ke/sb/rg/nl
Date : 00.00.00

Name of the Patient : Abc XyzMalmn / M / 91 yrs.
Referred by : Dr. Abc Xyz Parekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with paresthesias since 5 months.
H/O fall 30 years back with ? fracture of L1.

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 anterior wedging of the L1 vertebral body which shows fatty marrow changes.

There is a left paracentral disc herniation at the D12-L1 level.

Small posterior disc herniations are noted at the L1-L2, L2-L3 and L5-S1 levels. Small posterior disc bulges are noted at the L3-L4 and L4-L5 levels. The lumbar intervertebral discs show loss of water content.

Posterior peridiscal osteophytes are noted at the D12-L1, L1-L2 and L2-L3 levels.

Facetal arthropathy is seen at the L4-L5 and L5-S1 levels.





The rest of the lumbar vertebral bodies reveal normal signal intensity. The remaining facet joints and 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 :

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

IMPRESSION :

1. A left paracentral disc herniation at the D12-L1 level.

2. Small posterior disc herniations at the L1-L2, L2-L3 and L5-S1 levels.

3. Small posterior disc bulges at the L3-L4 and L4-L5 levels.

4. Facetal arthropathy at the L4-L5 and L5-S1 levels.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Anlmn / M / 32 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

C/O paresthesias in BLE since 2 days.
C/O retention of urine since 3 days.
H/O fever +.

EXAMINATION :

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

5 mm thick T1 Weighted and T2 Weighted sagittal images.
9 mm thick T1 Weighted axial images and 8 and 9 mm thick T2 Weighted axial images.

OBSERVATION :

There are ill-defined, hyperintense areas on the T2 Weighted images, in the cervical spinal cord, centrally, extending over the D1 to D11-D12 levels. This lesion appears iso to hypointense to normal cord on the T1 Weighted images. Focal areas of patchy altered signal are also noted at the L1, C6 and C2 to C4 vertebral levels.

The visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

There is no cord compression.

The conus medullaris terminates at the L1 level.

IMPRESSION :

Altered signal in the dorsal spinal cord over the D1 to D11-D12 levels with patchy altered signal at the L1, C6, C2 to C4 levels as described, is not specific for a single etiology. Myelitis/demyelination are likely possibilities. Ischemic lesions seems less likely.

ke/sb/rg/nl
Date : 00.00.00

Name of the Patient : Abc XyzMehta lmn / F / 33 yrs.
Referred by : Dr. Abc Xyzaubal.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

Known C/O Potts spine with psoas abscess since 00.00.00. On AKT.
C/O backache radiating to the LLE with paresthesias and limp.
H/O fever since 2 weeks.

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.

6 mm thick T1 Weighted coronal images.

OBSERVATION :

There is anterior wedging of the L1 vertebral body with mild angular kyphus at that level.

There is replacement of the normal marrow of the D12, L1 and the left antero-lateral margin of the L2 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. The superior and inferior cortical endplate of the L1 and D12 vertebral bodies are breached with involvement of the D12-L1 intervertebral disc. There is minimal prevertebral soft tissue extension at the D12 and L1 levels. There is bilateral paravertebral soft tissue extension, more on the left side, with involvement of the psoas muscle. The psoas muscle on the left side appears bulky and the lesion is seen to extend into the
Scan-00007



pelvis. These lesions are slightly hyperintense to muscle on the T1 Weighted images and turn hyperintense on the T2 Weighted images with presence of septae and would represent abscess formation. Minimal anterior epidural extension is seen at the D12-L1 level.

The rest of the visualized dorso-lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.

The visualized dorso-lumbar spinal cord reveals normal signal intensity. There is no cord compression.

The conus medullaris terminates at the L1-L2 level.

Focal fatty marrow change is noted in the L5 body and right pedicle, ?? due to previous infective focus and subsequent healing.

IMPRESSION :

In a known C/O Potts spine, the MRI features are suggestive of altered signal of the D12, L1 and L2 vertebral bodies with involvement of the D12-L1 intervertebral disc with extensions as described. A large left psoas abscess is noted extending from about the D12 vertebral level, into the pelvis.

As compared to the previous MRI dated 00.00.00, there is no significant change noted.

ke/sb/rg.
Date : 00.00.00

Name of the Patient : Abc XyzP. Dlmn / M / 74 yrs.
Referred by : Dr. Abc Xyzlkaka.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

H/O right hemiparesis in December 0000 which has recovered.
C/O weakness on the left side with speech disturbances and memory impairment since 15 days.
Known diabetic. On Rx.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images.

Intracranial and neck MRA were performed with 3D TOF and 2D TOF sequences, respectively.

OBSERVATION :

There is a hypointense area in the right lentiform nucleus extending into the right corona radiata on the T1 Weighted images which is seen to turn hyperintense on the T2 Weighted images and would represent an old infarct.

There is mild dilatation of both the lateral and the third ventricles. The fourth ventricle is normal. There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

The basal cisternal spaces are prominent. There is no shift of the midline structures.

INTRACRANIAL MRA :

The right vertebral artery is hypoplastic.

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar, left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.
..2/.



- 2 - scan-00006


NECK MRA :

The right vertebral artery in the neck also appears hypoplastic.

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

An old infarct in the right lentiform nucleus extending into the right corona radiata.

No significant abnormality is detected on the intracranial and neck MRA on this study.

ke/sb/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzar Klmn / M / 12 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures (2 episodes in 3 months) and headaches since 4 years.
H/O trauma 2 1/2 months back.

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.

OBSERVATION :

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

The hippocampal complex on either side is unremarkable.

A well-defined, extra-axial lesion is seen in the superior cerebellar cistern following CSF signal characteristics on all the pulse sequences and most likely represents an arachnoid cyst.

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 :

An extra-axial, CSF intensity lesion in the superior cerebellar cistern most likely represents an arachnoid cyst.

No other significant abnormality is detected on this study.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzBalmn / F / 44 yrs.
Referred by : Dr. Abc Xyzralay.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE since 15 days.
H/O backache radiating to the LLE with paresthesias in March 0000. Spinal surgery done on 00.00.00. Details not available.

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 (with fat saturation) axial images.

OBSERVATION :

There is slight retrolisthesis of the L5 vertebra over the S1 vertebra.

There is evidence of operative intervention in the soft tissues in the posterior lumbar region at L5 and S1 vertebral levels. There is effacement of the fat planes around the paraspinal muscles on the left at the S1 vertebral level. There is seen an approximately 3.0 x 3.8 x 4.0 cms sized well-marginated, intermediate signal intensity mass lesion on T1 Weighted images in the soft tissues in the posterior lumbar region within the subcutaneous fat in the midline, extending over the L5 and S1 vertebral levels. This lesion appears hyperintense on the T2 Weighted images. A focal, hyperintense signal on T1 Weighted images is noted within this lesion, which appears hypointense on the T2 Weighted images. This lesion probably tracks upto the spinal canal at the L5-S1 level.

There is still seen a posterior disc extrusion with peridiscal osteophyte at the L5-S1 level with anterior indentation of the thecal sac. There is inferior migration of the disc fragment with indentation upon the traversing S1 nerve roots (left more than right). Intermediate signal in the left lateral and posterior epidural space at the L5-S1 level may represent scar tissue. The L5-S1 facet joints show mild degenerative changes with slight effusion on the right side. There is bilateral neural foraminal narrowing at this level.

A postero-central disc herniation is noted at the L4-L5 level with anterior indentation of the thecal sac. The L4-L5 facet joints also show mild degenerative change.

Anterior disc herniations are noted at the L1-L2, L2-L3, L3-L4 and L5-S1 levels. The L4-L5 and L5-S1 intervertebral discs show loss of water content.

Type II degenerative changes are seen in the L5 and S1 vertebrae adjacent to the L5-S1 intervertebral disc and at the antero-superior aspect of the L3 and L4 vertebral bodies.

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

A cortical renal cyst is noted on the left side.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.
..3/.












- 3 - Scan-00004

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

14.0 mm at L1-L2
14.0 mm at L2-L3
14.0 mm at L3-L4
9.0 mm at L4-L5
9.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. Post-operative status.

2. An approximately 3.0 x 3.8 x 4.0 cms sized mass lesion in the posterior subcutaneous fat at the L5 and S1 levels as described most likely represents a posterior collection/abscess, in the given clinical setting. Altered signal intensity lesion within this collection may represent fat globules.

3. A posterior disc extrusion with peridiscal osteophytes at the L5-S1 level with inferior migration of the disc fragment and indentation on the traversing S1 nerve roots (left more than right) with mild facetal arthropathy at this level.

3. A postero-central disc herniation at the L4-L5 level with mild facetal arthropathy at this level.

4. Probable scar tissue in the thecal sac at the L5-S1 level.

As compared to the previous MRI (scan no.00009) dated 00.00.00, the patient is now status post-operative. There is however no significant change in the degree of disc herniation at the L4-L5 and L5-S1 levels.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzankar Slmn / M / 62 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O pain and swelling over the left side of face with diminished vision on the left side, tinnitus and decreased hearing on the left side since 3 months.
H/O pulmonary kochs since 1 1/2 months. On AKT since then.
Known diabetic.

EXAMINATION :

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

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

4 mm thick T1 Weighted and STIR coronal images.

5 mm thick T1 Weighted sagittal images.

MR cisternogram was obtained in the coronal plane.

OBSERVATION :

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

There is seen an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the left cavernous sinus, extending anteriorly upto the left orbital apex and extending inferiorly into the pterygopalatine fossa and via the pterygomaxillary fissure into the left infratemporal fossa. This lesion turns heterogeneously hyperintense (predominantly hypointense) on the T2 Weighted and STIR images. Hyperintense signal is however identified along the fat planes in the left infratemporal fossa, on the T2 Weighted and STIR images. The cavernous segment of the left internal carotid artery shows normal flow signal. The visualized left optic nerve also shows normal signal characteristics.
..2/.





Inflammatory changes are noted in the left maxillary sinus, left anterior ethmoidal air cells and in the mastoid air cells on the left. The left inferior nasal turbinate is not well identified.

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

Small lymphnodes are noted in the upper cervical region deep to the sternocleidomastoid muscles bilaterally.

IMPRESSION :

Altered signal intensity lesion in the left cavernous sinus, extending anteriorly upto the left orbital apex and inferiorly into the pterygopalatine fossa via the pterygomaxillary fissure into the left infratemporal fossa as described is not specific for a single etiology. This most likely is an inflammatory lesion. The possibility of a neoplastic lesion however cannot be entirely excluded.

Inflammatory changes are noted in the paranasal sinuses and left mastoid air cells as described.

A contrast enhanced scan would be worthwhile.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzMolmn / M / 24 yrs.
Referred by : Dr. Abc XyzShah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O pain in the LLE with tingling since 6-7 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 loss of water content of the L4-L5 intervertebral disc.

There is a postero-central disc herniation with peridiscal osteophyte at the L4-L5 level with thecal sac compression. Inferior migration of the disc fragment is noted more to the left of the midline with resultant indentation on the traversing left L5 nerve root.

A small posterior disc bulge is noted at the L5-S1 level. Schmorls nodes are seen in the lower dorsal region.

Slight facetal hypertrophy is noted at the L4-L5 and L5-S1 levels, bilaterally and at the L2-L3 level on the left.

The pedicles of the L4 and L5 vertebrae appear congenitally short in the antero-posterior dimensions.
Scan-00002


The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints and 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 :

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

IMPRESSION :

1. A postero-central disc herniation with peridiscal osteophyte at the L4-L5 level with inferior migration of the disc fragment, more to the left of the midline with resultant indentation on the traversing left L5 nerve root.

2. Slight facetal hypertrophy at the L4-L5 and L5-S1 levels, bilaterally and at the L2-L3 level on the left.

3. Congenitally short pedicles of the L4 and L5 vertebrae in the antero-posterior dimensions.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzni Ylmn / M / 45 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O giddiness with loss of consciousness and fever since 3-4 months.
C/O left sided seizures on 00.00.00 with weakness of the LUE and LLE with paresthesias and heaviness of head 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.

OBSERVATION :

There is an ill-defined, hyperintense signal on the proton, T2 Weighted and FLAIR images in the right frontal cortex and in the right high parietal cortex and subcortical white matter. This lesion appears relatively hypointense to normal white matter on the T1 Weighted images. There is a hyperintense signal on the T1 Weighted images along the cortex in the right frontal and right high parietal region. This signal remains hyperintense on the proton, T2 Weighted and FLAIR images and represents extracellular methemoglobin/paramagnetic substances.

Prominent perivascular spaces are noted in the frontal and parietal regions bilaterally.







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.

Inflammatory changes are noted in the left maxillary sinus.

IMPRESSION :

Altered signal in the right frontal cortex and right parietal cortex and subcortical white matter with evidence of hemoglobin break down products most likely represents a subacute haemorrhagic infarct.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzSalmn / M / 26 yrs.
Referred by : Dr. Abc Xyz Shah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O decreased hearing on the left side.

EXAMINATION :

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

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

3 mm thick T1 Weighted coronal images.

MR cisternogram was obtained in the coronal plane.

After administration of contrast the following parameters were used :

3 mm thick T1 Weighted axial and coronal images with fat saturation.

5 mm thick T1 Weighted axial images (with magnetization transfer).

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

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

There is mild dilatation 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.
..2/.








The seventh and eighth cranial nerve complex on either side are also unremarkable.

Inflammatory changes are noted in the right maxillary sinus and ethmoidal air cells.

After administration of contrast, there is no focal area of abnormal enhancement in the brain parenchyma, the meninges or along the seventh and eighth cranial nerve complex on either side.

IMPRESSION :

Mild dilatation of both the lateral ventricles.

No other significant abnormality is detected within the brain on this study.