/00002 Date : 19/00.00.00

Name of the Patient : Abc Xyz lmn / M / 68 yrs.
Referred by : Dr. Abc Xyz Shah.
Examination : M.R. Cholangiogram.

CLINICAL PROFILE :

C/O pain in the abdomen and vomiting since 8 days.

EXAMINATION :

The upper abdomen was scanned with 7 mm thick T1 Weighted and T2 Weighted axial images and 8 mm thick T2 Weighted coronal images.

MR cholangiogram was also obtained.

OBSERVATION :

The evidence of the eventration of the dome of the diaphragm on the right. The liver is placed at a much higher level than a normal. The bowel loops and fat are placed between the right dome of the diaphragm and the liver and this is suggestive of Chileaditi syndrome. There is no focal area of altered signal in the liver parenchyma. There is no dilatation of the intrahepatic radicles.

The gall bladder is small and contracted.

The tail of the pancreas is slightly ill-defined and bulky. Streaking of the peripancreatic fat plane is noted in the region of the pancreatic tail. A pocket of fluid is noted at the inferior pole of the spleen in the region of the tail of the pancreas. The head and body of the pancreas appear unremarkable. The pancreatic duct is not dilated.

Multiple renal cortical and parenchymal cysts are noted.






The spleen is normal in size and signal characteristics.

There are no abnormally enlarged abdominal lymph nodes noted.

The visualized adrenal glands are unremarkable.

A small left basal pleural effusion is noted with left basal atelectasis.

The MRCP reveals mild fullness of the common bile duct which measures approximately 1.0 cm in its maximum transverse dimensions. Mild concentric narrowing of the terminal CBD is noted without intrinsic lesion in the terminal CBD.

A focal hypointensity along the posterior wall of the common bile duct in its mid-segment is suspicious for a calculus (scan 102.10). There is no dilatation of the hepatic ducts or the intrahepatic biliary radicles. The cystic duct is not well-identified.

IMPRESSION :

1. Eventration of the dome of the diaphragm on the right.

2. Ill-defined and bulky tail of the pancreas with streaking of the peripancreatic fat in that region and a fluid collection at the inferior margin of the spleen as described may suggest focal pancreatitis. Small left basal pleural effusion and left basal atelectasis.
..3/.















- 3 - Scan-00005


3. Small and contracted gall bladder.

4. CBD measures 1.0 cm in its maximum transverse dimension. Concentratic narrowing of the terminal CBD is noted, without obvious intrinsic lesion in terminal CBD.

5. Suspicious calculus in the mid-segment of the CBD along its posterior wall. Terminal CBD and pancreatic ducts are unremarkable.

6. Multiple renal cortical and parenchymal cysts.

7. Chileaditi syndrome.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyze lmn / M / 25 yrs.
Referred by : Dr. Abc Xyzni / Dr. Abc Xyzhijwala.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE 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.

OBSERVATION :

There is loss of normal lumbar lordosis and loss of water content of the L3-L4 and L5-S1 intervertebral discs.

There is a postero-central disc herniation with peridiscal osteophyte at the L5-S1 level, slightly more to the left of the midline. Slight inferior migration of the disc fragment is noted with indentation on the dural theca anteriorly.

Posteriorly bulging discs are noted at the L4-L5 and L3-L4 levels.

The pedicles of the lower lumbar vertebrae are congenitally short in their antero-posterior dimensions.

Schmorls nodes are noted in the lumbar region.

A limbus vertebra is seen at the L4 vertebral level.


There is loss of normal posterior epidural fat of the D12 and upper half of the L1 vertebral levels. The thecal sac is widened at that level. The CSF posterior to the intrathecal nerve roots at these levels is slightly more hyperintense on the T2 Weighted images. The D12 nerve root sleeves appear baggy bilaterally, more on the left side. The intrathecal nerve roots at the D12 and L1 vertebral levels seem to be placed slightly more anteriorly than normal.

The lumbar vertebral bodies and the rest of the 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 D12 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 :

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

IMPRESSION :

1. A postero-central disc herniation with peridiscal osteophyte at the L5-S1 level, slightly more to the left of the midline with slight inferior migration of the disc fragment.

2. Posteriorly bulging discs at the L4-L5 and L3-L4 levels.

3. Changes in the dural sac identified at the D12 and L1 vertebral levels may suggest dural ectasia. An intradural arachnoid cyst cannot be, however, excluded.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzlmn / F / 34 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches with giddiness and vertigo since 15-20 days.
H/O ptosis on the right side 5 days back, which has recovered.
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.
3 mm thick T1 Weigted, STIR and FLAIR coronal images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
3 mm thick T1 Weighted axial and coronal images with fat saturation.

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. No obvious vascular anomaly is identified on this study.







The cavernous sinuses, suprasellar cistern and the optic nerves on either side show normal signal characteristics.

After administration of contrast, there is no focal area of abnormal enhancement in the brain parenchyma, the meninges, the cavernous sinuses or in the orbits on either side.

IMPRESSION :

No significant abnormality is detected within the brain parenchyma on this study.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyz Ralmn / M / 42 yrs.
Referred by : Dr. Abc Xyzhi.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O low back pain radiating to BLE since 3 months.
H/O spinal surgery 2 years back.

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 evidence of laminectomy of the L5 vertebra with post-operative changes in the soft tissues in the posterior lumbar region at that level.

There is central and anterior wedging of the L4 vertebral body which appears hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. Herniation of the L3-L4 disc into the body of the L4 vertebra is noted.

Small, posterior disc herniations with posterior peridiscal osteophytes are noted at the L4-L5 and L5-S1 levels.

The intrathecal nerve roots at the L4, L5 and S1 vertebral levels appear clumped suggesting arachnoiditis (Group I).

- 2 - scan-00002

The rest of the visualized lumbar vertebral bodies show spotty fatty marrow changes. The remaining intervertebral discs reveal normal signal intensity. The facet joints at the L4-L5 and L5-S1 levels appear slightly hypertrophied.
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 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
17.0 mm at L2-L3
15.0 mm at L3-L4
13.0 mm at L4-L5

Screening T1 Weighted sagittal images of the dorsal spine reveal spotty fatty marrow changes in some of the dorsal vertebrae.

IMPRESSION :

1. Post-oeprative changes.

2. Central and anterior wedging of the L4 vertebral body
with altered signal is not specific for a single etiology. These changes may suggest,
a. Wedge-fracture with bone bruise.
b. Metastasis/small cell tumors.
c. Osteitis.
A biopsy from the affected bone may be worthwhile.

2. Small, posterior disc herniations with posterior peridiscal osteophytes at the L4-L5 and L5-S1 levels.

3. Spotty fatty marrow of the rest of the lumbar and some dorsal vertebral bodies which may suggest osteoporosis.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / M / 9 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Hippocampal Region.

CLINICAL PROFILE :

C/O left focal seizures since 0000.

EXAMINATION :

M.R.I of the hippocampal region was performed, as requested using the following parameters :

3 mm thick T1 Weighted and T2 Weighted coronal images.
5 mm thick T2 Weighted axial and T1 Weighted sagittal images through the brain.

OBSERVATION :

There is no area of focal altered signal intensity on the T2 Weighted axial images of the brain.

The hippocampal complex is unremarkable on either side.

A prominent perivascular space is noted in the left posterior parietal deep white matter.

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.

Cerebellar tonsillar ectopia is noted and note is also made of enlarged adenoids.

IMPRESSION :

Cerebellar tonsillar ectopia.

No other significant abnormality detected within the brain on this study.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyzilal P. Limbalmn / M / 40 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O right hemiparesis 1 month back.
Now C/O memory lapses.

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 a well-marginated hypointense lesion on the T1 Weighted images in the left lentiform nucleus extending into the left anterior capsular region, head of the left caudate nucleus and left corona radiata. This lesion appears hyperintense on the proton, T2 Weighted and FLAIR images. Resultant focal dilatation of the frontal horn and body of the left lateral ventricle is noted. Perilesional hyperintense signal on the T1 Weighted images which is isointense to normal white matter on the T2 Weighted images may represent paramagnetic substance deposition (less likely to represent haemoglobin breakdown products).

Hyperintense signal on the proton, T2 Weighted and FLAIR images is also noted in the left inferior frontal cortex, left high frontal cortex and in the right posterior parietal cortex.

The right lateral, third and 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.
- 2 - scan-00000


Inflammatory changes are noted in the ethmoidal air cells and left frontal sinus.

IMPRESSION :

The MRI features are suggestive of :

1. Altered signal in the left lentiform nucleus extending into the left anterior capsular region, head of the left caudate nucleus and left corona radiata represents an old infarct with gliotic/encephalomalacic changes.

2. Altered signal in the left inferior frontal cortex, left high frontal cortex and in the right posterior parietal cortex represents cortical infarcts.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzabala Almn / F / 67 yrs.
Referred by : Dr. Abc Xyz. Desai.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O radicular pain in BLE with paresthesias and inability to stand 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 :

There is reduction in height and loss of water content of the lumbar intervertebral discs. A hypointense signal on all the pulse sequences in the lumbar intervertebral discs suggests calcium/vacuum phenomena.

There is Grade I spondylolisthesis of the L4 vertebra over the L5 vertebra without obvious spondylolysis. A posterior disc herniation is noted at the L4-L5 level, with bilateral neural foraminal narrowing. There is also hypertrophic facetal arthropathy and ligamentum flavum hypertrophy with resultant canal stenosis. Impingement of the right L4 nerve root in the right neural foramen at the L4-L5 level is also noted. A disc fragment is seen in the anterior epidural space at the L4 vertebral level.

Posterior peridiscal osteophytes with posterior disc herniation is noted at the L5-S1 level, indenting the dural


theca anteriorly. There is mild neural foraminal narrowing bilaterally with indentation upon the exiting left L5 nerve root at this level.

A posterior disc herniation with posterior peridiscal osteophytes is noted at the L3-L4 level with bilateral neural foraminal narrowing. A sequestered disc fragment is noted in the left lateral recess of the L4 vertebra with impingement of the traversing left L4 nerve root.

Posterior disc herniations with peridiscal osteophytes are noted at the D12-L1, L1-L2 and L2-L3 levels, indenting the dural theca anteriorly. A left paracentral disc herniation with a peridiscal osteophyte is noted at the D10-D11 level. A posterior disc bulge is seen at the D11-D12 level.

Slight facetal hypertrophy is noted in the lumbar region.

Ligamentum flavum hypertrophy is also noted at the L3-L4 and L2-L3 levels.

Type II degenerative marrow changes are noted adjacent to the L4-L5 and L5-S1 intervertebral discs.

Anterior disc herniations with anterior peridiscal osteophytes are noted in the lumbar region.

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 D12 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 :

12.0 mm at L1-L2
..3/.






- 3 - Scan-00009


12.0 mm at L2-L3
13.0 mm at L3-L4
7.0 mm at L4-L5
8.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. Grade I spondylolisthesis of the L4 vertebra over the L5 vertebra without obvious spondylolysis.

2. A posterior disc herniation at the L4-L5 level, with bilateral neural foraminal narrowing. There is also hypertrophic facetal arthropathy and ligamentum flavum hypertrophy with resultant canal stenosis. Impingement of the right L4 nerve root in the right neural foramen at the L4-L5 level is noted.

3. A posterior disc herniation with posterior peridiscal osteophytes at the L5-S1 level.

4. A posteriorly herniated disc with posterior peridiscal osteophyte at the L3-L4 level with a sequestered disc fragment in the left lateral recess of the L4 vertebra.

5. Posterior disc herniations with posterior peridiscal osteophytes at the D12-L1, L1-L2 and L2-L3 levels with a left paracentral disc herniation with posterior peridiscal osteophytes at the D10-D11 level.

6. Slight facetal hypertrophy in the lumbar region.

7. Ligamentum flavum hypertrophy at the L3-L4 and L2-L3 levels.

8. Lower lumbar canal stenosis.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyza V. Khanolmn / F / 55 yrs.
Referred by : Dr. Abc Xyzlwalkar.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

C/O backache since 2 months and paraplegia with bladder/bowel involvement since 8-10 days.
H/O fall/fever 2-3 months ago.

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 collapse of the D7 vertebral body. The D7 vertebral body and pedicles appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. The inferior cortical endplate is broken. The superior cortical endplate and the D6-D7 and D7-D8 intervertebral discs appear intact. There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the prevertebral, paravertebral and anterior epidural space at the D7 vertebral level. This lesion appears hyperintense on the T2 Weighted images. There is resultant cord compression and slight posterior displacement of the cord. The dorsal spinal cord over the D6 to D8 vertebral levels appears hyperintense on the T2 Weighted images, which suggests cord edema/ischemia/myelitis.

The C3, C7, D6, D8, D9, D10, L4 and L5 vertebral bodies and the spinous processes of some these vertebrae also appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images.
- 2 - scan-00008


The rest of the visualized dorsal vertebral bodies and intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.

The conus medullaris terminates at the D12 level.

Parenchymal infiltrates are noted in the bases of both lungs.

IMPRESSION :

Collapse of the D7 vertebral body with altered signal most likely represents osteitis, most likely tuberculous in etiology. Prevertebral, paravertebral and anterior epidural soft tissue lesion may represent granulation tissue/abscess. There is resultant cord compression and cord signal alteration at the D7 vertebral level suggesting cord edema/ischemia/myelitis.

Altered signal of the C3, C7, D6, D8, D9, D10, L4 and L5 vertebral bodies and the spinous processes of some of these vertebrae may also suggest osteitis.

The possibility of altered signal in the above described vertebrae representing metastasis or small cell tumor cannot be entirely excluded though less likely.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyzti Pralmn / F / 46 yrs.
Referred by : Dr. Abc Xyznawane.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 3 years radiating to the LLE with paresthesias since 2 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 sacralization of the L5 vertebra and the L1 vertebral body is as marked on the film.

There is loss of water content of the L1-L2 and L4-L5 intervertebral discs.

There is Grade I spondylolisthesis of the L4 over the L5 vertebra with probable spondylolysis at L4, bilaterally. A resultant pseudo-posterior disc bulge is noted at the L4-L5 level indenting the dural theca anteriorly.

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 D12 level and the thecal sac terminates at the S1 level.
- 2 - Scan-00007


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

16.0 mm at L1-L2

17.0 mm at L2-L3

20.0 mm at L3-L4

16.0 mm at L4-L5

11.0 mm at L5-S1.

IMPRESSION :

1. Sacralization of the L5 vertebra.

2. Grade I spondylolisthesis of the L4 over the L5 vertebra with probable spondylolysis at L4, bilaterally and a pseudo-posterior disc bulge at the L4-L5 level.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / F / 17 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches and vomiting since 25 days.
H/O neck pain with fever. Patient is on AKT.

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.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and 4 mm thick T1 Weighted coronal images (with magnetization transfer).

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is seen a fairly large, approximately 3.5 x 2.2 x 3.5 cms sized conglomeration of multiple rim-enhancing lesions in the cerebellar vermis extending slightly to the right of the midline.
This lesion appears iso to slightly hypointense to normal white matter on the T1 Weighted images and is relatively more hypointense on the proton and T2 Weighted images. There is perilesional edema with mild compression of the fourth ventricle.
Resultant mild dilatation of both the lateral ventricles is noted. The third ventricle is unremarkable.


The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

After administration of contrast, enhancement of the tentorial leaflets at the site of contact with the above described lesions is noted bilaterally.

IMPRESSION :

A conglomeration of multiple rim enhancing lesions in the cerebellar vermis as described follow the signal characteristics of multiple tuberculomas. Enhancement of the adjacent tentorial leaflets is also noted. Mild dilatation of both the lateral ventricles is also noted.

As compared to the previous CT Scan dated 00.00.00, there is slight reduction in the size of the ventricles.