hs/sb/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyza Anlmn / F / 43 yrs.
Referred by : Dr. Abc Xyzlkaka.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache and pain radiating to the RLE with paresthesias since 6 months.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is mild forward listhesis of the L3 over the L4 vertebra.

A postero-central disc herniation is seen to indent the thecal sac at the L3-L4 level. There is a posterior disc bulge at the L4-L5 level.

The L3-L4 and L4-L5 facet joints show hypertrophic degenerative changes. The L1-L2, L2-L3 and L5-S1 facet joints show degenerative changes. Effusion is noted within the facet joints bilaterally at the L3-L4 level and on the right side at the L2-L3 and L4-L5 levels.

Ligamentum flavum hypertrophy is seen at the L3-L4 and L4-L5 levels. A small well circumscribed lesion which is hypointense on the T1 Weighted images and turns heterogeneously hyperintense on the T2 Weighted images is seen within the right posterior epidural space at the L3-L4 level and this may represent a synovial cyst.


The lumbar intervertebral discs show loss of water content.

The lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

18.0 mm at L1-L2
16.0 mm at L2-L3
14.0 mm at L3-L4
13.0 mm at L4-L5
12.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. Mild forward listhesis of the L3 over the L4 vertebra.

2. A postero-central disc herniation at the L3-L4 level.

3. Hypertrophic facetal arthropathy at the L3-L4 and L4-L5 levels.

4. Facetal arthropathy at the L1-L2, L2-L3 and L5-S1 levels.

5. Ligamentum flavum hypertrophy at the L3-L4 and L4-L5 levels

6. A probable synovial cyst within the right posterior epidural space at the L3-L4 level.

ke/bv/nl/rg.
d Date : 00.00.00

Name of the Patient : Abc Xyza lmn / F / 20 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O weakness and tremors in the RUE and RLE since 6-8 months.
H/O fall 1 year back.
H/O menstrual irregularity.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

5 mm thick FLAIR and Fast Scan (T2 *) coronal images.

OBSERVATION :

There is no focal area of altered signal intensity in the brain parenchyma. (Hyperintense signal seen on the proton images in the medulla on the left side se/im 103/3 is artifactual).

Both the lateral, third and the fourth ventricles are normal. There is prominence of the cerebellar folia bilaterally. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study. Slow flow is identified in the left transverse and sigmoid sinuses.

Incidental note is made of a Thornwaldts cyst.

IMPRESSION :

Cerebellar atrophy.

ke/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzn Suklmn / M / 43 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

C/O cervical polyradiculopathy with proximal weakness of BUE and BLE and wasting of the right shoulder. Also C/O radicular pain in BLE.

EXAMINATION :

M.R.I of the cervical spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.

OBSERVATION :

There is loss of normal cervical curvature and loss of water content of the cervical intervertebral discs.

There is a large posterior disc herniation at the C4-C5 level with posterior peridiscal osteophytes and anterior compression of the cord. The spinal cord at this level shows a hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images. This is isointense to the cord on the T1 Weighted images suggestive of cord edema/ischemia.

A posterior disc herniation with a peridiscal osteophytes is seen at the C5-C6 level with right neural foraminal narrowing.

Left postero-lateral disc herniation with peridiscal osteophytes are noted at the C6-C7 and C7-D1 levels.



The cervical vertebral bodies show normal signal intensity. The joints of Luschka and the visualized pre and paravertebral soft tissues are unremarkable.

The atlanto-axial region and the cervico-medullary junction are unremarkable.

The vertebro-basilar system is dolichoectatic.

The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images and which show a posterior disc herniation with peridiscal osteophytes at the L5-S1 level and indentation upon the foraminal portion of the right L5 nerve root. A small posterior disc bulge is also noted at the L4-L5 level.

IMPRESSION :

The MRI features are suggestive of :

1. A large posterior disc herniation with posterior peridiscal osteophytes at the C4-C5 level with cord signal alteration at this level suggestive of cord edema/ischemia.

2. A posterior disc herniation with a peridiscal osteophytes at the C5-C6 level with right neural foraminal narrowing.

3. Left postero-lateral disc herniations with peridiscal osteophytes at the C6-C7 and C7-D1 levels.

ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc XyzMalmn / F / 60 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

Known C/O multiple myeloma.
C/O weakness of BLE (left more than right), backache, herpes and retention of urine since 3-4 days.

EXAMINATION :

M.R.I of the dorsal spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is replacement of the normal marrow of the right lamina and spinous process as well as the right transverse process of the D4 and D5 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hypointense on the T2 Weighted images. A large posterior epidural lesion is seen extending over the D4 and the D5 levels which is seen to displace and compress the spinal cord anteriorly. The spinal cord at these levels shows a hyperintense signal on the T2 Weighted images and is isointense to the cord on the T1 Weighted images suggestive of cord edema/ischemia/myelitis.

There is slight wedging of the D8 vertebral body. Hypointense areas are also noted within the D2, D3, D7 and D8 vertebrae on the T1 Weighted images.

The rest of the visualized dorsal vertebral bodies reveal spotty changes. The intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
..2/.








The conus medullaris terminates at the L1 level.

The lumbo-sacral spine was screened with 5 mm thick T1 Weighted sagittal images and which show anterior wedging of the L3 vertebral body. Few hypointense areas also noted in the lower dorsal and lumbar vertebrae.

IMPRESSION :

In a known C/O multiple myeloma, the MRI features are suggestive of the pathologic process involving the D4 and D5 vertebral bodies with extensions and cord compression and cord edema/ischemia/myelitis as described. Also seen is involvement of the D2, D3, D7 and D8 vertebral bodies.

ke/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzin Rodrilmn / M / 14 mnths.
Referred by : Dr. Abc Xyzubchandani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O high grade fever since 00.00.00.
C/O seizures on 00.00.00 with weakness of the LUE since 00.00.00.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

5 mm thick FLAIR coronal images.

5 mm thick T1 Weighted sagittal images.

SOME IMAGES SHOW PATIENT MOTION INSPITE OF SEDATION.

OBSERVATION :

There is no area of abnormal signal intensity in the brain parenchyma. Hyperintense areas seen in the posterior parietal regions represent terminal areas of myelination.

There is fullness of both the lateral ventricles. The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

Fullness of both the lateral ventricles.

If meningitis is strongly suspected clinically, a CSF examination/contrast enhanced scan would be worthwhile.

ke/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzar Khlmn / M / 5 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

3 mm thick T1 Weighted and T2 Weighted coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is no abnormal area of altered signal intensity in the brain parenchyma. Hyperintense areas seen within both parietal regions represent terminal areas of myelination (scan 102.13).

The hippocampal complex is unremarkable on either side.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Incidental note is made of enlarged adenoids.

IMPRESSION :

Normal study of the Brain.

ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzik Nlmn / M / 1 1/2 yrs.
Referred by : Dr. Abc Xyzwant.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O TB Meningitis with hydrocephalus.
A V.P.Shunt was placed 15 days ago.

EXAMINATION :

M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.

5 mm thick T2 Weighted and FLAIR coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

The pons and the lower portion of the medulla appear swollen. A lesion which is hypointense to the white matter on the T1 Weighted images is seen in the pons on the right side anteriorly and which is seen to turn hyperintense on the proton, T2 Weighted and FLAIR images. Hyperintense areas are also noted extending into the right middle cerebellar peduncle and the lower portion of the midbrain. Hypointense areas on the T2 Weighted and Proton images are seen within the lesion in the pons with a probable exophytic component. The fourth ventricle is slightly reduced in its antero-posterior dimension.

An intermediate signal intensity is seen within the aqueduct on the T1 Weighted images which is heterogeneously hyperintense on the proton and T2 Weighted images.



- 2 - Scan-00006


There is severe dilatation of the third and both the lateral ventricles with periventricular hypointensities (CSF ooze). There is resultant thinning of the corpus callosum. A ventriculostomy tube is seen to traverse from the right posterior parietal region superior to the body of the right lateral ventricle and extending anteriorly into the frontal parafalcine region.

A hypointense area is seen in the tip of the frontal horn of the right lateral ventricle (scans 103.10) on the T1 Weighted images and which is seen to bloom on the proton and T2 Weighted images and may represent air.

There is mild prominence of the cerebellar folia bilaterally.

IMPRESSION :

1. Post-shunt status with a ventriculostomy tube seen to traverse from the right posterior parietal region superior to the body of the right lateral ventricle with the tip in the right frontal parafalcine region.

2. Altered signal in the pons is not specific for a single etiology ? granulomas (? neoplastic process like an
astrocytoma)

3. ? debris ?? haemorrhage ? exudates in the aqueduct with severe dilatation of both the lateral and the third ventricles.

A contrast enhanced scan would be worthwhile.

ke/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzBlmn / M / 75 yrs.
Referred by : Dr. Abc Xyzmdar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE since 5-6 months with burning sensation.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.
5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is partial sacralization of the L5 vertebra and the L5 vertebra is as marked on the film.

There is reduction in height of the L4-L5 intervertebral disc and loss of water content of the lumbar intervertebral discs.

A posterior disc herniation with posterior peridiscal osteophytes is seen at the L4-L5 level with anterior indentation of the thecal sac and bilateral neural foraminal narrowing and indentation upon the foraminal portion of the L4 nerve roots. The thecal sac appears triangular in shape. The L4-L5 facet joints show degenerative changes, right more than left. Mild ligamentum flavum hypertrophy is noted at the L5 level.

A small posterior disc herniation with peridiscal osteophytes is seen at the L3-L4 level with bilateral far lateral disc bulges. A left far lateral disc bulge is noted at the L2-L3 level.

Anterior disc herniations with peridiscal osteophytes are seen at the D11-D12, D12-L1, L1-L2 and L2-L3 levels.
..2/.





The lumbar facet joints show degenerative changes.

There is replacement of the normal marrow of the D11 and D12 vertebral bodies by hypointense areas on the T1 Weighted images which are seen to turn hyperintense on the T2 Weighted images. This may represent marrow edema/Type I degenerative changes.

Type II degenerative changes are noted in the L4 and L5 vertebrae adjacent to the L4-L5 intervertebral disc and the L3 vertebral body adjacent to the L2-L3 disc.

The rest of the lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12 level and the thecal sac terminates at the S2 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

11.0 mm at L1-L2
10.0 mm at L2-L3
8.0 mm at L3-L4
6.0 mm at L4-L5
9.0 mm at L5-S1.

IMPRESSION :

1. A posterior disc herniation with posterior peridiscal osteophytes at the L4-L5 level with indentation upon the foraminal portion of the L4 nerve roots with the L4-L5 facet joints showing degenerative changes, right more than left, with tight lumbar canal.

2. A small posterior disc herniation with peridiscal osteophytes at the L3-L4 level and bilateral far lateral disc bulges at this level.

3. Degenerative changes of the lumbar facet joints.

hs/ke/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Salmn / F / 19 yrs.
Referred by : Dr. Abc Xyztel.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

C/O backache with fever since 4 months with weakness of BLE since 6-7 days.

EXAMINATION :

M.R.I of the dorsal spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

6 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is near complete collapse of the D5 vertebral body. Also seen is anterior wedging of the D4 vertebral body.

Areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted images are seen to involve the D1 to the D7 vertebral bodies and the pedicles of the D3, D4 and D5 vertebrae. The D10 vertebral body also shows subtle hypointense signal on the T1 Weighted images. There is also involvement of the D4-D5 and D5-D6 intervertebral discs.

There is extension of this pathologic process into the anterior epidural space over the D3 to D6 vertebral levels with resultant cord compression. The cord over these levels shows a hyperintense signal on the T2 Weighted images suggestive of cord edema/ischemia/myelitis.






This pathologic process is also seen to extend into the pre and paravertebral soft tissues over the D1 to the D7 vertebral levels. This lesion is seen to be hypointense with a hyperintense rim on the T1 Weighted images and hyperintense with a hypointense rim on the T2 Weighted images and most likely represents an abscess. Also seen is involvement of the costo-vertebral and costo-transverse joints at the D4, D5 and D6 vertebral levels.

The rest of the visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.

The lumbo-sacral spine was screened with 4 mm thick T1 Weighted sagittal images and is unremarkable.

IMPRESSION :

The MRI features are suggestive of a pathologic process involving the D1 to the D7 vertebral bodies and D4-D5 and D5-D6 intervertebral disc with extensions and cord edema/isclmn / Myelitis as described. This most likely represents an infective etiology like tuberculosis.

The possibility of this being a neoplastic process like a small cell tumor is less likely.

hs/ke/rg/nl.
s Date : 00.00.00

Name of the Patient : Abc Xyzanglmn / M / 71 yrs.
Referred by : Dr. Abc Xyzauhan.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (left more than right) with numbness in the LLE.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

Posterior disc herniations are seen to indent the thecal sac and narrow both neural foramina at the L3-L4 and L4-L5 levels. A disc portion is seen to lie within the left lateral recess of the L4 vertebra with resultant impingement of the traversing left L4 nerve root.

A postero-central disc herniation is seen to indent the thecal sac at the L5-S1 level.

Bilateral far lateral (extraforaminal) disc herniations are noted at the L3-L4 level. Bilateral far lateral (extraforaminal) disc bulges are noted at the L2-L3 and L4-L5 levels.

The L4-L5 and L5-S1 facet joints show severe hypertrophic degenerative changes. Mild hypertrophic degenerative changes of the facet joints are noted at the L1-L2, L2-L3 and L3-L4 levels. There is ligamentum flavum hypertrophy at the L5 level.

- 2 - Scan-00003


The lumbar intervertebral discs show loss of water content. The lumbar vertebral bodies show spotty areas of fatty replacement of normal marrow suggestive of osteoporotic changes.

A cortical cyst is noted at the superior pole of the right kidney.

The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12-L1 level and the thecal sac terminates at the S1 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

11.0 mm at L1-L2
11.0 mm at L2-L3
9.0 mm at L3-L4
12.0 mm at L4-L5
10.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. Posterior disc herniations at the L3-L4 and L4-L5 levels with canal stenosis at these levels. A disc portion is seen to lie within the left lateral recess of the L4 vertebra with resultant impingement of the traversing left L4 nerve root.
..3/.









- 3 - Scan-00003



2. A postero-central disc herniation at the L5-S1 level.

3. Bilateral far lateral (extraforaminal) disc herniations at the L3-L4 level.

4. Severe hypertrophic facetal arthropathy at the L4-L5 and L5-S1 levels.

5. Mild hypertrophic facetal arthropathy at the L1-L2, L2-L3 and L3-L4 levels.