MRN with Dr. Filler
Posted: Wed Oct 05, 2011 4:03 pm
Patient FIRST Name: Annmarie
Accession #: 127 00 06
Patient D.O.B.: 08/21/72
STUDY: SOFT TISSUE MR NEUROGRAPHY OF THE PELVIS
DATE OF STUDY: December 13, 2010
Site Name and Equipment: MRI Center of Peabody, Peabody, MA GE 1.5T, MRI Scanner
INDICATION: This is a 38-year-old woman suffering from pelvic neurologic symptoms.
FINDINGS: These images demonstrate the course and caliber of the lumbar and sacral spinal nerves, the lumbosacral plexus and pudendal nerves, as well as associated anatomical structures. Adequate image quality is provided throughout. There are no significant artifacts impairing image interpretation.
The lumbar and sacral spinal nerves are generally normal in course, caliber and contour as they traverse the proximal and distal foramina. There is no sacroiliac joint inflammation. There is no hip joint degenerative or inflammatory change. The psoas muscles are symmetric in size and shape. The piriformis muscles are small in caliber, but symmetric. The piriformis muscle on the left side demonstrates a bipartite structure, which is a common anatomical variant. There is no specific evidence of passage of the sciatic nerve through the piriformis muscle; however, the right S3 spinal nerve does traverse the right piriformis muscle and demonstrates significant hyperintensity irritative change as it traverses the piriformis muscle and introduces the formation of the pudendal nerve. The obturator internus muscles are slightly asymmetric being slightly smaller on the right. On the medial aspect of the obturator internus muscle there is significant vein dilatation bilaterally. This finding is consistent with the presence of obturator internus muscle spasm. Additionally the pudendal nerve branches are prominent being hyperintense and increase in caliber bilaterally involving multiple branches.
IMPRESSION: IRRITATIVE CHANGE WITHIN THE PUDENDAL NERVE IN THE ISCHIORECTAL FOSSA ASSOCIATED WITH BILATERAL PUDENDAL VEIN DILATATION, WHICH IS INDICATIVE OF OBTURATOR INTERNUS MUSCLE SPASM. ADDITIONALLY, THE RIGHT S3 SPINAL NERVE IS SEEN TO TRAVERSE THE RIGHT PIRIFORMIS MUSCLE WITH ASSOCIATED HYPERINTENSITY CHANGE AT THIS LEVEL. THESE FINDINGS WOULD BE CONSISTENT WITH A PIRIFORMIS LEVEL PUDENDAL SYNDROME AT LEAST ON THE RIGHT SIDE AND IS SIMILARLY EVIDENCED BILATERALLY OF MORE DISTAL PUDENDAL IRRITATION AND POSSIBLE BILATERAL OBTURATOR INTERNUS SPASM.
THREE- DIMENSIONAL RECONSTRUCTION AND ANALYSIS:
STUDY: Soft-Tissue MRI Neurography, three dimensional reconstruction and analysis.
TECHNICAL: 3D Multiplanar Reformations, image overlay assembly and optional maximum intensity projections were performed on an Advanced Voxar 3D Workstation.
FINDINGS: These images demonstrate the course and caliber of the pudendal neurovascular elements using multiplanar reformat techniques to provide an overview.
The general course of the pudendal elements is normal; however, there is significant increased caliber and image intensity affecting multiple branches of the pudendal nerves bilaterally and associated dilatation of the pudendal veins including alteration of caliber at the level of the Alcock's canal, particularly on the right side. These findings are consistent with the presence of bilateral obturator internus muscle spasm associated with the pudendal nerve irritative change.
IMPRESSION: BILATERAL PUDENDAL IRRITATIVE CHANGE WITH PUDENDAL VESSEL DILATATION ON THE MEDIAL ASPECT OF THE OBTURATOR INTERNUS MUSCLE. THESE FINDINGS ARE CONSISTENT WITH MUSCLE SPASM BASED PUDENDAL SYNDROME.
Signed:

Aaron Filler, MD, PhD
Neurography Institute Medical Associates
Accession #: 127 00 06
Patient D.O.B.: 08/21/72
STUDY: SOFT TISSUE MR NEUROGRAPHY OF THE PELVIS
DATE OF STUDY: December 13, 2010
Site Name and Equipment: MRI Center of Peabody, Peabody, MA GE 1.5T, MRI Scanner
INDICATION: This is a 38-year-old woman suffering from pelvic neurologic symptoms.
FINDINGS: These images demonstrate the course and caliber of the lumbar and sacral spinal nerves, the lumbosacral plexus and pudendal nerves, as well as associated anatomical structures. Adequate image quality is provided throughout. There are no significant artifacts impairing image interpretation.
The lumbar and sacral spinal nerves are generally normal in course, caliber and contour as they traverse the proximal and distal foramina. There is no sacroiliac joint inflammation. There is no hip joint degenerative or inflammatory change. The psoas muscles are symmetric in size and shape. The piriformis muscles are small in caliber, but symmetric. The piriformis muscle on the left side demonstrates a bipartite structure, which is a common anatomical variant. There is no specific evidence of passage of the sciatic nerve through the piriformis muscle; however, the right S3 spinal nerve does traverse the right piriformis muscle and demonstrates significant hyperintensity irritative change as it traverses the piriformis muscle and introduces the formation of the pudendal nerve. The obturator internus muscles are slightly asymmetric being slightly smaller on the right. On the medial aspect of the obturator internus muscle there is significant vein dilatation bilaterally. This finding is consistent with the presence of obturator internus muscle spasm. Additionally the pudendal nerve branches are prominent being hyperintense and increase in caliber bilaterally involving multiple branches.
IMPRESSION: IRRITATIVE CHANGE WITHIN THE PUDENDAL NERVE IN THE ISCHIORECTAL FOSSA ASSOCIATED WITH BILATERAL PUDENDAL VEIN DILATATION, WHICH IS INDICATIVE OF OBTURATOR INTERNUS MUSCLE SPASM. ADDITIONALLY, THE RIGHT S3 SPINAL NERVE IS SEEN TO TRAVERSE THE RIGHT PIRIFORMIS MUSCLE WITH ASSOCIATED HYPERINTENSITY CHANGE AT THIS LEVEL. THESE FINDINGS WOULD BE CONSISTENT WITH A PIRIFORMIS LEVEL PUDENDAL SYNDROME AT LEAST ON THE RIGHT SIDE AND IS SIMILARLY EVIDENCED BILATERALLY OF MORE DISTAL PUDENDAL IRRITATION AND POSSIBLE BILATERAL OBTURATOR INTERNUS SPASM.
THREE- DIMENSIONAL RECONSTRUCTION AND ANALYSIS:
STUDY: Soft-Tissue MRI Neurography, three dimensional reconstruction and analysis.
TECHNICAL: 3D Multiplanar Reformations, image overlay assembly and optional maximum intensity projections were performed on an Advanced Voxar 3D Workstation.
FINDINGS: These images demonstrate the course and caliber of the pudendal neurovascular elements using multiplanar reformat techniques to provide an overview.
The general course of the pudendal elements is normal; however, there is significant increased caliber and image intensity affecting multiple branches of the pudendal nerves bilaterally and associated dilatation of the pudendal veins including alteration of caliber at the level of the Alcock's canal, particularly on the right side. These findings are consistent with the presence of bilateral obturator internus muscle spasm associated with the pudendal nerve irritative change.
IMPRESSION: BILATERAL PUDENDAL IRRITATIVE CHANGE WITH PUDENDAL VESSEL DILATATION ON THE MEDIAL ASPECT OF THE OBTURATOR INTERNUS MUSCLE. THESE FINDINGS ARE CONSISTENT WITH MUSCLE SPASM BASED PUDENDAL SYNDROME.
Signed:

Aaron Filler, MD, PhD
Neurography Institute Medical Associates