SB/KE/NL/RG.
Date : 00.00.00

Name of the Patient : Abc Xyz Mlmn / M / 37 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O backache with weakness of the RLE and tingling in the RUE and RLE since February 0000.
Operated for an ependymoma in the dorsal region in February 0000. Radiotherapy received.

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.

After administration of contrast, 5 mm thick T1 Weighted sagittal images and 5 mm thick T1 Weighted axial images (with fat saturation) were obtained.

OBSERVATION :

There is evidence of laminectomy over the D12 to L3 vertebral levels with post-operative changes in the soft tissues in the posterior dorso-lumbar region over these levels.

There is seen an intradural-extramedullary mass lesion in the lower dorsal spinal cord at the conus-cauda region, at the L1 and L2 vertebral levels. This lesion is of intermediate signal on the T1 Weighted images and appears heterogeneously hyperintense on the T2 Weighted images. The tip of the conus medullaris and the intrathecal nerve roots are not well identified separately in that region.
Scan-00007


There is scalloping of the posterior margin of the D12, L1 and L2 vertebrae.

A hypointense signal on the T1 Weighted images which turns hyperintense on the T2 Weighted images is noted in the mid and lower dorsal spinal cord, centrally, over about D5 to L1 vertebral levels, which represents a syrinx.

The D12 to L3 vertebral bodies show fatty marrow changes, the sequelae of previous radiotherapy.

The visualized dorso-lumbar intervertebral discs show normal signal.

The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

After administration of contrast, there is enhancement of the previously described intradural-extramedullary lesion at the L1 and L2 vertebral levels. There is no other focal area of abnormal enhancement in the visualized dorsal spinal cord or the meninges.

IMPRESSION :

1. Post-operative, post-radiotherapy status.

2. An enhancing intradural-extramedullary lesion in the spinal canal at the L1 and L2 vertebral levels as described represents a residual/recurrent ependymoma. A syrinx is noted in the dorsal spinal cord over the D5 to L1 vertebral levels.

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

ke/sb/rg.
s Date : 00.00.00

Name of the Patient : Abc Xyzlaxmi Palmn / F / 30 yrs.
Referred by : Dr. Abc Xyzah / Dr. Abc Xyzrikh.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O backache with weakness of BLE and weight loss since 3 months.
H/O fall 4-5 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 near complete collapse of the D10 vertebral body with slight anterior wedging of the D9 vertebral body.

There is replacement of the normal marrow of the D9, D10 and the superior portion of the D11 vertebral bodies by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the T2 Weighted images. There is pre and paravertebral soft tissue extension over the D9 to D11 vertebral levels. Anterior epidural extension is also noted over these levels with slight compression of the spinal cord. The spinal cord over these levels shows a hyperintense signal on the T2 Weighted images. This is isointense to the normal cord on the T1 Weighted images and would represent cord edema/ischemia.

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


Subtle altered signal intensity is noted within the L3 and the D1 vertebral bodies.

The conus medullaris terminates at the L1 level.

IMPRESSION :

The MRI features are suggestive of :

1. Collapse of the D10 vertebral body.

2. Altered signal in the D9, D10, D11 and the L3 vertebral bodies with extensions as described is most probably due to granulomatous infective process like tuberculosis. The possibility of a neoplasm seems less likely.

3. Altered signal in the cord over the D9 to D11 vertebral levels suggests cord edema/ischemia.

ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Plmn / F / 22 yrs.
Referred by : Dr. Abc Xyztel.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

H/O fever with chills since 8 days.
C/O quadriparesis since 3 days.

EXAMINATION :

M.R.I of the cervical spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.

OBSERVATION :

The cervical spinal cord appears swollen and is hypointense to the normal cord on the T1 Weighted images. This is seen to turns hyperintense on the T2 Weighted and Fast Scan (T2 *) images. Superiorly this is seen to extend upto the cervico-medullary junction and inferiorly upto the D7 vertebral level. Slight effacement of the CSF space in the upper cervical region is noted. The gray and white matter differentiation is lost in the upper cervical region.

There are small posterior disc bulges at the C3-C4 and C4-C5 levels with anterior indentation of the thecal sac. The upper cervical intervertebral discs show loss of water content.

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

The atlanto-axial region is unremarkable.
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IMPRESSION :

The MRI features are suggestive of a swollen cervical spinal cord with altered signal extending upto the cervico-medullary junction superiorly and inferiorly upto the D7 vertebral level is not specific for a single etiology. The possibilities to be considered are,

1. Myelitis (most likely).

2. Demyelination.

3. Ischemia/infarction (less likely).

If clinically indicated, a contrast enhanced scan may be worthwhile.

ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzao Shlmn / M / 48 yrs.
Referred by : Dr. Abc Xyzorude.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches (left sided) and pain in the left ear since 1 1/2 months.
Known diabetic. 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 is no focal area of altered signal intensity in the brain parenchyma.

Both the lateral, third and the fourth ventricles are normal. Note is made of cavum septum pellucidum and cavum septum vergae. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.

There are hyperintense areas in the medial and lateral pterygoid muscles on the left side on the proton, T2 Weighted and FLAIR images. This is slightly hyperintense to the normal muscles on the T1 Weighted images. The facial planes are not well-visualized.

Incidental note is made of inflammatory changes in the sphenoid sinus, ethmoidal air cells and left mastoid air cells.


IMPRESSION :

1. Altered signal in the medial and lateral pterygoid muscles on the left side is not specific for a single etiology. This most probably is inflammatory in etiology and requires further evaluation.

2. Left mastoiditis and inflammation of the sphenoid and ethmoidal air cells.

ke/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz lmn / M / 46 yrs.
Referred by : Dr. Abc Xyzrani.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O headaches and occasional giddiness since 2-3 days.
H/O right craniotomy 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.

5 mm thick FLAIR coronal images.

5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There are susceptibility artifacts in the region of the right maxillary antrum with post-operative changes. The medial wall of the right maxillary antrum and the right orbit (lower medial wall) is not well-identified, probably the result of surgery.

There are hypointense areas on the T1 Weighted images in the frontal lobes bilaterally. These are seen to turn hyperintense on the proton, T2 Weighted and FLAIR images. A cystic area is seen in the right frontal lobe on the T1 Weighted images which turns hyperintense on the proton and T2 Weighted 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 gross inflammatory changes within the paranasal sinuses.


IMPRESSION :

1. Post-operative status.

2. Areas of encephalomalacia in the frontal lobes bilaterally with cystic changes in the right frontal lobe.

ke/sb/nl/rg.
/3 Date : 00.00.00

Name of the Patient : Abc XyzSlmn / F / 45 yrs.
Referred by : Dr. Abc Xyztrak.
Examination : M.R.I. of the Brain and
Intracranial and Neck M.R.A.

CLINICAL PROFILE :

C/O weakness of the left hand with giddiness since 1 day.
Known DM/HT. 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.

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

OBSERVATION :

BRAIN :

There are hyperintense areas on the proton, T2 Weighted and FLAIR images in the left frontal and high parietal region. These are isointense to the normal white matter on the T1 Weighted images and would represent ischemic changes.

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.

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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.

IMPRESSION :

Altered signal in the left frontal and high parietal region would represent ischemic changes.

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

ke/sb/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Mirlmn / F / 61 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Old C/O cavernous sinus thrombosis with right eye proptosis and visual loss on the right side and diminished vision of the left eye since February 0000.
H/O Embolization of CCF in May 0000.
Now C/O left hemiplegia with altered sensorium and generalized rigidity of all 4 limbs 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.
3 thick T1 Weighted and STIR coronal images.
5 mm thick T1 Weighted sagittal images.
FEW IMAGES SHOW PATIENT MOTION.

OBSERVATION :

There are ill-defined, hyperintense areas on the proton, T2 Weighted and FLAIR images in the periventricular deep white matter bilaterally. These are iso to hypointense to normal white matter on the T1 Weighted images and may represent ischemic changes.

Lacunar infarcts are noted in the right lentiform nucleus and bilateral centrum semiovale.

The optic nerves on either side show normal signal intensity bilaterally.



There is moderate dilatation of the ventricular system. There is a hypointense signal more pronounced on the T2 Weighted images
within the superior portion of the fourth ventricle, aqueduct and the third ventricle which may suggest increased CSF flow. There is slight prominence of the cerebral cortical sulci and cerebellar folia bilaterally. Prominence of the basal cisternal spaces is also noted. There is no shift of the midline structures. Slight ectasia of the vertebro-basilar system is seen.

Ill-defined, hyperintense signal on the STIR images are noted in the retro-orbital fat on the right, which may suggest inflammatory changes, in the given clinical setting.

Inflammatory changes are noted in the mastoid air cells bilaterally.

The cavernous sinuses are unremarkable on either side, on this study.

IMPRESSION :

1. Altered signal in the periventricular deep white matter bilaterally may suggest ischemic changes (less likely to represent transependymal CSF seepage).

2. Lacunar infarcts in the right lentiform nucleus and bilateral centrum semiovale.

3. Moderate dilatation of the ventricular system is disproportionate to the degree of the cerebral atrophy and this can be seen with normal pressure hydrocephalus.

4. Bilateral mastoiditis.

5. Altered signal in the retro-orbital fat on the right may suggest inflammatory changes.

The previous investigations were not available for review/comparison.

sb/bv/rg.
Date : 00.00.00

Name of the Patient : Abc Xyznt Nlmn / M / 45 yrs.
Referred by : Dr. Abc Xyzrges.
Examination : M.R.I. of the Cervical Spine.

CLINICAL PROFILE :

C/O neck pain and pain in the left scapular region with paresthesias and wasting of the LUE.

EXAMINATION :

M.R.I of the cervical spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.

OBSERVATION :

There is continuous ossification of the posterior longitudinal ligament extending over the C2 to C6 vertebral levels.

There is loss of water content of the cervical intervertebral discs.

Postero-central disc herniations with peridiscal osteophytes are noted at the C3-C4, C4-C5 and C5-C6 levels, indenting the cervical spinal cord anteriorly.

A left paracentral disc herniation with peridiscal osteophytes is noted at the C6-C7 level with left neural foraminal narrowing.

Degenerative changes of the joints of Luschka are noted at the C5-C6 and C6-C7 levels bilaterally. Facetal hypertrophy is noted at the C4-C5 and C5-C6 levels bilaterally.

The cervical vertebral bodies show spotty fatty marrow changes.
..2/.







The visualized pre and paravertebral soft tissues are unremarkable.

The cervical spinal cord reveals normal signal intensity.

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

IMPRESSION :

1. Continuous ossification of the posterior longitudinal ligament extending over the C2 to C6 vertebral levels.

2. Postero-central disc herniations with peridiscal osteophytes at the C3-C4, C4-C5 and C5-C6 levels.

3. A left paracentral disc herniation with peridiscal osteophytes at the C6-C7 level with left neural foraminal narrowing.

4. Degenerative changes of the joints of Luschka at the C5-C6 and C6-C7 levels bilaterally.

5. Facetal hypertrophy at the C4-C5 and C5-C6 levels bilaterally.

sb/bv/rg.
Date : 00.00.00

Name of the Patient : Abc XyzDhumlmn / M / 13 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

Known C/O TBM detected 2 years back. Completed AKT.
C/O seizures since 1 year. On anti-epileptics.

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 periatrial white matter. This lesion appears hypointense to normal white matter on the T1 Weighted images. Resultant mild focal dilatation of the atrium of the left lateral ventricle is noted.

A lacunar infarct is noted in the left thalamus.

There is a small subcentimeter, hypointense lesion on the T2 Weighted images in the left occipital parafalcine cortex and in the left posterior parietal cortex (scans 102.11 & 102.14). These lesion are not well-identified on the T1 Weighted images. There is no perilesional edema. Another circumscribed hypointense area is seen in the right occipital cortex on the Fast Scan (T2 *) images (Image No. 5).

The right 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 left temporal horn appears slightly larger than the right and may be a normal variant.
..2/.







IMPRESSION :

1. Altered signal in the left periatrial white matter may be ischemic in etiology (in the known C/O TBM).

2. A lacunar infarct in the left thalamus (may be the result of vasculitis).

3. Focal subcentimeter lesions in both occipital parafalcine cortex and in the left posterior parietal cortex most likely represent calcified granulomas.

sb/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzn Nlmn / F / 67 yrs.
Referred by : Dr. Abc Xyzhah.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

C/O vertigo, forgetfullness and dizziness since 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.

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 images (with magnetization transfer), 3 mm thick T1 coronal images (with magnetization transfer) and 5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There are small bright foci on the proton, T2 Weighted and FLAIR images in the subcortical and deep white matter in the frontal regions bilaterally. These lesions appears isointense to normal white matter on the T1 Weighted images.

The seventh and eighth cranial nerve complex is unremarkable bilaterally.

There is mild dilatation of both the lateral and the 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. No obvious vascular anomaly is identified on this study.
..2/.






After administration of contrast, there is no focal area of abnormal enhancement in the brain parenchyma, meninges or along the seventh and eighth cranial nerve complex on either side.

IMPRESSION :

1. Altered signal in the subcortical and deep white matter in the frontal regions bilaterally is most likely ischemic in etiology.

2. Mild cerebral cortical atrophy.