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Generate impression based on medical findings. | Female 20 years old Reason: evaluate for injury History: pain after 15 mi run, instability with knee "buckling" twice MENISCI: No meniscal tears.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is normal. There is a linear focus of low signal intensity extending through the articular cartilage of the femoral trochlea; this could represent a non-fluid-filled full-thickness cartilage fissure. The remainder of the cartilage appears normal.LIGAMENTS: The cruciate and collateral ligaments are intact. There is mild edema between the iliotibial band and lateral femoral condyle suggesting "iliotibial band friction syndrome". EXTENSOR MECHANISM: Appears normal.ADDITIONAL | 1.Findings suggestive of iliotibial band friction syndrome.2.Findings suggestive of a non-fluid filled fissure of the cartilage of the femoral trochlea. |
Generate impression based on medical findings. | The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. | Normal MRA. If there is continued clinical concern for vasculitis, a catheter angiogram would be recommended. |
Generate impression based on medical findings. | Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out. | 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.3.The alignment of the vertebral column throughout the spine remains normal. |
Generate impression based on medical findings. | Diagnosis: HeadacheClinical question: 3T scannerSigns and Symptoms: headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is no evidence for intracranial mass lesion to explain patient's headaches.2.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on medical findings. | Redemonstrated is nonenhancing T2/FLAIR hyperintense lesion with gyral thickening involving the left medial and anterior temporal lobe including the amygdala and extending to the insular cortex. Asymmetric T2/FLAIR hyperintensity is also noted involving the left posterior frontal corona radiata extending towards the posterior limb of the internal capsule and similar to prior. There is no new mass effect. There is an unchanged left thalamic developmental venous anomaly and adjacent T1 shortening and enhancement. Unchanged small focus of T2/FLAIR hyperintensity involving the left parietal subcortical white matter related to prior ischemia. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with small vessel ischemic and/or posttreatment changes. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No significant change in appearance of the infiltrating neoplasm involving the medial and anterior left temporal lobe as well as the insular cortex dating back to 12/19/2014. |
Generate impression based on medical findings. | 46 year old female with newly diagnosed multivessel coronary artery disease after admission for non-ST elevation myocardial infarction. Risk factors included hypertension, hyperlipidemia. She is referred for cardiac MRI for assessment of viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 131 ml/m2 (normal range: 65+/-11), the LVEDV is 254 ml (normal range 109+/-23), the LV end systolic volume index is 95 ml/m2 (normal range 18+/-5), the LVESV is 185 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There is hypokinesis of the basal anterolateral wall, the mid anteroseptum, anterior, anterolateral, and inferolateral walls; and the entire apex. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. No left ventricular thrombus is noted. The pre-contrast native myocardial T1 relaxation times are elevated (~1200 ms) which suggests presence of underlying fibrosis. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. The overall RV ejection fraction is 41%, the RV end diastolic volume index is 100 ml/m2 (normal range 69+/-14), the RVEDV is 195 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 115 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are dilated and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall bilateral pleural effusions are noted. 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. The left ventricle is severely dilated with severely reduced systolic function (LVEF 27%).2. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 41%).3. The majority of the left ventricle is free of myocardial infarction and viable. However, there is a small transmural myocardial infarction involving the basal to mid anterolateral wall which is not likely to be viable. There is a non-transmural myocardial infarction involving the mid anterior and anterolateral walls which has an intermediate probability of viability. A small apical anterior transmural myocardial infarction is noted and this segment is not viable. Additionally there is a mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern of late gadolinium enhancement is not typical for prior myocardial infarction and suggests the presence of a concomitant non-ischemic cardiomyopathy. 4. Biatrial enlargement. 5. The SVC and IVC are dilated.6. Moderate tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Altered mental status. Assess for stroke. The study is limited by patient motion.There is no diffusion restriction to indicate a recent infarct. There is inflammation related to the chronic right temporal infarct. Addition, there is extensive confluent periventricular cerebral white-matter T2 hyperintensity reflecting chronic microvascular ischemia. Focal volume loss and increased T2 signal involving the posterior-superior aspect of the right cerebellar hemisphere is probably related to chronic right superior cerebellar artery infarct. There is no gross parenchymal hemorrhage though the study is limited by motion.Posterior right lateral ventricular ex vacuo dilatation is superimposed on diffuse dilatation of the ventricular system and the other CSF-containing spaces reflecting moderate to severe volume loss.There is minimal fluid in the mastoid air cells and minimal mucosal thickening in the paranasal sinuses. The orbits show no gross abnormality. | 1.Study is limited by patient motion. 2.No evidence of acute intracranial hemorrhage, mass, or acute infarct.3.Moderate cerebral volume loss and chronic right temporal and cerebellar infarcts are present, as described above and on the previous CT scan report. |
Generate impression based on medical findings. | 60 year old with history of pulmonary sarcoidosis with irregular heart beat presenting for structural evaluationMEDICATIONS: albuterol inhaler First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 195 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 88 ml (normal range 47+/-19), the LV mass index is 37 g/m2, and the LV mass is 83 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a high signal focus in the right posterior medial lung, recommend PA/LAT chest xray for further evaluation. No significant lymphadenopathy. | 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%).4. Normal RV size and systolic function (RVEF 48%). |
Generate impression based on medical findings. | Ms. Nagle is a 51-year-old female with a family history of breast cancer in her maternal grandmother diagnosed in her 40s. Personal history of benign left breast biopsy. No current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.Again noted is a high T2 signal intensity focus in the left hepatic lobe which is stable and can represent a cyst or hemangioma. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | 92 year-old female with hypertensive urgency. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is an old left basal ganglia lacunar infarct. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation.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 definite evidence of acute intracranial abnormality. Small vessel ischemic disease and old lacunar infarct. |
Generate impression based on medical findings. | 11-year-old female with history of Crohn's disease, evaluate for small bowel disease.EXAMINATION: MR enterography without and with IV contrast 5/27/2015 ABDOMEN:LIVER, BILIARY TRACT: The liver is within normal limits.SPLEEN: The spleen appears normal.PANCREAS: No significant pancreatic abnormality.ADRENAL GLANDS: The adrenal glands are normal in appearance.KIDNEYS, URETERS: No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy or hemorrhage.BOWEL, MESENTERY:There is an approximately 12 cm segment of distal ileum, adjacent to the terminal ileum, which demonstrates wall thickening, abnormal increased enhancement, increased T2 signal intensity and mild adjacent edema. No small bowel obstruction or free air.The appendix is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The bladder is mildly distended, and appears normal.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Segmental bowel wall thickening/edema affects the distal ileum and TI, consistent with patient's given history of Crohn's disease. Additional mild wall thickening and increased enhancement suggesting sigmoid inflammation.BONES, SOFT TISSUES: There is a small linear area of enhancement within the left perineum likely to represent a perianal fistula.OTHER: No significant abnormality noted | 1. Distal ileum and sigmoid colon bowel wall thickening consistent with given history of Crohn's disease. 2. Likely left perianal fistula as described above. |
Generate impression based on medical findings. | 71 year-old female with substernal goiter with airway deviation. Evaluate for nodules. RIGHT LOBE MEASUREMENTS: 1.8 x 2.0 x 6.0 cmLEFT LOBE MEASUREMENTS: 13.4 x 8.8 x 6.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe is homogeneous in echotexture without focal lesions.LEFT LOBE: The left thyroid lobe is heterogeneous in echotexture and markedly enlarged; findings consistent with goiter.ISTHMUS: The isthmus is homogenous in echotexture without focal lesion. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 3 lymph node measures 0.9 x 0.8 x 0.4 cm and left level 3 lymph node measures 2.4 x 0.9 x 0.4 cm.OTHER: Deviation of the airway to the right is noted. | Left thyroid goiter with rightward deviation of the airway. |
Generate impression based on medical findings. | Female, 38 years old, with history of T2 and one squamous cell cancer of the right tongue status post partial glossectomy, neck dissection and radiation followed by recurrence. Image quality is degraded by motion artifact which is present on all sequences despite multiple repeat attempts. There is also loss of signal in the anterior inferior neck of uncertain etiology. Within these limitations, the following observations are made.Anatomic distortion of the tongue is seen with a defect involving the right anterior aspect, possibly postsurgical in nature. The remainder of the anterior oral tongue is thickened and abnormally T2 hyperintense. This tissue measures up to 48 x 33 mm (image 38 series 701). This tissue extends superiorly to encompass all of the anterior oral tongue, and it extends inferiorly to some degree into the floor of mouth. Posteriorly the oral tongue demonstrates normal morphology and signal intensity.A presumed submental lymph node is poorly visualized on the present examination. No definite additional pathologic adenopathy is seen, though for reasons discussed above, the concurrent and prior CTs provide a better assessment in this regard.Extensive presumably treatment related findings are seen including subcutaneous reticulation and infiltrative edema which affects the soft tissues of both sides of the neck. There is a sizable retropharyngeal effusion. The supraglottic laryngeal mucosa and the soft palate are edematous.No focal lesions of the parotid glands are suspected. The submandibular glands are not well delineated on this study. The thyroid is somewhat obscured by artifact and not adequately assessed. Patchy airspace opacities are seen in the right upper lung. | Image quality is significantly limited by motion artifact and loss of signal affecting the anterior inferior neck. Postoperative findings are seen in the anterior right tongue. The remainder of the anterior oral tongue is thickened and demonstrates pathologic T2 signal compatible with extensive local residual or recurrent tumor. This tumor fills the anterior oral tongue and potentially extends down into the floor of mouth.Extensive presumed treatment related findings are again seen including diffuse infiltrative edema of the soft tissues of the neck, a retropharyngeal effusion, and edema of the aerodigestive mucosa. Adenopathy is better assessed on concurrent and prior CTs. |
Generate impression based on medical findings. | Please note this examination is technically degraded, particularly the axial T2 fat-sat sequences. Coronal STIR images demonstrate grossly symmetric T2 hyperintensity involving the nerve roots of the brachial plexus proximally. There is suggestion of asymmetrically increased T2 hyperintensity involving the left C6 and C7 nerve roots and to a lesser degree C8 nerve roots more distally; findings seen on axial series 6 images 18 and 19; coronal STIR series 4 image 17. In retrospect, there appears to be subtle increased T2 signal involving the left C6 to left C8 nerve roots in the same region on prior brachial plexus MRI studies.No lymphadenopathy or extrinsic masses within the neck are appreciated. There is volume loss involving the left sternocleidomastoid muscle which was present on prior CT. Degenerative changes in the cervical spine are partially imaged. | Examination is suboptimal in quality and if clinically indicated repeat examination may be considered. There is however suggestion of subtle increased signal involving the distal aspects of the left C6 to C8 nerve roots which in retrospect also appears to be present on prior MRI from 1/13/2011 and 8/4/2009 studies. Findings may represent sequela of prior radiation. No obvious lymphadenopathy or masses to suggest extrinsic compression are appreciated. MRI with gadolinium may be helpful to identify the areas of scarring if surgery is contemplated. |
Generate impression based on medical findings. | Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, not intractable, without status epilepticus [G40.209] / Migraine with aura, not intractable, without status migrainosus [G43.109], No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement.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. | Normal brain MRI |
Generate impression based on medical findings. | 52-year-old male patient with right knee pain status post fall. Evaluate for lateral meniscus tear. MENISCI: The lateral and medial menisci are intact.ARTICULAR CARTILAGE AND BONE: There are bone contusions in the weightbearing portion of the lateral femoral condyle and the posterior aspect of the lateral tibial plateau. There is mild compression of the surface of the lateral femoral condyle overlying the contusion, compatible with a lateral notch sign. There are also nonspecific reactive marrow changes along the medial aspect of the medial femoral trochlea.There is partial thickness chondral fissuring in the apex of the patella.LIGAMENTS: There is at least a partial tear of the anterior cruciate ligament. Posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | At least partial anterior cruciate ligament tearing with characteristic bone contusions involving the lateral femoral condyle and posterior aspect of the lateral tibial plateau. |
Generate impression based on medical findings. | Female, 61 years old, with altered mental status, seizure. No restricted diffusion is seen. Numerous scattered foci of periventricular and subcortical T2 hyperintensity are seen within the cerebral hemispheres. The caudate heads and putamina are also involved, left side more than right. Fairly conspicuous central pontine T2 hyperintensity is noted as well. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. On postcontrast images, there is no evidence of pathologic parenchymal or extra-axial enhancement. | Patchy T2 hyperintensity is seen in the periventricular white matter, basal ganglia and central pons. The differential for these findings is broad and would include sequelae of small vessel ischemic disease, vasculitis, demyelination, or toxic/drug exposure. Similar features can also be seen in osmotic demyelination within the context of an electrolyte derangement. |
Generate impression based on medical findings. | 41-year-old female intravenous drug user with left hip fracture, febrile despite antibiotics. There is enhancement of the left hip joint indicating synovitis with small nonenhancing pockets representing small collections of fluid. There is a 2.0 x 2.0 x 0.8 cm collection of fluid along the anterosuperior aspect of the hip joint capsule, which possibly communicates with the underlying joint. There is edema and enhancement of the surrounding soft tissues of the hip extending into the proximal thigh musculature and off the field of view of this study. There is also edema and enhancement of the acetabulum and femoral head. There is loss of hip joint cartilage superiorly. There is flattening and fragmentation of the superior aspect of the femoral head, which is better seen on the recent CT scan. These findings are compatible with septic arthritis and adjacent osteomyelitis of the femoral head and acetabulum. Intramedullary edema and enhancement also extends to the femoral neck and intertrochanteric region to a lesser degree. The right hip, sacroiliac joints and pubic symphysis appear normal. Degenerative disc disease affects the lower lumbar spine. There is minimal peritrochanteric edema and enhancement on the right and mild enhancement of the obturator internus on the right, which is nonspecific. There is a Foley catheter within the bladder. | 1.Synovitis of the left hip with small pockets of fluid compatible with septic arthritis.2.Extensive inflammatory changes in the soft tissues with a small collection of fluid along the anterosuperior aspect of the hip joint, which may represent a small abscess.3.Abnormal signal in the femoral head and acetabulum compatible with osteomyelitis. |
Generate impression based on medical findings. | Evaluate for bilateral anterior cerebral artery ischemia/hypoperfusion/infarction in the setting of bilateral anterior cerebral artery vasospasm History: Lower extremity, abulia. Severely limited exam.There is an globular area of diffusion restriction in the posterior right frontal lobe corresponding to blood products on recent CT. Additional more punctate focus of diffusion restriction in the right frontal lobe adjacent to the right frontal horn may represent an acute infarct or less likely related to blood products (which is difficult to conclude in the absence of additional diagnostic sequences or hyperdensity on recent CT). Otherwise no acute infarcts including the bilateral anterior cerebral artery territory. Additional findings of intracranial blood products, right parietal craniotomy, left parietal ventriculostomy, and dilated ventricular system better seen on recent CT of 7/11/2016. | Severely limited study. Suspected punctate infarct in the right frontal lobe adjacent to the right lateral ventricle. Otherwise no clear evidence of acute infarction in the ACA territories or elsewhere in the brain. |
Generate impression based on medical findings. | Male, 74 years old, history of lung cancer with unsteady ambulation. At least 10 enhancing parenchymal lesions are identified in the brain, most of which are supratentorial. They range in size from punctate up to 15 mm in diameter. Most are solidly enhancing but several show a centrally cystic morphology. The lesions are surrounded by mild edema and they induce mild local mass effect. These lesions are new when compared to the prior examination.No significant generalized mass-effect is seen. No evidence of intra-cranial hemorrhage or any abnormal extra-axial collection is identified. The ventricles are normal in size and morphology. Apart from the above-mentioned lesions, there are a few scattered punctate foci of T2 hyperintensity within the cerebral white matter which are nonspecific and unchanged.Marrow replacement and pathologic enhancement is seen at the right skull base involving the right occipital condyle and right mastoid temporal bone. | 1. Numerous, at least 10, parenchymal metastatic lesions are seen, predominantly affecting the cerebral hemispheres. These lesions induce only mild local edema and mass effect. These are new when compared to the prior examination.2. Metastatic disease to the right skull base is seen involving the occipital condyle and the mastoid portion of the temporal bone. |
Generate impression based on medical findings. | Female, 58 years old. Right shoulder pain ROTATOR CUFF: Metallic suture material in the humeral head causes artifact, somewhat limiting evaluation. The supraspinatus, infraspinatus, and teres minor tendons and muscles are intact. There is mild to moderate tendinopathy of the subscapularis tendon, without discrete tear identified. There is minimal fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact within the limits of a nonarthrographic study.BICEPS TENDON: The tendon of the long head biceps is not well visualized due to metallic artifact.ADDITIONAL | Postoperative changes with mild rotator cuff tendinopathy as above. No discrete rotator cuff tear identified. |
Generate impression based on medical findings. | 58 year old female with a BRCA 1 mutation presents for screening MRI. Family history of breast cancer in her paternal grandmother at age 55, aunt at age 36 and cousin at age 48 There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | 42-year-old female with left hip pain. Evaluate greater trochanteric bursa. ACETABULAR LABRUM: The acetabular labrum appears intact within the limitations of a non arthrogram study.ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormality is identified. No full-thickness articular cartilage defects are seen.SOFT TISSUES: The imaged musculature of the left hip is normal in appearance ADDITIONAL | No evidence of a bursitis. No findings to account for the patient's left hip pain. Other findings as described. |
Generate impression based on medical findings. | 19 year-old male with abdominal pain, asses for Crohn's disease. 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: No significant abnormality noted.BOWEL, MESENTERY: There is no bowel wall thickening, signal abnormality, or abnormal enhancement to suggest active inflammation. No dilated loops of bowel to suggest obstruction. No focal fluid collection is identified to suggest abscess formation. No fistula formation is seen. There is a moderate amount of stool noted throughout the colon. | Moderate amount of stool noted throughout the colon without evidence of active inflammatory bowel disease, as clinically questioned. |
Generate impression based on medical findings. | Craniopharyngioma status post laser ablation and proton beam radiation. There are bilateral transfrontal catheters that terminate in the suprasellar mixed cystic and solid craniopharyngioma. Although many of the cystic components of the tumor have decreased in size, the overall size of the tumor has not significantly changed, measuring up to approximately 25 mm. There is patchy T2 hyperintensity in the adjacent brain parenchyma and optic apparatus, which appears to have increased slightly in extent. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. | Although many of the cystic components of the tumor have decreased in size, the overall size of the craniopharyngioma has not significantly changed, measuring up to approximately 25 mm. However, the patchy T2 hyperintensity, which may represent edema in the adjacent brain parenchyma and optic apparatus appears to have increased slightly in extent. |
Generate impression based on medical findings. | 11 year old female with history of Chiari malformation status post decompression 12/2012, with headaches and back pain Again seen are postsurgical changes of suboccipital craniectomy and C1 laminectomy for Chiari decompression. CSF spaces at the level of the foramen magnum are patent ventrally and dorsally. The cerebellum abuts the dura dorsally. No tonsillar herniation is evident. CSF flow analysis shows good biphasic anterior and posterior flow. Visualized intracranial structures show no hydronephrosis or other abnormality.Alignment of the spine is anatomic with intact vertebral body heights and disk spaces. Signal within the cord and conus is normal, which terminates normally at L2-L3. No significant central canal or neuroforaminal narrowing. No syrinx is evident. | Status post Chiari decompression with preservation of the CSF spaces ventrally and dorsally at the foramen magnum. No syrinx. |
Generate impression based on medical findings. | Altered mental status and ataxiaClinical question: r/o stroke, NPHSigns and Symptoms: r/o stroke, AMS ataxia There is a 20x29mm axial dimension cyst in the pineal region compatible with arachnoid cyst. It follows CSF on all pulse sequences. There is associated flattening of the tectal plate.The lateral ventricles are relatively large in relation to the sulci.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is loss of volume along the left middle frontal gyrus associated with medial displacement of the adjacent vasculature.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. The eye lenses are thin. | 1.Large lateral ventricles. The possibility of normal pressure hydrocephalus cannot be excluded. Another possibility is that this is related to the pineal region arachnoid cyst.2.Pineal region arachnoid cyst associated with flattening of the tectal plate.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for acute ischemic cerebral infarction.5.Focal volume loss along the left middle frontal gyrus is non-specific. |
Generate impression based on medical findings. | Reason: possible FAI History: possible femoral acetabular impingement ACETABULAR LABRUM: Degenerative tearing of the anterior and anterosuperior labrum. No chondrolabral detachment.ARTICULAR CARTILAGE AND BONE: No full-thickness cartilaginous defect is identified. There is no significant osteoarthritis. No acute fracture or malalignment.SOFT TISSUES: No significant abnormality noted. ADDITIONAL | 1.Degenerative tearing of the anterior and anterosuperior labrum. |
Generate impression based on medical findings. | 84-year-old male with right sided neglect x 2 to 3 days. On Coumadin. Evaluate for subdural. Findings consistent with mild small vessel disease of indeterminate age are noted. No definitive interval change since prior exam. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Vascular calcification. No evidence of extra axial hemorrhage. Calvarium remains intact. A clinical concern persists an MRI is recommended. | Small vessel disease of indeterminate age. |
Generate impression based on medical findings. | Reason: osteomyelitis of left foot? History: diabetic foot infection, high CRP Note is made of soft tissue irregularity along the plantar aspect of the distal phalanx of the great toe consistent with the stated history of ulceration. There is increased signal abnormality on fluid sensitive sequences within the subcutaneous tissue along the plantar aspect of the distal phalanx of the great toe indicating a cellulitis. There is extension of this enhancing signal abnormality to the plantar aspect of the distal tuft of the distal phalanx of the great toe. There is associated increased bone marrow signal abnormality on fluid sensitive sequences and decreased signal abnormality on T1-weighted images consistent with osteomyelitis of the tuft of the distal phalanx of the great toe. There is increased signal abnormality in the base of the distal phalanx and proximal phalanx of the great toe without corresponding decreased T1 signal abnormality likely reflecting reactive osteitis rather than osteomyelitis. The first metatarsal bone marrow signal is within normal limits. There is nonspecific increased signal abnormality within the plantar musculature of the foot which can be seen in diabetic patients. There is a small amount of fluid within the first MTP joint which may reflect a synovitis. There is no focal fluid collection to suggest abscess formation. | Findings consistent with osteomyelitis of the distal phalanx of the great toe. Other findings as described. |
Generate impression based on medical findings. | 23 year old female patient with seizure like episodes. History of bipolar type I as well as anxiety disorder. There is asymmetrically slight vertical alignment of the right collateral sulcus and a globular morphology of the right hippocampus, but the internal architecture and signal is not grossly abnormal and there is no significant hippocampal atrophy. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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, including a fetal origin of the right posterior cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Apparent mild malrotation of the right hippocampus, but no evidence of tumor or mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Since the prior brain MRI from 9/6/2016 there has been significant increase in size of a subdural hematoma along the left cerebral convexity which measures up to 22 mm in thickness, previously 12 mm. There are areas of T1 hyperintensity indicative of subacute hemorrhage, new since prior. There is increased effacement of the adjacent left frontal and parietal sulci. There is minimal rightward midline shift measuring up to 3 mm.There is no evidence of acute infarct. There is encephalomalacia in the right frontal lobe related to prior trauma. There is mild prominence of the overlying extra-axial CSF space suggesting a small leptomeningeal cyst, with prior study demonstrating heterogeneous extra-axial blood products in this region. There are also foci of T2/FLAIR hyperintensity in the left frontal subcortical white matter which are also compatible with sequela of prior trauma. Punctate chronic blood products in the left posterior left temporal lobe are also again seen. Ventricles remain normal in size. Biparietal skull fractures are better demonstrated on same-day CT.MR venogram demonstrates a normal variant right dominant transverse and sigmoid sinus. Previously seen outpouching involving the midportion of the superior sagittal sinus is no longer discretely appreciated. The superior sagittal sinus is patent. The inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. | 1. Significant interval increase in size of a left-sided subdural collection with MRI signal features and same-day CT findings suggesting subacute subdural hematoma, with new areas of hyperdensity/T1 shortening indicating new hemorrhage. There is increase in associated mass effect.2.Encephalomalacia in the right frontal lobe with suggestion of a small overlying "leptomeningeal cyst". Mild separation of the right parietal fracture fragment better demonstrated on CT.3.Patent venous system. Focal outpouching involving the mid aspect of the superior sagittal sinus seen on CTA dated 8/27/2016 is no longer discretely perceptible.Dr. Ali discussed findings with Darlene Simkhin (Dr. Frim's nurse) at 1630 hrs on 11/9/2016 |
Generate impression based on medical findings. | Clinical question: L frontal GBM initial Dx 9/2012. s/p RT/TMZ+TMZ. Off all Tx.Signs and Symptoms: GBM.Comments: GBM Dx 9/2012. S/p RT/TMZ+TMZ. Please compare to earlier studies. | The patient is status post left frontal lobe surgery for removal of a left frontal lobe mass. Since the prior exam a new 18mm focus of Flair and T2 signal change has developed along the left fontal lobe at the anterior aspect of the left superior frontal gyrus at the inferior and anterior aspect of the surgical site. This now enhances heterogenously following contrast administration. This associated with increased relative CBV and dilated flow voids on SWI.Flair and T2 signal change adjacent to and inferior and posterior to the surgical site remains stable when compared to the previous exams.Punctate foci of susceptibility on the susceptibility weighted images are present in the subcortical white matter of the supratentorial brain along the frontal and parietal lobesNormal 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. | Since the prior exam a new focal lesion has developed at the anterior aspect of the right frontal lobe adjacent to the anterior and inferior margin of the surgical site which is suspicious for local recurrence. |
Generate impression based on medical findings. | The patient is a 13-year-old female with history of neurofibromatosis. Cerebellar tumor resection in June 2005. Tinnitus, vertigo, ear pain and decreased hearing. Again seen is hypodensity in the left cerebellar hemisphere partially surrounded by calcified rim which appears unchanged from the prior study. Midline posterior craniectomy defect and postoperative changes in posterior fossa appear similar to the prior study.Ventricular shunt catheter tubing enters the a right frontal approach with tip terminating near midline, also unchanged from the comparison study.There is no evidence of intracranial hemorrhage, mass or edema. The internal auditory canals are normal in caliber and symmetric. However, for evaluation of tumor at this site, MRI is recommended. The cerebral hemispheres, brainstem and remainder of the cerebellum are normal in morphology and attenuation.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. | 1. Normal caliber internal auditory canals. For evaluation for possible tumor at this location, we recommend MRI.2. Stable postoperative findings. |
Generate impression based on medical findings. | 48-year-old male patient with known history of metastatic neuroendocrine tumor with liver metastases. ABDOMEN:LIVER, BILIARY TRACT: There are multiple hepatic lesions throughout the liver demonstrating T2 hyperintensity and arterial enhancement. Some of these have increased in size including a reference segment seven lesion which now measures 2.5 x 2.0 cm, previously 2.1 x 1.5 cm (image 20, series 4). Many of these lesions are more discrete on both T2 and arterial weighted imaging. No definite new lesion is identified. There is layering biliary sludge or small stones within the gallbladder. The hepatic vasculature is patent.Stable mild dilatation of the common bile duct measuring 12 mm in diameter. No definite obstructing lesion is identified.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum without pancreatic ductal dilatation.ADRENAL GLANDS: There is a right renal cyst. Additional subcentimeter T2 hyperintense foci too small to characterize, likely also represent cysts.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. Slight interval increase in size of multiple hepatic lesions. No new hepatic lesion is identified.2. Stable mild dilatation of the common bile duct. |
Generate impression based on medical findings. | Female 2 years old Reason: re-evaluation of cortical tubers, SEN History: tuberous sclerosis, refractory epilepsy, focal onset Redemonstration of numerous cortical/subcortical T2 hyperintense lesions throughout both hemispheres of the supratentorial brain. These are not significantly changed from prior. In addition there are multiple enhancing subependymal nodules, also not significantly changed.No new or growing lesions are seen. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Scattered paranasal sinus mucosal thickening, otherwise the paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable. | Stable exam with findings of tuberous sclerosis including scattered subcortical tubers and ependymal nodules. |
Generate impression based on medical findings. | Multiple sclerosis follow up. There are multiple cerebral white matter T2 hyperintense lesions, primarily in a periventricular distribution, but also in juxtacortical locations, such as in the right occipital lobe. In particular, there is a new lesion in the right parietal periventricular white matter. There is no associated enhancement and there is no evidence of intratentorial lesions. The ventricles and sulci are normal is size and configuration. There is no evidence of intracranial mass lesions. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Multiple sclerosis with a new lesions in the right parietal periventricular white matter. |
Generate impression based on medical findings. | Orbital cellulitisClinical question: assess after ENT decompressionSigns and Symptoms: s/p abscess drainageEpidural abscess There is redemonstration of ring-enhancing fluid collection along the left superior lateral aspect of the orbits which extends from the extraconal space to the preseptal space and superficial to the left cerebral orbital rim. It measures 15 x 25 mm axial dimensions. In general it appears larger on the current MRI exam relative to the prior CT exam. There is associated infiltration along the left extraconal space. The distance between the interzygomatic line and the left eye lens is approximately 21 mm.There is vacuum and meningeal enhancement present adjacent to the left frontal lobe. There is enhancement present across the left superior orbital roof. There is some leptomeningeal enhancement adjacent to the left frontal lobe.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 partial opacification of the left-sided paranasal sinuses more than the right sided paranasal sinuses. The visualized portions of the mastoid air cells demonstrate partial opacification of the mastoid air cells. | 1.There is a left orbital abscess present centered in the left superior lateral aspect of the left orbit preseptal space at the expected location of the lacrimal gland which extends across the left extraconal space including the superior aspect of the extraconal space as well as the subcutaneous tissues surrounding the left orbit. 2.There is associated with the pachymeningeal and leptomeningeal enhancement adjacent to the left frontal lobe suggesting possible intracranial extension with meningitis.3.Findings are suspicious for proptosis on the left side.4.There are inflammatory changes present within the left ethmoid air cells and the left maxillary sinus which were also present on the prior exam and likely related to sinusitis |
Generate impression based on medical findings. | Reason: suboptimal MRI CSF flow study on 1/3/2015. Radiologist recommended to repeat flow sequence with no additional change to the patient. History: Chiari malformation. There are mildly low-lying cerebellar tonsils. There is intact CSF flow across the anterior foramen magnum. but blunted CSF flow posteriorly at the level of the cerebellar tonsils. | Intact CSF flow across the anterior foramen magnum. but blunted CSF flow posteriorly at the level of the cerebellar tonsils. Please refer to the prior brain MRI report for additional details. |
Generate impression based on medical findings. | 18 years Female (DOB:7/28/1997)Reason: ? vasculitis History: confusion and h/o lupusPROVIDER/ATTENDING NAME: JAMES AHN RIMAS V LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a well-circumscribed focus of signal loss present in the left lentiform nuclei within the putamen which is associated with some enhancement.There is a tuft of enhancing serpiginous structures posteriorly with signal loss on susceptibility imaging located in the left frontal lobe adjacent to the left middle frontal gyrus which is suspected to represent a developmental venous anomalyThere is a mild degree of subcortical and periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly identified in the left hemisphere.No abnormal 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.MRA brain: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 relatively small to medium sized.. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is small to medium sized. The left vertebral artery is larger than the right vertebral artery. Findings also suggest a double origin left posterior inferior cerebellar artery. The vertebral arteries are similar in size. | 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is an ill-defined lesion present in the left basal ganglia. One possibility is that this may represent capillary telangiectasia.4.There is a lesion in the left frontal lobe which is suspected represent a developmental venous anomaly, however, it may be associated with capillary telangiectasia.5.There is a mild degree of subcortical and periventricular white matter lesions present predominantly in the left hemisphere. These are unusual at this age. Differential considerations include vasculitis as well as trauma, demyelinating disorder and vascular related lesions.6.Double origin left posterior inferior cerebellar artery. |
Generate impression based on medical findings. | 35-year-old female with left lower quadrant and abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is gallbladder sludge versus cholelithiasis. No definite evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus is enlarged and there is a central fundal mass which measures 5.6 x 6.4 cm, most likely due to a fibroid, at axial image 114/157. There is a larger anterior and superior central pelvic mass extending from the uterus which appears circumscribed with a thickened wall that measures 8.2 x 10 x 14.3 cm on axial image 91/157 of series 3 and coronal image 67/100. This mass contains fluid and central fat density. There are peripheral calcifications best seen at axial images 86 - 87/157 and coronal image 57/100. These findings suggest the presence of a mature cystic teratoma. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: A small amount of pelvic free fluid is present. | Central pelvic mass(es) as probably consisting of a fibroadenoma and teratoma, as described above. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.Cholelithiasis without cholecystitis. |
Generate impression based on medical findings. | Susceptibility with corresponding areas of T2 hypointensity is again visualized in the basal cisterns symmetrically and along scattered bilateral supratentorial and infratentorial subarachnoid spaces, more prominent along the left greater than right occipital lobes, right temporal lobe, left parietal lobe, right greater than left sylvian fissure, and cerebellar sulci outlining the folia, especially along the superior vermis. There is also prominent susceptibility in the fourth ventricular outflow. There is no significant change. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. No restricted diffusion to suggest the presence of acute ischemia. There is no abnormal enhancement within the brain. | Stable superficial hemosiderosis of the basal cisterns and scattered supratentorial and infratentorial subarachnoid spaces. |
Generate impression based on medical findings. | Clinical question: Reexploration posterior fossa, removal of hardware, placement of 4 ventricular shunt with connection to distal left ventriculoperitoneal shunt and craniotomy Signs and symptoms: Postop follow-up.. Nonenhanced cervical/thoracic MRI:Examination demonstrates extensive postoperative changes of suboccipital midline decompression and extensive metallic hardware placement for craniocervical fusion which results in extensive artifact. There is a catheter/stent device in the fourth ventricle with the superior tip at the superior aspect of the fourth ventricle on the left and the inferior extent appears to lie either within the left cerebellar tonsil or immediately medial to the tonsil. The position of catheter/stent demonstrate no significant change since prior exam however previously noted focus of FLAIR hyperintensity/edema surrounding the catheter is no longer identified likely due to complete resolution. Similar to prior exam the fourth ventricle remains within normal size.Examination demonstrates interval increased size of a previously known expansile syrinx of entire cervical cord with resultant further reduced CSF space throughout the cervical spine.The significantly expansile cervical syrinx extends inferiorly to T7-T8 disc level. There are no prior thoracic MRI exam for comparison. Very extensive postoperative changes and including bilateral transpedicular screw placement throughout the thoracic spine makes precise assessment difficult. Within this limitation there is no convincing evidence of syrinx inferior to T7-T8 disc level.Nonenhanced brain MRI:Examination demonstrates postoperative changes of suboccipital midline decompression with extensive metallic hardware artifact for craniocervical fusion.Diffusion weighted series are severely compromised due to metallic hardware artifact however within this limitation no evidence of restricted diffusion is detected.Linear foci of hemorrhagic FLAIR hyperintensity (L>R) consistent with tracts of previously removed ventricular catheters are again noted. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. The ventricular system remains within normal size and with maintained midline. The gray-white matter differentiation is normal. | 1.Nonenhanced MRI of cervical and thoracic spine demonstrate interval increased size of significantly expansile syrinx of entire cervical cord and extending inferiorly to thoracic cord to T7-T8 disc level. Postoperative changes decompression and placement of a catheter/stent within the fourth ventricle demonstrate no significant change and with normal size of fourth ventricle. Previously noted FLAIR hyperintensity surrounding the stent/catheter demonstrate interval resolution. There are no prior thoracic MRI for comparison.2.Nonenhanced brain MRI demonstrate chronic changes secondary to bilateral frontal approach ventricular catheters as detailed, extensive postoperative changes of suboccipital decompression and metallic hardware artifact from craniocervical fusion. Unremarkable exam otherwise and with stable normal sized ventricular system. |
Generate impression based on medical findings. | Clinical question: Vascular versus Alzheimer. Signs and symptoms: Memory loss starting 1.5year ago. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates numerous small narrowing size foci of FLAIR and T2 hyperintensity primarily in the periventricular white matter of cerebral hemispheres as well as bilateral basal ganglia, the sclerosis and minimally in the subcortical white matter of cerebral hemispheres. The findings are consistent with chronic small vessel ischemic strokes which are hemorrhagic in the basal ganglia. The signal intensity of the cerebral cortex, bilateral thalami, pons and cerebellum/vermis remains within normal.The cortical sulci and ventricular system as well as the CSF spaces are within normal and without finding to suggest parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are unremarkable.Images through the orbits are unremarkable.All paranasal sinuses are visualized and pneumatized however a small retention cyst in the dependent right maxillary sinus is noted. | 1.No acute intracranial process.2.Moderate chronic and minimally hemorrhagic small vessel ischemic strokes primarily in the periventricular and bilateral basal ganglia and to a lesser degree in the subcortical white matter as detailed.3.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age. |
Generate impression based on medical findings. | Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no stenoses or developmental anomalies.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at the mid L3 level, unchanged. There is no fat signal material within the filum terminale. Upon prone positioning, the conus translates anteriorly. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no stenoses or developmental anomalies. | 1.Negative noncontrast thoracic spine MRI.2.The conus is normal in signal and morphology and terminates at the mid L3 level, unchanged. There is no fat signal material within the filum terminale. Upon prone positioning, the conus translates anteriorly. |
Generate impression based on medical findings. | Diagnosis: SomnolenceClinical question: cause of altered mental statusSigns and Symptoms: altered mental status There is left-sided intraventricular blood present and to a lesser degree right-sided intraventricular blood.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense lesions are also present in the right thalamus, right external capsule and in the brainstem.Some susceptibility effect is identified along the tract coursing through the right frontal lobe into the right lateral ventricle presumably related to prior ventriculostomy tube which can be identified on recent head CTs and has since been removed.There is a high signal focus present along the caudate tail the subependymal region adjacent to the left lateral ventricle measuring approximately 18 x 4 mm axial dimensions.There are a couple foci of punctate signal loss on susceptibility imaging present. One is located within the left thalamus, one is located in the right frontal lobe subcortical white matter.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. The eyeball lenses are thin.Some retained secretions are present in the nasopharynx status post nasogastric tube placement. | 1.There is intraventricular blood present predominantly in the left lateral ventricle. There is associated intraparenchymal blood along the subependymal region along the caudate tail adjacent the body of the left lateral ventricle. Presumably this represents the source of bleeding.2.Lesions in the right thalamus and right external capsule most likely represent lacunar old infarcts3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on medical findings. | History of left renal exophytic lesion with possible mild increase in size in recent ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Diffuse, mildly decreased signal intensity of the hepatic parenchyma on out of phase images suggestive of hepatic steatosis. No focal hepatic lesions are identified. The hepatic vasculature appears patent. The gallbladder appears within normal limits. No biliary ductal dilatation.SPLEEN: The spleen is upper limits of normal in size without suspicious focal lesions.PANCREAS: The pancreas demonstrates normal signal intensity and enhancement without suspicious focal lesions.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Within the interpolar region of the right kidney, there is a subcentimeter cyst which lacks suspicious features and appears similar to recent ultrasound. There is an additional exophytic cyst arising from the left kidney interpolar region which measures approximately 9 x 11 x 11 mm and lacks suspicious features. No suspicious renal lesions are identified. The renal parenchyma enhances normally.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.Simple renal cysts without suspicious renal lesions.2.Hepatic steatosis. |
Generate impression based on medical findings. | Pilar cyst near cranial suture just left of midline. Does cyst communicate through suture? Brain or eye involvement? Subjective complaints of "my eyes hurt". Brain: There is a well-defined, partially enhancing, low T1 and T2 signal mass in the left apical scalp that measures 20 mm. There are multiple other punctate low signal foci within the scalp diffusely. 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. There is mild scattered paranasal sinus mucosal thickening.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions. | 1. A left apical scalp mass, as well as multiple other punctate low signal foci within the scalp diffusely, may represent pilomatrixomas or related skin adnexal lesions, without evidence of skull erosion or intracranial extension.2. The orbits are unremarkable. |
Generate impression based on medical findings. | Clinical question: Assess for artifact. Lesion/tumor or other causes of anosmia. Signs and symptoms: Anosmia for 6 months. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates no detectable abnormality of the skull base, bilateral frontal regions or the olfactory bulbs. Very minimal opacification of right ethmoid air cells is noted suggestive of minute sinusitis and unremarkable other paranasal sinuses.There is a focus of encephalomalacia in the right occipital and medial aspect of right temporal lobe posteriorly as well as a tiny focus in the right thalamus all suggestive of small foci of ischemic stroke in the distribution of right PCA.There is normal anatomic cord morphology of the brain parenchyma and with normal signal intensity on all MRI sequences otherwise.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of all major intracranial arterial branches are identified.Post contrast images demonstrate no abnormal parenchymal, leptomeningeal or calvarial enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Normal signal intensity of intracranial venous sinuses with normal pattern of enhancement. | 1.No diffusion-weighted abnormality.2.No evidence of pathology to explain patient's anosmia. Unremarkable calvarium and skull base.3.Foci of FLAIR hyperintensity in the right occipital, medial aspect of right posterior temporal and right thalamus suggestive of chronic ischemic changes of PCA territory.4.Unremarkable pre and post enhanced brain MRI otherwise and without abnormal enhancement.5.Minute right ethmoid sinus disease and unremarkable paranasal sinuses otherwise.6.Images through the nasal passage demonstrate moderate leftward nasal septum deviation. |
Generate impression based on medical findings. | Malignant neoplasm of bronchus and lung, unspecified site [162.9], Reason for Study: ^Reason: rule out metastases History: ams, There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is a focal high signal intensity on the right post central gyrus (224, series 406) but it does not show restricted diffusion and shows high signal intensity on T2 and FLAIR indicate T2 shine through artifact. Several scattered high signal intensity foci on bilateral hemispheres on FLAIR images indicate non specific.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. 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 on the scan.Non specific white matter lesions on FLAIR images as described above.If metastatic lesion is suspicious, MR exam should be repeated with Gadolinium enhancement. |
Generate impression based on medical findings. | Transient alteration of awareness [R40.4], Reason for Study: ^Reason: ? stroke History: see CT read There is no evidence of acute ischemic or hemorrhagic lesion.There are multifocal scattered T2/flair high signal intensity lesions on periventricular white matter indicating 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 acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Nonspecific small vessel ischemic disease. |
Generate impression based on medical findings. | New onset headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific punctate foci of high T2 signal in the cerebral white matter. The brain parenchyma, brainstem, and cerebellum otherwise appear unremarkable. There is no abnormal intracranial enhancement. There is flattening of the pituitary gland. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is apparent constriction of the bilateral transverse sinuses. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, mastoid air cells, and scalp soft tissues are grossly unremarkable. | No evidence of intracranial hemorrhage, mass, or acute infarct. Flattening of the pituitary gland, along with constriction of the bilateral transverse sinuses can be a sign of pseudotumor cerebri. |
Generate impression based on medical findings. | Sinonasal basaloid carcinoma that was resected. Planning for chemo/RT. There are interval postoperative findings related to interval resection of a sinonasal mass with a subcentimeter nodular lesion in the region of the olfactory recesses. There is slight extension of the tumor into the epidural space of the anterior cranial fossa via defects in portions of the ethmoid roof. There are residual secretions and mucosal thickening within the left maxillary sinus, left ethmoid cavity, and sphenoid sinuses. There is a dural based lesion along the posterior falx cerebri that measures up to 3 mm in width, which is unchanged. There is diffuse cerebral volume loss. There are bilateral lens implants and staphylomatous deformity of the globes. There is no evidence of tumor extension into the orbits. | 1. Postoperative findings related to interval resection of a sinonasal mass with a subcentimeter nodular lesion in the region of the olfactory recesses that appears to have slight epidural extension along the floor of the anterior cranial fossa, which is suggestive of residual tumor.2. A dural based lesion along the posterior falx cerebri that measures up to 3 mm in width is unchanged and may represent a meningioma. |
Generate impression based on medical findings. | Clinical question: Grade II astrocytoma of the cord. s/p RT 9w/ proton beam) + TMZ. Now receiving TMZ. Completed RT in ~5/2015. Signs and Symptoms: Grade II astrocytoma of spinal cord. Pre- and post enhanced cervical MRI:Examination redemonstrate an expansile lesion of the cervical cord extending from C2-C4 disc level to C7-T1 disc level. The expanded lesion occupies the entire spinal canal with effacement of subarachnoid space in particular at C5 level. The lesion is primarily on the right aspect of the cord however mildly extends across the midline to the left. It demonstrate T2/T2 STIR hyperintense and slightly hyperintense on T1-weighted images. The signal intensity, overall morphology and size of this mass remains identical to prior study.Mild-to-moderate degenerative changes of cervical spine most severely at C4-C5 through C6-C7 levels similar to prior exam and with evidence of mild reversal of cervical lordosis is again noted.Moderate to advanced degenerative changes of cervical spine in particular at C4-C5 through C6-C7 levels are present. There is resultant mild reversal of cervical lordosis. Signal changes of cervical vertebral column suggestive of prior radiation treatment.No detectable enhancement of the expansile cord lesion similar to prior exam.Pre and post enhanced thoracic MRI:Examination demonstrate a stable expansile lesion of the thoracic cord in signal intensity, morphology and extent since prior study. This mass extends from approximately mid T2 level inferiorly to mid T8 level similar to prior study. It measures approximately at 112 mm in craniocaudad axis. There is faint band of T2 STIR hyperintense extending from the inferior aspect of this mass to approximately the level of the conus with mild expansion of the cord similar to prior study. Finding is believed to represent peritumoral edema or possibly post radiation change.The signal intensity of vertebral column demonstrate changes consistent with prior radiation therapy. The alignment of vertebral, remains within normal.Mild to moderate degenerative disc disease and including a tiny disc protrusion at T7-T8 resulting tiny indentation of the ventral aspect of the cord.Post contrast images demonstrate no enhancement of the expansile cord lesion, which is a similar observation as prior exam.Pre- and post enhanced lumbar MRI.Signal intensity changes on vertebral column consistent with prior radiation in the upper lumbar spine is noted.There is normal anatomical alignment of vertebral column.There is moderate degenerative changes of the disc and facet hypertrophic changes and including bilateral facet effusion at L4-L5 with resultant moderate central spinal stenosis remain similar to prior exam.Post enhanced images demonstrate expected enhancement of the generative/hypertrophic changes of lower lumbar spine and without evidence of metastatic disease to the vertebral column or of the leptomeninges. | 1.Stable expansile mass of the cervical cord in size, extent and overall morphology as detailed.2.Stable expansile lesion of the thoracic cord in size, extent and overall morphology as detailed.3.Unremarkable MRI of the lumbar spine other than moderate central spinal stenosis secondary to degenerative disease at L4-L5 level. |
Generate impression based on medical findings. | 9-year-old female. Assess for dorsal ganglion cyst involvement of the scapholunate ligament and bone quality of lunate. The dorsal aspect of the capitolunate interval demonstrates a focal well-defined lobulated area of increased signal on T2 hyperintensity with associated decreased signal on T1 imaging. Marrow signal of the capitate and lunate bones is within normal limits. No acute fracture or malalignment is identified. | Focal well defined lesion in the dorsal aspect of the capitolunate interval with increased T2 signal intensity and decreased T1 signal intensity is most likely a ganglion cyst. The capitate and lunate bones are normal. |
Generate impression based on medical findings. | 39-year-old female with heavy bleeding. Evaluate size and number of uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus measures 11.4 cm in AP, 8.6 cm in transverse, and 10.1 cm in craniocaudal diameter. There is a 5.3 x 5.1 x 3.3 cm submucosal fibroid causing a contour deformity of the endometrium (axial series 5 image 23, sagittal series 7 image 21, coronal series 6 image 25). Smaller anterior and posterior intramural fibroids are also noted. There are multiple subcentimeter nabothian cysts. Normal bilateral ovaries.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. | Mildly enlarged uterus containing multiple fibroids, the largest of which is submucosal in location measuring 5.3 x 5.1 x 3.3 cm.5.3 x 5.1 x 3.3 cm submucosal fibroid |
Generate impression based on medical findings. | Diagnosis: Secondary malignant neoplasm of unspecified siteClinical question: pt with met melanoma and slurred speech please eval for brain metsSigns and Symptoms: met melanoma The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of status post left-sided craniotomy. A focus of encephalomalacia is redemonstrated in the left temporal lobe. There is associated ex vacuo effect along the adjacent left lateral ventricle.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.Status post left temporal craniotomy and left temporal lobe surgery.2.No evidence for brain metastases at this time. |
Generate impression based on medical findings. | There are nonspecific scattered foci of FLAIR signal superficially in the frontal lobe (series 4, images 8, 10, and 11) with the one in the left middle frontal gyrus more prominent compared to previous examination and the one in the left precentral gyrus new from previous exam. No abnormal enhancement within the brain parenchyma. No masses, mass effect, or midline shift. No evidence of acute intracranial hemorrhage. No extra-axial fluid collections or hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | 1.No evidence of acute intracranial enhancing mass.2.Small lesions in the left precentral gyrus and left middle frontal gyrus are most likely vascular related. The left middle frontal gyrus lesion is suspected to have been present in 2005 whereas the left precentral gyrus lesion is new. |
Generate impression based on medical findings. | 41 year old female patient with newly diagnosed cervical cancer pre-op vs chemotherapy. Vaginal discharge. PELVIS:UTERUS, ADNEXA: There is a mass at the cervical os extending externally, more towards the right than left. The mass extends into the endometrial canal, the superior extent of which is not clearly delineated. The lesion however does not demonstrate significant enhancement. There is no parametrial extension. In the left adnexa, there is a complex mass with an enhancing soft tissue component and multiple mural enhancing nodules. A tubular component of this mass in part likely represents a dilated fallopian tube. The right ovary is also enlarged with an enhancing soft tissue component, though smaller than the left side. These adnexal findings are suspicious for primary tumor or metastatic disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A T2 hyperintense, enhancing lesion within the L5 vertebral body appears to demonstrate intralesional fat and likely represents a hemangioma.OTHER: There is moderate ascites. The peritoneum appears thickened without discrete mass. | 1.Cervical mass compatible with provided history of malignancy.2.Bilateral complex adnexal masses, left greater than right, are suspicious for primary malignancy or metastatic disease. |
Generate impression based on medical findings. | 58 year old male with history of complex coronary disease with previous PCI to the LAD and PDA, with known anomalous left circumflex coronary artery and persistent stable angina, referred for cardiac MRI vasodilator stress testing. MEDICATIONS: aspirin, metoprolol, rosuvastatin, ticagrelor, amlodipine, ranolazine First Pass PerfusionDuring hyperemia, a small transmural perfusion defect is noted in the basal anterolateral wallViability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 151 ml (normal range 142+/-34), the LV end systolic volume index is 34 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 33 g/m2, and the LV mass is 67 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 70%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 45 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 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. A small transmural perfusion defect/ "ischemia" present in the basal anterolateral wall during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size with low normal systolic function (LVEF 54%).4. Normal RV size and systolic function (RVEF 70%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Neck pain, left hand numbness and tingling. History of cervical and lumbar fusion, status post MVA x2. Cervical: Craniovertebral junction demonstrates moderate degenerative changes but is otherwise within normal limits. The cervical vertebral bodies are appropriate in height. There are changes related to previous posterior decompression and fusion from C3 through C6 (laminectomy, dual posterior rods and lateral mass screws that are bilateral C3, C5 and C6 and only on the left at C4). There is solid osseous fusion anteriorly and posteriorly. There is mild cervical kyphosis with apex at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is benign.No abnormal cord signal. There is effacement of the dorsal thecal sac at the C2-C3 level with mild impression on the dorsal cord. There is also mild spinal canal stenosis at the C7-T1 level related to disc bulge. Spinal canal is well decompressed from C3 to C6. There is loss of disc height at the C6-C7 and C7-T1 levels. Individual levels as below:C2-3: Minimal narrowing of the spinal canal. No significant neural foraminal stenosis.C3-4: No significant compromise to the spinal canal. Mild left worse than right neural foraminal stenosis. C4-5: No significant compromise to the spinal canal. There is mild to moderate right and mild left neural foraminal narrowing.C5-6: No significant compromise to the spinal canal or left neural foramina. Mild right neural foraminal narrowing.C6-7: Uncovertebral hypertrophy with mild to moderate right and minimal left neural foraminal narrowing. No significant spinal canal stenosis.C7-T1: There is disc bulge, uncovertebral hypertrophy, and bilateral facet arthropathy which result in mild to moderate bilateral neural foraminal stenosis, right worse in left. There is mild mild spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild loss of normal lumbar lordosis. There is minimal anterolisthesis of L3 on L4 and L4-L5 with evidence of prior interbody fusion at these levels. Posterior fusion hardware is also seen at L4-L5 with bilateral paraspinous rods and pedicle screws. Bone marrow signal is benign.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is loss of disc space with disc bulge, with arthropathy, ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L3-L4: Anterior fusion. Minimal spinal canal narrowing related to facet arthropathy and ligamentum flavum thickening above the level of the laminectomy. No significant neural foraminal stenosis.L4-L5: Anterior and posterior fusion. Spinal canal is surgically decompressed. Susceptibility artifact limits evaluation; within this limitation, mild right worse in left neural foraminal stenosis is suspected, but no high-grade neural foraminal stenosis is evident.L5-S1: Left-sided facet arthropathy with mild left neural foraminal stenosis. No significant right neural narrowing. No significant spinal canal stenosis.Bilateral renal cysts. | 1. Postsurgical changes of prior laminectomy and C3 to C6 fusion with solid osseous fusion anteriorly and posteriorly. There are degenerative changes at the C7-T1 level with mild spinal canal stenosis and mild to moderate neural foraminal stenosis at this level. Otherwise no high-grade spinal canal or neural foraminal stenosis is seen in the cervical spine.2. Postsurgical changes of interbody fusion at L3-L4 and L4-L5 as well as posterior decompression and fusion at L4-5. Degenerative changes are seen including mild spinal canal stenosis at the L2-L3 level. There is also mild bilateral L2-L3 and mild left L5-S1 neural foraminal stenosis. No high-grade spinal canal or neural foraminal stenosis in the lumbar spine. |
Generate impression based on medical findings. | Reason: tremor, numbness and tingling. History of lupus. MRI brain:There is increased central T2 signal within the pons without associated diffusion restriction, mass effect, or susceptibility. No other parenchymal signal abnormalities are appreciated. There is no evidence of intracranial hemorrhage or acute infarct. An 8 mm pineal cyst is incidentally noted without mass effect. 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 and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable.MRI lumbar spine:Vertebral body heights are within normal limits. Alignment is maintained. Bone marrow signal is benign. No abnormal signal within the cord or conus, which ends at L1. Disks are intact. T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. | 1.Increased T2 signal within the central pons which may be related to prior osmotic demyelination. No abnormal signal in the basal ganglia is appreciated. Prior ischemia is also possible but less likely given the absence of significant white matter signal abnormality elsewhere in the brain. Remainder of the brain is unremarkable.2.Unremarkable lumbar spine MRI without significant spinal canal or neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Low back pain positive straight leg raise. There is prominent right L5-S1 facet hypertrophy and ligamentum flavum thickening, which indent the right neural foraminal nerve roots. There is mild facet hypertrophy on the left side of L5-S1 and bilaterally at L4-5, with slight level neural foraminal narrowing at this level. Otherwise, there are no significant disc bulges or herniations. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is no evidence of tumor in the lumbar spine. The paravertebral soft tissues are unremarkable. | Prominent right L5-S1 facet hypertrophy and ligamentum flavum thickening, which indent the right neural foraminal nerve roots. |
Generate impression based on medical findings. | Disc protrusion, foraminal stenosis. Right leg numbness, pain shooting down laterally, anteriorly. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis as well as grade 1 anterolisthesis of L4 on L5 and minimal L5 on S1 retrolisthesis. Bone marrow signal is benign with T1 hyperintense focus involving the L2 vertebral body consistent with hemangioma and multilevel endplate fatty signal changes on a degenerative basis. The conus medullaris is normal in position.Degenerative changes are seen throughout the lumbar spine including multilevel vacuum disc phenomena, better appreciated on recent CT, and disc space narrowing, worst at the L5-S1 levels. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge and prominence of the epidural fat resulting in mild spinal canal narrowing. There is mild right and minimal left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis. There is edema involving the posterior aspect of the disc, most likely on a degenerative basis. Vacuum phenomena better seen on recent CT. There is bilateral facet arthropathy, worse on the left. There is also mild disc bulge eccentric to the right. There is resulting mild to moderate stenosis involving the proximal aspect of the right neural foramen. There is minimal left neural foraminal narrowing. No significant central canal narrowing.L5-S1: Minimal retrolisthesis. Severe loss of disc height. There is facet arthropathy, worse on the left than the right. No significant spinal canal narrowing. There is mild bilateral neural foraminal narrowing, relatively worse on the left. There is a prominent left lateral vertebral osteophyte.Evidence of left nephrectomy. Paraspinous soft tissues are within normal limits. | Multilevel degenerative changes in the lumbar spine including mild spinal canal stenosis at the L3-L4 level. There is also also mild to moderate right neural foraminal narrowing at the L4-L5 level where there is possible impingement of the right L4 nerve root. Additional levels as above. |
Generate impression based on medical findings. | 44-year-old male with right shoulder pain. Rule out labral versus cuff pathology. The exam is limited by motion artifact.ROTATOR CUFF: Intermediate signal in the supraspinatus tendon consistent with tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Tear is present in the posterior labrum.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | 1. Tear in the posterior glenoid labrum.2. Abnormal signal in the acromioclavicular joint with bone marrow edema in the acromion and clavicle consistent with chronic repetitive stress.3. Intermediate signal in the supraspinatus tendon consistent with tendinopathy. |
Generate impression based on medical findings. | 71 years, Male, Reason: evaluate for HCC History: cirrhosis with rising AFP. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology with recanalization of the umbilical vein.Enhancing right segment 8 lesion with associated increased T2 signal and equivocal washout appears slightly increased in size measuring 3.1 x 1.8 cm, previously 2.7 x 1.7 cm, and now contains a low intensity focus. There are two additional enhancing lesions without enhancement which appears slightly more prominent. Two well-circumscribed segment 7 lesions with intrinsic T1 shortening and without significant enhancement are stable may represent dysplastic nodules.SPLEEN: Splenomegaly.PANCREAS: Cystic lesion in the pancreatic head is slightly decreased in size measuring 1.3 x 1.3 cm (3/99), previously 1.5 x 1.3 cm. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing left renal cyst with a thin septation is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small periumbilical hernia containing a recannulized periumbilical vein is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Arterially enhancing segment 8 lesion with equivocal washout appears slightly increased in size suspicious for hepatocellular carcinoma. Two adjacent enhancing lesions may represent additional foci of hepatocellular carcinoma.2.Segment 7 lesions seen on prior exams with intrinsic T1 shortening may represent dysplastic nodules.3.Stable cystic lesion in the pancreatic head. |
Generate impression based on medical findings. | Reason: brain and spine mets History: gait ataxia, RUE weakness, lung CA. MRI Brain: Please note lack of intravenous contrast limits evaluation for metastatic disease. There is a 1.2 x 0.9 cm lesion, measured on the axial T2/FLAIR sequences, in the right parietal lobe with susceptibility effect indicative of blood products. There is extensive adjacent vasogenic edema involving portions of the the right frontal, parietal, and superior temporal lobes. There is significant mass effect with 5.4 mm midline shift to the left, not significantly changed compared to recent CT. There is no restricted diffusion to suggest acute ischemia. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine:Vertebral body heights in the cervical spine are normal. There is mild reversal of cervical lordosis. Mild degenerative changes are seen throughout the cervical spine without high-grade spinal canal stenosis at any level. Postcontrast images are motion degraded however do not demonstrate suspicious enhancement to suggest osseous metastasis, epidural tumor, or cord lesion.Multilevel degenerative changes, as described below: At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. Minimal disc osteophyte complex.At C4-5 there is a small disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.At C5-6 there is a small disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal or neural foraminal stenosis. At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or right neural foramen. There is uncovertebral hypertrophy on the left and facet arthropathy resulting in mild left neural foraminal narrowing.Paraspinal soft tissues are unremarkable. | 1. Please note lack of postcontrast brain MRI sequences limits evaluation for metastatic disease. There is a 12x9 mm hemorrhagic lesion in the right parietal lobe with extensive surrounding vasogenic edema presumably representing metastasis given history. Suggest post contrast brain MRI for further evaluation including evaluation for additional lesions. There is mass effect related to the extensive edema with 5 mm leftward midline shift.2. Postcontrast images of the cervical spine are motion degraded but demonstrate no evidence of metastatic disease. There are mild degenerative changes without significant spinal canal stenosis at any level. No cord signal abnormality. Individual levels as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Bilateral L5 radiculitis. At L5-S1, there is a small annular fissure associated with minimal disc bulging and bilateral facet hypertrophy. There is no significant spinal canal or neural foramen stenosis at this level. At L4-L5, there is annular fissuring, mild disc bulging and bilateral facet hypertrophy with trace effusions. There is resultant mild bilateral neural foramen stenosis, but no significant spinal canal stenosis. At L3-4, there is no significant spinal canal or neural foramen stenosis. At L2-3, there is a small eccentric right dis protrusion with mild narrowing of the right neural foramen, but no significant spinal canal or left neural foramen stenosis. At L1-2, there is mid loss of disc space height and a small posterior disc protrusion without significant spinal canal or neural foramen stenosis. At T12-L1, there is no significant spinal canal or neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | Mild multilevel degenerative spondylosis, with mild bilateral neural foramen stenosis at L4-5, but no significant spinal canal stenosis at this or the other lumbar spine levels. |
Generate impression based on medical findings. | 21 years Female (DOB:10/10/1995)Reason: pituitary cystic lesion, enlarge in Sep 2015 w possible hemorrhage associated with headache, also has infratentorial lesion. History: normal vision and endocrine functionPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI brain:There is a 32 x 36 mm sagittal dimension and 52 x 36 mm axial dimension cystic mass in the posterior fossa compatible with arachnoid cyst associated with bone remodeling which appears largely unchanged when compared to the previous exam it follows spinal fluid on all pulse sequences.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 right sigmoid sinus appears to be absent. The left sigmoid sinus is large. The straight sinus is relatively small. The right transverse sinus is smaller than the left transverse sinus. The right transverse sinus appears to drain into vein of Labbe.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.MRI pituitary:There is redemonstration of a T1 hyperintense focus in the inferior aspect of the pituitary at the midline is unchanged compared to prior exam. It measures approximately 2 mm in size.The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally. | 1.Stable pituitary lesion which could represent a Rathke's cyst.2.There is a compatible with an arachnoid cyst in the posterior fossa which is stable compared to the prior exam.3.Findings suggest congenital absence or hypoplasia of the right sigmoid sinus. |
Generate impression based on medical findings. | Male, 47 years old, with multiple sclerosis. Assess for progression. Image quality is degraded by motion artifact. Within this limitation, the point observations are made.Numerous T2 hyperintense lesions are redemonstrated within the periventricular and juxtacortical white matter. An extensive lesion is also seen encompassing nearly the entire right medial temporal lobe. Lesions are also seen at the right cranial nerve V root entry zone and within the right middle cerebellar peduncle which shows volume loss.These lesions show no evidence of interval growth and no new lesions are detected. The parenchymal lesions do not enhance. Enhancement of the right cisternal cranial nerve V is unchanged. Most of the parenchymal lesions demonstrate moderate to marked T1 hypointensity which is also similar to prior. | No significant interval change in the size or number of demyelinating lesions. |
Generate impression based on medical findings. | Ms. Amerik is a 29 year old female with a personal history of BRCA1 mutation and a strong family history of breast cancer, including her mother (diagnosed at the age of 48) and a maternal aunt (diagnosed at the age of 44). Personal history of benign MR guided biopsy of right breast in 2011 for fibroadenoma. The patient is participating in a clinical trial of screening high-risk individuals. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.Susceptibility artifact from biopsy proven fibroadenoma in the right upper outer breast along with associated minimal surrounding residual enhancement is stable. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. Follow up should be per the research protocol. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on medical findings. | Reason: eval prior OSH surgery, possible Dupuytren's excision with continued pain and stiffness History: finger and palmer hand pain Suboptimal evaluation secondary to inability to properly position patient due to the inability to flatten the patient's fingers, per the technologist note.TENDONS: The flexor and extensor tendons appear intact. There is a small amount of circumferential fluid within the tendon sheaths of the flexor digitorum tendons at the level of the third MCP joint of questionable clinical significance.BONES: No bone marrow signal abnormalities are identified. There is apparent negative ulnar variance.ADDITIONAL | Linear decreased signal abnormality within the subcutaneous tissue along the volar aspect of the wrist and hand may reflect postsurgical scarring or fibrosis. |
Generate impression based on medical findings. | Male, 52 years old, with neurofibromatosis type I and a long-standing temporal lobe lesion, who recently had a seizure after being controlled for a few years. A multicystic lesion involving the left cavernous and choroidal fissure is redemonstrated showing no significant interval change in size, morphology or signal characteristics, comparing to exams dating back to 2007. The posterior component of the lesion continues to measure 18 x 11 mm (image 14 series 401), previously 18 x 11 mm. As before, no associated lesional enhancement is seen. There is a small vessel looping around and within the lesion, but this is unchanged.Brain parenchymal morphology is otherwise unremarkable. No areas of significant edema or mass effect is detected. At most, a punctate focus of T2 hyperintensity is seen within the right inferior parietal lobule, unchanged. No pathologic parenchymal or extra-axial enhancement is detected. No findings to suggest intracranial hemorrhage are seen. The ventricular system is normal in size and morphology.An ill-defined, enhancing cutaneous lesion is seen within the medial left periorbital soft tissues, unchanged. As before, vascular prominence is noted within the left masticator space. A chronic deformity of the left lamina papyracea is unchanged. | 1.No change in size or morphology of a nonenhancing multicystic lesion involving the left hippocampus and choroidal fissure. The lesion is unchanged when compared to an examination dating back to 2007.2.No new intracranial lesions are seen to account for the patient's seizure.3.A left periorbital cutaneous lesion is unchanged perhaps representing a plexiform neurofibroma. |
Generate impression based on medical findings. | Pain in left shoulder after fall going up stairs. Evaluate for torn ligament, tendon or other shoulder injury. ROTATOR CUFF: There is a full-thickness supraspinatus tear at its insertion, without significant retraction. The infraspinatus tendon appears intact. There is high signal within the subscapularis, consistent with tendinopathy. The subscapularis and teres minor appear intact. There is no fatty infiltration of the rotator cuff musculature.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: A small joint effusion is present within the subacromial/subdeltoid bursa. The labrum appears normal.BICEPS TENDON: There is nonvisualization of the proximal aspect of the biceps tendon, consistent with a tear. The distal aspect of the biceps tendon is visualized, but we do not see the proximal aspect within the bicipital groove.ADDITIONAL | 1. Full-thickness supraspinatus tear at its insertion, with no significant retraction.2. Nonvisualization of the proximal aspect of the biceps tendon, consistent with tear. |
Generate impression based on medical findings. | Clinical question: Rule out malignant otitis, rule out abscess. Signs and symptoms: Right ear pain. Enhanced CT of the maxillofacial:Examination demonstrates a low-density mass within the left submandibular gland measuring 21.5 mm x 15.2-mm in trans-axial dimensions on image 14 and 32.3-mm in cranial -- cephalad axis on sagittal reformatted image 36. There is no detectable enhancement of this lesion. The left submandibular gland is expanded and surrounds this lesion however it be done CT of the remaining gland remains within normal limits. There is no evidence of any calcification with this finding. Recommend further follow all with an MRI examination for better characterization of this lesion. The finding although could represent a says possibility of a tumor is high and should be further evaluated. There is no associated lymphadenopathy with this finding on this limited view of upper neck. There is also no evidence of any inflammatory changes of the adjacent fascial planes. No evidence of any mass effect on the airway and no evidence of any osseous or cartilaginous erosion.Images through the oral cavity and floor of the mouth are otherwise unremarkable.Normal appearing bilateral parotid glands.Images through the skull base and bilateral petrous bones demonstrate well pneumatized mastoid air cells and middle ear cavities as well as external auditory canals bilaterally. The ossicular chain are unremarkable. There is no evidence of any inflammatory changes in the periauricular region. The external year and has normal density and morphology. The TMJs are well-visualized and unremarkable. The sphenoid sinus/sphenoid bone is within normal limits. Minimal chronic sinus disease of bilateral maxillary sinuses are noted. No detectable abnormality at the level of nasal findings, oral findings is detected. | Examination demonstrates a low-density nonenhancing mass within the left submandibular gland measuring 21.5 x 15 times 32.3-mm in size. Follow up with an MRI examination is recommended. This lesion is not associated with any enhancement, inflammatory changes, abnormal calcification within the gland or the lesion and no evidence of any dilated ducts within the gland or any visible adenopathy on this exam. The left submandibular gland beyond the mass/cyst has normal density and pattern of enhancement. Enhanced CT of the maxillofacial is otherwise entirely unremarkable and in particular no evidence of otitis or mastoiditis is detected. |
Generate impression based on medical findings. | Right arm and leg weakness, numbness, and pain. Brain MRI: There are several small areas of encephalomalacia in the bilateral basal ganglia and pons. There are also scattered foci of high T2 signal in the cerebral white matter. There are scattered foci of supratentorial and infratentorial susceptibility effect, which may represent chronic microhemorrhages. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right maxillary sinus. There is a subcentimeter probable Thornwaldt cyst.Brain MRA: There is vertebrobasilar dolichoectasia. Otherwise, there is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions. | 1. Multiple chronic infarcts and small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck. |
Generate impression based on medical findings. | 72-year-old female with small cell lung cancer. Evaluate for metastasis. There are at least 12 enhancing lesions seen within the bilateral cerebral hemispheres and cerebellum. Many of these are very close to the or at the cortical surface concerning for involvement of the subarachnoid space. There is no definite cranial nerve enhancement. The lesions are all small with the largest along the medial aspect of the right middle cerebellar peduncle measuring 11 x 10 mm (series 10, image 54). Some of these lesions demonstrate mild surrounding T2 signal abnormality and 1 or 2 of these lesions produce very mild edema. There is no evidence of acute intracranial hemorrhage or hemorrhagic involvement of any of the lesions. Extensive underlying periventricular and subcortical white matter T2/FLAIR hyperintensity is seen most likely related to chronic small vessel ischemic disease. 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. | Numerous, at least 12, enhancing intracranial lesions are seen compatible with metastatic disease. |
Generate impression based on medical findings. | 55-year-old man with history of lumbar radiculopathy. Five lumbar type vertebral bodies are presumed to be present. There are degenerative endplate changes with Schmorl's nodes, otherwise vertebral body heights are within normal limits. Alignment is within normal limits. An area of T2 hyperintense signal and T1 isointense signal is seen in the posterior L1 vertebral body extending into the right pedicle (500/6). There is no cortical destruction. Additionally, a similar, smaller round lesion is seen in the L2 right pedicle. These lesions are favored to represent hemangiomas. The bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T11-T12: There is disc desiccation and loss of disc height with a disc bulge. Although this level was not imaged on the axial sequences, there is at least moderate narrowing of the spinal canal.T12-L1: There is disc desiccation and loss of disc height. Disc osteophyte complex causes mild-to-moderate narrowing of the spinal canal, moderate narrowing of the right neural foramen and mild narrowing of the left neural foramen.L1-L2: Relatively minimal disc disease. There is minimal disc bulge without significant narrowing of the lateral recesses, neural foramina, or spinal canal.L2-L3: There is disc desiccation along with slight bulging of the disc and ligamentum flavum hypertrophy. This causes mild neural foraminal narrowing bilaterally. No spinal canal stenosis.L3-L4: There is disc desiccation along with slight bulging of the disc and ligamentum flavum hypertrophy. This causes mild neural foraminal narrowing bilaterally. No spinal canal stenosis.L4-L5: There is disc desiccation, height loss, and formation of disc osteophyte complex. There is moderate neural foraminal narrowing on the right and severe neural foraminal narrowing on the left. There is mild central canal stenosis.L5-S1: There is disc desiccation with a central posterior protrusion. This causes mild narrowing of the left lateral recess and neural foramen. There is impression on the thecal sac without significant central canal stenosis.Simple bilateral renal cysts noted. Otherwise, paraspinous soft tissues are within normal limits. | Degenerative changes as described above with multilevel neural foraminal and spinal canal stenosis. |
Generate impression based on medical findings. | Male 58 years old Reason: assess right triceps mass History: present for 10 months Again noted with in the right arm, within the triceps muscle is a 3.8 x 4.6 x 5.0 cm soft tissue mass, stable/mildly increased from prior allowing for differences in imaging technique. Linear high signal and appearance suggestive of a dural tail extends from the superior and inferior aspects of the main body of the mass. This is homogeneously iso-/hypointense to muscle on T1 weighted images and somewhat inhomogeneously hyperintense to muscle on T2 weighted images. Postcontrast it demonstrates rim enhancement and inhomogeneous internal enhancement. It is well delineated without reactive edema in the surrounding musculature. The humerus is unremarkable. | 5.0-cm soft tissue mass in the right triceps muscle. Although this may represent a benign peripheral nerve sheath tumor, due to the inhomogeneity, the appearance is somewhat worrisome for a malignant peripheral nerve sheath tumor. |
Generate impression based on medical findings. | Fat saturation is slightly inhomogeneous. There is redemonstration of postoperative changes related to thyroid isthmusectomy and neck dissection with susceptibility artifact from surgical clips. There is no evidence of recurrent mass in the thyroid bed. No nasopharyngeal mass is identified. There is no diffusion abnormality.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the submandibular, sublingual, and parotid glands bilaterally is unremarkable. The remaining thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and the floor of mouth are unremarkable.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: The previously described right anterior frontal lobe intrinsic T1 hyperintensity adjacent curvilinear developmental venous anomaly, as well as the left midbrain cavernoma are again visualized. Please see separately dictated report for MRI brain of the prior day for further details. An area of pulmonary opacity is seen in the left upper lung field, slightly less confluent than on the prior exam. | Stable appearance of postoperative and posttreatment changes, without mass recurrence or lymphadenopathy. |
Generate impression based on medical findings. | Ms. Lindsey is a 24 year old female with personal history of right breast lumpectomy and sentinel lymph node biopsy in 2014 for IDC treated with neoadjuvant chemotherapy and radiation. She has no current breast related complaints. There is extreme amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes are identified in the right central breast and right axillary region, compatible with provided history of right breast lumpectomy with sentinel lymph node biopsy. No abnormal enhancement is seen in either breast. There is an area of increased T2 signal in the right anterior lung, which corresponds to the known area of maturing radiation reaction better characterized on recent CT from September 2015. No abnormal axillary lymph nodes are identified in either axillary region. | Expected postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | 57 year old with left breast carcinoma and metastatic left axillary lymph nodes, status post chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.The known carcinoma at posterior 2 o'clock position in the left breast seen on the prior study is no longer visualized. Marker clip is identified at left posterior 2 o'clock position.A proven fibroadenoma is unchanged at posterior 12 o'clock position in the left breast, with a marker clip at anterior aspect.There are again multiple enlarged lymph nodes (at least 9 abnormally enlarged lymph nodes) in the left axilla, although all of them appear reduced in size. Five of the 9 nodes are in the level one region, and three of them are in the level two region. The largest lymph node measures 17 mm in maximum diameter (previously 28 mm).Metallic artifacts from a port-A-cath is seen in the medial upper right breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in right axillary region. | 1. Complete imaging response of the right breast cancer.2. Interval reduction in size of the multiple abnormal left axillary lymph nodes3. No abnormal enhancement in right breast. 4. No abnormal lymph nodes in right axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | Clinical question: 28-year-old female with chronic history of migraines, escalating a recent month. Family history of aneurysm. Rule out mass, increased intracranial pressure. Signs and symptoms: Severe headache. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate normal anatomical morphology as well as signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Post infused images demonstrate a multi branch is small vascular enhancement in the right frontal and basal ganglia consistent with a congenital developmental venous anomaly without clinical significance. This finding is not associated with any detectable cavernoma. No detectable abnormal parenchymal or leptomeningeal enhancement.Signal void of major intracranial arterial branches are identified and unremarkable. Note should be made that this exam cannot exclude possibility of aneurysm.Unremarkable calvarium and orbits without detectable abnormal enhancement.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns. | 1.Pre- and post enhanced brain MRI demonstrate a small right basal ganglionic/frontal lobe congenital developmental venous anomaly and unremarkable otherwise.2.Note should be made that MRI cannot exclude possibility of aneurysm.3.Well-pneumatized paranasal sinuses and bilateral mastoid air cells and middle ear cavities and unremarkable calvarium. |
Generate impression based on medical findings. | Cyst and hydrocephalus: possible shunt malfunction. There is a catheter that enters via a right occipital burr hole and terminates in the anterior right lateral ventricle. There are thin septations within the dilated portion of the posterior right lateral ventricle, which has not significantly changed in size. The rest of the ventricular system is not particularly enlarged. There is confluent high T2 signal in the right frontal, parietal, and occipital white matter surrounding dilated right lateral ventricle, along with volume loss. There are also other scattered areas of periventricular and subcortical white matter T2 hyperattenuation. There is no evidence of acute infarction or intracranial hemorrhage. There are postoperative findings related to posterior fossa decompression with diminished flow of cerebrospinal fluid across the craniocervical junction. The cerebellum is not low-lying, however. There is an extra-axial catheter in the right frontoparietal convexity. There are no midline shift. The pituitary gland is normal in size. There is no abnormal intracranial enhancement. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. | 1. Dilatation of posterior portion of the shunted right lateral ventricle with septations, which may represent adhesions and perhaps cyst formation with surrounding encephalomalacia and gliosis. The constellation of findings may be the result of remote insult, such as infection and perhaps ischemia. Other scattered areas of periventricular and subcortical white matter T2 hyperattenuation may represent chronic small vessel ischemic disease, but no evidence of acute infarct. 2. Postoperative findings related to posterior fossa decompression with diminished flow of cerebrospinal fluid across the craniocervical junction. |
Generate impression based on medical findings. | Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is suggestion of bilateral pars defects at L5 without spondylolisthesis.L1-L2: There is disc desiccation at L1-L2 with a Schmorl's node involving the inferior L1 endplate. No significant surrounding edema. No disc herniation. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits. | 1. Minimal degenerative changes including disc desiccation at L1-L2 with small Schmorl's node. There is also mild L5-S1 facet arthropathy. No significant spinal canal or neural foraminal stenosis at any level. 2. Likely pars defects at L5 without associated spondylolisthesis. This finding can be better visualized with oblique radiographs or CT if clinically indicated. |
Generate impression based on medical findings. | 52 year old female with a personal history of biopsy-proven left breast intraductal papilloma with focal atypia. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally. Scattered bilateral enhancing foci are noted, none of which are uniquely enhancing.Within the medial aspect of the left breast, 2 cm from nipple, there is a 4 x 4 x 3 mm (AP x transverse X CC) enhancing focus adjacent to the medial aspect of the clip artifact corresponding to the patient's biopsy-proven papilloma. No significant ductal fluid or dilatation is noted. No additional masses or abnormal enhancement lesions is noted.No abnormal lymph nodes are identified in either axillary region. | Left breast lesion corresponding to the patient's biopsy-proven papilloma without additional mass or suspicious enhancement identified.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on medical findings. | Male, 60 years old, new diagnosis of head and neck cancer, abnormal lesion in the left thalamus on CT. Assess for metastases. T1 hyperintensity and mild susceptibility artifact is seen within the pulvinar of the left thalamus with at most a slight expansion of the affected tissue. There is no convincing enhancement above and beyond the intrinsic T1 hyperintensity. However, a venous structure originates within this tissue and passes through it to drain to the vein of Galen. Minimal T2 hyperintensity is seen in this location without evidence of edema.No restricted diffusion is seen in the brain. No other areas of significant parenchymal signal abnormality are detected. At most, there may be a few scattered punctate foci of white matter T2 hyperintensity which are nonspecific. No mass or pathologic enhancement is detected. No abnormal extra axial collections are seen. The ventricles are normal in size and morphology. | Corresponding to the lesion seen on recent prior CT, intrinsic T1 hyperintensity and mild susceptibility artifact are seen within the pulvinar of the left thalamus. The lesion as a whole does not enhance. However, there is a developmental venous anomaly which originates within and passes through the lesion.The findings are most suggestive of an incidental cavernous malformation with associated developmental venous anomaly. Alternately, the abnormal signal could reflect a complication of the developmental venous anomaly without an associated cavernoma. Other processes are known to produce T1 hyperintensity in the pulvinar, including metabolic and endocrinologic conditions, but these are usually bilateral and symmetric.In any event, this lesion is not consistent with a metastatic deposit, and there is no evidence of any additional intracranial metastatic disease. |
Generate impression based on medical findings. | 90 years Male (DOB:12/14/1925)Reason: eval for tia/stroke History: left facial droopPROVIDER/ATTENDING NAME: DAVID HOWES KEEGAN CHECKETT MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy T2 and FLAIR signal hyperintense lesions are present in the brainstem.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 an opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain: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. The right A1 segment is larger than the left A1 segment. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is mild narrowing of the proximal basilar arteryMRA 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.There is no evidence for acute cerebral ischemic infarction.2.No evidence for significant intracranial cerebrovascular occlusive disease3.There is no evidence for extracranial cerebrovascular occlusive disease4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.5.Patchy lesions in the brainstem are likely vascular related as well and most likely chronic in nature. |
Generate impression based on medical findings. | Shoulder pain The examination is limited secondary to motion artifact.ROTATOR CUFF: There is undersurface fraying and mild tendinosis of the supraspinatus tendon although no fluid-filled discrete tear is identified. There is tendinosis of the infraspinatus tendon at its insertion on the greater tuberosity but again no fluid-filled tear is identified. There is suggestion of focal undersurface tearing of the subscapularis tendon at its insertion which appears new from the prior exam but no full-thickness tear is identified. The teres minor tendon is intact. The corresponding rotator cuff musculature is normal in volume and signal.SUPRASPINATUS OUTLET: There is moderate osteoarthritis of the acromioclavicular joint with impression upon the superior fibers of the supraspinatus. A trace amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the labrum is limited secondary to motion and lack of intra-articular contrast however there is suspected age-related degeneration and degenerative tearing of the superior labrum. There is a small glenohumeral joint effusion with extension to the subscapular recess. There is mild osteoarthritis of the glenohumeral joint.BICEPS TENDON: There is fluid again noted within the tendon sheath of the long head of the biceps which may reflect tenosynovitis and/or extension of glenohumeral joint fluid. Overall this is similar to the prior exam. Otherwise evaluation of the intra-articular portion of the biceps tendon is limited secondary to motion and lack of intra-articular contrast. ADDITIONAL | 1. Limited examination secondary to motion artifact.2. Partial-thickness insertional tearing of the subscapularis tendon with additional rotator cuff tendinosis further detailed above. There is no evidence of a full-thickness rotator cuff tear.3. Osteoarthritis of the shoulder.4. Fluid within the biceps tendon sheath which could reflect tenosynovitis.5. Additional findings detailed above. |
Generate impression based on medical findings. | Low signal to noise is present secondary to patient positioning in relation to the MRI coil. There is loss of the normal cervical lordosis with a kyphotic angle centered at C5/C6. Vertebral body heights are grossly preserved. There is a trace anterolisthesis of C4 on C5 and grade 1 anterolisthesis of C5 on C6. There is disc dessication throughout the cervical spine with severe degenerative disc disease at C5/C6. Diffuse marrow heterogeneity with increased sclerosis (hypointensity on T1 and T2) is consistent with metastatic disease as seen on previous bone scan, likely demonstrating a treatment response. The cervicomedullary junction is normal. C2/3: No significant canal or neural foraminal stenosis.C3/4: There is right greater than left uncovertebral hypertrophy with mild right neural foraminal stenosis. Minimal posterior disc-osteophyte complex with effacement of the dorsal thecal sac consistent with mild spinal canal stenosis. C4/5: There is trace uncovering of the disc without significant spinal canal stenosis. There is uncovertebral and severe left facet hypertrophy contributing to severe left neural foraminal stenosis as well as mild right neural foraminal stenosis.C5/6: There is uncovering of the disc with a superimposed disc-osteophyte complex which causes mild spinal canal stenosis. There is uncovertebral hypertrophy and minimal bilateral neural foraminal stenosis. C6/7: There is a posterior-disc osteophyte complex causing mild to moderate spinal canal stenosis and uncovertebral hypertrophy causing mild bilateral neural foraminal stenosis. C7/T1: No significant spinal canal or neural foraminal stenosis. | 1. Multilevel degenerative changes of the cervical spine most prominent at C4/C5 with severe left neural foraminal stenosis and C5/C6 with grade I anterolisthesis and mild spinal canal stenosis. Additional findings as described above.2. Diffuse bone marrow heterogeneity with sclerosis is consistent with metastatic disease as seen on prior bone scan. |
Generate impression based on medical findings. | 54-year-old female with history of ventral hernia and hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule, enlarged from previous study now measuring 9 by 9 mm on image number 43, series number 7. MRI of the adrenal gland it helpful for further evaluation.KIDNEYS, URETERS: No focal lesions in both kidneys. No evidence of stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the lower anterior abdominal wall. There is a midline tissue defect through a short segment of midline incision. No evidence of herniating bowel segments. Small amount of fat indenting the fascia however no obvious evidence of herniation. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Heterogeneous uterus with possible multiple fibroids.BLADDER: Wall thickening of the bladder. This may represent cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes involving the bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Midline tissue defect along incision. Post surgical changes in the anterior abdominal wall. No evidence of obvious herniation.Mild wall thickening of the bladder suggestive of cystitis.MRI of the adrenal may be helpful for further evaluation of small left adrenal nodule, which is increased in size compared to previous study. Clinical correlation is recommended. |
Generate impression based on medical findings. | History of left parotid region squamous cell carcinoma with radiation necrosis of the temporal bone status post resection and reconstruction 3 weeks ago now with concern for possible abscess/cerebritis History: fevers, chills, AMS. There are postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction. There is heterogeneous fluid within the anterior portion of the surgical bed, which extends to the overlying skin incision and measures approximately 25 mm in width, 15 mm anteroposteriorly, and 20 mm in height. There appears to be a defect in the left tegmen, with mild herniation of the inferior temporal lobe, where there is patchy cortical and subcortical T2 hyperintensity and enhancement, as well as diffuse, confluent T2 hyperintensity of the white matter. There is no large intracranial fluid collection or evidence of acute territorial infarction. There is mild enhancement of the left cochlea and cranial nerves in the left internal auditory canal. There also appears to be mild thickening and enhancement of a portion of the V3 segment of the left trigeminal nerve in the region of foramen ovale and mild asymmetric prominence of the left cavernous sinus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributable to degenerative changes with subchondral sclerosis. There is mucosal thickening and secretions in the left posterior ethmoid sinus and a small retention cyst in the right sphenoid sinus. | 1. Postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction. There is heterogeneous fluid within the anterior portion of the surgical bed, which extends to the overlying skin incision and measures approximately 25 mm, which may represent s seroma with superimposed infection.2. Apparent defect in the left tegmen, with mild herniation of the inferior temporal lobe, where there is evidence of inflammatory changes, which may represent cerebritis superimposed upon underlying radiation necrosis.3. Mild enhancement of the left cochlea and cranial nerves in the left internal auditory canal may represent infectious and/or radiation-induced labyrinthitis and neuritis.4. Apparent mild thickening and enhancement of a portion of the V3 segment of the left trigeminal nerve in the region of foramen ovale and mild asymmetric prominence of the left cavernous sinus. |
Generate impression based on medical findings. | Meningioma status post CyberKnife in May 2014 and orbital pseudotumor. Brain: There are postoperative findings related to left suboccipital craniotomy for resection of a meningioma with encephalomalacia in the left cerebellar hemisphere. There is slight interval decrease in size of the tumor, which now measures up to 13 mm in thickness, previously 16 mm. There is a persistent nodular extra-axial lesion that is T2 hypointense with susceptibility effect and mild peripheral enhancement along the floor of the left posterior fossa, adjacent to the craniotomy defect that measures up to 15 mm. There is unchanged mild nonspecific periventricular T2 hyperintensity. There is no evidence of acute infarct or hemorrhage. The ventricular system is stable in size and configuration. There has been interval partial resection of a left earlobe keloid.Orbit: There are postoperative findings related to orbitozygomatic craniotomy. There is interval decrease in size of a right inferior intraconal nodular lesion, abutting the optic nerve, measuring up to 12 mm, previously 24 mm. There is persistent associated surrounding enhancement of the right orbital fat and multiple extra-ocular muscles. There is staphylomatous deformity of the bilateral globes. | 1.Slight interval decrease in size of the treated left posterior fossa meningioma.2. Persistent small nodular extra-axial lesion in left posterior fossa adjacent to the craniotomy margin may represent an organizing hematoma. 3. Decrease in size of the lesion within the inferior right orbit, abutting the optic nerve. |
Generate impression based on medical findings. | Male, 65 years old, with neck pain. The cervical lordosis is mildly reversed. There is a grade 1 retrolisthesis of C6 relative to C7.Fusion of the C3 through C5 vertebral bodies is demonstrated. Mild edema, likely degenerative in nature, is seen within the C5, C6 and C7 vertebral bodies.The visualized spinal cord demonstrates normal signal intensity throughout.A 2-mm nonspecific T2 hyperintense focus is seen within the left lateral thyroid gland.C2-3: Mild facet hypertrophy. Small central disk protrusion. No significant spinal canal or neuroforaminal stenosis. C3-4: Obliteration of the disk space with mild bony ridging in the left paracentral zone. No significant spinal canal or neuroforaminal stenosis. C4-5: Obliteration of the disk space with left paracentral/subarticular bony ridging which results in mild flattening of the left ventral cord. No significant generalized spinal canal stenosis. No significant foraminal narrowing. C5-6: Posterior disk osteophyte formation without significant spinal canal or neuroforaminal stenosis. C6-7: Posterior disk osteophyte formation asymmetric to the left. Mild generalized spinal canal stenosis. Mild right neuroforaminal narrowing. C7-T1: Facet hypertrophy and ligamentum flavum thickening. Posterior disk osteophyte formation. Moderate generalized spinal canal stenosis. No significant foraminal narrowing. | 1.Fusion of the C3 through C5 vertebral bodies with obliteration of the intervening disk spaces.2.At the C4-5 level, there is a bony ridge arising from the level of the obliterated disk space at the left paracentral/subarticular zone. This ridge mildly impinges upon the left ventral cord.3.A moderate spinal canal stenosis is seen at C7-T1 secondary to disk osteophyte and posterior element hypertrophy. |
Generate impression based on medical findings. | 55 years Female (DOB:5/3/1960)Reason: neck pain and RUE radiculopathy. S/p MRI without contrast showing nodular mass at C2-C3. MRI with contrast to evaluate further. History: abovePROVIDER/ATTENDING NAME: JAMES M MOK JAMES M MOK The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature. There is multilevel disc desiccation present. There is a 7 mm extra-axial and intradural nodule present adjacent to the spinal cord at the right lateral aspect of the spinal canal at the C2-3 level. It enhances following contrast administration.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a broad-based central disc protrusion which impresses on the ventral aspect of the thecal sac and partially effaces spinal fluid ventral to the spinal cord. Overall there is a mild degree of spinal stenosis resulting at this level. There is no compromise of the exiting nerve roots at this level.At C4-5 there is no significant compromise to the spinal canal. There are some uncovertebral osteophytes and disc material at the lateral recesses which mildly encroach on the exiting nerve roots.At C5-6 there is a disc bulge at this level associated with bilateral uncovertebral osteophytes resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a mild to moderate degree of spinal stenosis as well as encroachment of the exiting nerve roots.At C6-7 there is a central disc extrusion at this level associated with bilateral uncovertebral osteophytes resulting in effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis. There is no significant compromise to the exiting nerve roots within the neural foramina at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. | 1.There are multilevel degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is mild to moderate spinal stenosis at C5-6 and moderate spinal stenosis at C6-7 as well as encroachment of the exiting nerve roots within the neural foramina at C5-6. There are degenerative changes present at other levels as well with milder degrees of neural foraminal encroachment.2.There is an extra-axial and intradural well-circumscribed nodule present within the spinal canal at C2-3. Differential considerations include a schwannoma and less likely meningioma as well as - in the appropriate clinical setting - metastatic disease. |
Generate impression based on medical findings. | A 49 year old male with alcohol abuse and recently diagnosed biventricular heart failure (LVEF 10% by echo). An apical clot was suspected and anticoagulant treatment was started. Normal coronary arteries by left heart catheterization. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 15%, the LV end diastolic volume index is 177 ml/m2 (normal range: 74+/-15), the LVEDV is 398 ml (normal range 142+/-34), the LV end systolic volume index is 151 ml/m2 (normal range 25+/-9), the LVESV is 340 ml (normal range 47+/-19), the LV mass index is 89 g/m2 (normal range 85+/-15), and the LV mass is 200 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process.Native myocardial T1 times are mildly increased (~1100ms), suggesting the presence of mild, diffuse, interstitial fibrosis. No intracavitary thrombus was noted.No myocardial iron overload was noted.Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 29%, the RV end diastolic volume index is 123 ml/m2 (normal range 82+/-16), the RVEDV is 277 ml (normal range 142+/-31), the RV end systolic volume index is 88 ml/m2 (normal range 31+/-9), and the RVESV is 198 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation (functional).Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is upper normal size (37 X 38mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm).Venous AnatomyThe SVC and IVC drain into the right atrium. There is a catheter on the right subclavian vein. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere is a large right pleural effusion with likely associated compressionn atelectasis. There is a small left pleural effusion. 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. The left ventricle is severely dilated with severely reduced systolic function, the LVEF 15%. 2. There is no late gadolinium enhancement to suggest the presence of an underlying focal replacement fibrosing, infiltrative, or inflammatory process. However, native myocardial T1 times are mildly increased, suggesting the presence of mild interstitial fibrosis.3. No intracavitary thrombus was noted.4. No myocardial iron overload was noted.5. The right ventricle is mildly dilated with severely reduced systolic function, the RVEF is 29%. 6. The left atrium is severely dilated and the right atrium is mildly dilated7. There is mild to moderate mitral regurgitation (functional).8. The main pulmonary artery is mildly dilated.9. There is a small pericardial effusion.10. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Clinical question: Evaluate for hydrocephalus. Signs and symptoms: Gait instability. Non-enhanced CT of brain:Examination demonstrate a highly suspected loculated mass in the left cerebellum with extensive surrounding vasogenic edema. There is significant mass-effect on the fourth ventricle with near complete collapse of the ventricle. There is crowding of the cerebellar tonsils at the level of foramina magnum and effacement of prepontine and cerebellopontine angle cisterns as well as effacement and deformity of the quadrigeminal plate. Consistent with significant mass effect in the posterior fossa and upward transtentorial herniation.Images through supratentorial space demonstrates significant enlargement of the supratentorial ventricular system consistent with hydrocephalus. There are a few small foci of periventricular and subcortical low attenuation that although may represent small vessel disease considering patient's tumor but in the posterior fossa these areas of low attenuation may represent edema and metastatic lesions. A dedicated MRI with enhancement is recommended. There is no evidence of hemorrhage or midline shift. | 1.Mass with extensive surrounding vasogenic edema in the left cerebellum with significant associated mass effect and upward transtentorial herniation.2.Supratentorial hydrocephalus.3.Dedicated MRI examination with enhancement is recommended.4.The above findings were relayed to Dr.Thomas Kelley from neurosurgery department at the time of interpretation. |
Generate impression based on medical findings. | 28-year-old male with history of von Hippel-Lindau. History laminectomy for spinal hemangioblastoma. Has current cerebellar/spinal hemangioblastomas. Evaluate for growth and new lesions. BRAIN MRI: Compared to 1/3/2014, there is no significant change in size of left cerebellar enhancing lesion measuring 7 x 5 x 7 mm, previously measuring 6 x 5 x 7 mm. No evidence for restricted diffusion to suggest acute ischemia or infarction. The ventricles and sulci are symmetric and unremarkable. No hydrocephalus identified. No mass effect, midline shift, or basal cistern effacement. No intra-or extra-axial fluid collection identified. Proximal intracranial flow voids are identified.2 mm enhancing punctate lesion within the right posterior aspect of the medulla is better seen on the cervical spine MRI and unchanged (sagittal cervical postgad 8/15 and axial 3D postgad 8/80 series 4401). No other sites of abnormal intracranial enhancement identified. No evidence of gross endolymphatic sac abnormality.Orbital contents are unremarkable bilaterally. There is mild opacification of the anterior ethmoid air cells bilaterally, otherwise the paranasal sinuses and mastoid air cells are clear. MRI OF THE CERVICAL SPINE: There is mild straightening of the normal cervical lordosis. Laminectomies are identified from C3 to C6 and mild enhancement involving the posterior spinous paraspinous tissue consistent with postsurgical change. Unchanged linear enhancement along the posterior aspect of the cervical cord at the C4-C5 level which likely represents postsurgical change. Minimal T2 hyperintensity and possible minimal intramedullary enhancement within the cervical cord at the C4-C5 level is also unchanged.There is mild desiccation signal seen at C2 to C6 levels. No evidence of spinal stenoses or significant foraminal narrowing. No new or enlarging lesions are seen within the cervical cord.MRI OF THE THORACIC SPINE: The alignment and curvature of the thoracic spine are anatomic. There is preservation of the vertebral body heights. The intervertebral disks have normal signal intensity. The marrow signal is normal. No evidence of significant degenerative changes, disk herniation or spinal stenoses. The thoracic spinal cord is unremarkable. No evidence of pathological intradural or vertebral enhancement.The paraspinal soft tissues are unremarkable. Partially visualized intra-abdominal contents demonstrate multiple bilateral renal lesions. Some of these lesions are complex and indeterminate on this nontargeted examination. These are better seen on prior MR Abdomen Exam.MRI OF THE LUMBAR SPINE: The alignment and curvature of the lumbar spine are anatomic. There is preservation of the vertebral body heights. The intervertebral disks have normal signal intensity. The marrow signal is normal. There is no evidence of significant degenerative changes, disk herniation or spinal stenoses. The visualized distal spinal cord has normal signal intensity and morphology. The conus medullaris terminates at the inferior endplate level of T12. The cauda equina and filum terminale are unremarkable.No abnormal intradural or vertebral enhancement identified. The paraspinal soft tissues are within normal limits. The partially visualized intra-abdominal contents again demonstrates multiple complex and cystic renal lesions. | 1. Compared to 1/3/2014, there is no significant change in small enhancing lesion involving the left posterior cerebellar hemisphere compatible with a hemangioblastoma. A second punctate lesion identified on the prior study along the right posterior aspect of the medulla is also unchanged. No new lesions or evidence of intracranial mass effect.2. Stable postoperative changes in the cervical spine. Linear enhancement along the posterior surface of the cord at C4-5 and minimal T2 hyperintensity and punctate enhancement within the cervical cord at C4-5 are all unchanged and compatible with postsurgical change. Comparison with preoperative MRI would be helpful. No new or enlarging lesions in the cervical, thoracic, or lumbar spine.3. Please refer to separate report for findings in the abdomen including enhancing renal lesions. |
Generate impression based on medical findings. | 66 years Female (DOB:4/9/1949)Reason: r/o cervical spondylosis, ro/ cord impingement History: neck pain, brisk reflexes, lower extremity sensory symptomsPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of normal cervical curvature. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is mild loss of disc space height, disc desiccation and a disc bulge at this level associated with bilateral uncovertebral osteophytes and narrowing of the neural foramina bilaterally.At C4-5 there is no significant compromise to the spinal canal. There is a loss of disc space height, disc desiccation and disc bulge at this level associated bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.At C5-6 there is no significant compromise to the spinal canal. There is a loss of disc space height, disc desiccation and disc bulge at this level associated bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally but worse on the right side when compared to the left.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge present this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post intraspinous fixation at L4-5. There is mild anterior subluxation of L4 and L5.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a diffuse disc bulge at this level associated with chronic endplate reactive changes and some mild narrowing of the spinal canal. There is mild facet and ligamentum flavum hypertrophy at this level.At L4-5 there is mild anterior subluxation of L4 on L5 associated with loss of disc space height, disc desiccation and diffuse disc bulge as well as bilateral facet hypertrophy. There is crowding of the nerve roots within the thecal sac at this level and overall a moderate degree of spinal stenosis. The exiting nerve roots within the neural foramina are surrounded by fat at this level. The spinal stenosis is regressed compared to the 10/2/2012 exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and mild bilateral facet and ligamentum flavum hypertrophy at this level.At L2-3 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with mild facet and ligamentum flavum hypertrophy. There is partial effacement of the spinal fluid surrounding the cauda equina at this level. Overall there is a moderate degree of spinal stenosis at this level. This has progressed since the prior exam of 10/2/2012.At L1-2 there is no significant compromise to spinal canal or neural foramina.There are Schmorl's nodes present at T12-L1. There is a vertebral body hemangioma present at T12 and another one at T11 | 1.The patient is status post intraspinous posterior fusion at L4-5 since the prior exam. There is spinal stenosis at L4-5 has regressed compared to the prior exam but is still present.2.Moderate spinal stenosis due to degenerative changes at L2-3 has developed since the prior exam from 2012.3.Degenerative changes are present in the cervical spine mainly resulting in encroachment of exiting nerve roots within the neural foramina at C3-4, C4-5 and C5-6. |
Generate impression based on medical findings. | Family history of breast cancer in her mother, sister, maternal aunt, and maternal cousin. BRCA1. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable left lobe liver cysts. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |