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The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 21-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 55 seconds

Successful left shoulder arthrogram.

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There is no mass, mass-effect, or midline shift. There are no abnormal foci of enhancement. There is no diffusion abnormality to suspect acute stroke. There is no susceptibility weighted abnormality. The ventricles and sulci are within normal limits. The basal cisterns remain patent. The major intracranial vascular structures enhance normally. The midline structures and craniocervical junction are within normal limits. There is moderate mucosal thickening in the left maxillary sinus.

1. No evidence of intracranial mass, Chiari malformation, white matter lesions, or signs of hydrocephalus.2. Moderate left maxillary sinus opacification may represent sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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Female 38 years old; Reason: Achilles tear? Ankle instability. History: Ankle instability. Pain and swelling of achilles TENDONS: The anterior fibers of the distal Achilles tendon appear minimally convex with minimal streaky increased signal, which may represent minimal tendinosis, however this is equivocal and appears similar to that seen on the prior study. No Achilles tendon tear is seen. There is mild edema in the pre-Achilles fat which may reflect mild inflammation or bursitis, though this also appears similar to the prior study. There is mild edema in the superior aspect of the posterior calcaneus, which is likely reactive and related to the aforementioned soft tissue inflammation. There is perhaps a minimal Haglund deformity of the calcaneus. The remaining tendons are within normal limits. LIGAMENTS: The anterior talofibular ligament is attenuated, perhaps reflecting prior injury though appearing similar to the prior study. The calcaneofibular and posterior talofibular ligaments are intact. The distal tibiofibular syndesmosis is intact. Loss of the normal fatty striations of the deltoid ligament may reflect prior injury, however this appears similar to the prior study. ARTICULAR SURFACES AND BONE: Again seen is the small focus of increased T2 signal in the medial aspect of the talar dome, which may represent a degenerative cyst or old osteochondral defect and appears similar to that seen on the prior study. Other than the aforementioned calcaneal edema, no additional bone abnormality is seen.ADDITIONAL

1. Mild inflammatory changes in the pre-Achilles fat in the approximate location of the retrocalcaneal bursa, with mild reactive edema in the underlying calcaneus. There is perhaps minimal tendinosis of the distal Achilles tendon, however this is equivocal and is unchanged from the prior study.2. Other findings as described above, appearing similar to the prior study.

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23-year-old female with ductal dilatation on CT and right upper quadrant pain. Evaluate for a small stone causing ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: Similar-appearing mild intra and extrahepatic biliary ductal dilatation. The distal common bile duct measures 8.1 mm in diameter. There is a 3 mm stone in the midportion of the common bile duct (coronal series 801 image 61). The common bile duct remains dilated distal to this portion, and a benign stricture at the ampulla is suspected. In the peripheral aspect of hepatic segment 6, there is a 1.5 x 1.4 cm arterially enhancing focus that is isointense on the precontrast, portal venous, and delayed phases. No washout. No restricted diffusion. No corresponding lesion is identified on the prior CT scan.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Choledocholithiasis with mild intra and extrahepatic biliary ductal dilatation. Additionally, a benign stricture at the ampulla is suspected.2.A peripheral arterial enhancing focus of hepatic segment 6 is isointense on all other series. A perfusional variant is favored. A benign focal nodular hyperplasia is less likely.

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Diagnosis: Headache(784.0)Clinical question: r/o structural abnormalitySigns and Symptoms: headacheComments: S/p left parotidectomy | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the 9/7/2012 examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The left parotid gland is smaller than the right parotid gland - probably related to the reported history of parotidectomyThere is redemonstration of a cystic lesion in the superficial portion of the left parotid gland. It is homogeneously hyperintense in signal on T2-weighted imaging, intermediate signal on FLAIR imaging hyperintense on ADC map, hypointense on exponential ADC map, mildly hyperintense on diffusion imaging and hypointense on T1-weighted imaging. It measures 14 x 12 mm axial dimensions. On the prior exam it measured approximately 8 x 10 mm .There is now a similar lesion in the right parotid gland measuring 11 x 9 mm axial dimensions which was not present on the prior exam. It is adjacent and superficial to the right retromandibular vein. Along the posterior superficial aspect of the right parotid gland there is an incompletely visualized 10 x 6 mm similar lesion which previously measured 7 x 3 mm.

1.Continued enlargement of a left parotid gland lesion. In general this has a relatively benign appearance.2.New right parotid gland lesion which has similar signal characteristics and morphology to the left-sided parotid lesion but is smaller. It is adjacent and superficial to the right retromandibular vein.3.A smaller right parotid gland cystic type lesion along the posterior superficial portion has also mildly increased in size compared to the previous exam from 2012.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. These are stable compared to the 2012 exam.

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History of malignant neoplasm of head and neck cancer on the right, increased uptake on the right carotid bifurcation on PET and mass on US exam. 1. Neck MRIMotion artifacts degraded image quality.There is 9.4mm x 10mm x 12mm sized relatively well defined mass on the right carotid bifurcation. The mass shows high signal intensity on T2 weighted images with some signal void areas within the mass, low signal intensity on T1 weighted images and well enhancing on post Gad enhancement. These findings are consistent with paraganglioma (carotid body tumor).The right side neck shows decreased soft tissue and non visualization of platysma muscle as well as right submandibular gland indicating postoperative status. Left side submandibular gland is still well visualized.The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, and thyroid glands are unremarkable. No lymphadenopathy or mass is noted. 2. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. Right CCA bifurcation shows about 40% of luminal stenosis and the left CCA appears to be normal but tortuous. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

1. 9.4mm x 10mm x 12mm sized mass on the right carotid bifurcation. The MR characteristics and location of the mass is consistent with carotid body tumor.2. About 40% luminal stenosis on the right CCA bifurcation

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View for chronic and acute subdural hematoma: fall from bed. There is a mildly T1 hyperintense and T2 hyperintense right frontoparietal subdural collection that measures up to 8 mm in thickness. There is also a globular area of high T1 and low T2 signal with susceptibility effect in the right superior frontal convexity subdural space that measures up to 15 mm. There is cerebrospinal fluid signal intensity left frontoparietal subdural fluid collection that measures up to 4 mm in thickness. There is an epidural fluid collection with high T1 and low T1 signal that measures up to 3 mm in thickness along the left parietal convexity. There is a punctate focus of susceptibility effect along a cortical vein corresponding to the subarachnoid hyperattenuation on the prior CT. There is minimal prominence of the bilateral anterior frontal subarachnoid spaces. There is no evidence of acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is right posterior subgaleal hematoma that measures up to 5 mm in thickness with an underlying linear defect in the right parietal bone and perhaps the right occipital bone, which correspond to the non-displaced fractures. The orbits are grossly unremarkable.

1. A small focus of acute subdural hemorrhage is present in the right superior frontal convexity superimposed upon what likely corresponds to a late frontoparietal convexity subdural hematoma.2. A left frontoparietal convexity fluid collection may represent a subdural hygroma versus a chronic subdural hematoma with superimposed small parietal convexity epidural hematoma.3. A punctate focus of susceptibility effect along a cortical vein corresponding to the subarachnoid hyperattenuation on the prior CT may represent subarachnoid hemorrhage.4. Minimal prominence of the bilateral frontal subarachnoid spaces.5. The known non-displaced posterior right skull fractures are better depicted on the prior CT.

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Female, 53 years old, with worsening neck pain and history of cervical disc herniation seen in 2009. The cervical lordosis is straightened. Vertebral body heights are preserved. No evidence of pathologic marrow replacement or edema is seen. Signal alteration compatible with the presence of a hemangioma is seen within the T1 vertebral body and right pedicle, unchanged.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Loss of disc height with posterior disc-osteophyte complex formation slightly improved from prior. Minimal flattening of the ventral cord. No significant spinal canal stenosis. No foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a small superimposed left paracentral protrusion, slightly increased in size from prior. However, there is no clear impingement of the spinal cord and no significant canal stenosis. The neural foramina are patent. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

1.Minimal increase in size of a left paracentral protrusion at C6-7. However, there is no evidence of spinal cord impingement or significant canal stenosis at this level.2.Improvement in the size of a disc osteophyte at the C5-6 level, again without significant spinal canal stenosis.3.The neural foramina are patent throughout.4.No other significant interval changes are seen to account for the patient's worsening pain.

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54-year-old male with a history of right-sided weakness. Evaluate for acute stroke. There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. Periventricular hypoattenuation is nonspecific, but most consistent with small vessel ischemic disease of indeterminate age, appearing similar to the prior study. Additionally, note is made of punctate foci of hypoattenuation in the left internal capsule, and right thalamus, likely representing age indeterminate lacunar infarcts. The focus of hypoattenuation in the left internal capsule appears more prominent when compared to the prior study. While this may be related to technique, if strong clinical concern for acute ischemia, further evaluation with MRI could be considered.The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. The calvaria and skull base are radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

1. No evidence of acute territorial ischemia or intracranial hemorrhage. It should be noted that CT is insensitive in detecting acute, nonhemorrhagic stroke. 2. Hypoattenuation in the left internal capsule, and right thalamus are nonspecific, but most consistent with age indeterminate lacunar infarcts. The focus of hypoattenuation in the left internal capsule appears more prominent when compared to the prior study. While this may be related to technique, if strong clinical concern for acute ischemia, further evaluation with MRI could be considered.3. Hypoattenuation in the periventricular and subcortical white matter, are nonspecific but most consistent with small vessel ischemic disease of indeterminate age, appearing similar to the prior study.

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The patient was unable to complete the study secondary to pain thus axial thoracic spine, entire lumbar spine, and all contrast enhanced images were not obtained. The patient stated a desire to reschedule the exam at a later date.Several sequences are motion degraded, with attempts to repeat when possible.Cervical spine:There is reversal of normal upper cervical curvature. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy contribute to mild left neural foraminal and moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy contribute to severe left neural foraminal and moderate right neural foraminal stenosis.C7/T1: UnremarkableThoracic spine:Abnormal T2 hyperintensity is noted within the thoracic cord spanning the levels from T2 through T4/5 as well as more inferiorly from T9/10 through the conus, with mild conus expansion. Vertebral body heights are maintained and marrow signal is benign.

1.The patient was unable to complete the study secondary to pain thus axial thoracic spine, entire lumbar spine, and all contrast enhanced images were not obtained. The patient stated a desire to reschedule the exam at a later date.2.C5/6: Mild left neural foraminal and moderate right neural foraminal stenosis.3.C6/7: Severe left neural foraminal and moderate right neural foraminal stenosis.4.Abnormal T2 hyperintensity is noted within the thoracic cord spanning the levels from T2 through T4/5 as well as more inferiorly from T9/10 through the conus, with mild conus expansion.

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Tuberous sclerosis [Q85.1], Reason for Study: ^Reason: evaluate cortical tubers, SEN, SEGA History: tuberous sclerosis Multifocal bihemispheric cortical tubers involving bilateral frontal and parietal lobes (left greater than right) appear to be stable without evidence of enhancement, thus unchanged since prior scan.There are two susceptibility lesions on the left lateral ventricle and both show evidence of enhancement; one on the ependymal surface of the left lateral ventricle frontal horn, caudate head area and another on the ependymal surface of the left side foramen of Monroe area. Both were seen on prior scans and the both nodules showed enhancement (the former greater than the latter) on prior scans. Thus, unchanged MR characteristics and size since prior scan. The right frontal lobe DVA is again seen, unchanged since prior scan.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Evidence of bilateral frontal and right temporal craniotomy, unchanged since prior scan.The paranasal sinuses and mastoid air cells are clear.

Unchanged multifocal cortical tubers as described above.Stable size and MR characteristics including enhancement pattern of two subependymal nodules on the ependymal surface of the left lateral ventricle frontal horn.

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Altered mental status and stroke. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is periventricular and subcortical T2/FLAIR hyperintensity in a similar distribution to the prior MRI. The ventricles are prominent in proportion to the sulci compatible with parenchymal volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

1. No evidence of acute infarction, acute intracranial hemorrhage, or mass.2. Periventricular and subcortical white matter chronic small vessel ischemic disease is not significantly changed from the prior MRI.

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15-year-old female. Patient with lymphangioma retroperitoneum. Needs follow-up MRI in two months. On Inderal 40 mg BID. Need to assess for shrinkage of mass. The fluid filled mass with multiple septations located posterior to the superior gastric body, anterior to the upper pole of the left kidney, and medial to the spleen consistent with stated history of lymphangioma. It is not significantly changed in size at 6 x 7 x 5 cm. The mass is again seen to insinuate itself into the pancreatic body and tail with fine frond-like projections.The liver and spleen are normal in appearance. No biliary ductal dilatation. The kidneys are normal in appearance. No hydronephrosis.

Retroperitoneal lymphangioma without significant interval change in size.

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Male, 47 years old, with history of L3-4 diskitis osteomyelitis with MRSA bacteremia. The L3-4 intervertebral disk demonstrates abnormal increased T2 signal with irregularity and patchy T2 hyperintensity of the adjacent end plates. Moderate ill-defined T2 hyperintensity is seen within the adjacent paraspinal soft tissues, including the psoas musculature. No discrete epidural or paraspinal fluid collections are seen. A few scattered mildly prominent para-aortic and aortocaval lymph nodes are seen.Mild T2 hyperintensity is seen within the T11-12 disk space. There are small Schmorl's nodes along the adjacent end plates as well as increased T2 signal along the T12 superior endplate. Please note that this level is assessed only on sagittal images.A scoliotic curvature of the lumbar spine is demonstrated. Vertebral bodies are otherwise well aligned. Aside from endplate irregularity at L3-4, vertebral body heights and morphology are maintained.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet hypertrophy. Loss of disk height and T2 signal with disk bulging asymmetric to the right. Moderate generalized spinal canal stenosis with particular effacement of the right lateral recess. Moderate to severe right and mild left foraminal narrowing. L3-4: Moderate facet hypertrophy with a small facet effusion on the left and peri-facet edema. Bulging disk resulting in a moderate generalized spinal canal stenosis. Severe bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy with a small facet fusion on the right and peri-facet edema. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing.L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Constellation of findings at L3-4 including abnormal disk signal intensity, irregularity and abnormal signal intensity of the adjacent endplates, and edema/inflammation of the adjacent paraspinal soft tissues, compatible with diskitis osteomyelitis. No definite discrete or drainable epidural or paraspinal collections are seen, though sensitivity for this is somewhat reduced without IV contrast. Peri-facet edema at L3-4, and to a lesser extent at L4-5, may be degenerative in nature, but the possibility exists that the posterior elements are also involved with infection.Mild abnormal signal of the T11-12 disk with some evidence of endplate edema at T12 could be degenerative, but the possibility of osteomyelitis diskitis must be considered at this level as well.Degenerative disk disease and posterior element hypertrophy result in a moderate generalized spinal canal stenosis and significant right neuroforaminal narrowing at L2-3. Abnormalities of the disk and posterior elements at L3-4 contribute to a moderate generalized spinal canal stenosis and significant neuroforaminal narrowing.

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Dysarthria and vomiting. Evaluate for posterior circulation stroke. Brain MRI: There is an area of diffusion restriction and increased T2 signal in the right cerebellar hemisphere that measures up to 16 mm. There is also a punctate focus of diffusion restriction in the superior right postcentral gyrus. There are a few tiny scattered T2 hyperintense foci in the cerebral white matter that most probably reflect mild chronic microvascular ischemia. There is no evidence of intracranial mass lesions or hemorrhage. There is no midline shift or ventricular dilatation. The orbits and paranasal sinuses are unremarkable. The skull and scalp soft tissues are also grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. The right internal carotid artery has a retropharyngeal course.

1. Foci of diffusion restriction in the right cerebellar hemisphere and right postcentral gyrus are compatible with acute infarcts. 2. No evidence of significant steno-occlusive lesions in the head and neck arteries.

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Previously noted abnormal marrow signal and slight osseous expansion involving the body of the sphenoid, planum sphenodale, anterior clinoids, lesser wings of the sphenoids (right greater than left), shows no significant interval change.. Again seen is expansion and patchy enhancement of the clivus, similar in size and morphology compared to prior exam. Two or three scattered nonspecific foci of T2/FLAIR hyperintensity are seen in the cerebral hemispheres, without significant interval change. There is no evidence of intracranial hemorrhage or acute infarct. Stable mild ventricular enlargement and low lying cerebellar tonsils. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

No significant interval change of expansile bony lesions involving the clivus and sphenoid since prior exam, compatible with fibrous dysplasia.

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37-year-old man with history of right shoulder pain. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor muscles appear normal without evidence of abnormal tendon signal.SUPRASPINATUS OUTLET: There is a small amount of fluid in the subacromial bursa which is within normal limits. The acromioclavicular joint appears normal.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. Although this is a non-arthrogram study, the glenoid labrum appears intact.BICEPS TENDON: There is a normal amount of fluid in the biceps tendon sheath and the long head of the biceps tendon is intact. ADDITIONAL

No finding to account for the patient's pain.

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Pt with trochlear nerve palsy/recovering encephalopathy, hx of Multiple Myeloma. Please obtain CT head with special attention at skull bases, cavernous sinuses and orbits. There is no evidence of intracranial hemorrhage, mass or edema. Brain parenchyma is normal in attenuation and morphology. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.The bilateral globes, optic nerves, retro-orbital fat and extra-ocular muscles are unremarkable. MRI examination may be helpful to further evaluate patient's cranial nerve palsy, if clinically indicated.

Normal brain/orbit CT.

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There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. Mild mucosal thickening is present within the bilateral maxillary sinuses, sphenoid sinuses, and ethmoid air cells. The midline structures and craniocervical junction are within normal limits.

1.Brain MRI is within normal limits without evidence of intracranial mass or mass effect.2.Paranasal sinus mucosal thickening which may represent sinusitis.

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76 years male with tinnitus.Provider Name: RIMAS V. LUKAS BRAINBilateral subdural effusions are present related to age-related atrophy. No midline shift or herniation.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. Bilateral periventricular and subcortical white matter T2/FLAIR hyperintensity which are likely vascular related; additional areas of T2/FLAIR hyperintensity are present within the basal ganglia, thalami and brainstem also most likely vascular related.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits elongation the AP dimension of the eyes associated with scleral thickening posteriorly. The eyeball lenses are thin. IACThere is a lesion within the posterior aspect of the right internal auditory canal which demonstrates intermediate T1 and T2 signal intensity with enhancement measuring 4.4 x 3.9 mm (series 19, image 12). This is stable compared to prior exam. The left internal auditory canal is normal. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns.

1.Stable small enhancing lesion within the right internal auditory canal likely a vestibular schwannoma.2.Multiple patchy lesions in the brainstem, thalami and basal ganglia are most likely vascular related.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Small Bilateral subdural effusions are present likely related to age-related atrophy.5.Bilateral staphylomas.

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Reason: 1.2 cm right lateral temporal lobe ring-enhancing lesion s/p SRS History: follow up ill-defined T2 hyperintensity involving the mesial left temporal w/o pathologic enhancement on last MRI. This exam is for treatment planning purposes and is limited. There is a ring-enhancing lesion in the lateral right temporal lobe measuring 8 x 9 mm in greatest axial dimensions (series 401, image 80) by 7 mm in the craniocaudal dimension (series 403, image 152), previously 12 x 12 x 10 mm. The lesion remains T1 hypointense internally, and the previously seen internal enhancing septations are less prominent. There is minimal associated local sulcal effacement, slightly improved. There is now a slightly increased rim of susceptibility artifact surrounding the lesion compatible with treatment effect.Previously described T2 signal abnormalities are not evaluated on this limited treatment planning examination.The ventricles and sulci are otherwise within normal limits for age. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.

Limited examination for treatment planning demonstrating interval decrease in size of right lateral temporal lobe ring-enhancing lesion.

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53 years Female (DOB:10/13/1962)Reason: please do dr javed MS protocol compare to prior History: leg weakness, fatigue, dysequilibriumPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular and subcortical white matter lesions present within the brain parenchyma. These were also present on the prior exam. They have not significantly changed in number relative to the prior exam. No new lesions are appreciated. There are also several lesions present in the cerebellum and brainstem which are also unchanged. No abnormal enhancing lesions are appreciated within the brain parenchyma in association with these.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

There is redemonstration of multiple white matter lesions present within the subcortical and periventricular white matter as well as in the posterior fossa which are stable when compared to the prior exam.

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Migraine with aura, with intractable migraine, so stated, without mention of status migrainosus [346.01], Reason for Study: ^Reason: structural abnormality? Brain MRINo evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

1. No evidence of acute ischemic or hemorrhagic lesion. 2. No abnormal enhancement.3. Normal brain MRA and Neck MRA

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Female; 34 years old. Reason: gallstones, pancreatitis History: lipase >3000, gallstone on bedside u/s ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.Multiple small gallstones. Mild pericholecystic fluid and gallbladder wall thickening, which could be due to early acute cholecystitis. Normal caliber of the biliary tree. Common bile duct and distal cystic duct appear patent without evidence of choledochalithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Severe acute pancreatitis with diffuse interstitial pancreatic edema and large amount of peripancreatic free fluid, particularly in the left upper quadrant. No loculated fluid lesions. No pancreatic hemorrhage. Mild patchy enhancement of the pancreas due to pancreatitis. No evidence of pancreatic necrosis. No pancreatic ductal dilation. Splenic vein is patent. No splenic artery pseudoaneurysm is evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1. Severe acute pancreatitis as detailed above.2. Mild pericholecystic fluid and gallbladder wall thickening, which could be due to early acute cholecystitis.Findings discussed with the GI fellow (Dr. Coronel) at 9:50 a.m. on 4/17/15.

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Male 47 years old Reason: newly diagnosed rectal cancer History: rectal cancer Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: Wedge-shaped T2 hypointense foci in bilateral mid gland peripheral zones demonstrating restricted diffusion, particularly on the right. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes outside the mesorectal fascia: At least nine lymph nodes are identified. The largest is in the posterior left mesorectal fascia measuring approximately 2.8 x 2.2 cm (series 5, image 10).BOWEL, MESENTERY: Rectal Tumor:Size: 4.0 x 3.0 x 6.0 cmTumor appearance on T2-weighted images: T2 isointense lesionTumor location: Posterior rectal wall with invasion into the posterior perirectal fat.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 6 cmDistance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): 3 cmCircumference of the rectum involved: 180 degreesRelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Nonapplicable.MRI T-stage: T3c - Tumor invades >1cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: The tumor extends above the level of the mesorectal fascia. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Indeterminate mid gland peripheral zone prostate lesions. Correlation with PSA is recommended.2.Upper rectal mass with mesorectal lymphadenopathy as described above.

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Female 72 years old Reason: HCC/ s/p TheraSphere Administration History: HCC/ S/P TheraSphere Administration The absence of intravenous contrast limits evaluation of the solid organs and of the bowels. Additionally, extensive abdominal ascites noted. Given these limitations, despite repetition of multiple sequences the study is essentially nondiagnostic.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology is again seen. Previously described T2 hyperintense lesions are poorly seen.Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive ascites. Esophagogastric varices.BONES, SOFT TISSUES: No significant abnormality noted.

1.Essentially nondiagnostic study for the reasons detailed above. It is not possible to assess response to therasphere administration.

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There are are non-enhancing densely calcified globular and irregular extra-axial lesions along the planum sphenoidale and sella, as well as along the left petrous apex. There are also calcified globular lesions in the left temporal lobe and left basal ganglia, measuring up. In addition, there are patchy susceptibility effect and T1 hyperintensity diffusely within the bilateral lenticular nuclei. Furthermore, there are gyriform calcifications in the right temporal lobe. There are also scattered foci of susceptibility effect in the bilateral cerebral hemispheres. There are postoperative findings related to frontal craniotomy with encephalomalacia in the bilateral anterior frontal lobe with ex vacuo dilatation of the frontal horns of the bilateral lateral ventricles. There is also volume loss of the bilateral prechiasmatic optic nerves. There is diffuse cerebellar volume loss. There is a right frontal linear T2 high signal tracking to the right lateral ventricle related to a previous ventriculostomy tract. There is no evidence of acute infarction. There are no enhancing intracranial lesions.

1. Apparent postoperative findings related to remote frontal craniotomy with encephalomalacia and susceptibility effect corresponding to calcifications in the bilateral anterior frontal lobes, as well as atrophy of the bilateral optic nerves. 2. Densely calcified extra-axial lesions along the planum sphenoidale and sella, as well as along the left petrous apex, may represent dystrophic calcifications from prior hemorrhage or radiation therapy if this were indeed administered, versus calcifying pseudotumors of the neuraxis or related to treated neoplasm, perhaps originally a craniopharyngioma, for example. 3. Densely calcified globular lesions in the left temporal lobe and left basal ganglia, as well as multiple punctate scattered foci of susceptibility effect in the bilateral cerebral hemispheres may represent treated tumors, chronic hemorrhages, and/or cavernous malformations. 4. Patchy mineralization present diffusely within the bilateral lenticular nuclei may represent dystrophic calcifications related to treatment effects, such as mineralizing microangiopathy, or an underlying metabolic disorder.5. Gyriform calcifications in the right temporal lobe with underlying white matter hypoattenuation may represent sequela of prior trauma or infarction. 6. Diffuse cerebellar volume loss is likely related to anti-epileptic use.

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59 year old with strong family history of breast cancer including a sister at age of 21 and another sister at age 54. History of benign biopsy of the left medial breast on 1/7/05 and right anterior 12 o'clock lesion on 7/30/10. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. A few high T2 signal cysts are present. No suspicious enhancement is seen in either breast. Bilateral enhancing foci are again noted. None of the enhancing lesions is significantly changed compared to prior studies. Left post surgical distortion and right breast biopsy clip from prior benign biopsies are noted. No abnormal lymph nodes are identified in either axillary region.

No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.

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82 -year-old woman with history of non-small cell lung cancer and lesion noted on recent CT. There is a rim-enhancing 12 x 11 mm lesion in the left inferior frontal lobe (series 1401, image 17) with an adjacent, 4 mm enhancing nodule immediately anterior. The left inferior frontal lobe lesion demonstrates increased central T2 signal, likely related to cystic degeneration or necrosis. There is vasogenic edema within the surrounding white matter of the left frontal lobe with increased T2 signal extending to the left frontal horn of the left lateral ventricle. There is minimal associated mass effect with effacement of the overlying left frontal sulci.There is no abnormal leptomeningeal enhancement, although 3D T1 postcontrast images are slightly limited by artifact. The major intracranial vessels appear patent.Extensive, bilateral scattered areas of increased T2 signal in the periventricular and subcortical white matter are nonspecific but most suggestive of chronic small vessel ischemic disease.No abnormality on diffusion-weighted images to suggest acute ischemia. No abnormality on susceptibility weighted images to suggest intracranial hemorrhage.

1.Rim-enhancing lesion in the inferior left frontal lobe with enhancing small satellite nodule. Associated vasogenic edema with mild sulcal effacement but no significant mass effect. Given the history, this is most compatible with metastasis.2.No additional enhancing lesions identified.

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Right wrist/hand pain, decreased range of motion. Bone marrow signal intensity is normal. Note is made of congenital coalition of the lunate and triquetrum, a normal variant. There is perhaps mild synovitis dorsal to the proximal carpal row, but this is equivocal. The metacarpophalangeal joints appear normal. This study was not protocoled for detailed evaluation of the ligaments, but I see no gross abnormalities. Subjectively, there appears to be slight dorsal subluxation of the ulna relative to the sigmoid notch of the radius; however, using the modified radioulnar method of measurement as well as the epicenter method of measurement, distal radioulnar joint alignment is within normal limits. The visualized portions of the tendons of the hand and wrist appear normal. I see no definite abnormalities of the triangular fibrocartilage complex; apparent increase in signal intensity along the volar aspect of the volar radioulnar ligament likely simply represents interface with the ulnolunate and ulnotriquetral ligaments. The remaining soft tissue structures appear normal.

There is perhaps mild synovitis dorsal to the proximal carpal row, but I otherwise see no definite findings to account for the patient's pain. Although subjectively there appears to be slight dorsal subluxation of the distal ulna relative to the sigmoid notch of the radius, measurements do not support a true subluxation. If there is clinical concern for distal radioulnar joint instability then bilateral wrist CT with neutral, supination, and pronation positioning may be considered.

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History of breast cancer. Now with shoulder pain. 3 views of the right shoulder reveal a vague lucency in the humeral head that is most likely a pseudotumor. There is also some vague sclerosis in the humeral head that again is probably unremarkable. Because of the patient's shoulder pain however a shoulder MRI was suggested to the clinical service

Negative right shoulder radiographs

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77-year-old man with history of prior heavy EtOH and liver lesions seen on prior ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is a 20 x 20 mm lesion in segment 5/6 of the liver (series 1001, image 245) which is mildly T2 hyperintense, demonstrates mild diffusion restriction, avidly enhances in the arterial phase, and washes out relative to the liver. Additionally, this lesion has a periphery of delayed enhancement and there is mild capsular retraction.The background liver is normal in intensity but the hepatic fissure is mildly widened.The portal vein branches appear patent without evidence of mass or thrombus.Small gallstones are seen. There is no intra or extra hepatic biliary duct dilatation.SPLEEN: The spleen appears normal. An accessory splenule is noted.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: There is slight nodularity at the junction of the limbs of the left adrenal gland (series 601, image 22). The right adrenal gland is normal.KIDNEYS, URETERS: Bilateral renal cysts are identified.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Segment 5/6 lesion compatible with hepatocellular carcinoma with pseudocapsule. This finding was discussed with Dr. Cornel by phone at 9:45 on 10/26/2015.

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Reason: eval lesion in anterior pons History: BLE weakness. Again seen is a lesion with increased T2 signal in the anterior pons, left greater than right, without associated diffusion restriction, susceptibility or significant mass effect that measures approximately 2.0 x 1.5 cm. There may be some subtle speckled enhancement along the anterior aspect of the lesion, which may represent prominent vascularity. No masslike enhancement is identified.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

T2 hyperintense lesion within the pons without masslike enhancement. There is some subtle speckled enhancement along the anterior aspect which is suspected to represent prominent vasculature. This lesion remains nonspecific with differential including demyelinating, inflammatory and metabolic etiologies. A neoplastic process is considered less likely, as there is no significant mass effect or alteration of the contour of the pons.

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Again seen are postsurgical changes of Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. Again seen are foci of deformity of the posteroinferior aspect of the cerebellum, with tenting towards the overlying dura and unchanged. There is a retroflexed dens with associated narrowing of the column of cerebrospinal fluid flow across the anterior neo-foramen magnum. Biphasic flow anteriorly at the foramen magnum is otherwise preserved. There is diminished CSF flow and diminished CSF space dorsal to the cervical cord, not significantly changed since 2/11/2016, allowing for slight differences in technique. Biphasic flow at the foramen Magendie appears preserved.There appears to be slight further decrease in size of the thoracic syrinx with minimal residual prominence of the central canal measuring 1 to 2 mm seen at T5-T6 and in the mid to lower thoracic cord more inferiorly. Previous seen tiny syrinx which is less visible on the current study is likely partly related to motion degradation on the current study. No new cord signal abnormality. Vertebral body heights and alignment are grossly unremarkable aside from mild straightening. Conus is in normal position at the upper L2 level. No spinal canal or neural foraminal stenosis is evident.

Postoperative findings related to Chiari decompression again seen. Compared to 2/11/2016, there is no significant change in the appearance of the posterior fossa including retroflexed dens with associated narrowing of the anterior column of CSF flow as well as tenting of cerebellar tissue towards the overlying dura posteriorly, which may represent an adhesion. Motion degradation limits comparison, however, the residual tiny mid thoracic syrinx seen previously on 2/11/2016 is stable to slightly further decreased. Syrinx is markedly decreased when compared to 10/22/2015.

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Clinical question: r/o transverse myelitis and cord lesionSigns and Symptoms: b/l LE weakness. L>RComments: Thoracic, Lumbar, and Sacral. Will require sedation. | MRI thoracic spine:There is a 53x42 axial dimension and 53x64mm sagittal dimension mass located in the right posteromedial thoracic cavity abutting the right side of the T1 through T8 vertebral bodies which insinuates into the right sided neural foramina foramina from T1-2 through T6-7 especially at T3-4, T4-5 and T5-6 which it extends through the neural foramina into the spinal canal where ir compresses the thecal sac from the right side and flattens the spinal cord.The mass also extends along the posterior aspect of the mediastinum and displaces and compresses the trachea and bronchi and abuts and compresses the venous structures of the upper mediastinum and displaces the heart and aorta and great vessels.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a well formed disk at S1-S2. The bladder is large.No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

1.Large intrathoracic mass abutting he T1 through T8 vertebral bodies extends into the spinal canal through the T3-4, T4-5 , T5-6 right neural foramina behind the T2-T6 vertebral bodies where it markedly compresses the spinal cord. Differential consideration includes neuroblastoma as well as other neoplasms.2.The same mass compresses and narrows mediastinal airway structures and mediastinal vascular structures (especially veins). A CT chest would be of further benefit to evaluate this.3.Enlarged bladder may be neurogenic given the above findings.4.There is no compromise to the lumbar spinal canal.

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54 years, Male, Reason: f/u brain lesions History: brain lesions. History of leukemia and intracranial abscess. Compared to 6/18/2015, there is been marked improvement/resolution of the previously seen peripherally enhancing lesion with restricted diffusion within the left cerebellar hemisphere. Again seen is leptomeningeal enhancement involving the cerebellar surfaces as well as prominent enhancement involving the right greater than left ependymal surfaces of the bilateral, right greater than left occipital horns, not significantly changed compared to 6/18/2015. No new enhancing lesion. No new focus of restricted diffusion to suggest infarct. Unchanged caliber of the ventricular system without evidence of hydrocephalus. Major flow-voids are preserved. Trace mucosal thickening involving the paranasal sinuses. Paranasal sinuses otherwise clear. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

1. Previously seen left cerebellar abscess has resolved.2. Leptomeningeal enhancement involving the cerebellar surfaces as well as along the ependymal surface of the lateral ventricles is not significantly changed and compatible with leptomeningeal infection and ventriculitis. Leukemic involvement however can not be entirely excluded and continued follow-up is suggested as clinically indicated. 3. No new enhancing lesion, edema, mass effect, or hydrocephalus.

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Female, 42 years old, with headache and cranial 6 palsy. Assess for dural thickening/enhancement. Also history of lumbar spine epidural fluid collection, assess for resolution. Brain:Brain parenchymal morphology and signal characteristics are within normal limits. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.On postcontrast imaging, diffuse pachymeningeal thickening and enhancement shown on outside imaging has resolved. There is no evidence of any pathologic parenchymal or extra-axial enhancement on the present examination.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.Lumber spine:Spinal alignment is anatomic. Vertebral height and morphology are normal. No pathologic marrow replacement or evidence of marrow edema is seen.The visualized spinal canal is patent and unremarkable. Ventral epidural collections seen previously at L2-3 and L5 have resolved. No new epidural collections are detected.Visualized spinal cord, conus and cauda equina are within normal limits.The paraspinal soft tissues are normal.Intervertebral disk height and morphology are unremarkable. No evidence of disk bulge or herniation is seen. Mild facet hypertrophy is demonstrated at lower lumbar levels. No evidence of any significant spinal canal or neuroforaminal stenosis is detected.

1.Interval resolution of previously seen diffuse pachymeningeal thickening and enhancement. Evaluation of the brain is unremarkable.2.Interval resolution of previously seen ventral epidural collections in the lumbar spine. No new or significant abnormalities are detected.

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Female; 56 years old. Reason: Stem cell transplant patient with a recent CT showing a dome on her liver. Pt currently has a MSSA bacteremia. ABDOMEN:LIVER, BILIARY TRACT: Paradoxical loss of signal on in-and-out of phase images of the liver diffusely, suggestive of iron deposition.2.7 x 2.4 cm T2 hyperintense, T1 hypointense round segment 4a lesion with restricted diffusion. The degree of T2 hyperintensity is less than expected for simple fluid. The lesion demonstrates equivocal slight internal enhancement. Overall, the lesion is most suspicious for hepatic abscess, though solid lesion from tumor cannot be entirely excluded. Smaller, scattered hepatic cysts are similar to prior exams.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Old, healed right anterolateral rib fractures.OTHER: Patchy right lower lobe airspace opacities, similar to prior CT chest. Left axillary lymphadenopathy, partially visualized.

2.7 x 2.4 cm right hepatic lobe lesion most suspicious for hepatic abscess, though solid lesion from tumor cannot be entirely excluded.Findings discussed with Dr. Caponi at 10:35 a.m. on 4/27/15.

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Reason: hx of prostate cancer, scheduled for prostatectomy, evaluate further to guide nerve sparing and for extraprostatic disease History: see aboveBiopsy 3/22/2016: Right base Gleason 6, right mid Gleason 6, right apex Gleason 7, left apex Gleason 7 PELVIS:PROSTATE:Prostate Size: 4.4 x 2.8 x 3.4 cmPeripheral Zone: There is ill-defined low T2 signal in the left mid and apex peripheral zone (801/10) without early enhancement, suspicious for prostate adenocarcinoma. In the left apex, this lesion measures approximately 2.0 x 1.2 cm and has an ill-defined capsule with enhancing spiculations (801/11), suggestive of extracapsular extension.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left apical lesion lies immediately adjacent to the capsule which is ill-defined with enhancing spiculations, suggestive of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Ill-defined region of low T2 signal in the left mid and apex peripheral zone is suspicious for prostatic adenocarcinoma with findings suggestive of extracapsular extension.2.No pelvic lymphadenopathy.

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Pain. Question of ACL tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness loss of articular cartilage of the superior aspect of the lateral facet of the patella with underlying subchondral edema. Additionally, there is heterogeneity of cartilage more inferiorly suggesting degeneration along with superficial delamination of cartilage along the medial facet. There is loss of articular cartilage of the posterior and inner aspect of the medial tibial plateau adjacent to the fracture as described below.There is a minimally displaced longitudinal fracture through the medial aspect of the medial femoral condyle. Additionally, there is another non-displaced, non-depressed fracture through the middle medial femoral condyle with intra-articular extension (image 24, series 301 and image 25, series 601). The underlying cartilage, however, is intact.There is comminuted, oblique fracture through the posterior tibial plateau that includes the tibial spine. The posterior cruciate ligament and posterior root of the lateral meniscus attach normally to the fracture fragment which is distracted approximately 4 mm. A transverse fracture through the proximal fibular diaphysis is partially imaged. There is bone marrow edema throughout the distal femur and proximal tibia. LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament appears discontinuous at its attachment on the medial femoral condyle. The lateral collateral ligament is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

1. Multiple fractures through the medial femoral condyle, posterior tibial plateau, and proximal fibula as described above.2. Questionable MCL tear.3. Intact menisci and cruciate ligaments. 4. Chondromalacia as described above.

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Diagnosis: Other convulsionsClinical question: SeizureSigns and Symptoms: Seizure recurrent The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right frontal ventriculostomy tube placement for shunt. The tip of the catheter is in the frontal horn of the right lateral ventricle. The right lateral ventricle is smaller than the left lateral ventricle.The cerebellum is atrophic. Small foci of susceptibility effect are present along the periventricular areas adjacent fourth ventricle. There is encephalomalacia present along the medial aspects of the cerebellar hemispheres.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

1.Cerebellar atrophy associated with some encephalomalacia medially within the cerebellum.2.Status post ventriculostomy tube placement without evidence for ventriculomegaly on the current exam.

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Neutropenic fever. History of leukemia.IMAGE ACQUISITIONS: 1.5-mm contiguous axial images of the brain without contrast infusion.2.Thin section axial and reformatted coronal images of paranasal sinuses without contrast infusion. Low-attenuation in involving right internal capsule and periatrial white matter and small portion of right medial temporal lobe is consistent with infarct, likely in the right anterior choroidal artery territory, as previously described on MRI. There is no acute intracranial hemorrhage, mass effect or shift of midline structures. Small white matter infarcts over the cerebral convexities that were present on the previous MRI are not as well demonstrated on CT due to decreased sensitivity CT compared MRI.On previous CT of sinuses the March 11, 2009, there was mild mucosal thickening in the right side of the sphenoid sinus. On the current scan, there is some frothy or bubbly secretion in the right side of the sphenoid sinus, which is new compared with the previous scan. Minimal mucosal thickening is again noted in the right maxillary antrum. There are no other areas of mucosal thickening. There are no fluid levels. There is no bone obstruction or sinus expansion.. Ostiomeatal complexes are structurally normal. Mastoids are mostly included in the field of view and are well aerated.Bilateral proptosis is again noted.

1.Chronic right anterior choroidal artery infarct is again noted. CT of the brain is otherwise negative.2.There is some frothy secretion in the sphenoid sinus on the right. This has developed since the previous scan and could indicate early acute inflammation.

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History of Li Fraumeni Syndrome with liver lesions on PET. History of breast cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is loss of signal on the out of phase images consistent with fatty infiltration.There are several hepatic lesions. The largest in segment 6/7 measures 2.7 x 2.3 cm (series 11/20) and the inferior right hepatic lobe measuring 1.8 x 1.6 cm (series 11 image 32) with similar imaging characteristics, specifically homogeneous macroscopic fat content without enhancing components compatible with lipomas or angiomyolipomas.There are several additional arterial homogeneously enhancing foci most of which are subcentimeter. The largest in the inferior right hepatic lobe measures 1.5 x 1.6 cm (series 13/72), which is mildly hyperintense on T2-weighted sequences. This larger lesion demonstrates mild restricted diffusion. There is no washout on portal venous or delayed imaging, restricted diffusion of the remaining lesions, rim enhancement or other suspicious imaging characteristics.There is a right hepatic lobe segment 7 peripheral/subcapsular wedge-shaped region of post-contrast enhancement, compatible with a THID (Transient Hepatic Intensity Difference).No vascular abnormality. Status post cholecystectomy.SPLEEN: Normal splenic morphology and size without a focal lesion.PANCREAS: Normal pancreatic morphology and signal intensity without a discrete lesion. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Left ovarian physiologic cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1. Several arterial homogeneously enhancing foci most of which are subcentimeter, including an indeterminant 1.6 cm right inferior hepatic lobe lesion demonstrating mild T2-weighted hyperintensity, enhancement and restricted diffusion. The remaining lesions demonstrates no apparent washout, restricted diffusion, rim enhancement or other suspicious imaging characteristics. We recommend that the patient returns for a 45 minute to 2 hour delayed imaging sequence following hepatobiliary agent administration to evaluate whether this lesion is an FNH or possible metastatic lesion. The patient will be called back by the radiology department at no cost to the patient for this additional imaging.2. 2.7 and 1.8 cm hepatic lipomas. 3. Steatosis.

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Complains of headaches. On Coumadin. Rule out chronic subdural? Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The pituitary gland appears a slightly enlarged and with apparent extension into the basal cistern. This is concerning for a pituitary adenoma and follow-up with an MRI exam is recommended. This finding measures approximately 15.2 mm in cranial cephalad access on sagittal reformatted images.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation is within normal limits.Calvarium is intact.Paranasal sinuses and mastoid air cells are well pneumatized and unremarkable.

1.Pituitary adenoma as described above. Follow-up with an MRI is recommended.2.Unremarkable non-infused CT of brain and calvarium.3.Visualized paranasal sinuses and mastoid air cells are unremarkable.

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Neurofibromatosis, type 2 [Q85.02] / Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: eval for midbrain disease/infarct History: acute dysphagia, Brain MRIThere is dumbbell shaped extra axial mass appears to be attached to the inferior aspect of the right acoustic schwannoma extends toward right jugular foramen in particular pars nervosa indicating extension of the tumor. Thought it has not been separately reported, there is no interval change since prior scan.There are multiple extra axial enhancing masses involving bilateral acoustic schwannomas, left sylvian fissure enhancing lesion, and multiple dural based enhancing lesions indicating meningiomas, unchanged since prior scan.Multifocal FLAIR high signal intensity lesions of bilateral white matter are again seen, unchanged since prior scan. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear. Bilateral mastoid air cells show opacifications, unchanged since prior scan.Cervical Spine MRIMore prominent spinal cord T2 high signal intensities are seen at the level of C45 to C56 level especially on the right side. This is likely representing mixed partial volume effects of extradural intraspinal component of residual mass as well as increased extent of spinal cord edema.In addition, at the level of C67, there is T2 high signal intensity lesion on the left side of the spinal cord which is more likely representing spinal cord edema. Again this lesion was seen previously but appears to be more prominent than before. Other findings including prior C3 to C6 laminectomies, scattered intra axial enhancing lesions at medullar and upper cervical spinal cord, right C2 root mass, C45 right neural foraminal and intraspinal mass which still shows some mass effects against spinal cord, right C56 extraforaminal mass, C67 bilateral extraforaminal masses, C7T1 bilateral extraforaminal masses likely representing schwannomas are unchanged since prior scan.Kyphotic deformity of the C spine at the level of C56 with fluid collections on the laminectomy sites are again unchanged since prior scan.

1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multiple schwannomas on bilateral IACs and right jugular foramen as well as dural based enhancing lesions likely representing meningiomas are again seen, unchanged since prior scan.3. C45 to C67 spinal cord T2 high signal intensity lesions on the right side and left side spinal cord at the level of C67 lesion are more prominent on today's scan since prior scan which implies increased extent of spinal cord edema. 4. Multifocal various sized extraforaminal and intraspinal masses on cervical spine as well as intramedullar lesions do not show any significant interval change since prior scan as described above.

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Malignant neoplasm of right main bronchus [C34.01] No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Patchy bilateral periventricular white matter FLAIR/T2 high signal intensity lesions indicate nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic disease.

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Ovarian cancer and renal cell cancer ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense foci throughout the liver, similar in distribution/size to CT 1/26/2011, and likely benign.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right partial nephrectomy.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral oophorectomy. No evidence of recurrent tumor.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall.

Postsurgical changes without evidence of recurrent or residual disease.

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Male, 61 years old, with weakness. Assess for CNS metastases versus ischemia. A punctate focus of mild diffusion bright signal is seen within the right globus pallidus with equivocal ADC correlation. No other definite areas of restricted diffusion are seen.Moderate patchy T2 hyperintensity is seen within the subcortical and periventricular regions as well as the pons. No evidence of mass effect or parenchymal edema is seen. No significant intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are normal in size and morphology.On postcontrast images no pathologic parenchymal or extra-axial enhancement is detected.A few scattered small nonspecific T2 hyperintense enhancing skull lesions are demonstrated.

1.Moderate chronic small vessel ischemic disease.2.No definite evidence of acute ischemia. A punctate focus of questionable diffusion signal abnormality within the right globus pallidus is nonspecific and may simply be artifactual.3.No evidence of intracranial metastases.

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History of fistulous small bowel Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: The liver dome is not included in the coronal field-of-view. The visualized liver is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical changes from an ileocecectomy with neo-terminal ileum formation. The small bowel is normal in caliber without wall thickening or abnormal enhancement or adjacent inflammatory changes. The bowel demonstrates normal peristalsis on dynamic imaging without any fixed stricture evident. There is no abnormal restricted diffusion. BONES, SOFT TISSUES: Mild rectus muscle diastases. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

No evidence of active inflammation or significant stricture. No fluid collections.

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MRI CARD W/VASODILATOR STRESS WWO CNTRST, 9/6/2016 10:48 AM First Pass PerfusionDuring hyperemia, a non-transmural, moderate sized perfusion defect was noted in the basal anterolateral wall and the mid inferior and inferolateral wall. The overall ischemic burden is 9% of the LV mass. Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the basal anterolateral wall. This segment has an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 82 ml/m2 (normal range: 74+/-15), the LVEDV is 163 ml (normal range 142+/-34), the LV end systolic volume index is 35 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 45 g/m2, and the LV mass is 90 g. There is hypokinesis of the basal anterolateral and mid inferolateral walls. Native myocardial pre-contrast T1 relaxation time is mildly elevated in the septal mid myocardiumLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 147 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 66 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve has evidence of flow acceleration suggesting at least mild aortic valve stenosis. Correlation with echocardiography suggested. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLeft lung basilar discoid atelectasis, sternal wires consistent with previous bypass surgery. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

1. There is evidence of hibernating myocardium involving the basal anterolateral and mid inferior and inferolateral walls. This territory is ischemic and mostly viable. 2. There is a small myocardial infarction involving the basal anterolateral wall. 3. Normal LV size and systolic function (LVEF 58%). The native myocardial T1-relaxation time is mildly increased in the mid interventricular level suggesting the presence of interstitial fibrosis. 4. Normal RV size and systolic function (RVEF 55%).5. There is at least mild aortic stenosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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Re-evaluation after stage II resection of olfactory groove meningioma on 2/25/15: 3 month follow up There are postoperative findings related to recent bifrontal craniotomy with areas of susceptibility along the margins of the resection cavity and bilateral anterior frontal lobe encephalomalacia. There is an enhancing mass in the posterior aspect of the resection cavity, adjacent to the anterior cerebral arteries, that measures up to approximately 20 mm. There also appears to be sheet-like enhancement along the left planum sphenoidale that measures up to 10 mm in thickness, adjacent to the left optic nerve. The ventricles are unchanged in size and configuration. There is no evidence of territorial infarction. There is mild scattered paranasal sinus mucosal thickening.

Postoperative findings related to olfactory groove meningioma resection with no significant interval change in size of the residual tumor in the posterior aspect of the resection cavity and perhaps along the left planum sphenoidale.

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Cerebral vascular accident. 48-year-old male. The CSF spaces are appropriate for the patient's stated age with no midline shift. A hypodense focus is present along the left cerebellar hemisphere. It is somewhat ill-defined and measures 35 x 40 mm in axial dimensions and corresponds to an area of infarction identified on the MRI of 2/18/10.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

1.Left cerebellar hemisphere subacute infarction in PICA distribution.2.no hemorrhagic conversion.3.The ventricles are nondilated.

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History of visualization. Evaluate for adrenal pathology. Please note that the field of view of this study is intended to be limited to the adrenal glands.ABDOMEN:LIVER, BILIARY TRACT: The liver is not completely evaluated. There is no gross abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The inferior extent of the left adrenal gland is not included in the field-of-view on the axial images. The patient is returning for a repeat study at no additional charge to the patient.KIDNEYS, URETERS: Subcentimeter T2-weighted hyperintensities, likely benign simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

The inferior extent of the left adrenal gland is not included in the field-of-view on the axial images. The patient is returning for a repeat study at no additional charge to the patient, please refer to this subsequent examination report for characterization of the adrenal glands.

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59-year-old male with an ICD and history of CAD sent for CMR to assess for scar/late gadolinium enhancement. Wide-band imaging performed. Difficult images. Significant troubleshooting required at the MRI scanner. Extensive ICD artifact improved when patient was asked to lift arm above his head. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 91 ml/m2 (normal range: 74+/-15), the LVEDV is 234 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 121 ml (normal range 47+/-19). There is inferior/inferoseptal and inferolateral wall motion abnormalities which extend from the base of the heart to the apex. There is inferior/inferoseptal and inferolateral subendocardial late gadolinium enhancement extending from the base to mid myocardium. This is consistent with prior myocardial infarction and is of intermediate viability. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is difficult to quantify on short-axis views due to pacemaker artifact but visually appear normal in size with normal systolic function. Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve could not be assessed due to ICD artifact. .Mitral ValveThe mitral valve could not be assessed due to ICD artifact. Pulmonic ValveThe pulmonic valve could not be assessed due to ICD artifact. .Tricuspid ValveThe tricuspid valve could not be assessed due to ICD artifact. .AortaThere is a left sided aortic arch. The aortic root is normal in size.Pulmonary VeinsThe pulmonary veins were not well seen.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

1. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. There are inferior/inferoseptal and inferolateral wall motion abnormalities which extend from the base of the heart to the apex. There is inferior/inferoseptal and inferolateral subendocardial late gadolinium enhancement extending from the base to mid myocardium. This is consistent with prior myocardial infarction and is of intermediate viability. 2. The right ventricle is difficult to quantify on short-axis views due to pacemaker artifact but visually appear normal in size with normal systolic function.3. ICD-related artifact limited evaluation of valves.

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37-day-old female. Meningitis, GBS. Premature birth with gestational age of 31 weeks. Triplet gestation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There appears to be paucity of myelination in the perirolandic region. The brain parenchyma, brainstem, and cerebellum otherwise appear unremarkable. The pituitary gland also appears to be unremarkable. There is perhaps mild prominence of the subarachnoid spaced overlying the bilateral anterior temporal poles, but no evidence of abscess. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, sand scalp soft tissues are grossly unremarkable.

1. No evidence of intracranial abscess or infarct. 2. Apparently delayed myelination, even accounting for prematurity. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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T3N0 HPV/p16 positive SCCA of the left BOT on OPTIMA clinical trial, finished TFHX on 7/3/15, panendo/bx 9/18/15, re-evaluate compare to previous scans. Again seen are post-treatment findings in the neck with mild persistent supraglottic edema. The base of tongue and lingual tonsils appear unchanged with continued asymmetric prominence and T2 hyperintensity on the right, which may represent lingual tonsillar tissue. No new or enlarging mass is appreciated. There is no significant cervical lymphadenopathy. Small scattered cervical lymph nodes are similar to prior. There are no suspicious osseous lesions. There is mild degenerative spondylosis of the cervical spine including a disc osteophyte complex at the C3-C4 level with effacement of the ventral thecal sac. Orbits and visualized brain parenchyma are grossly unremarkable. Mucous retention cysts in the left greater than right maxillary sinuses are again seen.

1. Post-treatment findings in the neck without evidence of locoregional tumor recurrence. 2. No evidence of significant cervical lymphadenopathy based on size criteria.

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Male 8 years old Reason: Ao root dilatation Left VentricleThe left ventricle is normal in size. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Global LV function is normal.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is dephasing inferior to the aortic valve suggesting aortic regurgitation. Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaStatus post transposition correction (arterial switch correction, LeCompte maneuver). The ascending thoracic aorta is dilated. There is a left sided aortic arch. The right coronary artery arises from the posteriorly rotated right sinus of Valsalva and branches normally. The left coronary artery, arises from the anterior left sinus of Valsalva and courses posteriorly in between the aortic root and the left atrial appendage with no intramural portion or evidence of compression and branches normally.AORTA MEASUREMENTS: aortic valve ring: 18 mmsinuses of Valsalva: 38.5 mmsinotubular junction: 11.3 mmascending aorta: 14 mmaortic arch: 11 mmdescending aorta: 11.7 mmdiaphragmatic hiatus: 14 mmAORTA FLOW QUANTITATION: Stroke volume in ml: 40.3 Forward flow volume in ml: 74.8Backward flow volume in ml: 34.5Regurgitant factor in %: 46.1Pulmonary ArteryStatus post transposition correction (arterial switch correction, LeCompte maneuver). The main pulmonary artery is normal in size. The left pulmonary artery appears to be mildly narrowed, however flow quantification measurements demonstrate equal flow to the right and left pulmonary branches.PULMONARY ARTERY MEASUREMENTS:MAIN: 17 mmRIGHT: 13.4 mmLEFT: 8 mmPULMONARY ARTERIES FLOW QUANTITATION:Main pulmonary arteries flow quantitation values are as follows:Stroke volume in ml: N/AForward flow volume in ml: N/ABackward flow volume in ml: N/ARegurgitant factor in %: N/ARight pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 17.2Forward flow volume in ml: 20Backward flow volume in ml: 2.72Regurgitant factor in %: 13.6Left pulmonary artery flow quantitation values are as follows:Stroke volume in ml: 19.6Forward flow volume in ml: 19.7Backward flow volume in ml: 0.1Regurgitant factor in %: 0.6Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.

1. Status post arterial switch operation.2. Normal right and left ventricle function. 3. Significant aortic root dilatation (38 cm in diameter), significant aortic valve insufficiency.4. Particular coronary anatomy as described above.5. Normal cardiac viability, no evidence of intracardiac shunt.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.

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Trigeminal nerve entrapment versus CNS demyelinating lesion: right facial pain. Internal Auditory Canals: A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve. The bilateral trigeminals nerves are otherwise intact. There is no evidence of mass lesions. The bilateral cavernous sinuses and Meckel caves appear unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hypertrophy of the posterior left inferior turbinate. There is cosmetic filler material in the bilateral cheeks, but not near the infraorbital foramen. There are postoperative findings related to maxillary reconstruction, with metal susceptibility artifact that obscures surrounding structures.

1. A small venous structures courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve, which is nonspecific and may be indicative of a vascular loop syndrome or represent an incidental anatomical variant. Otherwise, no evidence of tumor or demyelinating lesions.2. Postoperative findings related to maxillary reconstruction and cosmetic fillers in the bilateral cheeks.MRI BRAIN WWO, MRI INT AUD CANAL WWO, 1/12/2016 8:02 PMCLINICAL INFORMATION:Trigeminal nerve entrapment versus CNS demyelinating lesion: right facial pain.TECHNIQUE: MRI BRAIN WWO, MRI INT AUD CANAL WWO CONTRAST. A total of 13 cc of Multihance was administered intravenously, with 2 cc wasted.COMPARISON: Sinus CT from 6/3/15.FINDINGS:Internal Auditory Canals: A small venous structure courses along the superior and medial aspects of the root entry zone of the right trigeminal nerve. The bilateral trigeminals nerves are otherwise intact. There is no evidence of mass lesions. The bilateral cavernous sinuses and Meckel caves appear unremarkable. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is hypertrophy of the posterior left inferior turbinate. There is cosmetic filler material in the bilateral cheeks, but not near the infraorbital foramen. There are postoperative findings related to maxillary reconstruction, with metal susceptibility artifact that obscures surrounding structures.

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This exam is degraded by motion artifact.There are unchanged postoperative findings with residual pneumocephalus related to placement of a right frontal approach catheter within a right basal ganglia hematoma. The overall cavity size is unchanged, as is the acute hematoma, currently measuring 52 x 37 mm. There is grossly unchanged surrounding edema. There is again blood layering within both lateral ventricles as well as minimal left parietal subarachnoid hemorrhage. There is unchanged 10 mm leftward midline shift. The ventricles are unchanged in size with questionable mild dilatation of the left lateral ventricle. There is susceptibility effect compatible with chronic microhemorrhage in the left basal ganglia and thalamus. There is no evidence of acute infarct. There are scattered patchy foci of T2 hyperintensity throughout the supratentorial and infratentorial white matter that are most compatible with chronic small vessel ischemic disease. Mild asymmetric T2 hyperintensity within left dentate nucleus is nonspecific but may also represent chronic small vessel ischemic disease. There is mild ectasia of the distal right internal carotid artery. The major cerebral flow voids are intact. There is minimal fluid within the mastoid air cells.

1.Essentially unchanged postoperative findings related to placement of a catheter within a right basal ganglia acute hematoma with surrounding edema and intraventricular extension. The size of the hematoma and the associated midline shift is unchanged. 2.The ventricles are unchanged in size with questionable mild dilatation of the left lateral ventricle.3.Unchanged mild left parietal subarachnoid hemorrhage.

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Meningiomas. Status post resection. Assess for recurrent/growth. Since the previous examination, the patient did have resection of the left anterior parietal convexity meningioma. There is a small focus (measuring 7 mm in diameter) of somewhat linear contrast enhancement in the treatment bed which may reflect the leptomeningeal scarring. The diffusion characteristics in the treatment plan and are difficult to assess given artifact related to the overlying craniotomy. However, there is no sizable effusion obstruction. Ureteral thickening underlying the craniotomy flap than expected.T1-hypointense, T2 hyperintense signal without mass-effect in the underlying anterior parietal white matter (including the postcentral gyrus) probably reflect gliosis. This is where the edema-like signal was present on the preoperative examination. The remainder of the brain shows unchanged tiny subcortical and deep white matter foci in the frontal lobes that probably reflect chronic microvascular ischemia. There is mild expansion of the ventricle system and the other CSF-containing spaces which is unchanged.The orbits are normal. The mastoid air cells and the paranasal sinuses are clear.

1.The patient did have resection of the left parietal paramedian convexity meningioma. 2.Seven millimeter focal contrast enhancement in the resection bed likely represent leptomeningeal scarring rather than residual tumor. However, follow-up MRI can more reliably rule out minimal residual tumor though.

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Evaluate for gliosis: Headaches, memory and executive problems after 3 concussions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

No evidence of gliosis. However, MR tractography may be useful for further evaluation.

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61 year old female with a personal history of left breast lumpectomy for breast cancer in 1997 followed by chemoradiation therapy. BRCA1 positive. Family history of breast cancer in sister and niece. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.There is a new enhancing mass measuring 16 x 10 x 12 mm at posterior 3:00 position in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

A new suspicious mass at posterior 3:00 position in the left breast. MR directed ultrasound study is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.

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There is a 3.9 x 3.8 cm partially solid and cystic enhancing mass within the right frontal lobe with marked surrounding vasogenic edema and mass-effect with compression of the right lateral ventricle and 9-mm leftward subfalcine herniation. There are three additional similar appearing but smaller masses with surrounding edema: a 1.1 x 1.8 cm mass within the right periatrial white matter, a 1.5 x 1.7 cm mass within the inferior left frontal lobe, and a 0.8 x 0.7 cm within the right cerebellar folia.

Four intracranial metastases, the largest of which is within the right frontal lobe and results in marked mass-effect and 9-mm leftward subfalcine herniation.

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Patient with history of squamous cell carcinoma of ethmoid sinus with recurrence.Please evaluate for disease. Metastases. CT of soft tissues of the neck.Images through the skull base and including cavernous sinuses remain within normal limits.Revisualization of extensive opacification of left ethmoid air cells which also demonstrated a small bony defect along its anterior aspect. In comparison with the prior examination there is evidence of reduction in the amount of soft tissue density that was immediately anterior to the bony defect of the lamina procedure and anterior aspect of the floor of the orbit on the left. This may be result of interval improvement of post therapy changes. Two entirely exclude possibility of residual tumor MRI examination in this case would be most helpful.The bony density of the area of the exam demonstrates no evidence of any new area of bony erosion. Images through the rest of the soft tissues of the neck demonstrate a few small nonpathologic lymph nodes which are stable since prior study. No pathologically enlarged lymph node is detected.Limited images through the apices of the lungs demonstrate extensive findings of multiple pulmonary emphysematous bulla (right greater than left. No definitive metastases is detected.CT of brain with infusion.Notice of metastatic disease to the brain, calvarial or leptomeninges is detected. This is study is essentially within normal limits.75 cc of Omnipaque was utilized for these studies.

1.Negative CT of brain with infusion.2.Reduction in the amount of soft tissue density at the level of the left ethmoid air cells and left orbit since prior study. Further evaluation to exclude residual tumor with an MRI is recommended.3.No areas of pathologic adenopathy in the neck and stable multiple small bilateral lymph nodes.

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41 year old with history of left breast cancer, status post left mastectomy and right prophylactic mastectomy. Status post bilateral mastectomies.There is no residual breast tissue in either breast.No abnormal enhancement is seen in either mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

No MRI evidence for malignancy. Status post bilateral mastectomies, no residual breast tissue.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.

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There has been interval appearance of at least three small enhancing nodular lesions along the right anterior temporal lobe and a single small enhancing lesion along the left anterior temporal lobe with surrounding FLAIR signal abnormality indicating vasogenic edema. The largest lesion in the tip of the right anterior lobe measures 8 x 9 mm (series 5, image 46). These findings are suspicious for metastatic lesions.There is unchanged underlying scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. A left frontal developmental venous anomaly is again incidentally noted. There is no diffusion abnormality. No extra-axial fluid collection is identified. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Again seen is a left maxillary sinus mucosal retention cyst.

Interval appearance of multiple small enhancing masslike lesions in the right greater than left anterior temporal lobes with surrounding FLAIR signal abnormality indicating vasogenic edema. Differential considerations include radiation necrosis and metastases.

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Reason: evaluate for small bowel inflammation History: abdominal distention, family history of IBD ABDOMEN:LIVER, BILIARY TRACT: Questionable small gallstone, please correlate with ultrasound. No focal liver lesion or biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Possible arcuate morphology of the uterus. Numerous small peripheral cysts in the bilateral ovaries, raising the possibility of PCOS. Please correlate with patient's history and obtain pelvic ultrasound if indicated. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.No MR evidence of inflammatory bowel disease.2.Questionable small gallstone, please correlate with ultrasound.3.Incidental findings of possible PCOS (polycystic ovarian syndrome) and arcuate morphology of the uterus. Please correlate with patient's history and obtain pelvic ultrasound if indicated.

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63 year-old female with BRCA gene mutation who presents for MRI guided biopsy of the right breast nonmass enhancement. Nonmass enhancement is identified in the medial aspect of the right breast, corresponding to the findings on the outside MRI breast, which is the target for today's MRI guided biopsy.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor with the aid of DynaCad software. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 6 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen digital radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a right unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed in the right breast at 2 o'clock position, which is approximately 1 cm lateral to the biopsy cavity. Benign calcifications are noted anterior and posterior to the biopsy cavity. No evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Wang under direct supervision of Dr. Schacht who was present throughout the procedure.

Successful MR guided core needle biopsy of the enhancing lesion at 3 o'clock in the right breast. The biopsy clip is approximately 1 cm lateral to the biopsy cavity. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation.

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Left upper extremity weakness and neck pain. C4-C5 fusion. Multiple sequences are motion degraded and repeated. Again seen are postoperative changes of ACDF at C4-C5 with solid osseous fusion better demonstrated on CT. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. Susceptibility artifact from patient's hardware and motion degradation somewhat limit evaluation. There is abnormal T2 signal involving the right ventral aspect of the cord at the C4-C5 level likely representing myelomalacia, presumably from prior compressive myelopathy. There is no spinal canal stenosis on the current study at this level.There is mild developmental narrowing of the cervical spinal canal with superimposed degenerative changes including small disc osteophyte complexes and mild multilevel facet arthropathy. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy. There is partial effacement of the ventral and dorsal thecal sac without significant spinal canal stenosis overall. There is mild to moderate right and mild left left neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina. Cord signal abnormality as described above.C5-6: There is a small disc osteophyte complex and ligamentum flavum thickening contributing to mild spinal canal stenosis. There is up to moderate, right slightly worse than left neural foraminal stenosis.C6-7: No significant compromise to the spinal canal. Minimal bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.

1. Postoperative changes of ACDF at C4-C5, with solid osseous fusion better demonstrated on CT.2. Degenerative changes in the cervical spine superimposed on mild developmental narrowing of the cervical spinal canal. There is mild spinal canal stenosis at the C5-C6 level. Otherwise no evidence of high-grade spinal canal stenosis. Neural foraminal stenosis is worst at the C5-C6 level where there may be impingement of the C6 nerve roots, right worse than left.3. Abnormal T2 signal involving the right ventral cord at the C4-C5 level likely represents myelomalacia and may be related to prior compression. There is no spinal canal stenosis on the current study at this level..

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The examination is limited by motion artifact. There is a large area of ischemia involving the left PICA territory, specifically the left lateral medulla and left cerebellar hemisphere. Small areas of ischemia are also present in the right cerebellum. There is ischemia involving the red nucleus of the right midbrain as well as a punctate area of ischemia in the left pons. Symmetric appearing areas of ischemia are demonstrated in the bilateral occipital lobes. Punctate foci of ischemia are demonstrated in the right frontal lobe and left parietal lobe. There is global volume loss with scattered lacunar infarcts present in the bilateral basal ganglia and periventricular white matter. There is no evidence for hydrocephalus. Scattered punctate areas of susceptibility are demonstrated however there is no evidence for hemorrhagic transformation in the areas of infarction. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There is scattered paranasal sinus disease with ethmoid mucosal thickening and air-fluid levels present in the left maxillary sinus and right sphenoid sinus.MRA HEAD

Limited examination secondary to motion artifact.1. Multifocal areas of ischemia involving the anterior and posterior circulation with largest area involving the left PICA territory. Additional smaller areas of ischemia are demonstrated in the right cerebellum, bilateral brainstem, bilateral occipital lobes, posterior right frontal lobe, and left parietal lobe.2. There is high-grade stenosis or occlusion of the distal left vertebral artery with nonvisualization of the left PICA.3. Mild to moderate multifocal areas of atherosclerotic disease involving the intracranial vasculature, most prominent involving the bilateral cavernous internal carotid arteries.4. Global volume loss and scattered white matter and basal ganglia lacunar infarcts likely related to chronic microvascular ischemic disease.5. There is scattered paranasal sinus disease with ethmoid mucosal thickening and air-fluid levels present in the left maxillary sinus and right sphenoid sinus.

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There are scattered nonspecific punctate foci of T2/FLAIR hyperintensity in the bilateral frontal subcortical and periventricular white matter. Ventricular size is normal for age with no midline shift. Basal cisterns are patent. There are no diffusion or susceptibility abnormalities. There is no abnormal enhancement. There is partially empty sella. There is mild left maxillary sinus mucosal thickening.

Unremarkable MRI of the brain.

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75-year-old female with history of multiple CVAs now presents with increased altered mental status and muscle twitches. Please evaluate for new bleed, mass effect or shift. Compared to previous to evaluate progression of CVA. There is no evidence of intracranial hemorrhage, mass or edema. The previously described there is low attenuation throughout the MCA vascular territory the left consistent with a subacute infarct but remains overall unchanged from the previous examination. Multiple other areas of hypodensity in the periventricular and subcortical white matter distribution is consistent with small vessel disease, age indeterminant. Multiple lacunar infarcts redemonstrated within the bilateral basal ganglia and cerebellum. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are stable in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

1. Stable right frontoparietal subacute infarct. 2. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.

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Reason: ? medial meniscus tear History: catching/pain MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: There a 2 foci of near full-thickness fissuring along the lateral patellar facet. The articular cartilage along the medial patellar facet, trochlea and medial and lateral compartments is intact.LIGAMENTS: The ACL and PCL are intact. There are 2 subcentimeter cysts at the ACL insertion. The medial and lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

1.No evidence of meniscal tear.2.Near full-thickness fissuring along the articular cartilage of the lateral facet of the patella.3.Small Baker's cyst.

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57-year-old female with history of right proximal humerus lesion. Redemonstrated is a heterogeneous lesion within the right proximal humeral metaphysis extending into both the epiphysis and diaphysis. This lesion measures 6.6 cm in maximal sagittal dimensions, previously 6.6 cm (image 18 series 1001). This lesion demonstrates decreased T1 and increased T2 signal with mild irregular enhancement. There are scattered foci of signal void corresponding to calcifications appreciated on plain film. There is no evidence of cortical breakthrough or extraosseous extension. Overall this lesion appears similar to the prior exam.The rotator cuff is grossly intact without evidence of tear. There is a trace amount of fluid within the subacromial bursa as well as mild AC joint osteoarthritis. The anterior and posterior glenoid labrum are grossly intact.

1.Stable right humeral lesion as above likely corresponding to a benign enchondroma.2.Mild AC joint osteoarthritis.

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26-year-old female with history of prior meningioma resection, placement of spinal instrumentation, and now more recently hardware removal. Patient now presents with back pain. Thoracic: Compared to prior MRI from 7/23/2015, thoracic fusion hardware has been removed. Redemonstrated is an extra-axial mass located at a T6-7 vertebral body level along the right posterior lateral aspect of the spinal canal which measures 5 x 10 mm in the axial plane and up to 19 mm in the craniocaudal dimension. This mass is not significantly changed since 7/23/2015 but demonstrates slight gradual enlargement when compared to more remote studies dating back to 6/5/2012. Associated calcifications better demonstrated on prior CT. As before, the mass contacts the thoracic cord without evidence of frank cord compression.There is focal dural thickening along the lateral aspects of the thecal sac at the T9-T10 level, which was present previously on the left but is new on the right, and much of it likely represents granulation tissue. Redemonstrated is an additional small focus of dural thickening along the left anterolateral thecal sac at the T10-T11 level measuring 4 x 7.5 mm in the axial plane and up to 12 mm in the craniocaudal dimension, grossly similar to prior although not well imaged on prior study due to presence of hardware. Focal T2 hyperintensity within the spinal cord at T10 with associated volume loss is not significantly changed and consistent with myomalacia. There remains deformity of the left anterolateral aspect of the cord with mild flattening from approximately the T7-T8 level to the T10-T11 levels which is suspected to be related to adhesions in the thecal sac but not significantly changed since prior. Dorsal epidural thickening with mild effacement of the dorsal thecal sac at the site of prior surgeries is compatible with granulation tissue and is not associated with mass effect. No evidence of high-grade spinal canal stenosis at any level. Neural foramina are also patent. The thoracic vertebral bodies are appropriate in the overall alignment and height. Lumbar: Vertebral body heights and alignment in the lumbar spine are normal. Alignment is normal. Bone marrow signal is benign. No significant disc disease. There is no significant spinal canal or neural foraminal stenosis in the lumbar spine. Lumbar paraspinous soft tissues are unremarkable. No abnormal enhancement.

1.Interval removal of thoracic spinal fusion hardware. There is no significant change in extra-axial mass likely representing a calcified meningioma at the T6-7 level compared to 7/23/2015. There is evidence of slight enlargement when compared to remote studies dating back to 2012.2.Again seen is dural thickening along the lateral aspects of the thecal sac at the T9-T10 level which was present on the left previously, but appears new on the right, and much of it likely represents granulation tissue. Small residual meningioma remains a possibility. No significant mass effect on the cord.3.No significant change in additional nodular focus of dural thickening along the left anterolateral thecal sac at the T10-T11 level which may also represent minimal residual meningioma. No significant mass effect on the cord.4.No change in T2 signal hyperintensity in the thoracic cord at the T10 level likely representing myelomalacia. Mild deformity of the left anterolateral aspect of the cord from approximately the T7-T8 level to the T10-T11 levels is suspected to be related to adhesions in the thecal sac and also not significantly changed since prior. 5. Lumbar spine MRI is unremarkable.

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Reason: 14 year old with intractable migraines s/p LP presenting with back pain, neck pain: please evaluate for focal defect History: Back pain, neck pain, headache, photo/phonophobia The craniocervical junction appears within normal limits. Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. Disc spaces are preserved. Alignment is maintained. No evidence of epidural hematoma or fluid collections in the paraspinous soft tissues are appreciated. No cord signal abnormality. There is diffuse engorgement of the epidural venous plexus in the cervical, thoracic, and lumbar spine. No significant spinal canal or neural foraminal stenosis is appreciated. Paraspinous soft tissues are grossly unremarkable.

No findings to suggest epidural hematoma or fluid collection in the paraspinous tissues to suggest a CSF leak. No significant spinal canal stenosis. There is diffuse prominence/engorgement of the epidural venous plexus in the cervical, thoracic, and lumbar spine which can be seen post lumbar puncture/with intracranial hypotension. Brain MRI can be considered as clinically indicated although no evidence of brain sagging based on the limited visualization of the posterior fossa.

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58 years Female (DOB:1/25/1958)Reason: rule out stroke History: right sided clumsiness, weaknessPROVIDER/ATTENDING NAME: IRA J BLUMEN HELENE G. RUBEIZ MRI of the brainThere is a small focus of diffusion restriction present in the posterior limb of the left internal capsule which extends to the centrum semiovale.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There appears to be duplication of the right middle cerebral artery. Findings suggest a 2 mm aneurysm at the community in segment of the right internal carotid artery. Findings also suggest a 2 mm aneurysm at the distal left internal carotid artery at the communicating segment.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the left posterior communicating artery. The right posterior communicating artery is small. The vertebral arteries are similar in size. The vertebrobasilar system is tortuous.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

1.Acute Lacunar infarction in the posterior limb of left internal capsule.2.The distal right internal carotid artery appears to be ectatic and associated with a duplicated right middle cerebral artery. 3.Findings suggest a small bilateral aneurysms at the at the distal internal carotid arteries distal to the origins of the posterior communicating arteries. This can be confirmed by CT angiography if clinically appropriate.4.The intracranial vasculature is tortuous which is a nonspecific finding.

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Headaches, CT shows tightening at the foramen magnum As seen on recent CT study there is prominent retroodontoid soft tissue thickening without erosion. There is a cystic component involving the posterior and superior aspect of the lesion. There is mass effect with deformity and kinking at the cervicomedullary junction. No abnormal parenchymal signal abnormality is appreciated. There is also effacement of the dorsal thecal sac at the level of the posterior C1 arch which narrows the spinal canal which contributes to the moderate spinal canal stenosis at the C1-C2 level.Vertebral body heights in the cervical spine are maintained. There is borderline widening of the anterior atlantoaxial joint with predental space measuring 2.5 mm, slightly more prominent than on recent cervical spine study. Radiographs may be considered to assess for instability at this level.Vertebral body heights in the cervical spine are normal. No cord signal abnormality. There is loss of cervical lordosis with mild retrolisthesis of C5 on C6. Again seen are multilevel degenerative changes with severe loss of disc space at the C5-C6 level and to a lesser degree C6-C7 and T1-T2 level. Individual levels as below:C2-3: No significant spinal canal stenosis. There is bilateral facet arthropathy, right worse than left, with mild to moderate right and mild left left neural foraminal stenosis. C3-4: There is right paracentral disc osteophyte complex, uncovertebral hypertrophy, and right worse than left facet arthropathy. There is no significant spinal canal narrowing. There is moderate to severe right and mild to moderate left neural foraminal stenosis. C4-5: There is disc osteophyte complex, ossification along the posterior longitudinal ligament, and right worse than left facet arthropathy. There is mild to moderate spinal canal narrowing. There is also moderate bilateral neural foraminal stenosis. Vacuum phenomena at the disc space.C5-6: Left paracentral osteophyte complex, mild ossification of the posterior longitudinal ligament, and bilateral uncovertebral hypertrophy, which results in moderate to severe spinal canal stenosis involving the left aspect of the spinal canal. There is severe left and moderate to severe right neural foraminal stenosis. There is severe loss of disc height at this level with vacuum phenomena.C6-7: There is disc osteophyte complex and mild ossification of the posterior longitudinal ligament. There is mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal stenosis. No significant right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. There are multiple cystic and solid nodules involving the bilateral thyroid lobes which were better assessed on prior thyroid ultrasound. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

1. Prominent retroodontoid soft tissue is again seen which is likely on a degenerative basis. There is a cystic component along its posterior-superior aspect, which is favored to represent a synovial cyst. There is associated mass effect with contour deformity and impression on the ventral cervicomedullary junction. No associated parenchymal signal abnormality. 2. There is borderline widening of the atlantoaxial distance. Consider dynamic radiographs to assess for atlantoaxial instability. 3. Multilevel degenerative changes with moderate to severe spinal canal stenosis involving the left aspect of the thecal sac at the C5-C6 level. There is also significant neural foraminal stenosis at multiple levels, as detailed above.

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Metastatic prostate cancer. There is redemonstration of findings related to right posterior parietal craniotomy with a small amount of fluid at the operative site. There has been gross total resection cystic mass overlying the right parietal lobe. A punctate enhancing focus in the right lateral margin of the section cavity may represent granulation tissue or a focally dilated vein. There is otherwise minimal residual edema in the brain parenchyma surrounding to the surgical bed. There is unchanged diffuse dural thickening and enhancement particularly along the bilateral cerebral convexities, measuring up to 10 mm in maximal thickness on the right side. There has been interval decease in the edema adjacent to the left inferior frontal lobe lesion. There is leftward midline shift of approximately 5 mm. The basal cisterns remain patent. There is no evidence of new mass or acute infarct. The major cerebral flow voids are intact. There is persistent fluid in the mastoid air cells bilaterally. There is a small retention cyst in the right maxillary sinus. The orbits and scalp soft tissues are grossly unremarkable.

1.Postoperative findings related to right posterior parietal craniotomy and resection of an right parietal dural metastasis with markedly decreased surrounding right parietal lobe edema.2. No significant change in size of the extensive remaining bilateral dural based metastatic disease, although left inferior frontal lobe edema has subsided.

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Right upper quadrant pain, elevated LFTs and leukocytosis. Susceptibility artifact from the patient's spinal fixation hardware limits some of the imaging sequences, particularly the diffusion weighted images which are non-diagnostic.ABDOMEN:LUNG BASES: Small right greater than left pleural effusion with minimal basilar atelectasis.LIVER, BILIARY TRACT: There is intrahepatic and extrahepatic biliary ductal dilatation with the common bile duct measuring 16 mm. The duct is dilated to the level of the superior aspect of the pancreatic head where it tapers abruptly. A short segment of the common bile duct is seen just proximal to the ampulla. At this level the pancreatic head is prominent, measuring 2.7 x 2.3 (series 1405/180), T2-hypointense and demonstrates relatively early and persistent enhancement relative to the background mildly atrophic pancreas. There is mild spiculation of the contours of the pancreatic head. The pancreatic duct is at the upper limits of normal in caliber. There is no soft tissue encasement or caliber abnormality of the adjacent SMV, splenic vein, protal vein or SMA. Posterior peri-pancreatic head lymph node measuring 7 mm in short-axis. No additional prominent lymph nodes.The gallbladder is mildly distended. There is mild smooth focal gallbladder wall thickening to 4 mm along the lateral aspect of the gallbladder which may reflect focal adenomyomatosis. The remainder of the gallbladder is normal in thickness. There is mild pericholecystic fluid. No filling defect to suggest gallstones.Minimal perihepatic fluid.There is mild loss of hepatic parenchymal signal intensity on out of phase imaging suggesting fatty infiltration. No focal suspicious hepatic lesion.SPLEEN: Minimal perisplenic fluid. The spleen is normal in size.PANCREAS: See the discussion above.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Symmetric minimal perinephric fat stranding. Subcentimeter left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Distended gallbladder with significant intra and extrahepatic biliary ductal dilatation to the pancreatic head. A pancreatic head mass is suspected, as described above, specifically a pancreatic adenocarcinoma or less likely a cholangiocarcinoma. EUS/ERCP evaluation and biopsy is recommended.2.Small pleural effusions.

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There are mild scattered nonspecific T2 hyperintensities in the cerebral white matter. There is also a nonspecific punctate focus of susceptibility effect in the posterior right temporal lobe. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

1. Mild scattered nonspecific T2 hyperintensities in the cerebral white matter may represent chronic small vessel ischemic disease. 2. A nonspecific punctate focus of susceptibility effect in the posterior right temporal lobe may represent a chronic microhemorrhage. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.

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72-year-old male with elevated PSA. Evaluate for prostate cancer. PELVIS:PROSTATE:Limited exam due to lack of contrast enhancement (related to the extravasation).Prostate Size: 4.9 cm in transverse, 3.7 cm in AP, and 4.2 cm in craniocaudal diameter.Peripheral Zone: In the right mid gland peripheral zone, there is a small focus of the hypointensity (axial series 604 image 164). Further evaluation is limited due to the lack of contrast enhancement (related to the contrast extravasation). Extensive stranding in the peripheral zone is suggestive of chronic prostatitis.Central Gland: Heterogenous appearance.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Suspicious lesion in the right mid gland peripheral zone. The lack of contrast enhancement (due to extravasation) and background of chronic prostatitis limit further evaluation.Contrast extravasation description:Supervising radiologist: Julie Sanders, MDMinor or major extravasation: MinorContrast type:18.2 cc of MultiHance were administered. Amount extravasated: 18.2 ccLocation of extravasation: Right antecubitalSigns and symptoms: Erythema and swellingTreatment given: Ice packDischarge instructions given: Yes

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19 year-old male with headache, sudden onset. Evaluate for intracranial hemorrhage. Electronic medical records provided history of sickle cell disease. There is no evidence of intracranial hemorrhage, mass or edema. A single focus of low attenuation is present along the anterior aspect of the left frontal horn which represents a focus of encephalomalacia. This is present on prior CT and MRI examinations compatible with a focus of encephalomalacia most likely secondary to sequela of sickle cell disease and appears unchanged. No new foci are appreciated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

No acute intracranial abnormalities.

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right side weakness and right partial retinal artery occlusion. No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered small high signal intensities on bilateral hemispheres on FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

No evidence of acute ischemic or hemorrhagic lesion.

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54-year-old male with bilateral knee pain. MENISCI:Left Knee: Linear increased signal is noted in the posterior horn of the left medial meniscus, extending to the articular surface. Findings are compatible with a radial tear but there is also a vertical component (series 601, image 21). The anterior horn of the left medial meniscus and both horns of the left lateral meniscus are unremarkable.Right Knee: Subtle increased signal in the posterior horn of the right medial meniscus, suggestive of a partial undersurface tear. The anterior horn of the right medial meniscus is unremarkable. Myxoid degeneration is noted in the anterior horn of the right lateral meniscus, which is otherwise unremarkable.ARTICULAR CARTILAGE AND BONE: Left Knee: No significant abnormality noted.Right Knee: Lobulated, T2-hyperintense lesion in the distal femoral metaphysis is compatible with a benign enchondroma. No significant bone marrow edema. Normal tricompartmental articular cartilage.LIGAMENTS: No significant abnormality noted in either knee. EXTENSOR MECHANISM: No significant abnormality noted in either knee.ADDITIONAL

1.Radial tear with vertical component in the posterior horn of the left medial meniscus.2.Findings suggestive of a partial undersurface tear in the posterior horn of the right medial meniscus.

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47-year-old female with left upper extremity pain and numbness.Additional EMR Data: two month history of left-sided arm numbness that is constant as well as intermittent shoulder numbness. Normal recent EMG of the left extremity. Motion limited exam. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is loss of disc height involving the C5-6 level. There is a likely hemangioma in the T2 vertebral body. The bone marrow signal is otherwise within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Degenerative changes are seen in the cervical spine as described below:C2-3 through C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Tiny left paracentral disc-osteophyte complex with mild left neuroforaminal narrowing but no spinal canal stenosis. C5-6: There is a diffuse disc osteophyte complex with minimal paracentral prominence along with some left facet arthropathy which contribute to moderate to severe left neuroforaminal narrowing. There is mild right neuroforaminal narrowing but no spinal canal stenosis. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: Trace disc-osteophyte complex without neuroforaminal narrowing or spinal canal stenosis.

Spondylotic changes of the cervical spine most prominent at the C5-6 level where there is moderate to severe left neuroforaminal stenosis. Correlate clinically for a left C5-6 radiculopathy.

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Reason: any plexiform tumor noted to left thumb area History: large fibroma to top of left thumb/wrist area, limited mobility, pain. Exam slightly limited by patient motion artifact on several sequences. Along the radial aspect of the distal first metacarpal, there is a lobulated T2 hyperintense, T1 hypointense, homogeneously enhancing mass measuring 2.8 x 1.6 x 2.3 cm (Obl AP x Obl TR x Obl CC) compatible with a plexiform neurofibroma given this patient's history. Smaller plexiform neurofibroma within the hypothenar subcutaneous fat measures 0.6 x 0.4 x 0.2 cm (Obl AP x Obl TR x Obl CC) and additional scattered small neurofibromas. Positive ulnar variance. T2 hyperintense, T1 hypointense, enhancing foci within the lunate and triquetrum likely due to impaction and inflammation related to positive ulnar variance.The remainder of the bones and soft tissues are within normal limits.

1.Scattered plexiform neurofibromas with the largest along the first metatarsal bone. 2.Positive ulnar variance with findings likely related to impaction involving the lunate and triquetral bones.

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Lower extremity weakness bilaterally There is interval increase in destructive changes at the C6-C7 disc level including the adjacent C6 and C7 vertebral bodies with loss of vertebral body height. T2 hyperintensity involving the disc space and bone marrow compatible with edema is stable to minimally increased in the interval. There is a dorsally projecting osteophyte/osseous retropulsion which results in flattening of the cord which is worse since prior. There is also increased T2 hyperintensity in the cord compatible with edema. Prevertebral edema is improved since prior. Moderate spinal canal stenosis at the C2-C3 C3-C4, C4-C5, and C5-C6 levels is similar to prior. There is T2 hyperintensity in the ventral epidural space extending from C5 to C7 which is favored to represent engorged epidural venous plexus.Diffuse low T1 and T2 bone marrow signal may be related to renal osteodystrophy and/or chronic anemia. Vertebral body heights and alignment in the thoracic and lumbar spine are maintained. Small Schmorl's nodes are incidentally noted. No significant spinal canal stenosis in the thoracolumbar spine is appreciated.

Examination is limited to sequences per cord compression protocol. Compared to 12/29/2014, there has been worsening of endplate destructive changes at the C6-C7 level, worsening vertebral body height loss, stable to slight worsening of disc/bone marrow edema at this level, and worsening of osseous retropulsion, which now results in severe spinal canal stenosis. There is edema in the cord at this level which is new since prior. Possibilities of this destructive process include dialysis-related spondyloarthropathy and chronic discitis-osteomyelitis. Epidural tissue in the C5-C6 level is favored to represent engorged venous plexus. Please refer to separate cervical spine MRI for additional findings.No significant spinal canal stenosis in the thoracic or lumbar spine.

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70-year-old male with back pain and abnormal CT For purposes of numbering, the lower-most level containing a well-formed disc is considered to be L5/S1. With this numbering nomenclature, there is L5 transitional anatomy, and the lower-most level containing ribs is T11. This is the same nomenclature utilized for the two comparison lumbar spine CT exams.There is normal lordotic curvature and alignment of the lumbar spine. The vertebral body heights are preserved. A chronic left L4 pars defect is better demonstrated by prior CT technique. No other fracture or destructive osseous lesion is seen.There is disc desiccation as well as mild disc height loss involving the L3-4 level and moderate disc height loss involving the L4-5 and L5-S1 levels. The paraspinal soft tissues are unremarkable.T12-L1 and L1-L2: No neural foraminal or spinal canal stenosis. These findings are unchanged.L2-L3: Mild disc bulge. Mild facet arthropathy. No spinal canal stenosis. Mild bilateral neural foraminal stenosis. These findings are unchanged.L3-L4: Diffuse annular disc bulge, moderate facet arthropathy, and ligamentum flavum hypertrophy. Moderate central, marked bilateral lateral recess, and moderate bilateral neural foraminal stenosis. These findings are unchanged.L4-L5: Evidence of prior partial laminectomy, at least on the left if not bilaterally. There is diffuse annular disc bulge with a superimposed right paracentral disc extrusion which extends below the disc level. There is also severe facet arthropathy and ligamentum flavum thickening. There is moderate to severe central, moderate to marked left lateral recess, marked right lateral recess, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis. These findings are unchanged.L5-S1: Mild disc bulge, severe facet, and severe arthropathy of the articulation between the L5 vertebral body and the sacral ala. No significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis with abutment and flattening of bilateral S1 nerve root sheath origins. These findings are unchanged.

1.For purposes of numbering, the lower-most level containing a well-formed disc is considered to be L5/S1. With this numbering nomenclature, there is L5 transitional anatomy, and the lower-most level containing ribs is T11. This is the same nomenclature utilized for the two comparison lumbar spine CT exams.2.L2-L3: Mild bilateral neural foraminal stenosis, unchanged.3.L3-L4: Moderate central, marked bilateral lateral recess, and moderate bilateral neural foraminal stenosis, unchanged.4.L4-L5: Moderate to severe central, moderate to marked left lateral recess, marked right lateral recess, moderate to severe left neural foraminal, and moderate right neural foraminal stenosis, unchanged.5.L5-S1: Mild bilateral neural foraminal stenosis with abutment and flattening of bilateral S1 nerve root sheath origins, unchanged.

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33-year-old female with knee instability, rule out ACL and medial meniscal tear MENISCI: There is a buckle handle tear of the medial meniscus with meniscal tissue displaced into the intracondylar notch, anterior to the PCL. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: We see no bone contusions. We see no fluid-filled articular cartilage defects.LIGAMENTS: The ACL appears disrupted at its femoral attachment which presumably represents a chronic tear given the lack of bone contusions. Additional ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

ACL tear and bucket-handle tear of the medial meniscus. These may be chronic given the lack of bone contusions.

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84-year-old female patient with biliary ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: There is mild intrahepatic biliary ductal dilatation. The common bile duct is dilated up to 14 mm proximally and smoothly tapers distally without evidence of an obstructing mass. The gallbladder is absent. Multiple scattered subcentimeter T2 hyperintense lesions likely represent biliary hamartomas. Mildly decreased signal on out of phase imaging is compatible with hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: There is age-related fatty atrophy of the pancreas. Multiple subcentimeter cystic lesions within the pancreas likely represent sidebranch IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Intra- and extrahepatic biliary ductal dilatation without evidence of an obstructing mass; this is likely secondary to a post-cholecystectomy state given normal bilirubin.2.Subcentimeter cystic hepatic and pancreatic lesions likely representing biliary hamartomas and sidebranch IPMN's, respectively.3.Hepatic steatosis.

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Reason: assess for recurrent disease History: high risk testis cancer s/p right orch ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A right periaortic lymph node is slightly increased in size measuring 1.0 x 0.7 cm (12/29), previously0.8 x 0.7 cm on the CT dated 10/1/2015.This is located near the right gonadal vein along the anterior aspect of the IVC.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

1.Mildly enlarged retroperitoneal lymph node is slightly increased in size from prior. This is located near the right gonadal vein along the anterior aspect of the IVC

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Knee pain. Knee injury three weeks. MENISCI: The menisci appear intact.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears intact. Bone marrow signal intensity appears normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is perhaps mild edema of the quadriceps fat pad, but this is of questionable clinical significance.ADDITIONAL

Mild edema of the quadriceps fat pad is of questionable clinical significance. I otherwise see no findings to account for the patient's pain.

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71 years Male (DOB: 5/7/1945)Reason: spontaneous muscle movement History: muscle twitchingPROVIDER NAME: RIMAS V. LUKAS RIMAS V. LUKAS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:Examination is degraded by patient motion. This obscures adequate visualization of the neural foramina and spinal canal.The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal. The left neural foramen appears to be narrowed. There appears to be facet hypertrophy in the left side at this level and left uncovertebral osteophyte formation and to a lesser degree right uncovertebral osteophyte formation..At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge. There are endplate uncovertebral osteophytes present at this level. There are some effacement of spinal fluid ventral and posterior the spinal cord at this level. Overall there is mild to moderate spinal stenosis. There is narrowing of the neural foramina bilaterally at this level. There appears be facet hypertrophy at this level.At C4-5 there is loss of disc space height, desiccation, disc bulge and endplate and uncovertebral osteophytes with some partial effacement of spinal fluid ventral but not posterior the spinal cord. There is facet hypertrophy and narrowing of the neural foramina bilaterally at this level with suspected encroachment of exiting nerve roots.At C5-6 there is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate and uncovertebral osteophytes. Some degree of narrowing of the neural foramina is present. There is mild narrowing of the spinal canal at this level.At C6-7 there is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate and uncovertebral osteophytes. Some degree of narrowing of the neural foramina is present. There is mild narrowing of the spinal canal at this level.At C7-T1 there is loss of disc space height, disc desiccation and a mild disc bulge associated with endplate and uncovertebral osteophytes. Some degree of narrowing of the neural foramina is present.The vertebral artery flow voids appear to be intact.

1.Examination of the cervical spine is degraded to patient motion artifact which will obscure more subtle abnormalities. There are multilevel degenerative changes present in the cervical spine with findings suspicious for neural foraminal encroachment at multiple levels and findings suspicious for mild to moderate spinal stenosis at the C3-4 level.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Examination of the brain is also degraded due to patient motion which may also obscure more subtle abnormalities.

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26-year-old man with history of testicular cancer, evaluate for metastases. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic cyst (600/23). The liver is otherwise normal in signal and morphology. The gallbladder appears normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

No evidence of metastatic disease in the abdomen or pelvis.

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Ms. Nichols is a 47-year-old female with history of right breast cancer status post mastectomy in 2008, implants 2009. History of chemotherapy and hormonal therapy. History of benign MRI-biopsy of the left breast in 2009. No current breast complaints. Three standard views and two implant displaced views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. There are no new masses, suspicious microcalcifications or areas of architectural distortion in the left breast. A biopsy clip is present in the left breast from prior benign MRI biopsy. An asymmetry in the left upper inner breast is not significantly changed since 2012.

No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.

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Dermatomyositis and skin wound Again seen is diffuse subcutaneous and muscle edema consistent with known history of the dermatomyositis. Overall, these findings have improved from the prior exam. There is a soft tissue defect overlying the mid lateral thigh. The soft tissue defect does not extend beyond the subcutaneous fat. There is no discrete fistulous tract or fluid collection identified. The underlying marrow signal of the femur is normal.

Improving subcutaneous and muscle edema. Soft tissue defect overlying the mid lateral thigh does not extend beyond the subcutaneous fat.

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19 years, Male, examination post tumor resection. History of ganglioglioma. Interval postsurgical changes of resection of recurrent tumor in the posterior fossa are seen. There is restricted diffusion involving the left cerebellar hemisphere along the posterior margin of the resection cavity related to blood products and/or cytotoxic edema. There is T1 shortening and susceptibility in the right paramedian region dorsal to the fourth ventricle related to blood products. There is no definite evidence of residual enhancing tumor. Expected postsurgical changes include small amount of pneumocephalus as well as extra-axial blood products in the posterior fossa. Air as well as blood products within the ventricular system are also noted. There is slight decrease in size of the ventricular system when compared to 1/12/2016.No midline shift or herniation. Again seen is a prominent CSF space/arachnoid cyst involving the right aspect of the pineal cistern with blood products indicative of communication with the ventricular system. Pronounced volume loss and areas of gliosis involving the right cerebellar hemisphere and right middle cerebellar peduncle related to prior treatment changes again noted. Major flow-voids are preserved.

Interval postsurgical changes related to resection of recurrent posterior fossa tumor as described above. No definite evidence of residual tumor is appreciated although blood products in the surgical bed limit evaluation for small residual lesions. Slight decrease in size of the ventricular system is noted.

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History of renal carcinoma and vertebral compression fractures. Thoracic spine: The expansile, lobulated metastatic lesion involving the left side of the T3 vertebra is overall slightly smaller, with almost complete resolution of the mass-effect on the thecal sac. In the axial plane, the mass along with its left paraspinal component measures 5.7 cm x 5.4 cm compared to 6.7 cm x 6.0 cm, previously. Obliteration of the left T2-T3 and T3-T4 neural foramina persists. The T7-L3 posterior fixation hardware, which is composed of bilateral transpedicular screws at T7, T8, T11, T12, L2 and L3 and dual posterior rods remain grossly unchanged. The metastatic, expansile lesion involving T9 and the smaller T10 vertebral body lesion are also improved with almost complete resolution of the mass-effect on the thecal sac at T9. The mild right T9 vertebral body compression fracture is unchanged or minimally increased. Vertebral body heights across the fused segment also remain preserved. The thoracic spinal cord shows normal signal and shape.Lumbar spine: There is an expandible cage in the right corpectomy defect at L1. Epidural extension of tumor at this level has virtually resolved. There is no significant change in a subcentimeter enhancing lesion in the inferior L5 vertebral body. There is no significant spinal canal stenosis at any of the lumbar spine levels. The L2 through L5 vertebral body heights are preserved. The metastatic, expansile lesions involving the right sacral ala are slightly smaller with less impingement on the epidural fat and nerve sleeves of the right first and second sacral nerves. Another lesion involving the left iliac crest is better defined and perhaps slightly larger and now contains foci of central T2-hyperintensity and peripheral T2-hypointensity. There are changes of previous left nephrectomy. The right adrenal mass is not completely imaged, while the left adrenal mass is not significantly changed in size, but shows central T2-hyperintensity, which may reflect necrosis.

1.The expansile metastatic lesions at T3 and T9 are overall smaller with almost complete resolution of the mass-effect on thecal sac. Also, the smaller T10 vertebral body lesion has regressed since January 2016. Mild right sided T9 vertebral body compression fracture is unchanged or minimally increased.2.The minimally expanded metastatic lesion at L1 vertebral body is slightly improved, with no significant impingement upon the lumbar spinal canal.3.A metastatic lesion involving the right sacral ala is also slightly smaller, with less impingement on the sacral neural foramina, while the left iliac crest metastatic lesion appears to be slightly larger, but may also feature treatment effects. 4.The left adrenal mass now demonstrates necrosis, while the right adrenal lesion is not completely imaged.

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Oropharyngeal fibroma status post biopsy. There is a residual subcentimeter mild nodular mucosal thickening in the region of the right tongue base and glossotonsillar sulcus without extension into the deeper tissues of the tongue. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The major cervical flow voids appear to be patent. There is a 15 mm diameter perineural cyst in the left T1-2 neural foramen, which is unchanged. Other punctate perineural cysts are present within the cervical spine neural foramina. The temporal bones, imaged intracranial structures, and orbits are grossly unremarkable. There appears to be filler material within the bilateral nasolabial folds. There are bilateral maxillary sinus retention cysts. There has been interval enlargement of left axillary lymph nodes, which measure up to 15 mm.

1. A subcentimeter lesion in the right oropharyngeal region is compatible with residual fibroma and/or inflammatory changes. 2. Unchanged left T1-2 neural foramen perineural cyst. 3. Interval enlargement of left axillary lymph nodes, which measure up to 15 mm, which is non-specific.