ke/hs
Date : 00.00.00

Name of the Patient : Abc Xyzana G. Mahlmn / F / 44 yrs.
Referred by : Dr. Abc Xyzidhungat.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O occasional giddiness with involuntary movements of head since 1 1/2 months.

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 are hyperintense areas on the T2 Weighted images in the lentiform nuclei, head of the caudate nucleus, periventricular white matter and bilateral corona radiata and centrum semiovale. These are suggestive of areas of ischemia/infarction.

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

INTRACRANIAL MRA :

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



- 2 - Scan - 00003


NECK MRA :

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. Altered signal in the lentiform nuclei, head of the caudate nucleus, periventricular white matter and bilateral corona radiata and centrum semiovale are suggestive of areas of ischemia/infarction.

2. No significant abnormality is detected on the intracranial and neck MRA on this study.

ke/hs
Date : 00.00.00

Name of the Patient : Abc Xyznd lmn / M / 55 yrs.
Referred by : Dr. Abc Xyzh / Dr. Abc Xyzhurandhar.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE:

C/O paresthesias on the right side of the body with momentary blackouts since 7 days.
Known hypertensive.

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 a hyperintense area on the T2 Weighted images in the head of the caudate nucleus on the right side and would represent an old infarct.

Small bright foci are seen on the T2 Weighted images in bilateral corona radiata suggestive of areas of ischemia/infarction. An area with similar signal is seen within the splenium on the left side.

Prominent perivascular spaces are seen in the fronto-parietal regions and lentiform nuclei bilaterally.

There is prominence of the cerebral cortical spaces in the fronto-parietal regions and of the cerebellar folia bilaterally.

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

- 2 - Scan - 00001



Incidental note is made of bilateral maxillary polyps.

INTRACRANIAL MRA :

There is slight irregularity and narrowing of the cavernous portion of the internal carotid artery on the right side which could be due to atherosclerosis.

There is faint visualization of the left posterior cerebral artery with irregularity and also could be due to atherosclerosis.

The right vertebral artery is slightly hypoplastic.

The petrous, cavernous and supraclinoid segments of the internal carotid artery on the left side and the petrous and supraclinoid segments of the internal carotid artery on the right side show normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar, left vertebral and right 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 in the neck.

There is slight vessel wall irregularity of the proximal segments of the internal and external carotid arteries on the right side.

The common carotid arteries appear normal bilaterally.
..3/.













- 3 - Scan - 00001


IMPRESSION :

1. An old infarct in the head of the caudate nucleus on the right side.

2. Areas of altered signal in the bilateral corona radiata and splenium of the left side are suggestive of areas of ischemia/ infarction.

3. Slight irregularity and narrowing of the cavernous portion of the internal carotid artery on the right side and of the proximal segments of the internal and external carotid arteries on the right side and which could be due to atherosclerosis.

4. Faint visualization of the left posterior cerebral artery with irregularity could also be due to atherosclerosis.

ke.hs
/00002 Date : 00.00.00

Name of the Patient : Abc Xyzben Mlmn / F / 65 yrs.
Referred by : Dr. Abc Xyzhta.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O paresthesias on the left side of the body since 7 days.

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.

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

Hyperintense areas on the T2 Weighted images are noted in the frontal and parietal white matter, corona radiata and centrum semiovale and periventricular deep white matter bilaterally on the T2 Weighted images and are most likely ischemic in etiology.

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

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







- 2 - Scan - 00000/00002


INTRACRANIAL MRA :

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

NECK MRA :

The common carotid arteries and their extracranial branches appear normal bilaterally. There are no obvious vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. Altered signal in the frontal and parietal white matter, corona radiata and centrum semiovale and periventricular deep white matter bilaterally are most likely ischemic in etiology.

2. No significant abnormality is detected on the intracranial and neck MRA on this study.

ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzttam Prajalmn / M / 51 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches since 1 month with diplopia and ptosis since 20 days.
H/O recently detected DM.

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.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is an intermediate signal intensity mass lesion, on the T1 Weighted images, which turns hyperintense on the T2 Weighted images having its epicentre in the sphenoid sinus. There is replacement of the normal marrow of clivus by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the proton, T2 Weighted and STIR images. There appears to be erosion of the clivus posteriorly with extension of the pathologic process into the prepontine cistern. There is extension into the cavernous sinus bilaterally with encasement of the cavernous segments of the internal carotid arteries bilaterally which show normal flow void signal on all the pulse sequences. Superiorly there is encasement of the anterior pituitary gland. Anteriorly there is extension in the spheno-ethmoidal recess with involvement of the posterior ethmoidal air cells bilaterally. Laterally there is indentation of the medial aspect of the temporal lobes, with probable involvement of the meninges. The pterygoid muscles bilaterally show hyperintense signal on the T2 Weighted and STIR images with soft tissue extension into the infratemporal fossa.
- 2 - Scan - 00009


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

Both the lateral, third and the fourth ventricles are normal. There is no shift of the midline structures.

Incidental note is made of inflammatory changes in the maxillary sinuses and in the middle group of ethmoidal air cells.

IMPRESSION :

The MRI features suggest a mass lesion having its epicentre in the sphenoid sinus with extensions as described. The possibilities to be considered are:

1. Squamous cell carcinoma of the sphenoid sinus.

2. Metastasis.

3. Infective process seems less likely.

Date : 00.00.00

Name of the Patient : Abc Xyznt Mhashelmn / M / 67 yrs.
Referred by : Dr. Abc Xyzndu.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O gait imbalance with diplopia since 2 days.
Known diabetic. 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 coronal images.

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

A hypointense area is noted in the left corona radiata on the T1 Weighted images and which is seen to turn hyperintense on the proton, T2 Weighted and FLAIR images and would be most likely ischemic in etiology.

Similar areas are seen in the periventricular white matter and fronto-parietal deep white matter bilaterally.

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

Incidental note is made of left maxillary sinusitis and inflammatory changes in the ethmoidal air cells and frontal sinus.
00008
- 2 -


IMPRESSION :

The MRI features are suggestive of altered signal in the left corona radiata and in the periventricular white matter and fronto-parietal deep white matter bilaterally and would ne most likely ischemic in etiology.

Date : 00.00.00

Name of the Patient : Abc Xyzir Gulmn / M / 48 yrs.
Referred by : Dr. Abc Xyzonawalla.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with slight numbness 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 a posterior disc bulge and a left far lateral (extraforaminal) disc herniation at the L4-L5 level with anterior indentation of the thecal sac and upon the extraforaminal portion of the exiting left L4 nerve root, respectively.

Small postero-central disc herniations with peridiscal osteophytes are noted at the L1-L2 and L2-L3 levels.

A right paracentral disc herniation is seen at the L5-S1 level with indentation upon the traversing right S1 nerve root.

The lumbar intervertebral discs except for the L3-L4 disc show loss of water content.



- 2 - Scan - 00007

The L4-L5 facet joints bilaterally and L5-S1 facet joint on the left side show degenerative changes. Hypointense signal suggestive of sclerotic changes is seen within the inferior articular facet of the L5 vertebra (?? osteoid osteoma).

Type II degenerative changes are noted in the L2 vertebral body adjacent to the L1-L2 intervertebral disc.

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 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 :

13.0 mm at L1-L2
15.0 mm at L2-L3
16.0 mm at L3-L4
12.0 mm at L4-L5
12.0 mm at L5-S1.

IMPRESSION :

1. A posterior disc bulge and left far lateral (extraforaminal) disc herniation at the L4-L5 level with indentation on the extraforaminal portion of the exiting left L4 nerve root.

2. Small posterior disc herniations with peridiscal osteophytes at the L1-L2 and L2-L3 levels.

3. A right paracentral disc herniation at the L5-S1 level.

4. Facetal arthropathy at the L4-L5 level bilaterally and at the L5-S1 level on the left.

ke/bv
Date : 00.00.00

Name of the Patient : Abc Xyzai G. Sanlmn / F / 60 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Dorsal Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE with paresthesias since 2 months. Also C/O gait imbalance.
H/O fall prior to this.
To r/o tubercle spine.

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 mild right postero-lateral disc bulge at the D11-D12 level with peridiscal osteophytes and antero-lateral indentation of the thecal sac at this level.

A left postero-lateral disc herniation is seen at the D8-D9 level.

A small posterior disc bulge is noted at the D12-L1 level.

Schmorls nodes are seen in the inferior aspect of the D7 vertebra.

The dorsal intervertebral discs show loss of water content.

The dorsal vertebral bodies reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
..2/.





00006
- 2 -

The dorsal spinal cord reveals normal signal intensity.

The conus medullaris terminates at the L1 level.

A small well-circumscribed lesion which is hyperintense to muscle
on the T1 Weighted and T2 Weighted images in the posterior aspect of the right lung at the D8/D9 levels (scans 108.16, 106.16). This may represent a granuloma or metastasis and would require further evaluation.

The cervico-dorsal spine was screened with 5 mm thick T2 Weighted sagittal images and does not reveal any significant feature of note. Mild ligamentum flavum hypertrophy is seen at the C6 level. Small posterior peridiscal osteophytes are seen in the cervical spine.

IMPRESSION :

The MRI features are suggestive of :

1. Mild right postero-lateral disc bulge at the D11-D12 level with peridiscal osteophytes at this level.

2. Left postero-lateral disc herniation at the D8-D9 level.

3. A small posterior disc bulge at the D12-L1 level.

4. A small well-circumscribed lesion in the posterior aspect of the right lung at the D8/D9 levels may represent a granuloma or metastasis and would require further evaluation.

DUPLICATE COPY
KE/BV
Date : 00.00.00

Name of the Patient : Abc Xyzhotlmn / F / 57 yrs.
Referred by : Dr. Abc Xyzhansali.
Examination : M.R.I. of the Right Thigh.

CLINICAL PROFILE :

H/O being operated for a myxoid liposarcoma Grade I on 00.00.00.
For follow-up.

EXAMINATION :

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

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

7 mm thick STIR sagittal images.

7 mm thick T1 Weighted coronal images.

OBSERVATION :

There is a post-operative scar in the antero-lateral aspect of the right thigh with susceptibility artifacts. The bulk of the right thigh appears small.

There is seen an ill-defined mass lesion in the anterior compartment of the right thigh deep to the quadriceps muscles and measures approximately 3.0 x 2.8 x 6.0 cms. This lesion is located approximately 4.0 cms cranially from the right knee joint. This lesion is hyperintense on the T1 Weighted images and is heterogenously hyperintense (predominantly hypointense) on the T2 Weighted and STIR images.
00005

- 2 -


An ill-defined hyperintense area is seen in the right antero-lateral aspect of the vastus lateralis muscle on the T2 Weighted and STIR images and is of intermediate signal intensity on the T1 Weighted images.

Subtle hyperintense signal seen in the vastus intermedius and lateralis muscle on the T2 Weighted images in the right thigh would be due to fatty change.

The visualized portion of the right femur shows normal signal intensity. There is no obvious bone destruction or erosion.

IMPRESSION :

In a known C/O myxoid liposarcoma Grade I, the MRI features are suggestive of :

1. Post-operative status.

2. Altered signal in the right vastus lateralis muscle and in the right vastus intermedius muscle, in some places, in the middle third of the right thigh as described and deep to the quadriceps muscle 6.0 cms cranially from the knee joint, most likely is the sequelae of previous surgery (post-operative fibrosis). The possibility of these signal intensity changes being due to tumor recurrence is less likely. A follow-up would be worthwhile.

As compared to the previous MRI (scan no:0000) dated 00.00.00, the previously identified mass lesion in the right thigh is not identified on the present study.

Date : 00.00.00

Name of the Patient : Abc Xyzhotlmn / F / 57 yrs.
Referred by : Dr. Abc Xyzhansali.
Examination : M.R.I. of the Right Thigh.

CLINICAL PROFILE :

H/O being operated for a myxoid liposarcoma Grade I on 00.00.00.
For follow-up.

EXAMINATION :

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

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

7 mm thick STIR sagittal images.

7 mm thick T1 Weighted coronal images.

OBSERVATION :

The scar of previous surgery is noted along the antero-lateral margin of the middle third of the right thigh.

There is slight decrease in bulk of the vastus lateralis muscle in the middle and lower third of the right thigh. The anterior half of the vastus lateralis muscle, in the middle third of the right thigh shows a hyperintense signal on the T2 Weighted and STIR images. This signal is isointense to normal muscle on the T1 Weighted images. The vastus intermedius muscle, just deep to the above described segment of the vastus lateralis muscle also shows an ill-defined hyperintense signal on the STIR images.



The rest of the visualized muscles of the right thigh are unremarkable. The facet planes are unremarkable. The visualized right femur shows normal signal. There is no bone erosion or destruction seen.

The visualized left thigh is also unremarkable.

IMPRESSION :

1. Post-operative status.

2. Altered signal in the right vastus lateralis muscle and in the right vastus intermedius muscle, in some places, in the middle third of the right thigh as described, most likely is the sequelae of previous surgery (post-operative fibrosis). The possibility of these signal intensity changes being due to tumor recurrence is less likely. A follow-up would be worthwhile.

As compared to the previous MRI (scan no:0000) dated 00.00.00, the previously identified mass lesion in the right thigh is not identified on the present study.

ke/hs
Date : 00.00.00

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

CLINICAL PROFILE :

C/O headaches 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 T2 Weighted coronal images.

OBSERVATION :

A focal area which is isointense to CSF on all the pulse sequences is seen within the left lentiform nucleus, inferiorly. This may represent a prominent Virchow-Robin space.

The hippocampal complex on either side is unremarkable.

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.

Incidental note is made of a left maxillary polyp.

IMPRESSION :

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