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Generate impression based on findings. | 60-year-old male patient with history of right pontine cavernoma. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mass redemonstrated the the right paracentric pons which has changed imaging characteristics when compared to the prior exam. There is interval decrease in central T2 signal hyperintensity with increased susceptibility effect centrally. The lesion is stable in size and currently measures 8 x 10 mm on T2-weighted imaging. It measures 8 x 10 mm on T2 weighted imaging. The lesion extends from the level of the superior cerebellar peduncle down to the pontomedullary junction.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 mucosal thickening in the maxillary sinuses, right greater than left, unchanged. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | Right pontine cavernoma is stable in size with interval increasing susceptibility artifact centrally. |
Generate impression based on findings. | 61-year-old male with history of left facial squamous cell cancer (likely cutaneous). Status post surgery and adjuvant RT. Please evaluate. Enhanced CT of soft tissues of neck:60 cc of Omnipaque 350 was administered for this exam.Axial 3 mm CT images of the soft tissues of the neck after administration of contrast are obtained. Coronal and sagittal 2-D reformatted images are also acquired.Diffusely irregular pattern of enhancement in the left parotid gland remains identical to prior study. Stranding of overlapping subcutaneous fat is also similar to prior study. The overall size and morphology of this abnormal parotid is identical to prior exam. These changes could represent residual tumor as well as post treatment changes. An MRI examination may be useful for further assessment of this changes.There is interval reduction in the degree of thickening and enhancement of the mucosal of the left lateral pharyngeal wall which extends to involve the left common base. These changes are likely secondary to post treatment. There is no evidence of pathologic lymphadenopathy.Enhanced head CT:This examination is essentially within normal limits and in particular no evidence of metastatic disease to brain parenchyma, that the meninges or the calvarium is detected.Calvarium, paranasal sinuses and mastoid air cells are unremarkable. | 1.Stable appearance of irregularly enhancing left parotid gland in size, morphology and pattern of enhancement since prior study.2.Decrease in the degree of mucosal enhancement of the left lateral oropharyngeal wall and left basal scarring likely representing improved posttherapy changes.3.No evidence of pathologic lymph nodes.4.Negative enhanced head CT. |
Generate impression based on findings. | 58-year-old woman personal history of left breast biopsy at outside hospital with pathology showing ADH presents for research MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Specifically, there is no abnormal enhancement in the upper outer quadrant of the left breast at the site of stereotactic biopsy or in the inferior posterior lateral left breast at the site of the additional cluster microcalcifications identified on outside hospital mammogram. Please note that diagnostic mammogram was performed for additional calcifications and results will be reported separately.No abnormal lymph nodes are identified in either axillary region. | (1) No MRI evidence for malignancy. (2) Please note that diagnostic mammogram was performed for additional calcifications in the left breast and the results will be reported under a separate accession.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male, 70 years old, with history of grade 3 meningioma. Postoperative findings are again seen compatible with left parietal craniotomy and tumor resection. A thin layer of extra-axial fluid along the craniotomy is unchanged. T2 hyperintensity and hemosiderin staining within the underlying precentral and postcentral gyri are also unchanged. No evidence of recurrent tumor is seen in the operative bed.A nodular area of dural based masslike enhancement is seen centered on the paramedian high right vertex with involvement of the superior sagittal sinus (see image 131 series 1203). This lesion has increased mildly in size when compared to the prior examination. A tumor-like lesion was, however, evident in this location on exams which predated the most recent surgery. More anteriorly, non-tumoral bilateral dural thickening along the vertex is unchanged likely related to prior subdural collections. No new enhancing lesions are seen. No new areas of parenchymal signal abnormality are detected. Hemosiderin staining is redemonstrated along the bilateral frontal lobe surfaces, right more than left. No evidence of acute intracranial hemorrhage is seen. The ventricular system is within normal limits. | Postoperative findings are demonstrated compatible with tumor resection from the left high convexity. No definite progressive tumor is seen in this location.A separate nodule of probable tumor located along the right paramedian vertex with involvement of the superior sagittal sinus has increased slightly in size.No entirely new intracranial lesions are seen. |
Generate impression based on findings. | Female, 39 years old, with a right cranial nerve 6 palsy, assess for brainstem lesion, please compare to MRI up loaded on PACS, please do Dr. Javed MS protocol. Multiple round and oval T2 hyperintense lesions are demonstrated within the bilateral cerebral white matter. Some of these contact the ventricular surface and are oriented radially with respect to the ventricles. Most of these lesions have not significantly change from the prior examination. One lesion in the right corona radiata has however notably decreased in size. This lesion enhanced vigorously on the prior examination and does so only minimally on today's study. Several additional lesions showed a faint blush of enhancement on the prior examination which has resolved.Since the prior examination, a new 5-mm focus of T2 hyperintensity has developed within the right aspect of the midbrain, lateral to the red nucleus and just posterior to the substantia nigra (image 13 series 501). This lesion does enhance on postcontrast imaging. Within the pons, there is a punctate (2-mm) focus of T2 hyperintensity just to the right of midline which is also probably new (image 11 of series 501). No clear evidence of enhancement is seen. There may also be a new 4-mm focus of T2 hyperintensity within the right aspect of the medulla (image 12 series 1601).No evidence of significant mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid is seen. The lateral ventricles are slightly asymmetric in size but this is likely within the limits of normal variation.The cisternal portions of the visualized cranial nerves are within normal limits. The pineal gland is mildly prominent which may represent the presence of small internal cysts, a stable finding. | 1. Multiple supratentorial white matter lesions are seen compatible with demyelinating disease. Most of these lesions are stable in size with the exception of one in the right corona radiata which has decreased in both size and enhancement from the prior exam.2. Several new lesions are identified within the brainstem including one at the right aspect of the midbrain, another just to the right of midline in the pons, and a third in the right aspect of the medulla. The lesion in the pons could potentially be affecting the right sixth cranial nerve as it passes from its nucleus anteriorly to its root exit point at the ventral pons. |
Generate impression based on findings. | 65 years Female (DOB:8/4/1951)Reason: Evaluation of lumbar spine History: lumbar back pain, not sciaticaPROVIDER/ATTENDING NAME: SARAH CHOXI SARAH CHOXI Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height this desiccation and diffuse disc bulge at this level associated with bilateral ligamentum flavum and facet hypertrophy. There is some narrowing of the neural foramina bilaterally but worse on the right when compared to the left side. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat.At L4-5 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some partial effacement of the fat at the lateral recess bilaterally. There is some narrowing of the neural foramina bilaterally at this level. Disc material extends into the left far lateral region where there is some mild encroachment of the left-sided exiting nerve roots after it exits the neural foramen. Overall there is a mild degree of spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet ligamentum flavum hypertrophy at this level associated with 1 to 2 mm anterior subluxation of L3 on L4. There is disc desiccation at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | There are degenerative changes present in the lower lumbar spine worse at L4-5 where there is a mild degree of spinal stenosis and some mild encroachment of the exiting nerve roots within the left neural foramen. |
Generate impression based on findings. | Reason: Biopsy needed of PET positive lesion at the T5 vertebra History: History of Hodgkins Lymphoma Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. No complications were identified following the procedure | T6 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis. |
Generate impression based on findings. | Female, 18 years old, 30 weeks and 5 days GA, with nonvisualization of the cavum septum pellucidum on fetal ultrasound, concern for absent corpus callosum. The corpus callosum is absent in its entirety with an expected colpocephalic pattern of ventricular dilatation. The caliber of the ventricles at the level of the atria is approximately 13 mm bilaterally.Asymmetry is also evident involving the frontal lobes and insula. The left frontal lobe is smaller than the right and the left insula may be smaller as well, or perhaps it simply appears this way due to a greater degree of closure of the left sylvian fissure.The brainstem and cerebellum are within normal limits. No evidence of any mass lesion is seen. No abnormal extra-axial collections or evidence of intracranial hemorrhage is seen. | 1.Agenesis of the corpus callosum.2.Asymmetry of the frontal lobes and insular regions is seen with structures on the left being somewhat smaller than those on the right. The precise nature and etiology for this asymmetry is not clear on the present examination. Findings can be better assessed on postnatal imaging. |
Generate impression based on findings. | Female, 62 years old, with multiple myeloma and kyphosis with back pain. Patchy inhomogeneous marrow signal intensity is seen with areas of T1 hypointense and STIR hyperintense signal most pronounced in the L3, L4 and L5 vertebral bodies as well as the sacrum.Spinal alignment is anatomic. Mild, less than 50%, loss of vertebral body height is evident at L3 and L4. Mild superior endplate concavity of the L1 vertebral body is also seen. These findings have not substantially changed from the prior examination.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Right greater than left facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L2-3: Mild facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Moderate facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. L4-5: Moderate facet arthropathy. Mild bulging disc. No significant spinal canal stenosis but the left lateral recess is slightly effaced. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: Moderate bilateral facet arthropathy. Mild disc bulging asymmetric to the left. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. | 1.Patchy abnormal marrow signal is seen most conspicuously affecting the lower lumbar spine and sacrum, similar to the prior examination, and compatible with multiple myeloma.2.Mild loss of height of the L1, L3 and L4 vertebral bodies is unchanged.3.Mild to moderate degenerative findings without significant change and without high-grade spinal canal stenosis. |
Generate impression based on findings. | Reason: further evaluate pancreatic changes noted on recent CT History: abdominal pain, anorexia ABDOMEN: Suboptimal examination due to motion artifact of several sequences. LIVER, BILIARY TRACT: The liver is enlarged measuring 23 cm in craniocaudal dimension, which may be due to a normal variant Riedel lobe. No focal hepatic lesion. No intrahepatic or extrahepatic biliary ductal dilatation. No gallstones. SPLEEN: No significant abnormality noted.PANCREAS: Fullness and mild restricted diffusion of the pancreatic head with marked fatty atrophy of the body and tail. There is diffuse decreased enhancement of the pancreatic head relative to the remainder of the pancreas, raising the question of parenchymal necrosis. No discrete abnormal fluid collection. No pancreatic mass identified. No pancreatic ductal dilatation. Peripancreatic and perigastric enlarged lymph nodes are unchanged and likely reactive.The SMV-portal vein junction is narrowed, although patent. No vascular complication. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of the stomach. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Fullness of the pancreatic head with associated likely reactive lymphadenopathy compatible with history of pancreatitis. Diffuse decreased enhancement of the pancreatic head raises the question of parenchymal necrosis. Recommend short term follow-up to resolution. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are breast MRI (12/24/15) performed at DuPage Medical Group. For comparison, digital mammographic images (11/21/15, 12/2/15), images from stereotactic biopsy of right breast with specimen radiograph and postprocedural right mammographic images (12/7/15) are available. Breast MRI was performed with a protocol outlined in the outside radiology report.Submitted images could not be processed with our dedicated workstation.There are 2 small seroma cavities from recent biopsy at 3:00 position in the right breast. Mild regional enhancement around the seroma cavities are also present, likely biopsy changes. No abnormal enhancement is seen elsewhere in the right breast or in the left breast.No abnormal lymph nodes are identified in either axillary region. | MRI demonstrated postbiopsy changes at the site of proven DCIS in the right breast at 3:00 position. There were no additional abnormal enhancement in either breast. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Enhancing lesion involving the involving the inferior cerebellar vermis and inferior fourth ventricle is again seen. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Mild degenerative changes are present in the cervical spine including small disc osteophyte complexes and uncovertebral hypertrophy, worst at the C4-C5 level where there is moderate right and mild left neural foraminal stenosis. There is also mild right C5-C6 neural foraminal stenosis. Spinal canal is grossly patent aside from mild developmental narrowing.THORACIC SPINE | 1. No evidence of spinal drop metastases.2. Mild developmental narrowing of the spinal canal, and mild degenerative changes as described above. |
Generate impression based on findings. | Male, 53 years old, with right-sided weakness. No evidence of restricted diffusion is seen. Numerous scattered small foci of T2 hyperintensity are demonstrated in the subcortical and periventricular white matter, unchanged and nonspecific.No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. A single punctate focus of susceptibility is seen within the posterior left parietal lobe compatible with a microhemorrhage, stable. The ventricles are normal in size and morphology. | 1.No evidence of acute ischemia.2.Scattered foci of white matter signal abnormality are nonspecific but probably represent chronic microvascular ischemic disease. |
Generate impression based on findings. | Stage IIIB (cT3N3) lung adenocarcinoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal scattered nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No evidence of intracranial metastases. |
Generate impression based on findings. | 26-year-old female with history of prior meningioma resection, placement of spinal instrumentation, and now more recently hardware removal. Patient now presents with back pain. Thoracic: Compared to prior MRI from 7/23/2015, thoracic fusion hardware has been removed. Redemonstrated is an extra-axial mass located at a T6-7 vertebral body level along the right posterior lateral aspect of the spinal canal which measures 5 x 10 mm in the axial plane and up to 19 mm in the craniocaudal dimension. This mass is not significantly changed since 7/23/2015 but demonstrates slight gradual enlargement when compared to more remote studies dating back to 6/5/2012. Associated calcifications better demonstrated on prior CT. As before, the mass contacts the thoracic cord without evidence of frank cord compression.There is focal dural thickening along the lateral aspects of the thecal sac at the T9-T10 level, which was present previously on the left but is new on the right, and much of it likely represents granulation tissue. Redemonstrated is an additional small focus of dural thickening along the left anterolateral thecal sac at the T10-T11 level measuring 4 x 7.5 mm in the axial plane and up to 12 mm in the craniocaudal dimension, grossly similar to prior although not well imaged on prior study due to presence of hardware. Focal T2 hyperintensity within the spinal cord at T10 with associated volume loss is not significantly changed and consistent with myomalacia. There remains deformity of the left anterolateral aspect of the cord with mild flattening from approximately the T7-T8 level to the T10-T11 levels which is suspected to be related to adhesions in the thecal sac but not significantly changed since prior. Dorsal epidural thickening with mild effacement of the dorsal thecal sac at the site of prior surgeries is compatible with granulation tissue and is not associated with mass effect. No evidence of high-grade spinal canal stenosis at any level. Neural foramina are also patent. The thoracic vertebral bodies are appropriate in the overall alignment and height. Lumbar: Vertebral body heights and alignment in the lumbar spine are normal. Alignment is normal. Bone marrow signal is benign. No significant disc disease. There is no significant spinal canal or neural foraminal stenosis in the lumbar spine. Lumbar paraspinous soft tissues are unremarkable. No abnormal enhancement. | 1.Interval removal of thoracic spinal fusion hardware. There is no significant change in extra-axial mass likely representing a calcified meningioma at the T6-7 level compared to 7/23/2015. There is evidence of slight enlargement when compared to remote studies dating back to 2012.2.Again seen is dural thickening along the lateral aspects of the thecal sac at the T9-T10 level which was present on the left previously, but appears new on the right, and much of it likely represents granulation tissue. Small residual meningioma remains a possibility. No significant mass effect on the cord.3.No significant change in additional nodular focus of dural thickening along the left anterolateral thecal sac at the T10-T11 level which may also represent minimal residual meningioma. No significant mass effect on the cord.4.No change in T2 signal hyperintensity in the thoracic cord at the T10 level likely representing myelomalacia. Mild deformity of the left anterolateral aspect of the cord from approximately the T7-T8 level to the T10-T11 levels is suspected to be related to adhesions in the thecal sac and also not significantly changed since prior. 5. Lumbar spine MRI is unremarkable. |
Generate impression based on findings. | Acute on chronic LBP with vertebral tenderness, please r/o fracture or other acute abnormality vs prior MRI in 2014 History: h/o chronic LBP, acute worsening Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. There is mild loss of the disc height at the L2-3 and L5-S1 levels. No abnormal cord signal.T12-1: Mild degenerative disc disease and loss of height but no neuroforaminal or spinal canal stenosis.L1-L2: Mild degenerative disc disease and loss of height but no neuroforaminal or spinal central spinal canal stenosis. There is a far lateral left annular fissure noted on series 701, image 43 which just abuts the left L1 nerve root.L2-3: Moderate disc disease in moderate facet and ligamentum flavum hypertrophic changes, including bilateral facet effusions and facet joint widening which has progressed compared to the previous exam. There is a shallow broad-based disc bulge along the lateral right and far lateral right neural foramen which causes mild neuroforaminal stenosis but this was seen previously. No central spinal canal or left neuroforaminal stenosis.L3-4: Mild degenerative disc disease and moderate bilateral facet and ligamentum flavum hypertrophic changes, including bilateral facet effusions right greater than left. There has been progression of the facet effusion and widening of the facet spaces. Similar to the previous exam, there is resultant mild central canal stenosis and the transverse dimension but not in AP dimension. No neuroforaminal stenosis.L4-5: Mild degenerative disc disease and moderate to severe left and moderate right facet degenerative changes. No central spinal canal or neuroforaminal stenosis. Again seen is evidence of a prior left-sided laminectomy.L5-S1: Moderate degenerative disc disease with mild facet degenerative changes. No central spinal canal or neuroforaminal stenosis. A tiny annular fissure is noted but unchanged.The paraspinous soft tissue structures appear within normal limits. Within the right SI joint is a small amount of increased signal which may represent a small joint effusion. | Multilevel degenerative changes appearing similar to the prior exam with the exception of progression of the facet joint effusions and facet joint widening at the L2-3 and L3-4 levels which can be a cause of increased pain. |
Generate impression based on findings. | Malignant neoplasm of ovary [183.0] / Secondary malignant neoplasm of brain and spinal cord(198.3) [198.3] / Other malignant neoplasm without specification of site [199.1], Reason for Study: ^Reason: Ovarian cancer with brain mets post radiation therapy. Overall metastatic lesions' maximum diameter and enhancing portions have been decreased since prior scan.Specifically, the right frontal lobe dural metastatic lesion shows significant size reduction of lenticular shaped metastatic lesion which now remained linear dural enhancement.The right frontal lobe middle frontal gyrus rim enhancing lesion shows significantly reduced enhancing portion since prior scan.Other parenchymal lesions including left frontal lobe just lateral aspect of left lateral ventricle frontal horn, right periventricular white matter lesion just outside of the right lateral ventricle occipital horn, and right cerebellar hemisphere all show decreased size since prior scan.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Interval decrease size of enhancing portion as well as size of dural and multiple brain parenchymal metastatic lesions as described above.No evidence of new enhancing lesion.No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | 26-year-old female with stricture and small bowel Crohn's disease now with subacute nausea and vomiting. ABDOMEN: The study is limited due to lack of IV contrast.LIVER, BILIARY TRACT: 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: Scattered mesenteric and porta hepatis lymph nodes.BOWEL, MESENTERY: There is a long segment of mid terminal ileum wall thickening with mild proximal small bowel dilation. There is a short segment of intervening normal appearing bowel in between the 15 long segment affected distal ileum The colon is fluid distended with air-fluid levels. There is corresponding restricted diffusion involving this segment reflecting active disease.BONES, SOFT TISSUES: No significant abnormality noted. | 1.Probable active on chronic disease involving the neoterminal ileum. No evidence of abscess. There is mild proximal dilation of small bowel without high-grade obstruction. |
Generate impression based on findings. | Acute onset paresthesias and back pain after twisting injury: left sided radiculopathy. There are far left lateral foraminal and perhaps extraforaminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels. There is also mild to moderate right neural foraminal stenosis at these levels. In general, the pedicles appear rather short, such that the neural foramina throughout the lumbar spine are not very capacious. Otherwise, there is no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | Far left lateral foraminal and perhaps extraforaminal disc protrusions superimposed upon disc bulges and mild facet hypertrophy at L4-5 and L5-S1, which compress the exiting nerve roots at these levels. |
Generate impression based on findings. | 9-year-old male with vision loss. Evaluate for abnormalities. MRI brain:Exam is limited by motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is scattered opacification of the ethmoid air cells and minimal mucosal thickening involving mucosa of the bilateral maxillary sinuses. Incidental note is made of rightward nasal septal deviation.MRI orbits:Exam is severely limited by motion rendering it nearly nondiagnostic. No gross space-occupying lesions are identified within the orbits. Image quality is not adequate for the detection of small or subtle lesions. | 1.No acute intracranial abnormality.2.Nearly nondiagnostic examination of the orbits. No gross space-occupying lesion is identified. |
Generate impression based on findings. | Malaise and fatigue. Left-sided weakness. Evaluate for stroke. There is restricted diffusion within the right posterior basal ganglia with associated T2 hyperintensity, compatible with acute infarction, as identified on recent CT. There is associated susceptibility, consistent with new hemorrhage since CT July 14, 2015. There are multiple additional punctate foci of the restricted diffusion within the right basal ganglia and the right MCA watershed territory in the deep white matter. A focus of restricted diffusion within the right inferior frontal cortex (series 501, image 248) is less intense on diffusion weighted imaging, probably subacute. There is a linear area of restricted diffusion within the right posterior parietal cortex (series 501, image 241), possibly artifactual, as no FLAIR abnormality is detected. There is no midline shift or herniation. There is loss of the normal right M2 flow void, best visualized on series 1301, image 15. There is corresponding mild intrinsic T1 hyperintensity in this location.There are additional foci of T2 hyperintensity within the periventricular and subcortical white matter, with no restricted diffusion, probably sequela of chronic microvascular ischemic disease. The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1.Acute infarct within the right basal ganglia now with associated blood products, with multiple additional adjacent foci of restricted diffusion, consistent with punctate infarcts.2.Additional possible subacute infarct in right inferior frontal gyrus.3.There is loss of the normal right M2 flow void, compatible with slow/irregular flow, corresponding to the hyperdense MCA seen on CT. |
Generate impression based on findings. | 46-year-old female with right first MTP pain and history of stepping on glass under fourth metatarsal head one month ago. Evaluate for foreign body and osteoarthritis. A marker was placed on the ball of the foot, plantar to the fourth MTP joint of the foot. Just beneath the skin surface adjacent to the marker, is a nonenhancing focus of intermediate signal intensity which is slightly hyperintense to skeletal muscle on T1-weighted images and also hyperintense to skeletal muscle on fat-saturated T2-weighted images, which measures approximately 7 mm in the longitudinal dimension and 7 x 3 mm and the transverse dimension. There is very mild, if any, enhancement of the adjacent soft tissues. The fourth metatarsal and phalanges of the fourth toe appear normal. There is a moderate hallux valgus deformity (metatarsal-phalangeal angle of approximately 30 degrees) with moderate osteoarthritis of the first MTP joint, as seen on recent radiographs. There is associated lateral subluxation of the sesamoid bones relative to their normal location beneath the first metatarsal head and moderate degenerative arthritic changes at the metatarsal-sesamoid articulations. There is low signal intensity within the subcutaneous fat along the medial aspect of the first metatarsal head with enhancement on postcontrast sequences that presumably representing scar tissue. There is a mild synovitis of the first MTP joint. | 1. Small cutaneous/subcutaneus focus of intermediate signal intensity within the soft tissues along the plantar aspect of the base of the proximal phalanx. The etiology and significance of this finding is uncertain, but the signal characteristics are atypical for a foreign body. This could represent a focus prior soft tissue injury. If there is strong clinical concern for a foreign body, targeted ultrasound examination is recommended.2. Osteoarthritis and hallux valgus deformity of the first MTP joint. |
Generate impression based on findings. | 57 years, Male, metastatic renal cell cancer with suspicious brain lesion. There are multiple enhancing lesions throughout the brain consistent with metastatic disease. At least 8 lesions are identified which on axial post gadolinium series 1201 are seen in the left posterior frontal lobe (image 240), left posterior cingulate gyrus (image 239), along the left mid callosal body surface (image 230), right precuneus (image 230), left occipital lobe (image 180), left occipital lobe (image 166), and bilateral occipital lobes (image 124). The largest of these are the left posterior mid callosal body lesion which measures 5 mm in diameter and the right parietal precuneus lesion which also measures approximately 5 mm in diameter. There is mild surrounding edema associated with the lesions. Some of these lesions demonstrate punctate foci of susceptibility compatible with minimal blood products.No abnormal dural or leptomeningeal enhancement. No midline shift or herniation. No hydrocephalus. No evidence of the infarct. Left cerebellar developmental venous anomaly incidentally noted. Major flow-voids are preserved. Minimal paranasal sinus mucosal thickening and small maxillary mucus retention cysts. Calvarium and extracranial soft tissues are otherwise grossly unremarkable. | There are at least 8 enhancing lesions throughout the brain as detailed above consistent with metastatic disease. Lesions measure up to 5 mm in diameter and are associated with mild surrounding edema. No midline shift or herniation. Some of these lesions demonstrate minimal associated blood products. |
Generate impression based on findings. | Vertebral body heights in the cervical spine are normal. Alignment is normal. Bone marrow signal is heterogeneous which is nonspecific but without focal suspicious lesions. T1, T2 hyperintense area in the C3 vertebral body may represent focal fat or hemangioma. The cervical cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Central disc protrusion is present without spinal canal or neural foraminal stenoses. C3/4: Central disc protrusion is present without spinal canal stenosis. Minimal right neural foraminal narrowing is noted.C4/5: Mild diffuse disc bulge is noted with moderate right and mild left neural foraminal narrowing. There is also mild spinal canal stenosis.C5/6: Mild diffuse disc bulge is present with bilateral mild-to-moderate neural foraminal narrowing. No spinal canal stenosis.C6/7: Mild diffuse disc bulge is present with bilateral moderate neural foraminal narrowing. No spinal canal stenosis.C7/T1: Minimal diffuse disc bulge is present without spinal canal or neural foraminal narrowing. | Mild to moderate degenerative changes in the cervical spine with scattered mild to moderate neural foraminal narrowing and mild spinal canal stenosis, predominantly in the lower cervical spine. |
Generate impression based on findings. | Reason: evaluate for dominant lesion for prostate biopsy History: hx of chronic prostatitis, Low grade prostate cancer under active surveillance Please note that study was terminated due to patient discomfort and claustrophobia. Full field of view images of the pelvis were not obtained.PELVIS:PROSTATE:Prostate Size: 6.0 x 4.5 x 4.6 cmPeripheral Zone: Linear area of low T2/ADC signal within the peripheral right mid peripheral zone may represent scarring. An adjacent well-defined T2 hypointense lesion measuring approximately 5 x 5 mm (701/19) within the right anterior peripheral zone is indeterminate.Central Gland: Multiple BPH nodules.Seminal Vesicles: No seminal vesicle involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small subcentimeter pelvic and inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Please note that the patient could not tolerate the postcontrast images and aborted the exam before acquisition of those images.1.Right anterior mid peripheral zone lesion is indeterminate, but may represent small focus of neoplasm.2.A additional linear lesion in the right peripheral zone may represent scarring.3.Small subcentimeter pelvic lymph nodes. |
Generate impression based on findings. | 66 year old female with personal history of breast cancer and strong family history of breast cancer. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Post-surgical density in the posterior depth of the left outer breast is without suspicious enhancement.No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on findings. | Diagnosis: Alzheimer's disease Dementia in conditions classified elsewhere without behavioral disturbance. Vascular dementia, uncomplicatedClinical question: cognitive declineSigns and Symptoms: memory loss 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 moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally multiple signal hyperintensities are also present in the brainstem and deep gray nuclei and internal capsules as well as the cerebellar hemispheres.There are punctate foci of signal loss present in the brainstem, left cerebellar hemisphere , bilateral thalami left medial temporal lobe, left and right inferior temporal gyrus and frontal lobes and parietal lobes bilaterally.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 demonstrate subchoroidal fluid along the right eye. | 1.There are periventricular, subcortical white matter, internal capsule, deep gray nuclei and brainstem signal changes present. These are nonspecific and could be vascular related. This could also relate to a neurodegenerative process such as nonspecific leukoencephalopathy of aging or represent a mixed pattern.2.There are multiple microhemorrhages present within the brain. This appears to be a mixed pattern without predominantly a hypertensive pattern. A superimposed less prevalent secondary pattern with subcortical and cortical microhemorrhages resulting for example from amyloid angiopathy cannot be excluded. |
Generate impression based on findings. | 61-year-old female with bladder cancer, status post ileostomy. Fever and shock. Indiana pouch with ileostomy. Evaluate for GI source of infection. Pulmonary embolism CT scan examination was performed in conjunction with this study, but will be reported separately. ABDOMEN:LUNG BASES: CT scan of the thorax for pulmonary embolism was performed and will be reported separately.LIVER, BILIARY TRACT: There are multiple benign-appearing simple hepatic cysts, unchanged from the recent MRI examination. There is diffuse gallbladder wall thickening with mucosal enhancement suggesting cholecystitis.SPLEEN: There is a splenic hemangioma unchanged since the recent MRI examination.PANCREAS: No evidence of pancreatitis was found.KIDNEYS, URETERS: Mild left hydronephrosis is found, as expected in this patient who is status post Indiana pouch ilial conduit. There is a focal left mid pole cortical thinning, probably due to prior infarct. No acute changes are found and compared with the prior examination.ADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is focal fat stranding in the right or quadrant, especially axial image 81/162, adjacent to the ilial conduit and a drainage tubing at axial image 97 / 162.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a left lower quadrant ileostomy at axial image 91/ 158.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New gallbladder wall thickening suggests interval development of cholecystitis. Multiple postoperative changes. No abscess or ascites. Multiple additional findings, as described above. |
Generate impression based on findings. | 80 year-old male with history of thyroid cancer status post thyroidectomy. Restaging of disease. Limited evaluation due to lack of contrast. MRI may be considered for further evaluation as clinically warranted.BRAIN: Limited intracranial images demonstrate 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 mastoid air cells are normally pneumatized. Sinus disease affects the ethmoid sinuses bilaterally.Skull base:Small nodules in the neck cannot be ruled out due to lack of contrast. MRI may be considered for further evaluation as clinically warranted.Fascial planes appear intact without evidence of architectural distortion or abnormal mass. The airways are patent. | Limited evaluation due to lack of contrast without evidence of gross abnormality. MRI can be considered for further evaluation as clinically warranted. |
Generate impression based on findings. | Reason: meniscus tear History: pain and catching. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Diffuse thinning of the medial compartment articular cartilage. Diffuse thinning of the lateral compartment articular cartilage with at least near full-thickness defect involving the weightbearing portion of the lateral tibial plateau measuring approximately 8 mm in AP dimension with associated underlying subchondral bone marrow edema. Diffuse thinning of the patellofemoral compartment without discrete defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | Osteoarthritis, greatest in the lateral compartment, where there is a near full-thickness defect involving the weightbearing portion of the lateral tibial plateau. |
Generate impression based on findings. | 63-year-old male, rule out rotator cuff tear ROTATOR CUFF: The patient is status post rotator cuff repair. There is full thickness near full width tearing of the distal supraspinatus with retraction of the undersurface fibers to the level of the glenoid. Some fibers of the supraspinatus remain attached to the greater tuberosity. The tear of the anterior aspect of the tendon measures approximately 1.2 cm in AP dimension and of the posterior aspect of the tendon measures 1.4 cm (images 19 and 17, series 8). There is mild to moderate supraspinatus muscle atrophy. Increased signal intensity within the supraspinatus and infraspinatus fibers within the supraspinatus outlet is compatible with tendinosis. There is mild infraspinatus muscle atrophy. The teres minor and subscapularis muscles and tendons are intact.SUPRASPINATUS OUTLET: An os acromiale is noted with mild to moderate AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the labrum is limited, but there appears to be degeneration of the labrum with degenerative tearing anteriorly.BICEPS TENDON: Status post biceps tenodesis.ADDITIONAL | 1. Full thickness, near full width tear of the supraspinatus tendon with retraction of the undersurface fibers to the level of the glenoid.2. Degeneration and tearing of the labrum as described above.3. Moderate distention of the subacromial subdeltoid bursa, containing debris.4. Os acromiale. |
Generate impression based on findings. | Spasticity, evaluate for cervical stenosis Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is osseous fusion involving the C3-C4 vertebral bodies and the C5-C6 vertebral bodies. There is minimal retrolisthesis of C5 on C6. Alignment is otherwise grossly maintained. Bone marrow signal is benign.Degenerative changes are seen in the cervical spine as described below:C2-3: There is mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. No significant compromise to the spinal canal or left neural foramen.C3-4: There is a subligamentous disc extrusion with approximately 6 mm superior migration. There is at least moderate spinal canal stenosis at this level with complete effacement of the ventral and dorsal thecal sac and subtle impression on the cord. There is questionable subtle T2 hyperintensity within the cord at this level.C4-5: Fusion at the intervertebral discs level. There is a small dorsally projecting osteophyte which results in mild spinal canal stenosis at this level. Mild left and minimal right neural foraminal narrowing.C5-6: There is a disc osteophyte complex and ligamentum flavum thickening which contribute to moderate to severe spinal canal stenosis at this level and deformity of the cord particularly in its right aspect. There is T2 hyperintensity in the cord and volume loss consistent with myomalacia. There is severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy and to a lesser degree facet arthropathy.C6-7: Fusion at the intervertebral disc level. No significant spinal canal stenosis. There is mild left and minimal right neural foraminal stenosis. C7-T1: There is a disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis at this level. There is mild to moderate bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. | 1. Postsurgical changes of remote anterior cervical fusion with solid osseous fusion evident at C4-C5 and C6-C7. 2. There is moderate to severe spinal canal stenosis at the C5-C6 level which is not fused. There is cord deformity at this level particularly on the right. There is also T2 hyperintensity and volume loss consistent with myelomalacia.3. There is also at least moderate stenosis at the C3-C4 level related to disc extrusion with superior migration. There is questionable subtle T2 signal abnormality at this level.4. Multilevel neural foraminal stenosis, worst at the C5-C6 level where there is severe right-sided neural foraminal stenosis. Additional levels as above. |
Generate impression based on findings. | Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: characterization of brain metsSigns and Symptoms: gait instability, newly diagnosed lung cancer There is an 18 x 24 mm axial dimension mass redemonstrated at the left cerebellopontine angle cistern which is associated with some adjacent dural thickening and has a broad-based towards the dura. Some susceptibility effect is associated with this lesion suggesting blood products lesion. It appears to have partial extra-axial location and may be exophytic from the adjacent cerebellumThere is a 6 x 8 mm axial dimension enhancing lesion present at the periphery of the left cerebellar hemisphere which was also present on the prior exam and is associated with susceptibility effect.There is redemonstration of a 16 x 21 mm sagittal dimension and 16 x 21 mm axial dimension ring-enhancing mass centered in the right cingulate gyrus which is associated with adjacent vasogenic edema and has also not changed substantially compared to the previous exam and is associated with susceptibility effectThere is a 3 mm enhancing focus in the right cerebellar hemisphereNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left frontal sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | There are multiple hemorrhagic intracranial lesions present which are stable compared to prior exam. One in the left cerebellopontine angle cistern appears to be exophytic. There are others in the left cerebellar hemisphere and right cingulate gyrus. Metastatic disease is not most likely consideration under the circumstances. |
Generate impression based on findings. | Please refer to the subsequent MRI report for further information.Exposure time: 50 seconds | Successful wrist arthrogram into the radiocarpal joint. |
Generate impression based on findings. | Multiple sclerosis, history of sensory and worsening leg weakness. Brain: There are multiple supratentorial and infratentorial T2 hyperintense lesions. Some of the lesions demonstrate corresponding T1 hypointensity. However, there is no abnormal enhancement or associated restricted diffusion in any of these lesions. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is an unchanged subcentimeter cystic pineal gland. The major cerebral flow voids are intact. There is hypoplasia of the right maxillary sinus with mild mucosal thickening and mucosal thickening involving the right ethmoid sinus. There is also fluid within the right sphenoid sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.Thoracic Spine: The thoracic spinal cord signal appears unremarkable. There is no evidence of mass lesions or abnormal enhancement. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There are prominent posterior disc osteophyte complex at T6-T7 and T7-T8, which indent the spinal cord. There is also a right neural foraminal disc-osteophyte complex at T9-10. The paravertebral soft tissue structures are otherwise unremarkable. | 1. No significant interval change of the demyelinating lesions in the brain.2. No evidence of demyelinating lesions in the thoracic cord.3. Prominent posterior disc osteophyte complex at T6-T7, T7-T8, and T9-T10 indent the spinal cord.4. Findings suggestive of acute sinusitis.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 history of progressive change in mental status, with symptom onset 1 month ago, and acute worsening overnight. History of DM, HTN, and RA (on weekly Enbrel). Elevated neuronal enolase. Patient motion limits evaluation. There are new confluent areas of increased T2 and decreased T1 signal abnormality especially within the grey and subcortical as well as deep white matter of bilateral occipital lobes and to a lesser extent other bilateral scattered cortex. Additionally, there is restricted diffusion and FLAIR hyperintensity present in the left greater than right caudate nuclei and bilateral putamen (in retrospect, the caudate abnormality may have been present on the prior MRI) with questionable restricted diffusion in bilateral occipital lobes. The left caudate appears mildly enlarged and edematous. There are progressive scattered punctate foci of subcortical white matter T2/FLAIR hyperintensity. There is no evidence of abnormal enhancement.There is asymmetric susceptibility suggested associated with the left dentate nucleus, although no other signal abnormality in this area is appreciated. The ventricles and basal cisterns are normal in size and configuration. There is no evidence of midline shift or mass-effect. The major cerebral flow voids are intact. | New areas of increased T2/FLAIR signal abnormality throughout bilateral occipital lobes, progressive scattered focal subcortical and cortical T2/FLAIR hyperintensity, and FLAIR hyperintensity as well as restricted diffusion within left greater than right caudate nuclei and putamen. No associated enhancement, with questionable susceptibility in left dentate nucleus.The differential diagnosis includes PRES (posterior reversible encephalopathy syndrome) possibly secondary to hypertension and/or from medications. There have been reports of Enbrel resulting in PRES. Other differential considerations should include various encephalitides, metabolic derangements including osmotic demyelination (extrapontine) if clinically appropriate, or the Headenhain variant of CJD given occipital involvement, although subcortical findings would be atypical. |
Generate impression based on findings. | Female 33 years old Reason: Labral tear? Instability ROTATOR CUFF: All the components of the rotator cuff are intact.SUPRASPINATUS OUTLET: Type I acromion. No abnormal narrowing of the supraspinatus outlet.GLENOHUMERAL JOINT AND GLENOID LABRUM: Focal gadolinium filled defect in the posterior labrum from the 3 to 4 o'clock location (series 501, image 11). No other labral defects are present. No loose bodies or visualized hyaline cartilage defect. The humeral head is normal in appearance and is well-seated at the glenoid. No evidence of osteoarthritis.BICEPS TENDON: The biceps tendon is situated within the bicipital groove and is normal in appearance. ADDITIONAL | Focal posterior labral tear. |
Generate impression based on findings. | Straightening of cervical spine which can be seen with positioning or muscle spasm. Otherwise, anatomic alignment with preservation of vertebral body heights, disk spaces, bony contour and morphology. Atlantal axial and atlantal dental intervals are preserved. No prevertebral soft tissue swelling and preservation of paraspinal fat pads. Circumscribed lucency at C4-5 with circumscribed margins and no cortical breakthrough most commonly focal fat or a hemangioma. | No acute traumatic abnormalities to the cervical spine. |
Generate impression based on findings. | Contrast promptly passed into the radioulnar joint suggest a tear of the triangular fibrocartilage complex. Please refer to the subsequent MRI report for further information.Exposure time: 0:31 minutes | Successful arthrogram of the right radiocarpal joint. Findings suggestive of a tear of the triangular fibrocartilage complex as above. Please refer to the subsequent MRI report for further information. |
Generate impression based on findings. | Male, 46 years old, with altered mental status and C-spine injury. Image quality is limited by patient motion artifact. No restricted diffusion is seen. No large areas of parenchymal signal abnormality, edema or mass effect are detected. The ventricles are not dilated. No large intracranial hemorrhage is suspected. Opacification and/or mucosal thickening is seen within the paranasal sinuses. | Limited examination due to motion artifact, but no large intracranial abnormality is suspected. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: New aphasia Non-infused CT of brain:Postoperative changes of an old left craniotomy in the frontal and temporal region. Focal areas of encephalomalacia in the left frontal, temporal and left caudate nucleus are again identified. There is ex vacuo dilatation of left frontal horn.Expected postoperative changes of a large right-sided frontal -- temporal craniotomy which extends across the midline. There is no evidence of parenchymal hemorrhage no definitive evidence of an ischemic process. Aneurysm clips bilaterally adjacent to the sella from prior surgeries produce significant artifact and obscures the detail in the peri-surgical site. Further follow-up with an MRI is recommended considering provided clinical data. The ventricular system are within normal size and no midline shift.No definitive detectable acute intracranial finding. | 1.No definitive new acute intracranial findings.2.Expected postoperative changes of a larger right frontal and temporal craniotomy.3.Old left frontal and temporal craniectomy with underlying foci of encephalomalacia in the right temporal, right frontal and right caudate nucleus. |
Generate impression based on findings. | Hepatomegaly and cirrhosis. Liver lesion on ultrasound and CT. History of HCV. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intra and extrahepatic biliary ductal prominence is likely related to cholecystectomy state.The liver measures 18 cm in craniocaudal dimension.The segment 4 liver lesion is homogeneously intermediate signal intensity on T2-weighted images and measures approximately 3.8 x 3.0 x 4.9 cm (series 3/18). The lesion demonstrates a thick rind of peripheral enhancement and central heterogeneous enhancement. Small adjacent punctate arterial enhancing foci are noted (series 10/31).There is an additional rim-enhancing lesion in segment 7 of the liver (series 10/28) measuring 9 mm which fills in with contrast on delayed phase imaging.SPLEEN: The spleen is normal in size without a focal lesion.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: Small fat-containing umbilical hernia. OTHER: No significant abnormality noted. | The dominant segment 4 lesion measuring at least 3.8 x 3.0 cm is not compatible with a hemangioma. It does not meet imaging criteria for HCC. A cholangiocarcinoma is favored over an atypical HCC or metastases. Additional rim-enhancing lesion in segment 7 is suspicious for a satellite versus metastatic lesion. |
Generate impression based on findings. | Reason: CCA screening History: PSC ABDOMEN:LIVER, BILIARY TRACT: Narrowing of the distal 1.8 cm common bile duct is similar to prior (series 3 image 70). Mild focal narrowing of the proximal hepatic duct is also unchanged. Subtle common hepatic and common bile ductal wall enhancement is unchanged. Mild intrahepatic biliary ductal dilatation, unchanged. No suspicious focal hepatic lesion.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: Nonspecific portacaval lymph nodes, unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable narrowing of the proximal hepatic and distal common bile ducts with mild intrahepatic biliary ductal dilatation. No suspicious focal hepatic lesion. |
Generate impression based on findings. | Reason: intracranial lesion on OSH imaging History: intracranial lesion on OSH imaging, p/w episode of syncope The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a uniformly enhancing mass present along the anterior cranial fossa centered at the midline measuring 44 x 50 mm axial dimensions and 30 x 50 mm sagittal dimensions. It contains a few flow voids. It displaces the inferior aspects of the frontal lobes posteriorly. It displaces the corpus callosum and anterior cerebral arteries superiorly and posteriorly. Within the adjacent brain parenchyma there is no significant signal change. The mass extends into the olfactory grooves. The olfactory bulbs are not separately identified. There is a large vein which courses along the right aspect of the mass anteriorly and laterally.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The superior ophthalmic veins are large . | 1.Large anterior fossa extracranial masses most likely represents a meningioma. |
Generate impression based on findings. | 19-year-old male with debridement of the right proximal tibia for osteomyelitis now complains of pain.VIEWS: Right tibia/fibula AP and lateral (2 views) 5/24/2016 at 1427 hours Again noted is a round lucent defect in the proximal tibial metaepiphysis compatible with debridement of osteomyelitis. Again noted are the radiodense antibiotic beads. Widespread osteonecrosis is better noted on the prior MRI examination. No regions of soft tissue gas or osseous erosions to suggest new osteomyelitis. No acute fracture. | No significant change in the postsurgical appearance of the right proximal tibial osteomyelitis debridement. |
Generate impression based on findings. | 58 years Female (DOB: 10/10/1957)Reason: stenosis? History: hyperreflexiaPROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild left-sided facet hypertrophy at this level.At C3-4 there is no significant compromise to the spinal canal . There is right-sided facet hypertrophy at this level associated with mild encroachment of the right-sided exiting nerve roots within the neural foramen..At C4-5 there is no significant compromise to the spinal canal. There is right-sided facet hypertrophy at this level associated with mild encroachment of the right-sided exiting nerve roots.At C5-6 there is loss of disc space height, diffuse disc bulge, endplate osteophytes and uncovertebral osteophytes associated with encroachment of the neural foramina bilaterally. Neural foraminal encroachment is worse on the left side where there is encroachment of the left-sided exiting nerve. There is partial effacement of spinal fluid ventral and posterior the spinal cord at this level with mild to moderate spinal stenosis.At C6-7 there is loss of disc space height and disc desiccation, endplate osteophyte formation and uncovertebral osteophytes with associated encroachment of the neural foramina bilaterally and encroachment of the exiting nerve roots bilaterally but worse on the right relative to the left side. There are some effacement of spinal fluid ventral to the spinal cord 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. | There are multilevel degenerative changes present in the cervical spine associated with encroachment of the right-sided exiting nerve roots at C6-7, left-sided exiting nerve roots at C5-6 due to uncovertebral osteophytes and disc material and some encroachment of right-sided exiting nerve roots at C4-5 due to facet hypertrophy. There is also mild to moderate spinal stenosis at C5-6 due to degenerative change. |
Generate impression based on findings. | Gait difficulty, memory issues, evaluate for NPH or any abnormality. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild global parenchymal loss, which appears appropriate for patient's age. There is minimally more prominent volume loss involving the bilateral frontal lobes and mild disproportional prominence of the bilateral frontal horns, which is favored to be on an ex vacuo basis. No findings to suggest communicating hydrocephalus. No disproportional volume loss involving the hippocampi is seen. No extra-axial collections are seen. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. | 1. No evidence of intracranial mass or mass effect. 2. Minimal chronic small vessel ischemic changes.3. Mild global parenchymal volume loss which appears appropriate for age. There is mildly more prominent volume loss involving the bilateral frontal lobes. There is also mild disproportionate prominence of the bilateral frontal horns, which is favored to be on an ex vacuo basis and unchanged since CT dated 11/24/2014. No findings to suggest communicating hydrocephalus/NPH. |
Generate impression based on findings. | Female 73 years old Reason: rectal cancer 1cm from the anal verge History: rectal cancer 1cm from the anal verge PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Note is made of multiple small perirectal lymph nodes, with a reference node, measuring 6 x 4 mm (20; series 4).Lymph nodes outside the mesorectal fascia: Note is made of small external iliac lymph nodes.BOWEL, MESENTERY: Rectal Tumor:Size: 4.9 x 1.3 cm (image 18/series 7)Tumor appearance on T2-weighted images: Heterogeneous, but predominantly increased signal intensity relative to musculature. There is probable invasion to the level of the serosa without convincing evidence of invasion of the mesorectal fat or mesorectal fascia. There is slight upstream dilation of the imaged sigmoid colon.Tumor location: Right anterior and lateral wall of the rectum.(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Approximately 2.4 cmCircumference of the rectum involved: 180 degreesBONES, SOFT TISSUES: No bone marrow signal abnormality is identified.OTHER: No significant abnormality noted. | Note is made of eccentric wall thickening with associated increased signal abnormality and enhancement of the rectum, consistent with the stated history of rectal carcinoma, extending to approximately 2.4 cm from the level of the anal verge. There are multiple perirectal lymph nodes in the surrounding area, with reference measurements provided above. |
Generate impression based on findings. | 81 year old woman. Evaluate for ICH/CVA. There is no evidence of intracranial hemorrhage, mass or edema. There are extensive periventricular and subcortical regions of hypoattenuation consistent with small vessel ischemic disease. These findings are age-indeterminate. If acute stroke remains a clinical concern, recommend evaluation with MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Extensive, age-indeterminate findings of small vessel ischemic disease. 2. No CT findings of acute cortical stroke or hemorrhage. |
Generate impression based on findings. | 55-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.4 x 2.6 x 3.5 cm (TR x AP x CC)Peripheral Zone: There is a focus of decreased T2 signal abnormality with apparent restricted diffusion in the right posterior mid body of the peripheral zone of the prostate gland. However, there is no convincing abnormal enhancement on the dynamic contrast enhanced sequences. These findings are indeterminant, however, prostate carcinoma is not excluded.Seminal Vesicles: No evidence of extension to involve the seminal vesicles.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: Mild concentric thickening of the wall of the bladder suggestive of chronic outlet obstruction.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No bone marrow signal abnormality is identified.OTHER: No significant abnormality noted. | Focus of signal abnormality in the right posterior mid body of the peripheral zone of the prostate gland with indeterminate imaging characteristics. Prostate carcinoma is not completely excluded. These findings were discussed directly with the patient. |
Generate impression based on findings. | Patient with pain and crepitus of the right shoulder, with concern for SLAP lesion. ROTATOR CUFF: There is an intermediate signal in the supraspinatus tendon, consistent with supraspinatus tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Posterior subchondral cysts are noted in the humeral head, raising the possibility of internal impingement. No labral tear is present.BICEPS TENDON: No abnormalities in the biceps tendon. ADDITIONAL | 1.Subchondral cysts in the posterior humeral head, raising the possibility of internal impingement.2.Supraspinatus tendinopathy. |
Generate impression based on findings. | 3 day old female with history open myelomeningocele. Evaluate ventricles. There is no evidence of intracranial hemorrhage, mass or edema. Moderately enlarged ventricles for age; recommend MRI for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Moderately enlarged ventricles for age; recommend MRI for further evaluation. |
Generate impression based on findings. | Persistent hyperprolactinemia. Rule out prolactinoma: Galactorrhea. There is an apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm. The pituitary gland is otherwise neither enlarged or atrophic. The pituitary infundibulum and posterior bright spot are intact. There is no compromise of the cavernous sinuses or | An apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm may represent a pars intermedia cyst or microadenoma. |
Generate impression based on findings. | T4N2cM1 tonsil ca admitted for cycle 4/7-8 FHX elderly frail. There is a lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the adjacent soft tissues measuring up to approximately 30 mm. There is diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus and perhaps into the right foramen rotundum. There is also mildly prominent enhancement and thickening of the adjacent dura along the floor of the middle cranial fossa. There are denervation changes in the right tongue and right masticator muscles. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is a lesion in the C7 vertebral body with endplate deformities. There is a punctate lesion in the superior portion of the C5 vertebra. There is multilevel degenerative cervical spondylosis with disc-osteophyte complexes at C3 through C7 that mildly indent the spinal cord. There is fluid within the bilateral mastoid air cells. There is mild mucosal thickening in the right maxillary sinus. | 1. A lingual cortex defect and diffuse enhancement in the right mandible, with ill-defined enhancement in the soft tissues, measuring up to approximately 30 mm, which likely corresponds to the previously treated tumor, superimposed upon right tongue denervation changed. 2. Diffuse thickening of the right trigeminal nerve from the inferior alveolar canal to the cavernous sinus is compatible with perineural tumor spread, with denervation changes in the right masseter muscles.3. Treated metastatic lesion in the C7 vertebral body with endplate deformities. A punctate lesion in the superior portion of the C5 vertebra is nonspecific.4. No significant residual cervical lymphadenopathy based on size criteria. 5. Nonspecific fluid within the bilateral mastoid air cells. |
Generate impression based on findings. | 46-year-old female with biopsy-proven left breast malignancy and enlarged left axillary lymph nodes on MRI. Evaluate for axillary adenopathy. A targeted left ultrasound was performed for the MRI area of concern in the left axilla. Multiple benign morphology lymph nodes are present within the left axilla. The largest is identified within the inferior left axillary region and measures 2.6 x 1.3 x 1.6 cm. This lymph node demonstrates thin cortex with preservation of the fatty hilum and hilar vascularity. | Multiple benign morphology lymph nodes within the left axilla. The largest measures 2.6 cm in greatest dimension, and corresponds to the lymph node visualized on MRI examination. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Reason: Assess for R achilles degeneration/tear/cystic changes History: Swollen, painful lump 4-5cm proximal to achilles insertion on calcaneus; pain with walking TENDONS: There is thickening and intermediate signal intensity within the Achilles tendon indicating moderate to severe tendinosis. There is linear fluid signal intensity within the medial fibers of the Achilles tendon approximately 4 cm proximal to its insertion on the calcaneus indicating partial thickness tearing. There is no significant retraction. The flexor and extensor tendons appear intact. The peroneal tendons appear intact. There is circumferential fluid within the tendon sheath of the flexor hallucis longus just proximal to the master knot of Henry which may represent a tenosynovitis/intersection syndrome.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The components of the deltoid ligament appear intactARTICULAR SURFACES AND BONE: There is increased bone marrow signal abnormality within the base of the second metatarsal which may reflect degenerative change. No additional bone marrow signal abnormality is identified. ADDITIONAL | Moderate to severe tendinosis of the Achilles tendon with partial thickness tearing as described. No significant retraction is identified. Other findings as above. |
Generate impression based on findings. | 47 years Female (DOB: 5/1/1969)Reason: HISTORY OF CERVICAL RADICULOPATHY History: AS ABOVEPROVIDER/ATTENDING NAME: KATARINA VESKOVIC KATARINA VESKOVIC The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.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. There is a disc bulge present at this level associated with some disc desiccation. There are small uncovertebral osteophytes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a left-sided perineural cyst 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. | There are some mild degenerative changes present in the cervical spine without significant compromise to spinal canal or exiting nerve roots. |
Generate impression based on findings. | 49 year old female with a personal history of right simple skin sparing mastectomy with immediate implant based reconstruction in 10/2012 for IDC/DCIS and a benign right axillary lymph node biopsy in 2015. RIGHT RECONSTRUCTED BREAST:Status post skin sparing mastectomy with implant based reconstruction. The retropectoral silicone implant appears unchanged in contour and appearance. No abnormal enhancement is seen.LEFT BREAST:There is scattered fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on findings. | History of anal cancer and anorectal fistulas with fecal incontinence. Evaluate fistulous disease. PELVIS:PROSTATE/SEMINAL VESICLES: The peripheral zone is homogeneously T2 hyperintense aside from a 3 mm T2 weighted hypointense lesion in the medial aspect of the mid gland.BLADDER: Partially distended bladder without a focal abnormality.LYMPH NODES: No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: The visualized pelvic bowel loops are normal in caliber. In the distal rectum/anal canal at the 6:00 position there is a short fluid tract extending dorsally to T2 very hypointense granulated/fibrotic tissue tract which extend caudally along the gluteal cleft to the skin surface on the right. The granulation extends caudally along the left in the ischioanal fossa towards the dorsal column of the acetabulum. Granulation tissue extends along the left aspect of the anal canal as well. There is a 1.0 x 0.5 cm fluid locule in the right intersphincteric space (series 1000 1/24) without associated rim enhancement or inflammatory changes. Overall the appearance is similar to 2004.Note is made of mild near-circumferential thickening and gradual enhancement of the anorectum, which may be treatment related without a discrete nodular component. BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity is nonspecific and may represent red marrow conversion.Thickening and enhancement of the left hamstring tendons.OTHER: No significant abnormality noted. | Complex predominantly granulated perianal fistulous tracts with a 1.0 cm fluid locule in the right intersphincteric space. Overall the configuration and extent of disease is similar to 2004 at which time there tracts were fluid filled. Mild near-circumferential thickening and gradual enhancement of the anorectum, which may be treatment related without a discrete nodular component. |
Generate impression based on findings. | Reason: cuff tear? History: pain ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus tendon at its insertion on the greater tuberosity with minimal (5 mm) retraction of the tendon. This tear measures approximately 1 cm in the AP dimension. There is intermediate signal intensity within the supraspinatus tendon more proximally and posteriorly, which indicates moderate tendinosis with fraying of both tendinous surfaces. A thin elongated collection of near fluid signal intensity extending along the myotendinous junction of the infraspinatus tendon indicates intrasubstance cyst formation with equivocal extension to the articular surface. There is mild fatty atrophy of the infraspinatus along the myotendinous junction. The teres minor muscle and tendon appear intact. There is thickening and increased signal intensity of the distal fibers of the subscapularis likely representing a combination of tendinosis and redundancy due to internal rotation of the humerus. There is mild fatty atrophy of the subscapularis along the myotendinous junction.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthrosis affects the glenohumeral joint. There is minimal posterior translation of the humeral head relative to the center of the glenoid. There is a small amount of fluid within the joint and there is intermediate signal intensity within the anterior aspect of the joint that we suspect represents synovitis. Additional heterogeneous low signal intensity situated between the glenoid and undersurface of the subscapularis likely represents a combination of redundancy of the capsular structures and synovitis. The superior labrum is largely replaced with intermediate signal intensity reflecting degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps is perched along the lateral aspect of the lesser tuberosity and we cannot exclude the possibility of a pulley injury. | 1. Rotator cuff tears and tendinosis as described above including a full-thickness tear of the anterior fibers of the supraspinatus tendon at its insertion.2. Osteoarthritis and other findings as described above. |
Generate impression based on findings. | 70 year-old female. Prior concern for malignancy. Evaluate for any suspicious lesions. ABDOMEN:LIVER, BILIARY TRACT: 1.5 x 1.5 cm segment 2 homogeneously arterially enhancing lesion with mild T2 hyperintensity and mild diffusion restriction, not significantly changed from 2012. Delayed images show that this lesion retains contrast and is mildly hyperintense to background liver without evidence of washout.Nodular contour of the liver consistent with a cirrhotic morphology.Patent hepatic artery, portal vein, and hepatic veins. No biliary ductal dilatation. No evidence of portal hypertension.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas with a mildly, diffusely dilated duct.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral 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. | 1.5-cm arterially enhancing lesion without washout in segment two of the liver, not significantly changed from 2012, and likely benign. |
Generate impression based on findings. | Foot weakness. Evaluation of the left lumbosacral plexus is requested. There is diffuse heterogeneity of the bone marrow signal which is nonspecific and may be related to marrow reconversion. No discrete destructive osseous lesion is demonstrated.There is no abnormal T2 signal or enhancement involving the lumbosacral nerve roots or the lumbosacral plexus more peripherally in the pelvis. No abnormal signal or enlargement of the sciatic nerves is present. No masses to suggest extrinsic compression. Aortoiliac ectasia again noted. Small disc bulges at L4-L5 and L5-S1 with minimal left neural foraminal narrowing again seen, without clear evidence of impingement. | 1. No abnormal signal or evidence of extrinsic compression involving the lumbosacral plexus.2. Diffuse heterogeneity of the bone marrow signal is nonspecific and may represent marrow reconversion. No discrete destructive osseous lesion is appreciated. |
Generate impression based on findings. | Female 76 years old with stocking glove neuropathy and numbness in her hands. Evaluate for cervical spine compression. There is moderate degenerative disc disease at C5-6 and C6-7 and mild degenerative disc disease at C4-5. There is loss of the normal cervical lordosis and minimal retrolisthesis at C5. Moderate multilevel neural foraminal narrowing is seen bilaterally which may in part be exaggerated by patient positioning. | Degenerative disc disease and other findings as described above. |
Generate impression based on findings. | Persistent left sciatica which has been increasing. Known spinal DJD. There is reversal of the lordosis with 3 mm of grade 1 retrolisthesis of L3 on L4 and 4 mm of retrolisthesis of L5 on S1. There is also levoscoliosis and moderate to severe degenerative disc narrowing at multiple levels. The bone marrow demonstrates a heterogeneous signal which is nonspecific. The spinal cord displays normal signal and morphology and terminates at the L1 level. The paravertebral soft tissues are unremarkable. T10-T11: On sagittal views, there is a small diffuse disc bulge but no significant central canal or neuroforaminal stenosis.T11-T12: A disc bulge is noted with facet hypertrophy and ligamentum flavum thickening. There is mild to moderate bilateral neural foraminal and mild to moderate central canal stenosis.T12-L1: There is a disc bulge with moderate facet hypertrophy and ligamentum flavum thickening which causes moderate bilateral neural foraminal stenosis and at most mild to moderate central canal stenosis.L1-L2: There is a disc bulge and left greater than right facet hypertrophy and ligamentum flavum thickening which causes mild right and moderate to severe left neuroforaminal stenosis and moderate central canal stenosis.L2-L3: There is a disc bulge with severe facet hypertrophy and ligamentum flavum thickening which causes minimal right and moderate to severe left neural foraminal stenosis as well as moderate central canal stenosis.L3-L4: A shallow left foraminal/far lateral disc protrusion is superimposed on the uncovering of the disc. There is also severe facet hypertrophy, right greater than left, and ligamentum flavum thickening which causes severe right and moderate to severe left neural foraminal stenosis. This also causes moderate to severe central canal stenosis with effacement of the right lateral recess.L4-5: A disc bulge is seen at this level with severe facet hypertrophy and ligamentum flavum thickening with moderate to severe bilateral neural foraminal stenosis and mild to moderate central canal stenosis.L5-S1: A disc bulge is noted with a superimposed left to right paracentral shallow disc protrusion with facet and ligamentum flavum hypertrophy. This causes left greater than right neural foraminal stenosis with effacement of the left lateral recess. There is also moderate central canal stenosis.A small rounded T2 hyperintense lesion is noted within the upper pole of the right kidney which is nonspecific but statistically most likely represents a renal cyst. | 1.Diffuse moderate to severe degenerative disease of the lower thoracic and lumbar spine with at most moderate-severe central spinal canal stenosis at L3-4 and multilevel neural foraminal stenosis, and multiple levels of moderate-severe to severe foraminal narrowing as detailed above.2.There is also lumbar levoscoliosis and degenerative grade 1 retrolisthesis of L3 on L4 and L5 on S1. |
Generate impression based on findings. | History of multiple sclerosis with slurred speech and weakness. Also recent sore throat with fevers. There are numerous, greater than 10, T2 hyperintense lesions involving the cerebral white matter, predominantly in a periventricular distribution. There are also T2 hyperintense lesion in the pons and bilateral middle cerebral peduncles. Many of the lesions are also T1 hypointense, but there is no associated enhancement. There may also be a T2 hyperintense lesion in the imaged upper cervical spine. There are nonspecific areas of susceptibility effect in the bilateral basal ganglia. However, there is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are diffusely prominent due to mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, mastoid air cells, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is diffuse thickening of the calvarium.There is mild prominence of the adenoids and there is a small amount of secretions in the nasopharynx. | 1. Stigmata of multiple sclerosis, but no evidence of acute intracranial hemorrhage, abscess, or acute infarct. 2. Mild prominence of the adenoids and there is a small amount of secretions in the nasopharynx may be attributable to an upper respiratory tract infection. |
Generate impression based on findings. | 46 years, Female, metastatic cervical cancer status post whole brain radiation therapy.. Compared to MRI dated 7/31/2015 and 7/23/2015, interval postsurgical changes of right frontal craniotomy for biopsy are seen. Again seen is abnormal dural thickening and enhancement as well as leptomeningeal enhancement along the right middle frontal gyrus, which is mildly decreased compared to 7/23/2015. Associated vasogenic edema also is decreased in the interval. Dural and leptomeningeal enhancement at the right anterior frontal pole appears similar to prior from 7/31/2015. Vasogenic edema in this region is minimally decreased in the interval.No new parenchymal or meningeal enhancement or mass is appreciated. No significant intracranial mass effect. No evidence of recent ischemia or hemorrhage. Minimal chronic blood products are noted in the right middle frontal gyrus. No extra-axial collections. No hydrocephalus. Calvarium and extracranial soft tissues are grossly unremarkable. | 1. Compared to preoperative MRI studies from 7/23/2015 and 7/31/2015, there is slight decrease in dural and leptomeningeal enhancement related to known metastatic disease along the right middle frontal gyrus with also decrease in associated edema. Dural and leptomeningeal enhancement along the right anterior frontal pole is not significantly changed. There is however mild decrease in associated edema. 2. No new parenchymal or meningeal enhancement or new mass lesion is evident. |
Generate impression based on findings. | 23-year-old male with right knee lateral joint line pain. MENISCI: Linear signal abnormality extends from the free edge of the body of the lateral meniscus through the peripheral fibers decompressing into a lobulated, slightly heterogeneous perimeniscal cyst. The configuration of the signal abnormality suggests a radial tear centrally that propagates as a horizontal tear peripherally. The anterior and posterior horns of the lateral meniscus appear normal. We see no tear of the medial meniscus.ARTICULAR CARTILAGE AND BONE: Articular cartilage and bone appear normal.LIGAMENTS: There is lateral bowing of the lateral collateral ligament due to the underlying perimeniscal cyst, but we see no ligament tear. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL | Lateral meniscal tear with perimeniscal cyst. |
Generate impression based on findings. | 69-year-old female with C7 fracture, evaluate for healing As seen on prior, there is mild loss of height of the C7 vertebral body involving depression of the superior endplate. Band of T2 hyperintensity and T1 hypointensity abnormality indicating edema along the superior endplate, more so on the right than on the left is slightly improved since 9/25/2014. Edema extending involving the C7 right pedicle and lamina is also improved in the interval. Edema within the interspinous soft tissues extending from C4 to C7 is also improved in the interval. Subtle edema involving the posterior longitudinal ligament is also noted at the C6 level. No evidence of frank ligamentous disruption. Anterior longitudinal ligament and ligamentum flavum also are intact.There is a central disk protrusion at the C6-C7 level similar to prior. There is possible T2 hyperintense in the right ventral cord at the C6-7 level which is more apparent than on prior. No cord swelling.Vertebral body heights are maintained. There is minimal anterolisthesis of C6 on C7 which was present on prior. Alignment is otherwise maintained.C2-3: Mild central posterior disk osteophyte with partial effacement of the ventral thecal sac. No significant spinal canal or foraminal narrowing. Mild facet arthropathy.C3-4: Mild central posterior disk osteophyte with effacement of the ventral thecal sac. No significant spinal canal or neuroforaminal narrowing. Mild facet arthropathy.C4-5: Mild central posterior disk osteophyte with effacement of the ventral thecal sac. No significant spinal canal or foraminal narrowing. C5-6: Minimal posterior disk osteophyte formation. No significant spinal canal or neuroforaminal narrowing. C6-7: Central disk protrusion with mild ventral cord deformity, similar to prior allowing for differences in position. There is also foraminal component of the disk on the right with mild narrowing of the right neural foramina. Left neural foramen is patent.C7-T1: Unremarkable. | 1. Fractures involving the superior endplate of the C7 vertebral body extending into the posterior elements on the right are better seen on prior CT. There is mild decrease in associated bone marrow edema compared to prior MRI from 9/25/2014, suggestive of healing.2. Mild anterolisthesis of C6 on C7. There is subtle edema involving the posterior longitudinal ligament and interspinous ligaments suggestive of ligamentous injury, which is decreased in the interval. No evidence of frank ligamentous disruption.3. Disk protrusion at C6-7 again seen with mild deformity of the ventral cord and mild narrowing of the right neural foramen. Given above findings, this disc herniation may be traumatic in etiology. 4. Possible minimal T2 hyperintensity in the right ventral cord at C6-7. |
Generate impression based on findings. | Clinical question: Is there change in cerebellum or ?olivary lesionSigns and Symptoms: ataxia MRI brain:There is redemonstration of cystic lesions in the medulla bilaterally at the expected location of the all of which is larger on the left compared to the right side. There is no associated diffusion restriction. There is no associated susceptibility effect. There is no associated contrast enhancement on the prior exam. The one on the left measures 4 x 5 mm axial dimensions and 4 x 9 mm coronal dimensions whereas the one on the right measures 3 x 3 mm axial dimensions and 3 x 3 mm coronal dimensions. These cystic lesions are slightly more prominent on the current prior exam though this appearance of a larger on the current versus the prior exam may be due to difference in slice thickness and gap on the prior MR acquisition and therefore may not be valid. This there is no convincing evidence for interval change in size of these lesions.There is associated cerebellar atrophy present. This is also present on the prior exam. The degree of cerebellar atrophy appears similar compared to the prior exam.There are no associated lesions appreciated in the dentate nuclei nor in the right nuclei.The supratentorial 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.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. | 1.There are cystic lesions centered in olivary nuclei bilaterally (left larger than right) - suspected to represent cystic degeneration - associated with relatively symmetric cerebellar atrophy.2.No intrinsic spinal cord lesions are appreciated3.There are mild degenerative changes present in the cervical spine mainly in the form of disk degeneration without significant compromise to the spinal canal or neural foramina. At age 22 this is more disk dessication than usually expected. |
Generate impression based on findings. | Intra-articular contrast extends into the distal radioulnar joint through the expected location of the triangular fibrocartilage complex. No intra-articular contrast is identified within the mid carpal joint. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 10 seconds. | Fluoroscopic guided right wrist arthrogram with findings indicating disruption of the triangular fibrocartilage complex. Please refer to the subsequent MRI arthrogram report for additional details. |
Generate impression based on findings. | Female, 32 years old, with multiple sclerosis. Comparison is complicated by artifact from dental appliances on both the present and prior examinations. A large T2 hyperintense lesion within the genu of the corpus callosum appears to be new and also appears to produce edema with mild local mass effect. This lesion, and a small lesion at the margin of the right frontal horn, both demonstrate enhancement on postcontrast images. Scattered additional smaller nonenhancing periventricular and corpus callosum T2 hyperintense lesions are seen which do not appear to have changed significantly in the interval. Slight effacement of the right lateral ventricle is seen due to the genu lesion. Otherwise, the ventricular system is within normal limits. | A large lesion within the genu of the corpus callosum appears to be new and is associated with edema and mild local mass effect. This lesion, and a smaller lesion at the margin of the right frontal horn, demonstrate enhancement. Multiple additional smaller nonenhancing lesions do not appear to have changed significantly. |
Generate impression based on findings. | History of right posterior thigh mass, evaluate for heterotopic bone. No fractures or osseous lesions are identified. No mineralization is present in the soft tissues, specifically at the site of the soft tissue mass seen on prior outside MRI. A small os acetabuli, a normal variant, is present. | No calcifications at site of soft tissue mass seen on outside MRI. |
Generate impression based on findings. | Clinical question: Assess for disk herniation. Signs and symptoms: Low back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.The marrow signal intensity of vertebral column demonstrate changes secondary to mild degenerative disease and unremarkable otherwise.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild to moderate disk disease and loss of disk height and mild to moderate bilateral ligamentum flavum hypertrophy. There is a tiny centrally located disk protrusion with resultant subtle indentation of thecal sac however without spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is a broad based shallow central and rightward disk protrusion with resultant slight flattening and posterior displacement of thecal sac on the right. There is no neural foraminal compromise however mild right lateral recess compromise is detected. No central spinal stenosis.L4 -- L5 demonstrate moderate bilateral ligamentum flavum hypertrophy and without evidence of disk disease, central spinal stenosis or neural foraminal compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and no appreciable facet disease. There is a right paramedian shallow disk protrusion present at this level. No central spinal stenosis. Mild right neural foraminal compromise secondary to degenerative changes. Unremarkable lowermost visualized thoracic spine and thoracic cord from T10 inferior. Unremarkable perispinal soft tissues. | 1.Normal anatomical alignment the vertebral column and without evidence of fracture.2.Multi-level shallow disk protrusions at L2 -- L3, L3 -- L4 and L5 -- S1 levels as detailed.3.There is no evidence of central spinal stenosis at any level. 4.Mild right neural foraminal compromise at L5 -- S1 on the right and patent at all other levels. Mild right lateral recess compromise at L3 -- L4.5.Please review detailed report per level above. |
Generate impression based on findings. | Torticollis and plagiocephaly, not making progress with helmet and irritable. Brain: There is mild plagiocephaly. There is slight prominence of the bilateral frontal convexity extra-axial CSF spaces. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There is no evidence of rotatory subluxation or spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There appears to be mild asymmetry of the sternocleidomastoid muscle thickness without altered signal characteristics. There are prominent suprahyoid lymph nodes bilaterally. The paravertebral soft tissues are otherwise unremarkable. | 1. Mild plagiocephaly, but no evidence of acute intracranial mass.2. Apparent mild asymmetric thickness of the sternocleidomastoid muscles may be due to torticollis, but no evidence of rotatory subluxation or spondylolisthesis in the cervical spine. 3. Prominent suprahyoid lymph nodes can be a normal feature for age. However, ultrasound may be useful for further evaluation if clinically warranted. |
Generate impression based on findings. | Biliary ductal dilatation seen on recent CT. Patient is asymptomatic. History of treated anal cancer. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. There is diffuse fatty infiltration. It demonstrates normal enhancement without a focal lesion.The patient is status post cholecystectomy. The common bile duct is dilated up to 1.2 cm. It tapers smoothly to the level of the ampulla without a focal lesion or obstructing stone.SPLEEN: The spleen is normal in size morphology and signal intensity without a focal lesion.PANCREAS: The pancreas is normal in morphology and signal intensity. The main pancreatic duct is normal in caliber. Bifid configuration of the main pancreatic suggestion of dominant duct of Santorini drainage, a normal variant. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral cysts. No hydroureteronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. Small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative endplate changes.OTHER: No significant abnormality noted. | Common bile duct dilatation up to 1.2 cm may be partly due to postcholecystectomy state as there is no obstructing stone or discrete lesion. Correlate with LFTs. |
Generate impression based on findings. | Left parietal lesion for stability. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral white matter bilaterally, without associated enhancement, which may represent chronic microvascular disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an enhancing lesion in the left parietal skull that measures up to 10 mm, which is unchanged. The orbits, mastoid air cells, and scalp soft tissues are grossly unremarkable. There are several paranasal sinus retention cysts. | 1. No evidence of brain metastases. 2. An enhancing lesion in the left parietal skull that measures up to 10 mm may represent a metastasis, but is unchanged in size. |
Generate impression based on findings. | There is no no abnormal enhancement, acute infarct, mass effect, or cerebral edema. There are moderate periventricular and subcortical white matter T2 hyperintensities which are nonspecific, likely representing chronic small vessel ischemic changes with involvement of the central pons. There is age related sulcal prominence. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. | No intracranial metastases. Moderate chronic small vessel ischemic changes. |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: Altered mental status. Non-enhanced CT of brain:Heavy vascular calcification of vertebral and cavernous carotid arteries are again identified.There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Findings consistent with small vessel disease are again identified and made no gross interval change since prior exam.Calvarium is intact. Mastoid air cells, middle ear cavities and limited view of paranasal sinuses are well pneumatized.A very small calcific dural based lesion is believed to represent a very small meningioma which was also noted on prior MRI examination from 2 -- 26 -- 2010. On coronal postinfusion image 14 of prior MRI exam this lesion measures approximately 5 mm in transaxial dimensions. | 1.No evidence of acute intracranial findings.2.Small vessel disease of indeterminate age with no gross interval change since prior exam.3.A tiny 5-mm left frontal calcific meningioma with no change since prior exam. |
Generate impression based on findings. | Memory, behavior changes and tremor. Evaluate for inflammatory changes. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are several punctate foci of nonspecific T2 hyperintensities scattered in the white matter of the cerebral hemispheres bilaterally, most likely representing chronic small vessel ischemic change and similar to prior. Again seen is bilateral symmetric high T2/FLAIR signal in the inferior dorsal pons at the level of the aqueduct and superior cerebellar peduncles. The ventricles and basal cisterns are unchanged in size and configuration. There is mild global parenchymal volume loss including the hippocampi in a nonspecific pattern. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. Unchanged appearance of the globes which are enlarged. | 1. No evidence of acute infarct, hemorrhage, mass, or edema. No findings to suggest an active inflammatory process although gadolinium might be helpful.2. Compared to 5/5/2011, no significant change in bilateral symmetric high T2/FLAIR signal in the inferior dorsal pons which may be related to remote inflammatory, toxic-metabolic, or demyelinating injury.3. Nonspecific mild white matter changes which are nonspecific but compatible with mild 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. | Clinical question: 48-year-old female with C6 numbness, evaluate cervical spine or for changes/abnormalities. Signs and symptoms: Numbness. No unenhanced cervical MRI,The alignment of vertebral column is anatomic, however there is mild reversal of cervical lordosis if to be secondary to degenerative disease.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild disc desiccation with decreased T2 signal intensity and height, shallow broad-based bulge of the disc and no significant facet or ligamentum flavum hypertrophy. There is moderate bilateral (L>R) neural foraminal compromise and no central spinal stenosis.C4-C5 demonstrate mild disc disease and loss of disc height, asymmetric left-sided uncovertebral hypertrophy and no significant facet or ligamentum flavum hypertrophy. There is moderate left and mild right neural foraminal compromise. There is also mild central spinal stenosis.C5-C6 demonstrate moderate disc disease and loss of disc height, asymmetric (L>R) uncovertebral hypertrophy and no significant facet or ligamentum flavum degenerative changes. Findings results in significant right neural foraminal compromise and mild central spinal stenosis. C7-T1 demonstrate minimal degenerative changes without spinal canal or neural foraminal compromise.There is no convincing evidence of cord signal abnormality at any level.Spinal soft tissues remain unremarkable. | 1.Degenerative changes at C5-C6 results in significant right neural foraminal compromise and mild central spinal stenosis.2.Degenerative changes at C4-C5 results in moderate left and mild right neural foraminal compromise and mild central spinal stenosis.3.Degenerative changes at C3-C4 results in moderate bilateral (left greater than right) neural foraminal compromise.4.The signal intensity of the cord remains within normal. |
Generate impression based on findings. | Primary biliary cirrhosis. Evaluate changes in cysts/hemangiomas. ABDOMEN:LIVER, BILIARY TRACT: No new hepatic lesion is identified. Unchanged segment 6, T2 hyperintense lesion measuring 1.2 x 1.0 cm (series 7, image 23), with progressive enhancement, consistent with a hemangioma. Unchanged subcapsular anterior T2 hyperintense lesion, retains contrast on delayed imaging and measures 0.9 x 0.6 cm (series 7, image 7), compatible with a hemangioma. An additional T2 hyperintense focus measuring 0.5 x 0.4 cm in segment 8/7 (series 7, image 10) demonstrates no definite enhancement, most likely a hepatic cyst, unchanged from prior. There is no biliary ductal dilatation. The liver is smooth in contour and normal in morphology.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 anterior cardiophrenic lymph node measures 1.8 x 1.0 cm (series 3, image 9), unchanged. A right paracardiac lymph node near the hepatic dome measures 1.2 x 0.7 cm (series 3, image 5), unchanged. Stable prominent gastrohepatic, periportal and peripancreatic lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Unchanged hepatic lesions, probably hemangiomas and a subcentimeter cyst. 2.Unchanged lymphadenopathy. |
Generate impression based on findings. | Reason: Left arm weakness History: Left arm weakness The exam is limited by patient motion.The cervical vertebral bodies are appropriate in overall alignment and height. The patient is status post recent laminectomies and posterior fusion with facet screws and at C2, C3 and C4. Previously noted spinal stenosis at C2-3, C3-4 and C4-5 has been alleviated.The patient has a focal signal hyperintensity at the C3-4 involving predominantly the spinal cord centrally - left more than right. Comparing to the prior exam it appears to have been previously present to some degree (see images 11 on series #4 and #7 of the prior exam) but may have been obscured by the severe spinal stenosis.Detailed evaluation of he neural foramina is partly obscured by patient motion. There are disk bulges present at C3-4, C4-5 , C5-6 associated with loss of disk space height and disk dessication. Bilateral neural foramen encroachment of exiting nerve roots is present at C3-4.The vertebral artery flow voids appear to be intact. | 1.Since the prior exam the patient has undergone multilevel laminectomies and posterior fusion in the upper cervical spine.2.A central spinal cord abnormality at C3-4 eccentric to the left hemicord is more obvious on the current exam. The possibility of progression of edema cannot be excluded. Most likely this is related to spondylitic myelopathy status post decompression. It is conceivable that there is new superimposed injury. Please correlate with clinical exam findings.3.Exam is limited by patient motion which can obscure more subtle abnormalities and changes. The patient was not able to tolerate more imaging. |
Generate impression based on findings. | left lower back pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal cana. There is a broad-based left lateral recess disc protrusion present at this level which extends from the midline to the proximal left neural foramen at this level mildly displacing the nerve root at the left lateral recess and mildly encroaching on the left-sided exiting nerve root within the neural foramen but not effacing the fat surrounding the left lateral recess nor the fat surrounding the left-sided exiting nerve root. There are endplate reactive changes with heterogeneous T2 high signal present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | There is a broad-based left lateral recess disc protrusion at L5-S1 which mildly displaces the nerve root at the left lateral recess and mildly encroaches on the nerve root in the left neural foramen. Associated endplate reactive changes appear to be subacute. |
Generate impression based on findings. | MRI Brain: Motion degraded examination.There is restricted diffusion involving the posterior limb of the left internal capsule extending into the left cerebral peduncle as well as involving the left periventricular white matter compatible with an acute infarct. Small additional chronic lacunar infarcts are noted along the superolateral aspect of the thalamus on the right. There is T1 shortening involving the right basal ganglia with suggestion of enhancement which may reflect subacute ischemia or metabolic injury.Enhancing mass involving the right aspect of the sella measures approximately 2.4 x 2.3 cm (series 1702, image 119). The mass extends into the right cavernous sinus and encases the cavernous segment of the right internal carotid artery. It also abuts the bifurcation of the right internal carotid artery. The pituitary infundibulum is displaced leftward. Enhancing tissue along the left aspect of the sella is compatible with residual pituitary tissue. There is mild effacement of the lateral aspect of the suprasellar cistern on the right, however, there is no mass effect on the optic chiasm.There is suggestion of prior surgery involving the sella with focal defect along the anterior aspect of the sella. Correlation with history is suggested. Tiny (~5 mm) meningioma is present along the anterior aspect of the falx abutting the inferior frontal lobe without significant mass effect.There is no midline shift or herniation. No hydrocephalus. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mucosal thickening in the paranasal sinuses most notably in the right maxillary sinus. The midline structures and craniocervical junction are within normal limits. MRA Head: Markedly motion degraded examination without evidence of high-grade stenosis.The intracranial internal carotid arteries are patent and demonstrate no significant stenosis. The sellar mass encases the cavernous segment of the right internal carotid artery and abuts the bifurcation. The middle and anterior cerebral arteries are also patent. The vertebral basilar artery system is diminutive, at least predominant due to developmental variant with prominent posterior communicating arteries and diminutive P1 segments. There are focal areas of signal loss along the bilateral posterior cerebral arteries which are likely artifactual with better visualization on the postcontrast MRI. No evidence of aneurysms or vascular malformations within the limits of motion degradation. | 1. Acute infarct involving the posterior limb the left internal capsule, left cerebral peduncle, and the left periventricular white matter.2. T1 shortening in the right basal ganglia with suggestion of enhancement may reflect subacute ischemia versus metabolic injury (such as non-ketotic hyperglycemia).3. Enhancing mass involving the right aspect of the sella with extension into the right cavernous sinus and encasement of the cavernous segment of the right internal carotid artery. Overall findings likely reflect residual or recurrent pituitary macroadenoma.4. Moderate chronic small vessel ischemic disease.5. Motion degraded MRA without evidence of high-grade stenosis.The above findings were communicated via telephone to Fabiane Santos de Lima at 11:00 AM on 10/18/16. |
Generate impression based on findings. | Brain parenchymal morphology is within normal limits. Myelination is age-appropriate. One questionable nonspecific punctate focus of T2/FLAIR abnormality in the periventricular white matter. No edema or mass effect is detected. No diffusion-weighted abnormality. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricular size and morphology are within normal limits. | No structural lesions or potential seizure foci are identified. |
Generate impression based on findings. | Female, 40 years old, with rheumatoid arthritis and severe pain with downward head and sideways head movement. Spinal alignment is anatomic. In particular, the craniocervical junction is normal. No evidence is seen to suggest C1-C2 instability on this non-dynamic examination.Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is seen.The visualized spinal cord is normal in signal intensity and morphology.C2-3: Left facet hypertrophy. Mild left foraminal narrowing. Mild interval progression.C3-4: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C4-5: Mild facet hypertrophy. Minimal right foraminal narrowing. No significant interval changes.C5-6: Mild facet hypertrophy. Suspected small annular fissure seen on the prior examination is no longer visualized. No significant spinal canal or foraminal stenosis. C6-7: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C7-T1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. | 1.No evidence of C1-2 instability on this non-dynamic examination.2.No other significant finding which would account for the patient's symptoms. |
Generate impression based on findings. | Acute myeloid leukemia in relapse with bilateral lower extremity weakness and low back pain. The bone marrow is diffusely heterogeneous. There is lack of the usual lumbar lordosis and slight anterolisthesis if L2 on L3. The cervical and thoracic vertebral column alignment is otherwise within normal limits. There are disc bulges at L4-5 and L5-S1, as well as ligamentum flavum thickening that result in mild to moderate neural foraminal narrowing and spinal canal narrowing. Less prominent degenerative spondylosis in the rest of the lumbar spine do not results in significant spinal canal or neural foraminal narrowing. LIkewise, there is no significant cervical or thoracic spinal canal stenosis. The vertebral body heights are preserved. The spinal cord is unremarkable, aside from diffuse linear artifact on STIR. The paravertebral soft tissues are unremarkable. There are multiple bilateral renal cysts. | 1. Diffuse bone marrow heterogeneity is likely attributable to acute myeloid leukemia.2. Degenerative spondylosis at L4-5 and L5-S1 result in mild to moderate neural foraminal narrowing and spinal canal narrowing. 3. No evidence of discitis-osteomyelitis. |
Generate impression based on findings. | Right frontal mass: preoperative planning for biopsy. There is a cystic lesion with a centrally hypoattenuating nodule with thin peripheral enhancement that measures up to 12 mm in the anterior right superior frontal gyrus. There is mild surrounding vasogenic edema, but no midline shift. The ventricles are within normal limits in size and configuration. Thre is a right maxillary sinus retention cyst. | A cystic lesion that measures up to 12 mm in the anterior right superior frontal gyrus has features suggestive of neurocysticercosis, although neoplasm is also a consideration. |
Generate impression based on findings. | History of multiple prior myocardial infarctions. Additional history of polysubstance abuse. Evaluate for viability. Left VentricleThe left ventricle is non dilated. The lateral wall and inferior wall are thinned with compensatory hypertrophy of the anterior septum. The apex is also markedly thinned and aneurysmal. The inferior and lateral wall are akinetic and the apex is dyskinetic. Within the apical aneurysm there is an approximately 2 cm thrombus. The overall LV ejection fraction is 37% Transmural delayed gadolinium enhancement is present in the inferior wall, lateral wall, and apex compatible with prior infarcts of the RCA, circumflex, and distal LAD. There is an additional small patchy subendocardial focus in the mid septum also compatible with ischemia (series 2001 image 1).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 56%. Right AtriumThe right atrium is unremarkable. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study. The valve leaflets appear mildly thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study. The valve leaflets appear mildly thickened.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumSmall pericardial effusion.Extracardiac FindingsIncompletely evaluated cystic focus in the superior pole of the left kidney. | 1. Findings of prior left circumflex, RCA, and distal LAD infarcts with transmural delayed gadolinium enhancement as described. Additional focus of subendocardial enhancement in the mid septum compatible with ischemia. The infarcted territories demonstrate marked wall thinning and there is associated compensatory hypertrophy of the anterior septum.2. Left ventricular apical aneurysm containing a 2 cm thrombus.3. Left ventricular wall motion abnormalities as described with an ejection fraction of 37%. Cardiac parameters will be listed as an addendum when they become available. |
Generate impression based on findings. | Clinical question: Acute L5 fracture with anterior/posterior fascicle involvement c/f instability. Signs and symptoms: Status post fall. Nonenhanced lumbar MRI:Examination demonstrate an acute wedge compression fracture of vertebral body of L5 anteriorly and with evidence of edematous changes of bone marrow. There is preserved normal anatomical alignment of compressed vertebrae and no evidence of spinal canal. Minimal left neural foraminal compromise secondary to degenerative changes is noted.There is no evidence of perispinal soft tissue abnormality with this finding. The maximum height of compressed fractured vertebrae measures at 9.9 -mm compared to maximum height of vertebrae posteriorly at 26.4-mm. There is intraosseous hemorrhage within the compressed vertebrae which minimally extend through the superior endplate into the disk space.There is no detectable epidural widening or abnormal signal intensity to suggest hemorrhage. There is no compromise of spinal canal T12 -- L1 and L1 -- L2 levels demonstrate mild degenerative changes and unremarkable otherwise.L2 -- L3 demonstrate mild disk disease and hypertrophic changes of facet/ligamentum flavum posteriorly. No central spinal stenosis or neural foraminal compromise. There is a chronic mild compression deformity of the superior endplate of L3.L4 -- L5 demonstrates above detailed which compression fracture of L5. L5 -- S1 demonstrate mild to moderate disk disease and loss of disk height without spinal stenosis. Mild left neural foraminal compromise secondary to degenerative changes is present. This examination covers from T10 through S3. Examination of lumbar spine was performed as a complete MRI of the lumbar spine the study which includes all axial series. However due to patient's inability to continue and excess motion artifact the service was notified and the rest of the exam for evaluation of thoracic spine was not performed.Normal as visualized thoracic spine and thoracic cord from T10 inferiorly demonstrate no evidence of acute abnormality, no central spinal stenosis, no significant neural foraminal compromise and normal signal intensity of the cord. | 1.Complete nonenhanced MRI of the lumber spine demonstrate more than 50% wedge shaped fracture of the anterior L5 vertebrae without evidence of spinal canal or neural foramina compromise. Intraosseous hemorrhage at the fracture site extends minimally into the disk space at L4 -- L5 level.2.Mild to moderate degenerative changes of lumbar spine otherwise however without spinal stenosis or any significant neural foraminal compromise.3.Almost visualized thoracic spine from T10 inferiorly is unremarkable with the exception of mild degenerative changes.4.Examination was terminated at this point due to patient's inability to continue. |
Generate impression based on findings. | Male, 18 years old, with history of hemoglobin SS undergoing pre-stem cell transplant evaluation. No significant parenchymal signal abnormality is seen. There is no evidence of edema or mass effect. Diffusion-weighted images are within normal limits. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology. A normal variant subcentimeter hippocampal sulcus remnant cyst is seen along the left medial temporal lobe. A subcentimeter focus of T1/T2 hyperintense signal is seen along the inner table of the left parietal bone, likely benign and of doubtful significance.On angiographic imaging, no significant intracranial vascular stenosis or occlusion is seen. The vessels of the anterior and posterior circulation demonstrate normal flow related signal. No aneurysm or vascular malformation is detected. | 1.No significant brain parenchymal abnormalities are seen.2.Unremarkable evaluation of the intracranial vasculature. |
Generate impression based on findings. | Male, 67 years old, with prostate cancer, and abnormal balance, concern for cord compression. Cervical:The marrow spaces are diffusely heterogeneous compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. The normal cervical lordosis is slightly reversed along with a very mild scoliotic curvature.The visualized spinal cord demonstrates normal signal intensity and morphology except as discussed by level below. No epidural abnormalities are suspected.C2-3: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left paracentral and foraminal zones. The disc osteophyte effaces the left ventral thecal sac and just contacts the cord with slight cord flattening but no evidence of cord compression or significant spinal canal stenosis. Severe left and moderate right foraminal narrowing. C4-5: Facet hypertrophy left more than right. Uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet hypertrophy left more than right. Uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C6-7: Facet hypertrophy left more than right. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Severe right and mild left foraminal narrowing C7-T1: Facet hypertrophy. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Thoracic:Diffuse marrow heterogeneity is again seen compatible with widespread osseous metastatic disease. Vertebral body heights are preserved. There is a mild scoliotic curvature of the thoracic spine. Sagittal alignment is within normal limits.Beginning at the T8 level and continuing down to the T10 level, the left lateral epidural space is encroached upon by soft tissue. This is most severe at the T8-9 level where the spinal cord is displaced right laterally and mildly compressed. There is complete effacement of CSF and a significant generalized stenosis at this level. No definite cord signal abnormality is seen.At the T11 level, there may be mild soft tissue encroachment upon the lateral and right dorsal epidural spaces. However, this causes no significant spinal canal stenosis or cord compression.Scattered disc bulges and/or disc protrusions are seen at multiple levels, some of which contact and/or mildly deform the cord such as at T3-4. These, however, cause no significant generalized spinal canal stenosis. The left-sided neural foramina at T8-9 and T9-10 are infiltrated and narrowed by epidural tumor as above. The foramina are otherwise unremarkable.Multiple tumor deposits are seen along the posterior thoracic wall of the left lung apex. | 1.Significant epidural tumor encroaching upon the left lateral spinal canal from T8 through T10. The lesion is most severe at the T8-9 level where there is displacement of the spinal cord to the right and mild cord compression but no definite evidence of cord edema.2.There may be a few additional small areas of epidural tumor as above, but these cause no significant spinal canal stenosis and no evidence of cord compression.3.No evidence of cord compression is seen in the cervical spine.4.Multilevel degenerative findings as discussed above. |
Generate impression based on findings. | New gait abnormality and confusion. Recent CT with intratemporal bleed on the left side. A lesion is again noted in the left temporal lobe which contains increased peripheral T1 signal intensity and susceptibility weighted abnormalities measuring 2.6 x 2.0 cm. There is surrounding vasogenic edema which appears similar to the previous exam. Within the limitations of the motion degraded enhanced exam, there is no evidence of abnormal enhancement to indicate an underlying mass and no abnormal surrounding flow voids are appreciated. This lesion corresponds to the intraparenchymal hematoma described on the recent CT from a few days ago, and appears slightly larger taking into account differences in technique. These findings are compatible with an acute to subacute evolving hemorrhage without discrete evidence of an underlying mass. Additional T2/FLAIR hyperintensities in the periventricular, subcortical region as well as within the pons are nonspecific but compatible with moderate small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | 1.Again seen is a left temporal intraparenchymal hematoma with surrounding vasogenic edema. The hematoma appears slightly larger compared to the noncontrast CT exam from 10/26/2015, with differences in technique limiting comparison. There is mild local mass effect. No underlying mass, abnormal enhancement or abnormal flow voids are noted within the area of hemorrhage. Follow-up MRI may be helpful to assess for underlying lesion once the intraparenchymal hematoma resolves, especially given the motion degradation on the current study.2.No foci of additional hemorrhage or abnormal enhancement are noted elsewhere in the brain.3.Moderate chronic small vessel ischemic disease. |
Generate impression based on findings. | Reason: cavernous aneurysm; vertebral pseudo aneurysm, history of cerebellar stroke; changes? History: transient right visual change, dizziness MRI of the brainNo diffusion weighted abnormalities are appreciated. There is encephalomalacia along the right cerebellar hemisphere.A couple punctate T2 and FLAIR hyperintense lesions are present in the cerebellar hemispheres . There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is a 2mm aneurysm at the left ICA at the origin of the left anterior choroidal artery which is unchanged since a CTA from 12/18/2008 CTA.There is a 3.5 mm left cavernous carotid aneurysm present directed medially at the level of the posterior bend which is unchanged since a CTA from 12/18/2008 CTA.There is a 1.5mm aneurysm present along the proximal ophthalmic segment of the RICA which is directed inferiorly and laterally which is unchanged since a CTA from 12/18/2008 CTA.There is a small infundibulum at the origin of the left PCOMA.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is hypoplastic. The posterior communicating arteries are small. The vertebral arteries are asymmetric in size - right larger than left. There is a mild focal dilation of the intracranial LVA distal to the PICA origin. The left PICA and right PICA each have an infundibulum. | 1.There is a 2mm aneurysm at the left ICA at the origin of the left anterior choroidal artery which is unchanged since a CTA from 12/18/2008 CTA.2.There is a 3.5 mm left cavernous carotid aneurysm present directed medially at the level of the posterior bend which is unchanged since a CTA from 12/18/2008 CTA.3.There is a 1.5mm aneurysm present along the proximal ophthalmic segment of the RICA which is directed inferiorly and laterally which is unchanged since a CTA from 12/18/2008 CTA.4.There is mild focal dilation of the intracranial LVA which is stable.5.There are infundibulae present at the origins of the left PCOMA and left and right PICA. 6.No evidence for cerebrovascular occlusive disease.7.There is encephalomalacia along the right cerebellar hemisphere.8.Periventricular, subcortical and cerebellar white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | 46-year-old female with elevated LFTs. Patient with widely metastatic cancer of unknown primary. Abdominal pain. LIVER: The liver measures 15.5 cm in length. No suspicious parenchymal lesions. The main portal vein demonstrates normal hepatopedal flow.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder is collapsed, which limits evaluation for wall thickening. No intraluminal stones identified. The common bile duct measures 4.2 mm in diameter.PANCREAS: The visualized aspect of the pancreas is unremarkable. Incomplete visualization of the distal pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 9.7 cm in length.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. No hydronephrosis. OTHER: Bilateral pleural effusions. The left kidney measures 11.9 cm in length. Mild left-sided hydronephrosis, unchanged. The partially visualized (better characterized on the 11th/22/2016 MRI pelvis exam. | 1. No suspicious hepatic lesions.2. Partially visualized uterine mass is better characterized on the 11/22/2016 MRI pelvis exam.3. Bilateral pleural effusions, unchanged.4. Mild left hydronephrosis, unchanged. |
Generate impression based on findings. | Metastatic squamous cell carcinoma of the lung staging. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is moderate cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution, which likely represent chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No evidence of intracranial metastases. |
Generate impression based on findings. | 51 years Female (DOB:4/20/1964)Reason: bilateral painful lumbar radiculopathy not improving with conservative measures, eval for e/o disc herniation or other compressive lesion History: numbness/tingling painReferring Attending: TODD STERN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet and ligamentum flavum hypertrophy at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. | 1.No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lower lumbar spine.2.No mass lesions are appreciated within the lumbar spinal canal |
Generate impression based on findings. | 12-year-old female with blurry vision and concern for infectious extension from meningitis and mastoiditis. MRI Brain:Redemonstrated is prominent abnormal thickening and enhancement involving the bilateral cavernous sinuses, pituitary region, dura along the inferomedial frontotemporal lobes, and cisternal segments of the trigeminal nerves. The right VII/VIII nerve complex is also enhancing. Diffuse sulcal enhancement/vascularity has progressed. However, there are no areas of abnormal brain parenchymal enhancement, restricted diffusion, edema, discrete or rim-enhancing fluid collections or other evidence of abscess formation. The ventricles remain normal in size and morphology.There is persistent extensive fluid through the bilateral mastoid air cells, middle ear cavities and petrous apices with associated enhancement. The material filling the mastoid air cells may be mildly diffusion restricted. There is also persistent paranasal sinus thickening and enhancement with fluid, particularly within the sphenoid sinuses. The left external auditory canals remains completely opacified with scattered patchy enhancement. The right external auditory canal is now at least partially patent on today's exam. MRI Orbits:Thin section MRI through the orbits demonstrates abnormal enhancement involving the optic nerve sheaths bilaterally. The extraocular muscles, orbital soft tissues and globes appear unremarkable. As noted above and on the prior examination, the cavernous sinuses are expanded and abnormally enhancing. Patchy diffusion restricting material is seen within the petrous apices and to a lesser extent the cavernous sinuses. The pituitary gland is again noted to be large.MRV Brain:There is mild normal variant hypoplasia of the left transverse sinus. The superior sagittal sinus, inferior sagittal sinus, transverse sinuses, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and visualized cortical veins are patent. There is no evidence of venous thrombosis. | 1.Findings are redemonstrated compatible with extensive bilateral otomastoiditis and sinusitis. Associated dural thickening and enhancement as well as sulcal enhancement are seen compatible with meningitis. No discrete or rim-enhancing intracranial collections are demonstrated to suggest abscess formation.2.As on the prior examination, the cavernous sinuses are expanded and abnormally enhancing likely indicating infectious involvement. This alone could produce visual symptoms due to cranial nerve irritation. However, note is also made of abnormal enhancement along the intraorbital optic nerve sheaths which may reflect elevated intracranial/orbital pressures, reactive inflammation or spread of infection.3.The intracranial MRV is within normal limits.4.As on the prior examination, the pituitary is noted to be enlarged. This may reflect infectious involvement of the sella, though it could also be physiologic in a patient of this age.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Nausea with vomiting [787.01], Reason for Study: ^Reason: 54 y.o. with h/o head trauma 2 years ago in MVA. Now with persistent nausea and emesis. Please eval for compression or possible etiology. Pt has tolerated MRI's in past. History: persistent N/V No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Normal brain MRI |
Generate impression based on findings. | Patient with right shoulder pain, evaluate for labral versus cuff tear. ROTATOR CUFF: There is a complete longitudinal split tear of the infraspinatus tendon near its attachment to the humeral head, with intact fibers distally and no evidence of retraction or buckling. Abnormal globular signal is noted in the subscapularis tendon, consistent with tendinopathy without evidence of distinct tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is marked labral defect extending anteriorly and inferiorly, which appears largely degenerated. Additionally, there is extensive underlying chondral defect.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL | 1.Complete longitudinal split tear of the infraspinatus tendon, without evidence of retraction or buckling.2.Abnormal globular signal in the subscapularis tendon, consistent with tendinopathy.3.Marked labral defect extending anteriorly and inferiorly, with underlying chondral defects, consistent with extensive degenerative changes.4.Cystic changes in the superior lateral aspect of the humeral head, consistent with moderate degenerative changes.5.Moderate joint effusion. |