ke/hs/nl.
Date : 00.00.00

Name of the Patient : Abc XyzShlmn / M / 7 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O Pulmonary Kochs. On AKT since 00.00.00.
C/O hearing loss, slurred speech and difficulty in walking since February 0000.

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 are hypointense areas in the temporo-occipito-parietal white matter bilaterally on the T1 Weighted images which are seen to turn hyperintense on the proton, T2 Weighted and FLAIR images. There is involvement of the splenium of the corpus callosum. Similar areas are noted in the cortico-spinal and cortico-neural fibres, in the pons, medulla as well as the middle cerebellar peduncles bilaterally.

The left lateral ventricle is slightly prominent as compared to the right.









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 :

The MRI features are suggestive of altered signal in the temporo-occipito-parietal white matter, splenium of the corpus callosum, in the cortico-spinal and cortico-neural fibres in the pons, medulla as well as the middle cerebellar peduncles bilaterally and this can be seen with X-Linked adrenoleukodystrophy.

ke/hs/nl/rg.
/00005 Date : 00.00.00

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

CLINICAL PROFILE :

C/O occasional giddiness with vomiting since 6 months.

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 are small hyperintense areas in the periventricular and fronto-parietal white matter on the T2 Weighted images and are most likely ischemic in etiology.

There is mild prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

There is mild to moderate dilatation of both the lateral and the third ventricles. The fourth ventricle is 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 :

1. Areas of altered signal intensity in the periventricular and fronto-parietal white matter bilaterally are most likely ischemic in etiology.

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

ke/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / M / 32 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since childhood.

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 reduction in the volume of the tail and posterior body of the hippocampus on the left side and which shows a subtle hyperintense signal on the T2 Weighted images.

The right hippocampus is unremarkable.

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 :

The MRI features are suggestive of left hippocampal sclerosis.

hs/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xylmn / F / 71 yrs.
Referred by : Dr. Abc Xyzlkaka.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

H/O giddiness with fall from bed.
C/O occasional numbness on the left side of the head.
C/O gait imbalance.

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.

There is mild fullness of both the lateral ventricles. Also seen is mild prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

Note is made of an empty sella.

No extracerebral collection is identified on this study.

The 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
A1 segment of the right anterior cerebral artery is hypoplastic. 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.

hs/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzne Dslmn / F / 62 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzani.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE since 1 year.

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 with peridiscal osteophytes is seen to indent the thecal sac at the L4-L5 level with resultant mild neural foraminal narrowing bilaterally at this level.

There is a suspicious break of the pars interarticularis of the L5 vertebra bilaterally. Please correlate with plain radiographs.

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

The L4-L5 facet joints show hypertrophic degenerative changes. Also seen is mild ligamentum flavum hypertrophy at the L4-L5 and L5 levels.

The lumbar intervertebral discs show loss of water content.

The lumbar vertebral bodies 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 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 :

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

IMPRESSION :

The MRI features are suggestive of :

1. A small posterior disc herniation with peridiscal osteophytes at the L4-L5 level.

2. Hypertrophic facetal arthropathy at the L4-L5 level and
mild ligamentum flavum hypertrophy at the L4-L5 and L5 levels.

3. A postero-central disc protrusion at the L5-S1 level.

4. Probable spondylolysis of the L5 vertebra bilaterally.
Please correlate with plain radiographs.

ke/sb/rg.
/60 Date : 00.00.00

Name of the Patient : Abc Xyzai Blmn / F / 55 yrs.
Referred by : Dr. Abc Xyziram.
Examination : M.R.I. of the Brain & intracranial MR Venogram.

CLINICAL PROFILE :

C/O giddiness since 2 months with tremors in BUE and BLE and gait ataxia.
H/O seizures since 15 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.

MR Venogram was also obtained.

OBSERVATION :

There are hyperintense areas in the head of the caudate nucleus, thalamus and the lentiform nucleus bilaterally on the proton, T2 Weighted and FLAIR images. These are hypointense to the normal white matter on the T1 Weighted images. Similar areas are seen in the right middle cerebellar peduncle, pons and bilateral cerebral peduncles.

Diffuse hypointense signal is seen in the fronto-parietal deep white matter with involvement of the internal and external capsules bilaterally as well as the periventricular deep white matter on the proton, T2 Weighted and FLAIR images. This is hypointense to the normal white matter on the T1 Weighted images.

Lacunar infarcts which are seen to follow CSF signal characteristics on all the pulse sequences are noted in the right cerebellar hemisphere.
..2/.




- 2 - scan-00008


Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

MR Venogram :

On the MRV the visualized dural and deep venous sinuses show normal flow characteristics. No obvious venous thrombosis is evident on this scan.

IMPRESSION :

The MRI/MRV features are suggestive of :

1. Altered signal in the head of the caudate nucleus, thalamus, head of the lentiform nucleus bilaterally,
in the right middle cerebellar peduncles, pons and bilateral cerebral peduncles and in the fronto-parietal deep white matter with involvement of the internal and external capsules bilaterally as well as the periventricular deep white matter as described is not specific for a single etiology.

The possibilites to be considered are,

a. Demyelination.

b. Ischemia/infarction.


c. Gliomatosis Cerebrii.

2. Lacunar infarcts in the right cerebellar hemisphere.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz. Mukalmn / F / 26 yrs.
Referred by : Dr. Abc XyzShah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O visual defect since 15 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 T1 Weighted and FLAIR coronal images.

3 mm thick STIR coronal images through the optic nerves.

OBSERVATION :

There are multiple, nodular, grey matter signal intensity lesions on all the pulse sequences in the subependymal lining along the lateral walls of the lateral ventricles bilaterally, more so on the left side. These lesions represent grey matter heterotopias.

Note is made of an empty sella.

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

The visualized optic nerves are normal in their course and signal intensity.

Mucosal thickening is noted in the maxillary antra bilaterally.

IMPRESSION :

Multiple, nodular, grey matter signal intensity lesions in the subependymal lining along the lateral walls of the lateral ventricles bilaterally (left more than right), most likely represent grey matter heterotopias.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzChaturlmn / F / 68 yrs.
Referred by : Dr. Abc Xyzani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O behavioural changes since 10-15 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 are ill-defined, hyperintense areas and small bright foci on the proton, T2 Weighted and FLAIR images in the subcortical white matter in the fronto-parietal regions bilaterally. These lesions appear isointense to normal white matter 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 basal cisternal spaces bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

IMPRESSION :

Altered signal in the subcortical white matter in the fronto-parietal regions bilaterally most likely represent ischemic changes.

ke/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Jethalmn / M / 42 yrs.
Referred by : Dr. Abc Xyzandel.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O headaches (frontal and left sided) since 1 1/2 years with decreased hearing on the left side.

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 are multiple, serpiginous and punctate hypointense areas in the left parafalcine frontal region on all the pulse sequences and would represent a vascular malformation. This lesion appears to be fed by the anterior cerebral artery which is prominent. A large draining vein is seen at its superior aspect and draining into the anterior portion of the superior sagittal sinus. There is suggestion of an aneurysmal dilatation of a vessel which measures approximately 2.2 cms in diameter. There is mild surrounding edema with mass effect and mild indentation on the frontal horn of the left lateral ventricle.

The right 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 anterior cerebral arteries appear prominent and are seen to feed the vascular malformation. A large draining vein is seen to join the anterior portion of the superior sagittal sinus. A twig from the left anterior cerebral artery is seen to be adjacent to the previously mentioned aneurysmal dilatation of a vessel.
- 2 - Scan-00004

The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized basilar, vertebral, middle and posterior cerebral arteries also show normal signal, calibre and wall margins.

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 :

The MRA features are suggestive of a vascular malformation in the left frontal region as described. This would represent an arterio-venous malformation with aneurysmal dilatation of a vessel.

sb/hs/nl.
Date : 00.00.00

Name of the Patient : Abc Xyzundar Rlmn / F / 52 yrs.
Referred by : Dr. Abc Xyz Shah.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE:

C/O neckpain since 1 month which has increased since 4 days.
C/O radicular pain to the RUE with paresthesias.

EXAMINATION :

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

5 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 lordosis and loss of water content of the cervical intervertebral discs.

There is a fairly large, left postero-lateral extruded disc with peridiscal osteophytes at the C4-C5 level with thecal sac compression and indentation on the left C5 nerve root.

A fairly large, postero-central and right paracentral extruded disc with peridiscal osteophytes is noted at the C5-C6 level with thecal sac compression and indentation on the right C6 nerve root. Superior and inferior migration of the disc fragment is noted into the right lateral recesses of the C5 and C6 vertebrae, respectively.

Small postero-central protruded discs are noted at the C2-C3 and C3-C4 levels and a small right paracentral protruded disc is noted at the C6-C7 level. A postero-central disc protrusion is seen at the D3-D4 level.


Spotty fatty marrow changes are noted in the cervical vertebrae.

The joints of Luschka and the visualized pre and paravertebral soft tissues are unremarkable.

The cervical spinal cord shows normal signal intensity.

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

IMPRESSION :

1. A fairly large, left postero-lateral extruded disc with peridiscal osteophytes at the C4-C5 level with indentation on the left C5 nerve root.

2. A fairly large, postero-central and right paracentral extruded disc with peridiscal osteophytes at the C5-C6 level with indentation on the right C6 nerve root. Superior and inferior migration of the disc fragment is noted into the right lateral recesses of the C5 and C6 vertebrae, respectively.

3. Small postero-central protruded discs at the C2-C3 and C3-C4 levels.

4. A small right paracentral protruded disc at the C6-C7 level.

5. A postero-central disc protrusion at the D3-D4 level.