hs/ke/nl/nl
/550 Date : 00.00.00

Name of the Patient : Abc Xyza Kuplmn / F / 52 yrs.
Referred by : Dr. Abc Xyzchale.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O weakness of BUE and BLE at 8.00 pm on 00.00.00 from which patient recovered within an hour.
Now C/O backache.
Known hypertensive/diabetic.

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.

The cervical spine was screened with 4 mm thick T2 Weighted sagittal images and 5 mm thick T1 Weighted and Fast Scan (T2 *) axial images. The dorsal spine was screened with 4 mm thick T2 Weighted sagittal images.

OBSERVATION :

There are small bright areas on the T2 Weighted images within the white matter in the fronto-parietal lobes and the periatrial white matter bilaterally and these are most likely ischemic in etiology.

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

The third ventricle is 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.

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.

There is reversal of the normal cervical lordotic curve and the cervical intervertebral discs show loss of water content. A postero-central disc herniation is seen to compress upon the spinal cord at the C4-C5 level. There is evidence of a space-occupying lesion within the posterior epidural space (more to the right) over the C5 to the C7 level. This is hyperintense to normal muscle on the T1 Weighted and Fast Scan (T2 *) images (? sequestered disc ? granulation tissue). This lesion is seen to indent the posterior aspect of the cord. A right paracentral disc protrusion is seen at the C5-C6 level and a postero-central disc protrusion is noted at the C3-C4 level. The C3-C4 to the C6-C7 joints of Luschka show mild degenerative changes.

There appears to be a D2-D3 block vertebra.
..3/.















- 3 - Scan-00007/550



IMPRESSION :

The MRA features are suggestive of :

1. Areas of altered signal within the white matter in the fronto-parietal lobes and the periatrial white matter bilaterally and these are most likely ischemic in etiology.

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

3. A postero-central disc herniation at the C4-C5 level.

4. A space-occupying lesion within the posterior epidural space (more to the right) over the C5 to the C7 level and this may represent sequestered disc/granulation tissue.

bv/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzShlmn / F / 26 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O seizures since 5 years.

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 no focal area of altered signal intensity in 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.

Note is made of inflammatory changes in the ethmoidal air cells, sphenoidal sinus and mucosal thickening is seen in the left maxillary sinus.

IMPRESSION :

Normal study of the Brain.

bv/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzal Ylmn / M / 60 yrs.
Referred by : Dr. Abc Xyzsari.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 6 months.
H/O fever at onset.

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 hypointense areas on the T1 Weighted images involving the D12, L1 and L2 vertebral bodies and the pedicles of the L1 and L2 vertebrae. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. There is destruction of the L1-L2 disc with erosion of the inferior cortical endplate of the L1 and superior cortical endplate of the L2 vertebrae. The intranuclear cleft is not well visualized.

Similar changes are also seen in the D12-L1 intervertebral disc with the D12-L1 disc appearing more hyperintense than normal on the T1 Weighted images and turning markedly hyperintense on the T2 Weighted images with slight destruction of the superior cortical endplate of L1 and inferior cortical endplate of the D12 vertebrae.







There is also pre and paravertebral extension of the disease process at the D12, L1 and L2 levels. There is encroachment into the L1-L2 neural foramina by the pathology, bilaterally with probable encasement of the nerve roots. There is epidural extension of the disease process at the L1 and L2 levels with compression of the thecal sac.

There is also formation of psoas abscesses bilaterally, the larger one being on the right side over the D12-L1 to atleast the L5 levels.

A postero-central disc protrusion is noted at the L5-S1 level and a mild posterior disc bulge is seen at the L4-L5 level. The L5-S1 intervertebral disc shows loss of water content.

The rest of the lumbar vertebral bodies reveal normal signal intensity.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1 level.

Lymphadenopathy is seen in the prevertebral lumbar region.

IMPRESSION :

The MRI features are suggestive of a granulomatous infective process like tuberculosis involving the D12, L1 and L2 vertebrae with involvement of the D12-L1 and L1-L2 intervertebral discs as described. There is also pre/ paravertebral and epidural extension with thecal sac compression and psoas abscesses as described.

The possibility of this being a neoplastic process like a small cell tumor is unlikely.

hs/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzne Bolmn / F / 13 yrs.
Referred by : Dr. Abc Xyzi.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Known C/O ALL. Diagnosed in 0000. Received chemotherapy and radiotherapy. Completed treatment in 0000.
Now C/O forgetfulness.

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 no focal area of altered signal intensity in the brain parenchyma.

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.

Mucosal thickening is seen in the right maxillary sinus.

IMPRESSION :

Normal study of the Brain.

hs/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzultan Ralmn / M / 25 yrs.
Referred by : Dr. Abc Xyzarikh.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O schizophrenia in 0000.
Now C/O aggressive behaviour, auditory hallucinations, anxiety, irritability and grandiose delusions, headaches and backpain.

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 no focal area of altered signal intensity in the brain parenchyma.

Both the lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. The basilar artery is ectatic with indentation upon the anterior aspect of the pons on the left side.

IMPRESSION :

Normal study of the Brain.

hs/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzV. Chlmn / M / 46 yrs.
Referred by : Dr. Abc Xyzhari.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache (mid to lowback) with numbness in BLE.

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 :

The L1-L2, L3-L4, L4-L5 and L5-S1 intervertebral discs show loss of water content.

A postero-central disc herniation is seen to indent the thecal sac at the L4-L5 level.

Small postero-central disc herniations are seen to indent the thecal sac at the L3-L4 and L5-S1 levels.

There is a postero-central disc protrusion at the L1-L2 level.

The L4-L5 facet joints show mild degenerative changes.

Type II degenerative changes are noted within the postero-inferior aspect of the L1 and L2 vertebral bodies and the antero-superior surface of the S1 vertebra.







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 L1-L2 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 :

17.0 mm at L1-L2
17.0 mm at L2-L3
15.0 mm at L3-L4
10.0 mm at L4-L5
14.0 mm at L5-S1.

IMPRESSION :

1. A postero-central disc herniation with facetal arthropathy at the L4-L5 level.

2. Small postero-central disc herniations at the L3-L4 and L5-S1 levels.

hs/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Amalsadilmn / M / 68 yrs.
Referred by : Dr. Abc Xyzgar / Dr. Abc Xyza.
Examination : M.R.I. of the Left Ankle & Foot.

CLINICAL PROFILE :

C/O pain and swelling over the left foot since 2 1/2 months.
Known diabetic. On Rx.

EXAMINATION :

M.R.I. of the left ankle and foot was performed using the following parameters :

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

5 mm thick T1 Weighted and STIR coronal images.

4 mm thick T1 Weighted and GRASS (with fat saturation) sagittal images.

OBSERVATION :

There are diffuse irregularly defined areas of hypointensity on the T1 Weighted images which turn hyperintense on the GRASS and STIR images within the subcutaneous soft tissues along the dorsum of the left foot anterior to the left ankle and lateral aspect of the left foot.

Fluid (hypointense on the T1 Weighted images and hyperintense on the STIR, T2 Weighted and GRASS images) is seen within the left ankle joint.

The visualized bones show normal configuration and signal intensity. No obvious bone destruction or erosion is evident.
Scan-00001



The visualized tendons and ligament show normal signal intensity.

IMPRESSION :

The MRI features are suggestive of :

1. Areas of altered signal within the subcutaneous soft tissues along the lateral aspect and dorsum of the left foot and anterior to the left ankle are most likely inflammatory in etiology.

2. Fluid in the left ankle joint.

hs/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzti Palmn / F / 65 yrs.
Referred by : Dr. Abc Xyzisheri.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE with paresthesias since 1 year.

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 Grade I spondylolisthesis of the L5 vertebra over the S1 vertebra. There is loss of water content of all the lumbar intervertebral discs with reduction in height of the L1-L2 and L2-L3 intervertebral discs.

A posterior disc bulge with peridiscal osteophytes is seen to narrow both neural foramina with impingement of the L5 nerve roots at the L5-S1 level, within the L5 neural foramina, (more on the left side).

Bilateral postero-lateral (foraminal) disc herniations are seen to narrow both neural foramina at the L3-L4 and L4-L5 levels. Slight retroplacement of the L3 over the L4 vertebra is also noted.

Posterior disc herniations with peridiscal osteophytes are seen to indent the thecal sac and narrow both neural foramina at the L1-L2 and L2-L3 levels.


There are left paracentral, left postero-lateral and left far lateral disc herniations at the D12-L1 level. Posterior peridiscal osteophytes are noted at this level.

Bilateral far lateral (extraforaminal) disc herniations are seen over the L1-L2 to the L5-S1 level. Large far lateral peridiscal osteophytes are noted at the L1-L2 level.

Anterior disc herniations with peridiscal osteophytes are noted in the dorso-lumbar region.

The L4-L5 and L5-S1 facet joints show hypertrophic degenerative changes. The rest of the lumbar facet joints show mild degenerative changes.

Type I degenerative changes (hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images) are seen within the D12 and L1 vertebral bodies adjacent to the D12-L1 intervertebral disc. Type II degenerative changes (isointense to fat) are seen within the vertebral bodies adjacent to the lumbar intervertebral discs.

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 :

18.0 mm at L1-L2
16.0 mm at L2-L3
19.0 mm at L3-L4
17.0 mm at L4-L5
15.0 mm at L5-S1.

Screening of the dorsal spine reveals no feature of note.
..3/.








- 3 - Scan-00009


IMPRESSION :

1. Grade I spondylolisthesis of the L5 vertebra over the S1 vertebra.

2. A posterior disc bulge with peridiscal osteophytes impinging both the L5 nerve roots at the L5-S1 level.

3. Posterior disc herniations with peridiscal osteophytes at the L1-L2 and L2-L3 levels.

4. Hypertrophic facetal arthropathy at the L4-L5 and L5-S1 levels and facetal arthropathy in the lumbar region.

ke/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzShlmn / M / 30 yrs.
Referred by : Dr. Abc Xyzgaonkar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O weakness of BLE with bladder involvement since 10-12 days.
Recently diagnosed as having Pulmonary Kochs.

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 :

The L5 vertebra appears to be as marked on the film. Please correlate with plain radiographs.

There is loss of normal lumbar lordosis and mild scoliosis with convexity to the left.

There is a large right postero-central disc herniation with peridiscal osteophytes at the L3-L4 level with compression upon the thecal sac. A sequestered disc fragment is seen to migrate posterior to the L3 vertebral body with resultant canal stenosis and impingement of the traversing L3 nerve roots. A small right postero-lateral disc herniation is seen to narrow the right neural foramen at the L3-L4 level.

Postero-central disc herniations are noted at the L1-L2, L2-L3 and L4-L5 levels with anterior indentation of the thecal sac.



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

The lumbar intervertebral discs show loss of water content.

The right L4-L5 facet joint shows hypertrophic degenerative changes. The L1-L2, L2-L3 and L3-L4 facet joints also show degenerative changes.

Bilateral far lateral (extraforaminal) disc bulges are seen at the L3-L4 level.

The pedicles of the lumbar vertebrae are congenitally short in their antero-posterior dimensions.

The lumbar vertebral bodies reveal normal signal intensity. 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.

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
8.0 mm at L3-L4
10.0 mm at L4-L5
12.0 mm at L5-S1.

The dorsal spine was screened with 4 mm thick T2 Weighted sagittal images and the visualized dorsal spine does not reveal any diagnostic feature of note.
..3/.











- 3 - Scan-00008


IMPRESSION :

1. A large postero-central disc herniation with peridiscal osteophytes at the L3-L4 level with a sequestered disc fragment migrating posterior to the L3 vertebral body with resultant canal stenosis and impingement of the traversing L3 nerve roots.

2. Postero-central disc herniations at the L1-L2, L2-L3 and L4-L5 levels.

3. Congenitally short pedicles of the lumbar vertebrae in their antero-posterior dimensions.

4. A small right postero-lateral disc herniation at the L3-L4 level.

5. Hypertrophic facetal arthropathy on the right side at the L4-L5 level and facetal arthropathy at the L1-L2, L2-L3 and L3-L4 levels.

ke/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzar Sawlmn / M / 65 yrs.
Referred by : Dr. Abc Xyzah.
Examination : Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O giddiness and gait ataxia since 15-20 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.

OBSERVATION :

There are hyperintense areas on the T2 Weighted images in the centrum semiovale bilaterally. Similar areas are also noted in the periatrial white matter and are most likely ischemic in etiology. There is fullness of both the lateral and third ventricles. The fourth ventricle is normal.

There is prominence of the cerebral cortical sulci and cerebellar folia bilaterally.

There is slight prominence of the basal cisternal spaces. There is no shift of the midline structures.

Incidental note is made of inflammatory changes in the sphenoid sinus and both maxillary sinuses.

INTRACRANIAL MRA :

The right posterior cerebral artery is seen to be a continuation of the right posterior communicating artery.

The right vertebral artery is slightly smaller in calibre as compared to the left and is most likely hypoplastic.



The petrous, cavernous and supraclinoid segments of the internal carotid arteries bilaterally show normal signal and calibre. The visualized anterior cerebral, middle cerebral, basilar 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 in the neck is also slightly smaller in calibre as compared to the left and is most likely 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 :

Areas of altered signal in the centrum semiovale and in the periatrial white matter bilaterally are most likely ischemic in etiology.

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