. The spinal curvature, the pelvic parameters and the volume of the thoracic cavity were affected by the four postures. The volumes of the kidneys, spleen, liver and abdominal object were mostly unaffected. The movement of organs was coherent with the effect of gravity. The deformation of organs between postures was expressed using geometrical transformations. Investigations should be pursued on a larger population to confirm the patterns observed on the first subject.
BibTeX:
@article{Lafon2010,
  author = {Lafon, Y. and Smith, F.W. and Beillas, P.},
  title = {Combination of a model-deformation method and a positional MRI to quantify the effects of posture on the anatomical structures of the trunk},
  journal = {Journal of Biomechanics},
  year = {2010},
  volume = {43},
  number = {7},
  pages = {1269--1278},
  url = {http://www.sciencedirect.com/science/article/pii/S0021929010000473}
}
Mauch, F., Jung, C., Huth, J. and Bauer, G. Changes in the Lumbar Spine of Athletes From Supine to the True-Standing Position in Magnetic Resonance Imaging 2010 Spine
Vol. 35(9), pp. 1002-1007 10.1097/BRS.0b013e3181bdb2d3 
article URL 
Abstract: Study Design. Case-control observational study.
Objective. Determination of dimensional changes in the lumbar spines of athletes between supine and stand-up position in MRI, concerning the lordosis, spinal canal cross-sectional area (SCCA), dural sac cross-sectional area (DSCA), sagittal dural sac diameter (SDSD), the lateral recess and the neural foramina.
Summary of Background Data. The development of positional MRI allows the examination of spine segments under a true weight-bearing situation.
Methods. About 35 athletes (20m/15f) were examined using a 0.25 T open MRI-Scanner (G-Scan, ESAOTE, Italy). In all cases, axial and sagittal SE-T1 + SSE-T2 images were recorded in supine and true standing position. All measurements were performed using MEDIMAGE software (Vepro AG, Germany). The blinded measurements were performed 3 times by 2 independent examiners. Sagittal images were used to determine the lordosis and the narrowing of the left/right foramen at all levels between L1/2 and L5/S1. Axial images were used to determine the SDSD, the SCCA and the DSCA at L3/4, L4/5, L5/S1, and narrowing of the left/right recessus lateralis of L4, L5 and S1.
Results. The lordosis showed a significant increase of 6.3° (14%) from supine to true standing position (P < 0.001). The SDSD is significantly smaller in true standing position, than in supine position at the level of L3/4 and L4/5 (P < 0.001). Narrowing of the foramen occurred in true standing position in 13.4% at L4/L5 and in 26.7% at level L5/S1. No significant differences were observed at the recessus lateralis, the SCCA and the DSCA.
Conclusion. The measurement method in supine and true standing position is excellent for depicting the anatomical regions relevant for spinal canal stenosis in healthy individuals. Measuring the lumbar lordosis angle in both positions is an important requirement for interpreting the relevant anatomical regions. Of particular importance here is the DSCA and the SDSD.
BibTeX:
@article{Mauch2010,
  author = {Mauch, Frieder and Jung, Christian and Huth, Jochen and Bauer, Gerhard},
  title = {Changes in the Lumbar Spine of Athletes From Supine to the True-Standing Position in Magnetic Resonance Imaging},
  journal = {Spine},
  year = {2010},
  volume = {35},
  number = {9},
  pages = {1002--1007

10.1097/BRS.0b013e3181bdb2d3}, note = {G-scan Esaote}, url = {http://journals.lww.com/spinejournal/Fulltext/2010/04200/Changes_in_the_Lumbar_Spine_of_Athletes_From.13.aspx} }
Meakin, J.R., Smith, F.W., Gilbert, F.J. and Aspden, R.M. The effect of axial load on the sagittal plane curvature of the upright human spine in vivo 2008 Journal of Biomechanics
Vol. 41(13), pp. 2850-2854 
article URL 
Abstract: Determining the effect of load carriage on the human spine in vivo is important for determining spinal forces and establishing potential mechanisms of back injury. Previous studies have suggested that the natural curvature of the spine straightens under load, but are based on modelling and external measurements from the surface of the back. In the current study, an upright positional MRI scanner was used to acquire sagittal images of the lumbar and lower thoracic spine of 24 subjects. The subjects were imaged in standing whilst supporting 0, 8 and 16 kg of load which was applied axially across the shoulders using an apron. An active shape model of the vertebral bodies from T10 to S1 was created and used to characterise the effect of load. The results from the shape model showed that the behaviour of the average-shaped spine was to straighten slightly. However, the shape model also showed that the effect of load exhibited systematic variation between individuals. Those who had a smaller than average curvature before loading straightened under load, whereas those who had a greater than average curvature before loading showed an increase in curvature under load. The variation in behaviour of differently shaped spines may have further implications for the effects of load in lifting manoeuvres and in understanding the aetiology of back pain.
BibTeX:
@article{Meakin2008,
  author = {Meakin, Judith R. and Smith, Francis W. and Gilbert, Fiona J. and Aspden, Richard M.},
  title = {The effect of axial load on the sagittal plane curvature of the upright human spine in vivo},
  journal = {Journal of Biomechanics},
  year = {2008},
  volume = {41},
  number = {13},
  pages = {2850--2854},
  url = {http://www.sciencedirect.com/science/article/pii/S0021929008003503}
}
Michael Burdumy, Louisa Traser Marco Vicari, M.W.B.R.J.H.M.Z. and Echternach, M. Comparative Study of a Professional Tenor in a Tilting MR-Scanner - Does Supine Position Change the Configuration of the Vocal Tract? 2012 Proceedings 20th Scientific Meeting ISMRMProceedings 20th Scientific Meeting ISMRM  conference URL 
Abstract: Only recently MR Imaging has been used to investigate movement patterns in the vocal tract during singing. In our study we compare structures of the vocal tract of a professional tenor while either in supine or prone position using a tilting 0.25T MR-Scanner. The tenor was instructed to sing an ascending scale in both supine and prone position. Then, distances between anatomical landmarks were measured in the acquired sagittal images. Our results indicate only minor differences in these distances in respect to posture.
BibTeX:
@conference{Burdumy2012,
  author = {Michael Burdumy, and Louisa Traser, Marco Vicari, Matthias Weigel, Bernhard Richter, Jürgen Hennig, Maxim Zaitsev, and Matthias Echternach},
  title = {Comparative Study of a Professional Tenor in a Tilting MR-Scanner - Does Supine Position Change the Configuration of the Vocal Tract?},
  booktitle = {Proceedings 20th Scientific Meeting ISMRM},
  journal = {Proceedings 20th Scientific Meeting ISMRM},
  year = {2012},
  note = {G-scan Esaote},
  url = {http://www.ismrm.org/12/ep_09.htm}
}
Nath, R.K., Paizi, M., Melcher, S.E. and Farina, K.L. Upright MRI of glenohumeral dysplasia following obstetric brachial plexus injury 2007 Magnetic Resonance Imaging
Vol. 25(9), pp. 1277-1282 
article URL 
Abstract: The purpose of this study was to evaluate the role of upright magnetic resonance imaging (MRI) shoulder scanning in the diagnosis of glenohumeral deformity following obstetric brachial plexus injury (OBPI). Eighty-nine children (ages 0.4 to 17.9 years) with OBPI who have medial rotation contracture and reduced passive and active lateral rotation of the shoulder were evaluated via upright MRI of the affected glenohumeral joint. Qualitative impressions of glenoid form were recorded, and quantitative measurements were made of glenoid version and posterior subluxation. Glenoid version of the affected shoulder averaged -16.8 ± 11.0 degrees (range -55 degrees to 1 degrees), and percentage of the humeral head anterior to the glenoid fossa (PHHA) averaged 32.6 ±16.5% (range, -17.8% to 52.4%). The glenoid form was normal in 43 children, convex in 19 children and biconcave in 27 children. Standard MRI protocols were used to obtain bilateral images from 14 of these patients. Among the patients with bilateral MR images, glenoid version and PHHA were significantly different between the involved and uninvolved shoulders (P<.000). Glenoid version in the involved shoulder averaged -19.0±13.1 degrees (range, -52 degrees to -3 degrees), and PHHA averaged 29.7±18.4% (range, -16.2% to 48.7%). In the uninvolved shoulder, the average glenoid version and PHHA were -5.2±3.7 degrees (range, -12 degrees to -1 degrees) and 47.7±3.0% (range, 43% to 54%), respectively. The relative beneficial aspects of upright MRI include lack of need for sedation, low claustrophobic potential and, most important, natural, gravity-influenced position, enabling the surgeon to visualize the true preoperative picture of the shoulder. It is an effective tool for demonstrating glenohumeral abnormalities resulting from brachial plexus injury worthy of surgical exploration.
BibTeX:
@article{Nath2007,
  author = {Nath, Rahul K. and Paizi, Melia and Melcher, Sonya E. and Farina, Kim L.},
  title = {Upright MRI of glenohumeral dysplasia following obstetric brachial plexus injury},
  journal = {Magnetic Resonance Imaging},
  year = {2007},
  volume = {25},
  number = {9},
  pages = {1277--1282},
  note = {???????},
  url = {http://www.sciencedirect.com/science/article/pii/S0730725X07001403}
}
Neuschwander, T.B., Cutrone, J., Macias, B.R., Cutrone, S., Murthy, G., Chambers, H. and Hargens, A.R. The Effect of Backpacks on the Lumbar Spine in Children: A Standing Magnetic Resonance Imaging Study 2010 Spine
Vol. 35(1), pp. - 
article URL 
Abstract: Study Design. This study is a repeated measures design to measure the lumbar spine response to typical school backpack loads in healthy children. The lumbar spine in this setting was measured for the first time by an upright magnetic resonance imaging (MRI) scanner. Objective. The purpose of this study is to measure the lumbar spine response to typical school backpack loads in healthy children. We hypothesize that backpack loads significantly increase disc compression and lumbar curvature. Summary of Background Data. Children commonly carry school backpacks of 10% to 22% bodyweight. Despite growing concern among parents about safety, there are no imaging studies which describe the effect of backpack loads on the spine in children. Methods. Three boys and 5 girls, age 11 ± 2 years (mean ± SD) underwent T2 weighted sagittal and coronal MRI scans of the lumbar spine while standing. Scans were repeated with 4, 8, and 12 kg backpack loads, which represented approximately 10%, 20%, and 30% body weight for our sample. Main outcome measures were disc compression, defined as post- minus preloading disc height, and lumbar asymmetry, defined as the coronal Cobb angle between the superior endplates of S1 and L1. Results. Increasing backpack loads significantly compressed lumbar disc heights measured in the midline sagittal plane (P < 0.05, repeated-measures analysis of variance [ANOVA]). Lumbar asymmetry was: 2.23°± 1.07° standing, 5.46° ± 2.50° with 4 kg, 9.18° ± 2.25° with 8 kg, and 5.68° ± 1.76° with 12 kg (mean ± SE). Backpack loads significantly increased lumbar asymmetry (P < 0.03, one-way ANOVA). Four of the 8 subjects had Cobb angles greater than 10° during 8-kg backpack loads. Using a visual-analogue scale to rate their pain (0-no pain, 10-worst pain imaginable), subjects reported significant increases in back pain associated with backpack loads of 4, 8, and 12 kg (P < 0.001, 1-way ANOVA). Conclusion. Backpack loads are responsible for a significant amount of back pain in children, which in part, may be due to changes in lumbar disc height or curvature. This is the first upright MRI study to document reduced disc height and greater lumbar asymmetry for common backpack loads in children.
BibTeX:
@article{Neuschwander2010,
  author = {Neuschwander, Timothy B. and Cutrone, John and Macias, Brandon R. and Cutrone, Samantha and Murthy, Gita and Chambers, Henry and Hargens, Alan R.},
  title = {The Effect of Backpacks on the Lumbar Spine in Children: A Standing Magnetic Resonance Imaging Study},
  journal = {Spine},
  year = {2010},
  volume = {35},
  number = {1},
  pages = {--},
  note = {Upright MRI Fonar},
  url = {http://www.united-chiropractic.org/wp-content/uploads/2011/11/Backpacks.pdf}
}
Nicholson, J.A., Sutherland, A.G., Smith, F.W. and Kawasaki, T. Upright MRI in kinematic assessment of the ACL-deficient knee 2012 The Knee
Vol. 19(1), pp. 41-48 
article URL 
Abstract: The ability to quantify in vivo femoro-tibial relations in the knee holds great advantage to further patient care. There is little consensus on the optimal weight-bearing environment and measurement method for MRI assessment of in vivo knee kinematics. This study set out to establish the optimal method of measuring femoro-tibial relations in an upright, weight-bearing environment in normal individuals and those with ACL deficiency. Upright, load bearing, MRI scans of both knees were evaluated by two methods, flexion facet centre (FFC) and femoro-tibial contact point (FTCP), in order to establish femoro-tibial relations in the sagittal plane throughout different angles of knee flexion. A group of healthy volunteers (n = 5) and a group with unilateral ACL insufficiency (n = 8) were studied. Abnormal femoro-tibial relations were found in all ACL-deficient knees (n = 8): the lateral tibial plateau was anteriorly displaced in extension and early flexion and, coupled with smaller changes in the medical compartment, this constitutes internal rotation of the tibia relative to the femur in early flexion. This study found that the FFC measurement technique holds an advantage over the FTCP technique in terms of validity, repeatability and ease of measurements, allowing detection of kinematic changes such as tibial internal rotation in early flexion in ACL-deficient knees in an upright weight-bearing model. We propose that FFC measurement in an upright, weight-bearing position is a reliable and representative tool for the assessment of femoro–tibial movement.
BibTeX:
@article{Nicholson2012,
  author = {Nicholson, Jamie A. and Sutherland, Alasdair G. and Smith, Francis W. and Kawasaki, Taku},
  title = {Upright MRI in kinematic assessment of the ACL-deficient knee},
  journal = {The Knee},
  year = {2012},
  volume = {19},
  number = {1},
  pages = {41--48},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0968016010002127}
}
Niesche, A., Tettke, M., Hochmann, D. and Kraft, M. Numerical evaluation and comparison of instantaneous anatomical knee joint axes and orthotic joint axes using MRI data under weight-bearing condition 2009 IFMBE Proceedings
Vol. 22IFMBE Proceedings, pp. 522-525- 
article URL 
Abstract: This paper presents the numerical methods used for the calculation of the functional axes of the knee joint on different flexion angles with and without knee brace and the axes of the knee brace using MRI data. These methods were developed during a student research project in the framework of the research project “Evaluation of the possibilities of a functional assessment of orthopedic assistive technologies using open MRI” at the Institute of Medical Engineering at the Technical University of Berlin, which is about exemplarily working out methods for determining the congruence of the instantaneous anatomical knee joint axis and a knee orthosis joint axis.
The fully automatically running process for the functional axes estimation comprises a registration using a genetic algorithm and a gradient based method as well as an axis calculation using the helical axis method. The orthosis axes are calculated using MRI sensitive markers attached to the orthosis frame.
The accuracy of the utilized methods and their restrictions were estimated by applying the calculations on test models generated by repeated segmentation of the same knee position transforming the models with given parameters. As a basic restriction a minimum rotation angle about 15° was found to be necessary to produce useful results for functional joint axes, which was found out by other authors as well. The comparison of the calculated axes is expected to allow a conclusion to be drawn about the effect of the knee orthosis on the knee kinematics. Some first results gained from a pilot study with two test persons are presented, however no statistical valid statements can be made based on that. Thus, a further study will be carried out comprising more test persons.
BibTeX:
@article{Niesche2009,
  author = {Niesche, Annegret and Tettke, Martin and Hochmann, David and Kraft, Marc},
  title = {Numerical evaluation and comparison of instantaneous anatomical knee joint axes and orthotic joint axes using MRI data under weight-bearing condition},
  booktitle = {IFMBE Proceedings},
  journal = {IFMBE Proceedings},
  publisher = {Springer Berlin Heidelberg},
  year = {2009},
  volume = {22},
  pages = {522-525--},
  note = {G-scan Esaote},
  url = {http://dx.doi.org/10.1007/978-3-540-89208-3_124}
}
Philip Ward New MRI approach can reveal medial meniscus tears 2012 Auntminnie.com  periodical URL 
BibTeX:
@periodical{Auntminnie2012,
  author = {Philip Ward,},
  title = {New MRI approach can reveal medial meniscus tears},
  journal = {Auntminnie.com},
  year = {2012},
  note = {G-scan Esaote},
  url = {http://www.auntminnieeurope.com/index.aspx?sec=sup&sub=mri&pag=dis&ItemID=607538}
}
Raffaello Sutera, F. Candela and F.Sorrentino G. Polizzi, P.A.M.M. Evaluation of lateral ankle instability with a weight-bearing MRI. Preliminary experience. 2009 conference  
Abstract: "To assess the usefulness of weight-bearing examination of the ankle performed with a dedicated MRI scanner in the assessment of patients with clinical evidence of lateral ankle instabiity. MATERIALS AND METHODS: Retrospective evaluation; 18 patients examined between Sep 2008 and Jan 2009; 0.25 Tesla scanner (G-Scan, Esaote , Genoa, Italy). RESULTS: Conventional supine position: 12/18 patients: partial tear of anterior talo-fibular (ATF) ligament; 3/18 patients: complete tear of ATF ligament and partial tear of calcaneo-fibular (CF) ligament; 3/18 patients: presence of post-traumatic bone oedema without ligament disruption. Weight-bearing position: In 5/12 patients with a partial tear of ATF ligament seen in normal conventional supine position there was instead a complete tear of ATF ligament along with partial tear of CF ligament. Moreover, a subtle partial tear of the plantar fascia was detected in one case, while in the conventional supine position there was evidence only of high-grade plantar fasciitis. CONCLUSION: Imaging the ankle in the weight-bearing position with a new developed MRI scanner is useful to demonstrate complete tears of the ATF ligament that are doubtful or defined as “partial tear” in the normal conventional supine position.
Moreover, in one case the weight-bearing position showed occasionally a partial tear of the plantar fascia, which could have been overlooked if the ankle was imaged only in the supine position."
BibTeX:
@conference{ESSR2009,
  author = {Raffaello Sutera, and F. Candela, and F.Sorrentino, G. Polizzi, P.Cimino, A.Iovane, M. Midiri.},
  title = {Evaluation of lateral ankle instability with a weight-bearing MRI. Preliminary experience.},
  booktitle = {-},
  year = {2009},
  note = {G-scan Esaote}
}
Russell, J.A., Shave, R.M., Yoshioka, H., Kruse, D.W., Koutedakis, Y. and Wyon, M.A. Magnetic resonance imaging of the ankle in female ballet dancers en pointe 2010 Acta Radiol
Vol. 51(6)Acta Radiologica, pp. 655-661 
article DOI URL 
Abstract: Background: Ballet dancers require extreme range of motion of the ankle, especially weight-bearing maximum plantar flexion (en pointe). In spite of a high prevalence of foot and ankle injuries in ballet dancers, the anatomy and pathoanatomy of this position have not been sufficiently studied in weight-bearing. Magnetic resonance imaging (MRI) is a beneficial method for such study.

Purpose: To develop an MRI method of evaluating the ankles of female ballet dancers standing en pointe and to assess whether pathological findings from the MR images were associated with ankle pain reported by the subjects.

Material and Methods: Nine female ballet dancers (age, 21±2.9 years; dance experience, 16±4.1 years; en pointe dance experience, 7±4.9 years) completed an ankle pain visual analog scale questionnaire and underwent T1- and T2-weighted scans using a 0.25 T open MRI device. The ankle was scanned in three positions: supine with full plantar flexion, standing with the ankle in anatomical position, and standing en pointe.

Results: Obtaining MR images of the ballet dancers en pointe was successful in spite of limitations imposed by the difficulty of remaining motionless in the en pointe position during scanning. MRI signs of ankle pathology and anatomical variants were observed. Convergence of the posterior edge of the tibial plafond, posterior talus, and superior calcaneus was noted in 100% of cases. Widened anterior joint congruity and synovitis/joint effusion were present in 71% and 67%, respectively. Anterior tibial and/or talar spurs and Stieda’s process were each seen in 44%. However, clinical signs did not always correlate with pain reported by the subjects.

Conclusion: This study successfully established an ankle imaging technique for ballet dancers en pointe that can be used in the future to assess the relationship between en pointe positioning and ankle pathoanatomy in ballet dancers.

BibTeX:
@article{Russell2010,
  author = {Russell, Jeffrey A. and Shave, Ruth M. and Yoshioka, Hiroshi and Kruse, David W. and Koutedakis, Yiannis and Wyon, Matthew A.},
  title = {Magnetic resonance imaging of the ankle in female ballet dancers en pointe},
  booktitle = {Acta Radiologica},
  journal = {Acta Radiol},
  publisher = {Informa Scandinavian},
  year = {2010},
  volume = {51},
  number = {6},
  pages = {655--661},
  note = {G-scan Esaote},
  url = {http://dx.doi.org/10.3109/02841851.2010.482565},
  doi = {http://dx.doi.org/10.3109/02841851.2010.482565}
}
Saifuddin, A., Blease, S. and MacSweeney, E. Axial Loaded MRI of the Lumbar Spine 2003 Clinical Radiology
Vol. 58(9), pp. 661-671 
article URL 
Abstract: Magnetic resonance imaging is established as the technique of choice for assessment of degenerative disorders of the lumbar spine. However, it is routinely performed with the patient supine and the hips and knees flexed. The absence of axial loading and lumbar extension results in a maximization of spinal canal dimensions, which may in some cases, result in failure to demonstrate nerve root compression. Attempts have been made to image the lumbar spine in a more physiological state, either by imaging with flexion/extension, in the erect position or by using axial loading. This article reviews the literature relating to the above techniques.
BibTeX:
@article{Saifuddin2003,
  author = {Saifuddin, A and Blease, S and MacSweeney, E},
  title = {Axial Loaded MRI of the Lumbar Spine},
  journal = {Clinical Radiology},
  year = {2003},
  volume = {58},
  number = {9},
  pages = {661--671},
  note = {Axial loading device (Dynawell)},
  url = {http://www.sciencedirect.com/science/article/pii/S0009926003002150}
}
Shapiro, L. and Gold, G. MRI of weight bearing and movement 2012 Osteoarthritis and Cartilage
Vol. 20(2), pp. 69-78 
article URL 
Abstract: Summary Conventional, static magnetic resonance imaging (MRI) is able to provide a vast amount of information regarding the anatomy and pathology of the musculoskeletal system. However, patients, especially those whose pain is position dependent or elucidated by movement, may benefit from more advanced imaging techniques that allow for the acquisition of functional information. This manuscript reviews a variety of advancements in MRI techniques that are used to image the musculoskeletal system dynamically, while in motion or under load. The methodologies, advantages and drawbacks of stress MRI, cine-phase contrast MRI and real-time MRI are discussed as each has helped to advance the field by providing a scientific basis for understanding normal and pathological musculoskeletal anatomy and function. Advancements in dynamic MR imaging will certainly lead to improvements in the understanding, prevention, diagnosis and treatment of musculoskeletal disorders. It is difficult to anticipate that dynamic MRI will replace conventional MRI, however, dynamic MRI may provide additional valuable information to findings of conventional MRI.
BibTeX:
@article{Shapiro2012,
  author = {Shapiro, L.M. and Gold, G.E.},
  title = {MRI of weight bearing and movement},
  journal = {Osteoarthritis and Cartilage},
  year = {2012},
  volume = {20},
  number = {2},
  pages = {69--78},
  note = {Upright MRI Fonar},
  url = {http://211.144.68.84:9998/91keshi/Public/File/8/20-2/pdf/1-s2.0-S1063458411003086-main.pdf}
}
Smith, F.W. Dynamic MRI in the seated position increases insight into disease of the lumbar spine. 2007 Nonfusion technologies in spine surgery, pp. 39-48  inbook URL 
BibTeX:
@inbook{Smith2007,
  author = {Francis W. Smith},
  title = {Dynamic MRI in the seated position increases insight into disease of the lumbar spine.},
  journal = {Nonfusion technologies in spine surgery},
  publisher = {Lippincott, Williams&Wilkins},
  year = {2007},
  pages = {39-48},
  note = {Upright MRI Fonar},
  url = {http://books.google.it/books?id=D8u1wSgV6vsC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false}
}
Splendiani A., G.M. Association with Disk Degeneration and Facet joint Osteoarthritis determine Neural Foramina Stenosis on the response to Loading: Preliminary Result Using Dedicated Upright MRI System 2008 conference URL 
Abstract: PURPOSE
Aim of our study was to evaluate the presence of dynamic foraminal stenosis using new low-field dedicated MR system with balancing system that permit to acquire imaging both in recumbent and upright position. We evaluated the relationship between disk degeneration and facet joint osteoartritis with or without thickening of ligamenta flava and dynamic foraminal stenosis
METHOD AND MATERIALS
In a period of 20 months , a total of 53 patients with low back pain (age range was 40-65 years; 27 male, 26 female) were examined with MRI dedicated system (G-scan Esaote, Genova, Italy). Disk appearance on MRI from normal to advanced degeneration, osteoarthritis changes in facet joint, ligamenta flava and dimension of neural foramina were evaluated on both the supine and upright position on the pathological level and at least an other apparently normal one. The modification of lumbar lordosis angle and lumbar sacral angle were also considered. 32 patients have performed plain film examination and 21 TC scan. The modifications of dimension of neural foramina on dynamic MRI study was compared with the presence of disk and facet degeneration using statistical analisis. (McNemara’test).
RESULTS
Our preliminary result show that when the MRI disk appearance was normal (53 level : 35 at L3-L4 and 18 at L2-L3 level), the dimension of neural foramina (NF) did not change from recumbent to the upright position with or without facet osteoartrosis (5/53 cases). The dimension of NF not change in presence of isolated disk alteration (23/53 cases : 18 at L4-L5 and 5 at L5-S1 level) but reduce itself when disk pathology was associated with facet artrosis (30/53cases P < 0.05) . The occult stenosis was more evident when there was thickening of ligamenta flava . In 37/53 cases there was modification of lumbar lordosis angle and lumbar sacral angle.
CONCLUSION
Our preliminary data show that the association between disk pathology and facet osteoartrosis can determine neural foramina occult stenosis. This study suggest that disk degeneration decreases the stiffness and the mobility of the lumbar spine.
CLINICAL RELEVANCE/APPLICATION
Strategies to image the spine under physiological load may improve the clinical diagnosis of radicular pain in the patients with non visible alteration on recumbent MR scan.
BibTeX:
@conference{RSNA2008,
  author = {Splendiani A., Gallucci M.},
  title = {Association with Disk Degeneration and Facet joint Osteoarthritis determine Neural Foramina Stenosis on the response to Loading: Preliminary Result Using Dedicated Upright MRI System},
  booktitle = {-},
  year = {2008},
  note = {G-scan Esaote},
  url = {http://rsna2008.rsna.org/event_display.cfm?em_id=6012385}
}
Sutera, R., Iovane, A., Candela, F., Sorrentino, F., Tortorici, E. and Midiri, M. Valutazione del dolore lombare con RM dedicata in ortostatismo. Esperienza preliminare. 2010 44° Congresso Nazionale SIRM, 11-15 Giugno 2010, Verona, Italia.  conference  
BibTeX:
@conference{SIRM2010,
  author = {Sutera, R. and Iovane, A. and Candela, F. and Sorrentino, F. and Tortorici, E. and Midiri, M.},
  title = {Valutazione del dolore lombare con RM dedicata in ortostatismo. Esperienza preliminare.},
  booktitle = {44° Congresso Nazionale SIRM, 11-15 Giugno 2010, Verona, Italia.},
  year = {2010},
  note = {G-scan Esaote}
}
Sutera, R., Iovane, A., Sorrentino, F., Candela, F., Mularo, V., Tona, G. and Midiri, M. Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers 2010 La radiologia medica
Vol. 115(2)La radiologia medica, pp. 246-260- 
article URL 
Abstract: Purpose. This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR) imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis.

Materials and methods. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients’ history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes.

Results. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal
signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position.

Conclusions. Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position.

Keywords Plantar fascia · MRI · Weight-bearing

BibTeX:
@article{Sutera2010,
  author = {Sutera, R. and Iovane, A. and Sorrentino, F. and Candela, F. and Mularo, V. and Tona, G. and Midiri, M.},
  title = {Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers},
  booktitle = {La radiologia medica},
  journal = {La radiologia medica},
  publisher = {Springer Milan},
  year = {2010},
  volume = {115},
  number = {2},
  pages = {246-260--},
  note = {G-scan Esaote},
  url = {http://dx.doi.org/10.1007/s11547-010-0534-z}
}
Suzuki, F., Fukami, T., Tsuji, A., Takagi, K. and Matsuda, M. Discrepancies of MRI findings between recumbent and upright positions in atlantoaxial lesion. Report of two cases 2008 European Spine Journal
Vol. 17(2)European Spine Journal, pp. 304-307- 
article URL 
Abstract: Two cases of atlantoaxial (A-A) instability that showed different MRI findings between supine and upright positions are presented. The upright MRI represented the findings corresponding to their symptoms. In A-A lesions, conventional MR images taken in the supine position do not always explain the pathophysiological consequences. The MR images taken in the upright position disclose the actual spinal pathophysiology with gravitational effects.
BibTeX:
@article{Suzuki2008,
  author = {Suzuki, Fumio and Fukami, Tadateru and Tsuji, Atsusi and Takagi, Kenji and Matsuda, Masayuki},
  title = {Discrepancies of MRI findings between recumbent and upright positions in atlantoaxial lesion. Report of two cases},
  booktitle = {European Spine Journal},
  journal = {European Spine Journal},
  publisher = {Springer-Verlag},
  year = {2008},
  volume = {17},
  number = {2},
  pages = {304-307--},
  note = {???????},
  url = {http://dx.doi.org/10.1007/s00586-008-0595-z}
}
Tarantino, U., Fanucci, E., Iundusi, R., Celi, M., Altobelli, S., Gasbarra, E., Simonetti, G. and Manenti, G. Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes 2012 Journal of Orthopaedics and Traumatology
Vol. -, pp. 1-8 
article DOI URL 
Abstract: Background
Patients with low back pain frequently demonstrate recumbent magnetic resonance imaging (MRI) alterations not always related to homogeneous clinical symptoms. The purpose of this study was to evaluate and quantify the statistical significance of variations of some anatomical parameters of the lumbosacral spine and reveal occult disc pathologies from recumbent to upright position in patients with acute and chronic low back pain.

Materials and methods
Fifty-seven patients complaining of low back pain (27 women, 30 men) underwent dynamic lumbosacral MRI with a 0.25-T tilting system (G-scan Esaote). We settled five parameters for which variations have been evaluated: lumbosacral angle, lordosis angle, L3–L4 intersomatic disc height, L3–L4 interspinous processes distance, and widest anteroposterior dural sac diameter. Images were obtained in both recumbent and upright positions.

Results
Statistically significant differences [one-way analysis of variance (ANOVA), p = 0.0043] were found between each pair of values of parameters sampled in recumbent and upright positions. In 70 % of patients, on visual qualitative analysis only, an increment of disc protrusions and/or spondylolisthesis was found in the upright position; in three cases, in the upright position only, an interarticular pseudocyst was found.

Conclusions
Dynamic MRI with an open-configuration, low-field tilting MRI system is a feasible and promising tool to study degenerative pathology of the spine. Moreover, in cases of low back pain with negative MRI in the recumbent position or in patients with pain in the upright position only, tilting MRI permits visualization of occult spine and disc pathologies in patients with acute or chronic low back pain.

BibTeX:
@article{Tarantino2012,
  author = {Tarantino, Umberto and Fanucci, Ezio and Iundusi, Riccardo and Celi, Monica and Altobelli, Simone and Gasbarra, Elena and Simonetti, Giovanni and Manenti, Guglielmo},
  title = {Lumbar spine MRI in upright position for diagnosing acute and chronic low back pain: statistical analysis of morphological changes},
  journal = {Journal of Orthopaedics and Traumatology},
  publisher = {Springer Milan},
  year = {2012},
  volume = {-},
  pages = {1-8},
  note = {G-scan Esaote},
  url = {http://dx.doi.org/10.1007/s10195-012-0213-z},
  doi = {http://dx.doi.org/10.1007/s10195-012-0213-z}
}
Traser, L., Burdumy, M., Richter, B., Vicari, M. and Echternach, M. The Effect of Supine and Upright Position on Vocal Tract Configurations During Singing—A Comparative Study in Professional Tenors 2013 Journal of Voice
Vol. --(0), pp. - 
article URL 
Abstract: SummaryIntroduction Previous studies using dynamic real-time magnetic resonance imaging (MRI) to analyze vocal tract configurations in singers are limited by the fact that the image acquisitions were performed in the supine position. The aim of this study was to examine differences of the vocal tract shape in professional tenors between supine and upright positions. Material and Methods The vocal tract profiles of nine professional Western classically trained tenors were analyzed using a rotating MRI scanner (0.25 T). The singers performed sustained tones in an ascending scale from C4 (262 Hz) to A4 (440 Hz) on the vowel /a/ in supine and upright positions, starting in modal register and continuing to their stage voice above passaggio or changing to falsetto register, respectively. Results Many articulators such as lip opening, jaw opening, tongue position, and uvula position were not affected by the subjects' positions. However, the larynx was found to be higher (P less than 0.001) and the jaw more protruded (P &lt; 0.001) for the supine position. The general changes associated with pitch and register were not affected by these systematic differences. Conclusions The effect of supine versus upright position on the vocal tract shape is considered to be rather small in professional tenors. The modifications in the vocal tract associated with register and pitch are not affected to a great extent by the position.
BibTeX:
@article{Traser2013,
  author = {Traser, Louisa and Burdumy, Michael and Richter, Bernhard and Vicari, Marco and Echternach, Matthias},
  title = {The Effect of Supine and Upright Position on Vocal Tract Configurations During Singing—A Comparative Study in Professional Tenors},
  journal = {Journal of Voice},
  year = {2013},
  volume = {--},
  number = {0},
  pages = {--},
  note = {G-scan Esaote},
  url = {http://www.sciencedirect.com/science/article/pii/S0892199712001944}
}
Wang, Y.-C., Jeng, C.-M., Wu, C.-Y., Chang, H.-Y., Huang, Y.-C., Wang, Y.-J. and Wang, P.-C. Dynamic Effects of Axial Loading on the Lumbar Spine During Magnetic Resonance Imaging in Patients with Suspected Spinal Stenosis 2008 Journal of the Formosan Medical Association
Vol. 107(4), pp. 334-339 
article URL 
Abstract: Background Previous studies have shown that axial compression in extension (ACE) of the spine during magnetic resonance imaging (MRI) has revealed unexpected pathological features compared with the conventional psoas-relaxed position (PRP) used in imaging. The purpose of this study was to evaluate the dynamic effect of axial loading on lumbar spinal stenosis using MRI in patients with spinal stenosis. Methods A total of 14 women and 11 men with lumbar spinal stenosis were examined in both PRP and ACE positions. We calculated the dural-sac cross-sectional area (DCSA) to evaluate severity of spinal canal stenosis. DCSA, as well as the dural-sac anteroposterior diameter (DAPD) and dural-sac transverse diameter (DTD) in both positions were measured using a digital image view station. A paired t test determined the differences in DCSA, DAPD and DTD between the two positions at each intervertebral disc level. Results Axial loading increased severity of lumbar spinal stenosis during MRI, as demonstrated by a decrease in DCSA from 20.5% to 6.3% (mean, 11.40 ± 3.66%) between the PRP and ACE positions (p less than 0.01). Significant differences were also noted in DAPD and DTD between the PRP and ACE positions (p &lt; 0.01). A significant correlation was found between the decrease in mean DCSA and that in DAPD and DTD. The decrease in mean DCSA, DAPD and DTD following axial compression was greatest at the L4/5 and L5/S1 levels. Conclusion Axial loading increases severity of lumbar canal stenosis and the effect of axial loading on MRI examination is greatest at the L4/5 and L5/S1 levels.
BibTeX:
@article{Wang2008,
  author = {Wang, Yung-Cheng and Jeng, Chin-Ming and Wu, Chau-Ying and Chang, Hsio-Yun and Huang, Yong-Chien and Wang, Yu-Jen and Wang, Pa-Chun},
  title = {Dynamic Effects of Axial Loading on the Lumbar Spine During Magnetic Resonance Imaging in Patients with Suspected Spinal Stenosis},
  journal = {Journal of the Formosan Medical Association},
  year = {2008},
  volume = {107},
  number = {4},
  pages = {334--339},
  note = {Axial loading device},
  url = {http://www.sciencedirect.com/science/article/pii/S0929664608600959}
}
Weishaupt, D. and Boxheimer, L. Magnetic Resonance Imaging of the Weight-Bearing Spine 2003 Semin Musculoskelet Radiol
Vol. 7(04), pp. 277-286- 
article URL 
Abstract: Weight-bearing magnetic resonance (MR) imaging of the spine can either be simulated by imaging the patient in the supine position in combination with a special axial loading device or be achieved by using vertically open-configuration MR systems, which allow for in vivo MR images of the spine under upright weight-bearing conditions in either seated or standing body positions. Weight-bearing MRI of the spine permits the study of physiological as well as pathological changes in the relationships of the intervertebral disk, the spinal canal, and the neural foramina as well as the assessment of segmental instability in physiologic body positions. With this technique, MR images may be taken in painful body positions so that morphological changes of the intervertebral disk or other spinal structures may be correlated with pain or other symptoms. In selected cases, weight-bearing MRI of the spine may demonstrate clinically relevant neural compromise or foraminal stenosis, which may be occult on conventional MR images obtained in the supine position.
BibTeX:
@article{Weishaupt2003,
  author = {Weishaupt, Dominik and Boxheimer, Larissa},
  title = {Magnetic Resonance Imaging of the Weight-Bearing Spine},
  journal = {Semin Musculoskelet Radiol},
  year = {2003},
  volume = {7},
  number = {04},
  pages = {277-286--},
  note = {General overview},
  url = {https://www.thieme-connect.com/DOI/DOI?10.1055/s-2004-815675}
}
Yan, J., Wang, Y., Liu, X., Li, J., Jin, Z. and Zheng, Z. Vertical weight-bearing MRI provides an innovative method for standardizing Spurling test 2010 Medical Hypotheses
Vol. 75(6), pp. 538-540 
article URL 
Abstract: Summary Although Spurling test, a foraminal compression test, is commonly used in clinical practice in patients with a suspected cervical radiculopathy, its protocol is still obscure. In undergoing this test, patients extend, laterally flex and slightly rotate neck to the symptomatic side, and then a pressure is applied on the top of patient’s head by examiner. The test is scored as positive if it causes pain or tingling that starts in the shoulder and radiates distally to the elbow. But the range of neck motion and level of load are not clearly defined. Magnetic resonance imaging (MRI) has proved to be an excellent method of assessing the situation of cervical intervertebral foramen. Unfortunately the conventional MRI system is not able to fully achieve this goal because it can only examine patient in supine position while Spurling test needs to be performed in a sitting position. Here we hypothesize that vertical weight-bearing MRI provides an innovative method for researching and standardizing the protocols of Spurling test. The result will provide better knowledge of the mechanism of Spurling test. Standardization of the test will improve its sensitivity and rate of reproducibility.
BibTeX:
@article{Yan2010,
  author = {Yan, Jun and Wang, Yi and Liu, Xiaofeng and Li, Jian and Jin, Zhigao and Zheng, Zugen},
  title = {Vertical weight-bearing MRI provides an innovative method for standardizing Spurling test},
  journal = {Medical Hypotheses},
  year = {2010},
  volume = {75},
  number = {6},
  pages = {538--540},
  note = {Upright MRI Fonar},
  url = {http://www.sciencedirect.com/science/article/pii/S0306987710002604}
}
Zou, J., Yang, H., Miyazaki, M., Wei, F., Hong, S.W., Yoon, S.H., Morishita, Y. and Wang, J.C. Missed Lumbar Disc Herniations Diagnosed With Kinetic Magnetic Resonance Imaging 2008 Spine
Vol. 33(5), pp. - 
article URL 
Abstract: Study Design. A novel dynamic magnetic resonance imaging (MRI) system, kinetic MRI (kMRI), was used to study lumbar disc herniations. Objective. The objective of this study was to determine if adding flexion and extension MRI studies to the traditional neutral views would be beneficial in the diagnosis of lumbar disc herniations. Summary of Background Data. Prior studies demonstrate that only 70% of patients with lumbar disc herniations based on physical examinations are confirmed by MRI studies. Recently, kMRI delivers the ability to scan patients in neutral, flexion, and extension positions, which may allow for improved diagnosis of this problem. Methods. Five hundred fifty-three patients underwent kMRI with assessment of the degree of disc bulge in neutral and flexion and extension. The images were analyzed using computer measurement technology to objectively quantify the amount of disc herniation. Results. For patients with normal or <3 mm of disc bulge in neutral, 19.46% demonstrated an increase in herniation to >3 mm bulge in extension, and 15.29% demonstrated an increase to >3 mm bulge in flexion. For patients in the neutral view that had a baseline disc bulge of 3 to 5 mm, 13.28% had increased herniations to >5 mm in extension and 8.47% had increased herniations to >5 mm in flexion. For patients with a baseline disc bulge of 5 to 7 mm in neutral, 10.58% increased in extension and 5.78% increased in flexion. In addition, for patients with a baseline disc bulge of 7 to 9 mm in neutral, 9.09% increased in extension and 4.55% increased in flexion. Conclusion. A significant increase in the degree of lumbar disc herniation was found by examining flexion and extension views when compared with neutral views alone. kMRI views provide valuable added information, especially in situations where symptomatic radiculopathy is present without any abnormalities demonstrated on conventional MRI.
BibTeX:
@article{Zou2008,
  author = {Zou, Jun and Yang, Huilin and Miyazaki, Masashi and Wei, Feng and Hong, Soon W. and Yoon, Seung H. and Morishita, Yuichiro and Wang, Jeffrey C.},
  title = {Missed Lumbar Disc Herniations Diagnosed With Kinetic Magnetic Resonance Imaging},
  journal = {Spine},
  year = {2008},
  volume = {33},
  number = {5},
  pages = {--},
  note = {Upright MRI Fonar},
  url = {http://journals.lww.com/spinejournal/Fulltext/2008/03010/Missed_Lumbar_Disc_Herniations_Diagnosed_With.26.aspx}
}

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