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Generate impression based on findings. | Reason: please do dr jave d ms protocol compare to prior History: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There is a moderate degree of periventricular and subcortical punctate and confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to last years exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is redemonstration of small foci of signal hyperintensity within the posterior aspect of the spinal cord along its midline at the C2, C3 -4 and C5-6 vertebral levels. These were also present on the prior exam from March of last year and is not display any interval change. No abnormal enhancing lesions are identified in the cervical spine.There is multilevel disk desiccation present cervical spine and mild reversal of the normal cervical curvature which is stable compared to the prior exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.A single hyperintense lesion measuring 12 mm in diameter is present which is bright on T2 and isointense on T1. It was not included on imaging on the prior exam it is associated with some enhancement following gadolinium administration. | 1.There are periventricular white matter lesions present which are stable since the prior exam and compatible with patient's clinical history of demyelinating disorder.2.There are several lesions present in the spinal cord which are compatible with a diagnosis of demyelination and stable since the prior exam. 3.There are mild degenerative changes present in the cervical spine without significant compromise of spinal canal or neural foramina. |
Generate impression based on findings. | 30-year-old male patient with PSC-IBD. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Again seen are alternating areas of intrahepatic biliary narrowing and dilation, particularly centrally and in the left hepatic lobe. These findings appear similar compared to comparison examination. No suspicious enhancing lesions seen. Hepatic vasculature is patent. Prominent lymph nodes are noted at the porta hepatis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesion in the inferior pole of the right kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Alternating intrahepatic biliary narrowing and dilatation compatible with known history of PSC, not significantly changed compared to prior.2.No evidence of cholangiocarcinoma. |
Generate impression based on findings. | 75 years, Female, Reason: Tremor, worse with action (such as finger to nose, where tremor becomes coarse). Difficulty with tandem gait (falls/steps rightward). Evaluate for cerebellar disease. There is mild volume loss involving the cerebellar hemispheres. There is also a tiny linear focus of T2 hyperintensity in the right cerebellar hemisphere suggestive of a small chronic infarct. Otherwise no significant abnormality in the cerebellum is appreciated. There is also mild supratentorial parenchymal volume loss, which is appropriate for age. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable.Degenerative changes in the cervical spine with spinal canal stenosis better assessed on recent MRI from 8/11/2016. | 1. No evidence of acute infarct, hemorrhage, or mass.2. Mild cerebellar and supratentorial parenchymal volume loss, which appears within normal limits for age. There is also a suggestion of a tiny chronic right cerebellar infarct. Brain MRI is otherwise unremarkable for age. |
Generate impression based on findings. | History of pancreatic tail cyst. Evaluate for any interval change. ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar simple cysts. Normally distended gallbladder. No focal suspicious lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable pancreatic tail unilocular cyst measuring 1.1 x 1.1 cm (series 901/28), unchanged. No suspicious enhancement. The main pancreatic duct is normal in caliber. Pancreas divisum.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. | No significant change in the is unilocular cystic pancreatic tail lesion. |
Generate impression based on findings. | 49-year-old female with abnormal uterine bleeding. Evaluate for adenomyosis. PELVIS: Motion artifact limits evaluation.UTERUS, ADNEXA: The junctional zone is ill-defined and diffusely thickened measuring up to 13 mm. There are multiple subserosal T2 heterogeneous lesions with the largest measuring approximately 3.7 mm; these lesions demonstrate heterogeneous enhancement and most compatible with leiomyomata.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: Right iliac fossa kidney is noted. | 1.Uterine leiomyomata.2.Within the limitations of motion artifact, findings suggestive of diffuse adenomyosis. |
Generate impression based on findings. | Female 49 years old; Reason: chronic tendinitis History: pain and swelling TENDONS: The flexor and extensor tendons are normal in appearance. The Achilles tendon is normal in appearance. No significant abnormality is noted.LIGAMENTS: The medial and lateral ligaments of the ankle are intact. No significant abnormality is noted.ARTICULAR SURFACES AND BONE: The bone marrow signal is within normal limits. No osteochondral defect is seen. No significant abnormality is otherwise noted. ADDITIONAL | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Orbital cellulitis possible orbital abscess: left orbital pain and blurry vision. There are secretions and moderate mucosal thickening diffusely throughout the left frontal anterior ethmoid, and maxillary sinuses. There is a defect in the left lamina papyracea with mild protrusion of the orbital contents, which is more conspicuous on the recent CT. There is high T2 signal and enhancement within the medial left orbital fat, mainly confined to the extraconal space. There is no evidence of intraorbital fluid collection. The left superior opthalmic vein demonstrates normal enhancement and the left globe and optic nerve appear to be intact. The right orbit appears unremarkable. The right maxillary and ethmoid sinuses and bilateral sphenoid sinuses appear unremarkable. There are several subcentimeter retention cysts in the adenoids. The imaged intracranial contents appear unremarkable. | Left osteomeatal unit pattern of sinusitis and medial left orbit cellulitis associated with a lamina papyracea defect, but no evidence of orbital abscess. |
Generate impression based on findings. | 60 year-old female with history of pain. There is narrowing along the superior aspect of the hip joint compatible with mild to moderate osteoarthritis. We see no fracture line, however there is periosteal bone formation along the medial aspect of the femoral neck which may represent a stress fracture in the correct clinical context. An MRI is recommended for further evaluation. | 1.Periosteal bone formation along the medial aspect of the femoral neck which may represent a stress fracture. An MRI is recommended for further evaluation.2.Osteoarthritis as above.Findings and plan discussed with Dr. Welch at 1030 on 2/4/15. |
Generate impression based on findings. | 81-year-old female with a history of a lung mass presents with back pain, concern for bony metastases; evaluate for spinal cord compression. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities or dural based metastases. There is diffuse patchy marrow replacement throughout the visualized spine.There are T2 hyperintense lesions corresponding to lytic lesions on recent chest CT and lumbar spine CT present. One is located on the right aspect of T5 and extends into the posterior elements of T5. There is soft tissue extension outside of the bony elements into the epidural space and into the adjacent T4-5 and T5-6 neural foramina. There is encroachment of exiting nerve roots at T4-5 and T5-6. There is no associated cord compression.There is a mild compression fracture present at T12 associated with a lytic lesion at T12 also visualized on the recent CT of the lumbar spine. There is no associated cord compression.There is a lytic lesion present along the anterior aspect of L2 which is hyperintense on T2 imaging and also identified on the recent CT of the lumbar spine. There is no associated cauda equina compressionThere are degenerative changes present in the cervical spine without evidence of associated spinal canal stenosis. This appears to be worse at C4-5, C5-6 and C6-7 where there are uncovertebral osteophytes and disc material narrowing neural foramina.There are degenerative changes present in the lumbar spine which appear worse at L5-S1 where there is a disc bulge present and loss of disc space heightA left lung mass lateral to the aorta and left-sided pleural thickening is partially imaged and better appreciated on the prior CT. | 1.No evidence of spinal cord compression. Please note that this is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities, nerve root involvement or dural based metastases. 2.There is a lytic lesion present at T5 which extends into the surrounding tissues including the right neural foramina of T4-5 and T5-6 and the epidural space. There is encroachment of the right-sided exiting nerve roots at T5-6 as a result. There is no spinal cord compression appreciated.3.There is a lytic lesion present at T12 associated with a mild compression fracture which is been also identified in the recent lumbar spine CT. There is no associated cord compression.4.There is a lytic lesion present within the L2 vertebral body which was also identified on the recent lumbar spine CT.5.There is a left-sided long the mass present which is associated pleural-based lesion. Please refer to the recent chest CT for further comments.6.There are degenerative changes present in the cervical spine and lumbar spine without evidence of spinal cord compression or cauda equina compression. |
Generate impression based on findings. | Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3], Reason for Study: ^Reason: hx of pituitary adenoma s/p RT, surveillance MRI History: HA Postsurgical changes with a defect along the right sella related to prior pituitary tumor resections are again demonstrated. The pituitary stalk remains mildly deviated to the right. No abnormal enhancing lesion is identified within the pituitary. Non pneumatization of the sphenoid sinus is again noted. Mild cerebellar tonsillar ectopia appears similar to prior examination. Scattered foci of T2/FLAIR hyperintensity involving the subcortical and periventricular white matter are again seen. The visualized brain parenchyma is otherwise grossly unremarkable. | Stable postoperative changes in the sella without new or enlarging lesions. |
Generate impression based on findings. | 58 years Female (DOB:4/12/1958)Reason: Left arm radicular pain with history of cervical fusion in 2002 History: AbovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The patient status post anterior fusion from C3 through C6. There is also osseous bridging across the C6-7 disc space. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with ligamentum flavum hypertrophy. There is effacement of spinal fluid ventral and posterior the spinal cord and overall a moderate degree of spinal stenosis at this level. There is also narrowing of the neural foramina bilaterally at this level with encroachment of exiting nerve roots. There is facet hypertrophy at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. | The patient is status post anterior fusion from C3 through C7. There is a moderate degree of spinal stenosis present at C7-T1 associated with encroachment of exiting nerve roots within the neural foramina at C7-T1. |
Generate impression based on findings. | Left sided weakness initially, followed by incontinence and LOC. Many of the images are degraded by patient motion.MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are subcentimeter defects in the bilateral thalami. There is mild supratentorial and infratentorial white matter T2 hyperintensity. There is no definite abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are secretions in the right posterior ethmoid sinus. There is a defect in the right medial orbital wall with herniation of the orbital fat and deformity of the medial rectus muscle. There is a subcentimeter right frontal scalp lipoma.MRA: There is mild stenosis of the right middle cerebral artery. The other major cerebral arteries appear to be patent. There is no evidence of cerebral aneurysms. | 1. Chronic lacunar infarcts in the thalami and mild small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or cerebral edema.2. Mild stenosis of the right middle cerebral artery.3. Chronic right medial orbital wall fracture. |
Generate impression based on findings. | Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Keflex 500 mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Keflex 500 mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Keflex 500 mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. Dynatrim was used to localize the left mid gland peripheral zone of the prostate at the site of the T2 hypointense lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the left side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc. | Successful core-biopsies of the left mid gland peripheral zone. |
Generate impression based on findings. | Female 85 years old with inflammation and severe pain in low back and left hip, evaluate for osteoarthritis Please note that the patient aborted the study before all pre-contrast sequences could be completed. No post-contrast sequences were performed.BONE MARROW: Bandlike signal abnormalities within the left sacral wing adjacent to the SI joint noted. There is similar but less extensive signal abnormality in the left superior iliac wing adjacent to the SI joint. There is also edema within the body and the superior ramus of the left pubic bone with edema in the adjacent adductor musculature of the hip. Based on location and morphology of these foci of signal abnormalities, we suspect they represent fractures, perhaps insufficiency fractures if there is no history of trauma. The bone marrow signal intensity is otherwise within normal limits.JOINTS: Trace fluid in in the left hip without frank effusion. There is a small amount of fluid in the right hip joint likely within normal limits.SOFT TISSUES: Other than the aforementioned edema of the left hip from a suspected stress fracture, the remaining visualized musculature is normal for age. ADDITIONAL | Limited study showing edema within the sacral ala bilaterally as well as the right pubic bone. Given the location and morphology of edema we suspect these represent fractures, perhaps stress fractures if there is no history of trauma. |
Generate impression based on findings. | 60-year-old female with past medical history of Crohn's status post colectomy with elevated bilirubin ABDOMEN:LIVER, BILIARY TRACT: Trace perihepatic fluid. The gallbladder is absent. No intrahepatic ductal dilation. The proximal common bile duct is difficult to visualize although the distal CBD is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 7 mm T2 hyperintense cyst in the right kidney. The right kidney is ptotic. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Ileus type bowel pattern. Small amount pelvic ascites is present.BONES, SOFT TISSUES: There is edema type signal in the subcutaneous tissue along the back.OTHER: Foley catheter is present. | 1.Limited examination due to the lack of IV contrast. The proximal common bile duct is difficult to visualize although the distal CBD appears normal in caliber. No intrahepatic ductal dilation. 2.The gallbladder is absent.3.Small volume abdominopelvic ascites and ileus type pattern. |
Generate impression based on findings. | Migraine, left sided numbness, and blurriness of vision. There is a punctate focus of high T2 signal and perhaps mild restricted diffusion in the medial right occipital lobe. There is no evidence of intracranial hemorrhage or acute infarct. There is a 20 mm wide arachnoid cyst in the middle cranial fossa with flattening of the anterior left temporal lobe. 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in a posterior left ethmoid air cell. | 1. A punctate focus of high T2 signal and perhaps mild restricted diffusion in the medial right occipital lobe may represent a recent "migrainous stroke" or embolic infarct or perhaps an atypical focus of demyelinating disease or incipient neoplasm, for example. Follow up via a brain MRI with contrast may be useful.2. Left middle cranial fossa arachnoid cyst. |
Generate impression based on findings. | Female, 51 years old. Pain MENISCI: The medial and lateral menisci are intact, without evidence of tear.ARTICULAR CARTILAGE AND BONE: There is a bone contusion along the posterior aspect of the medial femoral condyle. There is diffuse patellar chondral thinning, without focal defects.LIGAMENTS: The cruciate and collateral ligaments are unremarkable. EXTENSOR MECHANISM: Mild edema within the suprapatellar fat pad is nonspecific. The quadriceps and patellar tendons are unremarkable.ADDITIONAL | 1.Bone contusion along the posterior aspect of the medial femoral condyle. 2.Diffuse patellar chondral thinning, without focal cartilage defects. |
Generate impression based on findings. | 56 years Female (DOB:12/25/1959)Reason: please assess for atrophy History: MoCA score is 16, psychosisPROVIDER/ATTENDING NAME: KAMALA GULLAPALLI COTTS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of centrum semiovale, periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility weighted imaging there are punctate foci of signal loss present within the pons and left thalamus.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They are most likely vascular related. Please note that this degree of periventricular white matter lesion accumulation is more than expected at this age.2.Several microhemorrhages are noted in the brainstem and left thalamus. There are location suggests that these could be related to hypertension but they are nonspecific3.The degree of brain atrophy is commensurate with the patient's stated age. |
Generate impression based on findings. | 73 year old female with a left ear infection and pain with left face weakness, dysarthria, and stuttering. Evaluate the left ear and facial nerve for infection or mass. MRI Brain:Several sequences, including the axial thin section T2 and post-contrast sequences, are severely limited by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild-to-moderate periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.MRI IACs:Redemonstrated is left sided middle ear and mastoid air cell opacification. The bony erosion of the left lateral mastoid air cells is better appreciated on the recent head CT. There is extensive soft tissue edema and enhancement involving the left external auditory canal, peri-auricular soft tissues and extending inferiorly within the infratemporal space below the provided images. There is restricted diffusion involving this region as well. There is no loculated fluid or evidence of a drainable abscess. The left external auditory canal is narrowed from the edema compared to the right side but remains patent. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. | Significant left sided otomastoiditis with extensive soft tissue edema and enhancement involving the external auditory canal, peri-auricular soft tissues and extending inferiorly along the infra-temporal soft tissues. At this point, there is no evidence of intracranial extension and no evidence of a drainable abscess. |
Generate impression based on findings. | Right upper quadrant fullness, known PBC, evaluate for change in mass, known hemangioma ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic segment 6 T2 hyperintense focus demonstrating progressive enhancement, consistent with a hemangioma, measures 1 x 0.9 cm, image 17 series 3.Anteriorly located 0.9 x 0.5 cm subcapsular focus, T2 hyperintense with retention of contrast seen on delayed sequences, likely a hemangioma, image 7 series 3 and image 19 series 11. Additional subcentimeter focus previously seen more superiorly at level of hepatic dome not well visualized on current exam.Another T2 hyperintense focus measuring up to 4 mm and located in hepatic segment 8/7 on image 23 series 11 demonstrates no definite enhancement and is most likely a punctate cyst. Additional punctate cyst formation also seen.No biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Right-sided juxtaphrenic lymph nodes, stable to mildly decreased in size. Reference right anterior cardiophrenic lymph node measuring 1.6 x 1.1 cm, image 9 series 3, previously measured 1.9 x 1.1 cm. Right paracardiac lymph node near hepatic dome and measures 1.2 x 0.7 cm, image 5 series 3, previously measured 1.2 x 0.8 cm. Stable prominent gastrohepatic, periportal and retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable scattered cysts and hemangiomas.Unchanged lymphadenopathy. |
Generate impression based on findings. | Reason: h/o lung ca, r/o mets History: none The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subtle subtle T1 signal hyperintense small lesions located in the right thalamus, left putamen, left caudate nucleus, right posterior insular cortex and two at the right precentral gyrus (one at the hand motor area and another leg area). These are not associated with contrast enhancement. These were not clearly identified on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are additional T2 and flair signal hyperintensities within the pons - left more than right - and right thalamus which are not readily identified on the prior exam.Punctate foci of low signal on susceptibility-weighted imaging are present in the globus pallidi. Another one is present in the left hippocampus. These are stable and likely of little clinical relevance.Cortical T1 and FLAIR signal hyperintensities identifiable on the prior exam along the fusiform gyri just above the petrous bones are not identified on the current exam. They are located in an area where artifact may occur depending on the image acquisition. Please refer to comments from the prior report as these may be artifactual. The significance is thus uncertain.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.There is small lesions present in the right thalamus, left putamen, left caudate nucleus, right posterior insular cortex and two at the right precentral gyrus which are not identified on the prior exam. These are not typical for metastases, though it is conceivable in the appropriate clinical setting that they are related to partially treated metastases or atypical non-enhancing metastases. The possibility that these are benign cannot be excluded.2.Small lesions in the left pons and right thalamus are also new. These may be vascular related.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific but stable. At this age they are most likely vascular related. 4.Cortical T1 and FLAIR signal hyperintensities identifiable on the prior exam along the fusiform gyri just above the petrous bones are not identified on the current exam. They are located in an area where artifact may occur depending on the image acquisition. Please refer to comments from the prior report as these may be artifactual. The significance is thus uncertain. |
Generate impression based on findings. | Brain tumor. Status post resection. Evaluate extent of resection. The dural based, parasagittal right parietal mass has been near completely resected. There is small residual contrast enhancing tissue within the involved posterior segment of the superior sagittal sinus. There is also minimal, nodular contrast enhancing tissue is questioned in the adjacent dura over the right parietal convexity laterally and along the falx posteriorly. A small filling defect has developed in the superior sagittal sinus just anterior to the invaded segment and likely represents a small thrombus. Heterogeneous T1 shortening in the surgical bed reflects the blood products. Mild diffusion restriction along the resection cavity margin is consistent with cytotoxic edema with additional areas corresponding to blood products. The T2 hyperintensity surrounding the treatment surgical bed (vasogenic edema) has not significantly changed compared to the preoperative examination. The associated mass effect is stable or minimally improved with mild midline shift and mass effect on the right lateral ventricle but no uncal herniation.An extra-axial collection underlying the craniotomy flap has a maximum thickness of 11 mm (on sagittal images) causes mild mass effect on the underlying right perirolandic area. A small, thin right frontal subdural collection has a maximum thickness of 4 mm (on axial images) and causes no significant mass effect.The mastoid air cells and the paranasal sinuses are clear. The orbits are normal. | Expected postsurgical changes of right parietal parasagittal meningioma resection. There has been near total tumor resection with small residual enhancement within the invaded posterior superior sagittal sinus compatible with residual tumor. Minimal nodularity along the right parietal convexity dura and along the posterior falx may represent minimal residual tumor as well and can be assessed on follow-up studies. |
Generate impression based on findings. | Male 24 years old; Reason: injury History: pain, and decrease ROM LIGAMENTS: There is abnormal morphology and signal of the anterior bundle of the ulnar collateral ligament suggestive of a high-grade partial-thickness tear, if not a full thickness tear. Edema is seen in the adjacent soft tissues. The lateral collateral ligament appears intact.TENDONS: Mild edema is seen at the myotendinous junction of the flexor digitorum superficialis, suggestive of strain. The biceps, brachialis, and triceps tendons appear normal.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No osteochondral defect is seen.ADDITIONAL | 1. Findings suggestive of a tear of the anterior bundle of the ulnar collateral ligament.2. Strain of the flexor digitorum superficialis.3. Slight prominence of the radiohumeral plica, which can be seen in patients with synovial fringe syndrome, though is of questionable clinical significance in this patient. |
Generate impression based on findings. | Right parotid mass. There is a well-defined, bosselated, T2 hyperintense, heterogeneously enhancing mass in the superficial portion of the right parotid gland that measures 19 AP x 14 RL x 31 SI mm. The mass appears to be situated inferior to the main trunk of the right intraparotid facial nerve. The other major salivary glands are unremarkable. There is no evidence of significant lymphadenopathy in the neck. There are left thyroid nodules that measure up to 12 mm. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. | 1. A right parotid gland tumor that measures up to 31 mm likely represents a pleomorphic adenoma.2. Nonspecific left thyroid nodules measuring up to 12 mm. Follow up via thyroid ultrasound may be useful. |
Generate impression based on findings. | knee pain MENISCI: There is a bucket-handle type tear of the medial meniscus with the fragment displaced anteriorly towards the anterior horn of the meniscus. There is no evidence of lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: There are surgical changes of ACL reconstruction. The ACL graft is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1. Bucket-handle type tear of the medial meniscus with anterior displacement of the meniscal fragment. There is no evidence of a lateral meniscus tear.2. Intact ACL graft. |
Generate impression based on findings. | Female 85 years old Reason: evaluate for malignancy History: Eval abdomen and abnormal bladder wall thickening unintentional wt loss LIVER: 11.7 cm in length.Two septated cysts seen: 2.8 x 2.3 x 2.8 cm. The second measures 1.8 x 1.6 x 2.1 cm. These correspond to lesions seen on the MRI.Hemangioma along the posterior cortex of the liver is seen measuring 2.1 x 1.6 cm. Other smaller hemangioma seen on the MR is not visualized by ultrasound.Prominent diaphragmatic slips noted,should not be confused focal lesions. Flow in the portal vein is patent with a peak velocity .2 m/sec.GALLBLADDER, BILIARY TRACT: No evidence of gallstones. No intra-or extrahepatic biliary dilatation. Common bile duct .4 cm neither.PANCREAS: Small peripancreatic focal lesion 1.9 x 1.4 x 0.8 may represent a lymph node.RIGHT KIDNEY: 10.8 cm in length. Simple cysts. Upper pole cyst 2.6 x 2.2 x 2.2 cm.Large lower pole cyst 6.7 x 7.2 x 5.5 cm. No hydronephrosis.OTHER: Left kidney measures 10.4 cm in length. Left renal cyst 5.6 x 6.9 x 5.9 cm.No hydronephrosisSpleen 6.4 cm in length. | Hepatic cysts. Renal cysts. Peripancreatic lymph node. |
Generate impression based on findings. | 35-year-old male experiencing headache, history of AML status post stem cell transplant, recently hit in the face. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated is encephalomalacia in the right occipital lobe with predominantly gyriform areas of susceptibility effect, and ex vacuo dilatation of the right occipital horn. Also redemonstrated is mild encephalomalacia in the left occipital lobe. There are also a few scattered foci of susceptibility effect within the cerebral hemispheres and left cerebellar hemisphere, which are nonspecific, but may represent chronic microhemorrhages. There is no evidence of abnormal intracranial enhancement or acute infarction. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are unremarkable. | Stable bilateral occipital lobe encephalomalacia, right greater than left, but no evidence of intracranial mass or leptomeningeal disease. |
Generate impression based on findings. | Status post orthotopic liver transplant. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes from orthotopic liver transplant. The gallbladder has been surgically removed.No suspicious liver lesion. There is mild biliary ductal wall thickening and enhancement with mild central ductal dilatation without a focal lesion. The hepaticojejunostomy appears patent.The portal and hepatic veins are patent. Susceptibility artifact at the hepatic hilum limits evaluation of the hepatic artery.SPLEEN: Multiple punctate splenic siderotic nodules. The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes of the anterior abdominal wall.OTHER: No significant abnormality noted. | No suspicious liver lesion.There is mild biliary ductal wall thickening and enhancement with mild central ductal dilatation without a focal lesion. The hepaticojejunostomy appears patent. |
Generate impression based on findings. | A 38 year old female with hypertension and hyperlipidemia. Hospitalized now with a clinical diagnosis of myo-pericarditis. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal size with overall normal systolic function. There is mild hypokinesia and the basal to mid inferolateral wall. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 76 ml/m2 (normal range: 65+/-11), the LVEDV is 122 ml (normal range 109+/-23), the LV end systolic volume index is 31 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 69 g (normal range 114+/-24). There is late gadolinium enhancement in the subendocardium and mid myocardium of the infralateral wall at the basal and mid segments. This corresponds to the area of mild wall motion abnormality. While this can be seen with myocardial infarct, based on the clinical history, the finding is most suggestive of myocarditis. No thrombus is present.Left AtriumThe left atrium is normal size. Right VentricleThe right ventricle is normal size and normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 63 ml (normal range 35+/-13). Right AtriumThe right atrium is normal size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.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 no pericardial enhancement or effusion. | 1. The left ventricle is normal size with normal systolic function, the LVEF is 59%. There is mild hypokinesia at the area of enhancementdemonstrated by the infero-lateral wall base to midchamber. Given the clinical history, this is suggestive of myocarditis. No associated pericardial effusion or enhancement.2. The right ventricle is normal size and normal systolic function, the RVEF is 50%. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: 59M with gleason 6 PrCa on active surveillance History: as above. PELVIS:PROSTATE:Prostate Size: 2.8 x 4.8 x 4 cm.Peripheral Zone: In the left posterior mid/base peripheral zone there is a 0.7 x 0.9 x 0.8 cm tumor (series 501 image 80, series 601 image 21). Central Gland: Heterogeneous with probable hyperplastic nodules. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Findings suspicious for subcentimeter tumor in the left posterior mid/base peripheral zone. |
Generate impression based on findings. | Numerous FLAIR hyperintense foci are seen in the subcortical and periventricular white matter. Similar foci are seen in the centrum semiovale bilaterally, in the midbrain, pons and medulla. These foci are nonspecific but likely relate to chronic ischemic microvascular disease.Apparent punctate enhancement is suggested in the right aspect of the medulla (1501/32) and in the right aspect of the pons with no definite enhancement on the earlier obtained fat saturation post-contrast images. There is no corresponding abnormalities on T2 images, and therefore these are felt to be artifactual.Ventricular size is normal with no evidence of midline shift. No acute hemorrhage or edema. There are no diffusion abnormalities.There is a prominent area of intrinsic T1 hyperintensity in the suprasellar region posteriorly without significant superimposed enhancement and without drop out of signal on fat saturated images, consistent with an incidental ectopic posterior pituitary gland.There is leftward deviation of the nasal septum. There are mucous retention cysts in the posterior nasopharyngeal soft tissue. Scattered mucosal thickening is seen in the paranasal sinuses. | 1. No definite evidence of metastatic brain disease. 2. Incidental ectopic posterior pituitary.3. Moderate chronic small vessel ischemic changes. |
Generate impression based on findings. | Female, 63 years old, history of brain lesion, planning for resection. A rim-enhancing lesion centered in the right frontal corona radiata has increased in size compared to the prior examination, now measuring 45 x 41 mm, previously no more than 31 x 23 mm. The degree of surrounding parenchymal T2 signal abnormality and local mass effect is also increased.A second rim-enhancing lesion centered on the right paracentral lobule has also increased in size now measuring 28 x 19 mm, previously 14 x 11 mm.As above, there is some increase in local and regional mass effect related to these lesions with more sulcal effacement and a greater degree of midline shift to the left now up to 7 mm. The right lateral ventricle is minimally effaced if at all.No new enhancing lesions are seen. Sequela of prior right parietal vertex craniotomy are again seen. | Interval growth of both rim-enhancing right cerebral masses. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are 2 view mammograms of the bilateral breasts, 2 spot compression views of the right breast, and right grayscale ultrasonographic images dated 7/14/2016 and bilateral breast MRI dated 8/9/2016 performed at Saint Alexius Medical Center. Mammogram 7/14/16:Focal lobulated asymmetry is visualized within the retroareolar region of the right breast measuring approximately 5.2 x 4.9 cm extending towards the nipple that persists on spot compression views. No significant associated calcification is visualized. This asymmetry likely corresponds to patient's area of palpable abnormality.Ultrasound 7/14/16:Targeted grayscale ultrasound of the right breast at 12:00 about 3 cm from the nipple demonstrates a largely hypoechoic heterogeneous appearing lesion without significant posterior shadowing measuring 3.4 x 2.1 cm. Further, questionable satellite lesions are also visualized. No color images were obtained, as such vascularity was not assessed.In the interim between Ultrasound and Breast MRI FNA was performed for lack of correlate ultrasound findings when compared to the mammogram.Breast MRI 8/9/2016:There is abnormal non-mass contrast enhancement with many lateral and inferior satellite lesions within the central and superior right breast that reaches anteriorly to the nipple. The total extent of the pathologic enhancement measures 6.0 cm in the medial to lateral dimension, 7.7 cm in the AP dimension, and 5.5 cm in the superior to inferior dimension. Further, two axillary lymph nodes are pathologically enlarged, the largest of which measures 18 x 9 mm. | Abnormal non-mass enhancement on breast MRI dated 8/9/2016 as specifically outlined above (more disease seen on MRI than mammogram) dated 7/14/2016 and is compatible with malignancy. Further, two pathologically enlarged right axillary lymph nodes are visualized. Ultrasound of the right axilla can be performed.Kindly submit the pathology report of the right breast biopsy. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male, 44 years old, history of metastatic melanoma status post two cycles of Temodar. Assess response to therapy. Numerous enhancing parenchymal lesions are again seen, most of which have substantially decreased in size compared to the prior examination. Some of the larger lesions also show reduced edema. For example, a lesion along the left posterior insula now measures 6 x 3 mm, previously 10 x 7 mm. Likewise, a lesion along the right superior temporal sulcus measures 4 x 4 mm, previously 9 x 6 mm.A few lesions have not significantly changed in size but these represent the minority. No definite growing or new lesions are seen. As before, some of the lesions demonstrate hemosiderin staining compatible with blood product, particularly one along the left precentral gyrus, while others show intrinsic T1 hyperintensity which may reflect either blood product or melanin.No acute intracranial hemorrhage is suspected. No abnormal extra axial fluid collections are detected. The ventricles are stable and normal in size. | Interval response to treatment with a majority of the previously seen enhancing lesions showing a substantial reduction in size. |
Generate impression based on findings. | Male, 74 years old. Pain, swelling TENDONS: The Achilles tendon is thickened with areas of internal abnormal signal, compatible with mild to moderate tendinopathy. A 6-7 mm cystic structure is noted within the tendon posteriorly approximately 2 cm from its insertion. A focus of fluid signal along the middle third of the Achilles tendon insertion on the calcaneus indicates a partial tear. There is moderate edema in the soft tissues surrounding the Achilles tendon. The other visualized tendons of the ankle had normal appearance.LIGAMENTS: The ligaments of the ankle are intact.ARTICULAR SURFACES AND BONE: There is marked bone marrow edema of the calcaneus centered on the Achilles tendon insertion, likely related to the tendon injury as described above. No discrete fracture line is identified. There is a small osteochondral defect at the medial talar dome. Additional degenerative changes are noted particularly involving the cuneiform-metatarsal articulations. There is a small tibiotalar joint effusion.ADDITIONAL | 1.Partial tear of the Achilles tendon insertion is likely subacute in nature on a background of mild to moderate tendinopathy. Bone marrow edema in the calcaneus is likely secondary to the Achilles tendon insertion injury.2.Medial talar dome osteochondral defect and additional degenerative changes throughout the forefoot and midfoot. |
Generate impression based on findings. | Nontraumatic intracranial hemorrhage, unspecified, evaluate for microbleeds. The exam is degraded by patient motion. Within this limitation, there is an unchanged hematoma in the right thalamus with intrinsic T1 signal and surrounding T2 hyperintensity, measuring up to approximately 20 mm. There is no evidence of acute infarct. There is unchanged extensive T2 hyperintensity involving the bilateral cerebral white matter, bilateral basal ganglia, thalami, and brainstem. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right lens implant. The skull, paranasal sinuses, and scalp soft tissues are unchanged. | 1. Unchanged small subacute right thalamic hematoma.2. No evidence of acute ischemic cerebral infarction.3. Extensive white matter abnormality may represent chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 65-year-old female with altered mental status. Evaluate for CVA. Patient is status post right parietal craniotomy with region of encephalomalacia seen in the right precentral gyrus, involving the right centrum semi-ovale as well. Patchy hypoattenuation areas are also seen in bilateral corona radiata. These findings appear relatively unchanged on comparison to previous MRI from 2006. There is no evidence of acute intracranial hemorrhage, mass or edema. Hyperdense lesion seen in the medial right temporal lobe (series 4, image 9) also appears similar to prior studies. 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. | Postsurgical changes appearing similar to prior MRI from 2006. Please note that lack of IV contrast limits evaluation for tumor, and CT is insensitive to early detection of CVA. Consider contrast-enhanced CT or MRI to evaluate for tumor recurrence or stroke if clinically needed. |
Generate impression based on findings. | External impingement right shoulder ROTATOR CUFF: The supraspinatus and infraspinatus tendons are intact. There is a small articular sided partial tear of the subscapularis.SUPRASPINATUS OUTLET: Mild degenerative changes are seen at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of degenerative subchondral cysts in the humeral head.BICEPS TENDON: No significant abnormality noted. | Small articular sided partial tear of the subscapularis tendon. |
Generate impression based on findings. | Reason: r/o lose body fragment History: pain and locking of knee MENISCI: There is a oblique tear of the posterior horn of the medial meniscus which extends to the free edge of the meniscus as well as the tibial and femoral articular surface. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identifiedLIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Oblique tear of the posterior horn of the medial meniscus.2. Edema within the quadriceps fat pad is nonspecific but can be seen in fat pad impingement syndrome. |
Generate impression based on findings. | 64-year-old woman with history of HCC status post TACE/RFA in April 2015. ABDOMEN:LIVER, BILIARY TRACT: Ablation cavity in segment 5 (1011/172) appears similar to the prior examinations without evidence of arterial enhancing lesion. The liver is cirrhotic in morphology.No intra or extrahepatic biliary ductal dilatation. The patient is status post cholecystectomy.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: Bilateral breast prostheses noted. Mild degenerative changes in the lumbar spine noted.OTHER: No significant abnormality noted. | Segment five ablation zone without evidence of local recurrent or new disease. |
Generate impression based on findings. | 26-year-old male with recurrent dislocation of the patella. Evaluate for loose ligaments of the patella or internal derangement. MENISCI: There is linear signal abnormality which extends to the femoral articular surface within the posterior horn of the lateral meniscus which may reflect a small vertical tear. The anterior horn appears intact. There is linear increased signal abnormality within the blunted posterior horn of the medial meniscus which extends to the femoral articular surface consistent with a complex tear. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of full-thickness articular cartilage defects along the lateral aspect of the weightbearing portion of the medial femoral condyle. There are also full-thickness articular cartilage defects along the weightbearing surface of the lateral femoral condyle above the anterior horn of the meniscus with underlying subchondral signal abnormality. There is a suggestion of mild dysplasia of the medial facet of the femoral trochlea.LIGAMENTS: There is complete rupture of the ACL. There is a curvilinear focus of low signal intensity along the anterior aspect of the expected location of the ACL which may represent ligamentous fragments. The PCL appears intact. The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall-Salvati ratio measures 1.5 consistent with patella alta. The medial retinaculum appears intact. ADDITIONAL | 1. Complete rupture of the ACL.2. Tearing of the medial and lateral meniscus.3. Findings consistent with patellofemoral instability with a probable loose body within the joint space.4. Full-thickness articular cartilage defects as described above. |
Generate impression based on findings. | Osteomyelitis of the pubic symphysis. Evaluate for pelvic abscess. Extensive pelvic wall edema. Dependent body wall edema. Extensive edema signal of the adductor musculature bilaterally. Osteomyelitis affects the body of the pubic symphysis with extensive reactive osteitis extending along the pubic rami and inferiorly. There is air in the pubic symphysis and extending just superior to the pubic symphysis. This communicates with the fluid collection in the medial proximal aspect of the right thigh, better characterized on the dedicated MRI of the femur. There is extensive adjacent inflammatory/phlegmonous soft tissue changes about the pubic symphysis. The bladder is presumably collapsed and is not well seen. Involvement with the bladder cannot be excluded.No loculated drainable fluid collection is evident within the pelvis. Bilateral hip prostheses. | No loculated drainable fluid collection is evident in the pelvis. See the dedicated MRI of the femur report. Acute on chronic pubic symphysis osteomyelitis and inflammatory/phlegmonous soft tissue changes about the pubic symphysis, involvement with a collapsed non-visualized bladder cannot be excluded. |
Generate impression based on findings. | Multiple sclerosis with head and fatigue. There are several cerebral white matter lesions. A lesion in the left frontal centrum semiovale has slightly increased in size, although the associated enhancement has essential resolved. On the other hand, an anterior right frontal lobe lesion has decreased in size. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. | Multiple demyelinating lesions related to multiple myeloma, including decrease in size of a right anterior frontal lobe and slight increase in size of a left frontal centrum semiovale lesion. |
Generate impression based on findings. | 38-year-old male with tenderness, fever. Evaluate for epidural abscess. Alignment and bone density are within normal limits. Vertebral body heights and disk spaces are maintained. Hypertrophy of the facet joints at L3-4, L4-5, and L5-S1. The dorsal epidural fat pads are intact. There is no definite dural thickening along the ventral aspect of the spinal canal. No evidence of effacement on the thecal sac to suggest an epidural process. The paraspinous muscles are normal. No evidence of central spinal stenosis or neuroforaminal compromise at any level. | Limited study in evaluating for an epidural abscess. However, within the limitations, there are no findings to suggest an epidural process. No other specific findings on this study to explain the patient's symptoms. |
Generate impression based on findings. | 57 years, Female, Reason: H/o HCV; CT scan on admit showing 1.6 cm indeterminate lesion; stable from previous imaging in 11/2014; evaluate for HCC versus other etiology History: as above. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: 1.6-cm lesion in the left hepatic lobe is hyperintense on T2 weighted images with concentric enhancement which fills in on delayed phases. No washout.SPLEEN: Small splenule's. Subcentimeter splenic lesion which is hyperintense on T2, likely a lymphangioma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Enhancing left hepatic lobe lesion. There is a lack of nodular enhancement and an atypical hemangioma is considered most likely. 12-month follow-up is recommended. |
Generate impression based on findings. | Knee pain. Malignant neoplasm of the breast. Due to the patient's body habitus, the high-resolution knee coil could not be used. An alternative coil was used instead which results in slightly suboptimal image quality.MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: There is perhaps mild superficial degeneration of the articular cartilage along the lateral facet of the patella, but otherwise the articular cartilage appears normal for age. There is a 4 mm rounded focus of low signal intensity within the distal femoral metaphysis surrounded by a thin irregular rim of high signal intensity on the fat-suppressed T2-weighted images. This corresponds to a small sclerotic focus on recent radiographs. It is nonspecific. Bone marrow signal intensity otherwise is unremarkable.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact. There is mild signal heterogeneity of the quadriceps fat pad which is of questionable clinical significance. | 1.Minimal degeneration of the articular cartilage of the patella.2.Small focus of low signal intensity within the distal femoral metaphysis is nonspecific. While I suspect that it is benign in etiology, given the patient's history of breast cancer, follow-up radiographs are recommended to assess for interval change in size.3.Mild signal heterogeneity of the quadriceps fat pad may reflect chronic inflammation but is of questionable current clinical significance. |
Generate impression based on findings. | Female 79 years old with abdominal pain. A 1.5 cm cystic lesion in the uncinate process of the pancreas was seen on EUS done in August of 2016. Patient was also noted to have multiple other cystic type lesions. Please evaluate for interval changes. Additional history from the electronic medical record indicates a right nephrectomy for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: There are multiple T1 isointense to muscle, T2 bright, enhancing lesions within the right lobe of the liver. Corresponding restricted diffusion suggested. The largest lesion is in segment 6 and measures 1 x 1 cm (series 4, image 24). The hepatic vasculature is patent. There is no ascites.SPLEEN: No significant abnormality noted.PANCREAS: A 2.2 x 1.0 cm cystic, ovoid lesion in the uncinate process is favored to represent a side branch IPMN (series 4, image 14). An additional subcentimeter cystic lesion at the pancreatic head/uncinate process junction is likely an additional sidebranch PMN. No definite associated wall thickening or enhancement seen.There are multiple additional solid, avidly enhancing lesions along involving the length of the pancreas, i.e., the head, body and tail, at least one lesion shows central necrosis. The largest measures 3.5 x 3.4 cm (series 11, image 37) and insinuates between the pancreatic tail and stomach (versus a separate metastatic deposit separate from pancreas).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is surgically absent. There is a subcentimeter T1 bright lesion within the left kidney which most likely represents a proteinaceous or hemorrhagic cyst, evaluation suboptimal due to small size and lesion is not well delineated on postcontrast sequences. Additional small foci within the left kidney are too small to reliably evaluate.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. Solid enhancing lesions along the length of the pancreas are most suspicious for metastatic renal cell carcinoma given multiplicity and the patient's remote history of RCC. 2. Neuroendocrine tumor another differential consideration.3. Findings concerning for hepatic metastatic disease.4. Probable sidebranch IPMNs in uncinate process.5. Please refer to details above. |
Generate impression based on findings. | The exam is markedly degraded by dental brace artifact. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute infarction in the areas that are not degraded by artifact. The paranasal sinuses and mastoid air cells are grossly unremarkable, within the limitations of artifact. | The exam is markedly degraded by dental brace artifact, but there is no gross intracranial mass. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male; 75 years old. Reason: eval PSC for dominant stricture, eval for HCC, f/u pancreatic cyst History: cirrhosis, PSC, pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver again seen. No focal, enhancing hepatic lesions. Portal venous system is patent. Gallbladder sludge and/or small stones.Stable appearance of the biliary tree with stable mild narrowing of the common hepatic duct and proximal common bile duct. No dominant biliary stricture.SPLEEN: Splenomegaly, similar to prior study.PANCREAS: Limited examination of the pancreas on M.R.C.P. images due to ascites. Within this limitation, uncinate process cystic lesion, likely due to side branch IPMN, appears grossly stable measuring up to 1.1 x 1.5 cm on coronal image 20, series 7.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: New moderate upper abdominal retroperitoneal lymphadenopathy. For future reference, the largest lymph node measures 3.9 x 1.5 cm (series 3/16).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.New moderate retroperitoneal lymphadenopathy.2.No focal, enhancing hepatic lesions.3.Stable appearance of the biliary tree, likely secondary to sclerosing cholangitis, with no new dominant stricture evident.4.No gross change in multiseptated uncinate pancreatic IPMN. |
Generate impression based on findings. | History of urothelial cancer with new onset pain to scrotum, pain worsening, please evaluate PELVIS:PROSTATE/SEMINAL VESICLES: Prostatomegaly, evidence of BPH, gland measures up to 6.1 cm (please note that prostate is suboptimally assessed on this nondedicated study).BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy. Enlarged right iliac chain lymph node measuring 2.7 x 1.5 cm on image 57 series 801, seen on prior CT imaging as well, please note that comparative measurements difficult due to differences in technique and modality. Additional prominent lymph nodes also seen (see key images) including more superiorly located enlarged right pelvic lymph node located just anterior to sacrum on image 61 series 801, measuring 1.6 x 1.5 cm and in retrospect also present on earlier CT imaging. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially imaged right-sided nephroureteral stent, seen curled just beyond the level of the UVJ, mild focal wall thickening seen in this region and mild ureteral wall thickening also seen. | Pelvic lymphadenopathy as above. |
Generate impression based on findings. | Male, 41 days old, ex 28 weeker with history of presumed meningitis, now with poor head growth. Hemosiderin staining is evident along the germinal matrices bilaterally. Hemosiderin staining is also evident within the occipital horn of the left lateral ventricle. A small focus of susceptibility effect is demonstrated in the left cerebellar hemisphere.The corpus callosum is fully formed and intact. The pituitary region is within normal limits. The brainstem, cerebellar vermis and cerebellar hemispheres are normally formed and unremarkable.No restricted diffusion is seen. The ventricular margins are smooth and symmetric. Ventricular size is within normal limits. No areas of parenchymal signal abnormality, edema or mass effect are observed. The degree of cerebral gyration is appropriate for the corrected gestational age. White matter myelination is slightly delayed for the corrected gestational age. | 1.Sequelae of mild bilateral germinal matrix hemorrhages are seen. In addition, there is evidence of hemosiderin staining within the left lateral ventricle which would imply some degree of intraventricular hemorrhagic extension. Ventricular size, however, remains within normal limits.2.A small focus of susceptibility effect within the left cerebellum is nonspecific. This could be artifactual or could represent a small area of chronic microscopic hemorrhage.3.No evidence of any large acute or chronic ischemic injury.4.The degree of gyral development is appropriate for the corrected gestational age. White matter myelination is slightly delayed for corrected gestational age. |
Generate impression based on findings. | T4N2cM0 p16+ left BOT/oral tongue squamous cell carcinoma 1month post TFHX. There are post-treatment findings in the upper neck. There is no measurable residual oropharyngeal tumor. There is also no evidence of residual significant cervical lymphadenopathy. For example, a right level 2A lymph node measures 4 x 10 mm in axial section, previously 11 x 20 mm. There appears to be thrombosis of the catheterized right internal jugular vein. The salivary glands and thyroid appear unchanged. The osseous structures appear to be intact. The orbits are unremarkable. There is an unchanged left cerebellopontine angle cisterna and internal auditory canal mass that measures up to 24 mm. | 1. No measurable residual oropharyngeal tumor or residual significant cervical lymphadenopathy.2. Apparent thrombosis of the catheterized right internal jugular vein. Doppler ultrasound may be useful for further evaluation.3. Unchanged left vestibular schwannoma. |
Generate impression based on findings. | 37 year old with history of right mastectomy for IDC and DCIS. There is heterogeneous amount of fibroglandular tissue in the left breast. The patient is status post right mastectomy. Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in the left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region. Post-surgical changes are seen in the right axilla. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on findings. | 61-year-old female with poor PO intake. Evaluate for any small bowel abnormalities. ABDOMEN: Mild dependent right basilar atelectasis.LIVER, BILIARY TRACT: There is a mildly lobulated T2 hyperintense non- focus in the hepatic dome measuring 3.9 x 2.5 cm. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a T2 hyperintense, T1 hypointense, nonenhancing 9 mm focus in the left mid pole compatible with a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is severely distended. The small bowel is diffusely distended measuring up to 3.2 cm. There is increased ileal folds. A decrease in the number of jejunal folds is equivocal in this case. Large stool burden is noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Gastric and diffuse small bowel distention, consistent with diffuse adynamic ileus. The dilated ileum has a "hidebound appearance" with narrowed separation of the valvulae conniventes (despite the degree of bowel lumen dilatation) with normal-appearing thickness of the folds. Somewhat more than expected intraluminal fluid may reflect hypersecretion. Constellation of findings is especially suspicious for scleroderma (also given patient's history of interstitial lung disease), although other differential considerations such as celiac sprue cannot be entirely excluded. In the latter case there is classically jejunization of the ileum with increased folds seen; a decrease in the number of jejunal folds is equivocal in this case. Correlation with patient's clinical history and laboratory values recommended.2.Hepatic dome cystic lesion. Differential considerations include a simple cyst versus biliary cystic neoplasm. Hemangioma is considered much less likely. |
Generate impression based on findings. | 65 year old male with new diagnosis of heart failure with reduced ejection fraction, atrial fibrillation referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 135 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 66 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 134 g (normal range 164+/-36). There is mild-moderate left ventricular hypertrophy (mid septum 16-17mm, lateral wall 15 mm). There is global hypokinesis. There is diffuse predominantly mid to based subendocardial late gadolinium enhancement. The pre-contrast native myocardial T1 relaxation time is upper limits of normal 1080 ms. Left AtriumThe left atrium is mildly dilated with suggestion of diffuse late gadolinium enhancement. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 64 ml/m2 (normal range 82+/-16), the RVEDV is 137 ml (normal range 142+/-31), the RV end systolic volume index is 33 ml/m2 (normal range 31+/-9), and the RVESV is 71 ml (normal range 54+/-17). There is mild right ventricular hypertrophy. Right AtriumThe right atrium is mildly dilated with suggestion of diffuse late gadolinium enhancement.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is 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.PericardiumSmall circumferential pericardial effusion.Extracardiac FindingsLarge bilateral pleural effusions (right greater than left) with associated passive atelectasis. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is normal in size with mildly reduced systolic function (LVEF 51%) with global hypokinesis. 2. The right ventricle is normal in size with mildly reduced systolic function (RVEF 48%). 3. Mild-moderate left ventricular hypertrophy and mild right ventricular hypertrophy with diffuse predominantly mid to basilar subendocardial late enhancement. Overall these findings highly suggest cardiac amyloid. 6. See extracardiac findings as above. |
Generate impression based on findings. | 29 year old with BRCA 1 mutation. History of benign left breast MR guided biopsy in 2015. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Metallic artifact from prior benign biopsy is present in the upper inner quadrant in the left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | Female, 81 years old, with memory decline, history of pituitary macroadenoma. A chronic lacunar infarct of the right basal ganglia is unchanged. No diffusion restricting lesions are seen. No evidence of parenchymal edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are unchanged. There is mild generalized parenchymal volume loss, not out of proportion to age, and not significantly changed. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is observed. The pituitary gland remains enlarged, similar to that seen on the prior examination. | 1.A chronic right lacunar infarct is redemonstrated. No new or acute findings are seen.2.Stable enlargement of the pituitary gland. |
Generate impression based on findings. | Reason: Evaluate for cervical myelopathy History: LE weakness, hyperreflexia, LE numbness Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.No abnormal enhancing lesions are appreciated in the cervical spine. There is multilevel disk desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central broad-based disk protrusion present at this levelAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine. | 1.No spinal cord lesions are appreciated.2.There are mild degenerative changes present in the cervical spine. |
Generate impression based on findings. | Right knee pain. MENISCI: The apical portion of the body of the medial meniscus is not visualized. Additionally, there is abnormal signal adjacent to the anterior horn of the medial meniscus which may represent the displaced meniscal fragment. There is also blunting of the posterior horn of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1. Tear of the body of the medial meniscus with possible displacement as described above. 2. Intact cruciate ligaments. |
Generate impression based on findings. | Dizziness and giddiness [780.4], Reason for Study: ^Reason: HA, vertigo, possible neurosyphilis? History: HA, vertigo No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are opacification with retention cysts on bilateral maxillary sinus indicating sinusitis. | Maxillary sinusitis, otherwise unremarkable brain MRI. |
Generate impression based on findings. | There is mild narrowing of the distal cavernous right internal carotid artery. The intracranial internal carotid arteries are otherwise normal in course and caliber. There is a mildly hypoplastic right A1 segment. There is mild irregularity of the proximal left M1 segment. There is also mild irregularity of the proximal right M2 segments. The middle and anterior cerebral arteries are otherwise unremarkable.There is a fetal right posterior cerebral artery with absent right P1 segment. There is a hypoplastic left P1 segment with fetal type supply to the left posterior cerebral artery. There is mild-moderate focal narrowing of the proximal left P2 segment. There is additional mild focal irregularity and narrowing of the proximal posterior and anterior P2 sub-segments. The post-PICA right V4 segment is developmentally diminutive. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. There is a duplicated left superior cerebellar artery. | No flow-limiting stenosis or intracranial aneurysm. However, mild scattered posterior greater than anterior circulation atherosclerotic disease as detailed above. Of note, there is fetal right inferior type left supply to the PCAs. |
Generate impression based on findings. | 31-year-old female with left knee pain. MENISCI: There is a bucket-handle tear of the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: No significant thinning of the articular cartilage. There is bone marrow edema of the medial femoral condyle and medial tibial plateau.LIGAMENTS: The ACL is not visualized secondary to a tear. The PCL, LCL, and MCL are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1. Large joint effusion with bucket handle tear of the posterior horn of the medial meniscus.2. ACL tear.3. Bone marrow edema within the medial femoral condyle and medial tibial plateau. |
Generate impression based on findings. | Headaches, acoustic neuroma, preoperative planning. Examination is obtained for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen is an enhancing mass at the right cerebellopontine angle cistern measuring approximately 3.0 x 2.9 x 2.7 cm in the AP, transverse, and craniocaudal dimensions similar to prior. There is mass effect on the right lateral aspect of the pons as well as on the right middle cerebellar peduncle and right cerebellar hemispheres. There is also mass effect on the cisternal segment of the right trigeminal nerve which is anteromedially displaced. Enhancing mass extends through the porus acusticus into the right internal auditory canal. No extension into the cochlea seen, but can be correlated with prior dedicated IAC MRI.Unchanged diffuse prominence of the ventricular system without evidence of obstruction relating to the cerebellopontine angle neoplasm. Again noted is aneurysm involving the right MCA bifurcation as well as the left M1 segment as seen on recent CTA. | 1. Heterogeneously enhancing right cerebellopontine angle mass measuring 3.0 x 2.9 x 2.7 cm extending into the right internal auditory canal consistent with known vestibular schwannoma.2. Mass-effect on the right pons, middle cerebellar peduncle, cerebellum, as well as the cisternal segment of the right trigeminal nerve.3. Communicating hydrocephalus, possibly related to the schwannoma (associated with elevated CSF protein concentration). No direct mass effect on the ventricular system. 4. Middle cerebral artery aneurysms better demonstrated on recent CT angiogram. |
Generate impression based on findings. | Fatty filum, scoliosis, symptom changes. Please do on 3T. Urinary changes For the purposes of numbering, there are 5 lumbar type vertebral bodies. Conus appears to terminate at the L2-L3 level. Fatty infiltration of the filum terminale is noted below the upper L4 level and measuring up to 2.5 mm in the AP dimension. There is severe levoscoliosis with apex near the thoracolumbar junction which has progressed since remote study from 10/29/2008. There is trace prominence of the central canal at the conus. Prone images demonstrate no definite anterior motion of the conus although scoliosis makes evaluation difficult. No significant spinal canal stenosis or neural foraminal narrowing in the lumbar spine is appreciated. | 1. Conus appears to terminate at the lower L2/L2-L3 level which is borderline low. There is a fatty filum terminale measuring up to 2.5 mm in thickness at the L4 level. Overall findings are somewhat suggestive of tethered cord and can be correlated with clinical exam.2. Trace prominence of the central canal at the conus without discrete syrinx. |
Generate impression based on findings. | 58 year old man with history of HTN, AF, referred for cardiac MRI prior to planned AF ablation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 62 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 70 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 103 g (normal range 164+/-36). 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.No intracardiac thrombus.Left AtriumThe left atrial volume is 190.7ml. The left atrial volume index is 82.5ml/m2, which is severely increased. There is artifact on the dedicated 3-dimensional delayed viability sequences. No reliable evidence of left atrial enhancement.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 65 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The mitral valve leaflets appear thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid arteries (normal variant). The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Individual dimensions are:RUPV:16x17mm. There is either early branching or common origin of right middle lobe branches.RLPV: 21X26mm. There is early branching.LUPV: 14x16mmLLPV: 16x8mmPulmonary 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 effusion. | 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 51%. There is no late gadolinium enhancement in the left ventricle to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%.3. The left atrial volume index is 82.5ml/m2, which is severely increased. 4. Early branching of the right superior and inferior pulmonary veins. Two left pulmonary veins drain normally into the left atrium, dimensions as above. 5. Severe bi-atrial enlargement. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 14-year-old male with history of syncope and new right-sided limp. The cerebellar tonsils extend down to the level of the foramen magnum, raising the question of tonsillar herniation. This could be better evaluated on MRI.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. | Question of low lying cerebellar tonsils which could be better evaluated on MRI. Otherwise, unremarkable examination. |
Generate impression based on findings. | Reason: episodes of bilateral visual loss, h/o stroke History: bilat visual loss MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There is volume loss present in the posterior fossa with subdural effusions.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.Findings suggest a 4-mm sized right posterior communicating artery aneurysm which is directed laterally and inferiorlyFindings suggest a small infundibulum measuring 1.5 mm at the left posterior communicating artery origin.There is no evidence for cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is a little bit larger than the left A1 segment. The posterior communicating arteries are not readily identified. The vertebral arteries are asymmetric in size- left larger than right.There is extracranial origin of the left posterior inferior cerebellar artery. | 1.Findings suggest a 4 millimeter aneurysm at the communicating segment of the LICA. This can be confirmed with CTA. 2.Findings suggest 1.5mm Infundibulum at the origin of the left posterior communicating artery. This can be confirmed with CTA. 3.No evidence for cerebrovascular occlusive disease.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for acute ischemic cerebral infarction. |
Generate impression based on findings. | Reason: Rt long finger A2 pully rupture? History: pain and inability to straighten finger. LIGAMENTS: The flexor pulley system is intact, particularly the A2 pulley is intact as clinically questioned.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: Mild bone marrow edema involving the base of the proximal phalanx of the middle finger.ADDITIONAL | 1.Intact flexor pulley system.2.Mild nonspecific bone marrow edema involving the base of the proximal phalanx of the middle finger. |
Generate impression based on findings. | Clinical question: History of meningioma status post XRT. Please evaluate/computer. Signs and symptoms: Right blurry vision. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is revisualization of a meningioma within the right cavernous sinus with resultant expansion of the cavernous sinus, extension into the sella, minimal extension into the right Meckel's cave, right orbital apex and right paramedian subfrontal spread along the planum sphenoidale without convincing evidence of any significant interval change since prior study from 9-20 3-14. The largest transverse diameter of meningioma in the cavernous sinus and sella measures at 31 mm which compared to prior exam demonstrate no appreciable interval change. Minute extension of tumor into the right orbital apex to the right of optic nerve also remains identical to prior study. This finding is best appreciated on axial T2 series 701 image 12 axial post enhanced series 1001 image 12. If further more precise assessment of this finding is clinically desired dedicated pre- and post enhanced MRI of orbits would be helpful.The tumor similar to prior exam minimally bulges superiorly into the basal cistern however without mass effect on the chiasm. Minute spread of tumor into the prepontine cistern along the dorsal aspect of the dorsum sella remains also similar to prior exam. Similar to prior exam there is no convincing evidence of decreased caliber of right cavernous carotid which is encased by tumor.Similar to prior exam there is a tiny developmental venous anomaly in the right rectus jugular venous and is best appreciated on axial post enhanced series 1001 images 14 and 15 and sagittal reformatted post enhanced series 1/1/2002 on images 39 through 46.Multiple tiny foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres demonstrate no significant change and highly suggestive of mild chronic small vessel ischemic strokes without change. Ventricular system remains within normal and maintained midline. Unremarkable images through the calvarium, soft tissues of the scalp, mastoid air cells, middle ear cavities and visualized paranasal sinuses. | 1.No acute intracranial process and stable findings suggestive of mild chronic small vessel ischemic strokes.2.Stable size, morphology, signal intensity and homogeneous pattern of enhancement of a meningioma within the right cavernous sinus and sella turcica with minimal expansion superiorly into the basal cistern, minimally into the right orbital apex and minimally in the right Meckel's cave and right paramedian subfrontal as detailed above.3.Revisualization of a tiny right paramedian inferior frontal developmental venous anomaly. |
Generate impression based on findings. | Reason: eval for meniscus tear/chondromalacia History: knee pain. MENISCI: The posterior horn and posterior body of the lateral meniscus are diminutive with a low signal intensity structure anterior to the anterior horn of the lateral meniscus suspicious for a flipped fragment of the posterior horn and body. The anterior horn is diffusely degenerated. There is fraying of the free edge and undersurface of the anterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: The articular cartilage is intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.Tear of the posterior body and horn of the lateral meniscus with a fragment flipped anterior to the anterior horn of the lateral meniscus. 2.Fraying of the free edge and undersurface of the anterior horn of the medial meniscus.3.Small joint effusion. |
Generate impression based on findings. | History of Crohn's disease admitted with abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size and signal intensity. No intra or extrahepatic biliary ductal dilatation. No focal suspicious lesion.The gallbladder is normally distended with a large gallstone at the gallbladder body/neck junction. No gallbladder wall thickening or pericholecystic fluid. No choledocholithiasis, discrete stricture or mass lesion. SPLEEN: The spleen is normal in size and morphology without a focal lesion.PANCREAS: The pancreas is normal in morphology and size without a focal lesion. Normal main pancreatic duct caliber draining into the major papilla. 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: Mild scoliosis. Partially imaged pelvis demonstrates endometrial thickening within physiologic limits. Small volume of free pelvic fluid is within physiologic limits. Sacral Tarlov cysts are noted. | Gallstone at gallbladder body/neck junction of a normally distended gallbladder without specific findings of acute cholecystitis or biliary ductal dilatation. No choledocholithiasis, discrete stricture or lesion is evident. The findings seen on the patient's HIDA scan may reflect ampullary stenosis. |
Generate impression based on findings. | 31-year-old male with lateral meniscus repair 9 months ago now with new injury MENISCI: Mild globular intermediate signal within the medial meniscus may represent intrasubstance degeneration without discrete tear. Globular intermediate signal within an enlarged lateral meniscus is compatible with intrasubstance degeneration and degenerative fraying. Complex fragmentation of the posterior horn with vertical and horizontal components. Blunting of the anterior horn of the lateral meniscus is compatible with a radial tear.ARTICULAR CARTILAGE AND BONE: Edema type signal is noted within the lateral femoral condyle. The articular cartilage is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.Blunting of the anterior horn of the lateral meniscus compatible with a radial tear. Complex fragmentation of the posterior horn with vertical and horizontal components. 2.Edema within the lateral femoral condyle.3.Small joint effusion. |
Generate impression based on findings. | 60-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 4.7 x 3.1 x 3.5 cmPeripheral Zone: No significant abnormality.Central Gland: There is a lesion in the right transition zone extending into the anterior prostate measuring 1.1 x 0.9 cm which is hypointense on ADC, hyperintense on DWI, has ill-defined T2 signal and exhibits early enhancement, suspicious for prostate cancer.Seminal Vesicles: No significant abnormality.Extracapsular Extension: None identified.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Lesion in the right transition zone extending into the anterior prostate is suspicious for prostate cancer.2.No lymphadenopathy. |
Generate impression based on findings. | vertigo, vomiting and truncal ataxia No evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered bihemispheric high signal intensity lesions on FLAIR indicate age indeterminate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease. |
Generate impression based on findings. | 67-year-old female with history of right cerebellar pontine angle meningioma status post cyber knife and resection. Limited exam secondary to lack of IV contrast.Postsurgical changes from a right sided suboccipital craniotomy and CP angle tumor resection are seen. There is significantly reduced T2/flair hyperintensity in the right cerebellum, right middle cerebral peduncle, and right aspect of the pons. Additionally, there is reduced effacement of the fourth ventricle. There is slightly increased right cerebellar encephalomalacia with associated increased extra-axial fluid adjacent to the right cerebellar hemisphere, likely postsurgical. Small area of susceptibility within the surgical bed likely represent chronic blood product. There are scattered punctate foci of T2/flair hyperintensity in the periventricular and subcortical white matter. No acute ischemia is seen. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. | 1.Limited exam secondary to lack of IV contrast which decreases sensitivity for the detection of recurrence.2.Postsurgical changes of right CP angle meningioma resection with evidence of decreased local edema.3.No definitive evidence of bulky tumor recurrence without the benefit of IV contrast. If warranted, the patient may return to obtain just the post contrast imaging to complete her evaluation.4.Nonspecific T2/flair hyperintensity in the periventricular and subcortical white matter is likely secondary to chronic ischemic small vessel disease. |
Generate impression based on findings. | 37-year-old female with newly diagnosed right breast IDC with metastatic right axillary lymph node. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT:There is an irregularly shaped enhancing mass at 8:00 position in the right breast measuring 36 x 27 x 24 mm (AP x LR x CC), consistent with biopsy-proven carcinoma. The tumor demonstrates high signal on T2-weighted images. A marker clip is identified at superior-anterior aspect of this mass.There is a linear branching, clumped non-mass enhancing lesion, measuring 41 x 27 x 20 mm at right retroareolar region.In the right axilla, a proven metastatic lymph node is visualized, measuring 25 x 25 x 22 mm. No other abnormal lymph nodes are present in the right axilla.LEFT:No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in left axillary region.A port is present in the superior-medial chest wall. | 1. Biopsy proven right breast cancer with metastatic right axillary lymph node.2. Linear branching, clumped non-mass enhancing lesion in the right retroareolar region. MR-directed ultrasound is recommended. If no sonographic correlation is detected, MR guided biopsy should be considered.3. No MR evidence for malignancy in the left breast or left axilla.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Reason: see below History: Rt hand pain eval for etiology Multiple sequences are severely limited secondary to patient motion artifact. Evaluation of the intrinsic ligaments and triangular fibrocartilage complex of the wrist is limited due to lack of intra-articular contrast as well as extensive patient motion artifact.TENDONS: The flexor and extensor tendons appear intact BONES: There is subchondral cyst formation within the lunate and capitate. Note is made of negative ulnar variance. There is increased signal abnormality and fluid sensitive sequences within the lunate bone.ADDITIONAL | 1. Limited examination secondary to extensive patient motion artifact. Negative ulnar variance with increased signal abnormality within the lunate which may reflect early Kienböck's disease/avascular necrosis.2. Nonspecific edema within the pronator quadratus muscle belly. Although there is no corresponding edema within the flexor digitorum profundus and flexor pollicis longus muscle bellies, the possibility of anterior interosseous nerve syndrome could be considered in the correct clinical setting. |
Generate impression based on findings. | 75 year old female with metastatic breast cancer and pancreatitis status post ERCP on 10/27 with stent placement now with abdominal pain, nausea/vomiting, increasing lipase. Please evaluate for pancreatitis. ABDOMEN:LUNG BASES: Increase in bilateral pleural effusions since prior MRI, right greater than left with adjacent atelectasis/consolidation.LIVER, BILIARY TRACT: Air seen throughout the biliary tract consistent with recent biliary stent placement. Biliary stent appears patent. The portal vein is not well visualized. The SMV at the level of the confluence, confluence and the entire splenic vein are not visualized. The SMV proximal to the confluence appears patent. The gallbladder at the level of the gallbladder neck demonstrates a diffuse low attenuation lesion which enhances on arterial phase is suspicious for metastatic lesion measuring 1 cm x 1 cm best seen on image 4477, series 8.Re-identification of multiple scattered hypodense lesions throughout the liver the largest of which previously measured 1.4 x 1 cm best seen on image 64/97, series 4 now measures 1.1 cm best seen on image 16/138, series 10.SPLEEN: Splenic vein is not visualized however spleen appears unremarkable.PANCREAS: Diffuse pancreas enlargement with some posterior peripancreatic stranding out of proportion to ascites consistent with pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left-sided hydronephrosis and hydroureter with narrowing and loss of visualization of the distal ureter with resultant obstruction, best seen on image 70/138, series 10.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Re-identification of new multiple, sclerotic lesions due to metastatic disease.OTHER: Moderate intra-abdominal ascites.PELVIS:UTERUS, ADNEXAE: Calcified fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: As described above.OTHER: No significant abnormality noted | 1. Worsening of bilateral pleural effusions.2. Poor visualization of the portal vein, confluence, splenic vein and distal SMV consistent with thrombosis.3. New left-sided hydronephrosis and hydroureter with lack of visualization of the distal ureter consistent with obstruction.4. Apparent worsening of intra-abdominal ascites. |
Generate impression based on findings. | 44-year-old female with invasive ductal carcinoma in the lower inner left breast 2:00 location and metastatic disease in the left axillary lymph node presents for preop staging. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is no abnormal enhancement in the right breast.LEFT BREAST:There is high T2 and susceptibility artifact from the biopsy clip is identified in an enhancing mass in the left breast, 2:00 position, far posterior depth, which corresponds to the biopsy proven invasive ductal carcinoma in the left breast. This mass measures 2.5 x 2.6 x 3.1 cm (AP x LR x SI). This mass directly abuts the superficial skin with skin enhancement, which may represent skin involvement of the cancer and/or postbiopsy change in the skin. There is no involvement of the pectoralis muscle.No abnormal enhancement is seen elsewhere in the left breast. Axillae:The biopsied left axillary lymph node with Hydromark clip measures 1.5 cm. In addition, multiple abnormal appearing lymph nodes are identified in the left axilla and left subpectoral region. For example, one of the subpectoral lymph nodes measures 2.1 cm.No abnormal lymph nodes are identified in the right axillary region. | 1. Unifocal 3.1 cm biopsied malignancy in the far posterior left breast 2:00 position. Enhancement of the overlying skin is highly suggestive of skin involvement of cancer and/or postbiopsy change of the skin.2. Multiple abnormal-appearing lymph nodes in the left axilla including the subpectoral region compatible with metastatic disease.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Headache [R51], Reason for Study: ^Reason: seizure History: complex partial seizure. No evidence of acute ischemic or hemorrhagic lesion on the scan. There is no evidence of abnormal enhancement either.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is a however, well circumscribed lobulated right high convexity scalp lesion [13.3mm (RL) x 21mm(AP) x 12.1mm (CC)] which shows low on T1, mixed high on T2 without showing evidence of enhancement. The lesion also shows evidence of restricted diffusion especially center portion. Constellation of these findings suggest benign subcutaneous lesion such as sebaceous cyst. | Normal brain MRI.Sebaceous cyst on the right high convexity. |
Generate impression based on findings. | History of relapsed follicular lymphoma with bone lesions in the left humerus. Within the mid diaphyseal region of the left humerus is a somewhat ill-defined lesion that is dark on T1 and bright on T2 images with probable mild endosteal scalloping. This lesion enhances on postcontrast imaging. There is no adjacent soft tissue involvement. | Intraosseous lesion in the left mid-humeral diaphysis most consistent with the patient's history of lymphoma. |
Generate impression based on findings. | CERVICAL SPINE:Degenerative disc disease is noted within the cervical spine with disc dessication and mild loss of disc height. 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. C1/2: Normal atlantodental interval.C2/3-C4/5: No significant spinal canal stenosis or neuroforaminal narrowing. C5/6: There is a left C5 laminectomy defect present. There is also mild left uncovertebral hypertrophy but no significant spinal canal stenosis or neural foraminal narrowing. C6/7: Mild facet hypertrophy and ligamentum flavum thickening is present without significant spinal canal stenosis or neuroforaminal narrowing.C7/T1: No significant spinal canal stenosis or neural foraminal narrowing.THORACIC SPINE:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No significant disc bulge or cord encroachment from the T1/2-T9/10 levels. At T10/11 and T11/12 there is mild facet hypertrophy and ligamentum flavum thickening without significant central canal stenosis or neuroforaminal narrowing. There is no abnormal enhancement. The visualized intrathoracic and paraspinal soft tissues are unremarkable. | 1.Degenerative and post-surgical changes of the cervical spine as described above without significant spinal canal stenosis or neural foraminal narrowing.2.No cervical spine of thoracic spine compression fracture is identified. |
Generate impression based on findings. | Reason: R shoulder pain and popping after injury. Assess for rotator cuff pathology. ROTATOR CUFF: There is a full-thickness tear of the posterior aspect of the supraspinatus tendon which also involves the anterior aspect of the infraspinatus tendon, and extends over AP diameter of at least 12 mm. There is retraction of the proximal muscle belly of the supraspinatus to the level of the glenohumeral joint. There is a small amount of fluid in the subacromial/subdeltoid bursa, compatible with a full-thickness tear. This is superimposed on severe tendinopathy of the supraspinatus and infraspinatus tendons. There is mild fatty infiltration muscle atrophy of the supraspinatus and infraspinatus muscles. There is mild tendinosis of the subscapularis tendon. The teres minor is intact. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is diffuse grade 3 chondral thinning at the glenohumeral joint with reactive marrow changes in the humeral head.Within the limitations of a non-arthrographic study there appears near circumferential, degenerative tearing of the glenoid labrum.BICEPS TENDON: The extracapsular portion of the biceps is intact however, it is not well visualized within the joint, which may represent severe tendinopathy or chronic partial tearing.ADDITIONAL | 1.Full-thickness tear of the posterior supraspinatus/anterior infraspinatus tendons with associated retraction, tendinopathy, and mild muscular atrophy.2.Moderate degenerative arthritic changes at the glenohumeral joint with moderate chondral loss and near circumferential degenerative tearing of the glenoid labrum.3.The intra-articular portion of the long head of the biceps tendon is not well-visualized which may reflect severe tendinopathy or chronic partial tearing. |
Generate impression based on findings. | New onset slurred speech, now resolved, but residual left-sided weakness. There is a punctate focus of mildly restricted diffusion in the posterior limb of the right internal capsule. There is encephalomalacia with hemosiderin staining in the right basal ganglia and corona radiata. There is prominent underlying diffuse low susceptibility signal in the basal ganglia bilaterally, which may represent mineralization. There are a few scattered punctate foci of susceptibility effect in the cerebral hemisphere, which may represent chronic microhemorrhages. There is no evidence of acute intracranial hemorrhage. There is moderate predominantly periventricular white matter T2 hyperintensity without restricted diffusion. The ventricles are unchanged 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. | 1. Recent punctate infarction involving the posterior limb of the right internal capsule.2. Evolution of the hemorrhagic infarction involving the right basal ganglia and corona radiata, which is now in the chronic phase.3. Moderate probable chronic small vessel ischemic white matter disease. |
Generate impression based on findings. | Reason: Evaluate for structural lesions History: paresthesias 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 punctate signal hypointensity on susceptibility imaging along the posterior aspect of the putamen of the right basal ganglia.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery appears to be hypoplastic distally.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.No evidence for intracranial mass lesion or demyelination to explain the patient's paresthesias.2.A microhemorrhage along the right basal ganglia is of uncertain clinical significance in isolation. It is conceivable that this could be the source of paresthesia. Please correlate with clinical exam. |
Generate impression based on findings. | Four month-old female presents with infantile spasms. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may mild thinning of the posterior corpus callosum, measuring 2 mm in thickness, but otherwise the degree of myelination appears to be appropriate. The brain parenchyma and pituitary gland appear unremarkable. There are prominent subarachnoid spaces in the bilateral anterior cerebral convexities.. The ventricles and basal cisterns are normal in size and configuration. However, there is a persistent cavum septum pellucidum. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1. No evidence of hypoxic ischemic encephalopathy. 2. Prominent subarachnoid spaces in the bilateral anterior cerebral convexities.3. Perhaps mild thinning of the posterior corpus callosum, but otherwise the degree of myelination appears to be appropriate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Nasopharyngeal adenoid cystic carcinoma status post radiation therapy. There is no significant interval change in size of the enhancing perineural tumor in the left parapharyngeal space along the V3 segment of the left trigeminal nerve into the left cavernous sinus, measuring up to 6 mm in thickness. The left foramen rotundum and pterygopalatine fossa appear unchanged. There is an unchanged defect in the left greater with of the sphenoid with associated enhancement in this area. There is diffuse atrophy and T2 hyperintensity of the left optic nerve. The right orbital contents are unremarkable. There is persistent left otomastoid fluid and mucosal enhancement. There is a gradually enlarging tubular T2 hyperintense lesion in the right retromaxillary fat pad, with what may represent associated enhancement. There is mild mucosal thickening within the atelectatic left maxillary sinus. | 1. No significant interval change in the appearance of the treated perineural tumor related to nasopharyngeal adenoid cystic carcinoma involving the left trigeminal nerve.2. Unchanged nonspecific defect in the left greater with of the sphenoid with enhancement, which may be vascular rather than neoplastic in nature.3. Diffuse left optic nerve atrophy.4. Findings suggestive of left Eustachian tube dysfunction.5. A gradually enlarging tubular T2 hyperintense lesion in the right retromaxillary fat pad, with what may represent associated enhancement, may represent a peripheral nerve sheath tumor, for example. |
Generate impression based on findings. | 54-year-old male with right shoulder pain not improving despite injection. ROTATOR CUFF: There is fluid signal abnormality along the posterior aspect of the humeral head which may reflect a ganglion within the infraspinatus muscle or less likely a small interstitial tear. The supraspinatus and infraspinatus muscles and tendons otherwise appear intact. There is thickening and intermediate signal abnormality within the supraspinatus tendon consistent with mild tendinosis. There is mild fatty atrophy of the infraspinatus along the myotendinous junction. The teres minor and subscapularis muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid within the subacromial subdeltoid bursa. There is extensive increased bone marrow signal abnormality about the acromioclavicular joint and subcutaneous edema. There is subchondral cyst and osteophyte formation about the distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild to moderate degenerative changes affect the glenohumeral joint. There is heterogeneity and increased signal abnormality within the superior labrum suggestive of degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | 1. Extensive bone marrow edema and subcutaneous inflammatory change about the AC joint, which may be degenerative in etiology. Further evaluation with dedicated radiographs is recommended.2. Rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear. Other findings as described above. |
Generate impression based on findings. | Reason: H/o left shoulder lymphoma please restage History: prior mass and pain There is abnormal heterogeneous signal intensity within the glenoid and neck of the scapula compatible with the patient's known history of lymphoma with pathologic fracture. The fragmentation seen on the prior MRI study is not as evident indicating some interval healing. Signal abnormality extends along the lateral aspect of the body of the scapula also compatible with treated lymphoma. There is a focus of increased signal intensity again seen along the lateral body of the scapula, the enhancement of which appears less than on the prior study perhaps due to interval treatment. There is minimal edema along the body of the scapula which also appears decreased when compared to the prior study. There is edema within the infraspinatus and teres minor muscles which has also decreased when compared to the prior study. The small foci of enhancement seen within the muscle belly of the subscapularis on the prior study are no longer evident. There is residual posttraumatic deformity of the glenoid. There is slight posterior translation of the humeral head with respect to the glenoid. There is loss of cartilage along the surface of the glenoid as well as a small glenohumeral joint effusion and synovitis of the glenohumeral joint that is comparable to that seen on the prior study. . Mild osteoarthritis affects the acromioclavicular joint. Although this study was not optimally protocoled for detailed evaluation of the rotator cuff, we see no rotator cuff tear. There is a small amount of fluid and enhancement within the tendon sheath of long head of the biceps indicating a tenosynovitis. The reference enlarged axillary lymph node now measures approximately 2.7 x 1.5 x 2.5 cm which is decreased slightly when compared to the prior study. | 1. Findings indicating treatment of scapular lymphoma with an overall favorable response and continued healing of a pathologic fracture.2. Synovitis of the glenohumeral joint appearing similar to the prior study. |
Generate impression based on findings. | Redemonstrated is a primarily T2 hyperintense mass lesion in the parietal lobe containing some central T2 hypointense components. On recent comparison brain MRI this demonstrated ring enhancement with adjacent vasogenic edema. There is no significant associated mass effect. The ventricles are unchanged in size or shape. Expected vascular flow voids are demonstrated. Mucosal thickening is again noted within the right maxillary sinus and a single anterior left ethmoid air cell. The remaining paranasal sinuses and the mastoid air cells are clear.Incidental note is made of a 5 mm transverse x 5 mm AP x 7 mm craniocaudal focus within the posterior sella which is T1 hypointense and T2 hyperintense. This is unchanged when compared to the 2 prior comparison studies. Although not mentioned previously, it is felt to represent a benign entity such as a pars media or Rathke's cleft cyst. | 1.Redemonstrated is a primarily T2 hyperintense mass lesion in the parietal lobe containing some central T2 hypointense components2.Incidental note is made of a 5 mm transverse x 5 mm AP x 7 mm craniocaudal focus within the posterior sella which is T1 hypointense and T2 hyperintense. This is unchanged when compared to the 2 prior comparison studies. Although not mentioned previously, it is felt to represent a benign entity such as a pars media or Rathke's cleft cyst. |
Generate impression based on findings. | Clinical question: Evaluate for growth of AA status post RT/TMZ+ TMZ. Now off all treatments. Signs and symptoms: Right frontal anaplastic astrocytoma. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates a focus of FLAIR hyperintensity with underlying parenchymal volume loss and minimal chronic hemorrhage in the right frontal lobe and extending from cortex to the right lateral ventricle. Finding consistent with postsurgical and treatment changes of a anaplastic astrocytoma which remains nearly identical to prior exam.There is no detectable abnormal enhancement at the site which is also a similar observation as prior study.Unremarkable signal intensity of brain parenchyma otherwise on all MRI sequences and without detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable calvarium other than expected postoperative changes of right frontal craniotomy.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern. | 1.Stable post surgical/treatment changes of right frontal lobe astrocytoma.2.Unremarkable pre and post enhanced brain MRI otherwise and stable since prior study. |
Generate impression based on findings. | 67 year old with personal history of prior left lumpectomy, radiation therapy and chemotherapy in 2002. Family history of breast cancer in her sister and maternal aunt. BRCA2 positive. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Post surgical volume loss and scarring is noted in the left breast.No abnormal enhancement is seen in either breast. Intramammary lymph node in the left posterior 3:00 position is unchanged. No abnormal lymph nodes are identified in either axillary region.Trace pleural effusions. Probable hepatic cysts again noted. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on findings. | 46 year old man with history of non-ischemic cardiomyopathy with worsening LV function on serial echocardiograms. He was referred for cardiac MRI to evaluate cardiac function. Left VentricleThe left ventricle is normal in size with mild to moderate reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 214 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 129 ml (normal range 47+/-19). There is mild concentric hypertrophy. There is global hypokinesis with regional variation. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 38%, the RV end diastolic volume index is 100 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 62 ml/m2 (normal range 31+/-9), and the RVESV is 135 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is trace 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 mild 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 no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. Mild to moderately reduced LV systolic function (EF 40%) with normal LV size. When compared to the previous MRI of 5/13/2014, LV function appears slightly worse.2. No evidence of late gadolinium enhancement to suggest a myocardial infiltrative, inflammatory or fibrosis process. 3. Normal sized RV with moderately reduced function ( EF 38%). RV function has worsened since the previous MRI of 5/13/2014. 4. Mild LA dilation and moderate RA dilation. 5. Mild tricuspid regurgitation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Gait abnormality The spinal cord has grossly normal signal characteristics and overall morphology. There is no compromise of the spinal cord. The vertebral bodies are appropriate in overall height. There is straightening with loss of normal thoracic kyphosis and lumbar lordosis. There are degenerative changes in the cervical spine from C3-C4 to C6-C7 with mild to moderate spinal canal stenosis related to small disc osteophyte complexes and ligamentum flavum thickening. There are also multilevel degenerative changes in the lumbar spine including disc extrusion at the L4-L5 level which appears to cause high-grade spinal canal stenosis and cauda equina nerve root compression. | This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. There is however large disc extrusion at the L4-L5 level which appears to cause high-grade spinal canal stenosis and mass effect on the cauda equina nerve roots.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine. |
Generate impression based on findings. | Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: metastatic NSCLC with brain mets s/p SRS; assess for stability History: stability Redemonstration of enhancing nodules at bilateral cerebellar hemispheres, right posterior aspect of the pons and left occipital lobe, unchanged in terms of size since prior scan.Previously described right inferior parietal lobule and left inferior parietal lobule lesions are not as conspicuous as prior.There is no new abnormal enhancing lesion.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Multifocal enhancing lesions involving bilateral cerebellar hemispheres, pons and right occipital lobe as described above, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Previously reported bilateral inferior parietal lobule enhancing nodules are not as conspicuous as prior.4. No evidence of new abnormal enhancing lesion. |
Generate impression based on findings. | 14-year-old male with a history of left ureteral reimplantation presents with left flank pain, evaluate for renal stones or obstruction. BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Present. Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 9.5 cm Left: 10 cm Mean for age: 10 cm Range for age: 8.5 - 11.1 cmADDITIONAL OBSERVATIONS: None. | Normal sonographic evaluation of the kidneys. Specifically, no evidence of nephrolithiasis or hydronephrosis.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Clinical question: Compared to x-ray of the lumbar spine. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:At T12-L1 there is a T2 hypointense left lateral epidural defect (sagittal T2 image 7 and axial T2 series 601 images 38 through 40) finding extends into the left neural foraminal at T12-L1 level and is suspected of an extruded disc fragment. There is resultant moderate left neural foraminal compromise and no central spinal stenosis.L1-L2 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy however without spinal stenosis or neural foraminal compromise.L2-L3 demonstrates advanced disc disease with loss of disc height, grade 1 retrolisthesis, mild bilateral facet (right greater than left) and ligamentum flavum hypertrophy with resultant moderate right neural foraminal compromise and moderate central spinal stenosis.L3-L4 demonstrate advanced disc disease and loss of disc height, moderate bilateral (right greater than left) facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is resultant moderate central spinal stenosis with moderate to severe right neural foraminal compromise and mild left.L4-L5 demonstrate mild disc disease and minimal loss of disc height, significant bilateral facet hypertrophic changes (right greater than left) and moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis however bilateral moderate neural foraminal compromise is present.L5-S1 demonstrate moderate disc disease and loss of disc height however the extensive (left greater than right) facet hypertrophic changes and to a lesser degree of the ligamentum flavum. No central spinal stenosis however severe bilateral neural foraminal compromise is present.No detectable signal abnormality of cauda equina or the conus, lower thoracic cord.Small bilateral renal cysts are identified. | 1.Extensive degenerative changes of lumbar spine in particular hypertrophic changes of posterior elements are present.2.There is moderate central spinal stenosis at L2-L3 and L3-L4 levels.3.There is an extruded disc fragment posterior to the vertebral body of T12 and extending into the left T12-L1 neural foramina with resultant moderate compromise and no central spinal stenosis.4.Multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. |
Generate impression based on findings. | 11 years Female (DOB:11/7/2004)Reason: Please evaluate for tumor or dysplasia - seizure focus History: Complex partial epilepsy with staring and eye fluttering, seizure focus R frontal on EEGPROVIDER/ATTENDING NAME: CHALONGCHAI PHITSANUWONG YULIYA YANOVSKAYA The CSF spaces are appropriate for the patient's stated age with no midline shift. The hippocampi appear symmetric bilaterally. No abnormal signals appreciated within the hippocampi. No abnormal enhancing lesion is appreciated hippocampi.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a T2 hyperintense well circumscribed mass present in the left parotid gland measuring 31 x 24 mm coronal dimensions. There are additional nodules scattered in the left and right upper neck measuring up to 16 mm short axis diameter. | 1.There are multiple lesions present in the upper neck in particular in the left parotid space but also along the jugular chains. There is concern for lymphadenopathy and possibly a mass in the left parotid gland. This is incompletely imaged on this exam which is tailored for the brain and not the neck. If clinically appropriate evaluation of the patient's neck may be of benefit. |
Generate impression based on findings. | Left frontal meningioma resection in 1981. Reresection in 1994. Left falcine meningioma RT in 2009. There are postoperative findings related to left frontal meningioma resection with encephalomalacia in the underlying brain parenchyma and a small amount of enhancing tissue overlying the left middle frontal gyrus, which measures up to 5 mm in width. There is a falcine meningioma that measures up to 32 mm, previously 24 mm, with associated vasogenic edema in the adjacent portions of the bilateral frontal lobes. There is also an unchanged left lateral temporal convexity meningioma that measures up to 7 mm in width. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is unchanged enhancement within a presumed the left temporal craniotomy gap and within the left frontal craniotomy flap. | 1. Postoperative findings related to left frontal meningioma resection with encephalomalacia in the underlying brain parenchyma and a small amount of enhancing tissue overlying the left middle frontal gyrus, which measures up to 5 mm in width and may represent residual meningioma. 2. Interval increase in size of the falcine meningioma that measures up to 32 mm and associated vasogenic edema in the adjacent portions of the bilateral frontal lobes.3. Unchanged left lateral temporal convexity meningioma that measures up to 7 mm in width. 4. Unchanged nonspecific enhancement within a presumed the left temporal craniotomy gap and within the left frontal craniotomy flap. |
Generate impression based on findings. | Infection Note that the examination is significantly limited given the presence of metallic susceptibility artifact, and the lack of contrast, and extensive patient motion.The components of a total knee arthroplasty are noted. There is a extensive marrow abnormality within the distal femur, proximal tibia, proximal fibula and anterior surface of the patella. Extensive metallic susceptibility artifact overlies the soft tissues from prior surgical intervention. There is a small suprapatellar effusion. There is diffuse soft tissue edema and muscle atrophy. | 1. Significantly limited examination secondary to orthopedic hardware, extensive patient motion, and a lack of complete sequences.2. Diffusely abnormal marrow signal which may relate to known leukemia or be post-treatment in nature.3. Small joint effusion and diffuse soft tissue edema. |