I've had my car for a week, so I can't really comment on the reliability. I'll update it later. I originally went out looking to buy a Toyota Highlander, thinking that was the only SUV that was in my price range, but the deals on the MDX have been crazy so I could easily justify the $5 more I spent on the MDX. This car has everything I wanted. The SH-AWD is awesome, the luxurious interior is really comfortable and has a ton of features and tech (I got the tech package). The voice recognition is way better than my BMW I used to have and it drives much more like a sports car than the RX. I ordered all my accessories off of bernardi acura for way cheaper.
Tech package is definitely worth it. Backup camera, Nav, plays Mp3 cds, XM, power rear door, aux input, really nice speakers, reclining rear seats, memory seats, flip key, voice recognition, bluetooth, phonebook import.
I wish it had keyless entry/ignition like the comfort access on the BMW. Rear sensors to backup would be nice too even though it has a camera.