MRI evaluation of spine abnormalities in the supine position and under physiological load in athletes with a dedicated MR scanner

Purpose of our study was to evaluate the behavior of the lumbar spine of young athletes in the supine and standing position, taking into account all postural changes that the spine undergoes during physiological load, any alterations and any discrepancies in the detection of pathology between the two positions. Between August 2008 and October 2009, we evaluated 40 sportsman (20 men and 20 women) with symptoms of lumbar pain. All subjects underwent MRI with a dedicated scanner of 0.25 Tesla (G-Scan, Esaote Biomedica, Genoa, Italy) either in the conventional supine position, either in the weight-bearing position. Spin echo T1w and fast spin echo T2w images were acquired with a dedicated receiving coil for the lumbar spine (group B). Three radiologists, blinded on history and clinical examination of subjects, assessed, in consensus, variations of lumbar lordosis angle, of lumbo-sacral angle and presence of pathology on images acquired in both positions, in different sequences and in different planes. Conventional supine MRI was positive for pathology 30/40 while weight-bearing MRI was positive in 39/40 respectively. In particular, the evaluation in the weight-bearing position allowed, in 9 cases to detect diseases that would have remained unrecognized if the evaluation had been performed only in the supine position. Compared to MRI in the supine position, weight-bearing MRI showed changes of the lumbo-sacral angle in 31/40 subjects and of lumbar lordosis angle in all 40 subjects. Imaging the lumbar spine in weight-bearing position with a dedicated MRI scanner and a dedicated coil might allow identification of pathology that may be overlooked if imaging patients only in the supine position.