If abnormal, bladder wall thickness Normal Bladder volume ................ ml Trigone [perpendicular to Lumen at thickest part of Trigone] ...…….. mm Abnormal Dome, Midline ………….….......... mm Anterior wall, midline ……........ mm OTHER No Other (describe) Length ………….. cm (Please specify) High High High Yes .................................... Width ………….. cm Intermediate Intermediate Intermediate .................................... Transverse ..………… cm Low Low Low Part E: Other observations Fluid observed Free fluid Loculated fluid No No No Physiological Yes Yes Yes Adhesions Clearly seen? Organs implicated Suspected? Reason No 1. ...................................................................... Distortion of margins No Yes Clearly seen 2. ...................................................................... Proximity of organs No Yes Suspected 3. ...................................................................... Other (specify) No Yes Further Notes
Normal Abnormal If abnormal, bladder wall thickness Trigone [perpendicular to Lumen at thickest part of Trigone] ...…….. mm Dome, Midline ………….….......... mm Anterior wall, midline ……........ mm Bladder volume ................ ml OTHER (Please specify) No Yes Other (describe) .................................... .................................... Length ………….. cm Width ………….. cm Transverse ..………… cm High Intermediate Low High Intermediate Low High Intermediate Low Part E: Other observations Fluid observed No Physiological Yes Free fluid No Yes Loculated fluid No Yes Adhesions No Clearly seen Suspected Clearly seen? Organs implicated 1. ...................................................................... 2. ...................................................................... 3. ...................................................................... Suspected? Reason Distortion of margins Proximity of organs Other (specify) No Yes No Yes No Yes Further Notes
Form-07(a)(b)---Medal-study-MRI-Report-v1-7-04-03-2013.docx