sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyztulla Shlmn / M / 14 yrs.
Referred by : Dr. Abc Xyzzzare.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Alleged H/O fall from a bicycle 5 months back with injury to head.
C/O progressive weakness of BLE and RUE 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.

The cervical spine was screened with 4 mm thick T2 Weighted sagittal images.

OBSERVATION :

There are ill-defined hypointense areas on the T1 Weighted images in the posterior parietal periventricular white matter bilaterally, bilateral centrum semiovale and in the posterior body and splenium of the corpus callosum. These lesions appear hyperintense on the proton, T2 Weighted and FLAIR images. Small areas are seen in the frontal periventricular white matter bilaterally.

There is mild fullness of the posterior body of the lateral ventricles bilaterally.

The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is slight prominence of the cerebral cortical sulci bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.




The T2 Weighted sagittal images of the cervical spine do not reveal any significant feature of note.

IMPRESSION :

Altered signal in the posterior parietal and frontal periventricular white matter bilaterally, bilateral centrum semiovale and in the posterior body and splenium of the corpus callosum is not specific for a single etiology. These changes most likely represent demyelinating lesions (?dysmyelination eg. adrenoleukodystrophy and adrenomyeloneuropathy). Multiple sclerosis/progressive multifocal leukoencephalopathy should be ruled out.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyza Tlmn / F / 34 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O giddiness since 3 months with gait ataxia and mild headaches.

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.

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 are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the cerebellar vermis in the right occipital pole, left frontal deep white matter extending into the left centrum semiovale, right frontal periventricular white matter and in the right frontal parafalcine region. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images. After administration of contrast, there is nodular enhancement within the above described lesions. The enhancing lesions vary in size from about 6.0 mms to 1.1 cms in diameter. Minimal indentation on the frontal horn of the right lateral ventricle is noted by the lesion in the right frontal periventricular white matter.



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.

There is no abnormal meningeal enhancement identified on this study.

IMPRESSION :

Multiple, enhancing, nodular lesions in the cerebellar vermis and cerebral hemispheres bilaterally, with perilesional edema, as described, are not specific for a single etiology. These lesions may represent multiple granulomas (? tuberculomas, ?? toxoplasmosis). It is difficult to characterize the lesions on the basis of the signal intensity. Multiple metastases should also be ruled out.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Shlmn / F / 40 yrs.
Referred by : Dr. Abc Xyzlkaka.
Examination : Intracranial MR Venogram.

CLINICAL PROFILE :

C/O headaches since 3 months.
C/O vomiting since 4 days.

EXAMINATION :

The brain was screened with the help of 5 mm thick T1 Weighted sagittal images and T2 Weighted axial images.

MRV was performed using a 2D TOF technique.

OBSERVATION :

There is seen an ill-defined, hyperintense signal on the T2 Weighted images in the right temporal cortex and subcortical white matter. This lesion appears slightly hyperintense on the T1 Weighted images. Resultant mild indentation on the atrium of the right lateral ventricle is noted.

There is loss of normal flow void signal in the superior sagittal sinus and the right transverse and sigmoid sinuses on the spin-echo and Fast Spin-echo images. These sinuses show an intraluminal signal on the axial and sagittal images.

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

Mucosal thickening is noted in the left maxillary antrum.






INTRACRANIAL MRV :

There is loss of normal flow signal in the right transverse and sigmoid sinuses and in the posterior and anterior segment of the superior sagittal sinus. The left transverse sinus appears hypoplastic and shows normal flow signal. The straight sinus, vein of Galen and the internal cerebellar veins are unremarkable.

IMPRESSION :

1. Altered signal in the right temporal cortex and subcortical white matter most likely represents a haemorrhagic venous infarct(early subacute phase).

2. Loss of normal flow signal in the right transverse and sigmoid sinuses and in the posterior and anterior segments of the superior sagittal sinus suggests venous sinus thrombosis. The superior sagittal sinus is partially thrombosed/recanalized.

hs/sb/nl/nl
Date : 00.00.00

Name of the Patient : Abc lmn / M / 32 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O fall from a height.
C/O giddiness, vomiting, heaviness of head, tinnitus in the right ear and comatose state.

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.

OBSERVATION :

There is evidence of a small area of hypointensity on all the pulse sequences which is seen to bloom on the Fast Scan (T2 *) images within the left cerebellar hemisphere. This may represent hemosiderin/calcium/paramagnetic substances.

Areas of hypointensity on the Fast Scan (T2 *) images are seen within the right temporal lobe. These may represent hemosiderin (? the sequelae of previous hemorrhagic contusions - previous CT).

There is a sliver of hyperintensity on the proton and T2 Weighted images (se/im 102/10, 102/11, 103/10, 103/11) overlying the left temporal lobe. This may represent a small subdural collection of fluid/blood.

There is mild prominence of the cerebellar folia bilaterally.
Scan-00007



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.

Inflammatory changes/blood is seen within the mastoid air cells on the right side and sphenoid sinus.

IMPRESSION :

The MRI features are suggestive of :

1. A small area of altered signal intensity within the left cerebellar hemisphere may represent hemosiderin/calcium/ paramagnetic substances.

2. Areas of altered signal intensity within the right temporal lobe may represent hemosiderin and this may be the sequelae of previous hemorrhagic contusion.

3. A very small subdural collection of fluid/blood overlying the left temporal lobe.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzddin Shlmn / M / 51 yrs.
Referred by : Dr. Abc Xyzagwati.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O dysarthria since 2-3 days.
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 and Fast Scan (T2 *) coronal images.

OBSERVATION :

There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the posterior parietal periventricular white matter bilaterally, in the bilateral centrum semiovale and in the left frontal deep white matter. These lesions appear iso to hypointense to normal white matter on the T1 Weighted images.

There is a hyperintense signal on the T1 Weighted images in the globus pallidus bilaterally extending into the cerebral peduncles bilaterally. This signal appears isointense to normal brain parenchyma on the proton, T2 Weighted and FLAIR images.

There is mild fullness of both the lateral ventricles. The third and the fourth ventricles are normal. There is slight prominence of the cerebral cortical sulci, cerebellar folia and the basal cisternal spaces bilaterally. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
Scan-00006



Inflammatory changes are noted in the maxillary sinuses and ethmoidal air cells bilaterally.

IMPRESSION :

1. Altered signal in the posterior parietal periventricular white matter bilaterally, in the bilateral centrum semiovale and in the left frontal deep white matter most likely represent ischemic lesions.

2. Altered signal in the globus pallidus bilaterally extending into the cerebral peduncles bilaterally suggest paramagnetic substance deposition. Such changes are seen in hepato-cerebral syndromes.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzLokhlmn / M / 40 yrs.
Referred by : Dr. Abc Xyzrges.
Examination : Intracranial M.R.A.

CLINICAL PROFILE :

C/O giddiness since 3 days with vomiting, ptosis on the left side and altered sensorium.

EXAMINATION :

The brain was screened with 5 mm thick T2 Weighted axial images.

Intracranial MRA was performed with a 3D TOF sequence.

OBSERVATION :

There are ill-defined, hyperintense areas on the T2 Weighted images in the left lentiform nucleus, left thalamus and left temporo-parieto-occipital parafalcine cortex. These most likely represent ischemic lesions.

There are bilateral, small, subdural collections over the cerebral convexities on either side with a maximum width of about 7.0 mms. These lesions are hyperintense to CSF on all the pulse sequences. Focal hyperintensity within these lesions on the T1 Weighted images which appears hypointense on the T2 Weighted images are noted in the high parietal regions bilaterally and would represent hemoglobin breakdown products.

There is mild fullness of the third both the lateral ventricles. The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

Inflammatory changes are noted in the paranasal sinuses and in the mastoid air cells bilaterally.






INTRACRANIAL MRA :

The intracranial segment of the right vertebral artery appears 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, left vertebral and posterior cerebral arteries also show normal signal, calibre and wall margins. No obvious aneurysm or vascular malformation is identified.

IMPRESSION :

1. Altered signal in the left lentiform nucleus, left thalamus and left temporo-parieto-occipital parafalcine cortex most likely represents ischemic lesions.

2. Bilateral, small, subdural collections/hematomas overlying the cerebral convexities on either side with a maximum width of about 7.0 mms.

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

ke/sb/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzi Sonalmn / F / 40 yrs.
Referred by : Dr. Abc Xyzlke.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O altered behaviour with irrelevant talk since 00.00.00.
Known hypertensive. 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.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There are ill-defined hyperintense areas on the proton, T2 Weighted and FLAIR images within the pons, right cerebellar hemisphere, bilateral thalami, putamen, corona radiata, centrum semiovale and the periventricular deep white matter. These are isointense to hypointense to the normal white matter on the T1 Weighted images and are suggestive of areas of ischemia/infarction.

A small, ill-defined area is seen in the left frontal and fronto-temporal cortex which is hypointense on the T1 Weighted images and turns hyperintense on the proton, T2 Weighted and FLAIR images and would represent gliotic changes. There is slight involvement of the anterior portion of the insular cortex.

There is slight 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 :

1. Altered signal within the pons, right cerebellar hemisphere, bilateral thalami, putamen, corona radiata, centrum semiovale and the periventricular deep white matter are suggestive of areas of ischemia/infarction.

2. A small area of altered signal intensity in the left frontal region with slight involvement of the anterior portion of the insular cortex would represent gliotic changes, most likely the sequelae of a previous vascular insult.

hs/sb/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyza lmn / F / 33 yrs.
Referred by : Dr. Abc Xyzhah / Dr. Abc Xyzah.
Examination : M.R.I. of Both Hips.

CLINICAL PROFILE :

C/O pain in the left hip since 1 1/2 months.

EXAMINATION :

M.R.I of both hips was performed using the following parameters :

5 mm thick T1 Weighted and STIR coronal images.

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

5 mm thick Proton density sagittal images.

OBSERVATION :

There are diffuse areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted and STIR images within the head and neck of the left femur. Minimal effusion is noted within the left hip joint.

The right femoral head and the acetabulum reveal normal signal intensity. The articular cartilages are unremarkable. There is no effusion within the right hip joint.

The musculature surrounding both the hip joints and the visualized pelvis is normal.









IMPRESSION :

The MRI features are suggestive of diffuse altered signal within the head and neck of the left femur which is not specific for a single diagnosis.

The differential diagnosis would include :

1. Transient osteoporosis.

2. Early avascular necrosis.

As compared to the previous MRI dated 00.00.00, there is slight decrease in the signal intensity of the lesion on the present study.

sb/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzhai Jalmn / M / 72 yrs.
Referred by : Dr. Abc Xyzh Shah / Dr. Abc Xyztrak.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O left sided hemiparesis since 8.00 am of 00.00.00 with dysarthria.
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.

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

FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

BRAIN :

There is an ill-defined, hyperintense signal, best appreciated on the FLAIR images along the right cerebral cortex and in the right lentiform nucleus, head of the right caudate nucleus and right thalamus. This signal appears hypointense to normal grey matter on the T1 Weighted images. Resultant mild effacement of the cerebral cortical sulci in the right cerebral hemisphere is noted. The intracranial segment of the right internal carotid artery shows an intraluminal signal on all the pulse sequences.
Scan-00002


Lacunar infarcts (iso to hyperintense to CSF) are noted in the right thalamus, head of the left caudate nucleus and in the deep white matter in the left parietal region.

There is mild fullness of the third and both the lateral ventricles. The fourth ventricle is normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures.

INTRACRANIAL MRA :

There is non-visualization of the intracranial segment of the right internal carotid artery and its branches (though there is very faint visualization of the proximal right middle cerebral artery).

The petrous, cavernous and supraclinoid segments of the left internal carotid artery show normal signal and calibre. The visualized anterior cerebral, left 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 right internal carotid artery in the neck is also not visualized from the right common carotid bifurcation. The right external carotid, the left internal carotid artery and its bifurcation and the vertebral arteries are unremarkable.

IMPRESSION :

1. Altered signal along the cortex of the right cerebral hemisphere and in the right lentiform nucleus, head of the right caudate nucleus and right thalamus represents a recent ischemic lesion.
..3/.







- 3 - Scan-00002



2. Lacunar infarcts in the right thalamus, head of the left caudate nucleus and in the deep white matter in the left high parietal region.

3. Non-visualization of the right internal carotid artery and its branches from the right common carotid bifurcation (though there is very faint visualization of the proximal
right middle cerebral artery) may suggest thrombosis of the vessel.

sb/hs/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyz Mlmn / M / 40 yrs.
Referred by : Dr. Abc Xyznadkat.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE (right more than left) since 7 years.

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 vertebral body is as marked on the film.

There is a right paracentral disc herniation at the L5-S1 level with antero-lateral indentation of the thecal sac and right neural foraminal narrowing. There is a large posterior peridiscal osteophyte at this level.

There is a small postero-central disc herniation with peridiscal osteophyte at the L4-L5 level with mild anterior indentation of the thecal sac. The L4-L5 and L5-S1 intervertebral discs show loss of water content.

Posterior peridiscal osteophytes are noted at the L1-L2 level to the left of the midline.

Type II degenerative changes are noted in the S1 vertebral body adjacent to the L5-S1 intervertebral disc.






The rest of 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 level and the thecal sac terminates at the S3 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
19.0 mm at L3-L4
17.0 mm at L4-L5
15.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. A right paracentral disc herniation with peridiscal osteophytes at the L5-S1 level with right neural foraminal narrowing.

2. A small postero-central disc herniation with peridiscal osteophytes at the L4-L5 level.

3. A left paracentral peridiscal osteophyte at the L1-L2 level.