/93 Date : 00.00.00

Name of the Patient : Abc Xyza R. lmn / F / 40 yrs.
Referred by : Dr. Abc XyzV. Shah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain occasionally radiating to BLE.

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 posterior disc herniation at the L5-S1 level with anterior indentation of the thecal sac and bilateral neural foraminal narrowing. Far lateral (extraforaminal) disc herniations are also noted at this level with mild indentation upon the extraforaminal portion of the exiting L5 nerve roots. Ligamentum flavum hypertrophy and slight facetal arthropathy is also seen at this level.

A small posterior disc herniation is noted at the L4-L5 level with anterior indentation of the thecal sac. A posterior disc bulge is seen at the L3-L4 level.

Small bilateral far lateral (extraforaminal) disc bulges are seen at the L2-L3, L3-L4 and L4-L5 levels. A small postero-central disc herniation is seen at the L1-L2 level.

The lumbar intervertebral discs show loss of water content.

The lumbar facet joints show mild degenerative changes.


The lumbar vertebrae show areas of fatty replacement of normal marrow. 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 :

11.0 mm at L1-L2
13.0 mm at L2-L3
17.0 mm at L3-L4
19.0 mm at L4-L5
17.0 mm at L5-S1.

Note is made of small hyperintense areas in both the kidneys on the T2 Weighted images and may represent medullary cysts. Further evaluation may be worthwhile.

IMPRESSION :

1. A posterior disc herniation at the L5-S1 level.

2. Far lateral (extraforaminal) disc herniations at the L5-S1 level with mild indentation upon the extraforaminal portion of the exiting L5 nerve roots. Ligamentum flavum hypertrophy and slight facetal arthropathy is also seen at this level.

3. A small posterior disc herniation at the L4-L5 level.

4. Small bilateral far lateral (extraforaminal) disc bulges at the L2-L3, L3-L4 and L4-L5 levels.

5. A posterior disc bulge at the L3-L4 level.

6. A small postero-central disc herniation at the L1-L2 level.

7. Mild facetal arthropathy in the lumbar region.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc XyzWlmn / F / 75 yrs.
Referred by : Dr. Abc Xyzchha.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE.
H/O fall many years ago.

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 scoliosis of the lumbar spine with convexity to the left.

The L5-S1 and the D12-L1 intervertebral discs are reduced in height. The D11-D12 intervertebral disc shows a hyperintense signal on all the pulse sequences which may suggest discal calcification. The L4-L5 disc appears slightly hyperintense on the T2 Weighted images. The rest of the lumbar intervertebral discs show loss of water content.

There is slight wedging of the L3 and L4 vertebral bodies which appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. Mild generalized bulge of these vertebral bodies is noted. The cortical endplates appear to be intact. Herniation of the L3-L4 intervertebral disc into the body of L4 is noted.



Similar changes but to a much lesser extent are noted adjacent to the superior cortical endplate of L1. The D12 vertebral body is wedged, anteriorly, with fatty marrow changes.

There are bilateral far lateral disc bulges at the L5-S1 level with indentation upon the extraforaminal portion of the L5 nerve roots. A small posterior disc bulge with posterior peridiscal osteophyte is also noted at this level.

A posterior disc herniation is seen at the L4-L5 level with anterior indentation of the thecal sac and bilateral neural foraminal narrowing. The L4-L5 facet joints show hypertrophic degenerative changes with resultant lateral canal stenosis. There is suggestion of fusion within the L4-L5 facets.

A posterior and left far lateral disc bulge is seen at the L3-L4 level with mild left neural foraminal narrowing. The L3-L4 facet joints show mild degenerative changes.

A diffuse posterior disc herniation is seen at the L2-L3 level with narrowing of the right neural foramina. The L2-L3 facet joints on the right side shows degenerative change.

Anterior disc herniations with anterior peridiscal osteophytes are noted at the dorso-lumbar and lumbar regions.

The rest of the visualized lumbar vertebral bodies show spotty fatty marrow changes. 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 lower dorsal spinal cord shows normal signal.
..3/.










- 3 - Scan-00001

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

19.0 mm at L1-L2
11.0 mm at L2-L3
18.0 mm at L3-L4
11.0 mm at L4-L5
9.0 mm at L5-S1.

Screening, T1 Weighted sagittal images of the dorsal spine reveal fatty marrow changes in the visualized dorsal vertebrae except the D8 vertebral body which shows a hypointense signal. Central wedging of the D4 vertebral body is noted.

IMPRESSION :

1. Slight wedging of the L3 and L4 vertebral bodies with altered signal suggest bone bruise, the sequelae of compression fractures superimposed on and osteoporotic spine.

2. Central wedging of L1, D4 and anterior wedging of the D12 vertebral bodies may also be the sequelae of osteoporotic fractures.

3. Bilateral far lateral disc bulges at the L5-S1 level with indenation upon the extraforaminal portion of the L5 nerve roots.

4. A posterior disc herniation at the L4-L5 level with hypertrophic facetal arthropathy and resultant lateral canal stenosis.

5. A posterior and left far lateral disc bulge at the L3-L4 level with facetal arthropathy.

6. A diffuse posterior disc herniation at the L2-L3 level with mild facetal arthropathy.

sb/ke/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Slmn / M / 30 yrs.
Referred by : Dr. Abc Xyz. Desai.
Examination : M.R.I. of the Left Shoulder.

CLINICAL PROFILE :

H/O catch in May 0000, with pain in the upper back radiating to the LUE and numbness in the left thumb for 4-5 days. Pain relieved but discomfort in the left shoulder persists.

EXAMINATION :

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

4 mm thick T1 Weighted and GRASS axial images.

4 mm thick T2 Weighted sagittal images.

4 mm thick T1 Weighted, Proton and T2 Weighted coronal images.

OBSERVATION :

There is evidence of blunting of the anterior rim of the glenoid labrum with medial displacement of the avulsed labral fragment. The tendon of the subscapularis muscle appears slightly irregular and shows an ill-defined, hyperintense signal on the T2 Weighted images. There is however, no obvious discontinuity of the subscapularis tendon or the musculo-tendinous junction. Minimal fluid is noted in the gleno-humeral joint. The biceps tendon is visualized in the bicipital groove.

There is an ill-defined, hyperintense signal on the GRASS images at the tip of the tendinous insertion of the supraspinatous muscle. This lesion is of intermediate signal on the T1 Weighted images. Minimal fluid is noted in the subacromion bursa.







The acromion process is of Type I morphology and is seen to be sloping slightly laterally.

The head of the left humerus shows normal contour and the head and upper shaft of the left humerus show normal signal intensity. The visualized scapula appears normal.

The articular cartilage of the head of the left humerus appears normal.

There is no bone erosion or destruction seen.

The acromio-clavicular joint is normal.

The visualized axilla is unremarkable.

IMPRESSION :

1. Blunting of the anterior glenoid labrum with an avulsed fragment suggest an anterior labral tear (Bankart lesion).

2. Slight irregularity of the subscapularis tendon with altered signal may suggest a partial tear/strain of the subscapularis tendon.

3. Altered signal at the tip of the tendinous insertion of the supraspinatous muscle may suggest a partial tear/tendinitis.

4. Minimal fluid in the gleno-humeral joint.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzn H. Klmn / F / 27 yrs.
Referred by : Dr. Abc Xyzrkar / Dr. Abc Xyz.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE:

C/O neckpain since 3 years with pain radiating to BUE.
C/O tingling in the LLE since 1 year.

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 :

The cervical vertebral bodies and the intervertebral discs show normal signal intensity. 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.

Enlarged cervical lymph nodes are noted deep to the sternocleidomastoid muscles bilaterally and in the left suboccipital region.

IMPRESSION :

No significant abnormality is detected in the cervical spine on this study.

sb/hs/nl
Date : 00.00.00

Name of the Patient : Abc Xyzasad Milmn / M / 36 yrs.
Referred by : Dr. Abc XyzR> Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since 0000. On anti-epileptics. Detected to have left fronto-temporal glial cell tumor. Has received radiotherapy.
For follow-up.

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 still seen slight thickening of the left insular cortex. The gyri in the left anterior and medial temporal poles and in the left inferior frontal region posteriorly still appear hypointense to normal grey matter on the T1 Weighted images and hyperintense on the proton, T2 Weighted and FLAIR images.

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

Incidentally noted is a mega cisterna magna. The nasal septum is deviated to the right.

IMPRESSION :

Altered signal in the left inferior frontal and temporal lobe gyri as described, most likely represents a cortical astrocytoma.

As compared to the previous MRI (study no:0000) dated 00.00.00, there is no significant change noted.

hs/sb/nl
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / F / 25 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with radiation of pain to the LLE 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 appears to be sacralization of the L5 vertebra and it is as marked on the film. Please correlate with plain radiographs.

There is a large postero-central disc extrusion with a posterior peridiscal osteophytes compressing upon the thecal sac at the L4-L5 level. A disc portion is seen to lie within the left lateral recess of the L5 vertebra with impingement of the traversing left L5 nerve root.

There is mild ligamentum flavum and facetal hypertrophy at the L4-L5 level. Mild facetal hypertrophy is also seen at the L3-L4 level.

Bilateral far lateral (extraforaminal) disc herniations are seen to indent the extraforaminal portion of the exiting L4 nerve roots bilaterally (left more than right) at the L4-L5 level.





Type II degenerative changes are seen within the L5 vertebral body adjacent to the L4-L5 intervertebral disc.

The L4-L5 intervertebral disc shows loss of water content.

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 S1 level.

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

22.0 mm at L1-L2
20.0 mm at L2-L3
19.0 mm at L3-L4
8.0 mm at L4-L5
10.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. Probable sacralization of the L5 vertebra. Please correlate with plain radiographs.

2. A large postero-central disc extrusion with a posterior peridiscal osteophyte with resultant canal stenosis at the L4-L5 level. A disc portion is seen to lie within the left lateral recess of the L5 vertebra with impingement of the traversing left L5 nerve root.

3. Bilateral far lateral (extraforaminal) disc herniations at the L4-L5 level.

hs/sb/nl
Date : 00.00.00

Name of the Patient : Abc Xyzath Viclmn / M / 45 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with paresthesias since 1 month.

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 mild retroplacement of the L4 over the L5 and of the L5 over the S1 vertebral bodies.

There is a left paracentral disc herniation indenting the traversing left S1 nerve root at the L5-S1 level.

A posterior disc herniation is seen to indent the thecal sac and narrow both neural foramina at the L4-L5 level. A left postero-lateral (foraminal) disc herniation is seen to narrow the left neural foramina at the L3-L4 level.

There are far lateral (extraforaminal) disc herniations bilaterally at the L4-L5 level and on the left side at the L3-L4 level.


The pedicles of the lumbar vertebrae are congenitally short in their antero-posterior dimensions. The L3-L4, L4-L5 and L5-S1 facet joints show degenerative changes.

The L4-L5 and L5-S1 intervertebral discs show loss of water content.

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
13.0 mm at L2-L3
13.0 mm at L3-L4
11.0 mm at L4-L5
8.0 mm at L5-S1.

IMPRESSION :

1. A left paracentral disc herniation indenting the traversing left S1 nerve root at the L5-S1 level.

2. A posterior disc herniation at the L4-L5 level.

3. A left postero-lateral (foraminal) disc herniation at the L3-L4 level.

4. Far lateral (extraforaminal) disc herniations bilaterally at the L4-L5 level and on the left side at the L3-L4 level.

5. Congenitally short pedicles of the lumbar vertebrae in their antero-posterior dimensions with a tight canal over the L3-L4 to the L5-S1 levels.

Date : 00.00.00

Name of the Patient : Abc Xyz Plmn / M / 28 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Pelvis.

CLINICAL PROFILE :

C/O pain in the RLE since 3 months with decreased appetite and loss of weight by 10 kgs.

EXAMINATION :

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

7 mm thick T1 Weighted and T2 Weighted axial images.

5 mm thick T1 Weighted coronal images.

The dorsal and lumbar spines were screened with 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is an ill-defined, hypointense signal on the T1 Weighted images involving the right half of the sacrum including the right sacral ala and the iliac bones on either side adjacent to the sacro-iliac joints posteriorly. These lesions appear hyperintense on the T2 Weighted images. Similar signal intensity changes are noted in the left ischial tuberosity, head and neck of left femur, roof of the acetabulae on either side and probably the iliac crest, bilaterally.

There is seen a fairly large, intermediate signal intensity soft tissue component of the lesion in the presacral region to the right of the midline, extending into the right gluteal region through the sacro-sciatic notch. This lesion appears hyperintense on the T2 Weighted images. Slight extension into the posterior paraspinal muscles on the right and into the sacral canal is also noted.


The right gluteus maximus muscle shows an ill-defined hyperintense signal on the T2 Weighted images which suggests its involvement. The right piriformis muscle also seems to be involved by the lesion. The rectum is displaced slightly anteriorly and to the left of the midline by the soft tissue component of the right sacro-iliac lesion. There are no abnormally enlarged pelvic lymph nodes identified on this study. There is no free fluid in the visualized pelvis.

Screening images of the dorsal and lumbar spine show an ill-defined hypointense signal on the T1 Weighted images involving the majority of the dorsal and lumbar vertebral bodies. Hyperintense signal on the T1 Weighted images in the D7, D9 and L4 vertebral bodies represent hemangioma with fat content.

IMPRESSION :

Altered signal in the right half of the sacrum including the right sacral ala and the iliac bones on either side adjacent to the sacro-iliac joints posteriorly, in the left ischial tuberosity, head and neck of left femur, roof of the acetabulae on either side and probably the iliac crest, bilaterally and in the dorsal and lumbar vertebral bodies as described is not specific for a single etiology.

The differential diagnosis would include :

1. Round cell tumors.

2. Multiple metastases.

3. Multifocal tuberculosis - seems less likely.

A soft tissue component of the lesion is noted in the presacral region on the right at the level of the right sacro-iliac joint extending into the gluteal region and the spinal canal as described.

No previous scans were available for comparison.

ke/sb/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzni A. Klmn / F / 9 months.
Referred by : Dr. Abc Xyzthure.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O purulent discharge from low back since 1 month with fever.

EXAMINATION :

M.R.I of the lumbo-sacral spine was performed using the following parameters :

3 mm thick T1 Weighted and T2 Weighted sagittal images.

4 mm thick T1 Weighted coronal images.

4 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

The L5 vertebral body is as marked on the film.

There is seen an obliquely oriented linear, hypointense signal on all pulse sequences in the subcutaneous fat in the midline, in the posterior lumbo-sacral region at the S3 vertebral level. This lesion extends from the surface of the skin upto the posterior paraspinal muscle layer. Spina bifida is noted at S3 level. There is extension of this tract upto the lamina of the S3 vertebra (suspicious soft tissue/fibrous/bony spur is noted in the right postero-lateral epidural space at S2/S3 level).

The tip of the conus medullaris is noted at the L2-L3 level. No intraspinal lipoma/tethering of the cord is noted.

The lumbar vertebral bodies and the intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
- 2 - scan-00003


IMPRESSION :

The MRI features suggest a dorsal dermal sinus at about the S3 vertebral level as described. A probable S3 spina bifida is noted. There is no evidence of tethering.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyza C. Almn / F / 35 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with paresthesias since 4-5 months.
Alleged H/O fall prior to this.

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 :

The L5 vertebra is as marked on the film. Please correlate with plain radiographs. The L4-L5 intervertebral disc shows loss of water content.

There is a postero-central disc herniation at the L5-S1 level indenting the dural theca anteriorly.

A postero-central disc herniation with peridiscal osteophytes is noted at the L4-L5 level indenting the anterior dural theca.

Slight facetal hypertrophy is noted at the L4-L5 and L5-S1 levels. The pedicles of these vertebrae appear congenitally short in their antero-posterior dimensions. Slight ligamentum flavum hypertrophy is noted at the S1 vertebral level.

Schmorls nodes are noted along the superior cortical endplates of the L4 and L5 vertebrae.



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 L2 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
13.0 mm at L4-L5
11.0 mm at L5-S1.

IMPRESSION :

1. A postero-central disc herniation at the L5-S1 level.

2. A postero-central disc herniation with peridiscal osteophytes at the L4-L5 level.

3. Slight facetal hypertrophy at the L4-L5 and L5-S1 levels with congenitally short pedicles of these vertebrae in their antero-posterior dimensions and a resultant tight canal at these levels.