Datasets:
AiDoc
/
CT-MRI_metrics_validation_dataset

Dataset card Data Studio Files
xet
Community
exam_ID
int64
2k
16.7k
raw_report
stringlengths
56
10.9k
report_findings_positive
stringlengths
9
6.27k
report_findings_negative
stringlengths
9
6.27k
15,600
MR Cervical Spine wo contrast 1/25/2022 9:48 PM Clinical information: 75 years Female patient with C spine injury after fall Comparison: CT cervical spine from reformat dated 1/25/2022 at 15:10 hours. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Findings: Please refer to same-day CT of the cervical spine for better characterization of fracture lines. Confluent hypointense T1, hyperintense T2-weighted signal is noted involving the base of the dens, extending into the anterior atlantooccipital membrane, apical and cruciate ligaments. The tectorial membrane, transverse and alar ligaments remain intact. Prevertebral edema is noted descending to the level of C4. Ill-defined edema is also noted along the posterior craniocervical junction, including the posterior atlantooccipital membrane, extending to the level of C6. The sagittal images demonstrate otherwise persistent preservation of the cervical lordosis, without subluxations. The remaining vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated moderate C4-C5 and mild multilevel disc height loss. 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: The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex and uncovertebral hypertrophy, resulting in moderate left and mild right neuroforaminal narrowing, with moderate to severe spinal canal stenosis. C4-C5: Disc osteophyte complex and uncovertebral hypertrophy, resulting in moderate right and mild left neuroforaminal narrowing, with moderate spinal canal stenosis. C5-C6: Disc osteophytes complex and uncovertebral hypertrophy, resulting in moderate to severe spinal canal stenosis, without significant neuroforaminal narrowing. C6-C7: Left uncovertebral hypertrophy, resulting in mild left neuroforaminal narrowing and partial effacement of the left lateral recess, without significant spinal canal stenosis. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. IMPRESSION: 1. Please refer to same-day CT of the cervical spine for better characterization of fracture lines. 2. Confluent hypointense T1, hyperintense T2-weighted signal involving the base of the dens, extending into the anterior and posterior atlantooccipital membranes, apical and cruciate ligaments, suggestive of post traumatic avulsions. Intact tectorial membrane, transverse and alar ligaments. 3. No evidence of abnormal extra-axial fluid collections, spinal cord contusion or intramedullary hemorrhage. 4. Chronic multilevel degenerative changes, in a developmentally narrowed spinal canal as described, most pronounced at C3-C4 and C5-C6, resulting in moderate to severe spinal canal stenosis.
Findings: Please refer to same-day CT of the cervical spine for better characterization of fracture lines. Confluent hypointense T1, hyperintense T2-weighted signal is noted involving the base of the dens, extending into the anterior atlantooccipital membrane, apical and cruciate ligaments. The tectorial membrane, transverse and alar ligaments remain intact. Prevertebral edema is noted descending to the level of C4. Ill-defined edema is also noted along the posterior craniocervical junction, including the posterior atlantooccipital membrane, extending to the level of C6. The sagittal images demonstrate otherwise persistent preservation of the cervical lordosis, without subluxations. The remaining vertebral bodies maintain normal height and marrow signal. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated moderate C4-C5 and mild multilevel disc height loss. 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: The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex and uncovertebral hypertrophy, resulting in moderate left and mild right neuroforaminal narrowing, with moderate to severe spinal canal stenosis. C4-C5: Disc osteophyte complex and uncovertebral hypertrophy, resulting in moderate right and mild left neuroforaminal narrowing, with moderate spinal canal stenosis. C5-C6: Disc osteophytes complex and uncovertebral hypertrophy, resulting in moderate to severe spinal canal stenosis, without significant neuroforaminal narrowing. C6-C7: Left uncovertebral hypertrophy, resulting in mild left neuroforaminal narrowing and partial effacement of the left lateral recess, without significant spinal canal stenosis. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing.
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.
15,601
MR Cervical Spine wo contrast 1/25/2022 11:12 PM Clinical Information: Evaluation for cervical spine injury after fall Comparison: CT cervical spine dated 1/25/2022 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 are seen status post anterior fusion of C3-C4 vertebral bodies. No abnormality of cervical spinal alignment. Small focus of bone marrow edema is noted at superior endplate of C5 correlating with known fracture on previous CT scan however the fracture line can be better seen on the CT scan. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. There is mild prevertebral soft tissue edema from C5 to T2 level which is likely secondary to C5 fracture. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is moderate bilateral uncovertebral joint arthropathy and flaval hypertrophy, causing moderate bilateral neural foraminal and mild spinal canal narrowing. C3-C4: There is a small residual posterior osteophyte without obvious spinal canal stenosis or neural foraminal narrowing. C4-C5: There is disc bulging with a superimposed central herniation with mild spinal cancers and mild compression over the ventral aspect of cord. C5-C6: There is posterior disc osteophyte formation with mild spinal cancers and mild cord compression. There is mild bilateral neural from stenosis. C6-C7: There is posterior disc osteophyte formation with mild spinal canal stenosis and mild cord compression. C7-T1: There is disc bulging with minimal spinal canal stenosis and mild bilateral neural foraminal narrowing. T1-T2:. No evidence of neural foraminal narrowing or spinal canal stenosis is noted The visualized prevertebral and paravertebral soft tissues are unremarkable. Impression: The known superior endplate fracture of C5 is better seen on the CT scan. Small prevertebral soft tissue edema in the cervicothoracic region is likely secondary to mentioned C5 fracture. Otherwise no definite acute pathology of cervical spine given limitation of MRI with motion artifact. Advanced degenerative changes in cervical spine from C4 to C7 as described above. 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. Addendum is issued to correct a typo. C4-C5: There is disc bulging with a superimposed central herniation with mild spinal canal stenosis and mild compression over the ventral aspect of cord. C5-C6: There is posterior disc osteophyte formation with mild spinal canal stenosis and mild cord compression. There is mild bilateral neural from stenosis.
Findings: Postsurgical changes are seen status post anterior fusion of C3-C4 vertebral bodies. No abnormality of cervical spinal alignment. Small focus of bone marrow edema is noted at superior endplate of C5 correlating with known fracture on previous CT scan however the fracture line can be better seen on the CT scan. The visualized portions of the posterior fossa and craniocervical junction appear normal. The cervical spinal cord is unremarkable. There is mild prevertebral soft tissue edema from C5 to T2 level which is likely secondary to C5 fracture. Degenerative changes of the cervical spine are described on a level by level basis below: C2-C3: There is moderate bilateral uncovertebral joint arthropathy and flaval hypertrophy, causing moderate bilateral neural foraminal and mild spinal canal narrowing. C3-C4: There is a small residual posterior osteophyte without obvious spinal canal stenosis or neural foraminal narrowing. C4-C5: There is disc bulging with a superimposed central herniation with mild spinal cancers and mild compression over the ventral aspect of cord. C5-C6: There is posterior disc osteophyte formation with mild spinal cancers and mild cord compression. There is mild bilateral neural from stenosis. C6-C7: There is posterior disc osteophyte formation with mild spinal canal stenosis and mild cord compression. C7-T1: There is disc bulging with minimal spinal canal stenosis and mild bilateral neural foraminal narrowing. T1-T2:. No evidence of neural foraminal narrowing or spinal canal stenosis is noted The visualized prevertebral and paravertebral soft tissues are unremarkable.
Findings: There is no intracranial hemorrhage or acute infarction. There is no hydrocephalus or brain edema/mass effect. Diffuse brain volume loss with ex vacuo ventricular dilatation and moderate white matter microangiopathic changes. Small incidental malacia in bilateral temporal lobes. Gray-white matter differentiation is overall maintained. Multiple large arachnoid granulations along the occipital bone.
15,602
MR Cervical Spine wo+w contrast 1/25/2022 9:02 PM Clinical information: 54 years Female patient with Chiari malformation, G93.5 Compression of brain Comparison: None available. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Additionally, sagittal and axial T1 post contrast images were obtained. Patient weight: 234 lbs. Findings: The sagittal images demonstrate physiologic cervical lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal, with scattered prominent Schmorl nodes, and Modic type I changes with subtle wispy enhancement along the superior endplate of C6. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated moderate C5-C6 and mild multilevel disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. Note is made of 11 mm descending cerebellar tonsils through the foramen magnum, suggestive of Chiari type I malformation. A developmentally narrowed spinal canal is noted. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: Mild disc bulge and central disc protrusion, resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C4-C5: Mild disc bulge and central disc protrusion/annular fissure, resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C5-C6: Mild disc bulge and right subarticular protrusion, partially effacing the right lateral recess and resulting in moderate spinal canal stenosis, with moderate left neuroforaminal narrowing. C6-C7: The spinal canal and neuroforamina are patent. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. IMPRESSION: 1. No evidence of acute findings or abnormal enhancement in the cervical spine. 2. Note is made of 11 mm descending cerebellar tonsils through the foramen magnum, suggestive of Chiari type I malformation. 3. Chronic multilevel degenerative changes, in a developmentally narrowed spinal canal described, most pronounced at C5-C6, resulting in moderate spinal canal stenosis and moderate left neuroforaminal narrowing.
Findings: The sagittal images demonstrate physiologic cervical lordosis, without subluxations. The vertebral bodies maintain normal height and marrow signal, with scattered prominent Schmorl nodes, and Modic type I changes with subtle wispy enhancement along the superior endplate of C6. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated moderate C5-C6 and mild multilevel disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. Note is made of 11 mm descending cerebellar tonsils through the foramen magnum, suggestive of Chiari type I malformation. A developmentally narrowed spinal canal is noted. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: Mild disc bulge and central disc protrusion, resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C4-C5: Mild disc bulge and central disc protrusion/annular fissure, resulting in mild spinal canal stenosis, without significant neuroforaminal narrowing. C5-C6: Mild disc bulge and right subarticular protrusion, partially effacing the right lateral recess and resulting in moderate spinal canal stenosis, with moderate left neuroforaminal narrowing. C6-C7: The spinal canal and neuroforamina are patent. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement.
A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated depicting areas of ischemia (voxel values for MTT > 1.4 times mirror image voxels on the contralateral "normal side") in the color green and areas predictive of infarction (CBV values 4.0s = 292 mL) in right greater than left cerebral hemispheres and small areas of elevated Tmax >6.0 seconds in the right parietal and occipital lobes without corresponding abnormalities in cerebral blood flow or cerebral blood volume.
15,603
MR Cervical Spine wo contrast HISTORY: Paralysis Below T4 level without evidence of pathology on CT scan TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed without intravenous contrast. COMPARISON: CT of 1/25/2020 FINDINGS: There is motion artifact. ALIGNMENT: Normal. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. There is mildly decreased bone marrow signal intensity on T1 and T2. Clinical evaluation for active bone marrow and anemia is recommended. SPINAL CORD/POSTERIOR FOSSA: Normal in morphology and signal intensity. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, there is no spinal canal or foraminal stenosis. At C3-4, there is no spinal canal or foraminal stenosis. At C4-5, there is no spinal canal or foraminal stenosis. At C5-6, there is no spinal canal or foraminal stenosis. At C6-7, there is no spinal canal or foraminal stenosis. At C7-T1, there is no spinal canal or foraminal stenosis. IMPRESSION: No definite acute pathology in cervical spine.
FINDINGS: There is motion artifact. ALIGNMENT: Normal. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. There is mildly decreased bone marrow signal intensity on T1 and T2. Clinical evaluation for active bone marrow and anemia is recommended. SPINAL CORD/POSTERIOR FOSSA: Normal in morphology and signal intensity. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, there is no spinal canal or foraminal stenosis. At C3-4, there is no spinal canal or foraminal stenosis. At C4-5, there is no spinal canal or foraminal stenosis. At C5-6, there is no spinal canal or foraminal stenosis. At C6-7, there is no spinal canal or foraminal stenosis. At C7-T1, there is no spinal canal or foraminal stenosis.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Unchanged small layering effusions with associated atelectasis, unchanged from CT 12/10/2021. Right lower lobe calcified granuloma. HEART / VESSELS: Mild to moderate calcified atherosclerosis without aneurysm, including coronary atherosclerosis. Left subclavian dual-chamber pacemaker. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Calcified mediastinal/right hilar nodes. LYMPH NODES: None enlarged. CHEST WALL: New moderate anasarca. ABDOMEN and PELVIS: LIVER: No focal lesion. Fat along the falciform. Calcification, likely granuloma, along the anterior margin of the left medial segment. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. In the middle portion of the Roux limb, there is mucosal hyperenhancement, wall thickening, and adjacent stranding. The jejunojejunal anastomosis appears normal. COLON / APPENDIX: Diverticulosis without inflammation. Appendix is normal. PERITONEUM / MESENTERY: New small volume ascites. RETROPERITONEUM: Normal. VESSELS: Moderate scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic calcifications. Interval prosthetic. BODY WALL: New moderate to severe anasarca. MUSCULOSKELETAL: Degenerative changes of the right greater than left glenohumeral joints. Partial ankylosis along the anterior aspect of the right sacroiliac joint, unchanged. THORACIC SPINE: VERTEBRA: No interval fracture. Unchanged mild anterior wedging with superior endplate deformity of T3. Unchanged appearance of posterior arthrodesis spanning T9-T12. Laminectomy changes at T12. No interval hardware complication identified. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. Erosive endplate changes at T12-L1 appear unchanged. ALIGNMENT: Unchanged mild anterolisthesis of C7 on T1 and T9 on T10, with mild retrolisthesis of T12 on L1. LUMBAR SPINE: VERTEBRA: No interval fracture. Unchanged appearance of posterior arthrodesis hardware spanning L3-S1 with intervertebral spacers at L2-L3 and L3-L4 and associated plate and screw fixations along the left lateral aspect, with unchanged fracture of the inferior most screw. Laminectomy changes at L1 and L4-L5. No interval hardware complication. Unchanged mild anterior wedging of L2. DISC SPACES AND FACET JOINTS: No acute injury. Severe degenerative changes. Scattered erosive endplate changes appear overall unchanged. Partial ankylosis of the right L4-L5 disc. ALIGNMENT: Unchanged mild retrolisthesis of L2 on L3 and grade 1 anterolisthesis of L5 on S1. Mild levocurvature.
15,604
MR Thoracic Spine wo contrast HISTORY: Paralysis TECHNIQUE: Multiplanar, multisequence MRI of the thoracic spine was performed without intravenous contrast. COMPARISON: None available. FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. Decreased bone marrow signal intensity is noted on T1 and T2. There are small Schmorl nodes from T7 to T10 levels. SPINAL CORD: Normal in morphology and signal intensity. LEVELS: No significant degenerative changes seen. A cystic structure along the right adrenal gland is compatible with the known hematoma. IMPRESSION: No acute pathology of thoracic spine. Decreased bone marrow signal intensity. Evaluation for anemia and active bone marrow is recommended.
FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. Decreased bone marrow signal intensity is noted on T1 and T2. There are small Schmorl nodes from T7 to T10 levels. SPINAL CORD: Normal in morphology and signal intensity. LEVELS: No significant degenerative changes seen. A cystic structure along the right adrenal gland is compatible with the known hematoma.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Unchanged small layering effusions with associated atelectasis, unchanged from CT 12/10/2021. Right lower lobe calcified granuloma. HEART / VESSELS: Mild to moderate calcified atherosclerosis without aneurysm, including coronary atherosclerosis. Left subclavian dual-chamber pacemaker. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Calcified mediastinal/right hilar nodes. LYMPH NODES: None enlarged. CHEST WALL: New moderate anasarca. ABDOMEN and PELVIS: LIVER: No focal lesion. Fat along the falciform. Calcification, likely granuloma, along the anterior margin of the left medial segment. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. In the middle portion of the Roux limb, there is mucosal hyperenhancement, wall thickening, and adjacent stranding. The jejunojejunal anastomosis appears normal. COLON / APPENDIX: Diverticulosis without inflammation. Appendix is normal. PERITONEUM / MESENTERY: New small volume ascites. RETROPERITONEUM: Normal. VESSELS: Moderate scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic calcifications. Interval prosthetic. BODY WALL: New moderate to severe anasarca. MUSCULOSKELETAL: Degenerative changes of the right greater than left glenohumeral joints. Partial ankylosis along the anterior aspect of the right sacroiliac joint, unchanged. THORACIC SPINE: VERTEBRA: No interval fracture. Unchanged mild anterior wedging with superior endplate deformity of T3. Unchanged appearance of posterior arthrodesis spanning T9-T12. Laminectomy changes at T12. No interval hardware complication identified. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. Erosive endplate changes at T12-L1 appear unchanged. ALIGNMENT: Unchanged mild anterolisthesis of C7 on T1 and T9 on T10, with mild retrolisthesis of T12 on L1. LUMBAR SPINE: VERTEBRA: No interval fracture. Unchanged appearance of posterior arthrodesis hardware spanning L3-S1 with intervertebral spacers at L2-L3 and L3-L4 and associated plate and screw fixations along the left lateral aspect, with unchanged fracture of the inferior most screw. Laminectomy changes at L1 and L4-L5. No interval hardware complication. Unchanged mild anterior wedging of L2. DISC SPACES AND FACET JOINTS: No acute injury. Severe degenerative changes. Scattered erosive endplate changes appear overall unchanged. Partial ankylosis of the right L4-L5 disc. ALIGNMENT: Unchanged mild retrolisthesis of L2 on L3 and grade 1 anterolisthesis of L5 on S1. Mild levocurvature.
15,605
MR Lumbar Spine wo contrast HISTORY: Paralysis TECHNIQUE: Multiplanar, multisequence MRI of the lumbar spine was performed without intravenous contrast . COMPARISON: None available. FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. DISCS: Disc desiccation at L4-L5 is seen. CONUS MEDULLARIS: Normal in position and appearance and ends at L1-L2 level. SOFT TISSUES: Unremarkable. At L1-2, there is no spinal canal or foraminal stenosis. At L2-3, there is no spinal canal or foraminal stenosis. At L3-4, there is no spinal canal or foraminal stenosis. At L4-5, there is disc bulging with mild spinal canal stenosis and mild bilateral neural foraminal narrowing. At L5-S1, there is no spinal canal or foraminal stenosis. Urinary bladder is distended. IMPRESSION: No acute pathology in the lumbar spine. Mild soft tissue edema in the retroperitoneum.
FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. DISCS: Disc desiccation at L4-L5 is seen. CONUS MEDULLARIS: Normal in position and appearance and ends at L1-L2 level. SOFT TISSUES: Unremarkable. At L1-2, there is no spinal canal or foraminal stenosis. At L2-3, there is no spinal canal or foraminal stenosis. At L3-4, there is no spinal canal or foraminal stenosis. At L4-5, there is disc bulging with mild spinal canal stenosis and mild bilateral neural foraminal narrowing. At L5-S1, there is no spinal canal or foraminal stenosis. Urinary bladder is distended.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Unchanged small layering effusions with associated atelectasis, unchanged from CT 12/10/2021. Right lower lobe calcified granuloma. HEART / VESSELS: Mild to moderate calcified atherosclerosis without aneurysm, including coronary atherosclerosis. Left subclavian dual-chamber pacemaker. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Calcified mediastinal/right hilar nodes. LYMPH NODES: None enlarged. CHEST WALL: New moderate anasarca. ABDOMEN and PELVIS: LIVER: No focal lesion. Fat along the falciform. Calcification, likely granuloma, along the anterior margin of the left medial segment. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. In the middle portion of the Roux limb, there is mucosal hyperenhancement, wall thickening, and adjacent stranding. The jejunojejunal anastomosis appears normal. COLON / APPENDIX: Diverticulosis without inflammation. Appendix is normal. PERITONEUM / MESENTERY: New small volume ascites. RETROPERITONEUM: Normal. VESSELS: Moderate scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic calcifications. Interval prosthetic. BODY WALL: New moderate to severe anasarca. MUSCULOSKELETAL: Degenerative changes of the right greater than left glenohumeral joints. Partial ankylosis along the anterior aspect of the right sacroiliac joint, unchanged. THORACIC SPINE: VERTEBRA: No interval fracture. Unchanged mild anterior wedging with superior endplate deformity of T3. Unchanged appearance of posterior arthrodesis spanning T9-T12. Laminectomy changes at T12. No interval hardware complication identified. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. Erosive endplate changes at T12-L1 appear unchanged. ALIGNMENT: Unchanged mild anterolisthesis of C7 on T1 and T9 on T10, with mild retrolisthesis of T12 on L1. LUMBAR SPINE: VERTEBRA: No interval fracture. Unchanged appearance of posterior arthrodesis hardware spanning L3-S1 with intervertebral spacers at L2-L3 and L3-L4 and associated plate and screw fixations along the left lateral aspect, with unchanged fracture of the inferior most screw. Laminectomy changes at L1 and L4-L5. No interval hardware complication. Unchanged mild anterior wedging of L2. DISC SPACES AND FACET JOINTS: No acute injury. Severe degenerative changes. Scattered erosive endplate changes appear overall unchanged. Partial ankylosis of the right L4-L5 disc. ALIGNMENT: Unchanged mild retrolisthesis of L2 on L3 and grade 1 anterolisthesis of L5 on S1. Mild levocurvature.
15,606
CLINICAL HISTORY: Assess recently seen suprasellar lesion COMPARISON: CT head 1/20/2022 TECHNIQUE: Multiplanar multisequence MRI images of the brain were obtained before and after intravenous contrast administration. Axial time-of-flight MR angiography of the brain was performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 293 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There are mild scattered presumed chronic microangiopathic changes.. The ventricles are normal in caliber and configuration. There is mild mucosal thickening in the left maxillary and bilateral ethmoid sinuses. The mastoid air cells are relatively clear. Obscured orbits. The enhancing lesions in the right hemi-clivus and the body of the sphenoid bone. MRA BRAIN: There is a medially projecting 9 mm supraclinoid aneurysm (series 305 image one). This appears to measure 9 mm on the T2-weighted series 501 image 16. There is no occlusion, or flow-limiting stenosis in either internal carotid, anterior cerebral, middle cerebral, posterior cerebral, basilar or right vertebral artery. Fetal configuration of the left posterior cerebral artery. Attenuated signal in the distal V4 left vertebral artery, likely congenital variant. IMPRESSION: Postcontrast images are degraded due to involuntary patient motion. 1. Enhancing lesions in the right hemi-clivus and the body of the sphenoid bone. These are likely related to patient's multiple myeloma. 2. Recently seen suprasellar lesion corresponds to a partially calcified 9 mm left supraclinoid aneurysm.
FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There are mild scattered presumed chronic microangiopathic changes.. The ventricles are normal in caliber and configuration. There is mild mucosal thickening in the left maxillary and bilateral ethmoid sinuses. The mastoid air cells are relatively clear. Obscured orbits. The enhancing lesions in the right hemi-clivus and the body of the sphenoid bone. MRA BRAIN: There is a medially projecting 9 mm supraclinoid aneurysm (series 305 image one). This appears to measure 9 mm on the T2-weighted series 501 image 16. There is no occlusion, or flow-limiting stenosis in either internal carotid, anterior cerebral, middle cerebral, posterior cerebral, basilar or right vertebral artery. Fetal configuration of the left posterior cerebral artery. Attenuated signal in the distal V4 left vertebral artery, likely congenital variant.
FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Unchanged small layering effusions with associated atelectasis, unchanged from CT 12/10/2021. Right lower lobe calcified granuloma. HEART / VESSELS: Mild to moderate calcified atherosclerosis without aneurysm, including coronary atherosclerosis. Left subclavian dual-chamber pacemaker. Small pericardial effusion. MEDIASTINUM / ESOPHAGUS: Calcified mediastinal/right hilar nodes. LYMPH NODES: None enlarged. CHEST WALL: New moderate anasarca. ABDOMEN and PELVIS: LIVER: No focal lesion. Fat along the falciform. Calcification, likely granuloma, along the anterior margin of the left medial segment. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Scattered calcified granulomas. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. In the middle portion of the Roux limb, there is mucosal hyperenhancement, wall thickening, and adjacent stranding. The jejunojejunal anastomosis appears normal. COLON / APPENDIX: Diverticulosis without inflammation. Appendix is normal. PERITONEUM / MESENTERY: New small volume ascites. RETROPERITONEUM: Normal. VESSELS: Moderate scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic calcifications. Interval prosthetic. BODY WALL: New moderate to severe anasarca. MUSCULOSKELETAL: Degenerative changes of the right greater than left glenohumeral joints. Partial ankylosis along the anterior aspect of the right sacroiliac joint, unchanged. THORACIC SPINE: VERTEBRA: No interval fracture. Unchanged mild anterior wedging with superior endplate deformity of T3. Unchanged appearance of posterior arthrodesis spanning T9-T12. Laminectomy changes at T12. No interval hardware complication identified. DISC SPACES AND FACET JOINTS: No acute injury. Moderate degenerative changes. Erosive endplate changes at T12-L1 appear unchanged. ALIGNMENT: Unchanged mild anterolisthesis of C7 on T1 and T9 on T10, with mild retrolisthesis of T12 on L1. LUMBAR SPINE: VERTEBRA: No interval fracture. Unchanged appearance of posterior arthrodesis hardware spanning L3-S1 with intervertebral spacers at L2-L3 and L3-L4 and associated plate and screw fixations along the left lateral aspect, with unchanged fracture of the inferior most screw. Laminectomy changes at L1 and L4-L5. No interval hardware complication. Unchanged mild anterior wedging of L2. DISC SPACES AND FACET JOINTS: No acute injury. Severe degenerative changes. Scattered erosive endplate changes appear overall unchanged. Partial ankylosis of the right L4-L5 disc. ALIGNMENT: Unchanged mild retrolisthesis of L2 on L3 and grade 1 anterolisthesis of L5 on S1. Mild levocurvature.
15,607
CLINICAL HISTORY: Assess recently seen suprasellar lesion COMPARISON: CT head 1/20/2022 TECHNIQUE: Multiplanar multisequence MRI images of the brain were obtained before and after intravenous contrast administration. Axial time-of-flight MR angiography of the brain was performed. Additional 3D post-processing was done with MIP and volume rendered images, which were reviewed for interpretation. Patient weight: 293 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There are mild scattered presumed chronic microangiopathic changes.. The ventricles are normal in caliber and configuration. There is mild mucosal thickening in the left maxillary and bilateral ethmoid sinuses. The mastoid air cells are relatively clear. Obscured orbits. The enhancing lesions in the right hemi-clivus and the body of the sphenoid bone. MRA BRAIN: There is a medially projecting 9 mm supraclinoid aneurysm (series 305 image one). This appears to measure 9 mm on the T2-weighted series 501 image 16. There is no occlusion, or flow-limiting stenosis in either internal carotid, anterior cerebral, middle cerebral, posterior cerebral, basilar or right vertebral artery. Fetal configuration of the left posterior cerebral artery. Attenuated signal in the distal V4 left vertebral artery, likely congenital variant. IMPRESSION: Postcontrast images are degraded due to involuntary patient motion. 1. Enhancing lesions in the right hemi-clivus and the body of the sphenoid bone. These are likely related to patient's multiple myeloma. 2. Recently seen suprasellar lesion corresponds to a partially calcified 9 mm left supraclinoid aneurysm.
FINDINGS: MRI BRAIN: There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. There are mild scattered presumed chronic microangiopathic changes.. The ventricles are normal in caliber and configuration. There is mild mucosal thickening in the left maxillary and bilateral ethmoid sinuses. The mastoid air cells are relatively clear. Obscured orbits. The enhancing lesions in the right hemi-clivus and the body of the sphenoid bone. MRA BRAIN: There is a medially projecting 9 mm supraclinoid aneurysm (series 305 image one). This appears to measure 9 mm on the T2-weighted series 501 image 16. There is no occlusion, or flow-limiting stenosis in either internal carotid, anterior cerebral, middle cerebral, posterior cerebral, basilar or right vertebral artery. Fetal configuration of the left posterior cerebral artery. Attenuated signal in the distal V4 left vertebral artery, likely congenital variant.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in expected position with scattered secretions in the airways. Interval removal of the right thoracostomy tube with persistent dense consolidation in the right lower lobe. Smaller consolidation of the left lower lobe also appears similar. Trace right pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable postsurgical changes of the right hepatic lobe. Otherwise normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Normal for technique. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Feeding tube terminates in the duodenum. Otherwise normal. COLON / APPENDIX: Rectal tube in place. Otherwise normal. PERITONEUM / MESENTERY: Trace pelvic free fluid. RETROPERITONEUM: Normal. VESSELS: Interval placement of IVC filter in expected position. Otherwise unremarkable technique. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No new abnormality.
15,608
MR Cervical Spine wo contrast HISTORY: Evaluation for cord injury TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed without intravenous contrast COMPARISON: CT of 1/25/2022 FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: T2 hyper signal intensity and volume loss is seen involving the cord at the level of C3-C4. PARASPINAL SOFT TISSUES: There is mild edema at the tip of odontoid process. Minimal internal T2 hyper signal intensity is noted in the apical ligament in favor of partial injury. At C2-3, there is no spinal canal or foraminal stenosis. Mild bilateral facet arthropathy. At C3-4, there is advanced bilateral uncovertebral joint arthropathy with a large disc osteophyte which is eccentric to left side. There is moderate bilateral facet arthropathy. There is severe spinal canal stenosis and cord compression. There is moderate right and severe left lateral recess narrowing. There is moderate right and severe left neural foraminal stenosis. At C4-5, mild disc bulging. Mild bilateral facet arthropathy. Minimal spinal canal stenosis without neural foraminal narrowing. At C5-6, bilateral uncovertebral joint arthropathy with a superimposed right subarticular broad-based herniation. There is moderate spinal canal stenosis and mild cord compression. There is severe right lateral recess narrowing. There is severe right and mild left neural foraminal stenosis. At C6-7, there is a central disc extrusion with 19 mm superior and inferior extension of disc material with moderate spinal canal stenosis and moderate compression over the ventral aspect of cord. There is moderate bilateral neural foraminal narrowing. At C7-T1, there is no spinal canal or foraminal stenosis. IMPRESSION: Advanced degenerative changes of cervical spine including: A. A large disc osteophyte at C3-C4 eccentric to left side with severe spinal canal stenosis, severe cord compression, moderate right and severe left neural foraminal stenosis. T2 hyper signal intensity and mild volume loss of the cord at this level most consistent with myelomalacia. B. Disc osteophyte and right subarticular herniation at C5-C6 with moderate spinal canal stenosis, mild cord compression, severe right lateral recess narrowing and severe right neural foraminal stenosis. C. Central extrusion at C6-C7 with moderate spinal canal stenosis, moderate cord compression and moderate bilateral neural foraminal stenosis. Partial injury of apical ligament. Please note that diagnosis of the myelomalacia at C3-C4 is based on mild volume loss of the cord at this location. Possibility of acute on chronic cord injury at this level cannot be excluded on this MRI so if indicated follow-up MRI is recommended.
FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: T2 hyper signal intensity and volume loss is seen involving the cord at the level of C3-C4. PARASPINAL SOFT TISSUES: There is mild edema at the tip of odontoid process. Minimal internal T2 hyper signal intensity is noted in the apical ligament in favor of partial injury. At C2-3, there is no spinal canal or foraminal stenosis. Mild bilateral facet arthropathy. At C3-4, there is advanced bilateral uncovertebral joint arthropathy with a large disc osteophyte which is eccentric to left side. There is moderate bilateral facet arthropathy. There is severe spinal canal stenosis and cord compression. There is moderate right and severe left lateral recess narrowing. There is moderate right and severe left neural foraminal stenosis. At C4-5, mild disc bulging. Mild bilateral facet arthropathy. Minimal spinal canal stenosis without neural foraminal narrowing. At C5-6, bilateral uncovertebral joint arthropathy with a superimposed right subarticular broad-based herniation. There is moderate spinal canal stenosis and mild cord compression. There is severe right lateral recess narrowing. There is severe right and mild left neural foraminal stenosis. At C6-7, there is a central disc extrusion with 19 mm superior and inferior extension of disc material with moderate spinal canal stenosis and moderate compression over the ventral aspect of cord. There is moderate bilateral neural foraminal narrowing. At C7-T1, there is no spinal canal or foraminal stenosis.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube in expected position with scattered secretions in the airways. Interval removal of the right thoracostomy tube with persistent dense consolidation in the right lower lobe. Smaller consolidation of the left lower lobe also appears similar. Trace right pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable postsurgical changes of the right hepatic lobe. Otherwise normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal for technique. ADRENALS: Normal. KIDNEYS: Normal for technique. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Feeding tube terminates in the duodenum. Otherwise normal. COLON / APPENDIX: Rectal tube in place. Otherwise normal. PERITONEUM / MESENTERY: Trace pelvic free fluid. RETROPERITONEUM: Normal. VESSELS: Interval placement of IVC filter in expected position. Otherwise unremarkable technique. URINARY BLADDER: Collapsed around a Foley catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No new abnormality.
15,609
MR Brain wo+w contrast HISTORY: Evaluation for wound infection TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. COMPARISON: CT of 1/25/2022 FINDINGS: INTRACRANIAL FINDINGS: Postsurgical changes is again noted is status post right frontal craniotomy for clipping of the right MCA aneurysm. There is metallic artifact from the clips which partially obscures the right frontal lobe. Soft tissue swelling of the right frontotemporal region is most consistent with recent intervention. There is trace amount of extra-axial and subdural fluid collection in the right temporal region. Also, there is another larger fluid collection superficial to the dural matter measuring 9 mm with thickness. There are scattered foci of susceptibility artifact within this epidural fluid collection most consistent with hemorrhagic changes. However, there is a fluid fluid level within the dependent portion of the collection which is slightly low signal on T2, slightly hyper signal on T1 (in comparison to the CSF) with diffusion restriction. Areas of diffusion restriction are larger than foci of susceptibility artifact and this finding is concerning for pus and infection. After contrast injection mild smooth pachymeningeal enhancement is noted subject to surgery. There is minimal mass effect over the right cerebral hemisphere because of the fluid collection with 3 mm right-to-left midline shift. Also, trace fluid fluid level within the dependent portion of the bilateral occipital horns are seen with mild diffusion restriction but without signal drop on SWI sequence. There are a few tiny foci of microhemorrhages along the right aspect of corpus callosum and in periventricular region of the right atrium. Trace amount of subarachnoid hemorrhage of bilateral parietal lobes is seen. Tract of previous shunt catheter is noted across the right frontal parenchyma. Ventricular system is normal in size. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Trace effusion of left mastoidal sinus is seen. IMPRESSION: Persistent postsurgical changes status post right frontal craniotomy and clipping of the right MCA aneurysm. Trace amount of subdural fluid collection subjacent to surgery. Moderate amount of epidural fluid collection subjacent to the surgical location. Within the dependent portion of this fluid collection there is fluid fluid level with scattered foci of susceptibility artifact but with larger areas of diffusion restriction. This finding is concerning for pus. Small fluid fluid levels within the dependent portion of the occipital horns bilaterally with diffusion restriction without definite susceptibility artifact again concerning for debris/pus and ventriculitis.
FINDINGS: INTRACRANIAL FINDINGS: Postsurgical changes is again noted is status post right frontal craniotomy for clipping of the right MCA aneurysm. There is metallic artifact from the clips which partially obscures the right frontal lobe. Soft tissue swelling of the right frontotemporal region is most consistent with recent intervention. There is trace amount of extra-axial and subdural fluid collection in the right temporal region. Also, there is another larger fluid collection superficial to the dural matter measuring 9 mm with thickness. There are scattered foci of susceptibility artifact within this epidural fluid collection most consistent with hemorrhagic changes. However, there is a fluid fluid level within the dependent portion of the collection which is slightly low signal on T2, slightly hyper signal on T1 (in comparison to the CSF) with diffusion restriction. Areas of diffusion restriction are larger than foci of susceptibility artifact and this finding is concerning for pus and infection. After contrast injection mild smooth pachymeningeal enhancement is noted subject to surgery. There is minimal mass effect over the right cerebral hemisphere because of the fluid collection with 3 mm right-to-left midline shift. Also, trace fluid fluid level within the dependent portion of the bilateral occipital horns are seen with mild diffusion restriction but without signal drop on SWI sequence. There are a few tiny foci of microhemorrhages along the right aspect of corpus callosum and in periventricular region of the right atrium. Trace amount of subarachnoid hemorrhage of bilateral parietal lobes is seen. Tract of previous shunt catheter is noted across the right frontal parenchyma. Ventricular system is normal in size. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Trace effusion of left mastoidal sinus is seen.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus. Pulmonary artery caliber is normal. LUNGS / AIRWAYS / PLEURA: The lungs are clear. No pleural effusion or pneumothorax. HEART / OTHER VESSELS: Current 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 the abdomen demonstrate postsurgical changes of cholecystectomy, small accessory spleen. Otherwise unremarkable. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. Mild degenerative degenerative changes of the mid and inferior thoracic spine. Partially imaged ACDF hardware spanning and C6-C7 with artificial disc spacer There is a 1.5 cm rounded soft tissue nodule in the upper outer right breast.
15,610
MRI OF THE CERVICAL SPINE WITHOUT CONTRAST CLINICAL INDICATION: Assess C-spine fracture TECHNIQUE: Multiplanar multisequence MRI images of the cervical spine were obtained without intravenous contrast. COMPARISON: CT cervical spine performed on 1/25/2022 FINDINGS: The axial images are degraded due to involuntary patient motion. The left C7 superior articular process fracture is better seen on the recently performed cervical spine. There is small amount of fluid in the left C6-C7 facet joint. Also small/contusions of the superior articular processes of C5 and C4. The coronal series 901 is degraded due to involuntary patient motion. Tearing of the right alar ligament (series 901 image 15). There is asymmetric fluid in the right lateral atlantoaxial joint. Intact tectorial membrane and transverse ligaments are intact. There is mild edema in the interspinous ligaments at C3-C7. The vertebral body heights are maintained. The cervical spinal cord is normal in caliber and signal. No mass or abnormal fluid collection is present within the cervical spinal canal. The paravertebral soft tissues are unremarkable. There is no high-grade spinal canal, or neuroforaminal stenosis anywhere. IMPRESSION: 1. The left C7 superior articular process fracture is better seen on the recently performed cervical spine. There is small amount of fluid in the left C6-C7 facet joint. 2. Also small fracture/ contusions of the superior articular processes of C5 and C4. 3. The coronal series 901 is degraded due to involuntary patient motion. Tearing of the right alar ligament. Also small asymmetric fluid in the right lateral atlantoaxial joint.
FINDINGS: The axial images are degraded due to involuntary patient motion. The left C7 superior articular process fracture is better seen on the recently performed cervical spine. There is small amount of fluid in the left C6-C7 facet joint. Also small/contusions of the superior articular processes of C5 and C4. The coronal series 901 is degraded due to involuntary patient motion. Tearing of the right alar ligament (series 901 image 15). There is asymmetric fluid in the right lateral atlantoaxial joint. Intact tectorial membrane and transverse ligaments are intact. There is mild edema in the interspinous ligaments at C3-C7. The vertebral body heights are maintained. The cervical spinal cord is normal in caliber and signal. No mass or abnormal fluid collection is present within the cervical spinal canal. The paravertebral soft tissues are unremarkable. There is no high-grade spinal canal, or neuroforaminal stenosis anywhere.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Postsurgical changes of CABG. Heart chambers and great vessels appear normal in size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhosis with nodular surface and caudate hypertrophy. No suspicious hepatic lesions are identified. The hepatic and portal veins are patent. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis without gallbladder wall thickening, pericholecystic fluid, or pericholecystic fat stranding. PANCREAS: Normal. SPLEEN: Splenomegaly measuring up to 15.7 cm in the AP diameter. ADRENALS: Normal. KIDNEYS: Bilateral small simple renal cysts. No hydroureteronephrosis or radiopaque urinary tract calculi bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. RETROPERITONEUM: Normal. VESSELS: Mild ventral indentation of the celiac axis and mild to moderate narrowing. Mild poststenotic dilatation. These findings can be seen with median arcuate ligament syndrome in appropriate clinical setting. Aorta is nonaneurysmal. Portal, splenic and superior mesenteric veins and hepatic veins are patent. A few mesenteric and retroperitoneal venous collaterals. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. Bilateral ovaries appear unremarkable. BODY WALL: Small foci of gas are seen within the right anterior abdominal wall, suggestive of recent medication injection. Surgical clips in the right groin. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture. There is mild S-shaped scoliosis of the thoracolumbar spine with severe right intervertebral disc space narrowing with vacuum phenomena at L2-L3.
15,611
MRI brain with and without Indication: SP L frontal tumor resection Spec Inst: STEALTH PROTOCOL Comparison: Multiple priors including Preoperative MRI brain with contrast 12/28/2021 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: 220 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: Patient status post partial resection/biopsy of the left frontal nonenhancing tumor. Expected post surgical changes with left frontal craniotomy and minimal extra-axial collection and blood products in the operative bed. The extent of surrounding T2/FLAIR hyperintense signal is overall unchanged since the preoperative study. No abnormal focus of enhancement is identified. A tiny focus of T2/FLAIR hyperintense signal without restricted diffusion or enhancement is seen in the left frontal lobe cortex, non specific (series 401 image 20) Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Scattered paranasal sinus mucosal thickening. Impression: Status post left frontal tumor resection with expected postsurgical changes and residual nonenhancing surrounding T2/FLAIR hyperintense signal around the operative bed. No abnormal enhancement identified.
Findings: Patient status post partial resection/biopsy of the left frontal nonenhancing tumor. Expected post surgical changes with left frontal craniotomy and minimal extra-axial collection and blood products in the operative bed. The extent of surrounding T2/FLAIR hyperintense signal is overall unchanged since the preoperative study. No abnormal focus of enhancement is identified. A tiny focus of T2/FLAIR hyperintense signal without restricted diffusion or enhancement is seen in the left frontal lobe cortex, non specific (series 401 image 20) Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. Scattered paranasal sinus mucosal thickening.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Segmental and subsegmental right lower lobe (axial series 401, image 74). - Pulmonary Artery Diameter: Normal. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Normal. - Interventricular Septum: Normal. - Contrast reflux into IVC: No significant abnormality. LUNGS / AIRWAYS / PLEURA: Mild centrilobular and paraseptal emphysematous changes diffusely. No focal consolidation, pneumothorax or pleural effusion. Minimal posterior dependent atelectatic changes. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Few prominent right hilar lymph nodes, likely reactive. CHEST WALL: Right IJ approach chest port in place with catheter tip at the cavoatrial junction. No significant abnormality. UPPER ABDOMEN: Spleen is surgically absent. No other significant abnormality. MUSCULOSKELETAL: No significant abnormality.
15,612
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: New seizure activity with concern for process. COMPARISON: CT head dated 1/25/2022. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 145 lbs. IV contrast: ProHance, 14 ml, per protocol. FINDINGS: There are multiple patchy foci of cortical FLAIR hyper signal intensity involving the bilateral frontal, bilateral parieto-occipital lobes as well as bilateral aspect of cerebellum. The lesions are not associated with significant diffusion restriction and appears to be mainly vasogenic edema. Also, there are scattered foci of smaller FLAIR hyper signal intensities in the white matter of the bilateral centrum semiovale and within the left basal ganglia and right caudate head. Also there are patchy foci of leptomeningeal and cortical mild enhancement involving the bilateral frontal, left parietal and bilateral occipital lobes. No evidence of hydrocephalus or extra-axial fluid collection is seen. Retained secretion of nasopharynx is likely secondary to intubation. Mild mucosal thickening of the frontal and ethmoidal sinuses and mild mucosal thickening of sphenoidal air cells is suggestive for sinusitis. CONCLUSION: Multiple foci of patchy cortical based T2 and FLAIR hyper signal intensity involving the bilateral frontal, parieto-occipital lobes as well as bilateral cerebellar hemispheres with morphology in favor of vasogenic edema. Distribution of the lesions are most consistent with PRES syndrome. Similar finding can be seen secondary to hypoglycemia however hyperglycemia is a clinical diagnosis. 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.
FINDINGS: There are multiple patchy foci of cortical FLAIR hyper signal intensity involving the bilateral frontal, bilateral parieto-occipital lobes as well as bilateral aspect of cerebellum. The lesions are not associated with significant diffusion restriction and appears to be mainly vasogenic edema. Also, there are scattered foci of smaller FLAIR hyper signal intensities in the white matter of the bilateral centrum semiovale and within the left basal ganglia and right caudate head. Also there are patchy foci of leptomeningeal and cortical mild enhancement involving the bilateral frontal, left parietal and bilateral occipital lobes. No evidence of hydrocephalus or extra-axial fluid collection is seen. Retained secretion of nasopharynx is likely secondary to intubation. Mild mucosal thickening of the frontal and ethmoidal sinuses and mild mucosal thickening of sphenoidal air cells is suggestive for sinusitis.
FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. RIGHT CAROTID: Patent without flow-limiting stenosis. LEFT CAROTID: 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. Fetal origin of the right PCA. RAPID angiographic images demonstrate decreased vessel density in the right MCA territory, nonspecific. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Soft tissues of the neck are unremarkable. Visualized lung apices are clear. No acute osseous abnormality.
15,613
MR Brain wo contrast 1/26/2022 9:12 PM Clinical information: 63 years Male patient with autoimmune encephalitis Comparison: MRI brain with and without contrast dated 12/24/2018. Technique: Multiplanar, multisequence MRI of the brain was performed without the administration of intravenous contrast. Patient weight: 180 lbs. FINDINGS: Please note that motion artifact limits evaluation. Cerebral parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. No intracranial mass lesion, hemorrhage, or infarction. Unchanged 6 mm right cerebellar tonsillar ectopia. 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: Persistent scattered ethmoid and bilateral maxillary sinus mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Unchanged under pneumatization of the right mastoid tip. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality. IMPRESSION: 1. Limited evaluation due to motion artifact, especially on the FLAIR sequences, without definitive acute intracranial process identified. 2. Unchanged 6 mm right cerebellar tonsillar ectopia.
FINDINGS: Please note that motion artifact limits evaluation. Cerebral parenchyma: Mild frontal age-appropriate brain parenchymal volume loss is again seen. No intracranial mass lesion, hemorrhage, or infarction. Unchanged 6 mm right cerebellar tonsillar ectopia. 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: Persistent scattered ethmoid and bilateral maxillary sinus mucosal thickening. Visualized orbits: No ocular or retrobulbar pathology. Calvarium and skull base: No osseous destruction. Unchanged under pneumatization of the right mastoid tip. Pituitary and Pineal Glands: No mass lesion. Soft tissues: No significant abnormality.
FINDINGS: AORTIC ARCH: Patent without flow-limiting stenosis. Normal three vessel aortic arch is noted. RIGHT CAROTID: Patent without flow-limiting stenosis. LEFT CAROTID: 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. Fetal origin of the right PCA. RAPID angiographic images demonstrate decreased vessel density in the right MCA territory, nonspecific. NONVASCULAR FINDINGS: Please see same-day CT head without contrast for dedicated nonvascular intracranial findings. Soft tissues of the neck are unremarkable. Visualized lung apices are clear. No acute osseous abnormality.
15,614
Clinical history:Concern for intracranial metastasis Comparison:CT head 1/25/2022, 10/19/2020, PET 4./14/2021 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 185 lbs. IV contrast: ProHance, 18 ml, per protocol. Findings: There is a 3.4 x 0.8 x 2 cm dural based enhancing lesion involving the right vertex. Also mild enhancement in the adjacent calvarium. There is chronic encephalomalacia in the posterior right temporal lobe. There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Mild scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. Impression: A 3.4 cm dural based enhancing lesion involving the right vertex. Also mild enhancement in the adjacent calvarium.
Findings: There is a 3.4 x 0.8 x 2 cm dural based enhancing lesion involving the right vertex. Also mild enhancement in the adjacent calvarium. There is chronic encephalomalacia in the posterior right temporal lobe. There is no restricted diffusion to suggest an acute infarct. There is no evidence of acute hemorrhage on the susceptibility weighted images. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. Mild scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits.
Findings: There is no intracranial hemorrhage or acute infarction. There is no hydrocephalus or brain edema/mass effect. Gray-white matter differentiation is overall maintained. Perivascular spaces versus chronic lacunar infarcts in bilateral basal ganglia. Mild white matter microangiopathic changes are seen.
15,615
EXAM: MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast CLINICAL INFORMATION: Trauma COMPARISON: CT cervical spine and thoracic spine dated 1/26/2022. TECHNIQUE: MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast. FINDINGS: CERVICAL SPINE: There is mild cervical levocurvature which is likely positional finding. No acute compression deformity of the visualized cervical vertebral bodies. Redemonstrated left C7 inferior facet fracture with a small amount of associated edema. No spondylolisthesis or disc height loss. No abnormal spinal cord signal in the visualized cervical cord. No significant spinal canal or foraminal narrowing. Mild bilateral uncovertebral joint arthropathy at C3-C4 and C4-C5 is seen without significant spinal canal stenosis. Mild broad-based disc bulge at C5-C6. Thoracic spine: Redemonstrated complex three column fracture dislocation injury at T3-T4 with better characterization of osseous involvement on the prior CT chest abdomen pelvis. Only a mild amount of associated marrow edema is noted at this level although images are mildly degraded by motion. Redemonstrated scattered osseous fragments are noted within the spinal canal this level resulting in mild to moderate spinal canal narrowing. Mild T2 hyper signal intensity within the cord at T3-T4 is in favor of edema. No large associated epidural collection or significant susceptibility signal dropout on GRE sequences to suggest epidural hematoma. Redemonstrated anterior compression fractures of T5 and T6 with only mild associated marrow edema. The remaining visualized thoracic and lumbar vertebral bodies are unremarkable. CONCLUSION: 1. Redemonstrated is a three column fracture dislocation injury at T3-T4 with only a mild amount of associated marrow edema. Persistent osseous fragments are noted within the spinal canal anteriorly with mild to moderate spinal canal narrowing . Mild cord edema at T3-T4 level. 2. Redemonstrated anterior compression fractures of T5 and T6 with only mild associated marrow 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.
FINDINGS: CERVICAL SPINE: There is mild cervical levocurvature which is likely positional finding. No acute compression deformity of the visualized cervical vertebral bodies. Redemonstrated left C7 inferior facet fracture with a small amount of associated edema. No spondylolisthesis or disc height loss. No abnormal spinal cord signal in the visualized cervical cord. No significant spinal canal or foraminal narrowing. Mild bilateral uncovertebral joint arthropathy at C3-C4 and C4-C5 is seen without significant spinal canal stenosis. Mild broad-based disc bulge at C5-C6. Thoracic spine: Redemonstrated complex three column fracture dislocation injury at T3-T4 with better characterization of osseous involvement on the prior CT chest abdomen pelvis. Only a mild amount of associated marrow edema is noted at this level although images are mildly degraded by motion. Redemonstrated scattered osseous fragments are noted within the spinal canal this level resulting in mild to moderate spinal canal narrowing. Mild T2 hyper signal intensity within the cord at T3-T4 is in favor of edema. No large associated epidural collection or significant susceptibility signal dropout on GRE sequences to suggest epidural hematoma. Redemonstrated anterior compression fractures of T5 and T6 with only mild associated marrow edema. The remaining visualized thoracic and lumbar vertebral bodies are unremarkable.
Findings/impression: Nondiagnostic CT perfusion secondary to rapid software failure.
15,616
EXAM: MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast CLINICAL INFORMATION: Trauma COMPARISON: CT cervical spine and thoracic spine dated 1/26/2022. TECHNIQUE: MR Cervical Spine wo contrast, MR Thoracic Spine wo contrast. FINDINGS: CERVICAL SPINE: There is mild cervical levocurvature which is likely positional finding. No acute compression deformity of the visualized cervical vertebral bodies. Redemonstrated left C7 inferior facet fracture with a small amount of associated edema. No spondylolisthesis or disc height loss. No abnormal spinal cord signal in the visualized cervical cord. No significant spinal canal or foraminal narrowing. Mild bilateral uncovertebral joint arthropathy at C3-C4 and C4-C5 is seen without significant spinal canal stenosis. Mild broad-based disc bulge at C5-C6. Thoracic spine: Redemonstrated complex three column fracture dislocation injury at T3-T4 with better characterization of osseous involvement on the prior CT chest abdomen pelvis. Only a mild amount of associated marrow edema is noted at this level although images are mildly degraded by motion. Redemonstrated scattered osseous fragments are noted within the spinal canal this level resulting in mild to moderate spinal canal narrowing. Mild T2 hyper signal intensity within the cord at T3-T4 is in favor of edema. No large associated epidural collection or significant susceptibility signal dropout on GRE sequences to suggest epidural hematoma. Redemonstrated anterior compression fractures of T5 and T6 with only mild associated marrow edema. The remaining visualized thoracic and lumbar vertebral bodies are unremarkable. CONCLUSION: 1. Redemonstrated is a three column fracture dislocation injury at T3-T4 with only a mild amount of associated marrow edema. Persistent osseous fragments are noted within the spinal canal anteriorly with mild to moderate spinal canal narrowing . Mild cord edema at T3-T4 level. 2. Redemonstrated anterior compression fractures of T5 and T6 with only mild associated marrow 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.
FINDINGS: CERVICAL SPINE: There is mild cervical levocurvature which is likely positional finding. No acute compression deformity of the visualized cervical vertebral bodies. Redemonstrated left C7 inferior facet fracture with a small amount of associated edema. No spondylolisthesis or disc height loss. No abnormal spinal cord signal in the visualized cervical cord. No significant spinal canal or foraminal narrowing. Mild bilateral uncovertebral joint arthropathy at C3-C4 and C4-C5 is seen without significant spinal canal stenosis. Mild broad-based disc bulge at C5-C6. Thoracic spine: Redemonstrated complex three column fracture dislocation injury at T3-T4 with better characterization of osseous involvement on the prior CT chest abdomen pelvis. Only a mild amount of associated marrow edema is noted at this level although images are mildly degraded by motion. Redemonstrated scattered osseous fragments are noted within the spinal canal this level resulting in mild to moderate spinal canal narrowing. Mild T2 hyper signal intensity within the cord at T3-T4 is in favor of edema. No large associated epidural collection or significant susceptibility signal dropout on GRE sequences to suggest epidural hematoma. Redemonstrated anterior compression fractures of T5 and T6 with only mild associated marrow edema. The remaining visualized thoracic and lumbar vertebral bodies are unremarkable.
FINDINGS: STRUCTURED REPORT: CT Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Previously described perirectal abscess in December 2021 has significantly decreased in size with asymmetric skin thickening of the left gluteal cleft. No fluid collection is seen in the perirectal perianal region URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Recurrent versus residual thick-walled, peripherally enhancing, heterogenous collection at the level of the proximal posterior left thigh measuring 5.5 x 2.5 x 3.7 cm) series 401 image 134, series 403 image 49). Extensive surrounding subcutaneous edema and fat stranding.1 No evidence of superior extension of this abscess to the perineal or perianal region. MUSCULOSKELETAL: No significant abnormality.
15,617
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Knee pain, injury COMPARISON: Radiographs dated 1/7/2022 TECHNIQUE: Multiplanar multisequence images were obtained through the knee. Findings: There are multiple areas of full-thickness articular cartilage loss along the medial facet and mid sagittal ridge of the patella. There is mild diffuse thinning of the femoral trochlear cartilage. There is severe full-thickness cartilage loss throughout the medial tibiofemoral compartment. Lateral tibiofemoral cartilage shows mild degenerative change. There is a moderate size knee joint effusion. No popliteal cyst is seen. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is normal. There is a high-grade, probably full-thickness radial tear through the posterior central root of the medial meniscus. There is marked peripheral extrusion of the medial meniscus. Quadriceps and patellar tendons are unremarkable. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable. Impression: 1. High-grade radial tear through the posterior central root of the medial meniscus near the tibial attachment. The tear is probably full thickness given the high degree of peripheral extrusion of the meniscal body. 2. Extensive degenerative articular cartilage loss greatest in the medial patellofemoral and medial tibiofemoral compartments. 3. Moderate joint effusion.
Findings: There are multiple areas of full-thickness articular cartilage loss along the medial facet and mid sagittal ridge of the patella. There is mild diffuse thinning of the femoral trochlear cartilage. There is severe full-thickness cartilage loss throughout the medial tibiofemoral compartment. Lateral tibiofemoral cartilage shows mild degenerative change. There is a moderate size knee joint effusion. No popliteal cyst is seen. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is normal. There is a high-grade, probably full-thickness radial tear through the posterior central root of the medial meniscus. There is marked peripheral extrusion of the medial meniscus. Quadriceps and patellar tendons are unremarkable. The medial collateral ligament, patellar retinaculum, iliotibial band, and posterior lateral corner structures are unremarkable.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Age-appropriate cerebral atrophy. 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.
15,618
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Cirrhosis, hepatocellular carcinoma screening COMPARISON: MRI of abdomen dated 1/7/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 176 lbs. IV contrast: ProHance, 17 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: Smooth hepatic contour without evidence of overt cirrhotic morphology. Moderate steatosis. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) VIII - Size: 1.0 cm (series 603, image 56), unchanged from prior exam. - 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. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Unchanged cystic lesion in the pancreatic head measuring approximately 7 mm (series 301, image 15). No main pancreatic ductal dilatation. No suspicious enhancing septations or nodules. ADRENALS: Normal. KIDNEYS: Left parapelvic and cortical cysts. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Atherosclerosis. Accessory left renal artery. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Subcentimeter LR-3 observation in the periphery of the right hepatic lobe, unchanged since the prior exam. No new hepatic lesion identified. 2. Unchanged cystic lesion in the pancreas, possibly representing a side branch IPMN without worrisome features. Attention on follow-up examination. 3. Hepatic steatosis without sequela of portal hypertension. 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.
FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Smooth hepatic contour without evidence of overt cirrhotic morphology. Moderate steatosis. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) VIII - Size: 1.0 cm (series 603, image 56), unchanged from prior exam. - 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. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Unchanged cystic lesion in the pancreatic head measuring approximately 7 mm (series 301, image 15). No main pancreatic ductal dilatation. No suspicious enhancing septations or nodules. ADRENALS: Normal. KIDNEYS: Left parapelvic and cortical cysts. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Atherosclerosis. Accessory left renal artery. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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 (
15,619
Right hand MRI: Indication: Pain over first MCP radial collateral ligament, evaluate for ligament injury Technique: Multiplanar multisequence images were obtained through the hand with specific attention to the thumb. Comparison: Radiographs dated 11/17/2021 Findings: The radial collateral ligament of the thumb MCP joint appears stretched but intact. There is prominent cystlike change and bone marrow edema beneath its metacarpal head attachment site. There are moderate diffuse degenerative changes of the thumb MCP joint with mild ulnar subluxation of the proximal phalanx relative to the metacarpal head. There is edema within the flexor pollicis brevis and abductor pollicis brevis tendons and muscles at their attachments. Impression: 1. Although the radial collateral ligament appears intact, there is sub-attachment edema and cystlike change in the thumb metacarpal head which may reflect acute on chronic stress reaction. Findings are superimposed on moderate thumb MCP joint degenerative changes. 2. Strain of the flexor pollicis brevis and abductor pollicis brevis insertions.
Findings: The radial collateral ligament of the thumb MCP joint appears stretched but intact. There is prominent cystlike change and bone marrow edema beneath its metacarpal head attachment site. There are moderate diffuse degenerative changes of the thumb MCP joint with mild ulnar subluxation of the proximal phalanx relative to the metacarpal head. There is edema within the flexor pollicis brevis and abductor pollicis brevis tendons and muscles at their attachments.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Calcified coronary atherosclerosis. Aortic valve calcification. ABDOMEN and PELVIS: LIVER: Scattered subcentimeter hypoattenuating lesions, likely cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral hypodensities, some cysts, some too small to characterize. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Unchanged large hiatal hernia. No small bowel abnormality. COLON / APPENDIX: Diverticula without inflammation. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatic clips. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Unchanged appearance of acute inferior endplate fracture of T12 without significant vertebral body height loss or retropulsion. Unchanged 50% anterior wedging of T7 with 25% anterior wedging of T10. Moderate to severe degenerative changes of the lumbar spine. Diffuse demineralization. Right total hip arthroplasty without complication. Degenerative left hip changes.
15,620
EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Knee pain COMPARISON: Radiographs dated 1/24/2022 TECHNIQUE: Multiplanar multisequence images were obtained through the knee Findings: There is severe, near complete articular cartilage loss over the medial facet and mid sagittal ridge of the patella. There is mild fissuring of the femoral trochlear cartilage. There is moderate cartilage loss in the medial tibiofemoral compartment. A small joint effusion is present. There is a tiny popliteal cyst. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is discoid, but no focal tear is seen. There is a small radial tear of the central free edge of the body of the medial meniscus. There is mild degenerative signal in the posterior horn of the medial meniscus without discrete tear. There is strandy edema tracking along the medial collateral ligament. The edema wraps posteriorly along the posterior medial oblique ligament. Quadriceps and patellar tendons are intact. The patellar retinaculum is unremarkable. The iliotibial band and posterior lateral corner structures are normal. Impression: 1. Severe patellar articular cartilage loss along the medial facet and mid sagittal ridge. Moderate medial tibiofemoral articular cartilage loss. 2. Tiny degenerative radial tear of the central free edge of the medial meniscus. 3. Edema tracking along the medial collateral ligament and posterior medial oblique ligament suggesting ligament sprain.
Findings: There is severe, near complete articular cartilage loss over the medial facet and mid sagittal ridge of the patella. There is mild fissuring of the femoral trochlear cartilage. There is moderate cartilage loss in the medial tibiofemoral compartment. A small joint effusion is present. There is a tiny popliteal cyst. The anterior and posterior cruciate ligaments are intact. The lateral meniscus is discoid, but no focal tear is seen. There is a small radial tear of the central free edge of the body of the medial meniscus. There is mild degenerative signal in the posterior horn of the medial meniscus without discrete tear. There is strandy edema tracking along the medial collateral ligament. The edema wraps posteriorly along the posterior medial oblique ligament. Quadriceps and patellar tendons are intact. The patellar retinaculum is unremarkable. The iliotibial band and posterior lateral corner structures are normal.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bibasilar subsegmental atelectasis. Right upper lobe calcified granuloma. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Postsurgical changes of hiatal hernia repair, with small residual hiatal hernia. Fluid collection along the distal right aspect of the esophagus measures 1.9 x 1.7 cm (series 201 image 184). No pneumomediastinum. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered subcentimeter hypoattenuating lesions, likely cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Wedge-shaped hypoattenuating lesion along the superomedial aspect. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypoattenuating lesions, likely cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of hiatal hernia repair. No small bowel abnormality. COLON / APPENDIX: Diverticula without inflammation. Appendix is absent. PERITONEUM / MESENTERY: Trace pneumoperitoneum, likely postprocedural. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Circumaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Bilateral inguinal canal subcutaneous gas, likely postprocedural. BODY WALL: Postsurgical changes from recent laparoscopic hiatal hernia repair. MUSCULOSKELETAL: Minimal degenerative spine changes.
15,621
RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pulsatile tinnitus. Per chart review, history of pulsatile tinnitus in the right ear for several weeks without hearing loss. COMPARISON: None available. TECHNIQUE: MR Brain wo+w contrast Patient weight: 165 lbs. IV contrast: ProHance, 8 ml, per protocol. 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. FINDINGS: INTRACRANIAL FINDINGS: No acute intraparenchymal infarct, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Confluent periventricular and scattered subcortical/deep cerebral T2/FLAIR hyperintensities bilaterally, likely mild chronic microangiopathic changes. Multiple foci of signal dropout with rim of FLAIR hyperintensity in the lateral ventricle peritrigonal regions predominant on left side, likely chronic lacunar infarcts with surrounding gliosis. Age-appropriate cerebral volume. 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. Trace mucosal thickening of the bilateral anterior ethmoid sinuses. The paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable. CONCLUSION: 1. No acute intracranial process or pathologic enhancement. Specifically, no evidence to explain patient's right-sided pulsatile tinnitus, such as idiopathic intracranial hypertension, sigmoid sinus/jugular bulb diverticulum, or aberrant ICA. 2. Multiple suspected chronic lacunar infarcts in the left peritrigonal white matter. 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.
FINDINGS: INTRACRANIAL FINDINGS: No acute intraparenchymal infarct, edema, hydrocephalus, space-occupying lesion, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. Confluent periventricular and scattered subcortical/deep cerebral T2/FLAIR hyperintensities bilaterally, likely mild chronic microangiopathic changes. Multiple foci of signal dropout with rim of FLAIR hyperintensity in the lateral ventricle peritrigonal regions predominant on left side, likely chronic lacunar infarcts with surrounding gliosis. Age-appropriate cerebral volume. 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. Trace mucosal thickening of the bilateral anterior ethmoid sinuses. The paranasal sinuses and mastoid air cells are clear. Both orbits are unremarkable.
FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bibasilar subsegmental atelectasis. Right upper lobe calcified granuloma. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Postsurgical changes of hiatal hernia repair, with small residual hiatal hernia. Fluid collection along the distal right aspect of the esophagus measures 1.9 x 1.7 cm (series 201 image 184). No pneumomediastinum. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Scattered subcentimeter hypoattenuating lesions, likely cysts. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Wedge-shaped hypoattenuating lesion along the superomedial aspect. ADRENALS: Normal. KIDNEYS: Bilateral subcentimeter hypoattenuating lesions, likely cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of hiatal hernia repair. No small bowel abnormality. COLON / APPENDIX: Diverticula without inflammation. Appendix is absent. PERITONEUM / MESENTERY: Trace pneumoperitoneum, likely postprocedural. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. Circumaortic left renal vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Bilateral inguinal canal subcutaneous gas, likely postprocedural. BODY WALL: Postsurgical changes from recent laparoscopic hiatal hernia repair. MUSCULOSKELETAL: Minimal degenerative spine changes.
15,622
EXAM: MR Cervical Spine wo contrast 1/26/2022 7:18 AM CLINICAL INFORMATION: Cervical radiculopathy, no red flags, Radiculopathy, cervical region. COMPARISON: Cervical spine radiographs dated 1/21/2022, 12/5/2018. TECHNIQUE: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. FINDINGS: Mild retrolisthesis of C3 on C4, unchanged. Trace anterolisthesis of C4 on C5, unchanged. Trace stepwise retrolisthesis of C5 on C6 and C6 on C7, unchanged. Mild chronic C5 anterior wedge compression deformity, unchanged. Heterogenous T1 and T2 marrow hyperintensity in the C5-C7 vertebral bodies, likely fatty marrow conversion. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No definite cord signal abnormality is identified. Multilevel degenerative discogenic disease and desiccation, with moderate disc space height loss most prominently at C5-C7. Degenerative findings are discussed on a level by level basis: C2-3: Minimal central disc protrusion and mild right facet arthropathy. No significant spinal canal or neuroforaminal stenosis. C3-4: Mild disc osteophyte complex and mild bilateral facet arthropathy, resulting in effacement of the ventral thecal sac and mild spinal canal stenosis. Narrowing of the left greater than right lateral recesses and suspected contact upon the transiting C5 nerve roots bilaterally. Severe right neuroforaminal stenosis. C4-5: Mild bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. C5-6: Moderate disc osteophyte complex and mild bilateral facet arthropathy, resulting in effacement of the ventral thecal sac and mild spinal canal stenosis. Narrowing of both lateral recesses with compression of the transiting C7 nerve roots bilaterally. Severe bilateral neuroforaminal stenosis. C6-7: Mild disc osteophyte complex and mild bilateral facet arthropathy, resulting in mild spinal canal stenosis. Narrowing of both lateral recesses with suspected contact upon the transiting nerve roots bilaterally. C7-T1: Minimal disc osteophyte complex and moderate bilateral facet arthropathy without significant spinal canal stenosis. Mild left neuroforaminal stenosis. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. CONCLUSION: 1. Multilevel degenerative spondylosis and spondylolisthesis as detailed above, resulting in mild spinal canal stenosis at C3-C4 and C5-C7. 2. Severe right-sided neuroforaminal stenosis at C3-C4 and bilateral stenosis at C5-C6. Suspected compression of the transiting C7 nerve roots at the level of C5-C6. 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.
FINDINGS: Mild retrolisthesis of C3 on C4, unchanged. Trace anterolisthesis of C4 on C5, unchanged. Trace stepwise retrolisthesis of C5 on C6 and C6 on C7, unchanged. Mild chronic C5 anterior wedge compression deformity, unchanged. Heterogenous T1 and T2 marrow hyperintensity in the C5-C7 vertebral bodies, likely fatty marrow conversion. There are no suspicious bone marrow signal abnormalities. The craniovertebral junction appears unremarkable. No definite cord signal abnormality is identified. Multilevel degenerative discogenic disease and desiccation, with moderate disc space height loss most prominently at C5-C7. Degenerative findings are discussed on a level by level basis: C2-3: Minimal central disc protrusion and mild right facet arthropathy. No significant spinal canal or neuroforaminal stenosis. C3-4: Mild disc osteophyte complex and mild bilateral facet arthropathy, resulting in effacement of the ventral thecal sac and mild spinal canal stenosis. Narrowing of the left greater than right lateral recesses and suspected contact upon the transiting C5 nerve roots bilaterally. Severe right neuroforaminal stenosis. C4-5: Mild bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. C5-6: Moderate disc osteophyte complex and mild bilateral facet arthropathy, resulting in effacement of the ventral thecal sac and mild spinal canal stenosis. Narrowing of both lateral recesses with compression of the transiting C7 nerve roots bilaterally. Severe bilateral neuroforaminal stenosis. C6-7: Mild disc osteophyte complex and mild bilateral facet arthropathy, resulting in mild spinal canal stenosis. Narrowing of both lateral recesses with suspected contact upon the transiting nerve roots bilaterally. C7-T1: Minimal disc osteophyte complex and moderate bilateral facet arthropathy without significant spinal canal stenosis. Mild left neuroforaminal stenosis. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics.
FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. Age-appropriate cerebral atrophy with ex vacuo ventricular dilatation. No abnormal intracranial enhancement. 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.
15,623
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma surveillance. COMPARISON: MRI of abdomen dated 10/26/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 175 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory, though arterial phase is too early. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. TREATED LIVER LESIONS: 1. Wedge-shaped hyperenhancement adjacent to the ablation defect at the periphery of the right hepatic lobe (hepatic segment V) is unchanged since the prior exam without evidence of washout, LR-TR nonviable. 2. Ablation defect in hepatic segment II is unchanged without suspicious nodular postcontrast enhancement. 3. Early arterial phase limits follow-up evaluation of previously described nodular arterial enhancing foci at the margin of the ablation defect in the hepatic dome (hepatic segment VII/VIII), however the area of washout adjacent to the treated zone is unchanged in size, measuring approximately 1.1 cm (series 705, image 296), LR-TR viable. UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Ill-defined area of arterial hyperenhancement in the periphery of the left hepatic lobe adjacent to the heart, which degrades evaluation due to motion artifact. - Location: Segment(s) II (series 703, image 302 - Size: 1.8 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 1 - Enhancing "capsule": Not present. - Nonperipheral "washout": . - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-5 Previously seen LR-3 observations are not identified on the current study, likely due to early arterial technique. 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: Cholelithiasis. LYMPH NODES: None enlarged. SPLEEN: Enlarged, with area of scarring and probable Gamna-Gandy bodies. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter right renal cyst. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. New arterially enhancing lesion with washout in the left hepatic lobe, LR-5. Of note, cardiac motion limits evaluation of this lesion, which may be artifactual. Consider CT liver protocol confirmation. 2. Similar appearance of treated lesion in the hepatic dome with nodular area of washout, LR-TR viable. 3. Additional treated lesions in hepatic segment V and II are without suspicious postcontrast enhancement, LR-TR nonviable. 4. Suboptimal early arterial phase limits evaluation for previously described LR-3 observations. 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.
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory, though arterial phase is too early. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. TREATED LIVER LESIONS: 1. Wedge-shaped hyperenhancement adjacent to the ablation defect at the periphery of the right hepatic lobe (hepatic segment V) is unchanged since the prior exam without evidence of washout, LR-TR nonviable. 2. Ablation defect in hepatic segment II is unchanged without suspicious nodular postcontrast enhancement. 3. Early arterial phase limits follow-up evaluation of previously described nodular arterial enhancing foci at the margin of the ablation defect in the hepatic dome (hepatic segment VII/VIII), however the area of washout adjacent to the treated zone is unchanged in size, measuring approximately 1.1 cm (series 705, image 296), LR-TR viable. UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Ill-defined area of arterial hyperenhancement in the periphery of the left hepatic lobe adjacent to the heart, which degrades evaluation due to motion artifact. - Location: Segment(s) II (series 703, image 302 - Size: 1.8 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 1 - Enhancing "capsule": Not present. - Nonperipheral "washout": . - Threshold growth (>= 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-5 Previously seen LR-3 observations are not identified on the current study, likely due to early arterial technique. 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: Cholelithiasis. LYMPH NODES: None enlarged. SPLEEN: Enlarged, with area of scarring and probable Gamna-Gandy bodies. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter right renal cyst. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: Right hemicraniectomy has been performed since the prior examination with drainage catheter in the craniectomy bed. There is packing material right temporal convexity. There is an gas containing extra-axial hemorrhage underlying the craniectomy site. Large volume MCA territory infarction is again noted with herniation of brain parenchyma beyond the craniectomy defect. There is no hemorrhagic conversion. Hyperdense right MCA branches are seen. Small 10 mm intraparenchymal hemorrhage in the right temporal lobe is likely postsurgical on image 24 series 3. Small left MCA territory infarctions in the left frontal and left parietal lobe are unchanged. There is no new infarction. There is no hydrocephalus. There is mucosal thickening in the ethmoid, right maxillary and bilateral sphenoid sinuses with small left maxillary sinus is retention cysts. The mastoid air cells are clear.
15,624
MR Brain wo+w contrast, MR Perfusion 1/26/2022 8:27 AM Clinical Information: History of GBM Comparison: Brain MRI dated 12/15/2021 Technique: Axial diffusion, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal, dynamic susceptibility contrast MR perfusion exam. Patient weight: 168 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 4 ml per sec. Findings: Since prior MRI dated 12/15/2021 there is interval size increase of the rim enhancing and centrally necrotic mass lesion located in the deep white matter of the right frontal lobe measuring 69 x 59 mm on transverse diameter previously 45 x 46 mm. Also there is interval enlargement of the solid component of the enhancing in inferior portion of the mass as well. The lesion contains foci of diffusion restriction as well as microhemorrhages. The mass is passing the genu of corpus callosum with infiltration along the subependymal region of the right frontal horn. There is interval worsening of mass effect and effacement of the right lateral ventricle especially in the right frontal horn. There is 13 mm right-to-left midline shift. There is increased perfusion anterior the right frontal horn corresponding to the solid enhancement of the lesion most consistent with viable neoplasm and findings are most consistent with interval disease progression. Since prior MRI there is interval mild worsening of extensive edema involving the right frontal parietal lobe with extension to the genu of corpus callosum Decreased perfusion within the right centrum semiovale is likely combination of the edema and postradiation changes. There is a punctate focus of microhemorrhage in the left cerebellum. Foci of periventricular FLAIR signal intensities on the left cerebral hemisphere is most consistent with microvascular angiopathy. Similar foci are also seen in the central portion of the pons. Orbits and paranasal sinuses are unremarkable. Impression: Interval enlargement of the rim-enhancing centrally necrotic mass in the white matter of the right frontal lobe with more solid enhancement, worsening of mass effect as well as a focus of elevated perfusion in the inferior portion of the mass most consistent with viable neoplasm and interval disease progression. 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.
Findings: Since prior MRI dated 12/15/2021 there is interval size increase of the rim enhancing and centrally necrotic mass lesion located in the deep white matter of the right frontal lobe measuring 69 x 59 mm on transverse diameter previously 45 x 46 mm. Also there is interval enlargement of the solid component of the enhancing in inferior portion of the mass as well. The lesion contains foci of diffusion restriction as well as microhemorrhages. The mass is passing the genu of corpus callosum with infiltration along the subependymal region of the right frontal horn. There is interval worsening of mass effect and effacement of the right lateral ventricle especially in the right frontal horn. There is 13 mm right-to-left midline shift. There is increased perfusion anterior the right frontal horn corresponding to the solid enhancement of the lesion most consistent with viable neoplasm and findings are most consistent with interval disease progression. Since prior MRI there is interval mild worsening of extensive edema involving the right frontal parietal lobe with extension to the genu of corpus callosum Decreased perfusion within the right centrum semiovale is likely combination of the edema and postradiation changes. There is a punctate focus of microhemorrhage in the left cerebellum. Foci of periventricular FLAIR signal intensities on the left cerebral hemisphere is most consistent with microvascular angiopathy. Similar foci are also seen in the central portion of the pons. Orbits and paranasal sinuses are unremarkable.
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: Interval development of hazy bilateral centrilobular groundglass nodules, and some areas with a tree-in-bud type of distribution, predominantly in the dependent lungs, but involving all lobes, may represent atypical infection/bronchiolitis versus aspiration. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
15,625
MRI brain with and without contrast Clinical Information: Female aged 56 years, meningioma. Comparison: MR 7/21/2021 and 3/26/2020 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 145 lbs. IV contrast: ProHance, 14 ml, per protocol. Findings: The left orbital apex enhancing mass encases the left prechiasmatic optic nerve. The intraorbital portion measures 2.2 x 1.1 x 1.4 cm (axial series 803, image 27 and coronal series 802, image 23), previously 2.2 x 1.1 x 1.4 cm. The intraorbital portion completely circumscribes the nerve and produces mild mass effect on the medial rectus muscle. The mass extends posteriorly to the clinoid and superiorly to the suprasellar cistern, encasing the prechiasmatic optic nerve and supraclinoid ICA and abut the left A1 segment. Mild upper deviation of the left optic chiasm, overall unchanged. This left anterior clinoid and tuberculum sella mass measures 1.8 x 0.7 x 1.6 cm (axial series 3, image 31 and coronal series 2, image 37), previously 1.8 x 0.7 x 1.6 cm. No flow-limiting stenosis visualized in the left ICA or A1 segment. Redemonstration of the 1.1 cm homogeneously enhancing extra-axial lesion in the left occipital para falcine region, stable since prior study. No evidence of osseous invasion. No new intracranial abnormalities identified. Conclusion: 1. Unchanged left intraorbital mass encircling the optic sheath. 2. Unchanged left anterior clinoid and tuberculum sella mass. 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.
Findings: The left orbital apex enhancing mass encases the left prechiasmatic optic nerve. The intraorbital portion measures 2.2 x 1.1 x 1.4 cm (axial series 803, image 27 and coronal series 802, image 23), previously 2.2 x 1.1 x 1.4 cm. The intraorbital portion completely circumscribes the nerve and produces mild mass effect on the medial rectus muscle. The mass extends posteriorly to the clinoid and superiorly to the suprasellar cistern, encasing the prechiasmatic optic nerve and supraclinoid ICA and abut the left A1 segment. Mild upper deviation of the left optic chiasm, overall unchanged. This left anterior clinoid and tuberculum sella mass measures 1.8 x 0.7 x 1.6 cm (axial series 3, image 31 and coronal series 2, image 37), previously 1.8 x 0.7 x 1.6 cm. No flow-limiting stenosis visualized in the left ICA or A1 segment. Redemonstration of the 1.1 cm homogeneously enhancing extra-axial lesion in the left occipital para falcine region, stable since prior study. No evidence of osseous invasion. No new intracranial abnormalities identified.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Low-attenuation lesion in the right lobe of the liver measuring about 0.9 cm in diameter and about 50 Hounsfield units in attenuation, indeterminate. Another tiny low-attenuation lesion in the right lobe of the liver is too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A small low-attenuation lesion in the left kidney, likely a cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered high attenuation material within the colon, likely ingested materials. PERITONEUM / MESENTERY: Small free fluid in the pelvis, likely physiologic. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Intrauterine device in place. Small low-attenuation area in the anterior body, may represent a small fibroid. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
15,626
MR Brain wo+w contrast, MR Perfusion 1/26/2022 8:27 AM Clinical Information: History of GBM Comparison: Brain MRI dated 12/15/2021 Technique: Axial diffusion, T1 sagittal and axial spin echo, T2 axial fast spin echo, axial FLAIR, postcontrast T1 axial, coronal, and sagittal, dynamic susceptibility contrast MR perfusion exam. Patient weight: 168 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 4 ml per sec. Findings: Since prior MRI dated 12/15/2021 there is interval size increase of the rim enhancing and centrally necrotic mass lesion located in the deep white matter of the right frontal lobe measuring 69 x 59 mm on transverse diameter previously 45 x 46 mm. Also there is interval enlargement of the solid component of the enhancing in inferior portion of the mass as well. The lesion contains foci of diffusion restriction as well as microhemorrhages. The mass is passing the genu of corpus callosum with infiltration along the subependymal region of the right frontal horn. There is interval worsening of mass effect and effacement of the right lateral ventricle especially in the right frontal horn. There is 13 mm right-to-left midline shift. There is increased perfusion anterior the right frontal horn corresponding to the solid enhancement of the lesion most consistent with viable neoplasm and findings are most consistent with interval disease progression. Since prior MRI there is interval mild worsening of extensive edema involving the right frontal parietal lobe with extension to the genu of corpus callosum Decreased perfusion within the right centrum semiovale is likely combination of the edema and postradiation changes. There is a punctate focus of microhemorrhage in the left cerebellum. Foci of periventricular FLAIR signal intensities on the left cerebral hemisphere is most consistent with microvascular angiopathy. Similar foci are also seen in the central portion of the pons. Orbits and paranasal sinuses are unremarkable. Impression: Interval enlargement of the rim-enhancing centrally necrotic mass in the white matter of the right frontal lobe with more solid enhancement, worsening of mass effect as well as a focus of elevated perfusion in the inferior portion of the mass most consistent with viable neoplasm and interval disease progression. 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.
Findings: Since prior MRI dated 12/15/2021 there is interval size increase of the rim enhancing and centrally necrotic mass lesion located in the deep white matter of the right frontal lobe measuring 69 x 59 mm on transverse diameter previously 45 x 46 mm. Also there is interval enlargement of the solid component of the enhancing in inferior portion of the mass as well. The lesion contains foci of diffusion restriction as well as microhemorrhages. The mass is passing the genu of corpus callosum with infiltration along the subependymal region of the right frontal horn. There is interval worsening of mass effect and effacement of the right lateral ventricle especially in the right frontal horn. There is 13 mm right-to-left midline shift. There is increased perfusion anterior the right frontal horn corresponding to the solid enhancement of the lesion most consistent with viable neoplasm and findings are most consistent with interval disease progression. Since prior MRI there is interval mild worsening of extensive edema involving the right frontal parietal lobe with extension to the genu of corpus callosum Decreased perfusion within the right centrum semiovale is likely combination of the edema and postradiation changes. There is a punctate focus of microhemorrhage in the left cerebellum. Foci of periventricular FLAIR signal intensities on the left cerebral hemisphere is most consistent with microvascular angiopathy. Similar foci are also seen in the central portion of the pons. Orbits and paranasal sinuses are unremarkable.
Findings: Please note, evaluation is limited due to motion artifact. CT of the head with and without contrast: There is no acute infarction, hemorrhage, or cerebral edema. The gray-white matter differentiation is maintained. Age-appropriate cerebral atrophy with ex vacuo ventricular dilatation. There is no space occupying intracranial lesion. No enhancing intracranial abnormality. There is no acute osseous or orbital abnormality. The paranasal sinuses and mastoid air cells are clear. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation. VERTEBROBASILAR ARTERIES: There is no evidence of stenosis, occlusion, or aneurysmal dilation.
15,627
MR Facial Bones wo+w contrast HISTORY: History of SCC of hypopharynx TECHNIQUE: Multiplanar, multisequence MRI of the face was performed without and after intravenous contrast. COMPARISON: MRI dated 7/17/2021 FINDINGS: INTRACRANIAL FINDINGS: Since prior MRI dated 7/17/2021 there is interval marked size decrease of infiltrative enhancing mucosal mass of the left oropharynx, left tonsillar region and left supraglottic space. There is a small amount of residual mucosal nodularity and enhancement in the left supraglottic space measuring 8 mm and 7 mm on transverse diameter most consistent with a small residual neoplasm. Also, there is interval significant size decrease of infiltrative enhancing soft tissue extending from the anterior tonsillar pillar and glossotonsillar sulcus toward the left carotid space most consistent with treated neoplasm. Measurement of this structure is difficult because of irregular morphology however it measures about 36 x 15 mm on transverse diameter previously about 50 x 36 mm. There is interval significant size decrease of the left retropharyngeal lymph node which now measures 10 x 6 mm on transverse diameter previously 13 x 11 mm. The right retropharyngeal lymph node is not visualized anymore. Also, the previously noted large left-sided cervical lymphadenopathy is not visualized anymore. Diffuse mucosal edema is present in the oropharynx which is likely sequela of radiation and mucositis. New bone marrow edema is present in the right aspect of mandibular bone which is new finding since prior study likely sequela of radiation. There is persistent postsurgical changes status post left-sided mastoidectomy. Ill-defined soft tissue enhancement within the location of the mastoidectomy is most consistent with postsurgical changes. There is a persistent enhancing soft tissue at the location of the left jugular foramen measuring 17 x 16 mm on transverse diameter, previously 15 x 12 mm concerning for a slow growing residual paraganglioma. There is persistent edema of the left occipital condyle. . On limited images from brain no acute pathology seen. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Fluid is noted in the right mastoidal air cells and within the residual left-sided mastoidal air cells. IMPRESSION: Interval significant size decrease of the mucosal neoplasm of the left oropharynx with extension to the left supraglottic region. Two foci of residual mucosal nodularity in the left supraglottic region is seen. Interval significant size of infiltrative enhancing soft tissue extending from the left oropharynx toward the left carotid space most consistent with treated neoplasm with fibrosis. Interval significant size decrease of the left retropharyngeal lymph node. Other cervical lymph nodes are not visualized anymore. In summary, findings are most consistent with interval partial treatment response. Persistent postsurgical changes status post left-sided mastoidectomy with a slowly enlarging soft tissue at the location of the left jugular foramen concerning for a slow enlargement of residual paraganglioma. New bone marrow edema in right aspect of mandibular bone most consistent with sequela of radiation however if presentation is concerning for osteonecrosis correlation with CT scan is recommended.
FINDINGS: INTRACRANIAL FINDINGS: Since prior MRI dated 7/17/2021 there is interval marked size decrease of infiltrative enhancing mucosal mass of the left oropharynx, left tonsillar region and left supraglottic space. There is a small amount of residual mucosal nodularity and enhancement in the left supraglottic space measuring 8 mm and 7 mm on transverse diameter most consistent with a small residual neoplasm. Also, there is interval significant size decrease of infiltrative enhancing soft tissue extending from the anterior tonsillar pillar and glossotonsillar sulcus toward the left carotid space most consistent with treated neoplasm. Measurement of this structure is difficult because of irregular morphology however it measures about 36 x 15 mm on transverse diameter previously about 50 x 36 mm. There is interval significant size decrease of the left retropharyngeal lymph node which now measures 10 x 6 mm on transverse diameter previously 13 x 11 mm. The right retropharyngeal lymph node is not visualized anymore. Also, the previously noted large left-sided cervical lymphadenopathy is not visualized anymore. Diffuse mucosal edema is present in the oropharynx which is likely sequela of radiation and mucositis. New bone marrow edema is present in the right aspect of mandibular bone which is new finding since prior study likely sequela of radiation. There is persistent postsurgical changes status post left-sided mastoidectomy. Ill-defined soft tissue enhancement within the location of the mastoidectomy is most consistent with postsurgical changes. There is a persistent enhancing soft tissue at the location of the left jugular foramen measuring 17 x 16 mm on transverse diameter, previously 15 x 12 mm concerning for a slow growing residual paraganglioma. There is persistent edema of the left occipital condyle. . On limited images from brain no acute pathology seen. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. Fluid is noted in the right mastoidal air cells and within the residual left-sided mastoidal air cells.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Surgical changes of bilateral lung transplant with near complete resolution of previously described areas of diffuse bilateral pulmonary groundglass opacities. There is persistent small areas of subpleural thickening/scarring and micronodular nodularity along the anterolateral right upper lobe. Airways are patent and normal in morphology. Small bilateral pleural effusions with a right lateral approach pigtail drainage catheter within the pleural space. The right pleural effusion is slightly smaller. The left pleural effusion is slightly larger. HEART / VESSELS: Cardiac chambers and great vessels appear normal in size. Advanced coronary artery calcifications with stenting of the LAD. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Soft tissue stranding of the bilateral anterior chest wall without organized fluid collection. Postsurgical changes of clamshell sternotomy. Surgical clips in the left lateral chest wall are noted. UPPER ABDOMEN: Imaged portions of superior abdomen are unremarkable for unenhanced technique. MUSCULOSKELETAL: No significant abnormality. Advanced osteoarthritic degenerative changes of bilateral glenohumeral joints, left greater than right.
15,628
MRI brain with and without contrast Clinical Information: Male aged 67 years. Primary CNS lymphoma, monitor Comparison: CT 1/12/2022 and MR 11/24/2021 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 202 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: Bilateral frontoparietal hygromas measuring 9 mm bilaterally. There is diffuse pachymeningeal enhancement along the bilateral cerebral convexities. Postsurgical appearance of the left temporal lobe with interval decrease in edema with decrease in FLAIR hyperintensities along the left temporal lobe at the sites of surgical resection with retained hemorrhagic products. The previously seen nodular enhancement along the posterior wall the anterior resection cavity is no longer seen although there is still linear posterior wall enhancement (series 9, image 23). No new abnormal enhancement in the resection bed. Fluid in the maxillary, ethmoid and frontal sinuses. Fluid within the left mastoid air cells and middle ear now with internal enhancement (series 9, image 21). No new infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. Conclusion: 1. Postsurgical appearance of left temporal lobe resection with interval resolution of nodular enhancement along the posterior wall, most suggestive of postsurgical healing. No new abnormal enhancement identified. 2. Bilateral frontoparietal hygromas measuring 9 mm bilaterally and associated diffuse pachymeningeal enhancement, previously measuring approximately 7 mm on CT 1/12/2022. The differential diagnosis include CSF hypotension. 3. Fluid within the paranasal sinuses concerning for acute sinusitis. 4. Fluid within the left mastoid air cells and middle air now with internal enhancement concerning for inflammatory fluid collections. 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.
Findings: Bilateral frontoparietal hygromas measuring 9 mm bilaterally. There is diffuse pachymeningeal enhancement along the bilateral cerebral convexities. Postsurgical appearance of the left temporal lobe with interval decrease in edema with decrease in FLAIR hyperintensities along the left temporal lobe at the sites of surgical resection with retained hemorrhagic products. The previously seen nodular enhancement along the posterior wall the anterior resection cavity is no longer seen although there is still linear posterior wall enhancement (series 9, image 23). No new abnormal enhancement in the resection bed. Fluid in the maxillary, ethmoid and frontal sinuses. Fluid within the left mastoid air cells and middle ear now with internal enhancement (series 9, image 21). No new infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality noted. ABDOMEN and PELVIS: LIVER: Clips along the posterior margin of the right lobe. Otherwise normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydronephrosis or nephrolithiasis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Scattered minimal subcutaneous stranding along the right flank. Fat-containing umbilical hernia. MUSCULOSKELETAL: Minimal degenerative spine changes.
15,629
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Cervical cancer COMPARISON: No prior pelvic MR comparison. TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 185 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 0.50 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: Pathologically enlarged right external iliac lymph node measures 1.8 cm in short axis (image 27, series 10), previously measured 2.2 cm in short axis (image 379, series 201, CT 12/2/2021, remeasured). This lymph node is centrally necrotic on the current MR examination. Previously described left pelvic sidewall lymphadenopathy is not appreciated on the current MR examination. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Postsurgical changes of prior cesarean section. The uterus and ovaries bilaterally are normal in size. Persistent cervical mass is decreased in size since the prior CT examination, measuring approximately 1.7 x 1.5 x 1.1 cm (anterior posterior, medial lateral, craniocaudal). This mass appears contained within the cervix without parametrial involvement on the current examination. BODY WALL: Diastases of the rectus muscles. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Interval decrease in size of patient's known cervical mass, consistent with treatment response (yTIbN1). 2. Persistently pathologically enlarged right external iliac lymph node with central necrosis (N1). 3. Additional incidental findings, as detailed.
FINDINGS: STRUCTURED REPORT: MRI Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: Pathologically enlarged right external iliac lymph node measures 1.8 cm in short axis (image 27, series 10), previously measured 2.2 cm in short axis (image 379, series 201, CT 12/2/2021, remeasured). This lymph node is centrally necrotic on the current MR examination. Previously described left pelvic sidewall lymphadenopathy is not appreciated on the current MR examination. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Postsurgical changes of prior cesarean section. The uterus and ovaries bilaterally are normal in size. Persistent cervical mass is decreased in size since the prior CT examination, measuring approximately 1.7 x 1.5 x 1.1 cm (anterior posterior, medial lateral, craniocaudal). This mass appears contained within the cervix without parametrial involvement on the current examination. BODY WALL: Diastases of the rectus muscles. MUSCULOSKELETAL: No significant abnormality.
Findings: There is no evidence of acute intracranial hemorrhage, infarction, brain edema, mass effect or hydrocephalus. Stable encephalomalacia in right greater than left frontal lobes. Stable dense falx calcifications. Posterior fossa structures appear normal. Partially empty sella. The visualized paranasal sinuses, mastoid air cells and middle ear cavities are clear. Both orbits appear normal.
15,630
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Left adrenal lesion; evaluate for interval change. Per electronic medical record, patient underwent workup for pheochromocytoma, which was negative. The patient also has a side branch IPMN. COMPARISON: CT abdomen and pelvis with contrast 12/29/2020 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 175 lbs. IV contrast: ProHance, 8 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: The main pancreatic duct is not dilated. Previously seen 5 mm nonenhancing focal hypoattenuation on prior CT examination 12/29/2020 does not have a T2 hyperintense correlate on the current MR examination, possible focal fat invagination. No pancreatic lesion identified. SPLEEN: Normal. ADRENALS: Mild thickening of the left adrenal gland without discrete nodule. The previously seen hyperenhancing focus in the left adrenal gland does not have an MR correlate. The right adrenal gland is normal in size. KIDNEYS: T2 hyperintense nonenhancing renal cysts bilaterally. No hydronephrosis or suspicious enhancing renal mass. Small 4 mm focus of intrinsic T1 signal hyperintensity in the lower pole of the right kidney, technically indeterminate, possible tiny hemorrhagic cyst. 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: Similar degenerative changes of the imaged thoracolumbar spine. No destructive osseous lesion identified. CONCLUSION: 1.Mild thickening of the left adrenal gland without discrete nodule. The previously seen hyperenhancing focus in the left adrenal gland does not have an MR correlate. The right adrenal gland is normal in size. 2. No pancreatic lesion identified. No main pancreatic ductal dilation. Favor that the previous focus of hypoattenuation on prior CT examination 12/29/2020 in the pancreatic body/neck represents focal fat. 3. Additional incidental findings, as detailed.
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: The main pancreatic duct is not dilated. Previously seen 5 mm nonenhancing focal hypoattenuation on prior CT examination 12/29/2020 does not have a T2 hyperintense correlate on the current MR examination, possible focal fat invagination. No pancreatic lesion identified. SPLEEN: Normal. ADRENALS: Mild thickening of the left adrenal gland without discrete nodule. The previously seen hyperenhancing focus in the left adrenal gland does not have an MR correlate. The right adrenal gland is normal in size. KIDNEYS: T2 hyperintense nonenhancing renal cysts bilaterally. No hydronephrosis or suspicious enhancing renal mass. Small 4 mm focus of intrinsic T1 signal hyperintensity in the lower pole of the right kidney, technically indeterminate, possible tiny hemorrhagic cyst. 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: Similar degenerative changes of the imaged thoracolumbar spine. No destructive osseous lesion identified.
FINDINGS: Exam is mildly limited by motion. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. No hematoma. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral maxillary sinuses. Tiny mucus retention left maxillary sinus.
15,631
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma status post ablation. COMPARISON: MRI of abdomen dated 11/17/2021, CT-guided ablation dated 12/16/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 155 lbs. IV contrast: ProHance, 14 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. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Interval ablation of the lesion in hepatic segment IVb with areas of T1 shortening on the precontrast sequences, suggestive of hemorrhagic/proteinaceous material. - Location: Segment(s) IVB - Size of largest enhancing portion of the mass: N/A. - Enhancement: Treatment-specific expected enhancement pattern - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable Posttreatment related changes are again seen at the inferior right hepatic lobe (hepatic segment V/VI; series 705, image 100) with adjacent wedge-shaped enhancement and capsular retraction is unchanged without suspicious nodular enhancement, LR-TR nonviable. Posttreatment related changes of the left hepatic lobe (hepatic segment II; series 705, image 248) with associated treatment related postcontrast enhancement, LR-TR nonviable. UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Arterially enhancing lesion with associated intermediate T2 signal - Location: Segment(s) VI (Image 163, Series 704). - Size: 2.2 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Present. - Other features: Suspected intralesional fat on in and out of phase imaging. - LI-RADS: LR-5 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: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Cystic foci in the pancreatic uncinate process are again noted, largest measuring approximately 1.8 cm, increased from prior exam when it measured approximately 9 mm. Main pancreatic duct is not dilated. No suspicious nodular enhancement. ADRENALS: Normal. KIDNEYS: Small left renal cyst. STOMACH / SMALL BOWEL: Unremarkable COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Cirrhosis with two LR-5 observations in the right hepatic lobe, the largest measuring up to 2.2 cm. 2. Posttreatment related changes from interval ablation to the segment IVB lesion without suspicious nodular postcontrast enhancement, LR-TR nonviable. 3. Additional nonviable treated lesions as described. 4. Increased size of cystic lesion in the uncinate process of the pancreas, now measuring approximately 1.8 cm, and possibly representing a side branch IPMN versus sequela of prior groove pancreatitis. Consider further evaluation with endoscopy; if endoscopy is not pursued, 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.
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Interval ablation of the lesion in hepatic segment IVb with areas of T1 shortening on the precontrast sequences, suggestive of hemorrhagic/proteinaceous material. - Location: Segment(s) IVB - Size of largest enhancing portion of the mass: N/A. - Enhancement: Treatment-specific expected enhancement pattern - Additional features: - Arterial phase hyperenhancement: Present. - Washout: Not present. - Enhancement similar to pretreatment: Not present. - Vascular invasion: No - LI-RADS: LR-TR Nonviable Posttreatment related changes are again seen at the inferior right hepatic lobe (hepatic segment V/VI; series 705, image 100) with adjacent wedge-shaped enhancement and capsular retraction is unchanged without suspicious nodular enhancement, LR-TR nonviable. Posttreatment related changes of the left hepatic lobe (hepatic segment II; series 705, image 248) with associated treatment related postcontrast enhancement, LR-TR nonviable. UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Arterially enhancing lesion with associated intermediate T2 signal - Location: Segment(s) VI (Image 163, Series 704). - Size: 2.2 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. - Threshold growth (>= 50% in = 50% in <= 6 months): Present. - Other features: Suspected intralesional fat on in and out of phase imaging. - LI-RADS: LR-5 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: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Cystic foci in the pancreatic uncinate process are again noted, largest measuring approximately 1.8 cm, increased from prior exam when it measured approximately 9 mm. Main pancreatic duct is not dilated. No suspicious nodular enhancement. ADRENALS: Normal. KIDNEYS: Small left renal cyst. STOMACH / SMALL BOWEL: Unremarkable COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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 (
15,632
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Follow-up meningioma. COMPARISON: Multiple priors most recently dated 1/26/2021. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 211 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: No acute infarction, intraparenchymal hemorrhage, or significant edema. Periventricular and subcortical white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. No abnormal intraparenchymal enhancement. Redemonstrated dural based mass arising from the medial left frontal convexity. This mass shows persistence homogeneous enhancement and measures 2.2 x 1.9 x 1.8 cm on axial series 1852 image 136 and coronal series 1850 image 56 (previously 2.2 x 1.9 x 1.7 cm). The ventricles are within normal size limits and there is no midline shift. Vascular flow voids are unremarkable. A focus of susceptibility signal drop on the right superior frontal gyrus is most consistent with a small focus of old hemorrhage. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable.The visualized soft tissues are unremarkable. CONCLUSION: Redemonstrated left frontal convexity meningioma without significant interval change in size or appearance. 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. As mentioned above scattered foci of deep white matter FLAIR signal intensities are likely microvascular angiopathy however a few of them are abutting the ventricular system. Clinical evaluation for history of demyelination is recommended.
FINDINGS: No acute infarction, intraparenchymal hemorrhage, or significant edema. Periventricular and subcortical white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. No abnormal intraparenchymal enhancement. Redemonstrated dural based mass arising from the medial left frontal convexity. This mass shows persistence homogeneous enhancement and measures 2.2 x 1.9 x 1.8 cm on axial series 1852 image 136 and coronal series 1850 image 56 (previously 2.2 x 1.9 x 1.7 cm). The ventricles are within normal size limits and there is no midline shift. Vascular flow voids are unremarkable. A focus of susceptibility signal drop on the right superior frontal gyrus is most consistent with a small focus of old hemorrhage. No abnormal marrow signal. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable.The visualized soft tissues are unremarkable.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Clot within the distal main pulmonary arteries bilaterally with extension to the lobar, segmental, and subsegmental vessels. - Pulmonary Artery Diameter: Enlarged at 3.7 cm. - Ascending Aortic Diameter: Normal at 3.5 cm. - RV:LV Ratio: 1.3:1 - Interventricular Septum: Flattening of the interventricular septum and slight bowing to the left. - Contrast reflux into IVC: Probable reflux of contrast into the IVC and hepatic veins although the presence of two boluses can compromise this. LUNGS / AIRWAYS / PLEURA: Endotracheal tube in the upper trachea in good position. Bilateral dependent airspace opacities may represent a combination of aspiration and pulmonary infarctions. HEART / OTHER VESSELS: Heart size is enlarged. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly enlarged mediastinal lymph nodes, for example a pretracheal lymph node measures about 1.2 cm in short axis (series 401; image 50). A right paratracheal lymph node measures about 1.1 cm in short axis (series 401; image 47). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
15,633
EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/26/2022 1:20 PM Referring MD: Jason Windham Height: 170 cm. Patient weight: 119 kg. BSA: 2.27 Heart Rate: 108 bpm. EGFR 60. The patient's creatinine was 0.8 on 01/26/2022. The patient received 20 cc's of Gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: Recurrent tachyarrhythmia Spec Inst: Evaluate s History: Concern for cardiac sarcoidosis. Prior cardiac MRI from 4/13/2020 had potential abnormality however scan quality was not ideal due to patient motion COMPARISON: 04/13/2020 cardiac MR. Images compared along side each other TECHNIQUE: CV MR Cardiac w contrast 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 Short AX T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed contrast enhancement, Perfusion General: Inpatient ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 28 LV End Diastolic Dimension: 56 LV End Systolic Dimension: 39 LV Posterior Wall: 6 Right Atrium 36 RV End Diastolic Dimension: 44 Interventricular Septum: 9 Left Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 164 ED Index 72 End Systolic Volume: 74 ES Index 33 Stroke Volume: 90 SV Index 40 Ejection Fraction: 54.9% Right Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 148 ED Index 65 End Systolic Volume: 64 ES Index 28 Stroke Volume: 84 SV Index 37 Ejection Fraction: 56.8% Morphology: The patient is imaged with multiple planes through the chest using ECG gated spin echo and cine gradient echo technique and postcontrast imaging. Left and right ventricles are normal size and have normal systolic function and there are no regional wall motion abnormalities. Following infusion of intravenous gadolinium contrast material under resting conditions there were no evident resting first pass perfusion defects. Late after administration of contrast there were no areas of abnormal late gadolinium enhancement. When compared to the previous cardiac MR, the current images are far superior quality and what appear to rule out significant scarring from cardiac conditions such as sarcoidosis. There are no significant valvular abnormalities Pericardium: Normal in thickness with no significant effusion Vascular: Visualized portions of the thoracic aorta and pulmonary arterial system are normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 24 Aortic Arch 21 [18-37] Right Pulmonary Artery 12 Ascending Aorta 25 [19-37] Left Pulmonary Artery 10 Inferior Vena Cava 21 Descending Aorta 18 [16-29] INCIDENTAL FINDINGS: None noted CONCLUSION: 1. Normal left and right ventricle systolic function 2. No abnormal late gadolinium enhancement 3. Normal cardiac MRI 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.
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 Short AX T2 Sequences: FSE 2IR FSE 3IR SSFP FGRE ET Additional views: Delayed contrast enhancement, Perfusion General: Inpatient ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 28 LV End Diastolic Dimension: 56 LV End Systolic Dimension: 39 LV Posterior Wall: 6 Right Atrium 36 RV End Diastolic Dimension: 44 Interventricular Septum: 9 Left Ventricle (short axis): Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 164 ED Index 72 End Systolic Volume: 74 ES Index 33 Stroke Volume: 90 SV Index 40 Ejection Fraction: 54.9% Right Ventricle (short axis):Volumes in mL, Index volumes in mL per square meter End Diastolic Volume: 148 ED Index 65 End Systolic Volume: 64 ES Index 28 Stroke Volume: 84 SV Index 37 Ejection Fraction: 56.8% Morphology: The patient is imaged with multiple planes through the chest using ECG gated spin echo and cine gradient echo technique and postcontrast imaging. Left and right ventricles are normal size and have normal systolic function and there are no regional wall motion abnormalities. Following infusion of intravenous gadolinium contrast material under resting conditions there were no evident resting first pass perfusion defects. Late after administration of contrast there were no areas of abnormal late gadolinium enhancement. When compared to the previous cardiac MR, the current images are far superior quality and what appear to rule out significant scarring from cardiac conditions such as sarcoidosis. There are no significant valvular abnormalities Pericardium: Normal in thickness with no significant effusion Vascular: Visualized portions of the thoracic aorta and pulmonary arterial system are normal. Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 24 Aortic Arch 21 [18-37] Right Pulmonary Artery 12 Ascending Aorta 25 [19-37] Left Pulmonary Artery 10 Inferior Vena Cava 21 Descending Aorta 18 [16-29] INCIDENTAL FINDINGS: None noted
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Steatosis without cirrhosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. No hydronephrosis or radiopaque urinary tract stones. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Transverse colonic diverticulitis without inflammation. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: Degenerative spine changes. No aggressive osseous abnormality.
15,634
MR Cervical Spine wo+w contrast HISTORY: Follow-up for spinal mass and demyelination TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed without and after intravenous contrast. COMPARISON: MRI dated 1/25/2021 FINDINGS: ALIGNMENT: Normal. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: There is a persistent focus of superficial T2 hyper signal intensity in left dorsal aspect of cord at C3-C4 level. There is another tiny T2 hyper signal intensity in left dorsal aspect of cord at level of C5 slightly more prominent since prior study. Minimal T2 hyper signal intensity in the right hemicord at the level of T1 is partially visualized and appears unchanged. Again noted is a stable avidly enhancing soft tissue within the right neural foramen at C3-C4 along the right-sided nerve roots most consistent with a nerve sheath tumor measuring 31 x 10 mm on transverse diameter previously 30 x 10 mm. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, mild bilateral uncovertebral joint arthropathy without spinal canal stenosis or neural foraminal narrowing. At C3-4, mild disc bulging with minimal spinal canal stenosis. No left neural foraminal narrowing. Persistent widening of the right neural foramen. At C4-5, posterior disc osteophyte which is eccentric to right side with mild spinal canal stenosis, mild cord compression and mild right lateral recess narrowing. There is mild right neural foraminal narrowing. At C5-6, posterior disc osteophyte formation with mild spinal canal stenosis, mild cord compression and moderate bilateral neural foraminal stenosis. At C6-7, small posterior disc osteophyte with minimal spinal canal stenosis without cord compression. Mild bilateral neural foraminal stenosis. At C7-T1, there is no spinal canal or foraminal stenosis. IMPRESSION: No significant interval change since prior MRI with a presumed nerve sheath tumor along the right neural foramen of C3-C4. Persistent scattered foci of T2 hyper signal intensity within the cord. The dominant lesion at C3-C4 is unchanged. The tiny lesion at C5 level is slightly more prominent on today's study but without abnormal enhancement..
FINDINGS: ALIGNMENT: Normal. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: There is a persistent focus of superficial T2 hyper signal intensity in left dorsal aspect of cord at C3-C4 level. There is another tiny T2 hyper signal intensity in left dorsal aspect of cord at level of C5 slightly more prominent since prior study. Minimal T2 hyper signal intensity in the right hemicord at the level of T1 is partially visualized and appears unchanged. Again noted is a stable avidly enhancing soft tissue within the right neural foramen at C3-C4 along the right-sided nerve roots most consistent with a nerve sheath tumor measuring 31 x 10 mm on transverse diameter previously 30 x 10 mm. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, mild bilateral uncovertebral joint arthropathy without spinal canal stenosis or neural foraminal narrowing. At C3-4, mild disc bulging with minimal spinal canal stenosis. No left neural foraminal narrowing. Persistent widening of the right neural foramen. At C4-5, posterior disc osteophyte which is eccentric to right side with mild spinal canal stenosis, mild cord compression and mild right lateral recess narrowing. There is mild right neural foraminal narrowing. At C5-6, posterior disc osteophyte formation with mild spinal canal stenosis, mild cord compression and moderate bilateral neural foraminal stenosis. At C6-7, small posterior disc osteophyte with minimal spinal canal stenosis without cord compression. Mild bilateral neural foraminal stenosis. At C7-T1, there is no spinal canal or foraminal stenosis.
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: Trace fluid within the posterior ethmoid sinuses.
15,635
Lumbar MRI without contrast - Clinical indication: Lumbar ligamentous injury. - 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: CT lumbar spine from reformat 1/25/2022. - Findings: Sagittal imaging demonstrates the intervertebral disc spaces, vertebral body heights, and alignment to be maintained. The marrow signal appears maintained. The conus terminates at the pedicle level of L1 The anterior and posterior longitudinal ligament, ligamenta flava and interspinous ligaments appear intact. Diffuse lumbar subcutaneous soft tissue edema ill-defined soft tissue edema in the left gluteal subcutaneous tissue. Axial images are evaluated on a level by level basis: - T11-12, T12-L1, L1-2, L2-3: Normal. - L3-4: Mild diffuse bulge is present. No significant central neuroforaminal stenosis. - L4-5: Diffuse bulge asymmetric to the left causing mild central, moderate right neural foraminal and moderate to severe left neuroforamina. Trace bilateral facet effusions.. - L5-S1: There is a dysplastic posterior elements L5-S1. No significant disc bulge. No central or neuroforaminal stenosis. Fracture of the left iliac bone. Multiple lumbar spine fractures are better evaluated on CT the mild right psoas in the right L3-4. Diffuse posterior paraspinal muscle edema in the lower lumbar spine.. - Impression: 1. No ligamentous injury identified. No intraspinal hemorrhage. No visualized conus/ cord compression. 2. Bony injury is better evaluated on CT. 3. Degenerative discogenic changes at L3-4 and L4-5 as described. 4. Soft tissue edema/ contusions associated with bony injury. No large hematoma identified. -
Findings: Sagittal imaging demonstrates the intervertebral disc spaces, vertebral body heights, and alignment to be maintained. The marrow signal appears maintained. The conus terminates at the pedicle level of L1 The anterior and posterior longitudinal ligament, ligamenta flava and interspinous ligaments appear intact. Diffuse lumbar subcutaneous soft tissue edema ill-defined soft tissue edema in the left gluteal subcutaneous tissue. Axial images are evaluated on a level by level basis: - T11-12, T12-L1, L1-2, L2-3: Normal. - L3-4: Mild diffuse bulge is present. No significant central neuroforaminal stenosis. - L4-5: Diffuse bulge asymmetric to the left causing mild central, moderate right neural foraminal and moderate to severe left neuroforamina. Trace bilateral facet effusions.. - L5-S1: There is a dysplastic posterior elements L5-S1. No significant disc bulge. No central or neuroforaminal stenosis. Fracture of the left iliac bone. Multiple lumbar spine fractures are better evaluated on CT the mild right psoas in the right L3-4. Diffuse posterior paraspinal muscle edema in the lower lumbar spine.. -
FINDINGS: There is no evidence of acute ischemia, intracranial hemorrhage, or intracranial mass. The ventricles and basal cisterns are unremarkable. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. The visualized extra-cranial soft tissues are unremarkable. No acute osseous abnormality.
15,636
EXAM: CV MR Cardiac for Function and Morph PATIENT DATA Date of Study: 1/26/2022 12:10 PM Referring MD: Brandi Thomas Height: 162 cm. Patient weight: 73 kg. BSA: 1.81246 Heart Rate: 110 bpm. EGFR 60. The patient's creatinine was 1.0 on . The patient received 16 cc's of gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: LV thrombus, HFrEF Spec Inst: ro myocarditis History: Systolic heart failure, LV thrombus, evaluate for possible myocarditis COMPARISON: No prior cardiac MRI. Contrast CT of chest and echocardiogram were reviewed. TECHNIQUE: CV MR Cardiac for Function and Morph. Height: 162 cm. Patient weight: 73 kg. BSA: 1.81246 Heart Rate: 110 bpm. FINDINGS: IMAGING DATA Imaging System: Philips 3T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta perfusion delayed enhancement Sequences: BB Haste, BTFE, look locker, PSIR Additional views: General: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 35 LV End Diastolic Dimension: 49 LV End Systolic Dimension: 54 LV Posterior Wall: 7 Right Atrium 50 RV End Diastolic Dimension: 41 Interventricular Septum: 11 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 261 ED index=147 End Systolic Volume: 214 ES index=120 Stroke Volume: 47 SV index=27 Ejection Fraction: 18.0% Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 222 ED index=125 End Systolic Volume: 167 ES index=94 Stroke Volume: 55 SV index=31 Ejection Fraction: 24.8% Morphology: The patient is imaged with multiple planes through the chest using ECG gated spin echo and cine gradient echo technique and postcontrast imaging. Left and right ventricles are enlarged and both ventricles have severely reduced systolic function. The left ventricle exhibits global hypokinesis. LV wall thicknesses are normal. Within the ventricular cavity, there are two discrete masses seen. One lies adjacent to the mid anteroseptum and measures approximately 9 mm in size. Another lies along the inferolateral apical aspect of the left ventricle and has a more lobulated complex shape and measures at least 12 mm in size. These do not take up contrast and are most consistent with thrombi in this setting. There is also a small area along the subepicardial in the lateral wall which exhibits abnormal late gadolinium enhancement which may be consistent with current or prior myocardial fibrosis. Left atrium is enlarged. There is moderate mitral valve regurgitation and no other significant valvular abnormalities are identified. Pericardium: Normal in thickness with a medium sized effusion without any evidence of right atrial or ventricular compression. Vascular: Visualized portions of the thoracic aorta and pulmonary arterial system are normal Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 26 Aortic Root Aortic Arch 21 [18-37] Right Pulmonary Artery 15 Ascending Aorta 33 [19-37] Left Pulmonary Artery 16 Inferior Vena Cava 26 Descending Aorta 19 [16-29] INCIDENTAL FINDINGS: Right pleural effusion, small size, is present. No other findings noted CONCLUSION: 1. Severe biventricular systolic dysfunction 2. Small area of abnormal late gadolinium enhancement in the lateral wall is not suggestive of ischemic process but may represent prior or present myocardial fibrosis 3. Left ventricle thrombus present Cardiac MRI Technologist: Billy Fisher 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.
FINDINGS: IMAGING DATA Imaging System: Philips 3T Overall Image Quality: Excellent CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta perfusion delayed enhancement Sequences: BB Haste, BTFE, look locker, PSIR Additional views: General: Inpatient ECG gated: yes MEASUREMENTS: in millimeters Left Atrium: 35 LV End Diastolic Dimension: 49 LV End Systolic Dimension: 54 LV Posterior Wall: 7 Right Atrium 50 RV End Diastolic Dimension: 41 Interventricular Septum: 11 Left Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 261 ED index=147 End Systolic Volume: 214 ES index=120 Stroke Volume: 47 SV index=27 Ejection Fraction: 18.0% Right Ventricle (short axis): Volumes in mL, index in mL per square meter End Diastolic Volume: 222 ED index=125 End Systolic Volume: 167 ES index=94 Stroke Volume: 55 SV index=31 Ejection Fraction: 24.8% Morphology: The patient is imaged with multiple planes through the chest using ECG gated spin echo and cine gradient echo technique and postcontrast imaging. Left and right ventricles are enlarged and both ventricles have severely reduced systolic function. The left ventricle exhibits global hypokinesis. LV wall thicknesses are normal. Within the ventricular cavity, there are two discrete masses seen. One lies adjacent to the mid anteroseptum and measures approximately 9 mm in size. Another lies along the inferolateral apical aspect of the left ventricle and has a more lobulated complex shape and measures at least 12 mm in size. These do not take up contrast and are most consistent with thrombi in this setting. There is also a small area along the subepicardial in the lateral wall which exhibits abnormal late gadolinium enhancement which may be consistent with current or prior myocardial fibrosis. Left atrium is enlarged. There is moderate mitral valve regurgitation and no other significant valvular abnormalities are identified. Pericardium: Normal in thickness with a medium sized effusion without any evidence of right atrial or ventricular compression. Vascular: Visualized portions of the thoracic aorta and pulmonary arterial system are normal Vessel dimensions: (In mm normal range dimensions mm) Main Pulmonary Artery 26 Aortic Root Aortic Arch 21 [18-37] Right Pulmonary Artery 15 Ascending Aorta 33 [19-37] Left Pulmonary Artery 16 Inferior Vena Cava 26 Descending Aorta 19 [16-29] INCIDENTAL FINDINGS: Right pleural effusion, small size, is present. No other findings noted
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild age-appropriate diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Paranasal sinuses are clear. VESSELS: Normal noncontrast appearance of the vessels.
15,637
MRI brain with and without Indication: Neoplasm, cerebellopontine angle (CPA) or brainstem, D32.0 Benign neoplasm of cerebral meninges Spec Inst: Right CPA mass sp SRS completed 5172021. fu scan Comparison: Multiple priors, most recent MRI brain with and without contrast 11/11/2021. 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: 188 lbs. IV contrast: ProHance, 18 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Redemonstration of enhancing extra-axial mass in the right CP angle with extension along the proximal right internal auditory canal with enhancing dural tail and possible extension into the proximal Meckel's cave shows mild interval decrease in size measuring 21 x 8 mm, previously 22 x 9 mm in axial plane. Mass effect on the adjacent pons and the middle cerebellar peduncle, the cisternal segments of the right seventh 8th nerve complex and the right trigeminal nerve is similar. A focus of nonenhancement in the anterior aspect of the lesion likely hemorrhage/calcification also appears similar. Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. No new findings seen. Impression: 1. No acute intracranial process. 2. Status post SRS to right CP angle mass with mild interval decrease in size as described. 3. No worrisome new findings.
Findings: Redemonstration of enhancing extra-axial mass in the right CP angle with extension along the proximal right internal auditory canal with enhancing dural tail and possible extension into the proximal Meckel's cave shows mild interval decrease in size measuring 21 x 8 mm, previously 22 x 9 mm in axial plane. Mass effect on the adjacent pons and the middle cerebellar peduncle, the cisternal segments of the right seventh 8th nerve complex and the right trigeminal nerve is similar. A focus of nonenhancement in the anterior aspect of the lesion likely hemorrhage/calcification also appears similar. Echoplanar diffusion-weighted imaging demonstrates no evidence of restricted diffusion at this time. No new findings seen.
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 (
15,638
MR brain without contrast Clinical Information: Impaired balance. Left unilateral hearing loss Comparison: MR 8/21/2020 Technique: Multiplanar, multisequence images of the brain were obtained in the sagittal, axial and coronal planes without the use of intravenous contrast per departmental protocol. Findings: No acute infarct or intracranial hemorrhage. T2/FLAIR matter hyperintensities consistent with chronic microangiopathic disease. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. The mastoid air cells are clear. No abnormal enhancement within the internal auditory canal. Normal appearance of the otic structures as visualized. No significant abnormality of the extracranial osseous and soft tissue structures. ---------------- Conclusion: No acute intracranial process to explain hearing loss. 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.
Findings: No acute infarct or intracranial hemorrhage. T2/FLAIR matter hyperintensities consistent with chronic microangiopathic disease. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. The mastoid air cells are clear. No abnormal enhancement within the internal auditory canal. Normal appearance of the otic structures as visualized. No significant abnormality of the extracranial osseous and soft tissue structures. ----------------
FINDINGS: Exam is mildly limited by motion. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. No hematoma. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mild mucosal thickening of the bilateral maxillary sinuses. Tiny mucus retention left maxillary sinus.
15,639
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma status post TACE COMPARISON: MRI of abdomen dated 10/20/2021 and chemoembolization dated 12/20/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 170 lbs. IV contrast: ProHance, 16 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. ABDOMEN: LIVER: Cirrhotic. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Treated lesion anterior to the IVC in hepatic dome - Location: Segment(s) IVA/II (treated zone measuring 2.7 cm on the subtraction sequences; series 607, image 78) - 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 - Lesion Number: 2 - Description: Treated lesion in the inferior right hepatic lobe - Location: Segment(s) V - Size of largest enhancing portion of the mass: Questionable nodular arterial hyperenhancement measuring approximately 1.6 cm of the medial border of the treated lesion on subtraction series 606, image 41. No definite associated restricted diffusion. This portion of the lesion appears T2 hypointense, which would argue against significant residual disease (series 301, image 30). - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - 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: Rounded lesion of arterial hyperenhancement anterior to the intrahepatic IVC - Location: Segment(s) I (series 603, image 65) - Size: 1.3 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. (Series 604, image 65) - Threshold growth (>= 50% in <= 6 months): Present., Previously measured approximately 7 mm (series 1203, image 294) - Other features: None. - LI-RADS: LR-5 Additional scattered foci of arterial hyperenhancement, some of which are seen on the prior exam, are again noted scattered throughout the liver, for example on series 603, images 78, 69, and 36. None these lesions demonstrate definite washout, all 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: Small (
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Treated lesion anterior to the IVC in hepatic dome - Location: Segment(s) IVA/II (treated zone measuring 2.7 cm on the subtraction sequences; series 607, image 78) - 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 - Lesion Number: 2 - Description: Treated lesion in the inferior right hepatic lobe - Location: Segment(s) V - Size of largest enhancing portion of the mass: Questionable nodular arterial hyperenhancement measuring approximately 1.6 cm of the medial border of the treated lesion on subtraction series 606, image 41. No definite associated restricted diffusion. This portion of the lesion appears T2 hypointense, which would argue against significant residual disease (series 301, image 30). - Enhancement: Nodular, masslike, or thick irregular tissue in or along the treated lesion - 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: Rounded lesion of arterial hyperenhancement anterior to the intrahepatic IVC - Location: Segment(s) I (series 603, image 65) - Size: 1.3 cm. - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. (Series 604, image 65) - Threshold growth (>= 50% in <= 6 months): Present., Previously measured approximately 7 mm (series 1203, image 294) - Other features: None. - LI-RADS: LR-5 Additional scattered foci of arterial hyperenhancement, some of which are seen on the prior exam, are again noted scattered throughout the liver, for example on series 603, images 78, 69, and 36. None these lesions demonstrate definite washout, all 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: Small (
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Multifocal groundglass and consolidative opacities involving all lung segments may represent interstitial thickening and atelectatic changes in the lower lobes. Endotracheal tube terminates near the carina. Tracheal bronchial airways are patent. HEART / VESSELS: Heart is normal in size. There is no pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal unenhanced and superior. There is gas within the left branch of portal vein and tiny gas foci in the peripheral right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate normal unenhanced appearance. Nonspecific bilateral perinephric stranding without any discrete fluid collection. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is moderately distended. Esophagogastric tube is seen in place. Diffuse dilatation of small bowel loops without any definite arising zone. COLON / APPENDIX: Ascending colonic wall thickening with bowel wall pneumatosis. Appendix is unremarkable. PERITONEUM / MESENTERY: There is diffuse mesenteric edema in the right hemiabdomen. Trace pelvic free fluid. No bowel wall pneumatosis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended, contains Foleys catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.
15,640
EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Aphasia. COMPARISON: Multiple priors most recently dated 1/26/2022. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 200 lbs. IV contrast: ProHance, 20 ml, per protocol. FINDINGS: No abnormal parenchymal restricted diffusion. No significant abnormal T2 or FLAIR parenchymal signal. Redemonstrated at left cerebral convexity extra-axial collection shows heterogeneous increased signal on T1 and T2 with scattered regions of susceptibility signal dropout . There is unchanged associated mass effect with 7 mm of rightward midline shift and effacement of the left lateral ventricle. No significant region of susceptibility signal dropout involving the brain parenchyma. On postcontrast sequences there is left cerebral convexity dural thickening and enhancement likely postsurgical. Postsurgical changes of left cerebral convexity craniotomy. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable.The remaining visualized soft tissues are unremarkable. CONCLUSION: Persistent postsurgical changes status post left cerebral craniotomy for evacuation of left hemispheric subdural hemorrhage. Persistent moderate residual subdural hemorrhage of left cerebral hemisphere with mild mass effect and severe millimeters left-to-right midline shift. 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.
FINDINGS: No abnormal parenchymal restricted diffusion. No significant abnormal T2 or FLAIR parenchymal signal. Redemonstrated at left cerebral convexity extra-axial collection shows heterogeneous increased signal on T1 and T2 with scattered regions of susceptibility signal dropout . There is unchanged associated mass effect with 7 mm of rightward midline shift and effacement of the left lateral ventricle. No significant region of susceptibility signal dropout involving the brain parenchyma. On postcontrast sequences there is left cerebral convexity dural thickening and enhancement likely postsurgical. Postsurgical changes of left cerebral convexity craniotomy. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are unremarkable.The remaining visualized soft tissues are unremarkable.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Multifocal groundglass and consolidative opacities involving all lung segments may represent interstitial thickening and atelectatic changes in the lower lobes. Endotracheal tube terminates near the carina. Tracheal bronchial airways are patent. HEART / VESSELS: Heart is normal in size. There is no pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal unenhanced and superior. There is gas within the left branch of portal vein and tiny gas foci in the peripheral right hepatic lobe. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Atrophic SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate normal unenhanced appearance. Nonspecific bilateral perinephric stranding without any discrete fluid collection. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is moderately distended. Esophagogastric tube is seen in place. Diffuse dilatation of small bowel loops without any definite arising zone. COLON / APPENDIX: Ascending colonic wall thickening with bowel wall pneumatosis. Appendix is unremarkable. PERITONEUM / MESENTERY: There is diffuse mesenteric edema in the right hemiabdomen. Trace pelvic free fluid. No bowel wall pneumatosis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended, contains Foleys catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.
15,641
MRI brain without Indication: Dementia, vascular suspected, R41.3 Other amnesia, I48.91 Unspecified atrial fibrillation, R31.9 Hematuria, unspecified, I10 Essential (primary) hypertension, Z79.899 Other long term (current) drug therapy Comparison: CT head from 1/5/2021 Technique: Multiple T1 and T2-weighted, sagittal, 3-D T1 sagittal, coronal and axial MPRAGE sequence images of the brain were obtained in the sagittal axial and coronal planes without administration of intravenous contrast per departmental protocol. Findings: There is no restricted diffusion. There is no evidence of supratentorial cerebral atrophy. There is no definite abnormal T2/flair hyperintense signal in the bilateral periventricular white matter. No significant hippocampal atrophy is identified. There is no hydrocephalus. There is no abnormal increased susceptibility on SWI. Impression: No acute intracranial process is identified. No definite cerebral atrophy is identified. No hydrocephalus is identified.
Findings: There is no restricted diffusion. There is no evidence of supratentorial cerebral atrophy. There is no definite abnormal T2/flair hyperintense signal in the bilateral periventricular white matter. No significant hippocampal atrophy is identified. There is no hydrocephalus. There is no abnormal increased susceptibility on SWI.
FINDINGS: Limited exam due to streak artifact. BRAIN PARENCHYMA: Acute, large intraparenchymal hemorrhage in the left parietotemporal lobes measuring 4.5 x 3.3 x 2.5 cm (image 42, series #204 and image 61, series #205). Moderate surrounding edema. Severe left uncal and subfalcine herniation with approximately 20 mm left to right midline shift. EXTRA-AXIAL SPACES: Large extra-axial hemorrhage with left cerebral convexity mixed density subdural hematoma measuring up to 35 mm (image 37, series #204). Mass effect and midline shift as above. There is additionally left parafalcine and tentorial leaflet small subdural hemorrhage. Large subarachnoid hemorrhage layering in the left cerebral cortical sulci and suprasellar cisterns. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Complete effacement of the third ventricle and near complete effacement of the left lateral ventricle with asymmetric enlargement of the right lateral ventricle concerning for entrapment. Suspected intraventricular hemorrhage in the third ventricle (image 34, series #204). ORBITS: Limited evaluation due to motion artifact. SINUSES: Paranasal sinuses are clear. VESSELS: Limited evaluation.
15,642
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatic adenoma surveillance COMPARISON: MRI abdomen dated 7/27/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 123 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: Liver is normal in morphology without steatosis. Post surgical changes from partial left hepatectomy and subsegmental resection at segments VII/VIII. Mildly T2 hyperintense, arterially enhancing lesion in hepatic segment VIII measures 1.6 x 1.4 cm on image 65 series 8, previously measuring similarly (this lesion measured 1.4 cm on 5/1/2019). This lesion does washout on portal venous or transitional phase and does not retain contrast on hepatobiliary phase. No intralesional fat seen. Additional more centrally located T2 hyperintense lesion in hepatic segment VIII with peripheral discontinuous nodular enhancement that progressively fills in is unchanged. No new liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny bilateral renal cysts. 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: Unchanged hepatic segment VIII lesions, most consistent with a lipid poor hepatic adenoma and hemangioma. No new liver 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.
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: Liver is normal in morphology without steatosis. Post surgical changes from partial left hepatectomy and subsegmental resection at segments VII/VIII. Mildly T2 hyperintense, arterially enhancing lesion in hepatic segment VIII measures 1.6 x 1.4 cm on image 65 series 8, previously measuring similarly (this lesion measured 1.4 cm on 5/1/2019). This lesion does washout on portal venous or transitional phase and does not retain contrast on hepatobiliary phase. No intralesional fat seen. Additional more centrally located T2 hyperintense lesion in hepatic segment VIII with peripheral discontinuous nodular enhancement that progressively fills in is unchanged. No new liver lesions. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny bilateral renal cysts. 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.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries secondary to respiratory motion artifact. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Lungs are hyperexpanded. Inspissated secretions within the trachea. Diffuse peribronchial thickening. Apical predominant emphysematous changes. Tree-in-bud nodularity in the anterior right lung. Calcified granuloma in the right lung. HEART / OTHER VESSELS: The heart is mildly enlarged. LAD stent is noted. Scattered vascular calcifications. MEDIASTINUM / ESOPHAGUS: Esophagus is patulous and partially fluid-filled. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Multiple posterior chronic rib deformities. Multilevel discogenic degenerative change. Thoracic dextroscoliosis.
15,643
EXAM: MR Pelvis wo+w contrast CLINICAL INFORMATION: Uterine fibroids; evaluation for possible uterine artery embolization COMPARISON: Pelvic ultrasound dated 11/16/2021 TECHNIQUE: MR Pelvis wo+w contrast Patient weight: 195 lbs. IV contrast: ProHance, 19 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Uterine Fibroids LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: UTERUS: Enlarged uterus with multiple fibroids. - UTERINE SIZE: 9.4 x 15.8 x 19.6 cm in AP by transverse by craniocaudal dimensions (image 26 series 4, image 25 series 3). - ENDOMETRIUM: Normal endometrial thickness. Endometrial cavity is displaced by large uterine fibroids. - JUNCTIONAL ZONE: Poorly evaluated secondary to distortion by multiple large fibroids. - NUMBER OF UTERINE FIBROIDS: >10 --- Fibroid 1: ------ Size: 8.0 x 10.5 x 8.2 cm in AP by transverse by craniocaudal dimensions (image 30 series 4, image 28 series 3). ------ Location: Anterior aspect of the uterine fundus. ------ Growth Pattern: Myometrial ------ Pre-contrast signal characteristics: T2 hypointense and T1 isointense. ------ Enhancement pattern: Heterogeneous ------ Features Suspicious for Sarcoma: None. --- Fibroid 2: ------ Size: 7.1 x 7.5 x 7.7 cm in AP by transverse by craniocaudal dimensions (image 15 series 4, image 13 series 3). ------ Location: Right lateral aspect of the uterine fundus. ------ Growth Pattern: Subserosal ------ Pre-contrast signal characteristics: T2 hypointense and T1 isointense. ------ Enhancement pattern: Homogeneous ------ Features Suspicious for Sarcoma: None. --- Fibroid 3: ------ Size: 4.6 x 5.4 x 5.0 cm in AP by transverse markings, dimensions on image 14 series 4, image 28 series 3). ------ Location: Midline uterine fundus. ------ Growth Pattern: Myometrial ------ Pre-contrast signal characteristics: T2 hypointense and T1 isointense. ------ Enhancement pattern: Homogeneous ------ Features Suspicious for Sarcoma: None. OTHER UTERINE FIBROIDS: There are multiple additional smaller uterine fibroids. Of note, there is a small submucosal fibroid measuring approximately 2 cm (image 19, series 3 and image 26, series 4) that has approximately 25-50% intracavitary component. CERVIX: No abnormality. RIGHT OVARY: Normal size and appearance. LEFT OVARY: Normal size and appearance. VAGINA: No abnormality. VESSELS: Mild prominence of bilateral adnexal vessels. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Enlarged uterus with multiple fibroids, as detailed above. 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.
FINDINGS: STRUCTURED REPORT: MRI Uterine Fibroids LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: UTERUS: Enlarged uterus with multiple fibroids. - UTERINE SIZE: 9.4 x 15.8 x 19.6 cm in AP by transverse by craniocaudal dimensions (image 26 series 4, image 25 series 3). - ENDOMETRIUM: Normal endometrial thickness. Endometrial cavity is displaced by large uterine fibroids. - JUNCTIONAL ZONE: Poorly evaluated secondary to distortion by multiple large fibroids. - NUMBER OF UTERINE FIBROIDS: >10 --- Fibroid 1: ------ Size: 8.0 x 10.5 x 8.2 cm in AP by transverse by craniocaudal dimensions (image 30 series 4, image 28 series 3). ------ Location: Anterior aspect of the uterine fundus. ------ Growth Pattern: Myometrial ------ Pre-contrast signal characteristics: T2 hypointense and T1 isointense. ------ Enhancement pattern: Heterogeneous ------ Features Suspicious for Sarcoma: None. --- Fibroid 2: ------ Size: 7.1 x 7.5 x 7.7 cm in AP by transverse by craniocaudal dimensions (image 15 series 4, image 13 series 3). ------ Location: Right lateral aspect of the uterine fundus. ------ Growth Pattern: Subserosal ------ Pre-contrast signal characteristics: T2 hypointense and T1 isointense. ------ Enhancement pattern: Homogeneous ------ Features Suspicious for Sarcoma: None. --- Fibroid 3: ------ Size: 4.6 x 5.4 x 5.0 cm in AP by transverse markings, dimensions on image 14 series 4, image 28 series 3). ------ Location: Midline uterine fundus. ------ Growth Pattern: Myometrial ------ Pre-contrast signal characteristics: T2 hypointense and T1 isointense. ------ Enhancement pattern: Homogeneous ------ Features Suspicious for Sarcoma: None. OTHER UTERINE FIBROIDS: There are multiple additional smaller uterine fibroids. Of note, there is a small submucosal fibroid measuring approximately 2 cm (image 19, series 3 and image 26, series 4) that has approximately 25-50% intracavitary component. CERVIX: No abnormality. RIGHT OVARY: Normal size and appearance. LEFT OVARY: Normal size and appearance. VAGINA: No abnormality. VESSELS: Mild prominence of bilateral adnexal vessels. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. BODY WALL: Tiny fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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: Small, subcentimeter left adrenal nodule is unchanged from prior. KIDNEYS: Normal. LYMPH NODES: Scattered mildly prominent para-aortic and mesenteric lymph nodes. These prominent mesenteric lymph nodes are most pronounced in the left mid to left lower quadrant. STOMACH / SMALL BOWEL: Stomach is normal. Multiple loops of small bowel in the left lower quadrant shows significant wall thickening and mild adjacent inflammatory stranding. No definitive evidence of enteric fistula, however sensitivity for detection of small early fistulas is limited. Small bowel is not significantly dilated. COLON / APPENDIX: The appendix is normal. Colon is unremarkable. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. Inflammatory stranding adjacent to multiple small bowel loops in the left mid abdomen and left lower quadrant. RETROPERITONEUM: Normal. VESSELS: Accessory inferior right hepatic vein. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
15,644
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: History of cirrhosis status post percutaneous ablation presenting for follow-up. COMPARISON: 7/27/2021. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 280 lbs. IV contrast: ProHance, 20 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. ABDOMEN: LIVER: Cirrhotic. Moderate steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Ablation defect within the inferior right hepatic lobe. - Location: Segment(s) 5/6 - Size: 3.5 x 2.3 cm (Image 33, Series 704). - 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): None. 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: Borderline enlarged periportal lymph nodes. SPLEEN: Normal size and appearance. 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: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Post treatment change within the inferior right hepatic lobe without evidence of residual or recurrent malignancy (LR-TR nonviable). 2. Hepatic cirrhosis and steatosis, without significant sequelae of portal hypertension.
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. Moderate steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Ablation defect within the inferior right hepatic lobe. - Location: Segment(s) 5/6 - Size: 3.5 x 2.3 cm (Image 33, Series 704). - 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): None. 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: Borderline enlarged periportal lymph nodes. SPLEEN: Normal size and appearance. 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: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Age-appropriate cerebral atrophy. Confluent periventricular hypoattenuating areas, compatible with moderate chronic microangiopathic disease. Cystic structure in the sella measuring up to 1.0 cm is unchanged compared with prior exam. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
15,645
MR Lumbar Spine wo contrast HISTORY: lumbago with sciatica TECHNIQUE: Multiplanar, multisequence MRI of the lumbar spine was performed without intravenous contrast . COMPARISON: None available. FINDINGS: ALIGNMENT: Lumbar vertebral column alignment seems normal.. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. Vertebral body hemangiomas are noted near the superior endplate of T12 was and L1 vertebra. CONUS MEDULLARIS: Normal in position and appearance, which ends at L1-L2 level. SOFT TISSUES: No evidence of soft tissue abnormality is noted.. At T11-T12: No evidence of spinal canal stenosis or neural foramina narrowing is noted. AtT12-L1: No significant neural foraminal narrowing or spinal canal stenosis. At L1-2, there is no spinal canal or foraminal stenosis.. Mild bilateral facet joint arthropathy is seen. At L2-3, there is mild bilateral facet joint arthropathy without significant spinal canal stenosis or neural foraminal narrowing.. At L3-4, mild disc bulging without significant spinal canal stenosis or neural foraminal narrowing. At L4-5, there is disc bulging with mild bilateral facet arthropathy. There is mild spinal canal stenosis without obvious neural foraminal narrowing. At L5-S1, there is bilateral facet joint arthropathy without significant spinal canal stenosis or neural foramina narrowing.. IMPRESSION: Mild degenerative changes of lumbar spine without obvious spinal canal stenosis or neural foraminal 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.
FINDINGS: ALIGNMENT: Lumbar vertebral column alignment seems normal.. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion. Vertebral body hemangiomas are noted near the superior endplate of T12 was and L1 vertebra. CONUS MEDULLARIS: Normal in position and appearance, which ends at L1-L2 level. SOFT TISSUES: No evidence of soft tissue abnormality is noted.. At T11-T12: No evidence of spinal canal stenosis or neural foramina narrowing is noted. AtT12-L1: No significant neural foraminal narrowing or spinal canal stenosis. At L1-2, there is no spinal canal or foraminal stenosis.. Mild bilateral facet joint arthropathy is seen. At L2-3, there is mild bilateral facet joint arthropathy without significant spinal canal stenosis or neural foraminal narrowing.. At L3-4, mild disc bulging without significant spinal canal stenosis or neural foraminal narrowing. At L4-5, there is disc bulging with mild bilateral facet arthropathy. There is mild spinal canal stenosis without obvious neural foraminal narrowing. At L5-S1, there is bilateral facet joint arthropathy without significant spinal canal stenosis or neural foramina narrowing..
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Thyroid gland is unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: There are multiple scattered bilateral subcentimeter noncalcified pulmonary nodules, the largest is noted within the right upper lobe, measuring 4 mm (on series 201 image 37). No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent and clear. HEART / VESSELS: The left atrium is mildly dilated. Other cardiac chambers appear normal in size. No pericardial effusion. Hypoattenuating blood pool relative to the myocardium, denoting patient's anemia. Mediastinal great arteries are normal in caliber. MEDIASTINUM / ESOPHAGUS: Evaluation of the mediastinal structures is limited in such a noncontrast study. No focal esophageal wall abnormalities. LYMPH NODES: Multiple small and prominent mediastinal lymph nodes are noted, for example: A lateral aortic lymph node measures up to 9 mm in short axis (series 201, image 44). Within the limits of the noncontrast scan, no evidence of pathologically enlarged intrathoracic lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Ascites, partially evaluated. Cirrhotic hepatic morphology. Otherwise, no acute upper abdominal abnormalities. Please refer to the recent MRI of the abdomen dated 1/11/2022 for further details about the abdominal findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Chronic appearing fracture deformity of the left posterior 10th rib.
15,646
MR Brain wo+w contrast 1/26/2022 9:58 AM Clinical Information: Evaluation for brain metastasis Comparison: Brain MRI dated 9/24/2021 Technique: Diffusion weighted series, sagittal T1, axial GRE, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 128 lbs. IV contrast: ProHance, 12 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: There is diffuse cerebral volume loss, with associated ex vacuo dilatation of ventricular system, secondary to atrophic changes. There is also areas of periventricular and deep white matter FLAIR hyper signal intensity suggesting microangiopathic changes. There are scattered foci of FLAIR hyper signal intensity in the left cerebellopontine angle, right frontal and left parietal cortex which shows stable appearance since prior study. There are persistent numerous foci of susceptibility artifact in the cerebral hemispheres, brainstem and cerebellum likely sequela of previous radiation. There is a stable appearance of left occipital, right parietal, left frontal, calvarial lesions. No evidence of new abnormal enhancing lesion is noted. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses are clear. No acute osseous or soft tissue abnormality. Trace effusion of bilateral mastoidal sinuses is seen. Impression: 1. No acute intracranial findings.. 2. No new abnormal enhancing parenchymal lesion. 3. Stable calvarial lesions. This MRI has not been protocoled for evaluation of the neck structures. In this context, there is lack of enhancement in the superior portion of the left internal jugular vein in association with peripheral inflammation and enhancement which is concerning for thrombosis of the left internal jugular vein. Correlation with Doppler ultrasound is recommended. 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.
Findings: There is diffuse cerebral volume loss, with associated ex vacuo dilatation of ventricular system, secondary to atrophic changes. There is also areas of periventricular and deep white matter FLAIR hyper signal intensity suggesting microangiopathic changes. There are scattered foci of FLAIR hyper signal intensity in the left cerebellopontine angle, right frontal and left parietal cortex which shows stable appearance since prior study. There are persistent numerous foci of susceptibility artifact in the cerebral hemispheres, brainstem and cerebellum likely sequela of previous radiation. There is a stable appearance of left occipital, right parietal, left frontal, calvarial lesions. No evidence of new abnormal enhancing lesion is noted. No intracranial mass, mass effect, edema, hemorrhage, hydrocephalus, or evidence of acute infarction is seen. The visualized paranasal sinuses are clear. No acute osseous or soft tissue abnormality. Trace effusion of bilateral mastoidal sinuses is seen.
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: Fissural lymph node in the periphery of the right lung on axial series 402 image 70. Basilar dependent atelectasis. Scattered apical predominant centrilobular and paraseptal emphysema. Accessory lobe is noted in the medial aspect of the left base. No focal consolidation, pleural effusion, or pneumothorax. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Subtle irregularity of the lateral aspect of the right sixth rib.
15,647
MR Cervical Spine wo contrast Clinical Information: 81-year-old male with cervical disc disorder at C5-C6 level with radiculopathy Comparison: None. Technique: Multiplanar multisequence MRI of the cervical spine was performed without contrast. Findings: Mild straightening with loss of cervical lordosis and mild anterolisthesis of C7 on T1. No fracture is identified. Mild loss of disc space at C5-C7. The marrow signal is normal. Hemangioma in the dens of C2. Mild thickening of the posterior longitudinal ligament. The cervical cord has normal signal with no evidence of compression. C2-C3: No significant disc bulge. No significant spinal canal or foraminal narrowing. C3-C4: No significant disc bulge. No significant spinal canal or foraminal narrowing. C4-C5: Mild diffuse disc bulge and bilateral uncovertebral hypertrophy resulting in mild foraminal narrowing. No significant spinal canal narrowing. C5-C6: Mild disc bulge. Mild bilateral uncovertebral hypertrophy resulting in mild foraminal narrowing. No significant spinal canal narrowing. C6-C7: Mild disc bulge. Mild bilateral uncovertebral hypertrophy resulting in mild foraminal narrowing. No significant spinal canal narrowing. C7-T1: Moderate diffuse disc bulge with indentation of the anterior thecal sac without touching the spinal. No significant spinal canal or foraminal narrowing. Prevertebral soft tissues are normal. Anterior and posterior ligamentous complexes are intact. CONCLUSION: 1. Mild multilevel degenerative changes of the spine with loss of normal disc height most significant at C5-C7 and uncovertebral hypertrophy at C4-C5 resulting in mild bilateral foraminal narrowing. 2. No significant spinal canal stenosis or cord signal changes. 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.
Findings: Mild straightening with loss of cervical lordosis and mild anterolisthesis of C7 on T1. No fracture is identified. Mild loss of disc space at C5-C7. The marrow signal is normal. Hemangioma in the dens of C2. Mild thickening of the posterior longitudinal ligament. The cervical cord has normal signal with no evidence of compression. C2-C3: No significant disc bulge. No significant spinal canal or foraminal narrowing. C3-C4: No significant disc bulge. No significant spinal canal or foraminal narrowing. C4-C5: Mild diffuse disc bulge and bilateral uncovertebral hypertrophy resulting in mild foraminal narrowing. No significant spinal canal narrowing. C5-C6: Mild disc bulge. Mild bilateral uncovertebral hypertrophy resulting in mild foraminal narrowing. No significant spinal canal narrowing. C6-C7: Mild disc bulge. Mild bilateral uncovertebral hypertrophy resulting in mild foraminal narrowing. No significant spinal canal narrowing. C7-T1: Moderate diffuse disc bulge with indentation of the anterior thecal sac without touching the spinal. No significant spinal canal or foraminal narrowing. Prevertebral soft tissues are normal. Anterior and posterior ligamentous complexes are intact.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Small left pleural effusion with overlying atelectasis. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: Coronary and valvular calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple small nonobstructing renal calculi, bilaterally the largest of which is a focal left inferior pole and measures 6 mm. There is mild right hydronephrosis and hydroureter with adjacent inflammation tracking along the course of the right ureter. Obstructing right UVJ stone measuring up to 2 mm on axial series 2 image 286. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not visualized. Scattered diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Inflammation adjacent to the course of the right ureter. There is also mild right perinephric stranding. VESSELS: Extensive vascular calcifications. Mild infrarenal abdominal aortic ectasia measuring up to 2.4 cm is unchanged. URINARY BLADDER: Right UVJ stone as described above. REPRODUCTIVE ORGANS: Metallic markers again seen in the prostate. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Anterior wedge deformity of the L1 vertebral body is unchanged from 2019. Grade 1 anterolisthesis of L3 on L4. Multilevel discogenic degenerative change with lower lumbar spine facet arthropathy. Degenerative change of both hips.
15,648
EXAM:MR Shoulder Left wo+w contrast CLINICAL INFORMATION:43-year-old female with restaging of osteosarcoma, status post resection. COMPARISON:MRI left shoulder 4/24/2021. TECHNIQUE:Multiplanar multisequence imaging of the left shoulder was performed before and after contrast administration. Patient weight: 190 lbs. IV contrast: ProHance, 18 ml, per protocol. STRUCTURED REPORT: MRI SHOULDER FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. There has been interval resection of the left clavicle. ROTATOR CUFF: Supraspinatus:Intermediate signal within the proximal supraspinatus tendon near its insertion on the humeral head, consistent with tendinosis. Infraspinatus:Normal. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:Trace fluid within the subacromial/subdeltoid bursa and subcoracoid bursa. Slight increased enhancement after contrast administration. ACROMIAL CLAVICULAR JOINT: No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. Following contrast administration, there is no abnormal enhancement. CONCLUSION: 1. Postsurgical changes from resection of the left clavicle osteosarcoma without evidence of residual or recurrent malignancy. 2. Subacromial/subdeltoid fluid and slight increased contrast enhancement may reflect bursitis. 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.
FINDINGS: BONES:No fracture, marrow replacement or suspicious focal lesion. There has been interval resection of the left clavicle. ROTATOR CUFF: Supraspinatus:Intermediate signal within the proximal supraspinatus tendon near its insertion on the humeral head, consistent with tendinosis. Infraspinatus:Normal. Subscapularis:Normal. Teres minor:Normal. LONG HEAD BICEPS TENDON:Normal. GLENOHUMERAL JOINT: Position:Normal. Articular cartilage:Normal. Ligaments/Capsule:Normal. Labrum:Normal given limitations of non-arthrographic technique. BURSAE:Trace fluid within the subacromial/subdeltoid bursa and subcoracoid bursa. Slight increased enhancement after contrast administration. ACROMIAL CLAVICULAR JOINT: No os acromiale. SUBACROMIAL ENCROACHMENT:None. MUSCLES:No atrophy. Following contrast administration, there is no abnormal enhancement.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. Left inferior orbital laceration with mild swelling. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Minimally displaced fracture of the right nasal bone, new since prior CT from 2/10/2021. There is mild overlying soft tissue swelling. Bilateral pterygoid plates are intact. Upper lip laceration with small hematoma and gas. Numerous dental caries and periapical lucency. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mucous retention cysts in the bilateral maxillary sinuses.
15,649
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: History of liver transplant, nausea, vomiting diarrhea and abdominal pain. Evaluate transplant status. COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 140 lbs. IV contrast: ProHance, 13 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: Postsurgical changes of hepatic transplant. The transplant liver is normal in size and morphology. No steatosis. LIVER LESIONS: None. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent anastomosis. - 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: Mild intra and extrahepatic biliary ductal dilation with pneumobilia, consistent with anastomotic patency. No abnormal bile duct wall thickening or enhancement. No focal dilation of the bile ducts to suggest stricture. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Mild diffuse atrophy. No main pancreatic ductal dilation. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Liquid stool is seen within the colon, which is nonspecific, but can be seen with enteritis. No abnormal small bowel or colonic wall thickening or enhancement. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Incisional changes of the anterior abdomen. No drainable fluid collection. MUSCULOSKELETAL: Degenerative changes of the thoracolumbar spine. No destructive osseous lesion. CONCLUSION: 1. Postsurgical changes of hepatic transplant with patent transplant vasculature. Pneumobilia with mild intra and extrahepatic biliary ductal dilation, suggesting anastomotic patency. No suspicious hepatic lesion. 2. Liquid stool is seen within the colon, which is nonspecific, but can be seen with enteritis/colitis; although, no MR findings to suggest colonic or small bowel inflammation in the upper abdomen.
FINDINGS: STRUCTURED REPORT: MR HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Postsurgical changes of hepatic transplant. The transplant liver is normal in size and morphology. No steatosis. LIVER LESIONS: None. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent anastomosis. - 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: Mild intra and extrahepatic biliary ductal dilation with pneumobilia, consistent with anastomotic patency. No abnormal bile duct wall thickening or enhancement. No focal dilation of the bile ducts to suggest stricture. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Mild diffuse atrophy. No main pancreatic ductal dilation. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Liquid stool is seen within the colon, which is nonspecific, but can be seen with enteritis. No abnormal small bowel or colonic wall thickening or enhancement. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Incisional changes of the anterior abdomen. No drainable fluid collection. MUSCULOSKELETAL: Degenerative changes of the thoracolumbar spine. No destructive osseous lesion.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetric left gynecomastia. Subtle contusion overlying the anterior soft tissues near the sternum. ABDOMEN and PELVIS: LIVER: Diffuse hypoattenuation of the liver. 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: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced right hepatic artery arising from the SMA. Accessory inferior right hepatic vein. Two right renal arteries. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing Umbilical hernia. Ballistic fragments are noted overlying the left shoulder. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,650
EXAM: MR Pelvis wo contrast CLINICAL INFORMATION: Evaluate for pelvic dyssynergy, rectal pain COMPARISON: MRI of the pelvis dated 7/9/2021 TECHNIQUE: MR Pelvis wo contrast FINDINGS: STRUCTURED REPORT: MRI Dynamic Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: ANATOMIC EVALUATION: Surgical changes: Not applicable. Levators: Normal symmetric appearance. DYNAMIC EVALUATION: - H line (pubic symphysis to posterior anorectal junction; normal 1 cm below pubococcygeal line): -- Rest: 1.2 cm above PCL line. -- Defecation / Maximal Strain: 0 cm above PCL line. - Urethral hypermobility (abnormal if > 30 degree rotation from rest): Present. MIDDLE COMPARTMENT: - Vaginal apex/cervix (abnormal if >1 cm below pubococcygeal line) -- Rest: 3.8 cm above PCL line. -- Defecation / Maximal Strain: 1.7 cm above PCL line. - Peritoneocele: Absent. - Enterocele: Absent. POSTERIOR COMPARTMENT: - Rectocele (abnormal if >2 cm beyond anterior rectal wall): Present. - Rectocele size: 2.2 cm at rest and during defecation. - Anorectal plate junction angle (normal 108-127 degrees at rest; should increase 15-20 degrees with evacuation; should decrease 15-20 degrees with Kegel) -- Rest: 135 degrees. -- Defecation / Maximal Strain: 114 degrees. - Rectal intussusception: Absent. -- Dept of rectal intussusception: Not applicable. -- Location of intussusception prolapse: Not applicable. - Sigmoidocele: Absent. Incomplete evacuation of the rectal gel with the majority (approximately 90%) of administered gel remaining in the rectum. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Posterior compartment dysfunction with moderate descent on evacuation and small rectocele. 2. Incomplete evacuation of the rectal gel. 3. Mild urethral hypermobility. 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.
FINDINGS: STRUCTURED REPORT: MRI Dynamic Pelvis LOWER ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: No other abnormality. PELVIS: ANATOMIC EVALUATION: Surgical changes: Not applicable. Levators: Normal symmetric appearance. DYNAMIC EVALUATION: - H line (pubic symphysis to posterior anorectal junction; normal 1 cm below pubococcygeal line): -- Rest: 1.2 cm above PCL line. -- Defecation / Maximal Strain: 0 cm above PCL line. - Urethral hypermobility (abnormal if > 30 degree rotation from rest): Present. MIDDLE COMPARTMENT: - Vaginal apex/cervix (abnormal if >1 cm below pubococcygeal line) -- Rest: 3.8 cm above PCL line. -- Defecation / Maximal Strain: 1.7 cm above PCL line. - Peritoneocele: Absent. - Enterocele: Absent. POSTERIOR COMPARTMENT: - Rectocele (abnormal if >2 cm beyond anterior rectal wall): Present. - Rectocele size: 2.2 cm at rest and during defecation. - Anorectal plate junction angle (normal 108-127 degrees at rest; should increase 15-20 degrees with evacuation; should decrease 15-20 degrees with Kegel) -- Rest: 135 degrees. -- Defecation / Maximal Strain: 114 degrees. - Rectal intussusception: Absent. -- Dept of rectal intussusception: Not applicable. -- Location of intussusception prolapse: Not applicable. - Sigmoidocele: Absent. Incomplete evacuation of the rectal gel with the majority (approximately 90%) of administered gel remaining in the rectum. VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetric left gynecomastia. Subtle contusion overlying the anterior soft tissues near the sternum. ABDOMEN and PELVIS: LIVER: Diffuse hypoattenuation of the liver. 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: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced right hepatic artery arising from the SMA. Accessory inferior right hepatic vein. Two right renal arteries. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing Umbilical hernia. Ballistic fragments are noted overlying the left shoulder. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,651
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Further evaluation of questionably enhancing renal lesion seen on recent CT COMPARISON: CT abdomen and pelvis dated 11/26/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 230 lbs. IV contrast: ProHance, 20 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: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small amount of intrinsic T1 signal hyperintensity associated with the exophytic lesion in the interpolar region of the left kidney. This lesion does not demonstrate enhancement. Simple right upper pole cyst. No other suspicious renal lesions. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aortobiiliac stent graft is in place. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No suspicious enhancing renal lesion. Lesion in the interpolar region of the left kidney is most consistent with a renal cyst with small amount of hemorrhagic/proteinaceous debris. 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.
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: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small amount of intrinsic T1 signal hyperintensity associated with the exophytic lesion in the interpolar region of the left kidney. This lesion does not demonstrate enhancement. Simple right upper pole cyst. No other suspicious renal lesions. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Aortobiiliac stent graft is in place. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: CTA neck: The visualized aortic arch appears normal. There is no evidence of traumatic aortic arch injury. There are no great vessel origin stenoses. There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. The included major intracranial arteries appear normal. C-spine: Cervical intervertebral alignment is normal. Craniocervical junction is maintained. No acute fracture. Chronic appearing lucency along the anterior osteophyte at C5. There is no prevertebral edema or other soft tissue abnormality. Mild multilevel discogenic, uncovertebral degenerative changes of the cervical spine, most significant at C5-C6.
15,652
RADIOLOGIC EXAM: MR Neuro Research Grant Study CLINICAL INFORMATION: Blue Earth Study, Encounter for examination for normal comparison and control in clinical research program, Secondary malignant neoplasm of brain. Spec Inst: IRB-300006469. Per chart review, history of stage IV melanoma metastatic to the brain, status post adjuvant chemoradiation with immune checkpoint inhibitor therapy, right temporal craniotomy metastasis resection, and radiotherapy due to brain metastasis recurrence completed in January 2021. COMPARISON: MRI brain dated 12/16/2021, 9/22/2021, 7/21/2021. PET dated 7/21/2021. TECHNIQUE: MR Neuro Research Grant Study Patient weight: 151 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 1 ml per sec. 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. FINDINGS: INTRACRANIAL FINDINGS: Stable postsurgical changes from right temporoparietal craniotomy tumor resection with encephalomalacia/gliosis and chronic blood products. Stable multifocal ringlike enhancement within the resection bed, overall unchanged and likely reflecting radiation posttreatment changes. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Mild frontoparietal cerebral volume loss, similar to prior. Minimal periventricular and scattered foci of subcortical/deep cerebral T2/FLAIR hyperintensity, similar to prior, likely mild chronic microangiopathic changes. 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 otherwise demonstrate normal signal characteristics. Small-volume aerated secretions in the left maxillary sinus, unchanged. Trace right mastoid effusion, new. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. No acute intracranial process. 2. Stable right temporoparietal craniotomy postsurgical changes without evidence of enlarging residual or recurrent tumor. Stable ringlike enhancement within the resection bed, likely radiation posttreatment changes. 3. Persistent left maxillary sinusitis. New trace right mastoid effusion. 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.
FINDINGS: INTRACRANIAL FINDINGS: Stable postsurgical changes from right temporoparietal craniotomy tumor resection with encephalomalacia/gliosis and chronic blood products. Stable multifocal ringlike enhancement within the resection bed, overall unchanged and likely reflecting radiation posttreatment changes. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Mild frontoparietal cerebral volume loss, similar to prior. Minimal periventricular and scattered foci of subcortical/deep cerebral T2/FLAIR hyperintensity, similar to prior, likely mild chronic microangiopathic changes. 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 otherwise demonstrate normal signal characteristics. Small-volume aerated secretions in the left maxillary sinus, unchanged. Trace right mastoid effusion, new. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetric left gynecomastia. Subtle contusion overlying the anterior soft tissues near the sternum. ABDOMEN and PELVIS: LIVER: Diffuse hypoattenuation of the liver. 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: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced right hepatic artery arising from the SMA. Accessory inferior right hepatic vein. Two right renal arteries. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing Umbilical hernia. Ballistic fragments are noted overlying the left shoulder. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,653
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: History of prostate cancer in the left posterolateral peripheral zone extending from the mid gland to apex status post high intensity focused ultrasound ablation in February 2021; patient's PSA has been downtrending following ablation, most recently 3.41 on 9/22/2021 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: 183 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: MRI dated 9/28/2020 FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 4.2 x 4.4 x 5.1 cm; estimated volume: 49 cc Focal lesion(s): None. Diffuse prostate abnormalities: Multiple BPH nodules in the central gland. Abnormal T2 signal hyperintensity in the right peripheral zone may be related to prostatitis. Other prostate findings: Volume loss and T2 signal hypointensity in the left posterolateral peripheral zone extending from the mid gland to the apex are consistent with prior targeted ablation. No abnormal diffusion restriction are contrast enhancement to suggest residual/recurrent disease. VESSELS: No significant abnormality. LYMPH NODES: Similar prominent right prevesicular lymph node measures 0.9 x 0.8 cm on image 47 series 14, previously measuring the same. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: Nonenhancing left lower pole lesion, likely cyst. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse bone marrow signal heterogeneity is similar to the prior exam. Additionally there is patchy enhancement associated with several lower lumbar spine vertebral bodies. 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. Posttreatment changes related to ablation of the left peripheral zone at the base and apex without evidence of local recurrence or residual disease. 2. Diffuse bone marrow signal heterogeneity and areas of patchy enhancement in the lower lumbar spine are nonspecific. While metastatic disease is unlikely, given downtrending PSA, it could have this appearance. Recommend further evaluation with CT Pelvis. 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.
FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 4.2 x 4.4 x 5.1 cm; estimated volume: 49 cc Focal lesion(s): None. Diffuse prostate abnormalities: Multiple BPH nodules in the central gland. Abnormal T2 signal hyperintensity in the right peripheral zone may be related to prostatitis. Other prostate findings: Volume loss and T2 signal hypointensity in the left posterolateral peripheral zone extending from the mid gland to the apex are consistent with prior targeted ablation. No abnormal diffusion restriction are contrast enhancement to suggest residual/recurrent disease. VESSELS: No significant abnormality. LYMPH NODES: Similar prominent right prevesicular lymph node measures 0.9 x 0.8 cm on image 47 series 14, previously measuring the same. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: Within normal limits. OTHER PELVIC FINDINGS: Nonenhancing left lower pole lesion, likely cyst. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Diffuse bone marrow signal heterogeneity is similar to the prior exam. Additionally there is patchy enhancement associated with several lower lumbar spine vertebral bodies. 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
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Asymmetric left gynecomastia. Subtle contusion overlying the anterior soft tissues near the sternum. ABDOMEN and PELVIS: LIVER: Diffuse hypoattenuation of the liver. 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: The appendix and colon are normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Replaced right hepatic artery arising from the SMA. Accessory inferior right hepatic vein. Two right renal arteries. URINARY BLADDER: Distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Fat-containing Umbilical hernia. Ballistic fragments are noted overlying the left shoulder. MUSCULOSKELETAL: No significant abnormality. THORACIC: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,654
EXAM: MRI OF THE CHEST W/O AND W/ IV CONTRAST HISTORY: 27 years -old Male with Mediastinal mass, K22.89 Other specified disease of esophagus TECHNIQUE: Multiplanar T1-, T2-, and diffusion-weighted imaging were performed. 3D T1-weighted dynamic images were obtained before and after the uneventful administration of I.V. contrast. Patient weight: 225 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: CT from 12/23/2021, 3/13/2015. FINDINGS: Mediastinum: Redemonstration of lobulated mass along the left lateral distal esophagus extending up to the GE junction, shows hyperintense signal on T2-weighted imaging, isointense on precontrast T1 weighted imaging, with no associated diffusion restriction.On postcontrast images, there is progressive low-grade postcontrast enhancement. No definite internal fat, hemorrhage, or calcifications noted. It approximately measures 38 x 30 mm (series 401 image 8). On craniocaudal images, it measures up to 61 mm (series 501 image 19). The mass focally abuts the distal descending thoracic aorta along the anterior aspect. There is medial displacement of the esophageal lumen with no obstruction or upstream dilation. The mass abuts the crus of the left hemidiaphragm without definite infiltration (series 501 image 18, 19). Lungs and Pleura: Within normal limits. Lymphadenopathy: No enlarged lymph nodes. Skeleton: Within normal limits. Upper Abdomen: Visualized portions of upper abdomen are within normal limits. Other: None. IMPRESSION: 1. Overall stable solid submucosal/intramural mass along the distal esophagus without obstruction. Differentials include leiomyoma or granular cell tumor among others. Possibility of malignancy is considered unlikely, however not excluded. Tissue sampling is recommended.
FINDINGS: Mediastinum: Redemonstration of lobulated mass along the left lateral distal esophagus extending up to the GE junction, shows hyperintense signal on T2-weighted imaging, isointense on precontrast T1 weighted imaging, with no associated diffusion restriction.On postcontrast images, there is progressive low-grade postcontrast enhancement. No definite internal fat, hemorrhage, or calcifications noted. It approximately measures 38 x 30 mm (series 401 image 8). On craniocaudal images, it measures up to 61 mm (series 501 image 19). The mass focally abuts the distal descending thoracic aorta along the anterior aspect. There is medial displacement of the esophageal lumen with no obstruction or upstream dilation. The mass abuts the crus of the left hemidiaphragm without definite infiltration (series 501 image 18, 19). Lungs and Pleura: Within normal limits. Lymphadenopathy: No enlarged lymph nodes. Skeleton: Within normal limits. Upper Abdomen: Visualized portions of upper abdomen are within normal limits. Other: None.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. Left inferior orbital laceration with mild swelling. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: Minimally displaced fracture of the right nasal bone, new since prior CT from 2/10/2021. There is mild overlying soft tissue swelling. Bilateral pterygoid plates are intact. Upper lip laceration with small hematoma and gas. Numerous dental caries and periapical lucency. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Mucous retention cysts in the bilateral maxillary sinuses.
15,655
MR Cervical Spine wo contrast HISTORY: Cervical pain TECHNIQUE: Multiplanar, multisequence MRI of the cervical spine was performed without intravenous contrast COMPARISON: None available. FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: Normal in morphology and signal intensity. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, there is no spinal canal or foraminal stenosis. At C3-4, there is posterior disc osteophyte with mild spinal canal narrowing and mild indentation over the ventral aspect of cord. There is mild bilateral neural foraminal stenosis. At C4-5, mild bilateral uncovertebral joint arthropathy with a small disc osteophyte with minimal spinal canal stenosis without cord compression. No obvious neural foraminal narrowing. At C5-6, mild disc bulging without obvious spinal canal stenosis cord compression or neural foraminal narrowing. At C6-7, mild disc bulging without obvious spinal canal stenosis, cord compression or neural foraminal narrowing. At C7-T1, there is no spinal canal or foraminal stenosis. IMPRESSION: Mild degenerative changes of cervical spine which is more prominent at C3-C4 with mild spinal canal stenosis mild cord compression and mild bilateral neural foraminal narrowing and at C4-C5 with minimal spinal canal stenosis.
FINDINGS: ALIGNMENT: Straightening of the normal cervical lordosis. VERTEBRAE: No vertebral body compression fracture or aggressive marrow lesion. SPINAL CORD/POSTERIOR FOSSA: Normal in morphology and signal intensity. PARASPINAL SOFT TISSUES: Unremarkable. At C2-3, there is no spinal canal or foraminal stenosis. At C3-4, there is posterior disc osteophyte with mild spinal canal narrowing and mild indentation over the ventral aspect of cord. There is mild bilateral neural foraminal stenosis. At C4-5, mild bilateral uncovertebral joint arthropathy with a small disc osteophyte with minimal spinal canal stenosis without cord compression. No obvious neural foraminal narrowing. At C5-6, mild disc bulging without obvious spinal canal stenosis cord compression or neural foraminal narrowing. At C6-7, mild disc bulging without obvious spinal canal stenosis, cord compression or neural foraminal narrowing. At C7-T1, there is no spinal canal or foraminal stenosis.
Findings: CTA neck: The visualized aortic arch appears normal. There is no evidence of traumatic aortic arch injury. There are no great vessel origin stenoses. There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. The included major intracranial arteries appear normal. C-spine: Cervical intervertebral alignment is normal. Craniocervical junction is maintained. No acute fracture. Chronic appearing lucency along the anterior osteophyte at C5. There is no prevertebral edema or other soft tissue abnormality. Mild multilevel discogenic, uncovertebral degenerative changes of the cervical spine, most significant at C5-C6.
15,656
EXAM: MR Abdomen wo contrast CLINICAL INFORMATION: History of hepatocellular carcinoma status post TACE COMPARISON: MRI abdomen and pelvis dated 10/9/2019 TECHNIQUE: MR Abdomen wo contrast FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: The quality of the images obtained are satisfactory; however, contrast is required for definitive evaluation for residual or new hepatocellular carcinoma. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: Previously treated hepatic segment VIII lesion. Lobular mild T2 signal hyperintensity in hepatic segment VIII extending inferiorly to hepatic segment V. The greatest axial dimensions on this signal abnormality measures 5.5 x 5.4 cm on image 43 series 6. There are areas of restricted diffusion associated with this T2 signal hyperintensity. UNTREATED OR NEW LIVER LESION(S): No convincing new lesions. LIVER VASCULATURE AND COLLATERALS: Poorly evaluated in the absence of contrast. Portal vein flow voids are preserved. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Bilateral T2 hyperintense renal cysts. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Susceptibility artifact in the left mid back soft tissues. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Abnormal T2 signal hyperintensity and diffusion restriction in hepatic segment VIII are suspicious for recurrence at the site of the previously treated hepatocellular carcinoma. Liver MRI with Prohance is recommended for definitive characterization. 2. Hepatic cirrhosis with sequela of portal hypertension including trace ascites. 3. Cholelithiasis and additional chronic/incidental findings detailed above. 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.
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: The quality of the images obtained are satisfactory; however, contrast is required for definitive evaluation for residual or new hepatocellular carcinoma. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: Previously treated hepatic segment VIII lesion. Lobular mild T2 signal hyperintensity in hepatic segment VIII extending inferiorly to hepatic segment V. The greatest axial dimensions on this signal abnormality measures 5.5 x 5.4 cm on image 43 series 6. There are areas of restricted diffusion associated with this T2 signal hyperintensity. UNTREATED OR NEW LIVER LESION(S): No convincing new lesions. LIVER VASCULATURE AND COLLATERALS: Poorly evaluated in the absence of contrast. Portal vein flow voids are preserved. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Cholelithiasis. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Bilateral T2 hyperintense renal cysts. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: Susceptibility artifact in the left mid back soft tissues. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Basilar dependent atelectasis. No pleural effusion. 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: Stomach is normal. Duodenal diverticulum. The small bowel is normal in caliber. COLON / APPENDIX: The appendix and colon are normal. PERITONEUM / MESENTERY: Subtle increased attenuation within the left mid mesentery. Trace free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is present. Left corpus luteal cyst. BODY WALL: Fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality.
15,657
Clinical history:Assess for cause of confusion Comparison:CT head /25/2022 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 210 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: Submitted images are degraded due to involuntary patient motion. There is no enhancing intracranial mass or abnormal enhancement. There are punctate foci of increased DWI signal in the right greater than left frontal lobes and right temporal lobe (series 5 image 43, 45, 41). No convincing low ADC is noted There is chronic encephalomalacia is seen involving the left frontal, left parietal and temporal lobes. There is no evidence of acute hemorrhage on the GRE images. Mild exvacuo dilatation of the atrium of left lateral ventricle. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Small amount of scattered fluid in the mastoid air cells. Postsurgical changes of bilateral lens replacement. No suspicious calvarial lesion is noted. Impression: 1. Punctate foci of increased DWI signal in the right greater than left frontal lobes and right temporal lobe. No convincing low ADC is noted. These could represent small punctate subacute infarcts. 2. Multifocal chronic encephalomalacia in the left cerebral hemisphere.a
Findings: Submitted images are degraded due to involuntary patient motion. There is no enhancing intracranial mass or abnormal enhancement. There are punctate foci of increased DWI signal in the right greater than left frontal lobes and right temporal lobe (series 5 image 43, 45, 41). No convincing low ADC is noted There is chronic encephalomalacia is seen involving the left frontal, left parietal and temporal lobes. There is no evidence of acute hemorrhage on the GRE images. Mild exvacuo dilatation of the atrium of left lateral ventricle. The intracranial vascular flow voids are present. Minor scattered paranasal mucosal thickening. Small amount of scattered fluid in the mastoid air cells. Postsurgical changes of bilateral lens replacement. No suspicious calvarial lesion is noted.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Thick-walled cavitary right upper lobe lesion measuring approximately 3.1 x 2.8 cm (series 502 image 56), with surrounding groundglass and consolidative opacities. Additional consolidative opacity in the right lower lobe. Trace effusions. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Mildly enlarged right hilar node measuring 1.4 cm (series 502 image 60) and epicardial nodes measuring up to 0.8 cm (image 92), likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Gallbladder is absent. MUSCULOSKELETAL: No acute abnormality. H shaped vertebrae compatible with sickle cell disease.
15,658
MR Lumbar Spine Partial Study HISTORY: Evaluation for lumbar spinal stenosis TECHNIQUE: Sagittal T2 sequence COMPARISON: None available. FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion on single T2 sequence. The patient is status post posterior fusion from L2 to L5 and anterior fusion at L5-S1.. DISCS: Status post discectomy at L5-S1. Disc space narrowing at L2-L3 and L3-L4. CONUS MEDULLARIS: Normal in position and appearance. SOFT TISSUES: Unremarkable. There is severe metallic artifact from the hardware devices. In this context, no obvious spinal canal stenosis is noted. Mild disc bulging at L1-L2 is causing mild spinal canal stenosis and mild bilateral neural foraminal narrowing. Neural foramina of the other levels of lumbar spine cannot be evaluated because of artifact. IMPRESSION: The patient has spinal stimulator electrode in place. According to the guideline provided by the vendor and to reduce the time of scanning, only one single sequence of sagittal T2 was performed. In this sequence no obvious residual spinal canal stenosis is noted status post posterior fusion from L2 to L5 and anterior fusion at L5-S1. Mild spinal canal stenosis at L1-L2 because of disc bulging. If any additional sequence is needed the patient must be scheduled for another day.
FINDINGS: ALIGNMENT: Normal. VERTEBRAE: There is no vertebral body compression fracture or aggressive marrow lesion on single T2 sequence. The patient is status post posterior fusion from L2 to L5 and anterior fusion at L5-S1.. DISCS: Status post discectomy at L5-S1. Disc space narrowing at L2-L3 and L3-L4. CONUS MEDULLARIS: Normal in position and appearance. SOFT TISSUES: Unremarkable. There is severe metallic artifact from the hardware devices. In this context, no obvious spinal canal stenosis is noted. Mild disc bulging at L1-L2 is causing mild spinal canal stenosis and mild bilateral neural foraminal narrowing. Neural foramina of the other levels of lumbar spine cannot be evaluated because of artifact.
FINDINGS: No intraparenchymal hemorrhage, mass effect or edema. The gray white matter differentiation is maintained. Empty sella. No extra axial collections. The ventricles are within normal size limits and there is no midline shift. No acute osseous abnormality. Numerous mucous retention cysts within the maxillary sinuses. The orbits are unremarkable. The visualized soft tissues are unremarkable.
15,659
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Perfusion CLINICAL INFORMATION: Glioblastoma. Per chart review, history of left frontal lobe glioblastoma (grade 4, LDH wild-type, unmethylated) status post craniotomy for resection on 2/22/2020 and adjuvant chemoradiation completed November 2020. Residual tumor enlargement on imaging in June 2021, status post SRS completed August 2021. Recent imaging from November 2021 concerning for disease progression. COMPARISON: MRI brain dated 11/30/2021, 8/10/2021. TECHNIQUE: MR Brain wo+w contrast, MR Perfusion Patient weight: 250 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 4 ml per sec. 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. FINDINGS: MR Brain: INTRACRANIAL FINDINGS: Interval increase in size of peripherally enhancing left frontal lobe mass extending from the resection bed to to the left frontal horn margin, now measuring 4.2 x 2.0 cm (series 1102, image 35), previously 3.7 x 1.3 cm (series 10, image 84). Associated diffuse left anterior frontotemporal vasogenic edema extending into the genu of the corpus callosum, appears to be slightly increased. There is small area of restricted diffusion located anterior medial margin of the enhancing lesion. No significant change in size or appearance of small enhancing lesion in the right middle frontal gyrus with associated perilesional edema, now measuring 0.5 x 0.5 cm (series 1102, image 44, previously 0.5 x 0.4 cm (series 10, image 105). Left frontal craniotomy postsurgical changes with associated encephalomalacia, resection bed blood products, and subjacent dural thickening/enhancement, overall unchanged. There is another small area of enhancing focus in the septum pellucidum, new since prior study.. No acute intraparenchymal infarct, hydrocephalus or extra-axial collection. Age-appropriate cerebral volume. Additional confluent periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely mild chronic microangiopathic changes. Stable ventricular system caliber with ex vacuo ventricular dilatation of the left frontal horn secondary to encephalomalacia. 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. Trace mucosal thickening of the bilateral maxillary sinus floors with small right mucous retention cyst. Scattered mucosal thickening of the anterior ethmoid air cells and underpneumatized frontal sinuses bilaterally. Trace left mastoid effusion, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MR Perfusion: MR perfusion shows mild increased rCBV along the margin of the left frontal lobe enhancing lesion. CONCLUSION: 1. Interval enlargement of the heterogeneously enhancing lesion in the left frontal lobe with focal areas of restricted diffusion and interval increase of the surrounding T-2/flair hyperintense signal, now extending into the genu of the corpus callosum, concern for worsening of the disease. There is mild increased rCBV on perfusion images. Another small nodular enhancement focus in the septum pellucidum, new since prior study. Minimally enlarged right frontal lobe lesion with focal enhancing nodule. 2. Persisting trace left mastoid effusion. 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.
FINDINGS: MR Brain: INTRACRANIAL FINDINGS: Interval increase in size of peripherally enhancing left frontal lobe mass extending from the resection bed to to the left frontal horn margin, now measuring 4.2 x 2.0 cm (series 1102, image 35), previously 3.7 x 1.3 cm (series 10, image 84). Associated diffuse left anterior frontotemporal vasogenic edema extending into the genu of the corpus callosum, appears to be slightly increased. There is small area of restricted diffusion located anterior medial margin of the enhancing lesion. No significant change in size or appearance of small enhancing lesion in the right middle frontal gyrus with associated perilesional edema, now measuring 0.5 x 0.5 cm (series 1102, image 44, previously 0.5 x 0.4 cm (series 10, image 105). Left frontal craniotomy postsurgical changes with associated encephalomalacia, resection bed blood products, and subjacent dural thickening/enhancement, overall unchanged. There is another small area of enhancing focus in the septum pellucidum, new since prior study.. No acute intraparenchymal infarct, hydrocephalus or extra-axial collection. Age-appropriate cerebral volume. Additional confluent periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely mild chronic microangiopathic changes. Stable ventricular system caliber with ex vacuo ventricular dilatation of the left frontal horn secondary to encephalomalacia. 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. Trace mucosal thickening of the bilateral maxillary sinus floors with small right mucous retention cyst. Scattered mucosal thickening of the anterior ethmoid air cells and underpneumatized frontal sinuses bilaterally. Trace left mastoid effusion, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MR Perfusion: MR perfusion shows mild increased rCBV along the margin of the left frontal lobe enhancing lesion.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, edema, or mass effect. Scattered white matter hypodensities, likely microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Calcified atherosclerosis of the vertebral arteries and carotid siphons. VENTRICULAR SYSTEM: Normal. ORBITS: Extraocular muscle calcifications. SINUSES: Normal. SOFT TISSUES: Normal.
15,660
RADIOLOGIC EXAM: MR Brain wo+w contrast, MR Perfusion CLINICAL INFORMATION: Glioblastoma. Per chart review, history of left frontal lobe glioblastoma (grade 4, LDH wild-type, unmethylated) status post craniotomy for resection on 2/22/2020 and adjuvant chemoradiation completed November 2020. Residual tumor enlargement on imaging in June 2021, status post SRS completed August 2021. Recent imaging from November 2021 concerning for disease progression. COMPARISON: MRI brain dated 11/30/2021, 8/10/2021. TECHNIQUE: MR Brain wo+w contrast, MR Perfusion Patient weight: 250 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 4 ml per sec. 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. FINDINGS: MR Brain: INTRACRANIAL FINDINGS: Interval increase in size of peripherally enhancing left frontal lobe mass extending from the resection bed to to the left frontal horn margin, now measuring 4.2 x 2.0 cm (series 1102, image 35), previously 3.7 x 1.3 cm (series 10, image 84). Associated diffuse left anterior frontotemporal vasogenic edema extending into the genu of the corpus callosum, appears to be slightly increased. There is small area of restricted diffusion located anterior medial margin of the enhancing lesion. No significant change in size or appearance of small enhancing lesion in the right middle frontal gyrus with associated perilesional edema, now measuring 0.5 x 0.5 cm (series 1102, image 44, previously 0.5 x 0.4 cm (series 10, image 105). Left frontal craniotomy postsurgical changes with associated encephalomalacia, resection bed blood products, and subjacent dural thickening/enhancement, overall unchanged. There is another small area of enhancing focus in the septum pellucidum, new since prior study.. No acute intraparenchymal infarct, hydrocephalus or extra-axial collection. Age-appropriate cerebral volume. Additional confluent periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely mild chronic microangiopathic changes. Stable ventricular system caliber with ex vacuo ventricular dilatation of the left frontal horn secondary to encephalomalacia. 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. Trace mucosal thickening of the bilateral maxillary sinus floors with small right mucous retention cyst. Scattered mucosal thickening of the anterior ethmoid air cells and underpneumatized frontal sinuses bilaterally. Trace left mastoid effusion, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MR Perfusion: MR perfusion shows mild increased rCBV along the margin of the left frontal lobe enhancing lesion. CONCLUSION: 1. Interval enlargement of the heterogeneously enhancing lesion in the left frontal lobe with focal areas of restricted diffusion and interval increase of the surrounding T-2/flair hyperintense signal, now extending into the genu of the corpus callosum, concern for worsening of the disease. There is mild increased rCBV on perfusion images. Another small nodular enhancement focus in the septum pellucidum, new since prior study. Minimally enlarged right frontal lobe lesion with focal enhancing nodule. 2. Persisting trace left mastoid effusion. 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.
FINDINGS: MR Brain: INTRACRANIAL FINDINGS: Interval increase in size of peripherally enhancing left frontal lobe mass extending from the resection bed to to the left frontal horn margin, now measuring 4.2 x 2.0 cm (series 1102, image 35), previously 3.7 x 1.3 cm (series 10, image 84). Associated diffuse left anterior frontotemporal vasogenic edema extending into the genu of the corpus callosum, appears to be slightly increased. There is small area of restricted diffusion located anterior medial margin of the enhancing lesion. No significant change in size or appearance of small enhancing lesion in the right middle frontal gyrus with associated perilesional edema, now measuring 0.5 x 0.5 cm (series 1102, image 44, previously 0.5 x 0.4 cm (series 10, image 105). Left frontal craniotomy postsurgical changes with associated encephalomalacia, resection bed blood products, and subjacent dural thickening/enhancement, overall unchanged. There is another small area of enhancing focus in the septum pellucidum, new since prior study.. No acute intraparenchymal infarct, hydrocephalus or extra-axial collection. Age-appropriate cerebral volume. Additional confluent periventricular and scattered punctate subcortical/deep cerebral white matter T2/FLAIR hyperintensities, similar to prior, likely mild chronic microangiopathic changes. Stable ventricular system caliber with ex vacuo ventricular dilatation of the left frontal horn secondary to encephalomalacia. 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. Trace mucosal thickening of the bilateral maxillary sinus floors with small right mucous retention cyst. Scattered mucosal thickening of the anterior ethmoid air cells and underpneumatized frontal sinuses bilaterally. Trace left mastoid effusion, unchanged. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. MR Perfusion: MR perfusion shows mild increased rCBV along the margin of the left frontal lobe enhancing lesion.
FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: Advanced calcified and noncalcified atherosclerosis. No aneurysmal dilation. ABDOMINAL AORTA: Advanced calcified and noncalcified atherosclerosis of the abdominal aorta and branch vessels. Infrarenal abdominal aortic aneurysm measuring up to 4.3 cm (image 143, series #5). CELIAC AXIS: Small in caliber, particularly the common hepatic artery. Severe atherosclerosis of the proximal celiac artery with diffuse narrowing of the celiac axis and branch vessels, likely atherosclerotic. No wall thickening or stranding. The celiac artery and branch vessels are opacified. SMA: Severe atherosclerosis of the proximal SMA without flow-limiting stenosis. The distal SMA branches are poorly opacified. RIGHT RENAL: Severe atherosclerosis at the origin. Narrow caliber right renal artery which is opacified with contrast. LEFT RENAL: Severe atherosclerosis at the origin. Narrow caliber left renal artery which is opacified with contrast. IMA: Patent proximally. Diffusely severely narrowed, limiting evaluation for distal opacification. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Advanced calcified and noncalcified atherosclerosis without aneurysmal dilation or flow-limiting stenosis. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Advanced calcified and noncalcified atherosclerosis without aneurysmal dilation or flow-limiting stenosis. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Small left and trace right pleural effusions, unchanged. Bilateral dependent atelectasis. DISTAL ESOPHAGUS: Esophagogastric catheter in place. HEART / VESSELS: Advanced coronary atherosclerosis. ABDOMEN and PELVIS: LIVER: Calcified granuloma in the hepatic dome. Heterogeneous attenuation of the liver, likely congestive hepatopathy. BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Severe diffuse periportal edema, likely secondary to fluid overload. GALLBLADDER: Markedly diffuse wall edema, secondary to volume overload. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Hyperenhancement on the portal venous phase KIDNEYS: Bilateral striated nephrograms. No hydronephrosis or renal calculi. Contrast within the renal collecting systems. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the stomach. No pneumatosis. No small bowel obstruction COLON / APPENDIX: Diverticulosis without diverticulitis. Normal appendix. PERITONEUM / MESENTERY: No free intraperitoneal air. Trace periportal fluid. RETROPERITONEUM: Normal. OTHER VESSELS: Enlarged intrahepatic IVC. Small foci of gas within the infrahepatic IVC and left common iliac vein. Left common femoral approach central venous catheter terminates in the left common iliac vein. URINARY BLADDER: Decompressed with Foley catheter present. Small amount of excreted contrast and intraluminal gas. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small bilateral fat-containing inguinal hernias. Two soft tissue nodules in the left lower paraspinal subcutaneous fat, measuring up to 2.6 cm (image 194, series #11), possibly representing lymph nodes or posttraumatic. MUSCULOSKELETAL: Small. Lesions in the lumbar vertebrae and within the pelvis, largest within the vertebral body. A lesion in the right posterior femoral neck which raises possibility for pathologic fracture. Mild multilevel discogenic degenerative change of the lumbar spine. Mild retrolisthesis of L5 on S1.
15,661
MR Lumbar Spine wo+w contrast 1/26/2022 9:12 PM Clinical information: 63 years Male patient with LE weakness, new incontinence Comparison: MRI lumbar spine without contrast dated 3/15/2019. Technique: Sagittal and axial T1, T2 and STIR images were obtained of the lumbar spine, without intravenous contrast administration. Additionally, sagittal and axial T1 post contrast images were obtained. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. Findings: The sagittal images demonstrate persistent preservation of the lumbar lordosis, with grade 1 anterolisthesis of L4 on L5, and minimal retrolisthesis of L5 on S1. The vertebral bodies maintain normal height with scattered Modic type II changes and Schmorl nodes, without abnormal enhancement. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated severe L5-S1 and moderate L4-5 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: Mild bilateral facet hypertrophy, without significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Mild circumferential disc bulge, bilateral facet and ligamentum flavum hypertrophy, without significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Circumferential disc bulge, bilateral facet and ligamentum flavum hypertrophy, with superimposed facet effusions, resulting in mild to moderate bilateral neuroforaminal narrowing, with moderate spinal canal stenosis. L4-5: Pseudodisc bulge, with central annular fissure, bilateral facet and ligamentum flavum hypertrophy, resulting in severe bilateral neuroforaminal narrowing, with severe spinal canal stenosis. Persistent thickening and clumping of the terminal caudate equina nerve roots, with associated enhancement. L5-S1: Circumferential disc bulge with bilateral facet and ligamentum flavum hypertrophy, resulting in severe bilateral neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. Partially visualized unchanged 9 mm right simple renal cyst. IMPRESSION: 1. Persistent preservation of the lumbar lordosis, with grade 1 anterolisthesis of L4 on L5, and minimal retrolisthesis of L5 on S1. 2. Unchanged chronic multilevel degenerative changes as described, most significant at L4-5, with pseudodisc bulge, central annular fissure, bilateral facet and ligamentum flavum hypertrophy, resulting in severe bilateral neuroforaminal narrowing and severe spinal canal stenosis, impinging upon the bilateral L4 and L5 nerve roots. 3. Persistent thickening and clumping of the terminal caudate equina nerve roots, with associated enhancement, suggestive of chronic arachnoiditis.
Findings: The sagittal images demonstrate persistent preservation of the lumbar lordosis, with grade 1 anterolisthesis of L4 on L5, and minimal retrolisthesis of L5 on S1. The vertebral bodies maintain normal height with scattered Modic type II changes and Schmorl nodes, without abnormal enhancement. The intervertebral discs appear desiccated from decreased T2-weighted signal, with associated severe L5-S1 and moderate L4-5 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: Mild bilateral facet hypertrophy, without significant spinal canal stenosis or neuroforaminal narrowing. L2-L3: Mild circumferential disc bulge, bilateral facet and ligamentum flavum hypertrophy, without significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Circumferential disc bulge, bilateral facet and ligamentum flavum hypertrophy, with superimposed facet effusions, resulting in mild to moderate bilateral neuroforaminal narrowing, with moderate spinal canal stenosis. L4-5: Pseudodisc bulge, with central annular fissure, bilateral facet and ligamentum flavum hypertrophy, resulting in severe bilateral neuroforaminal narrowing, with severe spinal canal stenosis. Persistent thickening and clumping of the terminal caudate equina nerve roots, with associated enhancement. L5-S1: Circumferential disc bulge with bilateral facet and ligamentum flavum hypertrophy, resulting in severe bilateral neuroforaminal narrowing, without significant spinal canal stenosis. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. Partially visualized unchanged 9 mm right simple renal cyst.
FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including pontine hemorrhage. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: Tortuous vertebral and basilar arteries. There is no evidence of stenosis, occlusion, or aneurysmal dilation. No evidence of extravasation or underlying lesion within the pontine hemorrhage. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. Visualized lung apices are clear. CERVICAL SPINE: Advanced multilevel discogenic degenerative change of the cervical spine. Severe left C3-C4 and bilateral C5-C6 neuroforaminal narrowing. No aggressive osseous lesions.
15,662
MR Cervical Spine wo+w contrast 1/26/2022 9:12 PM Clinical information: 63 years Male patient with LE weakness, hx of cervical fusion Comparison: Plain films of the cervical spine dated 6/26/2017.. Technique: Multiplanar multisequence images of the cervical spine were obtained, without intravenous contrast administration. Additionally, sagittal and axial T1 post contrast images were obtained. Patient weight: 180 lbs. IV contrast: ProHance, 17 ml, per protocol. Findings: The sagittal images demonstrate persistent preservation of the cervical lordosis, with minimal retrolisthesis of C3 on C4. Post surgical anterior spinal fusion at C4-C5 and C5-C6 again seen, creating susceptibility artifact and limiting evaluation at these levels. The visualized vertebral bodies maintain normal height, with scattered Modic type II changes and Schmorl nodes, without abnormal enhancement. The intervertebral discs appear otherwise desiccated from decreased T2-weighted signal, with associated moderate C3-C4 disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The craniocervical junction appears within normal limits. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex and uncovertebral hypertrophy, resulting in moderate right and mild left neuroforaminal narrowing, with mild spinal canal stenosis. C4-C5: Fused level with residual uncovertebral facet hypertrophy, resulting in mild bilateral neuroforaminal narrowing, without significant spinal canal stenosis. C5-C6: Fused level with residual uncovertebral facet hypertrophy, resulting in severe left and moderate right neuroforaminal narrowing, without significant spinal canal stenosis. C6-C7: Uncovertebral hypertrophy, without significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement. IMPRESSION: 1. No evidence of acute findings, pathologic enhancement or discrete abnormal spinal cord signal in the cervical spine. 2. Post surgical anterior spinal fusion at C4-C5 and C5-C6 again seen, creating susceptibility artifact and limiting evaluation at these levels. 3. Chronic multilevel degenerative changes as described, most significant at C5-C6, resulting in severe left and moderate right neuroforaminal narrowing, impinging upon the left C6 nerve root with residual mild C3-C4 spinal canal stenosis.
Findings: The sagittal images demonstrate persistent preservation of the cervical lordosis, with minimal retrolisthesis of C3 on C4. Post surgical anterior spinal fusion at C4-C5 and C5-C6 again seen, creating susceptibility artifact and limiting evaluation at these levels. The visualized vertebral bodies maintain normal height, with scattered Modic type II changes and Schmorl nodes, without abnormal enhancement. The intervertebral discs appear otherwise desiccated from decreased T2-weighted signal, with associated moderate C3-C4 disc height loss. The spinal cord is normal in size and signal intensity, without expansile lesions or abnormal enhancement. The craniocervical junction appears within normal limits. C2-C3: The spinal canal and neuroforamina are patent. C3-C4: Disc osteophyte complex and uncovertebral hypertrophy, resulting in moderate right and mild left neuroforaminal narrowing, with mild spinal canal stenosis. C4-C5: Fused level with residual uncovertebral facet hypertrophy, resulting in mild bilateral neuroforaminal narrowing, without significant spinal canal stenosis. C5-C6: Fused level with residual uncovertebral facet hypertrophy, resulting in severe left and moderate right neuroforaminal narrowing, without significant spinal canal stenosis. C6-C7: Uncovertebral hypertrophy, without significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: No significant spinal canal stenosis or neuroforaminal narrowing. The paraspinal soft tissues appear unremarkable, without organized fluid collections or abnormal enhancement.
FINDINGS: CT of the head with and without contrast: Please see separately reported same day noncontrast CT head for intracranial findings including pontine hemorrhage. No abnormal intracranial enhancement within the limitations of arterial phase exam. CT angiogram of the brain: RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Unremarkable. VERTEBROBASILAR ARTERIES: Tortuous vertebral and basilar arteries. There is no evidence of stenosis, occlusion, or aneurysmal dilation. No evidence of extravasation or underlying lesion within the pontine hemorrhage. CT angiogram of the neck: AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT CAROTID: There is no evidence of stenosis, occlusion, or aneurysmal dilation. RIGHT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. LEFT VERTEBRAL ARTERY: There is no evidence of stenosis, occlusion, or aneurysmal dilation. SOFT TISSUES: No soft tissue abnormality within the neck. Visualized lung apices are clear. CERVICAL SPINE: Advanced multilevel discogenic degenerative change of the cervical spine. Severe left C3-C4 and bilateral C5-C6 neuroforaminal narrowing. No aggressive osseous lesions.
15,663
EXAM: MR Thoracic Spine wo contrast CLINICAL INFORMATION: T3 inferior spinous process avulsion fracture with concern for ligamentous injury. COMPARISON: CT thoracic spine dated 1/25/2022. TECHNIQUE: MR Thoracic Spine wo contrast, with multiplanar multisequence noncontrast images of the thoracic spine. FINDINGS: No acute displaced vertebral body fracture or compression deformity. Previously noted questionable T3 spinous process avulsion fracture is not identified on the current exam. No significant marrow edema or adjacent soft tissue edema is noted involving the T3 spinous process. No spondylolisthesis. The disc spaces are maintained throughout. No neuroforaminal or spinal canal narrowing at any level. The conus terminates at L1. Limited images of the soft tissues are unremarkable. Mild bilateral dependent atelectasis. Please refer to the recently performed chest imaging for the assessment of the partially visualized thoracic contents. CONCLUSION: Previously noted questionable T3 spinous process avulsion fracture is not identified on the current exam and there is no significant marrow edema or adjacent soft tissue edema to suggest fracture in this area. This likely represents a benign chronic calcification. 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.
FINDINGS: No acute displaced vertebral body fracture or compression deformity. Previously noted questionable T3 spinous process avulsion fracture is not identified on the current exam. No significant marrow edema or adjacent soft tissue edema is noted involving the T3 spinous process. No spondylolisthesis. The disc spaces are maintained throughout. No neuroforaminal or spinal canal narrowing at any level. The conus terminates at L1. Limited images of the soft tissues are unremarkable. Mild bilateral dependent atelectasis. Please refer to the recently performed chest imaging for the assessment of the partially visualized thoracic contents.
Findings: There is hemorrhagic focus in the central pons with minimal surrounding vasogenic edema. Hemorrhage measures approximately 1.4 x 1.3 cm . Supratentorial brain shows no hemorrhage or territorial infarction. There are advanced white matter microangiopathic changes.
15,664
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: History of cirrhosis. COMPARISON: 1/20/2021. TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 287 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. There is unchanged left hepatic lobe hypertrophy and atrophy of the posterior right hepatic lobe. Redemonstration of ill-defined T2 hyperintensity surrounding few intrahepatic ducts within the posterior superior right hepatic lobe. No abnormal arterial hyperenhancement or regions of delayed washout are visualized. There is no restricted diffusion. 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: There is redemonstration of multifocal segmental dilatation and short segment stricturing tilting and beading throughout the intrahepatic bile ducts, again consistent with patient's known primary sclerosing cholangitis. No definite dominant stricture is visualized. No intraluminal filling defects. Several MRCP sequences are degraded by patient motion and artifact. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts, including a T1 hyperintense proteinaceous/hemorrhagic cyst which does not demonstrate suspicious post contrast enhancement. Otherwise, bilateral kidneys are normal without hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Hepatic cirrhosis with mild splenomegaly. No suspicious hepatic lesions are visualized. 2. Intrahepatic biliary ductal multiple all segmental dilatation is unchanged in appearance compared to prior within limits of technique, consistent with known primary sclerosing cholangitis. No definite high-grade stricture is visualized.
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. There is unchanged left hepatic lobe hypertrophy and atrophy of the posterior right hepatic lobe. Redemonstration of ill-defined T2 hyperintensity surrounding few intrahepatic ducts within the posterior superior right hepatic lobe. No abnormal arterial hyperenhancement or regions of delayed washout are visualized. There is no restricted diffusion. 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: There is redemonstration of multifocal segmental dilatation and short segment stricturing tilting and beading throughout the intrahepatic bile ducts, again consistent with patient's known primary sclerosing cholangitis. No definite dominant stricture is visualized. No intraluminal filling defects. Several MRCP sequences are degraded by patient motion and artifact. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts, including a T1 hyperintense proteinaceous/hemorrhagic cyst which does not demonstrate suspicious post contrast enhancement. Otherwise, bilateral kidneys are normal without hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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: Interval increase in size of the right upper lobe nodule which currently measures about 2.7 x 2.0 cm (series 402; image 55), previously about 0.7 x 0.8 cm mild bilateral upper lung predominant paraseptal emphysema. Bilateral dependent atelectatic changes. Left pleural thickening and scarring near the lung bases redemonstrated. Interval development of a small left pleural effusion.. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Enlarged right hilar lymph node measuring 1.6 x 2.7 cm (series 402; image 62). A prominent right paratracheal lymph node measures about 1.0 cm in short axis (series 402; image 52). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Acute left posterior ninth and 10th rib fractures.
15,665
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: History of cirrhosis. COMPARISON: 1/20/2021. TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 287 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. There is unchanged left hepatic lobe hypertrophy and atrophy of the posterior right hepatic lobe. Redemonstration of ill-defined T2 hyperintensity surrounding few intrahepatic ducts within the posterior superior right hepatic lobe. No abnormal arterial hyperenhancement or regions of delayed washout are visualized. There is no restricted diffusion. 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: There is redemonstration of multifocal segmental dilatation and short segment stricturing tilting and beading throughout the intrahepatic bile ducts, again consistent with patient's known primary sclerosing cholangitis. No definite dominant stricture is visualized. No intraluminal filling defects. Several MRCP sequences are degraded by patient motion and artifact. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts, including a T1 hyperintense proteinaceous/hemorrhagic cyst which does not demonstrate suspicious post contrast enhancement. Otherwise, bilateral kidneys are normal without hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Hepatic cirrhosis with mild splenomegaly. No suspicious hepatic lesions are visualized. 2. Intrahepatic biliary ductal multiple all segmental dilatation is unchanged in appearance compared to prior within limits of technique, consistent with known primary sclerosing cholangitis. No definite high-grade stricture is visualized.
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. There is unchanged left hepatic lobe hypertrophy and atrophy of the posterior right hepatic lobe. Redemonstration of ill-defined T2 hyperintensity surrounding few intrahepatic ducts within the posterior superior right hepatic lobe. No abnormal arterial hyperenhancement or regions of delayed washout are visualized. There is no restricted diffusion. 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: There is redemonstration of multifocal segmental dilatation and short segment stricturing tilting and beading throughout the intrahepatic bile ducts, again consistent with patient's known primary sclerosing cholangitis. No definite dominant stricture is visualized. No intraluminal filling defects. Several MRCP sequences are degraded by patient motion and artifact. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts, including a T1 hyperintense proteinaceous/hemorrhagic cyst which does not demonstrate suspicious post contrast enhancement. Otherwise, bilateral kidneys are normal without hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: Extensive mucosal edema and mucosal hyperenhancement seen involving the oropharynx, larynx and hypopharynx. Severe prevertebral edema and swelling measuring up to 19 mm posterior to the oropharynx from C2 to C6. The epiglottis is severely edematous and enlarged. Mass effect with diffusely thickened vocal cords resulting in severe narrowing of the laryngeal airway which measures 1.8 x 0.5 cm (image 294, series #301). Diffuse circumferential edema and thickening of the esophageal wall. No free air. Bilateral cervical lymphadenopathy, likely reactive. The base of tongue appear normal. There is mild edema of the nasopharyngeal soft tissues. Normal appearance of the submandibular, parotid, and thyroid glands. Included portions of the brain and skull base appear normal. Advanced multilevel discogenic degenerative change of the cervical spine. Kyphosis centered at C4-C5. No aggressive osseous lesions.
15,666
MR Angio Head wo+w contrast 1/26/2022 11:07 AM Clinical Information: Status post coiling of left supraclinoid aneurysm. Routine follow up Angio head, Z98.890 Other specified postprocedural states Spec Inst: Cure protocol; Cerebral aneurysm Comparison: Multiple priors, most recent MRA head with and without contrast: 1/26/2021 Technique: 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. Patient weight: 120 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: There is no definite of residual filling of coiled left supraclinoid ICA aneurysm, the appearance stable since multiple prior studies.. Again seen is mild narrowing of the distal cavernous and supraclinoid left ICA, unchanged. There are no additional aneurysms. No flow-limiting stenosis/occlusion identified. Impression: No definite refilling of coiled left supraclinoid ICA aneurysm, the appearance stable since multiple prior studies.
Findings: There is no definite of residual filling of coiled left supraclinoid ICA aneurysm, the appearance stable since multiple prior studies.. Again seen is mild narrowing of the distal cavernous and supraclinoid left ICA, unchanged. There are no additional aneurysms. No flow-limiting stenosis/occlusion identified.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: There is edema within the false cords and aryepiglottic folds causing narrowing of the laryngeal airway. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Diffuse esophageal submucosal edema with paraesophageal stranding and oral contrast fluid. No extraluminal gas or obvious esophageal wall defect. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Steatotic liver MUSCULOSKELETAL: No significant abnormality.
15,667
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma surveillance COMPARISON: MRI of abdomen dated 10/27/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 295 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory, though equilibrium phase is degraded by motion artifact. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: Treated lesions in the hepatic dome (series 604, image 72), hepatic segment VII (series 604, image 68), and hepatic segment V (series 604, image 44) are again noted. All of these lesions are without suspicious, nodular postcontrast enhancement, LR-TR nonviable. UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Previously described LR-4 lesion just inferior to the hepatic V treated lesion is redemonstrated, image, however now with an enhancing capsule. - Location: Segment(s) V - Size: 2.3 cm (series 604, image 36). - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. (series 603, image 38) - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-5 Additional subcentimeter hypoenhancing focus adjacent to the falciform ligament without washout (series 603, image 67), 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. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Biliary sludge. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Enhancing neoplasm in the pancreatic uncinate process measures approximately 2.6 x 1.5 cm (image 31, series 603), previously measured 2.5 x 1.5 cm, unchanged. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts, some of which are proteinaceous/hemorrhagic. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Cirrhosis with no significant sequela of portal hypertension. 2. Increasing size of two arterially enhancing lesions with central washout, concerning for hepatocellular carcinoma, LR-5. 3. Previously treated lesions without suspicious postcontrast enhancement, LR-TR nonviable. 4. Similar appearance of enhancing pancreatic uncinate process neuroendocrine 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.
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory, though equilibrium phase is degraded by motion artifact. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. TREATED LIVER LESIONS: Treated lesions in the hepatic dome (series 604, image 72), hepatic segment VII (series 604, image 68), and hepatic segment V (series 604, image 44) are again noted. All of these lesions are without suspicious, nodular postcontrast enhancement, LR-TR nonviable. UNTREATED OR NEW LIVER LESION(S): - Lesion Number: 1 - Description: Previously described LR-4 lesion just inferior to the hepatic V treated lesion is redemonstrated, image, however now with an enhancing capsule. - Location: Segment(s) V - Size: 2.3 cm (series 604, image 36). - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 3 - Enhancing "capsule": Present. - Nonperipheral "washout": Present. (series 603, image 38) - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-5 Additional subcentimeter hypoenhancing focus adjacent to the falciform ligament without washout (series 603, image 67), 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. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Biliary sludge. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Enhancing neoplasm in the pancreatic uncinate process measures approximately 2.6 x 1.5 cm (image 31, series 603), previously measured 2.5 x 1.5 cm, unchanged. ADRENALS: Normal. KIDNEYS: Bilateral renal cysts, some of which are proteinaceous/hemorrhagic. No hydronephrosis. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Tiny mucus retention cyst in left maxillary sinus.
15,668
left T3, right T5, T5 mid lamina/ spinous process Thoracic MRI with and without contrast - Clinical indication: Bone neoplasm suspected, T-spine, no prior imaging, C34.90 Malignant neoplasm of unspecified part of unspecified bronchus or lung. - Technique: Multiple T1 and T2 weighted MR sequence images of the thoracic spine were obtained in the axial and sagittal plane without and with the use of intravenous contrast per departmental cervical spine protocol. Patient weight: 121 lbs. IV contrast: ProHance, 11 ml, per protocol. IV contrast injection rate: 1 ml per sec. - Comparison: No previous similar studies are presented for comparison.. - Findings: Enhancing and expansile lesion is seen involving the left transverse process of the T3 vertebra. Enhancing lesion is noted involving the right pedicle, transverse process, lamina and spinous process of the T5 vertebra Small central disc protrusion at T1-2 with no cord compression or cord signal abnormality. Hemangioma/focal fatty change in the T1 vertebral body,. Scattered similar foci throughout the thoracic vertebrae which do not show evidence of contrast enhancement. There is no intraspinal lesion. Intrathoracic disease is better evaluated on prior CT and PET. Sagittal imaging demonstrates the intravertebral disc spaces, vertebral body heights, and alignment to be well-maintained. Cord signal appears within normal limits. Axial imaging otherwise demonstrates no significant disc degenerative changes. There is no evidence of neural impingement. Spinal canal and neural foramina otherwise appear patent. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. - Impression: Enhancing lesions involving the posterior elements of T3 and T5 vertebrae as described.. -
Findings: Enhancing and expansile lesion is seen involving the left transverse process of the T3 vertebra. Enhancing lesion is noted involving the right pedicle, transverse process, lamina and spinous process of the T5 vertebra Small central disc protrusion at T1-2 with no cord compression or cord signal abnormality. Hemangioma/focal fatty change in the T1 vertebral body,. Scattered similar foci throughout the thoracic vertebrae which do not show evidence of contrast enhancement. There is no intraspinal lesion. Intrathoracic disease is better evaluated on prior CT and PET. Sagittal imaging demonstrates the intravertebral disc spaces, vertebral body heights, and alignment to be well-maintained. Cord signal appears within normal limits. Axial imaging otherwise demonstrates no significant disc degenerative changes. There is no evidence of neural impingement. Spinal canal and neural foramina otherwise appear patent. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. -
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: A few scattered small nodules are noted at both bases likely infectious versus inflammatory. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation within the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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: The appendix is not definitively identified. Colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The right renal arteries. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced posterior left eighth rib fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. Segmentation anomaly is noted at T9/T10. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Partial fusion of the L4 on L5 vertebral bodies with a right partial hemivertebral body at L6. ALIGNMENT: Grade 1 retrolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,669
EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Right knee pain, evaluate extensor mechanism COMPARISON: 8/3/2021 TECHNIQUE: Multiplanar and multisequence MRI of the right knee was obtained without intravenous contrast. Metal suppression techniques were utilized. FINDINGS: Status post total knee arthroplasty. Extensive metallic artifact limits evaluation of the osseous structures. Large joint effusion. The patella is again noted to be low-lying. Additionally, there is lateral patellar tilt. The quadriceps tendon is not visualized. The patellar tendon. Well-visualized secondary to metallic artifact. Prepatellar soft tissue edema is noted. CONCLUSION: 1. Low-lying patella. The quadriceps and patellar tendons are not well-visualized secondary to metallic artifact; however, given the position of the patella, quadriceps insufficiency is likely. Ultrasound could better evaluate the extensor tendons. 2. Status post total knee arthroplasty. 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.
FINDINGS: Status post total knee arthroplasty. Extensive metallic artifact limits evaluation of the osseous structures. Large joint effusion. The patella is again noted to be low-lying. Additionally, there is lateral patellar tilt. The quadriceps tendon is not visualized. The patellar tendon. Well-visualized secondary to metallic artifact. Prepatellar soft tissue edema is noted.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: A few scattered small nodules are noted at both bases likely infectious versus inflammatory. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation within the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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: The appendix is not definitively identified. Colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The right renal arteries. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced posterior left eighth rib fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. Segmentation anomaly is noted at T9/T10. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Partial fusion of the L4 on L5 vertebral bodies with a right partial hemivertebral body at L6. ALIGNMENT: Grade 1 retrolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,670
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: History of biliary stricture status post right hepatectomy. COMPARISON: MRI of abdomen dated 9/8/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 140 lbs. IV contrast: ProHance, 13 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: Postsurgical changes of right hepatectomy. No focal hepatic lesion identified. Mild hepatic iron deposition. BILIARY TRACT/MRCP: Unchanged focal intrahepatic ductal dilatation adjacent to the hepaticojejunostomy/resection margin of the right hepatic lobe. Additionally, there is minimal prominence of the intrahepatic duct extending into the caudate lobe, also unchanged. These mildly dilated ducts are prominent to the level of the hepaticojejunostomy (series 601, image 93). The prominent ducts measure up to 5 to 6 mm in diameter. No left intrahepatic ductal dilatation. The left hepatic lobe drains into the common bile duct which is nondilated. GALLBLADDER: Absent. PANCREAS: Unchanged cystic foci in the pancreas (\R\2) without worrisome features such as enhancing septations or nodularity. The largest lesion measures approximately 8 mm (series 401, image 9) Main pancreatic duct is not dilated. SPLEEN: Enlarged. Mild splenic iron deposition. ADRENALS: Normal. KIDNEYS: Left 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: Bilateral gynecomastia. Postsurgical changes of anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes of partial right hepatectomy and hepaticojejunostomy with unchanged mildly prominent intrahepatic biliary ducts adjacent to the resection margin in the right hepatic lobe and caudate lobe. No left hepatic lobe intrahepatic biliary ductal dilatation no significant change since prior exam. 2. Unchanged appearance of cystic foci in the pancreas, possibly representing side branch IPMNs. 3. Mild hepatic and splenic iron deposition. 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.
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: Postsurgical changes of right hepatectomy. No focal hepatic lesion identified. Mild hepatic iron deposition. BILIARY TRACT/MRCP: Unchanged focal intrahepatic ductal dilatation adjacent to the hepaticojejunostomy/resection margin of the right hepatic lobe. Additionally, there is minimal prominence of the intrahepatic duct extending into the caudate lobe, also unchanged. These mildly dilated ducts are prominent to the level of the hepaticojejunostomy (series 601, image 93). The prominent ducts measure up to 5 to 6 mm in diameter. No left intrahepatic ductal dilatation. The left hepatic lobe drains into the common bile duct which is nondilated. GALLBLADDER: Absent. PANCREAS: Unchanged cystic foci in the pancreas (\R\2) without worrisome features such as enhancing septations or nodularity. The largest lesion measures approximately 8 mm (series 401, image 9) Main pancreatic duct is not dilated. SPLEEN: Enlarged. Mild splenic iron deposition. ADRENALS: Normal. KIDNEYS: Left 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: Bilateral gynecomastia. Postsurgical changes of anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: 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 (
15,671
EXAM: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP CLINICAL INFORMATION: History of biliary stricture status post right hepatectomy. COMPARISON: MRI of abdomen dated 9/8/2021 TECHNIQUE: MR Abdomen wo+w contrast, MR Cholangiopancreatography MRCP Patient weight: 140 lbs. IV contrast: ProHance, 13 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: Postsurgical changes of right hepatectomy. No focal hepatic lesion identified. Mild hepatic iron deposition. BILIARY TRACT/MRCP: Unchanged focal intrahepatic ductal dilatation adjacent to the hepaticojejunostomy/resection margin of the right hepatic lobe. Additionally, there is minimal prominence of the intrahepatic duct extending into the caudate lobe, also unchanged. These mildly dilated ducts are prominent to the level of the hepaticojejunostomy (series 601, image 93). The prominent ducts measure up to 5 to 6 mm in diameter. No left intrahepatic ductal dilatation. The left hepatic lobe drains into the common bile duct which is nondilated. GALLBLADDER: Absent. PANCREAS: Unchanged cystic foci in the pancreas (\R\2) without worrisome features such as enhancing septations or nodularity. The largest lesion measures approximately 8 mm (series 401, image 9) Main pancreatic duct is not dilated. SPLEEN: Enlarged. Mild splenic iron deposition. ADRENALS: Normal. KIDNEYS: Left 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: Bilateral gynecomastia. Postsurgical changes of anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Postsurgical changes of partial right hepatectomy and hepaticojejunostomy with unchanged mildly prominent intrahepatic biliary ducts adjacent to the resection margin in the right hepatic lobe and caudate lobe. No left hepatic lobe intrahepatic biliary ductal dilatation no significant change since prior exam. 2. Unchanged appearance of cystic foci in the pancreas, possibly representing side branch IPMNs. 3. Mild hepatic and splenic iron deposition. 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.
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: Postsurgical changes of right hepatectomy. No focal hepatic lesion identified. Mild hepatic iron deposition. BILIARY TRACT/MRCP: Unchanged focal intrahepatic ductal dilatation adjacent to the hepaticojejunostomy/resection margin of the right hepatic lobe. Additionally, there is minimal prominence of the intrahepatic duct extending into the caudate lobe, also unchanged. These mildly dilated ducts are prominent to the level of the hepaticojejunostomy (series 601, image 93). The prominent ducts measure up to 5 to 6 mm in diameter. No left intrahepatic ductal dilatation. The left hepatic lobe drains into the common bile duct which is nondilated. GALLBLADDER: Absent. PANCREAS: Unchanged cystic foci in the pancreas (\R\2) without worrisome features such as enhancing septations or nodularity. The largest lesion measures approximately 8 mm (series 401, image 9) Main pancreatic duct is not dilated. SPLEEN: Enlarged. Mild splenic iron deposition. ADRENALS: Normal. KIDNEYS: Left 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: Bilateral gynecomastia. Postsurgical changes of anterior abdominal wall. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: A few scattered small nodules are noted at both bases likely infectious versus inflammatory. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation within the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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: The appendix is not definitively identified. Colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The right renal arteries. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced posterior left eighth rib fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. Segmentation anomaly is noted at T9/T10. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Partial fusion of the L4 on L5 vertebral bodies with a right partial hemivertebral body at L6. ALIGNMENT: Grade 1 retrolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,672
MR Breast Diagnostic Bil wo+w contrast Clinical Information: hx implant recon, C50.919 Malignant neoplasm of unspecified site of unspecified female breast, Z90.11 Acquired absence of right breast and nipple, Z98.82 Breast implant status 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: 136 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 2 ml per sec. Comparison: Mammogram and ultrasound dating back to 6/5/2020 Amount of fibroglandular tissue: Heterogeneous fibroglandular tissue Background enhancement: Minimal Findings: Right breast: There are no suspicious masses or suspicious enhancement in the reconstructed right breast. Left breast: There are no suspicious masses or suspicious enhancement in the left breast. Implants: Bilateral implants are grossly intact. Lymph nodes: Innumerable enlarged lymph nodes are present from level one to laboratory in bilateral axillae. Prior lymph node biopsy showed benign results, however, these have been increasing in size and surgical excision is planned. No internal mammary lymphadenopathy on either side. Conclusion: Right breast: No MRI evidence of malignancy in the reconstructed breast. Grossly intact implant. Innumerable enlarged lymph nodes in level 1-3 right axilla. Surgical excision is planned. BI-RADS 4: Suspicious findings Left breast: No MRI evidence of malignancy in the left breast. Grossly intact implant. Innumerable enlarged lymph nodes in level 1-3 left axilla. Surgical excision is planned. BI-RADS 4: Suspicious findings Final BIRADS; BI-RADS 4: Suspicious findings
Findings: Right breast: There are no suspicious masses or suspicious enhancement in the reconstructed right breast. Left breast: There are no suspicious masses or suspicious enhancement in the left breast. Implants: Bilateral implants are grossly intact. Lymph nodes: Innumerable enlarged lymph nodes are present from level one to laboratory in bilateral axillae. Prior lymph node biopsy showed benign results, however, these have been increasing in size and surgical excision is planned. No internal mammary lymphadenopathy on either side.
FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: A few scattered small nodules are noted at both bases likely infectious versus inflammatory. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Increased attenuation within the anterior mediastinum is likely residual thymus. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: 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: The appendix is not definitively identified. Colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: The right renal arteries. URINARY BLADDER: Mildly distended. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced posterior left eighth rib fracture. THORACIC: VERTEBRA: No displaced fracture or compression deformity. Segmentation anomaly is noted at T9/T10. ALIGNMENT: No spondylolisthesis. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable. LUMBAR: VERTEBRA: No displaced fracture or compression deformity. Partial fusion of the L4 on L5 vertebral bodies with a right partial hemivertebral body at L6. ALIGNMENT: Grade 1 retrolisthesis of L5 on S1. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Unremarkable.
15,673
MR scan of the brain before and after contrast. Clinical: Status post SCCA left orbit. Technical: MR brain protocol before and after contrast. IV contrast: ProHance, 20 ml, per protocol. Findings: There are postsurgical changes in the left orbital roof and there is stable appearance of the left ocular prosthesis. No recurrent or residual tumor is seen. The brain parenchyma has normal appearance with no mass, hemorrhage, infarct or extracerebral collection. The ventricles are small with normal appearance. There is stable mucosal thickening in the lateral aspect of the left frontal sinus. There is stable enhancement in scar tissue in the surgical bed. There is no abnormal parenchymal enhancement. Compared to the prior scan there is no significant change. ---------- Conclusion: Stable postsurgical changes in the left orbit. No residual or recurrent tumor identified. No acute process.
Findings: There are postsurgical changes in the left orbital roof and there is stable appearance of the left ocular prosthesis. No recurrent or residual tumor is seen. The brain parenchyma has normal appearance with no mass, hemorrhage, infarct or extracerebral collection. The ventricles are small with normal appearance. There is stable mucosal thickening in the lateral aspect of the left frontal sinus. There is stable enhancement in scar tissue in the surgical bed. There is no abnormal parenchymal enhancement. Compared to the prior scan there is no significant change. ----------
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. No fracture. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. FACIAL BONES: No fracture. Bilateral pterygoid plates are intact. MANDIBLE: No fracture. Bilateral temporomandibular joints are intact. SINONASAL CAVITIES: Tiny mucus retention cyst in left maxillary sinus.
15,674
EXAM: MR Abdomen wo contrast CLINICAL INFORMATION: Evaluate for iron overload. COMPARISON: Limited comparison to ultrasound Elastography 1/7/2022. TECHNIQUE: MR Abdomen wo contrast FINDINGS: FAT QUANTIFICATION: The average liver fat content percentage calculated is: 2.3%, which is not compatible with hepatic steatosis. IRON QUANTIFICATION: The R2 water value is: 582 sec\S\-1, which is consistent with severe hepatic iron deposition. This was calculated using multiple hand drawn ROIs on the R2*map. Single liver evaluation ROI mean 424 sec\S\-1, std 219 sec\S\-1. OTHER FINDINGS: Qualitatively, there is diffuse decreased hepatic parenchymal signal on in phase imaging, suggesting iron deposition. Indeterminate right mid kidney intrinsically T1 hyperintense, T2 hypointense 7 mm focus, possible hemorrhagic or proteinaceous cyst; however, incompletely characterized without contrast. CONCLUSION: 1. Based on measurements in multiple regions of interest, the fat fraction of the liver is approximately 2.3%, which is normal (normal < 6%). 2. The study was performed at 3T. The R2 water value demonstrates Severe hepatic iron deposition. 3. Indeterminant 7 mm T1 hyperintense focus in the right lateral mid kidney, possible hemorrhagic or proteinaceous cyst. This may correspond to the complex cyst seen on prior abdominal sonogram 12/22/2020. Follow-up renal sonogram is recommended, if not recently performed.
FINDINGS: FAT QUANTIFICATION: The average liver fat content percentage calculated is: 2.3%, which is not compatible with hepatic steatosis. IRON QUANTIFICATION: The R2 water value is: 582 sec\S\-1, which is consistent with severe hepatic iron deposition. This was calculated using multiple hand drawn ROIs on the R2*map. Single liver evaluation ROI mean 424 sec\S\-1, std 219 sec\S\-1. OTHER FINDINGS: Qualitatively, there is diffuse decreased hepatic parenchymal signal on in phase imaging, suggesting iron deposition. Indeterminate right mid kidney intrinsically T1 hyperintense, T2 hypointense 7 mm focus, possible hemorrhagic or proteinaceous cyst; however, incompletely characterized without contrast.
FINDINGS: 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 (
15,675
MRI brain without Indication: right grade 1 VA injury, LUE 25 weakness Spec Inst: rule out stroke, LUE weakness Comparison: CT head without contrast 1/25/2022 Technique: Multiple T1 and T2-weighted MR sequence images of the brain were obtained in the sagittal axial and coronal planes without the use of intravenous contrast per departmental protocol. Findings: PSIF Occiput to C2. Extensive susceptibility artifacts from the hardware. DWI and SWI images of suboptimal quality due to extensive susceptibility artifacts. No definite acute infarct identified in the evaluable brain parenchyma. There appears to be trace intraventricular blood layering along the posterior horn of lateral ventricles and fourth ventricle. Remainder of the brain parenchyma is unremarkable. Impression: 1. Suboptimal study due to extensive artifacts. 2. No acute infarct in the evaluable brain parenchyma. 3. Trace intraventricular hemorrhage.
Findings: PSIF Occiput to C2. Extensive susceptibility artifacts from the hardware. DWI and SWI images of suboptimal quality due to extensive susceptibility artifacts. No definite acute infarct identified in the evaluable brain parenchyma. There appears to be trace intraventricular blood layering along the posterior horn of lateral ventricles and fourth ventricle. Remainder of the brain parenchyma is unremarkable.
Findings: There is a small area of evolving hypoattenuation involving the right insular cortex with associated adjacent hyperdense vessel, likely thrombosed M2 segment as seen on prior head CT from earlier today. There is also hypoattenuation involving the right caudate head and lentiform nucleus. No intracranial hemorrhage.
15,676
MR Cervical Spine wo contrast 1/26/2022 3:58 PM Clinical Information: please rule out cervical cord injury Spec Inst: left shoulder and arm weakness Comparison: CT cervical spine from reformat 1/25/2022 Technique: Multiplanar cervical spine imaging. Contrast as per departmental protocol Findings: Status post PSIF Occiput to C2 extensive ligamentous injury on dens with effacement of the anterior CSF space and the cervical medullary junction. However no cord compression or cord signal abnormality identified. Posterior dural thickening/ epidural hemorrhage extending from C2 to upper thoracic spine up to T2-3. Maintained anterior and posterior cervical CSF spaces. No evidence of cord compression or cord signal abnormality. Multilevel degenerative changes with anterior and posterior osteophytosis, mild disc bulges causing no central canal or significant neuroforaminal stenosis. Diffuse soft tissue edema in the posterior paraspinal musculature and supraspinous ligaments. The bony fractures are better evaluated on the comparison CT Impression: 1. Normal definite evidence of cervical cord injury. No cord compression. 2. Small volume posterior epidural hemorrhage extending into the upper thoracic spine.
Findings: Status post PSIF Occiput to C2 extensive ligamentous injury on dens with effacement of the anterior CSF space and the cervical medullary junction. However no cord compression or cord signal abnormality identified. Posterior dural thickening/ epidural hemorrhage extending from C2 to upper thoracic spine up to T2-3. Maintained anterior and posterior cervical CSF spaces. No evidence of cord compression or cord signal abnormality. Multilevel degenerative changes with anterior and posterior osteophytosis, mild disc bulges causing no central canal or significant neuroforaminal stenosis. Diffuse soft tissue edema in the posterior paraspinal musculature and supraspinous ligaments. The bony fractures are better evaluated on the comparison CT
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: No focal consolidation, pleural effusion, or pneumothorax. Mild dependent atelectasis. HEART / OTHER VESSELS: The heart is borderline-enlarged. Main pulmonary artery is upper limits of normal in size. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
15,677
MR Brachial Plexus wo contrast HISTORY: LUE weakness, please rule out brachial plexus TECHNIQUE: Multiplanar, multisequence MR imaging through the extraspinal components of the brachial plexi was performed before and after the intravenous administration of Gadavist. The study was performed on a magnet. COMPARISON: None available. FINDINGS: Suboptimal study due to motion artifacts on multiple sequences. There is diffuse soft tissue edema/ STIR hyperintense signal in the lower neck, greater on the left side. There appears to be increased signal along the left brachial plexus difficult to separate from the soft tissue changes. Mild discogenic degenerative changes in the cervical spine. No cord compression. IMPRESSION: Suboptimal study. Diffuse soft tissue edema, greater on the left. Increased signal along the left brachial plexus difficult to separate from the soft tissue edema. Consider repeat imaging after acute change subside.
FINDINGS: Suboptimal study due to motion artifacts on multiple sequences. There is diffuse soft tissue edema/ STIR hyperintense signal in the lower neck, greater on the left side. There appears to be increased signal along the left brachial plexus difficult to separate from the soft tissue changes. Mild discogenic degenerative changes in the cervical spine. No cord compression.
Findings: Central pontine intraparenchymal hemorrhage measures 20 x 17 mm, previously 14 x 13 mm. There is mild surrounding brain edema. There is no hydrocephalus. No new intracranial hemorrhage or evidence of acute infarction. There are advanced chronic microangiopathic changes in the deep cerebral white matter with developmental venous anomaly in the right frontal lobe. Cavum velum interpositum is incidentally noted. There is no acute osseous abnormality. The visualized paranasal sinuses and mastoid air cells are clear.
15,678
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Retroperitoneal mass COMPARISON: CT abdomen pelvis 1/4/2022 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 140 lbs. IV contrast: ProHance, 13 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. 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. PERITONEUM / MESENTERY: Trace free pelvic simple fluid, likely physiologic. RETROPERITONEUM: Again seen is a large, T2 hyperintense mass involving the right retroperitoneum, predominantly centered in the region of the right psoas muscle measuring approximately 7.0 x 8.3 cm (series 501, image 39), overall unchanged from prior CT. This mass displaces the right psoas muscle without definite invasion. There is also displacement of the right common iliac artery anteriorly. The right common iliac vein is nearly completely effaced by the mass. This lesion demonstrates internal septations. The lesion is predominantly cystic with only enhancement of the outer rim and internal septations noted. The lesion is lobulated, but well marginated, without definite invasion into adjacent structures. Redemonstration of periosteal reaction involving the L5 vertebral body. Scattered areas of low signal within the mass, likely corresponding to the calcification seen on CT. There is no significant intralesional fat identified on the in and out of phase sequences. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Large, cystic right retroperitoneal mass with rim and septal enhancement, for which differential diagnosis includes cystic teratoma or cystic lymphangioma. The patient has undergone percutaneous biopsy today. Correlation with pending pathology results is recommended. 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.
FINDINGS: STRUCTURED REPORT: MRI Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. 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. PERITONEUM / MESENTERY: Trace free pelvic simple fluid, likely physiologic. RETROPERITONEUM: Again seen is a large, T2 hyperintense mass involving the right retroperitoneum, predominantly centered in the region of the right psoas muscle measuring approximately 7.0 x 8.3 cm (series 501, image 39), overall unchanged from prior CT. This mass displaces the right psoas muscle without definite invasion. There is also displacement of the right common iliac artery anteriorly. The right common iliac vein is nearly completely effaced by the mass. This lesion demonstrates internal septations. The lesion is predominantly cystic with only enhancement of the outer rim and internal septations noted. The lesion is lobulated, but well marginated, without definite invasion into adjacent structures. Redemonstration of periosteal reaction involving the L5 vertebral body. Scattered areas of low signal within the mass, likely corresponding to the calcification seen on CT. There is no significant intralesional fat identified on the in and out of phase sequences. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is present. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
Findings: Central pontine hemorrhage is unchanged in interval measuring 20 x 18 mm. There is mild surrounding vasogenic edema without significant mass effect. There is no acute infarction or new hemorrhage. There are moderately advanced chronic microangiopathic changes in the deep cerebral white matter. There is no hydrocephalus. There is no acute osseous abnormality. The paranasal sinuses and mastoid air cells are clear.
15,679
EXAM: MR Pelvis wo+w contrast, MR Abdomen wo+w contrast CLINICAL INFORMATION: History of spontaneous miscarriage in November 2021 and ultrasound demonstrating an abnormal uterine cavity. There was concern for bicornuate versus uterine didelphys. The patient presents for evaluation of potential mullerian anomaly. COMPARISON: Limited comparison is made to OB gynecology ultrasound examination performed 12/13/2021 TECHNIQUE: MR Pelvis wo+w contrast, MR Abdomen wo+w contrast Patient weight: 150 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: STRUCTURED REPORT: MRI Pelvis ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: Limited evaluation of the abdomen demonstrates normal T2 appearance of the kidneys bilaterally. No hydronephrosis or suspicious renal mass. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is normal in size and anteverted. The endometrium and junctional zone are normal in thickness. The fundal contour is flat and the uterus is septated. There is a thick muscular septation with fibrous component in the inferior uterus that extends into the cervix (image 27, series 1201). There is a single cervix and no vaginal septum is identified. The ovaries are normal in size bilaterally measuring 3.4 x 1.7 x 1.5 cm on the right and 3.7 x 1.9 x 1.7 cm on the left. Numerous follicles are seen in the ovaries bilaterally. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Septated uterus with thick muscular septation and fibrous component in the inferior uterus that extends into the cervix. No vaginal septum identified. 2. The ovaries are present and normal in size bilaterally. 3. The kidneys are present and appear normal on T2-weighted sequences bilaterally.
FINDINGS: STRUCTURED REPORT: MRI Pelvis ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: Limited evaluation of the abdomen demonstrates normal T2 appearance of the kidneys bilaterally. No hydronephrosis or suspicious renal mass. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is normal in size and anteverted. The endometrium and junctional zone are normal in thickness. The fundal contour is flat and the uterus is septated. There is a thick muscular septation with fibrous component in the inferior uterus that extends into the cervix (image 27, series 1201). There is a single cervix and no vaginal septum is identified. The ovaries are normal in size bilaterally measuring 3.4 x 1.7 x 1.5 cm on the right and 3.7 x 1.9 x 1.7 cm on the left. Numerous follicles are seen in the ovaries bilaterally. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Normal. HEART / OTHER VESSELS: No significant abnormality. Right IJ port with tip at cavoatrial junction. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
15,680
EXAM: MR Pelvis wo+w contrast, MR Abdomen wo+w contrast CLINICAL INFORMATION: History of spontaneous miscarriage in November 2021 and ultrasound demonstrating an abnormal uterine cavity. There was concern for bicornuate versus uterine didelphys. The patient presents for evaluation of potential mullerian anomaly. COMPARISON: Limited comparison is made to OB gynecology ultrasound examination performed 12/13/2021 TECHNIQUE: MR Pelvis wo+w contrast, MR Abdomen wo+w contrast Patient weight: 150 lbs. IV contrast: ProHance, 7 ml, per protocol. FINDINGS: STRUCTURED REPORT: MRI Pelvis ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: Limited evaluation of the abdomen demonstrates normal T2 appearance of the kidneys bilaterally. No hydronephrosis or suspicious renal mass. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is normal in size and anteverted. The endometrium and junctional zone are normal in thickness. The fundal contour is flat and the uterus is septated. There is a thick muscular septation with fibrous component in the inferior uterus that extends into the cervix (image 27, series 1201). There is a single cervix and no vaginal septum is identified. The ovaries are normal in size bilaterally measuring 3.4 x 1.7 x 1.5 cm on the right and 3.7 x 1.9 x 1.7 cm on the left. Numerous follicles are seen in the ovaries bilaterally. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Septated uterus with thick muscular septation and fibrous component in the inferior uterus that extends into the cervix. No vaginal septum identified. 2. The ovaries are present and normal in size bilaterally. 3. The kidneys are present and appear normal on T2-weighted sequences bilaterally.
FINDINGS: STRUCTURED REPORT: MRI Pelvis ABDOMEN: BOWEL: No abnormality. PERITONEUM: Normal. OTHER: Limited evaluation of the abdomen demonstrates normal T2 appearance of the kidneys bilaterally. No hydronephrosis or suspicious renal mass. PELVIS: VESSELS: No significant abnormality. LYMPH NODES: None enlarged. PERIRECTAL / PERIANAL REGION: Normal. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is normal in size and anteverted. The endometrium and junctional zone are normal in thickness. The fundal contour is flat and the uterus is septated. There is a thick muscular septation with fibrous component in the inferior uterus that extends into the cervix (image 27, series 1201). There is a single cervix and no vaginal septum is identified. The ovaries are normal in size bilaterally measuring 3.4 x 1.7 x 1.5 cm on the right and 3.7 x 1.9 x 1.7 cm on the left. Numerous follicles are seen in the ovaries bilaterally. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: CT OF THE HEAD WITH CONTRAST: No enhancing intracranial abnormality. Please also see separate same day noncontrast CT head report. Right maxillary sinus is opacified with reactive hyperostosis suggesting chronicity. Mild mucosal thickening of the left maxillary sinus. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Common origin of the brachiocephalic and left common carotid. Suspected thrombosed dissection of the descending aorta distal to the origin of the left subclavian artery. RIGHT CAROTID: Mild calcified atherosclerosis of the siphon. LEFT CAROTID: Mild calcified atherosclerosis of the siphon. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Normal. Dominant. LEFT VERTEBRAL ARTERY: Diffusely hypoplastic. BASILAR ARTERY: Normal. NECK SOFT TISSUES: Moderate centrilobular and paraseptal emphysema. CERVICAL SPINE: Degenerative spine changes.
15,681
EXAM: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast CLINICAL INFORMATION: Follow-up pancreatic cystic lesion. COMPARISON: CT abdomen and pelvis performed 12/18/2020. TECHNIQUE: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast Patient weight: 166 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen Evaluation of several sequences is limited by patient motion. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: Small hiatal hernia. Post surgical changes redemonstrated. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is moderate extrahepatic and mild intrahepatic biliary ductal dilatation. The common bile duct measures up to 1.6 cm in diameter (series 1001, image 6). This is similar compared to remote prior CT. No intraluminal filling defects or stricturing visualized. GALLBLADDER: Absent. PANCREAS: Cystic lesions are seen within the pancreatic body; the largest measures up to 9 mm (series 701, image 19), overall similar to prior examination. No suspicious mural nodularity is visualized the main pancreatic duct is normal in caliber. 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: 1. Stable pancreatic body cystic lesion, likely sidebranch IPMN. No associated suspicious features. Continued annual follow up is recommended to ensure size stability. 2. Unchanged biliary ductal dilatation. No biliary stricture or intraluminal filling defects visualized.
FINDINGS: STRUCTURED REPORT: MRI Abdomen Evaluation of several sequences is limited by patient motion. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: Small hiatal hernia. Post surgical changes redemonstrated. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is moderate extrahepatic and mild intrahepatic biliary ductal dilatation. The common bile duct measures up to 1.6 cm in diameter (series 1001, image 6). This is similar compared to remote prior CT. No intraluminal filling defects or stricturing visualized. GALLBLADDER: Absent. PANCREAS: Cystic lesions are seen within the pancreatic body; the largest measures up to 9 mm (series 701, image 19), overall similar to prior examination. No suspicious mural nodularity is visualized the main pancreatic duct is normal in caliber. 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.
FINDINGS: CT OF THE HEAD WITH CONTRAST: No enhancing intracranial abnormality. Please also see separate same day noncontrast CT head report. Right maxillary sinus is opacified with reactive hyperostosis suggesting chronicity. Mild mucosal thickening of the left maxillary sinus. CT ANGIOGRAM OF THE HEAD AND NECK: AORTIC ARCH AND PROXIMAL GREAT VESSELS: Common origin of the brachiocephalic and left common carotid. Suspected thrombosed dissection of the descending aorta distal to the origin of the left subclavian artery. RIGHT CAROTID: Mild calcified atherosclerosis of the siphon. LEFT CAROTID: Mild calcified atherosclerosis of the siphon. ANTERIOR, MIDDLE, AND POSTERIOR CEREBRAL ARTERIES: Normal. RIGHT VERTEBRAL ARTERY: Normal. Dominant. LEFT VERTEBRAL ARTERY: Diffusely hypoplastic. BASILAR ARTERY: Normal. NECK SOFT TISSUES: Moderate centrilobular and paraseptal emphysema. CERVICAL SPINE: Degenerative spine changes.
15,682
EXAM: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast CLINICAL INFORMATION: Follow-up pancreatic cystic lesion. COMPARISON: CT abdomen and pelvis performed 12/18/2020. TECHNIQUE: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast Patient weight: 166 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen Evaluation of several sequences is limited by patient motion. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: Small hiatal hernia. Post surgical changes redemonstrated. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is moderate extrahepatic and mild intrahepatic biliary ductal dilatation. The common bile duct measures up to 1.6 cm in diameter (series 1001, image 6). This is similar compared to remote prior CT. No intraluminal filling defects or stricturing visualized. GALLBLADDER: Absent. PANCREAS: Cystic lesions are seen within the pancreatic body; the largest measures up to 9 mm (series 701, image 19), overall similar to prior examination. No suspicious mural nodularity is visualized the main pancreatic duct is normal in caliber. 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: 1. Stable pancreatic body cystic lesion, likely sidebranch IPMN. No associated suspicious features. Continued annual follow up is recommended to ensure size stability. 2. Unchanged biliary ductal dilatation. No biliary stricture or intraluminal filling defects visualized.
FINDINGS: STRUCTURED REPORT: MRI Abdomen Evaluation of several sequences is limited by patient motion. LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: Small hiatal hernia. Post surgical changes redemonstrated. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal. BILIARY TRACT: There is moderate extrahepatic and mild intrahepatic biliary ductal dilatation. The common bile duct measures up to 1.6 cm in diameter (series 1001, image 6). This is similar compared to remote prior CT. No intraluminal filling defects or stricturing visualized. GALLBLADDER: Absent. PANCREAS: Cystic lesions are seen within the pancreatic body; the largest measures up to 9 mm (series 701, image 19), overall similar to prior examination. No suspicious mural nodularity is visualized the main pancreatic duct is normal in caliber. 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.
Findings: There is no intracranial hemorrhage or acute infarction. There is no hydrocephalus or brain edema/mass effect. Gray-white matter differentiation is maintained. Mild diffuse brain volume loss.
15,683
MR Elastography CLINICAL INFORMATION: likely cirrhosis, K74.60 Unspecified cirrhosis of liver Spec Inst: Patient should be NPO 4 hours prior to test. Scan can only be performed at Kirklin Clinic. COMPARISON: None available. TECHNIQUE: MR Elastography. FINDINGS: STIFFNESS: The average liver stiffness calculated on MR Elastography is: 3.0 kPa, which is compatible with stage 1 fibrosis. Reference values: 5 kPa: cirrhosis These are broad categories and results should be interpreted with clinical and laboratory findings for other possible causes of increased liver stiffness. FAT QUANTIFICATION: The average liver fat content percentage calculated is: 4.1%, which is normal. IRON QUANTIFICATION: The R2 water value is: 63.2 sec\S\-1, which is normal. OTHER FINDINGS: None. CONCLUSION: 1. MR Elastography demonstrated a stiffness of 3.0 kPa, which is abnormal (normal < 2.5 kPa), indicating the presence of inflammation and/or fibrosis (if abnormal). 2. Based on measurements in multiple regions of interest, the fat fraction of the liver is approximately 4.1%, which is normal (normal < 6%). 3. The study was performed at 3T. The R2 water value demonstrates normal hepatic iron deposition (normal < 120 s\S\-1 at 3 T).
FINDINGS: STIFFNESS: The average liver stiffness calculated on MR Elastography is: 3.0 kPa, which is compatible with stage 1 fibrosis. Reference values: 5 kPa: cirrhosis These are broad categories and results should be interpreted with clinical and laboratory findings for other possible causes of increased liver stiffness. FAT QUANTIFICATION: The average liver fat content percentage calculated is: 4.1%, which is normal. IRON QUANTIFICATION: The R2 water value is: 63.2 sec\S\-1, which is normal. OTHER FINDINGS: None.
Findings: Unenhanced images of the brain demonstrate no acute abnormality. Delayed post contrast images demonstrate no acute abnormality. Color parametric maps demonstrate no asymmetric or abnormal regions of perfusion. Prognostic maps demonstrate no acute abnormality. Artifactual abnormalities are noted on Tmax images.
15,684
MRI brain with and without Indication: Anaplastic gliomasglioblastoma, monitor, C71.1 Malignant neoplasm of frontal lobe Comparison: Multiple priors, most recent MRI brain with and without contrast from outside facility dated 9/1/2021 and MRI brain without contrast dated 11/10/2021 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: 230 lbs. IV contrast: ProHance, 20 ml, per protocol. Findings: There is interval increase in the extent of the extensive confluent masslike T2/FLAIR hyperintense signal abnormality involving the right cerebral hemisphere with no prominent extension across the body of the corpus callosum to the left centrum semiovale and periventricular white matter. The abnormal masslike extension across the splenium of corpus callosum shows substantial interval increase in size. Abnormal signal seen in the septum pellucidum with new areas of involvement in the posterior parietal temporal and occipital regions. These have been annotated on axial FLAIR images. These lesions show multiple punctate and patchy postcontrast enhancement with the area of ill-defined enhancement in the in the right posterior parietal lobe and splenium of the corpus callosum worsened mass effect on the posterior horn of the right lateral ventricle with narrowing of the ventricular margins and ill-defined ventricular wall/ependymal. Foci of restricted diffusion may of which correspond to the abnormal focus of susceptibility are seen; a prominent focus in the right temporal periventricular white matter. Prior biopsy changes. Other findings are grossly similar. Impression: 1. Conventional imaging findings are concerning for disease progression. Further evaluation with MR perfusion may be considered to rule out the possibility of treatment related changes/ radiation necrosis. 2. Foci of restricted diffusion scattered within the mass like signal abnormality and enhancement are likely related to vasculopathy and or tumor progression.
Findings: There is interval increase in the extent of the extensive confluent masslike T2/FLAIR hyperintense signal abnormality involving the right cerebral hemisphere with no prominent extension across the body of the corpus callosum to the left centrum semiovale and periventricular white matter. The abnormal masslike extension across the splenium of corpus callosum shows substantial interval increase in size. Abnormal signal seen in the septum pellucidum with new areas of involvement in the posterior parietal temporal and occipital regions. These have been annotated on axial FLAIR images. These lesions show multiple punctate and patchy postcontrast enhancement with the area of ill-defined enhancement in the in the right posterior parietal lobe and splenium of the corpus callosum worsened mass effect on the posterior horn of the right lateral ventricle with narrowing of the ventricular margins and ill-defined ventricular wall/ependymal. Foci of restricted diffusion may of which correspond to the abnormal focus of susceptibility are seen; a prominent focus in the right temporal periventricular white matter. Prior biopsy changes. Other findings are grossly similar.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Advanced diffuse parenchymal volume loss. Confluent periventricular white matter hypoattenuation consistent with advanced microangiopathic change. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Ex vacuo dilatation, stable from prior. ORBITS: Bilateral pseudophakia. SINUSES: Paranasal sinuses are clear. VESSELS: Mild scattered calcified atherosclerosis of the carotid siphons and right vertebral artery.
15,685
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.
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
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 (
15,686
EXAM: CV MR Cardiac w contrast PATIENT DATA Date of Study: 1/26/2022 4:19 PM Referring MD: Chelsea Gatherwright Height: 182 cm. Patient weight: 158 kg. BSA: 2.82 Blood Pressure: 118/74 Heart Rate: 79 bpm. EGFR 60. The patient's creatinine was 0.9 on 01/26/2022. The patient received 20 cc's of Gadavist at a rate of 2 ml per second without immediate complication. CLINICAL INFORMATION: Patient studied for evaluation of: cf for shunt History: 47 year old man presenting with shortness of breath. Presenting for CMR for evaluation of possible shunt. COMPARISON: No prior cardiac MRI TECHNIQUE: CV MR Cardiac w contrast FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Good CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Sequences: SSFP FGRE ET Additional views: MS Axial, Velocity Flow Mapping, Delayed Contrast Enhancement, perfusion General: Inpatient ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 42 LV End Diastolic Dimension: 50 LV End Systolic Dimension: 35 LV Posterior Wall: 8 Right Atrium 52 RV End Diastolic Dimension: 46 Interventricular Septum: 11 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 144 ED Index 53 End Systolic Volume: 62 ES Index 23 Stroke Volume: 82 SV Index 30 Ejection Fraction: 56.9% Morphology: The patient is imaged with multiple planes through the chest using ECG gated cine gradient echo, phase contrast velocity mapping, and postcontrast imaging. There is normal left ventricular size and function. Ventricular wall thicknesses are normal. There is normal first pass resting gadolinium enhancement. There is no late gadolinium enhancement noted. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 163 ED Index 61 End Systolic Volume: 80 ES Index 30 Stroke Volume: 83 SV Index 31 Ejection Fraction: 50.9% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardial thickness with noted epicardial and pericardial fat. Pleural: No pleural effusion noted. VALVULAR MORPHOLOGY There is no significant valvular abnormality noted. Phase contrast velocity mapping: CO 5 L/min Qp/Qs 0.97, indicates no significant intracardiac shunt. No aortic regurgitation noted by flow curve Vessel dimensions: (In mm normal range dimensions mm) Aortic Root 31 Aortic Arch 37 [18-37] Right Pulmonary Artery 23 Left Pulmonary Artery 21 Inferior Vena Cava 20 Descending Aorta 24 [16-29] INCIDENTAL FINDINGS: None CONCLUSION: 1. Normal CMR Cardiac MRI Technologist: Billy Fisher 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.
FINDINGS: IMAGING DATA Imaging System: GE 1.5T Overall Image Quality: Good CARDIAC MORPHOLOGY AND VENTRICULAR FUNCTION Views: Axial Two chamber Four chamber Short axis LV LVOT Ascending aorta RVOT Sequences: SSFP FGRE ET Additional views: MS Axial, Velocity Flow Mapping, Delayed Contrast Enhancement, perfusion General: Inpatient ECG gated: YES MEASUREMENTS: In Millimeters Left Atrium: 42 LV End Diastolic Dimension: 50 LV End Systolic Dimension: 35 LV Posterior Wall: 8 Right Atrium 52 RV End Diastolic Dimension: 46 Interventricular Septum: 11 Left Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 144 ED Index 53 End Systolic Volume: 62 ES Index 23 Stroke Volume: 82 SV Index 30 Ejection Fraction: 56.9% Morphology: The patient is imaged with multiple planes through the chest using ECG gated cine gradient echo, phase contrast velocity mapping, and postcontrast imaging. There is normal left ventricular size and function. Ventricular wall thicknesses are normal. There is normal first pass resting gadolinium enhancement. There is no late gadolinium enhancement noted. Right Ventricle (short axis):Volumes in mL, index in mL per square meter End Diastolic Volume: 163 ED Index 61 End Systolic Volume: 80 ES Index 30 Stroke Volume: 83 SV Index 31 Ejection Fraction: 50.9% Morphology: There is normal right ventricular size and function. Pericardium: Normal pericardial thickness with noted epicardial and pericardial fat. Pleural: No pleural effusion noted. VALVULAR MORPHOLOGY There is no significant valvular abnormality noted. Phase contrast velocity mapping: CO 5 L/min Qp/Qs 0.97, indicates no significant intracardiac shunt. No aortic regurgitation noted by flow curve Vessel dimensions: (In mm normal range dimensions mm) Aortic Root 31 Aortic Arch 37 [18-37] Right Pulmonary Artery 23 Left Pulmonary Artery 21 Inferior Vena Cava 20 Descending Aorta 24 [16-29] INCIDENTAL FINDINGS: None
FINDINGS: STRUCTURED REPORT: CT Abdomen STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Trace Pericardial effusion. No other significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Layering sludge. PANCREAS: Mild stranding about the head/uncinate. No focal hypoenhancing parenchyma. Scattered calcifications, primarily in the head/uncinate, suggesting prior pancreatitis. Numerous cystic lesions within the pancreatic head and uncinate process largest measuring 22 x 20 mm on image 147 series 301. Small exophytic lesion arising from the proximal pancreatic body measuring 15 mm on image 78 series 301. SPLEEN: Normal. ADRENALS: Small left adrenal myelolipoma. Otherwise normal KIDNEYS: Atrophic right kidney. Right interpolar cyst with medial wall calcification, unchanged. Multiple nonobstructing multiple stones, overall unchanged, the largest measuring 1.6 cm. Left hypoattenuating lesions, likely cysts. Punctate nonobstructing nephrolithiasis, decreased. Left hydronephrosis has resolved. Left perinephric and proximal periureteral stranding LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No gastric abnormality. Suspected anterior duodenal diverticulum containing hyperdense material, unchanged. Periduodenal stranding may be reactive. No evidence of small bowel obstruction. COLON / APPENDIX: Portions of the right lateral colon were excluded from field-of-view. Diverticula without inflammation. Appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerosis without aneurysm. URINARY BLADDER: Partially obscured secondary to streak artifact from adjacent hip arthroplasties. No other significant abnormality. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Degenerative spine changes. Bilateral hip arthroplasties.
15,687
MR TMJ HISTORY: Abnormal jaw closure with pain and limited movement, bilaterally. TECHNIQUE: Multiplanar, multisequence MRI of the temporomandibular joints was obtained without intravenous contrast. The study was performed on a 1.5T magnet. COMPARISON: Cone been CT dated 9/8/2021. FINDINGS: Right side: The articular disc demonstrates mild thickening and intermediate signal posteriorly. Disc appears anteriorly and also mildly laterally displaced in the closed mouth position. There is a small joint effusion. The mandibular condyle and articular eminence have a normal appearance without evidence for degenerative change.There is lack of normal capture of the disc during open-mouth maneuvers. There is also this mildly decreased anterior translation. Left side: Disc is normally positioned. The articular disc demonstrates normal biconcave morphology and signal intensity. There is no joint effusion. The mandibular condyle and articular eminence have a normal appearance without evidence for degenerative change.There is normal articular disc and condylar translation in the opened mouth positions.. IMPRESSION: 1. On the right, disc is anteriorly and laterally displaced on the open-mouth views. There is lack of normal capture of the disc and mildly decreased anterior translation during open mouth maneuvers. 2. Normal left TMJ. 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.
FINDINGS: Right side: The articular disc demonstrates mild thickening and intermediate signal posteriorly. Disc appears anteriorly and also mildly laterally displaced in the closed mouth position. There is a small joint effusion. The mandibular condyle and articular eminence have a normal appearance without evidence for degenerative change.There is lack of normal capture of the disc during open-mouth maneuvers. There is also this mildly decreased anterior translation. Left side: Disc is normally positioned. The articular disc demonstrates normal biconcave morphology and signal intensity. There is no joint effusion. The mandibular condyle and articular eminence have a normal appearance without evidence for degenerative change.There is normal articular disc and condylar translation in the opened mouth positions..
FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Positive for pulmonary embolus. - Pulmonary Embolus Distribution: Extending from the distal aspect of the left main pulmonary artery to involve the lobar pulmonary arteries of both the upper and lower left lobes. Distal segmental branches of the pulmonary artery on the left appear well-opacified. There is also nonocclusive emboli extending from the distal aspect of the right main pulmonary artery into the lobar branches of the upper, middle, and lower right lobes. These extend into the segmental and subsegmental branches of the upper, middle and lower lobes. - Pulmonary Artery Diameter: Dilated measuring 38 mm. - Ascending Aortic Diameter: Normal. - RV:LV Ratio: Abnormal dilatation of the RV. - Interventricular Septum: Abnormal straightening. - Contrast reflux into IVC: Abnormal reflux into the IVC. LUNGS / AIRWAYS / PLEURA: Patchy opacities involving the superior and posterior aspect of the right middle lobe as well as a small portion of the inferior aspect of the right upper lobe. No pleural effusion or pneumothorax. The left lung is clear. Tracheobronchial tree is patent. HEART / OTHER VESSELS: Heart size is normal. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Hepatic steatosis. MUSCULOSKELETAL: No significant abnormality.
15,688
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Hepatocellular carcinoma status post TACE. COMPARISON: MRI of abdomen dated 11/9/2021 and chemoembolization dated 12/21/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 260 lbs. IV contrast: ProHance, 20 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. ABDOMEN: LIVER: Cirrhotic. No evidence of steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Suspected interval TACE of lesion in the hepatic dome. There is associated with intermediate T2 signal. - Location: Segment(s) VII - Size : 3.5 cm (series 603, image 75), similar in size to prior exam. - 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 - Lesion Number: 2 - Description: Suspected interval TACE of lesion in the right hepatic lobe. Associated intermediate T2 signal. - Location: Segment(s) VII - Size : 1.9 cm (series 603, image 56), decreased in size since prior exam. - 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 Redemonstration of posttreatment related changes involving the left hepatic lobe with areas of capsular retraction, atrophy, and heterogeneous T2/T1 signal intensity throughout. There is an area of nodular enhancement at the superior margin of the treated zone which is increased in conspicuity since the prior exam and measures approximately 1.5 cm (series 603, image 80). This area does not demonstrate washout, LR-TR equivocal. UNTREATED OR NEW LIVER LESION(S): Subcentimeter foci of arterial hyperenhancement without washout as seen on series 603, image 86 and 79, 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. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. 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: Unchanged enhancing, T2 hyperintense vascular malformation in the left chest wall (series 301, image 53) MUSCULOSKELETAL: Scoliosis. CONCLUSION: 1. Interval TACE of the right hepatic lobe lesions with peripheral arterial hyperenhancement, both LR-TR equivocal. 2. Redemonstration of treatment related effects involving the left hepatic lobe, with more conspicuous area of adjacent nodular enhancement without washout, LR-TR equivocal. 3. Additional LR-3 lesions as described. 4. Hepatic cirrhosis without significant sequela of portal hypertension. 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.
FINDINGS: STRUCTURED REPORT: MR HCC Follow-up IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No evidence of steatosis. TREATED LIVER LESIONS: - Lesion Number: 1 - Description: Suspected interval TACE of lesion in the hepatic dome. There is associated with intermediate T2 signal. - Location: Segment(s) VII - Size : 3.5 cm (series 603, image 75), similar in size to prior exam. - 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 - Lesion Number: 2 - Description: Suspected interval TACE of lesion in the right hepatic lobe. Associated intermediate T2 signal. - Location: Segment(s) VII - Size : 1.9 cm (series 603, image 56), decreased in size since prior exam. - 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 Redemonstration of posttreatment related changes involving the left hepatic lobe with areas of capsular retraction, atrophy, and heterogeneous T2/T1 signal intensity throughout. There is an area of nodular enhancement at the superior margin of the treated zone which is increased in conspicuity since the prior exam and measures approximately 1.5 cm (series 603, image 80). This area does not demonstrate washout, LR-TR equivocal. UNTREATED OR NEW LIVER LESION(S): Subcentimeter foci of arterial hyperenhancement without washout as seen on series 603, image 86 and 79, 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. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Absent. LYMPH NODES: None enlarged. SPLEEN: Normal size and appearance. 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: Unchanged enhancing, T2 hyperintense vascular malformation in the left chest wall (series 301, image 53) MUSCULOSKELETAL: Scoliosis.
FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Extensive coronary vascular calcifications. Postsurgical changes of CABG. Heart size is normal. MEDIASTINUM / ESOPHAGUS: Postsurgical changes of median sternotomy and CABG within the anterior mediastinum. Please see below musculoskeletal description for further findings related to sternotomy. LYMPH NODES: None enlarged. CHEST WALL: Mild body wall edema. Fat stranding overlies the anterior chest wall associated with the sternal wound. UPPER ABDOMEN: Asymmetric atrophy of the left kidney with respect to the right. Large simple left renal cyst. MUSCULOSKELETAL: Extensive widening of the previously noted median sternotomy with extensive bony resorption and destruction along its inferior aspect. Focal walled off fluid collection associated with the region of sternal resorption extends anteriorly into the anterior chest wall and measures 3.4 x 3.4 cm on axial series 201 image 55 there is questionable posterior extension/communication with the anterior mediastinum into a secondary region measuring approximately 2.7 x 1.8 cm on axial series 201 image 57. More superiorly there is another focal collection anterior to the sternum measures approximately 5.6 x 2.1 cm on axial series 201 image 34. At this location there is minimal associated bony resorption. Inferiorly there is extensive phlegmon and stranding most pronounced on axial series 201 image 89 measuring approximately 3.2 x 2.3 cm. Associated with this region there is apparent communication with the skin on axial series 201 image 78. Within the superior aspect of the anterior mediastinum there is increased soft tissue density, however this does not appear significantly changed from prior and may be unrelated to infectious etiologies and postsurgical in nature. Subacute fracture of the anterior left first rib. Multilevel discogenic degenerative change.
15,689
EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Falciform ligament lesion. COMPARISON: MRI of abdomen dated 5/2/2018 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 215 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: Loss of signal on opposed phase sequences adjacent to the falciform ligament, typical of focal fatty deposition. Mildly complex right hepatic lobe cyst with thin septation has slightly increased in size since the prior exam measuring approximately 6.1 x 5.0 cm (series 4, image 45), previously 4.3 x 3.0 cm. No internal postcontrast enhancement. Additional tiny subcentimeter cysts BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Unchanged cystic focus in the pancreatic tail measuring approximately 5 mm (series 4, image 42). No main pancreatic ductal dilatation. No associated worrisome features such as enhancing nodule or septation. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal right renal scarring. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Accessory bilateral renal arteries. Retroaortic left renal vein. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Focal fatty deposition along the falciform ligament. No suspicious hepatic lesion identified. 2. Subcentimeter cystic focus in the pancreatic tail is unchanged since prior exam and may represent a side branch IPMN. 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.
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: Loss of signal on opposed phase sequences adjacent to the falciform ligament, typical of focal fatty deposition. Mildly complex right hepatic lobe cyst with thin septation has slightly increased in size since the prior exam measuring approximately 6.1 x 5.0 cm (series 4, image 45), previously 4.3 x 3.0 cm. No internal postcontrast enhancement. Additional tiny subcentimeter cysts BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Unchanged cystic focus in the pancreatic tail measuring approximately 5 mm (series 4, image 42). No main pancreatic ductal dilatation. No associated worrisome features such as enhancing nodule or septation. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multifocal right renal scarring. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Accessory bilateral renal arteries. Retroaortic left renal vein. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subtle peripheral reticulation at both bases. DISTAL ESOPHAGUS: Small hiatal hernia. Wall thickening of the distal esophagus which can be seen with reflux esophagitis. HEART / VESSELS: 1 ABDOMEN and PELVIS: LIVER: Scattered simple hepatic cysts. BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal dilatation with the common bile duct measuring up to 1 cm. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Scattered simple renal cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is unremarkable. Small bowel is normal in caliber. COLON / APPENDIX: The appendix is not visualized. Moderate fecal burden. Diverticulosis. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Scattered vascular calcifications. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass within the limitations of extensive beam hardening artifact in the pelvis. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Severely decreased bone mineralization. Posterior fusion hardware spanning T10-L5 with multilevel disc spacers and anterior fixation screws at L2-L5. No evidence of hardware malfunction. Partially visualized right distal radius internal fixation hardware. Severe erosive changes in the bilateral hands and wrists suggestive of inflammatory arthropathy. Total left hip arthroplasty hardware is partially visualized. Advanced degenerative change of the bilateral MCP joints. Advanced degenerative change of the pubic symphysis with associated chondrocalcinosis, likely degenerative. Scattered regions of heterotopic ossification near the left hip.
15,690
MR Brain wo+w contrast 1/27/2022 11:21 PM Clinical Information: Word findings. Ro CVA and ICANS Spec Inst: Patient has a recent placement of IVCF and UJ stent Comparison: CT neck of 1/5/2022 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: 152 lbs. IV contrast: ProHance, 7 ml, per protocol. Findings: There is no acute infarct, intracranial hemorrhage, or mass effect. Brain volume is appropriate for age. Ventricles are normal in size. There are no extra-axial fluid collections. Major intracranial flow voids are patent. There is no abnormal enhancement. Conclusion: Unremarkable MRI of the brain.
Findings: There is no acute infarct, intracranial hemorrhage, or mass effect. Brain volume is appropriate for age. Ventricles are normal in size. There are no extra-axial fluid collections. Major intracranial flow voids are patent. There is no abnormal enhancement.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery atherosclerosis. ABDOMEN and PELVIS: LIVER: Unchanged hypoattenuating lesions in the right hepatic lobe, likely hepatic cysts. Subtle hypoattenuation in the posterior right hepatic lobe measuring 1.6 x 1.7 cm (image 84, series #2) corresponds to hyperenhancing lesion previously seen on CT abdomen and pelvis where it measured 1.6 x 1.3 cm (remeasured on prior exam). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal noncontrast appearance. SPLEEN: Calcified granulomas. ADRENALS: Normal. KIDNEYS: No renal calculi or hydronephrosis. Multiple vascular calcifications bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is not visualized. PERITONEUM / MESENTERY: Trace free fluid in the pelvis. RETROPERITONEUM: Normal. VESSELS: Advanced atherosclerosis of the infrarenal abdominal aorta and bilateral iliac arteries. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostatomegaly. BODY WALL: Small left fat-containing inguinal hernia. Small fat-containing periumbilical hernia. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change of the thoracolumbar spine. No aggressive osseous lesions.
15,691
MR scan of the brain without contrast. Clinical: Asymmetrical hearing loss, left greater than right. Technical: IAC protocol before and after contrast. ProHance, 20 ml, per protocol. Findings: The parenchyma appears normal with no infarct, mass, hemorrhage or extracerebral collection. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is normal appearance of the inner ear structures which are visible. Thin section CT scan of the petrous bones might be of value. There is a linear artifact in the right petrous bone at the plane of the IAC, axial series 6 #19. Postcontrast scans show no abnormal enhancement. Normal signal voids are seen in the major intracranial vessels and dural venous sinuses. No marrow defect is seen. --------------- Conclusion: Essentially negative pre and postcontrast cranial MR scan.
Findings: The parenchyma appears normal with no infarct, mass, hemorrhage or extracerebral collection. The ventricles are small with normal appearance. The posterior fossa contents are unremarkable. There is normal appearance of the inner ear structures which are visible. Thin section CT scan of the petrous bones might be of value. There is a linear artifact in the right petrous bone at the plane of the IAC, axial series 6 #19. Postcontrast scans show no abnormal enhancement. Normal signal voids are seen in the major intracranial vessels and dural venous sinuses. No marrow defect is seen. ---------------
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: Scattered vascular calcifications. CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: Hypoattenuating filling defect along the inferior aspect of the right main pulmonary artery best appreciated on coronal series 505 image 75 and sagittal series 502 image 122. Evaluation for distal pulmonary emboli is significantly limited secondary to bolus timing and significant respiratory motion. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: Extensive chronic appearing mural thrombus is noted extending from the distal aspect of the aortic arch into the descending thoracic aorta. No aortic aneurysm or evidence of acute dissection. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: Again noted is large chronic mural thrombus throughout the descending thoracic aorta. At the level of the hiatus there is mild ectatic dilatation measuring up to 2.8 cm. ABDOMINAL AORTA: Scattered mural thrombus and atherosclerotic plaque. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Common and external iliac arteries are patent. The internal iliac artery is not well opacified, likely occluded. Large collaterals are noted in the distribution of the right internal iliac artery suggesting chronicity. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Complete occlusion of the left common iliac artery without distal reconstitution within the field-of-view. Extensive collaterals are noted throughout this region suggesting chronicity. ------------------------------------------------------------- LOWER NECK: Mild enlargement of the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Apical predominant centrilobular and paraseptal emphysema. Dependent atelectasis bilaterally. Solid pulmonary nodule in the right lower lobe measuring up to 9 mm (axial series 502 image 142). Asymmetric elevation of left hemidiaphragm. HEART / OTHER VESSELS: Marked left ventricular hypertrophy. The right internal jugular vein is not well-visualized and appears atretic. Significant collateralization on this side is noted. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Few subcentimeter hypodensities are indeterminate, possibly representing cysts. Liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple small bilateral cortical defects involving the kidneys. Contrast is noted within the collecting systems and proximal ureters. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Partially visualized appendix is normal. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Distended with contrast. REPRODUCTIVE ORGANS: The prostate is enlarged with up lifting of the floor of the urinary bladder. The right testicle appears to be retracted into the canal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Advanced multilevel discogenic degenerative change with lower lumbar spine facet arthropathy. Advanced degenerative change of both hips.
15,692
EXAM:MR Wrist Right wo+w contrast CLINICAL INFORMATION:Right wrist pain with history of scaphoid fracture. For osteonecrosis COMPARISON:11/18/2021 TECHNIQUE:Multiplanar and multisequence MRI of the right wrist was obtained without and with intravenous contrast. Patient weight: 205 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. FINDINGS: BONES: Internal fixation is noted within the scaphoid resulting in significant metallic artifact within this region. No aggressive osseous lesion. ARTICULATIONS: Effusion:None. Alignment:Normal. Cartilage:No focal defects. Synovium:No synovial thickening. TRIANGULAR FIBROCARTILAGE:No perforation or tear. INTRINSIC LIGAMENTS: Scapholunate ligament: Not visualized secondary to artifact. Lunotriquetral ligament:Not visualized secondary to artifact. TENDONS: Flexor tendons:Normal. Extensor tendons:Normal. Extensor carpi ulnaris:Normal. No volar or dorsal ganglion cyst. CONCLUSION: 1. No definite etiology for wrist pain is seen. The scaphoid is not well evaluated secondary to metallic artifact. Recommend repeat radiographs 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.
FINDINGS: BONES: Internal fixation is noted within the scaphoid resulting in significant metallic artifact within this region. No aggressive osseous lesion. ARTICULATIONS: Effusion:None. Alignment:Normal. Cartilage:No focal defects. Synovium:No synovial thickening. TRIANGULAR FIBROCARTILAGE:No perforation or tear. INTRINSIC LIGAMENTS: Scapholunate ligament: Not visualized secondary to artifact. Lunotriquetral ligament:Not visualized secondary to artifact. TENDONS: Flexor tendons:Normal. Extensor tendons:Normal. Extensor carpi ulnaris:Normal. No volar or dorsal ganglion cyst.
FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: Scattered vascular calcifications. CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: Hypoattenuating filling defect along the inferior aspect of the right main pulmonary artery best appreciated on coronal series 505 image 75 and sagittal series 502 image 122. Evaluation for distal pulmonary emboli is significantly limited secondary to bolus timing and significant respiratory motion. Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: Extensive chronic appearing mural thrombus is noted extending from the distal aspect of the aortic arch into the descending thoracic aorta. No aortic aneurysm or evidence of acute dissection. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: Again noted is large chronic mural thrombus throughout the descending thoracic aorta. At the level of the hiatus there is mild ectatic dilatation measuring up to 2.8 cm. ABDOMINAL AORTA: Scattered mural thrombus and atherosclerotic plaque. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Common and external iliac arteries are patent. The internal iliac artery is not well opacified, likely occluded. Large collaterals are noted in the distribution of the right internal iliac artery suggesting chronicity. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Complete occlusion of the left common iliac artery without distal reconstitution within the field-of-view. Extensive collaterals are noted throughout this region suggesting chronicity. ------------------------------------------------------------- LOWER NECK: Mild enlargement of the right thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Apical predominant centrilobular and paraseptal emphysema. Dependent atelectasis bilaterally. Solid pulmonary nodule in the right lower lobe measuring up to 9 mm (axial series 502 image 142). Asymmetric elevation of left hemidiaphragm. HEART / OTHER VESSELS: Marked left ventricular hypertrophy. The right internal jugular vein is not well-visualized and appears atretic. Significant collateralization on this side is noted. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Few subcentimeter hypodensities are indeterminate, possibly representing cysts. Liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple small bilateral cortical defects involving the kidneys. Contrast is noted within the collecting systems and proximal ureters. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Partially visualized appendix is normal. The colon is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Distended with contrast. REPRODUCTIVE ORGANS: The prostate is enlarged with up lifting of the floor of the urinary bladder. The right testicle appears to be retracted into the canal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Advanced multilevel discogenic degenerative change with lower lumbar spine facet arthropathy. Advanced degenerative change of both hips.
15,693
MR Cervical Spine wo+w contrast 1/26/2022 1:09 PM Clinical Information: Primary spinal cord tumor, monitor, C72.0 Malignant neoplasm of spinal cord Comparison: Multiple priors, most recent MRI cervical spine with and without contrast 11/11/2021 Technique: T2 sagittal and axial fast spin spin echo, T1 sagittal spin echo, sagittal STIR, axial T2* gradient echo. Patient weight: 136 lbs. IV contrast: ProHance, 13 ml, per protocol. Findings: Stable postsurgical changes from prior C3 to C5 laminectomy. Reversal of cervical lordotic curvature and minimal degenerative changes with anterior and posterior osteophytosis, disc desiccation and disc height reduction appear similar to the prior study. Trace anterolisthesis of C3 on C4 and C4 on C5. Unchanged size and appearance of the cervical intramedullary mass extending from C2 to C5 measuring 49 mm and maximum craniocaudal extent. Again seen are punctate foci of enhancement within the lesion. No significant interval increase in size or new foci of enhancement identified. Multilevel degenerative changes in the axial images : C2-3: No significant disc bulge. No central canal or neuroforaminal stenosis. C3-4: Posterior disc osteophyte complex with mild bilateral neural foraminal narrowing. No central stenosis. C4-5: Unroofing of the disc. Posterior disc osteophyte complex with mild bilateral neural foraminal narrowing. No central stenosis. C5-6: Posterior disc osteophyte complex causing bilateral neural foraminal narrowing and mild central stenosis. No cord compression. C6-7: Posterior disc osteophyte complex causing moderate to severe bilateral neuroforaminal narrowing and mild central canal narrowing. No cord compression or cord signal carotid C7-T1: Small stable left paracentral disc protrusion. No significant neural foraminal or central stenosis. Impression: 1. Stable size and appearance of the intramedullary cervical condition with punctate foci of contrast enhancement. 2. Other findings as describe above are also unchanged.
Findings: Stable postsurgical changes from prior C3 to C5 laminectomy. Reversal of cervical lordotic curvature and minimal degenerative changes with anterior and posterior osteophytosis, disc desiccation and disc height reduction appear similar to the prior study. Trace anterolisthesis of C3 on C4 and C4 on C5. Unchanged size and appearance of the cervical intramedullary mass extending from C2 to C5 measuring 49 mm and maximum craniocaudal extent. Again seen are punctate foci of enhancement within the lesion. No significant interval increase in size or new foci of enhancement identified. Multilevel degenerative changes in the axial images : C2-3: No significant disc bulge. No central canal or neuroforaminal stenosis. C3-4: Posterior disc osteophyte complex with mild bilateral neural foraminal narrowing. No central stenosis. C4-5: Unroofing of the disc. Posterior disc osteophyte complex with mild bilateral neural foraminal narrowing. No central stenosis. C5-6: Posterior disc osteophyte complex causing bilateral neural foraminal narrowing and mild central stenosis. No cord compression. C6-7: Posterior disc osteophyte complex causing moderate to severe bilateral neuroforaminal narrowing and mild central canal narrowing. No cord compression or cord signal carotid C7-T1: Small stable left paracentral disc protrusion. No significant neural foraminal or central stenosis.
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Supraclavicular lymphadenopathy, left greater than right CHEST: LUNGS / AIRWAYS / PLEURA: Small bilateral pleural effusions. Dependent atelectasis. Scattered left lower lobe tree-in-bud and groundglass opacities, peribronchial thickening with mucous plugging. Noncalcified 3 mm nodule along the right minor fissure, likely lymph node. Biapical pleural-parenchymal scarring. Central airways are patent. Mild mucous plugging in the right lower and left upper lobe bronchi. HEART / VESSELS: Right IJ Mediport catheter is present with tip at the cavoatrial junction. Normal heart size. Small pericardial effusion. Advanced coronary artery atherosclerotic calcifications. Mild atherosclerosis of the aortic arch and branch vessels. MEDIASTINUM / ESOPHAGUS: Prominence of the distal esophageal wall (image 167, series #2 one) which may be secondary to decompression or may represent esophageal mass/thickening. LYMPH NODES: Multiple enlarged mediastinal lymph nodes. Enlarged left internal mammary chain, left subpectoral, left axillary lymph nodes. There is also a prominent right internal mammary chain lymph node on axial image 107. Shoddy supradiaphragmatic lymph nodes. CHEST WALL: Anasarca ABDOMEN and PELVIS: LIVER: No focal hepatic lesion identified, however evaluation is limited due to noncontrast technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Asymmetric thickening and nodularity of the left adrenal gland KIDNEYS: Bilateral renal atrophy. Left pelviectasis and mildly dilated ureter. LYMPH NODES: Multiple enlarged mesenteric lymph nodes, predominantly in the left hemiabdomen. Shoddy para-aortic lymph nodes. STOMACH / SMALL BOWEL: Heterogeneous appearance of the distal esophagus and proximal stomach at the gastroesophageal junction/lesser curve with associated wall thickening (image 196, series #201). COLON / APPENDIX: Mild thickening of the distal transverse and proximal descending colon wall. Normal appendix. PERITONEUM / MESENTERY: Diffuse mesenteric and peritoneal nodularity. Right lower abdominal drain terminating in the pelvis. Trace free fluid. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate calcified atherosclerosis of the abdominal aorta and branch vessels. URINARY BLADDER: Asymmetric hyperattenuating thickening of the left urinary bladder wall. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse body wall anasarca. Stranding and mild asymmetric enlargement of the abdominal wall musculature at the insertion site of the peritoneal drain without focal fluid collection. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative change of the thoracolumbar spine. Age indeterminate compression deformities of the T6, T8 and T9 vertebral bodies.
15,694
Clinical history:Dysmetria in the left upper extremity Comparison:CT head 1/22/2022, 1/2/2022 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained Patient weight: 140 lbs. IV contrast: ProHance, 13 ml, per protocol. Findings: There is continued evolution of a large 4.6 x4 x 3. cm large right frontal hematoma. There is surrounding edema, and 1.1 cm leftward bowing of the anterior interhemispheric falx. Accounting for intrinsic T1 signal, there is no underlying mass. Mild likely reactive dural thickening adjacent to the hemorrhages. There is an additional smaller higher medial right frontal contusion. Thin subdural hemorrhage along the right frontal convexity. Again seen small volume extra-axial hemorrhage along the right temporal convexity. Continued evolution of small extra-axial hemorrhage along the left frontal convexity. Continued evolution of left temporal contusions and adjacent extra-axial hemorrhages. There is also thin 5 mm millimeters left occipitoparietal subdural hemorrhage. There is no new hemorrhage. There is no intracranial infarct. Ventricular caliber and configuration are stable with mild effacement of the right frontal horn. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: Continued evolution of multifocal hemorrhages, with largest 4.6 cm hematoma involving the right frontal lobe. Associated edema results and 1.1 cm leftward bowing of the anterior interhemispheric falx. No appreciable underlying mass, within limits of intrinsic T1 signal. Additional multiple smaller hemorrhages as described in the report.
Findings: There is continued evolution of a large 4.6 x4 x 3. cm large right frontal hematoma. There is surrounding edema, and 1.1 cm leftward bowing of the anterior interhemispheric falx. Accounting for intrinsic T1 signal, there is no underlying mass. Mild likely reactive dural thickening adjacent to the hemorrhages. There is an additional smaller higher medial right frontal contusion. Thin subdural hemorrhage along the right frontal convexity. Again seen small volume extra-axial hemorrhage along the right temporal convexity. Continued evolution of small extra-axial hemorrhage along the left frontal convexity. Continued evolution of left temporal contusions and adjacent extra-axial hemorrhages. There is also thin 5 mm millimeters left occipitoparietal subdural hemorrhage. There is no new hemorrhage. There is no intracranial infarct. Ventricular caliber and configuration are stable with mild effacement of the right frontal horn. Minor scattered paranasal mucosal thickening. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.
FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: 11 mm hypodense nodule in the right thyroid lobe CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Extensive new patchy regions of consolidation and groundglass most pronounced within the upper lung fields. Interval development of a moderate left and small right pleural effusion with associated overlying atelectasis. Trace secretions within the trachea HEART / OTHER VESSELS: Coronary calcifications. Mild aortoiliac atherosclerotic calcifications extending into the origins of the mediastinal great vessels. MEDIASTINUM / ESOPHAGUS: Mild wall thickening of the distal esophagus. LYMPH NODES: None enlarged. CHEST WALL: Right upper anterior chest wall contusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: There is a tiny amount of stranding adjacent to the pancreatic tail. SPLEEN: Absent. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Redemonstrated gastric band. The small bowel is nondilated. COLON / APPENDIX: The appendix is not identified. The colon is normal. Left upper quadrant Blake drain is unchanged in positioning. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Right inferior approach arterial line is noted. Extensive atherosclerotic vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. Small amount of intraluminal gas REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Diffuse body wall edema. Interval evacuation of the large left anterior abdominal wall hematoma with postsurgical changes and surgical material packed within the cavity. Small residual hematoma is noted near the anterior opening. No active extravasation. MUSCULOSKELETAL: Redemonstrated left proximal clavicular fracture. Redemonstrated manubrial fracture. Numerous bilateral rib fractures are unchanged. L2 and L3 transverse process fractures are redemonstrated. Multilevel discogenic degenerative change. Redemonstrated anterior wedge compression fracture of T12.
15,695
EXAM: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast CLINICAL INFORMATION: Further evaluation of abnormality seen on CT. COMPARISON: None. TECHNIQUE: MR Cholangiopancreatography MRCP, MR Abdomen wo+w contrast Patient weight: 150 lbs. IV contrast: ProHance, 14 ml, per protocol. IV contrast injection rate: 1.70 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: No biliary ductal dilation. No dominant biliary stricturing or intraluminal filling defects visualized. GALLBLADDER: Absent. PANCREAS: The distal pancreatic body and tail are atrophic with multiple cystic lesions in the pancreatic tail, which appear to communicate with the main pancreatic duct. There is segmental dilation of the main pancreatic duct up to 0.9 cm on image 7 series 13. No solid pancreatic masses. Small separate cystic lesion more consistent with side branch IPMN in the uncinate process on image 14 series 8 measuring approximately 8 mm. No suspicious mural nodularity or abnormal enhancement is visualized. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A few small nonenhancing renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast implants. MUSCULOSKELETAL: Susceptibility artifact related to spinal fixation hardware in the lumbar spine. Otherwise no abnormal marrow signal abnormality. CONCLUSION: Segmental main pancreatic ductal dilation with associated cystic pancreatic tail lesions are most which could represent main duct stricture versus main duct IPMN. Recommend further evaluation with EUS, if clinically indicated. 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.
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: No biliary ductal dilation. No dominant biliary stricturing or intraluminal filling defects visualized. GALLBLADDER: Absent. PANCREAS: The distal pancreatic body and tail are atrophic with multiple cystic lesions in the pancreatic tail, which appear to communicate with the main pancreatic duct. There is segmental dilation of the main pancreatic duct up to 0.9 cm on image 7 series 13. No solid pancreatic masses. Small separate cystic lesion more consistent with side branch IPMN in the uncinate process on image 14 series 8 measuring approximately 8 mm. No suspicious mural nodularity or abnormal enhancement is visualized. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: A few small nonenhancing renal cysts. Otherwise, bilateral kidneys are normal without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: Bilateral breast implants. MUSCULOSKELETAL: Susceptibility artifact related to spinal fixation hardware in the lumbar spine. Otherwise no abnormal marrow signal abnormality.
FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. No evidence of acute infarction. Mild age-appropriate diffuse parenchymal volume loss. Periventricular white matter hypoattenuation consistent with chronic microangiopathic changes. Remote lacunar infarct in the right basal ganglia. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Bilateral mastoid air cells are clear. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mild mucosal thickening of the left maxillary sinus. Small mucous retention cyst in the right maxillary sinus. VESSELS: Scattered calcified atherosclerosis of the carotid siphons and vertebral arteries.
15,696
MR scan of the brain before and after contrast Clinical Information: Multiple sclerosis. Comparison: MR 9/7/2021, 7/1/2019, and 8/1/2006. Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes before and after contrast per departmental protocol. IV contrast: ProHance, 20 ml, per protocol. Findings: Multiple ovoid FLAIR hyperintensities at the callososeptal interface and perpendicular to the lateral ventricles similar to MR dated 7/1/2019. Isolated juxtacortical lesions, for example in the posterior left superior frontal gyrus, are unchanged. No new T2/FLAIR hyperintensities or enhancing parenchymal lesion is identified. No significant abnormality in the visualized cord. No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No significant abnormality of the extracranial osseous and soft tissue structures. ---------------- Conclusion: Unchanged pattern of T/2FLAIR hyperintensities consistent with patient's known multiple sclerosis. No enhancing lesions to suggest 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.
Findings: Multiple ovoid FLAIR hyperintensities at the callososeptal interface and perpendicular to the lateral ventricles similar to MR dated 7/1/2019. Isolated juxtacortical lesions, for example in the posterior left superior frontal gyrus, are unchanged. No new T2/FLAIR hyperintensities or enhancing parenchymal lesion is identified. No significant abnormality in the visualized cord. No acute infarct or intracranial hemorrhage. No midline shift, hydrocephalus, mass effect, or other space-occupying lesion. No significant abnormality of the extracranial osseous and soft tissue structures. ----------------
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip terminates 2.5 cm superior to the carina. Inspissated secretions within the trachea. Subtle regions of increased attenuation/groundglass are noted throughout both lungs with dependent atelectasis and mild septal thickening at the bilateral bases. No pleural effusion or pneumothorax. HEART / VESSELS: Right approach central venous catheter distal tip terminates in the right atrium. Minimal vascular coronary calcifications. Otherwise unremarkable for noncontrast technique. MEDIASTINUM / ESOPHAGUS: Esophagogastric catheter in place. LYMPH NODES: None enlarged. CHEST WALL: Mild gynecomastia. No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology of the liver. BILIARY TRACT: Normal. GALLBLADDER: Hyperdense contents within the gallbladder. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Layering hyperdense contents within a small pericalyceal cyst of the right kidney. The kidneys are otherwise unremarkable. LYMPH NODES: Scattered mildly prominent para-aortic and mesenteric lymph nodes. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the gastric fundus. Mild gastric wall thickening at the antrum. Diffusely dilated gas and fluid-filled small bowel without transition point. Distal loops of small bowel show fecalization suggestive of slow transit. COLON / APPENDIX: Partially visualized appendix is normal. The colon mildly dilated and otherwise unremarkable. PERITONEUM / MESENTERY: Large volume ascites. Significant mesenteric congestion is noted. RETROPERITONEUM: Retroperitoneal edema is noted. VESSELS: Extensive enlarged portal venous system collaterals including spleno renal shunt. Otherwise unremarkable for noncontrast technique aside from scattered atherosclerotic calcifications. URINARY BLADDER: Partially collapsed around a Foley balloon. REPRODUCTIVE ORGANS: A moderate amount of ascites is noted tracking within the left inguinal canal. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Bilateral L5 pars defects with associated grade 1 anterolisthesis of L5 on S1.
15,697
EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: History of prostate cancer undergoing active surveillance; rising PSA (5.13 in 12/2020-->9.53 in 12/2021). 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: 250 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2.50 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 5.3 x 7.4 x 6.6 cm; estimated volume: 135 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 10; image 701; - Size: 7 x 7 mm; - Location: left; low apex; posterolateral peripheral zone; - T2WI: 4; DWI: 4; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present); - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse prostate abnormalities: Multiple BPH nodules throughout the central gland. Other prostate findings: None. 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. PI-RADS 4 lesion in the left posterolateral peripheral zone at the apex. 2. Enlarged prostate gland with multiple BPH nodules. 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.
FINDINGS: STRUCTURED REPORT: MRI Prostate PROSTATE: Measurement: 5.3 x 7.4 x 6.6 cm; estimated volume: 135 cc Focal lesion(s): Lesion # 1 (index lesion): - Key image: series 10; image 701; - Size: 7 x 7 mm; - Location: left; low apex; posterolateral peripheral zone; - T2WI: 4; DWI: 4; DCE (early and focal enhancement): positive; - PI-RADS v2.1 score: 4 - High (clinically significant cancer is likely to be present); - Likelihood of extraprostatic extension: 1 - Highly unlikely; - Likelihood of seminal vesicle invasion: 1 - Highly unlikely; Diffuse prostate abnormalities: Multiple BPH nodules throughout the central gland. Other prostate findings: None. 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
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube distal tip terminates 2.5 cm superior to the carina. Inspissated secretions within the trachea. Subtle regions of increased attenuation/groundglass are noted throughout both lungs with dependent atelectasis and mild septal thickening at the bilateral bases. No pleural effusion or pneumothorax. HEART / VESSELS: Right approach central venous catheter distal tip terminates in the right atrium. Minimal vascular coronary calcifications. Otherwise unremarkable for noncontrast technique. MEDIASTINUM / ESOPHAGUS: Esophagogastric catheter in place. LYMPH NODES: None enlarged. CHEST WALL: Mild gynecomastia. No significant abnormality. ABDOMEN and PELVIS: LIVER: Cirrhotic morphology of the liver. BILIARY TRACT: Normal. GALLBLADDER: Hyperdense contents within the gallbladder. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Layering hyperdense contents within a small pericalyceal cyst of the right kidney. The kidneys are otherwise unremarkable. LYMPH NODES: Scattered mildly prominent para-aortic and mesenteric lymph nodes. STOMACH / SMALL BOWEL: Esophagogastric tube distal tip terminates in the gastric fundus. Mild gastric wall thickening at the antrum. Diffusely dilated gas and fluid-filled small bowel without transition point. Distal loops of small bowel show fecalization suggestive of slow transit. COLON / APPENDIX: Partially visualized appendix is normal. The colon mildly dilated and otherwise unremarkable. PERITONEUM / MESENTERY: Large volume ascites. Significant mesenteric congestion is noted. RETROPERITONEUM: Retroperitoneal edema is noted. VESSELS: Extensive enlarged portal venous system collaterals including spleno renal shunt. Otherwise unremarkable for noncontrast technique aside from scattered atherosclerotic calcifications. URINARY BLADDER: Partially collapsed around a Foley balloon. REPRODUCTIVE ORGANS: A moderate amount of ascites is noted tracking within the left inguinal canal. BODY WALL: Scattered body wall edema. MUSCULOSKELETAL: Bilateral L5 pars defects with associated grade 1 anterolisthesis of L5 on S1.
15,698
MR Brain wo+w contrast 1/26/2022 2:20 PM Clinical Information: Reevaluation after bilateral DBS placement Comparison: Not available Technique: Multiplanar MR imaging was performed with and without contrast as per department protocol. Findings: DBS implants are located in bilateral subthalamic regions. There is mild diffuse cerebral volume loss with associated ex vacuo dilatation of ventricular system, due to atrophic changes. There are scattered areas of periventricular and deep white matter FLAIR hyper signal intensity, secondary to microangiopathic changes. Magnetic susceptibility is noted in the location of bilateral DBS placement and along the tract of intervention. No evidence of abnormal enhancement is seen. 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 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.
Findings: DBS implants are located in bilateral subthalamic regions. There is mild diffuse cerebral volume loss with associated ex vacuo dilatation of ventricular system, due to atrophic changes. There are scattered areas of periventricular and deep white matter FLAIR hyper signal intensity, secondary to microangiopathic changes. Magnetic susceptibility is noted in the location of bilateral DBS placement and along the tract of intervention. No evidence of abnormal enhancement is seen. 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.
FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: 11 mm hypodense nodule in the right thyroid lobe CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Extensive new patchy regions of consolidation and groundglass most pronounced within the upper lung fields. Interval development of a moderate left and small right pleural effusion with associated overlying atelectasis. Trace secretions within the trachea HEART / OTHER VESSELS: Coronary calcifications. Mild aortoiliac atherosclerotic calcifications extending into the origins of the mediastinal great vessels. MEDIASTINUM / ESOPHAGUS: Mild wall thickening of the distal esophagus. LYMPH NODES: None enlarged. CHEST WALL: Right upper anterior chest wall contusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: There is a tiny amount of stranding adjacent to the pancreatic tail. SPLEEN: Absent. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Redemonstrated gastric band. The small bowel is nondilated. COLON / APPENDIX: The appendix is not identified. The colon is normal. Left upper quadrant Blake drain is unchanged in positioning. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Right inferior approach arterial line is noted. Extensive atherosclerotic vascular calcifications. URINARY BLADDER: Collapsed around a Foley balloon. Small amount of intraluminal gas REPRODUCTIVE ORGANS: The uterus is absent. No adnexal mass. BODY WALL: Diffuse body wall edema. Interval evacuation of the large left anterior abdominal wall hematoma with postsurgical changes and surgical material packed within the cavity. Small residual hematoma is noted near the anterior opening. No active extravasation. MUSCULOSKELETAL: Redemonstrated left proximal clavicular fracture. Redemonstrated manubrial fracture. Numerous bilateral rib fractures are unchanged. L2 and L3 transverse process fractures are redemonstrated. Multilevel discogenic degenerative change. Redemonstrated anterior wedge compression fracture of T12.
15,699
EXAM: MR lumbar spine wo contrast 1/26/2022 1:27 PM Clinical: progressive neurologic deficits, pain in right leg, pelvic and perineal pain. Leg weakness bilaterally. numbness and tingling in the legs. COMPARISON: CT abdomen dated 5/26/2019, 5/16/2014. 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 lumbar spine protocol. FINDINGS: Sagittal imaging demonstrates vertebral body heights and alignment to be maintained. Multilevel mild degenerative discogenic disease with diffuse disc desiccation, most prominently at T11-T12 with moderate disc space height loss. Ill-defined, T1 and T2 hyperintense lesion in the L1 vertebral body, likely intraosseous hemangioma, correlating with prior CTs. The marrow signals otherwise appear normal. The conus terminates at L2. There is matting of roots of the cauda equina posteriorly, likely adhesions. Axial images are evaluated on a level by level basis: T11-T12: Mild diffuse disc bulge with partial effacement of the ventral thecal sac. No significant spinal canal or neuroforaminal stenosis. T12-L1: Minimal diffuse disc bulge and minimal bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L1-2: Mild diffuse disc bulge and minimal bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild diffuse disc bulge and minimal bilateral facet arthropathy. No significant spinal canal stenosis. Minimal bilateral neuroforaminal stenosis. L3-4: Minimal left foraminal zone disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening. Minimal spinal canal stenosis. Minimal right and mild left neuroforaminal stenosis. L4-5: Mild diffuse disc bulge, mild right and minimal left facet arthropathy, and minimal ligamentum flavum thickening. Minimal spinal canal stenosis. Mild left neuroforaminal stenosis. L5-S1: Minimal diffuse disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. Left interpolar T2 hyperintense renal cyst. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. _________________________ CONCLUSION: 1. No acute lumbar spine process. Matting of roots of cauda equina posteriorly, likely adhesions. 2. Multilevel mild degenerative discogenic disease and facet arthropathy, resulting in mild left neuroforaminal stenosis at L3-L5. 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.
FINDINGS: Sagittal imaging demonstrates vertebral body heights and alignment to be maintained. Multilevel mild degenerative discogenic disease with diffuse disc desiccation, most prominently at T11-T12 with moderate disc space height loss. Ill-defined, T1 and T2 hyperintense lesion in the L1 vertebral body, likely intraosseous hemangioma, correlating with prior CTs. The marrow signals otherwise appear normal. The conus terminates at L2. There is matting of roots of the cauda equina posteriorly, likely adhesions. Axial images are evaluated on a level by level basis: T11-T12: Mild diffuse disc bulge with partial effacement of the ventral thecal sac. No significant spinal canal or neuroforaminal stenosis. T12-L1: Minimal diffuse disc bulge and minimal bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L1-2: Mild diffuse disc bulge and minimal bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild diffuse disc bulge and minimal bilateral facet arthropathy. No significant spinal canal stenosis. Minimal bilateral neuroforaminal stenosis. L3-4: Minimal left foraminal zone disc bulge, bilateral facet arthropathy, and ligamentum flavum thickening. Minimal spinal canal stenosis. Minimal right and mild left neuroforaminal stenosis. L4-5: Mild diffuse disc bulge, mild right and minimal left facet arthropathy, and minimal ligamentum flavum thickening. Minimal spinal canal stenosis. Mild left neuroforaminal stenosis. L5-S1: Minimal diffuse disc bulge and mild bilateral facet arthropathy. No significant spinal canal or neuroforaminal stenosis. Left interpolar T2 hyperintense renal cyst. The visualized paraspinal structures appear otherwise within normal limits. The remaining visualized osseous and soft tissue structures demonstrate normal MR signal characteristics. _________________________
FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Supraclavicular lymphadenopathy, left greater than right CHEST: LUNGS / AIRWAYS / PLEURA: Small bilateral pleural effusions. Dependent atelectasis. Scattered left lower lobe tree-in-bud and groundglass opacities, peribronchial thickening with mucous plugging. Noncalcified 3 mm nodule along the right minor fissure, likely lymph node. Biapical pleural-parenchymal scarring. Central airways are patent. Mild mucous plugging in the right lower and left upper lobe bronchi. HEART / VESSELS: Right IJ Mediport catheter is present with tip at the cavoatrial junction. Normal heart size. Small pericardial effusion. Advanced coronary artery atherosclerotic calcifications. Mild atherosclerosis of the aortic arch and branch vessels. MEDIASTINUM / ESOPHAGUS: Prominence of the distal esophageal wall (image 167, series #2 one) which may be secondary to decompression or may represent esophageal mass/thickening. LYMPH NODES: Multiple enlarged mediastinal lymph nodes. Enlarged left internal mammary chain, left subpectoral, left axillary lymph nodes. There is also a prominent right internal mammary chain lymph node on axial image 107. Shoddy supradiaphragmatic lymph nodes. CHEST WALL: Anasarca ABDOMEN and PELVIS: LIVER: No focal hepatic lesion identified, however evaluation is limited due to noncontrast technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Asymmetric thickening and nodularity of the left adrenal gland KIDNEYS: Bilateral renal atrophy. Left pelviectasis and mildly dilated ureter. LYMPH NODES: Multiple enlarged mesenteric lymph nodes, predominantly in the left hemiabdomen. Shoddy para-aortic lymph nodes. STOMACH / SMALL BOWEL: Heterogeneous appearance of the distal esophagus and proximal stomach at the gastroesophageal junction/lesser curve with associated wall thickening (image 196, series #201). COLON / APPENDIX: Mild thickening of the distal transverse and proximal descending colon wall. Normal appendix. PERITONEUM / MESENTERY: Diffuse mesenteric and peritoneal nodularity. Right lower abdominal drain terminating in the pelvis. Trace free fluid. No free intraperitoneal air. RETROPERITONEUM: Normal. VESSELS: Moderate calcified atherosclerosis of the abdominal aorta and branch vessels. URINARY BLADDER: Asymmetric hyperattenuating thickening of the left urinary bladder wall. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Diffuse body wall anasarca. Stranding and mild asymmetric enlargement of the abdominal wall musculature at the insertion site of the peritoneal drain without focal fluid collection. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative change of the thoracolumbar spine. Age indeterminate compression deformities of the T6, T8 and T9 vertebral bodies.