Richard J. Katz. Steven A. Albert, Alison Bender Ha mes. Stephen D. Greenberg Douglas R. DeCoralo, Gavin L. Duke, 14 EAST RIVER MEDICAL IMAGING, PC Paul S. Choi. Sean K Herman, Robert L Ludwig, Timothy W. Deyer, Michele A. Klein. James W. Br Morton Schneider, ret 519 & 523 East 72nd Street • Nev. York. NY 10021.3 East 75th Street. At Fifth Avenue • New York NY 10021 430 East 59th Street. Sutton Place • New York, NY 10022 Tel: 212-288-1575. Fax: 212-288.7616 • BRUCE W MOSKOWITZ, 1411 NORTH FLAGLER DRIVE SUITE 7100 WEST PALM BEACH, FL 33401 Patient: EPSTEIN, JEFFREY Exam Date: 10/14/15 Acc No: MRN: Dear Dr. Moskowitz, MRI SCAN OF THE LUMBAR SPINE Clinical History: 62-year-old male with bilateral leg numbness for 2 years. Technique: The examination was performed with sagittal T1 weighted images, STIR and T2 weighted images, and axial T2 weighted images of the lumbar spine. Coronal T2 weighted images were obtained as well. Comparison: No prior studies are available for comparison. Findings: Straightening of lumbar lordosis is noted with minimal retrolisthesis of U on L3 and minimal grade 1 anterolisthesis of L4 on 1.5. Vertebral heights are unremarkable. Small high signal intensity hemangiomata are present multiple levels. Multilevel decreased disc space signal is present. Disc space heights are unremarkable. EPSTEIN, JEFFREY ACC: Exam Date: 10/14/15 DOB: 01/20/1953 ACCESS YOUR PATIENTS IMAGES AND REPORTS (a: PET/CT • HIGH FIELD AIN • OPEN MRI • MULTIDETECTOR VOLUME CT (VCT) • BONE DENSITY • NUCLEAR MEDICINE ULTRASOUND • DIGITAL X-RAY • CORONARY CT ANGIOGRAPHY • VIRTUAL COLONOSCOPY • CT/MR ANGIOGRAPHY EFTA00590716 At the L1-L2 level, there is no evidence of canal stenosis or foraminal narrowing. At the L2-L3 level, above described subluxation with disc bulge asymmetric to the right is noted causing mild right foraminal narrowing and mild bilateral lateral recess stenosis without significant central canal stenosis or foraminal narrowing. Mild facet changes are present. At the L3-L4 level, disc bulge with facet changes are present causing mild bilateral foraminal narrowing and mild canal stenosis. At the L4-L5 level, above described subluxation with disc bulge and osteophyte asymmetric to the left is noted with facet changes causing severe left and moderate right foraminal narrowing. Disc bulge with ligamentous thickening is present causing severe central canal stenosis. At the L5-S1 level, osteophyte asymmetric to the right with facet changes are present causing moderate right foraminal narrowing as well as moderate left and severe right lateral recess stenosis. No significant left foraminal narrowing is present. The conus is normal shape and position. There is no evidence of prevertebral or paraspinal soft tissue abnormality. IMPRESSION Osteophyte with facet changes causing moderate right foraminal narrowing at L5-S1 with moderate left and severe right lateral recess stenosis. Grade 1 anterolisthesis of L4 on L5 with severe central canal stenosis and severe left and moderate right foraminal narrowing. Mild bilateral foraminal narrowing at L3-L4. Mild right foraminal narrowing at L2-L3. Very truly yours, PAUL CHOI, M.D. Electronically Signed By PAUL CHOI, M.D. Date/Time Transcribed: 10/14/15 5:39 am REPORT EPSTEIN, JEFFREY ACC: Exam Date: 10/14/15 DOB: 01/20/1953 EAST RIVER MEDICAL IMAGING, PC PET/CT • HIGH FIELD MR/ • OPEN MRI • MULTIDETECTOR VOLUME CT (VCT) • BONE DENSITY • NUCLEAR MEDICINE ULTRASOUND • DIGITAL X-RAY • CORONARY CTANGIOGRAPHY • VIRTUAL COLONOSCOPY.• CT/MR ANGIOGRAPHY EFTA00590717 CC: CC PATIENT EPSTEIN, JEFFREY ACC: Exam Date: 10/14/15 DOB: 01/20/1953 "itka n EAST RIVER MEDICAL IMAGING, PC PET/CT • HIGH FIELD AIN • OPEN MRI • MULTIDETECTOR VOLUME CT (VCT)• BONE DENSITY • NUCLEAR MEDICINE ULTRASOUND • DIGITAL X-RAV • CORONARY CTANGIOGRAPHY • VIRTUAL COLONOSCOPY • CT/AIR ANGIOGRAPHY EFTA00590718