MRI EXAMINATION OF THE PELVIS WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE PELVIS WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:           Ultrasound examination from XXXXXXXX showing changes consistent with fibroid, nabothian cyst, and ovarian cyst.  626.8.  Pelvic pain.  Vaginal bleeding.

FINDINGS:               Axial, sagittal, and coronal images were obtained on the Open MRI with and without I.V. contrast.  The evaluation shows a cyst in the right ovary, which measures approximately 3.5 x 3 x 3 cm.  There is no significant abnormal enhancing lesion, mass, or mural nodule.  The left ovary shows actually smaller cyst measuring up to 1.5–2 cm.  There is no significant free fluid in the cul-de-sac.  The remainder of the adnexal structures shows no gross abnormality and there is no significant enhancing lesion or mass.  In the uterus, there are changes consistent with a nabothian cyst, which measures approximately 8 mm.  There is slight irregularity in the uterus towards the cervix.  This though appears to most likely represent changes, which may represent a fibroid.  The endometrial canal noted in the body of the uterus shows no gross abnormality.  The changes that appear with slight irregularity are seen on image 10 of series 4.  There is no significant abnormal enhancing lesion or mass otherwise identified.  Would recommend clinical correlation.  If there is any further concern, would recommend further evaluation.  These changes noted in the uterus towards the cervix are also seen on image 14 of series 3.  The possibility of slight endometrial abnormality in this region cannot completely be excluded and would recommend clinical correlation.  The remainder of the pelvic evaluation shows no other significant adenopathy, mass lesions, free fluid, or abnormal enhancement.

IMPRESSION:          Right ovarian cyst measuring up to 3 cm, which appears simple in nature.  Small follicular cyst in the left ovary.  Small nabothian cyst measuring 8-9 mm.  Adjacent to the region of the nabothian cyst, there is slight irregularity at the endometrial canal of uncertain significance.  This may represent small amount of fluid within the endometrial canal.  There is no significant abnormal enhancing lesion or mass.  This also may represent changes in this region, which may represent a small fibroid also.  Would recommend clinical correlation or further evaluation as needed.

The remainder of the endometrial canal in the body of the uterus shows no gross abnormality.  There is no other significant adnexal lesion or mass.  Please see comments above.

Thank you for the referral.

XXXXXXXX

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:           Previous MRI examination from XXXXXXX.  Melanoma, recurrent.

FINDINGS:               Multiplanar and multisequence imaging was obtained on the 1.5 Tesla GE MRI with and without contrast.  The examination was compared to the prior study.  The prior examination report was reviewed.  There are changes consistent with defect in the superior aspect of the subcutaneous soft tissues over the calvarium consistent with prior surgery.  In this region though, there is an area of increased prominence to the soft tissue compared to the prior evaluation.  This area measures approximately 1.6 x 1 cm and seen on image 13 of series 9.  It is also seen on image 18 of series 8.  This may represent recurrent melanoma and would recommend clinical correlation.  The remainder of the subcutaneous soft tissues showed no other significant lesion.  The underlying calvarium, bony structures, brain parenchyma, and dura show no significant abnormality or abnormal enhancement.  These areas appear similar to what was seen previously.  There are significant age-related changes and periventricular white matter changes.  There is considerable atrophy centrally and cortically.  The possibility of NPH cannot completely be excluded.  There is no significant abnormal enhancing lesion or mass within the brain parenchyma.  The cerebellum, CP angles, and brainstem show age-related changes, atrophy, and small-vessel ischemic disease, but no other significant abnormality.  A preliminary report was discussed with Dr. XXXXXXX.  If there is any further concern, would recommend further evaluation as necessary.

IMPRESSION:          Slightly more prominent soft tissue mass in the subcutaneous soft tissue over the calvarium in the region of prior surgery as discussed.  The possibility of recurrent melanoma cannot completely be excluded.  There are significant age-related changes and small‑vessel ischemic disease.  This does not appear significantly changed compared to previously.  There is prominence to the ventricles and the possibility of NPH cannot be excluded.  There is no significant abnormal enhancement to the brain parenchyma.  Please see comments above.

Thank you for the referral.

XXXXXXX

MRI EXAMINATION OF THE LUMBAR SPINE WITHOUT CONTRAST

MRI EXAMINATION OF THE LUMBAR SPINE WITHOUT CONTRAST

INDICATION FOR STUDY:           Low back pain.

FINDINGS:               Sagittal T1 and T2 and axial T1 and T2 weighted images were obtained on the Open MRI at XXXXXXX.  The vertebral bodies appear to show slight desiccation of the disc.  There is exaggeration of the normal curvature, but no significant spondylolisthesis, but slight offset at the levels of L3-L4 and L4-L5 of few millimeters.  The patient also has slight rotary scoliosis.  The conus and nerve roots within the thecal sac show no gross abnormality.  There is a simple appearing cyst in the left kidney.  There are degenerative changes and atherosclerotic changes.  There are changes consistent with a compression deformity of the T12 vertebral body.  This does appear to have edema within it and concerning for subacute fracture with only slight vertebral body height loss.  Other etiologies cannot completely be excluded.  If there is any further concern, contrast evaluation or further evaluation may be considered or correlation with other imaging studies.

At the level of L1-L2, there is slight indentation on the anterior thecal sac, but no significant central canal stenosis or neuroforaminal narrowing.

At the level of L2-L3, there is ligamentum flavum hypertrophy, which appears prominent.  There are degenerative changes of the facet joints.  These changes overall are causing mild central canal stenosis.  There is no significant disc herniation or neuroforaminal narrowing.

At the level of L3-L4, there is prominent ligament flavum hypertrophy, degenerative changes of the facet joints, and slight indentation on the anterior thecal sac.  These changes overall are causing mild central canal stenosis.  There is slight indentation on the exiting nerve roots, but no significant impingement.

At the level of L4-L5, there is mild disc bulge with indentation on the anterior thecal sac.  There is no significant central canal stenosis.  There are slight degenerative changes of the facet joints.  There is no significant neuroforaminal narrowing.

 

At the level of L5-S1, there is slight indentation on the anterior thecal sac, but no significant central canal stenosis.  There is no significant neuroforaminal narrowing.  There are degenerative changes of the facet joints.  If there is any further concern, would recommend further evaluation as necessary.

IMPRESSION:          Compression deformity with edema in the T12 vertebral body with very little vertebral body height loss.  There are degenerative changes and changes consistent with spinal stenosis as discussed above for each of the levels.  A preliminary report was discussed with Dr. XXXXXXX.  Would recommend further evaluation as clinically necessary.

Thank you for the referral.

XXXXXXX

MRI EXAMINATION OF THE PELVIS WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE PELVIS WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:           625.9.  Prior CT from XXXXXXXX.  Hysterectomy.  Coccyx pain.  789.3.

FINDINGS:               The patient’s prior CT and ultrasound were reviewed.  There is a cystic mass in the pelvis.  It measures 4.2 x 2.5 x 3.1 cm.  This is seen on image 15 of series 102, image 16 of series 4, image 16 of series 103, and also various other sequences such as image 15 of series 2 and series 6 and 7.  This lesion appears well circumscribed.  It does appear as a simple cyst on MRI and shows no evidence of other solid mural nodule.  There is no significant complex nature within it.  This may represent a proteinaceous cyst.  It appears to abut against the left ovary region, but it is not far from the right ovary, but does appear separated from the right ovary.  The patient has had a hysterectomy and the lesion does abut against the region on the postsurgical changes towards the vaginal cuff.  There is no evidence of free fluid.  There is no adnexal lesion or mass otherwise identified or adenopathy.  The bowel loops are identified.  Post-contrast evaluation shows no significant abnormal enhancement.  The bladder is identified, but it is not significantly distended.

IMPRESSION:          Cystic mass identified as discussed above adjacent to the left ovary, which appears small in comparison and size.  There is no other significant abnormality in the pelvis or adenopathy.  There is no significant abnormal enhancement or mural nodule.  This may represent a proteinaceous cyst may be ovarian etiology.  Would recommend clinical correlation.  Would recommend reference to the patient’s prior examination reports.  Given its size, it is somewhat concerning and would recommend further evaluation as necessary.

Thank you for the referral.

XXXXXXXX

UPRIGHT MRI EXAMINATION OF THE HEAD WITHOUT CONTRAST

UPRIGHT MRI EXAMINATION OF THE HEAD WITHOUT CONTRAST

FINDINGS:                 Axial T1, T2, FLAIR, and diffusion weighted images, sagittal T1, and coronal T2 weighted images were obtained on the upright MRI.  There is an area of abnormality noted in the left medial upper cortex along the falx involving most of the parietal region.  This has edema surrounding it with an area of signal loss on the T1 weighted images and slightly increased signal on the T2 weighted images.  I understand the patient has had history of infarct.  This would correlate with this area.  Question if the patient had history of hemorrhagic infarct.  It is not clear that there is significant hemorrhage at this time, but would recommend clinical correlation or correlation with prior studies or CT as needed.  There are age-related changes consistent with atrophy and small-vessel ischemic disease.  There is question of a few small lacunar infarcts in the basal ganglia region especially on the right versus prominent Virchow-Robin spaces.  These appear chronic in nature.  This is also true in the region of the basal ganglia seen on the right on image 8 and 9 of series 102.  The cerebellar region shows no other significant abnormality.

IMPRESSION:           Changes consistent with an area of infarct in the left parietal region along the falx predominantly.  This is seen on multiple images.  This appears most likely more chronic in nature and question if the patient has an old area of hemorrhage in this area.  Would recommend clinical correlation or correlation with other imaging studies.  There is lacunar infarcts identified in the basal ganglia region and also in the region of the pons predominantly to the right.  These most likely are chronic in nature.  There is also age-related atrophy and small-vessel ischemic disease.  It is not clear that there is significant sulcal effacement.  The area in the high parietal region along the falx may represent some reinfarct ischemia in this region also.  Would recommend correlation with the patient’s other imaging studies.  There is small amount of pituitary tissue and changes suggestive of almost empty sella syndrome.  Please see comments above.  A preliminary report will be given.

Thank you for the referral.

XXXXXXXXX