hs/ke
Date : 00.00.00

Name of the Patient : Abc Xyz Mithalmn / M / 20 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O drooping of the right eye with paresthesias in the LUE and LLE and bladder involvement since 2 days.
H/O typhoid 5 months ago with difficulty in walking and fever 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.

5 mm thick T1 Weighted sagittal images.

3 mm thick T1 Weighted coronal images through the region of interest.

The cervical spine was screened with 5 mm thick T2 Weighted sagittal images.

OBSERVATION :

There is evidence of a focal hypointense lesion on the proton, T2 Weighted and FLAIR images in the region of the tectal plate/perimesencephalic cistern on the left side. It is seen to have a diameter of approximately of 8 mms.

Foci of hypointensity on the T1 Weighted images which turn hyperintense on the proton and T2 Weighted images are seen in the right lateral aspect of the pons and right postero-lateral aspect of the medulla. A hypointense focus on the T1 Weighted images which turns hypointense with a hyperintense rim on the FLAIR images is noted in the thalamus on the right side.





Irregularly defined areas of hyperintensity on the FLAIR images are noted along the grey matter in the right temporo-occipital lobes and superior aspect of the right cerebellar hemisphere.

An area which is iso to hypointense to CSF on all the pulse sequences is noted in the right temporal lobe, more so anteriorly. This may represent an area of cystic encephalomalacia.

Areas of intermediate signal intensity on the T1 Weighted images which turn heterogeneously hyperintense on the proton, T2 Weighted and FLAIR images are seen within the suprasellar cistern. The optic chiasm and pituitary stalk cannot be identified separately from this lesion.

There is moderate dilatation of the third and both lateral ventricles. Also seen is mild dilatation of the fourth ventricle.

There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

The screening images of the cervical spine are unremarkable.

IMPRESSION :

The MRI features are suggestive of :

1. Mild to moderate communicating hydrocephalus with presence of exudates in the suprasellar cistern.

2. Foci of altered signal intensity within the right lateral aspect of the pons, right postero-lateral aspect of the medulla and in the thalamus on the right side. These may be ischemic in etiology or may represent granulomas.
..3/.










- 3 - Scan-00007


3. Areas of altered signal along the grey matter in the right temporo-occipital lobes and superior aspect of the right cerebellar hemisphere and these are most likely ischemic in etiology (? evolving granulomas).

4. A well-circumscribed lesion having a diameter of 8.0 mms in the region of the tectal plate/perimesencephalic cistern on the left side most likely represents a granuloma.

5. An area of cystic encephalomalacia in the right temporal lobe, more so anteriorly.

A contrast enhanced study would be worthwhile.

hs/ke
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / M / 40 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Nasopharynx.

CLINICAL PROFILE :

C/O difficulty in swallowing and speech following right submandibular gland excision done 00.00.00 and dryness of mouth. Right half of tongue atrophied and on protrusion deviated towards right.

EXAMINATION :

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

7 mm thick T1 Weighted and T2 Weighted axial images.

7 mm thick T1 Weighted and T2 Weighted sagittal images.

After administration of contrast the following parameters were used :

7 mm thick T1 Weighted axial and coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is atrophy of the right half of the tongue with the posterior part bulging into the oropharynx on the right side.

There is no obvious masss lesion in the region of the nasopharynx. The parapharyngeal soft tissues are unremarkable.

Post-operative changes are noted in the right submandibular region. The right submandibular gland is not visualized, the result of previous surgery.

A polyp is noted in the right maxillary sinus.
..2/.





00006
- 2 -


IMPRESSION :

The MRI features are suggestive of :

1. Post-operative status.

2. Atrophy of the right half of the tongue.

3. No abnormality detected in the nasopharynx per se on this study.

Date : 00.00.00

Name of the Patient : Abc Xyz A. Dhorajilmn / M / 68 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain and Orbits.

CLINICAL PROFILE :

C/O drooping of left eyelid 2-3 days back with diplopia on seeing with both eyes.
C/O watering the left eye, nose and around the left eye 4-5 days back.
Known diabetic.

EXAMINATION :

M.R.I of the brain and orbits 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 and STIR coronal images.

After administration of contrast the following parameters were used :

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

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

OBSERVATION :

There are areas of hypointensity on the T1 Weighted images which turn hyperintense on the proton, T2 Weighted and FLAIR images within the periatrial white matter bilaterally and these are most likely ischemic in etiology.



A suspicious intermediate signal intensity lesion is seen in the left cavernous sinus lateral to the internal carotid artery (scans 107.6, 106.6, 108.6). After administration of contrast there is faint enhancement of this lesion. The left carotid artery however shows normal flow-void signal.

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

The left lacrimal gland is enlarged and shows a hyperintense signal on the STIR images. After contrast administration it is seen to enhance more intensely than normal (scans 111.8, 106.18. 104.7, 107.16, 107.15, 108.15).

The extraocular muscles within both the orbits show normal contour, size and signal characteristics.

The intraorbital optic nerves are of normal size and reveal normal signal characteristics. Adequate perioptic CSF is evident on this study.

The superior orbital fissure and optic canal bilaterally are unremarkable.

Mucosal thickening is identified in the left maxillary and ethmoidal air cells.

The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
..3/.












00005
- 3 -


IMPRESSION :

The MRI features are suggestive of :

1. An enlarged lacrimal gland with signal change and enhancement pattern as described. The differentially diagnosis may include :

a. Dacryoadenitis.

b. Neoplastic processes like epithelial neoplasia or lymphomatoid tumors.

2. A suspicious lesion within the left cavernous sinus ? pseudotumor ? granulomatous process.

A follow up scan would be worthwhile if clinically indicated.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzree R. Palmn / F / 55 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE:

C/O pain in the nape of the neck and dorsal region since 1 year.
C/O radicular pain to BUE and BLE since 4 days 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 slight loss of water content of the cervical intervertebral discs.

The C7, D1 and D2 vertebral bodies appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted and Fast Scan (T2 *) images. The C7-D1 intervertebral disc also appears hyperintense on the T2 Weighted images. There is an intermediate signal intensity soft tissue lesion with a hyperintense rim on the T1 Weighted images in the prevertebral region on either side of the midline, extending over the C3 to D3 vertebral levels. This lesion appears hyperintense with a hypointense rim on the T2 Weighted and Fast Scan (T2 *) images. Similar signal intensity lesion is also noted in the anterior epidural space at the C6 to D2 vertebral levels, with cord compression. There is




encroachment into the neural foramina at the C6-C7 and C7-D1 levels with involvement of the C7 and D1 pedicles, bilaterally. The cervical spinal cord at these levels shows a hyperintense signal on the T2 Weighted and Fast Scan (T2 *) images which suggests cord edema/ischemia/myelitis.

The rest of the cervical vertebral bodies show normal signal intensity. The joints of Luschka are unremarkable.

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

T1 Weighted sagittal images of the dorsal spine from the D3 to D12 vertebral levels show no significant abnormality.

IMPRESSION :

Altered signal of the C7, D1, and D2 vertebrae and the C7-D1 intervertebral disc most likely represents osteitis with discitis, probably tuberculous in etiology. Prevertebral and anterior epidural soft tissue lesion may represent an abscess/granulation tissue. There is cord compression at the C6 to D2 vertebral levels with cord signal alteration suggesting cord edema/ischemia/myelitis.

The possibility of the above described lesion representing a neoplasm is less likely.

Date : 00.00.00

Name of the Patient : Abc XyzJ. Glmn / F / 11 yrs.
Referred by : Dr. Abc Xyzdar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O swelling in the lumbo-sacral region since birth. Operated on 00.00.00. Histopathology s/o ? fibrolipoma, ? infundibular cyst.
Now C/O low backpain radiating to the LLE on sitting/standing or walking for a long time since 1 month.

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.

5 mm thick T1 Weighted and T2 Weighted axial images.

3 mm thick T2 Weighted coronal images.

OBSERVATION :

There is seen an open lumbo-sacral canal over the L3 to S2 vertebral levels. Susceptibility artifacts at the S1 vertebral level to the left of the midline, may be the sequelae of previous surgery.

There is seen an approximately 2.1 x 2.2 x 3.2 cms sized well-defined mass lesion within the thecal sac, extending over the L4 and L5 vertebral levels. This lesion is slightly hyperintense to CSF on all the pulse sequences. Along the postero-superior margin of the lesion, there is a focal hyperintense lesion on the T1 Weighted images which appears relatively hypointense on the T2 Weighted images and may represent fatty tissue. The intrathecal nerve roots of the



conus-cauda region are draped around this lesion. The tip of the conus medullaris is not well identified separately from the lesion. The spinal cord is low-lying and is tethered to the mass lesion. Scalloping of the posterior margins of the lumbar vertebrae is noted with probable dural ectasia in the lower lumbar region.

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

IMPRESSION :

1. Post-operative status.

2. An approximately 2.1 x 2.2 x 3.2 cms sized intradural mass lesion at the L4 and L5 vertebral levels as described is not specific for a single etiology. This may represent a dermoid/epidermoid cyst. A fat signal intensity lesion is noted along the postero-superior margin of the lesion. The spinal cord appears to be tethered to the mass lesion.

No previous investigations were available for comparison.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyzhan R. Dhalmn / F / 60 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE since 1 1/2 years.

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.

There is loss of water content of the L2-L3, L3-l4 and L4-L5 intervertebral discs.

There is a left far lateral disc herniation at the L5-S1 level.

A small, postero-central protruded disc with peridiscal osteophyte is noted at the L4-L5 level. A left far lateral disc herniation is also noted at this level.

Left far lateral disc bulges are noted at the L2-L3 and L3-L4 levels.

The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints at the L4-L5 level 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.
..2/.




00001
- 2 -


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

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

IMPRESSION :

1. Sacralized L5 vertebra.

2. A left far lateral (extraforaminal) disc herniation at the L5-S1 level.

3. A small, postero-central protruded disc with peridiscal osteophyte at the L4-L5 level.

4. Left far lateral disc bulges at the L2-L3 and L3-L4 levels.

sb/bv
Date : 00.00.00

Name of the Patient : Abc XyzGalmn / M / 20 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the S. I. Joints.

CLINICAL PROFILE :

C/O low back pain on the right side with radiation to the RLE since 2 months.

EXAMINATION :

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

5 mm thick T1 Weighted and T2 Weighted axial images.

5 mm thick T1 Weighted and STIR coronal images.

The lumbo-sacral spine was screened with 5 mm thick T1 Weighted sagittal images and 5 mm thick T2 Weighted axial images.

OBSERVATION :

There is an ill-defined, hypointense signal on the T1 Weighted images in the right iliac bone adjacent to the right sacro-iliac joint. This lesion appears hyperintense on the T2 Weighted and STIR images. There is no obvious bone erosion or destruction seen. There is slight widening of the right sacro-iliac joint space. The right sacral ala is unremarkable.

A subtle but similar signal intensity change to a much lesser degree, is noted in the left iliac bone, inferiorly, adjacent to the left S. I. joint (scan 106.9). Fatty marrow changes are also noted in the left iliac bone. The left S. I. joint per se is unremarkable. No abnormal soft tissue is noted adjacent to the S. I. joints on either side.
Scan-00000


The images of the lumbo-sacral spine reveal small posterior disc bulges at the L4-L5 and L5-S1 levels. Spina bifida is noted at S1.

IMPRESSION :

1. Altered signal in the right iliac bone adjacent to the right S. I. joint may suggest sacroilitis.

2. Similar signal intensity change, but to a lesser degree, is noted in the left iliac bone adjacent to the left S. I. joint.

3. Spina bifida at S1.

hs/ke
Date : 00.00.00

Name of the Patient : Abc Xyzuddin Marlmn / M / 30 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O Patient was operated upon for left cerebellar granulomas. AT present the patient has gait imbalance.
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.

After administration of contrast the following parameters were used :

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

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is evidence of a craniotomy in the left occipital region with resultant post-operative changes.

There are areas of hypointensity on the T1 Weighted images which turn hyperintense on the proton, T2 Weighted and FLAIR images within the left cerebellar hemisphere. Also seen are a few areas which are isointense to CSF within this lesion. This lesion would represent areas of encephalomalacia. Few areas with similar signal are seen within the right cerebellar hemisphere and pons and middle cerebellar peduncle on the left side. There is exvacuo dilatation of the fourth ventricle.
00009
- 2 -


Also seen is thickening of the tentorial leaflets and falx (especially posteriorly). After contrast administration there is enhancement of the tentorial leaflets and meninges overlying both cerebral hemispheres. The intracranial lesions however do not enhance.

A focus which is near isointense to CSF is seen within the thalamus on the left side and this may represent a lacune.

There is evidence of a large lesion which is mildly hyperintense to CSF on all the pulse sequences in the right fronto-temporal region. There is mild compression upon the right lateral ventricle with minimal shift to the contralateral side. This may represent an arachnoid cyst.

Thre is mild fullness of the left lateral ventricle.

No obvious vascular anomaly is identified on this study.

IMPRESSION :

The MRI features are suggestive of :

1. Post-operative status.

2. Areas of encephalomalacia in the cerebellar hemispheres (left more than right).

3. An arachnoid cyst in the right fronto-temporal region.

4. Thickening of the tentorial leaflets and meninges overlying both cerebral hemispheres bilaterally.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyzl lmn / M / 9 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since 1 1/2 months of age.
Family H/O epilepsy.

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 :

The right hippocampal complex appears slightly smaller in bulk when compared to left and shows a hyperintense signal on the T2 Weighted images. Resultant focal dilatation of the temporal horn of the right lateral ventricle is noted. There is a suspicious hyperintense signal located in the left hippocampus also (in the head and body).

There is mild fullness of the frontal horns of the lateral ventricles bilaterally. The 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.

Mucosal thickening is noted in the left maxillary antrum.

Incidentally noted are pointed cerebellar tonsils and enlarged adenoids.
00007
- 2 -


IMPRESSION :

1. Slight decrease in bulk of the right hippocampus, with altered signal, suggests right hippocampal sclerosis.

2. Suspicious altered signal in the left hippocampus also.
The possibility of left hippocampal sclerosis also to be evaluated.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyz V. Shlmn / M / 30 yrs.
Referred by : Dr. Abc Xyzndesha.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE:

C/O 2 episodes of tilting of head on the right side with stiffening of the right half of the body and tremors of the RUE since last 3 months.

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 slight loss of water content of the mid-cervical intervertebral discs and loss of normal cervical lordosis.

Small posterior disc bulges are identified at the C4-C5, C5-C6 and C6-C7 levels.

The cervical vertebral bodies 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.

IMPRESSION :

No significant abnormality is detected on this study.