sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzc Nazalmn / M / 33 yrs.
Referred by : Dr. Abc Xyzrman.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O fall from a train with injury to the back of the head 3 weeks back.
Now C/O giddiness (on turning to the side).

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 Fast Scan (T2 *) coronal images.

OBSERVATION :

There is no focal area of altered signal intensity in the brain parenchyma.

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.

IMPRESSION :

Normal study of the Brain.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz lmn / F / 33 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since the age of 10 years.

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 T2 Weighted and 5 mm thick FLAIR coronal images.

5 mm thick T1 Weighted sagittal images.

Limited 2D PC MRA sequence was obtained.

OBSERVATION :

There is volume loss of the left cerebral hemisphere. Thinning of the cortex of the left cerebral hemisphere is noted, with prominent sulcal spaces. There is resultant mild dilatation of the left lateral ventricle and slight thickening of the skull vault of the left hemicranium, more so in the frontal region. Slight hypertrophy of the left frontal sinus is noted as compared to the right. There is an ill-defined, hyperintense signal on the T2 Weighted and FLAIR images in the subcortical white matter in the left temporo-parieto-occipital region. This signal appears isointense to the normal white matter on the T1 Weighted images. Few similar areas are also seen in the left frontal region.






There is prominence of the cerebellar folia bilaterally, right more than left (? crossed cerebellar diaschisis).

The right lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is mild pull of the midline to the left. The left middle and posterior cerebral arteries appear smaller in calibre when compared to the right.

Inflammatory changes are noted in the right maxillary sinus.

IMPRESSION :

Volume loss of the left cerebral hemisphere with prominent sulcal spaces and mild dilatation of the left lateral ventricle suggest left sided hemiatrophy, most likely the sequelae of a previous vascular insult.

ke/sb/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzo M. Unlmn / M / 29 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 1-2 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 wedging of the L2 vertebral body.

The lumbar vertebrae show slightly hypointense marrow signal on the T1 Weighted images (when compared to normal fatty marrow) which may represent a hematopoeitic marrow.

Small posterior disc bulges with posterior peridiscal osteophytes are seen in the lumbar region. Schmorls nodes are also noted. Bulging of the lumbar discs into the bodies of the lumbar vertebrae is also noted.

The L2-L3 and L3-L4 intervertebral discs show loss of water content.

The remaining intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
Scan-00004


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 :

13.0 mm at L1-L2
11.0 mm at L2-L3
11.0 mm at L3-L4
14.0 mm at L4-L5
15.0 mm at L5-S1.

IMPRESSION :

1. Wedging of the L2 vertebral body.

2. Altered signal in the lumbar vertebrae could be due to hematopoeitic marrow.

3. Small posterior disc bulges with posterior peridiscal osteophytes in the lumbar region with Schmorls nodes.

sb/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzDlmn / M / 39 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O diplopia since 1 month. Similar complaints 1 year back.
C/O giddiness, gait ataxia and change in voice since 5-6 days.

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.

OBSERVATION :

There is an ill-defined, hyperintense signal on the proton, T2 Weighted and FLAIR images in the pons, centrally and more to the right of the midline, extending into the lower midbrain and right cerebral peduncle, superiorly and into the upper medulla on the right, anteriorly. This lesion appears hypointense on the T1 Weighted images.

There is mild fullness of both the lateral ventricles. The third and the fourth ventricles are normal. There is slight prominence of the cerebral cortical sulci and 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.










IMPRESSION :

Altered signal in the pons, extending into the lower midbrain and upper medulla as described, is not specific for a single etiology. Central pontine myelinolysis, demyelination or a neoplasm, may be considered as differential diagnosis.

The possibility of ischemic lesion or a granuloma seems less likely.

A contrast enhanced scan is essential.

Previous CT Scan was not available for review/comparison.

sb/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / F / 17 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Hippocampal Region.

CLINICAL PROFILE :

C/O seizures since the age of 2 months.

EXAMINATION :

M.R.I of the hippocampal region was performed, as requested using the following parameters :

5 mm thick T1 Weighted and FLAIR coronal images.

3 mm thick T2 Weighted coronal images.

5 mm thick T2 Weighted axial images through the brain.

OBSERVATION :

There is a large hypointense area in the right posterior parietal region on the T1 Weighted images. This is seen to follow CSF signal characteristics on the T2 Weighted images. Hyperintense areas are noted at the periphery of this lesion better appreciated on the FLAIR images which would represent areas of gliosis. There is dilatation of the atrium and posterior body of the right lateral ventricle. This lesion would represent an area of cystic encephalomalacia.

Similar smaller areas are seen in the posterior cerebellar hemispheres bilaterally.

The hippocampal complex is unremarkable on either side.







The left 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.

IMPRESSION :

1. Cystic encephalomalacia in the right posterior parietal region.

2. Area of gliosis bilaterally in the cerebellar, posteriorly.

ke/sb/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / M / 39 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O RTA on 00.00.00 with loss of consciousness for 12 hours.
C/O severe headaches since then.

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.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is thickening of the gyri in the left temporal lobe which appear hypointense to normal grey matter on the T1 Weighted images and turn hyperintense on the proton and T2 Weighted images. Few hyperintense areas are noted within this lesion which are seen to turn hypointense on the Fast Scan (T2 *) images with few areas blooming and would represent altered blood. The entire lesion would represent a haemorrhagic contusion.

A similar smaller lesion is seen in the right temporal cortex better appreciated on the FLAIR images.

Small sliver of subdural collection is seen along the right cerebral convexity and the left temporal region. These are hyperintense on all the pulse sequences and represent subacute hematoma.






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 subgaleal contusion/edema in the right fronto-parietal region.

IMPRESSION :

1. A haemorrhagic contusion in the left and right temporal lobes, larger on the left.

2. Very small, subacute subdural hematomas along the right cerebral convexity and the left temporal region.

3. Subgaleal contusion/edema in the right fronto-parietal region.

sb/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyznt Bhlmn / M / 53 yrs.
Referred by : Dr. Abc Xyzmani.
Examination : M.R.I. - Brain (Post-contrast Study).

CLINICAL PROFILE :

C/O left sided seizures since 8-9 months.
H/O injury to the left eye 8 months back for which patient was operated 4 months ago. Now C/O diminished vision in the left eye.

EXAMINATION :

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.

5 mm thick T1 Weighted sagittal images.

5 mm thick FLAIR coronal images were obtained prior to contrast administration.

OBSERVATION :

After administration of contrast, there are very small, disc and rim enhancing lesions in the subcortical white matter in the right posterior parietal and parietal region, right high parietal, parafalcine region, the left parietal, parafalcine region and in the right frontal cortex.

There is mild fullness of both the lateral and third ventricles. The fourth ventricle is normal.

There is no obvious meningeal enhancement noted.






Inflammatory changes are noted in the left maxillary antrum.

IMPRESSION :

Very small, disc and rim enhancing lesions (approximately 7.0 mms in diameter) in the subcortical white matter in the right posterior parietal and parietal region, right high parietal, parafalcine region, the left parietal, parafalcine region and in the right high frontal cortex as described, are not specific for a single etiology. These lesions most likely represent granulomas, probably cysticerci. The possibility of metastases, though less likely cannot be entirely excluded.

sb/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Gonsalmn / M / 65 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with radiating pain to BLE and paresthesias.

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 loss of water content of the lumbar intervertebral discs. Slight retroplacement of the L3 over the L4 and L4 over the L5 vertebrae is noted.

Posteriorly herniated discs with peridiscal osteophytes are noted at the L4-L5 and L3-L4 levels with bilateral neural foraminal narrowing. Slight inferior migration of the disc fragment is noted at the L3-L4 level. There is also facetal hypertrophy at these levels, with resultant canal stenosis.

A small posterior disc herniation with peridiscal osteophytes is noted at the L2-L3 level.

A minimal posterior disc bulge is noted at the L1-L2 level.

Bilateral far lateral disc bulges are seen at the L2-L3 and L3-L4 levels.
Scan-00009


Slight facetal hypertrophy is also noted at the L5-S1 level.

Focal fatty marrow changes are seen in the lumbar region, with Schmorls nodes in the upper and mid lumbar regions.

A probable, right sided conjoint L5 and S1 nerve root is noted.

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 :

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

IMPRESSION :

1. Posteriorly herniated discs with peridiscal osteophytes at the L4-L5 and L3-L4 levels with bilateral neural foraminal narrowing. Slight inferior migration of the disc fragment is noted at the L3-L4 level. Facetal hypertrophy is seen at these levels with resultant canal stenosis.

2. A small posterior disc herniation with peridiscal osteophytes at the L2-L3 level.

3. Slight facetal hypertrophy at the L5-S1 level.

4. A probable, right sided conjoint L5 and S1 nerve root.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Prasad Shlmn / M / 50 yrs.
Referred by : Dr. Abc Xyzrnad.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O paraplegia with severe backache and burning sensation in BLE since 15 days.
C/O bladder involvement since 1 day.

EXAMINATION :

M.R.I of the dorso-lumbar 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.

FEW IMAGES SHOW PATIENT MOTION INSPITE OF SEDATION.

OBSERVATION :

There is an ill-defined, hypointense signal on the T1 Weighted images involving the D10, D12, L2, L3, L5 and S1 vertebral bodies. These lesions appear iso to hyperintense to normal marrow on the T2 Weighted images. There is seen an intermediate signal intensity lesion on the T1 Weighted images in the left lateral and posterior epidural space over the D12 to L4 vertebral levels. This lesion appears hyperintense on the T2 Weighted images. Extension of the soft tissue along the neural foramina in the dorso-lumbar region is noted. Resultant mild cord compression and displacement of the lower dorsal spinal cord anterior and to the right of the midline is noted. The visualized lower dorsal spinal cord shows a hyperintense signal on the T2 Weighted images, suggesting cord edema/ischemia. The thecal sac in the upper and mid lumbar regions also appears slightly compressed. The intrathecal nerve roots in the lumbar region appear clumped, centrally.
..2/.







Small posterior disc bulges are noted at the L3-L4, L4-L5 and L5-S1 levels.

The facet joints at the L3-L4, L4-L5 and L5-S1 levels appear slightly hypertrophied.

The L5-S1 intervertebral disc shows loss of water content.

Screening, T1 Weighted sagittal images of the dorsal and cervical spines reveal altered signal involving the mid dorsal vertebrae and the D2 vertebral body.

IMPRESSION :

Altered signal of the mid dorsal vertebrae, lumbo-sacral vertebrae and the D2 vertebral body as described is not specific for a single etiology. These lesions may represent round cell tumor, metastases or multifocal tuberculosis.

Left lateral and posterior epidural soft tissue lesion over the D12 to L4 vertebral levels may represent soft tissue extension of the lesion/granulation tissue. There is resultant compression of the lower dorsal spinal cord with cord signal alteration suggesting cord edema/ischemia.

sb/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzqbal Anlmn / M / 17 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since 5 years.

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 seen an ill-marginated, hypointense lesion on the T1 Weighted images in the cortex and subcortical white matter in the left posterior parietal region. This lesion appears hyperintense on the proton and T2 Weighted images. There is no perilesional edema. Resultant mild focal fullness of the atrium of the left lateral ventricle is noted.

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

Inflammatory changes are noted in the maxillary sinuses and ethmoidal air cells bilaterally.







IMPRESSION :

Altered signal in the cortex and subcortical white matter in the left posterior parietal region, most likely represent gliotic/encephalomalacic changes, probably the sequelae of a previous vascular insult.

The possibility of it being an infective process is less likely.

A contrast enhanced scan would be worthwhile.