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Generate impression based on findings. | Reason: eval for sacroiliitis, inflammatory back pain There is no evidence of fracture or malalignment. Tiny osteophyte along the right SI joint but no fluid or enhancement within the SI joint to indicate sacroiliitis. There is benign-appearing cortically based lesion in the proximal right femur, which is incompletely imaged on this study, but of doubtful clinical significance and likely correlates with lucent lesion seen on CT from 7/20/2010. Otherwise bone marrow signal intensity is normal.There is small amount of fluid in the bilateral hip joints, which is normal. We see no synovitis. The muscles are within normal limits.Enlarged prostate is noted. | Minimal osteoarthritis of the right SI joint, but no evidence of sacroiliitis. Other findings as above. |
Generate impression based on findings. | 49-year-old female patient with low back pain, L5-S1. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There is a grade 1 retrolisthesis of L5 on S1 with severe degenerative disc disease at this level. There is also disc narrowing and dessication at L3/L4 and L4/L5. There is underlying mid to distal lumbar developmental narrowing of the spinal canal due to short pedicles and dorsal epidural fat. Multilevel degenerative changes are as described 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: Minimal posterior disc bulge, ligamentum flavum thickening, and facet hypertrophy contribute to minimal bilateral neural foraminal stenosis and mild central canal stenosis. There is a small central annular fissure.L4-L5: There is a small central annular fissure with a shallow central disc protrusion, ligamentum flavum thickening, and facet hypertrophy which contributes to mild bilateral neural foraminal stenosis. No spinal canal stenosis.L5-S1: Grade 1 retrolisthesis of L5 on S1 with disc uncovering and superimposed mild posterior disc bulge contributes to moderate to severe bilateral neural foraminal stenosis. No significant spinal canal stenosis. There is a left far lateral annular fissure. There is nodularity of the left partially imaged adrenal gland. | 1. Grade 1 retrolisthesis of L5 on S1 with severe degenerative disc disease and moderate to severe bilateral neural foraminal stenosis at this level. Other findings including multilevel annular fissures as described above.2. Nodularity of the partially imaged left adrenal gland. Dedicated imaging may be obtained as clinically indicated. |
Generate impression based on findings. | Left arm and left numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter nonspecific focus of T2 hyperintensity in the left anterior insular subcortical white matter, which may represent a prominent perivascular space with CSF flow. The brain parenchyma and pituitary gland appear otherwise unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No evidence of acute intracranial hemorrhage, mass, or acute infarct. |
Generate impression based on findings. | Reason: 81 yo female with hx of IPMN s/p distal pancreatectomy and splenectomy in 2010; please evaluate for any abnormalities and or recurrence History: IPMN. ABDOMEN:LIVER, BILIARY TRACT: Nonvisualization of the main portal vein with cavernous transformation, unchanged. No suspicious focal hepatic lesion.Status post cholecystectomy. No intrahepatic or extra hepatic biliary ductal dilatation.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy. Previously seen multiple T2 hyperintense pancreatic lesions along the pancreatectomy margin are no longer visualized. Stable 3 mm T2 hyperintense focus in the uncinate. No new lesions. No pancreatic duct dilatation. Stable linear nonenhancing focus in the mid pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts, some of which are hemorrhagic, again 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.Previously seen multiple cystic lesions in the distal pancreas along the pancreatectomy margin are no longer visualized. No new lesions.2.Stable portal vein thrombosis with cavernous transformation. |
Generate impression based on findings. | 48 year old female with vulvar cancer, chest pain, troponinemia without epicardial coronary artery disease on coronary angiogram, pericardial effusion referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 150 ml (normal range 109+/-23), the LV end systolic volume index is 36 ml/m2 (normal range 18+/-5), the LVESV is 68 ml (normal range 31+/-10), the LV mass index is 64 g/m2 (normal range 67+/-11), and the LV mass is 121 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pre-contrast native myocardial T1 relaxation times are elevated (1160 ms). There is mild diffuse high T2 signal involving the myocardium suggesting edema.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 56%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 145 ml (normal range 110+/-24), the RV end systolic volume index is 34 ml/m2 (normal range 22+/-8), and the RVESV is 64 ml (normal range 35+/-13). 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 not completely assessed. Grossly no significant regurgitation. Tricuspid ValveThe tricuspid valve opens widely. There is no significant 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 normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion. There is mild enhancement of the pericardium with late gadolinium enhancement imaging and high signal on T2-STIR imaging. There is no evidence of pericardial constriction noted. Extracardiac FindingsThere is a moderate sized left pleural effusion and small sized right pleural effusion. There is mild compressive atelectasis of the left lung. 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. Findings as above correlating with acute pericarditis with trace pericardial effusion but evidence of constrictive physiology.2. The pre-contrast native myocardial T1 relaxation times are elevated (1160 ms) and there is mild high T2 signal likely representing mild myocardial edema. 3. The left ventricle is normal size and systolic function (LVEF 55%).4. The right ventricle is normal size and systolic function (RVEF 56%).5. There is a moderate sized left pleural effusion and small sized right pleural effusion. |
Generate impression based on findings. | 64 years, Female, brain lesion cord lesion. Per chart, patient has progressive left lower extremity weakness. BRAIN | 1. Brain MRI demonstrates no evidence of infarct, intracranial mass, or mass effect. There is evidence of mild chronic small vessel ischemic disease.2. No abnormal signal within the spinal cord. No significant stenosis in the cervical, thoracic, or lumbar spine. 3. Mild degenerative changes in the spine. There is mild to moderate right C5-C6 neural foraminal stenosis. There is also mild neural foraminal stenosis at L3-L4, L4-L5, and L5-S1 as described above. |
Generate impression based on findings. | Female, 60 years old, with history of metastatic lung adenocarcinoma, surveillance scan. Two subcentimeter foci of enhancement seen previously within the right postcentral gyrus, and a third within the left superior frontal gyrus, are no longer evident. Mild associated T2 hyperintensity has also resolved in these locations.No evidence of any new enhancing or nonenhancing intracranial lesion is seen. Ill-defined periventricular T2 hyperintensity is again seen compatible with prior therapy. No evidence of parenchymal edema or mass effect is seen. No restricted diffusion is detected.There is no evidence of any significant intracranial hemorrhage or abnormal extra axial fluid. The ventricular system is normal in size. | 1.Interval resolution of subcentimeter lesions seen in the right post central gyrus and left superior frontal gyrus.2.No new intracranial lesions are evident. |
Generate impression based on findings. | Female, 27 years old, with new onset seizure. As on the prior examination, numerous small foci of susceptibility are evident predominantly within the corpus callosum, and to a lesser degree, in the periventricular white matter. Accounting for differences in image quality related to 3T technique on the present exam, there does not appear to have been a significant increase in the number or size of these lesions.The above-mentioned lesions are associated with neither edema nor mass effect. No evidence of restricted diffusion is seen. No acute intracranial hemorrhage is demonstrated. No pathologic parenchymal or extra-axial enhancement is detected. The ventricles are normal in size and morphology. | Redemonstrated are multiple small foci of microhemorrhage within the corpus callosum and, to a lesser degree, in the periventricular white matter. The nature of these findings is uncertain, but they are in any event chronic. No new or acute intracranial abnormalities are detected to account for the patient's symptoms. |
Generate impression based on findings. | Diagnosis: Neoplasm of uncertain behavior of brain, unspecified Unspecified convulsionsClinical question: residual pilocytic astrocytoma after a subtotal resection, No follow up since 2012, evaluate for changesSigns and Symptoms: tumor, follow up , yearly Since the prior exam and heterogeneously enhancing mass located at the right pontomedullary junction associated with a septated multicystic component has increased in size. The enhancing component currently measures 47 x 30 mm coronal dimensions and previously measured 33 x 25 mm in coronal dimensions. The enhancing component that has enlarged most as the more superior aspect of the patient's neoplasm which bulges into the fourth ventricle. The combined cystic and solid component currently measures 55 x 51 mm axial dimensions and previously measured 41 x 31 mm axial dimensions. The cystic component has enlarged since the prior exam is along the more lateral aspect of neoplasm. The mass bulges further into the fourth ventricle relative to the prior exam. There is redemonstration of ventriculomegaly with enlargement of the temporal horns of the lateral ventricles. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently approximately 67 mm and previously was approximately 69 mm. Third ventricular diameter remains at 17 mm.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.Since prior exam, a posterior fossa neoplasm which is consistent with the patient's diagnosis of pilocytic astrocytoma and is centered at the right half of the pontomedullary junction has enlarged.2.Since the prior exam ventriculomegaly has mildly regressed. |
Generate impression based on findings. | Grade 2 olfactory esthesioneuroblastoma treated with recent radiation/chemo/surgery. Face: There are interval post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. There is moderate mucosal thickening in the right maxillary sinus, ethmoid, and frontal sinuses. There is a small area of relative T2 hypointensity and hypoenhancement in the right superior anterior ethmoid surgical bed, but otherwise no evidence of gross residual tumor in the rest of the sinonasal region. There is leftward nasal septal deviation. There are findings related to right dacryocystorhinostomy, but the orbits are otherwise grossly intact. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst.Brain: There is no evidence of intracranial extension of tumor. There is a prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or 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. | 1. Interval sinonasal surgery with a small area in the right superior anterior ethmoid surgical bed that has features that resemble the original tumor, which may therefore represent a small amount treated tumor versus cauterized tissue amidst moderate right sinonasal mucosal inflammation, but otherwise no evidence of gross residual tumor in the rest of the sinonasal region.2. No evidence of intracranial tumor. |
Generate impression based on findings. | Pituitary cyst surveillance. There is no significant interval change in the nonenhancing low T1 and high T2 signal lesion centered in the left posterior pituitary that measures up to approximately 5 mm. The infundibulum and posterior pituitary bright spot is intact. There is no mass effect upon the optic apparatus. The cavernous sinuses are intact. | No significant interval change in the cystic lesion centered in the left posterior pituitary that measures up to approximately 5 mm. |
Generate impression based on findings. | Reason: evaluate for labral tear History: anterior hip pain ACETABULAR LABRUM: Small anterior superior labral tear with associated paralabral cyst.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL | Small anterior superior labral tear with associated paralabral cyst. |
Generate impression based on findings. | Low back pain, radiculopathy 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.Multilevel degenerative changes are seen, as described 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. Mild bilateral facet arthropathy.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild bilateral facet arthropathy.L4-L5: Disc desiccation without significant loss of height. There is moderate facet arthropathy bilaterally, particularly on the right. There is minimal bilateral neural foraminal narrowing. No significant spinal canal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Paraspinous soft tissues are within normal limits. There is a 2.9 cm cystic structure which is partially visualized and presumably and an adnexal cyst. Degenerative changes at the sacroiliac joints also noted. | 1. Mild degenerative changes in the lumbar spine with minimal bilateral neural foraminal narrowing at L4-L5. Otherwise no significant spinal canal or neural foraminal stenosis at any level.2. Multilevel facet arthropathy, relatively worse at L4-L5 which may be contributing to patient's low back pain. |
Generate impression based on findings. | 33-year-old male. Abdominal pain in left upper quadrant modified with food and alcohol. Perform gadolinium and secretin to rule out pancreas disease. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal signal intensity and morphology of the pancreas with no focal lesions. No pancreatic ductal dilatation. Appropriate physiologic response of the pancreas to secretin. Pancreatic duct is normal in morphology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Unremarkable MRCP of the pancreas. No evidence of acute or chronic pancreatitis. |
Generate impression based on findings. | 62-year-old male with weight loss, acute swelling, fluid testicles. PSA 4.9 (7/2/2016), 3.67 (1/12/2015). Biopsy 8/25/2016 Gleason 6. PELVIS:PROSTATE:Prostate Size: 5.2 x 5.8 x 2.9 cm.Peripheral Zone: There is diffuse T1 hyperintense signal throughout the peripheral zone consistent with hemorrhage. No dominant lesion is identified to suggest malignancy.Central Gland: Moderate degree benign prostatic hypertrophy.Seminal Vesicles: Asymmetric appearance of the seminal vesicles with loss of T2 signal on the left.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Large left hydrocele.OTHER: No significant abnormality noted. | 1.Significantly limited examination due to diffuse hemorrhage throughout the peripheral zone. No dominant lesion is identified to suggest malignancy.2.Large left hydrocele. |
Generate impression based on findings. | 15-year-old female with injury after basketball game. Evaluate for injury. MENISCI: Branching high signal is present within in the posterior horn of the medial meniscus, which extends to both articular surfaces compatible with complex meniscal tear. The anterior horn of the medial meniscus as well as the anterior and posterior horns of the lateral meniscus are intact.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal in the lateral femoral condyle compatible with edema, with associated high signal in the underlying femoral condylar articular surface suggesting articular cartilage tearing.LIGAMENTS: There is a complete tear of the anterior cruciate ligament. The posterior cruciate ligament is intact. The lateral collateral and medial collateral ligament complexes are intact. EXTENSOR MECHANISM: High signal is evident within the medial and lateral patellar retinaculum consistent with edema. The extensor mechanism is intact.ADDITIONAL | 1.Complete tear of the anterior cruciate ligament with associated marrow edema in the lateral femoral condyles.2.Complex tear of the posterior horn of the medial meniscus.3.Edema affecting the medial and lateral patellar retinaculum.4.Moderate/large joint effusion. |
Generate impression based on findings. | 16-year-old male with history of NF1. BONE MARROW: No significant abnormality noted.SOFT TISSUES: Plexiform neurofibroma extending from the bilateral lumbosacral spine through the left femur are again seen. JOINTS: No significant abnormality noted.ADDITIONAL | Extensive plexiform neurofibromas of the lumbosacral spine and left anteromedial femur, similar to prior. |
Generate impression based on findings. | 7-year-old male with history of tuberous sclerosis. Evaluate for renal angiomyolipoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is within normal limits.SPLEEN: The spleen is normal in appearance.PANCREAS: The pancreas is normal in appearance.ADRENAL GLANDS: No significant adrenal abnormality.KIDNEYS, URETERS: No hydronephrosis, hydroureter, masses or abnormal enhancement.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal abnormality.BOWEL, MESENTERY: No small bowel obstruction or significant abnormality.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No angiomyolipomas or additional significant abnormality. |
Generate impression based on findings. | 56-year-old man with lower back pain. History of lumbar fusion at outside hospital in 2013. Again seen are posterior spinal fixation rods with bilateral pedicle screws in the L3, L4, L5 and S1 vertebral bodies. Hardware loosening, described on recent MRI and CT studies, is not appreciated radiographically. There is no evidence of instability on flexion and extension views. | No evidence of lumbar spinal instability. |
Generate impression based on findings. | Female 59 years old Reason: chronic ACL tear, 6 months of left knee pain evaluate for meniscus tear, chondral injury History: left knee pain. MENISCI: There is a partial thickness radial tear of the posterior horn of the medial meniscus best seen on image 10 of series 4. There is additional intrasubstance signal within the posterior horn of the medial meniscus that appears to extend from the free edge of the meniscus to the periphery, likely representing additional horizontal tearing. There is intrasubstance degeneration of the body of the medial meniscus, and the anterior horn of the medial meniscus appears intact. Increased signal intensity within the posterior horn of the lateral meniscus likely simply represents the interface with the meniscofemoral ligament of Wrisberg. We see no definite lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is partial thickness degeneration of the articular cartilage of the medial femoral condyle just above the site of the aforementioned radial tear of the posterior horn of the medial meniscus. There also appears to be focal thinning of the subjacent articular cartilage of the medial tibial plateau. There is moderate thinning of the articular cartilage of the patella along both its medial and lateral facets, with subchondral cyst formation in the far medial aspect of the patella. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.Medial meniscal tear as described above.2.Partial-thickness cartilage degeneration as described above.3.Normal appearing ligaments. |
Generate impression based on findings. | Female 44 years old Reason: demoid tumor; colon cancer History: palpable RUQ mass 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: No significant abnormality noted.BONES, SOFT TISSUES: Again noted multiple enhancing lesions in the anterior abdominal wall predominantly on the right side but also on the left side. They have significantly decreased in size compared to previous MRI. An index lesion in the right upper lobe measures 4.2 x 4.4 cm on image #404, series #1104. An index lesion in the left anterior abdominal wall measures 1.9 cm in diameter image #354, series #1104. There are also multiple enhancing tracts likely secondary to previous laparoscopic surgery.Postsurgical changes secondary to recent surgery in the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:No evidence of pelvic mass or free fluid. | 1. Postsurgical changes in the anterior abdominal wall.2.Enhancing residual masses in the anterior abdominal wall on both sides. |
Generate impression based on findings. | 23-year-old female with 10-cm pelvic mass on outside CT. Interpretation of outside exam requested. ABDOMEN:LUNG BASES: Single right lower lobe micronodular on image one of 89. No other abnormalities in the lung bases. Small hiatal hernia is noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unremarkable.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild prominence of the left renal collecting system. No evidence of stone.RETROPERITONEUM, LYMPH NODES: Please see below.BOWEL, MESENTERY: Thickening of the lateral gastric wall extending towards the GE junction. Ill-defined soft tissue density between the greater curvature of the stomach and spleen measuring 3.5 x 1.3 cm. Etiology of this soft tissue mass is unknown and may be related to gastric wall thickening. No abnormality of the small bowel. Colon is unremarkable except for mass-effect as is mentioned below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Uterus and adnexa are displaced by and abut the 10-cm mass that will be described further below.BLADDER: Bladder is distended and displaced by the pelvic mass.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mass effect on the rectum, displacing it to the right of the pelvic mass. No evidence of bowel obstruction. No evidence of invasion into bowel, as the fat planes between the mass and bowel are preserved.BONES, SOFT TISSUES: No significant abnormality noted. Specifically, no involvement of the pelvic bones or sacrum by the pelvic mass.OTHER: 10-cm pelvic mass which has centrally low density likely due to necrosis. It is most likely that the mass arises from the posterior wall of the vagina (better appreciated on the companion MRI study) as the adjacent pelvic bones as well as the uterus and adnexa are not clearly contiguous with the mass (this is also better seen on the outside MR images). | 1. 10-cm pelvic mass which has mass-effect on the rectum, bladder and adnexa. We favor a sarcoma with origin of this lesion likely the posterior wall of the vagina (this is better appreciated on the companion MRI). 2. Soft tissue density adjacent to the splenic hilum and gastric wall thickening as described above . Upper endoscopy is recommended for further evaluation. |
Generate impression based on findings. | History of cervical cancer. PELVIS:UTERUS, ADNEXA: Mildly heterogeneous appearance of the uterus is noted. No significant endometrial cavity dilatation. Unremarkable adnexa.There is abnormal dilatation, heterogeneous intermediate T2-weighted signal and restricted diffusion at the level of the cervix compatible with patient's known cervical cancer measuring up to 5.7 x 3.4 cm which appears to extend slightly cranially towards the internal os but not extending to the myometrium/endometrial canal. On sagittal images the right lateral margin of the cervix is ill-defined (series 601/28), suspicious for parametrial tumor involvement. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume of fluid within the pelvis. No peritoneal surface nodularity or restricted diffusion is identified.Colonic wall thickening which may be treatment related. BONES, SOFT TISSUES: Marked anasarca. Muscle fatty atrophy.OTHER: No significant abnormality noted. | Limited nonenhanced study re-demonstrates the cervical mass with suspected parametrial tumoral extension. The mass cannot be reliably compared to prior studies due to modality differences. The extent of signal abnormality is grossly similar to the PET/CT appearance. |
Generate impression based on findings. | Other symptoms and signs involving cognitive functions and awareness [R41.89], Reason for Study: ^Reason: eval for stroke, lesion History: facial droop, drooling, unrespsonsive x 10 minutes Brain MRINo evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.Scattered multifocal bilateral periventricular white matter T2/FLAIR high signal intensity lesions indicate nonspecific small vessel ischemic disease.Scattered several susceptibility lesions on bilateral hemispheres indicate possible chronic microhemorrhages or mineralizations.The ventricles, sulci and cisterns are 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. The mastoid air cells are clear.Retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate ectatic changes with tortuosity of the distal intracranial ICAs indicate atherosclerotic changes. However, there is no significant luminal stenosis (more than 50%). There is no evidence of intracranial aneurysm.Distal left vertebral artery is hypoplastic. | 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.2. Nonspecific small vessel ischemic disease.3. Atherosclerotic changes of intracranial arterial system without significant luminal stenosis. |
Generate impression based on findings. | 71 year old male with history of fall with neck pain. Please evaluate. There is no evidence of intracranial hemorrhage, mass or edema. 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.There is grade I retrolisthesis of C5 on C6 of approximately 5 mm that appears unchanged from the prior MRI 3/3/2009. In addition, there are destructive changes of the endplates at C5-C6 that is also unchanged; these findings are compatible with a chronic, non-progressive destructive process.Disk bulge noted at C3-C4; unchanged from previous MRI.No acute fracture. The remainder of the spine is in normal alignment. | 1. Stable destructive process at C5-C6; there are no findings to suggest acute or progressive process.2. No acute intracranial abnormality. |
Generate impression based on findings. | This exam was terminated prior to completion due to the patient reported chest pain and a rapid response being called. The MRA head was performed along with only the sagittal T1 and diffusion brain sequences.BRAIN: There are foci of restricted diffusion within the lateral thalami, larger on the right.MRA HEAD: 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 with a fetal origin of both posterior cerebral arteries and a dominant left vertebral artery. There is no evidence of flow-limiting stenosis or aneurysm. | 1.Very limited brain MRI demonstrating bilateral acute infarcts within the lateral thalami, larger on the right. Completion of the brain MRI is suggested. 2.No evidence of flow-limiting stenosis or aneurysm within the head. |
Generate impression based on findings. | Ms. Beal is a 48-year-old female with strong family history of breast cancer. Family history of breast cancer in her mother x4 times. Personal history of bilateral benign breast biopsies (left breast 2:00-fibroadenoma). She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered cysts are identified in both breasts. There is re-identification of a previously biopsied left breast fibroadenoma in the left lateral breast with faint associated enhancement, appearing unchanged in size and appearance when compared to prior MRI examinationsThere 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. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | MRI findings: Extensive areas of restricted diffusion in the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons compatible with acute infarction. There is T2 hyperintensity and encephalomalacia in the left inferior cerebellum, left occipital lobe and pons compatible with chronic infarcts. There is mild periventricular white matter hyperintensity related to chronic small vessel ischemic disease. No evidence of susceptibility foci are evident.There is mild global parenchymal volume loss. No evidence of mass effect or midline shift. The basal cisterns remain patent. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. MRA head findings: Please note this is motion degraded exam as well as technically limited. The intracranial internal carotid arteries are normal in course and caliber. The anterior and middle cerebral arteries show flow related signal with some wall irregularity but without hemodynamically significant stenosis or occlusion. The left vertebral artery is not opacified. The right vertebral artery is diminutive beyond the proximal V4 segment. The basilar artery is not visualized. The posterior cerebral arteries are also not visualized. Bilateral PCOM arteries appear to be present but they do not apparently compensate for the vertebrobasilar abnormalities.MRA neck findings: The common carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. There is some narrowing at the carotid bifurcations but without high-grade stenosis or occlusion.Bilateral vertebral arteries are poorly visualized which may be technical or could be related to atherosclerotic disease. | 1. Extensive areas of acute infarction involving the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons.2. Lack of flow in the vertebrobasilar circulation compatible with severe stenosis or occlusion.3. No significant vaso-occlusive disease in the anterior circulation.Above findings were discussed with Dr Warnecke at 10:30 hours on 12/21/2015. |
Generate impression based on findings. | Reason: eval microfrx healing History: pain MENISCI: There is blunting and deformity of the posterior horn of the medial meniscus which likely represents a combination of postsurgical changes from prior partial meniscectomy, degeneration, and prior tearing, appearing similar to the prior study. No fluid-filled defect is identified to suggest a new tear. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of the lateral compartment appears intact. There is near full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle posteriorly above the posterior horn of the meniscus with underlying subchondral signal abnormality. There is near full-thickness articular cartilage degeneration along the lateral facet of the patella which may have progressed slightly when compared to the prior exam. There is low signal intensity material identified along the lateral facet of the patella likely representing fibrocartilage related to prior microfracture, appearing similar to the prior study. There is subchondral edema in the surrounding area.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is a subcentimeter focus of fluid signal intensity along the posterior aspect of the PCL which may represent mucoid degeneration versus ganglion formation.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Blunting and deformity of the posterior horn of the medial meniscus, appearing similar to the prior study, likely representing a combination of postsurgical changes from prior partial meniscectomy, degeneration, and prior tearing. No new fluid-filled tear is identified.2. Slight interval progression of articular cartilage degeneration affecting the patellofemoral articulation with postsurgical changes consistent with the stated history of prior microfracture. |
Generate impression based on findings. | Bilateral leg weakness, evaluate for cord compression. Please note because of discomfort, patient could not be positioned in the conventional manner within the scanner, and as a result image quality is significantly degraded. Examination in the cervical region is of very poor quality. The ventral epidural space in the cervical region shows fairly uniform moderate T1 intensity signal with corresponding dark signal on STIR sequence. Compared to recent prior CTA of the neck this appears to reflect a combination of ligamentous thickening and perhaps some venous engorgement with the possibility of an acute epidural process considered less likely based on this limited evaluation.There is narrowing of the cervical spinal canal particularly at C5-C6 and C6-C7. There is probable myelomalacia of the cord at this level which was also present previously.Within the constraints of degraded examination, no evidence of cord compression is evident in the thoracic region.The evaluation of the lumbar region is again of poor quality due to multiple factors, particularly orthopedic instrument related artifact. There is evidence of previous surgery in the lumbosacral spine with orthopedic instruments significantly obscuring a large part of the spine. As seen previously, there is disc or ossific material projecting posteriorly into the spinal canal at L2-3 level which causes significant spinal canal narrowing and probable impingement of the cauda equina. Similar findings were seen on the prior exam. There appears to be marrow space edema involving L2 and L3. In addition, the L3 vertebral body seems to have lost height relative to the prior exam.In the right paraspinal soft tissues including the musculature, extensive edema and abnormal signal is noted. In particular the right psoas muscle is very edematous and contains a 16 mm focus of low T2 and high T1 signal which could represent hemorrhage. There is a lesser degree of paraspinal soft tissue involvement on the left side. | 1. Thickening of the ventral epidural tissues in the cervical spine is felt to most likely reflect ligamentous thickening and/or venous engorgement based on comparison with a recent prior CTA. An acute epidural process is considered less likely. Dedicated C-spine MRI imaging can be considered if the patient can be made comfortable or with anesthesiology assistance.2. No cord compression in the thoracic region.3. Postsurgical findings in the lumbar spine including posterior fusion which significantly limit the evaluation. As in previous exam a high-grade canal stenosis at L2-3 is seen with disc or bony material projecting into the spinal canal appearing similar to the previous exam.4. There is severe edema in the right paraspinal musculature and soft tissues in the lumbar region, right more than left. There appears to be a small fluid collection within the edematous right psoas muscle which may reflect hemorrhage. In addition there is edema involving the L2 and L3 vertebral bodies with suspected further loss of height of the L3 vertebral body. These findings raise the possibility of an infectious process such as osteomyelitis. Further evaluation with dedicated abdomen and pelvis imaging is suggested for further evaluation. Given difficulties with MRI tolerance, CT would be appropriate for this patient.Findings were discussed with Dr. Jacobson by Dr. Kumar at 15:13 hours on 11/6/2015. |
Generate impression based on findings. | This limited surgical planning exam redemonstrates a T2 hyperintense 17 x 18 mm lesion within the left pars opercularis. There are a few scattered unchanged punctate foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease. | Pretreatment MRI redemonstrates an unchanged lesion within the left pars opercularis likely representing low-grade glial neoplasm. |
Generate impression based on findings. | Thoracic or lumbosacral neuritis or radiculitis, RLE pain. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 9mm cyst along the left renal parenchyma. Smaller cysts are present in the right kidney. | No compromise to lumbar spinal canal or neural foramina. There are no significant degenerative changes in the lumbar spine. |
Generate impression based on findings. | 63 years Female (DOB:11/9/1952)Reason: Deduce etiology of chronic lumbar region back pain History: Chronic pain with ambulationPROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN 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. There is multilevel disc desiccation presentAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate bilateral facet hypertrophy at this level. There is mild narrowing of the neural foramina and 2 mm anterior subluxation of L5 on S1. There is disc desiccation at this level.At L4-5 there is a moderate bilateral facet hypertrophy at this level. There is mild narrowing of the neural foramina and 2 mm anterior subluxation of L5 on S1. There is partial effacement of the fat surrounding the right-sided exiting nerve roots at this level. There is some partial effacement of the fat at the left lateral recess at this level with some mild encroachment of the nerve roots at the left lateral recess.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a minor disc bulge and mild ligamentum flavum hypertrophy at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 10 mm cyst along the right kidney. | There are degenerative changes present in the lumbar spine mainly in the form of facet hypertrophy and to a lesser degree disc bulges worse at L4-5 and L5-S1. There is some mild encroachment of the nerve roots of the left lateral recess and right neural foramen at L4-5 related to the degenerative changes associated with some mild narrowing of the spinal canal. |
Generate impression based on findings. | A 45 year old female with history of hypertension, breast cancer after chemotherapy (including doxorubicin) and radiotherapy. An echocardiography showed decreased left ventricular systolic function. Because of chest pain, the patient was referred to stress cardiac MRI for further evaluation.MEDICATIONS: clonazepam, lisinopril, metoprolol, tamoxifen, venlafaxine, zolpidem 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 56%, the LV end diastolic volume index is 70 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 30 ml/m2 (normal range 18+/-5), the LVESV is 75 ml (normal range 31+/-10), the LV mass index is 30 g/m2, and the LV mass is 73 g. There are no regional wall motion abnormalities present.No thrombus is present.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 153 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 74 ml (normal range 35+/-13). Right AtriumThe right atrium is normal. 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 pericardial effusion.Extracardiac FindingsThe patient is status post right lumpectomy 2012 with radiation and chemotherapy. There is a T2 iso to hypodense lesion within the right breast measuring 1.9 x 2.4 cm (301/14) that correlates to the likely coil cyst within the lumpectomy bed, as described on the recent mammogram. Dedicated imaging of this lesion was not performed. The breasts are not included in their entirety within the field-of-view. | 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 56%).4. Normal RV size and systolic function (RVEF 52%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 31 years, Male, with Dandy-Walker variant, hydrocephalus, pituitary tumor, and headaches. Question any change in the pituitary tumor or the ventricles.. The bilateral lateral ventricles and third ventricles are collapsed and not appreciably changed since CT dated 1/27/2016. Left parietal VP shunt catheter is in place with unchanged position of the ventriculostomy catheter with its tip near the foramen of Monro. There is unchanged FLAIR hyperintensity in the left periatrial region compatible with gliosis, probably related to the ventriculostomy catheter. Linear FLAIR hyperintensity involving the left frontal periventricular white matter is also likely related to prior ventriculostomy tract. Focal thinning involving the anterior callosal body with susceptibility/chronic blood products also remains unchanged and corresponds to tract of ventriculostomy catheter seen on 3/22/2009.No evidence of acute ischemia or hemorrhage. No extra-axial collections. There is diffuse thickening of the calvarium which may be related to chronic shunting. Unchanged posterior fossa findings including a retrocerebellar arachnoid cyst which is associated with superior bowing of the tentorium, anterior displacement of the cerebellum, and mild scalloping of the occipital bone. This finding remains unchanged dating back to 7/22/2009.Dedicated images of the pituitary gland demonstrate unchanged appearance of the pituitary gland without definite evidence of pituitary micro or macroadenoma. There is slight heterogeneity of the posterior aspect of the pituitary gland with subcentimeter focus of T2 hyperintensity and enhancement which may represent a pars intermedia cyst and unchanged. Normal T1 shortening involving the neurohypophysis is not clearly seen which is nonspecific. Bilateral cavernous sinuses are unremarkable. Infundibulum is unremarkable. Optic chiasm and nerves are unremarkable. | 1. Shunted ventricular system remains decompressed and unchanged since CT head dated 1/27/2016.2. Posterior fossa findings including a retrocerebellar arachnoid cyst with local mass effect remains unchanged dating back to 7/22/2009.3. Unchanged appearance of the pituitary gland without definite evidence of micro- or macroadenoma. Tiny nonenhancing area in the posterior pituitary gland remains unchanged and may represent a pars intermedia cyst. No associated mass effect. |
Generate impression based on findings. | There is asymmetric volume loss within the left temporal lobe as well as less so throughout the entire left cerebral hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small focus of T2 hyperintensity within the left paramedian cerebellum which likely represents chronic ischemia. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. | Asymmetric volume loss of the left cerebral hemisphere most prominent in the left temporal lobe may be seen in the clinical setting of semantic dementia. |
Generate impression based on findings. | Newly diagnosed squamous cell carcinoma of the cervix presents for staging. PELVIS:UTERUS, ADNEXA: The uterus measures 8.8 x 4.4 cm in the sagittal plane. The endometrial cavity/canal is normal in signal intensity and thickness. The inner myometrium/junctional zone measures up to 9 mm with poorly defined margins but no cystic or hemorrhagic foci. Several large nabothian cysts.The left and right ovary are normal in morphology and size, measuring 2.9 x 1.8 and 2.4 x 1.8 cm, respectively, containing numerous follicles.There appears to be circumferential relatively poor enhancement of the cervix without a discrete nodule or mass. No evidence of invasion into the endometrium, invasion into the vaginal canal or parametrial extension. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No discrete cervical lesion is identified.Findings raising possibility of mild diffuse adenomyomatosis. |
Generate impression based on findings. | Clinical question: Rule out ischemic lesion. Signs and symptoms: Left hemiparesis. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke.Ectopia of cerebellar tonsils of approximately 5 mm with subtle deformity of cerebellar tonsils.There are several punctate foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter and with normal morphology and signal intensity of brain parenchyma otherwise on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses appear normal.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable. | 1.No evidence of acute intracranial process.2.Mild ectopia of cerebellar tonsils of approximately 5 mm with subtle deformity of cerebellar tonsils.3.Few scattered mostly bilateral frontal subcortical and periventricular foci of FLAIR hyperintensity are nonspecific however in proper clinical setting could represent chronic changes of mild small vessel ischemic strokes.4.Unremarkable nonenhanced brain MRI otherwise. |
Generate impression based on findings. | Clinical question: History of pituitary adenoma status post resection. Signs and symptoms: Surveillance scan. Again seen is previously debulked, enhancing sellar mass consistent with known pituitary macroadenoma. Compared to 7/16/2014, there appears to be minimal interval increase in size, measuring approximately 37 x 36 x 26 mm in the AP, transverse, and craniocaudal dimensions, previously 30 x 34 x 24 mm. Signal features are similar to prior with slight change in size of cystic areas. As seen before, anterior extension results in obliteration of the sphenoid sinus. Superiorly, there is no significant suprasellar extension and no mass effect on the optic chiasm. Mild tenting of the optic chiasm is again noted consistent with postsurgical change. Infundibulum is rightward deviated, similar to prior. Lateral extension on the left into the left cavernous sinus with partial encasement of the left cavernous internal carotid artery is again seen without narrowing of the left ICA caliber.Limited evaluation of the remainder of the brain again demonstrates enlargement of the lateral ventricles, particularly the right frontal horn, stable to minimally decreased in size in the interval. Scattered foci of T2 hyperintensity in the white matter also again seen and may represent small vessel ischemic changes. | 1. Compared to 7/16/2014, there is minimal interval increase in size of the sellar mass consistent with known pituitary macroadenoma as detailed above. There is no mass effect on the optic chiasm.2. Ventriculomegaly is again seen and stable to minimally improved compared to prior. |
Generate impression based on findings. | 30 year-old female with multifocal giant cell tumor. Now with right-sided chest wall pain. Evaluate for thoracic spine or rib lesions. Nonenhanced CT of thoracic spine:Axial 3-mm images of entire thoracic spine with zero degree angulation of the gantry were obtained. Sagittal and coronal 2-D reformatted images were obtained.Examination demonstrates normal density and alignment of vertebral column. There is no detectable lytic or sclerotic lesions of the vertebral column. No definite acute abnormality of perispinal soft tissues is identified. Very minimal degenerative disk disease throughout the thoracic spine is present. No evidence of central spinal stenosis or definitive neural foramina compromise on this exam is detected. Recommend follow-up with an MRI examination.Limited view of the proximal thoracic ribs are negative for any osseous abnormalities. | Negative nonenhanced CT of thoracic spine. Follow-up with dedicated MRI of thoracic spine likely more helpful for detecting the cause of patient's right sided chest wall pain. |
Generate impression based on findings. | Female, 83 years old, with worsening back pain and gait abnormality, and right leg weakness. History of back surgery. Findings compatible with prior surgery are again seen at the L4-5 level where evidence of right-sided laminectomy and facetectomy is demonstrated.The lumbar lordosis is straightened similar to prior. A trace anterolisthesis of L4 relative to L5 has slightly progressed.Vertebral body marrow signal is mildly heterogeneous which likely represents a combination of inhomogeneous fat and superimposed degenerative endplate signal change.Degenerative disc disease has progressed at L4-5 with further loss of disc height. The remaining disc levels appear similar to the prior exam. Level specific findings are as follows below.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed by level below.T12-L1: Facet hypertrophy. Minimal bulging disc. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L1-2: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Minimal bulging disc. Prominence of the epidural fat. Slight narrowing of the thecal sac without change. Mild left foraminal narrowing without change. L3-4: Moderate facet hypertrophy and ligamentum flavum thickening. Left anterior disc osteophyte, increased in size. Mild bulging disc. Mild generalized narrowing of the spinal canal without change. Mild left foraminal narrowing without change. L4-5: Advanced left facet hypertrophy. Postoperative findings at the level of the right facet. Left anterior disc osteophyte slightly increased. Disc bulging and disc uncovering. Mild to moderate generalized spinal canal narrowing with medial displacement of the left-sided cauda equina nerve roots. Moderate right and severe left foraminal narrowing. No significant interval changes. L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. | 1.Postoperative findings compatible with right-sided laminectomy and facetectomy at L4-5.2.Progressive disc degeneration at L4-5 with further loss of disc height. The combination of disc degeneration and posterior element hypertrophy results in a mild to moderate generalized spinal canal narrowing asymmetric to the left without significant interval change. The L4-5 neural foramina are both significantly narrowed but without noticeable interval change.3.Degenerative findings at other levels are relatively mild and unchanged with the exception of multilevel anterior osteophytosis which has progressed but which does not affect the spinal canal or neural foramina. |
Generate impression based on findings. | Hemangioma of intracranial structures [228.02], Reason for Study: ^Reason: 3T Scanner, CCM Protocol History: Abnormality noted on prior MRI; CCM vs. AVM, please evaluate and compare with priori images Brain MRIRe-demonstration of right cingulate gyrus anterior aspect signal void just above the level of caudate head. The lesion does not show associated edema, nor high signal intensity on T1 weighted image.On Gad enhanced image, there is prominent vascular structure extending from the lesion to the adjacent cortex.There is another linear enhancing structure on the left frontal lobe middle frontal gyrus. These two white matter linear enhancing structure are likely representing developmental venous anomaly (DVA).And the signal void lesion on the right cingulate gyrus likely represent cavernous malformation. The size and MR characteristics of the lesion do not show any interval change since prior exam.There is prominent enhancement on the right side angular gyrus which could represent prominent vein of Labbe or associated small DVA.There focal signal void on the left frontal lobe medial orbital gyrus (series 1202, image 14/28), however, this lesion was not seen on the original gradient echo images, thus the reconstructed images likely represent volume averaging artifact. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. | 1. Right cingulate gyrus cavernous malformation with associated developmental venous anomaly. Another developmental venous anomaly on the left frontal lobe and possible DVA on the right angular gyrus. No change since prior exam.2. Normal brain MRA. |
Generate impression based on findings. | Intractable headaches and vertigo, new onset. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. Internal Auditory Canals: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There appears to be a small amount of fluid within the right mastoid air cells. | 1. No evidence of acute intracranial hemorrhage, mass, or acute cerebral infarction.2. No evidence of inner ear or retrocochlear lesions.3. Apparent nonspecific small amount of fluid within the right mastoid air cells. |
Generate impression based on findings. | BRCA 1 mutation, needs screening MRI in comparison to prior exams. The patient is currently breast-feeding There is heterogeneous amount of fibroglandular tissue in both breasts.Marked patchy parenchymal enhancement is noted bilaterally consistent with lactational changes.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. | Limited examination given the lactational changes in both breast. Within these limitations, no MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | Compression of brain [G93.5] / Low back pain [M54.5], Reason for Study: ^Reason: Chiari malformation with back pain and headaches, follow up with CSF flow study History: Chiari malformation and back pain23 years Female (DOB:11/6/1993)Reason: chiChiarilformation with back pain and headaches, follow up with CSF flow study History: Chiari malformation and back painPROVIDER/ATTENDING NAME: DAVID M. FRIM SERVICES ANCILLARY Complete Spine MRIRedemonstration of Chiari I malformation (downward displacement of cerebellar tonsils) are seen, unchanged since prior scan.There is no evidence of syringomyelia.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1-2. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues and musculature are unremarkable.2D Phase Contrast MRA for CSF flowBidBidirectionalF flows across the foramen magnum seen both anterior and posterior aspect of upper cervical cord and cervicomedullary junction. In addition, subtle bidbidirectionalF flow is seen through the foramen Magendie.Comparing to prior scan, there is no significant interval change though this exam is not quantitative. | 1. Unchanged Chiari 1 malformation since prior scan.2. No evidence of syringomyelia3. Unchanged bidirectional CSF flow across the foramen magnum both anterior and posterior aspect of upper cervical spine and cervicomedullary junction as well as foramen Magendie. |
Generate impression based on findings. | Altered mental status, multiple myeloma. The images are degraded by patient motion. There is a mass centred within the clivus with extension into the left cavernous sinus. There is no gross mass effect upon the pons. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits and scalp soft tissues are grossly unremarkable. There is mild right maxillary and bilateral sphenoid sinus mucosal thickening and fluid in the left maxillary sinus. | 1. A lesion in the central skull base with extension into the left cavernous sinus is likely related to multiple myeloma, but assessment of the previously demonstrated epidural extension is limited by patient motion and the lack of intravenous contrast.2. No evidence of acute intracranial hemorrhage or acute infarct.3. Findings suggestive of acute sinusitis. |
Generate impression based on findings. | 73-year-old male with left shoulder pain, evaluate for tendon injury ROTATOR CUFF: There is a fluid signal intensity within the distal supraspinatus tendon at its insertion on the greater tuberosity. This tear disrupts the bursal surface fibers, but appears to spare the articular surface fibers. There is 5 mm retraction of the bursal surface fibers. Overall, the tear involves at least 50% of the tendon thickness and is approximately 1.5 cm in the AP dimension. It appears to propagate posteriorly as an interstitial tear of the anterior insertional fibers of the infraspinatus tendon. The majority of the infraspinatus tendon, however, appears intact. There is minimal fatty infiltration along the myotendinous junction of the supraspinatus and infraspinatus, but otherwise the muscles appear normal. The teres minor tendon and muscle appears normal. The subscapularis tendon and muscles are within normal limits.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is perhaps a small 7 mm ossicle along the anterior aspect of the acromion process. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid in the glenohumeral joint, but no effusion. The superior labrum is attenuated, likely representing chronic degenerative tearing. Inferiorly, the labrum is within normal limits for age. Mild osteoarthritis affects the glenohumeral joint.BICEPS TENDON: The biceps tendon and long head of the biceps appears normal. ADDITIONAL | Insertional bursal surface tear of the supraspinatus tendon, and other findings as described above. |
Generate impression based on findings. | This exam is degraded by motion artifact. There is mildly restricted diffusion within the peri-rolandic and occipital cortex bilaterally. There is no evidence of intracranial hemorrhage or mass. There are scattered mild foci of T2 hyperintensity within the supratentorial white matter without restricted diffusion. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There is fluid within the mastoid air cells. | 1.Mild bilateral perirolandic and occipital cortical acute ischemia compatible with hypoxic injury.2.Mild chronic small vessel ischemic disease. 3.Non-specific bilateral mastoid air cell fluid. |
Generate impression based on findings. | Male, 86 years old, with Bell's palsy, dysfunction of cranial nerves V1, V2, CN7 and CN6 on the right. Scattered foci of T2 hyperintensity are evident within the periventricular white matter and the pons. No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, no evidence of any pathologic parenchymal enhancement is seen.Scattered small foci of susceptibility are evident through the brain compatible with chronic microhemorrhage. No evidence of significant or acute intracranial hemorrhage. No abnormal extra-axial collections are detected. Ventricles and sulci are prominent compatible with diffuse volume loss. Prominence of the perivascular spaces is seen.There may be mild enhancement of the distal cisternal portion of the right trigeminal nerve. The other cisternal cranial nerves including the seventh nerves within the IACs are unremarkable.Very subtle asymmetric expansion of the right cavernous sinus is seen. This is felt to reflect the presence of abnormal soft tissue within the sinus which demonstrates a slightly different pattern of enhancement from the remainder of the cavernous sinus (see image 34 series 26, and image 33 series 27). This tissue can also be appreciated on precontrast T1-weighted images (image 41 series 17) and on diffusion-weighted images (image 371 series 18). This tissue occupies predominantly the upper aspect of the cavernous sinus with sparing of Meckel's cave, though it does abut the right ICA with possible mild vascular narrowing. This soft tissue thickening extends anteriorly and superiorly, nearly to the level of the orbital apex. In addition, V2 is seen to be thickened as it passes through the foramen rotundum into the pterygopalatine fossa (image 31 series 27). No specific lesions in the facial soft tissues are seen. An area of thickening or adherent secretions is seen within the left maxillary sinus, and at the left frontoethmoidal recess. No masses or cervical adenopathy are appreciated in the neck. On limited views of the cervical spine, multilevel spondylosis is appreciated most severely affecting the C5-6 level where there may be a mild spinal canal stenosis. | An abnormal soft tissue process is suspected within the upper aspect of the right cavernous sinus. This abnormality, although subtle, can be visualized on both pre- and postcontrast images and on diffusion-weighted images. The distal cisternal right trigeminal nerve enhances mildly which may be related to this process. The right V2 branch is thickened as it passes through the foramen rotundum. Meckel's cave and V3 appear to be spared.The differential diagnosis for these findings would include a cavernous sinus meningioma or nerve sheath tumor, as well as an infiltrative neoplastic process such as lymphoma or perineural tumor spread, or an infiltrative nonneoplastic inflammatory or granulomatous process.Findings compatible with chronic small vessel ischemic disease of the brain are seen. No significant or acute brain parenchymal lesions are appreciated. |
Generate impression based on findings. | Ms. King is a 39 year old female with personal history of BRCA2 mutation and strong family history of breast cancer including her mother (diagnosed at the age of 44) and maternal grandmother (diagnosed at the age of 63). There is scattered fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: N - Routine Mammogram. |
Generate impression based on findings. | Unspecified cerebral artery occlusion with cerebral infarctionDiagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainThere is diffusion restriction along the right MCA territory predominantly involving patchy areas along the right inferior and middle frontal gyri as well as the insular cortex. There are small foci of diffusion restriction along the right temporal lobe.There is subtle FLAIR signal hyperintensity in these areas of diffusion restriction.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The right MCA flow voids are not readily recognized.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries. There is a high grade stenosis at the distal right m1 segment involving superior and inferior divisions.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the PCA bilaterally with a tiny right p1 segment and a small left p1 segment. The LVA is larger than the RVA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The origins of the vertebral arteries are tortuous. | 1.Near complete occlusion of the right m1 segment of the MCA at the bifurcation and distal m1 segment with evidence for slow antegrade flow "outline sign" at the proximal right superior and inferior divisions.2.Acute cerebral infarction involving predominantly the right middle and inferior frontal gyri as well as the right insular cortex with associated smaller foci of infarction in the right temporal lobe.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for stenosis at the carotid bifurcation. |
Generate impression based on findings. | 83 years Male (DOB:6/26/1932)Reason: cause of seizure History: seizurePROVIDER/ATTENDING NAME: DAVID A HARTER JOHN P KRESS There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are a few punctate foci of signal hyperintensity on T2 and FLAIR imaging located in the brainstem thalami and external capsules.The lateral ventricles are fairly large. The biventricular diameter is approximately 47 mm on axial imaging. On coronal imaging at the level of the foramen of Monro biventricular diameter is 47 mm. The temporal horns of the lateral ventricles are large. The third ventricle measures approximately 12 mm diameter. The fourth ventricle also appears fairly large.No foci of diffusion restriction are appreciated intracranially.Is a focus of susceptibility effect present in the right thalamus medially and another one in the left cerebellar hemisphere.Much of the imaging is degraded by patient motion.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. | 1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami and external capsules are likely vascular related.3.There are microhemorrhages present. Underlying cause is not clear. The locations could suggest hypertension but this is nonspecific. Only a couple right identified4.There is ventriculomegaly present. The possibility of normal pressure hydrocephalus cannot be excluded.5.Exam is moderately degraded due to patient motion which would obscure more subtle abnormalities |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: Confusion, seizures. Nonenhanced head CT:Images through posterior fossa are unremarkable and stable since prior study. Previously noted acute hematoma in the right occipital lobe is again identified in the definitive interval change in its density or measurements. Mildly dilated supratentorial ventricular system likely result of parenchymal volume loss remain stable. Small amount of blood in the dependent portion of occipital horn of the lateral ventricle is noted. There is slight increase in the amount of blood in the left occipital horn likely result profunda precipitation of blood within the ventricle. Small amount of blood in the subarachnoid space also is noted and stable.Advanced periventricular and subcortical low attenuation of white matter is suspected for extensive small vessel ischemic stroke of indeterminate age. This findings were present on multiple prior CT and MRI exams and if no appreciable change. | Stable constellation of intracranial findings of right occipital lobe hematoma and its minimal surrounding vasogenic edema, mildly dilated supratentorial ventricular system and extensive small vessel disease. |
Generate impression based on findings. | 45-year-old male patient with history of osteomyelitis status post right second toe amputation.New wound, edema. Evaluate for osteomyelitis. There is soft tissue ulceration along the ball of the foot with extensive signal abnormality in the underlying subcutaneous soft tissues. Additionally, there is diffuse edema throughout the soft tissues of the foot.As seen on the radiographs, there is dorsal dislocation of the proximal phalanx of the great toe relative to the first metatarsal. There is a small rim-enhancing fluid collection immediately plantar to the head of the first metatarsal. There is erosion of the plantar and medial aspects of the head of the first metatarsal surrounding a small intramedullary focus of near fluid signal intensity. Although there is little enhancement of the medullary bone, these findings are suggestive of chronic osteomyelitis and a small intramedullary abscess. There is proximal displacement of the sesamoid bones with surface irregularity and signal abnormality of the lateral sesamoid likely reflecting chronic osteomyelitis. Mild signal abnormality within the lateral aspect of the base of the proximal phalanx may be related to chronic osteomyelitis or reactive osteitis. Signal intensity of the distal phalanx appears normal.The patient is status post amputation of the second toe. There is a sinus tract extending from the plantar surface of the ball of foot to what remains of the head of the second metatarsal. Small rim-enhancing fluid collections surround the second metatarsal head and probably communicate with the aforementioned sinus. There is abnormal signal intensity and enhancement involving the head and diaphysis of the second metatarsal indicating osteomyelitis.As seen on radiographs, there is deformity of the head of the third metatarsal and signal abnormality compatible with chronic osteomyelitis. There is signal abnormality within the proximal phalanx of the third toe compatible with chronic osteomyelitis. Signal intensity within the middle and distal phalanges are within normal limits. There is also a small enhancing fluid collection adjacent to the head of the third metatarsal.Abnormal signal intensity and enhancement involving the head, neck, and diaphysis of the fourth metatarsal is compatible with osteomyelitis. The phalanges of the fourth toe appear normal.There is a tiny focus of edema type signal in the head of the fifth toe metatarsal which is favored to be arthritic in etiology over osteomyelitis. The phalanges of the fifth toe are within normal limits. There is also a small rim-enhancing fluid collection (4-5 mm) immediately adjacent to the lateral aspect of the base of the fifth metatarsal with surrounding inflammation. A 6-7 mm collection of fluid signal intensity dorsal to the base of the fifth metatarsal may represent a synovial cyst or ganglion.Degenerative arthritic changes affect the bones of the midfoot. There is thickening of the plantar fascia. The flexor hallucis longus tendon is also abnormally thickened likely due to a chronic full-thickness tear and becomes inseparable from the plantar fascia beneath the first metatarsal likely representing chronic scarring. There is also enhancement surrounding the flexor tendons near the first metatarsal neck suggestive of tenosynovitis. Distal to this, the tendons are not visualized and may be torn. | Soft tissue ulceration with multifocal osteomyelitis and other findings as described above.These findings were discussed with M. Jacobs via telephone at 0959 hrs. |
Generate impression based on findings. | 54-year-old female with reportedly newly diagnosed HCC, evaluate extent of disease/cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Mildly cirrhotic liver morphology.There is a lesion within the inferior aspect of segment 6 measuring 5.7 x 7.4 cm which is hyperintense on DWI and T2 and hypointense on T1-weighted images. Following contrast administration no definite hyperenhancement on arterial phase images is evident. Progressive delayed enhancement is suggested within the lesion, may reflect underlying fibrous composition. This lesion is hypointense on delayed phase images. A branch of the right portal vein leading to the lesion is thrombosed.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: Multiple enlarged portacaval nodes measuring 3.1 x 1.8 cm (13/38) and 3.8 x 2.5 cm (13/49)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Basilar pulmonary opacities. | Outside exam read:1.Cirrhotic liver morphology with large segment 6 lesion. There is no definite hyperenhancement on arterial phase images (which would favor a hepatocellular carcinoma). Cholangiocarcinoma is favored given apparent progressive delayed enhancement within lesion, however remaining among differential considerations are an atypical hepatocellular carcinoma or hypovascular metastatic disease.2.Thrombosis of a branch of the right portal vein.3.Enlarged portacaval lymph nodes. |
Generate impression based on findings. | 40-year-old male with complex renal cyst on MRA. Evaluate the renal cyst. ABDOMEN:LIVER, BILIARY TRACT: There is a segment 7 intermediate T2 signal lesion measuring approximately 2.2 x 2.5 cm with avid arterial enhancement which persists; this lesion most compatible with FNH.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS:RIGHT KIDNEY:Right exophytic, well encapsulated lesion anteriorly (series 4, image 15) which demonstrates T1 and T2 heterogeneous signal with probable low level contrast enhancement. This lesion measures 2.7 x 2.3 cm. This is suspicious for renal cell carcinoma.Right inferior pole subcentimeter T2 hyperintense focus with thin septations which likely enhance (series 4, image 28).Right posterior T2 hyperintense focus with mildly enhancing thin septations (series 4, image 18), compatible with a complex cyst.Additional subcentimeter T2 hyperintense nonenhancing foci compatible with cysts.LEFT KIDNEY: Left mid pole T2 hyperintense subcentimeter focus with questionable enhancement (series 4, image 12). This lesion is too small to characterize.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.Right renal exophytic lesion anteriorly suspicious for renal cell carcinoma. Differential considerations include papillary over chromophobe.2.There are 2 complex cysts on the right and one complex cyst on the left as detailed above. Attention on follow-up is recommended.3.Segment 7 hepatic FNH. |
Generate impression based on findings. | 44-year-old male with new onset seizure. Evaluate for stroke, edema. There is an area of hypodensity in the right frontal subcortical region that may represent edema or encephalomalacia. This could be related to old ischemic change. However, an MRI is recommended for further evaluation. The ventricles and sulci are mildly prominent, which may represent volume loss considering the patient's age. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Right frontal subcortical hypodensity may represent edema or encephalomalacia. This could be related to old ischemic change. However, an MRI is recommended for further evaluation. |
Generate impression based on findings. | Left knee pain, questioning iliotibial band syndrome or patellofemoral stress syndrome MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is abnormal marrow edema within the patella with areas of near full-thickness to full-thickness articular cartilage loss particularly affecting the lateral facet. The articular cartilage of the medial and tibial compartments is relatively preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Articular cartilage loss affecting the undersurface of the patella with areas of near full-thickness to full-thickness loss affecting the lateral patellar facet associated with likely reactive marrow edema within the patella. The remaining knee otherwise appears normal. |
Generate impression based on findings. | Right-sided cervical radiculopathy. Motion artifact degrades the exam quality despite several repeat sequences. Axial T2* sequences are nondiagnostic due to technical factors.The cervical vertebral bodies are appropriate in overall alignment and height. There is mild desiccation of the intervertebral discs, with mild-moderate loss of disc height at C5-6. Disc heights are otherwise preserved. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to spinal canal or neural foramina.At C3-4 there is a trace disc bulge with superimposed mild left paracentral/foraminal posterior osteophyte disc complex and left uncovertebral arthropathy. This results in indentation of the left ventral thecal sac and moderate left neuroforaminal stenosis.At C4-5 there is mild left facet and uncovertebral arthropathy resulting in mild left neuroforaminal stenosis. There is no significant spinal canal stenosis.At C5-6 there is diffuse posterior osteophyte disc complex with left paracentral prominence. There may be resultant severe right and moderate-severe left neuroforaminal stenosis, but this is not well assessed secondary to motion artifact. There is no significant spinal canal stenosis.At C6-7 there is mild disc bulge with right paracentral/foraminal disc protrusion, left foraminal disc-osteophyte complex, and mild bilateral facet and uncovertebral arthropathy. These findings result in right greater than left moderate to severe neuroforaminal stenosis. There is no significant spinal canal stenosis.At C7-T1 there is focal right mid-foraminal disc-osteophyte complex with mild right neuroforaminal stenosis. There is no significant spinal canal stenosis.The vertebral artery flow voids appear to be intact. | Motion degraded exam. Moderate scattered spondylotic changes, with up to moderate-severe right greater than left neuroforaminal stenosis at C6-7 and C5-6, with focal right paracentral/foraminal disc protrusion at C6-7. |
Generate impression based on findings. | 46 or old female with multiple myeloma. Evaluate for bone lesions. SKULL: Two views of the skull show no discrete myelomatous lesions. Small lucencies are likely vascular in etiology.CERVICAL SPINE: Two views of the cervical spine show no discrete myelomatous lesions.THORACIC SPINE: Single view of the thoracic spine shows no discrete myelomatous lesions. LUMBAR SPINE: Two views of the lumbar spine show no discrete myelomatous lesions.RIBS: Single view of the ribs shows no discrete myelomatous lesions.PELVIS: Single view of the pelvis is limited by overlying bowel gas, though we see no discrete myelomatous lesion.UPPER EXTREMITY: Two views of the bilateral humeri and single view of the bilateral forearms show no discrete myelomatous lesion.LOWER EXTREMITY: Two views of the bilateral femurs and a single view of the bilateral tibia/fibula show no discrete myelomatous lesions. | No discrete myelomatous lesions. |
Generate impression based on findings. | Memory loss. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is prominent hypointensity in the bilateral basal ganglia. There is mild scattered cerebral white matter T2 hyperintensity. There are also a few scattered punctate foci of intraparenchymal susceptibility effect. There is mild diffuse cerebral volume loss. 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. There are bilateral lens implants. | 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild scattered cerebral white matter T2 hyperintensity are nonspecific, but may represent chronic small vessel ischemic disease3. Prominent hypointensity in the bilateral basal ganglia may represent a neurodegenerative process versus age-related mineral deposition. 4. Mild diffuse cerebral volume loss.5. A few scattered punctate foci of intraparenchymal susceptibility effect may represent chronic microhemorrhages. |
Generate impression based on findings. | There is residual subcortical T2 hyperintensity within the occipital lobes bilaterally. There are a few punctate foci of susceptibility effect in the bilateral parietal and occipital lobes as well. There are also unchanged scattered punctate cerebral white matter T2 hyperintensities and a focal defect in the right aspect of the body of the corpus callosum. There is an unchanged configuration of the ventricular system, with prominence of the lateral ventricles, particularly posteriorly, with associated diminished periventricular white matter volume. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The hippocampi are symmetric without abnormal signal. There is no midline shift. There are unchanged minimally low-lying cerebellar tonsils. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the ethmoid sinuses. | 1. Residual stigmata of previous posterior reversible encephalopathy syndrome are unchanged.2. Mild probable chronic small vessel ischemic disease without evidence of acute infarction.3. Unchanged ventriculomegaly with what appears to be colpocephaly.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Clinical question: Evaluate for etiology of altered mental status (metastases, CVA). Signs and symptoms cord altered mental status No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Extensive patchy periventricular and subcortical areas of low attenuation are nonspecific however likelihood of advanced small vessel disease should be considered. No evidence of cortical abnormality. Cortical sulci and ventricular system as well as the CSF cisterns are within normal range for patient's stated age.This examination cannot exclude metastatic lesion to the brain or leptomeninges without the benefit of contrast infusion. Further follow-up with an MRI is recommended. There is however no definitive evidence of metastatic disease on this non-infused study. Calvarial, paranasal sinuses and mastoid air cells are unremarkable. | 1.Findings highly suspected off small vessel disease of indeterminate age.2.Limited value examination for dictation of metastatic disease due to lack of contrast. Follow-up with an MRI is recommended.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable. |
Generate impression based on findings. | 59 year old female with a prominent pancreatic duct and intrahepatic ductal dilation. Presents with epigastric pain, nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No evidence of significant intra- or extra-hepatic biliary ductal dilation. No focal mass lesion identified within the liver. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is mildly atrophic, intrinsic T1 signal of pancreas within normal limits. There is mild dilation of the main pancreatic duct measuring up to 6 mm in diameter, appearing similar to the findings on recent CT examinations. There is a normal exocrine response to secretin augmentation. However, the main pancreatic duct does not distend in response to secretin administration. This finding is nonspecific but is suggestive of chronic duct dysfunction. No definite pancreatic lesion delineated. A benign ductal stricture is also a differential consideration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of prior gastrojejunostomy. BONES, SOFT TISSUES: No significant abnormality noted. | 1.Dilation of the main pancreatic duct with associated diminished response to secretin augmentation which may reflect chronic duct dysfunction. There is no focal obstructing masslesion identified, however, a benign stricture proximal to the confluence of the common trunk is not entirely excluded. Correlation with ERCP could be considered if clinically indicated. |
Generate impression based on findings. | The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a 1.0 x 1.1 cm T1 hypointense and T2 hyperintense focus within the body of the C2 vertebral body. There are minimal posterior disc-osteophyte complexes at multiple levels, but no significant spinal canal or neural foraminal stenoses. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | 1. Minimal degenerative changes of the cervical spine without significant spinal canal or neural foraminal stenosis. No spinal cord signal abnormality.2. A lesion in the C2 body is likely benign. However, further evaluation with radiograph or CT may be useful. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 76-year-old female with right shoulder pain and difficulty raising the right arm. Rule out rotator cuff injury. Patient motion artifact limits examination.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus at the level of its insertion on the greater tuberosity with minimal retraction, measuring approximately 12 mm in AP dimension. There is thickening and intermediate signal abnormality affecting the supraspinatus tendon indicating moderate tendinosis. There is mild fatty infiltration/atrophy of the supraspinatus.There is interstitial tearing of the infraspinatus at the level of the myotendinous junction. There is fatty infiltration of the infraspinatus at the level of the myotendinous junction. The infraspinatus muscle and tendon otherwise appear intact. The teres minor and subscapularis muscles and tendons appear intact. There is thickening and intermediate signal intensity within the subscapularis indicating a combination of tendinosis and redundancy of the tendon, given the lack of external rotation of the humeral head on this examination.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint with inferior osteophyte formation off the acromion process and clavicle resulting in slight impression of the superior fibers of the supraspinatus. There is a small amount of fluid within the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of the glenoid labrum, the labrum appears intact.BICEPS TENDON: There is thickening and intermediate signal abnormality affecting the extra articular portion of the tendon of the long head of the biceps indicating moderate tendinosis. There is longitudinal split tearing of the extra-articular portion of the long head of the biceps tendon. The intra-articular portion of the long head of the biceps is also thickened with increased signal abnormality suggesting moderate tendinosis. There is a subcentimeter focus of low signal abnormality within the tendon sheath of the long head of the biceps, along the anterior aspect of the humeral metadiaphysis, which may represent a loose body. Circumferential fluid within the tendon sheath of the long head of the biceps may reflect fluid extension from the glenohumeral joint versus a tenosynovitis. ADDITIONAL | 1. Full-thickness tear of the supraspinatus tendon and interstitial tearing of the infraspinatus as described above. Rotator cuff tendinosis as described above.2. Longitudinal split tear of the long head of the biceps tendon.3. Small glenohumeral joint effusion and other findings as described above. |
Generate impression based on findings. | Reason: chronic lateral patellar dislocation History: lateral patellar dislocation. Due to patient's body habitus, the high-resolution coil could not be used. An alternative coil was used resulting in slightly suboptimal images. MENISCI: Small foci of increased signal intensity within the root of the posterior horn of the medial meniscus of questionable clinical significance, but we see no definite tear.Intrasubstance abnormal signal in the posterior horn of the lateral meniscus indicating degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: Chronic lateral dislocation of the patella. Although evaluation of the articular cartilage is limited, there appears to be full-thickness loss of cartilage along the medial facet of the patella and near full-thickness cartilage loss more focally along the lateral facet of the patella. Femoral trochlea is shallow compatible with dysplasia. Trochlear cartilage appears relatively intact. There are small patellofemoral osteophytes.The tibial tuberosity-trochlear groove distance is 2 cm.Osteophyte formation with overlying full-thickness cartilage loss along the anterior aspect of the lateral femoral condyle. Also moderate degeneration is apparent along the weightbearing surface of the lateral femoral condyle and perhaps the anterior aspect of the lateral tibial plateau.Articular cartilage of the medial compartment is intact.LIGAMENTS: The ACL is intact. The PCL is intact. The MCL is intact. The LCL complex is intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL | Chronic lateral patellar dislocation with osteoarthritic changes and other findings as described above. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Patient with hemoglobin SC, severe headache. Nonenhanced head CT:No detectable acute intracranial findings. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.If concern for stroke is high recommend follow up with an MRI examination.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.Prominence of adenoids is noted. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Memory issues. Signs and symptoms: Memory issues. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrate small foci of flair hyperintensity in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglia and thalami and pons which are nonspecific, nonhemorrhagic and nonenhancing. However considering patient's stated age of 76 this appearance most likely representing microvascular chronic ischemic changes of mild degree.There is a slight prominence of cortical sulci and supratentorial ventricular system which may be still within upper range of normal for age.Post-enhanced images are negative for any abnormal enhancement the brain parenchyma, leptomeninges, peritoneum or the retro-orbital spaces.There is normal signal intensity intracranial venous sinuses and with normal pattern of enhancement.Images through the orbits demonstrate a small chronic right lamina papyracea blowout fracture.Paranasal sinuses demonstrate minimal chronic left maxillary sinusitis. Mastoid air cells demonstrate patchy opacification bilaterally. | 1.No diffusion weighted abnormalities and no acute ischemic stroke. 2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.No detectable abnormal enhancement.4.Small right orbital lamina papyracea chronic blowout fracture. |
Generate impression based on findings. | Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: pre op to use for navigation History: planning left suboccipital craniotomy for resection of cerebellar tumor The purpose of this imaging scan is preoperative localization using STEALTH protocol.Multiple fiducial markers attached on the scalp.There is a large [51.5 mm(RL) x 39.4 mm(AP) x 33 mm(CC)] posterior fossa likely extra axial mass with mass effect toward the left cerebellar hemisphere. The fourth ventricle appears to be deformed due to mass effect, with a slightly prominent ventricular system.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 51.5 mm(RL) x 39.4 mm(AP) x 33 mm(CC) sized left side posterior fossa likely extra axial mass with mass effects. |
Generate impression based on findings. | Brain MRI:Lobular abnormality is noted centered within the clivus extending into the adjacent sphenoid sinuses (right greater than left). There are also several foci of signal abnormality throughout the calvarium.There are a few scattered foci of T2 hyperintensity within the white matter without restricted diffusion or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within left maxillary sinus. Fluid is also present within bilateral mastoid air cells.Limited cord compression spine MRI:Widespread abnormality can be found throughout the spine with vertebral body compression deformities at several levels. Multilevel stenoses are present throughout the cervical spine as well as at the T4-T6 levels secondary to a combination of degenerative changes as well as osseous expansion. There is also narrowing of the central canal from L3 through L4, also secondary to osseous expansion. There also appear to be foci of epidural extension at the T4/5 as well as L2/3 levels. There appears to be moderate central stenoses within the cervical spine, however severe at the T4-T6 levels, with more moderate stenoses involving the lumbar spine. | 1.Minimal chronic small vessel ischemic disease. No acute ischemia.2.There is widespread myeloma involvement throughout the spine with vertebral body compression deformities at multiple levels throughout each segment, including possible epidural extension at the T4/5 as well as L2/3 levels.There appears to be moderate central stenoses within the cervical spine, however severe at the T4-T6 levels by definition resulting in cord compression, with more moderate stenoses involving the lumbar spine. Given the widespread skeletal pathology without comparison, it is uncertain the chronicity of the cord compression and stenoses. |
Generate impression based on findings. | 22 years, Female, hx of MS here w leg weakness, blurred vision, R hand tremor, eval for PMS vs MS vs acute process Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter throughout the bilateral cerebral hemispheres with morphology and distribution consistent with known demyelinating disease. There has been increase in size of multiple foci of enhancement (greater than 20) and T2/FLAIR hyperintensity associated with the lesions seen on recent MRI from 11/9/2016. A dominant tumefactive lesion in the left centrum semiovale again demonstrates small focus of enhancement as before but otherwise unchanged.Several posterior fossa lesions including the left middle cerebellar peduncle along the right lateral aspect of the fourth ventricle as well as left cerebellar hemisphere are similar to prior and do not demonstrate enhancement. There is a relatively mild burden of T1 hypointense lesions. Brain parenchymal volume is preserved.No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. There is also abnormal signal involving the partially imaged cervical cord with multiple foci of enhancement including the C2 and C4-C5 levels which are more conspicuous than on prior from 11/9/2016 although can be better assessed with dedicated cervical spine MRI. | 1. |
Generate impression based on 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 findings. | Increasing forearm mass Note that a marker was placed along the volar aspect of the midforearm in the region of the patient's mass. Again seen is an irregularly-marginated mass within the underlying subcutaneous fat of the volar forearm that contacts the underlying deep peripheral fascia of the anterior compartment musculature. This mass extends to the skin with the overlying skin surface appearing thickened. It now measures approximately measures approximately 3.1 x 1.4 cm in the transverse dimensions and 6.1 cm in the longitudinal dimension as compared to 3 x 1 x 5 cm previously. The mass demonstrates irregular and spiculated margins and is slightly hyperintense to muscle on T1, hyperintense to muscle on T2, and shows diffuse enhancement following gadolinium administration. There is subcutaneous edema extending along the fascia both proximal and distal from the mass over the majority of the length of the forearm appearing similar to the prior exam. The mass again does not infiltrate the underlying musculature. The muscles of the forearm are normal in caliber and signal and the marrow signal of the radius and ulna is also normal. There is mild edema and enhancement of the subcutaneous fat posterior to the olecranon which may reflect mild inflammation. | Increasing size of left forearm mass. |
Generate impression based on findings. | Headache. There is no evidence of acute intracranial hemorrhage, mass-effect, or shift. No abnormal extra-axial fluid collections are identified. The ventricles and cortical sulci are within normal limits. There is an abnormal soft tissue lesion identified intraconally with the left orbit measuring approximately 1.5 cm. This examination was not tailored for evaluation of the orbits. If further imaging is warranted dedicated orbital CT or MRI may be helpful. | No evidence of acute hemorrhage or shift. Intraconal mass lesion involving left orbit. This was also identified on prior MR imaging from March 16, 2009. |
Generate impression based on findings. | 67-year-old male with history of fall. MENISCI: There is a 12-mm ossicle within the posterior horn of the medial meniscus near its root ("meniscal ossicle") which likely reflects the sequela of an old meniscal root tear, as the root attachment itself is not visualized. There is also globular signal abnormality within the remainder of the posterior horn extending into the body indicating intrasubstance degeneration.Intrasubstance signal within the lateral meniscus also reflects degeneration, but we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly at the patellofemoral joint, with portions of the lateral patellofemoral articulation essentially devoid of articular cartilage. There are multiple foci of degenerative signal abnormality within the underlying bone. There is moderate thinning of the articular cartilage along the medial femoral condyle just above the posterior horn of the medial meniscus. There are small subchondral cysts within the anterior aspect of the medial tibial plateau. There is relatively mild articular cartilage degeneration within the lateral compartment. There are tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.No evidence of ligamentous tear.2.Meniscal degeneration with no evidence of acute meniscal tear; however there is a large ossicle present within the posterior horn of the medial meniscus likely representing a chronic avulsion/root tear.3.Osteoarthritis most severely affecting the patellofemoral joint.4.Moderate-sized joint effusion.5.Mild soft tissue edema as described above including edema within the popliteus muscle perhaps representing a mild strain. |
Generate impression based on findings. | 69-year-old female for follow-up of thyroid nodules. Prior right thyroid lobectomy and parathyroidectomy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: 4.2 x 1.9 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No massesLEFT LOBE: 2 masses are again noted in the left lobe of the thyroid. A lower pole mass that is solid with cystic components measures 0.7 x 0.8 x 1.4 cm. This was not measured in the prior study and is unchanged in size. A second, heterogeneous mass in the inferior left lobe involving the left isthmus measures 0.9 x 1.2 x 2.3 cm. When retrospectively remeasuring the prior exam, this is unchanged. In addition, this contains multiple areas of comet tail artifact consistent with colloid.ISTHMUS: See abovePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | No mass in the right thyroid bed.No significant change in size of left thyroid masses, one of which clearly contains comet tail artifact. |
Generate impression based on findings. | Reason: RIGHT HIP PAIN, PLEASE EVALUATE FOR LABRAL TEAR, PLEASE INJECT WITH KENALOG 40MG AT TIME OF MRI ARTHROGRAM History: right hip pain ACETABULAR LABRUM: There is a tear extending through the anterior superior labrum extending from the 1 to 2 o'clock position. Heterogeneity of signal of the posterior labrum suggests degeneration and degenerative tearing.ARTICULAR CARTILAGE AND BONE: We see no full-thickness cartilage defects. The bone marrow signal intensity of the right hip is within normal limits. Mild degenerative disc disease affects the level of L5/S1. Although this examination was not protocoled for detailed evaluation of the lumbar spine, there is also edema within the upper medial right sacral wing that we suspect may be degenerative in etiology.SOFT TISSUES: There is mild peritrochanteric edema bilaterally which is not necessarily of any clinical significance. There is mild edema seen on the coronal fat saturated T2-weighted images situated between the lesser trochanter and ischium, bilaterally, that could reflect ischiofemoral impingement. The hamstring origins appear intact. ADDITIONAL | 1. Tear of the anterior superior labrum with additional degeneration/degenerative tearing of the posterior labrum.2. Mild edema between the lesser trochanter and ischium, bilaterally, may reflect ischiofemoral impingement, but the clinical significance of this is uncertain.3. Mild peritrochanteric edema of questionable significance.4. Degenerative arthritic changes of the lumbosacral spine which could be better evaluated with a dedicated lumbar spine MRI examination. |
Generate impression based on findings. | Brain MRI:There are a few scattered punctate foci of T2 hyperintensity within bifrontal subcortical white matter, without restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size; incidental note is made of a cavum septum pellucid et vergae. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the inferior aspect of bilateral maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. Incidental note is made of a a few postinflammatory cysts within the nasopharynx. There is no abnormal enhancement within the brain. Cervical spine MRI:There is straightening of the cervical spine which is likely positional. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no significant degenerative disease or stenoses. There are no abnormal enhancing foci. | 1.There are a few scattered punctate foci of T2 hyperintensity within bifrontal subcortical white matter, without restricted diffusion, susceptibility abnormality, or enhancement. These are nonspecific in appearance, and the differential diagnosis would most likely include small vessel disease, migraine sequelae, or residua from previous head trauma. Given lesional morphologies and locations, demyelination is to be unlikely.2.Negative contrast enhanced cervical spine MRI. |
Generate impression based on findings. | Female, 34 years old, with one episode of right lower extremity numbness, and now with right T6-T10 numbness, urinary incontinence, and new headaches. Brain:A 6 mm enhancing lesion is evident along the roof of the right lateral ventricular body without significant mass effect. No additional enhancing lesions are seen. However, at least 10 scattered foci of T2/FLAIR hyperintensity are seen within the bilateral periventricular white matter, particularly clustered in the parietal regions, with additional focal lesions in the right pons and left brachium pontis. None of these lesions shows significant enhancement, but rather, several demonstrate conspicuous T1 hypointensity.No evidence of any significant parenchymal edema or mass effect is seen. Brain parenchymal volume is preserved. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.Thoracic spine:There may be a slight scoliotic curvature of the thoracic spine, but this could also be positional. Sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement, enhancement or edema are seen.A suggestion of T2 signal abnormality is noted within the left lateral cord at the C6-7 level, though this is evident on the first slice of the sequence only and may therefore be artifactual. More convincing T2 hyperintensity is seen within the right lateral cord at the T5 level, extending in the CC dimension for approximately one vertebral body length. No convincing pathologic spinal cord enhancement is observed.The intervertebral discs are preserved. No significant bulge or herniation is seen. The spinal canal and neural foramina are patent. | Multiple white matter lesions are identified in the brain involving the periventricular regions bilaterally and the pons. One lesion, along the roof of the right lateral ventricle, demonstrates enhancement, while the remainder do not.Also noted is a nonenhancing T2 hyperintense lesion within the right lateral spinal cord which spans approximately one vertebral body in length. There may be an additional lesion in the left lateral cord at C6-7 but this is suboptimally evaluated.The above findings are most likely to represent demyelinating disease. The possibility of some other inflammatory or autoimmune process would be less likely. |
Generate impression based on findings. | 57-year-old female with right shoulder pain. ROTATOR CUFF: There is mild heterogeneity of the supraspinatus suggesting mild tendinosis, but we see no fluid-filled tear. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is no evidence of joint effusion. There is intermediate signal intensity within the superior labrum suggesting degenerative tearing. The anterior superior labrum is attenuated which may represent additional degenerative tearing. The inferior labrum appears intact. BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which is of questionable significance. | 1. Mild tendinosis of the supraspinatus tendon without evidence of a rotator cuff tear.2. Mild osteoarthritis of the acromioclavicular joint.3. Degenerative tearing of the glenoid labrum. |
Generate impression based on findings. | Brain:Again seen are extensive postsurgical changes involving the calvarium including left and posterior calvarial cranioplasty as well as a suboccipital craniectomy and cranioplasty, better seen on prior CT. Again seen is a right posterior approach shunt catheter which courses within the right lateral ventricle and terminates near the callosal body. A stent is again seen extending between the cerebral aqueduct and dorsal subarachnoid space at the foramen magnum. The right lateral and third ventricles remain slitlike, unchanged. The left lateral ventricle is relatively larger but not particularly dilated and unchanged since 2/3/2014. The fourth ventricle remains enlarged, unchanged in extent, partially on an ex-vacuo basis secondary to encephalomalacia involving the inferior cerebellar hemispheres (right greater than left) and vermis. The degree of T2 and flair signal alteration involving the cerebellar hemispheres and vermis is stable. No areas of diffusion restriction is seen to suggest an acute ischemic event. There is high T2/FLAIR signal involving the bilateral cavernous sinuses extending into the bilateral tentorium favored to represent dural thickening/venous engorgement related to chronic shunting, and more pronounced when compared to more remote studies dating back to 2009. There is FLAIR hyperintensity along the surface of the left temporal lobe, which is new since 2/3/2014 MRI and may represent gliosis related to prior left-sided craniotomy and/or adjacent extra-axial collection seen on CT from March 20, 2014.CSF flow study redemonstrates biphasic flow anteriorly at the foramen magnum with no discernible CSF pulsation posteriorly, similar to the prior examination. As before, no definite evidence of CSF flow pulsation through the cerebral aqueduct, within the fourth ventricle, or through the stent. High-resolution 3-D T2 sequence also demonstrates focally diminished CSF space dorsally at the foramen magnum.Cervical spine: Motion degradation on the current and prior studies limit assessment, but there appears to be slight increase in size of the cervical syrinx at the C2 and C3 levels. The more inferior aspect of the syrinx extending from C4 to C7 is not appreciably changed and measuring approximately 10 x 9 mm at the C5-C6 level.A central disk protrusion asymmetric to left is present at C6-C7 with ligamentum flavum thickening similar to prior. Right paracentral disc protrusion at C7/T1 is also similar in appearance to the prior examination. There remains mild spinal canal stenosis from C5-C6 to the C7-T1 levels as before. | 1. Compared to MRI brain dated 2/3/2014 there is no significant change in appearance of the posterior fossa with evidence of prior Chiari decompression, fourth ventricular stent, as well as effaced CSF spaces and diminished flow dorsally at the foramen magnum.2. No significant change in size of the ventricular system without evidence of hydrocephalus. Unchanged slitlike right lateral ventricle and relatively larger left lateral ventricle. 3. Again seen is a cervical syrinx. Compared to 2/3/2014, there appears to be mild increase in size of the syrinx component at the C2 and C3 levels. The more inferior aspect of the syrinx which is larger extending from C4 to C7 is not significantly changed.4. Please see additional details above. |
Generate impression based on findings. | 25 year-old woman with history of knee pain status post motor vehicle accident. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a small focus of bone marrow edema affecting the lateral condyle of the femur, however there is no acute fracture. The articular cartilage of the knee is intact.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | Bone contusion of the left lateral condyle. |
Generate impression based on findings. | History of abdominal pain and biliary dilatation on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again is intrahepatic and extrahepatic biliary ductal dilatation with the common bile duct measuring up to 1.4 cm. This is similar to the recent 1/5/2015 CT of the abdomen and 10/9/2015 CT of the chest. It appears to taper smoothly at the level of the ampulla without a filling defect or discrete mass lesion. The intrahepatic ducts are mildly tortuous near the confluence of the left and right hepatic ducts. There is no abnormal duct wall enhancement.No focal liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Minimal calyectasis of the right renal inferior pole collecting system versus renal sinus cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Small right-sided Tarlov cyst is noted.OTHER: Susceptibility artifact from an ASD Amplatz closure device. | Intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla without associated pancreatic ductal dilatation, similar to CT from 10/09/2015. No filling defect, mass lesion or evidence of stricture. This may represent progressive changes from postcholecystectomy state. |
Generate impression based on findings. | Reason: hx atypical meningioma. Eval for growth History: none- surveillance Postoperative changes are again seen from previous right parietal craniotomy with paramedian craniectomy with subsequent cranioplasty.There is a small focus of diffusion restriction and intrinsic T1 hyperintensity anterior to the left paramedian parietal resection cavity with peripheral susceptibility, likely representing a small hematoma. There are other areas of other curvilinear susceptibility along the parietal lobes bilaterally, greater on the left side, consistent with chronic hemosiderin deposition. There is a similar configuration of extra-axial fluid subjacent to the craniectomy.There is redemonstration of an irregular heterogeneously enhancing nodule along the left parietal lobe at the upper margin of the resection cavity. Overall the pattern of enhancement appears slightly less confluent than on the prior exam, with a more lacelike appearance despite similar order of postcontrast imaging. This area of nodular enhancement measures up to 2.4 cm on the current exam on 1201/122, compared to previous comparable 2.8 cm. However, the rind of enhancement along the anterior aspect of the resection cavity measures 8 mm in greatest thickness on the current exam, previously 5 mm. In addition, there is a small area of new nodular enhancement anteromedial to the resection cavity as seen on 1201/128 which measures 6 x 5 mm in greatest axial dimensions. More inferiorly, this area of nodularity is again confluent with the prominent nodular enhancement located along the inferior aspect of the resection cavity extending to the right of midline which appears similar in overall size.The degree of T2/FLAIR hyperintensity within the surrounding parietal lobes in a vasogenic pattern appears similar. Areas of cystic degeneration are again seen along the right parietal lobe appears stable in size. Other scattered foci of nonspecific T2/FLAIR hyperintensity are seen within the periventricular and subcortical white matter. Ventricular caliber appears similar consistent with global volume loss.There is persistent left frontal sinus opacification. Scattered ethmoidal air cell opacification is also noted. | 1.Findings concerning for slight progression of tumor at the site of prior tumor resection in the high parietal regions, although slight decreased size and confluence of enhancement of the more superior posterior heterogeneous nodule.2.Stable pattern of edema the parietal lobes with evidence of cystic encephalomalacia in the right parietal lobe.3.Small focus of likely interval blood product anterior to the resection cavity. |
Generate impression based on findings. | Known osteochondral defect MENISCI: The medial meniscus is unremarkable. The lateral meniscus however demonstrates fraying of the inner edge with more discrete loss involving the apical aspect involving the posterior horn. Specifically extension is observed to the inferior articular surface. Both menisci are well anchored posteriorlyARTICULAR CARTILAGE AND BONE: The large medial femoral condyle osteochondral defect is again observed measuring 2 cm in both AP dimension and medial laterally. Depth approximately 6 mm in the defect extends up to and just touching the intercondylar notch. No evidence of underlying loosening or abnormal fluid.Marrow signal is otherwise unremarkable. The remaining cartilage is otherwise also unremarkable without focal defectsLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Large medial femoral condylar osteochondral defect and minimal apical lateral meniscal tear extending into the posterior horn. |
Generate impression based on findings. | No findings to suggest a seizure focus are appreciated. No evidence of cortical dysplasia, heterotopic gray matter, or loss of gray-white differentiation. There is no evidence of mass or acute infarct. There are no areas of abnormal parenchymal signal. The hippocampal formations are symmetric; normal in size and signal intensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Borderline low-lying cerebellar tonsils are again seen measuring up to 3-4 mm below the foramina magnum on the right. The midline structures and craniocervical junction are otherwise normal. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is paranasal sinus mucosal thickening most prominent in the maxillary sinuses where there is also a retention cyst. | 1. No evidence for mass or structural abnormality to suggest seizure focus.2. Borderline low-lying cerebellar tonsils without clear evidence of Chiari 1. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Clinical question: 63-year-old male with GBM. Off all treatments. Previously was on Avastin. Signs and symptoms: GBM. Pre and postcontrast enhanced brain MRI:Diffusion weighted images demonstrate a punctate focus of restricted diffusion in the subcortical white matter of the right superior temporal gyrus posteriorly (diffusion-weighted series 5 image 18).Examination demonstrate a large focus of FLAIR hyperintensity in the pattern of vasogenic edema however without mass effect in the right hemisphere extending from high convexity right posterior frontal to right parietal and extensively in the right posterior temporal region consistent with gliosis and with ex vacuo dilatation of right trigone of lateral ventricle. Minimal hemorrhagic changes in the right posterior temporal at the site of prior surgical intervention is again noted. No appreciable change since prior exam.Post enhanced images demonstrate no evidence of residual or recurrence of tumor. A very thin linear enhancement traversing the posterior edge of surgical cavity is identical to prior exam.Small focus of periventricular FLAIR hyperintensity in the left hemisphere similar to prior exam and highly suggestive of treatment changes.Subtle FLAIR hyperintensity in the pons similar to prior study and could represent posttreatment change or chronic small vessel ischemic stroke. Tiny small focus of FLAIR hyperintensity in the right cerebellum without enhancement or interval change since prior exam is also noted.Slight prominence of lateral ventricles with maintained midline is similar to prior exam. | 1.Punctate focus of restricted diffusion in the right superior temporal sinus posteriorly.2.Stable post operative and treatment changes of right posterior temporal lobe tumor without evidence of tumor recurrence as detailed. |
Generate impression based on findings. | Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: new right frontal mass History: LLE weakness There are irregular margin heterogeneously enhancing intra-axial masses one on the right middle frontal gyrus with the surrounding edema and another lesion on the right post central gyrus extended toward right superior parietal lobule. Both lesions show mixed signal intensities with enhancement. The right post central gyrus lesion shows restricted diffusion with subtle increase in CBV on perfusion imaging indicating high cellularity mass lesion instead of ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable except subtle mass effect toward right lateral ventricle. There are multiple small signal voids within the right middle frontal gyrus lesion indicating intra-tumoral hemorrhages.The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Multifocal irregular margined mixed enhancing masses with surrounding edema, differential diagnosis include multifocal primary intraaxial high grade glial tumor. Metastatic tumors are also one of differential diagnosis. |
Generate impression based on findings. | Bladder CA status post radical cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Cholelithiasis without cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. No suspicious renal lesion. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Postoperative changes of a cystectomy and neobladder creation, without evidence of complication. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal non-specific pelvic free fluid. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 64-year-old male with left knee pain. Evaluate medial meniscus. MENISCI: The lateral meniscus appears intact. There is increased signal abnormality and deformity of the posterior horn of the medial meniscus consistent with degenerative tearing. ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage most pronounced along the medial tibiofemoral compartment with foci of full-thickness and near full-thickness articular cartilage defects. There are foci of underlying bone marrow signal abnormality which are likely degenerative in etiology. No sign of tricompartmental degenerative changes including osteophyte formation and joint space narrowing.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | Degenerative arthritic changes most pronounced along the medial tibiofemoral compartment with associated degenerative tearing of the posterior horn of the medial meniscus and articular cartilage degeneration, as described above. |
Generate impression based on findings. | History of peak 53 mutation. Presents for cancer screening. SOFT TISSUES OF THE NECK: No significant abnormality noted.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 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:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedFEMURS: Within the distal diaphysis of the right femur there are several distinct adjacent very well-defined lobular medullary lesions which are mildly hyperintense on T1-weighted imaging relative to skeletal muscle and is homogenously hyperintense on T2-weighted imaging. There is mild expansion of the mid/distal femoral diaphysis. There is suggestion of peripheral sclerosis of the lesions. The extent of abnormality measures 10.2 cm in length (series 1001/13). There is no associated restricted diffusion or cortical breakthrough evident. There appears to be thin peripheral enhancement of the lesion, however this was not a dedicated post-contrast study. | Incompletely characterized lesions involving the distal right femoral diaphysis likely representing a benign etiology such as non-ossifying fibroma. Further evaluation with radiographs and dedicated imaging is recommended to exclude a less likely diagnosis of sarcoma. These findings and recommendations were discussed with the referring physician Dr. Onel. |
Generate impression based on findings. | Dizziness and giddiness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates a mucosal thickening in left sphenoid sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate medial deviation of the medial wall of the right orbit probably related to old right medial blowout fracture | 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for acute ischemic cerebral infarction. |
Generate impression based on findings. | Right shoulder pain not responsive to physical therapy. ROTATOR CUFF: The rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal in appearance. No fluid is noted within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is intact.The labrum is grossly within normal limits on this non-augmented evaluation.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are bilateral digital mammographic images (7/17/14), right digital mammographic images (7/24/14), left digital mammographic images (5/22/15), ultrasound images of right breast (7/24/14), ultrasound images of left breast (5/22/15), breast MRI (6/19/15) performed at Edward Hospital. For comparison, digital mammographic images (1/12/13, 12/4/10) are available. BILATERAL DIGITAL MAMMOGRAPHIC IMAGES (7/17/14):The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. RIGHT DIGITAL MAMMOGRAPHIC IMAGES (7/24/14):No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast.LEFT DIGITAL MAMMOGRAPHIC IMAGES (5/22/15):No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast.ULTRASOUND IMAGES OF RIGHT BREAST (7/24/14): There are no abnormal findings in the submitted images.ULTRASOUND IMAGES OF LEFT BREAST (5/22/15):There are no abnormal findings in the submitted images.BREAST MRI (6/19/15):MRI was performed with a protocol outlined in the outside radiology report.Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No mammographic, sonographic or MRI evidence of malignancy.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 92 year-old female. Follow-up ICH. Intraparenchymal hemorrhage is present in the right frontal pole. Edema is present throughout the right cerebral hemisphere with effacement of the cortical sulci which is most pronounced in the frontal pole. Accounting for differences in technique, these findings appear grossly unchanged when compared to the MRI dated 4/21/2009.The hemorrhage associated edema exerts mass effect upon the right lateral ventricle. Approximately 6 mm of midline shift and subfalcine herniation is present at the level of the genu of the corpus callosum. The basal cisterns appear preserved.In addition to the parenchymal hemorrhage, subarachnoid blood is noted along the right frontotemporal region and in the left frontal convexity.Mucosal thickening and an air-fluid level (likely blood) are present in the left maxillary sinus. Scattered mucosal thickening is present in the ethmoid air cells. Scattered opacification is present in the mastoid air cells bilaterally.Fracture is present in the left posterolateral aspect of the maxilla (series 3 image 3). Bruising is noted in the soft tissues of the left facial region. | 1. Right frontal lobe parenchymal hemorrhage with associated cerebral edema, mass effect, and midline shift. Accounting for differences in technique, these findings appears grossly unchanged from the MRI dated 4/21/2009.2. Maxillary fracture as detailed above. If this injury has not been previously evaluated, consider maxillofacial CT.3. Additional abnormalities as detailed above. |
Generate impression based on findings. | 60 year old with metastatic breast cancer. Now with new stroke seen on MRI. Signs and symptoms: new stroke stroke seen on brain MRI. CTA of intracranial circulation:65 cc of omni-350 is administered for this study.3-D reformatted images of this study were obtained utilizing a independent workstation. These images were utilized for interpretation on this exam. Additional 2-D reformatted images as well as MIP images were also utilized.CTA of intracranial circulation:Examination demonstrates patent and normal appearing bilateral internal carotid arteries across to skull base and in their supraclinoid portions. There are normal appearing patent bilateral posterior communicating arteries.Bilateral ophthalmic arteries are also visualized and unremarkable.Bilateral anterior and middle cerebral arteries with no evidence of pathology. Anterior communicating artery is unremarkable.There is a small left vertebral artery (hypoplastic nondominant). The left pica is visualized and unremarkable. The distal portion of left vertebral artery is extremely small and hypoplastic. This is a normal anatomical variation.The patent dominant right vertebral artery is also very small in size in a uniform fashion. The right pica is visualized and unremarkable. The basilar artery is small in it's caliber in a uniform fashion however remains patent throughout its course.The small size of the vertebral -- basilar system is believed to be secondary to prominent bilateral posterior communicating arteries.None infuse head CT:Examination again demonstrates a large area of vasogenic edema surrounding a mass in the right lateral aspect of the cerebellum measuring approximately 34 x 25-mm in size as was noted on prior MRI exam. There is significant mass effect on the fourth ventricle and anterior displacement and partial collapse of the fourth ventricle. This results in early onset of hydrocephalus of supratentorial ventricular system. Mass-effect in the posterior fossa and results in minimal effacement of the quadrigeminal plate cistern as well.Images through supratentorial space again demonstrate a focus of attenuation in the left periventricular white consistent with patient's known acute stroke described on prior MRI. There is no evidence of hemorrhagic transformation. There is no evidence of any new finding since prior exam. | 1.CTA of intracranial circulation demonstrates no detectable abnormality of bilateral internal carotid arteries, middle and anterior cerebral arteries and their branches. There are prominent bilateral posterior communicating arteries. There is small caliber of bilateral vertebral arteries and basilar artery in a uniform fashion which is believed to be due presence of large bilateral posterior communicating arteries. There is however no evidence of any definitive vascular lumen compromise of the vertebral -- basilar system infectious carotid disease and or dissection.2.None infuse head CT demonstrates right cerebellar tumor with surrounding vasogenic edema and mass effect on the fourth ventricle. Resultant mild hydrocephalus and supratentorial ventricles. These findings remain stable since prior MRI exam. Stable left periventricular white matter stroke with no interval change. |
Generate impression based on findings. | History of hepatitis C cirrhosis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic fibrotic liver morphology. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.Normally distended gallbladder.SPLEEN: Splenomegaly measuring 19.9 cm in the craniocaudal dimension.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: Gastroesophageal varices.BONES, SOFT TISSUES: Susceptibility artifact from lower lumbar spinal fusion hardware.OTHER: No significant abnormality noted. | Cirrhosis without a suspicious lesion. Gastroesophageal varices and splenomegaly. |
Generate impression based on findings. | Ms. Discipio is a 67-year-old female with known left breast cancer. Recent MRI demonstrated an indeterminate enhancing mass in the right upper inner breast. She presents today for MR directed ultrasound of this finding. A targeted right ultrasound was performed for the MRI/mammographic area of concern. In the right breast 2:00 location, approximately 2 cm from the nipple, two adjacent anechoic lesions are identified, measuring up to 8 x 2 x 4 mm. These are compatible with simple cysts. Additional similar appearing cysts are seen in the vicinity. These correspond to the MRI area of concern. | Multiple small cysts in the right upper inner breast, corresponding to the MRI area of concern. No sonographic evidence of malignancy. No additional imaging workup is necessary for the right breast. All results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | Syrinx of cervical and thoracic spine with adhesions. LP shunt. Worsening symptoms. Evaluate for changes. Examination is motion degraded. Again seen are are extensive postsurgical changes of suboccipital craniectomy and multiple cervical and thoracic laminectomies. Again seen is kyphotic attenuation of the cervical spine. Vertebral body heights are maintained. There are small disc protrusions at the C3-C4 to C5-C6 levels as well as a disc bulge at the C6-C7 level which are similar to prior and not associated with significant spinal canal stenosis. There is moderate to severe stenosis involving the right C3-C4 neural foramen and mild to moderate right and mild left neural foraminal stenosis at the C4-C5 level.Compared to 6/12/2014 there are areas of slight decrease in size of the cervical syrinx, which extends from the obex to the upper C6 level. For example at the mid C2 level syrinx measures 10 mm in the AP dimension previously 13 mm. At the right C4-C5 level, syrinx measures 3 to 4 mm in the AP dimension, previously 5 mm. There is significant volume loss involving the cervical and partially imaged thoracic cord as seen before with particular thinning at the lower cervical and thoracic level. The cord is posteriorly positioned along the posterior dural margin particularly at the cervicothoracic junction suspected to be related to adhesions. Position of the catheter within the syrinx from the C2-C4 level is similar to prior. A separate thoracic catheter is partially imaged. Thoracic syrinx which extends below the T2 level is seen only on the sagittal sequences.Diffuse calvarial thickening is partially imaged. | 1. Note patient could not tolerate the full requested studies and only cervical spine MRI could be obtained. There is mild decrease in size of the cervical syrinx compared to 6/12/2014. Thoracic syrinx is partially imaged and not adequately assessed.2. Significant volume loss involving the cervical and thoracic cord as seen previously with particular flattening and posterior position of the upper thoracic cord which may be related to adhesions. |