I saw three lumbar cases this week where a 0.6T upright MRI and axial-loaded sequences exposed L4–5 foraminal stenosis that appeared mild on standard 1.5T supine. For those doing this regularly, which protocols are giving you the best diagnostic yield — axial-loaded supine with 10–15% body weight compression, or true weight-bearing with thin-slice 3 mm sagittals and foraminal obliques?
10–15% body weight compression, or true weight-bearing with thin-slice 3 mm sagittals and foraminal obliques? I get more positives with 15% axial-loaded supine if I keep them in slight extension and grab the foraminal obliques first within the first minute of loading; if their pain is flexion-relieved, I’ll switch to upright neutral…
Short answer from my side: I’m seeing the same pattern — one concrete thing that helped was writing down the exact handoff and timebox it to 15–20 min. Does that match what you’re running into?
We’ve gotten better yield with 15% axial-loaded supine when we pre-load for 3–4 minutes before the scan; the “creep” turns a ‘mild’ L4–5 into clear foraminal impingement surprisingly often. True weight-bearing still wins with low‑grade listhesis or facet-driven narrowing, but motion trashes thin slices, so we use a small sacral wedge for slight extension and keep sequences short.
One thing that’s been clutch for us: on the 0.6T upright we put them in slight extension and run a 3D T2 (1 mm iso) so we can reformat true foraminal obliques — L4–5 that looks ‘mild’ supine becomes obvious. @msmith77 if time’s tight, 3 mm oblique sagittals with fat-sat plus a knee wedge and hand rests to steady them gets 80% of the answer. Motion blur on these thin slices, , drives me nuts.