sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyzh D. lmn / M / 41 yrs.
Referred by : Dr. Abc Xyzlkarni.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE 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.

OBSERVATION :

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

There is a left postero-lateral and left far lateral disc herniation at the L5-S1 level with left neural foraminal narrowing. Resultant indentation on the traversing left S1 nerve root and indentation on the extraforaminal segment of the left L5 nerve root is noted.

There is a fairly large, right paracentral extruded disc at the L4-L5 level with right neural foraminal narrowing and indentation on the foraminal right L4 nerve root. A sequestered disc fragment is noted in the right lateral recess of L5 compressing the thecal sac with impingement of the right L5 nerve root.

A small posterior disc bulge with peridiscal osteophyte is noted at the L3-L4 level.

Slight facetal hypertrophy is noted at the L4-L5 and L5 levels with mild facet joint effusion on the right at the L4-L5 level.
..2/.







Type II degenerative marrow changes are noted adjacent to the L5-S1 disc. 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 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 :

19.0 mm at L1-L2
18.0 mm at L2-L3
14.0 mm at L3-L4
7.0 mm at L4-L5
10.0 mm at L5-S1.

IMPRESSION :

1. A fairly large, right paracentral extruded disc at the L4-L5 level with right neural foraminal narrowing and indentation on the foraminal right L4 nerve root. A sequestered disc fragment is noted in the right lateral recess of L5 with impingement of the right L5 nerve root.

2. A left postero-lateral and left far lateral disc herniation at the L5-S1 level with indentation on the traversing left S1 nerve root and indentation on the extraforaminal segment of the left L5 nerve root at that level.

3. A small posterior disc bulge with peridiscal osteophyte at the L3-L4 level.

4. Slight facetal hypertrophy at the L4-L5 and L5 levels with mild facet joint effusion on the right at the L4-L5 level.

hs/sb
Date : 00.00.00

Name of the Patient : Abc XyzN. Goslmn / F / 48 yrs.
Referred by : Dr. Abc Xyzlal
Examination : M.R.I. of the Abdomen.

CLINICAL PROFILE :

H/O vaginal hysterectomy 16 years back. Detected to have vaginal squamous cell carcinoma 6 months back. Received radiotherapy.
Now C/O vaginal discharge, burning micturition and abdominal pain.

EXAMINATION :

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

10 mm thick T1 Weighted and T2 Weighted axial images.

8 mm thick STIR coronal images.

OBSERVATION :

The liver is normal in size, shape and position. There is no focal or diffuse area of altered signal intensity. There is no intrahepatic biliary radicle dilation. The intrahepatic venous architexture is normal.

The gall bladder is normal and reveals no intrinsic abnormality.

The pancreas is normal in size and shape.

The spleen and both adrenals are normal.

Both the kidneys are normal in size and shape.





- 2 - Scan - 00004


No lymphadenopathy is detected. There is no evidence of free fluid within the abdomen.

There is a focal hyperintensity on the T2 Weighted and STIR images within the left lateral aspect of a lower dorsal vertebral body (se/im 102/6, 104/4).

IMPRESSION :

No abnormality detected within the abdomen per se.

A focal signal alteration within a lower dorsal vertebral body is of undetermined etiology.

hs/bv
Date : 00.00.00

Name of the Patient : Abc XyzN. Goslmn / F / 48 yrs.
Referred by : Dr. Abc Xyzlal.
Examination : M.R.I. of the Pelvis.

CLINICAL PROFILE :

H/O vaginal hysterectomy done 16 years back. Detected to have vaginal squamous cell carcinoma 6 months back. Received radiotherapy.
Now C/O vaginal discharge, burning micturition and abdominal pain.

EXAMINATION :

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

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

8 mm thick T1 Weighted and T2 Weighted (with fat saturation) sagittal images.

7 mm thick T1 Weighted coronal images.

OBSERVATION :

The body of the uterus is not identified, the result of previous surgery.

The vagina is seen to be bulky and shows hyperintense signal on the T2 Weighted images (isointense to normal muscle on the T1 Weighted images). The vaginal lumen is compressed and shifted to the left side. The vaginal stump also shows similar signal characteristics. The fat planes between the vagina and the urinary bladder and rectum are lost. There is no extension of this lesion into the ischio-rectal fossa bilaterally.





The wall of the urinary bladder is markedly thickened and may be the result of previous radiotherapy. Hyperintense signal seen within the soft tissues on the T2 Weighted images around the vagina may represent post-radiotherapy changes. There is also extension into the soft tissues just below the skin surface.

There are no abnormally enlarged pelvic lymph nodes identified. Subcentimetre lymph nodes are visualized in the inguinal region bilaterally. No obvious vascular anomaly is noted. A small amount of free fluid is identified anterior to the sacrum.

IMPRESSION :

In a known C/O squamous cell carcinoma of the vagina, the MRI features are suggestive of a mass lesion involving the vagina as described. There is no obvious extension of this mass lesion into the parametrium or ischio-rectal fossae. However the fat planes between the vagina and the urinary bladder and rectum are lost.

hs/sb
Date : 00.00.00

Name of the Patient : Abc XyzB. lmn / F / 45 yrs.
Referred by : Dr. Abc Xyzmpat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O weakness of the RUE and RLE since 00.00.00.

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 prominence of the cerebral cortical sulci with loss of volume of the left fronto-parietal lobes (frontal more than parietal). Hyperintense areas on the T2 Weighted images are noted within these lobes, which would most likely represent gliotic changes (? the result of a previous vascular insult). There is ex-vacuo dilatation of the left lateral ventricle and prominence of the left Sylvian fissure.

There is prominence of the cerebellar folia bilaterally. The left cerebral peduncle is decreased in volume (may represent Wallarian degeneration).

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

The left frontal sinus is overpneumatized.




- 2 - Scan - 00002

INTRACRANIAL MRA :

There is attenuation of the flow signal in the distal aspect of the M1 segment of the left middle cerebral artery. Also seen is a paucity of the Sylvian branches of the left middle cerebral artery.

The right posterior communicating artery is prominent. The right vertebral artery is slightly hypoplastic. The A1 segment of the right anterior cerebral artery is hypoplastic.

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

NECK MRA :

The right vertebral artery is slightly hypoplastic.

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 MRI/MRA features are suggestive of :

1. Areas of encephalomalacia in the left fronto-parietal lobes (frontal more than parietal), with volume loss, suggesting left cerebral hemiatrophy.

2. Cerebellar atrophy.

3. Attenuation of the flow signal of the distal aspect of the M1 segment of the left middle cerebral artery and a paucity of the Sylvian branches of the left middle cerebral
artery.

hs/bv
Date : 00.00.00

Name of the Patient : Abc Xyzed Samlmn / M / 18 yrs.
Referred by : Dr. Abc Xyzlwalkar.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE:

C/O neckpain since 4-5 months with painful movements.
H/O fever prior to this.

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.

Flexion and Extension images were obtained using 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

Irregularly defined areas of hypointensity on the T1 Weighted images which turn heterogeneously hyperintense on the T2 Weighted and Fast Scan (T2 *) images are seen to involve the odontoid process and left lateral mass of the C2 vertebra. There appears to be extension of this pathologic process into the periodontoid space (the odontoid is displaced to the right) and anterior to the left lateral mass of the C2 vertebra. There is mild indentation upon the cervico-medullary junction and upper cord by the odontoid process. There is suspicious involvement of the right occipital condyle by the lesion.

The atlanto-dens interval is seen to measure approximately 5.0 mms. There is no significant change on the flexion and extension images.
- 2 - Scan - 00001


Enlarged cervical lymph nodes are seen deep to the sternomastoid muscle bilaterally.

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

The cervical spinal cord shows normal signal intensity.

Screening of the dorsal and lumbar spine shows no significant feature of note. Note is made made of a distended bladder.

IMPRESSION :

The MRI features are suggestive of a pathologic process involving the C2 vertebra and right occipital condyle with minimal atlanto-axial subluxation as described. This may be the result of an infective process like tuberculosis.

The possibility of a neoplastic process like a small cell tumor is less likely.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzm B. Chlmn / M / 68 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O involuntary movements since 2-3 years. Similar complaints in his son.

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 on the proton, T2 Weighted and FLAIR images in the left lentiform nucleus and the periventricular white matter bilaterally. These lesions appear hypointense on the T1 Weighted images and most likely represent ischemic changes.

The putamen and head of the caudate nucleus bilaterally, appear slightly smaller in size, more so on the right side.

There is mild dilatation of both the lateral ventricles. There is slight fullness of the third ventricle. The fourth ventricle is normal. There is 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.



- 2 - Scan - 00000


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

IMPRESSION :

1. Altered signal in the left lentiform nucleus and periventricular white matter bilaterally most likely represents ischemic changes.

2. Slight atrophy of the putamen and head of the caudate nucleus bilaterally - neurodegenerative disorders may be considered as a likely possibility.

3. Mild cerebral cortical atrophy.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzmal lmn / M / 60 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O slowing of activities since several years.
C/O loss of consciousness for 5-6 hours, 5-6 days ago with inability to speak clearly.

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 are small bright foci on the proton, T2 Weighted and FLAIR images in the left centrum semiovale, white matter in both parietal lobes and white matter in the right frontal lobe. These are isointense to white matter on the T1 Weighted images.

There is mild dilatation of both the lateral and third ventricles. The fourth ventricle is normal. There is prominence of the cerebral cortical sulci, sylvian fissures and basal cisternal spaces bilaterally.

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

IMPRESSION :

1. Foci of altered signal in the left centrum semiovale, white matter in both parietal lobes and white matter in the right frontal lobe and these are most likely ischemic in etiology.

2. Mild cerebral cortical atrophy.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyz B. Mlmn / F / 2 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O delayed milestones with mental retardation and intractable 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 :

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

The hippocampal complex is unremarkable on either side.

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 :

Normal study of the Brain.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyz. Gholmn / M / 15 yrs.
Referred by : Dr. Abc Xyzgy (Dr. Abc Xyzah).
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O paresthesias on the right side of the body since 00.00.00, with slurred speech.

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 wedge shaped, hyperintense signal on the proton, T2 Weighted and FLAIR images in the pons on the left, which appears mildly hypointense to normal white matter on the T1 Weighted images. A focal hyperintensity on the proton, T2 Weighted and FLAIR images is seen in the left cerebral peduncle.

Lacunar infarcts (iso to hyperintense to CSF on all the pulse sequences) are noted in the right thalamus and in the splenium of the corpus callosum on the left.

An area of cystic encephalomalacia (isointense to CSF on all the pulse sequences is noted in the right cerebellar hemisphere antero-superiorly.

There is mild dilatation of both the lateral ventricles. 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.

- 2 - Scan - 00007


IMPRESSION :

1. Altered signal in the pons on the left is most likely an ischemic lesion, probably of recent onset.

2. Lacunar infarcts in the right thalamus and in the splenium of the corpus callosum on the left.

3. An area of cystic encephalomalacia in the right cerebellar hemisphere antero-superiorly is most likely the sequelae of a previous vascular insult.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyza Klmn / F / 58 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with radiation of pain to BLE since 2 years. H/O spinal surgery 10 years back (details not available).

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 all the lumbar intervertebral discs except the L3-L4 disc. The L5-S1 disc is reduced in height and is dessicated and also shows presence of calcification/vacuum phenomenon.

There is evidence of laminectomy of the L3, L4 and L5 vertebrae with post-operative changes in the soft tissues in the posterior lumbar region over these levels.

There is Grade I spondylolisthesis of the L4 over the L5 and L5 over the S1 vertebrae. Resultant compromise of the neural foramen at the L4-L5 and L5-S1 levels is noted, with probable impingement of the L5 nerve roots bilaterally.

Posterior peridiscal osteophytes are noted at the L4-L5 and L5-S1 levels with bilateral neural foraminal narrowing.
Scan - 00006


Probable fusion with bone grafting is done in the L5/S1 region. The facet joints at the L5-S1 level appear hypertrophied with a posterior bony bar and canal stenosis at the L5-S1 level.

The facet joints at the L4-L5 level also appears hypertrophied.

The L5 and S1 vertebrae show fatty marrow changes.The rest of the lumbar vertebral bodies reveal normal signal intensity. The remaining 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 :

12.0 mm at L1-L2
12.0 mm at L2-L3
12.0 mm at L3-L4

IMPRESSION :

1. Post-operative status with laminectomy of the L3 to L5 vertebrae and fusion with bone grafting in the L5/S1 region.

2. Grade I spondylolisthesis of the L4 over the L5 and L5 over the S1 vertebrae.

3. Posterior peridiscal osteophytes at the L4-L5 and L5-S1 levels, with bilateral neural foraminal narrowing, with impingement of the L5 nerve roots in the neural foramen bilaterally.

4. Facetal hypertrophy at the L4-L5 and L5-S1 levels with a posterior bony bar at the L5-S1 level and canal stenosis at the L4-L5 and L5-S1 levels.