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Generate impression based on medical findings. | Tingling down right arm in C6-7 distribution. There is a congenitally narrow spinal canal. In addition, there are small posterior disc-osteophyte complexes at C3-4 through C7-T1 that at least partially efface the anterior thecal sac cerebrospinal fluid, but do not compress the spinal cord. There is also uncovertebral hypertrophy, which contribute to mild bilateral neural foraminal stenosis at C3-4, C4-5, and C7-T1, and at least mild to moderate neural foraminal stenosis bilaterally at C5-6 and C6-7. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. | Congenitally narrow spinal canal and small posterior disc-osteophyte complexes at C3-4 through C7-T1 that at least partially efface the anterior thecal sac cerebrospinal fluid, but do not compress the spinal cord. Uncovertebral hypertrophy, which contribute to mild bilateral neural foraminal stenosis at C3-4, C4-5, and C7-T1, and at least mild to moderate neural foraminal stenosis bilaterally at C5-6 and C6-7. |
Generate impression based on medical findings. | Male 81 years old Reason: stenosis? History: Right lower extremity radiculopathy The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body heights are well-maintained. Probable T11 hemangioma is incidentally noted. Mild degenerative endplate signal change at L5-S1. Otherwise no focal marrow signal abnormality is appreciated. The conus medullaris on sagittal imaging is grossly intact, with its tip at the L1-2 level.T12-L1: There is no significant compromise to spinal canal or neural foramina.L1-L2: There is no significant compromise to spinal canal or neural foramina.L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: Mild broad-based disc bulge. Moderate facet hypertrophy. Mild central spinal stenosis. No neural foraminal narrowing. L4-5: Moderate facet hypertrophy. Broad-based bulge with superimposed central protrusion, with severe central spinal stenosis. Mild bilateral foraminal narrowing.L5-S1: Moderate facet hypertrophy. Broad-based disc bulge with superimposed left paracentral disc protrusion, with mild central spinal stenosis. Effacement of the left lateral recess, with the S1 nerve root posteriorly displaced. Moderate left and mild right neural foraminal narrowing. | Multilevel degenerative spondylosis, with central protrusion at L4-5 with severe central spinal stenosis, and other findings as above. |
Generate impression based on medical findings. | MRI Brain:There is a prominent area of restricted diffusion involving the posterior limb of the right internal capsule and right corona radiata compatible with an acute infarct. Encephalomalacia the left basal ganglia, left internal capsule and left centrum semiovale probably represents sequela of a previous stroke. There is additional periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. Post-treatment changes are seen in the left globe secondary to prior retinal detachment. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening.MRA Brain: Again demonstrated is narrowing of the bilateral cavernous ICAs secondary to atherosclerotic disease. Additional scattered atherosclerotic stenoses are visualized elsewhere, including the right MCA trifurcation, left proximal A1 segment and right P2/P3 segments. There is no evidence of aneurysm or vascular malformation. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. | Evidence of a recent ischemic infarct involving the right internal capsule and right corona radiata. No evidence of hemorrhagic conversion, midline shift, or herniation.Encephalomalacia involving the left basal ganglia/IC and left anterior centrum semiovale related to chronic infarction.Underlying mild chronic small vessel ischemic disease.Atherosclerotic narrowing of the cavernous portions of the ICAs similar to previously. Additional scattered atherosclerotic stenoses are visualized elsewhere in the intracranial circulation. No evidence of significant steno-occlusive vascular disease in the neck. |
Generate impression based on medical findings. | 67-year-old male with vertigo and left-sided fullness. Evaluate for mass. Asymmetric fullness of the left cavernous sinus and left intracranial internal carotid and middle cerebral arteries raises the question of left cavernous-carotid fistula. MRI/MRA could be performed to help exclude this possibility.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Asymmetric fullness of the left cavernous sinus and proximal internal carotid and middle cerebral arteries and raises the question of cavernous carotid fistula. MRI/MRA could be obtained to further evaluate as clinically indicated. |
Generate impression based on medical findings. | Cerebral infarction due to embolism of left middle cerebral artery [I63.412], Reason for Study: ^Reason: evaluate penumbra, perform MRI brain with research protocol History: acute stroke from distal M1 occlusion, and right hemiparesis as result. There are multifocal restricted diffusion lesions involving left frontal lobe especially middle frontal gyrus and deep white matter of parietal and temporal lobes. There are also restricted diffusion lesions on the left external capsule and periventricular white matter. Constellation of above findings indicate both embolic and hemodynamic patterned acute ischemic infarction.On contrast enhanced scan, there are ill defined enhancement especially on the right superior frontal sulcus and adjacent to the left middle frontal gyrus which indicate contrast leakage due to blood brain barrier disruption or could represent parenchymal enhancement of acute/subacute ischemic tissue. There is no definitive evidence of hemorrhagic conversion.Underlying brain shows multifocal scattered FLAIR/T2 high signal intensities on bilateral periventricular white matter indicating non specific small vessel disease. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain perfusion imagingThe left MCA territory shows Increased MTT and Tmax comparing to that of right side.The left MCA rCBV shows significant increase and equivocal rCBF.Constellation of above findings indicate the left MCA territory is compensatory hypoperfusion status. In particular, the left frontal lobe especially middle frontal gyrus and deep white matter areas do not show increased rCBV with decreased rCBF, thus indicating ischemic tissue. | 1. Acute ischemic infarctions on the left MCA territory.2. MR perfusion map shows the left MCA territory is overall compensatory hyperperfusion status with ischemic tissues on the left middle frontal gyrus and deep white matter.3. MR findings as well as perfusion map indicate the acute ischemic lesions are most likely combined embolic and hemodynamic in nature. |
Generate impression based on medical findings. | Redemonstrated are postoperative findings related to right suboccipital and translabyrinthine craniectomy with fat graft for debulking of a right cerebellopontine angle tumor. Residual tumor within the cerebellopontine angle has decreased in size now measuring up to 3.5 cm in maximal dimension (previously 4 cm.) Enhancement within the skeletonized right internal auditory canal has become more defined and also extends along the operative tract (best visualized fat-saturated axial T1 series 19, image 9-10). As before, there are scattered areas of susceptibility effect within the residual tumor, which likely correspond to blood products, particularly along the surgical margins. Mass effect upon the adjacent brainstem and right cerebellar hemisphere, with leftward displacement of the vertebrobasilar system as well as partial effacement of the fourth ventricle, has slightly decreased over the interval. There has also been interval decrease of the vasogenic edema within the affected parenchyma. There remains no dilatation of the third and lateral ventricles. A previously demonstrated small area of restricted diffuse and high T2 signal in the lateral right cerebellar hemisphere has resolved. There are no current findings of restricted diffusion to suggest the presence of acute ischemia. The supratentorial brain is unremarkable. Previously demonstrated subgaleal fluid has resolved. | 1.Residual tumor within the right cerebellopontine angle has decreased in size now measuring up to 3.5 cm in maximal dimension (previously 4 cm.)2.Enhancement within the skeletonized right internal auditory canal has become more defined and also extends along the operative tract.3.Mass effect upon the adjacent brainstem and right cerebellar hemisphere, with leftward displacement of the vertebrobasilar system as well as partial effacement of the fourth ventricle, has slightly decreased over the interval. |
Generate impression based on medical findings. | 3-month-old with a AT/RT status post resection, VP shunt, and chemotherapy. Increasing morning vomiting. Rule out shunt malfunction, hydrocephalus. The VP shunt catheter enters the skull through the right aspect of the occipital bone. The catheter tip terminates in the left frontal lobe. Position of the catheter is stable from previous studies. Ventricular size is stable from the prior study.In the posterior fossa there is a rounded area of hypoattenuation at the region of the patient's previous tumor resection. This is enlarged since the prior study and raises concern for a cystic lesion exerting mass effect upon the brainstem. Recommend contrast enhanced MRI for better evaluation of this finding.There is increased attenuation in the right transverse and sigmoid sinus consistent with the patient's known dural sinus thrombosis.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Enlarging, cystic lesion in posterior fossa at site of patient's previous tumor resection. Recommend contrast enhanced MRI for further evaluation. 2. Stable catheter position and ventricular size.3. Stable findings of right transverse and sigmoid sinus thrombosis.These findings were discussed with Dr. Anzoma at 5:40 p.m. 08/19/2008. |
Generate impression based on medical findings. | 59 year old female with a history of biopsy proven amyloidosis referred for cardiovascular MRI to evaluate for cardiac involvement. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 73 g/m2 (normal range 67+/-11), and the LV mass is 117 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Late gadolinium kinetics are abnormal on the TI scout images (50 msec between cavity and myocardial nulling). There are several areas of abnormal Gd uptake in a patchy pattern involving the basal inferior and posterior wall and IVS. Left AtriumThe left atrium is dilated.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 120 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 39 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 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 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. Abnormal Gd kinetic and patches of late Gd enhancement c/w cardiac amyloid.2. Compared to 1-2014 Gd enhancement appears similar. |
Generate impression based on medical findings. | 50 years, Male, trigeminal neuralgia, radiation therapy planning. Examination is limited to susceptibility weighted and post gadolinium 3-D T1 sequences per radiation treatment planning protocol. There is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No midline shift or herniation. No extra-axial collections. Major vasculature structures appear patent. No obvious mass or vascular loop along the intracranial course of the trigeminal nerves is appreciated. Dedicated MRI brain per cranial nerve V protocol can be considered if clinically indicated. | Examination for radiation treatment planning. No obvious mass or vascular loop along the intracranial course of the trigeminal nerves is appreciated. Dedicated MRI brain per cranial nerve V protocol can be considered if clinically indicated. |
Generate impression based on medical findings. | Female, 37 years old, with a pineal lesion noted on head CT, please evaluate further. A cystic pineal lesion is evident measuring up to 15 mm AP, 9 mm CC, and 12 mm TV. Incomplete and somewhat irregular enhancement of the rim of the lesion is seen, along with a central enhancing component which could represent a septation or perhaps a portion of the native pineal gland.The lesion appears to exert mild mass effect upon the underlying tectum of the midbrain. No significant parenchymal edema is seen though there may be very slight associated narrowing of the cerebral aqueduct.Brain parenchymal morphology is otherwise unremarkable. No significant edema or generalized mass effect is detected. No other enhancing lesions are observed. There are no findings to suggest intracranial hemorrhage. Ventricles are normal in size and morphology. | The presence of a cystic pineal lesion is confirmed on this examination measuring up to 15 mm in maximum dimension. The lesion is slightly complex as there is partial irregular wall enhancement, along with an enhancing central component which could, however, represent a portion of the native pituitary gland. Statistically, this lesion most likely represents a benign pineal cyst, with a neoplastic etiology such as a pineocytoma considered less likely. A follow-up examination is recommended in 6-12 months to verify stability of the lesion. |
Generate impression based on medical findings. | Reason: Assess the collateral ligaments of the THUMB MCP and flexor Pollicis longus tendon for rupture History: pain and swelling LIGAMENTS: There is partial thickness tearing of the proximal fibers of the ulnar collateral ligament extending to involve it's mid substance fibers. There is no evidence of a Stener lesion. The radial collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. BONES: No bone marrow signal abnormality is identified.ADDITIONAL | Partial thickness tearing of the ulnar collateral ligament without evidence of a Stener lesion. |
Generate impression based on medical findings. | 55-year-old male with weakness, evaluate for tumor or ligamentous injury There is diffuse increased T2 signal and mild enhancement within the visualized portions of the rectus femoris, vastus lateralis, gluteal muscles and the adductor muscles given the field of view amd the extent of which is only partially visualized on this exam. There are no avulsions or discrete tears visualized. The hip joint itself appears unremarkable. The bone marrow signal is within normal limits. Note is made of artifact within the scrotum, likely due to testicular calcification and prior abscess drainage as seen on prior exams. | Edema and enhancement of the muscles of the thigh which is consistent with denervation and changes described on the correlating lumbar MR; however the appearance and changes are non-specific. In the appropriate clinical setting an infectious or inflammatory myositis could not be entirely excluded. |
Generate impression based on medical findings. | 31 year old male patient with ileal Crohn's diease with phlegmon on OSH CT. Evaluate for resolution of phlegmon since starting Humira treatment. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Subcentimeter T2 hyperintense lesions within this spleen are compatible cysts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: A right ureteral stent is in place without hydronephrosis. There is circumferential thickening and enhancement of the mid to distal right ureter in the region of the terminal ileum likely representing secondary inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening and narrowing of approximately 14 cm of the terminal ileum which demonstrates progressive enhancement compatible with active inflammation. The appendix demonstrates wall enhancement as well. There is a fistulous connection between the terminal ileum to an adjacent small bowel loop within the right lower quadrant (image 62, series 15). Furthermore, there are inflammatory changes within the right lower quadrant with several sinus tracts (image 59, series 15). No drainable fluid collection is identified. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Enhancement, wall thickening, and narrowing of the terminal ileum compatible with active inflammation.2.Right lower quadrant enteroenteric fistula, inflammatory changes, and sinus tracts. No drainable fluid collection.3.Enhancement and thickening of the right ureter likely represent secondary inflammation from the adjacent terminal ileum. Right ureteral stent in place without hydronephrosis. |
Generate impression based on medical findings. | Reason: prostate cancer History: see aboveBiopsy 4/15/2016; right base Gleason 6, left mid Gleason 6, left base Gleason 6, left apex Gleason 6. PELVIS:PROSTATE:Prostate Size: 4.7 x 2.8 x 3.4 cm Peripheral Zone: Focus (6mm) of low T2 low ADC signal without associated enhancement right mid prostate anteriorly (801/13). No associated perfusion abnormalitya.Central Gland: BPH nodules.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Smaller free fluid is present within the pelvis | 1.6mm lesion in the right mid prostate.2.No pelvic lymphadenopathy. |
Generate impression based on medical findings. | 62-year-old man with intermittent right leg numbness and weakness in the right L4 or 5 distribution when sitting in a cramped position. There are five lumbar type vertebral bodies present. There is minimal anterolisthesis of L5 on S1 and loss of disc height at this level; otherwise, the vertebral body and disk heights are well-maintained. The conus medullaris terminates at L1. At L4-5, there is bilateral facet joint hypertrophy and ligamentum flavum thickening resulting in mild bilateral neural foraminal narrowing, but no significant compromise to spinal canal. At L5-S1, there is degenerative disc disease with fatty endplate bone marrow signal alterations and mild facet arthropathy resulting in moderate right and severe left neural foraminal narrowing, but no significant compromise to the spinal canal. While the entire kidneys are not included in the field of view, the imaged portions appear extensively replaced with cysts. There is atrophy of the paraspinous muscles. | 1.Degenerative spondylosis with mild bilateral neural foraminal narrowing at L4-L5 and moderate right and severe neural foraminal narrowing at L5-S1, but no significant spinal canal stenosis.2.The imaged portions of the kidneys appear replaced with cysts, which may represent polycystic kidney disease or other form or renal disease. Dedicated renal imaging is recommended for further evaluation if outside studies are unavailable for comparison. |
Generate impression based on medical findings. | Unspecified convulsions [R56.9], Reason for Study: ^Reason: structural abnormality underlying seizures? History: seizures There is no evidence of acute ischemic or hemorrhagic lesion on the 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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | Normal brain MRI |
Generate impression based on medical findings. | Osteosarcoma, left scapular mass The examination is limited secondary to metallic susceptibility artifact by the presence of the left humerus endoprosthesis as well as by motion artifact. A large multifocal mass surrounds the scapula with replacement of the majority of the supra and infraspinatus muscles and a portion of the superior subscapularis muscle. Exact delineation of the mass is somewhat difficult given the multifocal nature however its entirety measures approximately 11 x 11 x 7.3 cm in the greatest craniocaudal, transverse, and AP dimensions. The mass demonstrates a multicystic appearance, appearing predominantly isointense to muscle on T1 sequences and hyperintense to muscle on T2 sequences. Areas of increased T1 signal within the supraspinatus and infraspinatus portions likely reflect areas of hemorrhage. Small scattered fluid fluid levels are identified within the mass and following contrast administration, there is a heterogeneous, septal-like enhancement pattern. Abnormal marrow signal is seen throughout the scapular spine. There is a mild amount increased signal and enhancement within the subcutaneous tissues likely reflecting edema and inflammation. There is partial visualization of scarring in the left upper lobe | Large multifocal mass surrounding the scapula consistent with recurrent malignancy. |
Generate impression based on medical findings. | Intermittent bilateral vision loss. Orbit MRI: The globes and ocular adnexa are intact bilaterally. There is no evidence of orbital mass lesions or abnormal enhancement. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the right mastoid air cells. There are subcentimeter retention cysts in the maxillary sinuses. Brain MRA: There is no evidence of significant steno-occlusive lesions or cerebral aneurysms. There is a right fetal posterior cerebral artery, which is an anatomic variant.Neck MRA: There is no evidence of significant steno-occlusive lesions. | 1. Unremarkable orbits.2. No evidence of acute intracranial hemorrhage, mass, or acute infarction.3. No evidence of significant cerebrovascular steno-occlusive lesions, although the sensitivity for small vessel vasculitis on MRA is relatively low. |
Generate impression based on medical findings. | 49-year-old female with right knee pain, history of right knee arthroscopy with medial and lateral partial meniscectomies, grade 3 chondromalacia of the patella was chondroplasty, extensive microfracture of the patella, medial femoral condyle and lateral tibial plateau (6/4/2015) MENISCI: Linear intrasubstance signal abnormality within the posterior horn of the medial meniscus extending to the femoral articular surface consistent with a tear. Interval increase in degree of extrusion of the body of the medial meniscus. Intermediate signal within the inner edge of the body of the medial meniscus reflective of a radial tear.New globular intermediate signal within the anterior horn of the lateral meniscus extending to the femoral articular joint may represent degenerative tearing.ARTICULAR CARTILAGE AND BONE: Grade IV chondromalacia of the medial tibiofemoral compartment with joint space narrowing, bulky osteophytosis, subchondral sclerosis, and thinning of the articular cartilage. Focal fissuring/laminar tearing is noted along the posterior medial femoral condyle. Focal full-thickness signal abnormality in the posterior medial femoral condyle cartilage with underlying subchondral edema type signal.Grade 1-2 chondromalacia of the lateral tibiofemoral compartment with focal full-thickness chondral defect of the tibial articular cartilage measuring 7 mm in the AP dimension, worsened in the interval. A focal delamination defect is present along the medial aspect of the femoral trochlea. Edema type marrow signal is noted within and around the lateral tibial spine.Grade 2-3 chondromalacia of the patellofemoral compartment worst along the patellar ridge. Postsurgical appearance of microfracture of the lateral facet of the patella.LIGAMENTS: The cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL | 1.New tearing of the body and posterior horn of the medial meniscus with interval increase in degree of extrusion. 2.New globular intermediate signal within the anterior horn of the lateral meniscus extending to the femoral articular joint may represent degenerative tearing.3.Focal fissuring/laminar tearing is noted along the posterior medial femoral condyle is new. Focal delamination defect is present along the medial aspect of the femoral trochlea.4.Worsened focal full-thickness chondral defect in the lateral tibial articular cartilage measuring 7 mm in the AP dimension.5.Severe osteoarthritis affects the right knee, worst at the medial tibiofemoral compartment. 6.Interval resolution of joint effusion. Interval decrease in size of Baker's cyst now containing a 7 mm loose body. |
Generate impression based on medical findings. | Diagnosis: Stable burst fracture of t11-T12 vertebra, initial encounter for closed fractureClinical question: Bone biopsy, h/o pulmonary nodules, concern for metsSigns and Symptoms: t6 fractureComments: DIET RESTRICTION: NPO after midnight. Must have radiologist approval. | Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the T11 vertebral lesion. Post procedure images do not identify any complications. | T11 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis. The cytologist reports that carcinoma is present on the touch preps. |
Generate impression based on medical findings. | Female 76 years old with vaginal bleeding and discharge new diagnosis of cervical cancer, evaluation of extent of disease. PELVIS:UTERUS, ADNEXA: Enlarged, lobular uterine contour containing multiple T2 hypointense intramural lesions compatible with fibroids the largest of which measures 3.2 x 3.1 x 3.8 cm. There is distortion of the endometrial cavity likely due to mass effect from the fibroids. No evidence of adenomyosis. The adnexa appear unremarkable.A T2 hypointense, enhancing mass compatible with the patient's known cervical cancer is centered primarily along the left cervix and measures up to 2.7 cm in craniocaudal dimension (series 3, image 22) and 2.6 x 3.9 cm transverse by AP (series 5, image 23). The mass touches the posterior aspect of the urinary bladder. The intervening fat between the cervix and the rectum is obliterated, serosal invasion of the rectum is not excluded (series 5, image 25). Hazy T2 hypointensity in the fat adjacent to the cervix on the left indicates parametrial invasion (series 5, image 24).BLADDER: The cervical mass touches the posterior aspect of the urinary bladder.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: The intervening fat between the cervix and the rectum is obliterated and serosal invasion of the rectum is not excluded. Colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes affect the pubic symphysis.OTHER: There is a small amount of pelvic free fluid. No hydroureter. | 1.Left cervical mass described above is compatible with the patient's history of cervical cancer. There is evidence of parametrial invasion on the left.2.Cervical mass touches the urinary bladder. Intervening fat between the cervix and rectum is obliterated and serosal invasion of the rectum is not excluded.3.No pelvic lymphadenopathy.4.Fibroid uterus. |
Generate impression based on medical findings. | There is no evidence of intracranial hemorrhage or acute infarct. There appears to be patchy high signal on the thin-section postcontrast T1 images along the right internal auditory canal. There are also minimal scattered punctate foci of T2 hyperintensity within the cerebral white matter. The brain, brainstem, and cerebellar parenchyma otherwise 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. | 1.Apparent patchy high signal on the thin-section postcontrast T1 images along the right internal auditory canal may be artifactual, vascular, inflammatory, or represent leptomeningeal metastatic disease. Follow up via a temporal bone MRI may be useful if there is clinical concern. Otherwise, no evidence of intra-axial metastases.2.Punctate foci of T2 hyperintensity in the cerebral white matter are nonspecific, but may represent chronic microvascular ischemic disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | There are artifacts from the right parietal approach shunt valve which limits interpretation of the diffusion and the susceptibility images.There is redemonstration of ventriculostomy catheter with the left frontal horn, revised since prior MR. The ventricles are slitlike and decompressed. Compared to the previous CT, there is grossly stable fourth ventricular dilatation, measuring approximately 28 x 19 mm in transaxial view. The right foreman of Luschka is widened.There is dysmorphic appearance of the brain. There is diffuse white matter volume loss with also prominence of the sulci.In the visualized portion of the susceptibility images, low signal is seen in the left thalamus and in the right centrum semiovale. The left thalamic cyst that was seen in the previous study is still present but has significantly decreased in size from 22 mm to 7 mm CC. There is greater extent of the T2/FLAIR high signal in the periventricular white matter with involvement of the centrum semiovale.The falx is dysplastic and there is a focal leftward herniation of the medial posterior right frontal lobe through the falcine deficiency.There is an abnormal cleft perhaps along the spectrum of schizencephaly of the left frontoparietal region, versus severe gliosis and loss of white matter with abnormal sulcation. However, no definite abnormal gyral thickening or polymicrogyria is detected.The anterior body and the genu of the corpus callosum are seen with small rostrum. The posterior body and splenium are not as well visualized, suggesting hypoplasia. | 1. Persistent slitlike lateral and third ventricles with significantly dilated fourth ventricle and widened right foramen of Luschka, unchanged from the previous CT. Stable right parietal approach ventriculostomy catheter.2. The left thalamic cyst has significant decreased in size, likely in communication with the lateral ventricles.3. Greater extent of the T2/FLAIR high signal in the periventricular and deep white matter, which may relate to areas of gliosis perhaps relating to underlying periventricular leukomalacia. Extensive volume loss, especially of white matter.4. Dysplastic anterior falx with leftward herniation of the right medial posterior frontal lobe.5. Hypoplastic posterior corpus callosum.6. Abnormal deep sulcus along left frontoparietal region, with questionable schizencephaly spectrum abnormality vs. gliosis and abnormal sulcation. No definite migrational abnormality appreciated. |
Generate impression based on medical findings. | Female, 53 years old, with CCM and intractable epilepsy, fMRI for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps as expected along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation, sentence completion and rhyming paradigms. Language is left dominant. Broca's area activity is seen within the left inferior frontal gyrus, primarily pars opercularis and pars triangularis. Foci of activity favored to reflect Wernicke's are seen along the posterior aspect of the left superior temporal sulcus, and just cranially at the posterior margin of the sylvian fissure. These foci are lateral and posterior to the patient's left temporal lesion. Although not in the most typical location for Wernicke's area, they are consistently seen on each language paradigm, and no other likely candidates for Wernicke's area are identified. Please note that as the left temporal lesion induces a large area of susceptibility artifact and signal void, the immediate surrounding parenchyma cannot be accurately assessed with functional MRI. As such, the presence of some functional activity immediately adjacent to the lesion cannot be excluded. | Technically successful functional MRI for sensorimotor and language mapping. The sensorimotor and visual cortices are well delineated. Language is left dominant. Broca's area is seen in its customary location. Wernicke's area is also likely visualized with foci of activation located lateral and posterior to the patient's left temporal lesion. |
Generate impression based on medical findings. | Clinical question: altered mental status. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrate multiple foci of vasogenic edema extensively on the left side and to a lesser degree on the right. This results in effacement of adjacent cortical sulci and mass effect on the left lateral ventricle as well as 7.7-mm rightward midline shift. Within the areas of vasogenic edema there are isodense to mildly high density masses which are highly suspected for multiple metastatic foci. Images through the posterior fossa are unremarkable.Calvarium is intact. Visualized mastoid air cells and middle ear cavities as well as paranasal sinuses are unremarkable. Recommend further follow-up with a dedicated MRI of brain with enhancement. | Multiple bihemispheric foci of vasogenic edema a component disease left greater than right) and suspected internal foci of isodense to slightly high density masses. Findings are highly suspected of metastatic disease. Recommend further follow-up with an MRI exam for confirmation of metastases and/or an infectious process. |
Generate impression based on medical findings. | Reason: pelvic mass behind the uterus History: pelvic pain PELVIS:UTERUS, ADNEXA: The uterus is normal in appearance. No focal mass is identified. Both ovaries are identified and appear normal with small physiologic follicles. There is no significant free fluid.BLADDER: The gallbladder is partially collapsed but appears normal.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Benign perineural cysts are noted dorsal to the sacrum. There is a femoroacetabular impingement cyst at the right femoral head neck junction.OTHER: There is a large, complex presacral mass which demonstrates heterogeneous T1 and T2 signal intensity, with a T2 hypointense rim, measuring 7.0 x 7.7 x 8.4 cm. The mass appears to the tethered to the anterior coccyx, possibly representing sacral nerve roots. There is heterogeneous enhancement with a large nodular enhancing portion in the superior portion of the mass, which measures approximately 2.5 x 2.2 cm. | Complex presacral mass with heterogeneous signal intensity and enhancement, for which the differential diagnosis includes tumors of neural origin including giant schwannoma and paraganglioma. |
Generate impression based on medical findings. | 79-year-old female status post fall 3 days ago. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse hypodensity within the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is concern for acute stroke, an MRI may be considered. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | small vessel disease, age indeterminate. If there is concern for acute stroke, an MRI may be considered. |
Generate impression based on medical findings. | Hodgkin's lymphoma with left buttock pain, post bone marrow biopsy in February. Now with numbness of left leg. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is some loss of normal lumbar lordosis. Alignment is otherwise within normal limits. The conus medullaris is normal in position. There are multiple small T1 hypointense, T2 hyperintense, and enhancing lesions throughout the lumbar spine and partially visualized lower thoracic spine.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: There is left paracentral disk protrusion with effacement of the left lateral recess which may be impinging on the traversing left L5 nerve root. No central spinal canal or neural foraminal stenosis. Mild facet hypertrophy.L5-S1: There is disk desiccation and small central disk protrusion. No significant spinal canal or neural foramina stenosis. Mild facet hypertrophy.Atrophic native kidneys and right renal transplant partially visualized. Paraspinous soft tissues are unremarkable. | 1. Multiple small osseous lesions throughout the lumbar and visualized lower thoracic spine compatible with known lymphoma. No prior MRI lumbar spine is available for comparison. No pathologic fractures or evidence of epidural tumor. 2. Degenerative changes at the L4-L5 and L5-S1 levels as detailed above. There is left paracentral disk protrusion at L4-L5 which may be impinging on the traversing left L5 nerve root in the lateral recess. |
Generate impression based on medical findings. | 52-year-old male with pain at the proximal patella and lateral quadriceps tendon. Evaluate extensor mechanism. MENISCI: The medial lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is mild thinning or degeneration of the articular cartilage along the anterior aspect of the medial femoral condyle, but the articular cartilage is otherwise within normal limits. There is focal edema within the anterior aspect of the patella, lateral to the midline, that appears to extend into a small enthesophyte of the quadriceps tendon. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is focal edema within the anterior fibers of the quadriceps tendon at its insertion, just lateral to the midline, adjacent site of bone marrow edema seen within the patella, likely representing a focal partial-thickness insertional tear, probably of the lateral fibers of the rectus femoris. There is mild retraction of a few of the anterior fibers, but this is equivocal. The remainder of the quadriceps tendon appears slightly thickened suggestive of mild tendinosis. The patellar tendon is within normal limits.ADDITIONAL | 1. Small focal insertional tear of the distal fibers of the quadriceps tendon, with edema within the underlying patella, on a background of mild tendinosis of the quadriceps.2. Mild degeneration of the articular cartilage of the anterior aspect of the medial femoral condyle. |
Generate impression based on medical findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (8/24/16), images from stereotactic biopsy of right breast with specimen radiograph and postprocedural right mammographic images (9/16/2016), breast MRI (9/27/2016) performed at outside institution. DIGITAL MAMMOGRAPHIC IMAGES (8/24/16):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). A cluster of pleomorphic calcifications is present at posterior lower outer quadrant in the right breast, measuring 13 x 10 mm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM STEREOTACTIC BIOPSY OF RIGHT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (9/16/2016):Stereotactic biopsy of the right breast calcifications at lower outer quadrant was performed by lateral approach. Specimen radiograph demonstrates multiple target calcifications in at least 6 samples. Postprocedural right mammographic images show a marker clip is placed approximately 18 mm medially from the target.Per outside pathology report, the result was malignant; invasive ductal carcinoma grade 3 with ductal carcinoma in situ grade 2 and 3.BREAST MRI (9/27/2016):Breast MRI was performed with a protocol outlined in the outside report. There is a linear non-mass enhancement corresponding to the biopsy-proven carcinoma at posterior lower outer quadrant in the right breast measuring 19 x 18 x 22 mm (AP x LR x CC). A marker clip is present at medial aspect of this non-mass enhancement. There is a linear enhancement from this lesion to lateral side of the skin, consistent with biopsy changes. Multiple slowly enhancing foci and masses are seen in the left breast, likely parenchymal enhancement and benign lesions. No abnormal lymph nodes are identified in either axillary region. | Biopsy proven invasive and in situ carcinoma at posterior lower outer quadrant in the right breast. Although a marker clip is displaced medially on mammogram, MRI demonstrates a marker clip is located within the enhancing lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on medical findings. | Adenoid cystic carcinoma of the left external ear with positive margins treated with TFHX, now with metastatic disease. There are postoperative findings related to left lateral temporal bone resection with diffuse patchy enhancement in the region of the surgical bed. There is also diffuse regional linear dural enhancement, which is likely reactive in nature. However, there are small nodular dural-based enhancing lesions along the anterior left frontal and posterior right frontal convexities, the largest of which measures up to 10 mm, without significant mass-effect upon the brain parenchyma. There is also a nodular enhancing lesion involving the pituitary infundibulum that measures up to 18 mm, with assocated mild vasogenic edema in the adjacent hypothalamus and optic apparatus. In addition, there is a punctate enhancing lesion in the posterior right occipital lobe. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. There appears to be relatively slow flow through the asymmetrically narrow left sigmoid sinus. The orbits are grossly unremarkable. | 1. Multiple dural-based lesions, a pituitary infundibular lesion, and a punctate right occipital lobe lesion likely at least in part represent metastatic disease.2. Postoperative findings related to left lateral temporal bone resection with nonspecific diffuse enhancement in the overlying soft tissues. |
Generate impression based on medical findings. | Male, 11 years old, with altered mental status, status post cardiac arrest. Evaluate for HIE. History of spinal muscular atrophy type 1. Mild, bilaterally symmetric restricted diffusion is evident within the precentral cortex, bodies of the caudate nuclei, the posterior lateral putamina and the ventromedial thalami. Mild gyriform restricted diffusion is also suspected within the occipital cortex and questionably along the left hippocampal formation.The background brain demonstrates marked bilateral cerebral white matter loss with widening of the ventricles and sulci. The degree of white matter loss seems to have progressed when compared to a prior head CT from 2005. Small areas of cavitation are also evident along the right frontal horn.The corpus callosum is thinned. Although the quantity of white matter is deficient, the pattern of myelination is essentially mature. The brainstem may be somewhat slender but is otherwise normally formed. The cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of significant intracranial hemorrhage is seen. Prominence of the CSF spaces anterior to the temporal lobes could represent volume loss or, less likely, the presence of arachnoid cysts.Layering fluid is evident within the nasal cavity and nasopharynx. | 1.Findings are seen compatible with hypoxic ischemic injury involving the peri-Rolandic cortex, basal ganglia and thalami, the occipital cortex, and possibly the left hippocampus.2.These findings exist on a background of extensive white matter volume loss which seems to have progressed from a 2005 examination. |
Generate impression based on medical findings. | 32-year-old male with left heel infection. Evaluate for abscess versus bone infection. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon appears intact.LIGAMENTS: Limited evaluation secondary to patient motion artifact. The anterior talofibular ligament is not well visualized which may reflect a chronic tear/injury. The distal tibiofibular syndesmotic complex appears intact. The visualized portions of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No findings to suggest osteomyelitis.ADDITIONAL | Nonspecific subcutaneous edema most pronounced along the medial aspect of the ankle with a 3.4 cm superficial fluid collection which does not enhance on postcontrast sequences and may represent a seroma or hematoma. No evidence to suggest osteomyelitis. |
Generate impression based on medical findings. | Medial left elbow pain Tendons: The common extensor tendon origin is intact. The common flexor tendon origin is intact. The triceps tendon insertion is intact. The biceps tendon is not completely visualized upon its insertion on the radial tuberosity but the visualized portion is intact. Ligaments: There is tearing of the ulnar collateral ligament with mild contrast extravasation into the medial gutter. The lateral ulnar collateral ligament is intact. The radial collateral ligament is intact.Joints: The bone marrow signal is normal. There is no dislocation. The articular cartilage is intact. There is no osteochondral defect.Muscles: The muscles about the elbow are normal in caliber and signal. | Tear of the ulnar collateral ligament. Remaining internal structures of the elbow are otherwise intact. |
Generate impression based on medical findings. | Clinical question to be answered: Evaluate for epidural hematoma in an anticoagulated patient can't get an MRI. Signs and symptoms: Myelopathy. This examination was performed with contrast to evaluate for possible epidural process (abscess, hematoma). This examination is not the appropriate test and it may not visualize any of these abnormalities on this exam. This exam however was performed due to patient's inability to obtain an MRI. Advanced degenerative disk disease at C3 -- C4 and C4 and C5 levels are again identified. There is grade 1 retrolisthesis of C4 in respect to C5. There is reversal of cervical lordosis into kyphotic deformity centered at C3 -- C4 level.Axial and sagittal reformatted images demonstrate no definitive evidence of any abnormal enhancement within the epidural space in the cervical region from C2 through C7. Images below this level are even further obscured due to shoulder artifacts and nondiagnostic for any of the above clinical question concerns.Foramina magnum.Examination at this level is unremarkable.C2 -- C3. No central spinal stenosis or neural foramina compromise.C3 -- C4.Minimal compromise of bilateral neural foramina. Flattening and posterior displacement of the cord secondary to ventral hypertrophic changes. Borderline central spinal stenosis of 7.9-mm is suspected.C4 -- C5. Advanced degenerative disk disease and retrolisthesis. Central spinal stenosis of 6.6-mm is suspected. Compromise of bilateral neural foramina secondary to degenerative changes.C5 -- C6. Minimal degenerative changes. Suspected minimal left neural foramina compromise. No central spinal stenosis.C6 -- C7.No central spinal stenosis or neural foramina compromise.C7 -- T1.Examination at this level is unremarkable.100 cc of Omnipaque was utilized for the above study. | 1.Extensive degenerative changes of cervical spine with multilevel neural foramina compromise and central spinal stenosis as detailed.2.Limited value examination for detection of epidural hematoma or abscess however no definitive finding to suggest either one of the above suspected clinical questions.A |
Generate impression based on medical findings. | Altered mental status. Evaluate for brain edema or midline shift. A small focus of increased density in the right cerebellar hemisphere is unchanged from the prior CT. Please note that the previously described small enhancing lesions seen on the prior MRI are not visualized on this noncontrast head CT. There is no evidence of intracranial hemorrhage, mass, edema, or midline shift. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | No acute intracranial abnormality. |
Generate impression based on medical findings. | 62-year-old female with worsening neck pain after falling in 2/2016. She also has gait imbalance. Axial sequences are degraded secondary to patient motion. Given this caveat: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.Complete loss of disc space with vertebral body osseous fusion at C6/7 is consistent with a history of prior neck surgery, and is stable in appearance.At the C2-C3 level, bilateral facet hypertrophy is evident which causes mild right neural foraminal stenosis, unchanged.At C3-C4, there is moderate narrowing of the left neural foramen secondary to bony degenerative changes, unchanged. At C4-C5, there is mild narrowing of the right foramen secondary to bony degenerative changes. Small posterior osteophyte causes minimal effacement of the thecal sac but no deformity of the cord or central stenosis. These findings are unchanged.At C5-C6, there is a large osteophyte eccentric to the right of midline with some flattening of the right side of the cord as well as narrowing of the neural foramen bilaterally secondary to bony degenerative changes. There is mild to moderate central stenosis, moderate to marked left neural foraminal stenosis, and mild right neural foraminal stenosis. These findings are unchanged. At the C6-C7 postoperative level, there is no evidence of central or foraminal stenosis, unchanged.At C7-T1, no evidence of central or foraminal stenosis, unchanged. | 1.C2-C3: Mild right neural foraminal stenosis, unchanged.2.C3-C4: Moderate narrowing of the left neural foramen, unchanged. 3.C4-C5: Mild narrowing of the right foramen, unchanged.'4.C5-C6: Mild to moderate central, moderate to marked left neural foraminal stenosis, and mild right neural foraminal stenosis, unchanged. |
Generate impression based on medical findings. | 12-year-old male in auto accident with loss of consciousness Calvarium remains within normal limits and no evidence of posttraumatic fracture. Mastoid air cells are well pneumatized and unremarkable. Limited view of the paranasal sinuses demonstrates complete opacification of left chamber of the sphenoid sinus with no bony fracture which is believed to represent chronic sinus disease.Images through intracranial space demonstrates no evidence of post traumatic findings in particular no evidence of intra-axial or extra-axial hemorrhage is detected. No definitive evidence of edema is present. There is however multiple periventricular and subcortical area of low attenuation which appear old. These findings are suspicious for multiple foci of encephalomalacia which are nonspecific however differentials includes demyelinating disease, multiple areas of encephalomalacia from a prior infectious process or ischemic. There is no evidence of any abnormal intracranial calcification. There are no old films available for comparison. Further evaluation with a dedicated MRI is recommended. | 1.No definitive evidence of any post traumatic findings intracranially or of the calvarium.2.Multiple small foci of low attenuation which appear old and needs further evaluation with a dedicated MRI of brain. Please see above comments. |
Generate impression based on medical findings. | Patient with poorly controlled hypertension presenting with occipital headache x 1 week. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI may be considered for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | Small vessel ischemic disease, age indeterminate. If there is concern for an acute stroke, an MRI may be considered for further evaluation. |
Generate impression based on medical findings. | Reason: Sickle-cell disease without crisis [D57.1] / Moyamoya disease History: surveillance Postoperative changes are again seen from previous bilateral pial synangiosis.There is slight asymmetric right-sided cerebral volume loss, as previously noted, similar to prior exams. There is a similar pattern of T2/FLAIR hyperintensity scattered in the frontal lobe white matter predominantly consistent with chronic small vessel ischemic changes, with additional gadolinium punctate foci. A prominent focus is seen in the posterior aspect of the posterior limb of the right internal capsule on the right side, unchanged.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal. There is likely a prominent perivascular space along the right basal ganglia. Chronic lacunar infarct is noted in the left caudate, with slightly progressed ex vacuo dilatation of the adjacent left frontal horn. There is no diffusion abnormality. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. Prominent mucous retention cysts are noted in the posterior nasopharyngeal soft tissues.MRA HEAD: Images are somewhat limited by patient motion. There is redemonstration of complete or near complete occlusion of the distal right internal carotid artery, along its supraclinoid portion and terminus. A right M1 segment is again not identified, with numerous serpentine vessels along its expected course consistent with collaterals. Asymmetrically diminished flow related enhancement is identified in the M2 segments and distally. On the left, the carotid terminus and proximal left M1 segment are not well visualized, although there are persistent serpentine vessels along the expected proximal M1 location. The remainder of the left middle cerebral artery appears relatively unremarkable. There is a large right and small left P-comm with relatively large caliber posterior cerebral arteries bilaterally. A1 segments are also not visualized, although diminutive A1 segments are suggested bilaterally. Posterior circulation is relatively unremarkable.There is a similar appearance of thin flow related enhancement traversing the site of right sided synangiosis, at the site of EC-IC bypass. On the left, flow related enhancement associated with the site of EC-IC bypass is not as well visualized as on prior exam, although this in part could be due to artifact. | 1. No evidence of acute infarct. Similar pattern of mild to moderate scattered chronic small vessel ischemic changes, most prominent along the frontal lobes bilaterally relating to underlying moyamoya disease, without significant progression.2. Similar appearance of bilateral bilateral distal ICA occlusion/near total occlusion compatible with moyamoya, with resultant collateral vessels including the reconstitution of the left MCA and more distal right MCA.3. Grossly stable appearance of right synangiosis site with decreased delineation of left synangiosis site, which may in part be technical in nature. |
Generate impression based on medical findings. | 51-year-old female with history of Crohn's ileitis, status post ileocecectomy in 6/2015. Currently not on any medications. Now with right lower quadrant pain. Evaluate for Crohn's disease activity. 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: Stable right lower pole renal parenchymal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval Ileocecectomy since the 2/9/2015 CT enterography exam. The neoterminal ileum is identified near the hepatic flexure and demonstrates short segment (approximately 5 cm) thickening and T2 hypointensity of the bowel wall. This region also demonstrates persistent narrowing and wall enhancement suggesting active disease.Nondilated small bowel loops within a small right Spigelian hernia also demonstrate questionable wall enhancement and could represent a skip lesion.An adjacent ileal loop near the neoterminal ileum demonstrates a 3.2 cm segment of wall thickening and suspected enhancement, which could also represent an additional skip lesion.No obvious fistulization or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Arising from or abutting the uterus is a 10.2 x 8.9 cm lesion that is hypointense on T2 and demonstrates diffuse avid contrast-enhancement.In the left adnexa, there is a T2 hypointense, T1 hyperintense focus. This could represent a hemorrhagic cyst versus endometrioma. | 1.Status post ileocecectomy with findings suggesting active disease within a short segment (approximately 5 cm) of the neoterminal ileum. Additionally, two adjacent ileal segments with suspected wall enhancement are concerning for skip lesions. One of these suspected skip lesions is located within a small spigelian hernia.2.A 10.2 x 8.9 cm T2 hypointense, enhancing lesion abutting the uterus could represent an exophytic fibroid versus an adjacent ovarian Brenner tumor, but favor to be the former.3.A small T1 hyperintense, T2 hypointense lesion in the left adnexa could represent a hemorrhagic cyst versus an endometrioma. Follow-up ultrasound in 3-6 weeks is recommended. |
Generate impression based on medical findings. | Seizures. There is a porencephalic cyst that measures up to 9 cm associated with considerable tissue deficiency of the right cerebral hemisphere, such portions of the frontal lobe measure less than 1 mm in thickness, but with relative sparing of the temporal lobe, although there is extension of the porencephalic cyst into the temporal horn, where there are two more discrete compartments that measure 1.0 cm and 1.5 cm in diameter. There is absence of at least a portion of the septum pellucidum. The posterior fossa structures and left cerebral hemisphere are relatively intact, with mild deformity in response to the right cerebral hemisphere abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. | Extensive right cerebral hemisphere volume loss associated with porencephalic cyst formation. |
Generate impression based on medical findings. | Male, 32 years old, with headaches and right frontal lobe lesion. Nonenhancing T2 hyperintensity and gyral thickening is again seen involving the posterior aspect of the right frontal operculum. There is evidence of prior biopsy with a burr hole and small biopsy tract just superior to the lesion. No additional abnormality is identified. No pathologic intracranial enhancement is observed. The ventricles are normal in size and morphology. | Demonstration of a region of nonenhancing T2 hyperintense gyral thickening involving the posterior aspect of the right frontal operculum. |
Generate impression based on medical findings. | S/p ventriculoscopy. Possible HCP. Examination demonstrates post operative changes of ventriculoscopy, including right frontal burr hole and air in the right frontal region and left frontal horn. A right frontal linear low density is present along the previous catheter tract. A cyst with peripheral calcification is present in the region of the pineal gland, which is unchanged in size from prior brain MRI. There is no intracranial hemorrhage, mass, midline shift or abnormal extra-axial fluid collection. The ventricles are normal in size and are symmetric. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. | 1. Expected postoperative change of ventriculoscopy. No evidence of a hydrocephalus or hemorrhage.2. Pineal cyst. |
Generate impression based on medical findings. | 34 years Female (DOB:6/23/1981)Reason: Eval for demyelinating disease History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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. Metallic artifact partially sutures the left orbit which is less not readily visualized on this exam.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is 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.No abnormal lesions are identified in the cervical spinal cord.2.There are several subcortical white matter lesions present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. In general they are not typical in imaging appearance of demyelinating lesions related to multiple sclerosis |
Generate impression based on medical findings. | 34 years Female (DOB: 10/17/1981)Reason: ? Spinal cord process History: L sided hypotensionPROVIDER NAME: MICHAEL A WARD NAOUM P ISSA MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus. There is partial desiccation of the left frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is 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.No intracranial mass lesion or other explanation for the patient's generalized weakness is appreciated.2.There is no compromise of the cervical spinal canal and no abnormal enhancing lesion within the cervical spine.3.There is an air-fluid level in the left maxillary sinus. The possibility of an acute sinusitis cannot be excluded. Please correlate with patient's clinical evaluation. |
Generate impression based on medical findings. | pt had MRI previously L3-L5 bulging discs. No improvement in pain with patient has bulging worsened 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. There is a formed disc at S1-S2. There is mild disc desiccation at L3-4 and L4-5 associated with mild loss of disc space height.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a broad-based central disc extrusion present at this level associated with some disc material tracking behind the superior endplate of L5. The fat at the lateral recesses sees is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced.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. | 1.Please note that there is a formed disc at S1-S2 which may confound enumeration of the vertebra2.There is a small central disc extrusion at L4-5 without significant compromise to the spinal canal or exiting nerve roots. |
Generate impression based on medical findings. | Benign neoplasm of pituitary gland [D35.2] / Benign neoplasm of craniopharyngeal duct [D35.3] / Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch), yearly follow up Pituitary MRIRedemonstration of convoluted shaped recurrent pituitary mass which is encasing right cavernous sinus ICA and extends toward left side suprasellar cistern, unchanged. The mass is measured about 23.6mm (AP measured on contrast enhanced sagittal scan) x 30.9mm (RL measured on T2 coronal scan) x 21.4mm CC measured on T2 coronal scan) which is unchanged since prior scan. The size, configuration and MR signal intensities appear to be stable, unchanged.The orbits and contents are unremarkable. Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. The sellar mass with suprasellar and right cavernous sinus extension is again seen, appears to be stable since prior scan.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter are seen, indicating non specific small vessel ischemic disease, unchanged since prior scan.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. | 1. Recurrent pituitary mass with suprasellar as well as right cavernous sinus extension, stable in terms of size, configuration and MR characteristics.2. No evidence of acute ischemic or hemorrhagic lesion. No other abnormal enhancement.3. Unchanged non specific FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter. |
Generate impression based on medical findings. | Pinching/kinking of the cervical spinal cord and 1q42.1-44 interstitial deletion. There is persistent considerable narrowing of the upper cervical spinal canal associated with a narrow C1 arch in the anteroposterior dimension. The posterior arch of C1 indents the cervical spinal cord, but there is no evidence of associated signal abnormality within the spinal cord. The atlantoaxial articulation otherwise appears to be intact and the remainder of the cervical spine and imaged upper thoracic spine appears to be unremarkable. The paraspinal soft tissues are unremarkable. | Persistent narrowing of the upper cervical spinal canal associated with a narrow C1 arch in the anteroposterior dimension with indentation of the cervical spinal cord likely represents a developmental anomaly. Please refer to the recent brain MRI report regarding intracranial findings. |
Generate impression based on medical findings. | Female, 65 years old, with imbalance and question of midline lesion seen on prior exam. The cerebellar fissures are more prominent than what is typically seen suggesting underlying parenchymal volume loss, similar to the prior examination. Pacchionian granulations are evident along the right occipital bone.A focus of encephalomalacia is evident within the posterior right cingulate gyrus, again appearing similar to the prior exam. No other parenchymal signal abnormality is seen. There is no evidence of edema or mass effect. The pattern of intracranial enhancement is within normal limits.No abnormal extra-axial collection or intracranial hemorrhage is seen. The ventricular system is normal in size and morphology. | 1.Moderate cerebellar atrophy is seen, similar to that noted on the prior examination from 2007. This finding caries a broad differential diagnosis including sequelae of prior infection/inflammation, effect of certain medications and toxic exposures, and inherited syndromes.2.A small focus of chronic encephalomalacia is evident within the posterior right cingulate gyrus, also unchanged. The etiology for this finding is uncertain.3.No acute intracranial abnormality or other significant intracranial findings are seen. In particular, no evidence of any midline lesion is detected. |
Generate impression based on medical findings. | 60 years, Female, sensory disturbances in the extremities, evaluate for white matter disease and demyelination.. Brain: Brain parenchyma appears within normal limits for age. No significant parenchymal T2/FLAIR signal abnormalities are seen to suggest demyelinating or other white matter disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchymal volume is within normal limits. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Partially empty sella incidentally noted, which can be normal variant. Minimal mucosal thickening in the paranasal sinuses. Heterogeneous low T1 marrow signal is noted which is nonspecific and can be seen in conditions such as chronic anemias; no destructive osseous lesions. Cervical Spine: The cervical spinal cord has normal signal characteristics and overall morphology without evidence of demounting disease. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. 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: Small disc protrusion. No significant spinal canal or neural foraminal stenosis.C5-6: Small disc osteophyte complex which partially effaces the ventral thecal sac. Minimal spinal canal stenosis. There is mild left neural foraminal narrowing. No significant right neural foraminal narrowing.C6-7: Disc osteophyte complex and uncovertebral hypertrophy on the left. There is partial effacement of the ventral thecal sac. Minimal spinal canal stenosis. There is moderate left neural foraminal stenosis and minimal right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.No abnormal enhancement. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. | 1. MRI of the brain is within normal limits for patient's age. Specifically, no findings to suggest demyelinating disease.2. No cervical cord signal abnormality to suggest demyelinating disease.3. Mild degenerative changes in the cervical spine as detailed above with small disc osteophyte complexes at C5-C6 and C6-C7 resulting in minimal spinal canal narrowing. There is moderate left-sided neural foraminal stenosis at the C6-C7 level which may which may be impinging on the left C7 nerve root. |
Generate impression based on medical findings. | Diffuse large non-Hodgkin's lymphoma status post 6 cycles chemotherapy. Given the limitations of the lack of contrast material, I see no evidence of pathologic lymphadenopathy within the neck. Visceral structures are unremarkable.Bone windows reveal no osseous abnormality | No definite lymphadenopathy in the study which is limited by the lack of IV contrast. |
Generate impression based on medical findings. | 59 years Male (DOB:9/3/1957)Reason: Cervical radiculopathy History: arm painPROVIDER/ATTENDING NAME: DALIA H ELMOFTY YASMIN HASAN Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is left-sided facet hypertrophy present at this level and a disc bulge. There are small uncovertebral osteophytes present this level associated with disc material and mild narrowing of the neural foramina bilaterally.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild facet hypertrophy present at this level associated with minor disc bulge. There is mild narrowing of the right neural foramen at this level related to some small right-sided uncovertebral osteophytes and disc material.At C5-6 there is mild loss of disc space height, disc desiccation, diffuse disc bulge, endplate and uncovertebral osteophytes as well as encroachment of the exiting nerve roots within the neural foramina and effacement of spinal fluid ventral and posterior the spinal cord. Overall there is mild to moderate spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal . There is a left lateral recess disc protrusion present at this level extending into the left neural foramen which is associated with some uncovertebral osteophytes. There is encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation, endplate osteophytes and a diffuse disc bulge at this level associated with mild facet hypertrophy. There is more facet hypertrophy on the left side when compared to the right. There is some mild encroachment of the left-sided exiting nerve roots within the neural foramen at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet and ligamentum flavum hypertrophy at this level associated with a disc bulge.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. | 1.There are degenerative changes present in the cervical spine worse at C5-6 and C6-7 where there is mild to moderate spinal stenosis at C5-6 and encroachment of exiting nerve roots bilaterally at C5-6 and on the left-sided C6-7.2.There are some mild degenerative changes present in the lower lumbar spine without significant compromise to the spinal canal or exiting nerve roots. |
Generate impression based on medical findings. | 31-year-old female with history of bowel resection 10 years ago for obstruction. Evaluate for evidence of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintense lesion in the left kidney is too small to characterize but likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ileocolic anastomosis is present in the right lower quadrant. No abnormal bowel wall thickening or enhancement to suggest inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is enlarged by multiple fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic ascites, likely physiologic. | 1. No specific evidence of inflammatory bowel disease.2. Fibroid uterus. |
Generate impression based on medical findings. | Head and neck cancer. Head CT:There is a vague area of enhancement in the left temporal lobe (image #11, series 10). This should be evaluated with MRI brain to exclude the possibility of a metastatic disease. No obvious mass is identified.Neck CT:Post-treatment changes with associated soft tissue thickening in the neck are unchanged. There is no evidence of mass, or adenopathy based on size criteria.The limited view of the upper lungs appear unremarkable.Degenerative disease of the cervical spine is again present, with mild neuroforaminal narrowing at C3 -- C4 and C4 -- C5 levels. | 1. Vague enhancement in the left temporal lobe may be vascular in etiology. However, further evaluation with MRI brain without and with contrast is recommended to exclude the small possibility of a metastatic focus. 2. No evidence of recurrence or adenopathy in the neck. |
Generate impression based on medical findings. | History of diarrhea and abdominal pain with eating. Evaluate for small bowel inflammation. 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: Suboptimal distention by oral contrast. This limits the sensitivity of this study. Given this limitation there is no abnormal bowel dilatation, wall thickening, enhancement or restricted diffusion. No perienteric inflammatory changes. No evidence of fibrostenotic disease. No evidence of fistula or sinus tract formation. Trace right pericolic gutter fluid is within physiologic limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal physiologic cyst.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. | Somewhat suboptimal study due to poor small bowel distention; the patient was unable to finish the oral contrast prior to examination. No evidence of active inflammation of the small bowel or fibrostenotic disease. |
Generate impression based on medical findings. | Female 56 years old with cirrhosis. Assess liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology without arterially enhancing or washout lesion. Specifically, the previously described lesion in the right hepatic dome is not seen on today's study. TIPS catheter with associated susceptibility artifact is again noted.SPLEEN: The spleen measures 11 cm in craniocaudal dimension. Stable 1.5 cm left artery aneurysm.PANCREAS: There is a 4 mm T2 hyperintense lesion in the pancreatic tail (series 7, image 22), not significantly changed compared to the previous exam. The pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Cirrhotic liver without suspicious liver lesion.2.Stable 1.5 cm splenic artery aneurysm. |
Generate impression based on medical findings. | Clinical question: Evaluate back pain. Signs and symptoms: Persistent back pain. Pre and post enhanced cervical MRI:.Similar to prior brain MRI exam from3/4/2015 there is redemonstration of mild dorsiflexion of the dens and suggestion of subtle platybasia without change since prior exam.Similar to prior brain MRI examination there is 5.5 mm space between the anterior arch of C1 and dens with fatty signal intensity within this space. The measurement is at the upper limits of normal. Clinical significance of this finding is questionable. If patient has symptoms relevant to this region further evaluation and including flexion and extension views would be helpful for further assessment. Also unusual for patient's stated age of 11 there are tiny linear T2stir hyperintensity within the annulus of the disc at C4-C5 and C5-C6 levels (sagittal T2 STIR series 501 images 8 and 9) which demonstrate subtle enhancement. This appearance in adult population represents annular fissure and unusual for pediatric age group. Clinical significance of this finding also remains questionable.No detectable abnormality at the level of foramen magnum. The alignment of cervical spine is anatomical. The signal intensity and caliber of the cervical cord is within normal.No evidence of spinal canal or neural foraminal compromise at any level. Post enhanced images are unremarkable other than above mentioned finding.Pre and post enhanced thoracic MRI:There is normal anatomical development, signal intensity and alignment of the vertebral column. No spinal stenosis or neural foraminal compromise at any level.Normal signal intensity and caliber of the cord. No abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.No detectable paraspinal soft tissue abnormalities.Pre and post enhanced lumbar MRI:There is normal anatomical development, normal signal intensity and alignment of lumbar spine. No spinal stenosis or neural foraminal compromise at any level.There is normal signal intensity of the lower most visualized thoracic cord and conus. There is termination of the cord at L1 level.There is a tiny uniform linear fatty signal intensity of the filum terminale extending from L1-L2 disc level inferiorly to L4-L5 disc level which is best appreciated on axial T1 series 2401.Although there is normal termination of the cord at L1 level to entirely exclude possibility of tethered cord follow up with prone sagittal T2-weighted images is recommended. | 1.MRI of cervical spine demonstrate normal signal intensity and caliber of the cord without abnormal enhancement. No spinal stenosis or neural foraminal compromise. Mild platybasia, 5.5 mm space between the anterior arch of C1 and dens at the upper limits of normal, tiny signal changes and enhancement in the annulus of the disc at C4-C5 and C5-C6 levels consistent with annular fissure which is an unusual finding for this age group. Please see above comments.2.MRI of thoracic spine is unremarkable.3.Pre- and post enhanced MRI of lumbar spine demonstrate a tiny uniform fatty signal intensity of the filum terminale extending from L1-L2 disc level inferiorly to L4-L5 disc level. There is termination of the cord at upper L1 level. Unremarkable lumbar MRI otherwise. To entirely exclude possibility of tethered cord follow-up with prone sagittal T2-weighted images is recommended. |
Generate impression based on medical findings. | 67 years, Male, metastatic melanoma enrolling in immunotherapy trial. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. A few small foci of susceptibility effect are demonstrated in the bilateral posterior frontal periventricular white matter, compatible with chronic microhemorrhages. A few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is a punctate focus of high T1 signal involving the choroid plexus of the left lateral ventricle with suggestion of hypoattenuation on prior PET/CT suggesting tiny lipoma. The ventricles are within normal limits in size and configuration. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. | 1. No evidence of intracranial metastatic disease. 2. Few nonspecific chronic microhemorrhages in the bilateral posterior frontal lobes.3. Mild chronic small vessel ischemic changes. |
Generate impression based on medical findings. | Unspecified fall, initial encounter [W19.XXXA], Reason for Study: ^Reason: r/o cord compression History: s/p fall, profound weakness. There is about 10% compression fracture of T12 vertebral body with the vertebral body bone marrow edema.In addition, there is high signal intensity on T 11-12 inter-spinous process ligament as well as subcutaneous tissues overlying T 11-12 spinous process indicating soft tissue contusion and possible T 11-12 intraspinous ligament injury.However, alignment of thoracic vertebral bodies appears to be maintained.There is normal cervical lordosis. The cranial-cervical junction appears to be normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. There is no evidence of cord compression or mass. | 1. Compression fracture of T12 vertebral body with about 10% height loss with possible associated T11-12 interspinous process injury and soft tissues overlying T11-12 spinous process contusion.2. No evidence of spinal cord compression or abnormal MR signal intensity. |
Generate impression based on medical findings. | The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild heterogeneity of the vertebral bone marrow signal with scattered foci of T1 hyperintense signal in the lumbar spine, likely representing focal fatty replacement or fat-containing hemangiomas. There are mild lateral disc bulges at L3-4 and L4-5 without significant spinal canal or foraminal stenosis. The spinal cord displays normal signal and morphology. The tip of the conus medullaris terminates at the level of L1-2. There is no pathologic intrathecal enhancement. | 1. No pathologic enhancement to suggest leptomeningeal disease in the spine. 2. No significant spinal canal or foraminal stenosis. |
Generate impression based on medical findings. | Female, 14 years old, with history of glioma and growing lesion on a recent prior MRI scan. Assess for disease progression. Single voxel spectroscopy was performed on a region of progressive thickening and T2 signal abnormality within the right frontal periventricular white matter. The lesion spectrum is compared to a control spectrum obtained more posteriorly within the right frontal lobe from tissue which appears radiographically normal.The lesion spectrum demonstrates a reversal of the choline and NAA peaks, and when comparison is made to the control spectrum, the choline peak obtained from the lesion is indeed seen to be elevated relative to normal tissue. | MR spectroscopic findings concerning for progressive tumor. |
Generate impression based on medical findings. | Progressive numbness, weakness in left upper extremity. Low back pain with or without sciatica. Evaluate for possible nerve root compression or other CNS pathology. Cervical: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine with disc height loss at multiple levels, relatively worse at the C4-C5, C5-6, and C6-C7. Individual levels 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: Right paracentral and foraminal disc osteophyte complex with effacement of the right ventral thecal sac. No significant spinal canal stenosis overall. There is mild to moderate right-sided neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex with uncovertebral hypertrophy result in moderate to severe bilateral neural foraminal stenosis, left slightly worse than right. Mild spinal canal stenosis. C6-7: Small disc osteophyte complex and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis related to uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing related to uncovertebral hypertrophy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace anterolisthesis of L2 on L3 and trace retrolisthesis of L3 on L4. There is also mild anterolisthesis of L5 on S1. There is disc desiccation throughout the lumbar spine with suggestion of vacuum phenomena at the L4-L5 and L5-S1 levels. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, ligamentum flavum thickening, and mild bilateral facet arthropathy. There is no significant spinal canal stenosis. Minimal bilateral neural foraminal narrowing.L3-L4: Mild disc bulge, and bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L4-L5: Mild disc bulge, ligamentum flavum thickening, and moderate bilateral facet arthropathy. There is also prominence of the dorsal and ventral epidural fat resulting in moderate spinal canal stenosis. There is clumped appearance of the nerve roots which is favored to be related to extrinsic compression. There is moderate to severe right neural foraminal stenosis and moderate left neural foraminal stenosis. There are mild edematous changes involving the endplates which are likely on a degenerative basis.L5-S1: There is advanced bilateral facet arthropathy and grade 1 anterolisthesis. There is no significant spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal stenosis.There is mild fatty atrophy involving the lower lumbar paraspinous musculature. | 1. Multilevel degenerative changes in the cervical spine. There is mild spinal canal narrowing at C5-C6 and C6-C7. No high-grade spinal canal stenosis or cord signal abnormality. There is multilevel neural foraminal stenosis, relatively worst at the left C5-C6 level where there may be impingement of the left C6 nerve root. Additional levels as above.2. Multilevel degenerative changes in the lumbar spine. There is up to moderate spinal canal stenosis at the L4-L5 level. There is also significant neural foraminal stenosis bilaterally at L4-L5 and L5-S1, right worse than left, as described above where there may be impingement of the exiting nerve roots.3. Advanced bilateral facet arthropathy at L5-S1 and to a lesser degree at L4-L5, which may be contributing to patient's low back pain. |
Generate impression based on medical findings. | 28-year-old female with chronic elbow pain and intermittent fevers. Rule out osteomyelitis. Somewhat suboptimal examination secondary to the inability to use a dedicated HD coil and inability to optimally position the patient.LIGAMENTS: Although this examination was not protocoled for evaluation of the ligamentous structures, the radial collateral, ulnar collateral, and lateral ulnar collateral ligaments are unremarkable.TENDONS: The common flexor and extensor tendons appear intact. The biceps brachii and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: The bone marrow signal intensity is within normal limits without evidence to suggest osteomyelitis.SURROUNDING STRUCTURES: The imaged musculature is normal in appearance.ADDITIONAL | No evidence of osteomyelitis or other findings to account for the patient's elbow pain. |
Generate impression based on medical findings. | Squamous cell carcinoma of the right nasal bridge and left cheek with perineural invasion. Status post Mohs 9/9/2014 and radiation therapy completed 12/4/2014. Evaluate for recurrence. There are post-treatment changes of the left cheek. There is no evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are grossly intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. There is interval persistent mucosal thickening and secretions within the paranasal sinuses. There is fluid within the left mastoid air cells and middle ear. | 1. No definite evidence of local tumor recurrence, although the assessment is limited by the lack of intravenous contrast.2. Persistent mucosal thickening and secretions within the paranasal sinuses, which may represent sinusitis. 3. Fluid within the left mastoid air cells and middle ear may represent otomastoiditis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Clinical question: Stroke. Signs and symptoms: Aphasia expressive. Nonenhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrate diffuse nonspecific foci of flair hyperintensity only in the periventricular and subcortical white matter of cerebral hemispheres which considering patient's stated age of 84 most likely representing chronic nonhemorrhagic small vessel ischemic strokes of mild-to-moderate degree.There is also a small focus of cortical and subcortical encephalomalacia in the left frontal lobe consistent with a chronic nonhemorrhagic ischemic stroke. Images through posterior fossa demonstrate multiple tiny chronic cerebellar ischemic strokes in the distribution of Michael branches. Unremarkable signal intensity of brain parenchyma otherwise.The signal void of major intracranial arterial branches are identified.Incidental note is made of anatomical variation of partially empty sella.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium. | 1.No acute intracranial process.2.Mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter. Multiple small pica territory bilateral cerebellar chronic strokes.3.Unremarkable exam otherwise. |
Generate impression based on medical findings. | There is mild straightening of the normal lumbar lordosis which may be due to positioning. Alignment is otherwise within normal limits without sagittal spondylolisthesis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement within the spine. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There is partial visualization of the known area of left piriform abscess, further detailed on the concurrent MRI of the pelvis. | No acute abnormalities or evidence of infection within the lumbar spine. Please see accompanying MRI of pelvis for further details regarding the pelvic abscess. |
Generate impression based on medical findings. | T3N2b right BOT HPV+ SCC, non-smoker, on OPTIMA trial, s/p induction chemotherapy with carboplatin/abraxane followed by 5/5 cycles of TFHX completed on 11/11/16. The images are degraded by patient motion. There are post-treatment findings without evidence of measurable residual oropharyngeal tumor. The irregular right level 2A lymph node is no longer discernible and a right level 3 lymph node measures 8 x 9 mm, previously 9 x 14 mm. The left cervical lymph nodes are not particularly enlarged. The salivary glands are unremarkable. There is mild degenerative spondylosis at C4-5 and C5-6. There is a subcentimeter left maxillary sinus retention cyst. The orbits and imaged intracranial structures are grossly unremarkable. | 1. Post-treatment findings without evidence of measurable residual oropharyngeal tumor, although the images are degraded by patient motion. 2. No evidence of significant residual cervical lymphadenopathy, although the images are degraded by patient motion. |
Generate impression based on medical findings. | Female, 64 years old, with cervicalgia and spinal stenosis, history of cervical fusion. Preoperative evaluation for corpectomy. Again demonstrated is partial osseous fusion of the C6 and C7 vertebrae. Spinal alignment is anatomic. Vertebral body heights are preserved allowing for endplate degeneration. No evidence of marrow edema or pathologic marrow replacement is seen.The visualized spinal cord shows normal signal throughout. No epidural lesions are suspected.C2-3: Bilateral facet arthropathy. No spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C3-4: Advanced facet arthropathy on the left. No spinal canal stenosis. Moderate left foraminal narrowing. No interval changes. C4-5: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation. Mild effacement of the ventral thecal sac. Mild right foraminal narrowing. No interval changes. C5-6: Broad posterior disc-osteophyte complex formation causing at least moderate spinal canal stenosis with some deformation of the spinal cord but no evidence of cord edema. Moderate left and mild right foraminal narrowing. No interval changes. C6-7: No significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis. | 1.Fusion of the C6 and C7 vertebrae is redemonstrated compatible with prior surgery.2.A broad disc osteophyte at C5-6 continues to produce moderate spinal canal stenosis and mild deformation of the cord, similar to prior.3.Scattered additional degenerative changes, including mild-to-moderate foraminal narrowing as above, show no significant interval change. |
Generate impression based on medical findings. | 47-year-old female with abdominal pain, fatigue. Evaluate small bowel for inflammation in patient with Crohn's colitis. ABDOMEN:LIVER, BILIARY TRACT: There are scattered subcentimeter hepatic cysts.SPLEEN: There are multiple splenic cysts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. There is a dilated right upper pole calyx.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a long segment of decompressed small bowel within the mid-abdomen which does not abnormally enhance or demonstrate restricted diffusion. This likely represents peristaltic bowel as it is not delineated on later timed sequences likely secondary to distension. No small bowel wall thickening, restricted diffusion, or abnormal enhancement is identified. The terminal ileum is unremarkable. No focal areas of bowel dilatation or evidence of small bowel obstruction. The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal intra-abdominal collection.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a long segment of decompressed small bowel within the mid-abdomen which does not abnormally enhance or demonstrate restricted diffusion. This likely represents peristaltic bowel as it is not delineated on later timed sequences. No small bowel wall thickening, restricted diffusion, or abnormal enhancement is identified. The terminal ileum is unremarkable. No focal areas of bowel dilatation or evidence of small bowel obstruction. The colon is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No abnormal intrapelvic collection. | 1. No specific findings of active or chronic inflammatory bowel disease.2. Hepatic, renal, and splenic cysts. |
Generate impression based on medical findings. | Paresthesias. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few T2 hyperintense lesions in the bilateral periventricular white matter, including the corpus callosum. There are no definite infratentorial lesions. 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. | A few lesions in the bilateral periventricular white matter may represent demyelinating lesions. |
Generate impression based on medical findings. | Male 51 years old Reason: elevated psa History: elevated psa PELVIS:PROSTATE:Prostate Size:4.0 x 4.2 x 4.2 cm.Signal abnormality: Dominant focus of T2 hypointense signal abnormality at the mid gland anteriorly which measures 2.4 x 1.5 cm (series 704, image 144) which is dark on ADC. Additional subcentimeter focus in the left apex posteriorly measuring 0.8 x 0.6 cm (series 704, image 104). These are suspicious for foci of prostatic carcinoma.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Dominant 2.4 cm focus of signal abnormality within the anterior prostate with additional subcentimeter focus in the posterior left apex. These are suspicious for foci of prostatic carcinoma. No evidence of seminal vesical invasion or extracapsular extension. |
Generate impression based on medical findings. | 63 year old man with history of recent heart transplant, with reduced cardiac output on right heart catheterization concerning for occult rejection, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 115 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 51 ml (normal range 47+/-19), the LV mass index is 83 g/m2 (normal range 85+/-15), and the LV mass is 130 g (normal range 164+/-36). The basal septum measures 11mm in thickness. There is no regional wall motion abnormality. There is a borderline area of patchy late gadolinium enhancement in the basal inferolateral wall, which is improved from before but may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native myocardial T1 time in the septum is 1048-1062ms, and 1133ms in the basal inferior wall (On previous study, native T1 time was reported as 1063ms in basal septum and 1150ms in basal inferior wall). Extracellular volume fraction is 27%, which is within normal limits. There is no evidence of significant edema on T2 STIR imaging. Due to artifact, T1 black blood imaging was nondiagnostic.Left AtriumThe left atrium is consistent with cardiac transplant. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 56 ml/m2 (normal range 82+/-16), the RVEDV is 91 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 49 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 bovine 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 drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternotomy wires are present. There is a right lower lobe consolidation versus mass which has increased in size from the previous study and does not enhance with contrast. Also, there may be a mass in the left hilum and a small nodule in the left upper lung. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered. | 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, which is improved from before. 2. There is a borderline area of patchy late gadolinium enhancement in the basal inferolateral wall, which is improved from before but may suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, which is stable when compared to the previous study.4. See extra-cardiac findings.Findings discussed with Dr. Uriel.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on medical findings. | Reason: dystonic reaction vs seizure History: as above There is no evidence of intracranial hemorrhage, mass or diffusion restriction.There are scattered punctate periventricular and subcortical T2 hyperintensities without diffusion restriction. Similarly there are punctate T2 and FLAIR hyperintense lesions in the left thalamus and pons.A cavum septum pellucidum and vergae are noted. The ventricles and sulci are prominent suggesting mild age-related volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable. | 1.No findings to explain patient's seizures.2.Periventricular and subcortical white matter changes of a moderate degree as well as several punctate lesions in the brainstem and left thalamus are nonspecific. At this age they are most likely vascular related. |
Generate impression based on medical findings. | 38 year old female with a personal history of left breast lumpectomy in 2014 for IDC/DCIS followed by radiation and chemotherapy. Family history of breast cancer in mother and maternal aunt. No current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.Fibroadenolipoma is again seen at medial retroareolar region in the right breast without significant changes.Post surgical scar is present in the medial left breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region. | No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram. |
Generate impression based on medical findings. | History of elevated PSA with prior negative biopsy. 6.3 - 10.9 - 7.87 - 12.85 PELVIS:PROSTATE:Prostate Size: 5.3 x 6.3 x 5.6 cmPeripheral Zone: The peripheral zone is relatively homogeneously hyperintense on T2-weighted imaging without a dominant discrete lesion. No discrete lesion with restricted diffusion.Central Gland: Changes from benign prostatic hyperplasia.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific right external iliac lymph node measuring approximately 7 mm in short-axis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No discrete lesion is evident. |
Generate impression based on medical findings. | There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is interval increase in mild mucosal thickening in the left maxillary sinus. There is minimal mucosal thickening in the bilateral ethmoid air cells. There is a punctate adenoid retention cyst. | 1. No evidence of mass lesions, hydrocephalus, or intracranial hemorrhage.2. Mild paranasal sinus inflammation, which has slightly increased. |
Generate impression based on medical findings. | Bulbar weakness, facial weakness. Possible brainstem lesion. No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement. |
Generate impression based on medical findings. | Diagnosis: Encounter for examination for normal comparison and control in clinical research programClinical question: Day 28: clinical trial eval The patient status post right frontal craniotomy for removal of a right frontal lobe mass. There is signal hyperintensity present along the right frontal lobe within the subcortical and periventricular white matter in the right superior middle and inferior frontal gyri as well as the white matter of the right external capsule. The extent of the white matter signal abnormality remains stable and compared to the previous exam from October 19, however, this white matter signal change appears to be more extensive than on the 7/23/2015 exam. Compared to the 9/15/2015 exam - which is preoperative- the outer extent of the white matter signal change appears very similar. There are punctate foci of susceptibility effect present within the white matter signal change adjacent to the surgical site. These were also present on the 9/15/2015 exam. There is redemonstration of ill-defined patchy enhancement where these punctate foci of susceptibility are surrounding the surgical margins . This contrast enhancement is stable and compared to the previous exam.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. | Since the previous exam is no substantial change. There is redemonstration of status post right frontal lobe surgery. The possibility of a residual neoplasm in the remaining right frontal lobe cannot be excluded. |
Generate impression based on medical findings. | Clinical question: Preoperative planning for seizure examination. Signs and symptoms: Seizure. Pre and post infusion brain MRI:Examination is performed utilizing surgical/treatment planning protocol and is not a true diagnostic test. There is no detectable abnormal parenchymal or leptomeningeal enhancement.There is a linear focus of T2 hypointensity extending from the inner table of left stereotactic bone across the brain parenchyma and terminating in the medial aspect of the left anterior temporal lobe representing track of surgical ablation device. Small loculated focus of T2 hyperintense and T1 hypointense along the medial aspect of the left mid temporal lobe deep to represent focus of surgical ablation for seizure. This finding measures approximately at 11 x 14 mm in transaxial dimensions.Unremarkable study otherwise.New since prior exam there is a focus of T2 hyperintensity and T1 hypointensity in the left anterior frontal lobe involving the cortex and subcortical white matter which is best appreciated on axial series 201 on images 125 through 141 which is at the sites of previously placed surface electrodes. There is subtle superficial enhancement which may represent a meningioma scarring.Postoperative changes of a left anterior temporal craniotomy is also noted. Ventricular system remains within normal and with maintained midline. | 1.Focus of encephalomalacia in left anterior frontal lobe is new since prior exam.2.No acute intracranial process.3.Expected postoperative changes of laser ablation in the left medial temporal lobe. |
Generate impression based on medical findings. | Brain cyst, shunt, headaches, worsening symptoms. Evidence of right-sided hemispherectomy is again seen as well as fragmentation involving the right calvarium related to multiple prior craniotomies. There has been evolution and minimal decrease in size of extra-axial/extra-dural fluid collection along the right cerebral convexity. Unchanged position of catheter is in place spanning from this fluid collection to the left, across the residual left cerebral hemisphere, terminating within the left temporal lobe.A cyst within the anteromedial left temporal lobe measuring approximately 20 x 24 x 12 mm similar to prior previously 21 x 23 x 12 mm. Cysts posterior to the catheter appear similar to prior. A more posterior medial cyst which demonstrates an air-fluid level on 3/9/2016 and demonstrated decrease in size in 3/23/2016 appears to have resolved. Extensive chronic cerebral dysmorphism is unchanged. The white matter surrounding the residual left sided ventricular system remains T2 hyperintense. No new cysts or new mass effect is appreciated. | 1.Grossly unchanged catheter traversing the right sided extra-dural fluid collection across to the left temporal lobe. The right-sided extradural fluid collection demonstrates evolution and minimal decrease in size.2.Cysts just anterior and posterior to the lateral aspect of the catheter persist but not clearly changed in size allowing for slight differences in measurement technique. There is a cyst more posteromedially which demonstrated an air-fluid level on 3/9/2016 and some decrease in size on 3/23/2016 which now appears to have resolved.3.Chronic dysmorphism of the brain and sequelae of right hemispherectomy are again seen. |
Generate impression based on medical findings. | External impingement right shoulder ROTATOR CUFF: The supraspinatus and infraspinatus tendons are intact. There is a small articular sided partial tear of the subscapularis.SUPRASPINATUS OUTLET: Mild degenerative changes are seen at the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Note is made of degenerative subchondral cysts in the humeral head.BICEPS TENDON: No significant abnormality noted. | Small articular sided partial tear of the subscapularis tendon. |
Generate impression based on medical findings. | History of recurrent low grade astrocytoma s/p craniotomy and chemotherapy. There has been interval decrease in size of the predominantly enhancing lobular mass with peripheral cystic components centered in the hypothalamic region, now measuring up to 57 mm in the sagittal plane, previously 60 mm. There are punctate scattered foci of susceptibility effect in the tumor. The mass encases and displaces portions of the bilateral internal carotid, middle cerebral, and anterior cerebral arteries. There is persistent prominence of the lateral ventricles and partial effacement of the third ventricle. There is encephalomalacia in the anterolateral right frontal lobe, which may be related to right frontal craniotomy for tumor biopsy. There is no evidence of acute infarction. | Interval decrease in size of the hypothalamic region astrocytoma. |
Generate impression based on medical findings. | Clinical question: Evidence of herniation, please evaluate for brainstem and foramina magnum. Signs and symptoms: Status post PEA arrest, nonresponsive. Nonenhanced CT of brain:Portable CT at bedside is performed. Images through posterior fossa are severely obscured due to extensive artifact from patient's multiple bilateral dental fillings. The brainstem cannot be properly evaluated due to extensive artifact. Recommend follow-up with a standard nonportable CT. The fourth ventricle is identified in the midline. The prior portable CT did not include the fourth ventricle and comparison cannot be made.Images through supratentorial space demonstrate no gross evidence of hemorrhage, mass-effect, hydrocephalus or midline shift. Possibility of edema cannot be evaluated due to very poor quality of the study. There is however no visualization of cortical sulci this may indicate underlying diffuse cerebral edema. Follow-up exam with a dedicated nonportable CT or an MRI is recommended. | Suboptimal study due to extensive artifact however no gross abnormality since prior exam. Possibility of cerebral edema cannot be evaluated. |
Generate impression based on medical findings. | Reason: 3T Scanner, SRS for AVM March 2013 History: Please evaluate for changes post SRS MRI of the brainAn arteriovenous malformation located adjacent to and posterior medial to the trigone of the left lateral ventricle is less conspicuous on the T2 images relative to the prior exam, however, it is still visible on the SWI and GRE images indicating that it has decreased in size compared to the prior exams. Feeding arteries and draining veins have also decreased in caliber. Post contrast images demonstrate some of the adjacent draining veins. The right basal vein is larger than the left basal vein. This is non-specific, however, and may relate to normal asymmetry, decrease in caliber of the left basal vein with redirection of venous drainage - especially since the straight sinus was reportedly narrowed proximally - or persistent venous drainage for the AVM. The patient has developed some T2 and flair bright signal changes in the adjacent brain parenchyma which has regressed since the prior exam and is associated with encephalomalacia. There is associated contrast enhancement along a small portion of this signal changeIncidental note is made of a left-sided periclival persistent trigeminal arteryThe 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 3 mm axial dimension arteriovenous malformation located adjacent to and posterior medial to the trigone of the left lateral ventricle. On the 10/6/14 exam it measured 7mm. Its drainage into the vein of Galen is note readily depicted, however, its drainage into the superior sagittal sinus remains visible. The left posterior cerebral artery distal branches near the AVM appear larger than the right posterior cerebral artery distal branches, suggesting supply from the left posterior cerebral artery.Incidental note is made of a left-sided periclival persistent trigeminal artery | 1.Continued regression of arteriovenous malformation located adjacent to the trigone of the left lateral ventricle.2.Tissue reaction surrounding the AVM along the adjacent brain parenchyma - likely related to postradiation effect - continues to regress.3.Persistent trigeminal artery. |
Generate impression based on medical findings. | 3-year-old male status post intubation with recent fever; evaluate for cerebral edema. There is a focus of hypoattenuation in the right basal ganglia which is somewhat nonspecific on this nonenhanced CT scan. Additional hypoattenuating regions are seen in the bilateral posterior parietal/occipital lobes with extension to the cerebral cortex. Further imaging with MRI is recommended. There is no evidence of intracranial hemorrhage or midline shift. The gray-white matter differentiation appears somewhat indistinct. There is diffuse loss of the cortical sulci which can be seen as a normal variant in young patients; however this may also suggest diffuse cerebral edema.The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. There is partial opacification of the right mastoid air cells and middle ear cavity. | 1. Findings suspicious for cerebral edema. 2. Nonspecific foci of hypoattenuation in the right thalamus and bilateral posterior parietal/occipital lobes. Further imaging with MRI is recommended. 3. Partial opacification of the right mastoid air cells and middle air cavity is nonspecific, but otomastoiditis cannot be excluded. |
Generate impression based on medical findings. | Clinical question: Assess for progression of metastatic lesions. Signs and symptoms: History of metastatic melanoma with prior brain metastases. No new periods of intermittent confusion, concerning for progression of disease. Limited nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Images through posterior fossa demonstrate mildly prominent fourth ventricle and unremarkable otherwise and without interval change.There is a hemorrhagic metastatic lesion in the right occipital lobe without significant surrounding edema measuring 16 x 17 mm in size compared to prior study measurement of 8.4 x 7 mm.A right posterior parietal occipital hemorrhagic metastatic lesion is again noted without significant surrounding edema or mass effect and measuring at 12.3 x 13.4 mm without significant change since prior exam.Metastatic hemorrhagic lesion in the left posterior parietal with extensive surrounding vasogenic edema demonstrates interval increased size and increased surrounding edema and associated regional mass effect. The tumor measures approximately 15 x 16 mm intravenous axial dimensions compared to prior study measurement of 12 x 14.Focus of FLAIR hyperintensity in the right anterior frontal with evidence of hemorrhagic changes demonstrate no significant change since prior study. There is evidence of prior surgical intervention at this site and findings could represent post surgical change.Metastatic lesion in the high convexity right anterior parietal and is surrounding edema demonstrate no significant change. A well demarcated CSF signal intensity cystic-like lesion likely representing postsurgical change in high convexity left paramedian posterior frontal measures up to 24 x 23 without significant change since prior study.Mildly dilated supratentorial ventricular system with maintained midline demonstrate no appreciable interval change. The CSF cisterns and cortical sulci remain patent. | 1.Incomplete and nonenhanced MRI of brain is performed due to patient's inability to continue.2.There is no acute intracranial process and negative diffusion-weighted images.3.Interval increased size and surrounding vasogenic edema of the metastatic lesions as detailed/measured above.4.Stable mildly dilated supratentorial ventricular system however with maintained midline.5.Stable postoperative changes as detailed. |
Generate impression based on medical findings. | Female, 80 years old. Reason: evaluate for RA, OA History: flexion contractures at PIP's Right hand: The bones appear demineralized. Moderate osteoarthritis affects multiple interphalangeal joints. Severe osteoarthritis affects the first carpometacarpal joint. We see no specific radiographic features of rheumatoid arthritis.Left hand: The bones appear demineralized. Moderate osteoarthritis affects multiple interphalangeal joints. Moderate osteoarthritis also affects the first carpometacarpal joint. We see no specific radiographic features of rheumatoid arthritis.Right knee: Severe osteoarthritis affects the right knee, particularly the lateral and patellofemoral compartments. A cluster of calcifications in the distal femoral metaphysis likely represents a benign enchondroma. The patella appears low lying, which may simply represent artifact related to patient positioning. However, if there is clinical concern for quadriceps tendon injury, MRI can be considered for further evaluation.Left knee: Severe osteoarthritis affects the left knee, particularly the lateral and patellofemoral compartments. | Osteoarthritis of both hands and both knees; other findings as above. |
Generate impression based on medical findings. | There is a small 4 x 7 mm lesion (as measured on axial T2) within the frontal lobe just above the right lateral ventricle with mixed T1 and T2 signal intensity, although primarily hypointense. It demonstrates susceptibility blooming, however has no perilesional edema or associated developmental venous anomaly. There are no other similar appearing lesions.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. | 4 x 7 mm cavernous malformation just above the right lateral ventricle without perilesional edema or associated developmental venous anomaly. |
Generate impression based on medical findings. | Other benign neoplasm of connective and other soft tissue of unspecified site [215.9], Reason for Study: ^Reason: history of schwannoma History: history of schwannoma Redemonstration of prior T12-L2 laminectomies for the resection of schwannoma.There is no evidence of residual or recurrence of the tumor on this scan.There is focal protrusion of disc at the level of T10-T11 which abuts thecal sac, no change of the degree of protrusion since prior exam. There is focal high signal intensity within the spinal cord at the level of T12 on T2 weighted image indicating focal myelomalacia, no change since prior exam.Although there are some degenerative changes, the thoracic and lumbar spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the L1-L2 level. There is no evidence of abnormal enhancement, cord compression or mass. Mild degenerative changes such as disc dessication, diffuse bulging of disc were seen along the lumbar spine, no change since prior exam. | 1. Post laminectomy status from T12 to L2, no unusual finding.2. No evidence of abnormal enhancement indicating residual or recurrent tumor on this scan.3. Focal disc protrusion at the level of T10-T11, no change since prior exam.4. Mild degenerative changes of lumbar spine, no change since prior exam. |
Generate impression based on medical findings. | Headache. CVA. Cerebral infarction.IMAGE ACQUISITIONS: 4.5-mm contiguous axial CT sections of the brain without contrast infusion. No acute intracranial hemorrhage, mass effect or shift of midline structures. Small low attenuation lesions in the cerebellum consistent with chronic infarcts are again noted. A low-attenuation lesion in the genu of the right corpus callosum, consistent with chronic lacunar infarction is unchanged. Multiple small foci of periventricular low-attenuation have not significantly changed. There is abnormal low attenuation in the genu of the corpus callosum, corresponding with high signal intensity on MRI. Low-attenuation is also present in bilateral periatrial white matter. Small juxtacortical foci of low-attenuation are again noted. A chronic left occipital infarct is unchanged. | Stable CT findings. No CT evidence of new infarction. No acute intracranial hemorrhage. |
Generate impression based on medical findings. | Back pain, evaluate for epidural abscess Examination is technically degraded. Vertebral body heights are within normal limits. There is straightening of the lumbar curvature, with otherwise preserved alignment. Diffusely low T1 and T2 signal are noted throughout the bone marrow without focal destructive osseous lesions. The conus medullaris is normal in position. Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Prominent paraspinous collateral vessels are noted. Ascites. | 1. Examination is technically degraded (artifact possible related to extensive ascites) and absence of contrast limits evaluation for small lesions. However, there are no findings to suggest discitis- osteomyelitis, and no epidural or paraspinous collections are apparent to suggest abscess.2. Diffusely low T1 and T2 marrow signal which is nonspecific but can be seen with conditions such as chronic anemia or renal osteodystrophy. |
Generate impression based on medical findings. | Left ischium pressure ulcer to bone. Rule out osteomyelitis. Large soft tissue ulceration is seen laterally extending from the skin to the greater trochanter. Surrounding soft tissue edema suggests inflammation or infection. There is cortical loss of the underlying bone and marrow signal abnormality in the proximal femur centered in the greater trochanter, with increased T2 signal and decreased T1 signal as well as enhancement on postcontrast images, compatible with osteomyelitis.Small skin ulceration is also seen in the posterior subcutaneous soft tissues superficial to the coccyx with soft tissue enhancement suggesting inflammation or infection. No clear evidence of marrow signal abnormality, cortical disruption, or abnormal osseous enhancement is seen to suggest underlying osteomyelitis.There are no other areas of bone signal abnormality. Specifically, there is no involvement of the ischium. Small bilateral hip joint effusions are present, right greater than left. | 1.Large ulceration of the lateral left hip and underlying osteomyelitis centered in the greater trochanter of the left femur.2.Additional sacral ulcer without evidence of osteomyelitis in this region. |
Generate impression based on medical findings. | Unspecified cerebral artery occlusion with cerebral infarctionClinical question: l mca strokeSigns and Symptoms: L mca strokeWeakness and neglect. 60 years old male. MRI of the brainThere is diffusion restriction present involving the left insular cortex, the left middle and inferior frontal lobe gyri as well as the left parietal lobe and portions of the posterior aspect of the left temporal lobe superior temporal lobe gyrus. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.On susceptibility imaging there are lower signal serpiginous flow-voids at the edge of the area of infarction signifying hypoxia along the watershed zone.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and scattered opacities elsewhere.. 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 a occlusion of the left middle cerebral artery distal to the left anterior temporal artery. There is some antegrade flow present along the left frontal orbital artery which appears to originate from the left anterior temporal artery.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally associated with small P1 segments. The left vertebral artery is small and predominantly supplies the left posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. On the basis of NASCET criteria there is 90% stenosis at the origin of the left internal carotid artery. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from a common trunk with the right common carotid artery. The right subclavian artery has an aberrant origin originating distal to the left subclavian artery. Findings suggest narrowing at the proximal right common carotid artery just distal to the origin of the left common carotid artery with approximately 50% stenosis of the right common carotid artery. The origin of the right vertebral artery is narrowed by approximately 50%. The left vertebral artery is small. | 1.Subacute left middle cerebral artery territory infarction involving the left insular cortex, left inferior and middle frontal gyri and left parietal lobe as well as the left superior temporal gyrus. There is no evidence for hemorrhagic conversion at this time.2.Occlusion of the left middle cerebral artery at the M1 segment with some antegrade filling of the left anterior temporal artery to appears to be fairly large probably supplying part of the left frontal lobe and temporal lobe.3.90% stenosis at the origin of the left internal carotid artery.4.50% stenosis at the proximal right common carotid artery artery just distal to the origin of the left common carotid artery. Please note that the right subclavian artery has an aberrant origin and the right common carotid artery and left common carotid artery have a common trunk.5.50% stenosis at the origin of the right vertebral artery which is associated with a very small left vertebral artery |
Generate impression based on medical findings. | The cervical spine is in normal alignment, with exaggeration of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. At C5-C6 and C6-C7, there are trace disc bulges without stenosis. There is also mild ligamentum flavum thickening particularly at C6-C7. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. Patchy T2 hyperintensity seen within the pons and the midbrain which is nonspecific but may relate to chronic small vessel ischemic changes, as seen on previous dedicated brain MRI. Incidental note is made of a small oval T2 hyperintense and T1 hypointense structure in the left palatine tonsil measuring 7 x 5 mm on 601/29. This measures 8 mm CC on 401/1. However, correlating with previous brain images where it is partially visualized, there is no significant enhancement.LUMBAR SPINE | 1. Mild lower cervical spondylotic changes without significant stenosis.2. Mild lower lumbar spondylotic changes with focal right foraminal disc protrusion resulting in only mild right foraminal narrowing.3. Questioned slight increased cranial caudal dimension of the liver. Please correlate with physical exam.4. Small deep left palatine tonsil T2 hyperintense lesion which is incompletely assessed, previously not noted to demonstrate associated enhancement. This is nonspecific, but may represent a small cyst. Dedicated CT or MRI of the neck may be obtained as clinically indicated. |
Generate impression based on medical findings. | 42 years Male (DOB: 10/28/1973)Reason: Eval for progression of c-spine stenosis History: cervical radiculopathyPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The cervical vertebral bodies are appropriate in overall alignment and height. There is mild reversal of the normal cervical curvature present.There is a small T2 hyperintense focus in the right hemicord at the C6-7 disc space level which is not readily appreciated on sagittal imaging. It is seen on a single slice and likely represents artifact.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a left lateral recess disc protrusion present at this level which extends into the left neural foramen at this level and encroaches on the left-sided exiting nerve roots. There are endplate reactive changes present this level. These findings are stable compared to the prior exam.At C4-5 there is no significant compromise to the spinal canal . There is a left lateral broad-based disc protrusion present at this level which extends into the left neural foramen and encroaches on the left-sided exiting nerve roots. There are endplate reactive changes present this level. These findings are stable compared to the prior exam.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present this level associated with some disc desiccation and mild narrowing of the neural foramina. There are endplate reactive changes present this level. These findings are stable compared to the prior exam.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height and disc desiccation and diffuse disc bulge at this level associated with endplate and uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramen at this level. There are endplate reactive changes present this level which are high signal on T2 and T1. These endplate reactive changes were not present on the prior exam. The neural foramen encroachment is unchanged compared to the prior exam.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 degenerative changes present in the cervical spine with associated encroachment of exiting nerve roots within the neural foramina bilaterally at C6-7 and on the left side at C5-6. These findings are stable when compared to the prior exam though there are more endplate reactive changes present at C6-7 on the current exam when compared to the previous.2.There is no convincing evidence for demyelinating lesion within the cervical spinal cord on the basis of this exam. |
Generate impression based on medical findings. | Female, 43 years old, with multiple sclerosis. Brain:Approximately 10 T2 hyperintense lesions are evident in the periventricular and juxtacortical regions of the cerebral hemispheres as well as the genu of the corpus callosum. There may also be a lesion at the midline superior pons but this could also be artifactual.Since the prior examination, three new lesions are identified, one in the right parietal lobe (image 57 series 601), one in the left operculum) image 52 series 601), and one in the left temporal lobe (image 39 series 601). A periventricular lesion along the right lateral ventricular atrium may have slightly increased in size but this is equivocal.No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are detected. The ventricles remain normal in size and morphology. Overall brain volume is relatively preserved.C-spine:No focal cervical cord lesions are demonstrated. The spinal cord shows normal morphology throughout. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or marrow edema is observed.At C5-6, there is mild posterior disc-osteophyte complex formation with left uncovertebral hypertrophy resulting in mild left foraminal narrowing, without significant interval change. No other significant spinal canal or foraminal compromise is seen. | 1.Multiple T2 hyperintense lesions are evident in the brain compatible with demyelinating disease. Three lesions are new when compared to the prior examination and one pre-existing lesion may be slightly larger.2.No evidence of demyelinating disease is seen in the cervical spinal cord. |
Generate impression based on medical findings. | Ankle swelling TENDONS: There is a small amount of fluid within the tendon sheaths of the posterior tibialis and flexor digitorum longus as they cross posterior to the medial malleolus. The amount of fluid is slightly more than typically expected and is suggestive of mild tenosynovitis. There is also a mild amount of edema in the overlying subcutaneous fat. The remaining tendons appear normal.LIGAMENTS: The lateral collateral ligament complex is intact. The distal tibiofibular ligament complex is intact. The visualized components of the deltoid ligament complex appear intact. A mild amount of edema is noted within the sinus tarsus which is of uncertain clinical significance.ARTICULAR SURFACES AND BONE: The marrow signal of the ankle is normal and there are no osteochondral defects identified. ADDITIONAL | Mild tenosynovitis of the posterior tibialis and flexor digitorum longus tendons with additional findings described above. |
Generate impression based on medical findings. | Clinical question: Worsening L4 on L5 the spondylolisthesis? Signs and symptoms: Low back pain with radiculopathy. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 it is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 is unremarkable with the exception of mild degenerative changes.L4 -- L5 demonstrate mild disk desiccation without significant change since prior exam. Minimal grade 1 retrolisthesis remain similar to prior study. Examination demonstrates widening bilateral articulating facets with T2/T2 stir increased signal intensity consistent with bilateral facet inflammatory changes/effusion. This finding demonstrate interval progression since prior exam from 10 -- 7 -- 14. There is no evidence of a spinal stenosis. Moderate to severe bilateral neural foramina compromise is again identified.L5 -- S1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise. | 1.No acute findings since prior study.2.Widening of bilateral facet spaces with fluid signal intensity at the L4 -- L5 level with interval worsening since prior exam. Moderate bilateral neural foraminal compromise and without convincing evidence of central spinal stenosis stable since prior exam. Mild grade 1 anterolisthesis also remains stable since prior study.3.Unremarkable images at other levels and without evidence of spinal stenosis or neural foraminal compromise. |
Generate impression based on medical findings. | MRI brain: The study is degraded by motion. There is a large confluent area of restricted diffusion, T2 hyperintensity, and mild swelling involving the right precentral gyrus. There are also punctate foci of restricted diffusion and T2 hyperintensity in the right middle frontal gyrus. There is a background of diffuse cerebral white matter T2 hyperintensity without restricted diffusion. There is encephalomalacia in the right pons. There is diffuse cerebral volume loss. There is no midline shift or evidence of acute intracranial hemorrhage. MRA brain: There are atherosclerotic steno-occlusive lesions of the M1 segments of the middle cerebral arteries bilaterally. The middle cerebral arteries are patent up to the level of the bifurcation. The anterior cerebral arteries appear to be patent. However, there are also atherosclerotic irregularities of the internal carotid arteries bilaterally. There are also atherosclerotic irregularities of the V4 segments of the bilateral vertebral arteries. The basilar artery appears patent. The posterior cerebral arteries are patent. The anterior cerebral arteries are patent. | 1. Early subacute infarct involving the right precentral gyrus and to a lesser degree the right middle frontal gyrus, without evidence of hemorrhagic transformation or midline shift.2. Chronic right pontine infarct and diffuse chronic small vessel ischemic disease of the cerebral white matter.3. Atherosclerotic steno-occlusive lesions of the M1 segments of the middle cerebral arteries bilaterally and V4 segment of the vertebral arteries bilaterally.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |