hs/ke
Date : 00.00.00

Name of the Patient : Abc Xyzma H. Jailmn / F / 20 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches since 1 year with diplopia since 1 month and weakness of the LUE.

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.

4 mm thick T1 Weighted coronal images.

5 mm thick T1 Weighted sagittal images.

PATIENT REFUSED CONTRAST ADMINISTRATION.

OBSERVATION :

There is evidence of a space occupying lesion within the thalamus, hypothalamus, and right cerebral peduncle and extending into the lower midbrain and upper pons. This lesion is relatively hypointense to grey matter on all the pulse sequences. Perilesional edema is noted, which is also seen to extend into the right middle cerebellar peduncle, right cerebellar hemisphere, right lentiform nucleus, posterior limb of the right internal capsule and right corona radiata.









The lesion appears to be extending along the right optic tract. There is compression upon the third ventricle with shift to the left side and upon the body of the right lateral ventricle with resultant superior displacement. Also seen is slight compression upon the aqueduct and fourth ventricle. There is mild to moderate dilatation of both the lateral ventricles with periventricular hyperintensities on the proton, T2 Weighted and FLAIR images suggestive of CSF ooze.

No obvious vascular anomaly is identified on this study.

IMPRESSION :

The MRI features are suggestive of a mass lesion in the right thalamus and right cerebral peduncle with obstructive hydrocephalus as described.

This most likely represents a neoplastic process like a glial cell tumor (especially in view of the right optic tract involvement).

The possibility of this being a granulomatous lesion is less likely. However a contrast enhanced scan may be worthwhile.

hs/ke
/61 Date : 00.00.00

Name of the Patient : Abc Xyzben Ghatlmn / F / 71 yrs.
Referred by : Dr. Abc Xyzndhi.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O giddiness.

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.

3 mm thick T1 Weighted coronal images.

MR cisternogram was obtained in the coronal plane.

5 mm thick T1 Weighted sagittal images.

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

NECK MRA SHOWS PATIENT MOTION.

OBSERVATION :

BRAIN :

There is a small bright focus on the FLAIR images in the right corona radiata and this may be ischemic in etiology.

There is beaking of the cerebellar tonsils and the tip is seen to lie at the foramen magnum level.


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

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

Note is made of an empty sella.

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

INTRACRANIAL MRA :

The posterior cerebral arteries are ectatic. Hypoplasia of the right vertebral artery is noted.

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

NECK MRA :

The right vertebral artery is hypoplastic. The left vertebral artery is unremarkable. The carotid arteries are ectatic.

IMPRESSION :

The MRI/MRA features are suggestive of :

1. A foci of altered signal intensity in the right corona radiata which is most likely ischemic in etiology.

2. An empty sella.

hs/ke
Date : 00.00.00

Name of the Patient : Abc Xylmn / M / 59 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O giddiness with blurred vision (on the left side) and occasional tingling in the LUE and LLE since 00.00.00.
Known diabetic/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 and Fast Scan (T2 *) coronal images.

OBSERVATION :

There is evidence of a diffuse area of hypointensity on the T1 Weighted images which turn hyperintense on the proton, T2 Weighted and FLAIR images within the right temporo-occipital lobe and is also seen to be involving the cortical grey matter and subcortical white matter and would most likely represent a fresh infarct. Similar but smaller area is seen in the right high parietal region.

Multiple well-defined areas which are iso to hyperintense to CSF on all the pulse sequences are noted within the lentiform nucleus and corona radiata bilaterally, head of the left caudate nucleus, left centrum semiovale, right middle cerebral peduncle and right cerebellar hemisphere.

Small areas of hypointensity on the T1 Weighted images which are seen to turn hyperintense on the proton, T2 Weighted and FLAIR images within white matter in the fronto-parietal lobes and periventricular white matter bilaterally and would represent ischemic changes.
..2/.









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

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

There is ectasia of the vertebro-basilar system.

IMPRESSION :

The MRI features are suggestive of :

1. Altered signal intensity within the right temporo-occipital lobe and right high parietal region would most likely represent a fresh infarct.

2. Lacunar infarcts within the lentiform nucleus and corona radiata bilaterally, head of the left caudate nucleus, left centrum semiovale, right middle cerebral peduncle and right cerebellar hemisphere.

hs/ke
Date : 00.00.00

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

CLINICAL PROFILE :

H/O high grade fever with chills 1 year back with weakness on the left side and involuntary movements on the left side.
Now C/O gait imbalance since 6 months

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 STIR coronal images through the optic nerves.

OBSERVATION :

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

The left optic nerve shows a hyperintense signal on the STIR images. The right optic nerve is unremarkable.

There is mild prominence of the cerebellar folia.

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 altered signal of the left optic nerve and may represent optic neuritis/demyelination/ ischemia.

hs/ke
Date : 00.00.00

Name of the Patient : Abc Xyzra Jailmn / M / 25 yrs.
Referred by : Dr. Abc Xyzlwalkar.
Examination : M.R.I. of Both Hips.

CLINICAL PROFILE :

C/O pain on the right side (hip bone to knee) since 15-20 days with difficulty in walking.
H/O Aplastic anemia with epilepsy since 2 years.

EXAMINATION :

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

5 mm thick T1 Weighted and STIR coronal images.

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

5 mm thick Proton density sagittal images.

OBSERVATION :

There is evidence of areas which are isointense to fat with a hypointense rim on all the pulse sequences within the femoral head bilaterally. This would suggests Class A avascular necrosis.

Areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted and STIR images are seen within the right acetabulum and the head and neck of the right femur. Fluid is noted within the right hip joint.

Hyperintense signal seen in the right gluteal region on the T2 Weighted and STIR images may be the result of an intramuscular injection.

There is no effusion within the left hip joint.
- 2 - Scan-00006


IMPRESSION :

The MRI features are suggestive of :

1. Class A avascular necrosis within the femoral head bilaterally.

2. Altered signal within the right acetabulum and the head and neck of the right femur with presence of fluid within the right hip joint. This may be the result of avascular necrosis or an infective process.

hs/ke
/55 Date : 00.00.00

Name of the Patient : Abc Xyzhanuben H. Ajlmn / F / 51 yrs.
Referred by : Dr. Abc Xyz Desai.
Examination : M.R.I. of the Temporal bones and Skull
base.

CLINICAL PROFILE :

C/O headaches with right ear pain, tinnitus and decreased hearing with pus discharge. Now also C/O difficulty in swallowing.
O/E VII, IX, X, XII cranial nerve palsy on the right side.
H/O DM/HT.
Patient is a known C/O malignant otitis externa on the right side.

EXAMINATION :

M.R.I of the temporal bones and skull base was performed using the following parameters :

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

4 mm thick T1 Weighted and STIR coronal images.

4 mm thick T1 Weighted sagittal images.

MR Cisternogram was obtained in the coronal plane.

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

OBSERVATION :

There is evidence of an ill-defined soft tissue lesion in the region of the external and middle ear and mastoid air cells on the right side. It is iso to hyperintense to normal muscle but hypointense to fat on the T1 Weighted images and hyperintense to both on the T2 Weighted and STIR images. It is seen to extend into the right lateral soft tissues of the neck at the C1/C2 levels. Also seen is erosion of the occipital condyle and right lateral mass of the C1 vertebra on the right side. There is
..2/.







erosion of the Styloid process on the right side. Also seen is encasement of the right carotid sheath at the C1/C2 levels and also of the petrous component of the right internal carotid artery. However flow void signal is seen in the right internal carotid artery at these levels.

The right transverse and sigmoid sinuses show an intraluminal signal which is isointense to brain parenchyma on the T1 Weighted images and hyperintense on the STIR and T2 Weighted images. This may suggest slow flow/thrombus.

The right eustachian tube appears to be filled with fluid (hyperintense on the T2 Weighted images).

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

IMPRESSION :

In a known C/O malignant otitis externa the MRI features are suggestive of a soft tissue lesion involving the mastoid air cells, external and middle ear and the occipital condyle and lateral mass of the C1 vertebra on the right side as described.

Intraluminal signal within the right lateral and sigmoid sinuses may suggest slow/flow thrombus.

A venogram/MRV may be performed to rule out a thrombus.

sb/bv
Date : 00.00.00

Name of the Patient : Abc XyzGhelmn / M / 69 yrs.
Referred by : Dr. Abc Xyzr Archik.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE since 4-5 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.

IMAGES SHOW PATIENT MOTION. PATIENT REFUSED SEDATION.

OBSERVATION :

There is central and anterior wedging of the D12 vertebral body. Hypointense signal on all pulse sequences in the body of the D12 vertebra may represent compressed trabeculae. The rest of the visualized D12 vertebral body shows a hyperintense signal on the T2 Weighted images which may suggest bone bruise/edema. Minimal retropulsion of D12 body is noted, indenting the thecal sac at that level. There is a paravertebral intermediate signal intensity lesion on the T1 Weighted images which appears hyperintense on the T2 Weighted images and may represent a soft tissue hematoma. The D11-D12 and D12-L1 intervertebral discs show a subtle hyperintense signal on the T2 Weighted images.

Slight anterior wedging of the L1 vertebral body is also noted without change in signal intensity.

There is loss of water content of the lumbar intervertebral discs.
..2/.








The lumbar and rest of the visualized dorsal vertebral bodies show spotty fatty marrow changes suggesting osteoporosis.

Small posterior disc bulges are noted at the L4-L5 and L5-S1 levels. Slight facetal hypertrophy is noted in the lumbar region.

Bilateral postero-lateral disc herniations are seen at the L3-L4 level.

The lower spinal cord shows normal signal intensity.

The conus medullaris terminates at the L1-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 :

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

Screening, T1 Weighted sagittal images of the dorsal spine do not reveal any significant feature of note.

IMPRESSION :

Central and anterior wedging of the D12 vertebral body with altered signal most likely is the sequelae of previous trauma. There is no significant cord compression or cord signal alteration.

Slight anterior wedging of L1 vertebral body without any change in signal is also noted. The rest of the visualized lumbar and dorsal vertebral bodies show spotty fatty marrow changes suggesting osteoporotic changes.

The possibility of a pathologic fracture superimposed upon an osteoporotic spine seems less likely.

sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzl Nlmn / M / 49 yrs.
Referred by : Dr. Abc Xyzdar / Dr. Abc Xyzagwati.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O railway accident on 00.00.00, with altered sensorium 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 coronal images.

SOME IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There is still seen a subtle ill-defined, hyperintense signal on the proton and T2 Weighted images in the right occipital cortex and in the subcortical white matter in the high frontal deep white matter on the right (scan 105.16). These lesions appear nearly isointense to normal white matter on the T1 Weighted images.

There is mild dilatation of both the lateral, third and fourth ventricles. There is slight prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

Inflammatory changes are noted in the right maxillary antrum.










IMPRESSION :


1. Altered signal in the subcortical white matter in the right high frontal region and right occipital cortex may represent contusions/shearing injuries in the given clinical setting.

2. Mild dilatation of both the lateral, third and fourth ventricles with prominence sulcal spaces and basal cisterns.

As compared to the previous MRI (study no:00006) dated 00.00.00, there is reduction in the size and signal intensities of the previously described contusions/shearing injuries. There is also complete resolution in the previously identified subdural collections. There is however, mild dilatation of the ventricular system and prominence of cortical sulcal spaces and basal cisterns.

sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzlal K. lmn / M / 72 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 1 year.
C/O radicular pain to the LLE since 2 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 scoliosis of the lumbar spine with convexity to the left. Clockwise rotational anomaly of the upper lumbar vertebrae is noted.

There is reduction in height of the L3-L4 and L4-L5 discs and loss of water content of the lumbar intervertebral discs.

There is slight anterior translation of the L3 over the L4 vertebra and slight retroplacement of the L4 over the L5 vertebra.

Left postero-lateral and left far lateral disc bulge with peridiscal osteophyte is noted at the L5-S1 level with slight left neural foraminal narrowing. Facetal hypertrophy is noted at this level.





A left postero-lateral disc herniation with peridiscal osteophyte is seen at the L4-L5 level indenting the traversing left L5 nerve root and narrowing the left neural foramen at that level. Facetal and ligamentum flavum hypertrophy is noted at this level.

A right postero-lateral disc bulge with peridiscal osteophyte is noted at the L3-L4 level with right neural foraminal narrowing. Right sided facetal and ligamentum flavum hypertrophy is noted at this level.

Type III degenerative marrow changes are noted adjacent to the L3-L4 disc.

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

The conus medullaris terminates at the L2 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
19.0 mm at L2-L3
16.0 mm at L3-L4
13.0 mm at L4-L5
11.0 mm at L5-S1.

The cerivco-dorsal spine was screened with the help of 5 mm thick T1 Weighted sagittal images which do not reveal any diagnostic feature of note.

IMPRESSION :

1. Scoliosis of the lumbar spine with convexity to the left with clockwise rotational anomaly of the upper lumbar vertebrae.
..3/.









- 3 - Scan-00001


2. Slight anterior translation of the L3 over the L4 vertebra and slight retroplacement of the L4 over the L5 vertebra.

3. Left postero-lateral and left far lateral disc bulge with peridiscal osteophyte at the L5-S1 level with facetal hypertrophy at this level.

4. A left postero-lateral disc herniation with peridiscal osteophyte at the L4-L5 level indenting the traversing left L5 nerve root with facetal and ligamentum flavum hypertrophy at this level.

5. A right postero-lateral disc bulge with peridiscal osteophyte at the L3-L4 level with right sided facetal and ligamentum flavum hypertrophy at this level.

ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzlal K. lmn / M / 69 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

C/O gradually progressive weakness of BLE with bladder involvement since 15 days.
H/O spinal surgery 20 years back. Laminectomy over L1 to L5 done on 00.00.00.

EXAMINATION :

M.R.I of the dorsal 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 right paracentral disc herniation with a peridiscal osteophyte at the D12-L1 level with anterior indentation of the cord.

Small posterior disc herniations with peridiscal osteophytes are seen at the L1-L2 and L2-L3 levels with anterior indentation of the thecal sac. There is bilateral neural foraminal narrowing at the L2-L3 level. The visualized dorso-lumbar intervertebral discs show loss of water content. The lower dorso-lumbar facet joints show degenerative changes.

The visualized dorsal vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable. Slight anterior wedging of the D12 body is noted.



The visualized dorsal spinal cord reveals normal signal intensity.

The conus medullaris terminates at the L1 level.

The cervico-dorsal spine was screened with 5 mm thick T2 Weighted sagittal images which shows posterior disc herniations with peridiscal osteophytes at the C3-C4, C4-C5 and C5-C6 levels with anterior indentation of the cord and a tight canal. The spinal cord at the C3-C4 level shows a subtle hyperintense signal suggestive of cord edema/ischemia. A detailed study of the cervical spine may be worthwhile.

The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images which shows post-operative changes with laminectomy over the L1 to L5 levels and degenerative changes in the lumbar spine.

IMPRESSION :

1. A right paracentral disc herniation with a peridiscal osteophyte at the D12-L1 level.

2. Posterior disc herniations with peridiscal osteophytes at the C3-C4, C4-C5 and C5-C6 levels with a tight canal.

3. Altered signal of the spinal cord at the C3-C4 level suggestive of cord edema/ischemia.

4. Post-operative changes in the lumbar spine with h/o laminectomy over the L1 to L5 levels and degenerative changes in the lumbar spine.

A dedicated study of the cervical spine is indicated.