Female, 45 years old, with new left arm weakness. Assess for new ischemic lesions or masses. Assess for critical vascular stenosis requiring intervention. Also severe back pain, leg weakness and positive straight leg test. Assess for lumbar degenerative disease. Please note that most of the sequences in the brain examination are degraded by artifact such that the central portion of the images demonstrates significant loss of signal. This artifact substantially reduces sensitivity for small or subtle abnormalities. Within this limitation, the following observations are made.MRI brain:No definite restricted diffusion is seen. Scattered foci of white matter T2 hyperintensity are redemonstrated similar to prior and without significant interval change. In the cerebellum, multiple chronic strokes are redemonstrated similar to prior.No evidence of large intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricular size and morphology are within normal limits. On post contrast images, no pathologic parenchymal or extra-axial enhancement is appreciated.MRA brain:The left vertebral artery flow void is not identified on the MRA of the brain which may reflect small size or reduced flow velocity. The right vertebral artery, basilar artery, and PCAs are within normal limits.The ICAs demonstrate normal flow related signal without significant stenosis. Prominent PCOM arteries are evident bilaterally. The MCA distributions are within normal limits given the limitations of technique. The right A1 segment is hypoplastic. Only a single A2 ACA segment is identified which may reflect an azygos configuration.MRA neck:Common origin of the brachiocephalic and left common carotid arteries is seen. The right ICA is somewhat narrowed at its origin but no more than than 50% by NASCET criteria. The ICAs otherwise demonstrate relatively normal opacification to the level of the skull base. Incidental note is made of an asymmetrically prominent right internal maxillary artery of uncertain but doubtful significance. The proximal right vertebral artery may be slightly narrowed but otherwise demonstrates relatively normal caliber through the neck. The left vertebral artery is not specifically visualized until the V4 segment is reached where there appears to be a small amount of contrast opacification.MRI lumbar spine:Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal abnormality is detected.Severe, essentially complete loss of disc height is evident at L5-S1 with fatty degenerative endplate signal change. Additional level specific findings are detailed below.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable. Multiple scattered perineural root sleeve cysts are seen within the lumbar spine and sacrum.L1-2: Unremarkable. L2-3: Left facet hypertrophy. No significant spinal canal or foraminal stenosis. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mildly reduced disc height and T2 signal. No disc herniations. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy and ligamentum flavum thickening. Mildly reduced disc height and T2 signal with a small central annular fissure and questionable shallow central protrusion. No significant spinal canal or foraminal stenosis. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Essentially complete loss of disc height with osteophytic spurring which slightly effaces the ventral thecal sac. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing presentIncidental note is made of bilateral adnexal cystic lesions, likely physiologic.
1.Brain MRI image quality is significantly reduced by artifact as discussed above. Within this limitation, no definite acute intracranial abnormality is seen. However, the sensitivity for detection of smaller subtle lesions is significantly reduced. Therefore, the patient will be invited to return for repeat imaging at no additional cost. These repeat images will be interpreted in a separate report.2.Demonstration of multiple scattered areas of white matter signal abnormality which are nonspecific and not significantly changed. Multiple chronic cerebellar strokes are also unchanged.3.The left vertebral artery is not specifically visualized in the neck which could indicate severe narrowing or occlusion, possibly also a congenitally diminutive vessel. Some reconstitution of the vessel is seen at the V4 segment. No definite high-grade intracranial stenoses are suspected, though again, image quality intracranially is significantly reduced and the MRA examination will be repeated. Possible azygos configuration of the ACA is suggested.4.Degenerative disc disease at L5-S1 with essentially complete loss of disc height and posterior endplate spurring. Despite this, however, there is no significant spinal canal stenosis and only mild foraminal narrowing.