sb/ke/nl/rg
Date : 00.00.00

Name of the Patient : Abc Xyzl Ganlmn / M / 78 yrs.
Referred by : Dr. Abc Xyzagwati / Dr. Abc Xyztrak.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O weakness of the LLE since 00.00.00 and LUE since 00.00.00.
C/O increased frequency of micturition.
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 and Fast Scan (T2 *) coronal images.

5 mm thick T1 Weighted sagittal images.

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

OBSERVATION :

BRAIN :

There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the posterior parietal periventricular white matter bilaterally and in the corona radiata and centrum semiovale bilaterally. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images and most likely represent ischemic changes. Similar signal intensity lesions are noted in the right lentiform nucleus, posteriorly and in the right corona radiata, posteriorly which may be recent ischemic lesions in the given clinical setting. No obvious haemorrhage is identified on this study.



There is mild dilatation of both the lateral and third ventricles. The fourth ventricle is normal. There is prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally. There is no shift of the midline structures.

INTRACRANIAL MRA :

There is irregularity and narrowing of the petrous and cavernous segments of the left internal carotid artery. Slight irregularity of the left vertebral artery, basilar artery in its mid segment, P2 segment of the left posterior cerebral artery and ? irregularity of the right middle cerebral artery, distally, is noted.

The A1 segment of the left anterior cerebral artery appears hypoplastic. The right posterior cerebral artery appears as a continuation of the right posterior communicating artery.

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

NECK MRA :

There is tortuousity of the right common carotid artery and the vertebral arteries bilaterally.

An atherosclerotic plaque is noted along the posterior wall of the left internal carotid artery at its origin.
..3/.









- 3 - Scan-00000



The common carotid arteries and their bifurcations are unremarkable.

IMPRESSION :

1. Altered signal in the posterior parietal periventricular white matter bilaterally and in the corona radiata and centrum semiovale bilaterally most likely represent ischemic changes.

2. Altered signal in the right lentiform nucleus, posteriorly and in the right corona radiata, posteriorly may be recent ischemic lesions in the given clinical setting.

3. Irregularity and narrowing of the petrous and cavernous segments of the left internal carotid artery with slight irregularity of the left vertebral artery, basilar artery in its mid segment, P2 segment of the left posterior cerebral artery and ? irregularity of the right middle cerebral artery, distally, may be atherosclerotic in etiology.

4. An atherosclerotic plaque along the posterior wall of the right internal carotid artery just distal at its origin.

As compared to the previous MRI dated 00.00.00, the lesions in the right lentiform nucleus, posteriorly, right corona radiata posteriorly are new lesions.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzelmn / M / 35 yrs.
Referred by : Dr. Abc XyzV. Shah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE since 5-6 months which increased since 2-3 days.

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 probable sacralization of the L5 vertebra (Kindly correlate with plain radiographs).

There is loss of water content of the L4-L5 intervertebral disc.

There is a small, postero-central disc herniation at the L4-L5 level, indenting the dural theca anteriorly. Small posterior peridiscal osteophytes and slight facetal hypertrophy is also noted at this level.

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 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 :

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

IMPRESSION :

1. Probable sacralization of the L5 vertebra (Kindly correlate with plain radiographs).

2. Degenerated L4-L5 disc with a small, postero-central disc herniation at that level. Small posterior peridiscal osteophytes and slight facetal hypertrophy is also noted at this level.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzlata N. lmn / F / 35 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (right more than left) 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 loss of water content of the L4-L5 and L5-S1 intervertebral discs.

There is Grade I spondylolisthesis of the L4 over the L5 vertebra and the L5 over the S1 vertebra without obvious spondylolysis.

There is a right paracentral disc herniation at the L5-S1 level indenting the traversing right S1 nerve root. Bilateral far lateral disc bulges are also noted at these levels. There is slight facetal hypertrophy at this level.

A posteriorly herniated disc is noted at the L4-L5 level with bilateral neural foraminal narrowing. There is also facetal and ligamentum flavum hypertrophy at that level. Bilateral small facet joint effusions are noted at the L4-L5 level with a small synovial cyst in relation to the right facet joint at the L4-L5 level, postero-laterally.




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-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 :

14.0 mm at L1-L2
13.0 mm at L2-L3
13.0 mm at L3-L4
11.0 mm at L4-L5
9.0 mm at L5-S1.

IMPRESSION :

1. Grade I spondylolisthesis of the L4 over the L5 vertebra and the L5 over the S1 vertebra without obvious spondylolysis.

2. A right paracentral disc herniation at the L5-S1 level indenting the traversing right S1 nerve root with slight facetal hypertrophy at this level.

3. A posteriorly herniated disc at the L4-L5 level with facetal and ligamentum flavum hypertrophy and canal stenosis.

4. Bilateral small facet joint effusions at the L4-L5 level with a small synovial cyst in relation to the right facet joint at the L4-L5 level, postero-laterally.

sb.sb.rg.
Date : 00.00.00

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

CLINICAL PROFILE :

C/O backache with pain in the left paraspinal region since 00.00.00.
H/O lifting heavy weights.

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 L5-S1 intervertebral disc.

There is a small, left paracentral protruded disc at the L5-S1 level with minimal indentation on the traversing left
S1 nerve root.

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

The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. 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 S1-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
17.0 mm at L3-L4
15.0 mm at L4-L5
12.0 mm at L5-S1.

IMPRESSION :

Degenerated L5-S1 intervertebral disc with a small, left paracentral protruded disc at that level, minimally indenting the traversing left S1 nerve root.

sb/hs/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzj Bhlmn / M / 39 yrs.
Referred by : Dr. Abc Xyzr Archik/Dr. Abc Xyzrude.
Examination : M.R.I. of the Lumbo-sacral Spine.
(Post-contrast Study).


After administration of contrast the following parameters were used :

5 mm thick T1 Weighted sagittal images (with fat saturation).

6 mm thick T1 Weighted axial images.

6 mm thick T1 Weighted axial images with fat saturation through the region of interest.

There is sacralization of the L5 vertebra.

After administration of contrast, there is diffuse, ill-defined, enhancement in the posterior soft tissues in the lumbar region at the L3, L4, L5 and S1 regions. Enhancement is also noted in the superior half of the L5 vertebral body which my be due to previous surgery. There is also enhancement in the right lateral epidural space at the L5 vertebral level and in epidural space at the L4-L5 disc level and may represent scar tissue. There is also enhancement of the intrathecal nerve roots at the L4 and L5 vertebral levels.

A fairly large, posteriorly extruded disc at the L4-L5 level is still well identified.

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyza Ralmn / F / 38 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE with paresthesias.

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 nearly all the lumbar intervertebral discs except the L3-L4 disc.

Small postero-central disc herniations are noted at the L2-L3, L4-L5 and L5-S1 levels.

A small, right paracentral disc herniation is noted at the L1-L2 level.

The lumbar vertebral bodies reveal normal signal intensity. 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 :

15.0 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. Small postero-central disc herniations at the L2-L3, L4-L5 and L5-S1 levels.

2. A small, right paracentral disc herniation at the L1-L2 level.

ke/bv/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzi Slmn / M / 48 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O weakness of the LUE since 4 days.

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.

5 mm thick T1 Weighted sagittal images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is a well circumscribed lesion in the right frontal region (in the precentral gyrus) which measures approximately 2.4 x 2.3 x 2.1 cms. This lesion is hypointense on the T1 Weighted images with a hyperintense periphery. The centre is seen to turn hyperintense on the proton, T2 Weighted and FLAIR images and the periphery turning hypointense. Surrounding edema is noted with slight effacement of the adjacent sulci. On administration of contrast there is thick peripheral enhancement of the lesion.
Scan-00003


There is no other area of abnormal enhancement.

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 :

The MRI features are suggestive of a well circumscribed lesion in the right frontal region measuring approximately 2.4 x 2.3 x 2.1 cms. with thick peripheral enhancement. This is not specific for a single etiology.

The possibilities to be considered are :

1. Infective process like an abscess.

2. Neoplastic process like a glial cell tumor or metastasis.

A follow up scan would be worthwhile.

hs/ke/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzar lmn / M / 64 yrs.
Examination : Brain & Intracranial M.R.A.

CLINICAL PROFILE :

C/O headaches and nausea.

EXAMINATION :

The brain was examined with 5 mm thick T1 Weighted and T2 Weighted axial images and 5 mm thick FLAIR coronal images.

Intracranial MRA was performed with 3D TOF sequence.

OBSERVATION :

There are small foci of hyperintensity on the T2 Weighted and FLAIR images within the white matter in the left frontal lobe. These are iso to hypointense to white matter on the T1 Weighted images and are most likely ischemic in etiology.

There is fullness of the third and both the lateral ventricles. Note is made of an empty sella.

There is mild prominence of the cerebral cortical sulci bilaterally.

The fourth ventricle is normal. 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.




IMPRESSION :

1. An empty sella.

2. Areas of altered signal within the white matter in the left frontal lobe most likely are ischemic in etiology.

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

sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyza Kalmn / F / 60 yrs.
Referred by : Dr. Abc Xyzm.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O loss of consciousness for 2 hours on 00.00.00 and similar complaints on 00.00.00 for a day.
C/O 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.
5 mm thick T1 Weighted sagittal images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial and coronal images with magnetization transfer.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is seen a conglomeration of multiple rim enhancing lesions in the right medial temporal lobe. This conglomeration measures approximately 1.8 x 1.2 x 1.2 cms. This lesion appears iso to hypointense to normal white matter on the T1 Weighted images and appears hypointense on the T2 Weighted images. There is mild perilesional edema.

After contrast administration, there are multiple, very small, subcentimeter, rim enhancing lesions at the tip of the left cerebellar tonsil and in the left temporal cortex near the left Sylvian fissure. These lesions are not well identified on the unenhanced scan.

A CSF signal intensity lesion on all the pulse sequences is noted in the head of the left caudate nucleus and left anterior capsular region which most likely represents an old infarct.
..2/.




There are ill-defined, non-enhancing hyperintense lesions on the proton, T2 Weighted and FLAIR images in the pons, subcortical white matter in the left posterior parietal region, posterior parietal periventricular white matter bilaterally and in the corona radiata and centrum semiovale. These most likely represent ischemic changes.

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.

Incidentally noted is intermediate signal within the left sigmoid sinus and proximal left internal jugular vein which may represent slow flow.

An empty sella is also noted.

IMPRESSION :

1. An approximately 1.8 x 1.2 x 1.2 cms sized conglomeration of multiple rim enhancing lesions in the right medial temporal region follows the signal characteristics of tuberculomas. Smaller, subcentimeter lesions are noted in the left cerebellar tonsil and left temporal cortex.

The possibility of these lesions representing neoplasm seems less likely.

2. Old infarcts in the head of the left caudate nucleus and left anterior capsular region.

3. Areas of altered signal in the pons, subcortical white matter in the left posterior parietal region, posterior parietal periventricular white matter bilaterally and in the corona radiata and centrum semiovale most likely represent ischemic changes.

sb/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzolmn / F / 17 yrs.
Referred by : Dr. Abc Xyzelwal.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O railway accident on 00.00.00.
C/O vomiting and patient is in semiconscious state 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 and Fast Scan (T2 *) coronal images.

OBSERVATION :

There is an ill-defined hyperintense signal on the proton, T2 Weighted and FLAIR images in the left high frontal cortex. This lesion appears hypointense to the normal gray matter on the T1 Weighted images and blooms on the Fast Scan (T2 *) images and represents a haemorrhagic cortical contusion, in the given clinical setting. Similar signal but to a lesser extent is noted in the right high frontal cortex.

There is an ill-defined, hyperintense signal on the T2 Weighted and FLAIR images in the right hippocampus. This lesion appears iso to hypointense to normal gray matter on the T1 Weighted images.

Hyperintense signal, best appreciated on the FLAIR images is noted in the sulcal spaces in the right high parietal region which may suggest subarachnoid haemorrhage.

The CSF spaces in the frontal regions bilaterally appear slightly prominent, which may suggest small subdural effusions.

There is asymmetric fullness of the left lateral ventricle as compared to the right.
..2/.






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.

A subgaleal contusion is noted in the right fronto-parietal region.

IMPRESSION :

1. Haemorrhagic cortical contusions in the high frontal region bilaterally, left more than right.

2. Altered signal in the right hippocampus is not specific for a single etiology. This may represent hippocampal contusion.

3. Altered signal intensity in the sulcal spaces in the right high parietal region may suggest subarachnoid haemorrhage.

4. Small subdural effusions in the frontal regions bilaterally.