Preview
FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
EXHIBIT Q
FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
Alpb“ '
J45 East'32nd Street, Ground Floor
New York, New York 1001 6-6055
ph.212-868-921 o-ofax:212-86_8-9213
5D mgimmmgng info@nymri.com o www.nymri. com
mgNYMR SOLLrnons
MANAGED BY Alpha Imaging Consultants, PLLC
Mehrdad Golzad, MD Patient: Erazo, Sarah
91-31 Queens Blvd., Suite 601 MRN: 79260
Elmhurst, NY 11373 DOB:
(718)454-2222 Phone Exam: MRI of the BrainlD'I‘I/MRVIMRSINeuroQuant®
(718)264-0257 Fax Date of Exam: May 18, 2020 .
History: MVA on 03/1 112020.
Technique:
1. MRI Brain: MRI examination of the brain was performed on a Siemens Trio 3.0 Tesla scanner utilizing saginal 3D 1.1 mm
3D ADNI, TZIFLAIR, with multiplanar reformation, axial fat sat T2. and axial 3D SW1.
2. NeuroQuant®: The 3D ADNI scan was analyzed by NeuroQuant® (Cortechs Labs). a 3D morphometric technique utilizing
an anatomic atlas based upon >2000 age (between 3 and 100 years) and gender-matched controls yielding percentile volume scores.
3. DTI Brain: Diffusion-tensor imaging (DTI) was performed on a Siemens Tn'o 3.0 Tesla scanner utilizing 30 directions with 5
mm sections. 1.5 mm gap, 230 mm field of view, TEII‘R 106/3000 ms, two averages, AP phase, 128x128 matrix, 1.8 x 1.8 x 5.0 mm
voxel size with llfimm slice gap, GRAPPA acceleration factor 2, 30 reference lines, b values of 0 s/mm2, and 2000 s/mm2. bw =
1396 Hz/Px and EPI factor of 128. After informed consent was obtained, 119 control subjects were scanned at Alpha 3T MRI using
this technique, including NeuroQuant® and 3D T2IFLAIR as above. Exclusion criteria included prior head trauma, known
neurologic or psychiatric disorder, and T2fFLAIR abnormality inappropriate for age. Eight pre~selected anatomic ROIs were drawn
on the mean control FA map using MRIcro sent to a DTI analyst and a biostatistician (S. Meda, H. Zhu). 9 subjects were removed .
due to technical factors; 109 control subjects remained. From those subjects, 3/872 statistically outlying ROIs were removed (2 in
RDT, 1 in Geuu, all for Z score > 3). Excel file calculator regressed for age and gender yielding a p-value (lower tail) for each patient
FA ROI input. No correction for multiple comparisons was necessary since the 8 anatomic ROI locations were designated a-priori.
4. MRV: MR venogram of the brain was performed without intravenous contrast administration utilizing whole brain 3D PC
(VENC=10; TEITR=7.85/46.30; 1.6 x 1.6 x 0.9 mm voxels). The Combined Conduit Score (CCS; Farb et. al.) is 4, 3, 2, l and 0 for
transverselsigmoid sinus (corresponding to focal or segmental caliber reductions of 0%, 25%. 50%, 75% and 100%
respectively). The normal patency score is 8 (4 for each side). Bilateral CCS < 4 is most likely abnormal. Unilateral CCS = 0 may be
reach
abnormal, needing clinical correlation. CCS=5-71s nonspecific.
5. ZD- CSI Spectroscopy (Chemical Shift Imaging): 2D- CSI spectroscopy of the centrum semiovale was performed on a
Siemens Trio 3 .0 Tesla scanner utilizing 16 voxels placed within the centrum semiovale centrally. oriented parallel to the Anterior-
posterior commissure line, having voxel (ROI) dimensions of 15 mm. Sequence parameters were TE/TR 135 ms/1700 ms, with
- -
three averages; BW— 1200, vector size = 1024; width: 50; flip angle— 90 degrees; weak water suppression at 50 Hz, without
spectral suppression. ROIs within the centrum semiovale were analyzed in eight locations; the outer row of 4 ROls centered within
the midportion of each centrum semiovale were analyzed; the center two rows of ROIs positioned within the gray matter were not
analyzed, yielding four ROIs on the right and four on the left, numbered front-to-back: CholNaa, Cr/Naa and Cho/Cr 1-4 and 5-8.
One ratio for each of 24 ROIs and three ratios for Sum Spectral peak values (27 ratios) were analyzed for each patient, compared
with the same ratios for 50 controls. Exclusion criteria included prior head trauma, known neurologic or psychiatric disorder,
significant atrophy on NeuroQuant® in regions highly prone to contusion, and T2/FLAIR abnormality inappmpriate for age. An
Excel calculator regressed for age and gender using an upper tailed test, yields a p-value for each patient ratio input. No correction
for multiple comparisons was necessary since the 8 anatomic ROI locations were designated a-priori.
Findings:
1. MRI Brain: Pineal cyst contacts the tectal plate measuring 9 mm in greatest dimension, unchanged since prior
examination. There is no narrowing of the aqueduct. No other intracranial cyst or mass identified. No abnormal fluid
collection. No intracranial bleed of any age is detected with particular attention to the SWI sequence. Orbits, sella,
parasellar regions, cerebellopontine angles and craniovertebral junction appear normal.
000002
FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
I45 East 32nd Street, Ground Floor
New Yofk, New York 1 001 6—6055
ph:212-868-921 0 0 fax:212-868-9213
éDIagmm Imaging info@nymn'.com o www.nymn'.com
mgNYMR SOLUTIONS
MANAGED BY Alpha Imaging Consultants, PLLC
Mehrdad Golzad, MD Patient: Erazo, Sarah
91-31 Queens BIvd., Suite 601 MRN: 79260
Elmhurst, NY 11373 DOB:
(7 1 8)454-2222 Phone Exam: MRI of the Brain!DTI/MRVMRS/NeuroQuant®
(718)264-0257 Fax Date of Exam: May 18, 2020
2. DIFFUSION TENSOR IMAGING (DTI): 8 ANATOMIC ROIS (n = 109, 49y, f) Date: 2020-05-18
Region of Interest (ROI) Mean FA Patient FA p<,0.10
'
p<0-.05 Z score p value
Right Deep Temporal 701.0 719.1 612.3 586.7 0.264 0.6042
Left Deep Temporal 702.1 706.7 622.9 601.4 0.167 0.5664
Right Deep Frontal 491.3 683.6 373.4 343.3 2.541 0.9945
Left Deep Frontal 473.5 680.7 348.7 317.3 2.630 0.9957
Genu Corpus Callosum 873.1 947.7 812.1 794.3 1.531 0.9371
‘
Splenium Corpus Callosum 926.8 945.0 884.3 869.9 0.280 0.6104
Right Centrum Semiovale 546.3 520.4 449.4 421.9 —0.325 0.3725
Left Centrum Semiovale 544.4 595.7 439.2 407.6 0.551 0.7093
Color Code Key <0. 10 <0.05 {191125991 84:31 t
Nostatistically significant FA reduction1s detected on DTI.
DIFFUSION TENSOR IMAGING (DTI): 8 ANATOMIC ROIs (n = 109, 47y, f) Date: 2018-12-03
Region of Interest (ROI) Mean FA Patient FA p< 0.10 p<0.05 Z score p value
1
A
Right Deep Temporal 701.0 714.0 613.6 588.0 0.171 0.5680
Left Deep Temporal 702.1 689.3 624.2 602.8 —0.156 0.4378
Right Deep Frontal 491.3 482.8 375.3 345.3 0.043 0.5 173
Left Deep Frontal 473.5 445.0 351.2 3 19.8 -0.175 0.4306
Genu Corpus Callosum 873.1 939.5 812.9 795.1 1.345 0.9107
Splenium Corpus Callosum 926.8 9.69.7 884.2 869.8 0.918 0.8208
Right Centrum Semiovale 546.3 419.8 449.5 422.0 —1.679
Left Centrum Semiovale V
544.4
g
505.5 439.3 407.6 -0.505 0.3068
Color Code Key <0. 0 <0 .05 {lyspgngt/ Media!
Statistically significant FA reduction—is present within the right centrurn semiovale.
DIFFUSION TENSOR MAGING (DTI): 8 ANATOMIC ROIs (n = 109, 46y, f) Date: 2017-1 1-20
Region of Interest (ROI) Mean FA Patient FA p<0.10 p<0.05 Z score _p value
Right Deep Temporal 701.0 661.9 614.3 588.7 -0.592 0.2770
Left Deep Temporal 702.1 710.9
g
624.9 603.5 0.204 0.5810
Right Deep Frontal 491 .3 494.4
'
376.4 346.3 0.174 0.5690
Left Deep Frontal 473.5 461 .2 352.5 321.0 0.001 0.5003
Genu Corpus Callosum 873.1 938.3 813.3 795.5
. 1.312 0.9052
Splenium Corpus Callosum 926.8 964.7 884.1 869.7 0.792 0.7857
’
Right Centrum Semiovale 546.3 425.5. ~
449.6 422.1 -1.604 i :1 ,- I
Left Centrum Semiovale 544.4 472.7 439.3 407.7 ~0.889 0.1870 _
Color Code Key "<0. 10 n.<0 .05 Hussmagv Mada, _'
000003
'Statistically significant FA reduction,1s present within t ntrum Semiovale.
FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
J45 East 32nd Street, Ground Floor
Alpha
a.“ New York, New York 1001 6—6055 r
ph:212~868-921o o fm212-868-9213
info@nymri.com o www.nymri.com
MANAG‘EgggN‘'YEMS'R” £07'L‘ my?“ Alpha Imaging Consultants, PLLc
Mehrdad Golzad, MD Patient: Erazo, Sarah
91-31 Queens Blvd., Suite 601 MRN: 79260
Elmhurst, NY 11373 DOB:
(7 18)454-2222 Phone Exam: MRI of the Brain/DTIIMRVIMRS/NeuroQuant®
(718)264-0257 Fax Date of Exam: May 18, 2020
3. MRV: Flow si nal is focal} reduced within the left transverse sinus; the combined conduit score (CCS)=5.
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FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
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FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
J45 East 32nd Street, Ground Floor
New York, New York 1001 6-6055
ph:212-868—921 0 0 fax:212-868-9213
CGDlagnwn'cI info@nymn'.com www.nymri.com
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MANAGED BY NYMR SOLLmONs Alpha Imaging Consultants, PLLC
Mehrdad Golzad, MD Patient: Erazo, Sarah
91-31 Queens Blvd., Suite 601 MRN: 79260
Elmhurst, NY 11373 DOB:
(718)454-2222 Phone Exam: MRI of the Brain/DTI/MRV/MRS/NeuroQuant®
(718)264-0257 Fax Date of Exam: May 18, 2020
4. MR SPECTROSCOPY: CENTRUM SEMIOVALE WHITE MATTER (n = 50, 49 , t) '
Metabolite Ratio Control Value Patient Value Z score p value
Sum Cr/Naa 0.5297 0.51 N/A N/A
Sum Cho/Naa 0.5411 0.53 N/A N/A
Sum Cho/Cr 1.0216 1.02 N/A N/A
Cr/Naa 1 0.4978 0.43 N/A N/A
CrlNaa 2 0.4168 0.26 N/A N/A
Cr/Naa 3 0.4048 0.34 N/A N/A
Cr/Naa 4 0.4066 0:34 N/A N/A
Cr/Naa 5 0.5032 0.78 5.7671 0.0000
Cr/Naa 6 0.4288 0.33 N/A N/A
Cr/Naa 7 0.4224 0.64 5.6173 0. 000
Cr/Naa 8 0.4384 ='0.76 7.2135 0.0000
Cho/Naa 1 0.5212 0.45" N/A N/A
Cho/Naa 2 0.461 8 0.24 N/A N/A
Cho/Naa 3 0.4447 0.38 N/A N/A
Cho/Naa 4 0.3947 0.36 N/A N/A
Cho/Naa 5 0.5335 0.72 2.3762 0.0087
Cho/Naa 6 0.4855 0.46 N/A N/A
Cho/Naa 7 0.4604 0.68 3 .79 19 0.000
Cho/Naa 8 0.4308 0.40 N/A N/A
Cho/Cr 1 1.0550 1.04 N/A NIA
Cho/Cr 2 1.0956 0.93 N/A NIA
Cho/Cr 3 1. 1010 1.09 NIA NIA
Cho/Cr 4 0.9794 1.06 0.6017 0.2737
Cho/Cr 5 1.0614 0.92. N/A NIA
Che/Cr 6 1.1298 1 .40 2.2200
Cho/Cr 7 1.0912 1.06 N/A NIA
Cho/Cr 8 0.9756 0.52 NIA NIA
i Cglor Code Key , fl Hussmani Meda____ '.
Statistically significant major metabolite ratio derangement is present.
000006
FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
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FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020
NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023
145 East 32nd Street, Ground Floor
New York, New York 10016-6055
[El-pk“
@TMRI
60m mmcIma
ph:212-868-9210 - fax:212-868-9213
inf0@nymri-com o wwwmymricom
MANAGED sYgNYMR Sofigrinnégns Alpha Imaging Consultats, PLLC
5. NeuroQuant®= Significant cortical atrophy has developed throughout the left frontal lobe (3rd percentile).
Cortical volumes within the left frontal lobe were at» the 10th and 18th percentiles on previous examinations of
11/20/2017 and 12/03/2018. Global cortical gray matter volume is at the 34th percentile, reduced since prior
examinations. Ventricular volume is at the 35th percentile. not appreciably changed siHCe prior examinations.
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Patient ID: Patient Name: Sax: Age: Referring Physician:
79260 ERAZO, SARAH F 49 GOLZAD
SCAN INFORMATION
Scan Date: Accession Number:
2020-05-18 A413164393
MORPHOMEI'RY RESULTS
Percentile Corflcal Iraln Regions
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Preview
FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 EXHIBIT Q FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 Alpb“ ' J45 East'32nd Street, Ground Floor New York, New York 1001 6-6055 ph.212-868-921 o-ofax:212-86_8-9213 5D mgimmmgng info@nymri.com o www.nymri. com mgNYMR SOLLrnons MANAGED BY Alpha Imaging Consultants, PLLC Mehrdad Golzad, MD Patient: Erazo, Sarah 91-31 Queens Blvd., Suite 601 MRN: 79260 Elmhurst, NY 11373 DOB: (718)454-2222 Phone Exam: MRI of the BrainlD'I‘I/MRVIMRSINeuroQuant® (718)264-0257 Fax Date of Exam: May 18, 2020 . History: MVA on 03/1 112020. Technique: 1. MRI Brain: MRI examination of the brain was performed on a Siemens Trio 3.0 Tesla scanner utilizing saginal 3D 1.1 mm 3D ADNI, TZIFLAIR, with multiplanar reformation, axial fat sat T2. and axial 3D SW1. 2. NeuroQuant®: The 3D ADNI scan was analyzed by NeuroQuant® (Cortechs Labs). a 3D morphometric technique utilizing an anatomic atlas based upon >2000 age (between 3 and 100 years) and gender-matched controls yielding percentile volume scores. 3. DTI Brain: Diffusion-tensor imaging (DTI) was performed on a Siemens Tn'o 3.0 Tesla scanner utilizing 30 directions with 5 mm sections. 1.5 mm gap, 230 mm field of view, TEII‘R 106/3000 ms, two averages, AP phase, 128x128 matrix, 1.8 x 1.8 x 5.0 mm voxel size with llfimm slice gap, GRAPPA acceleration factor 2, 30 reference lines, b values of 0 s/mm2, and 2000 s/mm2. bw = 1396 Hz/Px and EPI factor of 128. After informed consent was obtained, 119 control subjects were scanned at Alpha 3T MRI using this technique, including NeuroQuant® and 3D T2IFLAIR as above. Exclusion criteria included prior head trauma, known neurologic or psychiatric disorder, and T2fFLAIR abnormality inappropriate for age. Eight pre~selected anatomic ROIs were drawn on the mean control FA map using MRIcro sent to a DTI analyst and a biostatistician (S. Meda, H. Zhu). 9 subjects were removed . due to technical factors; 109 control subjects remained. From those subjects, 3/872 statistically outlying ROIs were removed (2 in RDT, 1 in Geuu, all for Z score > 3). Excel file calculator regressed for age and gender yielding a p-value (lower tail) for each patient FA ROI input. No correction for multiple comparisons was necessary since the 8 anatomic ROI locations were designated a-priori. 4. MRV: MR venogram of the brain was performed without intravenous contrast administration utilizing whole brain 3D PC (VENC=10; TEITR=7.85/46.30; 1.6 x 1.6 x 0.9 mm voxels). The Combined Conduit Score (CCS; Farb et. al.) is 4, 3, 2, l and 0 for transverselsigmoid sinus (corresponding to focal or segmental caliber reductions of 0%, 25%. 50%, 75% and 100% respectively). The normal patency score is 8 (4 for each side). Bilateral CCS < 4 is most likely abnormal. Unilateral CCS = 0 may be reach abnormal, needing clinical correlation. CCS=5-71s nonspecific. 5. ZD- CSI Spectroscopy (Chemical Shift Imaging): 2D- CSI spectroscopy of the centrum semiovale was performed on a Siemens Trio 3 .0 Tesla scanner utilizing 16 voxels placed within the centrum semiovale centrally. oriented parallel to the Anterior- posterior commissure line, having voxel (ROI) dimensions of 15 mm. Sequence parameters were TE/TR 135 ms/1700 ms, with - - three averages; BW— 1200, vector size = 1024; width: 50; flip angle— 90 degrees; weak water suppression at 50 Hz, without spectral suppression. ROIs within the centrum semiovale were analyzed in eight locations; the outer row of 4 ROls centered within the midportion of each centrum semiovale were analyzed; the center two rows of ROIs positioned within the gray matter were not analyzed, yielding four ROIs on the right and four on the left, numbered front-to-back: CholNaa, Cr/Naa and Cho/Cr 1-4 and 5-8. One ratio for each of 24 ROIs and three ratios for Sum Spectral peak values (27 ratios) were analyzed for each patient, compared with the same ratios for 50 controls. Exclusion criteria included prior head trauma, known neurologic or psychiatric disorder, significant atrophy on NeuroQuant® in regions highly prone to contusion, and T2/FLAIR abnormality inappmpriate for age. An Excel calculator regressed for age and gender using an upper tailed test, yields a p-value for each patient ratio input. No correction for multiple comparisons was necessary since the 8 anatomic ROI locations were designated a-priori. Findings: 1. MRI Brain: Pineal cyst contacts the tectal plate measuring 9 mm in greatest dimension, unchanged since prior examination. There is no narrowing of the aqueduct. No other intracranial cyst or mass identified. No abnormal fluid collection. No intracranial bleed of any age is detected with particular attention to the SWI sequence. Orbits, sella, parasellar regions, cerebellopontine angles and craniovertebral junction appear normal. 000002 FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 I45 East 32nd Street, Ground Floor New Yofk, New York 1 001 6—6055 ph:212-868-921 0 0 fax:212-868-9213 éDIagmm Imaging info@nymn'.com o www.nymn'.com mgNYMR SOLUTIONS MANAGED BY Alpha Imaging Consultants, PLLC Mehrdad Golzad, MD Patient: Erazo, Sarah 91-31 Queens BIvd., Suite 601 MRN: 79260 Elmhurst, NY 11373 DOB: (7 1 8)454-2222 Phone Exam: MRI of the Brain!DTI/MRVMRS/NeuroQuant® (718)264-0257 Fax Date of Exam: May 18, 2020 2. DIFFUSION TENSOR IMAGING (DTI): 8 ANATOMIC ROIS (n = 109, 49y, f) Date: 2020-05-18 Region of Interest (ROI) Mean FA Patient FA p<,0.10 ' p<0-.05 Z score p value Right Deep Temporal 701.0 719.1 612.3 586.7 0.264 0.6042 Left Deep Temporal 702.1 706.7 622.9 601.4 0.167 0.5664 Right Deep Frontal 491.3 683.6 373.4 343.3 2.541 0.9945 Left Deep Frontal 473.5 680.7 348.7 317.3 2.630 0.9957 Genu Corpus Callosum 873.1 947.7 812.1 794.3 1.531 0.9371 ‘ Splenium Corpus Callosum 926.8 945.0 884.3 869.9 0.280 0.6104 Right Centrum Semiovale 546.3 520.4 449.4 421.9 —0.325 0.3725 Left Centrum Semiovale 544.4 595.7 439.2 407.6 0.551 0.7093 Color Code Key <0. 10 <0.05 {191125991 84:31 t Nostatistically significant FA reduction1s detected on DTI. DIFFUSION TENSOR IMAGING (DTI): 8 ANATOMIC ROIs (n = 109, 47y, f) Date: 2018-12-03 Region of Interest (ROI) Mean FA Patient FA p< 0.10 p<0.05 Z score p value 1 A Right Deep Temporal 701.0 714.0 613.6 588.0 0.171 0.5680 Left Deep Temporal 702.1 689.3 624.2 602.8 —0.156 0.4378 Right Deep Frontal 491.3 482.8 375.3 345.3 0.043 0.5 173 Left Deep Frontal 473.5 445.0 351.2 3 19.8 -0.175 0.4306 Genu Corpus Callosum 873.1 939.5 812.9 795.1 1.345 0.9107 Splenium Corpus Callosum 926.8 9.69.7 884.2 869.8 0.918 0.8208 Right Centrum Semiovale 546.3 419.8 449.5 422.0 —1.679 Left Centrum Semiovale V 544.4 g 505.5 439.3 407.6 -0.505 0.3068 Color Code Key <0. 0 <0 .05 {lyspgngt/ Media! Statistically significant FA reduction—is present within the right centrurn semiovale. DIFFUSION TENSOR MAGING (DTI): 8 ANATOMIC ROIs (n = 109, 46y, f) Date: 2017-1 1-20 Region of Interest (ROI) Mean FA Patient FA p<0.10 p<0.05 Z score _p value Right Deep Temporal 701.0 661.9 614.3 588.7 -0.592 0.2770 Left Deep Temporal 702.1 710.9 g 624.9 603.5 0.204 0.5810 Right Deep Frontal 491 .3 494.4 ' 376.4 346.3 0.174 0.5690 Left Deep Frontal 473.5 461 .2 352.5 321.0 0.001 0.5003 Genu Corpus Callosum 873.1 938.3 813.3 795.5 . 1.312 0.9052 Splenium Corpus Callosum 926.8 964.7 884.1 869.7 0.792 0.7857 ’ Right Centrum Semiovale 546.3 425.5. ~ 449.6 422.1 -1.604 i :1 ,- I Left Centrum Semiovale 544.4 472.7 439.3 407.7 ~0.889 0.1870 _ Color Code Key "<0. 10 n.<0 .05 Hussmagv Mada, _' 000003 'Statistically significant FA reduction,1s present within t ntrum Semiovale. FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 J45 East 32nd Street, Ground Floor Alpha a.“ New York, New York 1001 6—6055 r ph:212~868-921o o fm212-868-9213 info@nymri.com o www.nymri.com MANAG‘EgggN‘'YEMS'R” £07'L‘ my?“ Alpha Imaging Consultants, PLLc Mehrdad Golzad, MD Patient: Erazo, Sarah 91-31 Queens Blvd., Suite 601 MRN: 79260 Elmhurst, NY 11373 DOB: (7 18)454-2222 Phone Exam: MRI of the Brain/DTIIMRVIMRS/NeuroQuant® (718)264-0257 Fax Date of Exam: May 18, 2020 3. MRV: Flow si nal is focal} reduced within the left transverse sinus; the combined conduit score (CCS)=5. “W 3T “R' ' A ' Farli'éthlih I] Z a. : SD O78] «078] 000004 FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 BROLRGB Alpha 3T MRI BROLRGB Alpha 3T MRI Se. 108 Evazo Sarah Se 108 Erazo Sara? :m 1 Ac: N031120 1m 5 Acc‘ N031 1 2C 049Y F 79260 O-IQY F 7926C DOB “L“ DOB AL“ Dos 2020-05-12 Dos 2020.05.18 ‘ ‘ same/20 é. r awn/20 ‘v ; ' ' 111+. 5 g. - '. ' ' ' I t . 1 u I: I ’ ,‘ RAF I!“ rem: ‘ . ‘ a “ ‘ a ,- . ‘, " I a . ' r ,J .‘ :1. I5 ‘ .\-:,'. " I - V‘ G fl f ,1 'l J ~ t ' 'V . i .‘5 I. 43 x“ '9‘ - ['5' t FA ‘ FA no (so .InzwA [0,] no [90,: znwA [0,] Ann 0mm OFFICIus OFF Anal 0PM» wrnus OFF W 1000 C 500 W 1000 C 50C w 255L 127 w 255L 127 BROI_RGB Alpha 3T MR! 8ROI_RGB AIpha 3T MRI Se 108 Etazo Sarah Se 108 Erazo Sarah Im 9 Acc. N031120 Im 11 Acc N031126 OJSY F 79260 049Y F 79260 DOB DOB AL“ DOS 2020-05-18I DOS 2020-05-18 FA RA Tracew mean 309v Mean SDev Mean SDev l0 Size I Mm I Max Sizel MinIMax Size ! Min I Max 'f s IMA 15/20 " r ' .' .' i _, I ‘ "a . t 1:597 an 2.211 1n :57 14 | 1‘7".» Bt‘) 7 «11331-3 MGM“ Rm: . . . _ - 6 9‘53 33.7 12243 1250 J17 lb QICCSHOOO 9H053H4'4 900125 7 5204 1120 4788 1162 682 37 , . 2611931673 25l!59!653 28139152 1 l FA ho 150.1 222mm [0.4 AMI OFFIFM OFF/Cm: OFF W 1000 C 500 W 255L 127 W'255L 127 FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 J45 East 32nd Street, Ground Floor New York, New York 1001 6-6055 ph:212-868—921 0 0 fax:212-868-9213 CGDlagnwn'cI info@nymn'.com www.nymri.com o MANAGED BY NYMR SOLLmONs Alpha Imaging Consultants, PLLC Mehrdad Golzad, MD Patient: Erazo, Sarah 91-31 Queens Blvd., Suite 601 MRN: 79260 Elmhurst, NY 11373 DOB: (718)454-2222 Phone Exam: MRI of the Brain/DTI/MRV/MRS/NeuroQuant® (718)264-0257 Fax Date of Exam: May 18, 2020 4. MR SPECTROSCOPY: CENTRUM SEMIOVALE WHITE MATTER (n = 50, 49 , t) ' Metabolite Ratio Control Value Patient Value Z score p value Sum Cr/Naa 0.5297 0.51 N/A N/A Sum Cho/Naa 0.5411 0.53 N/A N/A Sum Cho/Cr 1.0216 1.02 N/A N/A Cr/Naa 1 0.4978 0.43 N/A N/A CrlNaa 2 0.4168 0.26 N/A N/A Cr/Naa 3 0.4048 0.34 N/A N/A Cr/Naa 4 0.4066 0:34 N/A N/A Cr/Naa 5 0.5032 0.78 5.7671 0.0000 Cr/Naa 6 0.4288 0.33 N/A N/A Cr/Naa 7 0.4224 0.64 5.6173 0. 000 Cr/Naa 8 0.4384 ='0.76 7.2135 0.0000 Cho/Naa 1 0.5212 0.45" N/A N/A Cho/Naa 2 0.461 8 0.24 N/A N/A Cho/Naa 3 0.4447 0.38 N/A N/A Cho/Naa 4 0.3947 0.36 N/A N/A Cho/Naa 5 0.5335 0.72 2.3762 0.0087 Cho/Naa 6 0.4855 0.46 N/A N/A Cho/Naa 7 0.4604 0.68 3 .79 19 0.000 Cho/Naa 8 0.4308 0.40 N/A N/A Cho/Cr 1 1.0550 1.04 N/A NIA Cho/Cr 2 1.0956 0.93 N/A NIA Cho/Cr 3 1. 1010 1.09 NIA NIA Cho/Cr 4 0.9794 1.06 0.6017 0.2737 Cho/Cr 5 1.0614 0.92. N/A NIA Che/Cr 6 1.1298 1 .40 2.2200 Cho/Cr 7 1.0912 1.06 N/A NIA Cho/Cr 8 0.9756 0.52 NIA NIA i Cglor Code Key , fl Hussmani Meda____ '. Statistically significant major metabolite ratio derangement is present. 000006 FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 csi_se_135_KH«RGB Alpha 3T MRI :si__se#135_KH_RGB Alpha 3T MRI MR035161 Erazo Sarah MRC35161 Erazo Sarah Se 111 Acc N031120 Se 111 Ace; N031 120 Im 1 049YF 79260 Irn 2 049V F 79260 DOB 1 DOB ‘ DOS 2020-05-18 DOS. 2020-05-18 4 Muluvoxel C HEA.HEP_nc_4 Ser 10 C HEA HEP_nc_.4 w 230 L. 151 P W 230L 151 cs:__se_135,_KH_RGB A Alpha 3T MRI :si_se_.135_KH_RGB A Alpha 37 MRI MRC35161 Erazo Sarah MRC35161 Etazo Sarah Se 111 Ac; N03112O Se. 111 Acc N031120 Im. 3 049Y F 79260 1m 4 049V F 79260 Al H DOB M“ DOB DOS 2020v05-1 B DOS 2020-05-18 ll ‘u 3 “It: Ser 10 C HEA.HEP inc '4 Ser 1O C'HEA HEP_nc 4 P W 230L451— W 230 L. 151 FILED: KINGS COUNTY CLERK 09/13/2023 10:29 PM INDEX NO. 523020/2020 NYSCEF DOC. NO. 80 RECEIVED NYSCEF: 09/13/2023 145 East 32nd Street, Ground Floor New York, New York 10016-6055 [El-pk“ @TMRI 60m mmcIma ph:212-868-9210 - fax:212-868-9213 inf0@nymri-com o wwwmymricom MANAGED sYgNYMR Sofigrinnégns Alpha Imaging Consultats, PLLC 5. NeuroQuant®= Significant cortical atrophy has developed throughout the left frontal lobe (3rd percentile). Cortical volumes within the left frontal lobe were at» the 10th and 18th percentiles on previous examinations of 11/20/2017 and 12/03/2018. Global cortical gray matter volume is at the 34th percentile, reduced since prior examinations. Ventricular volume is at the 35th percentile. not appreciably changed siHCe prior examinations. ' A1 a 3'r_ Max ® v NeuroQuant . . We augmg m" can I Triage Bram Atrophy Report. tin-nan turn Rid/man Version 3.0.0 Patient ID: Patient Name: Sax: Age: Referring Physician: 79260 ERAZO, SARAH F 49 GOLZAD SCAN INFORMATION Scan Date: Accession Number: 2020-05-18 A413164393 MORPHOMEI'RY RESULTS Percentile Corflcal Iraln Regions - Pcrcenflles J I Right Tohl Frontal Lobe: —3- 14 I 7 Superior Fronhl 13 46 - 25‘ t mm Mum—ML— Inferior Frontal 13 -2— -{Q-l To“. Volume, »P"ff"m°' . 17 V 21 _""—_ 16 . - Rld'lt lateral Drbltofroncal -1_ 52 10 can”?! Wh'te "amr 55 55 51 Medial Orbltofrontal 4S 37 38 cortical 5'3 "finer 31 37 34 Paracentral .4— 4O 1: vent'wos 3.5 35 3.§ Primary Motor 11‘ 2-9 1! ”fie—”Mi ' 65 93 so 73 71‘ - 71 fiereohif‘atlegflies. Suhaorflcal Sundial-es Mo" 51 3.7 cerebellar White Matter "99m mean i; “‘22“ “12;“ Cerebellar Gra Mathr “We“ Thalamus Venual Dione. halal) 16 - 91 1B ‘ Mammy 21 - 9 18 85 12 , W mar—lugs:- In'efior Mom a.— ofli [m uh" facial Occiaim . -—-§5—- so