sb/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / M / 60 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O sudden onset of gait ataxia, slurred speech and altered sensorium since 20 days.
Old C/O anteroseptal myocardial infarction with LV dysfunction with LV clot.

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 an ill-defined hyperintense area on the T2 Weighted images in the right temporo-parietal region. This lesion appears hypointense on the T1 Weighted images and represents an area of cystic encephalomalacia, most likely the sequelae of a previous vascular insult.

There is mild dilatation of both the lateral and the third ventricles. The fourth ventricle is normal. There is slight prominence of the cerebral cortical sulci bilaterally. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

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

INTRACRANIAL MRA :

There is slight attenuation of the Sylvian branches of the right middle cerebral artery.


The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, left 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 :

1. Altered signal in the right temporo-parietal region
represents an area of cystic encephalomalacia, most likely the sequelae of a previous vascular insult.

2. Slight attenuation of the Sylvian branches of the right middle cerebral artery.

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

sb/ke/rg.
Date : 00.00.00

Name of the Patient : Abc XyzH. lmn / F / 60 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O right hemiparesis with slurred speech since 10 days.
Known hypertensive. On Rx.

EXAMINATION :

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

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

OBSERVATION :

There is a well-marginated, hyperintense lesion on the T2 Weighted images in the left high fronto-parietal region (scans 102.15). This lesion appears hypointense to normal white matter on the T1 Weighted images and may represent a recent ischemic lesion.

CSF signal characteristics lesions on all pulse sequences are noted in the right occipital lobe, right cerebellar hemisphere and in the head of right caudate nucleus and right anterior capsular region. These represent areas of cystic encephalomalacia, most likely the sequelae of previous vascular insult. Evidence of extracellular methaemoglobin (late subacute haemorrhage) is noted in the head of right caudate nucleus and right anterior capsular region.

There are ill-defined hyperintense areas on the T2 Weighted and FLAIR images in the periventricular white matter bilaterally and in the thalami, lentiform nuclei and centrum semiovale bilaterally. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images and most likely represent ischemic changes.
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There is mild dilatation of both the lateral, third and the fourth ventricles. The basal cisternal spaces are unremarkable. There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally. There is no shift of the midline structures.

INTRACRANIAL MRA :

The right vertebral artery appears hypoplastic. The right posterior cerebral artery appears as a continuation of the right posterior communicating artery.

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.

NECK MRA :

There is slight concentric narrowing of the proximal left internal carotid artery, approximately 1.9 cms distal to the left common carotid bifurcation. The common corotid arteries and their bifurcations bilaterally are unremarkable.

The right vertebral artery in the neck also appears hypoplastic.

IMPRESSION :

1. Altered signal in the left high fronto-parietal region may represent a recent ischemic lesion.

2. Altered signal in the right occipital lobe, right cerebellar hemisphere and in the head of right caudate nucleus and right anterior capsular region represent areas of cystic encephalomalacia, most likely the sequelae of previous vascular insult.
..3/.






- 3 - Scan-00004


3. Evidence of extracellular methaemoglobin (late subacute haemorrhage) in the head of right caudate nucleus and right anterior capsular region.

4. Altered signal in the periventricular white matter
bilaterally and in the thalami, lentiform nuclei and centrum semiovale bilaterally most likely represent ischemic changes.

5. Slight concentric narrowing of the proximal left internal carotid artery, approximately 1.9 cms distal to the left common carotid bifurcation.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz lmn / M / 47 yrs.
Referred by : Dr. Abc Xyzehta.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O radicular pain to the LLE with numbness.

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 and L5-S1 intervertebral discs.

There is a fairly large, left paracentral extruded disc at the L4-L5 level with impingement of the traversing left L5 nerve root.

A postero-central protruded disc is noted at the L5-S1 level.

The articular facets at the L4-L5 and L5-S1 levels appear hypertrophied. Bilateral far lateral (extraforaminal) disc bulges are seen at these levels.

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 :

18.0 mm at L1-L2
17.0 mm at L2-L3
18.0 mm at L3-L4
10.0 mm at L4-L5
13.0 mm at L5-S1.

IMPRESSION :

1. A fairly large, left paracentral extruded disc at the L4-L5 level with impingement of the traversing left L5 nerve root and resultant canal stenosis.

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

3. Facetal hypertrophy at the L4-L5 and L5-S1 levels.

sb/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz lmn / F / 45 yrs.
Referred by : Dr. Abc Xyzlkarni / Dr. Abc Xyzhah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with paresthesias since 3-4 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 L3-L4, L4-L5 and L5-S1 intervertebral discs.

There is Grade I spondylolisthesis of the L5 over the S1 vertebra with probable spondylolysis at the L5 bilaterally. A resultant pseudo-posterior disc bulge is noted at the L5-S1 level. Slight compromise of the neural foramen at the L5-S1 level is noted bilaterally.

A small posterior disc bulge with peridiscal osteophytes is noted at the L4-L5 level.

A small posterior disc herniation with peridiscal osteophytes is noted at the L3-L4 level.

Type II degenerative marrow changes are noted adjacent to the L5-S1 intervertebral disc.



The rest of 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.

There is evidence of a syrinx in the lower dorsal spinal cord.

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 :

17.0 mm at L1-L2
17.0 mm at L2-L3
16.0 mm at L3-L4
15.0 mm at L4-L5
15.0 mm at L5-S1.

Screening images of the dorsal spine reveal, a syrinx in the centre of the cord over D9 to D11 vertebral levels. The spinal cord at the D9 level appears slightly irregular with slight atrophy of the cord above it. A contrast enhanced study would be worthwhile to rule out the cause of the syrinx.

IMPRESSION :

1. Grade I spondylolisthesis of the L5 over the S1 vertebra with probable spondylolysis at the L5 bilaterally. A resultant pseudo-posterior disc bulge is noted at the L5-S1 level.

2. A small posterior disc bulge with peridiscal osteophytes at the L4-L5 level.

3. A small posterior disc herniation with peridiscal osteophytes at the L3-L4 level.

4. A syrinx in the lower dorsal spinal canal.

sb/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc XyzHusain Shlmn / M / 50 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O headaches with drooping of the right eyelid since 8-9 days with pain, diplopia and nausea.

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/rg.
Date : 00.00.00

Name of the Patient : Abc Xyze Medlmn / F / 30 yrs.
Referred by : Dr. Abc Xyzlkaka.
Examination : Intracranial and neck M.R.A.

CLINICAL PROFILE :

C/O 3 episodes of weakness of the LUE and LLE for 10 minutes since the last 3 days.
C/O associated heaviness of the head and dizziness.

EXAMINATION :

The brain was screened with 5 mm thick T1 Weighted and T2 Weighted axial images and 5 mm thick FLAIR coronal images.

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

OBSERVATION :

There is an ill-defined, hyperintense signal on the T2 Weighted and FLAIR images along the right high parietal and posterior parietal cortex and in the right corona radiata. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images.

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 :

There is slight concentric narrowing of the cavernous segment of the right internal carotid artery. The proximal segment of the right middle cerebral artery shows attenuated signal. The distal right middle cerebral artery and its Sylvian branches are however well identified.



The petrous, cavernous and supraclinoid segments of the left internal carotid artery show normal signal and calibre. The visualized anterior cerebral, left 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 seen a plaque along the postero-lateral wall of the proximal right internal carotid artery at and just distal to the right common carotid artery bifurcation with resultant slight narrowing of the origin of the right internal carotid artery.

The left common carotid artery and its bifurcation and the vertebral arteries are unremarkable.

IMPRESSION :

1. Altered signal along the right high parietal and posterior parietal cortex and in the right corona radiata most likely represent ischemic changes.

2. Slight concentric narrowing of the cavernous segment of the right internal carotid artery and attenuated signal of the proximal segment of the right middle cerebral artery may be due to atherosclerotic changes.

3. A plaque along the postero-lateral wall of the proximal right internal carotid artery at and just distal to the right common carotid artery bifurcation.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzulrelmn / M / 28 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (left more than right) 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.

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There is loss of water content of the L4-L5 and L5-S1 intervertebral discs.

There is a postero-central protruded disc at the L5-S1 level.

There is a fairly large, postero-central and left paracentral extruded disc with a peridiscal osteophyte at the L4-L5 level (with slight inferior migration of the disc fragment) impinging the traversing left L5 nerve root. Bilateral neural foraminal narrowing is noted at this level. The facet joints show hypertrophic degenerative changes at this level with a resultant tight canal.

Focal fatty marrow changes are noted within the L2 vertebral body.

The L3-L4 and L5-S1 facet joints show degenerative changes.
..2/.







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.

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 :

17.0 mm at L1-L2
14.0 mm at L2-L3
15.0 mm at L3-L4
8.0 mm at L4-L5
10.0 mm at L5-S1.

IMPRESSION :

1. A fairly large, postero-central and left paracentral extruded disc with a peridiscal osteophyte at the L4-L5 level (with slight inferior migration of the disc fragment) impinging the traversing left L5 nerve root. Bilateral neural foraminal narrowing and hypertrophic facetal arthropathy with a resultant tight canal is also noted.

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

sb/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzh Gumanslmn / F / 60 yrs.
Referred by : Dr. Abc Xyz Patel.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O radicular pain in BLE (left more than right) with mild paresthesias since 8-10 days.

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 upper lumbar intervertebral discs.

Small postero-central protruded discs are noted at the L5-S1 and the L1-L2 levels. Bilateral far lateral disc bulges are noted at the L5-S1 level.

A small left far lateral disc bulge is noted at the L3-L4 level and a posterior disc bulge is identified at the L4-L5 level.

Slight facetal and ligamentum flavum hypertrophy is noted at the L5-S1 and L4-L5 levels.

Type II degenerative marrow changes are noted in the L5 vertebral body adjacent to the L5-S1 intervertebral disc.

Anterior disc herniations are seen in the upper lumbar region with peridiscal osteophytes.

..2/.







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.

Fat is identified in the filum over the L4 and L5 vertebral levels which may be a normal variant.

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
13.0 mm at L2-L3
14.0 mm at L3-L4
14.0 mm at L4-L5
10.0 mm at L5-S1.

IMPRESSION :

1. Small postero-central protruded discs at the L5-S1 and the L1-L2 levels.

2. Slight facetal and ligamentum flavum hypertrophy at the L5-S1 and L4-L5 levels.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Mlmn / F / 39 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzt Rathi.
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.

OBSERVATION :

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

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 slight prominence of the cerebral cortical sulci and cerebellar folia bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Incidentally noted is a Thornwaldts cyst in the posterior pharyngeal wall.

IMPRESSION :

The MRI features are suggestive of slight prominence of the cerebral cortical sulci and cerebellar folia, bilaterally.

sb/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / M / 57 yrs.
Referred by : Dr. Abc Xyzapadia.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE with tingling since February 0000.
H/O L4-L5 laminectomy in April 0000.

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 evidence of laminectomy at L4 and L5 vertebral levels with post-operative changes in the soft tissues in the posterior lumbar region at these levels.

There is loss of water content of the L4-L5 and L5-S1 intervertebral discs which appear reduced in height.

Slight retroplacement of the L5 over the S1 and the L4 over the L5 vertebrae is noted.

There is seen a postero-central and right paracentral disc herniation with peridiscal osteophytes at the L4-L5 level with indentation on the traversing L5 nerve roots bilaterally more on the right side. The thecal sac is slightly retroplaced at this level due to the previous laminectomy. Scar tissue is noted along the posterior margin of the thecal sac at this level.

A small postero-central protruded disc with peridiscal osteophytes is noted at the L5-S1 level.
..2/.






Anterior disc herniations with anterior peridiscal osteophytes are noted at L4-L5 and L5-S1 levels.

The facet joints at the L4-L5, L3-L4 and L2-L3 levels appear slightly hypertrophied.

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 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
15.0 mm at L2-L3
14.0 mm at L3-L4

IMPRESSION :

1. Post-operative status.

2. Slight retroplacement of the L5 over the S1 and the L4 over the L5 vertebrae.

3. A postero-central and right paracentral disc herniation with peridiscal osteophytes at the L4-L5 level with indentation on the traversing L5 nerve roots bilaterally more on the right side.

4. Slight facetal hypertrophy at the L4-L5, L3-L4 and L2-L3 levels.

As compared to the previous MRI dated 00.00.00 (Study No.00008), there is reduction in the size of the disc fragment at the L4-L5 level. The patient is now status post-operative.