hs/sb/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzath Klmn / M / 75 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O involuntary movements of the left hand since 1 year.
Past H/O left sided hemiparesis (3 episodes since 0000) from which patient has recovered.
Known diabetic/hypertensive.

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 evidence of an ill-defined area of hypointensity on the T1 Weighted images which turns hyperintense on the proton, T2 Weighted and FLAIR images within the right parieto-occipital lobes. This would represent an old infarct.

There are areas of hyperintensity on the proton, T2 Weighted and FLAIR images within the right centrum semiovale and periventricular white matter bilaterally. These are iso to hypointense to normal white matter on the T1 Weighted images and are most likely ischemic in etiology.

There are lacunar infarcts (iso to hyperintense to CSF) within the right thalamus, left lentiform nucleus and left corona radiata.








There is fullness of the third and both the lateral ventricles. There is prominence of the cerebral cortical sulci, Sylvian fissures and cerebellar folia bilaterally. Also seen is mild prominence of the basal cisternal spaces with presence of an empty sella.

The normal intraocular lens is not visualized on either side, ? due to cataract surgery.

The fourth ventricle is normal. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

1. An old infarct within the right parieto-occipital lobes.

2. Areas of altered signal within the right centrum semiovale and periventricular white matter bilaterally are most likely ischemic in etiology.

3. Lacunar infarcts within the right thalamus, left lentiform nucleus and left corona radiata.

hs/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyza Ilmn / F / 27 yrs.
Referred by : Dr. Abc Xyznna.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 3-4 years.

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 :

A small posterior disc herniation is seen to indent the thecal sac at the L5-S1 level. Slight bilateral neural foraminal narrowing is seen at this level.

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

Slight central wedging of the D12 body is noted, without change in signal intensity.

The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. 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
14.0 mm at L3-L4
16.0 mm at L4-L5
11.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of a small posterior disc herniation at the L5-S1 level.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xylmn / M / 35 yrs.
Referred by : Dr. Abc Xyz. Shah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O occasional giddiness with loss of consciousness since 10-12 years, ? TIA.

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 no focal area of altered signal intensity within 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.

INTRACRANIAL MRA :

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







NECK MRA :

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

IMPRESSION :

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

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzootwlmn / M / 14 yrs.
Referred by : Dr. Abc Xyz. Kapadia.
Examination : M.R.I. of the Left Distal Femur.

CLINICAL PROFILE :

Known C/O osteosarcoma in the left femur. Has received 3 cycles of chemotherapy.
For follow-up.

EXAMINATION :

M.R.I of the left distal femur was performed using the following parameters :

7 mm thick T1 Weighted and STIR sagittal images.
7 mm thick T1 Weighted and STIR coronal images.
10 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.

OBSERVATION :

There is still seen a fairly large, well-defined mass lesion in the lower one third of the left femur which extends cranially for about 14.5 cms from the left knee joint. There is a clear zone of transition between the lesion and normal marrow. Mixed signal intensity areas are seen in this lesion on the T1 Weighted images which are seen to turn heterogeneously hyperintense on the T2 Weighted and STIR images. There is break in the anterior and posterior cortex with periosteal elevation and spread of the pathology in the adjacent soft tissue. The lesion is predominantly metaphyseal. The epiphysis shows a mottled appearance in the medial and lateral condyle and is hypointense on the T1 Weighted images and turns hyperintense on the T2 Weighted and STIR images suggestive of its involvement.

The left knee joint per se however appears to be spared.





The scar of the previous surgery is noted along the antero-lateral margin of the distal left thigh at about the level of the upper margin of the tumor. The subcutaneous fat and the quadriceps muscles in the distal left thigh show a hyperintense signal on the T2 Weighted and STIR images. The fat planes around these muscles are however well identified. Atrophy of the muscles of the left thigh are noted when compared to the right. No obvious vascular encasement is noted.

Small effusion is noted within the left knee joint.

The femoral attachment of the anterior and posterior cruciate ligament of the femur is also involved.

IMPRESSION :

The MRI features are suggestive of a mass lesion in the distal metaphysis of the left femur with its cranio-caudate extension measuring 14.5 cms with involvement of the epiphysis and periosteal extensions as described. The biopsy is suggestive of an osteosarcoma.

Altered signal in the quadriceps muscles and in the subcutaneous fat in the distal left thigh may either represent soft tissue edema, the sequelae of previous surgery or may represent tumor infiltration. Atrophy of the muscles of the left thigh is noted.

As compared to the previous MRI dated 00.00.00 (study no:00008), there is no significant change in the size and extent of the lesion. Altered signal is however noted in the quadriceps muscles as described, which extends upto the mid-thigh level.

ke/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz DSlmn / M / 54 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to the RLE with 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 a postero-central disc herniation indenting the thecal sac at the L5-S1 level. A right far lateral (extraforaminal) disc bulge is seen to indent the extraforaminal portion of the exiting right L5 nerve root at this level.

A postero-central disc herniation, more to the right of the midline is seen at the L4-L5 level with mild indentation upon the thecal sac. A disc portion is seen to lie within the right lateral recess of the L5 vertebra with impingement of the traversing right L5 nerve root.

Postero-central disc protrusions are seen at the D12-L1, L1-L2, L2-L3 and L3-L4 levels.

Bilateral far lateral (extraforaminal) disc bulges are seen at the L2-L3, L3-L4 and L4-L5 levels.

The lumbar intervertebral discs show loss of water content. The lumbar facet joints show mild degenerative changes.

The lumbar vertebral bodies reveal normal signal intensity. 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 :

16.0 mm at L1-L2
14.0 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. A postero-central disc herniation at the L5-S1 level.

2. A postero-central disc herniation at the L4-L5 level with a disc portion within the right lateral recess of the L5 vertebra with impingement of the traversing right L5 nerve root.

3. Postero-central disc protrusions at the D12-L1, L1-L2, L2-L3 and L3-L4 levels.

4. Mild facetal arthropathy in the lumbar region.

5. Far lateral (extraforaminal) disc bulges bilaterally at the L2-L3, L3-L4 and L4-L5 levels and on the right side at the L5-S1 level.

hs/sb/nl/nl
/57 Date : 00.00.00

Name of the Patient : Abc XyzPoolmn / M / 57 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzzzare.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O dyspahgia since 3 weeks.
C/O weakness of BLE with slurred speech.

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 :

An area of hyperintensity on the T2 Weighted images is seen within the left corona radiata and left thalamus. Smaller similar areas are seen within the right thalamus, both lentiform nuclei and right corona radiata. These are isointense to CSF on the source images and would represent old infarcts.

There is fullness of the third and both the lateral ventricles. Also seen is prominence of the basal cisternal spaces and the cerebral cortical sulci, Sylvian fissures and cerebellar folia bilaterally.

The fourth ventricle is normal. There is no shift of the midline structures.









INTRACRANIAL MRA :

There is narrowing and irregularity of the vessel walls of the supraclinoid and distal cavernous portions of both internal carotid arteries, proximal portions of the M1 segments of both middle cerebral arteries and the origin of both anterior cerebral arteries. Also seen is irregularity of the Sylvian branches of both middle cerebral arteries. Slight narrowing of the terminal segment of the right vertebral artery is noted. The posterior cerebral and basilar arteries are unremarkable.

NECK MRA :

There is ectasia of the neck vessels.

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

IMPRESSION :

The MRA features are suggestive of :

1. Old infarcts within the left corona radiata and left thalamus, the right thalamus, both lentiform nuclei and right corona radiata.

2. Narrowing and irregularity of the vessel walls of the supraclinoid and distal cavernous portions of both internal carotid arteries, proximal portions of the M1 segments of both middle cerebral arteries and the origin of both anterior cerebral arteries.

3. Irregularity of the Sylvian branches of both middle cerebral arteries.

4. Slight narrowing of the terminal segment of the right vertebral artery.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzK. Shlmn / F / 15 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Pelvis.

CLINICAL PROFILE :

C/O pain and swelling over the left hip region radiating forwards to the left upper thigh since 5-6 months with a limp.
H/O fall prior to this.

EXAMINATION :

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

7 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images.

7 mm thick T1 Weighted and STIR coronal images.

7 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is an ill-defined, hypointense signal on the T1 Weighted images involving the marrow of the left iliac, pubic and the ischial bones and probably of the ala of the sacrum on the left and the bodies of the first two sacral segments. This signal remains predominantly hypointense on the T2 Weighted and STIR images. Probable involvement of the left sacro-iliac joint per se is noted.

There is seen a fairly large intermediate signal intensity mass lesion on the T1 Weighted images within the left half of the pelvis and in the left gluteal region, on either side of the left iliac bone. This lesion turns heterogeneously hyperintense on














the T2 Weighted images and seems to be incontinuity through the left sciatic notch. The left gluteal muscles are displaced postero-laterally. The left ilio-psoas and the left pyriformis muscles are not well identified separately from the medial margin of the tumor. The left obturator internus muscle is displaced medially. The left iliac vessels, recto-sigmoid, urinary bladder and the uterus and its adnexae are displaced to the right of the midline. The fat plane between the recto-sigmoid, urinary bladder and the mass lesion however seems to be well identified. The left ischio-rectal fossa is effaced.

The supero-inferior extent of the lesion is from the level of the left iliac crest upto the left ischial tuberosity.

There is no obvious extension of the lesion into the left hip joint per se. The left femoral head and neck show normal signal. A small left hip joint effusion is noted.

The fat planes in the proximal left thigh show a hyperintense signal on the T2 Weighted and STIR images which may represent soft tissue edema. The visualized right hip joint and the pelvic bones on the right are unremarkable.

IMPRESSION :

Altered signal of the left iliac, pubic and the ischial bones and probably of the ala of the sacrum on the left and the bodies of the first two sacral segments with soft tissue lesion in the left half of the pelvis and the left gluteal region as described is not specific for a single etiology. This most likely represents a primary bone neoplasm. Osteogenic sarcoma, chondrosarcoma or round cell tumors should be considered as differential diagnosis.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzn lmn / F / 60 yrs.
Referred by : Dr. Abc Xyzin / Dr. Abc Xyzlal.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

Known C/O Ca gall bladder with alleged H/O fall 2 months back.
C/O backache with pain radiating to BLE with tingling since then.

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.

OBSERVATION :

There is sacralization of the L5 vertebra and the L3 vertebral body is as marked on the film. Please correlate with plain radiographs.

There is slight loss of water content of the visualized dorso-lumbar intervertebral discs.

There is anterior wedging of the D11 vertebral body and which appears predominantly hypointense on all the pulse sequences. Ill-defined hyperintense signal on the T2 Weighted images is noted in the posterior third of the body of the D11 vertebral body. There is minimal indentation on the anterior dural theca by the postero-superior margin of the D11 vertebral body. Break in the superior cortical endplate of D11 is noted (scan 102.4). The D10-D11 and D11-D12 intervertebral discs are otherwise unremarkable. Slight hypertrophy of the D10-D11 articular facets is noted



Minimal posterior disc bulges are noted at the L1-L2, L2-L3, L3-L4 and L4-L5 levels. Bilateral far lateral (extraforaminal) disc bulges are seen at the L4-L5 level.

Slight facetal hypertrophy is also noted at the L2-L3, L3-L4 and L4-L5 levels.

Schmorls nodes are noted in the dorso-lumbar region.

Slight central wedging of the D10 vertebral body is also noted.

The rest of the visualized dorso-lumbar vertebral bodies show spotty fatty marrow changes suggesting osteoporosis. The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12-L1 level.

Screening, T1 Weighted sagittal images of the cervico-dorsal region reveal fatty marrow changes involving the cervico-dorsal vertebral bodies.

IMPRESSION :

1. Wedging of the D11 vertebral body with altered signal most likely represents a compression fracture superimposed on an osteoporotic spine. The possibility of this lesion representing a pathological fracture or a metastatic deposit cannot be entirely excluded in the given clinical setting.

2. Fatty marrow changes in the rest of the spinal axis suggests osteoporotic changes.

3. Sacralized L5 vertebra. Please correlate with plain radiographs.

sb/ke/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzai Galmn / M / 74 yrs.
Referred by : Dr. Abc Xyzndhi.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O momentary loss of vision of the left eye on 00.00.00, lasting for few seconds and recovered on its own. ? left sided TIA.

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 lacunar infarct in the right temporo-parietal region which is isointense to CSF on the T1 Weighted and T2 Weighted images.

Prominent perivascular spaces are noted in the fronto-parietal regions, bilaterally.

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

The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

INTRACRANIAL MRA :

The calibre of the left internal carotid artery in its cavernous and supraclinoid portion appears slightly smaller as compared to the right.
..2/.














Tortuousity of the vertebro-basilar system is noted.

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

NECK MRA :

There is significant, concentric narrowing of an approximately 1.2 cm segment of the left internal carotid artery in the neck about 1.0 cm distal to the left common carotid bifurcation. The carotid bifurcations are however unremarkable on either side. The vertebral arteries in the neck are also unremarkable.

IMPRESSION :

1. A lacunar infarct in the right temporo-parietal region.

2. Calibre of the left internal carotid artery in its cavernous and supraclinoid portion appears slightly smaller as compared to the right.

3. Significant concentric narrowing of an approximately 1.2 cm segment of the left internal carotid artery in the neck, about 1.0 cm distal to the left common carotid bifurcation.

ke/hs/rg/nl
/51 Date : 00.00.00

Name of the Patient : Abc Xyzra lmn / M / 63 yrs.
Referred by : Dr. Abc Xyznchal.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O episodic headaches with loss of vision and giddiness for 10-15 minutes (once in 15 days) since 5 years.
Known hypertensive. On Rx.

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.

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

OBSERVATION :

BRAIN :

There is no focal area of altered signal intensity within 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.

Incidental note is made of pansinusitis.

INTRACRANIAL MRA :

The left vertebral artery is hypoplastic.
..2/.




- 2 - scan-00009/51


The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar, right vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. The posterior cerebral arteries appear to be predominantly supplied by the posterior communicating arteries. No obvious aneurysm or vascular malformation is identified.

NECK MRA :

The left 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 :

No significant abnormality is detected within the brain parenchyma or on the intracranial and neck MRA on this study.