instruction
stringclasses 1
value | input
stringlengths 15
6.12k
| output
stringlengths 3
2.67k
|
|---|---|---|
Generate impression based on findings. | Metastatic embryonal rhabdomyosarcoma off therapy since May, 2013. Assess for recurrent disease. Brain: There is no evidence of intracranial mass. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There cerebellar tonsils appear to extend up to 7 mm inferior to the foramen magnum. The major cerebral flow voids are intact. The cerebellar tonsil remains low lying especially on the left. There is left parieto-occipital plagiocephaly. There is trace fluid in the left mastoid air cells. The orbits and scalp soft tissues are grossly unremarkable.Neck: There are post-treatment findings in the left parotid space region, but no evidence of underlying measurable mass lesions. The cervical lymph nodes are unchanged. The thyroid and major salivary glands are unchanged, including an asymmetrically small left submandibular gland. The major cervical flow voids are intact. The airways are patent. The osseous structures are unremarkable. | 1. Post-treatment findings in the left parotid gland without discernible recurrent tumor.2. No significant change in the cervical lymph nodes.3. No evidence of intracranial mass.4. Findings suggestive of possible Chiari I malformation. |
Generate impression based on findings. | Demyelinating disease of central nervous system, unspecified [G37.9], Reason for Study: ^Reason: Demyelinating disease; eval for progression History: paresthesias Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are suspicious enhancing area which most likely represent a venous channel (series 2101, image 34). Otherwise there is no evidence of abnormal enhancement.Comparing to prior scan which showed a couple of enhancing lesions on the right posterior frontal lobe and right mid-pons lesion do not show any evidence of enhancement on today's scan.Multifocal scattered white matter T2/FLAIR high signal lesions were again seen and do not show any significant interval changes in terms of size and distribution since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical Spine MRIRedemonstration of subtle T2 high signal intensity lesions throughout the cervical spine, unchanged since prior scan.On Gad enhanced scan, there is no evidence of definitive, discrete enhancing lesion within the spinal cord.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow signal abnormality or enhancement is seen. No significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues are unremarkable. | 1. Unchanged bihemispheric scattered FLAIR high signal intensity lesions since prior scan.2. No definitive evidence of enhancing lesion on today's scan. Specifically, previously shown nodular enhancing lesions do not show any evidence of enhancement on today's scan.3. Subtle T2 high signal lesions throughout the cervical cord is again seen without definitive enhancing lesion, unchanged since prior scan. |
Generate impression based on findings. | 16 years, Male, status post Chiari decompression 3 months ago. Evaluate CSF flow and syrinx. Brain: There are postoperative changes of suboccipital craniectomy and resection of the posterior arch of C1 for Chiari I decompression. There has been significant improvement in CSF spaces at the foramen magnum when compared to the sagittal counting sequence on prior thoracic MRI which partially imaged the craniocervical junction.CSF flow sequence is technically suboptimal but demonstrates preserved biphasic flow ventrally and dorsally at the foramen magnum.Multiple brain sequences are motion degraded but demonstrate no significant signal abnormality involving the brain parenchyma. No evidence of intracranial mass, mass effect, midline shift, or herniation. Ventricles appear normal in size. No gross evidence of infarct or hemorrhage. Major flow-voids are preserved.Right maxillary sinus mucus retention cysts are incidentally noted.Cervical and Thoracic Spine:There is been marked decrease in size of the previously seen syrinx extending from approximately the C3-C4 to C7 levels. Cervical syrinx which was partially imaged on the prior thoracic study measured approximately 6 mm in the AP dimension in the sagittal plane at the C4-C5 level, and currently measures less than 1 mm in the AP dimension. Syrinx is relatively maximal on the current study at the C6-C7 level where it measures 2.8 x 5.0 mm in the AP and transverse dimensions which is also smaller than priorThe cervical and thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. At T5-6 there is a small disc bulge present, and at T6-7 there is a small right paramedian disc protrusion present which mildly indents the cord. These findings are not significantly changed, and there is otherwise no significant spinal canal or neural foraminal stenosis. | Expected postsurgical changes of Chiari I decompression with interval expansion of CSF spaces at the foramen magnum and marked decrease in size of cervical syrinx. |
Generate impression based on findings. | A 49 year old male with personal history of intermittent LBBB and sinus tachycardia, hypertension, hyperlipidemia, overweight, obstructive sleep apnea. Due to chest pain he had a left cardiac catheterization in 2014 that showed non-significant coronary artery disease and a recent echocardiography showed a decrease in left ventricular systolic function from 55 to 45%. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 279 ml (normal range 142+/-34), the LV end systolic volume index is 61 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 93 g (normal range 164+/-36). The thickness of the myocardium is normal-to-thin. There is global mild hypokinesis with dyssynchrony due to conduction defects. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native myocardial T1-times are mildly and diffusely increased (~1100-1150ms), suggesting interstitial fibrosis.The values of Global Relative enhancement, T2-STIR edema ratio and Extracellular Volume Fraction are all between normal values.No findings to support myocardial edema in T2-STIR sequence.No myocardial iron overload.No intracavitary thrombus.Left AtriumThe left atrium is mildly dilated (103ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 96 ml/m2 (normal range 82+/-16), the RVEDV is 239 ml (normal range 142+/-31), the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is mildly dilated with mildly reduced systolic function, the LVEF is 45%. The thickness of the myocardium is normal-to-thin. There is global mild hypokinesis with dyssynchrony due to conduction defects. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1-times are mildly and diffusely increased, suggesting interstitial fibrosis. No findings to support myocardial edema. No myocardial iron overload. No intracavitary thrombus.3. The right ventricle is normal in size and systolic function, the RVEF is 55%. 4. There is mild biatrial enlargement. |
Generate impression based on findings. | There is nonspecific straightening of the normal cervical lordosis. There is mild loss of intervertebral disc space height and endplate degenerative changes noted at C5-6. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal and caliber. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant spinal canal stenosis or neural foraminal narrowing.C2/3: No significant spinal canal stenosis or neural foraminal narrowing.C3/4: No significant spinal canal stenosis or neural foraminal narrowing.C4/5: No significant spinal canal stenosis or neural foraminal narrowing.C5/6: Uncovertebral joint hypertrophy and a posterior disc osteophyte complex results in flattening of the ventral thecal sac and mild/moderate bilateral neural foraminal narrowing, right greater than leftC6/7: No significant spinal canal stenosis or neural foraminal narrowing.C7/T1: No significant spinal canal stenosis or neural foraminal narrowing. | Focal degenerative changes at C5-6 resulting in mild/moderate bilateral neural foraminal narrowing. Otherwise, no significant spinal canal stenosis or neural foraminal narrowing is evident. |
Generate impression based on findings. | Female 49 years old Reason: Pt s/p distal pancreatectomy and splenectomy 1/24/14 for a mucinous cystic neoplasm and endocrine neoplasm - please evaluate for recurrence History: mucinous neoplasm ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. No suspicious hepatic lesion. Hepatic and portal veins are patent. The common bile duct and intrahepatic biliary tree are normal in caliber.SPLEEN: Status post splenectomy. Tiny soft tissue signal foci in postoperative bed (series 3 image 14/series 100 image 53) of unlikely clinical significance, may be mesenteric vessels or nodes, appears to have been present on earlier preoperative exam, tiny splenules also a differential consideration but considered less likely.PANCREAS: Interval distal pancreatectomy with resection of the previously described cystic lesion situated in the distal pancreatic body/tail.ADRENAL GLANDS: Left adrenal nodule measures 1.6 x 1.1 cm, appearing similar to the prior study (46; series 14). There is no signal loss on out of phase sequences to confirm microscopic fat, may be a lipidpoor adenoma but lesion is incompletely characterized on this nondedicated study. KIDNEYS, URETERS: Small renal cysts. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. No mesenteric lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1.Interval resection of the previously described cystic mass in the pancreatic body/tail, without evidence of residual or recurrent disease.2.Stable indeterminate left adrenal nodule. |
Generate impression based on findings. | 64-year-old man with history of prostate cancer on surveillance. Additional history as per chart: Biopsy on 10/5/2015 revealed Gleason 6 adenocarcinoma, last PSA of 8.1. PELVIS:PROSTATE:Prostate Size: 53 x 43 mm.Peripheral Zone: There is a very small 5 x 4 mm T2 hypointensity in the right peripheral apex (series 801, image 53) which demonstrates restriction on diffusion weighted images and mild enhancement. No additional tumor is identified.Central Gland: There is hypertrophy of the transitional zone.Seminal Vesicles: The seminal vesicles appear normal.Extracapsular Extension: There is no evidence of extracapsular extension.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Very small focus of abnormal signal in the right prostatic apex without extracapsular extension which may represent adenocarcinoma. |
Generate impression based on findings. | Tremors and worsening migraines, left sided weakness and numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Persistent headaches. Non-enhanced CT of brain:There is no evidence of intracranial hemorrhage, edema, mass effect or midline shift or hydrocephalus. There is a small foci of low-attenuation in the right basal ganglia close to CSF density on axial image 13 which may represent small old lacunar in part. This examination is otherwise unremarkable. Please correlate with history and risk factors and follow-up with an MRI.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter remains otherwise within normal limits. Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable. | 1.A single small focus of low-attenuation in the right basal ganglia measuring 7 times 4-mm in size with close to CSF density is suspected for an old lacunar infarct. Exam is otherwise unremarkable. Correlate with history and risk factors and follow.2.Normal calvarium, visualized paranasal sinuses and mastoid air cells. |
Generate impression based on findings. | History of breast cancer, on chemotherapy, now with right-sided headache and blurry vision. Evaluate for metastases. There is no evidence of intracranial hemorrhage, edema or midline shift. Though no mass effect is present, evaluation for metastatic lesions is limited by a lack of intravenous contrast. If there is a high suspicion for metastases, an MRI with contrast is recommended.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. There is opacification of a few ethmoid air cells. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized. | No acute intracranial abnormality. No mass lesions are identified. If there is strong clinical concern for intracranial metastases, an MRI with contrast may be considered for further evaluation. |
Generate impression based on findings. | 76 year old female with a remote history of breast cancer, active colon cancer undergoing treatment referred for cardiac MRI after abnormal echocardiogram (apex with unclear clot/mass limited by poor acoustic windows). Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 139 ml (normal range 109+/-23), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5), the LVESV is 58 ml (normal range 31+/-10). There is thinning of apical myocardium, is a small symmetric distribution, which likely represents a normal variant. There is sigmoid septum (normal variant). There is abnormal motion of the interventricular septum of unclear significance. There is late non-transmural gadolinium enhancement of the mid anterolateral wall that may represent previous myocardial infarction. Less likely is inflammation or infiltrative disease. There is no thrombus or mass noted in the apex. The pre-contrast native myocardial relaxation T1 times of the myocardial septum is normal (965 ms). There is no evidence of iron overload. Left AtriumThe left atrium is normal in size. Interatrial septal aneurysm.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 127 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a mass in the SVC - likely catheter but a catheter related thrombus can not be excluded.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is normal in size and systolic function (LVEF 58%).2. The right ventricle is normal in size and systolic function (RVEF 58%). 3. There is late non-transmural gadolinium of the mid anterolateral wall that may represent previous myocardial infarction. Less likely is inflammation or infiltrative disease.5. There is no thrombus noted in the apex. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 76-year-old female with history of pancreatic head mass. ABDOMEN:LIVER, BILIARY TRACT: Multiple ring-enhancing T2 hyperintense lesions are seen scattered throughout the liver compatible with metastatic disease.Reference segment 2 lesion measures 2.3 x 2.2 cm (image 542 of series 1402).Reference segment 6 lesion measures 2.4 x 1.8 cm (image 357 of series 1402).Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: At the pancreatic head/body junction, there is a solid mass with intermediate T2 signal abnormality and persistent peripheral enhancement measuring 3.4 x 2.3 cm (image 362 of series 1402). There is significant downstream atrophy and pancreatic ductal dilatation. This lesion is intimately associated with the SMV and hepatic artery. The SMA, and splenic artery are uninvolved. The main portal and splenic veins are patent. Several prominent enhancing peripancreatic lymph nodes are present.There are additional smaller cystic lesion, for instance, located within the uncinate process measuring 13 x 12 mm (image 22 of series 601).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter renal cysts, some of which are T1 hyperintense, likely representing a combination of hemorrhagic, proteinaceous, and/or simple cysts.A solid T1 hyperintense right interpolar lesion enhances avidly measures 16 x 16 mm (image 317 of series 1402).Additional exophytic right superior pole round lesion with decreased nodular peripheral signal measures 2.9 x 2.8 cm, and is nonspecific.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion. | 1. Findings consistent with primary pancreatic adenocarcinoma with liver metastases as above. The tumor is intimately associated with the proximal SMV and hepatic artery, however the remaining vessels appear patent. Reference measurements are provided.2. Right midpole enhancing renal lesion suspicious for neoplasm. |
Generate impression based on findings. | 7-year-old female with history of left femoral osteosarcoma, concern for recurrence. Exam is significantly limited by metal related artifact from left femoral endoprosthesis.The prepubertal uterus appears normal. The ovaries are not visualized. The bladder is normal. There is no significant pelvic lymphadenopathy identified. No bowel abnormalities identified. The bone marrow signal appears normal in the pelvis and right femur. The left paraspinal muscles and left thigh musculature is diffusely atrophied.Evaluation of the hip joint itself is again limited by metal artifact. There is no evidence of gross disease recurrence or soft tissue mass identified. The known superolateral subluxation of the hip joint is better imaged on the current radiograph. | 1.Extremely limited exam without gross evidence for disease recurrence.2.Diffuse muscle atrophy in the left hemipelvis and left lower extremity. |
Generate impression based on findings. | Ms. Mohanty is a 42-year-old female with recent right breast excisional biopsy demonstrating DCIS (cribriform and papillary type) with several close margins. She presents today for an MRI evaluation postoperatively. Mild parenchymal enhancement is noted bilaterally.Right breast: In the right upper outer breast, post-surgical changes including a 2.1 cm post-operative seroma are identified. Immediately abutting the seroma in both the postero-superior and antero-inferior direction is non-mass-enhancement. The postero-superior component measures approximately 2.5 x 1.4 cm. The antero-inferior component of enhancement measures approximately 0.6 x 0.8 cm. Although this type of enhancement adjacent to the seroma cavity may all represent recent post-operative changes, underlying residual malignancy cannot be excluded. Left breast: No abnormal enhancement is seen in the left breast. No abnormal axillary lymph nodes are identified in either axillary region. | Post-surgical seroma identified in the right upper outer breast with non-mass-enhancement abutting the seroma cavity in both the postero-superior and antero-inferior direction. Although this type of enhancement adjacent to the seroma cavity may all represent post-operative changes from her recent surgery, underlying residual malignancy cannot be excluded. Recommend correlation with final pathology from our own departmental review and surgical consultation with Dr. Chhablani. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 65-year-old female with known right breast malignancy and metastatic right axillary lymph node. She presents today for needle localization of the right breast malignancy (2 sites index plus adjacent satellite) and localization of right axillary lymph node which will be performed under sonographic guidance. On review of the prior studies, a right 7:00 5 cm from nipple 0.7 cm irregular hypoechoic mass corresponding to the index malignancy will be targeted. An adjacent 0.5 cm irregular hypoechoic anterior satellite mass, will also be targeted. Two abnormal right axillary lymph nodes were identified at MRI, with subsequent ultrasound-guided biopsy of one of them revealing invasive ductal carcinoma. Preprocedural ultrasound evaluation of the right axilla, revealed the clip marker to be adjacent to one of the enlarged lymph node which will be targeted.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast and axilla were cleansed with chlorhexidine over the target areas. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, a 7 cm Kopans needle was placed in the index malignancy. Another 7 cm Kopans needle was placed in the adjacent satellite mass. The spring wires were then deployed. A 9 cm Kopans needle was placed in an enlarged lymph node adjacent to the biopsy clip.Repeat three view orthogonal mammograms reveal the three spring wires to be in excellent position. The posterior wire corresponds to the mass with clip. The anterior wire corresponds to the anterior satellite. The wire in the axilla corresponds to the enlarged biopsied lymph node with the clip being slightly superior to it. Patient tolerated the procedure well and was sent to the holding area in stable condition. Drs. Tremblay and Kulkarni performed the procedure. Orthogonal digital specimen radiographs were obtained and results reported separately. | 1. Successful needle localization of the right breast index malignancy/adjacent satellite lesion.2. Successful needle localization of a metastatic right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | History of partial left nephrectomy in 2008. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Hepatic steatosis.SPLEEN: Stable subcentimeter enhancing soft tissue nodule along the anteroinferior margin of the spleen is consistent with an accessory spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative appearance of a partial nephrectomy on the left. In the surgical bed there is a stable cystic lesion measuring 2.7 x 2.6 cm (series 8/27), compared to 3.0 x 2.3 cm previously. There is internal debris but no enhancing components. No hydronephrosis. No new suspicious renal lesion. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are not significantly changed and measure less than 1 cm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA:7.2 x 7.7 cm uterine fibroid in the right uterine body/fundus is similar in appearance. 2.4 cm uterine fundus fibroid. The endometrial thickness is normal. The inner myometrium/junctional zone is normal in thickness and signal intensity. Numerous nabothian and Bartholin's cysts are present.Right adnexal cyst measuring 2.8 x 2.5 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post partial left nephrectomy with stable cystic changes at the surgical bed. No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Evaluate for sacroiliitis, ankylosing spondylitis. There is no evidence of acute fracture or malalignment. Bone marrow signal is within normal limits. No specific findings of sacroiliitis. Bone island noted in the right sacral alar. Intraosseous lipoma is noted in the mid sacrum. No significant degenerative change of the lower lumbar spine. No abnormal enhancing structure is identified. | No MRI evidence of sacroiliitis. |
Generate impression based on findings. | Male, 78 years old, with recent falls plus minus loss of consciousness in the setting of persistent afib on warfarin. No restricted diffusion is seen. Scattered foci of white matter and basal ganglia T2 hyperintensity are demonstrated, many of which have a cystic quality and are likely reflective of chronic lacunar infarcts. No enhancing lesions are seen.No evidence of acute intracranial hemorrhage is seen. A few scattered small foci of susceptibility are noted likely indicating chronic microhemorrhage. The ventricles are within normal limits with respect to size and morphology. Mild volume loss of the cerebellum is noted. | 1.No definite evidence of any acute intracranial abnormality.2.Sequelae of chronic microvascular and lacunar ischemia are seen. |
Generate impression based on findings. | Male, 20 years old, with leg weakness. Assess for right lower extremity plexopathy. The lumbar spine as visualized is free of significant abnormalities. In particular, no evidence of pathologic enhancement of the cauda equina is seen. More distally along the lumbosacral plexi, no obvious lesions or abnormalities are identified. | No findings to account for the patient's symptoms. |
Generate impression based on findings. | 44 years Female (DOB:9/24/1972)Reason: stroke? Chiari? History: HAsPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying and extend 4 mm below the level of the foramen magnum. They are not pointed.The marrow of the skull and skull base and visualized upper cervical spine is predominantly lower signal which is a nonspecific finding.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. | 1.The cerebellar tonsils are low lying and borderline for Chiari I malformation.2.In general there is a mottled appearance to the visualized marrow structures including upper cervical spine and skull base and calvarium. This is nonspecific and could be within the range of normal at this age. Low marrow signal can be seen with chronic disease, anemia, lymphoproliferative disorder, myeloproliferative disorder. It is a nonspecific finding |
Generate impression based on findings. | Clinical question: preop for brain tumor resection. Signs and symptoms: Brain tumor. Unenhanced Stealth head CT:A standard preoperative nonenhanced stealth head CT is performed. A halo is secured to patient's head.Examination demonstrates mass in the right anterior temporal lobe with extension into the inferior right frontal lobe and right basal ganglia. Mass effect and deviation of third ventricle to the left is similar to prior MRI exam from 9 -- 6 -- 11. Ventricular system remains stable in size and unchanged. There is no detectable hemorrhage or any new foci of abnormality since prior exam. There is evidence of a small burr hole in right frontal bone likely from prior surgical approach for biopsy. | Nonenhanced stealth head CT reveals stable right temporal, frontal and basal ganglia mass and its associated mass effect. |
Generate impression based on findings. | Yearly follow up for ganglioglioma, status post resection. Postsurgical changes of left temporal ganglioglioma resection with left-sided craniotomy are redemonstrated. The large left cerebral convexity subdural fluid collection with multiple adhesions is unchanged in size from the prior exam measuring up to 28 mm on coronal images, previously 28 mm. Ventricular asymmetry with partial effacement of the left lateral ventricle and mild right ventricular enlargement is stable. An 8 mm rightward midline shift is unchanged. Subtle increased FLAIR signal in the left temporal lobe is again noted. Volume loss in the left anterior temporal lobe is also stable. Mild enhancement along the left anterior medial aspect of the resection cavity is redemonstrated. No new enhancing lesions to suggest recurrence or metastases. Tenting of the left frontal lobe to the overlying dura is not significantly changed. No acute intracranial infarction or hemorrhage. There are prominent cortical veins bilaterally, which are unchanged from the prior examinations and do not show evidence of thrombus on postcontrast imaging.A small mucous retention cyst is again noted in the left maxillary sinus. The visualized paranasal sinuses and mastoid air cells are otherwise clear. No acute intraorbital abnormality is evident. | Stable examination including large chronic left holohemispheric subdural fluid collection with midline shift. No evidence of recurrence or metastasis. |
Generate impression based on findings. | Pain along anterior aspect. Check for chondral injury versus meniscal tear MENISCI: Globular signal is observed in the body of the medial meniscus extending into the posterior horn extending up to the inferior articular surface. No definite discrete linear component is identified. Associated fraying of the inner edge and apical aspect are also observed. The lateral meniscus is significant for a similar globular signal in the posterior body again without a linear distinct component (image 9 series 6 and image 18 series 4); partial radial-like tear cannot entirely be excluded. The body and anterior aspects of the lateral meniscus are otherwise unremarkable. Both menisci are properly anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Diffuse moderate to severe thinning of the cartilage bilaterally is observed in all 3 compartments and most pronounced in the patellofemoral. Specifically the lateral patellar facet is nearly completely lost. Underlying moderate degenerative changes are also observed with subchondral cysts and osteophytes throughout the joint. Contusion is observed along the medial tibial plateauLIGAMENTS: Mild MCL sprain with otherwise continuous intact fibers. The LCL, ACL and PCL all otherwise intact EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Bone contusion without discrete evidence of a fracture in the medial tibial plateau, meniscal degenerative changes and cartilaginous destruction with moderate to marked degenerative osteoarthritic changes are observed. See details provided above |
Generate impression based on findings. | Please note examination is significantly motion degraded as patient could not tolerate the study. Post gadolinium images were obtained of the thoracic spine. Post contrast images of the cervical spine could not be obtained.As seen on recent lumbar spine MRI from 8/1/2016 there is a fluid collection involving the ventral epidural space extending superiorly from the lumbar spine. Current cervical and thoracic MRI images demonstrate large fluid collection which extends throughout the cervical and thoracic spine. Mild peripheral enhancement is evident on the thoracic study. The collection extends superiorly to the C1 level. The cervical and thoracic cord are posteriorly displaced and there is impression on the ventral aspects of the cervical and thoracic cords. Fluid collection predominantly involves the right ventral aspect of the upper thoracic spinal canal and the bilateral ventral epidural space in the lower thoracic as well as the cervical spine. Small loculations are evident in the upper cervical spine.No obvious cord signal abnormality within the limits of the study. Minimal degenerative changes are evident in the cervical and thoracic spine.There is deformity involving the superior T12 endplate with mild height loss and prominent Schmorl's node. Vertebral body heights in the cervical and thoracic spine are grossly maintained. No obvious destructive osseous lesions. No findings to suggest discitis-osteomyelitis in the cervical or thoracic spine based on the limited sequences. | Large ventral epidural fluid collection with peripheral enhancement which tracks superiorly from the lumbar spine and involves the entire thoracic as well as the cervical spine to the C1 level. There is at least moderate degree of diffuse cervical and thoracic spinal canal stenosis and mild flattening of the spinal cord. Given the extent of the epidural collection as well as a paraspinous collection, this may have originated as a pseudomeningocele/CSF leak, now with suspected superimposed infection/epidural abscess formation. |
Generate impression based on findings. | Check for meniscal tear or Baker's cyst. Knee swelling MENISCI: The menisci are intact and unremarkable. Old demonstrate proper anchoring posteriorly. However, extensive multilobulated cysts are observed posteriolateral to the lateral meniscus and displacing the lateral head of the gastrocnemius. Additional similar cysts are observed posterior to the medial condyles and epiphyseal plate, compatible with ACL ganglion cysts.ARTICULAR CARTILAGE AND BONE: Moderate thinning with underlying contusion involving the patellofemoral compartment, specifically the medial facet. The remaining compartments are otherwise unremarkable. Marrow signal is normal. Small bone island observed in the medial femoral condyle.LIGAMENTS: No significant abnormality noted. Specifically the ACL appears intact with discrete fibers.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Multiple scattered para-meniscal and ACL ganglion cysts involving largely the postero-medial and lateral aspects of the knee. See detail provided |
Generate impression based on findings. | There is no evidence of acute infarction, intracranial hemorrhage, or mass lesions. There is unchanged moderate T2 hyperintensity within the supratentorial and infratentorial cerebral white matter, which are likely related to micrangiopathy. There are also punctate foci of encephalomalacia in the left cerebellar hemisphere and left basal ganglia that likely represent chronic infarcts. There is a left hippocampal remnant cyst. The ventricles and sulci are stable in size and configuration. The major cerebral flow voids are grossly intact. There is a small amount of fluid within the bilateral mastoid air cells. There are bilateral lens implants. | 1.No evidence of acute infarct, mass lesion, or intracranial hemorrhage.2.Unchanged moderate cerebral white matter signal abnormality likely related to microangiopathy and punctate foci of encephalomalacia in the left cerebellar hemisphere and left basal ganglia that likely represent chronic infarcts. |
Generate impression based on findings. | Female, 67 years old, with history of L1 compression fracture. Evaluate for resolution or progression. Since the prior examination, further collapse of the L1 vertebral body has occurred. There is now approximately 60-70% loss of vertebral body height centrally. Elevated STIR signal within the L1 marrow space persists compatible with edema. The degree of retropulsion and associated ventral thecal sac effacement have progressed only minimally if at all. The conus is deflected posteriorly, but does not appear to be frankly impinged as there remains a thin cushion of CSF along its posterior surface.The remaining vertebral bodies demonstrate preserved height. No worrisome marrow abnormalities are detected. A grade 1/2 anterolisthesis of L4 relative to L5 seems to have progressed slightly from the prior examination now measuring up to 8 mm, previously 6 mm. There has been slight progression in the focal kyphotic angulation of the spine centered at L1 as well.T12-L1: L1 vertebral body retropulsion results in a mild to moderate generalized spinal canal stenosis but without frank impingement of the conus. The left neural foramen is mildly narrowed. No significant changes. L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Minimal laterally bulging disc. No significant spinal canal stenosis or neuroforaminal narrowing. No significant interval changes.L3-4: Minimal laterally bulging disc. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L4-5: Advanced facet degeneration with ligamentum flavum thickening. Disc bulging and disc uncovering with a superimposed right paracentral superiorly directed extrusion. Severe narrowing of the spinal canal with crowding and likely impingement of the cauda equina nerve roots. Moderate to severe right and mild left neuroforaminal narrowing. No interval changes. L5-S1: Advanced left and mild right facet degeneration. No significant spinal canal or neuroforaminal stenosis. No interval changes. | 1.Further interval collapse of the L1 vertebral body. Associated retropulsion and ventral thecal sac effacement are minimally changed if at all. This results in a moderate generalized spinal canal stenosis. The conus is deflected posteriorly but not frankly impinged.2.A grade 1/2 anterolisthesis of L4 relative to L5 has increased from prior, though this could represent differences in positioning. Degenerative findings at this level, including facet arthropathy, disc bulging and a right paracentral extrusion, have not significantly changed. The spinal canal is severely narrowed with crowding and impingement of the cauda equina similar to prior. |
Generate impression based on findings. | Ms. Hand is a 40-year-old female with a strong family history of breast cancer including maternal grandmother, paternal grandmother, mother, sister and maternal great aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.There is revisualization of three circumscribed enhancing masses, consistent with multiple benign fibroadenomata of both breasts. The mass in the right breast 3:00 position now measures 1.2 x 0.7 x 0.9 cm, previously measuring 1.2 x 0.7 x 0.9 cm. The mass in the right breast 12:00 position now measures 1.0 x 0.7 x 0.7 cm, compared to 1.0 x 0.8 x 0.7 cm. The mass in the left breast 8:00 position now measures 1.5 x 1.0 x 0.9 cm, compared to 1.5 x 1.01 x 0.9 cm. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region. | Stable benign fibroadenomata of both breasts .No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | Pain, unspecified [R52], Reason for Study: ^Reason: evaluate for disc herniation, nerve root compression History: L leg paresthesias, numbness, severe pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. Motion artifacts degraded exam quality especially axial scan. If clinically necessary, the exam can be repeated.There is slight loss of normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the T12-L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: There is foraminal focal disc protrusion on the left side narrowing neuroforamen. Disc dessication is seen. No spinal stenosis. L3-L4: There is broad based disc protrusion toward left side neuroforamen results neuroforaminal stenosis. No spinal stenosis. Disc dessication is seen.L4-L5: Diffuse bulging of disc abuts thecal sac. no neuroforaminal narrowing or spinal stenosis. L5-S1: Diffuse bulging of disc. no neuroforaminal narrowing or spinal stenosis. | 1. Multilevel disc protrusions including L23 and L34 toward left side neuroforamen as described above.2. No evidence of spinal cord signal abnormality. |
Generate impression based on findings. | H/o unknown primary with widely metastasis. Examination demonstrates diffuse bony destruction in the thoracic and lumbar spine as well as sacrum with loss of vertebral body height in T2, T12, L1 and L2. It appears that the spinal canal narrows at Levels T2 and L1. Please refer to spine MRI for details of cord compression. Specifically, there is bony destruction in the C7, T1-7, T9-L3, and L5 vertebral bodies and sacrum, in which posterior element destruction is seen in the C7-T3, T12-L3 and L5, and rib destruction is seen at levels T1-T3 and T7. Bilateral effusion is also noted. | Diffuse metastatic disease in the thoracic and lumbar spine as detailed above. spinal canal stenosis at levels T2 and L1, please refer to spine MRI for details of cord compression. |
Generate impression based on findings. | 16 year old male with knee pain and instability. Evaluate meniscus and ACL MENISCI: There is a vertical tear with blunting of the posterior horn of the lateral meniscus. The medial meniscus is intact with no significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. Specifically the ACL is intact with no abnormal signal noted.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Findings compatible with a tear of the posterior horn of the lateral meniscus. |
Generate impression based on findings. | Metastatic esophageal cancer with new brain metastasis. There is a lesion in the left precentral gyrus that measures up to 8 mm and contains susceptibility effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Preoperative planning MRI demonstrates a subcentimeter metastasis in the in the left precentral gyrus. |
Generate impression based on findings. | There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.Modic type I reactive endplate change with adjacent atypical hemangioma is present involving the anterosuperior aspect of C5.C2/3: UnremarkableC3/4: UnremarkableC4/5: Mild posterior osteophyte disc complex without stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe bilateral neural foraminal stenosis.C6/7: Mild posterior osteophyte disc complex without stenosis.C7/T1: Unremarkable | C5/6: Moderate to severe bilateral neural foraminal stenosis. |
Generate impression based on findings. | Evaluate previously identified perianal abscess. PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple bilateral inguinal prominent lymph nodes are unchanged from prior.BOWEL, MESENTERY: No significant abnormality noted.BONES/SOFT TISSUES: The previously identified left perianal soft tissue fluid collection is decreased in size (series 401, image 52), now measuring approximately 1.2 x 0.4 cm, previously 1.6 x 0.7 cm, with a perianal drainage catheter in place. This collection is hyperintense on T2 imaging, hypointense on T1 imaging and has restricted diffusion, compatible with abscess. Adjacent inflammation is identified on T2 imaging, which extends to the base of the left scrotum and minimally involves the right perineum. A right perianal drainage catheter is identified, with no associated drainable collection. No new fluid collection is identified. | Decreased size of the left perineal abscess and associated inflammation. Bilateral perianal drainage catheters are in place. |
Generate impression based on findings. | Female, 46 years old, with worsening ataxia and falls and new right sixth nerve palsy. Again seen is severe atrophy of the right cerebral hemisphere with patchy superimposed nonmasslike parenchymal enhancement. Modest atrophy of the brainstem and left cerebral hemisphere is also redemonstrated.No CP angle or IAC masses are seen. No pathologic enhancement is demonstrated in the basal cisterns, IACs or inner ear structures.The cisternal portions of the sixth cranial nerves are identified and seem to be within normal limits. The eighth cranial nerves are likewise unremarkable bilaterally. The right facial nerve is not well seen and may be somewhat atrophic.No significant cavernous sinus lesions are suspected, though a small laterally directed right cavernous ICA aneurysm is probably revisualized. The right globe deviates nasally compatible with the stated history. The right lateral rectus muscle is somewhat thin. | 1.Redemonstration of right greater than left cerebellar atrophy and atrophy of the brainstem.2.No definite CP angle, IAC or cranial nerve lesions are identified.3.The right globe deviates nasally, and the right lateral rectus muscle is somewhat thin which could reflect passive stretch or flaccidity. |
Generate impression based on findings. | Prostate cancer, evaluate disease extent PELVIS:PROSTATE:Prostate Size: 7 cm in transverse dimension x 6.9 cm in craniocaudal dimension x 7.4 cm in AP dimension.Peripheral Zone: Ovoid focus of T2 hypointense signal in right-sided mid peripheral zone posteriorly measuring 9 x 7 mm. Corresponding marked low ADC signal visualized, image 184 series 704. Early arterial enhancement suggested.Central Gland: Marked BPH with median lobe hypertrophy extending into bladder.Seminal Vesicles: Symmetric signal seen.Extracapsular Extension: Right-sided 9 mm peripheral zone T2 hypointense lesion does not demonstrate extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Right greater than left small fat-containing inguinal hernias.OTHER: Increased T1 signal seen in bilateral transition zones posteriorly, suspicious for underlying hemorrhage. To a lesser degree similar signal seen in bilateral peripheral zones. Atherosclerotic abdominal aorta, mildly aneurysmal. | 1. Right-sided 9 mm mid peripheral zone lesion suspicious for prostatic adenocarcinoma given decreased T2 signal and marked low ADC signal.2. Mildly aneurysmal abdominal aorta partially imaged, measuring up to 3 cm. |
Generate impression based on findings. | Diagnosis: Hemangioma of intracranial structuresClinical question: Please evaluate cavernomas for changes, 3T Scanner, QSM/Permeability, CCM Protocol. Please compare to outside scan from July.Signs and Symptoms: Brainstem cavernomas, worsening vision, gait in recent months since last MRIComments: Please evaluate cavernomas for changes, 3T Scanner, QSM/Permeability, CCM There is redemonstration of a 10 x 6 mm lesion in the right pons associated with heterogeneous signal on T2 and T1 and a popcorn-like appearance on T2. There is some associated contrast enhancement.There is a redemonstration of a heterogeneous lesion with susceptibility effect present in the left midbrain along the tectal plate which measures 10 x 7 mm axial dimensions and previously measured similar dimensions there is redemonstration of T2 signal hyperintensity along the anterior lateral aspects of the medulla bilaterally. There is some associated contrast enhancement.There is a developmental venous anomaly present along the pons.On susceptibility weighted imaging there is a punctate focus of signal loss in the medial aspect of the left occipital lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Redemonstration of a pontine and midbrain cerebral cavernous hemangiomas associated with an adjacent developmental venous anomaly.2.Some signal changes in the medulla are present which are nonspecific. Stable since the prior exam and could be reactive to the above lesions. |
Generate impression based on findings. | Primary CNS lymphoma, please restage. Please note lack of contrast limits evaluation for tumor recurrence. Again seen are postoperative findings related to left transfrontal biopsy. There is unchanged confluent T2 hyperintensity and susceptibility effect in the superior left frontal lobe without associated mass effect or restricted diffusion. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution, which is compatible with chronic small vessel ischemic and/or posttreatment changes. There is no evidence of acute infarct. There is global parenchymal volume loss commensurate with patient's advanced age. No hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a left occipital scalp lipoma. | Lack of contrast again limits evaluation for tumor recurrence. There is no significant change in FLAIR hyperintensity involving the left frontal lobe, which while nonspecific, is favored to represent posttreatment change. No new mass or mass effect to suggest tumor recurrence. |
Generate impression based on findings. | Reason: please do Dr. Javed MS protocol History: headaches and numbness. Brain: Compared to 10/31/2014, no significant change is seen in the multiple scattered foci of FLAIR hyperintensity within the periventricular, juxtacortical, and deep white matter. No new lesions. No lesions with enhancement to suggest active demyelination. There is no evidence of intracranial mass or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Brain parenchymal volume is within normal limits for age.Cervical Spine: There is no convincing T2 signal abnormality or enhancement of the spinal cord. Apparent T2 hyperintensity in the right ventral cord at the C4 level on the axial T2 sequence is not corroborated on the other sequences and likely artifactual. There are mild degenerative changes in the cervical spine including facet arthropathy but without significant spinal canal or neural foraminal stenosis at any level. There are unchanged enhancing foci within the C7 and T4 vertebral bodies with some T1 hyperintensity associated with the T4 lesion, and favored to represent hemangiomas. The vertebral body heights and alignment are preserved, aside from trace retrolisthesis of C6 on C7 as seen before. | 1. Compared to10/31/2014, there are no new lesions or abnormal enhancement to suggest active demyelination. 2. No evidence of demyelinating lesions within the cervical spinal cord.3. Enhancing focus within the C7 and T4 vertebral bodies likely represent hemangiomas. |
Generate impression based on findings. | Male 62 years old Reason: Left knee pain (superolateral) and instability for one month, no trauma. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Marked thinning of the articular cartilage involving the lateral femoral condyle, but no focal cartilage defect. Mild irregularity of the medial facet of the patella.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL | No MRI findings to account for patient's symptoms. Extensive chondrocalcinosis involving the left knee on 8/27/2015 radiograph may account for patient's symptoms. |
Generate impression based on findings. | 11-year-old female with chronic right hip pain in the setting of neuroblastoma. Evaluate for right hip pathology. Bone marrow signal intensity is normal. No osseous masses are evident. The femoral head is well-positioned within the acetabulum with no joint space narrowing or effusion.The surrounding soft tissues appear normal. No areas of abnormal enhancement are evident. | No osseous or soft tissue abnormality affect the right hip. |
Generate impression based on findings. | 61-year-old female with history of liver lesion seen on outside MRI. ABDOMEN:LIVER, BILIARY TRACT: Segment 7 T2 hyperintense lesion demonstrating discontinuous peripheral nodular enhancement with progressive filling compatible with hemangioma measuring 22 x 18 mm (image 6 of series 4). Additional T2 hyperintense lesion at the medial aspect of segment 7 also demonstrates discontinuous peripheral nodular enhancement with progressive filling compatible with hemangioma measuring 25 x 29 mm (image 11 of series 4). Hyperenhancing focus in the lateral aspect of segment 7 measures 10 x 9 mm and likely represents a flash filling hemangioma. Nonenhancing segment 6 T2 hyperintense lesion compatible with simple cyst measuring 42 x 35 mm (image 16 of series 4).Additional subcentimeter nonenhancing T2 hyperintense lesions likely represent small cysts or hemangiomas.No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 2 cm left ovarian cyst.Bilateral small breast cysts.Small volume free fluid. | Benign-appearing hepatic hemangiomas and simple cysts. |
Generate impression based on findings. | 55-year-old male with knee pain and previous subchondral plasty. New AVN? MENISCI: There is linear increased signal abnormality which traverses the posterior horn of the medial meniscus and extends to the tibial articular surface consistent with a horizontal tear which extends to the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality and cyst formation. There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial tibial plateau and thinning of the articular cartilage along the lateral femoral condyle. There is full-thickness articular cartilage degeneration along the lateral facet of the patella. There is partial-thickness articular cartilage degeneration along the medial facet of the patella. There is full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea and centrally. There is diffuse increased signal abnormality within the medial femoral condyle and to a lesser degree the medial tibial plateau which may represent avascular necrosis although no characteristic serpentine signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL | 1. Diffuse bone marrow signal abnormality within the medial femoral condyle and medial tibial plateau may represent avascular necrosis superimposed on degenerative osteoarthritic changes, although this does not demonstrate the typical serpentine signal abnormality characteristic of this entity.2. Osteoarthritis of the right knee including full-thickness articular cartilage degeneration as described above3. Horizontal tear of the medial meniscus as described above. |
Generate impression based on findings. | 26-year-old male patient with lower back pain. Evaluate for sacroiliitis/ankylosing spondylitis. We see no enhancement of the sacroiliac joints to suggest sacroiliitis. There is minimal edema-type signal along the lateral aspect of the lower right sacrum, which is nonspecific and could be degenerative rather than inflammatory in etiology. We see no definite erosions or ankylosis. Otherwise, the bone marrow signal intensity is normal. | Minimal edema in the lateral aspect of the lower right sacrum is nonspecific. We see no enhancement of the sacroiliac joints to confirm sacroiliitis. |
Generate impression based on findings. | Clinical question: Worst headache of life, posterior headaches, left-sided weakness, slurred speech. Signs and symptoms: Worst headache of her life, posterior headache, left-sided weakness, slurred speech. Nonenhanced CT of brain:Images through posterior fossa are unremarkable.Edema in the right anterior temporal tip with a small amount of hemorrhage is noted. Combination of these findings measures approximately 46 mm x 25 minute periodsmall area of parenchymal edema in the right frontal pole measuring 19 mm times 19-mm. No hemorrhage associated with this finding.Minimal subarachnoid hemorrhage localized to the right anterior parietal region.Suspect a small CSF density extra-axial collection in the left frontal and temporal region. This finding measures approximately 4.5 Mm in size. The gray -- white matter differentiation is preserved. Ventricular system is within normal size and no midline shift.No -attenuation of the white matter of bilateral occipital lobes and is believed to be artifactual.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells demonstrate minimal findings of acute sinusitis in the right maxillary sinus no detectable fracture on this exam. No definitive abnormality of the scalp. For further evaluation MRI examination of brain is recommended. | 1.Foci of edema in the right anterior temporal tip with minimal hemorrhage and right anterior -- inferior frontal lobe without hemorrhage and minimal localized right parietal subarachnoid hemorrhage. Findings are suspected for posttraumatic changes. Follow-up with an MRI is recommended to exclude extent of injury or additional cause for these findings.2.Normal size of ventricular system and no midline shift.3.Negative calvarium. |
Generate impression based on findings. | T2N0 right lateral oral tongue squamous cell carcinoma. The right lateral oral tongue lesion is not discernible. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable. The orbits and imaged intracranial structures are unremarkable. | The right lateral oral tongue lesion is not discernible. No evidence of significant cervical lymphadenopathy. |
Generate impression based on findings. | 49 years Female (DOB:6/13/1967)Reason: patient with MS and cognitive decline - please assess MS burden (compare with 2003) History: language impairment and retrieval memoryPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI JAMES A. MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images as well as the left pons and middle cerebellar peduncle. There is FLAIR and T2 hyperintensity present in the gray matter adjacent to the right collateral sulcus. The trigones of the lateral ventricles are generous. These findings were present on the prior exam from 2003 but have not changed substantially. Please note however that the prior exam was somewhat compromised due to motion artifact.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. | 1.Multiple periventricular, subcortical and subcortical white matter lesions are present in which appear to have been present on prior exam from 2003. There is not appear to be a significant change since that time to the extent of comparison possible.2.Mild ventriculomegaly is also stable. |
Generate impression based on findings. | Female, 55 years old. Reason: complains of hoarseness and has had multinodular goiter History: rule out enlargement RIGHT LOBE MEASUREMENTS: 7.9 x 2.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 8.3 x 3.2 x 3.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules. A right superior Palmetto measures 1.3 x 0.8 by 1.6 cm, heterogeneous and hypoechoic, predominantly solid, calcified, with mild internal vascularity. A right inferior pole nodule measures 1.1 x 0.6 x 2.1 cm, heterogeneous, solid, calcified, with minimal internal vascularity. A right mid thyroid nodule measures 2.2 x 1.8 x 2.2 centimeters, solid and heterogeneous, noncalcified, with mild internal vascularity.LEFT LOBE: Heterogeneous echotexture, with multiple nodules. A lower pole nodule measures 2.1 x 1.1 x 1 .9 cm, solid and heterogeneous, with internal calcification and moderate internal vascularity. A mid to superior pole nodule measures 2.3 by 1.9 x 1 .5 cm, isoechoic and mildly heterogeneous, noncalcified, with moderate internal vascularity.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.7 x 0.4 x 1.4 cm, with a fatty hilum. A left level 3 lymph node measures 0.4 x 0.2 x 0.4 cm, with a fatty hilum.OTHER: No significant abnormality noted. | Multinodular goiter, not significantly changed from prior. |
Generate impression based on findings. | 18-year-old female with Chiari malformation, now experiencing neck pain and headache, status post the compression. Brain: There has been interval repositioning of a fourth ventricular shunt now extending from the level of the dura, into the fourth ventricle, terminating within the cerebral aqueduct. The fourth ventricular height measured in the midline is decreased from 15 to 13 mm. Overlying the dura, there is a a larger post procedural fluid collection measuring 25 mm transverse x 35 mm AP x 65 mm craniocaudal, without significant mass effect upon the adjacent dura. There has been increase in both lateral and third ventricular sizes, the former measuring 38 mm (previously 32 mm), and the latter measuring 6 mm (previously 2 mm), as measured on coronal T2 imaging at the level of the foramen Monroe.Redemonstrated are postoperative findings related to Chiari decompression. Mild deformity of the posterior inferior cerebellum and medulla associated is unchanged. There is slightly more biphasic CSF flow noted posteriorly at the level of the cerebellar tonsils. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Expected vascular flow-voids are demonstrated. The paranasal sinuses and mastoid air cells are clear.Cervical Spine: There is no evidence of syringohydromyelia. The vertebral body heights are preserved. There is no significant spinal canal or neural foraminal stenosis. The vertebral bone marrow signal is unremarkable. The vertebral column alignment is unchanged with mild retroflexion of the dens and lack of the usual lordosis. There appears to be a left thyroid nodule. | 1.There has been interval repositioning of a fourth ventricular shunt now extending from the level of the dura, into the fourth ventricle, terminating within the cerebral aqueduct. The fourth ventricular height measured in the midline is decreased from 15 to 13 mm. There has been increase in both lateral and third ventricular sizes. Overlying the dura, there is a a larger post procedural fluid collection measuring 25 mm transverse x 35 mm AP x 65 mm craniocaudal, without significant mass effect upon the adjacent dura. There is slightly more biphasic CSF flow noted posteriorly at the level of the cerebellar tonsils. 2.There is no evidence of syringohydromyelia. |
Generate impression based on findings. | 51-year-old male. Right hip pain. Evaluate for AVN, labral path. ACETABULAR LABRUM: Intermediate signal abnormality in the anterior superior labrum consistent with degeneration. No discrete tear is evident.ARTICULAR CARTILAGE AND BONE: Abnormal low signal intensity involving the subchondral bone of the superior aspect of the right femoral head consistent with avascular necrosis. This avascular necrosis involves nearly the entire articular surface of the femoral head. There is adjacent edema in the femoral head extending into the neck and intertrochanteric region. No frank articular surface collapse of the right femoral head. There is also avascular necrosis of the left femoral head as seen on the large FOV images without frank articular collapse.SOFT TISSUES: No significant abnormality noted. ADDITIONAL | 1. Avascular necrosis of the bilateral femoral heads without frank articular collapse. Large amount of associated edema in the right femoral head and neck.2. Degeneration of the right anterior superior labrum without a discrete tear. |
Generate impression based on findings. | Male 37 years old Reason: evaluation of persistent shoulder pain, poss labral injury History: same ROTATOR CUFF: All components of the rotator cuff are intact. No muscle atrophy.SUPRASPINATUS OUTLET: Type I acromion.GLENOHUMERAL JOINT AND GLENOID LABRUM: Humeral head is well seated at the glenoid. No evidence of a labral tear. No loose bodies joint. No evidence of a Bankart or Hill-Sachs lesion.BICEPS TENDON: Biceps tendon is well seated within the bicipital groove.ADDITIONAL | Normal MRI of the shoulder. |
Generate impression based on findings. | 68-year-old male with chronic pancreatitis and pancreatic cyst, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensities likely reflect cysts. The common bile duct is normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal is diminished. Numerous T2 hyperintense cystic foci scattered throughout an atrophic pancreas some of which demonstrate communication with the main pancreatic duct. No pancreatic divisum is present. The main pancreatic duct is normal in caliber. Please note that calcifications are not reliably identified on MR. ADRENAL GLANDS: Mild left adrenal gland thickening.KIDNEYS, URETERS: Subcentimeter cysts in bilateral kidneys. No hydronephrosis.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.Atrophic pancreas with numerous hyperintense cystic foci scattered throughout the pancreas; provided the patient's history, findings likely represent sidebranch ectasia. Underlying IPMNs cannot be entirely excluded. |
Generate impression based on findings. | Status post fall from 6 stories, status post removal of bolt. Evaluate for DAI. Evaluate for ligamentous injury, C1 fracture. Brain: Linear tract with T2/FLAIR hyperintensity is noted in the right frontal lobe related to prior ICP bolt. Remainder of the brain appears within normal limits. No evidence of intracranial hemorrhage. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No extra-axial collections. Major flow-voids are preservedSella and orbits are grossly within normal limits. There is diffuse opacification of the paranasal sinuses and mastoid air cells which may be related to intubation. Bone marrow signal is within normal limits.Cervical Spine: Images of the cervical spine are slightly motion degraded. No convincing cord signal abnormality is appreciated. Fracture involving the anterior C1 arch on the left is better appreciated on recent CT. Atlantodental interval is maintained. Transverse ligament is intact. Coronal sequence was not obtained however no obvious evidence of alar ligament injury. Minimal fluid is noted involving the occipital condyle/C1 joint and atlantoaxial joint. No evidence of cord contusion or epidural hematoma. Ligamentous structures are intact. Vertebral body heights are normal. Alignment is normal. No significant spinal canal or neural foraminal stenosis is appreciated. | 1. No evidence of intracranial hemorrhage. No findings to suggest diffuse axonal injury. 2. Fracture involving the anterior C1 arch better demonstrated on CT. No findings to suggest ligamentous injury. No abnormal signal in the cervical cord. No epidural hematoma. |
Generate impression based on findings. | 72-year-old male status post transphenoidal hypophysectomy. There is no evidence of intracranial hemorrhage or edema. Reidentified is a large, pituitary macroadenoma with extensive expansion of the sella and invasion of the sphenoid sinus and clivus which appears to be overall slightly smaller in size when compared to be presurgical MRI. There is no extension into the pre-pontine cistern There is bilateral involvement of the cavernous sinuses. There is significant extension of the tumor into the basal cistern.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. The paranasal sinuses and sphenoid sinus demonstrate opacification and air fluid levels which may be consistent with postsurgical blood and or packing material. | Expected postsurgical changes as described above. |
Generate impression based on findings. | At least ten distinct T2 hyperintense white matter lesions are seen, many of which are perpendicular to the lateral ventricles in orientation, with a few lesions in the corpus callosum anterior and posterior body. There is interval improvement of the left parietal/occipital lobe lesion in the left periatrial white matter on series 701 image 36. The remaining lesions are stable and no new lesions are seen. | Mild improvement in the left parietal/occipital periatrial white matter lesion. No new white matter lesions. Other white matter lesions are stable. |
Generate impression based on findings. | Reason: Grade II oligodendroglioma s/p RT/PCV. Now off all Tx. Again seen are postsurgical changes in the left frontal lobe with the resection cavity appearing similar in size compared to the prior study. Compared to most recent study, there is no significant change in extent of T2/FLAIR hyperintensity surrounding the resection cavity, involving the left frontal corona radiata and extending into the right frontal corona radiata across the body of the corpus callosum. As noted before there is slight increase in extent of FLAIR signal abnormality when compared to more remote studies which is nonspecific and may be related to posttreatment change.Additional scattered nonspecific foci of T2/FLAIR hyperintensity in the bilateral cerebral white matter are also not significantly changed. No new mass effect, midline shift, or herniation. Ventricles are normal in size aside from the ex vacuo dilatation involving the left lateral ventricle. There is no suspicious enhancement. Unchanged nodular enhancement projecting into the cavity from the midline falx and linear enhancement along the posterior inferior cavity margin. Susceptibility artifact surrounding the cavity margins is compatible with chronic blood products. | No evidence of tumor progression. |
Generate impression based on findings. | 51 year old female with a personal history of right breast lumpectomy for invasive ductal carcinoma with DCIS in 2009 followed by chemotherapy and radiation therapy. She also has a personal history of Hodgkin's lymphoma, right breast reconstruction and left breast lift in 2012. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. Post-operative changes in the right lumpectomy bed are stable. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on findings. | History of lung cancer with brain metastases. Pretreatment planning for stereotactic radiosurgery. Post surgical changes from prior right frontal craniotomy. Redemonstration of a cystic lesion containing a fluid fluid level and susceptibility artifact compatible with hemorrhage in a surgical resection/biopsy cavity. There is residual nodular peripheral enhancement as seen on the prior MRI. In aggregate this measures 2.3 x 1.9 cm in axial dimension. This is associated with stable surrounding decreased T1 signal suggestive of edema as well as local mass effect with effacement of the overlying sulci.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are grossly clear. | Examination for treatment planning. No significant interval change in cystic cavity with peripheral nodular enhancement at the right frontal operculum compatible with residual tumor . |
Generate impression based on findings. | Female, 39 years old, approximately 35 weeks gestational age, with ultrasound showing fetal ventricles at the upper limit of normal. Both lateral ventricular atria measure up to 10 mm in diameter which is the upper limit of normal. The third and fourth ventricles are not dilated. The cerebral aqueduct is well-visualized and patent. The corpus callosum is fully formed and intact. The cavum septum pellucidum is visualized. The cerebral hemispheres demonstrate a normal degree of gyration for gestational age. The brainstem and cerebellum are normally formed and intact. No evidence of any focal parenchymal lesion is seen. No abnormal extra-axial collections are suspected. | 1.The atria of the lateral ventricles measure up to 10 mm in diameter which is the upper limit of normal. The third and fourth ventricles are within normal limits.2.The examination is otherwise within normal limits for gestational age. |
Generate impression based on findings. | Right shoulder pain ROTATOR CUFF: There is increased signal intensity within the distal fibers of the supraspinatus tendon near its insertion upon the greater tuberosity reflecting mild tendinosis or very slight interstitial tearing. Otherwise there is no evidence of a full-thickness rotator cuff tear..SUPRASPINATUS OUTLET: Mild osteophyte is affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Within the limits of a nonarthrogram study, there is blunting and abnormal signal within the anterior superior labrum likely reflecting degenerative tearing.BICEPS TENDON: No significant abnormality noted. ADDITIONAL | 1. Tendinopathy of the supraspinatus without evidence of rotator cuff tear.2. Likely degenerative tearing of the anterior superior labrum. |
Generate impression based on findings. | 39 year old man with recent history of ventricular tachycardia s/p dual chamber ICD and non-ischemic cardiomyopathy who was referred for cardiac MRI to evaluate for scar. Left VentricleThe left ventricle is severely dilated. Due to interference from device-related artifact, cardiac volumes could not be reliably assessed. However, systolic function appears severely reduced (LVEF <20%), and there is global hypokinesis with regional variation. There is no evidence of late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle appears normal in size. Due to interference from device-related artifact, cardiac volumes could not be reliably assessed. A device lead is noted.Right AtriumThe right atrium is dilated. A device lead is noted.Mitral ValveThe mitral valve opens widely.Tricuspid ValveThe tricuspid valve opens widely. AortaThere is a left sided aortic arch. Pulmonary VeinsTwo right sided pulmonary veins are visualized and drain into the left atrium; the left sided veins are not well seen.Venous AnatomyThe SVC and IVC drain normally into the right atrium. There are device leads visualized in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a pulse generator in the left upper chest with associated artifact. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. Severely dilated left ventricle with severely reduced systolic function (EF <20%). 2. No evidence of late gadolinium enhancement to suggest the presence of an underlying inflammatory, infiltrative or fibrotic process. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is diffuse T2 signal hyperintensity in the left slightly greater than right periventricular white matter and appears similar to prior MRI in 2012; findings compatible with periventricular leukomalacia and encephalomalacia. Diffusely diminished supratentorial white matter volume as well as thinning of the corpus callosum compatible with Wallerian degeneration, not significantly changed. The ventricles are normal in size. Cystic foci adjacent to the frontal horns favored to represent cystic encephalomalacia, less likely connatal cysts given similar appearance posteriorly. The cisterns remain patent. There is no midline shift or mass effect. There are no other areas of abnormal signal or pathological enhancement. No evidence of heterotopia or migrational anomaly. Bilateral hippocampi are symmetric in size and signal characteristics. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. | 1.No significant change in extensive periventricular T2/FLAIR signal abnormality, periventricular cystic changes, and diminished supratentorial white matter volume. Findings are again consistent with periventricular leukomalacia/encephalomalacia related to remote injury.2.No intracranial mass, acute infarct, or hemorrhage. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 60 female patient with history right arm numbness two days ago with persistent numbness in right hand. Possible infarct on head CT. There is a focus of restricted diffusion within the left thalamus compatible with acute ischemia. There is no associated susceptibility artifact to suggest hemorrhage. There is otherwise patchy subcortical and periventricular abnormal T2/FLAIR signal abnormality corresponding to chronic small vessel ischemic disease. A focus of encephalomalacia within the right thalamus is compatible with a chronic lacunar infarct. 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 mucosal thickening within the floor of the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable. | 1. Left thalamic acute ischemic infarct.2. Chronic small vessel ischemic disease and chronic right thalamic lacunar infarct.Findings were discussed by the RROC with Dr Lu by telephone at 1800 hrs on 9/11/2016. |
Generate impression based on findings. | Male, 75 years old, with probable Alzheimer's disease and multiple hemangioblastomas. Evaluate for change. Sequelae of prior right frontal craniotomy and prior posterior fossa surgery are again seen. Enhancing dural thickening and tumor nodularity along the anterior interhemispheric falx is demonstrated. Likewise, multiple enhancing nodules within the posterior fossa and the upper cervical spinal cord are again seen. The size of these enhancing lesions has not significantly changed when compared to the immediate prior examination but has increased relative to the older examination of 7/29/2015. Likewise, the associated edema is unchanged from the immediate prior but progressed relative to the older study. rCBV mapping shows elevated blood volume within the enhancing lesions and in the immediate surrounding parenchyma.Within the limitations of a motion degraded examination, no definite evidence of any new enhancing lesion is seen. No restricted diffusion is evident. Scattered small foci of white matter T2 hyperintensity are unchanged and nonspecific, perhaps representing microvascular ischemic disease. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are stable in size. | Findings compatible with hemangioblastomatosis are again seen including dural tumor studding along the anterior interhemispheric falx and numerous enhancing nodules within the posterior fossa. Relative to the immediate prior examination, there has been no significant interval change. Compared to an older examination, increased tumor size and progressive edema are noted. |
Generate impression based on findings. | History of colon cancer now with enlarging liver lesion and renal lesion. Negative PET scan. Please evaluate for metastasis. ABDOMEN:LIVER, BILIARY TRACT: There is susceptibility artifact in the gallbladder fossa related to the surgical clips. Within the liver parenchyma adjacent to the gallbladder fossa there is a geographic area of signal dropout on the out of phase images compatible with focal intracellular fat. There is no associated enhancement, T2 signal abnormality, or restricted diffusion. Findings are compatible with focal fatty infiltration. No additional suspicious hepatic lesions.Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Mild splenomegaly with the spleen measuring 13 cm in length.PANCREAS: Pancreas is normal in signal and morphology. The main pancreatic duct is nondilated.ADRENAL GLANDS: Redemonstration of a left adrenal nodule which measures 1.5 x 2.0 cm. This lesion demonstrates signal dropout on the out of phase images compatible with intracellular fat. There is mild restricted diffusion. The lesion enhances similarly to the background adrenal parenchyma. The right adrenal gland is unremarkable.KIDNEYS, URETERS: Redemonstration of a 11 x 10 mm exophytic nodular lesion arising from the superior pole of the right kidney. This has mildly increased T2 signal, restricted diffusion, and enhances on the postcontrast images. Appearance is compatible with a small renal cell carcinoma.Numerous additional simple cysts bilaterally. No hydronephrosis.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.Findings compatible with focal fatty infiltration in the gallbladder fossa. No evidence of hepatic metastasis.2.No significant change in small right superior pole renal mass compatible with small renal cell carcinoma.3.Left adrenal nodule with imaging findings compatible with a benign adenoma. |
Generate impression based on findings. | 70 year old with personal and family history of breast cancer. Personal history of left breast lumpectomy in 1992 for cancer followed by radiation and hormonal therapy. She also had a benign right breast surgery approximately 27 years ago. Mild parenchymal enhancement is noted bilaterally. There is heterogeneous amount of fibroglandular tissue in both breasts. The left breast remains smaller than the right. No suspicious enhancement is seen in either breast. Expected postsurgical volume loss and scarring in the left breast is unchanged. No abnormal axillary lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on findings. | Neck stiffness with disc degeneration seen on x-ray, decreased reflexes in the hands, and increased trapezius tone. There is multilevel degenerative cervical spondylosis associated with lack of the usual cervical lordosis. In particular, at C4-5, a posterior disc-osteophyte complex that is eccentric to the right nearly abuts the spinal cord, at C5-6, a posterior disc-osteophyte complex that abuts the spinal cord, and at C6-7, a posterior disc-osteophyte complex that is eccentric to the right indents the spinal cord and adjacent exiting nerve roots. However, the spinal cord displays normal signal. There is no significant spinal canal stenosis at the other cervical spine levels. In addition, there is no significant neural foraminal stenosis in the cervical spine. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no abnormal enhancement in the spine or evidence of mass lesions. The paravertebral soft tissues and imaged intracranial structures are unremarkable. | Multilevel degenerative cervical spondylosis associated with lack of the usual cervical lordosis. In particular, at C4-5, a posterior disc-osteophyte complex that is eccentric to the right nearly abuts the spinal cord, at C5-6, a posterior disc-osteophyte complex that abuts the spinal cord, and at C6-7, a posterior disc-osteophyte complex that is eccentric to the right indents the spinal cord and adjacent exiting nerve roots. |
Generate impression based on findings. | History of meniscal repair in 2001 with subsequent injury in 2009. Now complains of right knee pain. Due to the patient's body habitus, the high resolution coil could not be used. An alternative coil was used which results in slightly suboptimal image quality.MENISCI: There is marked deformity of the posterior horn of the lateral meniscus with fluid signal intensity in its substance indicating extensive complex tearing. This tearing extends into the body of the lateral meniscus and there is anterior extrusion of the anterior horn. We see no discrete tearing of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the lateral femoral condyle and lateral tibial plateau posteriorly with underlying subchondral cysts. There is also more focal degeneration and tearing of the articular cartilage of the medial femoral condyle and medial tibial plateau adjacent to the posterior horn of the medial meniscus. There is also moderate degeneration of the articular cartilage of the patellofemoral joint with subchondral cysts in the patella. There are tricompartmental osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL | 1.Extensive complex tearing of the lateral meniscus.2.Tricompartmental osteoarthritis.3.Collection of fluid signal intensity along the posteromedial aspect of the proximal tibia which may represent a ganglion or pes anserine bursitis. |
Generate impression based on findings. | Male, 34 years old, with GBM status post re-resection. Evidence of re-resection of the patient's left frontal lobe tumor is seen. The resection cavity has been expanded and contains predominantly FLAIR hypointense fluid. An oval collection of blood product is evident along the floor of the resection cavity which appears to be intraparenchymal but which probably represents clot within the prior cystic cavity in this location. The previously described, slowly progressive soft tissue thickening along the margins of the original resection cavity has been debulked. This includes a majority of the irregular enhancing tissue which was particularly prominent along the inferior margin of the cavity. Some irregular enhancing tissue does remain along the posterior aspect of the cavity with extension into the genu of the corpus callosum appearing similar to prior.The degree of T2 signal abnormality surrounding the resection cavity appears geographically similar to that on the preoperative examination. Ill-defined periventricular FLAIR hyperintensity is unchanged. No new parenchymal lesions are identified. The ventricles are stable and normal in size. | Expected findings are seen status post debulking of the patient's left frontal lobe tumor. A small amount of residual tumor is seen mostly along the posterior resection margin with invasion of the genu of the corpus callosum appearing similar to the preoperative examination. |
Generate impression based on findings. | Reason: Evaluate for Posterior Tibial Tendon Dysfunction left History: 41-year-old female with pain and edema along lateral aspect left ankle and anterior ankle with decreasing medial long arch TENDONS: There is circumferential fluid within the tendon sheath of the flexor hallucis longus just proximal to the master knot of Henry suggestive of a mild tenosynovitis/intersection syndrome (image 17; series 501). The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No full-thickness articular cartilage defects are seen. ADDITIONAL | 1. Findings suggesting a synovitis of the tibiotalar joint.2. Findings suggestive of a mild tenosynovitis of the flexor hallucis longus as described above. The posterior tibialis tendon appears normal. |
Generate impression based on findings. | The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right wrist was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge needle.Under fluoroscopic guidance, a 22-gauge spinal needle was advanced into the midcarpal joint. Next, 5 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint. A spot radiograph was obtained in neutral, ulnar flexion, and carpal flexion for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 59 seconds. | Successful right wrist midcarpal joint arthrogram injection. Please refer to the subsequent MRI report for further evaluation. |
Generate impression based on findings. | Right knee pain MENISCI: There is increased horizontal signal within the posterior horn of the medial meniscus, reflecting tear. There is mild extrusion of the meniscus into the medial gutter although the root appears intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the medial compartment of both the femoral condyle and tibial plateau there is associated degenerative marrow signal within the underlying bone. The articular cartilage of the lateral compartment is relatively preserved. There is thinning of the articular cartilage of the femoral trochlea without full-thickness defect of the patellar cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | 1. Horizontal tear of the posterior horn of the medial meniscus with mild extrusion.2. Full-thickness cartilage loss of the medial compartment with milder thinning of the patellofemoral and lateral compartments.3. Small joint effusion and mild synovitis. |
Generate impression based on findings. | Rule out abscess or osteomyelitis of the right pubic bone. Study is severely limited by artifact from bilateral total hip prosthesis. There is generalized muscle atrophy in bilateral thighs. There is a 3 x 2 cm fluid collection, which may represent an abscess in the proximal medial aspect of the thigh. There is no definite signal changes within the adjacent pubic bone to indicate osteomyelitis. Adjacent edema and inflammatory changes are noted in the medial thigh. Superficial soft tissue defect is noted in the region, which may be related to prior radiation or surgery.Multiple defects are noted in the distal femur which are most likely postsurgical. There are bilateral knee effusions, right greater than the left. Small right Baker's cyst is noted. Scattered varicosities are noted within the thigh. | 1.3 x 2 cm fluid collection which may represent an abscess in the medial proximal aspect of the thigh. There is adjacent soft tissue edema and inflammatory changes, but within the limitations of the study, there is no definite signal changes within the pubic bone to indicate osteomyelitis.2.Superficial soft tissue defect adjacent to the fluid collection in the medial thigh, which may represent sequela of prior radiation or surgery.3.Bilateral knee joint effusions.4.Generalized atrophy of bilateral thigh musculature.5.Defects in the right distal femur which are most likely postsurgical in etiology. |
Generate impression based on findings. | Systemic lupus erythematosus and neuromyelitis optica on research treatment protocol. Evaluation for progressive multifocal leukoencephalopathy is requested. There are numerous T2 hyperintense lesion in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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. | Multiple nonspecific cerebral white matter lesions, but no particular findings to suggest progressive multifocal leukoencephalopathy. |
Generate impression based on findings. | Abulia. Also history of depression, migraines, HTN, seizures on Keppra, pseudotumor status post cisterna-magna shunt with Codman valve last revised in 2009. MRI: Some of the images are degraded by patient motion. There is an area of high T2 signal and restricted diffusion involving a portion of the left globus pallidus and posterior limb of the internal capsule. There is also a punctate focus of encephalomalacia in the right corona radiata. There is a posterior fossa catheter that traverses the left aspect of the fourth ventricle and protrudes into medulla. The fourth ventricle appears similar in size as in 2013, but slightly larger than in 2010. There is persistent effacement of the third ventricle and the lateral ventricles appear slightly larger. There is herniation of a portion of the left medial temporal lobe along with a small portion of the temporal horn into the left perimesencephalic cistern. There also appears to be slumping and distortion of the brainstem with effacement of the surrounding cerebrospinal fluid spaces. The pituitary gland displays convex contours.MRA: The left vertebral artery terminates are the PICA, which is an anatomic variant. There is no evidence of significant steno-occlusive lesions. There is no evidence of cerebral aneurysms. | 1. Acute lacunar infarction involving a portion of the left basal ganglia and chronic lacunar infarction involving the right corona radiata.2. The posterior fossa catheter traverses the left aspect of the fourth ventricle and protrudes into medulla. The fourth ventricle appears similar in size as in 2013, but slightly larger than in 2010.3. Cerebellar tonsillar herniation, herniation of a portion of the left medial temporal lobe along with a small portion of the temporal horn into the left perimesencephalic cistern, and slumping and distortion of the brainstem with effacement of the surrounding cerebrospinal fluid spaces may represent sagging brain syndrome. In addition, there is persistent effacement of the third ventricle and the lateral ventricles appear slightly larger. 4. No evidence of significant steno-occlusive lesions in the head and neck arteries. |
Generate impression based on findings. | 77-year-old female with lumbar spinal stenosis Vertebral body heights are intact. Endplate degenerative changes, most severe and L3-L4, are unchanged. Multilevel disk desiccation with loss of disk height at L3-L4. Signal within the distal cord and conus is normal. Alignment is anatomic.T12-L1: Mild facet arthropathy. No significant central canal or neuroforaminal stenosis.L1-L2: Diffuse disk bulge with small right paramedian protrusion is unchanged. Mild facet arthropathy. No significant spinal or central canal stenosis.L2-L3: Diffuse disk bulge, asymmetric to the left. Mild facet arthropathy and ligamentum flavum thickening. No significant central or neuroforaminal stenosis.L3-L4: Diffuse disk bulge, ligamentum flavum thickening and facet arthropathy is unchanged. Mild to moderate central canal stenosis, unchanged. Moderate right neuroforaminal stenosis, unchanged.L4-L5: Diffuse disk bulge, asymmetric to the left, with facet arthropathy and ligamentum flavum thickening is unchanged. Mild central canal stenosis is unchanged. Mild left neuroforaminal stenosis is unchanged.L5-S1: Diffuse disk bulge, unchanged. Facet arthropathy. No central canal stenosis. Minimal left neuroforaminal stenosis. | Stable spondylosis of the lumbar spine with narrowing of the central canal and neuroforaminal stenosis at L3-L4 and L4-L5. |
Generate impression based on findings. | Diagnosis: Multiple sclerosisClinical question: please dom Dr Javed MS protocol, compare to priorSigns and Symptoms: progression MS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of multiple periventricular and subcortical white matter lesions within the brain parenchyma which were also present on the prior exam from May 4, 2015.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus which was also present on the prior exam.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There are small foci of T2 signal hyperintensity within the cervical spinal cord centrally and anteriorly at the C3 vertebral body level measuring approximately 3 mm in size along the right posterior lateral aspect of the spinal cord at the T3-4 disc space level, along the left lateral aspect of the spinal cord at the C45 disc space level measuring 3 mm and along the right posterior lateral aspect of the spinal cord at the C6-7 disc space level measuring 2 x 3 mm.. There is an additional lesion present at the T7 T1 level along the right posterior lateral aspect of the spinal cord. None of these are associated with contrast enhancement. Compared to the prior exam 5/13/2015 these lesions are stable.No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level. This has not changed substantially since the prior exam.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. There is a left lateral recess disc protrusion present at this level which was also present on the prior exam and encroaches on the left-sided exiting nerve roots at the left lateral recess..At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. | 1.There are multiple lesions present in the cervical spinal cord which appears stable when compared to prior exam.2.There are multiple lesions present within the brain parenchyma which appears stable compared to the prior exam.3.There are degenerative changes present in the cervical spine associated with left lateral recess disc protrusion at C5-6 which encroaches on the left-sided exiting nerve root and is stable since the prior exam. |
Generate impression based on findings. | 49 old woman with transient left-sided weakness since morning an ongoing left weakness. There is no evidence of intracranial hemorrhage, mass or edema. No CT findings of acute stroke. However if acute stroke is of clinical concern, recommend MRI.The ventricles and basal cisterns are normal in size and configuration. A partially empty sella, a nonpathologic finding, is noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. No CT findings of acute intracranial abnormality. If stroke is a clinical concern recommend MRI. |
Generate impression based on findings. | Radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with several small T1 hyperintense vertebral body lesions compatible with hemangiomas or foci of fat. No destructive osseous lesions are appreciated.The cervical spinal cord has normal signal characteristics. Mild degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: There is moderate disc height loss and left paracentral disc osteophyte formation with associated effacement of the left ventral thecal sac and mild impression on the left aspect of the cord. There is mild spinal canal stenosis involving the left aspect of the spinal canal. No cord signal abnormality. There is also mild to moderate left neural foraminal stenosis. Right neural foramen is patent. C6-7: Small right paracentral disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. | Degenerative changes at the C5-C6 level where there is a left paracentral disc osteophyte complex and uncovertebral hypertrophy contributing to mild stenosis involving the left aspect of the spinal canal as well as mild to moderate left-sided neural foraminal stenosis. No cord signal abnormality. Spinal canal and neural foramina at the other levels are preserved. |
Generate impression based on findings. | 35-year-old female. Pain occurring after slipping on ice and ankle. TENDONS: The Achilles tendon and other tendons of the ankle are normal in signal intensity and morphology. LIGAMENTS: The anterior talofibular and posterior talofibular ligaments as well as deltoid ligamentous complex are grossly intact. The distal tibiofibular syndesmotic complex appears intact. ARTICULAR SURFACES AND BONE: Mild patchy edema in the talus and distal fibular tip are suggestive of contusions. No osteochondral defect is seen in the talar dome. Mild edema at the calcaneocuboid articulation, likely degenerative in etiology. ADDITIONAL | 1. Mild edema in the talus and fibular tip suggestive of contusions given patient history of trauma.2. No evidence of ligamentous or tendon injury.3. Small ankle joint effusion. |
Generate impression based on findings. | Neutropenic fever. HIV infection.. There is susceptibility artifact in the region of the ears which causes mild limitation, most pronounced on diffusion-weighted imaging and fat saturated postcontrast axial imaging.There is a punctate T2-hyperintense right frontal white-matter lesion (series #401, image #19), which shows no diffusion restriction or contrast enhancement. This is nonspecific. Otherwise, the brain shows normal signal characteristics. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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 dural venous sinuses are patent. Major intracranial arterial flow voids are preserved.There is mild polypoid thickening (versus small retention cysts) in the left maxillary sinus. The other paranasal sinuses and the mastoid air cells are clear. The pituitary gland is slightly smaller than expected for age which is nonspecific. | 1.Right frontal punctate T2-hyperintensity is nonspecific. The rest of the brain examination is normal.2.Left maxillary sinus mucosal thickening (versus retention cysts) is mild and nonspecific. |
Generate impression based on findings. | Evaluate for bleed. 68-year-old female Examination is suboptimal due to extensive motion artifacts in particular in the posterior fossa. However no definitive abnormality within the posterior fossa is noted in 4 to remains within normal size and location.Several area of low-attenuation is suspected in the left posterior temporal occipital region. This was also partially visualized on the prior examination and may represent area of acute stroke. Several areas of subcortical lucencies are also noted in bilateral cerebral hemispheres. These may represent small vessel disease of undetermined age. An MRI examination is recommended since the quality of both of these recent CT exams are not very good for detection of very acute stroke. | Suboptimal exam however suspected left posterior temporal -- occipital stroke and small vessel disease. MRI is recommended. |
Generate impression based on findings. | Multiple myeloma, right thigh pain There are multiple foci of endosteal scalloping involving the femoral diaphysis which account for the lucent lesions seen on prior osseous survey. However, the signal intensity of the femur including these foci parallels fat signal indicating that these are treated lesions. There are no discrete high signal intensity lesions within the marrow of the femur on the fat-suppressed T2-weighted images to suggest an active focal myelomatous lesion. There is also no edema type signal to suggest the presence of stress fracture.There is mild osteoarthritis of the right knee with a small joint effusion and a mild amount of nonspecific edema overlying the subcutaneous fat anterior to the patella and patellar tendon. Although this exam was not tailored for the evaluation of the abductors of the hip, there is mild peritrochanteric edema bilaterally, right greater than left, suggesting mild inflammation. Large field-of-view coronal images demonstrate a moderate to large joint effusion of the left knee. There is mild fatty atrophy of the pelvic and thigh musculature, particularly posteriorly. | Foci of endosteal scalloping involving the femoral diaphysis which demonstrate the signal intensity of fat indicating these are treated lesions. There are no discrete myelomatous lesions evident in the femur on this exam. |
Generate impression based on findings. | A 71 year old male with CNS lymphoma with suspected cardiac involvement according to PET study. Referred to cardiac MRI to evaluate cardiac involvement. Left VentricleThere is motion artifact secondary to breathing which limits the quality of the examination. The left ventricle is mildly enlarged with mildly reduced systolic function. There is thinning of the inferior wall from the base to the apical two thirds of the left ventricular chamber. The thickened segments are akinetic. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 112 ml/m2 (normal range: 74+/-15), the LVEDV is 221 ml (normal range 142+/-34), the LV end systolic volume index is 58 ml/m2 (normal range 25+/-9), the LVESV is 115 ml (normal range 47+/-19), the LV mass index is 44 g/m2 (normal range 85+/-15), and the LV mass is 91 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 84 ml/m2 (normal range 82+/-16), the RVEDV is 167 ml (normal range 142+/-31), the RV end systolic volume index is 32 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion. | 1. The patient was unable to cooperate with breathing instruction and thus the image quality is limited. Contrast was not injected for this reason.2. The left ventricle is mildly enlarged with mildly reduced systolic function, the LVEF is 48%. There is thinning of the inferior wall from the base to the apical two thirds of the left ventricular chamber, favoring prior myocardial infarct. The segments are akinetic.3. The right ventricle is normal in size with normal systolic function, the RVEF is 62%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Patient is having breast pain, history of previous breast augmentation, evaluate implants There is scattered fibroglandular tissue in both breasts. Bilateral retro-glandular silicone implants appear intact. No evidence of implant rupture.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. No evidence of implant rupture.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | Altered mental status, abnormal signal intensity on pons, bilateral thalami and basal ganglia. Increased T2 signal intensities on brainstem especially midbrain and pons, bilateral thalami and basal ganglia do not show significant interval change since prior exam.There is evidence of circumferential restricted diffusion especially on the pons, but again the pattern and MR signal characteristics have not been changed since prior exam.There is no evidence of acute hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Above described lesions are again non specific.The restricted diffusion lesion on pons could represent acute ischemic lesion but not typical feature considering not following vascular territory. Bilateral thalami and basal ganglia lesions may indicate metabolic lesions or encephalitis but again non specific. Above findings do not show any significant interval change since prior exam.Gad enhanced MRI can be helpful for differential diagnosis. | Multifocal high signal intensities on FLAIR images including bilateral thalami, basal ganglia, as well as pons which shows circumferential restricted diffusion lesions. No significant interval change since prior exam.These are again non specific findings and not typical for acute ischemic lesion, nor hepatic encephalopathy. Gad enhanced MRI is recommended for further evaluation. |
Generate impression based on findings. | Left knee locking. Assess for meniscal pathology. Evaluation of the knee is limited by metallic susceptibility artifact resulting from what I presume to be orthopedic hardware in the distal femur.MENISCI: I see no meniscal tear.ARTICULAR CARTILAGE AND BONE: I see no defects in the articular cartilage not distorted by the aforementioned metallic stability artifact.LIGAMENTS: The proximal fibers of the anterior cruciate ligament are distorted by artifact, but the ligament appears intact on the sagittal intermediate-weighted series. The posterior cruciate ligament appears intact. The medial collateral ligament appears intact although its proximal attachment is distorted by artifact. The lateral collateral ligament complex appears intact.EXTENSOR MECHANISM: The extensor mechanism is intact. | Limited study due to metallic susceptibility artifact arising from what I presume to be orthopedic hardware in the distal femur. Given this limitation, I see no meniscal pathology or other specific findings to account for the patient's knee locking. |
Generate impression based on findings. | Reason: Eval GBM. Pt Dx in 2014. Off all Tx for past year. History: GBM. Postoperative changes are again seen relating to prior left frontal craniotomy and left frontal lobe tumor resection. The mildly hemosiderin stained resection bed appears stable. There is no pathologic enhancement in the surgical bed. Specifically, a previously noted small focus of enhancement within the right superior frontal gyrus is no longer visualized.Patchy T2/FLAIR hyperintensity within the left greater than right frontal lobe white matter has progressed from prior more remote examinations, without mass-like appearance. A few scattered punctate foci of T2/FLAIR hyperintensity within the cerebral white matter remain nonspecific, unchanged. There is subtle progressive increased extent of T2/FLAIR hyperintensity along the right basal ganglia. ADC images are not currently available, to accompany diffusion-weighted images.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental empty sella is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. A left maxillary mucus retention cyst is again noted. | 1.Stable appearing left frontal lobe surgical bed with no evidence of pathological enhancement.2.Progressive ill-defined frontal lobe white matter signal abnormality, most likely post-treatment effects.3.Gradual increased ill-defined FLAIR abnormality in right basal ganglia, which may also be post-treatment related. Addendum will be issued with ADC images are provided. |
Generate impression based on findings. | Right shoulder pain The exam is limited by motion artifact.ROTATOR CUFF: There is increased signal intensity of the subscapularis tendon indicating mild tendinosis. Additionally, there is a linear focus of longitudinal signal intensity involving the superior fibers of the subscapularis tendon likely representing interstitial tearing, measuring just over 1 cm. The remaining rotator cuff tendons are intact. The muscles of the rotator cuff are normal in signal and caliber.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is normal alignment of the glenohumeral joint and there is no joint effusion. A small amount of fluid partially separates the superior glenoid from the underlying labrum which is thought to represent a sublabral sulcus. There is also separation of the anterior superior labrum from the anterior glenoid which is thought to represent a sublabral foramen. Small paralabral cysts are seen along the anterior superior margin of the glenoid but there is no definite tear identified.BICEPS TENDON: No significant abnormality noted. | 1. Mild tendinosis and interstitial tearing of the distal subscapularis tendon. The remaining rotator cuff tendons and musculature are intact.2. Probable normal variants of the glenoid labrum further detailed above. If there is strong clinical concern for labral pathology, an MR arthrogram can be considered. |
Generate impression based on findings. | 62 year-old female with history of severe headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2 hyperintensity in the cerebral white matter. The ventricles and basal cisterns are normal in size and configuration. However, there is mild nonspecific prominence of the bilateral frontal convexity subarachnoid spaces. There is no midline shift or herniation. The major cerebral flow voids appear to be intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Minimal nonspecific foci of increased T2 signal within the periventricular and subcortical white matter, which is likely due to chronic small vessel ischemic disease. Otherwise, no evidence intracranial mass or hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 44 years old Reason: demoid tumor; colon cancer History: palpable RUQ mass ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted multiple enhancing lesions in the anterior abdominal wall predominantly on the right side but also on the left side. They have significantly decreased in size compared to previous MRI. An index lesion in the right upper lobe measures 4.2 x 4.4 cm on image #404, series #1104. An index lesion in the left anterior abdominal wall measures 1.9 cm in diameter image #354, series #1104. There are also multiple enhancing tracts likely secondary to previous laparoscopic surgery.Postsurgical changes secondary to recent surgery in the anterior abdominal wall.OTHER: No significant abnormality noted.PELVIS:No evidence of pelvic mass or free fluid. | 1. Postsurgical changes in the anterior abdominal wall.2.Enhancing residual masses in the anterior abdominal wall on both sides. |
Generate impression based on findings. | Status of intracranial injury. Seizure. There is a small amount of scattered T1 hyperintense subdural hemorrhage along the posterior falx cerebri and cerebelli that measures up to 3 mm in thickness. There is no significant associated mass effect or midline shift. There is minimal prominence of the subarachnoid CSF spaces in the bilateral anterior frontal and temporal regions, which likely represent hygromas. The brain parenchyma appears unremarkable without evidence of acute infarction or contusion. The ventricles are unchanged in size and configuration. There is minimal deformity of the occipital bone. The orbits and scalp soft tissues appear to be unremarkable. There is a subcentimeter T1 hypointense and T2 hyperintense lesion in the midline tongue base region. | 1. Mild subacute subdural hemorrhage along the posterior falx cerebri and cerebelli without associated significant mass effect or cerebral contusion. 2. A subcentimeter T1 hypointense and T2 hyperintense lesion in the midline tongue base region is incompletely characterized, but may represent a thyroglossal duct cyst or vallecular retention cyst. An ultrasound may be useful for further evaluation. |
Generate impression based on findings. | follow up meningioma resection. Previously shown left high fronto-parietal extra axial mass has been removed near totally. Subtle non enhancing area just underneath of the craniotomy site adjacent to the prior tumor location is most likely localized brain with swelling. Superior aspects of sinus invasion portion of the tumor have also been removed significantly. In particular bilateral dural leaflets of superior sagittal sinus as well as superior aspect of the superior sagittal sinus appear to be much less tumor burden than prior exam. Intra-sinus extension of the tumor also appears to be removed significantly.On coronal post enhanced scan, there were some non enhancing lesions mainly attached to the left side dural leaflet may suggest remained tumor.Significant parenchymal edema which compresses left lateral ventricle is again shown. The extent and degree of the mass effects do not show any significant interval change since prior exam (Jan 12 2015 Stealth MRI).There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of new unusual enhancement or engorged venous structure comparing to prior exam.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. Post operative status of the left high frontal and parietal meningioma with extensive parenchymal edema and superior sagittal sinus invasion.2. Near total removal of main tumor as well as sinus invasion portion as described above. Small residual mass is suspected especially intra-sinus portion of the tumor.3. There is no evidence new parenchymal edema or hemorrhagic lesion postoperatively. |
Generate impression based on findings. | Visual changes and word finding difficulties with headache in the setting of pregnancy. MRI of the brainNo diffusion weighted abnormalities are appreciated.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.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The A1 segments are similar in size. The right posterior communicating artery is medium size whereas the left PCOMA is small. The vertebral arteries are similar in size.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. | 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits.4.No evidence for intracranial mass lesion or cerebral infarction. |
Generate impression based on findings. | 64 year-old female with tongue tumor. 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. A partially empty sella is noted. | No intracranial metastasis. |
Generate impression based on findings. | Facial weakness [R29.810], Reason for Study: ^Reason: evaluate for brain stem infarct or tumor History: new right sided weakness, stroke risk factors, h/o malignancy No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.A couple of scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter is nonspecific, but could represent small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Unusually enlarged distal vertebral arteries and basilar artery with a tortuous course indicating so-called vertebrobasilar dolichoectasia implying intracranial atherosclerotic disease. There is no evidence of significant (more than 50%) luminal stenosis.The mastoid air cells are clear.There is a retention cyst on the left maxillary sinus. | 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Vertebrobasilar dolichoectasia. |
Generate impression based on findings. | Toe ulcer The examination is limited by motion artifact.There is abnormal signal intensity within the distal phalanx of the great toe, particularly within the tuft, compatible with osteomyelitis. There is ulceration of the skin dorsal to the distal phalanx. The proximal phalanx and first metatarsal demonstrate normal marrow signal. The second ray is unremarkable.A bandlike focus of abnormal signal intensity traverses the middle and proximal phalanges of the third toe representing nondisplaced fractures. Edema within the distal phalanx of the third toe may represent an additional nondisplaced fracture.The fourth ray is unremarkable.Bandlike signal abnormality noted within the neck of the proximal phalanx of the fifth toe represents a nondisplaced fracture.The metatarsals demonstrate normal marrow signal. There is mild diffuse soft tissue edema of the foot. | Limited exam demonstrates osteomyelitis of the distal phalanx of the great toe with multiple phalangeal fractures as detailed above. |
Generate impression based on findings. | Wrist pain Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: There is no extravasation of contrast into the radiocarpal space or the distal radioulnar joint. The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Joints: There is abnormal marrow signal intensity involving the lunate dorsally with a small amount of cystic change. There is no evidence of gross collapse or fragmentation although there is some irregularity along the dorsal margin best appreciated on series 601 image 14. The remaining marrow signal of the carpal bones as well as the distal radius and ulna are normal. There is no dislocation or subluxation. There is no significant arthrosis.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Nerves: The median nerve in the carpal tunnel is unremarkable. The ulnar nerve in Guyon’s canal is unremarkable. | 1. Abnormal marrow signal intensity and cystic change which is isolated to the lunate. These findings are concerning for developing avascular necrosis. Although this could conceivably be posttraumatic in nature, it is thought to be less likely as the marrow signal intensity of the remaining osseous and surrounding soft tissue structures is normal.2. Intact scapholunate ligament. |
Generate impression based on findings. | History of ankylosing spondylitis and back pain. BONE MARROW: Heterogenous bone marrow signal within the visualized osseous structures is compatible with normal red marrow without suspicious focal space-occupying lesions. No fractures are identified.SOFT TISSUES: The visualized musculature and soft tissues are within normal limits. JOINTS: The hip joints are within normal limits. The sacroiliac joints are within normal limits without specific findings to suggest sacroiliitis or inflammatory arthritis.ADDITIONAL | Unremarkable examination without specific evidence of sacroiliitis. |
Generate impression based on findings. | 65 years Male (DOB:2/15/1951)Reason: r/o compression History: low back pain with shooting pain down left legPROVIDER/ATTENDING NAME: HELENE G. RUBEIZ HELENE G. RUBEIZ 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 within the lumbar spinal canal. There is some patchy enhancement between the spinous processes of L4 and L5 and to lesser degree L3 and L4 associated with some T2 signal hyperintensity.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present this level associated with disc desiccation.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.Some of the images are degraded due to patient motionThere is a 15 mm well-circumscribed cystic lesion in the right kidney most likely representing simple cyst. | 1.There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots.2.Findings raise the question of Baastrup's syndrome in the lower lumbar spine. Please correlate with patient's clinical symptoms3.No abnormal lesions are appreciated within the lumbar spine noted that would explain the patient's polyneuropathy. |
Subsets and Splits