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15,500 |
CLINICAL HISTORY: Follow-up aneurysm COMPARISON: 1/26/2021, 1/28/2020 TECHNIQUE: Axial time-of-flight and postcontrast MR angiography of the brain were performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 230 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: Stable changes of coil embolization of basilar tip aneurysm. No residual filling. There is no intracranial occlusion of flow-limiting stenosis. Shunted ventricles without hydrocephalus with a right frontal approach ventriculostomy catheter. IMPRESSION: Stable changes of coil embolization of basilar tip aneurysm. No residual filling.
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FINDINGS: Stable changes of coil embolization of basilar tip aneurysm. No residual filling. There is no intracranial occlusion of flow-limiting stenosis. Shunted ventricles without hydrocephalus with a right frontal approach ventriculostomy catheter.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucous retention cysts in the maxillary sinuses. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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15,501 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatic adenoma. COMPARISON: MRI of abdomen dated 10/13/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 247 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Arterially enhancing lesions with contrast nonretention on hepatobiliary phase liver are unchanged in size and number, the largest measuring approximately 5.1 x 4.1 cm in the right hepatic lobe (series 13, image 43). Diffuse loss of signal in the hepatic parenchyma on the opposed phase sequences, compatible with hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Loss of signal in the spleen on the in phase sequences, suggestive of iron deposition. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Unchanged size and number of multiple arterially enhancing lesions throughout the liver, most compatible with hepatic adenomas. 2. Hepatic steatosis. 3. Findings suggestive of iron deposition within the reticuloendothelial system. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Arterially enhancing lesions with contrast nonretention on hepatobiliary phase liver are unchanged in size and number, the largest measuring approximately 5.1 x 4.1 cm in the right hepatic lobe (series 13, image 43). Diffuse loss of signal in the hepatic parenchyma on the opposed phase sequences, compatible with hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Loss of signal in the spleen on the in phase sequences, suggestive of iron deposition. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bibasilar subsegmental atelectasis. Small volume of right inferior subpleural hematoma adjacent to sites of rib fractures. Lungs are otherwise clear. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Excreted contrast within the bilateral collecting systems. No hydroureteronephrosis or renal lesion bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air. There is trace fluid in the deep pelvis, likely reactive. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Normal. BODY WALL: Rectus diastases. MUSCULOSKELETAL: Minimally displaced right anterolateral rib fractures spanning ribs 5-8. The fractures involving the right 7th rib are segmental. Congenital nonunion of the bilateral L1 transverse process
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15,502 |
CV MR Brain wo+w contrast Clinical Information: tumor rano This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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Findings: CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,503 |
EXAM: MR Brain wo contrast 1/25/2022 1:25 PM CLINICAL INFORMATION: Memory Loss, memory decline. COMPARISON: CT head dated 2/2/2019, 8/16/2010, 12/30/2004. TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without intravenous contrast. FINDINGS: The study is mildly degraded by motion artifact. Multiple sequences were repeated. INTRACRANIAL FINDINGS: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Progressive, age-appropriate generalized cerebral volume loss compared to prior CTs from 2019, 2010, and 2004, given differences in technique. Mild, age-appropriate diffuse but symmetric cortical atrophy. Proportionate ex vacuo ventricular dilatation. Multifocal subcortical, deep cerebral, and periventricular T2/FLAIR hyperintensities bilaterally, likely mild chronic microangiopathic changes. Additional T2/FLAIR hyperintense foci in the right basal ganglia and medial bilateral thalami. Susceptibility artifact in the bilateral basal ganglia, correlating with physiologic calcification on prior CT. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: Bilateral ocular lens replacements. The orbital contents are otherwise unremarkable. Trace bilateral anterior ethmoid sinus mucosal thickening. The visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. _________________________ CONCLUSION Mild, age-appropriate diffuse brain involution, progressed in expected manner compared to prior CTs . There is mild ventriculomegaly with periventricular white matter signal changes and dilated temporal horn and narrow callosal angle suggesting probable normal pressure hydrocephalus. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The study is mildly degraded by motion artifact. Multiple sequences were repeated. INTRACRANIAL FINDINGS: No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Progressive, age-appropriate generalized cerebral volume loss compared to prior CTs from 2019, 2010, and 2004, given differences in technique. Mild, age-appropriate diffuse but symmetric cortical atrophy. Proportionate ex vacuo ventricular dilatation. Multifocal subcortical, deep cerebral, and periventricular T2/FLAIR hyperintensities bilaterally, likely mild chronic microangiopathic changes. Additional T2/FLAIR hyperintense foci in the right basal ganglia and medial bilateral thalami. Susceptibility artifact in the bilateral basal ganglia, correlating with physiologic calcification on prior CT. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: Bilateral ocular lens replacements. The orbital contents are otherwise unremarkable. Trace bilateral anterior ethmoid sinus mucosal thickening. The visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. _________________________
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bibasilar subsegmental atelectasis. Small volume of right inferior subpleural hematoma adjacent to sites of rib fractures. Lungs are otherwise clear. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. Otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Excreted contrast within the bilateral collecting systems. No hydroureteronephrosis or renal lesion bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air. There is trace fluid in the deep pelvis, likely reactive. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Normal. BODY WALL: Rectus diastases. MUSCULOSKELETAL: Minimally displaced right anterolateral rib fractures spanning ribs 5-8. The fractures involving the right 7th rib are segmental. Congenital nonunion of the bilateral L1 transverse process
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15,504 |
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: F/u meningioma. Per chart review, history of planum sphenoidale meningioma under surveillance since 2017. COMPARISON: MRI brain dated 1/26/2021, 1/21/2020. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. MR Brain wo+w contrast Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: The study is moderately degraded by motion artifact. INTRACRANIAL FINDINGS: No significant interval change in size or appearance of dural-based, homogenously enhancing mass occupying the sella, extending into the suprasellar region and along the planum sphenoidale. The mass invades the right cavernous sinus with encasement of the right cavernous ICA up to 180 degrees, overall unchanged. The bilateral cavernous ICAs are patent. The mass closely approximates the optic chiasm without definite contact. The right prechiasmatic optic nerve is not well-visualized, suspicious for encasement. Associated partial effacement of the suprasellar cistern and mass effect on the inferomedial right greater than left frontal lobes, unchanged. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, or extra-axial collection. Postcontrast series demonstrates no new enhancing lesion. Multifocal bilateral periventricular and subcortical white matter T2/FLAIR hyperintensities, overall unchanged, likely mild chronic microangiopathic disease. Left pontine chronic lacunar infarct, unchanged. The ventricular system is normal in caliber and configuration. The basal cisterns are otherwise clear. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Persistent right sphenoid sinus opacification. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements. CONCLUSION: 1. Stable sellar/suprasellar/planum sphenoidale meningioma with invasion of the right cavernous sinus and moderate encasement of the right cavernous ICA. Suspected encasement of the right prechiasmatic optic nerve. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The study is moderately degraded by motion artifact. INTRACRANIAL FINDINGS: No significant interval change in size or appearance of dural-based, homogenously enhancing mass occupying the sella, extending into the suprasellar region and along the planum sphenoidale. The mass invades the right cavernous sinus with encasement of the right cavernous ICA up to 180 degrees, overall unchanged. The bilateral cavernous ICAs are patent. The mass closely approximates the optic chiasm without definite contact. The right prechiasmatic optic nerve is not well-visualized, suspicious for encasement. Associated partial effacement of the suprasellar cistern and mass effect on the inferomedial right greater than left frontal lobes, unchanged. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, or extra-axial collection. Postcontrast series demonstrates no new enhancing lesion. Multifocal bilateral periventricular and subcortical white matter T2/FLAIR hyperintensities, overall unchanged, likely mild chronic microangiopathic disease. Left pontine chronic lacunar infarct, unchanged. The ventricular system is normal in caliber and configuration. The basal cisterns are otherwise clear. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Persistent right sphenoid sinus opacification. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements.
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Findings: There is cortical laminar necrosis in the left parietal and posterior temporal gyri in the region of subacute infarcts seen on recent MRI. Stable appearing encephalomalacia right frontal operculum. No space-occupying lobar hemorrhage. Remaining brain appears normal. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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15,505 |
MR Brain wo contrast 1/25/2022 10:45 AM Clinical Information: Traumatic brain injury Comparison: Not available Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, and axial T2 FS sequences were acquired of the brain without the use of intravenous contrast. Findings: No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Impression: No acute or significant intracranial abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality.
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FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. Age-appropriate cerebral volume loss with ex vacuo ventricular dilatation. Periventricular hypoattenuating areas, compatible with mild chronic microangiopathic disease. Bilateral lens replacements. The orbits are otherwise unremarkable. The paranasal sinuses and mastoid air cells are clear. The visualized extra-cranial soft tissues are unremarkable. No acute osseous abnormality.
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15,506 |
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: prostate cancer, history of Gleason score 3+3 = 6 prostate cancer, most recent prostate biopsy in 2019 was negative for prostate cancer. PSA trend: 1/25/2022 = 11.3 5/6/2021 = 4.36 TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging of the pelvis were performed on a 3 Tesla scanner. Axial T1-weighted images were obtained before, during, and after administration of intravenous contrast. Patient weight: 225 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: MRI of the prostate dated 3/18/2019 FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 5.8 x 4.8 x 5.7 cm; estimated volume: 83 cc, PSA density = 0.14 Focal lesion(s): 1 Lesion # 1 (index lesion): - Key image: image 10; series 8 - Size: 11 mm - Location: left; apex; anterior peripheral zone - T2WI: 4 ; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present) - Likelihood of extraprostatic extension: 3 - Indeterminate - Likelihood of seminal vesicle invasion: 5 - Highly likely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: Enlarged gland with multiple BPH nodules and median lobe hypertrophy bulging into the bladder base. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS CONCLUSION: 1. Lesion #1 (index): PI-RADS v2.1 score 4 lesion measuring 11 mm centered at the left mid anterior peripheral zone; findings equivocal for extraprostatic extension; no evidence of seminal vesicle invasion. 2. Severe BPH with evidence of chronic bladder outlet obstruction. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report. In the findings, with regard to likelihood of seminal vesicle invasion, the line should read: "Likelihood of seminal vesicle invasion: 1 - Highly unlikely " As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 5.8 x 4.8 x 5.7 cm; estimated volume: 83 cc, PSA density = 0.14 Focal lesion(s): 1 Lesion # 1 (index lesion): - Key image: image 10; series 8 - Size: 11 mm - Location: left; apex; anterior peripheral zone - T2WI: 4 ; DWI: 4; DCE (early and focal enhancement): negative - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present) - Likelihood of extraprostatic extension: 3 - Indeterminate - Likelihood of seminal vesicle invasion: 5 - Highly likely Diffuse prostate abnormalities: Diffusely striated appearance of the peripheral zone on T2WI may reflect prostatitis Other prostate findings: Enlarged gland with multiple BPH nodules and median lobe hypertrophy bulging into the bladder base. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Note: For more details about the Prostate Imaging-Reporting and Data System (PI-RADS) version 2.1, please visit: http://www.acr.org/Quality-Safety/Resources/PIRADS
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Polymicrogyria involving right greater than left frontal lobes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Partial opacification of the left sphenoid sinus and sphenoethmoidal recess. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. There is a nasoenteric tube in place.
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15,507 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: HCC surveillance, C22.0 Liver cell carcinoma COMPARISON: Multiple liver MRs, most recently dated 8/24/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 189 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: Cardiac device is partially imaged within the right ventricle at the septum. Artifact from median sternotomy wires are present. Trace pericardial fluid. ABDOMEN: LIVER: Cirrhotic. No steatosis. Linear focus of diffusion restriction within the right anterior lobe (image 360, series 301) does not correspond with lesion seen on other pulse sequences and is felt to be artifactual. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Post ablation changes are redemonstrated, with increased prominence and nodular enhancement along the posterior aspect of the ablation bed. - Location: Segment(s) 7 - Size of largest enhancing portion of the mass: 2.1 cm (Image 72, Series 1201). - Enhancement: Enhancement atypical for treatment-specific expected enhancement pattern and not meeting criteria for probably or definitely viable - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Equivocal UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: - Location: Segment(s) 7 (Image 72, Series 1201). - Size: 1.7 x 1.3 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 0 - Enhancing "capsule": Not present. - Nonperipheral "washout": Not present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-3 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. New signal void at the GE junction of unknown significance. - Other varices or collaterals: Small perigastric collateral vessels. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Splenomegaly with heterogenous enhancement. No focal lesion. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Post ablation changes of the right body wall are unchanged. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Posttreatment changes of segment VII lesion as above, with nodular enhancement along the posterior aspect which is more prominent as compared to the prior study and indeterminate for recurrent disease (LR TR equivocal). Continued follow-up imaging is recommended. 2. Additional segment VII lesion is mildly increase in size, with non-peripheral arterial enhancement, without convincing pseudocapsule or washout (LIRADS LR 3). 3. Cirrhosis with stigmata of portal hypertension as above. No acute abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: Cardiac device is partially imaged within the right ventricle at the septum. Artifact from median sternotomy wires are present. Trace pericardial fluid. ABDOMEN: LIVER: Cirrhotic. No steatosis. Linear focus of diffusion restriction within the right anterior lobe (image 360, series 301) does not correspond with lesion seen on other pulse sequences and is felt to be artifactual. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Post ablation changes are redemonstrated, with increased prominence and nodular enhancement along the posterior aspect of the ablation bed. - Location: Segment(s) 7 - Size of largest enhancing portion of the mass: 2.1 cm (Image 72, Series 1201). - Enhancement: Enhancement atypical for treatment-specific expected enhancement pattern and not meeting criteria for probably or definitely viable - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Equivocal UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: - Location: Segment(s) 7 (Image 72, Series 1201). - Size: 1.7 x 1.3 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 0 - Enhancing "capsule": Not present. - Nonperipheral "washout": Not present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-3 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. New signal void at the GE junction of unknown significance. - Other varices or collaterals: Small perigastric collateral vessels. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Splenomegaly with heterogenous enhancement. No focal lesion. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Post ablation changes of the right body wall are unchanged. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of distal most subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Largest areas of PE burden are located within the subsegmental pulmonary arteries supplying the right upper lobe (for example series 501 image 50) and left upper lobe (for example series 501 image 39 and 49). Bladder also seen within the segmental arteries supplying the right middle lobe (for example series 501 image 60). Numerous subsegmental pulmonary emboli supplying the bilateral lower lobes. - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Abnormal dilatation of the RV. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Trace groundglass opacities of the anterior right lung apex, medial segment middle lobe. HEART / OTHER VESSELS: Cardiac chambers are otherwise normal in size. No pericardial effusion. At least mild LAD coronary calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Gynecomastia. Otherwise unremarkable UPPER ABDOMEN: Partially imaged changes of Roux-en-Y gastric bypass. Otherwise unremarkable for arterial phase technique. MUSCULOSKELETAL: No evidence of aggressive osseous lesion. Thoracic spine DISH.
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15,508 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: 72-year-old man with history of cirrhosis and hepatocellular carcinoma, status post TACE and SBRT, undergoing surveillance. COMPARISON: Abdominal MR 10/19/2021, abdominal CT 4/20/2021. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 185 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. OTHER: Unchanged eventration of the posterior diaphragm with small focal fat-containing Bochdalek hernia. ABDOMEN: LIVER: Cirrhotic. No steatosis. Mildly increased T2 and mildly diminished T1 signal surrounding the lesion in the hepatic dome is likely postradiation effect, with no postcontrast correlate identified. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Ablated lesion in the posterior dome measuring 3.4 cm long axis today (image 284 six series 705); was 3.3 cm (image 304 series 905). - Location: Segment(s) Central segment VII - Size of largest enhancing portion of the mass: N/A - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Hepatic dome peripheral lesion - Location: Segment(s) VII (Image 286, Series 703-T1 arterial phase). - Size: 1.2 cm., Was 1.0 cm long axis image 42 series 11 on the CT from 4/20/2021. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 1 - Enhancing "capsule": Not present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: Abnormal restricted diffusion is suspected though artifacts are present in the region (image 312 series 605). - LI-RADS: 4 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Unchanged splenomegaly with scattered multifocal small wedge-shaped areas of altered signal consistent with evolving infarctions. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Focal macroscopic fat-containing lesion in the uncinate is unchanged and consistent with lipoma. No new abnormalities. ADRENALS: Normal. KIDNEYS: Unchanged small bilateral renal cysts. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON / APPENDIX: No abnormality in visualized portions. MESENTERY: Normal. RETROPERITONEUM: Previously noted soft tissue densities in the right perirenal space are smaller/nearly resolved, with only an 8 mm soft tissue nodule seen lateral to the right lower pole (image 160 series 705. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Treated lesion in the hepatic dome, LR TR nonviable 2. Focal arterial phase hyperenhancing lesion in the lateral dome has not changed appreciably in size compared to April 2021 but does appear to washout and restricted diffusion today, LR-4. 3. Cirrhosis with stable findings of portal hypertension. 4. Decreasing soft tissue nodularity in the right perirenal fat, nonspecific. 5. Other incidental findings as above, stable.
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FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. OTHER: Unchanged eventration of the posterior diaphragm with small focal fat-containing Bochdalek hernia. ABDOMEN: LIVER: Cirrhotic. No steatosis. Mildly increased T2 and mildly diminished T1 signal surrounding the lesion in the hepatic dome is likely postradiation effect, with no postcontrast correlate identified. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Ablated lesion in the posterior dome measuring 3.4 cm long axis today (image 284 six series 705); was 3.3 cm (image 304 series 905). - Location: Segment(s) Central segment VII - Size of largest enhancing portion of the mass: N/A - Enhancement: No lesional enhancement - Additional features: - Arterial phase hyperenhancement: Not present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Hepatic dome peripheral lesion - Location: Segment(s) VII (Image 286, Series 703-T1 arterial phase). - Size: 1.2 cm., Was 1.0 cm long axis image 42 series 11 on the CT from 4/20/2021. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 1 - Enhancing "capsule": Not present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: Abnormal restricted diffusion is suspected though artifacts are present in the region (image 312 series 605). - LI-RADS: 4 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Unchanged splenomegaly with scattered multifocal small wedge-shaped areas of altered signal consistent with evolving infarctions. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Focal macroscopic fat-containing lesion in the uncinate is unchanged and consistent with lipoma. No new abnormalities. ADRENALS: Normal. KIDNEYS: Unchanged small bilateral renal cysts. STOMACH / SMALL BOWEL: No abnormality in visualized portions. COLON / APPENDIX: No abnormality in visualized portions. MESENTERY: Normal. RETROPERITONEUM: Previously noted soft tissue densities in the right perirenal space are smaller/nearly resolved, with only an 8 mm soft tissue nodule seen lateral to the right lower pole (image 160 series 705. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,509 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Left knee pain and instability. Suspected lateral meniscal tear and bone contusion. COMPARISON: Radiographs, dated 01/24/2022 TECHNIQUE: MR Knee Left wo contrast FINDINGS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex and popliteus tendon are intact. There is a complex tear of the lateral meniscus with horizontal tear, involving the posterior horn and radial component at the junction of the body and posterior horn. The medial meniscus is intact. The extensor mechanism is intact. There is a moderate size suprapatellar joint effusion. There is no popliteal cyst distention. There is some edema in the Hoffa fat pad. The cartilage in the patellofemoral and to more tibial compartments is normal. There is no traumatic marrow edema or marrow replacing lesion. CONCLUSION: Complex tear of the lateral meniscal body and posterior horn.
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FINDINGS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament and lateral collateral ligament complex and popliteus tendon are intact. There is a complex tear of the lateral meniscus with horizontal tear, involving the posterior horn and radial component at the junction of the body and posterior horn. The medial meniscus is intact. The extensor mechanism is intact. There is a moderate size suprapatellar joint effusion. There is no popliteal cyst distention. There is some edema in the Hoffa fat pad. The cartilage in the patellofemoral and to more tibial compartments is normal. There is no traumatic marrow edema or marrow replacing lesion.
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FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. The ventricles and basal cisterns are unremarkable. The orbits are unremarkable. Mild mucosal thickening of the right sphenoid sinus. The other paranasal sinuses and mastoid air cells are clear. The visualized extra-cranial soft tissues are unremarkable. No acute osseous abnormality.
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15,510 |
MRI brain with and without Indication: Brain metastases protocol for SCLC, C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung Spec Inst: 1) Axial T2FLAIR, 2) Axial T2 GRE, 3) diffusion weighted imaging, 4) post contrast 2D T2w and 5) pre and .br post gadolinium contrast-enhanced three-dimensional inversion .br recovery (IR) prepped spoiled gradient echo (SPGR), magnetizationprepared rapid Comparison: No previous similar studies are available for comparison at this time. Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 128 lbs. IV contrast: ProHance, 12 ml, per protocol. Findings: No enhancing intracranial lesion identified. Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are a few scattered and mildly confluent white matter FLAIR hyperintensitiesin the bilateral periventricular regions and pons. Remote Lacunar infarct in the left centrum semiovale. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. Heterogeneity of the calvarial marrow with prominent ill-defined asymmetric enhancement of the right parietal bone at the convexity/vertex, unchanged since 8/9/2021. It shows no lytic process on CT or soft tissue. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Impression: 1. No evidence of intracranial metastasis 2. Calvarial marrow reconversion with no definite lytic lesion; asymmetric enhancement in the right parietal bone at the vertex. Continued attention on follow up imaging.
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Findings: No enhancing intracranial lesion identified. Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Whole brain T2 and FLAIR imaging demonstrate no midline shift, mass effect, or other space-occupying lesion. There are a few scattered and mildly confluent white matter FLAIR hyperintensitiesin the bilateral periventricular regions and pons. Remote Lacunar infarct in the left centrum semiovale. The ventricular system is of normal morphology. The basal cisterns are clear. The visualized vascular flow voids appear normal. Post administration of contrast material, there is no other abnormal enhancement. Heterogeneity of the calvarial marrow with prominent ill-defined asymmetric enhancement of the right parietal bone at the convexity/vertex, unchanged since 8/9/2021. It shows no lytic process on CT or soft tissue. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics.
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FINDINGS: LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: No abnormal bowel wall thickening or enhancement. No dilated bowel loops. PERITONEUM / MESENTERY: No fistula or abscess. COLORECTAL: Long segment wall thickening of transverse colon, splenic flexure, descending colon and sigmoid colon is redemonstrated with slightly improved pericolonic stranding. APPENDIX: Normal. PERIANAL TISSUES: No fistula or abscess. LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Horseshoe renal morphology. Stable simple right renal cyst. No hydronephrosis. LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Subcutaneous gas foci in the right anterior abdominal wall. MUSCULOSKELETAL: Stable osseous structures.
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15,511 |
MR Breast Screening wo+w contrast CLINICAL INFORMATION: 48-year-old woman with history of ADH in the left breast status post excisional biopsy in 2015 and family history of breast cancer. Examination is performed for annual supplemental screening. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant axial sequence with 3D reconstructions. Fast scan. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 128 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: MR breast 1/20/2021 and mammogram 7/23/2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions. Breast tissue is heterogeneously fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Scattered T2 hyperintensities without enhancement are redemonstrated. LEFT BREAST: There is a 5 mm focus of enhancement in the lower inner quadrant, posterior depth breast which may represent background enhancement. Additional scattered foci are stable. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign. LEFT BREAST: Prominent 5 mm focus of enhancement in the lower inner quadrant, posterior depth breast is probably benign. BI-RADS 3: Probably benign finding. Recommend six-month follow-up MRI to assess stability. Overall BI-RADS assessment: BI-RADS 3: Probably benign. Patient is due for mammography in July 2022 and breast MRI in six months. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions. Breast tissue is heterogeneously fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Scattered T2 hyperintensities without enhancement are redemonstrated. LEFT BREAST: There is a 5 mm focus of enhancement in the lower inner quadrant, posterior depth breast which may represent background enhancement. Additional scattered foci are stable. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Age-appropriate cerebral volume loss. Confluent periventricular hypoattenuating areas, compatible with moderate chronic microangiopathic disease. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: ex vacuo dilatation. ORBITS: Bilateral lens replacements. The orbits are otherwise unremarkable. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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15,512 |
MRI brain with and without Indication: Right Petrous Apex tumor, D49.6 Neoplasm of unspecified behavior of brain Spec Inst: fu Right Petrous Apex tumor Comparison: No previous similar studies are available for comparison at this time. Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 205 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: Lobular soft tissue density mass showing homogeneous postcontrast enhancement and an enhancing dural tail extending inferiorly and posteriorly is seen along the right petrous apex in the right the pontine cistern closely abutting the cisternal segment of the right trigeminal nerve. It extends partially into the right Meckel's cave and the cavernous sinus and closely abuts/partially encases the cavernous portion of the right ICA. It measures 26 x 18 x 23 mm (series 903 image 40, series 901 image 145).Despite the difference in techniques of post contrast scan acquisition there appears to be interval increase in size, previously the tumor measured 22 x 18 x 20 mm (when measured similarly by me) Nonenhancing periventricular T-2/flair hyperintensities, many of these perpendicular to the callososeptal and callosomarginal interface and also seen in the bilateral temporal and occipital periventricular locations. Mild generalized prominence of the extra-axial spaces is seen. No enhancing parenchymal lesion identified. Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Impression: 1. Mild interval increase in size of the extra-axial homogeneously enhancing right petrous apex lesion with extent as described likely meningioma. 2. Nonenhancing, predominantly periventricular white matter hyperintensities are concerning for demyelinating process but appear similar in extent and distribution compared to the prior study. No new or enhancing parenchymal lesions.
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Findings: Lobular soft tissue density mass showing homogeneous postcontrast enhancement and an enhancing dural tail extending inferiorly and posteriorly is seen along the right petrous apex in the right the pontine cistern closely abutting the cisternal segment of the right trigeminal nerve. It extends partially into the right Meckel's cave and the cavernous sinus and closely abuts/partially encases the cavernous portion of the right ICA. It measures 26 x 18 x 23 mm (series 903 image 40, series 901 image 145).Despite the difference in techniques of post contrast scan acquisition there appears to be interval increase in size, previously the tumor measured 22 x 18 x 20 mm (when measured similarly by me) Nonenhancing periventricular T-2/flair hyperintensities, many of these perpendicular to the callososeptal and callosomarginal interface and also seen in the bilateral temporal and occipital periventricular locations. Mild generalized prominence of the extra-axial spaces is seen. No enhancing parenchymal lesion identified. Echoplanar diffusion-weighted imaging demonstrates no evidence of restrained diffusion at this time. Post administration of contrast material, there is no other abnormal enhancement. The remaining visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion and left basilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Diffuse dilation of the small bowel and stomach without transition point. COLON / APPENDIX: Possible defect in the rectosigmoid colon (series 10, image 231) adjacent to the large pelvic abscess. PERITONEUM / MESENTERY: Interval development of a large pelvic abscess which measures approximately 14.2 x 11.5 cm on series 10, image 228. Additional small free fluid is noted throughout. No large amount of free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Small amount of gas in the urinary bladder. REPRODUCTIVE ORGANS: Postsurgical changes from supracervical hysterectomy. BODY WALL: Postsurgical changes without subcutaneous fluid collection. MUSCULOSKELETAL: No significant abnormality.
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15,513 |
EXAM: MR Cervical Spine wo contrast CLINICAL INFORMATION: Female patient 65 years with Cervical radiculopathy, no red flags, M54.12 Radiculopathy, cervical region TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, axial T2 and axial T1-weighted images of the cervical spine were obtained without intravenous gadolinium. COMPARISON: Radiographs dated 12/22/2021 FINDINGS: There is no loss of height of the cervical vertebrae or malalignment. There aren't foci of increased T2 signal within the C4, C5, C6, C7 and T1 vertebral bodies likely representing reactive endplate changes. There is also significant hypointense signal within the C7 vertebral body. There is no prevertebral soft tissue swelling or abnormal paraspinal soft tissue swelling. Craniocervical junction is unremarkable. There is focal increased T2 signal within the right side of the spinal cord at C4-C5. No other abnormal cord signal is identified. There is multilevel disc desiccation. There is also mild loss of disc height at C6-C7. Degenerative changes will be described below. C2-C3: There is a broad disc bulge. There is no significant central canal narrowing. There is no significant neural foraminal narrowing. C3-C4: There is a broad disc bulge resulting in mild central canal narrowing. There are also uncovertebral degenerative changes resulting in mild bilateral neural foraminal narrowing. C4-C5: There is a broad disc bulge and thickening of the ligamentum flavum. Findings combine to result in flattening of the cervical spinal cord. There is nearly complete effacement of the CSF there is increased signal within the right side of the spinal cord likely representing edema or may represent chronic compressive myelopathy. There are bilateral uncovertebral degenerative changes resulting in severe right and moderate left neural foraminal narrowing. C5-C6: There is a broad disc bulge resulting in mild central canal narrowing.. There are advanced left greater than right uncovertebral degenerative changes. There is severe left and moderate right neural foraminal narrowing. C6-C7: There is a broad disc bulge without significant central canal narrowing. There are left greater than right advanced uncovertebral degenerative changes. There is severe left and moderate right neural foraminal narrowing. C7-T1: There is a broad disc bulge. There are moderate left uncovertebral degenerative changes resulting in severe left neural foraminal narrowing. There is mild right neural foraminal narrowing. There is a oval-shaped T2 hyperintensity within the left lobe of the thyroid gland. This region is significantly obscured by saturation bands and lesion is not completely evaluated. Vertebral artery flow voids are maintained. CONCLUSION: 01. Multilevel moderate degenerative disc disease. Findings are most pronounced at C4-C5 where broad disc bulge and ligamentum flavum thickening combining to result in cord compression with abnormal signal lateralized to the right side of the spinal cord as described above. 02. Multilevel significant uncovertebral degenerative changes. There is severe left neural foraminal narrowingat C5-C6, C6-C7 and C7-T1. There is also severe right-sided neural foraminal narrowing at C4-C5.Recommend clinical correlation for radiculopathy at these levels. 03. Partially visualized T2 hyperintense lesion within the left lobe of the thyroid gland. Recommend ultrasound for further evaluation.
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FINDINGS: There is no loss of height of the cervical vertebrae or malalignment. There aren't foci of increased T2 signal within the C4, C5, C6, C7 and T1 vertebral bodies likely representing reactive endplate changes. There is also significant hypointense signal within the C7 vertebral body. There is no prevertebral soft tissue swelling or abnormal paraspinal soft tissue swelling. Craniocervical junction is unremarkable. There is focal increased T2 signal within the right side of the spinal cord at C4-C5. No other abnormal cord signal is identified. There is multilevel disc desiccation. There is also mild loss of disc height at C6-C7. Degenerative changes will be described below. C2-C3: There is a broad disc bulge. There is no significant central canal narrowing. There is no significant neural foraminal narrowing. C3-C4: There is a broad disc bulge resulting in mild central canal narrowing. There are also uncovertebral degenerative changes resulting in mild bilateral neural foraminal narrowing. C4-C5: There is a broad disc bulge and thickening of the ligamentum flavum. Findings combine to result in flattening of the cervical spinal cord. There is nearly complete effacement of the CSF there is increased signal within the right side of the spinal cord likely representing edema or may represent chronic compressive myelopathy. There are bilateral uncovertebral degenerative changes resulting in severe right and moderate left neural foraminal narrowing. C5-C6: There is a broad disc bulge resulting in mild central canal narrowing.. There are advanced left greater than right uncovertebral degenerative changes. There is severe left and moderate right neural foraminal narrowing. C6-C7: There is a broad disc bulge without significant central canal narrowing. There are left greater than right advanced uncovertebral degenerative changes. There is severe left and moderate right neural foraminal narrowing. C7-T1: There is a broad disc bulge. There are moderate left uncovertebral degenerative changes resulting in severe left neural foraminal narrowing. There is mild right neural foraminal narrowing. There is a oval-shaped T2 hyperintensity within the left lobe of the thyroid gland. This region is significantly obscured by saturation bands and lesion is not completely evaluated. Vertebral artery flow voids are maintained.
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Findings: CT head: Limited by beam hardening and motion. BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of sphenoid sinuses. Air-fluid level within the left frontal sinus.
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15,514 |
MR Brain wo+w contrast 1/25/2022 11:32 AM Clinical Information: Brain metastases, monitor, G93.89 Other specified disorders of brain Comparison: MR brain 12/13/2021. Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, coronal T2* gradient echo, post contrast axial and coronal T1. Patient weight: 169 lbs. IV contrast: ProHance, 16 ml, per protocol. Findings: Intracranial vascular flow-voids appear unremarkable. Soft tissues of the upper neck appear normal. Post surgical changes present in the right temporal fossa with cystic cavity with mild surrounding edema in the right temporal lobe but with no significant mass effect on the temporal horn or midline shift. Postcontrast images demonstrate residual enhancement in the right parietal lobe measuring approximately 8 x 8 mm on image 156 series 800, previously 10.2 x 11.3 mm. There is a tiny enhancing focus within the medial left cerebellum on image 109 same series measuring 3 mm. There is another enhancing lesion in the superior and posterior medial left frontal lobe measuring 5 x 4 mm on image 204 Impression: Postsurgical changes in the right temporal lobe. Decreasing size of the right parietal metastasis but stable other metastatic lesions. No new metastatic lesion. Impression:
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Findings: Intracranial vascular flow-voids appear unremarkable. Soft tissues of the upper neck appear normal. Post surgical changes present in the right temporal fossa with cystic cavity with mild surrounding edema in the right temporal lobe but with no significant mass effect on the temporal horn or midline shift. Postcontrast images demonstrate residual enhancement in the right parietal lobe measuring approximately 8 x 8 mm on image 156 series 800, previously 10.2 x 11.3 mm. There is a tiny enhancing focus within the medial left cerebellum on image 109 same series measuring 3 mm. There is another enhancing lesion in the superior and posterior medial left frontal lobe measuring 5 x 4 mm on image 204
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Descending and sigmoid diverticulosis with a focally inflamed diverticulum with surrounding pericolonic fat stranding. No evidence of perforation or peridiverticular abscess. PERITONEUM / MESENTERY: Pericolonic fat stranding adjacent to inflamed diverticulum as above. No free fluid in the pelvis. No free air. RETROPERITONEUM: Normal. VESSELS: Circumaortic left renal vein. Otherwise unremarkable URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
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15,515 |
MR Rsh Forero ACRIN Breast F111216002 Clinical Information: testing new Gardendale Rsh CDM Technique: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Comparison: Findings: The breasts are composed of adipose tissue and fibroglandular tissue. Postcontrast administration there is background glandular enhancement. Conclusion: 1. BI-RADS 2. BI-RADS
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Findings: The breasts are composed of adipose tissue and fibroglandular tissue. Postcontrast administration there is background glandular enhancement.
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FINDINGS: CT HEAD: There has been no significant change in small volume subarachnoid hemorrhage in the sulci of the left parietal and occipital lobes. Mild increase size of the 10 mm left occipital hemorrhage with surrounding edema and previously 7 mm. Increased small extra-axial hemorrhage adjacent to the left tentorium (series 603 image 75). New 2.4 cm right cerebellar parenchymal hematoma. New/ increased small occipital horn hemorrhages. There is no hydrocephalus. Patient is intubated. There is layering fluid in the sphenoid and maxillary sinuses. Redemonstration of severe mastoid and middle ear cleft opacification. There is no acute osseous process. CT VENOGRAM HEAD: Superior sagittal, straight, bilateral transverse and sigmoid sinuses are patent and there is no intracranial dural venous thrombosis. No large vessel occlusion or flow-limiting stenosis in the intracranial arteries. Small infundibulum at the right ophthalmic artery origin (series 503 image 90).
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15,516 |
MR Brain wo+w contrast HISTORY: Follow-up for pituitary tumor TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: MRI dated 1/12/2021 FINDINGS: INTRACRANIAL FINDINGS: Again noted is postsurgical changes status post transsphenoidal surgery for resection of the pituitary lesion. There is a persistent lobulated mass in the left sellar and suprasellar region which is not significantly changed in size and morphology since prior MRI and measures 22 mm on the maximum diameter on coronal plan. It is abutting the cavernosal segment of left internal carotid artery for less than 90 degrees and abuts the left cavernous sinuses but without definite invasion. It also abuts the supraclinoid portion of the left ICA, unchanged. The lesion is isosignal on T1 and T2 with mild enhancement after contrast injection. The residual pituitary tissue is located in the right aspect of sella turcica and the pituitary stalk is deviated to right side. Mild inferior tethering of the chiasm is again noted which is likely sequela of previous mass effect. On limited images from brain no acute intracranial lesion is seen. IMPRESSION: No obvious interval change since prior MRI. Status post transsphenoidal surgery for pituitary lesion. A stable residual pituitary adenoma located in the left sella and left suprasellar region.
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FINDINGS: INTRACRANIAL FINDINGS: Again noted is postsurgical changes status post transsphenoidal surgery for resection of the pituitary lesion. There is a persistent lobulated mass in the left sellar and suprasellar region which is not significantly changed in size and morphology since prior MRI and measures 22 mm on the maximum diameter on coronal plan. It is abutting the cavernosal segment of left internal carotid artery for less than 90 degrees and abuts the left cavernous sinuses but without definite invasion. It also abuts the supraclinoid portion of the left ICA, unchanged. The lesion is isosignal on T1 and T2 with mild enhancement after contrast injection. The residual pituitary tissue is located in the right aspect of sella turcica and the pituitary stalk is deviated to right side. Mild inferior tethering of the chiasm is again noted which is likely sequela of previous mass effect. On limited images from brain no acute intracranial lesion is seen.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Similar appearance of dissection flap. ABDOMINAL AORTA: Dissection flap extends along the descending thoracic aorta through the abdominal aorta to the level of the proximal left SFA. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Mild atherosclerotic narrowing at the origin. LEFT RENAL: Mild atherosclerotic narrowing at the origin. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Unchanged dissection flap extending to the level of the left SFA. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Partially imaged loculated small right hemorrhagic pleural effusion and small dependent left pleural effusion. Bibasilar intralobular septal thickening and numerous centrilobular micronodules. There is trace right anterior pneumomediastinum. DISTAL ESOPHAGUS: Esophagogastric tube is seen with tip terminating at the mid gastric body. HEART / VESSELS: Partially imaged surgical changes of the aortic root repair and aortic valve replacement. Swan-Ganz catheter is seen with tip terminating at the proximal right pulmonary artery. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Slight increase in peripancreatic stranding adjacent to the pancreatic head. Otherwise normal. SPLEEN: Small subcapsular hematoma with contrast extravasation on the dependent aspect, best seen on portal venous phase (for example series 10 image 124) ADRENALS: Normal. KIDNEYS: Renal infarct with evolving renal cortical necrosis of the posterior right upper pole. Kidneys otherwise unremarkable. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is massively distended with air and fluid. Small bowel is normal in caliber and enhancement throughout. COLON / APPENDIX: Diffuse gaseous distention along the length of the colon. Air is seen within the rectum. No colonic wall thickening or pericolonic fat stranding. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Collapsed. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Severe body wall anasarca with scrotal edema. Skin staples are seen at the left groin. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Partially imaged postsurgical changes of median sternotomy. Postsurgical changes of posterior lumbar fusion with artificial disc spacer at L4-L5.
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EXAM: MR Thoracic Spine wo+w contrast CLINICAL INFORMATION: Female patient 70 years with Compression fracture, T-spine, M54.9 Dorsalgia, unspecified Spec Inst: Breast cancer, severe osteoporosis, and chronic back pain. Please schedule at UAB Gardendale with thoracic spine imaging. Do not schedule week of 1227. TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, axial T1 and axial T2 images of the thoracic spine were obtained without intravenous gadolinium. In addition axial T1 and sagittal T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 145 lbs. IV contrast: ProHance, 14 ml, per protocol. COMPARISON: None available. FINDINGS: There is no loss of height of the thoracic vertebrae and no malalignment. There are no abnormal foci of T2 hyperintense signal within the thoracic vertebrae. There is no prevertebral soft tissue swelling or abnormal paraspinal soft tissue swelling. There is no abnormal signal within the thoracic spinal cord and caliber is within normal limits. There is no fluid collection within the thoracic spinal canal. There is multilevel disc desiccation. There is also mild loss of disc height at several levels within the upper and mid thoracic spine on degenerative basis. There is a mild disc bulge at T5-T6 and also at T6-T7 and T7-T8 without central canal narrowing. There is a small left paracentral disc protrusion at T9-T10 resulting in mild left-sided central canal narrowing. There is no significant neural foraminal narrowing. There is a small incidental perineural cyst at T12-L1 on the left. There is no abnormal enhancement within the thoracic vertebral bodies and also no abnormal enhancement within the thoracic spinal cord or spinal canal. CONCLUSION: 01. No acute fracture or remote fracture. No enhancing osseous lesion to suggest metastatic disease. 02. Mild multilevel degenerative disc disease as described above. No significant thoracic spinal canal narrowing or neural foraminal narrowing.
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FINDINGS: There is no loss of height of the thoracic vertebrae and no malalignment. There are no abnormal foci of T2 hyperintense signal within the thoracic vertebrae. There is no prevertebral soft tissue swelling or abnormal paraspinal soft tissue swelling. There is no abnormal signal within the thoracic spinal cord and caliber is within normal limits. There is no fluid collection within the thoracic spinal canal. There is multilevel disc desiccation. There is also mild loss of disc height at several levels within the upper and mid thoracic spine on degenerative basis. There is a mild disc bulge at T5-T6 and also at T6-T7 and T7-T8 without central canal narrowing. There is a small left paracentral disc protrusion at T9-T10 resulting in mild left-sided central canal narrowing. There is no significant neural foraminal narrowing. There is a small incidental perineural cyst at T12-L1 on the left. There is no abnormal enhancement within the thoracic vertebral bodies and also no abnormal enhancement within the thoracic spinal cord or spinal canal.
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FINDINGS: Redemonstrated areas of hypoattenuation involving the bilateral frontal, left temporal and left parietal lobes. Punctate hyperdensity in the left parietal lobe (axial series 2, image 40) which may represent a tiny focus of new hemorrhage. The right parietal convexity extra-axial hemorrhage is decreased in size compared with prior exam. Hyperdensity in the left anterior temporal convexity may represent trace extra-axial hemorrhage versus dural thickening. No mass effect or midline shift. Trace increase in ventriculomegaly. The orbits are unremarkable. Mucosal thickening of bilateral sphenoid sinuses. Mucous retention cyst in the left frontal sinus. Bilateral mastoid effusions. Redemonstrated fractures of the left calvarium.
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EXAM:MR Lumbar Spine wo+w contrast CLINICAL INFORMATION: COMPARISON:None. TECHNIQUE:MR Lumbar Spine wo+w contrast Patient weight: 145 lbs. IV contrast: ProHance, 14 ml, per protocol. Findings: Comparison made with previous lumbar spine radiograph from 6/24/2021. There is normal alignment. Mild chronic wedge compression deformity of the superior endplate of L1. No marrow edema. Conus and cauda equina appear unremarkable. Spine paravertebral soft tissues appear unremarkable. The uterus is heterogeneous but is partially visualized. T12-L1, L1-L2, L2-L3 and L3-L4: Unremarkable. L4-L5: Posterior disc herniation with facet hypertrophy results in no canal or neural foramina narrowing. L5-S1: Reduced height of the disc. Posterior disc in addition with facet hypertrophy results in mild to moderate left foraminal narrowing. Impression: 1. Mild degenerative changes at L5-S1 results in moderate left foraminal narrowing at L5-S1 but no significant nerve compression. 2. Partially visualized uterus which likely contains fibroids.
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Findings: Comparison made with previous lumbar spine radiograph from 6/24/2021. There is normal alignment. Mild chronic wedge compression deformity of the superior endplate of L1. No marrow edema. Conus and cauda equina appear unremarkable. Spine paravertebral soft tissues appear unremarkable. The uterus is heterogeneous but is partially visualized. T12-L1, L1-L2, L2-L3 and L3-L4: Unremarkable. L4-L5: Posterior disc herniation with facet hypertrophy results in no canal or neural foramina narrowing. L5-S1: Reduced height of the disc. Posterior disc in addition with facet hypertrophy results in mild to moderate left foraminal narrowing.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Partially imaged moderate right and small left pleural effusions with adjacent passive atelectasis. Aerated portions of the lung bases are clear. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and small bowel. Normal in caliber and enhancement throughout. End ileostomy in the left lower quadrant with a catheter internally in the ostomy. COLON / APPENDIX: Interval creation of Hartmann pouch in subtotal colectomy. Pouch itself appears inflamed. PERITONEUM / MESENTERY: Interval placement of percutaneous pigtail drainage catheter within the deep pelvic abscess, which is significantly decreased in size. There is a least a moderate residual abscess, although it is almost impossible to measure given the configuration. New thin perihepatic abscess measuring approximately 6.9 x 1.9 cm (series 201 image 65). RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Air within the anterior bladder, suggestive of recent catheterization versus fistulization. REPRODUCTIVE ORGANS: Uterus is surgically absent. Bilateral adnexa appear unremarkable. BODY WALL: Similar-appearing of anterior abdominal wall drainage catheter with tip closely approximating the prior enterocutaneous fistula adjacent to the deep pelvic abscess (axial image 159 and sagittal image 103). A second prior enterocutaneous fistula is seen more superiorly, medial to the abdominal wall drainage catheter (axial series 201 image 133 and sagittal series 204 image 95). Postsurgical changes of midline laparotomy. A right rectus and intramuscular abscess demonstrates interval decrease in size, now measuring 3.8 x 2.8 cm (series and one image 117, previously measuring 4.4 x 2.4 cm as remeasured by me series 309 image 107). Severe body wall anasarca. MUSCULOSKELETAL: No evidence of fracture.
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EXAM: MR Cervical Spine Partial Study CLINICAL INFORMATION: Concern for radiculopathy. COMPARISON: None. TECHNIQUE: MR Cervical Spine Partial Study. FINDINGS: Exam was aborted secondary to extensive patient motion. No gross abnormality of the visualized vertebral body marrow signal. No severe cervical spinal canal narrowing. Otherwise nondiagnostic exam. CONCLUSION: No severe cervical spinal canal narrowing. Otherwise nondiagnostic exam due to patient motion artifact. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Exam was aborted secondary to extensive patient motion. No gross abnormality of the visualized vertebral body marrow signal. No severe cervical spinal canal narrowing. Otherwise nondiagnostic exam.
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Findings: Examination is limited secondary to motion artifact. There is mild sulcal effacement which may be seen in diffuse cerebral edema. There is no acute infarction or intracranial hemorrhage. There is no intracranial mass or hydrocephalus. There is no acute osseous abnormality or focal aggressive osseous lesion. The orbits appear normal. There is mucosal thickening throughout the paranasal sinuses with bilateral mastoid effusions.
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EXAM: MR Brain wo contrast 1/25/2022 12:00 PM CLINICAL INFORMATION: Cavernoma. COMPARISON: MRI brain dated 1/26/2021, 5/31/2019. CT head dated 6/12/2021. TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without intravenous contrast. FINDINGS: INTRACRANIAL FINDINGS: No significant interval change in size or appearance of heterogenous lobulated lesion in the left superior frontal gyrus with rim of T2 hypointensity and diffuse susceptibility artifact, compatible with cavernoma. No significant perilesional FLAIR hyperintensity. No acute intraparenchymal infarct, hemorrhage, edema, or hydrocephalus. Mild periventricular and multifocal punctate right frontal subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely chronic microangiopathic changes. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mild mucosal thickening of the bilateral maxillary, ethmoid, and sphenoid sinuses. Left sphenoid sinus mucous retention cyst. Visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. _________________________ CONCLUSION 1. Stable left frontal cavernoma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: INTRACRANIAL FINDINGS: No significant interval change in size or appearance of heterogenous lobulated lesion in the left superior frontal gyrus with rim of T2 hypointensity and diffuse susceptibility artifact, compatible with cavernoma. No significant perilesional FLAIR hyperintensity. No acute intraparenchymal infarct, hemorrhage, edema, or hydrocephalus. Mild periventricular and multifocal punctate right frontal subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely chronic microangiopathic changes. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Mild mucosal thickening of the bilateral maxillary, ethmoid, and sphenoid sinuses. Left sphenoid sinus mucous retention cyst. Visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. _________________________
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Findings: There is a right frontal approach ventriculostomy terminating in the right frontal horn. There is stable moderate to severe ventriculomegaly involving the lateral and 3rd ventricles with transependymal CSF flow. Pneumocephalus has decreased in the interval. There is hemostatic material along the high right frontal convexity underlying the burr holes. Hyperattenuating lesions in the bilateral cerebellar hemisphere and adjacent to the body of the right lateral ventricle are grossly unchanged. Right anterior frontal lobe lesion is not well appreciated. There is a small amount of subdural hemorrhage along the interhemispheric fissure on the right. There is no acute infarction or brain edema elsewhere. There is no acute osseous abnormality there are focal aggressive osseous lesion. The paranasal sinuses and mastoid air cells are clear.
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EXAM: MR Lumbar Spine wo+w contrast CLINICAL INFORMATION: Male patient 67 years with post lumbar fusion increased leg pain, M54.16 Radiculopathy, lumbar region, M54.50 Low back pain, unspecified Spec Inst: Post lumbar fusion; recent decline with lumbar and bilateral leg pain TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, axial T2 and axial T1-weighted images were obtained after the intravenous administration of gadolinium. In addition sagittal T1 and axial T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 182 lbs. IV contrast: ProHance, 17 ml, per protocol. COMPARISON: MRI dated 4/21/2021 and also CT dated 1/9/2022 FINDINGS: There has been revision of hardware since the prior MRI exam which demonstrated only pedicle screws at the L4-L5 level and intervertebral spacer. There are laminectomy changes at L3 and L5. There are also facetectomy changes bilaterally at L3-L4 and L2-L3 on the right. There are intervertebral spacers at L3-L4 and L4-L5 and L5-S1. There is mild rightward curvature of the inferior most lumbar spine and leftward curvature of the thoracolumbar junction. These findings do not appear significantly changed since the recent CT however There are pedicle screws extending from at least T11-S1 bilaterally connected by rods. The conus medullaris terminates at approximately the L1 level. Evaluation of the inferior thoracic spinal cord and nerve roots is limited secondary to artifact from hardware.. There is no significant spinal canal narrowing. There is moderate neural foraminal narrowing on the left at L5-S1 and mild narrowing on the left at L4-L5. There is no significant right-sided neural foraminal narrowing There is a large fluid collection within the paraspinal soft tissues extending from T12-L1 to S1-S2. It measures approximately 19 cm in craniocaudal dimension. It measures approximately 3 cm in AP dimension and 5 cm in transverse dimension There appear to be large areas of potential communication with the spinal canal at the L1 and L3 levels suggesting this represents a pseudomeningocele.. This fluid collection appears new since prior MRI and appears to have mildly enlarged since recent CT where the lesion measures. The collections measure approximately 17 cm in craniocaudal dimension on CT an approximately 3 x 5 cm in transverse dimensions. There is also a large fluid collection which appears to arise from the left psoas which appears new since the prior MRI. However both of these collections were present on recent CT dated 1/9/2022 and do not appear significantly changed in size since that exam. CONCLUSION: 01. Extensive posterior thoracolumbar-sacral spinal fixation hardware not significantly changed in position since recent CT. There appears to be neural foraminal narrowing on the left at L5-S1 and to a lesser extent at L4-L5 as described above. Spinal canal contents are not well seen secondary to artifact but there is no appreciable focal stenosis. 02. Large fluid collection within the paraspinal soft tissues likely representing pseudomeningocele given apparent communication between the collection and the spinal canal. The collection appears to be mildly larger since recent CT 03. There is a large fluid collection within the left psoas muscle of uncertain etiology, incompletely visualized which appears grossly stable in size
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FINDINGS: There has been revision of hardware since the prior MRI exam which demonstrated only pedicle screws at the L4-L5 level and intervertebral spacer. There are laminectomy changes at L3 and L5. There are also facetectomy changes bilaterally at L3-L4 and L2-L3 on the right. There are intervertebral spacers at L3-L4 and L4-L5 and L5-S1. There is mild rightward curvature of the inferior most lumbar spine and leftward curvature of the thoracolumbar junction. These findings do not appear significantly changed since the recent CT however There are pedicle screws extending from at least T11-S1 bilaterally connected by rods. The conus medullaris terminates at approximately the L1 level. Evaluation of the inferior thoracic spinal cord and nerve roots is limited secondary to artifact from hardware.. There is no significant spinal canal narrowing. There is moderate neural foraminal narrowing on the left at L5-S1 and mild narrowing on the left at L4-L5. There is no significant right-sided neural foraminal narrowing There is a large fluid collection within the paraspinal soft tissues extending from T12-L1 to S1-S2. It measures approximately 19 cm in craniocaudal dimension. It measures approximately 3 cm in AP dimension and 5 cm in transverse dimension There appear to be large areas of potential communication with the spinal canal at the L1 and L3 levels suggesting this represents a pseudomeningocele.. This fluid collection appears new since prior MRI and appears to have mildly enlarged since recent CT where the lesion measures. The collections measure approximately 17 cm in craniocaudal dimension on CT an approximately 3 x 5 cm in transverse dimensions. There is also a large fluid collection which appears to arise from the left psoas which appears new since the prior MRI. However both of these collections were present on recent CT dated 1/9/2022 and do not appear significantly changed in size since that exam.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mucous retention cysts in bilateral maxillary sinuses. Opacification of the posterior right ethmoid air cells. The other paranasal sinuses are clear. MASTOIDS: Left mastoid effusion. Trace right mastoid effusion. SOFT TISSUE: Unremarkable.
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MRI OF THE PITUITARY CLINICAL INFORMATION: 52-year-old female, pituitary adenoma COMPARISON: MR 1/19/2021 TECHNIQUE: Sagittal T1-weighted, axial T2-weighted, and postcontrast axial MP-RAGE images of the whole brain were obtained with coronal and sagittal reformats of the MP-RAGE sequence. Thin-section coronal precontrast T1-weighted, coronal T2-weighted, and postcontrast coronal and sagittal T1-weighted images of the pituitary gland, including dynamic postcontrast T1-weighted coronal images, were obtained. Patient weight: 190 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: PITUITARY: Patchy heterogenously enhancing lobulated sellar lesion that measures 1.0 x 1.3 cm (series 8, image nine), previously 1.3 x 1.3 cm (series 401, image 10). The lesion measures 1.3 cm in AP dimension (series 9, image 8), previously 1.3 cm by my measurement (series 801, image 14). The lesion has cystic portions of T2 hyperintensity with corresponding T1 hypointensity. Again, sellar floor remodeling on the right without osseous invasion. Lesion remains T1 bright partially. The pituitary stalk is not well seen. The optic chiasm and visualized optic nerves appear normal. Normal flow voids within the cavernous portions of ICAs. WHOLE BRAIN: No acute intracranial abnormality within the visualized portion of the brain. Mild mucosal thickening of the maxillary sinuses. CONCLUSION: Overall unchanged size and morphology of the previously seen complex similar lesion. Again, the differential includes prior hemorrhagic pituitary adenoma versus Rathke cleft cyst. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: PITUITARY: Patchy heterogenously enhancing lobulated sellar lesion that measures 1.0 x 1.3 cm (series 8, image nine), previously 1.3 x 1.3 cm (series 401, image 10). The lesion measures 1.3 cm in AP dimension (series 9, image 8), previously 1.3 cm by my measurement (series 801, image 14). The lesion has cystic portions of T2 hyperintensity with corresponding T1 hypointensity. Again, sellar floor remodeling on the right without osseous invasion. Lesion remains T1 bright partially. The pituitary stalk is not well seen. The optic chiasm and visualized optic nerves appear normal. Normal flow voids within the cavernous portions of ICAs. WHOLE BRAIN: No acute intracranial abnormality within the visualized portion of the brain. Mild mucosal thickening of the maxillary sinuses.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Partially imaged postsurgical changes of the left inferior neck soft tissues. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral lungs are clear. Tracheoesophageal prosthesis and tracheostomy tube are seen in appropriate positioning. No pleural effusions. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. No pneumomediastinum. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of the superior abdomen are unremarkable. MUSCULOSKELETAL: No significant abnormality.
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MR Cervical Spine wo contrast 1/25/2022 11:53 AM Clinical Information: Neck pain, limited range of motion Comparison: Cervical spine radiograph dated 12/27/2021 Technique: Axial and sagittal T1, axial and sagittal T2, and sagittal STIR sequences were acquired of the cervical spine without the use of intravenous contrast. Findings: Postsurgical changes is seen as status post anterior fusion of C6-C7. There is mild decrease in cervical lordosis most prominent at C6-C7 level. Multilevel disc desiccation is seen. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. There is a slightly increase in signal intensity of cervical cord in mid cervical levels. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is evidence of left paracentral disc protrusion with mild pressure effect on the left side of thecal sac in association with bilateral facet arthropathy, without significant canal stenosis or neural foramina narrowing. C3-C4: There is central disc protrusion with mild mass effect effect on the thecal sac. There is mild bilateral neural foramina narrowing C4-C5: There is disc disc osteophyte complex most prominent in right side, causing moderate right neural foraminal narrowing. C5-C6: There is diffuse disc bulge with moderate pressure effect on the anterior aspect of thecal sac, without significant neural foraminal narrowing. C6-C7: There is postsurgical changes with fusion at this level. Mild bony foraminal narrowing on the right side. Mild canal narrowing. C7-T1: No evidence of canal stenosis or neural foraminal narrowing is noted. T1-T2: No evidence of neural foraminal or spinal canal stenosis is noted. The visualized prevertebral and paravertebral soft tissues are unremarkable. Incidental mucous retention cyst in the location of the left tonsil. Impression: 1. Postsurgical changes status post fusion of C6-C7 vertebral bodies, resulting in mild spinal canal narrowing in this level. 2. Moderate degenerative changes as disc desiccation and facet arthropathy in the upper cervical levels. There is moderate right foraminal narrowing at C4-C5. 3. Mild canal narrowing at C5-C6 from degenerative changes and ligamentum flavum hypertrophy. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Postsurgical changes is seen as status post anterior fusion of C6-C7. There is mild decrease in cervical lordosis most prominent at C6-C7 level. Multilevel disc desiccation is seen. The bone marrow is of normal signal intensity. The visualized portions of the posterior fossa and craniocervical junction appear normal. There is a slightly increase in signal intensity of cervical cord in mid cervical levels. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is evidence of left paracentral disc protrusion with mild pressure effect on the left side of thecal sac in association with bilateral facet arthropathy, without significant canal stenosis or neural foramina narrowing. C3-C4: There is central disc protrusion with mild mass effect effect on the thecal sac. There is mild bilateral neural foramina narrowing C4-C5: There is disc disc osteophyte complex most prominent in right side, causing moderate right neural foraminal narrowing. C5-C6: There is diffuse disc bulge with moderate pressure effect on the anterior aspect of thecal sac, without significant neural foraminal narrowing. C6-C7: There is postsurgical changes with fusion at this level. Mild bony foraminal narrowing on the right side. Mild canal narrowing. C7-T1: No evidence of canal stenosis or neural foraminal narrowing is noted. T1-T2: No evidence of neural foraminal or spinal canal stenosis is noted. The visualized prevertebral and paravertebral soft tissues are unremarkable. Incidental mucous retention cyst in the location of the left tonsil.
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Findings: Right craniectomy changes are again noted with stable small extra-axial fluid collection underlying the craniectomy site. There is an isodense subdural collection along the interhemispheric fissure measuring up to 5 mm, new since the prior exam. Left orbitofrontal epidural hematoma is unchanged. There is developing encephalomalacia in the right cerebral hemisphere involving the right frontal lobe and right parieto-occipital lobes. Cortical laminar necrosis throughout the right cerebral hemisphere is somewhat less conspicuous. There is progressive encephalomalacia in the left frontal lobe with cortical laminar necrosis in the left parieto-occipital lobes. There is a chronic infarct in the left thalamus and within the pons. Ventriculostomy has been removed since prior examination. Ventricles are slightly increase in size in interval, however there is no evidence of hydrocephalus. Multiple skull base, left maxillofacial fractures and left temporal bone fractures are again demonstrated. There is mucosal thickening and air-fluid levels throughout the paranasal sinuses somewhat sparing the right maxillary sinus. There are large bilateral mastoid effusions.
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MR Stroke Protocol with MRAs 1/28/2022 2:00 AM Clinical Information: new R MCA stroke Comparison: CT stroke protocol of 1/2/2022 Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal. Patient weight: 141 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 2 ml per sec. Routine 3-D time-of-flight MRA with a short echo time (TE = 3 ms) and centric phase encoded 3D contrast-enhanced MRA utilizing a short echo time (1.4 msec) was performed. 3-D volume rendered and maximum intensity projection segmented MR angiographic projections were generated from the dataset. Findings: Redemonstrated acute right and subacute left MCA territory large infarcts without hemorrhagic conversion. No midline shift or significant mass effect. Basal cisterns are patent. Chronic microvascular ischemic changes within the white matter and pontine belly. No extra-axial fluid collections. MRA head demonstrates marked attenuation of flow related signal in the right MCA just distal to the M1 origin. On the left, there is a focal stenosis involving the M2 segment albeit with grossly preserved flow related signal. Bilateral ACAs are patent. Bilateral ICAs are patent. Vertebrobasilar system is grossly patent. MRA neck demonstrates patency of the carotid and vertebral arteries bilaterally. Again noted is tortuosity of the cervical ICAs. Conclusion: Acute right and subacute left large MCA territory infarct without hemorrhagic conversion or significant mass effect. Marked attenuation of flow related signal in the right MCA. Focal stenosis of the left M2. Anterior cerebral arteries and posterior circulation appear grossly patent without focal high-grade stenosis. Patent neck arteries.
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Findings: Redemonstrated acute right and subacute left MCA territory large infarcts without hemorrhagic conversion. No midline shift or significant mass effect. Basal cisterns are patent. Chronic microvascular ischemic changes within the white matter and pontine belly. No extra-axial fluid collections. MRA head demonstrates marked attenuation of flow related signal in the right MCA just distal to the M1 origin. On the left, there is a focal stenosis involving the M2 segment albeit with grossly preserved flow related signal. Bilateral ACAs are patent. Bilateral ICAs are patent. Vertebrobasilar system is grossly patent. MRA neck demonstrates patency of the carotid and vertebral arteries bilaterally. Again noted is tortuosity of the cervical ICAs.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion. Bibasilar subsegmental atelectasis.. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Mild cardiomegaly. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild dilatation of common bile duct and central intrahepatic ducts. GALLBLADDER: Surgically absent PANCREAS: Surgical changes of Whipple's procedure. Persistent extensive peripancreatic edema and stranding, stable to slightly improved. Small anterior peripancreatic collection in the lesser sac is more organized with wall enhancement and measures about 4.0 x 3.1 cm (series 2/image 124), previously 5.2 x 5.0 cm. This collection extends to the adjacent precaval region (on series 2/image 127). Residual pancreatic body and tail appears unremarkable. No pancreatic ductal dilatation. SPLEEN: Normal. ADRENALS: Mild left adrenal gland thickening. Right adrenal gland is normal. KIDNEYS: Symmetric renal enhancement. Stable large parapelvic right renal cyst. No hydronephrosis. No perinephric collection. LYMPH NODES: Multiple enlarged reactive mesenteric lymph nodes in the central abdomen.. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Stable trace pelvic free fluid. No pneumoperitoneum. No new discrete intra-abdominal fluid collection to suggest an abscess. Stable small loculated collection along the inferior margin of left hepatic lobe measuring about 4.3 x 2.6 cm (series 2/45) Stable position of midline percutaneous drainage catheter terminating in the inferior margin of right hepatic lobe. Additional right-sided drainage catheter has been removed. RETROPERITONEUM: Normal. VESSELS: Aorta is nonaneurysmal. Persistent moderate compression of the portal confluence and cranial superior mesenteric vein. Mild narrowing of splenic vein. No definite intraluminal thrombus. Hepatic veins are patent. IVC is not well opacified. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Stable small subincisional seroma in the midline anterior abdominal wall. No peripheral wall enhancement. MUSCULOSKELETAL: Stable osseous structures.
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MR Angio Lower Extremity Right TECHNIQUE: Multiplanar and multisequence MRI of the right lower extremity without and with intravenous contrast was obtained extending from the distal femur through the calcaneus. Additionally, dynamic MR angio images of the right lower extremity were obtained. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation after completion of the post-processing. CLINICAL INFORMATION: AV malformation. COMPARISON: None FINDINGS: No abnormal bone marrow signal is noted to suggest acute fracture or aggressive osseous lesion. Intramedullary nail is noted within the left tibia. The arterial vasculature of the bilateral forelegs is unremarkable without stenosis or occlusion. Extensive T2 hyperintense lesion involving the muscles of the superficial and deep posterior compartments, predominantly involving the posterior tibialis and soleus muscles, with postcontrast enhancement. Given the extent, this lesion is only partially imaged and extends inferiorly and superiorly out of the field of view. Multiple fluid fluid levels are noted within the regions of this lesion. Intramedullary extension is noted within the distal fibula. This lesion demonstrates filling in the late arterial phase. Increased signal seen within the Achilles tendon likely related to the AV malformation. CONCLUSION: 1. Extensive, infiltrative, partially imaged vascular malformation of the right lower extremity. Lesion shows slow enhancement beginning in the late arterial phase. Given the extent of the lesion, CTA of the right lower extremity is recommended for further evaluation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: No abnormal bone marrow signal is noted to suggest acute fracture or aggressive osseous lesion. Intramedullary nail is noted within the left tibia. The arterial vasculature of the bilateral forelegs is unremarkable without stenosis or occlusion. Extensive T2 hyperintense lesion involving the muscles of the superficial and deep posterior compartments, predominantly involving the posterior tibialis and soleus muscles, with postcontrast enhancement. Given the extent, this lesion is only partially imaged and extends inferiorly and superiorly out of the field of view. Multiple fluid fluid levels are noted within the regions of this lesion. Intramedullary extension is noted within the distal fibula. This lesion demonstrates filling in the late arterial phase. Increased signal seen within the Achilles tendon likely related to the AV malformation.
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FINDINGS: THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Postsurgical changes from splenectomy. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel moderate discogenic degenerative changes and facet arthropathy, most prominent from L3-S1. Mild to moderate narrowing of the L5-S1 neural foramina more on the left PREVERTEBRAL SOFT TISSUES: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. ALIGNMENT: Normal. Visualized portions of the abdomen show diverticulosis.
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Lumbar MRI without contrast Clinical information:53-year-old male with low back pain. Comparison: Radiographs 6/11/2021 Technique: Multiplanar multisequence MRI of the lumbar spine were obtained in the axial and sagittal plane without the use of intravenous contrast per protocol. Findings: Five nonrib-bearing lumbovertebral bodies. Alignment is normal. The vertebral body and disc space heights are normal. Tiny hemangioma in the vertebral body of T12 and small vertebral hemangioma at L1. T1/T2 hyperintensity of the anterior inferior endplate of L1 the adjacent anterior endplates of L2 and L3 and in adjacent inferior endplates of L4-L5 (for example series 201, image 11). The conus terminates at the pedicle level of L1. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: Mild diffuse disc bulge and mild bilateral facet hypertrophy resulting in bilateral neural foraminal narrowing without nerve root compression. No significant spinal canal narrowing. L2-3: Mild bilateral subarticular disc extrusion inferiorly resulting in bilateral narrowing of the lateral recesses. The disc appears to abut the transiting L3 nerve roots on the left (series 701, image 38). Mild bilateral facet hypertrophy resulting in foraminal narrowing without nerve root compression. No significant spinal canal narrowing. L3-4: Mild bilateral subarticular disc extrusion inferiorly resulting in bilateral narrowing of the lateral recesses. The disc appears to abut the transiting L4 nerve roots on the left (series 701, image 30). Mild bilateral facet arthropathy resulting in mild narrowing of the neuroforamen bilaterally, greater on the right, without compression of the exiting nerve roots. No significant spinal canal narrowing. L4-5: Mild bilateral subarticular disc extrusion inferiorly resulting in bilateral narrowing of the lateral recesses and abutment of the bilateral transiting nerve roots of L5 (for example series 701, image 22). Moderate bilateral facet hypertrophy with interarticular T2 hyperintensity resulting in moderate foraminal narrowing, greater on the left with abutment of the left exiting nerve root (series 701, image 25). No significant spinal canal narrowing. L5-S1: Mild bilateral subarticular disc extrusion resulting in narrowing of the lateral recesses without compression of the transiting nerve roots. Tiny annular fissure on the right (series 201, image 16). Bilateral facet hypertrophy with mild bilateral foraminal narrowing but no compression of the exiting nerve roots. No significant spinal canal narrowing. The paraspinal structures are normal. The remaining osseous and soft tissue structures are normal. Anterior and posterior ligamentous complexes are intact. There are incidental Tarlov's perineural cysts within the sacrum. CONCLUSION: Mild degenerative changes but no canal or neural foramina narrowing at any level.. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Five nonrib-bearing lumbovertebral bodies. Alignment is normal. The vertebral body and disc space heights are normal. Tiny hemangioma in the vertebral body of T12 and small vertebral hemangioma at L1. T1/T2 hyperintensity of the anterior inferior endplate of L1 the adjacent anterior endplates of L2 and L3 and in adjacent inferior endplates of L4-L5 (for example series 201, image 11). The conus terminates at the pedicle level of L1. T12-L1: No significant disc bulge. No significant spinal canal or foraminal narrowing. L1-2: Mild diffuse disc bulge and mild bilateral facet hypertrophy resulting in bilateral neural foraminal narrowing without nerve root compression. No significant spinal canal narrowing. L2-3: Mild bilateral subarticular disc extrusion inferiorly resulting in bilateral narrowing of the lateral recesses. The disc appears to abut the transiting L3 nerve roots on the left (series 701, image 38). Mild bilateral facet hypertrophy resulting in foraminal narrowing without nerve root compression. No significant spinal canal narrowing. L3-4: Mild bilateral subarticular disc extrusion inferiorly resulting in bilateral narrowing of the lateral recesses. The disc appears to abut the transiting L4 nerve roots on the left (series 701, image 30). Mild bilateral facet arthropathy resulting in mild narrowing of the neuroforamen bilaterally, greater on the right, without compression of the exiting nerve roots. No significant spinal canal narrowing. L4-5: Mild bilateral subarticular disc extrusion inferiorly resulting in bilateral narrowing of the lateral recesses and abutment of the bilateral transiting nerve roots of L5 (for example series 701, image 22). Moderate bilateral facet hypertrophy with interarticular T2 hyperintensity resulting in moderate foraminal narrowing, greater on the left with abutment of the left exiting nerve root (series 701, image 25). No significant spinal canal narrowing. L5-S1: Mild bilateral subarticular disc extrusion resulting in narrowing of the lateral recesses without compression of the transiting nerve roots. Tiny annular fissure on the right (series 201, image 16). Bilateral facet hypertrophy with mild bilateral foraminal narrowing but no compression of the exiting nerve roots. No significant spinal canal narrowing. The paraspinal structures are normal. The remaining osseous and soft tissue structures are normal. Anterior and posterior ligamentous complexes are intact. There are incidental Tarlov's perineural cysts within the sacrum.
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FINDINGS: THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Moderate multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Postsurgical changes from splenectomy. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel moderate discogenic degenerative changes and facet arthropathy, most prominent from L3-S1. Mild to moderate narrowing of the L5-S1 neural foramina more on the left PREVERTEBRAL SOFT TISSUES: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. ALIGNMENT: Normal. Visualized portions of the abdomen show diverticulosis.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: with eovist; evaluate hepatic mets sp TACE and Y90 with elevated CEA, C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct COMPARISON: CT abdomen pelvis dated 12/9/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 149 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Posttreatment change in right lobe contiguous lesions occupying the central aspects of segments VIII and V, with precontrast T1 hypointensity and mild T2 hyperintensity. On postcontrast images, the measures 2.8 x 3.1 cm and 3.1 x 2.6 cm, respectively (image 63 and 53, series 602), previously 2.4 x 2.3 and 2.0 x 1.6 cm. In both lesions, heterogeneous enhancement is seen with central arterial/venous postcontrast enhancement. These lesions also demonstrate diffusion restriction (images 21 and 25, series 1252). Posttreatment changes are noted in the left lobe lesion which appears heterogenous, T1 hypointense, and T2 hyperintense. The overall treatment area measures 3.1 x 3.9 cm (image 79, series 602), was 6.5 x 3.9 cm (image 16 series 4). A new nodular 1.1 x 1.6 cm (image 76 series 602) contiguous area of abnormal enhancement projects posteriorly from this larger lesion and demonstrates central arterial/venous enhancement similar to the previously described lesions. Additionally, this region demonstrates diffusion restriction on image 18, series 1252. No new suspicious enhancing lesions are seen throughout the remaining liver. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Thickened left adrenal gland without discrete nodule. Unremarkable right adrenal gland. KIDNEYS: Multiple right renal cysts. No acute abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. The right lobe post TACE lesions demonstrate interval increase in size, residual heterogeneous postcontrast enhancement, diffusion restriction, and are compatible with residual viable tumor. 2. Left lateral lobe lesion is overall decreased in size, with residual, heterogenous enhancement, indeterminate for residual tumor. However, there is a new posterior contiguous nodule with similar enhancement pattern to the right lobe lesions and is compatible with viable metastasis. 3. No evidence of additional metastases throughout the imaged abdomen. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Posttreatment change in right lobe contiguous lesions occupying the central aspects of segments VIII and V, with precontrast T1 hypointensity and mild T2 hyperintensity. On postcontrast images, the measures 2.8 x 3.1 cm and 3.1 x 2.6 cm, respectively (image 63 and 53, series 602), previously 2.4 x 2.3 and 2.0 x 1.6 cm. In both lesions, heterogeneous enhancement is seen with central arterial/venous postcontrast enhancement. These lesions also demonstrate diffusion restriction (images 21 and 25, series 1252). Posttreatment changes are noted in the left lobe lesion which appears heterogenous, T1 hypointense, and T2 hyperintense. The overall treatment area measures 3.1 x 3.9 cm (image 79, series 602), was 6.5 x 3.9 cm (image 16 series 4). A new nodular 1.1 x 1.6 cm (image 76 series 602) contiguous area of abnormal enhancement projects posteriorly from this larger lesion and demonstrates central arterial/venous enhancement similar to the previously described lesions. Additionally, this region demonstrates diffusion restriction on image 18, series 1252. No new suspicious enhancing lesions are seen throughout the remaining liver. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Thickened left adrenal gland without discrete nodule. Unremarkable right adrenal gland. KIDNEYS: Multiple right renal cysts. No acute abnormality. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left lens replacement. The orbits are otherwise normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Status post liver resection for mucinous colorectal metastasis COMPARISON: MRI of abdomen dated 8/2/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 95 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Right Bochdalek hernia. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Postsurgical changes from interval partial hepatectomy and resection of inferior right hepatic lobe metastasis. No new suspicious hepatic lesion identified. Unchanged cyst involving the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small right renal cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Postsurgical changes related to hepatic metastasis resection without new suspicious hepatic lesion identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: Right Bochdalek hernia. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Postsurgical changes from interval partial hepatectomy and resection of inferior right hepatic lobe metastasis. No new suspicious hepatic lesion identified. Unchanged cyst involving the left hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small right renal cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings: There is an evolving infarct in the left superior cerebellar hemisphere without hemorrhagic conversion. There is mild associated mass effect. There is no hydrocephalus. Smaller infarcts in the left middle frontal gyrus and right centrum semiovale is better appreciated on MRI. There are multiple chronic infarcts in the left occipital lobe, right basal ganglia, right thalamus and bilateral cerebellar hemispheres. There is diffuse cortical involution. There is no intracranial mass or hydrocephalus. There is no acute osseous abnormality. The paranasal sinuses and mastoid air cells are clear.
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EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Female patient 56 years with , D35.2 Benign neoplasm of pituitary gland Spec Inst: Pituitary tumor - evaluate sella TECHNIQUE: Coronal T2 and coronal T1 thin cut images through the sella were obtained without intravenous gadolinium. In addition coronal T1 and sagittal T1 as well as dynamic series were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 270 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: 1/10/2017 FINDINGS: The sella is chronically enlarged without interval change. There is stable appearance to small amount of soft tissue along the floor of the sella with focal T2 hyperintensity on the right without interval change. Soft tissue is slightly thicker on the right and there is mild hypoenhancement on the right which has been stable for many years probably representing posttreatment changes. The stalk is deviated to the left. There is no abnormal soft tissue within the cavernous sinuses and ICA flow voids appear within normal limits. Optic chiasm appears unremarkable. Sphenoid sinus is clear clear. Note is made of prominent Meckel's caves bilaterally. CONCLUSION: Stable posttreatment changes within the sella with stable appearance of mildly heterogeneously enhancing soft tissue along the floor of the sella. No evidence of recurrent tumor.
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FINDINGS: The sella is chronically enlarged without interval change. There is stable appearance to small amount of soft tissue along the floor of the sella with focal T2 hyperintensity on the right without interval change. Soft tissue is slightly thicker on the right and there is mild hypoenhancement on the right which has been stable for many years probably representing posttreatment changes. The stalk is deviated to the left. There is no abnormal soft tissue within the cavernous sinuses and ICA flow voids appear within normal limits. Optic chiasm appears unremarkable. Sphenoid sinus is clear clear. Note is made of prominent Meckel's caves bilaterally.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Moderate size bilateral pleural effusions and basilar atelectasis, slightly decreased on the right. DISTAL ESOPHAGUS: Esophagogastric catheter is in place. HEART / VESSELS: Trace pericardial effusion. ABDOMEN and PELVIS: LIVER: Periportal edema BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Findings consistent with severe necrotizing pancreatitis redemonstrated. Overall, the extensive loculated peripancreatic fluid collections surrounding the pancreas and lower anterior abdomen are slightly decreased in size in the interval. For example a collection centered around the diaphragmatic hiatus and pancreatic body measures 9.6 x 5.4 cm on axial image 112 previously measuring 11.3 x 6.4 cm on axial image 202 The amount of gas within the fluid collections have decreased since the prior exam SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric catheter terminating in the proximal jejunum. No evidence of bowel obstruction. COLON / APPENDIX: Diverticulosis. Wall thickening of the transverse colon abutting the gas containing peripancreatic fluid collection PERITONEUM / MESENTERY: Interval placement of pigtail catheter terminating in the anterior lower abdomen. Associated peripheral enhancing free fluid has significantly decreased in the interval. Extensive mesenteric congestion and omental nodularity. No other free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Significant narrowing of the cranial SMV and splenic vein. No pseudoaneurysm. URINARY BLADDER: Foley catheter in place. Moderate amount of intraluminal gas. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Severe anasarca MUSCULOSKELETAL: No significant abnormality.
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EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Female patient 44 years with pituitary adenoma, D35.2 Benign neoplasm of pituitary gland Spec Inst: evaluate sella TECHNIQUE: Coronal T1, coronal T2 thin cut images through the sella and coronal T1 and sagittal T1 as well as dynamic series were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 220 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1.20 ml per sec. COMPARISON: 5/19/2021 FINDINGS: The sella is mildly enlarged. There is increased T2 heterogeneous soft tissue within the sella. The soft tissue demonstrates a convex superior margin. The pituitary stalk is deviated to the left. The lesion encroaches upon the optic chiasm but there is no impingement. There is no extension into the cavernous sinuses and the ICA flow voids appear within normal limits. Postcontrast images demonstrate relative central nonenhancement and peripheral enhancement along the superior margin. The nonenhancing portion measures approximately 10 x 15 mm in the coronal plane, previously measured 10 x 13 mm. There is extensive opacification of the sphenoid sinuses as well as the frontal and ethmoid sinuses and also maxillary sinuses with multiple cystic changes likely representing mucous retention cysts as well as mucosal thickening CONCLUSION: 01. Prominence of soft tissues within the sella. There is central hypoenhancing lesion which is not significantly changed in size, possibly minimally increased in size. Findings most likely represent pituitary macroadenoma. There is no mass effect upon the optic chiasm and also no significant extension into the cavernous sinuses 02. Interval diffuse opacification of the paranasal sinuses with multiple mucous retention cysts and mucosal thickening
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FINDINGS: The sella is mildly enlarged. There is increased T2 heterogeneous soft tissue within the sella. The soft tissue demonstrates a convex superior margin. The pituitary stalk is deviated to the left. The lesion encroaches upon the optic chiasm but there is no impingement. There is no extension into the cavernous sinuses and the ICA flow voids appear within normal limits. Postcontrast images demonstrate relative central nonenhancement and peripheral enhancement along the superior margin. The nonenhancing portion measures approximately 10 x 15 mm in the coronal plane, previously measured 10 x 13 mm. There is extensive opacification of the sphenoid sinuses as well as the frontal and ethmoid sinuses and also maxillary sinuses with multiple cystic changes likely representing mucous retention cysts as well as mucosal thickening
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Moderate atherosclerotic disease without significant abnormality. ABDOMINAL AORTA: Moderate atherosclerotic disease without significant abnormality. CELIAC AXIS: No significant abnormality. SMA: Moderate atherosclerotic disease with a focal area of significant stenosis (series 401, image 114), without poststenotic dilatation. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild atherosclerotic disease without significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild atherosclerotic disease without significant abnormality. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Small bilateral pleural effusions with associated bilateral lower lobe atelectasis, similar to prior. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Mildly enlarged. Redemonstrated indeterminant hypoattenuating lesions, similar to prior. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Unchanged retroperitoneal lymph node prominence. Borderline prominent periportal nodes are also noted. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. Otherwise, the colon is normal. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing periumbilical hernia. Postsurgical changes are again seen involving the lumbosacral spine. Peripherally enhancing subcutaneous fluid collection is redemonstrated which measures 3.3 x 1.7 x 9.5 cm (series 501, image 169; series 504, image 76), previously 3.5 x 1.7 x 12.1 cm. There is persistent stranding involving the paraspinal musculature at this level. There is persistent phlegmonous extension into the epidural region (series 504, image 81), evaluation of which is limited due to significant associated streak artifact. However, there has been interval decrease in volume of gas within the spinal canal compared to prior exam. MUSCULOSKELETAL: Spinal postsurgical changes as above. No aggressive osseous lesions.
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15,531 |
MR Lumbar Spine wo contrast 1/25/2022 12:28 PM Clinical Information: Low back pain, > 6 wks Comparison: Lumbar spine radiograph from 8/5/2021. Technique: T1 sagittal and axial spin echo, sagittal STIR, T2 sagittal and axial fast spin echo. Findings: There is normal height of the vertebral bodies. There is grade 1 anterolisthesis of L4 on L5 with no pars defects. There is degenerative marrow edema at the L5-S1 level. There is chronic degenerative endplate signal changes at L2-L3. There is a simple appearing cyst in the upper pole of the left kidney. Pre and paravertebral soft tissues appear unremarkable. The conus and cauda equina appear unremarkable. T12-L1 and L1-L2: Unremarkable. L2-L3: Disc bulge with facet hypertrophy results in mild right foraminal narrowing. L3-L4: Disc bulge with facet hypertrophy results in no significant canal or neural foramina narrowing. L4-L5: Mild anterolisthesis with disc bulge and facet hypertrophy results in mild foraminal narrowing. There is also ligamentum flavum thickening and these changes result in moderate canal narrowing. L5-S1: Posterior disc extrusion with slight inferior migration and facet hypertrophy results in minimal foraminal narrowing. Impression: Degenerative changes mainly at L4-L5 where there is mild anterolisthesis, disc bulge and ligament flavum thickening resulting in mild to moderate canal narrowing. Less advanced degenerative changes elsewhere. Please see above report for further details.
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Findings: There is normal height of the vertebral bodies. There is grade 1 anterolisthesis of L4 on L5 with no pars defects. There is degenerative marrow edema at the L5-S1 level. There is chronic degenerative endplate signal changes at L2-L3. There is a simple appearing cyst in the upper pole of the left kidney. Pre and paravertebral soft tissues appear unremarkable. The conus and cauda equina appear unremarkable. T12-L1 and L1-L2: Unremarkable. L2-L3: Disc bulge with facet hypertrophy results in mild right foraminal narrowing. L3-L4: Disc bulge with facet hypertrophy results in no significant canal or neural foramina narrowing. L4-L5: Mild anterolisthesis with disc bulge and facet hypertrophy results in mild foraminal narrowing. There is also ligamentum flavum thickening and these changes result in moderate canal narrowing. L5-S1: Posterior disc extrusion with slight inferior migration and facet hypertrophy results in minimal foraminal narrowing.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subpleural groundglass nodule in the left lower lobe measuring up to 6 mm, likely infectious/inflammatory in etiology. No pleural effusion. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Tiny punctate nonobstructing calculus in the left lower pole. No radiopaque right urinary tract calculus. No significant hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Cervical cancer status post external beam radiation therapy, planning for brachytherapy. COMPARISON: PET/CT dated 11/19/2021 and CT abdomen pelvis dated 11/18/2021. TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 180 lbs. IV contrast: ProHance, 9 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: Sigmoid diverticulosis. This questionable tethering of a small bowel loop to the superior portion of the bladder (series 10, image 4), however there is no obstruction. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. REPRODUCTIVE ORGANS/BLADDER: There is diffuse abnormal T2 intermediate signal involving the entirety of the cervix. Additionally the posterior wall of the bladder is abnormally thickened, also with heterogeneous, intermediate T2 signal, compatible with invasion. There is diffuse circumferential peripheral postcontrast enhancement of the ulcerated cervical malignancy measuring approximately 5.4 x 3.5 x 4.5 cm (series 14, image 71, series 12 image 74). Mucosal hyperenhancement extends anteriorly along the vesicovaginal fistula (series 14, image 72). The cervical mass extends into the lower uterine segment. There is no definite extension into the rectum. Vesicovaginal fistula is redemonstrated with a fluid distended tract measuring approximately 4 mm in dimension. Air within the urinary bladder due to the vesicovaginal fistula is again noted. Subserosal fibroid measuring up to 4.2 cm off the left posterior uterine body. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Redemonstration of ulcerated cervical mass invading the posterior wall of the bladder with resultant vesicovaginal fistula. No pelvic lymphadenopathy. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: Sigmoid diverticulosis. This questionable tethering of a small bowel loop to the superior portion of the bladder (series 10, image 4), however there is no obstruction. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. REPRODUCTIVE ORGANS/BLADDER: There is diffuse abnormal T2 intermediate signal involving the entirety of the cervix. Additionally the posterior wall of the bladder is abnormally thickened, also with heterogeneous, intermediate T2 signal, compatible with invasion. There is diffuse circumferential peripheral postcontrast enhancement of the ulcerated cervical malignancy measuring approximately 5.4 x 3.5 x 4.5 cm (series 14, image 71, series 12 image 74). Mucosal hyperenhancement extends anteriorly along the vesicovaginal fistula (series 14, image 72). The cervical mass extends into the lower uterine segment. There is no definite extension into the rectum. Vesicovaginal fistula is redemonstrated with a fluid distended tract measuring approximately 4 mm in dimension. Air within the urinary bladder due to the vesicovaginal fistula is again noted. Subserosal fibroid measuring up to 4.2 cm off the left posterior uterine body. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bibasilar consolidations involving the posterior segment of the lower lobes with volume loss. Small left pleural effusion. No definite findings suggestive of interstitial lung disease. Trace fissural fluid bilaterally. No pneumothorax. HEART / VESSELS: Cardiomegaly. Trace pericardial effusion, decreased from prior exam. Enlarged MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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EXAM: MR Bone Pelvis wo+w contrast CLINICAL INFORMATION: Evaluate for sacroiliitis COMPARISON: 1/3/2022. TECHNIQUE: Multiplanar and multisequence MRI of the sacrum was obtained without and with intravenous contrast. Patient weight: 128 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: BONES: No acute fracture or aggressive osseous lesion. There is a small amount of edema within the bilateral ilia at the bilateral sacroiliac joints with mild postcontrast enhancement. Additionally, there are subtle erosive changes, best demonstrated on the T1 images. HIP JOINTS: The visualized portions of the bilateral hips are unremarkable without significant degenerative changes. No joint effusion. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: 1. Findings consistent with bilateral symmetric sacroiliitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES: No acute fracture or aggressive osseous lesion. There is a small amount of edema within the bilateral ilia at the bilateral sacroiliac joints with mild postcontrast enhancement. Additionally, there are subtle erosive changes, best demonstrated on the T1 images. HIP JOINTS: The visualized portions of the bilateral hips are unremarkable without significant degenerative changes. No joint effusion. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis.
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Findings: Examination is limited secondary to infarction artifact. There is a stable intraparenchymal hemorrhage within the posterior central pons with mass effect on the 4th ventricle. There is no hydrocephalus. There is no new hemorrhage or evidence of acute infarction. There are mild chronic marked hepatic changes in the periventricular white matter. There is no acute osseous abnormality. There is fluid and mucosal thickening throughout the ethmoid, left maxillary and sphenoid sinuses. There is a trace left mastoid effusion.
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EXAM:MR Shoulder Right wo contrast CLINICAL INFORMATION:Right shoulder pain COMPARISON:11/12/2021 TECHNIQUE: Multiplanar multisequence MRI of the right shoulder was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus: Full-thickness tear of the anterior fibers. Partial thickness articular surface tear of the posterior fibers with tendinosis. Infraspinatus:Thickening and intermediate signal without discrete tear. Subscapularis:Partial thickness articular surface tear. Teres minor:Normal. LONG HEAD BICEPS TENDON:There is medial subluxation of the distal long head biceps tendon. The intra-articular portion of the tendon is thickened with intermediate signal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum: Degenerative tearing of the anterior superior labrum. BURSAE:Moderate amount fluid. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. CONCLUSION: 1. Anterior leading edge tear of the supraspinatus in the background of tendinosis. 2. Partial-thickness articular surface tear of the subscapularis tendon. 3. Infraspinatus tendinosis. 4. Long head biceps tendon subluxation and tendinosis. 5. Degenerative tearing of the anterior superior labrum As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. ROTATOR CUFF: Supraspinatus: Full-thickness tear of the anterior fibers. Partial thickness articular surface tear of the posterior fibers with tendinosis. Infraspinatus:Thickening and intermediate signal without discrete tear. Subscapularis:Partial thickness articular surface tear. Teres minor:Normal. LONG HEAD BICEPS TENDON:There is medial subluxation of the distal long head biceps tendon. The intra-articular portion of the tendon is thickened with intermediate signal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum: Degenerative tearing of the anterior superior labrum. BURSAE:Moderate amount fluid. ACROMIAL CLAVICULAR JOINT:Osteophytes are present with capsular hypertrophy. No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy.
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Findings: Examination is limited secondary to motion artifact. There is an evolving ACA territory infarction involving the right parasagittal frontal lobe and anterior right parietal lobe. There is no definite hemorrhagic conversion or significant mass effect. There is no new infarction, new hemorrhage or brain edema elsewhere. There is no intracranial mass or hydrocephalus. The orbits appear normal. There is no acute osseous abnormality. There is mild mucosal thickening in the left sphenoid sinus. The remaining paranasal sinuses and mastoid air cells are clear.
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EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Indeterminate liver lesion, history of anal squamous cell cancer with PET positive liver metastases. COMPARISON: CT abdomen pelvis dated 1/19/2022 and PET/CT dated 9/7/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 210 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: T2 intermediate signal lesions in the right hepatic lobe (hepatic segment VI/VII) with contrast nonretention on hepatobiliary phase. The largest lesion measures approximately 1.7 x 1.4 cm (series 501, image 29). This lesion demonstrates restricted diffusion (ADC map series 1106, image 268) and hypoenhancement. Two other lesions with similar enhancement characteristics are seen in the right lobe (image 53 and 60 series 1201, compatible with metastatic disease. Two small hepatic cirrhosis and cysts are present (image 53, image 79 series 1201. Loss of signal on the opposed phase sequences, compatible with hepatic steatosis. Scattered small hepatic cysts again noted, corresponding to the lesions described on prior CT. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Redemonstration of known hepatic metastasis in the right hepatic lobe measuring up to 1.7 cm. In total there are three hepatic metastases. Two small cysts are also present. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: T2 intermediate signal lesions in the right hepatic lobe (hepatic segment VI/VII) with contrast nonretention on hepatobiliary phase. The largest lesion measures approximately 1.7 x 1.4 cm (series 501, image 29). This lesion demonstrates restricted diffusion (ADC map series 1106, image 268) and hypoenhancement. Two other lesions with similar enhancement characteristics are seen in the right lobe (image 53 and 60 series 1201, compatible with metastatic disease. Two small hepatic cirrhosis and cysts are present (image 53, image 79 series 1201. Loss of signal on the opposed phase sequences, compatible with hepatic steatosis. Scattered small hepatic cysts again noted, corresponding to the lesions described on prior CT. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace left pleural effusion and dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Advanced coronary artery atherosclerosis. Prosthetic mitral valve. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Calcified granulomas. Indeterminate hypoattenuating lesions in the spleen. ADRENALS: Normal. KIDNEYS: No renal calculi or hydronephrosis. Retained contrast in the collecting system. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid diverticulosis. No other abnormality. PERITONEUM / MESENTERY: No free intraperitoneal fluid or air. RETROPERITONEUM: Normal. VESSELS: No significant atherosclerosis of the bilateral external iliac arteries. Tiny calcified atherosclerosis in the proximal right common iliac artery. URINARY BLADDER: Retained contrast is present. Small diverticulum arising from the left posterior lateral bladder wall. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild stranding in the right inguinal region may be secondary to recent vascular access. MUSCULOSKELETAL: No significant abnormality.
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MRI brain with and without Indication: Brain metastases, monitor, C76.0 Malignant neoplasm of head, face and neck, C79.31 Secondary malignant neoplasm of brain Spec Inst: Please coordinate with Dr. Willey follow up Comparison: Multiple priors, most recent MRI brain with and without contrast 10/21/2021 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 158 lbs. IV contrast: ProHance, 15 ml, per protocol. Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. The treated right frontal lesion at the vertex shows further interval decrease in size and peripheral post contrast enhancement measuring 9 x 7 mm, previously 11 x 9 mm. No other brain parenchymal lesions identified. No significant interval change in appearance of the postsurgical changes related to bicoronal craniotomy and free flap repair. Again seen is bifrontal and right temporal encephalomalacia, diffuse reactive bifrontal dural thickening and mild enhancement. Ex vacuo dilatation of the frontal horns of both lateral ventricles. Enlarging enhancing lesion in the midline occipital bone which measures 10 x 39 mm in sagittal plane (series 10 image 731). Postsurgical changes in the paranasal sinuses with diffuse scattered paranasal sinus mucosal thickening. Impression: 1. Enlarging enhancing midline occipital bone lesion concerning for metastasis. 2. Further interval decrease in size of the treated right frontal metastasis. No other enhancing intra-axial lesions identified. 3. Stable posttreatment changes as described.
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Findings: Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. The treated right frontal lesion at the vertex shows further interval decrease in size and peripheral post contrast enhancement measuring 9 x 7 mm, previously 11 x 9 mm. No other brain parenchymal lesions identified. No significant interval change in appearance of the postsurgical changes related to bicoronal craniotomy and free flap repair. Again seen is bifrontal and right temporal encephalomalacia, diffuse reactive bifrontal dural thickening and mild enhancement. Ex vacuo dilatation of the frontal horns of both lateral ventricles. Enlarging enhancing lesion in the midline occipital bone which measures 10 x 39 mm in sagittal plane (series 10 image 731). Postsurgical changes in the paranasal sinuses with diffuse scattered paranasal sinus mucosal thickening.
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Findings: Right MCA territory infarction is again seen involving the right basal ganglia and right insular cortex with mass effect on the right lateral ventricle. Hyperdense right sylvian branch of the right MCA is again seen. There is new loss of gray-white differentiation in the right parietal lobe involving the the postcentral gyrus. There is no intracranial hemorrhage or significant mass effect. There is no intracranial mass or hydrocephalus. There is no acute osseous abnormality. There is a small right maxillary sinus mucus retention cyst. The remaining paranasal sinuses and mastoid air cells are clear.
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15,537 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 75-year-old woman with history of left breast cancer in 1997 status post breast conservation therapy with recently diagnosed right breast DCIS. Examination is performed to evaluate extent of disease. Right Breast IDC, C50.919 Malignant neoplasm of unspecified site of unspecified female breast Spec Inst: Evaluate extent of disease TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 165 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior mammograms including most recent bilateral exam dated 12/1/2021 with subsequent imaging related to right breast workup in 2021 and 2022. FINDINGS: The breasts are heterogeneous fibroglandular. There is mild background parenchymal enhancement. Right breast: Irregular enhancing spiculated mass in the lower inner quadrant, posterior depth breast with associated central biopsy marker/susceptibility artifact measuring 18 x 13 x 7 mm (AP x TV x CC series 400 image 145, series 7 image 145) represents biopsy-proven invasive ductal carcinoma. There is clumped segmental nonmass enhancement in the medial breast spanning anterior to posterior depth including sites of malignant biopsies at 2:00 and 3:00 (DCIS) and 5:00 (invasive ductal carcinoma) measuring approximately 75 x 15 x 51 mm (AP x TV x CC series 403 image 1, series 7 image 145). There is no involvement of the nipple, skin, or pectoralis musculature. Focal skin enhancement in the upper inner quadrant, posterior depth breast (series 400 image 166) is most likely related to recent adjacent biopsy. Left breast: There are changes of prior breast conservation therapy. There is no MRI evidence of malignancy within the breast. Nodes: There is no axillary or internal mammary adenopathy. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Extensive biopsy-proven multicentric disease involving the medial breast including a site of invasive disease in the lower inner breast involving the medial breast altogether measuring 75 x 15 x 51 mm. BI-RADS 6: Biopsy-proven malignancy. Surgical excision when clinically appropriate. 2. Left Breast: Changes of prior breast conservation therapy without MR evidence of malignancy. 3. No axillary or internal mammary adenopathy. Overall BI-RADS assessment: BI-RADS 6.
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FINDINGS: The breasts are heterogeneous fibroglandular. There is mild background parenchymal enhancement. Right breast: Irregular enhancing spiculated mass in the lower inner quadrant, posterior depth breast with associated central biopsy marker/susceptibility artifact measuring 18 x 13 x 7 mm (AP x TV x CC series 400 image 145, series 7 image 145) represents biopsy-proven invasive ductal carcinoma. There is clumped segmental nonmass enhancement in the medial breast spanning anterior to posterior depth including sites of malignant biopsies at 2:00 and 3:00 (DCIS) and 5:00 (invasive ductal carcinoma) measuring approximately 75 x 15 x 51 mm (AP x TV x CC series 403 image 1, series 7 image 145). There is no involvement of the nipple, skin, or pectoralis musculature. Focal skin enhancement in the upper inner quadrant, posterior depth breast (series 400 image 166) is most likely related to recent adjacent biopsy. Left breast: There are changes of prior breast conservation therapy. There is no MRI evidence of malignancy within the breast. Nodes: There is no axillary or internal mammary adenopathy. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Extensive biopsy-proven multicentric disease involving the medial breast including a site of invasive disease in the lower inner breast involving the medial breast altogether measuring 75 x 15 x 51 mm. BI-RADS 6: Biopsy-proven malignancy. Surgical excision when clinically appropriate. 2. Left Breast: Changes of prior breast conservation therapy without MR evidence of malignancy. 3. No axillary or internal mammary adenopathy. Overall BI-RADS assessment: BI-RADS 6.
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Findings There is interval increase in size of the locally invasive necrotic subglottic mass which presently measures 4.0 x 5.2 x 2.6 cm. Large necrotic bilateral cervical nodes have also increased in size. Left level II node now measures 2.6 x 2.6 cm, previously 2.5 x 2.1 cm. Left tonsillar mass has also increase in size and now measures 2.7 x 3.2 cm, previously 1.5 x 1.5 cm. There is complete obliteration of the laryngeal air way with patent tracheostomy tube. Visualized lung fields are clear. No aggressive lytic or sclerotic osseous lesion is seen. Polypoid lesion in the left maxillary sinus extending into the nasal cavity and posterior nasopharynx is redemonstrated.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 48-year-old woman with history of left breast triple negative invasive ductal carcinoma (2018) status post neoadjuvant chemotherapy and left breast total mastectomy with TRAM flap reconstruction and right breast reduction for symmetry. Examination is performed for supplemental screening. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 130 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior breast MR exams including most recent MR dated 01/25/2021. Prior mammograms including most recent right mammogram dated 6/28/2021. FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: There are changes of prior reduction mammoplasty. There is no suspicious enhancement within the breast. LEFT BREAST: There are changes of prior mastectomy with autologous flap reconstruction. There is no suspicious enhancement within the reconstructed breast. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign. LEFT BREAST: Postsurgical changes from mastectomy with autologous flap reconstruction. No evidence of recurrent or residual disease.: BI-RADS 2: Benign. Overall BI-RADS assessment: BI-RADS 2: Benign. Recommend continued annual mammography and breast MRI. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is scattered fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: There are changes of prior reduction mammoplasty. There is no suspicious enhancement within the breast. LEFT BREAST: There are changes of prior mastectomy with autologous flap reconstruction. There is no suspicious enhancement within the reconstructed breast. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Please see separately dictated same-day CT neck soft tissue. CHEST: LUNGS / AIRWAYS / PLEURA: Mixed groundglass and nodular opacities of the anterior right upper lobe, middle lobe, and lower lobe with tree-in-bud nodularity. The left lung appears clear. Bibasilar subsegmental atelectasis. No pleural effusions. Interval placement of tracheostomy tube with tip terminating at the thoracic inlet. HEART / VESSELS: Segmental pulmonary thromboemboli at the distal left pulmonary artery extending to both the left upper and left lower lobes (for example series 3 images 43 through 58). No evidence of right ventricular dilatation or intraventricular septal deviation to suggest right heart strain. Cardiac chambers and great vessels are normal in size. MEDIASTINUM / ESOPHAGUS: Trace anterior and middle pneumomediastinum, likely post procedural given recent tracheostomy. Weighted esophagogastric tube is seen with tip terminating at the gastric fundus. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of the superior abdomen are unremarkable. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
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RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Migraines, Spec Inst: 20 yo with new onset migraine syndrome this year, daily HAs and episodes of acute neurological deficits; normal outside head CT on 01/09/2022. COMPARISON: None available. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. MR Brain wo+w contrast Patient weight: 192 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: The study is significantly degraded by metallic artifact, possibly secondary to dental amalgam. Limited evaluation of the anterior frontotemporal lobes bilaterally. INTRACRANIAL FINDINGS: Within limitations of the study, no acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. A couple of punctate T2/FLAIR hyperintense foci in the left anterior frontal lobe subcortical white matter. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Limited visualization of the paranasal sinuses and mastoid air cells. The visualized orbits are normal. CONCLUSION: 1. The study is significantly degraded by artifact. Within limitations of the exam, no acute intracranial process or pathologic enhancement. 2. A couple of punctate T2/FLAIR hyperintense foci in the left anterior frontal subcortical white matter. This is a nonspecific finding an can be seen in patients with migraines. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The study is significantly degraded by metallic artifact, possibly secondary to dental amalgam. Limited evaluation of the anterior frontotemporal lobes bilaterally. INTRACRANIAL FINDINGS: Within limitations of the study, no acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. A couple of punctate T2/FLAIR hyperintense foci in the left anterior frontal lobe subcortical white matter. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Limited visualization of the paranasal sinuses and mastoid air cells. The visualized orbits are normal.
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Findings: Image quality is severely degraded due to motion, limiting utility of this exam. There is no evidence of acute intracranial hemorrhage or large territorial infarction. There is hypoattenuation in the left occipital lobe which is likely felt to be artifact. There is mucosal thickening in the right greater than left sphenoid and left maxillary sinus.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 72-year-old woman with history of bilateral breast cancer status post right mastectomy and left breast conservation therapy. hx of right breast cancer, left native breast, Z85.3 Personal history of malignant neoplasm of breast TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 198 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior MR exams including most recent MRI dated 10/21/2020. Prior left mammograms including most recent mammogram dated 08/02/2021. FINDINGS: Right breast: There are changes of prior mastectomy with silicone implant reconstruction. There is focal nonmass enhancement measuring 6 x 7 x 6 mm (AP x TV x CC series 500 image 176, series 7 image 142) in the upper inner quadrant, posterior depth reconstructed breast. Left breast: The breast is extreme fibroglandular. There is mild background parenchymal enhancement. There are changes of prior breast conservation therapy. There is no suspicious enhancement within the breast. Nodes: There is no axillary or internal mammary adenopathy. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Focal nonmass enhancement measuring 6 x 7 x 6 mm in the upper inner quadrant, posterior depth reconstructed breast is suspicious. BI-RADS 4: Suspicious finding. Biopsy is recommended. Recommend targeted ultrasound for biopsy planning. 2. Left Breast: Changes of prior breast conservation therapy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 4.
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FINDINGS: Right breast: There are changes of prior mastectomy with silicone implant reconstruction. There is focal nonmass enhancement measuring 6 x 7 x 6 mm (AP x TV x CC series 500 image 176, series 7 image 142) in the upper inner quadrant, posterior depth reconstructed breast. Left breast: The breast is extreme fibroglandular. There is mild background parenchymal enhancement. There are changes of prior breast conservation therapy. There is no suspicious enhancement within the breast. Nodes: There is no axillary or internal mammary adenopathy. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Focal nonmass enhancement measuring 6 x 7 x 6 mm in the upper inner quadrant, posterior depth reconstructed breast is suspicious. BI-RADS 4: Suspicious finding. Biopsy is recommended. Recommend targeted ultrasound for biopsy planning. 2. Left Breast: Changes of prior breast conservation therapy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 4.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Diffuse, bilateral, peripheral predominant, groundglass opacities with interlobular septal thickening, some of which are associated with subpleural sparing. These are superimposed on a background of by basilar reticulation and mild traction bronchiectasis, right greater than left. No pleural effusions. HEART / OTHER VESSELS: Cardiac chambers and great vessels are normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of superior abdomen demonstrate cholelithiasis without gallbladder wall thickening or pericholecystic fat stranding. Otherwise unremarkable.. MUSCULOSKELETAL: No significant abnormality.
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MR Lumbar Spine wo+w contrast 1/25/2022 5:19 PM Clinical information: 37 years Female patient with lumbar radiculopathy, evaluate for multiple sclerosis and transverse myelitis. Comparison: Lumbar spine radiograph dated 7/9/2020. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, with and without the uneventful administration of intravenous contrast. Patient weight: 205 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: The sagittal images demonstrate preservation of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal, without abnormal enhancement. Incidental L3 vertebral body intraosseous hemangiomas. The intervertebral discs appear well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-L4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-L5: Mild broad-based posterior disc bulge and bilateral facet arthropathy, result in mild bilateral neuroforaminal narrowing, without significant spinal canal stenosis. L5-S1: Mild broad-based posterior disc bulge, epidural lipomatosis extending into the sacral canal and left greater than right facet arthropathy, resulting in mild left-sided neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. IMPRESSION: 1. No acute abnormality or pathologic enhancement of the lumbar spine, distal spinal cord or cauda equina. 2. Early degenerative changes of the lower lumbar spine as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The sagittal images demonstrate preservation of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal, without abnormal enhancement. Incidental L3 vertebral body intraosseous hemangiomas. The intervertebral discs appear well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-L4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-L5: Mild broad-based posterior disc bulge and bilateral facet arthropathy, result in mild bilateral neuroforaminal narrowing, without significant spinal canal stenosis. L5-S1: Mild broad-based posterior disc bulge, epidural lipomatosis extending into the sacral canal and left greater than right facet arthropathy, resulting in mild left-sided neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement.
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Findings: Evolving infarctions in the left cerebral hemisphere with associated mass effect. No significant midline shift. There are subtle hyperdensities corresponding to petechial hemorrhages on the recent MRI in the left frontal lobe. No space-occupying lobar hemorrhage. No new infarction. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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15,542 |
MR Brain wo+w contrast 1/25/2022 5:19 PM Clinical information: 37 years Female patient with intermittent blurry vision, concern for multiple sclerosis. Comparison: MRI brain without contrast dated 6/14/2006. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 205 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. There is no abnormal T2/FLAIR hyperintense signal in the white matter. No abnormal postcontrast enhancement. Incidental left basal ganglia enlarged perivascular spaces at the level of the anterior commissure. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Mild right mastoid effusion. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: No acute intracranial pathology or abnormal enhancement identified. In particular, no MR findings to suggest demyelinating disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. There is no abnormal T2/FLAIR hyperintense signal in the white matter. No abnormal postcontrast enhancement. Incidental left basal ganglia enlarged perivascular spaces at the level of the anterior commissure. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Mild right mastoid effusion. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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Findings: Large left frontoparietal intraparenchymal hemorrhage and surrounding vasogenic edema is grossly unchanged compared to the prior examination. There is persistent rightward midline shift measuring 8 mm, previously measuring 6 mm. There are evolving infarcts in the inferior frontal lobes, left temporal lobe and right cerebellum. There is no new infarction or new intracranial hemorrhage. . There is no hydrocephalus. There are moderate chronic microangiopathic changes in the deep cerebral white matter. There is no acute osseous abnormality. The paranasal sinuses and mastoid air cells are clear. Left-sided nasogastric tube is in place.
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EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Cervical cancer, status post chemotherapy. COMPARISON: PET/CT dated 12/20/2021 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 210 lbs. IV contrast: ProHance, 10 ml, per protocol. FINDINGS: STRUCTURED REPORT: MRI Pelvis Please note the patient requested vaginal gel not be administered. LOWER ABDOMEN: BOWEL: No involvement of the rectum by the cervical mass. PERITONEUM: Normal. OTHER: Small amount of fluid in the cul-de-sac. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: Previously described FDG avid lymph nodes appear grossly stable in size allowing for differences in modality. For example, the left external iliac lymph node demonstrates an atypical rounded morphology with slightly spiculated margins and measures approximately 9 mm (series 701, image 45 and image 40 series 801). PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Probable extension of heterogeneous cervical mass signal abnormality into the posterior bladder wall (series 301, image 20). REPRODUCTIVE ORGANS: Abnormal T2 hyperintense signal involving the cervix and lower uterine segment spanning an area of approximately 4.0 x 3.3 cm (series 301, image 21) with heterogeneous postcontrast enhancement. The cervical os is patent without evidence of obstruction/distended endometrial canal. The uterus is anteflexed/anteverted. Bilateral ovaries are normal in appearance.. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No vaginal gel administered per patient request. 2. Large cervical mass with probable involvement of the posterior bladder wall as described. 3. Grossly unchanged size of bilateral external iliac lymph nodes, which were suspicious for nodal metastases on prior PET/CT. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Pelvis Please note the patient requested vaginal gel not be administered. LOWER ABDOMEN: BOWEL: No involvement of the rectum by the cervical mass. PERITONEUM: Normal. OTHER: Small amount of fluid in the cul-de-sac. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: Previously described FDG avid lymph nodes appear grossly stable in size allowing for differences in modality. For example, the left external iliac lymph node demonstrates an atypical rounded morphology with slightly spiculated margins and measures approximately 9 mm (series 701, image 45 and image 40 series 801). PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Probable extension of heterogeneous cervical mass signal abnormality into the posterior bladder wall (series 301, image 20). REPRODUCTIVE ORGANS: Abnormal T2 hyperintense signal involving the cervix and lower uterine segment spanning an area of approximately 4.0 x 3.3 cm (series 301, image 21) with heterogeneous postcontrast enhancement. The cervical os is patent without evidence of obstruction/distended endometrial canal. The uterus is anteflexed/anteverted. Bilateral ovaries are normal in appearance.. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Imaged portions of the neck soft tissues demonstrate a left internal jugular central venous catheter with tip terminating at the left brachiocephalic vein CHEST: LUNGS / AIRWAYS / PLEURA: Postsurgical changes of left lung transplant. Scattered ground glass opacities and micronodules throughout the transplanted left lung, most prominent within the left lower lobe. Small, partially loculated left pleural effusion with adjacent passive atelectasis. The native right lung moderate to advanced centrilobular emphysema with calcified right apical pleural parenchymal scarring. Right lung is otherwise clear. HEART / VESSELS: Cardiac chambers are normal in size. No pericardial effusion. Atherosclerotic calcifications of the distal ascending thoracic aorta, aortic arch, and descending thoracic aorta without aneurysmal dilatation MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of superior abdomen are unremarkable. MUSCULOSKELETAL: Osteoporosis. No aggressive osseous lesion or acute fracture. Partially imaged ACDF hardware at C7.
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MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 71-year-old woman with history of right breast invasive ductal carcinoma status post mastectomy in 1998. Examination is performed for supplemental screening. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 129 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: MR breast 1/26/2017 and mammogram and ultrasound 1/25/2022. CT abdomen and pelvis 5/13/2021 FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: Postsurgical changes from right mastectomy. No suspicious mass or nonmass enhancement in the surgical bed. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Scattered T2 hyperintense cysts in the liver and parapelvic renal cysts are redemonstrated. Marrow signal is normal. IMPRESSION: RIGHT BREAST: Postsurgical changes from right mastectomy without evidence of recurrent or residual disease.: BI-RADS 2: Benign. LEFT BREAST: No MRI evidence of malignancy.: BI-RADS 1: Negative. Overall BI-RADS assessment: BI-RADS 2: Benign. Continued annual breast MRI is recommended. Patient will be due for follow-up left axillary ultrasound in three months. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is heterogeneous fibroglandular tissue. Postcontrast administration there is minimal background enhancement. RIGHT BREAST: Postsurgical changes from right mastectomy. No suspicious mass or nonmass enhancement in the surgical bed. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. BILATERAL Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Scattered T2 hyperintense cysts in the liver and parapelvic renal cysts are redemonstrated. Marrow signal is normal.
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FINDINGS: BONES/JOINTS: Acute, comminuted fracture of the inferolateral patella. Suspected nondisplaced fracture of the anterolateral right lateral femoral condyle (series 201 image 264). Small volume upper patellar knee joint lipohemarthrosis. ACL and PCL appear grossly intact. Small bone island of the distal right femoral diaphysis. SOFT TISSUES: Extensive soft tissue edema of the anteromedial right knee soft tissues. There is stranding within Hoffa's fat pad.
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EXAM: MR Hip Right wo contrast, MR Hip Left wo contrast CLINICAL INFORMATION: Bilateral hip pain COMPARISON: Radiographs dated 12/22/2020 and MRI dated 11/2/2020 TECHNIQUE: Multiplanar and multisequence MRI of the bilateral hips was obtained without intravenous contrast. FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. RIGHT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Near full-thickness articular cartilage loss with associated extensive marrow edema within the acetabulum and femoral head as well as subchondral cystic changes. Capsule and ligaments:Normal. LEFT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Mild joint space loss with prominent subchondral cyst in the acetabular roof. Trace subchondral marrow edema is noted. Capsule and ligaments:Normal. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: 1. Severe right and moderate left osteoarthritis of the hips. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. RIGHT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Near full-thickness articular cartilage loss with associated extensive marrow edema within the acetabulum and femoral head as well as subchondral cystic changes. Capsule and ligaments:Normal. LEFT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Mild joint space loss with prominent subchondral cyst in the acetabular roof. Trace subchondral marrow edema is noted. Capsule and ligaments:Normal. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis.
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Findings: There is no acute infarction, hemorrhage, or brain edema. There is no intracranial mass or hydrocephalus. Cavum septum pellucida et vergae is incidentally noted. Orbits appear normal. There is no acute osseous abnormality. Air-fluid level in the right maxillary sinus and mild mucosal thickening in the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear.
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EXAM: MR Hip Right wo contrast, MR Hip Left wo contrast CLINICAL INFORMATION: Bilateral hip pain COMPARISON: Radiographs dated 12/22/2020 and MRI dated 11/2/2020 TECHNIQUE: Multiplanar and multisequence MRI of the bilateral hips was obtained without intravenous contrast. FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. RIGHT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Near full-thickness articular cartilage loss with associated extensive marrow edema within the acetabulum and femoral head as well as subchondral cystic changes. Capsule and ligaments:Normal. LEFT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Mild joint space loss with prominent subchondral cyst in the acetabular roof. Trace subchondral marrow edema is noted. Capsule and ligaments:Normal. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis. CONCLUSION: 1. Severe right and moderate left osteoarthritis of the hips. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES: No fracture, marrow replacement or aggressive osseous lesion. RIGHT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Near full-thickness articular cartilage loss with associated extensive marrow edema within the acetabulum and femoral head as well as subchondral cystic changes. Capsule and ligaments:Normal. LEFT HIP JOINT: Alignment: Normal. Effusion: None. Labrum: Degenerative signal is noted within the labrum. Cartilage: Mild joint space loss with prominent subchondral cyst in the acetabular roof. Trace subchondral marrow edema is noted. Capsule and ligaments:Normal. MUSCLES/TENDON: Normal. VESSELS:No significant disease. NERVES: Normal. INTRAPELVIC: No visceral or solid organ abnormality within the pelvis. No lymphadenopathy. No free fluid in the pelvis.
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FINDINGS: No acute maxillofacial or mandibular fracture. No suspicious osseous lesion is identified. Complete opacification of the left frontal sinus and frontoethmoidal recess with retained hyperdense secretions. Patchy opacification of the ethmoid air cells bilaterally and mucosal thickening of bilateral maxillary sinuses with right-sided maxillary mucosal retention cyst. The mastoid air cells are clear. The orbits are normal in appearance. Soft tissues are unremarkable. Visualized portions of brain demonstrate no acute abnormality. Periapical lucency along the right central incisor, likely related to a small periapical abscess
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Lumbar MRI without contrast - Clinical indication: lumbar stenosis, M48.061 Spinal stenosis, lumbar region without neurogenic claudication Spec Inst: lumbar stenosis. - Technique: Multiple T1 and T2 weighted MR sequence images of the lumbar spine were obtained in the axial and sagittal plane without the use of intravenous contrast per departmental cervical spine protocol. - Comparison: MR lumbar spine with and without contrast November 2, 2020.. - Findings: Sagittal imaging demonstrates vertebral body heights, and alignment to be maintained. Narrowing of the lumbar canal secondary to short pedicles. Multilevel degenerative changes with anterior and posterior osteophytes, multilevel disc desiccation. Reduction in disc height at L2-3 and L5-S1. Prominence of the posterior epidural fat. The marrow signal appears maintained. The conus terminates at L1 Axial images are evaluated on a level by level basis: - T12-L1: No significant disc bulge. No central or neuroforaminal stenosis. Bilateral facet arthropathy and ligamentum flavum thickening.. - L1-2: Mild bulge indenting the ventral thecal sac. No significant central narrowing. Bilateral facet arthropathy and ligamentum flavum thickening.. - L2-3: Diffuse bulge and bilateral facet arthropathy with ligamentum flavum thickening and prominent posterior epidural fat causes severe thecal sac narrowing AP diameter 6 mm. Mild left neuroforaminal narrowing. - L3-4: Diffuse bulge bilateral facet arthropathy and ligamentum flavum thickening, epidural fat causing severe central stenosis AP thecal sac diameter 7mm.. Mild left and Mild/moderate right neural foraminal narrowing. - L4-5: Diffuse bulge bilateral facet arthropathy and ligamentum flavum thickening, epidural fat causing severe central stenosis AP thecal sac diameter 4mm. Moderate bilateral neural foraminal narrowing. - L5-S1: Small right paracentral disc extrusion with mass effect on the descending right S1 nerve. Bilateral facet arthropathy. No significant central or neuroforaminal stenosis.. - The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. - Impression: 1. Multilevel degenerative changes with multilevel thecal sac narrowing most pronounced at L4-5, similar to prior. 2. A new small right paracentral disc extrusion with mass effect on the descending right S1 nerve root. -
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Findings: Sagittal imaging demonstrates vertebral body heights, and alignment to be maintained. Narrowing of the lumbar canal secondary to short pedicles. Multilevel degenerative changes with anterior and posterior osteophytes, multilevel disc desiccation. Reduction in disc height at L2-3 and L5-S1. Prominence of the posterior epidural fat. The marrow signal appears maintained. The conus terminates at L1 Axial images are evaluated on a level by level basis: - T12-L1: No significant disc bulge. No central or neuroforaminal stenosis. Bilateral facet arthropathy and ligamentum flavum thickening.. - L1-2: Mild bulge indenting the ventral thecal sac. No significant central narrowing. Bilateral facet arthropathy and ligamentum flavum thickening.. - L2-3: Diffuse bulge and bilateral facet arthropathy with ligamentum flavum thickening and prominent posterior epidural fat causes severe thecal sac narrowing AP diameter 6 mm. Mild left neuroforaminal narrowing. - L3-4: Diffuse bulge bilateral facet arthropathy and ligamentum flavum thickening, epidural fat causing severe central stenosis AP thecal sac diameter 7mm.. Mild left and Mild/moderate right neural foraminal narrowing. - L4-5: Diffuse bulge bilateral facet arthropathy and ligamentum flavum thickening, epidural fat causing severe central stenosis AP thecal sac diameter 4mm. Moderate bilateral neural foraminal narrowing. - L5-S1: Small right paracentral disc extrusion with mass effect on the descending right S1 nerve. Bilateral facet arthropathy. No significant central or neuroforaminal stenosis.. - The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. -
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy groundglass opacities in the right greater than left upper lobes. Scattered subsegmental atelectasis, most prominent at the bases. Trace left effusion. Endotracheal tube tip 3.5 cm above carina. HEART / VESSELS: Left IJ CVL with tip in proximal right atrium. Nonocclusive filling defect in the right brachiocephalic vein. Mild enlargement of the main pulmonary artery measuring 3.9 cm, similar to prior. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube. LYMPH NODES: Mildly enlarged right paratracheal node measuring 1.5 cm (series 6 image 46), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse steatosis. Hepatomegaly and Riedel lobe. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Upper normal in size. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube with tip in gastric body. No small bowel abnormality. COLON / APPENDIX: No abnormality. Fecal incontinence. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Mostly obscured by ring artifact. Previously noted pelvic sidewall and perivesicular collections are not well evaluated, although there is no gross enlargement. BODY WALL: Moderate anasarca, unchanged. Temporary abdominal closure with wound VAC in place, similar to prior. Scattered cutaneous defects with interval placement of packing material. MUSCULOSKELETAL: Diffuse muscular atrophy. Degenerative spine changes.
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MR Breast Diagnostic Bil wo+w contrast Clinical Information: Right Breast Cancer, C50.919 Malignant neoplasm of unspecified site of unspecified female breast Spec Inst: Right Breast 10:00 and Right Axilla Neoplasm Evaluate end of treatment response to chemotherapy Technique: Three plane localizer, T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. Patient weight: 227 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Comparison: Mammogram and ultrasound 1/26/2022, breast MRI 7/30/2021 Amount of fibroglandular tissue: Scattered fibroglandular tissue Background enhancement: Minimal Motion degrades image quality. Findings: Right breast: There is minimal, faint enhancement around postbiopsy clip in the upper outer right breast, barely measuring 7 x 5 x 3 mm (Series 400 image #132, Series 6 image #179). There is another circumscribed oval enhancing mass at 9:00 right breast, measuring 9 x 5 x 5 mm (Series 400 image #122, Series 6 image #187). This is within the extent of the previous malignancy seen on the prior MRI dated 7/30/2021 and likely seen retrospectively. Left breast: There are no suspicious masses or suspicious enhancement in the left breast. Lymph nodes: No axillary lymphadenopathy on either side. One of the lymph node in the right axilla shows associated clip artifact, however, not enlarged (series 3 image #65). No internal mammary lymphadenopathy on either side. Conclusion: Right breast: 1. Minimal enhancement around the biopsy clip in the upper outer right breast, at the area of known malignancy. 2. A subcentimeter oval mass at 9:00 right breast, within the original extent of the known malignancy. Ultrasound-guided core biopsy can be performed, if clinically indicated. BI-RADS 4: Suspicious findings Left breast: No MRI evidence of malignancy. BI-RADS 1: Negative Final BIRADS; BI-RADS 4: Suspicious findings
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Findings: Right breast: There is minimal, faint enhancement around postbiopsy clip in the upper outer right breast, barely measuring 7 x 5 x 3 mm (Series 400 image #132, Series 6 image #179). There is another circumscribed oval enhancing mass at 9:00 right breast, measuring 9 x 5 x 5 mm (Series 400 image #122, Series 6 image #187). This is within the extent of the previous malignancy seen on the prior MRI dated 7/30/2021 and likely seen retrospectively. Left breast: There are no suspicious masses or suspicious enhancement in the left breast. Lymph nodes: No axillary lymphadenopathy on either side. One of the lymph node in the right axilla shows associated clip artifact, however, not enlarged (series 3 image #65). No internal mammary lymphadenopathy on either side.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy groundglass opacities in the right greater than left upper lobes. Scattered subsegmental atelectasis, most prominent at the bases. Trace left effusion. Endotracheal tube tip 3.5 cm above carina. HEART / VESSELS: Left IJ CVL with tip in proximal right atrium. Nonocclusive filling defect in the right brachiocephalic vein. Mild enlargement of the main pulmonary artery measuring 3.9 cm, similar to prior. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube. LYMPH NODES: Mildly enlarged right paratracheal node measuring 1.5 cm (series 6 image 46), likely reactive. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Diffuse steatosis. Hepatomegaly and Riedel lobe. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Normal. SPLEEN: Upper normal in size. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube with tip in gastric body. No small bowel abnormality. COLON / APPENDIX: No abnormality. Fecal incontinence. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Mostly obscured by ring artifact. Previously noted pelvic sidewall and perivesicular collections are not well evaluated, although there is no gross enlargement. BODY WALL: Moderate anasarca, unchanged. Temporary abdominal closure with wound VAC in place, similar to prior. Scattered cutaneous defects with interval placement of packing material. MUSCULOSKELETAL: Diffuse muscular atrophy. Degenerative spine changes.
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RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Brain metastases, monitor. Per chart review, history of stage IV lung adenocarcinoma metastatic to the brain status post chemoradiation completed November 2020. Status post SRS for treatment of brain metastases completed 10/26/2021. COMPARISON: MRI brain dated 11/30/2021, 10/6/2021, 9/24/2021, 9/8/2020. TECHNIQUE: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes pre- and post administration of intravenous contrast per departmental protocol. MR Brain wo+w contrast Patient weight: 163 lbs. IV contrast: ProHance, 16 ml, per protocol. FINDINGS: The study is mildly degraded by motion artifact. INTRACRANIAL FINDINGS: Slight interval increase in size of right posterior parietal enhancing lesion, now measuring 0.6 x 0.5 cm (series 1003, image 54), previously 0.4 x 0.2 cm (series 10, image 22). No significant interval change in size or appearance of enhancing lesions in the right frontal lobe, left occipital lobe, or left cerebellar hemisphere as described below. Confluent vasogenic edema associated with the left occipital lobe lesion, overall unchanged. Foci of susceptibility artifact within these lesions, increased compared to prior, likely radiation posttreatment blood products. * Right frontal lobe: 0.9 x 0.4 cm (series 1003, image 62), previously 1.0 x 0.4 cm (series 10, image 146) * Left occipital lobe: 1.3 x 0.9 cm (series 1003, image 37), previously 1.2 x 0.8 cm (series 10, image 83) * Left cerebellar hemisphere: 0.2 x 0.3 cm (series 1003, image 18), previously 0.3 x 0.3 cm (series 10, image 43) Additional punctate focus of susceptibility artifact in the right cerebellar hemisphere, likely chronic microhemorrhage. No acute intraparenchymal infarct, hydrocephalus, or extra-axial collection. Multifocal periventricular, deep cerebral, and subcortical T2/FLAIR hyperintensities in the bilateral cerebral white matter, likely chronic microangiopathic changes, similar to prior. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Mild mucosal thickening of the bilateral ethmoid sinuses. Trace right mastoid effusion, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements. CONCLUSION: 1. Slight enlargement of right posterior parietal and left occipital enhancing metastatic lesions as described.. 2. Stable right frontal lobe left cerebellar hemisphere metastases. Interval increase in blood products within these lesions, likely radiation posttreatment changes. 3. No new lesions. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The study is mildly degraded by motion artifact. INTRACRANIAL FINDINGS: Slight interval increase in size of right posterior parietal enhancing lesion, now measuring 0.6 x 0.5 cm (series 1003, image 54), previously 0.4 x 0.2 cm (series 10, image 22). No significant interval change in size or appearance of enhancing lesions in the right frontal lobe, left occipital lobe, or left cerebellar hemisphere as described below. Confluent vasogenic edema associated with the left occipital lobe lesion, overall unchanged. Foci of susceptibility artifact within these lesions, increased compared to prior, likely radiation posttreatment blood products. * Right frontal lobe: 0.9 x 0.4 cm (series 1003, image 62), previously 1.0 x 0.4 cm (series 10, image 146) * Left occipital lobe: 1.3 x 0.9 cm (series 1003, image 37), previously 1.2 x 0.8 cm (series 10, image 83) * Left cerebellar hemisphere: 0.2 x 0.3 cm (series 1003, image 18), previously 0.3 x 0.3 cm (series 10, image 43) Additional punctate focus of susceptibility artifact in the right cerebellar hemisphere, likely chronic microhemorrhage. No acute intraparenchymal infarct, hydrocephalus, or extra-axial collection. Multifocal periventricular, deep cerebral, and subcortical T2/FLAIR hyperintensities in the bilateral cerebral white matter, likely chronic microangiopathic changes, similar to prior. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Mild mucosal thickening of the bilateral ethmoid sinuses. Trace right mastoid effusion, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Bilateral ocular lens replacements.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Common origin of the brachiocephalic and left common carotid arteries. RIGHT CAROTID: Mild atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. LEFT CAROTID: Mild atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: Atherosclerotic narrowing of bilateral intracranial carotid siphons without evidence of aneurysm or dissection. The right A1 segment is hypoplastic. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. The left V4 segment is hypoplastic. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Thyroid is surgically absent. Soft tissues of the neck are otherwise unremarkable. Mild multilevel discogenic degenerative changes of the cervical spine. Visualized lung apices are clear.
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RADIOLOGIC EXAM: MR Facial Bones wo+w contrast CLINICAL INFORMATION: Desmoplastic fibroma. Per chart review, status post right disarticulation mandibulectomy for infratemporal fossa approach with tumor resection, right parotidectomy, facial nerve preservation, right retromolar trigone tumor resection, selective neck dissection, tracheostomy on 11/2/2021. Status post right fibular free flap harvest, partial pharyngoplasty reconstruction, right mandibular osteoplasty reconstruction on 11/2/2021. COMPARISON: MRI facial bones dated 9/25/2021. CT neck dated 9/13/2021. TECHNIQUE: Multiplanar, multisequence MRI of the facial bones was obtained pre- and post administration of intravenous contrast per departmental protocol. MR Facial Bones wo+w contrast Patient weight: 110 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: The study is mildly degraded by pulsation artifact. EXTRACRANIAL FINDINGS: Interval postsurgical changes from prior right-sided masticator space tumor resection, partial mandibulectomy, parotidectomy, retromolar trigone and neck dissection, as well as pharyngeal reconstruction with flap reconstruction and fat packing. No focal masslike enhancement in the resection bed, diffuse enhancement of the right masticator space muscles. Trace mucosal thickening of the bilateral anterior ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. INTRACRANIAL FINDINGS: The imaged brain demonstrates no acute intraparenchymal infarct, edema, hydrocephalus, space-occupying lesion, or mass effect. No intracranial pathologic enhancement. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal. CONCLUSION: 1. No acute intracranial process. 2. Interval right masticator space postsurgical changes without focal masslike enhancement in the resection bed to suggest residual or recurrent tumor. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The study is mildly degraded by pulsation artifact. EXTRACRANIAL FINDINGS: Interval postsurgical changes from prior right-sided masticator space tumor resection, partial mandibulectomy, parotidectomy, retromolar trigone and neck dissection, as well as pharyngeal reconstruction with flap reconstruction and fat packing. No focal masslike enhancement in the resection bed, diffuse enhancement of the right masticator space muscles. Trace mucosal thickening of the bilateral anterior ethmoid air cells. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. INTRACRANIAL FINDINGS: The imaged brain demonstrates no acute intraparenchymal infarct, edema, hydrocephalus, space-occupying lesion, or mass effect. No intracranial pathologic enhancement. The ventricular system is normal in caliber and configuration. The basal cisterns are clear. The visualized proximal cerebrovascular flow voids appear normal.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Common origin of the brachiocephalic and left common carotid arteries. RIGHT CAROTID: Mild atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. LEFT CAROTID: Mild atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: Atherosclerotic narrowing of bilateral intracranial carotid siphons without evidence of aneurysm or dissection. The right A1 segment is hypoplastic. The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. The left V4 segment is hypoplastic. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Thyroid is surgically absent. Soft tissues of the neck are otherwise unremarkable. Mild multilevel discogenic degenerative changes of the cervical spine. Visualized lung apices are clear.
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15,551 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma. COMPARISON: Abdominal ultrasound dated 12/29/2021. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 111 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: No focal hepatic lesion with arterial hyperenhancement and washout is identified to suggest the presence of hepatocellular carcinoma. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: No focal hepatic lesion with arterial hyperenhancement and washout is identified to suggest the presence of hepatocellular carcinoma. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: Small (
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FINDINGS: There is no acute territorial loss of gray-white differentiation. Asymmetric hypodensities in the left centrum semiovale. There is no intracranial hemorrhage or extra-axial collection. There is no intracranial mass effect or midline shift. The ventricular caliber and configuration are within normal limits. Basal cisterns are patent. Imaged portions of the orbits are grossly unremarkable. Minor scattered paranasal mucosal thickening. The mastoid air cells are clear. No calvarial fracture is appreciated.
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15,552 |
MR Brain wo+w contrast 1/26/2022 12:08 PM Clinical Information: Follow-up for grade II astrocytoma, status post bifrontal craniotomy for left frontal lobe tumor resection. Comparison: Preoperative Brain MRI dated 1/13/2022 Technique: Multiplanar MR imaging was performed with and without contrast as per departmental protocol.. Patient weight: 158 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: Stable postsurgical changes with bifrontal craniotomy and resection of the medial left frontal lobe mass. Resection of the non enhancing left frontal lobe mass with blood products in the operative bed. No abnormal post contrast enhancement identified. There is a right frontal cavernoma. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Evidence of frontal craniotomy is noted Impression: 1.Expected post surgical changes status post resection of left frontal lobe mass. No definite residual mass identified. No abnormal post contrast enhancement. 2. Stable right frontal cavernoma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Stable postsurgical changes with bifrontal craniotomy and resection of the medial left frontal lobe mass. Resection of the non enhancing left frontal lobe mass with blood products in the operative bed. No abnormal post contrast enhancement identified. There is a right frontal cavernoma. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Evidence of frontal craniotomy is noted
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Findings: Images are degraded due to to involuntary patient motion. RAPID images demonstrate CBF less than 30% volume: 0 cc and T. Max greater than 6seconds volume: 6 cc. Mismatch volume is 6 cc. Six cc region of ischemia involving bilateral medial cerebellum by automated analysis.
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15,553 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Assessment liver lesion, rule out metastasis, versus HCC, versus benign, C43.9 Malignant melanoma of skin, unspecified COMPARISON: CT abdomen pelvis dated 1/4/2022 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 300 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic and mildly steatotic. Arterial phase is limited by motion artifact, however no suspicious focal arterial enhancement is identified. On delayed phases, there is no evidence of washout to suggest presence of metastasis or HCC. Multiple cysts are seen scattered throughout the liver. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Mild splenomegaly. ADRENALS: Thickening of the left adrenal gland without discrete mass. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No evidence of abnormal arterial enhancement seen within the liver, specifically at the dome (as was present on the recent CT), although exam is moderately limited by motion. Additionally, there is no evidence of washout on delayed phases or restricted diffusion to suggest the presence of metastasis or HCC. 2. Hepatic cirrhosis with splenomegaly suggestive of portal hypertension. 3. No evidence of additional metastases within the imaged abdomen. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic and mildly steatotic. Arterial phase is limited by motion artifact, however no suspicious focal arterial enhancement is identified. On delayed phases, there is no evidence of washout to suggest presence of metastasis or HCC. Multiple cysts are seen scattered throughout the liver. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Mild splenomegaly. ADRENALS: Thickening of the left adrenal gland without discrete mass. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small sliding-type hiatal hernia. HEART / VESSELS: Cardiovascular calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cysts. Otherwise normal aside from mild cortical scarring and nonspecific perinephric stranding bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Noninflamed colonic diverticula. Appendix is normal. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Moderate aortoiliac atherosclerotic disease without aneurysm URINARY BLADDER: Mildly distended. Otherwise normal REPRODUCTIVE ORGANS: Prior hysterectomy. No acute abnormality. BODY WALL: Unremarkable MUSCULOSKELETAL: Chronic L1 compression deformity. No acute fracture or destructive osseous lesion.
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15,554 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Corticated osseous fragment inferior to the tip of the lateral malleolus likely represents sequela from remote trauma. Mild soft tissue edema throughout the ankle and foot. SOFT TISSUES: No large hematoma or fluid collection.
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15,555 |
EXAM: CV MR Cardiac w contrast, CV MR for Velocity Flow DATE OF STUDY: 1/25/2022 2:40 PM - REFERRING MD: Zubair Khan PATIENT DATA Height: 172 cm. Patient weight: 68 kg. BSA: 1.80247 Blood Pressure: 132/65 Heart Rate: 95 bpm. EGFR 49. The patient's creatinine was 1.4 on 01/25/22. The patient received 14 cc's of gadavist at a rate of 2 ml per second without immediate complication. INDICATION: Patient studied for evaluation of: cardiomyopathy, I42.9 Cardiomyopathy, unspecified HISTORY: 82 year old man with past medical history of CAD and systolic heart failure, which he subsequently had PCI to TCA and LAD/diagonal branch 7/23/21. COMPARISON TO: No prior IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIOVASCULAR MRI TECHNIQUE: Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta Sequences: FSE 2IR SSFP FGRE ET perfusion Additional views: delayed contrast enhancement General: ECG gated: yes FINDINGS: CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION The right and left ventricular volumes and functions were compared to the reference values from "Kawel-Boehm et al. Journal of Cardiovascular Magnetic Resonance (2015) 17:29, DOI 10.1186/s12968-015-0111-7". A - LEFT VENTRICLE: Morphology and function: The left ventricular size is severely dilated (LVEDVi: 130.02 mL/m\S\2). The left ventricular systolic function is severely reduced. The LVEF is 27%. There is severe global left ventriclar hypokinesis. There is thinning and akinesis of the mid and apical anterior, mid anterolateral and the apical lateral segments. There is dyssynchrony of the septum. There is no perfusion defect at rest with first pass imaging. Overall, there is a large amount of late gadolinium enhancement (LGE) as follows: there is subendocardial LGE involving the entire anterolateral wall (50% at the mid and transmural at the apex), there is subendocardial LGE involving the entire anterior wall ((50% at the mid and apex), there is subendocardial LGE involving the basal and mid inferior wall (50% transmurality), there is subendocardial LGE involving the basal and mid inferolateral (50% at the mid), there is subendocardial LGE at the basal inferoseptum (50%). Left Ventricle measurements: LV End Diastolic Dimension: 57.3 mm LV End Systolic Dimension: 48.5 mm LV Posterior Wall: 8.7 mm Interventricular Septum: 10.0 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 245.64 mL - EDV Index = 130.02 mL/m2 End Systolic Volume: 179.94 mL - ESV Index = 95.25 mL/m2 Stroke Volume: 65.7 mL - SV Index = 34.77 mL/m2 Ejection Fraction: 26.74% B - RIGHT VENTRICLE: Morphology and function: The right ventricular size is normal. The right ventricular systolic function is normal. Right Ventricle measurements: RV End Diastolic Dimension: 43.0 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 113.11 mL - EDV Index = 59.63 mL/m2 End Systolic Volume: 54.16 mL - ESV Index = 28.55 mL/m2 Stroke Volume: 58.95 mL - SV Index = 31.08 mL/m2 Ejection Fraction: 52.12% C - ATRIA: Mildly dilated left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Left Atrium: 41.8 mm Right Atrium: 50.2 mm D - VALVES: Mitral: Mildly thickened anterior leaflet Regurgitation: mild-moderate, functional mitral regurgitation. Based on 2D phase contrast imaging, the regurgitant volume is 15.54 mL and the regurgitant fraction is 24%. Stenosis: None Aortic: tricuspid Regurgitation: trivial Stenosis: None Tricuspid: Normal Regurgitation: None Stenosis: None Pulmonary: Not well visualized E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The main pulmonary artery is mildly dilated. The thoracic aorta is normal in caliber. Vessel dimensions: Main Pulmonary Artery: 33.5 mm Aortic Root: 33.5 mm Ascending Aorta: 33.8 [19-37] mm Descending Aorta: 23.1 [16-29] mm F - PERICARDIUM: The pericardium is normal in thickness and SI. No evidence of pericardial effusion. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable. Degenerative changes of the spine. CONCLUSIONS: 1. The left ventricular size is severely dilated (LVEDVi: 130.02 mL/m\S\2). The left ventricular systolic function is severely reduced. The LVEF is 27%. There is severe global left ventriclar hypokinesis. There is thinning and akinesis of the mid and apical anterior, mid anterolateral and the apical lateral segments. There is dyssynchrony of the septum. 2. There is no perfusion defect at rest with first pass imaging. Overall, there is a large amount of late gadolinium enhancement (LGE) as follows: there is subendocardial LGE involving the entire anterolateral wall (50% at the mid and transmural at the apex), there is subendocardial LGE involving the entire anterior wall ((50% at the mid and apex), there is subendocardial LGE involving the basal and mid inferior wall (50% transmurality), there is subendocardial LGE involving the basal and mid inferolateral (50% at the mid), there is subendocardial LGE at the basal inferoseptum (50%). 3. The right ventricular size is normal. The right ventricular systolic function is normal. 4. Mildly dilated left and right atrium. No thrombus in the visualized segments of the left atrial appendage. 5. Mildly thickened anterior leaflet of the mitral valve. There is mild-moderate, functional mitral regurgitation. Based on 2D phase contrast imaging, the regurgitant volume is 15.54 mL and the regurgitant fraction is 24%. 6. The main pulmonary artery is mildly dilated. 7. Degenerative changes of the spine. Overall, viability assessment as follows: Left Anterior Descending territory: non viable at the mid and apical segments Left Circumflex territory: non viable at the mid and apical segments Right Coronary Artery territory: viable Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION The right and left ventricular volumes and functions were compared to the reference values from "Kawel-Boehm et al. Journal of Cardiovascular Magnetic Resonance (2015) 17:29, DOI 10.1186/s12968-015-0111-7". A - LEFT VENTRICLE: Morphology and function: The left ventricular size is severely dilated (LVEDVi: 130.02 mL/m\S\2). The left ventricular systolic function is severely reduced. The LVEF is 27%. There is severe global left ventriclar hypokinesis. There is thinning and akinesis of the mid and apical anterior, mid anterolateral and the apical lateral segments. There is dyssynchrony of the septum. There is no perfusion defect at rest with first pass imaging. Overall, there is a large amount of late gadolinium enhancement (LGE) as follows: there is subendocardial LGE involving the entire anterolateral wall (50% at the mid and transmural at the apex), there is subendocardial LGE involving the entire anterior wall ((50% at the mid and apex), there is subendocardial LGE involving the basal and mid inferior wall (50% transmurality), there is subendocardial LGE involving the basal and mid inferolateral (50% at the mid), there is subendocardial LGE at the basal inferoseptum (50%). Left Ventricle measurements: LV End Diastolic Dimension: 57.3 mm LV End Systolic Dimension: 48.5 mm LV Posterior Wall: 8.7 mm Interventricular Septum: 10.0 mm Left Ventricle Volumes (short axis): End Diastolic Volume: 245.64 mL - EDV Index = 130.02 mL/m2 End Systolic Volume: 179.94 mL - ESV Index = 95.25 mL/m2 Stroke Volume: 65.7 mL - SV Index = 34.77 mL/m2 Ejection Fraction: 26.74% B - RIGHT VENTRICLE: Morphology and function: The right ventricular size is normal. The right ventricular systolic function is normal. Right Ventricle measurements: RV End Diastolic Dimension: 43.0 mm Right Ventricle Volumes (short axis): End Diastolic Volume: 113.11 mL - EDV Index = 59.63 mL/m2 End Systolic Volume: 54.16 mL - ESV Index = 28.55 mL/m2 Stroke Volume: 58.95 mL - SV Index = 31.08 mL/m2 Ejection Fraction: 52.12% C - ATRIA: Mildly dilated left and right atrium. No thrombus in the visualized segments of the left atrial appendage. Left Atrium: 41.8 mm Right Atrium: 50.2 mm D - VALVES: Mitral: Mildly thickened anterior leaflet Regurgitation: mild-moderate, functional mitral regurgitation. Based on 2D phase contrast imaging, the regurgitant volume is 15.54 mL and the regurgitant fraction is 24%. Stenosis: None Aortic: tricuspid Regurgitation: trivial Stenosis: None Tricuspid: Normal Regurgitation: None Stenosis: None Pulmonary: Not well visualized E - GREAT ARTERIES: Left-sided aortic arch with normal branching pattern. The main pulmonary artery is mildly dilated. The thoracic aorta is normal in caliber. Vessel dimensions: Main Pulmonary Artery: 33.5 mm Aortic Root: 33.5 mm Ascending Aorta: 33.8 [19-37] mm Descending Aorta: 23.1 [16-29] mm F - PERICARDIUM: The pericardium is normal in thickness and SI. No evidence of pericardial effusion. G - LUNG, PLEURA AND OTHER NONCARDIOVASCULAR STRUCTURES: There is no pleural effusion. The visualized lungs are grossly unremarkable. Degenerative changes of the spine.
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FINDINGS: There is a partially calcified dural based 1.1 cm right posterior fossa lesion. There is no acute territorial loss of gray-white differentiation. There is chronic encephalomalacia in the left frontal lobe. There is no intracranial hemorrhage or extra-axial collection. There is no midline shift. Mild chronic parenchymal loss with associated ventricular prominence. Basal cisterns are patent. Imaged portions of the orbits are grossly unremarkable. Minor scattered paranasal mucosal thickening. The mastoid air cells are clear. No calvarial fracture is appreciated.
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15,556 |
EXAM: CV MR Cardiac w contrast, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/26/2022 11:15 AM Referring MD: Steven Lloyd Height: 173 cm. Patient weight: 53 kg. BSA: 1.59591 Blood Pressure: 116/63 Heart Rate: 82 bpm. EGFR 60. The patient's creatinine was 0.8 on 01/26/22. The patient received 10 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: arrythmia, I47.2 Ventricular tachycardia History: 20 year old woman with past medical history of connective tissue disease and palpitations presenting for CMR COMPARISON: no prior CMR TECHNIQUE: CV MR Cardiac w contrast, CV MR for Velocity Flow FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR FSE 3IR SPGR SS SSFP FGRE ET perfusion Additional views: delayed contrast enhancement, phase contrast velocity flow General: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 19 LV End Diastolic Dimension: 47 LV End Systolic Dimension: 34 LV Posterior Wall: 8 Right Atrium 39 RV End Diastolic Dimension: 40 Interventricular Septum: 7 Left Ventricle (short axis): Volume in mL, index in mL per square meter End Diastolic Volume: 121 ED index: 74 End Systolic Volume: 49 ES index: 30 Stroke Volume: 72 SV index: 44 Ejection Fraction: 59% The patient is imaged with multiple planes through the chest using ECG gated spin echo and cine gradient echo technique, postcontrast imaging, and phase contrast velocity mapping. Morphology: There is normal left ventricular size and function without focal wall motion abnormalities. There is septal motion consistent with bundle branch block-the patient has known incomplete right bundle branch block on ECG. There is normal T2 signal intensity. Fat suppression technique does not suggest fatty infiltration of the ventricular myocardium. There is normal first pass resting gadolinium enhancement. There is no late gadolinium enhancement noted. Right Ventricle (short axis): Volume in mL, index in mL per square meter End Diastolic Volume: 125 ED index: 76.5 End Systolic Volume: 55.4 ES index: 34 Stroke Volume: 69 SV index: 42 Ejection Fraction: 55.5% Morphology: There is normal right ventricular size and function without focal wall motion abnormalities. Atria appear normal in size. Pericardium: Normal without effusion. Pleural: No pericardial effusion noted. VALVULAR MORPHOLOGY Valve: Mitral: There is minimal posterior leaflet prolapse without associated regurgitation. No significant regurgitation or stenosis. Aortic: No significant regurgitation or stenosis. Tricuspid: No significant regurgitation or stenosis. Pulmonary: No significant regurgitation or stenosis. Phase Contrast velocity mapping: Cardiac output = 5.4 liters per minute QpQs 1.04 The Qp/Qs value close to 1.0 indicating no intracardiac shunt. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 23 Aortic Root 31 Aortic Arch 17 [18-37] Right Pulmonary Artery 10 Ascending Aorta 25 [19-37] Left Pulmonary Artery 10 Inferior Vena Cava 22 Descending Aorta 18 [16-29] INCIDENTAL FINDINGS: None CONCLUSION: 1. Normal left and right ventricle systolic function with marginally dyssynchronous interventricular septum consistent with the patient's known incomplete right bundle branch block; and minimal mitral valve prolapse without regurgitation 2. No abnormal late gadolinium enhancement or evidence of arrhythmogenic RV cardiomyopathy 3. No intracardiac shunt by Qp/Qs measurement. 4. Essentially Normal CMR Cardiac MRI Technologist: Trina Corbitt As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR FSE 3IR SPGR SS SSFP FGRE ET perfusion Additional views: delayed contrast enhancement, phase contrast velocity flow General: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 19 LV End Diastolic Dimension: 47 LV End Systolic Dimension: 34 LV Posterior Wall: 8 Right Atrium 39 RV End Diastolic Dimension: 40 Interventricular Septum: 7 Left Ventricle (short axis): Volume in mL, index in mL per square meter End Diastolic Volume: 121 ED index: 74 End Systolic Volume: 49 ES index: 30 Stroke Volume: 72 SV index: 44 Ejection Fraction: 59% The patient is imaged with multiple planes through the chest using ECG gated spin echo and cine gradient echo technique, postcontrast imaging, and phase contrast velocity mapping. Morphology: There is normal left ventricular size and function without focal wall motion abnormalities. There is septal motion consistent with bundle branch block-the patient has known incomplete right bundle branch block on ECG. There is normal T2 signal intensity. Fat suppression technique does not suggest fatty infiltration of the ventricular myocardium. There is normal first pass resting gadolinium enhancement. There is no late gadolinium enhancement noted. Right Ventricle (short axis): Volume in mL, index in mL per square meter End Diastolic Volume: 125 ED index: 76.5 End Systolic Volume: 55.4 ES index: 34 Stroke Volume: 69 SV index: 42 Ejection Fraction: 55.5% Morphology: There is normal right ventricular size and function without focal wall motion abnormalities. Atria appear normal in size. Pericardium: Normal without effusion. Pleural: No pericardial effusion noted. VALVULAR MORPHOLOGY Valve: Mitral: There is minimal posterior leaflet prolapse without associated regurgitation. No significant regurgitation or stenosis. Aortic: No significant regurgitation or stenosis. Tricuspid: No significant regurgitation or stenosis. Pulmonary: No significant regurgitation or stenosis. Phase Contrast velocity mapping: Cardiac output = 5.4 liters per minute QpQs 1.04 The Qp/Qs value close to 1.0 indicating no intracardiac shunt. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 23 Aortic Root 31 Aortic Arch 17 [18-37] Right Pulmonary Artery 10 Ascending Aorta 25 [19-37] Left Pulmonary Artery 10 Inferior Vena Cava 22 Descending Aorta 18 [16-29] INCIDENTAL FINDINGS: None
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Findings: Foci of hypoattenuation in left centrum semiovale and frontal cortex are seen corresponding to recent infarcts. No new infarction, intracranial hemorrhage, brain edema, mass effect or hydrocephalus. There is enlargement and diffuse hypoattenuation of the left optic nerve corresponding to ischemic changes on the prior MRI. Evolving post surgical changes from paranasal sinus surgery with residual mucosal thickening and packing material.
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15,557 |
Clinical Information: Evaluation for stroke Comparison: CT head dated 1/28/2022 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, and axial T2 sequences were acquired of the brain without the use of intravenous contrast. Findings: Small focus of diffusion restriction is noted in deep white matter of left temporal lobe and along the posterior limb of the left internal capsule, which indicates infarction in the territory of M2 perforating branches. There is mild diffuse volume loss secondary to atrophic changes associated with confluent areas of periventricular and deep white matter hyper signal intensity secondary to microangiopathic changes. Chronic lacunar infarcts in left caudate head, left posterior thalamus and right periventricular white matter. Prominent perivascular spaces are also seen around the bilateral basal ganglia. There are scattered foci of magnetic susceptibility in the frontoparietal cortices, likely secondary to microangiopathy. No intracranial mass, mass effect, edema, hydrocephalus is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. There is a small T2 hyperintense lesion which is partially visualized in the superficial lobe of left parotid gland which may represent a benign salivary gland tumor such as pleomorphic adenoma. Impression: 1. Small volume diffusion restriction in the left deep temporal lobe and internal capsule, suggesting acute infarction. 2. T2 hyperintense lesion in the superficial lobe of left parotid gland may represent a pleomorphic adenoma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Small focus of diffusion restriction is noted in deep white matter of left temporal lobe and along the posterior limb of the left internal capsule, which indicates infarction in the territory of M2 perforating branches. There is mild diffuse volume loss secondary to atrophic changes associated with confluent areas of periventricular and deep white matter hyper signal intensity secondary to microangiopathic changes. Chronic lacunar infarcts in left caudate head, left posterior thalamus and right periventricular white matter. Prominent perivascular spaces are also seen around the bilateral basal ganglia. There are scattered foci of magnetic susceptibility in the frontoparietal cortices, likely secondary to microangiopathy. No intracranial mass, mass effect, edema, hydrocephalus is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. There is a small T2 hyperintense lesion which is partially visualized in the superficial lobe of left parotid gland which may represent a benign salivary gland tumor such as pleomorphic adenoma.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral small pleural effusions. Atelectasis at the medial right base. Central airways are patent. HEART / VESSELS: Coronary vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple enlarged mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Slight interval increase in the amount of pneumobilia, left-sided predominant. GALLBLADDER: Tubular structure is noted within the gallbladder fossa which may represent the gallbladder with intraluminal gas versus a duodenal diverticulum extending to the gallbladder fossa. PANCREAS: Normal. SPLEEN: Splenomegaly. ADRENALS: Unchanged indeterminate left adrenal gland nodule posterior right adrenal gland is normal. KIDNEYS: Normal LYMPH NODES: Prominent para-aortic lymph nodes. Enlarged portocaval lymph node is unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Osseous destruction involving the anterior/inferior endplate of T8 and the anterior/superior endplate of T9 with associated significant surrounding phlegmon in the paravertebral soft tissues. Phlegmonous extension appears to span T7-T10 and involve both sides of the vertebral column. No definitive walled off/drainable abscess. Mild lumbar spine facet arthropathy.
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15,558 |
CV MR Brain wo+w contrast Clinical Information: tumor This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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This examination was performed in the Boshell Building MRI Facility. To access the report, please look in the Documentation section of IMPACT/Cerner, Choose to list All, and the report will be found titled Radiology Reports-- Neurology Procedure Note on the date it was performed. ?Please call 934-9906 if you have any questions about this.
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FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral small pleural effusions. Atelectasis at the medial right base. Central airways are patent. HEART / VESSELS: Coronary vascular calcifications. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple enlarged mediastinal lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Slight interval increase in the amount of pneumobilia, left-sided predominant. GALLBLADDER: Tubular structure is noted within the gallbladder fossa which may represent the gallbladder with intraluminal gas versus a duodenal diverticulum extending to the gallbladder fossa. PANCREAS: Normal. SPLEEN: Splenomegaly. ADRENALS: Unchanged indeterminate left adrenal gland nodule posterior right adrenal gland is normal. KIDNEYS: Normal LYMPH NODES: Prominent para-aortic lymph nodes. Enlarged portocaval lymph node is unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Osseous destruction involving the anterior/inferior endplate of T8 and the anterior/superior endplate of T9 with associated significant surrounding phlegmon in the paravertebral soft tissues. Phlegmonous extension appears to span T7-T10 and involve both sides of the vertebral column. No definitive walled off/drainable abscess. Mild lumbar spine facet arthropathy.
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15,559 |
EXAM: CV MR Cardiac for Function and Morph, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/26/2022 2:45 PM Referring MD: Marc Cribbs Height: 162 cm. Patient weight: 88 kg. BSA: 1.98 Blood Pressure: 127/79 Heart Rate: 74 bpm. CLINICAL INFORMATION: Patient studied for evaluation of: papvr, Q26.3 Partial anomalous pulmonary venous connection History: 52 year old woman with past medical history of known anomalous pulmonary vein presenting for CMR. COMPARISON: prior CMR 7/20/2017 TECHNIQUE: CV MR Cardiac for Function and Morph, CV MR for Velocity Flow FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Fair-Limited due to significant ectopy resulting in difficulty gating the images from the ECG. CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Sagittal Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: MS Axial, Velocity Flow Mapping ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 32 LV End Diastolic Dimension: 46 LV End Systolic Dimension: 29 LV Posterior Wall: 6 RV End Diastolic Dimension: 50 Interventricular Septum: 11 Left Ventricle (Long Axis): End Diastolic Volume: 144 End Systolic Volume: 64 Stroke Volume: 80 Ejection Fraction: 55.6% Morphology: There is normal left ventricular size and function. There are no regional wall motion abnormalities. Right Ventricle (short axis): unable to accurately quantitate due to frequent arrhythmia during scan. Grossly, wall motion appears normal. Morphology: The right ventricle is visually dilated with normal systolic function. Pericardium: The pericardium is normal with trivial pericardial effusion. Pleural: There is no pleural effusion Atria The right atria is dilated The left atria is visually normal The visualized atrial septum is normal, no defect seen. VALVULAR MORPHOLOGY There is no significant valvular stenosis or regurgitation Evaluation of tricuspid regurgitation limited by image quality, but likely mild at most. Vascular There is normal aorta and arterial structures images. There is an anomalous right upper pulmonary vein that is draining into the SVC. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 27 Aortic Root 30 Aortic Arch 21 [18-37] Right Pulmonary Artery 23 Ascending Aorta 29 [19-37] Left Pulmonary Artery 16 Inferior Vena Cava 34 Descending Aorta 21 [16-29] INCIDENTAL FINDINGS: None CONCLUSION: 1. There is anomalous right upper pulmonary vein draining into the SVC. 2. The Qp/Qs is 2.17 consistent with significant left to right shunt. 3. There is no obvious ASD visualized but difficult to exclude a superior sinus venosus defect. 4. There was frequent arrhythmia noted limiting ability to quantify RV size and function as well as tricuspid regurgitation severity. Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Fair-Limited due to significant ectopy resulting in difficulty gating the images from the ECG. CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Sagittal Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: MS Axial, Velocity Flow Mapping ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 32 LV End Diastolic Dimension: 46 LV End Systolic Dimension: 29 LV Posterior Wall: 6 RV End Diastolic Dimension: 50 Interventricular Septum: 11 Left Ventricle (Long Axis): End Diastolic Volume: 144 End Systolic Volume: 64 Stroke Volume: 80 Ejection Fraction: 55.6% Morphology: There is normal left ventricular size and function. There are no regional wall motion abnormalities. Right Ventricle (short axis): unable to accurately quantitate due to frequent arrhythmia during scan. Grossly, wall motion appears normal. Morphology: The right ventricle is visually dilated with normal systolic function. Pericardium: The pericardium is normal with trivial pericardial effusion. Pleural: There is no pleural effusion Atria The right atria is dilated The left atria is visually normal The visualized atrial septum is normal, no defect seen. VALVULAR MORPHOLOGY There is no significant valvular stenosis or regurgitation Evaluation of tricuspid regurgitation limited by image quality, but likely mild at most. Vascular There is normal aorta and arterial structures images. There is an anomalous right upper pulmonary vein that is draining into the SVC. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 27 Aortic Root 30 Aortic Arch 21 [18-37] Right Pulmonary Artery 23 Ascending Aorta 29 [19-37] Left Pulmonary Artery 16 Inferior Vena Cava 34 Descending Aorta 21 [16-29] INCIDENTAL FINDINGS: None
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries the bilateral lung bases secondary to patient respiratory motion artifact.. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus within constraints as above. LUNGS / AIRWAYS / PLEURA: Diffuse, bilateral, peripheral predominant, groundglass opacities with interlobular septal thickening along with more nodular areas of consolidation. These changes are superimposed on a background of mild biapical predominant centrilobular emphysema and patchy reticulations seen on prior examination exam on the basis of chronic interstitial lung disease. No pleural effusion or pneumothorax. Central airways are patent.. HEART / OTHER VESSELS: Mild cardiomegaly. The main pulmonary artery is enlarged measuring up to 4.4 cm in transverse diameter. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of superior abdomen demonstrate postsurgical changes of Roux-en-Y gastric bypass MUSCULOSKELETAL: T2 compression fracture shows interval worsening in their height loss, now approximately 70%. Interval development of T7 compression fracture with approximately 90% vertebral body height loss. Retropulsion of posterior vertebral body results in mild narrowing of the central spinal canal. Both of these compression fractures demonstrate sclerotic components.
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15,560 |
EXAM: CV MR Cardiac for Function and Morph, CV MR for Velocity Flow PATIENT DATA Date of Study: 1/26/2022 2:45 PM Referring MD: Marc Cribbs Height: 162 cm. Patient weight: 88 kg. BSA: 1.98 Blood Pressure: 127/79 Heart Rate: 74 bpm. CLINICAL INFORMATION: Patient studied for evaluation of: papvr, Q26.3 Partial anomalous pulmonary venous connection History: 52 year old woman with past medical history of known anomalous pulmonary vein presenting for CMR. COMPARISON: prior CMR 7/20/2017 TECHNIQUE: CV MR Cardiac for Function and Morph, CV MR for Velocity Flow FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Fair-Limited due to significant ectopy resulting in difficulty gating the images from the ECG. CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Sagittal Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: MS Axial, Velocity Flow Mapping ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 32 LV End Diastolic Dimension: 46 LV End Systolic Dimension: 29 LV Posterior Wall: 6 RV End Diastolic Dimension: 50 Interventricular Septum: 11 Left Ventricle (Long Axis): End Diastolic Volume: 144 End Systolic Volume: 64 Stroke Volume: 80 Ejection Fraction: 55.6% Morphology: There is normal left ventricular size and function. There are no regional wall motion abnormalities. Right Ventricle (short axis): unable to accurately quantitate due to frequent arrhythmia during scan. Grossly, wall motion appears normal. Morphology: The right ventricle is visually dilated with normal systolic function. Pericardium: The pericardium is normal with trivial pericardial effusion. Pleural: There is no pleural effusion Atria The right atria is dilated The left atria is visually normal The visualized atrial septum is normal, no defect seen. VALVULAR MORPHOLOGY There is no significant valvular stenosis or regurgitation Evaluation of tricuspid regurgitation limited by image quality, but likely mild at most. Vascular There is normal aorta and arterial structures images. There is an anomalous right upper pulmonary vein that is draining into the SVC. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 27 Aortic Root 30 Aortic Arch 21 [18-37] Right Pulmonary Artery 23 Ascending Aorta 29 [19-37] Left Pulmonary Artery 16 Inferior Vena Cava 34 Descending Aorta 21 [16-29] INCIDENTAL FINDINGS: None CONCLUSION: 1. There is anomalous right upper pulmonary vein draining into the SVC. 2. The Qp/Qs is 2.17 consistent with significant left to right shunt. 3. There is no obvious ASD visualized but difficult to exclude a superior sinus venosus defect. 4. There was frequent arrhythmia noted limiting ability to quantify RV size and function as well as tricuspid regurgitation severity. Cardiac MRI Technologist: Cathy Gunn As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Fair-Limited due to significant ectopy resulting in difficulty gating the images from the ECG. CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Sagittal Two chamber Four chamber Right two chamber Short axis LV LVOT Ascending aorta RVOT Sequences: FSE 2IR SSFP Additional views: MS Axial, Velocity Flow Mapping ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 32 LV End Diastolic Dimension: 46 LV End Systolic Dimension: 29 LV Posterior Wall: 6 RV End Diastolic Dimension: 50 Interventricular Septum: 11 Left Ventricle (Long Axis): End Diastolic Volume: 144 End Systolic Volume: 64 Stroke Volume: 80 Ejection Fraction: 55.6% Morphology: There is normal left ventricular size and function. There are no regional wall motion abnormalities. Right Ventricle (short axis): unable to accurately quantitate due to frequent arrhythmia during scan. Grossly, wall motion appears normal. Morphology: The right ventricle is visually dilated with normal systolic function. Pericardium: The pericardium is normal with trivial pericardial effusion. Pleural: There is no pleural effusion Atria The right atria is dilated The left atria is visually normal The visualized atrial septum is normal, no defect seen. VALVULAR MORPHOLOGY There is no significant valvular stenosis or regurgitation Evaluation of tricuspid regurgitation limited by image quality, but likely mild at most. Vascular There is normal aorta and arterial structures images. There is an anomalous right upper pulmonary vein that is draining into the SVC. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 27 Aortic Root 30 Aortic Arch 21 [18-37] Right Pulmonary Artery 23 Ascending Aorta 29 [19-37] Left Pulmonary Artery 16 Inferior Vena Cava 34 Descending Aorta 21 [16-29] INCIDENTAL FINDINGS: None
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Findings: Exam is limited due to motion. There is no CT evidence of intracranial hemorrhage, acute infarct, hydrocephalus, or mass effect. The visualized paranasal sinuses and mastoid air cells are clear. Bilateral pseudophakia.
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15,561 |
MR Brain wo+w contrast 1/25/2022 3:10 PM Clinical Information: History of tinnitus, asymmetric right-sided hearing loss. Comparison: Not available Technique: Diffusion weighted series, sagittal T1, axial FLAIR, axial T2 3D, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. Findings: . No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. No evidence of abnormal enhancement is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality. Impression: 1. No acute or significant intracranial abnormality. 2. No inner ear abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: . No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. No evidence of abnormal enhancement is noted. The visualized paranasal sinuses and mastoid air cells are clear. No acute osseous or soft tissue abnormality.
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FINDINGS: Please note, evaluation is significantly limited due to motion artifact. AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Atherosclerotic calcifications. RIGHT CAROTID: Patent without flow-limiting stenosis. LEFT CAROTID: Complete occlusion of the entire cervical ICA with distal reconstitution in its supraclinoid portion. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: The proximal left vertebral artery appears occluded with reconstitution around the level of C4. There is multifocal atherosclerotic narrowing distally with otherwise normal appearing caliber in its V4 segment prior to the basilar artery. INTRACRANIAL ARTERIES: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Multilevel discogenic degenerative changes. Ankylosis of the C5-C6 vertebral bodies. Advanced centrilobular and paraseptal emphysematous changes in bilateral visualized upper lungs. There is soft tissue pleural nodularity within the visualized left upper lung such as a region of nodularity measuring 3.8 x 2.4 cm. There is also pleural soft tissue nodularity along the right posterior lateral with permeated destruction of the right posterior fifth rib.
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15,562 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 56-year-old woman with history of right breast cancer status post mastectomy and excisional biopsy in the left breast. Examination is performed for BI-RADS 3 follow-up in the left breast. Breast cancer, C50.919 Malignant neoplasm of unspecified site of unspecified female breast TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 150 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior MR exams including most recent MRI dated 7/20/2021. Prior mammograms including most recent left mammogram dated 1/25/2021. FINDINGS: Right breast: There are postsurgical changes from prior mastectomy. There is no suspicious enhancement within the mastectomy bed. Left breast: Changes of prior excisional biopsy with areas of fat necrosis are redemonstrated in the superior central breast. The previously described focal nonmass enhancement in the left 6:00 middle depth breast has decreased in size and conspicuity since the prior exam and currently measures 3 mm (series 500 image 124). Nodes: There is no axillary or internal mammary adenopathy. Extramammary: Multiple T2 hyperintense thyroid lesions are redemonstrated. These has been previously evaluated with benign assessment. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Changes of prior mastectomy without MR evidence of malignancy. BI-RADS 2: Benign findings. 2. Left Breast: Changes of prior excisional biopsy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 2. Recommend continued annual mammography and breast MRI.
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FINDINGS: Right breast: There are postsurgical changes from prior mastectomy. There is no suspicious enhancement within the mastectomy bed. Left breast: Changes of prior excisional biopsy with areas of fat necrosis are redemonstrated in the superior central breast. The previously described focal nonmass enhancement in the left 6:00 middle depth breast has decreased in size and conspicuity since the prior exam and currently measures 3 mm (series 500 image 124). Nodes: There is no axillary or internal mammary adenopathy. Extramammary: Multiple T2 hyperintense thyroid lesions are redemonstrated. These has been previously evaluated with benign assessment. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Changes of prior mastectomy without MR evidence of malignancy. BI-RADS 2: Benign findings. 2. Left Breast: Changes of prior excisional biopsy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 2. Recommend continued annual mammography and breast MRI.
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FINDINGS: Please note, evaluation is significantly limited due to motion artifact. AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. Atherosclerotic calcifications. RIGHT CAROTID: Patent without flow-limiting stenosis. LEFT CAROTID: Complete occlusion of the entire cervical ICA with distal reconstitution in its supraclinoid portion. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: The proximal left vertebral artery appears occluded with reconstitution around the level of C4. There is multifocal atherosclerotic narrowing distally with otherwise normal appearing caliber in its V4 segment prior to the basilar artery. INTRACRANIAL ARTERIES: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Multilevel discogenic degenerative changes. Ankylosis of the C5-C6 vertebral bodies. Advanced centrilobular and paraseptal emphysematous changes in bilateral visualized upper lungs. There is soft tissue pleural nodularity within the visualized left upper lung such as a region of nodularity measuring 3.8 x 2.4 cm. There is also pleural soft tissue nodularity along the right posterior lateral with permeated destruction of the right posterior fifth rib.
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15,563 |
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Nausea vomiting diarrhea, abdominal pain, poor appetite, history of liver transplant COMPARISON: None. TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 140 lbs. IV contrast: ProHance, 7 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes of the anterior abdominal wall and left groin. MUSCULOSKELETAL: Susceptibility artifact from left total hip arthroplasty and posterior lumbar spinal fixation hardware CONCLUSION: No acute findings in the pelvis. Abdominal MRI to be dictated separately. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes of the anterior abdominal wall and left groin. MUSCULOSKELETAL: Susceptibility artifact from left total hip arthroplasty and posterior lumbar spinal fixation hardware
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Findings: RAPID images demonstrate CBF less than 30% volume: 0 cc and T. Max greater than 6seconds volume: 0 cc . Mismatch volume is 0 cc . Color parametric maps demonstrate symmetric rCBF, rCBV, MTT, and Tmax values.. Prognostic maps demonstrate no areas with high probability for completed infarction (rCBF reduced by >70%) or areas of ischemia (Tmax >6 seconds).. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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15,564 |
EXAM: MR Enterography CLINICAL INFORMATION: 20 cc, in clinical remission. COMPARISON: None. TECHNIQUE: MR Enterography Patient weight: 135 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Enterography LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: No abnormal bowel wall thickening or enhancement. No dilated bowel loops. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter nonenhancing hemorrhagic/proteinaceous cyst in the left kidney (series 800, image 134). LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No evidence of active Crohn's disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: MRI Enterography LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN AND PELVIS: STOMACH: No abnormality. SMALL BOWEL: No abnormal bowel wall thickening or enhancement. No dilated bowel loops. PERITONEUM / MESENTERY: Normal. COLORECTAL: No abnormal bowel wall thickening or enhancement. APPENDIX: Normal. LIVER: Partially imaged portions are normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. SPLEEN: Partially imaged portions are normal. PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter nonenhancing hemorrhagic/proteinaceous cyst in the left kidney (series 800, image 134). LYMPH NODES: None enlarged. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. CHEST: PULMONARY ARTERIES: Negative for central or lobar pulmonary embolus. The main pulmonary artery trunk is normal in caliber, measuring up to 29 mm. LUNGS / AIRWAYS / PLEURA: Evaluation of the lung parenchyma is degraded by respiratory motion artifact. Advanced upper lobe predominant panlobular emphysematous changes. Small left and trace right pleural effusion. There is irregular, lobulated pleural thickening throughout the left hemithorax measuring soft tissue density. The central tracheobronchial tree is grossly patent. No pneumothorax. HEART / OTHER VESSELS: The heart size normal without pericardial effusion. Multivessel coronary artery calculations are present. Advanced mixed calcified and noncalcified atherosclerotic plaque throughout the descending thoracic aorta, aortic arch, and proximal great vessels. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None pathologically enlarged. CHEST WALL: Nonspecific subcutaneous edema within the right upper extremity and right supraclavicular region. UPPER ABDOMEN: Unremarkable. MUSCULOSKELETAL: Scattered degenerative changes of the thoracic spine. Central superior endplate deformity in the T12 vertebral body with adjacent discogenic degenerative changes. Partially healed fracture deformities of the right 5th rib with associated lytic lesion.
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15,565 |
EXAM: MR TMJ CLINICAL INFORMATION: Female patient 57 years with TMJ pain and popping, M26.609 Unspecified temporomandibular joint disorder, unspecified side Spec Inst: Open and closed jaw MRI w contrast for TMJ protocol. TECHNIQUE: Sagittal proton-density, sagittal T2 and coronal proton-density closed mouth views as well as sagittal proton-density, coronal proton-density open-mouth views and cine images of the TMJs were obtained without intravenous gadolinium. COMPARISON: None available. FINDINGS: The left mandibular condyle is normally seated within the glenoid fossa. The disc is normally positioned. There is no significant joint effusion. There is a focal depression within the articular cortex which may simply represent a developmental variant, less likely focal degenerative changes. There is normal capture of the disc during the open-mouth maneuver but there is decreased anterior translation on the static images. The cine images also demonstrate decreased anterior translation and also paradoxical motion Right mandibular condyle is normally seated within the glenoid fossa. The disc is normally positioned and there is no significant joint effusion. There is capture of the disc but there is decreased anterior translation on the static images. The cine images also demonstrate decreased anterior translation and also apparent occipital motion CONCLUSION: LEFT TMJ: Disc is normally positioned in the closed mouth position. There is normal capture of the disc but decreased anterior translation during open mouth maneuvers. There is also apparent paradoxical motion on cine images RIGHT TMJ: Disc is normally positioned in the closed mouth position. There is normal capture of the disc but decreased anterior translation during open mouth maneuvers. There is also apparent paradoxical motion on cine images
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FINDINGS: The left mandibular condyle is normally seated within the glenoid fossa. The disc is normally positioned. There is no significant joint effusion. There is a focal depression within the articular cortex which may simply represent a developmental variant, less likely focal degenerative changes. There is normal capture of the disc during the open-mouth maneuver but there is decreased anterior translation on the static images. The cine images also demonstrate decreased anterior translation and also paradoxical motion Right mandibular condyle is normally seated within the glenoid fossa. The disc is normally positioned and there is no significant joint effusion. There is capture of the disc but there is decreased anterior translation on the static images. The cine images also demonstrate decreased anterior translation and also apparent occipital motion
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Age-appropriate cerebral volume loss. Periventricular hypoattenuating areas, compatible with mild chronic microangiopathic disease. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Trace left mastoid effusion. Right mastoid air cells are clear. SOFT TISSUE: Unremarkable.
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15,566 |
MR Lumbar Spine wo+w contrast 1/25/2022 7:01 PM Clinical information: 39 years Male patient with concern for cauda equina syndrome. Comparison: CT lumbar spine from reformat dated 1/25/2022 at 13:43 hours. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, with and without the uneventful administration of intravenous contrast. Patient weight: 150 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: The sagittal images demonstrate persistent preservation of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height with confluent Modic type I changes at L4-L5 extending into the intervening disc, with associated wispy enhancement. Diffuse disc desiccation and mild height loss at L4-L5. The intervertebral discs otherwise appear well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-L4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-L5: Large right paracentral disc protrusion/annular fissure, causing effacement of the right lateral recess, moderate spinal canal stenosis, and severe right greater than than left neuroforaminal narrowing. L5-S1: Small broad-based posterior disc bulge and bilateral facet arthropathy, with epidural lipomatosis extending into the sacral canal, result in mild bilateral neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. IMPRESSION: 1. No evidence of acute findings in the lumbar spine. 2. Focal degenerative disc disease centered at L4-5, with large right paracentral disc protrusion/annular fissure, resulting in moderate spinal canal stenosis, effacement of the right lateral recess, and severe right greater than than left neuroforaminal narrowing, impinging upon the bilateral L4 and right L5 nerve roots. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The sagittal images demonstrate persistent preservation of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height with confluent Modic type I changes at L4-L5 extending into the intervening disc, with associated wispy enhancement. Diffuse disc desiccation and mild height loss at L4-L5. The intervertebral discs otherwise appear well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The tip of the conus medullaris terminates normally at L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-L4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-L5: Large right paracentral disc protrusion/annular fissure, causing effacement of the right lateral recess, moderate spinal canal stenosis, and severe right greater than than left neuroforaminal narrowing. L5-S1: Small broad-based posterior disc bulge and bilateral facet arthropathy, with epidural lipomatosis extending into the sacral canal, result in mild bilateral neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Rounded consolidation of the superior segment left lower lobe with small focus of internal gas. This region measures approximately 3.5 x 2.8 cm (series 201 image 53). Surrounding tree-in-bud nodularity in the adjacent lung parenchyma. There is additional areas of consolidation adjacent to the pulmonary vasculature within the anterolateral left upper lobe and lingula (for example series 201 image 42 and 62) small tree-in-bud nodules also surrounds these areas of smaller consolidation. Similar appearance of advanced biapical paraseptal emphysema with large right apical bleb. No pleural effusions. HEART / VESSELS: Right chambers and great vessels are normal in size. No central PE. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Nontender unremarkable. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
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15,567 |
RADIOLOGIC EXAM: MR Brain wo contrast CLINICAL INFORMATION: Seizure, nontraumatic. Per chart review, no significant past medical history. Evaluated in the ED on 11/30/2021 and 12/1/2021 for new-onset witnessed unprovoked seizures. EEG pending. COMPARISON: CT and CTA head dated 11/30/2021. TECHNIQUE: MR Brain wo contrast Multiplanar, multisequence MRI of the brain was performed without intravenous contrast. FINDINGS: INTRACRANIAL FINDINGS: Focal area of asymmetric T2/FLAIR hyperintensity in the left temporal horn periventricular white matter adjacent to the hippocampal tail(series 11, images 18-19). No acute intraparenchymal infarct, hemorrhage, hydrocephalus, space-occupying lesion, or mass effect. Additional scattered T2/FLAIR hyperintense foci in the subcortical and deep cerebral white matter of the left greater than right frontal lobes, nonspecific. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. Subcentimeter pineal cyst. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Scattered mild bilateral ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise well-aerated. CONCLUSION: 1. Focal area of asymmetric T2/FLAIR hyperintensity in the left temporal horn periventricular white matter adjacent to the hippocampal tail. Recommend contrast-enhanced MRI for further evaluation. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: INTRACRANIAL FINDINGS: Focal area of asymmetric T2/FLAIR hyperintensity in the left temporal horn periventricular white matter adjacent to the hippocampal tail(series 11, images 18-19). No acute intraparenchymal infarct, hemorrhage, hydrocephalus, space-occupying lesion, or mass effect. Additional scattered T2/FLAIR hyperintense foci in the subcortical and deep cerebral white matter of the left greater than right frontal lobes, nonspecific. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. Subcentimeter pineal cyst. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Scattered mild bilateral ethmoid sinus mucosal thickening. Visualized paranasal sinuses and mastoid air cells are otherwise well-aerated.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Stable appearing diffuse cerebral volume loss and chronic white matter microangiopathic changes. Unchanged chronic small left basal ganglia lacunar infarct. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Right parietal burr hole is unchanged. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,568 |
MR Brain wo+w contrast 1/26/2022 9:06 AM Clinical Information: Status post left frontoparietal craniotomy for resection of left frontal lobe meningioma. Comparison: CT head dated 1/26/2022, MRI brain dated 12/21/2021 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 218 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: The patient is status post left frontal craniotomy for resection of left frontal lobe meningioma. Again noted, There is evidence of left frontoparietal vasogenic edema with associated mass effect on the left lateral ventricle and 7mm left-to-right midline shift, previously 8 mm. Susceptibility artifact is noted, secondary to hemorrhagic changes, with associated underlying extra-axial collection in the surgical bed. Mild diffusion restriction around the resection location is felt to be postsurgical changes. No evidence of abnormal enhancement is seen in the surgical resection cavity. The visualized paranasal sinuses and mastoid air cells are clear. Impression: 1. Status post left frontal craniotomy for resection of the presumed left frontal meningioma. Persistent extensive vasogenic edema of the left frontal lobe however with slight improvement of mass effect and left-to-right midline shift as described above. 2. No abnormal residual nodular or masslike enhancement is noted within the surgical location to suggest residual neoplasm. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The patient is status post left frontal craniotomy for resection of left frontal lobe meningioma. Again noted, There is evidence of left frontoparietal vasogenic edema with associated mass effect on the left lateral ventricle and 7mm left-to-right midline shift, previously 8 mm. Susceptibility artifact is noted, secondary to hemorrhagic changes, with associated underlying extra-axial collection in the surgical bed. Mild diffusion restriction around the resection location is felt to be postsurgical changes. No evidence of abnormal enhancement is seen in the surgical resection cavity. The visualized paranasal sinuses and mastoid air cells are clear.
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Findings: Multicompartment intracranial hemorrhage is grossly unchanged in the interval including small-volume subarachnoid hemorrhage, left frontal and bilateral temporal lobe hemorrhagic contusions, small left greater than right bilateral cerebral convexity subdural hemorrhage extending to the cerebellar tentorium and small subdural hematoma along the anterior interhemispheric fissure. There is small-volume intraventricular hemorrhage which is slightly increased in the interval. There is no acute infarction or new hemorrhage. There is diffuse cortical involution with moderately advanced chronic microangiopathic changes in the deep cerebral white matter. There is no acute osseous abnormality. The paranasal sinuses and mastoid air cells are clear.
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15,569 |
Clinical Information: Follow-up for cavernomas Comparison: MRI dated 10/1/2021 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 230 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: There is overall stable size of the left lateral pointine cavernoma, which now measures 1.19 x 1.5 cm on FLAIR sequences, previously measured 1.2 x 1 cm. There is also another cavernoma, located in the left anterior frontal lobe, measuring 11 x 0.9 cm, without significant change since prior study. Stable scattered foci of susceptibility artifact around the left centrum semiovale, corpus callosum and peritrigonal area is noted. Prominent perivascular spaces around the bilateral basal ganglia is noted. No intracranial mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. Mucosal thickening in bilateral ethmoidal air cells is obvious. No acute osseous or soft tissue abnormality. Impression: Stable appearing hemorrhagic lesions within the anterior left frontal lobe and left middle cerebellar peduncle, most likely cavernoma's. Stable nonspecific scattered chronic hemorrhagic foci within the cerebral hemispheres, which could also represent tiny cavernoma's. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There is overall stable size of the left lateral pointine cavernoma, which now measures 1.19 x 1.5 cm on FLAIR sequences, previously measured 1.2 x 1 cm. There is also another cavernoma, located in the left anterior frontal lobe, measuring 11 x 0.9 cm, without significant change since prior study. Stable scattered foci of susceptibility artifact around the left centrum semiovale, corpus callosum and peritrigonal area is noted. Prominent perivascular spaces around the bilateral basal ganglia is noted. No intracranial mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses and mastoid air cells are clear. Mucosal thickening in bilateral ethmoidal air cells is obvious. No acute osseous or soft tissue abnormality.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Stable appearing diffuse cerebral volume loss and chronic white matter microangiopathic changes. Unchanged chronic small left basal ganglia lacunar infarct. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Right parietal burr hole is unchanged. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,570 |
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Pancreatic lesion follow-up. COMPARISON: CT abdomen 10/27/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 128 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: 5 mm pancreatic head T2 hyperintense cystic lesion with sidebranch communication to the main pancreatic duct (images 29 through 35, series 1101). No nodular or enhancing component to this cystic lesion. The main pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Pancreatic head T2 hyperintense cystic lesion measuring 5 mm with sidebranch connection to the main pancreatic duct is most consistent with a side branch IPMN. No suspicious features or main pancreatic ductal dilation. Recommend follow-up MR examination to assess stability in one year, if not clinically indicated sooner.
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FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: 5 mm pancreatic head T2 hyperintense cystic lesion with sidebranch communication to the main pancreatic duct (images 29 through 35, series 1101). No nodular or enhancing component to this cystic lesion. The main pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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Findings:The paranasal sinuses are clear. There is no significant mucosal thickening or air-fluid levels. The ostiomeatal complexes are clear/patent. There is no periapical maxillary dental disease that might produce symptoms mimicking sinusitis or be responsible for odontogenic sinusitis. Retroantral, orbital, premaxillary and pterygopalatine fossa fat planes appear normal. There is no mass in the left nasopharynx. Left middle ear, mastoid air cells and external auditory canal appear normal. There is cerumen within the left external auditory canal. No bony erosions. Ossicular chain appears intact. The temporal bones appear normal. The intraorbital soft tissues appear normal.
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15,571 |
MR Hand Left wo contrast Clinical Information: 29-year-old male with left thumb injury, concern for UCL rupture. Comparison: Left hand radiograph and left hand ultrasound 1/12/2022. Technique: Multiplanar multisequence imaging was obtained through the left hand with a focus on the left thumb. Findings: There is bone marrow edema along the dorsal aspect of the thumb metacarpal head. At the site of edema, there is a T1 hypointense linear signal without intra-articular extension (series 13 image 8). The radial collateral ligament is intact. The ulnar collateral ligament appears thickened with increased fluid signal at its attachment to the base of the proximal phalanx. There is no retraction of the UCL ligament or Stener lesion. There is mild soft tissue edema overlying the radial aspect of the thumb MCP joint. The flexor pollicis longus and extensor pollicis longus tendons are intact. There is no significant joint effusion. The remaining visualized carpal bones are unremarkable. Conclusion: 1. Grade 2 sprainof the thumb UCL. No Stener lesion. 2. Bone marrow edema/contusion of the dorsal thumb metacarpal head with a questionable nondisplaced fracture. Overlying dorsal soft tissue edema. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: There is bone marrow edema along the dorsal aspect of the thumb metacarpal head. At the site of edema, there is a T1 hypointense linear signal without intra-articular extension (series 13 image 8). The radial collateral ligament is intact. The ulnar collateral ligament appears thickened with increased fluid signal at its attachment to the base of the proximal phalanx. There is no retraction of the UCL ligament or Stener lesion. There is mild soft tissue edema overlying the radial aspect of the thumb MCP joint. The flexor pollicis longus and extensor pollicis longus tendons are intact. There is no significant joint effusion. The remaining visualized carpal bones are unremarkable.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis with trace bilateral pleural effusions. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Partially imaged coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Splenomegaly measuring 15.8 cm in the CC dimension. ADRENALS: Normal. KIDNEYS: Bilateral perinephric stranding, nonspecific. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Moderate mixed calcified and atheromatous plaque of the infrarenal abdominal aorta iliac vasculature. Right common iliac artery ectasia measuring up to 2.2 cm. URINARY BLADDER: Decompressed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture. Partially imaged right hip arthroplasty with heterotopic desiccation surrounding the trochanters. Advanced facet arthropathy at L4-L5 and L5-S1, left greater than right. Moderate left facet arthropathy at L2-L3 and L3-L4.
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15,572 |
MR Stroke Protocol with MRAs HISTORY: Evaluation for stroke TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. Brain MR angiogram without contrast with 3-D reconstruction. Neck MR angiogram with and without contrast with 3-D reconstruction. COMPARISON: CT dated 1/25/2022 FINDINGS: INTRACRANIAL FINDINGS: There is mild diffuse cerebral volume loss. Confluent periventricular and deep white matter FLAIR signal intensity seen most consistent with advanced microvascular angiopathy (Fazekas grade 3). Similar foci is noted in the pons. There is a small old lacunar infarction of the left cerebellum. There is a tiny focus of cortical based diffusion restriction the left occipital lobe most consistent with a tiny acute infarction. There are several foci of tiny microhemorrhages in the cortex of bilateral occipital lobes. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. Soft tissue edema is noted in the posterior portion of the neck. EXTRACRANIAL FINDINGS: There is minimal soft tissue edema within the intraconal spaces of bilateral orbits. Also the extraocular muscles appear edematous. The visualized paranasal sinuses and mastoid air cells are well aerated. Neck MR angiogram: Noncontrast neck MR angiogram is markedly limited for severe motion artifact. On postcontrast neck MR angiogram the aortic arch appears patent. The origin of the main arteries are also patent. It appears that there is moderate narrowing at origin of right vertebral artery. The cervical portion of the right vertebral artery is otherwise patent. The cervical portion of the left vertebral artery is patent. Decreased flow signal is noted at the proximal right common carotid artery which can be because of motion artifact. Mid cervical portion of the right common cartilage is patent. The right carotid bifurcation appears patent however decreased flow signal is noted at proximal portion of the right internal carotid artery. The left common carotid arteries patent. The left carotid bifurcation and cervical portion of the left internal carotid artery is patent. Brain MR angiogram: Intracranial portion of the ICAs are patent with diffuse atherosclerosis and mild narrowing. A1 segments are patent with mild diffuse irregularity and moderate narrowing at origin of right A1 segment. Visualized portion of ACAs are patent. Irregularity and mild narrowing involving the right M1 segment in favor of atherosclerosis. Cortical branches of the right MCA are patent but with multiple foci of irregularity and mild narrowing. Minimal irregularity of the left MCA is seen. There is a fusiform aneurysm along the superior branch of left MCA measuring 4 mm in the diameter. V4 segments are patent and the left vertebral artery is dominant. Basilar artery is patent with a focus of mild narrowing and atherosclerosis. Diffuse irregularity is noted along the right PCA with areas of severe narrowing of the bilateral P1-P2 junctions. Diffuse irregularity and atherosclerosis of the distal portion of PCAs are also seen. IMPRESSION: Mild cerebral volume loss. Advanced microvascular angiopathy. A tiny focus of cortical based acute infarction in the left occipital lobe. Multiple foci of intracranial atherosclerosis and narrowing including moderate narrowing at origin of the right A1, mild narrowing of the right M1 segment and cortical branches of the right MCA, mild narrowing of the basilar artery, diffuse atherosclerosis involving the bilateral PCAs with severe narrowing at bilateral P1/P2 junctions. A fusiform aneurysm along the superior branch of left MCA. Technical Limited neck MR angiogram. In this context decreased flow signal at superior portion of the right common carotid artery and proximal portion of right internal carotid artery remains indeterminate and can be secondary to a slow flow/narrowing versus motion artifact. Moderate narrowing at origin of right vertebral artery. Mild intraconal orbital edema and edema of the extraocular muscles are also seen. This finding can be secondary to generalized edema however evaluation for myositis is recommended.
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FINDINGS: INTRACRANIAL FINDINGS: There is mild diffuse cerebral volume loss. Confluent periventricular and deep white matter FLAIR signal intensity seen most consistent with advanced microvascular angiopathy (Fazekas grade 3). Similar foci is noted in the pons. There is a small old lacunar infarction of the left cerebellum. There is a tiny focus of cortical based diffusion restriction the left occipital lobe most consistent with a tiny acute infarction. There are several foci of tiny microhemorrhages in the cortex of bilateral occipital lobes. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. Soft tissue edema is noted in the posterior portion of the neck. EXTRACRANIAL FINDINGS: There is minimal soft tissue edema within the intraconal spaces of bilateral orbits. Also the extraocular muscles appear edematous. The visualized paranasal sinuses and mastoid air cells are well aerated. Neck MR angiogram: Noncontrast neck MR angiogram is markedly limited for severe motion artifact. On postcontrast neck MR angiogram the aortic arch appears patent. The origin of the main arteries are also patent. It appears that there is moderate narrowing at origin of right vertebral artery. The cervical portion of the right vertebral artery is otherwise patent. The cervical portion of the left vertebral artery is patent. Decreased flow signal is noted at the proximal right common carotid artery which can be because of motion artifact. Mid cervical portion of the right common cartilage is patent. The right carotid bifurcation appears patent however decreased flow signal is noted at proximal portion of the right internal carotid artery. The left common carotid arteries patent. The left carotid bifurcation and cervical portion of the left internal carotid artery is patent. Brain MR angiogram: Intracranial portion of the ICAs are patent with diffuse atherosclerosis and mild narrowing. A1 segments are patent with mild diffuse irregularity and moderate narrowing at origin of right A1 segment. Visualized portion of ACAs are patent. Irregularity and mild narrowing involving the right M1 segment in favor of atherosclerosis. Cortical branches of the right MCA are patent but with multiple foci of irregularity and mild narrowing. Minimal irregularity of the left MCA is seen. There is a fusiform aneurysm along the superior branch of left MCA measuring 4 mm in the diameter. V4 segments are patent and the left vertebral artery is dominant. Basilar artery is patent with a focus of mild narrowing and atherosclerosis. Diffuse irregularity is noted along the right PCA with areas of severe narrowing of the bilateral P1-P2 junctions. Diffuse irregularity and atherosclerosis of the distal portion of PCAs are also seen.
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Findings: No acute intracranial hemorrhage or infarction. No mass effect or midline shift. Ventricles are normal. No abnormal intracranial contrast enhancement. Bilateral ACAs, MCAs and PCAs are patent without flow-limiting stenosis or aneurysm. The intracranial carotid and vertebrobasilar arteries are normal. There is normal opacification of the superior sagittal sinus, transverse sinuses, sigmoid sinuses and visualized portions of the internal jugular veins. There is no venous sinus thrombosis. The deep cerebral veins are patent. There is no CT evidence of cavernous sinus thrombosis.
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15,573 |
MR Lumbar Spine wo contrast 1/25/2022 4:52 PM Clinical information: 74 years Male patient with lumbar radiculopathy. Comparison: None available. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, without intravenous contrast administration. Findings: The sagittal images demonstrate left-sided pars defect at L4 with grade 1 anterolisthesis of L4 and L5, but otherwise preservation of normal lumbar lordosis without subluxation. The vertebral bodies maintain normal height and heterogeneous marrow signal likely related to marrow reconversion. There are also degenerative endplate changes at L4-L5. The intervertebral discs appear diffusely desiccated, with multilevel height loss worst at L3-L4 and L4-L5. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at L1. Partial laminectomies at L5-S1, a left side at L5 and right-sided S1 T11-12: Small central disc protrusion indenting the ventral thecal sac. No central neuroforaminal stenosis. T12-L1: No significant spinal canal or neuroforaminal narrowing. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Broad-based posterior disc bulge and bilateral facet arthropathy result in moderate bilateral neuroforaminal narrowing. L3-L4: Broad-based posterior disc bulge with asymmetric protrusion into the left lateral recess results in severe left and moderate right neuroforaminal narrowing. L4-L5: Grade 1 anterolisthesis of L4 on L5 and bilateral facet arthropathy result in moderate left greater than right neuroforaminal narrowing and severe spinal canal narrowing. The CSF signal in the thecal sac is preserved. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. There are bilateral simple renal cysts. IMPRESSION: Multilevel degenerative change as described above is worst at L3-L4 and L4-L5 where there is moderate to severe bilateral neuroforaminal narrowing.. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The sagittal images demonstrate left-sided pars defect at L4 with grade 1 anterolisthesis of L4 and L5, but otherwise preservation of normal lumbar lordosis without subluxation. The vertebral bodies maintain normal height and heterogeneous marrow signal likely related to marrow reconversion. There are also degenerative endplate changes at L4-L5. The intervertebral discs appear diffusely desiccated, with multilevel height loss worst at L3-L4 and L4-L5. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at L1. Partial laminectomies at L5-S1, a left side at L5 and right-sided S1 T11-12: Small central disc protrusion indenting the ventral thecal sac. No central neuroforaminal stenosis. T12-L1: No significant spinal canal or neuroforaminal narrowing. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Broad-based posterior disc bulge and bilateral facet arthropathy result in moderate bilateral neuroforaminal narrowing. L3-L4: Broad-based posterior disc bulge with asymmetric protrusion into the left lateral recess results in severe left and moderate right neuroforaminal narrowing. L4-L5: Grade 1 anterolisthesis of L4 on L5 and bilateral facet arthropathy result in moderate left greater than right neuroforaminal narrowing and severe spinal canal narrowing. The CSF signal in the thecal sac is preserved. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. There are bilateral simple renal cysts.
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FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. Age-appropriate cerebral atrophy with ex vacuo ventricular dilatation. Confluent periventricular hypoattenuating areas, compatible with mild chronic microangiopathic disease. Bilateral lens replacements. The orbits are otherwise unremarkable. The paranasal sinuses and mastoid air cells are clear. The visualized extra-cranial soft tissues are unremarkable. No acute osseous abnormality.
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15,574 |
Left humerus MRI: Indication: New humeral fracture. History of thyroid carcinoma. Evaluate for possible lesion Technique: Multiplanar multisequence images were obtained through the humerus both pre and post intravenous contrast administration. Technique: Patient weight: 190 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There is a fracture of the proximal humeral metaphysis with medial displacement and moderate proximal impaction of the distal shaft fragment. There is surrounding edema and enhancing soft tissue corresponding to the developing external callus seen on prior radiographs. Bone marrow edema extends through the humeral shafts of the mid diaphysis. There are moderate glenohumeral degenerative changes. Impression: It is difficult to entirely exclude an underlying lesion at this time. All of the MR findings are expected given the healing, non-internally fixed proximal humeral fracture.
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Findings: There is a fracture of the proximal humeral metaphysis with medial displacement and moderate proximal impaction of the distal shaft fragment. There is surrounding edema and enhancing soft tissue corresponding to the developing external callus seen on prior radiographs. Bone marrow edema extends through the humeral shafts of the mid diaphysis. There are moderate glenohumeral degenerative changes.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white differentiation is maintained. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Partial opacification of the left anterior ethmoid air cells. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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15,575 |
MR Brain wo contrast 1/25/2022 4:43 PM Clinical Information: Dementia, Alzheimer s suspected, G31.84 Mild cognitive impairment, so stated Spec Inst: per memory protocol .br .br Alzheimer s Disease suspected Comparison: None available Technique: Diffusion weighted series, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, coronal T2* gradient echo, post contrast axial and coronal T1. Findings: Intracranial vascular flow-voids appear unremarkable. Soft tissues of the upper neck appear unremarkable. Microangiopathic changes are present in the cerebral white matter. No hydrocephalus. No abnormality on diffusion imaging. Sella and craniocervical junction appear unremarkable. There is extreme atrophy of the right hippocampus, by visual grading approximately grade 4. There is mild atrophy of the left hippocampus approximately grade 3. There is moderate cortical atrophy with no lobar projection. No intracranial hemorrhage. Next line Impression: Mild to moderate diffuse cortical atrophy. There is asymmetric hippocampal atrophy, more severe on the right side. Findings are nonspecific and do not particularly correlate with any particular type of cortical dementia.
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Findings: Intracranial vascular flow-voids appear unremarkable. Soft tissues of the upper neck appear unremarkable. Microangiopathic changes are present in the cerebral white matter. No hydrocephalus. No abnormality on diffusion imaging. Sella and craniocervical junction appear unremarkable. There is extreme atrophy of the right hippocampus, by visual grading approximately grade 4. There is mild atrophy of the left hippocampus approximately grade 3. There is moderate cortical atrophy with no lobar projection. No intracranial hemorrhage. Next line
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Findings: No brain edema, intracranial mass, hemorrhage, visible acute infarcts, or hydrocephalus. Mild cerebral atrophy. Remote right corona radiata infarct is noted. No evidence of calvarial fracture. Bilateral orbits are unremarkable apart from artificial lens replacement. Mild mucosal thickening of the maxillary sinuses. Paranasal sinuses and mastoid air cells are otherwise clear.
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15,576 |
MR Brain wo+w contrast 1/25/2022 6:20 PM Clinical information: 67 years Male patient with bilateral hearing loss, asymmetrically worse on the right. Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 225 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. Mild periventricular and subcortical white matter chronic microangiopathic disease, extending into the pons. No intracranial mass lesion, hemorrhage, or infarction. No abnormal postcontrast enhancement. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild mucosal thickening in the ethmoid sinuses. Mucus retention cyst in the right maxillary and left frontal sinus. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Bilateral internal auditory canals appear unremarkable. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. In particular no evidence of internal auditory canal pathology. 2. Age-appropriate brain involution and mild chronic microvascular ischemic disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Cerebral parenchyma: The brain parenchyma volume is appropriate for patient's age. Mild periventricular and subcortical white matter chronic microangiopathic disease, extending into the pons. No intracranial mass lesion, hemorrhage, or infarction. No abnormal postcontrast enhancement. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild mucosal thickening in the ethmoid sinuses. Mucus retention cyst in the right maxillary and left frontal sinus. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Bilateral internal auditory canals appear unremarkable. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Common origin of the brachiocephalic and left common carotid arteries. RIGHT CAROTID: Calcified atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. LEFT CAROTID: Calcified atherosclerotic disease of the bulb and the proximal ICA, otherwise patent without flow-limiting stenosis. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. Aortic origin. INTRACRANIAL ARTERIES: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. NONVASCULAR FINDINGS: No acute intracranial hemorrhage or infarction. Brain parenchymal volume is appropriate for age. Gray-white differentiation is maintained. Ventricles are normal. No mass effect or midline shift. Dehiscence of the lamina papyracea bilaterally. Unchanged appearance of the surgical plate along the anterior medial aspect of the inferior right orbit with medial migration and obstruction of the right frontoethmoidal recess. The right globe is normal in appearance. The left orbit is normal. Complete opacification of the right frontal sinus. Mucosal thickening of bilateral maxillary sinuses. The mastoid air cells are clear. Partially visualized hardware at the left mandibular angle. Partially visualized right IJ approach chest port. Mild emphysematous changes in bilateral lung apices.
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15,577 |
Clinical History: Assess for epidural and paraspinal abscesses Comparison: MRI 1/20/2022, 10/27/2021, CT 1/10/2022 Technique: Multiplanar multisequence MRI images of the lumbar spine were performed before and after intravenous contrast administration. Patient weight: 187 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: Redemonstration of postsurgical changes of posterior fusion instrumentation and laminectomies at L3-S1. There is unchanged grade 1 anterolisthesis of L4 over L5. There is continued abnormal enhancement in the L4 and L5 vertebral bodies. There is abnormal fluid in the L4-L5 intervertebral disc with increased erosions of the adjacent endplates. There is associated ventral epidural phlegmon. There is phlegmon measuring up to 1.5 cm in the adjacent anterior prevertebral soft tissues. There are likely small microabscesses in the adjacent left psoas muscle and inflammatory changes in the right psoas muscle as well. Abnormal enhancement extends in to the bilateral L5-S1, L4-L5 and to lesser extent L3-L4 neural foramina. Increased size of the 7.4 x 1.9 x 3 cm rim-enhancing dorsal epidural collection which extends into the laminectomy defects at L3-S1, previously 4.4 x 2 x 2.5 cm. In combination of the ventral phlegmon there is severe spinal canal stenosis at L4-L5 and moderate to severe stenosis at L3-L4. There is a continued 9.2 x 1.5 x 2 cm rim enhancing collection in the midline subcutaneous soft tissues with increased craniocaudal extent. Continued enhancement in the posterior paravertebral muscles Redemonstration of abnormal enhancement in the T11 vertebral body adjacent to the fracture. The tip of the conus is at normal location. Impression: 1. Increase size of the large 7.4 cm dorsal epidural abscess at L3-S1. In combination with ventral epidural phlegmon results in severe spinal canal stenosis at L4-L5, and moderate to severe stenosis at L3-L4. Also, also findings worrisome for progression in discitis osteomyelitis at L4-L5, with abnormal enhancement extending into the adjacent neural foramina, anterior prevertebral soft tissues, adjacent psoas muscles with small microabscesses on the left side. Inflammatory changes also extend into the left iliacus muscle. 2. Increased craniocaudal extension of the midline subcutaneous superficial rim enhancing collection also worrisome for infection. Continued enhancement in the posterior paravertebral muscles suggestive of myositis. 3. Redemonstration of abnormal enhancement in the T11 vertebral body adjacent to the fracture.
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Findings: Redemonstration of postsurgical changes of posterior fusion instrumentation and laminectomies at L3-S1. There is unchanged grade 1 anterolisthesis of L4 over L5. There is continued abnormal enhancement in the L4 and L5 vertebral bodies. There is abnormal fluid in the L4-L5 intervertebral disc with increased erosions of the adjacent endplates. There is associated ventral epidural phlegmon. There is phlegmon measuring up to 1.5 cm in the adjacent anterior prevertebral soft tissues. There are likely small microabscesses in the adjacent left psoas muscle and inflammatory changes in the right psoas muscle as well. Abnormal enhancement extends in to the bilateral L5-S1, L4-L5 and to lesser extent L3-L4 neural foramina. Increased size of the 7.4 x 1.9 x 3 cm rim-enhancing dorsal epidural collection which extends into the laminectomy defects at L3-S1, previously 4.4 x 2 x 2.5 cm. In combination of the ventral phlegmon there is severe spinal canal stenosis at L4-L5 and moderate to severe stenosis at L3-L4. There is a continued 9.2 x 1.5 x 2 cm rim enhancing collection in the midline subcutaneous soft tissues with increased craniocaudal extent. Continued enhancement in the posterior paravertebral muscles Redemonstration of abnormal enhancement in the T11 vertebral body adjacent to the fracture. The tip of the conus is at normal location.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Common origin of the brachiocephalic and left common carotid arteries. RIGHT CAROTID: Calcified atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. LEFT CAROTID: Calcified atherosclerotic disease of the bulb and the proximal ICA, otherwise patent without flow-limiting stenosis. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. Aortic origin. INTRACRANIAL ARTERIES: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. NONVASCULAR FINDINGS: No acute intracranial hemorrhage or infarction. Brain parenchymal volume is appropriate for age. Gray-white differentiation is maintained. Ventricles are normal. No mass effect or midline shift. Dehiscence of the lamina papyracea bilaterally. Unchanged appearance of the surgical plate along the anterior medial aspect of the inferior right orbit with medial migration and obstruction of the right frontoethmoidal recess. The right globe is normal in appearance. The left orbit is normal. Complete opacification of the right frontal sinus. Mucosal thickening of bilateral maxillary sinuses. The mastoid air cells are clear. Partially visualized hardware at the left mandibular angle. Partially visualized right IJ approach chest port. Mild emphysematous changes in bilateral lung apices.
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15,578 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 55-year-old woman with history of left breast cancer in 2012 status post breast conservation therapy. Examination is performed given history of breast cancer and presence of dense breast tissue. hx dense breasts, C50.919 Malignant neoplasm of unspecified site of unspecified female breast, Z92.3 Personal history of irradiation, Z98.890 Other specified postprocedural states TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 107 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior MR exams including most recent MRI dated 12/26/2019. Prior mammograms including most recent bilateral exam dated 6/1/2021. FINDINGS: The breasts are heterogeneous fibroglandular. There is minimal background parenchymal enhancement. Changes of breast conservation therapy are redemonstrated in the left breast. There is no suspicious enhancement within either breast. There is no axillary or internal mammary adenopathy. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: No MR evidence of malignancy. BI-RADS 1: Negative. 2. Left Breast: Changes of breast conservation therapy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 2. Recommend continued annual mammography and breast MRI.
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FINDINGS: The breasts are heterogeneous fibroglandular. There is minimal background parenchymal enhancement. Changes of breast conservation therapy are redemonstrated in the left breast. There is no suspicious enhancement within either breast. There is no axillary or internal mammary adenopathy. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: No MR evidence of malignancy. BI-RADS 1: Negative. 2. Left Breast: Changes of breast conservation therapy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 2. Recommend continued annual mammography and breast MRI.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Age-appropriate cerebral atrophy. Confluent periventricular hypoattenuating areas, compatible with mild chronic microangiopathic disease. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Ex vacuo dilatation. ORBITS: Bilateral lens replacements. The orbits are otherwise unremarkable. SINUSES: Minimal opacification of the right posterior ethmoid air cells. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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15,579 |
MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: 49-year-old woman with history of left breast invasive ductal carcinoma status post mastectomy and right breast invasive lobular carcinoma status post breast conservation therapy. MRI is performed for annual supplemental screening. Other, Z85.3 Personal history of malignant neoplasm of breast, Z17.1 Estrogen receptor negative status [ER-] Spec Inst: personal hx of breast cancer diagnosed in 40s, high risk TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast sagittals. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Prior MR exams including most recent MRI dated 11/30/2020. Prior mammograms including most recent right mammogram dated 5/20/2021. FINDINGS: Right breast: The breasts is heterogeneous fibroglandular. There is mild background parenchymal enhancement. Changes of breast conservation therapy are redemonstrated. There is no suspicious interval change when compared to prior exams. Left breast: There are changes of prior mastectomy. There is no suspicious enhancement within the surgical bed. Nodes: There is no axillary or internal mammary adenopathy. Prominent left internal mammary lymph node measuring 11 mm (series 8 image 121) is unchanged dating back to 2018. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Changes of breast conservation therapy without MRI evidence of malignancy. BI-RADS 2: Benign findings. 2. Left Breast: Changes of prior mastectomy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 2. Recommend continued annual right breast mammogram and breast MRI.
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FINDINGS: Right breast: The breasts is heterogeneous fibroglandular. There is mild background parenchymal enhancement. Changes of breast conservation therapy are redemonstrated. There is no suspicious interval change when compared to prior exams. Left breast: There are changes of prior mastectomy. There is no suspicious enhancement within the surgical bed. Nodes: There is no axillary or internal mammary adenopathy. Prominent left internal mammary lymph node measuring 11 mm (series 8 image 121) is unchanged dating back to 2018. IMPRESSION AND RECOMMENDATION(S): 1. Right Breast: Changes of breast conservation therapy without MRI evidence of malignancy. BI-RADS 2: Benign findings. 2. Left Breast: Changes of prior mastectomy without MR evidence of malignancy. BI-RADS 2: Benign findings. Overall BI-RADS assessment: BI-RADS 2. Recommend continued annual right breast mammogram and breast MRI.
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,580 |
MR Brain wo+w contrast 1/25/2022 5:20 PM Clinical information: 85 years Female patient with suspected multiple system atrophy with severe dystonia and tremor. Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 125 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: Cerebral parenchyma: There is moderate diffuse cerebral atrophy predominantly involving the frontoparietal lobes. Mild to moderate atrophy involving the medial temporal lobes. There is advanced confluent areas of periventricular and subcortical white matter microangiopathic disease, which also involves the pons and bilateral cerebellar peduncles. No intracranial mass lesion, hemorrhage, or infarction. There are subtle increased T2 hyperintense signal involving the globus pallidus on either side, likely secondary to prior toxic/metabolic conditions. No abnormal postcontrast enhancement, given the limitation of movement artifacts.. Posterior fossa: There are T2 hyperintense lesions involving the bilateral medial cerebellar peduncles. There is no definite evidence of pontine atrophy to suggest multisystem atrophy. Subtle apparent enhancement in the posterior fossa, likely secondary to the artifacts. Ventricular system: Ex vacuo dilation without hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild mucosal thickening in the anterior ethmoid sinuses. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial pathology. Diffuse cerebral atrophy predominantly involving the bilateral frontoparietal lobes and diffuse confluent T-2/flair hyperintensities in the corona radiata and centrum semiovale, likely microangiopathic changes or leukoencephalopathy.. 2. Nonspecific T2/FLAIR signal in the bilateral middle cerebellar peduncles is a nonspecific finding that can be seen with microangiopathic disease or secondary to demyelination. No associated increased signal in the pontocerebellar tracts or significant atrophy of the brainstem or cerebellum. Subtle T2 hyperintense signal in the bilateral globus pallidi, likely secondary to the prior metabolic/toxic etiology. 3. Homogeneously enhancing small subcentimeter extra-axial lesion in the anterior left para falcine location, favors meningioma. No significant mass effect is identified. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Cerebral parenchyma: There is moderate diffuse cerebral atrophy predominantly involving the frontoparietal lobes. Mild to moderate atrophy involving the medial temporal lobes. There is advanced confluent areas of periventricular and subcortical white matter microangiopathic disease, which also involves the pons and bilateral cerebellar peduncles. No intracranial mass lesion, hemorrhage, or infarction. There are subtle increased T2 hyperintense signal involving the globus pallidus on either side, likely secondary to prior toxic/metabolic conditions. No abnormal postcontrast enhancement, given the limitation of movement artifacts.. Posterior fossa: There are T2 hyperintense lesions involving the bilateral medial cerebellar peduncles. There is no definite evidence of pontine atrophy to suggest multisystem atrophy. Subtle apparent enhancement in the posterior fossa, likely secondary to the artifacts. Ventricular system: Ex vacuo dilation without hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild mucosal thickening in the anterior ethmoid sinuses. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Evaluation is mildly limited by artifact from respiratory motion. The central tracheobronchial tree is patent. Redemonstration of extensive multifocal consolidative opacities throughout both lungs. Worsening groundglass opacities with interlobular septal thickening as well as patchy tree-in-bud nodular opacities in the bilateral upper lobes. Upper lobe predominant centrilobular emphysematous changes. Interval decrease in volume of moderate left pleural effusion. Small right pleural effusion. No pneumothorax. HEART / VESSELS: Heart size normal. Hypoattenuation of the intracardiac blood pool relative to myocardium, suggestive of anemia. Small pericardial effusion. Mild calcific atherosclerosis in the coronary arteries. The main pulmonary artery is borderline dilated, measuring 30 mm in diameter. The thoracic aorta is normal in caliber. MEDIASTINUM / ESOPHAGUS: Trace fluid in the thoracic esophagus. Mild thickening of the distal esophageal wall, likely related to reflux esophagitis. LYMPH NODES: Multiple enlarged mediastinal lymph nodes, similar to prior examination. CHEST WALL: Mild chest wall edema. UPPER ABDOMEN: No significant abnormality in the visualized soft tissue structures of the upper abdomen. MUSCULOSKELETAL: No aggressive osseous abnormality is identified.
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15,581 |
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Knee injury COMPARISON: Radiographs dated 1/9/2022 TECHNIQUE: Multiplanar multisequence images were obtained through the knee. Findings: There is mild degenerative fissuring of the patellar articular cartilage. There is a large full-thickness cartilage defect over the anterior lateral femoral trochlea. A small joint effusion is present. There is no popliteal cyst. There is mild diffuse subcutaneous edema along the anterior knee. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is normal. There is myxoid degenerative signal in the medial meniscus posterior horn and body without discrete tear. Quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum, and iliotibial band are unremarkable. There is chronic appearing thickening of the proximal third of the fibular collateral ligament, but the ligament is intact. Impression: 1. Diffuse subcutaneous edema along the anterior knee may be related to the recent trauma. There is no acute internal knee injury. 2. Overall moderate tricompartment degenerative changes with a large full-thickness focal cartilage defect along the lateral femoral trochlea
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Findings: There is mild degenerative fissuring of the patellar articular cartilage. There is a large full-thickness cartilage defect over the anterior lateral femoral trochlea. A small joint effusion is present. There is no popliteal cyst. There is mild diffuse subcutaneous edema along the anterior knee. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is normal. There is myxoid degenerative signal in the medial meniscus posterior horn and body without discrete tear. Quadriceps and patellar tendons are intact. The medial collateral ligament, patellar retinaculum, and iliotibial band are unremarkable. There is chronic appearing thickening of the proximal third of the fibular collateral ligament, but the ligament is intact.
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FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: Scattered moderate to severe calcified atherosclerosis. CORONARY ARTERIES: There are atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. Right PICC with tip at cavoatrial junction. DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Severe calcified atherosclerosis. CELIAC AXIS: Mild origin stenosis. SMA: Mild origin stenosis. RIGHT RENAL: Mild origin stenosis. LEFT RENAL: Mild origin stenosis. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Severe atherosclerosis. Patent SFA stent. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Severe atherosclerosis. Short segment occlusion of the profunda femoris with distal reconstitution. Proximal left SFA pseudoaneurysm is status post repair without residual abnormality. Patent SFA stent, partially visualized. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy diffuse bilateral groundglass and consolidative opacities with interlobular septal thickening. Small right greater than left effusions. Endotracheal tube tip 2 cm above carina. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube. LYMPH NODES: Scattered mildly enlarged mediastinal nodes, for example, a subcarinal node measuring 1.7 cm in short axis (series 601 image 282), likely reactive. CHEST WALL: Mild anasarca. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small splenule ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube within gastric fundus. No small bowel abnormality. COLON / APPENDIX: Diverticula without inflammation. Appendix is not seen. PERITONEUM / MESENTERY: Unremarkable RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Scrotum is edematous. BODY WALL: Moderate anasarca. Prior ventral abdominal wall hernia mesh repair. Postoperative changes from left groin pseudoaneurysm repair with two percutaneous drains and left groin hematoma measuring approximately 6.7 x 1.7 (TR x AP x CC, series 601 image 1386). Additional intramuscular hematoma within the left vastus medialis and intermedius measuring approximately 5.9 x 3.6 x 6.3 cm and containing focus of internal active contrast extravasation. Scattered subcutaneous gas along the anterior thigh with associated clips. MUSCULOSKELETAL: Acute minimally displaced fractures of the right fourth through sixth and left fourth through fifth ribs. Healing right lateral seventh and left posterolateral 11th rib fractures. Sternoto1my wires with nonunited sternum. Degenerative spine changes.
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15,582 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: 30-year-old female presenting for evaluation of cyst. COMPARISON: None available. TECHNIQUE: MR Knee Left wo contrast STRUCTURED REPORT: MRI Knee FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:Trace suprapatellar effusion. Patellofemoral compartment:Mild chondromalacia of the medial patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. There is a well-circumscribed T1 hypointense, PD FS heterogeneous lesion anterior to the inferior patella and superior patellar tendon with surrounding edema measuring approximately 2.7 x 1.0 x 3.2 cm (series 7 image 12 and series 5 image 11). CONCLUSION: 1. Well-circumscribed, heterogeneous lesion with surrounding edema within the soft tissues anterior to the inferior patella. Concerning for a fibrous lesion, including malignancy. An MRI with contrast is recommended for further evaluation. Radiographs would also be helpful to evaluate for small calcifications. 2. Mild chondromalacia of the medial patellar facet. These results were discussed with Dr. Amit Momaya at 10:50 AM on 1/26/2022. Further history was obtained at this time including the unilateral nature of this lesion , no significant history of patient kneeling/chronic trauma to the area, and no history of gout. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. ARTICULATIONS: Effusion:Trace suprapatellar effusion. Patellofemoral compartment:Mild chondromalacia of the medial patellar facet. Medial compartment:No cartilage defect. Lateral compartment:No cartilage defect. MENISCI: Medial meniscus:Intact. Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. There is a well-circumscribed T1 hypointense, PD FS heterogeneous lesion anterior to the inferior patella and superior patellar tendon with surrounding edema measuring approximately 2.7 x 1.0 x 3.2 cm (series 7 image 12 and series 5 image 11).
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FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: Scattered moderate to severe calcified atherosclerosis. CORONARY ARTERIES: There are atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. Right PICC with tip at cavoatrial junction. DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: Severe calcified atherosclerosis. CELIAC AXIS: Mild origin stenosis. SMA: Mild origin stenosis. RIGHT RENAL: Mild origin stenosis. LEFT RENAL: Mild origin stenosis. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Severe atherosclerosis. Patent SFA stent. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Severe atherosclerosis. Short segment occlusion of the profunda femoris with distal reconstitution. Proximal left SFA pseudoaneurysm is status post repair without residual abnormality. Patent SFA stent, partially visualized. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patchy diffuse bilateral groundglass and consolidative opacities with interlobular septal thickening. Small right greater than left effusions. Endotracheal tube tip 2 cm above carina. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube. LYMPH NODES: Scattered mildly enlarged mediastinal nodes, for example, a subcarinal node measuring 1.7 cm in short axis (series 601 image 282), likely reactive. CHEST WALL: Mild anasarca. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. Small splenule ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube within gastric fundus. No small bowel abnormality. COLON / APPENDIX: Diverticula without inflammation. Appendix is not seen. PERITONEUM / MESENTERY: Unremarkable RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Decompressed by Foley catheter. REPRODUCTIVE ORGANS: Scrotum is edematous. BODY WALL: Moderate anasarca. Prior ventral abdominal wall hernia mesh repair. Postoperative changes from left groin pseudoaneurysm repair with two percutaneous drains and left groin hematoma measuring approximately 6.7 x 1.7 (TR x AP x CC, series 601 image 1386). Additional intramuscular hematoma within the left vastus medialis and intermedius measuring approximately 5.9 x 3.6 x 6.3 cm and containing focus of internal active contrast extravasation. Scattered subcutaneous gas along the anterior thigh with associated clips. MUSCULOSKELETAL: Acute minimally displaced fractures of the right fourth through sixth and left fourth through fifth ribs. Healing right lateral seventh and left posterolateral 11th rib fractures. Sternoto1my wires with nonunited sternum. Degenerative spine changes.
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15,583 |
MR Brain wo+w contrast 1/25/2022 5:58 PM Clinical information: 48 years Male patient with seizure. Comparison: None available. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 210 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: Cerebral parenchyma: Slightly age advanced frontoparietal brain parenchymal volume loss. No evidence of neuronal migrational disorder, intracranial mass lesion, hemorrhage, or infarction. The bilateral hippocampi and parahippocampal gyri are normal in size and signal intensity. No abnormal postcontrast enhancement. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild mucosal thickening in the ethmoid and right maxillary sinuses. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: No acute intracranial process or abnormal enhancement identified. In particular, no MR evidence of anatomic abnormality to explain seizures. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Cerebral parenchyma: Slightly age advanced frontoparietal brain parenchymal volume loss. No evidence of neuronal migrational disorder, intracranial mass lesion, hemorrhage, or infarction. The bilateral hippocampi and parahippocampal gyri are normal in size and signal intensity. No abnormal postcontrast enhancement. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Mild mucosal thickening in the ethmoid and right maxillary sinuses. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: BONES/JOINTS: There is a mildly impacted, comminuted, intra-articular fracture of the distal radius, extending from the metaphysis to the radial articular surface and nears the DRUJ. Slight dorsal offset of the distal fracture fragments. No significant widening of the DRUJ. There is also small ulnar styloid avulsion fracture. No displaced fracture of the scaphoid or remaining bones and joints of the wrist or visualized hand appreciated. Mild soft tissue swelling around fracture. SOFT TISSUES: Mild soft tissue swelling around the fractures.
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15,584 |
EXAM:MR Shoulder Left wo contrast CLINICAL INFORMATION:Shoulder pain, injury COMPARISON:Radiographs dated 1/19/2022 TECHNIQUE:Multiplanar multisequence images were obtained through the shoulder. STRUCTURED REPORT: MRI SHOULDERv5/23//2019 Findings: There are complete tears of the supraspinatus and infraspinatus tendons from the humeral insertion site. Both tendons are retracted centrally approximately 3.9 cm. There is sub attachment bone marrow edema in the greater tuberosity. There is also extensive intramuscular edema in the infraspinatus. Teres minor is unremarkable. There is subscapularis tendinosis without definite tear. The long head biceps tendon is intact and properly positioned within the bicipital groove. There is avulsion of the majority of the posterior labrum with a more focal tear of the posterior inferior labrum. There are moderate hypertrophic degenerative changes of the acromioclavicular joint. Type II acromion shows no abnormal downsloping. The humeral head is elevated against the undersurface of the acromion. Impression: 1. Acute appearing complete tears of the supraspinatus and infraspinatus insertions with considerable central retraction and soft-tissue edema. 2. Extensive posterior labral tear with avulsion of the majority of the posterior labrum. 3. Moderate AC joint degenerative changes.
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Findings: There are complete tears of the supraspinatus and infraspinatus tendons from the humeral insertion site. Both tendons are retracted centrally approximately 3.9 cm. There is sub attachment bone marrow edema in the greater tuberosity. There is also extensive intramuscular edema in the infraspinatus. Teres minor is unremarkable. There is subscapularis tendinosis without definite tear. The long head biceps tendon is intact and properly positioned within the bicipital groove. There is avulsion of the majority of the posterior labrum with a more focal tear of the posterior inferior labrum. There are moderate hypertrophic degenerative changes of the acromioclavicular joint. Type II acromion shows no abnormal downsloping. The humeral head is elevated against the undersurface of the acromion.
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Findings: Right pterional craniotomy has been performed since the prior examination for evacuation of large right cerebral convexity subdural hematoma and right orbitofrontal intraparenchymal hemorrhage. There is an extracalvarial drainage catheter and a drainage catheter in the subdural space. There is a small gas containing epidural hemorrhage underlying the craniotomy site. There is a small residual mixed attenuation subdural hemorrhage along the right cerebral convexity measuring up to 9 mm. There is persistent leftward midline shift measuring 13 mm. There is an evolving right ACA territory infarct. Interval decrease in subdural hemorrhage along the right interhemispheric fissure extending to the bilateral cerebellar tentorium. Small subdural hemorrhage along the left parieto-occipital convexity and cerebellar convexities likely secondary to redistribution. Stable parenchymal hemorrhage in the left frontal lobe and small volume left frontal parietal subarachnoid hemorrhage. There is no other new intracranial hemorrhage There is no acute osseous abnormality. The visualized paranasal sinuses and mastoid air cells are clear.
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15,585 |
MR Lumbar Spine wo+w contrast 1/25/2022 5:43 PM Clinical information: 45 years Male patient with lumbar radiculopathy and right leg pain. Comparison: MRI lumbar spine dated 1/5/2021. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, with and without the uneventful administration of intravenous contrast. Patient weight: 197 lbs. IV contrast: ProHance, 19 ml, per protocol. Findings: The sagittal images demonstrate preservation of the lumbar lordosis, without subluxations. Enhancing lesion (T1 and T2 hypointense) in the right L5 transverse process measures 1.1 x 1.3 cm on image 10, series 801, unchanged. The vertebral bodies otherwise maintain normal height and marrow signal. The intervertebral discs appear mildly desiccated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-L4: Small broad-based posterior disc bulge, bilateral facet arthropathy, and ligamentum flavum hypertrophy result in mild spinal canal and mild left greater than right neuroforaminal narrowing. L4-L5: Postsurgical changes from prior laminectomy. Broad-based posterior with right paracentral disc extrusion and bilateral facet arthropathy resulting in mild bilateral neuroforaminal narrowing. . The extruded disc fragment appears to be larger in the interval and resulting in severe central canal stenosis and right lateral recess stenosis with indentation of the traversing right L5 nerve root. There is mild to moderate bilateral neural foraminal narrowing, right greater than left without nerve root indentation. L5-S1: Bilateral facet arthropathy results in mild bilateral neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. Gluteal injection granulomas are noted. IMPRESSION: 1. Slight interval progression of recurrent disc herniation at L4-L5 extending into the right lateral recess and causing impingement of the transiting right L5 nerve root and severe spinal canal narrowing. 2. Unchanged appearance of enhancing lesion in the right L5 transverse process,, likely benign osseous lesion rather than metastasis, given the stability since January 2020. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The sagittal images demonstrate preservation of the lumbar lordosis, without subluxations. Enhancing lesion (T1 and T2 hypointense) in the right L5 transverse process measures 1.1 x 1.3 cm on image 10, series 801, unchanged. The vertebral bodies otherwise maintain normal height and marrow signal. The intervertebral discs appear mildly desiccated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates normally at L1. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-L4: Small broad-based posterior disc bulge, bilateral facet arthropathy, and ligamentum flavum hypertrophy result in mild spinal canal and mild left greater than right neuroforaminal narrowing. L4-L5: Postsurgical changes from prior laminectomy. Broad-based posterior with right paracentral disc extrusion and bilateral facet arthropathy resulting in mild bilateral neuroforaminal narrowing. . The extruded disc fragment appears to be larger in the interval and resulting in severe central canal stenosis and right lateral recess stenosis with indentation of the traversing right L5 nerve root. There is mild to moderate bilateral neural foraminal narrowing, right greater than left without nerve root indentation. L5-S1: Bilateral facet arthropathy results in mild bilateral neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. Gluteal injection granulomas are noted.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: New moderate right hydronephrosis. No corticomedullary thinning. Left kidney appears unremarkable. No radiopaque urinary tract calculi are seen bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Diffusely dilated small bowel loops throughout the abdomen with an abrupt tapering in the deep pelvis) for example series 301 image 271 and series 601 image 153). The bowel distal to this obstruction appears normal in caliber without complete collapse. Ileal conduit appears normal, exiting at the right lower quadrant. COLON / APPENDIX: Colon is not completely collapsed and filled with fluid. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Mild calcified and atheromatous plaque of the infrarenal abdominal aorta. No aneurysmal dilatation URINARY BLADDER: Bladder is surgically absent. No evidence of abnormal soft tissue nodularity or hyperenhancement at the cystectomy bed. REPRODUCTIVE ORGANS: Uterus is surgically absent. Bilateral adnexa appear unremarkable. BODY WALL: Ileal conduit exiting in the right lower quadrant. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Mild retrolisthesis of L5 on S1 with severe intervertebral disc space narrowing at this level.
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15,586 |
MR Cervical Spine wo contrast 1/25/2022 7:36 PM Clinical information: 57 years Female patient with Cervical radiculopathy, no red flags, M54.2 Cervicalgia, M54.12 Radiculopathy, cervical region Comparison: Plain films of the cervical spine dated 1/19/2022. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Findings: The sagittal images demonstrate mild straightening of the cervical lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated mild C4-C5, C5-C6 and C6-C7 disc height loss. Ossification of the posterior longitudinal ligament is noted extending from C2-C3 to C6-C7. The spinal cord is normal in size and signal intensity, without expansile lesions. The craniocervical junction appears within normal limits. A developmentally narrowed spinal canal is noted. C2-C3: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and mild spinal canal stenosis, without significant neuroforaminal narrowing. C3-C4: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and severe spinal canal stenosis, with severe right and moderate left neuroforaminal narrowing. C4-C5: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and severe spinal canal stenosis, with mild left neuroforaminal narrowing. C5-C6: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and severe spinal canal stenosis, with mild left neuroforaminal narrowing. C6-C7: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess, without significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: Small central disc protrusion, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. IMPRESSION: 1. No evidence of acute findings or definitive abnormal spinal cord signal in the cervical spine. 2. Chronic multilevel degenerative changes in a developmentally narrowed spinal canal, with superimposed ossification of the posterior longitudinal ligament as described, resulting in severe C3-C4 to C5-C6 spinal canal stenosis and severe right/moderate left C3-C4 neuroforaminal narrowing, impinging upon the right C4 nerve root.
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Findings: The sagittal images demonstrate mild straightening of the cervical lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated mild C4-C5, C5-C6 and C6-C7 disc height loss. Ossification of the posterior longitudinal ligament is noted extending from C2-C3 to C6-C7. The spinal cord is normal in size and signal intensity, without expansile lesions. The craniocervical junction appears within normal limits. A developmentally narrowed spinal canal is noted. C2-C3: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and mild spinal canal stenosis, without significant neuroforaminal narrowing. C3-C4: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and severe spinal canal stenosis, with severe right and moderate left neuroforaminal narrowing. C4-C5: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and severe spinal canal stenosis, with mild left neuroforaminal narrowing. C5-C6: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess and severe spinal canal stenosis, with mild left neuroforaminal narrowing. C6-C7: Disc osteophyte complex and ossification of the posterior longitudinal ligament, resulting in effacement of the left lateral recess, without significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: Small central disc protrusion, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections.
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Findings: Postsurgical changes of right frontotemporal craniotomy with persistent mixed density extra-axial collection along the right cerebral convexity with right to left midline shift of 5 mm, previously 6 mm. Interval removal of right scalp and subdural drainage catheters. Decreased but persistent right pneumocephalus. No new foci of intracranial hemorrhage are identified. No visible acute infarcts or hydrocephalus. Bilateral orbits appear unremarkable. Paranasal sinuses and mastoid air cells appear clear.
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15,587 |
MRI OF THE THORACIC SPINE WITHOUT AND WITH CONTRAST CLINICAL INDICATION: Assess for lesion in the thoracic spine TECHNIQUE: Patient did not tolerate the entire study and only noncontrast sagittal T1, sagittal T2, sagittal STIR, axial T2, axial T1-weighted images were acquired. Contrast images could not be acquired. COMPARISON: MRI neck 1/19/2022, MRI cervical spine 2/15/2021, evaluation of the 7/22/2021, cervical spine 11/12/2020, MRI 11/4/2020 FINDINGS: There is mild exaggeration of the kyphotic curvature centered at T7-T8. The vertebral body heights are maintained. There is no suspicious bone marrow signal abnormality. The thoracic spinal cord is normal in caliber and signal. No mass or abnormal fluid collection is present within the spinal canal. The paravertebral soft tissues are unremarkable. There are multilevel disc bulges and small disc protrusions without significant spinal or neuroforaminal stenosis anywhere. For example at T7-T8, there is small central protrusion with flattens the cord. Mild left neuroforaminal narrowing at the C6-C7 due to facet hypertrophy. IMPRESSION: Exam was prematurely terminated and post contrast images were not acquired. Mild degenerative changes without high-grade spinal canal or neuroforaminal stenosis. No abnormal cord signal
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FINDINGS: There is mild exaggeration of the kyphotic curvature centered at T7-T8. The vertebral body heights are maintained. There is no suspicious bone marrow signal abnormality. The thoracic spinal cord is normal in caliber and signal. No mass or abnormal fluid collection is present within the spinal canal. The paravertebral soft tissues are unremarkable. There are multilevel disc bulges and small disc protrusions without significant spinal or neuroforaminal stenosis anywhere. For example at T7-T8, there is small central protrusion with flattens the cord. Mild left neuroforaminal narrowing at the C6-C7 due to facet hypertrophy.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is normal. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Small simple cyst left ovary. Uterus and right adnexa are unremarkable. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
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15,588 |
MRI OF THE CERVICAL SPINE WITHOUT CONTRAST CLINICAL INDICATION: Assess previously seen lesions within the cervical cord TECHNIQUE: Study was prematurely and postcontrast images were not acquired. Acquired images include sagittal T1, sagittal T2, sagittal STIR, axial T2, axial T1-weighted images of the cervical spine without intravenous contrast. COMPARISON: MRI neck 1/19/2022, 12/15/2021, 11/4/2020 FINDINGS: Accounting for differences in technique, there has been no significant change in the size of the 6 mm T2 hypointense lesion in the right hemicord at the level of C3-C4. However there is new surrounding edema extending from C2 through C5 with associated cord expansion. There is mild straightening of the cervical spine lordotic curvature. The vertebral body heights are maintained. There is no suspicious bone marrow signal abnormality. No mass or abnormal fluid collection is present within the cervical spinal canal. There is a unchanged 1.9 x 1 cm multiloculated cystic lesion in the left parotid gland (series 601 image 23) On a level by level basis: At C2-C3, no significant spinal canal or neural foraminal stenosis. At C3-C4, small central protrusion, though no significant spinal canal or neural foraminal stenosis. At C4-C5, small central protrusion, though no significant spinal canal or neural foraminal stenosis. At C5-C6, combination of disc bulge, right greater than left uncovertebral facet hypertrophy results in flattening of the cord and overall mild spinal canal narrowing. Moderate right neuroforaminal stenosis. At C6-C7, no significant spinal canal or neural foraminal stenosis. At C7-T1, no significant spinal canal or neural foraminal stenosis. Small perineural cyst in the right T1-T2 neural foramina. IMPRESSION: Exam was prematurely terminated as per patient's request, and postcontrast images could not be obtained. 1. Accounting for differences in technique and possible motion degradation, no significant change in the size of the 6 mm T2 hypointense lesion in the right hemicord at the level of C3-C4 since November 2020. However there is new moderate surrounding cord edema since December 2021. Findings could represent interval hemorrhage in the small cavernoma resulting in surrounding edema. However, when they were able to tolerate recommend postcontrast images to assess for underlying malignant lesion. 2. Unchanged nonaggressive appearing 1.9 cm multiloculated cystic lesion in the left parotid gland.
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FINDINGS: Accounting for differences in technique, there has been no significant change in the size of the 6 mm T2 hypointense lesion in the right hemicord at the level of C3-C4. However there is new surrounding edema extending from C2 through C5 with associated cord expansion. There is mild straightening of the cervical spine lordotic curvature. The vertebral body heights are maintained. There is no suspicious bone marrow signal abnormality. No mass or abnormal fluid collection is present within the cervical spinal canal. There is a unchanged 1.9 x 1 cm multiloculated cystic lesion in the left parotid gland (series 601 image 23) On a level by level basis: At C2-C3, no significant spinal canal or neural foraminal stenosis. At C3-C4, small central protrusion, though no significant spinal canal or neural foraminal stenosis. At C4-C5, small central protrusion, though no significant spinal canal or neural foraminal stenosis. At C5-C6, combination of disc bulge, right greater than left uncovertebral facet hypertrophy results in flattening of the cord and overall mild spinal canal narrowing. Moderate right neuroforaminal stenosis. At C6-C7, no significant spinal canal or neural foraminal stenosis. At C7-T1, no significant spinal canal or neural foraminal stenosis. Small perineural cyst in the right T1-T2 neural foramina.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Unchanged chronic infarct-related encephalomalacia within the parasagittal right frontal parietal lobe. Additional unchanged chronic ischemic change within the right frontal operculum and insular cortex. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left maxillary sinus mucous retention cyst. Prior right wall down mastoidectomy. Multiple dental caries with scattered periapical lucencies. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,589 |
MR Brain wo+w contrast 1/25/2022 6:11 PM Clinical information: 51 years Female patient with non-small cell lung cancer, evaluate for intracranial metastasis. Comparison: CT head without contrast dated 2/25/2011. Whole body PET/CT dated 1/14/2022. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 115 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: Cerebral parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is seen. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Unchanged right frontal convexity arachnoid cyst. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Opacification of a single right posterior ethmoid air cell. Small mucous retention cyst in the right maxillary sinus. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: No acute intracranial pathology or abnormal enhancement identified to suggest metastatic disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Cerebral parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is seen. No abnormal enhancement, intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Unchanged right frontal convexity arachnoid cyst. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Opacification of a single right posterior ethmoid air cell. Small mucous retention cyst in the right maxillary sinus. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Unchanged chronic infarct-related encephalomalacia within the parasagittal right frontal parietal lobe. Additional unchanged chronic ischemic change within the right frontal operculum and insular cortex. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left maxillary sinus mucous retention cyst. Prior right wall down mastoidectomy. Multiple dental caries with scattered periapical lucencies. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,590 |
MR Stroke Protocol with MRAs 1/27/2022 12:11 PM Clinical Information: infarcts on MRI Comparison: MRI brain dated 1/24/2022. Technique: Axial DWI (b=1000 and 2000) with ADC maps, axial SWI with phase map, axial T2/FLAIR/T1, and post contrast axial and sagittal T1, 3-D multislab TOF MRA of the head and axial 2-D TOF MRA of the neck without contrast, and coronal thick slab CE-MRA of the neck Patient weight: 196 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: Previous left parietal subcortical lacunar infarct shows interval resolution of diffusion restriction. No new area of diffusion restriction is identified. Pronounced chronic small vessel ischemic disease involving the bilateral periventricular/deep white matter and pons is again noted. No interval acute intracranial abnormality is identified. Intracranial contrast enhancement is of normal pattern. The intracranial ICA, MCA, ACA and PCA show no evidence of focal luminal stenosis or branch occlusion. No aneurysm or vascular malformation is identified. The intracranial segment of the right vertebral artery is not visualized. The left V4 segment, basilar artery, and bilateral PICA are patently visualized. Neck MRA demonstrates no flow limiting stenoses along the bilateral CCA and cervical ICA. There is focal high-grade stenosis of the right ECA origin. Ostial stenosis of the right vertebral artery is suspected. Dominant left vertebral artery is well maintained. Impression: 1. Resolved diffusion restriction of the left parietal subcortical lacunar infarct. 2. Probable right vertebral artery V4 segment occlusion. 3. Focal high-grade stenosis of the right ECA origin. 4. Probable right vertebral artery ostial stenosis.
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Findings: Previous left parietal subcortical lacunar infarct shows interval resolution of diffusion restriction. No new area of diffusion restriction is identified. Pronounced chronic small vessel ischemic disease involving the bilateral periventricular/deep white matter and pons is again noted. No interval acute intracranial abnormality is identified. Intracranial contrast enhancement is of normal pattern. The intracranial ICA, MCA, ACA and PCA show no evidence of focal luminal stenosis or branch occlusion. No aneurysm or vascular malformation is identified. The intracranial segment of the right vertebral artery is not visualized. The left V4 segment, basilar artery, and bilateral PICA are patently visualized. Neck MRA demonstrates no flow limiting stenoses along the bilateral CCA and cervical ICA. There is focal high-grade stenosis of the right ECA origin. Ostial stenosis of the right vertebral artery is suspected. Dominant left vertebral artery is well maintained.
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Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Small mucous tension cyst in the left sphenoid sinus. The remaining visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
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15,591 |
MR Brain wo+w contrast 1/25/2022 6:26 PM Clinical information: 26 years Female patient with multiple sclerosis. Comparison: MR brain with and without contrast dated 4/12/2018. Technique: Multiplanar, multisequence MRI of the brain was performed with and without the uneventful administration of intravenous contrast. Patient weight: 173 lbs. IV contrast: ProHance, 16 ml, per protocol. FINDINGS: Cerebral parenchyma: Scattered T2/FLAIR hyperintense periventricular white matter lesions with a pericallosal and septocallosal distribution are overall similar in size and number, except for a few new punctate lesions in the left corona radiata (for example on image 107, series 401). No associated diffusion restriction or abnormal enhancement in any of these lesions. The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: Mild bilateral exophthalmos, unchanged. No acute ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. Incidental unchanged 9 mm right anterior intraparotid hyperintense T2-weighted lesion, likely a reactive lymph node. IMPRESSION: 1. No acute intracranial process or abnormal enhancement identified. 2. A few T2/FLAIR hyperintense demyelinating lesions in the left corona radiata are new since April 2018. There is otherwise stable disease, without evidence of active demyelination. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Cerebral parenchyma: Scattered T2/FLAIR hyperintense periventricular white matter lesions with a pericallosal and septocallosal distribution are overall similar in size and number, except for a few new punctate lesions in the left corona radiata (for example on image 107, series 401). No associated diffusion restriction or abnormal enhancement in any of these lesions. The brain parenchyma volume is appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: Mild bilateral exophthalmos, unchanged. No acute ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. Incidental unchanged 9 mm right anterior intraparotid hyperintense T2-weighted lesion, likely a reactive lymph node.
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FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,592 |
MR Lumbar Spine wo contrast 1/25/2022 6:15 PM Clinical information: 25 years Female patient with increasing lower back and bilateral leg pain. Comparison: Lumbar spine radiograph dated 1/24/2022. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, without intravenous contrast administration. Findings: The sagittal images demonstrate mild straightening of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates at the level of T12. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Small broad-based disc bulge without significant spinal canal or neuroforaminal narrowing. L5-S1: Epidural lipomatosis extending into the sacral canal, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections. IMPRESSION: 1. No evidence of acute findings in the lumbar spine. 2. Early degenerative disc disease centered at L4-5, without significant spinal canal stenosis or neuroforaminal narrowing. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The sagittal images demonstrate mild straightening of the lumbar lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear well-hydrated, without significant disc height loss. The distal spinal cord is normal in size and signal intensity, without expansile lesions. The tip of the conus medullaris terminates at the level of T12. L1-L2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: The spinal canal and neural foramina are patent. L3-4: No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Small broad-based disc bulge without significant spinal canal or neuroforaminal narrowing. L5-S1: Epidural lipomatosis extending into the sacral canal, without significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus. Main pulmonary artery trunk is normal in caliber, measuring up to 22 mm. LUNGS / AIRWAYS / PLEURA: Dense airspace consolidation in the left lower lobe. There are additional scattered nodular airspace opacities scattered throughout both lungs, particularly in the right upper lobe. No pleural effusion or pneumothorax. Central tracheobronchial tree is widely patent and clear. HEART / OTHER VESSELS: Heart size is normal without pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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15,593 |
EXAM:MR Ankle Left wo contrast CLINICAL INFORMATION:Ankle pain COMPARISON:1/18/2022 MRI dated 9/8/2021 TECHNIQUE: Multiplanar and multisequence MRI of the left ankle was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. There is a prominent trigonal process of the posterior talus without associated edema to suggest posterior ankle impingement. Os peroneum. ARTICULATIONS: Effusion: Small effusions within the tibiotalar and subtalar joints. Tibiotalar joint:Normal. Subtalar joint:Normal. Tarsal joints:Normal. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex:Normal. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Thickening and intermediate signal as well as linear hyperintense intrasubstance signal between the peroneal tubercle of the calcaneus in the os peroneum. Peroneus brevis tendon:Intermediate signal is noted within the distal tendon. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament:Chronic, complete tear. Posterior talofibular ligament:Normal. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Small amount of edema within the distal soleus muscle with fluid around the distal Achilles tendon. Small amount of fluid is noted at the retrocalcaneal bursa. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal. CONCLUSION: 1. Partial thickness intrasubstance tear of the peroneus longus tendon with tendinosis between the os perioneus and calcaneal peroneal tubercle. 2. Low-grade strain of the soleus muscle with associated Achilles peritendinitis. 3. Tendinosis of the peroneus brevis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. There is a prominent trigonal process of the posterior talus without associated edema to suggest posterior ankle impingement. Os peroneum. ARTICULATIONS: Effusion: Small effusions within the tibiotalar and subtalar joints. Tibiotalar joint:Normal. Subtalar joint:Normal. Tarsal joints:Normal. MEDIAL COMPARTMENT: Medial malleolus:Normal. Posterior tibial tendon:Normal. Flexor digitorum longus tendon:Normal. Deltoid ligament complex:Normal. LATERAL COMPARTMENT: Lateral malleolus:Normal. Peroneus longus tendon:Thickening and intermediate signal as well as linear hyperintense intrasubstance signal between the peroneal tubercle of the calcaneus in the os peroneum. Peroneus brevis tendon:Intermediate signal is noted within the distal tendon. Anterior tibiofibular ligament:Normal. Posterior tibiofibular ligament:Normal. Anterior talofibular ligament:Chronic, complete tear. Posterior talofibular ligament:Normal. Calcaneofibular ligament:Normal. POSTERIOR COMPARTMENT: Flexor hallucis longus:Normal. Achilles tendon:Small amount of edema within the distal soleus muscle with fluid around the distal Achilles tendon. Small amount of fluid is noted at the retrocalcaneal bursa. Plantar fascia:Normal. ANTERIOR COMPARTMENT: Anterior tibial tendon:Normal. Extensor hallucis longus:Normal. Extensor digitorum longus:Normal. TARSAL TUNNEL:Normal. SINUS TARSI:Normal.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Bilateral maxillary sinus mucosal disease with left maxillary sinus mucous retention cyst MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,594 |
MR Brain wo+w contrast 1/26/2022 4:28 PM Clinical Information: GBM status post tumor resection Comparison: CT head dated 1/25/2022 Technique: Multiplanar MR imaging was performed with and without contrast per department protocol.. Findings: The patient is status post right frontal craniotomy, for resection of the underlying frontal lobe tumor. There is residual pneumocephalus and pneumoventricle. Diffusion restriction along the resection cavity is noted. Scattered areas of magnetic susceptibility is noted in the residual cavity, secondary to postsurgical hemorrhagic changes. There is associated extensive nonenhancing T2/FLAIR hyperintense signal similar extent the preoperative MR. Similar mass effect on the right lateral ventricle and about 12 mm right-to-left midline shift. Right uncal herniation and mild mass effect on the right cerebral peduncle. There is residual irregular thick enhancement at the posterior margin of the resection cavity medially measuring about 1 cm in maximum thickness (series 801 image 23) The visualized paranasal sinuses and mastoid air cells are clear. Impression: 1. Postsurgical changes as frontal craniotomy with similar extent of non enhancing T2/ FLAIR hyperintense signal with mass effect on the right lateral ventricle and 12 mm right-to-left midline shift. 2. There appears to be residual irregular enhancement along the posterior margin of the resection cavity. Suggest attention on follow up imaging. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The patient is status post right frontal craniotomy, for resection of the underlying frontal lobe tumor. There is residual pneumocephalus and pneumoventricle. Diffusion restriction along the resection cavity is noted. Scattered areas of magnetic susceptibility is noted in the residual cavity, secondary to postsurgical hemorrhagic changes. There is associated extensive nonenhancing T2/FLAIR hyperintense signal similar extent the preoperative MR. Similar mass effect on the right lateral ventricle and about 12 mm right-to-left midline shift. Right uncal herniation and mild mass effect on the right cerebral peduncle. There is residual irregular thick enhancement at the posterior margin of the resection cavity medially measuring about 1 cm in maximum thickness (series 801 image 23) The visualized paranasal sinuses and mastoid air cells are clear.
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Bilateral maxillary sinus mucosal disease with left maxillary sinus mucous retention cyst MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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15,595 |
Left humerus MRI: Indication: Left humerus pain. Remote history of tumor resection x2. Evaluate for tumor recurrence. Technique: Multiplanar multisequence images were obtained through the humerus both pre and post intravenous contrast administration. Technique: Patient weight: 221 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: The area of interest was demarcated along lateral arm with external skin capsules. No abnormal underlying mass is seen. Subcutaneous adipose tissue, muscles, and bone marrow show normal signal characteristics. After contrast administration, no abnormal enhancement is seen. The shoulder joint is suboptimally evaluated due to the imaging protocol; however, there are moderate glenohumeral degenerative changes. The supraspinatus and infraspinatus tendons appear attenuated and probably torn. Impression: 1. No abnormal mass seen in the arm. 2. Glenohumeral degenerative changes and probable large rotator cuff tear. Limited evaluation due to protocol tailoring for tumor evaluation.
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Findings: The area of interest was demarcated along lateral arm with external skin capsules. No abnormal underlying mass is seen. Subcutaneous adipose tissue, muscles, and bone marrow show normal signal characteristics. After contrast administration, no abnormal enhancement is seen. The shoulder joint is suboptimally evaluated due to the imaging protocol; however, there are moderate glenohumeral degenerative changes. The supraspinatus and infraspinatus tendons appear attenuated and probably torn.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Bilateral lower lung predominant scattered dense airspace opacities and groundglass opacities could represent multifocal infection/Covid. HEART / OTHER VESSELS: Mildly enlarged heart. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Mildly prominent mediastinal lymph nodes, likely reactive. CHEST WALL: Redemonstrated scarring within the right posterior chest wall. UPPER ABDOMEN: Diffuse fatty infiltration of the liver. MUSCULOSKELETAL: Old healed bilateral rib fractures again seen. Right rib fracture fixation hardware again seen.
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15,596 |
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Knee pain COMPARISON: Radiographs dated 1/14/2022 TECHNIQUE: Multiplanar multisequence images were obtained through the knee. Findings: There is severe tricompartment osteoarthrosis. There is near complete articular cartilage loss throughout the patellofemoral and tibiofemoral compartments. Severe, extensive bone marrow infarcts are present throughout the distal femur and proximal tibia and fibular head. There is a large knee joint effusion with a moderate amount of internal debris. No popliteal cyst is seen. There is severe myxoid degenerative change of the anterior and posterior cruciate ligaments. The lateral meniscus is severely macerated with no significant identifiable pieces remaining. There is complex tearing of the entire medial meniscus, especially the meniscal body which is impacted upon a large femoral osteophyte. The quadriceps and patellar tendons are intact. The medial collateral ligament is chronically thickened and peripherally displaced by large femoral osteophytes. The patellar retinaculum, iliotibial band, and posterior lateral corner structures are intact. Impression: 1. Severe tricompartment osteoarthrosis with near complete articular cartilage loss. 2. Extensive bone marrow infarcts around the knee. 3. Complete maceration of the lateral meniscus. Extensive chronic tearing of the medial meniscus. 4. Severe myxoid degenerative change of the anterior and posterior cruciate ligaments. 5. Large knee joint effusion with moderate internal debris.
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Findings: There is severe tricompartment osteoarthrosis. There is near complete articular cartilage loss throughout the patellofemoral and tibiofemoral compartments. Severe, extensive bone marrow infarcts are present throughout the distal femur and proximal tibia and fibular head. There is a large knee joint effusion with a moderate amount of internal debris. No popliteal cyst is seen. There is severe myxoid degenerative change of the anterior and posterior cruciate ligaments. The lateral meniscus is severely macerated with no significant identifiable pieces remaining. There is complex tearing of the entire medial meniscus, especially the meniscal body which is impacted upon a large femoral osteophyte. The quadriceps and patellar tendons are intact. The medial collateral ligament is chronically thickened and peripherally displaced by large femoral osteophytes. The patellar retinaculum, iliotibial band, and posterior lateral corner structures are intact.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: 8 mm noncalcified nodule of the posterior dependent right lower lobe with surrounding groundglass opacity (series 201 image 63). DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Borderline cirrhotic with a recanalized periumbilical vein. BILIARY TRACT: Mild multifocal irregular intrahepatic biliary ductal dilation. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Stable splenomegaly. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Mildly prominent periportal and right cardiophrenic nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Within normal limits PERITONEUM / MESENTERY: Trace pelvic free fluid. No free air RETROPERITONEUM: Normal. VESSELS: Small venous varices in the upper abdomen. Enlarged main portal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
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15,597 |
Lumbar MRI with and without contrast - Clinical indication: Back pain in known CNS leukemia lymphoma; concern for disease in spine. - Technique: Multiple T1 and T2 weighted MR sequence images of the lumbar spine were obtained in the axial and sagittal plane without and with the use of intravenous contrast per departmental cervical spine protocol. Patient weight: 211 lbs. IV contrast: ProHance, 20 ml, per protocol. - Comparison: No previous similar studies are presented for comparison.. - Findings: Sagittal imaging demonstrates Intervertebral disc spaces, vertebral body heights, and alignment to be maintained. Visualized homogeneous marrow replacement which appears hypointense on T1 and T2-weighted images. Multilevel mixed Modic type I and type II degenerative endplate changes. Axial imaging demonstrates no significant disc degenerative changes. The conus terminates at L1-2 There is thick leptomeningeal enhancement along the anterior and posterior surface of the lower thoracic cord and conus. The nodular focus of enhancement along the descending cauda equina nerve roots is seen at L3 level (series 18 image 47. Subcentimeter left renal cysts. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. - Impression: 1. Leptomeningeal enhancement along the lower thoracic cord and conus with nodular focus of enhancement along the descending cauda equina nerve roots in this case of AML with intracranial lesions is suggestive leptomeningeal deposits. 2. Generalized thoracolumbar marrow replacement. No evidence of osteomyelitis/ spondylodiskitis. -
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Findings: Sagittal imaging demonstrates Intervertebral disc spaces, vertebral body heights, and alignment to be maintained. Visualized homogeneous marrow replacement which appears hypointense on T1 and T2-weighted images. Multilevel mixed Modic type I and type II degenerative endplate changes. Axial imaging demonstrates no significant disc degenerative changes. The conus terminates at L1-2 There is thick leptomeningeal enhancement along the anterior and posterior surface of the lower thoracic cord and conus. The nodular focus of enhancement along the descending cauda equina nerve roots is seen at L3 level (series 18 image 47. Subcentimeter left renal cysts. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. -
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FINDINGS: THORACIC SPINE: VERTEBRA: Acute T12 inferior compression fracture endplate fracture. No additional acute fractures identified. Chronic appearing compression fractures at T5, T7, and T10. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Atherosclerotic calcifications of the thoracic aorta. No other significant abnormality. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Chronic appearing mild compression deformity of L4. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most severe at L3-L4 and L5-S1. Bilateral facet arthropathy. PREVERTEBRAL SOFT TISSUES: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. No other significant abnormality. ALIGNMENT: Normal. OTHER: Partially visualized right hip arthroplasty changes.
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15,598 |
MR Brain wo+w contrast 1/26/2022 5:13 PM Clinical information: 76 years Female patient with meningioma Comparison: CT head without contrast dated 1/26/2022 at 05:06 hours. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 172 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: Cerebral parenchyma: Evolving postsurgical biparietal craniotomy changes for meningioma resection are again seen, demonstrating two discrete residual enhancing nodules, anteriorly measuring up to 12 mm and posteriorly up to 10.5 mm, with associated multi compartmental SWI susceptibility artifact suggestive of hemorrhages, including posterior parietal subdural hematoma extending into the falx and scattered petechial hemorrhages in the adjacent brain parenchyma. Unchanged confluent right centrum semiovale vasogenic edema, involving the right pre- and post-central gyri, with a small amount of abnormal hyperintense long TR signal extending also into the left precentral gyrus. Diffuse dural enhancement, most likely reactive in nature. Ventricular system: No hydrocephalus or midline shift. Vascular system: Severe luminal narrowing and filling defects involving the posterior aspect of the superior sagittal sinus, concerning for thrombosis. No loss of the major arterial vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Unchanged bilateral lens replacements. Calvarium and skull base: Postsurgical changes as above. No osseous destruction. Minimal left mastoid air cell effusion. Pituitary and Pineal Glands: Stable partially empty sella. No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Evolving postsurgical biparietal craniotomy changes for meningioma resection, demonstrating two discrete residual enhancing nodules, anteriorly measuring up to 12 mm and posteriorly up to 10.5 mm, with associated multi compartmental hemorrhages, including posterior parietal subdural hematoma extending into the falx and scattered petechial hemorrhages in the adjacent brain parenchyma. 2. Severe luminal narrowing and filling defects involving the posterior aspect of the superior sagittal sinus, concerning for thrombosis. 3. Unchanged confluent right centrum semiovale vasogenic edema, involving the right pre- and post-central gyri, with a small amount of abnormal hyperintense long TR signal extending also into the left precentral gyrus.
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FINDINGS: Cerebral parenchyma: Evolving postsurgical biparietal craniotomy changes for meningioma resection are again seen, demonstrating two discrete residual enhancing nodules, anteriorly measuring up to 12 mm and posteriorly up to 10.5 mm, with associated multi compartmental SWI susceptibility artifact suggestive of hemorrhages, including posterior parietal subdural hematoma extending into the falx and scattered petechial hemorrhages in the adjacent brain parenchyma. Unchanged confluent right centrum semiovale vasogenic edema, involving the right pre- and post-central gyri, with a small amount of abnormal hyperintense long TR signal extending also into the left precentral gyrus. Diffuse dural enhancement, most likely reactive in nature. Ventricular system: No hydrocephalus or midline shift. Vascular system: Severe luminal narrowing and filling defects involving the posterior aspect of the superior sagittal sinus, concerning for thrombosis. No loss of the major arterial vascular flow voids. Visualized paranasal sinuses: No mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Unchanged bilateral lens replacements. Calvarium and skull base: Postsurgical changes as above. No osseous destruction. Minimal left mastoid air cell effusion. Pituitary and Pineal Glands: Stable partially empty sella. No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: THORACIC SPINE: VERTEBRA: Acute T12 inferior compression fracture endplate fracture. No additional acute fractures identified. Chronic appearing compression fractures at T5, T7, and T10. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes. PREVERTEBRAL SOFT TISSUES: Atherosclerotic calcifications of the thoracic aorta. No other significant abnormality. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture. Chronic appearing mild compression deformity of L4. DISC SPACES AND FACET JOINTS: No acute injury. Multilevel discogenic degenerative changes, most severe at L3-L4 and L5-S1. Bilateral facet arthropathy. PREVERTEBRAL SOFT TISSUES: Mild calcific atherosclerosis of the abdominal aorta and its branch vessels. No other significant abnormality. ALIGNMENT: Normal. OTHER: Partially visualized right hip arthroplasty changes.
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15,599 |
MR Brain wo+w contrast 1/25/2022 8:45 PM Clinical information: 45 years Female patient with Astrocytoma oligodendroglioma, monitor, C71.1 Malignant neoplasm of frontal lobe Comparison: MRI brain with and without contrast dated 8/23/2021. Technique: Multiplanar, multisequence MRI of the brain was performed before and after the administration of intravenous contrast. Patient weight: 195 lbs. IV contrast: ProHance, 19 ml, per protocol. FINDINGS: Cerebral parenchyma: Remote postsurgical right parietal craniotomy changes are again seen, with underlying resection cavity demonstrating unchanged thin enhancement along its anterior margin and stable surrounding abnormal hyperintense long TR signal suggestive of posttreatment changes. The brain parenchyma volume is otherwise appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Unchanged tiny left maxillary sinus mucous retention cyst and mild scattered anterior ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. No acute intracranial process or significant interval change identified. 2. Stable remote postsurgical right parietal craniotomy changes, with underlying resection cavity demonstrating unchanged thin enhancement along its margin aspect and stable surrounding abnormal hyperintense long TR signal suggestive of posttreatment changes.
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FINDINGS: Cerebral parenchyma: Remote postsurgical right parietal craniotomy changes are again seen, with underlying resection cavity demonstrating unchanged thin enhancement along its anterior margin and stable surrounding abnormal hyperintense long TR signal suggestive of posttreatment changes. The brain parenchyma volume is otherwise appropriate for patient's age. No intracranial mass lesion, hemorrhage, or infarction. Ventricular system: No hydrocephalus or midline shift. Extra axial spaces: No epidural, subdural, or subarachnoid hemorrhage. No basal cistern effacement. Vascular system: No loss of the major vascular flow voids. Visualized paranasal sinuses: Unchanged tiny left maxillary sinus mucous retention cyst and mild scattered anterior ethmoid air cell mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
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FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. RIGHT CAROTID: Atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. LEFT CAROTID: Atherosclerotic disease of the bulb and proximal ICA, otherwise patent without flow-limiting stenosis. RIGHT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. LEFT VERTEBRAL ARTERY: Patent without flow-limiting stenosis. INTRACRANIAL ARTERIES: The bilateral ACAs, MCAs and PCAs appear patent, without flow-limiting stenoses or discrete aneurysms. The vertebrobasilar axis is patent without flow-limiting stenoses. Atherosclerotic calcifications of the carotid siphons. Mild irregularities along the distal cortical branches of right MCA. NONVASCULAR FINDINGS: Please see same-day CT without contrast for dedicated nonvascular intracranial findings. No significant soft tissue abnormality in the neck. Visualized lung apices are clear. Multilevel discogenic degenerative changes. Partial ankylosis of T3-T4.
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