Upright / positional MRI

Upright/positional magnetic resonance imaging (uMRI) was first reviewed by the HTA program in 2007.

  • In 2012, a review of uMRI medical literature was conducted to determine if newly available evidence published since 2007 was likely to change the original coverage decision. The technology was not selected for rereview.

Status: Decision completed

Policy context

Upright/positional magnetic resonance imaging (uMRI) is a diagnostic imaging technology that permits multiple positions and weight bearing images. There is high concern over diagnostic accuracy leading to poor or worse diagnosis and inappropriate care, especially compared with traditional MRI technology. Imaging technology utilization is standard for multiple, common conditions including shoulder, knee, and spinal injuries and pain.

Primary criteria ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = Medium
Documents (all assessments)

Update literature (2012)

Documents (2007 assessment)

Background

Standard, supine magnetic resonance imaging (MRI) is a widely used diagnostic method for evaluation of many musculoskeletal conditions, particularly to visualize soft tissue structures that are difficult to image with traditional radiographs and CT. MRI imaging requires patients to remain motionless for extended periods of time, although systems with more powerful magnets shorten the imaging time required. Standard, recumbent MRI (rMRI) systems also generally require that the patient be recumbent while sectional images are acquired. The patient lies on a bed that is moved through a magnetic field in order obtain sequential images. Standard rMRI systems employ magnets with the strength of 1.0-3.0 Tesla(T). Magnet strength is a major factor related to image quality and resolution as well as speed of image acquisition. Upright and positional MRI (uMRI) is a magnetic resonance imaging test designed to be preformed with patients in weight bearing or different positions, (e.g. upright, sitting, standing, flexed or extended). Current alterative imaging tests used to diagnose spinal and other joint conditions are a regular MRI (lying down), Computerized Tomography (CT) myelogram, regular or flexion and extension radiographs (x-rays), and discography.

The potential advantage of a uMRI is that the weight bearing or positional images may capture additional findings. Also, the open MRI equipment may improve patient compliance by combating the claustrophobia of traditional MRI scanners and enhance patient comfort. Potential disadvantages are that weight bearing and different positions can cause patient pain and result in an inability to complete the test; and the magnet strength, which determines image quality, of a uMRI is lower (o.6T for uMRI compared to a standard MRI range of 1.0T to 3.0T).

The potential impact on the health system is unknown. Potential benefits may include: more accurate findings, reduced reliance on other tests, and more appropriate treatments and better health outcomes. Potential risks are that lower quality images, less accurate findings, or more findings without an understanding of clinical significance lead to additional or unnecessary tests, inappropriate treatment, and poorer health outcomes.