hs/ke
/49 Date : 00.00.00

Name of the Patient : Abc Xyzl N. lmn / M / 84 yrs.
Referred by : Dr. Abc Xyzarikh / Dr. Abc Xyzmpat.
Examination : M.R.I. of the Brain and Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O gradually progressive loss of vision bilaterally since 1 year.
H/O mild right sided TIAs.
Known diabetic.

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 STIR coronal images through the optic nerves.

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

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

BRAIN :

There are fairly well-defined areas which are near isointense to CSF on all the pulse sequences within the right occipital lobe. Adjacent to these are areas which are hypointense on the T1 Weighted images and which turn hyperintense on the Proton, T2 Weighted and FLAIR images and would represent gliotic changes. This lesion in toto would represent an area of cystic encephalomalacia. There is ex-vacuo dilatation of the occipital horn of the right lateral ventricle.

Hyperintense areas are noted in the left periatrial deep white matter on the T2 Weighted and FLAIR images and would represent areas of ischemia/infarction.

Few areas which are iso to hyperintense to CSF on all the pulse sequences suggestive of lacunar infarcts are seen within the right thalamus and in the white matter adjacent to the left frontal horn. Also seen are prominent Virchow Robin spaces within both cerebral hemispheres.
..2/..





- 2 -


There is fullness of the third and both the lateral ventricles. Also seen is prominence of the basal cisternal spaces, cerebellar folia and cerebral cortical sulci bilaterally.

The fourth ventricle is normal. There is no shift of the midline structures.

Inflammatory changes are noted in both the maxillary sinuses.

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 :

There is ectasia of the visualized vessels in the neck.

There are no vessel wall irregularities or stenosis of the vessels noted.

IMPRESSION :

1. An area of cystic encephalomalacia in the right occipital lobe.

2. Lacunar infarcts within the right thalamus and in the white matter adjacent to the left frontal horn.

3. Area of ischemia/infarction in the left periatrial deep white matter.

4. No significant abnormality is detected within the intracranial /neck MRA on this study.

hs/bv
Date : 00.00.00

Name of the Patient : Abc XyzKatplmn / M / 58 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Right Knee Joint.

CLINICAL PROFILE :

C/O right knee pain and swelling. Alleged H/O fall on 00.00.00 .
Past H/O right thigh/femur surgery.

EXAMINATION :

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

5 mm thick GRASS axial images.

4 mm thick T1 Weighted, Proton and GRASS sagittal images.

4 mm thick T1 Weighted and T2 Weighted coronal images.

OBSERVATION :

Menisci

The anterior and posterior horns of the lateral and medial menisci reveal normal configuration and signal characteristics.

Cruciate Ligaments :

The anterior and posterior cruciate ligaments show normal contour and signal characteristics.

Collateral Ligaments and the Patellar Tendon :

The medial and lateral collateral ligaments and the patellar tendon are normal.

Hoffas Fat Pad :

The Hoffas fat pad is irregularly defined. ..2/..








- 2 -


Articular cartilage and bones :

There is a fracture of the postero-superior aspect of the tibial plateau. There is non-displacement of the fractured fragment. Linear hypointensities on all the pulse sequences in the medial tibial condyle may represent compressed trabeculae. Susceptibility artifacts within the visualized lower femoral shaft may be the result of previous surgery.

Effusion is seen within the right knee joint.

IMPRESSION :

The MRI features are suggestive of :

1. Fracture of the postero-superior aspect of the right tibial plateau and medial tibial condyle.

2. Effusion within the right knee joint.

ke/bv
Date : 00.00.00

Name of the Patient : Abc Xyza lmn / F / 22 yrs.
Referred by : Dr. Abc XyzV. Shah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE since 1 month.
H/O laminectomy at the L4 level with discectomy at the L4-L5 level on 00.00.00.

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 are post-operative changes in the posterior soft tissues at the L4 and L5 levels with laminectomy at the L4 level.

There is reduction in the height of the L4-L5 disc.

There is replacement of the normal marrow of the L4 and L5 vertebrae by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. There is erosion of the superior and inferior cortical endplates of the L5 and L4 vertebral bodies respectively, with involvement of the L4-L5 intervertebral disc. There is slight pre and paravertebral soft tissue extension of the pathology at the L4 and L5 level.

A hyperintense signal is seen along the left lateral and posterior aspect of the thecal sac at the L4-L5 level on the T1 Weighted images which is seen to turn hyperintense on the T2 Weighted images and would represent granulation tissue. Similar signal intensity is noted in the left lateral recess at the L5 level encasing the left L5 nerve root. The L4-L5 facet joints show degenerative changes.

A posterior disc bulge is seen at the L5-S1 level.

The rest of the lumbar vertebral bodies and the remaining intervertebral discs show normal signal intensity. The rest of the facet joints are unremarkable.
...2/..










- 2 -



The conus medullaris terminates at the 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 :

17.0 mm at L1-L2

18.0 mm at L2-L3

15.0 mm at L3-L4

12.0 mm at L5-S1.

IMPRESSION :

1. Post-operative status.

2. Altered signal in the L4 and L5 vertebrae with extensions as described most likely represents osteitis.

3. Altered signal along the left lateral and posterior aspect of the thecal sac at the L4-L5 level and L5 level encasing the left L5 nerve root would represent granulation tissue.

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzmmed Javed lmn / M / 12 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since the age of 1 year.

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.

The pituitary gland is seen along the floor of the sella, suggestive of an empty sella.

IMPRESSION :

The MRI features are suggestive of an empty sella.

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

kesb
Date : 00.00.00

Name of the Patient : Abc Xyzaprakash Malmn / M / 24 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O loss of vision in both eyes for 10-12 days followed with vomiting for 2-3 days 25 days back.
H/O fever, 15 days prior to this.

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 T2 Weighted (with fat saturation) coronal images through the optic nerves.

OBSERVATION :

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

Both the optic nerves show normal signal intensity on the T2 Weighted coronal images.

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.

Note is made of cavum septum pellucidum, cavum vergae and right maxillary sinusitis.

IMPRESSION :

Normal study of the Brain.

ke/sb
ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzal G. lmn / M / 65 yrs.
Referred by : Dr. Abc Xyzankhla / Dr. Abc Xyzin.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O vehicular accident on 00.00.00, with vomiting and bleeding from left ear, pain in the left shoulder and pain in the left side of chest.
Known hypertensive/diabetic.

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 Fast Scan (T2 *) coronal images.

OBSERVATION :

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

Small sliver of hyperintense signal is seen in the right temporal region and right parieto-occipital region (subdural in location) on the T1 Weighted images which is seen to remain hyperintense on the proton, T2 Weighted and Fast Scan (T2 *) images and may represent haemorrhage in the given clinical setting. There is a suggestion of fracture of the right temporal bone anteriorly. Hyperintense areas are seen in the right fronto-temporal subgaleal region and left temporo-parietal subgaleal region on the proton and T2 Weighted images and would represent contusion/subgaleal edema/hematoma. Susceptibility artifacts are seen in the right fronto-parietal region.

Hyperintense signal seen on all the pulse sequences within the left mastoid region and left external auditory canal would represent haemorrhage, in the given clinical setting.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no midline shift. There is slight prominence of the cerebral cortical sulcal spaces in the fronto-parietal regions bilaterally. No obvious vascular anomaly is identified on this study.
....2/.








- 2 -


Incidental note is made of pansinusitis.

IMPRESSION :

1. Sliver of small subdural collection/hematoma in the right temporal region and right parieto-occipital region.

2. Probable fracture of the right temporal bone with right fronto-temporal and left temporo-parietal subgaleal contusion/edema/hematoma.

sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzl Nlmn / M / 49 yrs.
Referred by : Dr. Abc Xyzdar.
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 seen a left fronto-temporo-parietal, subdural collection which follows CSF signal on all the pulse sequences. The maximum width of this lesion is about 1.0 cm. Resultant mild effacement of the cortical sulcal spaces is noted, with minimum indentation on the frontal horn of the left lateral ventricle.

A smaller, similar signal intensity lesion is noted in the right frontal region, measuring about 4.0 mms in width.

There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the subcortical white matter in the right high frontal region, right occipital cortex and along the postero-lateral margins of the pons and the junction of the pons and midbrain, bilaterally. These lesions appear iso to hyperintense to normal white matter on the T1 Weighted images.

Both the lateral, third and the fourth ventricles are otherwise unremarkable. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
....2/.









- 2 -


Fracture of the left zygomatic arch is noted.

IMPRESSION :

1. Left fronto-temporo-parietal and right frontal, subdural collections as described.

2. Altered signal in the subcortical white matter in the right high frontal region, right occipital cortex and along the postero-lateral margins of the pons and the junction of the pons and midbrain, bilaterally may represent contusions/shearing injuries in the given clinical setting.

3. Fracture of the left zygomatic arch.

As compared to the previous CT Scan dated 00.00.00, there is an increase in the size of the left fronto-temporo-parietal collection.

ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzsh N. Slmn / M / 11 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since the age of 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.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is a small hypointense area in the right frontal deep white matter on the T1 Weighted images which is seen to turn hyperintense on the T2 Weighted images (se/m 104/14, 103/14, 102/14, 105/14, 106/14). This may represent partial volume with grey matter/perivascular space.

There is slight fullness of the left lateral ventricle as compared to the right and which may be a normal variant.

The hippocampus complex on either side is unremarkable.

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. Note is made of an empty sella.

Incidental note is made of right maxillary sinusitis, inflammatory changes in the ethmoidal air cells and enlarged adenoids.

IMPRESSION :

The MRI features are suggestive of an empty sella.

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

sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzli Wlmn / F / 51 yrs.
Referred by : Dr. Abc XyzV. Shah.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

C/O neckpain radiating to the LUE since 15 days.
H/O similar complaints in 0000 from which patient recovered.

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 water content of the C4-C5, C5-C6 and C6-C7 intervertebral discs.

A small posterior peridiscal osteophyte is noted at the C3-C4 level.

Posterior and left postero-lateral disc herniations with fairly large posterior peridiscal osteophytes are noted at the C4-C5, C5-C6 and C6-C7 levels, indenting the dural theca anteriorly. Slight neural foraminal narrowing is noted at these levels, bilaterally. There is also ligamentum flavum hypertrophy at the C5 and C6 vertebral levels. The joints of Luschka on the right at the C4-C5 level and bilaterally at the C5-C6 level show mild degenerative changes.

Slight facetal hypertrophy is noted at the C3-C4, C4-C5 and C5-C6 levels.

The cervical vertebral bodies and the remaining intervertebral discs show normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

The cervical spinal cord reveals normal signal intensity.
....2/.









- 2 -



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

Incidentally noted is an approximately 1.0 cm diameter sized hyperintense lesion on all the pulse sequences in the left globe of the thyroid gland which is a ? complicated thyroid cyst.

IMPRESSION :

1. Posterior and left postero-lateral disc herniations with fairly large posterior peridiscal osteophytes at the C4-C5, C5-C6 and C6-C7 levels.

2. Ligamentum flavum hypertrophy at the C5 and C6 vertebral levels.

3. Degenerative changes of the joints of Luschka on the right at the C4-C5 level and bilaterally at the C5-C6 level.

As compared to the previous MRI dated 00.00.00, there is no significant change noted.

sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzlya Glmn / F / 32 yrs.
Referred by : Dr. Abc Xyzzare.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches since 3-4 years.
C/O ? convulsion with loss of consciousness for 10-12 hours on 00.00.00.

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.

5 mm thick FLAIR coronal images.

OBSERVATION :

There are seen a conglomeration of multiple, well-marginated, hyperintense lesions with a peripheral hypointense rim on the proton and T2 Weighted images in the subcortical white matter in the right posterior parietal region. This lesion appears hypointense to normal white matter on the T1 Weighted images and measures approximately 1.1 x 0.5 x 0.6 cms. An intermediate signal intensity inclusion is noted within this lesion, best appreciated on the coronal T1 Weighted images (scan 106.7) which may represent a scolex. There is perilesional edema with effacement of the sulcal spaces and minimal indentation on the right lateral ventricle, posteriorly.

The left 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 :

An approximately 1.1 x 0.5 x 0.6 cms sized conglomeration of multiple small lesions in the subcortical white matter in the right posterior parietal region follows the signal characteristics of neurocysticercii in the colloid-vesicular stage.