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15,800	EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Male patient 58 years with fu brain lesion, G93.89 Other specified disorders of brain TECHNIQUE: Axial FLAIR, axial DWI, axial T2, axial SWI images of the brain were obtained without intravenous gadolinium. In addition multiplanar T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 170 lbs. IV contrast: ProHance, 16 ml, per protocol. COMPARISON: 1/16/2020 FINDINGS: There is stable heterogeneous abnormal T2 hyperintense signal involving the medial left temporal lobe. There is extension into the posterior left hippocampus. There is also suggestion of minimal extension into the left insula. There is no abnormal enhancement. There is no abnormal restricted diffusion. No hemorrhage is identified. There is stable focal mass effect upon the left temporal horn CONCLUSION: No significant interval change in appearance of heterogeneous T2 hyperintense nonenhancing lesion within the medial left temporal lobe	FINDINGS: There is stable heterogeneous abnormal T2 hyperintense signal involving the medial left temporal lobe. There is extension into the posterior left hippocampus. There is also suggestion of minimal extension into the left insula. There is no abnormal enhancement. There is no abnormal restricted diffusion. No hemorrhage is identified. There is stable focal mass effect upon the left temporal horn	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: Normal. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
15,801	MR scans of the thoracic spine. Clinical: 1. Sarcoma of posterior thorax status post treatment Technical: T-spine protocol before and after contrast. Findings: There is a right paraspinal T6-T9 on the right, measuring 1.3 x 2.5 x 5 5.5 cm with T2/STIR hyperintensity and avid homogeneous enhancement, phlegmon vs recurrent tumor. There is extension along the posterior pleural space. Compared to the prior MR scan of the T-spine on 9/90/21 the appearance is similar, suggesting phlegmon. See (axial postcontrast series 18 #1). There is lesser slight enhancement in the left pleural space, unchanged. The thoracic vertebrae are normally formed and aligned. The craniovertebral junction appears normal on sagittal scout sequences. The cord has normal dimensions and signal intensity with no tumor, syrinx or atrophy. There is only minor, early degenerative disc disease. There is no significant disc bulge, protrusion or herniation. The marrow spaces and the paraspinal soft tissues are unremarkable. No prior scans are available. --------------- Conclusion: Avid enhancement in paraspinal soft tissues from T6 to T9, stable compared to prior scan on 9/90/21, apparent phlegmon.	Findings: There is a right paraspinal T6-T9 on the right, measuring 1.3 x 2.5 x 5 5.5 cm with T2/STIR hyperintensity and avid homogeneous enhancement, phlegmon vs recurrent tumor. There is extension along the posterior pleural space. Compared to the prior MR scan of the T-spine on 9/90/21 the appearance is similar, suggesting phlegmon. See (axial postcontrast series 18 #1). There is lesser slight enhancement in the left pleural space, unchanged. The thoracic vertebrae are normally formed and aligned. The craniovertebral junction appears normal on sagittal scout sequences. The cord has normal dimensions and signal intensity with no tumor, syrinx or atrophy. There is only minor, early degenerative disc disease. There is no significant disc bulge, protrusion or herniation. The marrow spaces and the paraspinal soft tissues are unremarkable. No prior scans are available. ---------------	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries secondary to delayed bolus timing. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: The distribution of PTE supplying all segmental branches of the bilateral lungs is unchanged; however, the clot burden relative to December 2021 has decreased. There are no new areas of pulmonary thromboembolism appreciable with the constraint of bolus timing as above. LUNGS / AIRWAYS / PLEURA: Trace bilateral pleural effusions with adjacent passive atelectasis. HEART / OTHER VESSELS: The main pulmonary artery is dilated at 3.5 cm in transverse diameter. Right ventricular hypertrophy, similar to that of prior examination. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of the superior abdomen demonstrate hepatic steatosis. Indeterminate left adrenal nodule, partially imaged. Otherwise unremarkable for arterial phase technique. MUSCULOSKELETAL: No evidence of aggressive osseous lesion or acute fracture.
15,802	CLINICAL HISTORY: Concern for vascular markings sinonasal. COMPARISON: None available TECHNIQUE: Multiplanar multisequence MRI images of the brain were acquired without intravenous contrast. FINDINGS: There is no restricted diffusion to suggest an acute infarct. There are mild scattered T2/FLAIR hyperintensities. There is a small chronic microhemorrhage in the left temporal lobe. The ventricles are normal in caliber and configuration. There is mild-to-moderate mucosal thickening in the ethmoid sinuses. Small mucus retention cyst in the right sphenoid and left maxillary sinus. The mastoid air cells are relatively clear. There are postsurgical changes of bilateral lens replacement/ No suspicious calvarial lesion is noted. IMPRESSION: No acute intracranial process or mass effect by noncontrast evaluation. Mild presumed scattered chronic microangiopathic changes.	FINDINGS: There is no restricted diffusion to suggest an acute infarct. There are mild scattered T2/FLAIR hyperintensities. There is a small chronic microhemorrhage in the left temporal lobe. The ventricles are normal in caliber and configuration. There is mild-to-moderate mucosal thickening in the ethmoid sinuses. Small mucus retention cyst in the right sphenoid and left maxillary sinus. The mastoid air cells are relatively clear. There are postsurgical changes of bilateral lens replacement/ No suspicious calvarial lesion is noted.	FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis 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: Multifocal consolidative opacities involving all the lung segments. There is elevated right hemidiaphragm with compressive right lung basilar atelectasis. Trachea is central. Tracheal bronchial airways are patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Simple right hepatic cyst. Liver is otherwise unremarkable. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Stable simple bilateral renal cysts. No hydronephrosis or hydroureter. LYMPH NODES: Stable subcentimeter retroperitoneal/iliac lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute osseous findings. Thoracic and lumbar vertebra demonstrate normal height and multilevel degenerative changes.
15,803	EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Renal AML, D17.71 Benign lipomatous neoplasm of kidney, D43.2 Neoplasm of uncertain behavior of brain, unspecified, Q85.1 Tuberous sclerosis, Z98.2 Presence of cerebrospinal fluid drainage device COMPARISON: MR abdomen dated 3/20/2020 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 171 lbs. IV contrast: ProHance, 16 ml, per protocol. 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: Mild steatosis. Subcentimeter lesion within the inferior right posterior lobe which demonstrates signal dropout out of phase demonstrates questionable arterial enhancement on image 56, series 803, again compatible with an adenoma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Redemonstration of innumerable enhancing, fat-containing lesions throughout both kidneys, compatible with AMLs. Interval decrease in size of the index lesions. For example, the right upper pole lesion which previously measured 2.2 x 2.8 cm now measures 2.1 x 2.6 cm (image 24, series 805) and the left upper pole lesion which measured 3.9 x 4.6 cm now measures 3.3 x 4.3 cm (image 25, series 805). Additional bilateral simple and hemorrhagic/proteinaceous cysts also demonstrated. 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. Mild S-shaped scoliosis. CONCLUSION: 1. Bilateral enhancing, fat-containing renal lesions, compatible with AMLs. The two largest lesions have decreased in size. No significant interval growth involving the remaining lesions. 2. Mild hepatic steatosis. 3. Probable tiny hepatic adenoma. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	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: Mild steatosis. Subcentimeter lesion within the inferior right posterior lobe which demonstrates signal dropout out of phase demonstrates questionable arterial enhancement on image 56, series 803, again compatible with an adenoma. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Redemonstration of innumerable enhancing, fat-containing lesions throughout both kidneys, compatible with AMLs. Interval decrease in size of the index lesions. For example, the right upper pole lesion which previously measured 2.2 x 2.8 cm now measures 2.1 x 2.6 cm (image 24, series 805) and the left upper pole lesion which measured 3.9 x 4.6 cm now measures 3.3 x 4.3 cm (image 25, series 805). Additional bilateral simple and hemorrhagic/proteinaceous cysts also demonstrated. 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. Mild S-shaped scoliosis.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace right pleural effusion. Bibasilar subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. No focal hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Stable left adrenal nodule. Right adrenal gland is normal. KIDNEYS: Normal. LYMPH NODES: Stable subcentimeter periportal lymph nodes. STOMACH / SMALL BOWEL: Stomach is partially distended. No abnormal dilatation small bowel loops. COLON / APPENDIX: Moderate colonic stool burden. PERITONEUM / MESENTERY: Redemonstrated multiple omental/peritoneal carcinomatosis in the lower abdomen, grossly similar in appearance compared to prior CT. Stable tiny perihepatic nodules. No ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: Large complex solid cystic pelvic mass measures about 18 x 8.5 cm, grossly unchanged compared to prior CT. Unchanged right adnexa solid mass. BODY WALL: Small nonspecific subcutaneous nodule in the bilateral low back region. No anterior abdominal wall fluid collection. No ventral hernia. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.
15,804	MR Brain wo+w contrast 1/27/2022 2:01 PM Clinical Information: Epilepsy, G40.919 Epilepsy, unspecified, intractable, without status epilepticus, F84.0 Autistic disorder Spec Inst: MRI Brain w Comparison: MRI of the brain dated 3/2/2021. Technique: Sagittal T1, axial FGATIR, FLAIR, DWI with ADC map, SWI and pre and post contrast axial MPRAGE. Patient weight: 167 lbs. IV contrast: ProHance, 16 ml, per protocol. Findings: Previous focal signal abnormality in the left anterior body of the corpus callosum has evolved to 1 cm cavitary encephalomalacia. Previous SEEG implant related multifocal hemorrhagic foci are also visualized. No new focal signal abnormality or contrast enhancing lesion is identified in the brain. The ventricles are symmetrically normal in size and configuration. No acute intracranial abnormality is identified. A large left maxillary sinus retention cyst is redemonstrated. Impression: 1. Interval left callosal focal encephalomalacic change. 2. No evidence of new intracranial pathology.	Findings: Previous focal signal abnormality in the left anterior body of the corpus callosum has evolved to 1 cm cavitary encephalomalacia. Previous SEEG implant related multifocal hemorrhagic foci are also visualized. No new focal signal abnormality or contrast enhancing lesion is identified in the brain. The ventricles are symmetrically normal in size and configuration. No acute intracranial abnormality is identified. A large left maxillary sinus retention cyst is redemonstrated.	Findings: CT Head: Unenhanced images of the brain are unremarkable. The postcontrast images demonstrate no abnormal meningeal or parenchymal enhancement. Small mucous retention cysts of the left maxillary sinus. The paranasal sinuses and mastoid air cells are clear. CTA Neck: There is no evidence of dissection, transection, or occlusion of the cervical vasculature. No flow limiting stenosis is identified. The internal jugular veins appear normal. The soft tissues of the neck are unremarkable. Cervical spine is normal. CTA Head: There is no occlusion, flow-limiting stenosis, aneurysm, or vascular malformation identified within the intracranial vasculature. No evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. The internal jugular veins are patent
15,805	EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Female patient 39 years with Pituitary Tumor, D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system Spec Inst: Pituitary tumorEvaluate Sella TECHNIQUE: Coronal T1, coronal T2 images through the sella were obtained without intravenous gadolinium. In addition coronal T1 and sagittal T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 179 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: 10/5/2021 FINDINGS: There has been interval transsphenoidal resection of sellar/suprasellar lesion. There is significantly decreased soft tissue within the sella and resolution of mass effect upon the optic chiasm. The stalk is slightly deviated to the left. There is mild persistent remodeling of the floor of the sella on the right. There is a small area of hypoenhancement within the right side of the sella on coronal image 10, series 7 measuring approximately 4 x 4 mm in the coronal plane. There is also hypoenhancing soft tissue more anteriorly but this is within the sphenoid sinus.. Both ICA flow voids appear unremarkable. There is no acute parenchymal abnormality. CONCLUSION: Interval transsphenoidal resection of sellar/suprasellar lesion.Significantly decreased soft tissue within the sella and resolution of mass effect upon the optic chiasm. There is small faint area of hypoenhancement within the right side of the sella is nonspecific, may represent small amount of residual lesion or could simply represent postsurgical changes. Recommend continued follow-up.	FINDINGS: There has been interval transsphenoidal resection of sellar/suprasellar lesion. There is significantly decreased soft tissue within the sella and resolution of mass effect upon the optic chiasm. The stalk is slightly deviated to the left. There is mild persistent remodeling of the floor of the sella on the right. There is a small area of hypoenhancement within the right side of the sella on coronal image 10, series 7 measuring approximately 4 x 4 mm in the coronal plane. There is also hypoenhancing soft tissue more anteriorly but this is within the sphenoid sinus.. Both ICA flow voids appear unremarkable. There is no acute parenchymal abnormality.	Findings: CT Head: Unenhanced images of the brain are unremarkable. The postcontrast images demonstrate no abnormal meningeal or parenchymal enhancement. Small mucous retention cysts of the left maxillary sinus. The paranasal sinuses and mastoid air cells are clear. CTA Neck: There is no evidence of dissection, transection, or occlusion of the cervical vasculature. No flow limiting stenosis is identified. The internal jugular veins appear normal. The soft tissues of the neck are unremarkable. Cervical spine is normal. CTA Head: There is no occlusion, flow-limiting stenosis, aneurysm, or vascular malformation identified within the intracranial vasculature. No evidence of venous sinus thrombosis. There is normal asymmetric size of the right transverse sinus relative to the left. The deep cerebral veins also appear patent. The internal jugular veins are patent
15,806	Clinical history: Pulmonary sarcoidosis, assess for cause of transient global ischemia Comparison:MRI 11/19/2021, 8/25/2015 Technique: Multiplanar multisequence noncontrast MRI images of the brain were obtained. After uneventful administration of intravenous contrast, postcontrast images were obtained. Patient weight: 260 lbs. IV contrast: ProHance, 10 ml, per protocol. Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. There are chronic small infarcts in the left basal ganglia and left cerebellum. Increased bilateral patchy T2/FLAIR hyperintensities since 2015. There is no evidence of acute hemorrhage on the susceptibility weighted images. There is a small microhemorrhage in the left basal ganglia. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. There is partial opacification of some of the right ethmoid air cells. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted. Impression: 1. No acute infarct or abnormal intracranial enhancement. 2. Increased bilateral patchy T2/FLAIR hyperintensities since 2015, suggesting chronic microangiopathic changes. Chronic small lacunar infarcts.	Findings: There is no enhancing intracranial mass or abnormal enhancement. There is no restricted diffusion to suggest an acute infarct. There are chronic small infarcts in the left basal ganglia and left cerebellum. Increased bilateral patchy T2/FLAIR hyperintensities since 2015. There is no evidence of acute hemorrhage on the susceptibility weighted images. There is a small microhemorrhage in the left basal ganglia. The ventricles are within normal limits for caliber and configuration. The intracranial vascular flow voids are present. There is partial opacification of some of the right ethmoid air cells. Mastoid air cells are clear. The orbits are within normal limits. No suspicious calvarial lesion is noted.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Hydrocephalus with slight interval enlargement in ventricular size compared with prior exam. ORBITS: Normal. SINUSES: Patchy opacification of the left anterior ethmoid air cells. Mucosal thickening of the maxillary sinuses. The other paranasal sinuses are clear. MASTOIDS: Trace right mastoid effusion. Left mastoid air cells are clear. SOFT TISSUE: No acute abnormality. Abandoned VP shunt catheter is seen in the right occipital scalp and posterior neck soft tissues.
15,807	EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Male patient 40 years with brain lesion, G93.9 Disorder of brain, unspecified TECHNIQUE: Sagittal T1, axial FLAIR, axial DWI, axial T2, axial SWI images of the brain were obtained without intravenous gadolinium. In addition multiplanar T1-weighted images were obtained after the intravenous administration of gadolinium. Technique: Patient weight: 176 lbs. IV contrast: ProHance, 8 ml, per protocol. IV contrast injection rate: 1 ml per sec. COMPARISON: 4/29/2021 FINDINGS: There is mildly decreased abnormal T2 hyperintense signal within the right anterior temporal lobe. There are several cysts within the lesion and also small amount of isointense/hypointense signal. There is mild patchy enhancement at the periphery of the lesion measures 2.6 x 1.5 cm, previously measured 2.5 x 1.7 cm. The major intracranial vessels appear within normal limits. Right sinonasal postsurgical changes are noted. There is extensive mucosal thickening within the maxillary sinuses bilaterally.. There is also significant mucosal thickening within the right ethmoid air cells and right frontal sinus. CONCLUSION: 01. Grossly stable complex lesion within the anterior right temporal lobe. There is stable mild patchy enhancement of the anterior aspect of the lesion. There is mildly increased abnormal adjacent T2 hyperintense signal, nonspecific but may represent posttreatment changes 02. Right sinonasal postsurgical changes. Grossly stable Extensive inflammatory changes within the right paranasal sinuses	FINDINGS: There is mildly decreased abnormal T2 hyperintense signal within the right anterior temporal lobe. There are several cysts within the lesion and also small amount of isointense/hypointense signal. There is mild patchy enhancement at the periphery of the lesion measures 2.6 x 1.5 cm, previously measured 2.5 x 1.7 cm. The major intracranial vessels appear within normal limits. Right sinonasal postsurgical changes are noted. There is extensive mucosal thickening within the maxillary sinuses bilaterally.. There is also significant mucosal thickening within the right ethmoid air cells and right frontal sinus.	FINDINGS: STRUCTURED REPORT: CT Chest PE and Abdomen Pelvis OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Linear scarring at the left lung apex from prior ballistic injury. Round atelectasis versus scarring of the lingula. The lungs are otherwise clear. No pleural effusions. Central airways are patent. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality ABDOMEN and PELVIS: LIVER: Hepatic steatosis with focal fat sparing at the gallbladder fossa. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No hydroureteronephrosis. Left upper pole renal scarring. Bilateral renal hypodensities are too small to adequately characterize, but statistically represent simple cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach appears normal. Small bowel anastomosis within the midabdomen is again noted with distention of the anastomosed bowel without convincing evidence of obstruction. COLON / APPENDIX: Noninflamed diverticula. PERITONEUM / MESENTERY: No free intraperitoneal air or fluid. Scattered ballistic fragments within the left hemiabdomen are similar to that of prior examination. RETROPERITONEUM: Numerous retained ballistic fragments within the left retroperitoneal space and left psoas muscle, similar to prior OTHER VESSELS: Mild aorto-iliac atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Numerous retained ballistic fragments within the left back/gluteal soft tissues and proximal left thigh. MUSCULOSKELETAL: Healed, chronic medial one third clavicle, anterior right first rib, posterior right third rib fractures. No acute fractures. Sclerotic lesion in the right proximal femur partially included unchanged. Sclerosis of the right femoral head, unchanged suggestive of a vascular necrosis
15,808	MR Brain wo+w contrast 1/27/2022 11:31 AM Clinical Information: Ventriculitis Comparison: CT head dated 1/26/2022, MRI brain dated 1/18/2022 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial, sagittal and coronal T1 FS postcontrast sequences were acquired of the brain. Patient weight: 176 lbs. IV contrast: ProHance, 8 ml, per protocol. Findings: There are multiple ventricular drains, two posterior approach and another left temporal approach. Increased foci of hemorrhage adjacent to the left posterior drain since MRI 1/18/2022, not significantly changed since CT head performed recently. There is a catheter shape linear structure in the right frontal lobe with tip appears to be in the right orbit (series 501 image 11). There is new ependymal enhancement in the left temporal horn. Otherwise no significant change in extensive periependymal contrast enhancement in association with periependymal diffusion restriction suggesting ventriculitis. This continues to involve all the ventricles, with extension into the foramen of Luschka, and upper cervical spinal canal. Since MRI 1/18/2022, increased extensive surrounding periventricular T2 FLAIR hyper signal intensity in bilateral frontal, parietal and temporal lobes, most prominent in left side, and around the catheters. Interval decompression of lateral ventricles is noted, without significant change in size of the fourth ventricle and third ventricles. Stable irregularity unchanged cervical spine syrinx. There is persistent loculated CSF collection in the right cervical region, stable since prior study. Mucosal thickening in the left maxillary sinus is noted . Severe opacification of the bilateral mastoid air cells Impression: 1. A catheter shape linear structure in the right frontal lobe with tip appears to be in the right orbit, only seen on T2-weighted images. 2. Mild worsening in the diffuse chronic ventriculitis, with new enhancement in the left temporal horn and increased surrounding edema. 3. Interval decompression of lateral ventricles without significant change from the 3rd and fourth ventricles and cervical cord syrinx. 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 ventricular drains, two posterior approach and another left temporal approach. Increased foci of hemorrhage adjacent to the left posterior drain since MRI 1/18/2022, not significantly changed since CT head performed recently. There is a catheter shape linear structure in the right frontal lobe with tip appears to be in the right orbit (series 501 image 11). There is new ependymal enhancement in the left temporal horn. Otherwise no significant change in extensive periependymal contrast enhancement in association with periependymal diffusion restriction suggesting ventriculitis. This continues to involve all the ventricles, with extension into the foramen of Luschka, and upper cervical spinal canal. Since MRI 1/18/2022, increased extensive surrounding periventricular T2 FLAIR hyper signal intensity in bilateral frontal, parietal and temporal lobes, most prominent in left side, and around the catheters. Interval decompression of lateral ventricles is noted, without significant change in size of the fourth ventricle and third ventricles. Stable irregularity unchanged cervical spine syrinx. There is persistent loculated CSF collection in the right cervical region, stable since prior study. Mucosal thickening in the left maxillary sinus is noted . Severe opacification of the bilateral mastoid air cells	FINDINGS: STRUCTURED REPORT: CTA CAP VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Dilated, measuring 35 mm in diameter (series 401, image 237). ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Single right renal artery without significant abnormality. LEFT RENAL: Single left renal artery without significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: ET tube terminates in the proximal thoracic trachea. Layering secretions in the distal thoracic trachea and left mainstem bronchus. Diffuse bilateral groundglass opacities with interlobular septal thickening in a configuration suggesting a crazy paving. Dependent areas of consolidation in both lower lobes. Rounded heterogeneous density collection in the lateral left upper lobe measures 2.6 x 2.5 cm (series 401, image 197) likely a loculated hematoma. Loculated left hemopneumothorax without layering hematocrit level or definite active contrast extravasation identified. Multiple areas of hyperattenuation in the posterior left hemithorax adjacent to healing left rib fractures, likely representing periosteal reaction. The left pleural gas tracks through the left fifth-sixth intercostal space into a large left axillary/posterolateral chest wall gas and relatively hyperattenuating fluid containing collection, measuring approximately 8.8 x 5.6 x 17.3 cm (AP by TR by CC on series 401, image 302 and series 402, image 161). A few small foci of active contrast extravasation the left chest wall collection (series 401, images 262 and 290 as well as series 402, image 95). Additional foci of left pleural gas extending through the left seventh-eighth intercostal space into the overlying chest wall soft tissues at the site of the prior thoracostomy tube. HEART / OTHER VESSELS: Heart size is normal. Small pericardial effusion. Left IJ approach vascular catheter terminates in the distal SVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple enlarged mediastinal and left axillary lymph nodes are likely reactive. CHEST WALL: Large left axillary/posterolateral chest wall gas relatively hyperattenuating fluid containing collection, as above. Multiple small arterial branches are visualized in the cranial aspect of the collection without definite active contrast extravasation identified. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Surgically absent. ADRENALS: Normal. KIDNEYS: Symmetric contrast enhancement. No radiopaque nephrolithiasis. No hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric catheter is looped in the proximal stomach with its tip terminating in the distal gastric body. Gas-filled loops of small bowel without dominant transition point, possibly adynamic ileus. Otherwise, no significant abnormality in the stomach or small bowel. COLON / APPENDIX: No significant abnormality in the colon. The appendix is not definitely visualized. PERITONEUM / MESENTERY: Small volume pelvic ascites. No pneumoperitoneum. RETROPERITONEUM: Normal. OTHER VESSELS: Interval removal of the right common femoral vein approach a catheter and left common femoral vein approach ECMO cannula. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Progressive interval increase in size of the caudal left rectus sheath hematoma, measuring 4.4 x 6.8 x 7.6 cm (AP by TR by CC on series 401, image 254 and series 403, image 119), previously measuring 6.1 x 4.6 x 5.8 cm (AP by TR by CC on series 6, image 215 and series 12, image 160). Again seen is a relatively prominent vessel tracking through the cranial aspect of the hematoma without definite contrast extravasation identified. Unchanged small right periumbilical hematoma. MUSCULOSKELETAL: Redemonstration of multiple healing left rib fractures with plate and screw fixation hardware along the posterolateral left a left ribs 6-10. Chronic L1-L5 left transverse process fractures are unchanged. No new osseous abnormality is identified.
15,809	EXAM: MR Knee Left wo contrast CLINICAL INFORMATION: Swollen left knee COMPARISON: 12/6/2021 TECHNIQUE: Multiplanar and multisequence MRI of the left knee was obtained without intravenous contrast. FINDINGS: BONES:No fracture, marrow replacement, or aggressive osseous lesion. Subcentimeter T2 hyperintense and T1 hypointense lesion in the anterior distal femoral metaphysis likely represents a benign cartilaginous lesion such as an enchondroma. Marrow edema is noted at the anterior medial tibial plateau and lateral aspect of the lateral femoral condyle near the insertion of the popliteus tendon. ARTICULATIONS: Effusion: Small. Patellofemoral compartment: Articular cartilage thinning with subchondral marrow edema of the medial patellar facet. Medial compartment:No full-thickness articular cartilage defect. Lateral compartment:No full-thickness articular cartilage defect. MENISCI: Medial meniscus: Normal Lateral meniscus:Tiny radial tear of the free edge of the meniscal body. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. Edema overlies the superficial aspect of the distal biceps femoris and fibular collateral ligaments. There is a prominent medial patellar plica EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Tiny popliteal cyst. CONCLUSION: 1. Findings of medial patellar plica syndrome. 2. Small radial tear of the free edge of the body of the lateral meniscus. 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 aggressive osseous lesion. Subcentimeter T2 hyperintense and T1 hypointense lesion in the anterior distal femoral metaphysis likely represents a benign cartilaginous lesion such as an enchondroma. Marrow edema is noted at the anterior medial tibial plateau and lateral aspect of the lateral femoral condyle near the insertion of the popliteus tendon. ARTICULATIONS: Effusion: Small. Patellofemoral compartment: Articular cartilage thinning with subchondral marrow edema of the medial patellar facet. Medial compartment:No full-thickness articular cartilage defect. Lateral compartment:No full-thickness articular cartilage defect. MENISCI: Medial meniscus: Normal Lateral meniscus:Tiny radial tear of the free edge of the meniscal body. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. Edema overlies the superficial aspect of the distal biceps femoris and fibular collateral ligaments. There is a prominent medial patellar plica EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Tiny popliteal cyst.	FINDINGS: BONES/JOINTS: There is a comminuted impacted fracture of the proximal tibial metaphysis without definite extension to the lateral tibial plateau. Transverse oblique component of fracture separates the tibial diametaphysis the diaphysis. There is mild medial displacement of the major distal fragment. There is also an oblique minimally displaced and comminuted fracture of the proximal fibula. The proximal tibiofibular joint appears maintained. The tibial articular surfaces appear maintained and the distal femur and patella appear intact. Tricompartmental osteoarthritic changes of the knee. SOFT TISSUES: No large hematoma or fluid collection. Trace suprapatellar effusion. Soft tissue edema and contusions about the knee and proximal foreleg.
15,810	EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Female patient 61 years with Low back pain, progressive neurologic deficit, R29.898 Other symptoms and signs involving the musculoskeletal system Spec Inst: Right leg weakness TECHNIQUE: Sagittal T2, sagittal T1, sagittal STIR, axial T2 and axial T1-weighted images of the lumbar spine were obtained without intravenous gadolinium. COMPARISON: None available. FINDINGS: There is no loss of height of the lumbar vertebrae. There is mild anterolisthesis of L4 on L5 on degenerative basis. There is no focal abnormal marrow signal. There is no prevertebral soft tissue swelling or paraspinal soft tissue swelling. Conus medullaris terminates at the L1 level. The visualized inferior thoracic spinal cord is unremarkable. There is mild disc desiccation at L5-S1. There is mild disc bulge at this level. There is also mild disc bulge at L4-L5. At L3-L4 there is moderate bilateral facet arthropathy. There is mild bilateral neural foraminal narrowing at this level. At L4-L5 there is moderate to severe bilateral facet arthropathy. There is mild to moderate bilateral neural foraminal narrowing but no exiting nerve root impingement. There is moderate left and mild right facet arthropathy at L5-S1. There is moderate left and mild right neural foraminal narrowing. CONCLUSION: 01. Advanced multilevel inferior lumbar spine facet arthropathy from L3-L4 to L5-S1. Findings are most pronounced at L4-L5 level. There is moderate bilateral neural foraminal narrowing at L4-L5 and also on the left at L5-S1 but there is no definite exiting nerve root impingement. 02. Mild disc bulges within the inferior lumbar spine but no significant spinal canal narrowing.	FINDINGS: There is no loss of height of the lumbar vertebrae. There is mild anterolisthesis of L4 on L5 on degenerative basis. There is no focal abnormal marrow signal. There is no prevertebral soft tissue swelling or paraspinal soft tissue swelling. Conus medullaris terminates at the L1 level. The visualized inferior thoracic spinal cord is unremarkable. There is mild disc desiccation at L5-S1. There is mild disc bulge at this level. There is also mild disc bulge at L4-L5. At L3-L4 there is moderate bilateral facet arthropathy. There is mild bilateral neural foraminal narrowing at this level. At L4-L5 there is moderate to severe bilateral facet arthropathy. There is mild to moderate bilateral neural foraminal narrowing but no exiting nerve root impingement. There is moderate left and mild right facet arthropathy at L5-S1. There is moderate left and mild right neural foraminal narrowing.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Trace pericardial effusion. Coronary vascular calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Prior cholecystectomy PANCREAS: Postsurgical changes of a pancreaticoduodenectomy. No evidence of hyperenhancement or soft tissue nodularity at the pancreatic resection bed. SPLEEN: Small hypoattenuating lesion in the lower spleen is indeterminant but statistically benign. Otherwise normal aside from calcified granuloma. ADRENALS: Normal. KIDNEYS: Nonobstructing right renal stones. Few subcentimeter hypoattenuating bilateral renal lesions are too small to characterize but likely cysts. Otherwise normal aside from mild nonspecific perinephric stranding. LYMPH NODES: Similar appearing mfew mildly enlarged retroperitoneal lymph nodes, such as an aortocaval node measuring 12 mm in short axis on image 130, series 201 STOMACH / SMALL BOWEL: Postsurgical changes of pancreaticoduodenectomy. Small amount of surgical material along the lesser curvature stomach appears similar to prior. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: VP shunt catheter is seen with tip curled at the left superior abdomen, anterior to the transverse colon. No pseudocyst or dissection catheter discontinuity. RETROPERITONEUM: Normal. VESSELS: Mild calcified plaque of the infrarenal abdominal aorta and proximal iliac vasculature. The main portal vein is dilated. URINARY BLADDER: Small amount of iatrogenic gas within the nondependent bladder. REPRODUCTIVE ORGANS: Uterus surgically absent. Adnexa are unremarkable. BODY WALL: Healed prior midline incision. MUSCULOSKELETAL: No acute fracture or surgical osseous lesion
15,811	MRI brain with and without contrast Clinical Information: Female aged 46 years with Astrocytomaoligodendroglioma Comparison: MR 9/30/2021 and 9/19/2016 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 143 lbs. IV contrast: ProHance, 13 ml, per protocol. Findings: Right frontal lobe resection now with fluid-filled surgical cavity and adjacent gliosis. Interval resolution of previous postprocedural pneumocephalus. Suggestion of Increased T2/FLAIR hyperintensities along the posterior superior frontal gyrus possibly due to overall decreased size of surgical cavity. Increased ex vacuo dilatation of the right frontal horn. Mild nodular enhancement along the edge of the resection bed is significantly increased from prior (for example axial series 1203, image 52). Mild persistent pachymeningeal adjacent to the craniotomy site. No significant mass effect. Persistent FLAIR subarachnoid hyperintensity along the superior frontal cranial vault, which could be sequela of compensatory increase in adjacent extra-axial spaces. No acute infarct or intracranial hemorrhage. Normal vascular flow voids. Prominent cisterna magna unchanged. Conclusion: Evolving postsurgical changes associated with right frontal lobe surgical cavity there is mildly increased conspicuity of adjacent abnormal T2 hyperintense signal which may represent posttreatment changes. There is no mass effect. Mild enhancement now outlining the the edges of the surgical cavity probably postsurgical. Recommend continued follow-up. 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 frontal lobe resection now with fluid-filled surgical cavity and adjacent gliosis. Interval resolution of previous postprocedural pneumocephalus. Suggestion of Increased T2/FLAIR hyperintensities along the posterior superior frontal gyrus possibly due to overall decreased size of surgical cavity. Increased ex vacuo dilatation of the right frontal horn. Mild nodular enhancement along the edge of the resection bed is significantly increased from prior (for example axial series 1203, image 52). Mild persistent pachymeningeal adjacent to the craniotomy site. No significant mass effect. Persistent FLAIR subarachnoid hyperintensity along the superior frontal cranial vault, which could be sequela of compensatory increase in adjacent extra-axial spaces. No acute infarct or intracranial hemorrhage. Normal vascular flow voids. Prominent cisterna magna unchanged.	FINDINGS: Thin bilateral cerebral convexity subdural collections are similar to prior. The right frontal convexity dural thickening is essentially unchanged. The left parietal convexity extra-axial collection again demonstrates subtle associated postcontrast enhancement. There is otherwise no evidence of acute intracranial hemorrhage or infarction. Ventricles and basilar cisterns are unremarkable. No significant mass effect or midline shift. The orbits are unremarkable. Patchy opacification of the ethmoid air cells with layering fluid in the right sphenoid sinus. The mastoid air cells are clear. The calvarium and proximal cervical spine are diffusely sclerotic.
15,812	EXAM: MR Thoracic Spine wo contrast CLINICAL INFORMATION: Thoracic syrinx. COMPARISON: MR thoracic spine dated 7/20/2021. TECHNIQUE: MR Thoracic Spine wo contrast. FINDINGS: No abnormal marrow signal, acute displaced fracture, or compression deformity. The disc heights are maintained with only slight disc desiccation at T5-T6. No spondylolisthesis. No significant spinal canal or foraminal narrowing at any level. Redemonstrated upper thoracic syrinx with its most dilated prominent portion measuring a longitudinal length of approximately 5 cm spanning approximately 2 1/2 vertebral levels from the midportion of the T2 vertebral body to the inferior portion of the T4 vertebral body (previously 4.8 cm). On the axial sequences central syrinx is noted extending from the C6 vertebral body to the conus. The axial diameter measures up to 4 mm, previously 3 mm. No significant soft tissue abnormality. CONCLUSION: Slight interval increase in conspicuity of the upper thoracic syrinx. 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 marrow signal, acute displaced fracture, or compression deformity. The disc heights are maintained with only slight disc desiccation at T5-T6. No spondylolisthesis. No significant spinal canal or foraminal narrowing at any level. Redemonstrated upper thoracic syrinx with its most dilated prominent portion measuring a longitudinal length of approximately 5 cm spanning approximately 2 1/2 vertebral levels from the midportion of the T2 vertebral body to the inferior portion of the T4 vertebral body (previously 4.8 cm). On the axial sequences central syrinx is noted extending from the C6 vertebral body to the conus. The axial diameter measures up to 4 mm, previously 3 mm. No significant soft tissue abnormality.	Findings: The nasopharynx and oropharynx are normal in appearance. The base of the tongue and lymphoid tissue within Waldeyer's ring are unremarkable. The hypopharynx and larynx appear normal. No discrete mass or lymphadenopathy is identified in the neck. The parotid, submandibular, and thyroid glands appear normal. All visualized osseous structures are diffusely sclerotic, similar to prior exam. Multilevel discogenic degenerative changes of the cervical spine with bulky anterior osteophyte formation from C4-C7. Right IJ approach chest port in place. Partially visualized left upper extremity PICC. Visualized lung apices are clear.
15,813	MR Brain wo+w contrast 1/27/2022 10:42 AM Clinical Information: Evaluation for brain metastasis. Comparison: Brain MRI dated 12/12/2021 Technique: Diffusion weighted series, sagittal T1, axial SWI, axial FLAIR, axial T2 FS, axial T1 postcontrast, and axial and coronal T1 FS postcontrast sequences were acquired of the brain. Findings: There is diffuse cerebral volume loss due to atrophic changes. There is also scattered areas of periventricular and deep white matter hyper signal intensity due to microangiopathic changes. There are multiple supratentorial and infratentorial enhancing lesions with associated vasogenic edema, suggesting brain metastases. There is interval mild increase in peripheral enhancement of the largest metastatic lesion, located in the right superior frontal gyrus, with associated interval increase in peripheral vasogenic edema, which has caused mild pressure effect on the right lateral ventricle and about 3 mm right-to-left midline shift. Diffusion restriction is noted within the largest metastatic lesion. Magnetic susceptibility is noted in the right superior frontal lesions secondary to hemorrhagic changes. The other frontal lobe metastasis seems stable since prior study. There is also two newly diagnosed tiny enhancing lesions in right and left inferior frontal gyrus. The infratentorial enhancing lesion located in the left cerebellar hemisphere seems stable since prior study. There is also another tiny enhancing lesion located in the left aspect of cerebellar vermis. No intracranial 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: 1. Interval necrotic change in the right medial frontal, right frontal opercular and left cerebellar masses. 2. Decreased size of the right anterior superior frontal lesion. 3. Increased extent of vasogenic edema in the right frontal lobe and left cerebellum in accordance with post-RT situation. 4. Three new contrast enhancing lesions in the bilateral orbitofrontal and left superior cerebellar regions representing interval metastatic disease. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	Findings: There is diffuse cerebral volume loss due to atrophic changes. There is also scattered areas of periventricular and deep white matter hyper signal intensity due to microangiopathic changes. There are multiple supratentorial and infratentorial enhancing lesions with associated vasogenic edema, suggesting brain metastases. There is interval mild increase in peripheral enhancement of the largest metastatic lesion, located in the right superior frontal gyrus, with associated interval increase in peripheral vasogenic edema, which has caused mild pressure effect on the right lateral ventricle and about 3 mm right-to-left midline shift. Diffusion restriction is noted within the largest metastatic lesion. Magnetic susceptibility is noted in the right superior frontal lesions secondary to hemorrhagic changes. The other frontal lobe metastasis seems stable since prior study. There is also two newly diagnosed tiny enhancing lesions in right and left inferior frontal gyrus. The infratentorial enhancing lesion located in the left cerebellar hemisphere seems stable since prior study. There is also another tiny enhancing lesion located in the left aspect of cerebellar vermis. No intracranial 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: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized calvarium is diffusely sclerotic. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
15,814	EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: multiple liver lesions, K76.9 Liver disease, unspecified Spec Inst: eval liver lesions using EOVIST COMPARISON: Abdominal MRI dated 10/28/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 181 lbs. IV contrast: Eovist, 10 ml, per protocol. IV contrast injection rate: 1 ml per sec. FINDINGS: STRUCTURED REPORT: MRI Abdomen LOWER CHEST: LUNG BASES / PLEURA: No significant abnormality. DISTAL ESOPHAGUS: No significant abnormality. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Mild diffuse hepatic steatosis. No cirrhosis. Multiple lesions throughout the liver which demonstrate homogenous arterial enhancement, diffusion restriction, nonretention on hepatobiliary phase, compatible with multiple adenomas. Segment II lesion measures 2.6 x 2.0 cm on arterial enhanced image 34, series 12 (previously 2.7 x 2.2 cm). Segment VI lesion is not appreciated on postcontrast images secondary to motion artifact, however measures up to 3.0 x 1.8 cm on DWI image 15, series 100 (previously 2.9 x 2.0 cm). Segment VI lesion adjacent to the porta hepatis measures up to 2.5 x 1.9 cm on image 60, series 12 (previously 2.7 x 1.9 cm). Additional smaller, peripheral segment VI lesion measures 1.0 x 0.7 cm on image 57, series 12 (previously 1.0 x 1.0 cm). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Multiple hepatic lesions as above most compatible with adenomas are overall stable in size as compared to the prior study, as detailed above. 2. Mild hepatic steatosis without cirrhosis. 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: Mild diffuse hepatic steatosis. No cirrhosis. Multiple lesions throughout the liver which demonstrate homogenous arterial enhancement, diffusion restriction, nonretention on hepatobiliary phase, compatible with multiple adenomas. Segment II lesion measures 2.6 x 2.0 cm on arterial enhanced image 34, series 12 (previously 2.7 x 2.2 cm). Segment VI lesion is not appreciated on postcontrast images secondary to motion artifact, however measures up to 3.0 x 1.8 cm on DWI image 15, series 100 (previously 2.9 x 2.0 cm). Segment VI lesion adjacent to the porta hepatis measures up to 2.5 x 1.9 cm on image 60, series 12 (previously 2.7 x 1.9 cm). Additional smaller, peripheral segment VI lesion measures 1.0 x 0.7 cm on image 57, series 12 (previously 1.0 x 1.0 cm). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: Tracheostomy tube terminates within the trachea. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Moderate bilateral pleural effusions, right greater than left, with adjacent atelectasis of the bibasilar lobes. Additionally, there are scattered areas of patchy consolidation throughout both lungs, greater on the right. HEART / OTHER VESSELS: No significant abnormality. Reflux of contrast into the IVC and proximal hepatic veins. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None pathologically enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Esophagogastric tube terminates below the diaphragm. MUSCULOSKELETAL: Mild discogenic degenerative changes within the thoracic spine. Numerous bilateral rib fractures, at least second through ninth on the right and at least second through eight on the left.
15,815	EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Liver lesion, > 1cm, US nondiagnostic, K76.89 Other specified diseases of liver Spec Inst: Four-phase MR requested; patient should be NPO 4 hours prior to test; patient with chronic hepatitis B with complex hepatic cyst rule out cystadenoma COMPARISON: Abdominal ultrasound dated 8/9/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 125 lbs. IV contrast: ProHance, 6 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: Segment VIII/V lesion appears mildly complex multiple lobulations and thin internal septations. Cyst measures 1.8 x 2.0 x 1.7 cm (previously 2.2 x 1.4 x 2.2 cm on prior ultrasound). No thickened internal septations, nodules, calcification or enhancing component is appreciated. Additional scattered hepatic cysts are seen throughout both lobes. Ill-defined peripheral focus of arterial enhancement without corresponding signal abnormality on other sequences, likely perfusional. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Suspected duplicated IVC. BODY WALL: Bilateral breast implants are noted. A few small T2 hyperintense areas surrounding bilateral, left greater than right, breast implants are nonspecific but may reflect small pockets of fluid. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Complex cyst in liver segment VIII/V, stable to decreased in size as compared to the prior study. No imaging features suggestive of biliary cystadenoma are present. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	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: Segment VIII/V lesion appears mildly complex multiple lobulations and thin internal septations. Cyst measures 1.8 x 2.0 x 1.7 cm (previously 2.2 x 1.4 x 2.2 cm on prior ultrasound). No thickened internal septations, nodules, calcification or enhancing component is appreciated. Additional scattered hepatic cysts are seen throughout both lobes. Ill-defined peripheral focus of arterial enhancement without corresponding signal abnormality on other sequences, likely perfusional. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Suspected duplicated IVC. BODY WALL: Bilateral breast implants are noted. A few small T2 hyperintense areas surrounding bilateral, left greater than right, breast implants are nonspecific but may reflect small pockets of fluid. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Tiny subcentimeter left lung base nodule, stable since prior CT. No lung consolidation, pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal unenhanced appearance of liver. No focal hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: Gallbladder hyperdensity likely represent vicarious contrast excretion. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Mild left adrenal gland thickening. KIDNEYS: Kidneys demonstrate symmetric enhancement. Symmetric contrast excretion. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: There is mild to moderate diffuse distention of small bowel loops with transition zone in the terminal ileum and right lower quadrant (on series 203, image 71). Distal to this transition zone, terminal ileum is decompressed.. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Small volume ascites in the right hemiabdomen and perihepatic region. No pneumoperitoneum. RETROPERITONEUM: No retroperitoneal fluid collection. VESSELS: Nonaneurysmal abdominal aorta. URINARY BLADDER: Urinary bladder is moderately distended contains excreted contrast. REPRODUCTIVE ORGANS: Anteverted uterus, slightly enlarged in size probably due to intramural fibroid. BODY WALL: Mild body wall edema. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height and multilevel degenerative changes.
15,816	Clinical History: Low back pain for more than six weeks Comparison: Lumbar spine radiograph 12/19/2019 Technique: Multiplanar multisequence MRI images of the lumbar spine were performed without intravenous contrast. Findings: Normal vertebral alignment. Chronic appearing mild wedging of the T12 vertebral body. There are no acute compression fractures. There is moderate disc height loss at L5-S1 with associated Modic type I changes. The conus terminates just below the L1-L2 disc, and has normal morphology and signal intensity. T12-L1: Mild disc bulge asymmetric to left, though no significant spinal canal or neural foraminal stenosis. L1-2: Mild disc with asymmetric to left with superimposed left paracentral disc protrusion, though no significant spinal canal or neural foraminal stenosis. Mild left lateral recess narrowing. L2-3: Mild disc bulge and facet hypertrophy, though no significant spinal canal or neural foraminal stenosis. L3-4: Combination of mild disc bulge, facet and ligamentum flavum hypertrophy with joint fluid results in mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. L4-5: Combination of mild disc bulge, moderate facet and ligamentum flavum hypertrophy with joint fluid results in mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. L5-S1: Combination of moderate disc height loss, disc bulge asymmetric to right with annular fissure, moderate bilateral facet hypertrophy results in moderate bilateral neuroforaminal narrowing. No significant spinal canal stenosis. The paraspinal soft tissues and visualized abdominal contents are unremarkable. Impression: Likely chronic wedging of the T12 vertebral body. No acute process in the cervical spine. Bilateral moderate neuroforaminal narrowing at L5-S1. Mild spinal canal narrowing at L3-L4.	Findings: Normal vertebral alignment. Chronic appearing mild wedging of the T12 vertebral body. There are no acute compression fractures. There is moderate disc height loss at L5-S1 with associated Modic type I changes. The conus terminates just below the L1-L2 disc, and has normal morphology and signal intensity. T12-L1: Mild disc bulge asymmetric to left, though no significant spinal canal or neural foraminal stenosis. L1-2: Mild disc with asymmetric to left with superimposed left paracentral disc protrusion, though no significant spinal canal or neural foraminal stenosis. Mild left lateral recess narrowing. L2-3: Mild disc bulge and facet hypertrophy, though no significant spinal canal or neural foraminal stenosis. L3-4: Combination of mild disc bulge, facet and ligamentum flavum hypertrophy with joint fluid results in mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. L4-5: Combination of mild disc bulge, moderate facet and ligamentum flavum hypertrophy with joint fluid results in mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis. L5-S1: Combination of moderate disc height loss, disc bulge asymmetric to right with annular fissure, moderate bilateral facet hypertrophy results in moderate bilateral neuroforaminal narrowing. No significant spinal canal stenosis. The paraspinal soft tissues and visualized abdominal contents are unremarkable.	FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis with prominent gallbladder wall thickening and trace pericholecystic fluid PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Scattered bilateral renal cysts. No hydroureteronephrosis, radiopaque urinary tract calculi, or suspicious renal lesion bilaterally. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion or acute fracture.
15,817	EXAM: MR Lumbar Spine wo contrast CLINICAL INFORMATION: Male patient 65 years with PERIPHERAL NEUROPATHY, G62.9 Polyneuropathy, unspecified TECHNIQUE: Sagittal T1, sagittal T2, sagittal STIR, axial T2 and axial T1-weighted images of the lumbar spine were obtained without intravenous gadolinium. COMPARISON: None available. FINDINGS: There is no loss of height of the lumbar vertebrae or malalignment. There is no focal abnormal T2 hyperintense signal within the bone marrow. There is no prevertebral or abnormal paraspinal soft tissue swelling. Conus medullaris terminates at the L1 level. Visualized inferior thoracic spinal cord and nerve roots of the cauda equina are unremarkable. There is mild disc desiccation at L4-L5 and L5-S1. At L4-L5 there is a broad disc bulge. There is moderate hypertrophic facet arthropathy with fluid in the facet joints. There is also thickening of the ligamentum flavum. These combine to result in moderate central canal narrowing. There is also moderate bilateral neural foraminal narrowing with encroachment upon and apparent contact of both exiting L4 nerve roots. At L5-S1 there is a mild disc bulge. There is moderate bilateral facet arthropathy with moderate cyst arising from the left L5-S1 facet joint representing synovial cyst measuring 10 x 9 mm. This results in mass effect upon the lateral recess and mildly displaces the transiting left S1 nerve root. There is no significant central canal narrowing. There is moderate bilateral neural foraminal narrowing, left greater than right with contact of the exiting L5 nerve roots. CONCLUSION: 01. Advanced inferior lumbar spine facet arthropathy at L4-L5 and L5-S1. In combination with mild disc bulges there is moderate neural foraminal narrowing at both L4-L5 and L5-S1 encroaching upon and likely contacting the exiting nerve roots bilaterally. 02. There is a moderate-sized synovial cyst arising from the left L5-S1 facet joints resulting in mild mass effect upon the transiting left S1 nerve root. 03. There is moderate central canal narrowing at L4-L5 secondary to combination of disc bulge and ligamentum flavum thickening and hypertrophic facet arthropathy. No other significant spinal canal narrowing.	FINDINGS: There is no loss of height of the lumbar vertebrae or malalignment. There is no focal abnormal T2 hyperintense signal within the bone marrow. There is no prevertebral or abnormal paraspinal soft tissue swelling. Conus medullaris terminates at the L1 level. Visualized inferior thoracic spinal cord and nerve roots of the cauda equina are unremarkable. There is mild disc desiccation at L4-L5 and L5-S1. At L4-L5 there is a broad disc bulge. There is moderate hypertrophic facet arthropathy with fluid in the facet joints. There is also thickening of the ligamentum flavum. These combine to result in moderate central canal narrowing. There is also moderate bilateral neural foraminal narrowing with encroachment upon and apparent contact of both exiting L4 nerve roots. At L5-S1 there is a mild disc bulge. There is moderate bilateral facet arthropathy with moderate cyst arising from the left L5-S1 facet joint representing synovial cyst measuring 10 x 9 mm. This results in mass effect upon the lateral recess and mildly displaces the transiting left S1 nerve root. There is no significant central canal narrowing. There is moderate bilateral neural foraminal narrowing, left greater than right with contact of the exiting L5 nerve roots.	FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstrated multifocal centrilobular and tree-in-bud opacities in both upper lobes, and right lower lobe. Left lower lobe is atelectatic. Tracheobronchial airways are patent. HEART / VESSELS: Heart is normal in size. Moderate-sized pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Small right anterior chest wall abscess, grossly unchanged in size since prior CT. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny nonobstructing left renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stable moderate-sized hiatal hernia. No abnormal dilatation small bowel loops. COLON / APPENDIX: Hyperattenuating collection in the large bowel loops with moderate distention.. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. No discrete intra-abdominal fluid collection to suggest abscess or hematoma. RETROPERITONEUM: No discrete retroperitoneal collection/hematoma VESSELS: Aorta is nonaneurysmal. Aorta, IVC and bilateral iliac vasculature are patent. URINARY BLADDER: Partially distended and contains Foleys catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anterior abdominal wall edema. MUSCULOSKELETAL: Chronic dislocation of left hip joint. Mild synovial thickening of the right hip joint. Redemonstrated spinal dysraphism with posterior meningocele.1
15,818	MR Brain wo contrast 1/27/2022 11:49 AM Clinical Information: Brain metastases, monitor, C79.31 Secondary malignant neoplasm of brain Spec Inst: eval brain mets Comparison: MRI of the brain dated 10/11/2021. Technique: Axial T1, T2, FLAIR, DWI with ADC map and GRE. Findings: Previously treated multiple intra-axial metastatic lesions involving the right frontal, parietal and temporal lobes and right cerebellum show decreased surrounding edema and interval encephalomalacic regression. Posttreatment remnant blood product is seen in the treated tumor bed. Interval right ventricular ex vacuo dilatation is also seen. Residual focal diffusion restriction remains visualized in the right middle cerebellar peduncle. There is no new intracranial space-occupying lesion, mass effect or acute vascular territory ischemia. Impression: 1. Post treatment encephalomalacic regression of the multiple intra-axial metastatic lesions with decreased surrounding edema. 2. Persistent diffusion restricting posttreatment necrosis in the right middle cerebellar peduncle.	Findings: Previously treated multiple intra-axial metastatic lesions involving the right frontal, parietal and temporal lobes and right cerebellum show decreased surrounding edema and interval encephalomalacic regression. Posttreatment remnant blood product is seen in the treated tumor bed. Interval right ventricular ex vacuo dilatation is also seen. Residual focal diffusion restriction remains visualized in the right middle cerebellar peduncle. There is no new intracranial space-occupying lesion, mass effect or acute vascular territory ischemia.	FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Redemonstrated multifocal centrilobular and tree-in-bud opacities in both upper lobes, and right lower lobe. Left lower lobe is atelectatic. Tracheobronchial airways are patent. HEART / VESSELS: Heart is normal in size. Moderate-sized pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Small right anterior chest wall abscess, grossly unchanged in size since prior CT. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny nonobstructing left renal calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stable moderate-sized hiatal hernia. No abnormal dilatation small bowel loops. COLON / APPENDIX: Hyperattenuating collection in the large bowel loops with moderate distention.. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. No discrete intra-abdominal fluid collection to suggest abscess or hematoma. RETROPERITONEUM: No discrete retroperitoneal collection/hematoma VESSELS: Aorta is nonaneurysmal. Aorta, IVC and bilateral iliac vasculature are patent. URINARY BLADDER: Partially distended and contains Foleys catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Mild anterior abdominal wall edema. MUSCULOSKELETAL: Chronic dislocation of left hip joint. Mild synovial thickening of the right hip joint. Redemonstrated spinal dysraphism with posterior meningocele.1
15,819	EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: Abdominal pain COMPARISON: CT abdomen pelvis dated 2/5/2021 TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 100 lbs. IV contrast: ProHance, 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small left renal cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Dilated left gonadal vein may be seen in the clinical setting of pelvic congestion syndrome. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Normal appearance of the pancreas without evidence of malignancy. 2. Dilated left gonadal vein, which can be seen in the clinical setting of pelvic congestion syndrome. Recommend clinical correlation. Otherwise no acute intra-abdominal abnormality to account for the patient's symptoms. 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 left renal cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Dilated left gonadal vein may be seen in the clinical setting of pelvic congestion syndrome. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.	FINDINGS: Right knee: BONES/JOINTS: There is a comminuted fracture of the distal femoral metaphysis with considerable impaction of the major fracture fragments. There is extension into the knee joint through the intercondylar notch. An unrelated, nonaggressive cartilaginous lesion is incidentally noted in the proximal tibial metaphysis. SOFT TISSUES: Moderate lipohemarthrosis and moderate soft tissue contusions/hematomas. Mild diffuse muscular atrophy. Left knee: BONES/JOINTS: There is a comminuted fracture of the distal left femoral metaphysis with moderate impaction of fracture fragments. There is intra-articular extension of the fracture. Bones are severely osteopenic. SOFT TISSUES: Moderate lipohemarthrosis and moderate soft tissue contusions/hematomas. Mild diffuse muscular atrophy.
15,820	MR Lumbar Spine wo+w contrast 1/27/2022 11:23 AM Clinical Information: lumbar meningioma, D32.9 Benign neoplasm of meninges, unspecified Comparison: MRI of the lumbar spine dated 11/30/2021. Technique: Axial T1/T2 and sagittal T1/T2/STIR and postcontrast axial and sagittal fat-sat T1-weighted images. Patient weight: 165 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 1 ml per sec. Findings: An encapsulated fluid collection in the L1/L2 laminectomy site is slightly decreased in size measuring 0.9 x 1.6 cm axially and 6.4 cm craniocaudally. There is an anterior intradural nodular lesion with avid contrast enhancement in the central-left paracentral region at L2 measuring 0.5 x 0.7 x 1.5 cm, stable when compared with previous exam. There is a poorly marginated intradural lesion encasing cauda equina at L1-L2, measures approximately 1.3 x 1.1 cm axially and 2.9 cm craniocaudally, which appears increased in size when compared with previous exam. This lesion does not show apparent contrast enhancement. The cauda equina nerve roots within this lesion are indistinctively visualized. Also seen is a homogeneously enhancing nodular lesion measuring 0.6 x 0.5 cm in the right paracentral epidural space at L1-L2, likely representing a focal transligamentous disc extrusion with vascularized granulation. There is continued spondylotic spinal canal stenosis, severe at L3-L4 and moderate at L4-L5. Impression: 1. Slightly decreased size of L1/L2 laminectomy fluid collection. 2. Stable size of anterior intradural nodular enhancing lesion at L2, likely residual meningioma. 3. Increased size of poorly marginated nonenhancing intradural lesion encasing cauda equina at L1-L2. Possibly postsurgical epidermoid tumor or masslike adhesive arachnoiditis versus less likely nonenhancing meningioma. 4. Interval nodular enhancing transligamentous disc extrusion at L1-L2. 5. Continued spondylotic spinal canal stenosis, severe at L3-L4 and moderate at L4-L5.	Findings: An encapsulated fluid collection in the L1/L2 laminectomy site is slightly decreased in size measuring 0.9 x 1.6 cm axially and 6.4 cm craniocaudally. There is an anterior intradural nodular lesion with avid contrast enhancement in the central-left paracentral region at L2 measuring 0.5 x 0.7 x 1.5 cm, stable when compared with previous exam. There is a poorly marginated intradural lesion encasing cauda equina at L1-L2, measures approximately 1.3 x 1.1 cm axially and 2.9 cm craniocaudally, which appears increased in size when compared with previous exam. This lesion does not show apparent contrast enhancement. The cauda equina nerve roots within this lesion are indistinctively visualized. Also seen is a homogeneously enhancing nodular lesion measuring 0.6 x 0.5 cm in the right paracentral epidural space at L1-L2, likely representing a focal transligamentous disc extrusion with vascularized granulation. There is continued spondylotic spinal canal stenosis, severe at L3-L4 and moderate at L4-L5.	FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Age-appropriate cerebral atrophy. Confluent periventricular hypoattenuating areas, compatible with mild chronic microangiopathic changes EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Stable in caliber and configuration, concordant with mild central predominant chronic parenchymal volume loss. ORBITS: Left lens replacement. SINUSES: Mucous retention cysts in the maxillary sinuses. Patchy opacification of the right ethmoid air cells. The other paranasal sinuses are clear. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
15,821	MR Brain wo contrast 1/28/2022 8:04 PM Clinical Information: SDH Spec Inst: include DWI and ADC Comparison: CT head 1/27/2022 and MR brain 1/26/2022 Technique: Axial diffusion, axial FLAIR, sagittal T1, axial T2 and SWI. Findings: Postsurgical changes from left craniotomy. There is overall stable size and extent of fluid and gas collection underlying the craniotomy flap. There is decreased size and extent of left convexity subdural collection compared to the prior MRI from 1/26/2022. There is increased FLAIR signal along the left cerebral sulci which is likely artifactual. No evidence of subarachnoid hemorrhage on SWI. There is persistent mild mass effect on the left cerebral hemisphere with rightward midline shift by 5 mm. There is no restricted diffusion or space-occupying lobar hemorrhage. Impression: 1. Stable postsurgical changes from left craniotomy. Overall unchanged size of fluid and gas underlying the craniotomy flap. No acute abnormality. 2. Interval decrease in size and extent of left convexity subdural collection. Persistent but decreased mass effect and rightward midline shift (5 mm, previously 7 mm).	Findings: Postsurgical changes from left craniotomy. There is overall stable size and extent of fluid and gas collection underlying the craniotomy flap. There is decreased size and extent of left convexity subdural collection compared to the prior MRI from 1/26/2022. There is increased FLAIR signal along the left cerebral sulci which is likely artifactual. No evidence of subarachnoid hemorrhage on SWI. There is persistent mild mass effect on the left cerebral hemisphere with rightward midline shift by 5 mm. There is no restricted diffusion or space-occupying lobar hemorrhage.	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 (
15,822	EXAM: MULTIPARAMETRIC MRI OF THE PROSTATE W AND WO IV CONTRAST CLINICAL INDICATION: Prostate cancer, 12/30/14 ? TRUSbx with 2/12 cores positive: RLM: GG1, LMB: GG1 PSA trend: 12/13/18 ? PSA 2.3. 1/16/20 ? PSA 1.6. 2/8/21 ? PSA 1.5 8/26/21 ? PSA 1.4 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 ml per sec. COMPARISON: None. FINDINGS: STRUCTURED REPORT: MRI Prostate Right hip and femoral hardware degrades evaluation of the prostate, particularly of the diffusion-weighted sequences. PROSTATE: Measurement: 4.0 x 3.3 x 4.1 cm; estimated volume: 28 cc Focal lesion(s): None, although exam is mildly limited by metallic hardware artifact. Diffuse prostate abnormalities: There is diffuse hypointense T2 signal throughout the central gland and peripheral zone, suggestive of prior treatment related effects. Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: There are multiple enlarged mesorectal/mesocolic lymph nodes (see Key images). Reference node measuring 8 mm in short axis noted on axial series 9 one, image 92. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: The bladder has a slightly atypical configuration with the fundus extending far superiorly beyond the field-of-view. There is a large amount of air within the bladder. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Right hip and femoral hardware. 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. No focal prostate lesion identified. Diffuse T2 hypointense signal throughout the prostate, would suggest possible treatment related effects, such as from prior radiation. Please correlate with history. 2. Multiple enlarged mesocolic/mesorectal lymph nodes as described above. This finding is indeterminate, however, recommend correlation with clinical and prior colonoscopic history. 3. Somewhat atypical configuration of the bladder with large volume of intraluminal air. The superior extent of the bladder is not included within the field-of-view. Consider further evaluation with CT of the abdomen and pelvis to better delineate the anatomy and etiology for intraluminal air in the absence of recent instrumentation. 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 Right hip and femoral hardware degrades evaluation of the prostate, particularly of the diffusion-weighted sequences. PROSTATE: Measurement: 4.0 x 3.3 x 4.1 cm; estimated volume: 28 cc Focal lesion(s): None, although exam is mildly limited by metallic hardware artifact. Diffuse prostate abnormalities: There is diffuse hypointense T2 signal throughout the central gland and peripheral zone, suggestive of prior treatment related effects. Other prostate findings: None. VESSELS: No significant abnormality. LYMPH NODES: There are multiple enlarged mesorectal/mesocolic lymph nodes (see Key images). Reference node measuring 8 mm in short axis noted on axial series 9 one, image 92. PERIRECTAL / PERIANAL REGION: Normal. BLADDER: The bladder has a slightly atypical configuration with the fundus extending far superiorly beyond the field-of-view. There is a large amount of air within the bladder. OTHER PELVIC FINDINGS: None. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Right hip and femoral hardware. 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: LUMBAR SPINE: VERTEBRA: No acute fracture. L1 compression deformity is likely chronic although new since the DEXA scan dated 1/4/17 point. No suspicious osseous lesions. DISC SPACES AND FACET JOINTS: No acute injury. Severe discogenic degenerative changes at L2-3 and L3-4 with additional less prominent multilevel discogenic degenerative changes. Central disc protrusion at L3-4 resulting in mild spinal canal narrowing. There is also broad-based disc bulge at L2-3 resulting in likely mild spinal canal narrowing Multilevel lumbar facet arthropathy most prominent in the lower lumbar spine. Moderate to severe right and mild left neural foraminal narrowing at L3-4. There is also mild neural foraminal narrowing on the right at L2-3. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Lumbar posterior vertebral alignment is normal. Leftward convex lumbar spine curvature centered at L3. Moderate aortoiliac atherosclerotic disease without aneurysm. Coronary vascular calcifications. Noninflamed colonic diverticula. Large duodenal diverticulum. Small hiatal hernia.
15,823	EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Sensorineural hearing loss. COMPARISON: Brain MR dated 2/11/2015. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 133 lbs. IV contrast: ProHance, 6 ml, per protocol. FINDINGS: No abnormal restricted diffusion. Periventricular and subcortical white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. There is diffuse cerebral atrophy with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. On postcontrast sequences there is no abnormal parenchymal enhancement, leptomeningeal enhancement, or pachymeningeal enhancement. No extra-axial collection. Visualized vasculature is unremarkable. There is cerebellar atrophy. On thin slice axial and coronal 3-D T2 high-resolution sequences no abnormal masses noted in either CP angle or involving either internal auditory canal. The bilateral facial and vestibular cochlear nerves are unimpeded in their cisternal and canalicular courses. The bilateral inner ear structures are unremarkable. The course of the bilateral trigeminal nerves, Meckel's caves, and Dorello's canals are all normal. No abnormal marrow signal. Trace bilateral mastoid effusions. There is also increased T2 fluid signal within the right middle ear. Mild mucosal thickening diffusely throughout the paranasal sinuses. The orbits and globes are normal.No abnormal soft tissue. CONCLUSION: 1. No significant abnormality to explain the patient's sensorineural hearing loss. 2. Cerebellar atrophy.. 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 restricted diffusion. Periventricular and subcortical white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. There is diffuse cerebral atrophy with prominence of the cortical sulci, sylvian fissures and compensatory dilatation of the ventricles. On postcontrast sequences there is no abnormal parenchymal enhancement, leptomeningeal enhancement, or pachymeningeal enhancement. No extra-axial collection. Visualized vasculature is unremarkable. There is cerebellar atrophy. On thin slice axial and coronal 3-D T2 high-resolution sequences no abnormal masses noted in either CP angle or involving either internal auditory canal. The bilateral facial and vestibular cochlear nerves are unimpeded in their cisternal and canalicular courses. The bilateral inner ear structures are unremarkable. The course of the bilateral trigeminal nerves, Meckel's caves, and Dorello's canals are all normal. No abnormal marrow signal. Trace bilateral mastoid effusions. There is also increased T2 fluid signal within the right middle ear. Mild mucosal thickening diffusely throughout the paranasal sinuses. The orbits and globes are normal.No abnormal soft tissue.	FINDINGS: Please note, some of the images are degraded by motion. BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Left-sided maxillary mucosal retention cyst. The rest of the paranasal sinuses and mastoid air cells are clear..
15,824	MR Brain wo+w contrast 1/27/2022 11:32 AM Clinical Information: Brain metastases, monitor, C79.9 Secondary malignant neoplasm of unspecified site Spec Inst: Metastatic lung cancer sp SRS to 3 lesions completed 12172020. fu scan Comparison: MRI of the brain dated 9/30/2021. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 154 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Previously treated residual enhancing lesions in the right superior parietal cortex and left cerebellum appear similar in size. No new intracranial enhancing lesion, cerebral edema or mass effect is identified. Intracranial leptomeningeal enhancement appears within normal limits. The ventricles are normal in size and configuration. No acute cerebral ischemia or intracranial hemorrhage is noted. Impression: 1. Unchanged small residual contrast enhancing lesions in the right superior parietal cortex and left cerebellum. 2. No evidence of new intracranial metastatic disease.	Findings: Previously treated residual enhancing lesions in the right superior parietal cortex and left cerebellum appear similar in size. No new intracranial enhancing lesion, cerebral edema or mass effect is identified. Intracranial leptomeningeal enhancement appears within normal limits. The ventricles are normal in size and configuration. No acute cerebral ischemia or intracranial hemorrhage is noted.	FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine Moderately degraded by motion. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. Right breast calcification. ABDOMEN and PELVIS: LIVER: The liver is cirrhotic in morphology with surface nodularity. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: The bilateral kidneys are mildly atrophic. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Large duodenal diverticulum arising from the third portion. The small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. Left retroperitoneal and umbilical collaterals. Mesenteric varices. URINARY BLADDER: Decompressed around Foley catheter. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE: VERTEBRA: Several thoracic and lumbar spine osseous hemangiomas. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel degenerative changes of the thoracic spine and moderate multilevel degenerative changes of the lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Thoracic dextroscoliosis and lumbar levoscoliosis. Grade 1 L3 over L4 retrolisthesis.
15,825	MR Brain wo+w contrast 1/27/2022 11:49 AM Clinical Information: Glioblastoma, monitor. Comparison: MRI of the brain dated 10/7/2021. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 197 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 2 ml per sec. Findings: The left superior temporal lobe again shows patch area of diffusion restriction reflecting antiangiogenic treatment related coagulation tissue necrosis, unchanged from previous exam. Multiple spotty contrast enhancement around the anteromedial margin of the left temporal surgical bed and parahippocampal granulation tissue enhancement are also stable in appearance. The left posterior thalamic punctate enhancement is prominently visualized. Also noted is slightly increased size of the focal gyriform enhancement in the left insular cortex. Overall extent of the left parietotemporal white matter T2 prolongation appears grossly stable. No new mass effect or evidence of leptomeningeal disease is noted. Impression: 1. Grossly Stable left temporal treated tumor bed with residual multifocal contrast enhancement. 2. Slightly increased enhancement in the left insular cortex and left posterior thalamus.	Findings: The left superior temporal lobe again shows patch area of diffusion restriction reflecting antiangiogenic treatment related coagulation tissue necrosis, unchanged from previous exam. Multiple spotty contrast enhancement around the anteromedial margin of the left temporal surgical bed and parahippocampal granulation tissue enhancement are also stable in appearance. The left posterior thalamic punctate enhancement is prominently visualized. Also noted is slightly increased size of the focal gyriform enhancement in the left insular cortex. Overall extent of the left parietotemporal white matter T2 prolongation appears grossly stable. No new mass effect or evidence of leptomeningeal disease is noted.	FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine Moderately degraded by motion. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. Right breast calcification. ABDOMEN and PELVIS: LIVER: The liver is cirrhotic in morphology with surface nodularity. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: The bilateral kidneys are mildly atrophic. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Large duodenal diverticulum arising from the third portion. The small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. Left retroperitoneal and umbilical collaterals. Mesenteric varices. URINARY BLADDER: Decompressed around Foley catheter. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE: VERTEBRA: Several thoracic and lumbar spine osseous hemangiomas. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel degenerative changes of the thoracic spine and moderate multilevel degenerative changes of the lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Thoracic dextroscoliosis and lumbar levoscoliosis. Grade 1 L3 over L4 retrolisthesis.
15,826	MR Brain wo+w contrast 1/27/2022 12:20 PM Clinical Information: meningioma, D32.9 Benign neoplasm of meninges, unspecified Comparison: MRI of the brain dated 9/30/2021. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 159 lbs. IV contrast: ProHance, 15 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: The left supraorbital eyebrow craniotomy remains unchanged. There is no evidence of extra-axial tumor recurrence. The left frontal encephalomalacia with residual edema and ex vacuo dilatation of the left frontal horn are unchanged. No new extra-axial mass or intracranial acute abnormality is identified. Impression: No evidence of left frontal extra-axial tumor recurrence.	Findings: The left supraorbital eyebrow craniotomy remains unchanged. There is no evidence of extra-axial tumor recurrence. The left frontal encephalomalacia with residual edema and ex vacuo dilatation of the left frontal horn are unchanged. No new extra-axial mass or intracranial acute abnormality is identified.	Findings: Please note, evaluation is limited due to motion artifact. CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
15,827	EXAM: MR Abdomen wo+w contrast CLINICAL INFORMATION: 75-year-old male with history of renal cell carcinoma status post nephrectomy; additional history of prostate cancer. COMPARISON: None. TECHNIQUE: MR Abdomen wo+w contrast Patient weight: 205 lbs. IV contrast: ProHance, 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: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Multiple tiny well-circumscribed T2 hyperintensities throughout the pancreas which appear to arise near the normal caliber main pancreatic duct. The largest lesion measures 6 cm on axial series 401, image 38. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Post right nephrectomy changes are again demonstrated. Multiple new/more conspicuous arterially enhancing nodules throughout the right nephrectomy bed (see Key images). Reference nodule measures 7 mm on axial series 1101, image 48. Few simple left 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: 1. Postsurgical changes associated with prior right nephrectomy. Multiple new arterially enhancing nodules throughout the surgical bed are concerning for sites of local recurrence. No evidence of metastatic disease elsewhere in the abdomen. 2. Multiple tiny pancreatic cystic structures with normal caliber main pancreatic duct, most suggestive of sidebranch IPMNs.	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: Multiple tiny well-circumscribed T2 hyperintensities throughout the pancreas which appear to arise near the normal caliber main pancreatic duct. The largest lesion measures 6 cm on axial series 401, image 38. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Post right nephrectomy changes are again demonstrated. Multiple new/more conspicuous arterially enhancing nodules throughout the right nephrectomy bed (see Key images). Reference nodule measures 7 mm on axial series 1101, image 48. Few simple left 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 Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine Moderately degraded by motion. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. Right breast calcification. ABDOMEN and PELVIS: LIVER: The liver is cirrhotic in morphology with surface nodularity. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: The bilateral kidneys are mildly atrophic. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Large duodenal diverticulum arising from the third portion. The small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. Left retroperitoneal and umbilical collaterals. Mesenteric varices. URINARY BLADDER: Decompressed around Foley catheter. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE: VERTEBRA: Several thoracic and lumbar spine osseous hemangiomas. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel degenerative changes of the thoracic spine and moderate multilevel degenerative changes of the lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Thoracic dextroscoliosis and lumbar levoscoliosis. Grade 1 L3 over L4 retrolisthesis.
15,828	RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Ependymoma. Per chart review, history of right frontal anaplastic ependymoma status post craniotomy resection on 8/15/2014, status post radiotherapy treatment. Presents for surveillance imaging. COMPARISON: MRI brain dated 7/22/2021, 1/21/2021, 7/23/2020. TECHNIQUE: MR Brain wo+w contrast Patient weight: 150 lbs. IV contrast: ProHance, 14 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: Stable right frontal craniotomy postsurgical changes with encephalomalacia/gliosis, chronic blood products in the resection bed, and smooth pachymeningeal thickening/enhancement. No focal nodular or masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Multiple additional punctate T-2/FLAIR hyperintense foci in the bilateral subcortical/deep cerebral as well as confluent periventricular white matter, similar prior, likely 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. Trace bilateral maxillary sinus floor and bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: 1. Stable posttreatment changes without evidence of enlarging residual or recurrent tumor. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.	FINDINGS: INTRACRANIAL FINDINGS: Stable right frontal craniotomy postsurgical changes with encephalomalacia/gliosis, chronic blood products in the resection bed, and smooth pachymeningeal thickening/enhancement. No focal nodular or masslike enhancement. No acute intraparenchymal infarct, hemorrhage, edema, hydrocephalus, space-occupying lesion, or mass effect. Multiple additional punctate T-2/FLAIR hyperintense foci in the bilateral subcortical/deep cerebral as well as confluent periventricular white matter, similar prior, likely 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. Trace bilateral maxillary sinus floor and bilateral anterior ethmoid sinus mucosal thickening. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.	FINDINGS: STRUCTURED REPORT: CT Chest, Abdomen, and Pelvis with Thoracic and Lumbar Spine Moderately degraded by motion. LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. Right breast calcification. ABDOMEN and PELVIS: LIVER: The liver is cirrhotic in morphology with surface nodularity. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Enlarged. ADRENALS: Normal. KIDNEYS: The bilateral kidneys are mildly atrophic. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach is unremarkable. Large duodenal diverticulum arising from the third portion. The small bowel is normal in caliber. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic disease of the abdominal aorta and its branches. Left retroperitoneal and umbilical collaterals. Mesenteric varices. URINARY BLADDER: Decompressed around Foley catheter. REPRODUCTIVE ORGANS: The uterus is surgically absent. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No significant abnormality. THORACIC AND LUMBAR SPINE: VERTEBRA: Several thoracic and lumbar spine osseous hemangiomas. DISC SPACES AND FACET JOINTS: No acute injury. Mild multilevel degenerative changes of the thoracic spine and moderate multilevel degenerative changes of the lumbar spine. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Thoracic dextroscoliosis and lumbar levoscoliosis. Grade 1 L3 over L4 retrolisthesis.
15,829	RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Intractable epilepsy, Spec Inst: For Or Planning For Placement Of Intracranial SEEG. Per chart review, PET/MRI notable for focally decreased FDG uptake in the left frontal lobe with associated cortical thinning as well as symmetric, mildly decreased bilateral temporal lobe activity. COMPARISON: CTA head dated same date. PET/MRI dated 8/3/2021. MRI brain dated 6/29/2021, 7/22/2016. TECHNIQUE: MR Brain wo+w contrast Patient weight: 218 lbs. IV contrast: ProHance, 20 ml, per protocol. Axial T1-weighted MR sequence images of the brain were obtained pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: INTRACRANIAL FINDINGS: There is focal T2 T2 hypointense and hyperintense signal within the left frontal pole. There is minimal adjacent abnormal T2 hyperintense signal. No evidence of space-occupying lesion, neuronal migration syndrome, cephalocele, vascular malformation, or mesial temporal sclerosis. No acute intraparenchymal hemorrhage, edema, hydrocephalus, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. The ventricular system is normal in caliber and configuration. The cerebrovascular structures are well-opacified. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Left maxillary sinus mucous retention cyst. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable. CONCLUSION: Redemonstration of heterogeneous T2 hypointense signal involving left frontal pole with minimal adjacent T2 hyperintense signal overall unchanged from prior PET/MRI in August 2021. The abnormality is new compared to MRI from July 2016. Findings suggest small area of encephalomalacia with remote blood products, does patient have history of previous head trauma.? . 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: There is focal T2 T2 hypointense and hyperintense signal within the left frontal pole. There is minimal adjacent abnormal T2 hyperintense signal. No evidence of space-occupying lesion, neuronal migration syndrome, cephalocele, vascular malformation, or mesial temporal sclerosis. No acute intraparenchymal hemorrhage, edema, hydrocephalus, or mass effect. Postcontrast series demonstrates no focal enhancing lesion. The ventricular system is normal in caliber and configuration. The cerebrovascular structures are well-opacified. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. Left maxillary sinus mucous retention cyst. The paranasal sinuses and mastoid air cells are otherwise clear. Both orbits are unremarkable.	FINDINGS: Please note, evaluation is limited due to motion. No acute maxillofacial or mandibular fracture. No suspicious osseous lesion is identified. Mucous retention cyst in the left maxillary sinus. The other paranasal sinuses and mastoid air cells are clear. The orbits are normal. Soft tissues are unremarkable. Visualized portions of the brain demonstrate no significant abnormality.
15,830	MR Brain wo contrast 1/27/2022 11:49 AM Clinical Information: Neuro deficit, acute, stroke suspected ; Stroke, follow up, Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits, G20 Parkinson s disease Comparison: CT head dated 3/18/2020. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI. Patient weight: 150 lbs. Findings: Diffusion-weighted imaging is negative for acute lacunar infarct or vascular territory ischemia. Chronic ischemic encephalomalacia involving the right occipital lobe is noted. Small area of chronic hemorrhagic remnant in the inferomedial aspect of the left occipital encephalomalacia exhibits focal diffusion restriction, unrelated to acute ischemic event. The trigone of the bilateral ventricular is dilated ex vacuo. No acute intracranial hemorrhage, mass or mass effect is noted. The brainstem and cerebellum are unremarkable. Impression: No evidence of acute cerebral ischemic stroke.	Findings: Diffusion-weighted imaging is negative for acute lacunar infarct or vascular territory ischemia. Chronic ischemic encephalomalacia involving the right occipital lobe is noted. Small area of chronic hemorrhagic remnant in the inferomedial aspect of the left occipital encephalomalacia exhibits focal diffusion restriction, unrelated to acute ischemic event. The trigone of the bilateral ventricular is dilated ex vacuo. No acute intracranial hemorrhage, mass or mass effect is noted. The brainstem and cerebellum are unremarkable.	Findings: Please note, evaluation is limited due to motion artifact. CT C-spine: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
15,831	RADIOLOGIC EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: Pituitary, monitor. Per chart review, history of incidental, nonfunctioning pituitary adenoma presenting for surveillance imaging. COMPARISON: MRI brain/orbits dated 5/12/2021. TECHNIQUE: MR Brain wo+w contrast Patient weight: 105 lbs. IV contrast: ProHance, 10 ml, per protocol. IV contrast injection rate: 2 ml per sec. Multiplanar, multisequence MR images of the brain were obtained in the coronal planes pre- and post administration of intravenous contrast per departmental protocol. FINDINGS: INTRACRANIAL FINDINGS: No significant interval change in size or appearance of heterogeneously enhancing sellar mass, now measuring 1.4 x 1.4 x 1.1 cm in AP by TV by CC (series 801, image 8; series 701, image 10), previously 1.3 x 1.4 x 1.0 cm (series 6, image 6; series 7, image 3). No significant cavernous sinus invasion. The visualized proximal cerebrovascular flow voids are patent. Minimal mass effect on the infundibulum, which is slightly left of midline. Minimal extension into the suprasellar cistern without encroachment upon the optic chiasm. The chiasm appears atrophic. Age-appropriate, mild frontoparietal cerebral volume loss with proportionate ex vacuo ventricular dilatation. Multifocal periventricular and deep white matter T2/FLAIR hyperintensities bilaterally, similar to prior, likely chronic microangiopathic changes. No additional pathologic enhancement. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The imaged paranasal sinuses and mastoid air cells are clear. CONCLUSION: 1. Stable enhancing sellar mass compatible with pituitary macroadenoma. No significant cavernous sinus invasion. 2. No obvious compression over the chiasm however the chiasm itself appears atrophic. The pituitary lesion can be incidental finding. Clinical correlation for optic nerve pathology including optic nerve ischemia or optic neuritis 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: INTRACRANIAL FINDINGS: No significant interval change in size or appearance of heterogeneously enhancing sellar mass, now measuring 1.4 x 1.4 x 1.1 cm in AP by TV by CC (series 801, image 8; series 701, image 10), previously 1.3 x 1.4 x 1.0 cm (series 6, image 6; series 7, image 3). No significant cavernous sinus invasion. The visualized proximal cerebrovascular flow voids are patent. Minimal mass effect on the infundibulum, which is slightly left of midline. Minimal extension into the suprasellar cistern without encroachment upon the optic chiasm. The chiasm appears atrophic. Age-appropriate, mild frontoparietal cerebral volume loss with proportionate ex vacuo ventricular dilatation. Multifocal periventricular and deep white matter T2/FLAIR hyperintensities bilaterally, similar to prior, likely chronic microangiopathic changes. No additional pathologic enhancement. EXTRACRANIAL FINDINGS: The visualized extracranial osseous and soft tissue structures demonstrate normal signal characteristics. The imaged paranasal sinuses and mastoid air cells are clear.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: Limited evaluation due to patient positioning. No significant abnormality as visualized. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Left chest terminates in the posterior medial left upper lung. Endotracheal tube terminates in the mid trachea. Trace secretions in the trachea and bilateral mainstem bronchi. Basilar predominant central and peripheral bronchiectasis. Diffuse bilateral upper lobe predominant patchy consolidation and groundglass opacities with associated interlobular septal thickening. Bilateral dependent atelectasis. Moderate right pleural effusion. Tiny pneumothorax along the anterior medial left lung (image 76 and 102, series #5). HEART / OTHER VESSELS: Left IJ central venous catheter terminates in the inferior right atrium. Reflux of contrast into the IVC. Mildly enlarged heart size. Small pericardial effusion. Borderline enlarged main pulmonary artery measuring 3.0 cm. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube courses below the diaphragm with tip excluded from the field-of-view. LYMPH NODES: None enlarged. CHEST WALL: Mild anasarca. UPPER ABDOMEN: Small amount of perihepatic ascites. MUSCULOSKELETAL: Minimal S-shaped scoliosis of the thoracolumbar spine. Moderate multilevel discogenic degenerative change with severe degenerative disc disease at T9-10.
15,832	Last night I had the chance to review the images with Dr. Singhal. We reviewed the brain MRI dated 1/25/2022 and compared it with multiple prior MRIs. On MRI dated 1/25/2022 there is a small suspicious nodular-like FLAIR hyper signal intensity in posterior portion of the resection cavity and also the FLAIR hyper signal intensity in the anterolateral portion of the resection cavity appears more prominent with faint nodularity. I put arrow and amrker over these regions (MRI dated 1/25/2022 series #5 image 35). However this MRI was performed under GE scanner 1.5 Tesla and with 3 mm slice thickness. Several older brain MRIs have been done by three Tesla scanner and with 5 mm slice thickness. We supposed that the mentioned prominent suspicious nodularity can be secondary to different technique and scanner. So we suggested to repeat FLAIR sequence by the three Tesla scanner and with 5 mm slice thickness to improve comparison with older images. Single FLAIR sequence was performed dated 1/27/2022 with 3 T scanner and 5 mm slice thickness. The previously mentioned suspicious nodularity in the posterior portion of the resection cavity and the prominent suspicious nodularity in the anterolateral portion of resection cavity is not visualized anymore and the resection cavity with associated peripheral FLAIR hyper signal intensity appears unchanged in comparison to prior MRI dated 8/23/2021. A focus of FLAIR hyper signal intensity in anterior aspect of resection cavity measuring 30 x 15 mm on transverse diameter appears unchanged in favor of treated neoplasm status post radiation. Other areas of the peripheral FLAIR hyper signal intensity around the resection cavity are unchanged. Also periventricular and deep white matter FLAIR hyper signal intensity adjacent to the right atrium are also unchanged. In conclusion, in comparison to prior dated 8/23/2021 no definite evidence of interval disease progression is noted. The focus of FLAIR hyper signal intensity in anterior aspect of resection cavity (series 201 image 19) is felt to be unchanged since the most recent MRI and it is smaller in comparison to the MRI before radiation (8/5/2019) and MRI shortly after completion of the radiation (dated 11/18/2019). This focus is most consistent with treated residual/recurrent neoplasm. Definite differentiation between the postradiation changes and viable neoplasm at this location is not possible on anatomic MRI and interval change over the time would be the best way to detect any interval progression. Findings were discussed with the patient.	The previously mentioned suspicious nodularity in the posterior portion of the resection cavity and the prominent suspicious nodularity in the anterolateral portion of resection cavity is not visualized anymore and the resection cavity with associated peripheral FLAIR hyper signal intensity appears unchanged in comparison to prior MRI dated 8/23/2021. A focus of FLAIR hyper signal intensity in anterior aspect of resection cavity measuring 30 x 15 mm on transverse diameter appears unchanged in favor of treated neoplasm status post radiation. Other areas of the peripheral FLAIR hyper signal intensity around the resection cavity are unchanged. Also periventricular and deep white matter FLAIR hyper signal intensity adjacent to the right atrium are also unchanged.	FINDINGS: There are new destructive changes involving the anterior opposing endplates at the T8-T9 level, compared to CT chest from 11/13/2021. There is associated anterior prevertebral phlegmon (measuring up to 2.9 cm on the right and 9 mm on the left). The phlegmon abuts the posterior aspect of the descending thoracic aorta. No appreciable drainable collection is is noted at this time. There is no involvement of the spinal canal. There is no high-grade bony canal stenosis in either thoracic or lumbar spine. There are mild bilateral neuroforaminal narrowing at T8-T9, and T10 and T12 due to combination of disc and facet degenerative changes. Also moderate right and mild left neuroforaminal narrowing at present due to combination of disc and facet degenerative changes. There are small bilateral pleural effusions and overlying atelectasis. Please refer to the CT, chest, abdomen and pelvis report for the detailed assessment of the soft tissue organs.
15,833	EXAM: MR Brain wo+w contrast CLINICAL INFORMATION: History of right frontal brain malignancy status post resection. Of note, the patient is now one month status post radiation therapy. COMPARISON: Multiple priors most recently dated 10/9/2021. TECHNIQUE: MR Brain wo+w contrast. Patient weight: 163 lbs. IV contrast: ProHance, 8 ml, per protocol. FINDINGS: Postsurgical changes of prior right frontal lobe mass resection with interval decrease in the amount of associated restricted diffusion within the resection bed. Interval decrease of FLAIR signal intensity in medial portion of the resection cavity. There is persistent focus of FLAIR signal intensity in posterior portion of the resection cavity is slightly more prominent since prior MRI. Overlying dural thickening is redemonstrated and likely related to postsurgical status. Enhancement within the resection cavity itself appears linear in favor of postsurgical changes. Minimal periventricular white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. The ventricles are within normal size limits and there is no midline shift. Expected T2 vascular flow voids are unremarkable aside from redemonstration of an AV malformation along the vein of Galen. Postsurgical changes of right cerebral convexity craniotomy. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are normal.No abnormal lymphadenopathy or significant soft tissue abnormality. CONCLUSION: Postsurgical changes of right frontal lobe with mass resection with overall interval decrease in the amount of associated diffusion restriction around the resection cavity. Smooth pachymeningeal thickening and enhancement subjacent to surgery is most consistent with postsurgical changes. Enhancement within the resection cavity is likely postsurgical and post radiation changes. There is interval size decrease of the FLAIR hyper signal intensity in medial portion of the resection cavity in favor of interval improvement of postsurgical changes. There is a focus of FLAIR hyper signal intensity in posterior portion of the resection cavity which is slightly more prominent since prior study (series 8 image 26). This focus remains indeterminate on today's MRI and can be secondary to recent radiation however it should be further evaluated by follow-up MRI preferably with MR perfusion sequence. Please note that this MRI was performed about one month after completion of the radiation and should be used as baseline MRI. Interval resolution of the postsurgical mass effect, effacement of the right lateral ventricle and right-to-left midline shift. Persistent AV malformation along the vein of Galen. 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: Postsurgical changes of prior right frontal lobe mass resection with interval decrease in the amount of associated restricted diffusion within the resection bed. Interval decrease of FLAIR signal intensity in medial portion of the resection cavity. There is persistent focus of FLAIR signal intensity in posterior portion of the resection cavity is slightly more prominent since prior MRI. Overlying dural thickening is redemonstrated and likely related to postsurgical status. Enhancement within the resection cavity itself appears linear in favor of postsurgical changes. Minimal periventricular white matter FLAIR hyperintensities are most consistent with chronic microangiopathic ischemic changes. The ventricles are within normal size limits and there is no midline shift. Expected T2 vascular flow voids are unremarkable aside from redemonstration of an AV malformation along the vein of Galen. Postsurgical changes of right cerebral convexity craniotomy. The middle ears, mastoid air cells, and paranasal sinuses are clear. The orbits and globes are normal.No abnormal lymphadenopathy or significant soft tissue abnormality.	FINDINGS: There are new destructive changes involving the anterior opposing endplates at the T8-T9 level, compared to CT chest from 11/13/2021. There is associated anterior prevertebral phlegmon (measuring up to 2.9 cm on the right and 9 mm on the left). The phlegmon abuts the posterior aspect of the descending thoracic aorta. No appreciable drainable collection is is noted at this time. There is no involvement of the spinal canal. There is no high-grade bony canal stenosis in either thoracic or lumbar spine. There are mild bilateral neuroforaminal narrowing at T8-T9, and T10 and T12 due to combination of disc and facet degenerative changes. Also moderate right and mild left neuroforaminal narrowing at present due to combination of disc and facet degenerative changes. There are small bilateral pleural effusions and overlying atelectasis. Please refer to the CT, chest, abdomen and pelvis report for the detailed assessment of the soft tissue organs.
15,834	MR Brain wo+w contrast 1/27/2022 1:05 PM Clinical Information: left upper extremity MCC, C4A.62 Merkel cell carcinoma of left upper limb, including shoulder Spec Inst: initial staging Comparison: None. Technique: Sagittal T1, axial T2, FLAIR, DWI with ADC map and SWI, postcontrast axial, coronal and sagittal T1. Patient weight: 200 lbs. IV contrast: ProHance, 20 ml, per protocol. IV contrast injection rate: 0.50 ml per sec. Findings: Intracranially no focal contrast enhancing abnormality, mass or mass effect is identified. Bilateral deep white matter shows mild chronic small vessel ischemic changes and prominent perivascular spaces. The ventricles, cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. The sella/pituitary gland, and cerebellum are normal in appearance. The calvarium and skull base show focal bony abnormality. Bilateral ethmoid sinus mucosal thickening and right sphenoid sinus retention cyst are noted. The orbits are unremarkable Impression: No evidence of intracranial metastatic disease.	Findings: Intracranially no focal contrast enhancing abnormality, mass or mass effect is identified. Bilateral deep white matter shows mild chronic small vessel ischemic changes and prominent perivascular spaces. The ventricles, cortical sulci and subarachnoid cisterns are symmetric and age-appropriate. The sella/pituitary gland, and cerebellum are normal in appearance. The calvarium and skull base show focal bony abnormality. Bilateral ethmoid sinus mucosal thickening and right sphenoid sinus retention cyst are noted. The orbits are unremarkable	FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. Diffuse cerebral volume loss and mild chronic white matter microangiopathic changes. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal.
15,835	MRI brain with and without contrast Clinical Information: Female aged 58 years. glioma, neoplasm of frontal lobe Comparison: MR 1/28/2021 and 8/22/2008 Technique: Multiplanar, multisequence MRI of the brain were obtained in multiple planes pre-and post administration of intravenous contrast per departmental protocol. Patient weight: 160 lbs. IV contrast: ProHance, 15 ml, per protocol. Findings: Prior right frontal craniotomy and mass resection of the right frontal operculum with overall unchanged appearance of resection bed and adjacent gliosis. T2 and FLAIR hyper signal intensity adjacent to the resection cavity with extension of the right centrum semiovale is not significantly changed in size and morphology since prior MRI. No abnormal parenchymal or leptomeningeal enhancement. No acute infarct or intracranial hemorrhage. No significant abnormality of the extracranial osseous and soft tissue structures. Mucosal thickening of bilateral maxillary sinuses suggestive for sinusitis. Conclusion: Right frontal craniotomy and resection, overall unchanged. No evidence of 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: Prior right frontal craniotomy and mass resection of the right frontal operculum with overall unchanged appearance of resection bed and adjacent gliosis. T2 and FLAIR hyper signal intensity adjacent to the resection cavity with extension of the right centrum semiovale is not significantly changed in size and morphology since prior MRI. No abnormal parenchymal or leptomeningeal enhancement. No acute infarct or intracranial hemorrhage. No significant abnormality of the extracranial osseous and soft tissue structures. Mucosal thickening of bilateral maxillary sinuses suggestive for sinusitis.	FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Diffuse, bilateral, peripheral predominant, groundglass opacities with intralobular septal thickening and "crazy paving," all of which appear worse relative to examination of 1/9/2022. These are superimposed on a background of mild biapical paraseptal emphysema. Airways are patent and normal in morphology. No pleural effusions. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Imaged portions of the superior abdomen are unremarkable for arterial phase technique MUSCULOSKELETAL: No significant abnormality.
15,836	MR Brain wo+w contrast HISTORY: Evaluation for pituitary lesion TECHNIQUE: Multiplanar, multisequence MRI of the pituitary was performed without and after intravenous contrast. COMPARISON: MRI of 3/16/2018 FINDINGS: There is a 2 mm tiny focus of decreased enhancement in the left aspect of the pituitary gland most likely a tiny microadenoma. No other space-occupying lesion is noted in the pituitary gland. Partial empty sella is noted. Pituitary stalk is located at the midline. No invasion to the cavernous sinuses, encasement of the carotid arteries or mass effect over the chiasm is seen. The right cerebellar tonsil is 7 mm below the foramen of magnum with minimal crowding at the level of foramen of magnum. IMPRESSION: A 2 mm tiny focus of decreased enhancement in left aspect of pituitary gland most consistent with a tiny microadenoma. Otherwise no other pathology in the pituitary gland.	FINDINGS: There is a 2 mm tiny focus of decreased enhancement in the left aspect of the pituitary gland most likely a tiny microadenoma. No other space-occupying lesion is noted in the pituitary gland. Partial empty sella is noted. Pituitary stalk is located at the midline. No invasion to the cavernous sinuses, encasement of the carotid arteries or mass effect over the chiasm is seen. The right cerebellar tonsil is 7 mm below the foramen of magnum with minimal crowding at the level of foramen of magnum.	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: Normal. BILIARY TRACT: Normal. GALLBLADDER: Prior cholecystectomy. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a 4 mm obstructing stone at the left UVJ with mild left hydroureteronephrosis and mild reactive stranding. Few additional punctate nonobstructing bilateral renal stones. No right hydronephrosis LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Trace fluid in the cul-de-sac, likely physiologic. No free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Mildly distended but otherwise normal. REPRODUCTIVE ORGANS: IUD in expected position. Otherwise normal. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. Small gas-filled synovial cyst along the right anterior SI joint L5 limbus vertebra
15,837	MR Brain wo+w contrast HISTORY: Left asymmetric hearing loss TECHNIQUE: Multiplanar, multisequence MRI of the brain was performed without and after intravenous contrast. Patient weight: 215 lbs. IV contrast: ProHance, 10 ml, per protocol. COMPARISON: Not available FINDINGS: INTRACRANIAL FINDINGS: There is mild diffuse cerebral volume loss. Patchy and confluent foci of periventricular and deep white matter FLAIR hyper signal intensities are most consistent with moderate microvascular angiopathy. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. No abnormal enhancement is seen. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated. IMPRESSION: No acute intracranial lesion. Moderate microvascular angiopathy. No definite pathology in the internal auditory canals.	FINDINGS: INTRACRANIAL FINDINGS: There is mild diffuse cerebral volume loss. Patchy and confluent foci of periventricular and deep white matter FLAIR hyper signal intensities are most consistent with moderate microvascular angiopathy. The brain parenchyma appears normal without evidence for acute ischemia, hemorrhage, or mass lesion. The ventricles are normal in size. There is no abnormal extra-axial collection. The flow voids at the skull base are normal. The cerebellar tonsils are normal in position. No abnormal enhancement is seen. EXTRACRANIAL FINDINGS: The orbital contents are unremarkable. The visualized paranasal sinuses and mastoid air cells are well aerated.	FINDINGS: STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bibasilar subsegmental atelectasis. No pleural effusion or lung consolidation. Trachea is central. Tracheobronchial airways are patent. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Multiple calcified mediastinal and left hilar lymph nodes. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Stable appearance of liver. No focal hepatic lesions. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent PANCREAS: Diffuse fatty infiltration of pancreas. Pancreatic duct is nondilated SPLEEN: Stable appearance of spleen. ADRENALS: Normal. KIDNEYS: Kidneys demonstrate symmetric enhancement. Subcentimeter left renal cortical hypoattenuating lesions too small to characterize probably represent simple cyst. No radiopaque calculus, hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Postsurgical changes of gastric bypass. Oral contrast has progressed to the distal ileum. Loop of distal ileum is again seen closely approximated/adherent in the right lower quadrant adjacent to the right ovary (on series 3/295). There is a small enteric fistulous tract as seen on series 3/image 282 and series 5/image 77 which communicates with the gas containing mesenteric collection in the right hemiabdomen which measures about 5.8 cm (series 3/image 241), previously about 3.5 cm. Additional small gas containing collection in the right lower quadrant has decreased in size measuring about 2.6 cm (on series 3/308), previously about 3.8 cm. This collection also communicates with the adjacent small bowel loops. Additional small enteric fistulous tract is seen on series 3/293. There is associated diffuse adjacent mesenteric edema and inflammatory stranding in the right hemiabdomen. Long segment circumferential wall thickening and enhancement of the distal ileum measuring about 10 cm (series 5/image 63). Terminal ileum and ileocecal junction are unremarkable. Appendix is normal. COLON / APPENDIX: Large bowel loops are unremarkable. PERITONEUM / MESENTERY: Stable small loculated pelvic collection, measuring about 4.7 x 4.3 cm (series 3/image 324). No discrete residual fluid collection is seen at the tip of percutaneous catheter in the left lower quadrant. There are/fluid containing collection in the left paracolic gutter appears similar in size measuring about 3 x 3 cm (series 3/image 22). Small mesenteric fluid loculations in the central abdomen, for example on series 3/image 280 measuring about 2.4 cm and series 3/image 91 measuring about 2.0 cm, appears similar to slightly decreased in size. RETROPERITONEUM: No discrete retroperitoneal fluid collection. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Anteverted uterus. Probable posterior wall intramural fibroid. BODY WALL: Small fat-containing umbilical hernia. No discrete intra-abdominal/fluid collection. MUSCULOSKELETAL: No acute osseous findings. Multilevel degenerative changes in lumbar spine.
15,838	MR Breast Diagnostic Bil wo+w contrast CLINICAL INFORMATION: History of left breast radial scar status post biopsy.. TECHNIQUE: T1 axial, FSE T2 fat sat axial, pre and post contrast vibrant sequence with 3D reconstructions and time intensity curves. Delayed post contrast axials. A dedicated 8 channel breast imaging coil was utilized. Patient weight: 165 lbs. IV contrast: ProHance, 16 ml, per protocol. IV contrast injection rate: 2 ml per sec. COMPARISON: Mammogram 12/8/2021 and ultrasound 12/8/2021. FINDINGS: All measurements provided in the format AP, TV, CC dimensions Breast tissue is extreme fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Susceptibility artifact from biopsy marker in the upper outer quadrant is noted. Adjacent enhancement measures approximately 17 x 16 x 12 mm on series 400 image 484 and series 7 image 46.. BILATERAL Scattered u Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal. IMPRESSION: RIGHT BREAST: No MRI evidence of malignancy.: BI-RADS 2: Benign. LEFT BREAST: Enhancement at site of biopsied radial scar is suspicious..: Surgical excision recommended. BI-RADS 4: Suspicious Overall BI-RADS assessment: BI-RADS 4: Suspicious 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: All measurements provided in the format AP, TV, CC dimensions Breast tissue is extreme fibroglandular tissue. Postcontrast administration there is moderate background enhancement. RIGHT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. LEFT BREAST: No suspicious mass, nonmass enhancement, or distortion is seen. Susceptibility artifact from biopsy marker in the upper outer quadrant is noted. Adjacent enhancement measures approximately 17 x 16 x 12 mm on series 400 image 484 and series 7 image 46.. BILATERAL Scattered u Internal mammary nodes are normal. Axillary lymph nodes are normal. EXTRAMAMMARY: There is no suspicious abnormality in the visualized lung fields. Visualized upper abdomen unremarkable. Marrow signal is normal.	FINDINGS: BRAIN PARENCHYMA: Punctate microhemorrhages within the genu and splenium of the corpus callosum and right thalamus. Suspected additional focus of intraparenchymal hemorrhage along the right cerebral peduncle, best seen on sagittal series (series 206 image 40). No mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Large left frontal subgaleal hematoma without underlying calvarial fracture. VENTRICULAR SYSTEM: Layering intraventricular hemorrhage within the occipital horn of the right ventricle. No hydrocephalus. CT maxillofacial: No evidence of acute maxillofacial or mandibular fractures. Bilateral orbits appear normal without evidence of fracture or soft tissue injury. Small mucous retention cysts of the right maxillary sinus. Remaining sinuses and mastoid air cells are clear.
15,839	EXAM: MR Knee Right wo contrast CLINICAL INFORMATION: Right knee injury COMPARISON: 1/13/2022 TECHNIQUE: Multiplanar and multisequence MRI of the right knee was obtained without intravenous contrast. FINDINGS: BONES:Impaction deformity and bone marrow edema like signal are noted at the anterolateral aspect of the lateral femoral condyle. Additionally, there is edema along the inferomedial aspect of the patella. No aggressive osseous lesion. ARTICULATIONS: Effusion:Moderate Patellofemoral compartment:No full-thickness articular cartilage defect. Wiberg Type III patella. Additionally, there is flattening of the trochlear groove Medial compartment:No full-thickness articular cartilage defect. Lateral compartment:No full-thickness articular cartilage defect. MENISCI: Medial meniscus:Radial tear of the body (image 20, series 1101) Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Edema overlies the superficial fibers. The MCL is intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Complete tear of the medial patellofemoral ligament near its femoral attachment. CONCLUSION: 1. Findings consistent with transient dislocation of the patella with high-grade tear of the medial patellofemoral ligament near its femoral attachment, associated contusion of the inferomedial patella and impaction fracture of the lateral femoral condyle. 2. Radial tear of the body of the medial meniscus. 3. Grade 1 sprain of the MCL. 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:Impaction deformity and bone marrow edema like signal are noted at the anterolateral aspect of the lateral femoral condyle. Additionally, there is edema along the inferomedial aspect of the patella. No aggressive osseous lesion. ARTICULATIONS: Effusion:Moderate Patellofemoral compartment:No full-thickness articular cartilage defect. Wiberg Type III patella. Additionally, there is flattening of the trochlear groove Medial compartment:No full-thickness articular cartilage defect. Lateral compartment:No full-thickness articular cartilage defect. MENISCI: Medial meniscus:Radial tear of the body (image 20, series 1101) Lateral meniscus:Intact. LIGAMENTS: Cruciate ligaments:Intact. Medial collateral ligament:Edema overlies the superficial fibers. The MCL is intact. Lateral collateral ligament:Intact. Posterolateral corner structures:Intact. EXTENSOR MECHANISM:The distal quadriceps and patellar tendons are intact. Complete tear of the medial patellofemoral ligament near its femoral attachment.	FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Patchy groundglass and airspace opacities in the left upper lobe. No pleural effusion or pneumothorax. Secretions within the distal trachea. Endotracheal tube with distal tip approximately 3.2 cm above carina. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue. Esophagogastric tube in place. 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: Splenomegaly measuring 14 cm. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube with distal tip in the proximal gastric body. Small bowel is nondilated. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Stranding along the right femoral vessels, likely related to recent instrumentation. URINARY BLADDER: Partially distended with a Foley. Gas within the bladder lumen related to recent Foley placement. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Minimally displaced fracture of the right first rib. Nondisplaced fracture of the left first rib. THORACIC AND LUMBAR SPINE: No fractures or malalignment. Vertebral heights and intervertebral spaces are preserved.