ke/bv
Date : 00.00.00

Name of the Patient : Abc XyzYlmn / F / 26 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

C/O weakness and wasting of the LUE with pain in the left wrist since 1 1/2 years.
EMG s/o electrophysiological evidence of partial denervation (chronic) involving the C5, C6, C7, C8 and T1 roots on the left.

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 :

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

Hyperintense signal on the Fast Scan (T2 *) images is seen in the region of the anterior horn cells within the cord, more so on the left side at the C6 and C7 levels.

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

Incidental note is made of slightly enlarged lymph nodes in the deep cervical chain on the right side.

Anti-clockwise rotation of the atlas is noted.

IMPRESSION :

The MRI features are suggestive of altered signal intensity within the spinal cord at the C6 and C7 vertebral levels.

Such changes may be seen with motor neuron disease and demyelination and the same should be excluded.

sb/ke
Date : 00.00.00

Name of the Patient : Abc Xyzar Salulmn / M / 17 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Brain

CLINICAL PROFILE :

C/O seizures since 1 year. On anti-epilepitcs.

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 T1Weighted and T2 Weighted coronal images.

OBSERVATION :

There is a subtle hyperintense signal on the T1 Weighted images in the globus pallidus bilaterally which may represent paramagnetic substance deposition.

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 midline shift. No obvious vascular anomaly is identified on this study.

Inflammatory changes are noted in the right maxillary sinus and enlarged adenoids.

IMPRESSION :

Paramagnetic substance deposition in the globus pallidus bilaterally may be seen with hepatic disease.

sb/kesb/ke
Date : 00.00.00

Name of the Patient : Abc XyzKhlmn / F / 56 yrs.
Referred by : Dr. Abc Xyzrankar
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE since 15 days.
H/O fall.

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 lumbar intervertebral discs.

There is mild retrolisthesis of the L5 over the S1 vertebra.

There is a posteriorly bulging disc with posterior peridiscal osteophyte at the L5-S1 level with bilateral neural foraminal narrowing and indentation on the traversing left S1 nerve root. Bilateral far lateral disc bulges are also noted at this level.

A small posterior disc bulge with peridiscal osteophytes is noted at the L4-L5 level with bilateral neural foraminal narrowing.

The lumbar vertebral bodies show spotty fatty marrow changes. The 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 S1 level.




- 2 -


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

17.0 mm at L1-L2

14.0 mm at L2-L3

15.0 mm at L3-L4

11.0 mm at L4-L5

10.0 mm at L5-S1.

IMPRESSION :

1. Mild retrolisthesis of the L5 over the S1 vertebra.

2. A posteriorly bulging disc with posterior peridiscal osteophyte at the L5-S1 level with bilateral neural foraminal narrowing and indentation on the traversing left S1 nerve root. Bilateral far lateral disc bulges are also noted at this level.

3. A small posterior disc bulge with peridiscal osteophytes at the L4-L5 level with bilateral neural foraminal narrowing.

4. Tight lumbar canal at the L4-L5 and L5-S1 levels.

sb/bv
Date : 00.00.00

Name of the Patient : Abc XyzMlmn / M / 25 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Right Shoulder.

CLINICAL PROFILE :

C/O painful and restricted movements of the right shoulder since 00.00.00.
H/O injury to right shoulder prior to this.

EXAMINATION :

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

5 mm thick T1 Weighted , proton and T2 Weighted axial images.

5 mm thick FLAIR coronal images.

OBSERVATION :




IMPRESSION :

sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyz. Mlmn / F / 20 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with numbness 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 appears to be sacralization of the L5 vertebra and the L3 vertebral body is as marked on the film. Please correlate with plain radiographs.

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

A fairly large, postero-central and left paracentral extruded disc is noted at the L4-L5 level with indentation on the anterior dural theca. Slight inferior migration of the disc fragment is noted with indentation on the traversing left L5 nerve root. Facetal hypertrophy is noted at the L4-L5 level.

Postero-central protruded discs are noted at the L3-L4 and L5-S1 levels .

The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The remaing facet joints and the visualised pre and paravertebral soft tissues are unremarkable.
..2/.















- 2 -


The conus medullaris terminates at the D12 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 :

20.0 mm at L1-L2

19.0 mm at L2-L3

15.0 mm at L3-L4

10.0 mm at L4-L5

11.0 mm at L5-S1.

IMPRESSION :

1. Sacralization of the L5 vertebra. Please correlate with plain radiographs.

2. A fairly large, postero-central and left paracentral extruded disc at the L4-L5 level with slight inferior migration of the disc fragment with indentation on the traversing left L5 nerve root.

3. Postero-central protruded discs at the L3-L4 and L5-S1 levels.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyzti H. Kanlmn / F / 50 yrs.
Referred by : Dr. Abc Xyzlwalkar.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O backache with paresthesias in BLE since 1 month.
H/O fall 6-7 months ago.

EXAMINATION :

M.R.I of the dorso-lumbar 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 Grade I spondylolisthesis of the L5 vertebra over the S1 vertebra with probable spondylolysis at the L5 vertebral level bilaterally. A pseudo-posterior disc bulge is identified at the L5-S1 level with ventral indentation upon the thecal sac. There is anterior wedging of the D10 and D11 vertebral bodies. The D10, D11 and D12 vertebral bodies appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. The D10-D11 and D11-D12 intervertebral discs are not completely visualized and also appear hyperintense on the T2 Weighted images and are involved by the pathology. Probable involvement of the spinous processes of the D10, D11 and D12 vertebrae is also noted.

There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the pre and paravertebral regions over D9 to D11 vertebral levels. This lesion appears hyperintense on the T2 Weighted images. Extension into the anterior epidural space via the neural foramen at the D10-D11 and D11-D12 levels is noted with resultant cord compression.. The lower dorsal spinal cord at the D10 and D11 vertebral levels appear hyperintense on the T2 Weighted images suggesting cord edema/ischemia.

A loculated, approximately 3.2 cms diameter sized collection is noted along the posterior chest wall, on the right at the D9 and D10 vertebral levels.



- 2 -


The rest of the visualized dorso-lumbar vertebral bodies and the intervertebral discs show normal signal intensity. The facet joints are unremarkable.

The conus medullaris terminates at the D12-L1 level.

Screening T1 Weighted sagittal images of the cervico-dorsal spine reveal a suspicious hypointense signal in the upper cervical vertebrae.

IMPRESSION :

1. Grade I spondylolisthesis of the L5 vertebra over the S1 vertebra with probable spondylolysis at the L5 vertebral level bilaterally.

2. Anterior wedging of the D10 and D11 vertebral bodies with altered signal of D10, D11 and D12 vertebral bodies and D10-D11 and D11-D12 intervertebral discs as described most likely represents osteitis with discitis, probably tuberculous in etiology. Pre, paravertebral and anterior epidural soft tissue lesions over D9 to D11 vertebral levels most likely represents granulation tissue/abscess. There is resultant cord compression and cord signal altertion at the D10 and D11 vertebral levels suggests cord edema/ischemia.

The possibility of a neoplasm seems less likely.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyza D. lmn / F / 42 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Brain

CLINICAL PROFILE :

Known C/O neuropathic gait imbalance with seizures on 00.00.00.
Altered sensorium with myoclonic jerks involving the left half of the body.
Known hypertensive.

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 still seen an ill-defined, hyperintense signal, best appreciated on the FLAIR images in the posterior parietal and high parietal cortex. This signal appears isointense to normal brain parenchyma on the T1 Weighted images (scans 106.4 to 106.8).

There is mild fullness 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.

IMPRESSION :

As compared to the previous MRI (scan no. 00002) dated 00.00.00, there is a decrease in the degree of the signal change in the right fronto-parieto-occipital region. The subgaleal fluid collection is also not identified.

Date : 00.00.00
sb/bv
Name of the Patient : Abc XyzSubhanlmn / M / 60 yrs.
Referred by : Dr. Abc Xyzlwalkar.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

C/O neck pain with numbness in BUE and BLE and gait imbalance since 2 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

3 mm T1 Weighted coronal images.

5 mm thick T1 Weighted sagittal images in flexion and extension.

OBSERVATION :

There is reduction in height and loss of water content of the cervical intervertebral discs.

Posterior disc bulges with posterior peridiscal osteophytes are noted at the C2-C3, C3-C4, C4-C5, C5-C6 and C6-C7 levels. Indentation on the cervical spinal cord is noted at the C3-C4, C4-C5 and C5-C6 levels. There is also ligamentum flavum hypertrophy at these levels with resultant tight lumbar canal at these levels.

There is atrophy of the cervical spinal cord at the C1-C2 level. The cervical spinal cord at this level shows a hyperintense signal on the T2 Weighted images posteriorly (isointense to normal cord on the T1 Weighted images) suggesting cord ischemia/contusion/gliosis. The atlanto-dens interval measures approximately 1.0 mm in the neutral position and approximately 8.0 mm in flexion. It reverts back to normal position in extension suggesting a mobile atlanto-axial dislocation.

The upper cervical vertebral bodies show spotty fatty marrow changes. The joints of Luschka at the C5-C6 level on the left shows degenerative changes. The facet joints at the C3-C4, C4-C5 and C5-C6 levels also appear slightly hypertrophied.
- 2 -


The visualized pre and paravertebral soft tissues are unremarkable.

IMPRESSION :

1. Mobile atlanto-dens subluxation with the atlanto-dens interval measuring approximately 8.0 mms in flexion and 1.0 mm in the neutral and extended positions.

2. Atrophy of the cervical spinal cord at the C1-C2 level with altered signal posteriorly as described may represent cord ischemia/contusion/gliosis in the given clinical setting.

3. Posterior disc bulges with posterior peridiscal osteophytes at the C2-C3, C3-C4, C4-C5, C5-C6 and C6-C7 levels with ligamentum flavum hypertrophy at the C3-C4, C4- C5 and C5-C6 levels with a tight cervical canal at these levels.

sb/bv
Date : 00.00.00

Name of the Patient : Abc Xyz Slmn / F / 53 yrs.
Referred by : Dr. Abc Xyzshtekar.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Known C/O primary Sjogrens syndrome. No complaints at present.
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.

3 mm thick T1 Weighted sagittal and T2 Weighted coronal images through the sella and perisellar region.

5 mm thick T1Weighted sagittal images.

OBSERVATION :

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

Both the lateral, third and the fourth ventricles are normal.. There is slight prominence of the cerebral cortical sulci, cerebellar folia and basal cisternal spaces bilaterally. There is no midline shift. No obvious vascular anomaly is identified on this study.

The sella appears shallow. The pituitary gland shows a convex superior margin and measures approximately 5.0 mm in height. No focal mass lesion is identified in the pituitary gland on this study. The posterior pituitary gland shows normal signal. The pituitary stalk is in the midline. The suprasellar region and the cavernous sinuses on either side are unremarkable.

Inflammatory changes are noted in the left maxillary sinus, left anterior ethmoidal air cells and in the sphenoid sinus, posterior ethmoidal air cells on the right and mastoid air cells on the left side.




- 2 -


IMPRESSION :

1. Mild age related cerebral and cerebellar atrophy.

2. Shallow sella with a convex superior margin of the pituitary gland.

3. Inflammatory changes in the paranasal sinuses and left mastoid as described.

As compared to the previous MRI dated 00.00.0000, there is no significant change noted.

sb/ke
/8 Date : 00.00.00

Name of the Patient : Abc Xyzta Slmn / F / 35 yrs.
Referred by : Dr. Abc Xyzelwal.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with severe pain in the iliac joints, more on the left side since 1 month with irregular motion.

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.

The dorsal spine was screened with 5 mm thick T1 Weighted and T2 Weighted sagittal images.

The sacro-iliac joints and both hips were screened with 5 mm thick T1 Weighted and STIR coronal images.

OBSERVATION :

There is sacralization of the L5 vertebra.

The visualized lumbar and sacral vertebral bodies shows a diffuse hypointense signal when compared to the normal marrow on the T1 Weighted images and appear heterogeneously hyperintense on the T2 Weighted images. No bone destruction or erosion is noted.

A small posterior disc bulge is noted at the L4-L5 level.

The lumbar intervertebral discs show normal signal intensity. The 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 S1 level.
- 2 -


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

20.0 mm at L1-L2
19.0 mm at L2-L3
18.0 mm at L3-L4
17.0 mm at L4-L5
11.0 mm at L5-S1.

Screening, T1 Weighted and T2 Weighted sagittal images of the dorsal spine reveal similar signal intensity changes in the dorsal vertebral bodies as visualized in the lumbo-sacral vertebrae. The dorsal spinal cord shows normal signal. There is no cord compression. Incidentally noted is a soft tissue density lesion in the right hilum which is probably an enlarged right hilar lymphnode.

Screening images of the pelvis and both hips reveal diffuse hypointense signal on the T1 Weighted images involving the pelvic bones and the neck and the proximal shaft of the femora on either side. This signal appears hyperintense on the T2 Weighted images.

IMPRESSION :

Diffuse altered signal involving the visualized dorsal and lumbo-sacral vertebrae, the pelvic bones and neck and proximal shafts of the femora on either side as described is not specific for a single etiology.

The differential diagnosis would include,

1. A reticulo-endothelial disorder.

2. Multiple metastases.

3. Multifocal tuberculosis.

4. Remote possibility of a metabolic bone disease.

An enlarged right hilar lymphnode is noted.

A bone biopsy would be worthwhile.