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 HEAD WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:           Disequilibrium.  Patient had refused I.V. contrast, poor venous access.

FINDINGS:               Multiplanar and multisequence imaging was obtained on the 1.5 Tesla GE MRI without contrast.  There are changes consistent with an area of infarct in the right cerebellar region seen on image 8 of series 6 and also in the right occipital region seen on image 10 of series 6.  These changes appear more chronic in nature and would recommend clinical correlation.  There is no significant acute area of sulcal effacement, bleed, midline shift, or extraaxial fluid collection.  The remainder of the cerebellum, CP angles, and brainstem show no gross abnormality.  The seventh-eighth nerve complex region shows no significant abnormality.  The pituitary, optic chiasm, and corpus callosum also appear without significant abnormality.  Would recommend clinical correlation or further evaluation as necessary.

IMPRESSION:          Area of infarct in the cerebellar region on the right at the superior mid‑to‑posterior aspect.  Area of infarct in the right occipital lobe region towards the medial aspect somewhat posteriorly.  These changes appear more chronic in nature.  There is no significant acute abnormality.  Would recommend clinical correlation or further evaluation as needed and correlation with any prior studies if available.  There are no prior studies at this facility for comparison.

Thank you for the referral.

XXXXXXXXX

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:         Trigeminal neuralgia.

FINDINGS:               Axial, sagittal, and coronal images were obtained on the multiple sequences with and without contrast on the 1.5 Tesla GE MRI.

There is an enhancing mass noted in the cavernous sinus region on the left, which appears to surround the region of the internal carotid artery and extends posteriorly and touches upon the brainstem.  This mass measures approximately at its greatest diameter 2.5 cm in the anterior posterior direction, 2 cm in a craniocaudal direction and approximately 2 cm in a medial lateral direction.  The internal carotid artery signal voids are patent and MRA evaluation was also performed, which show the vessels to be patent.  The sphenoid sinus region shows a small amount of fluid within it appears, but otherwise it is not clear that this lesion penetrates into the sinus region.  There is a small amount of fluid, especially in the right sphenoid sinus region.  The visualized area of the seventh-eighth nerve complex and mastoid air cells and inner ear region on the left show no significant abnormality.  There is question of slight inflammatory changes on the right, somewhat laterally seen on image 5 of series 4, may represent slight inflammatory changes in the anterior mastoid air cells.  The remainder of the brainstem shows no significant abnormal enhancement and the basilar artery signal void also appears patent and without significant abnormality.  The cerebellum and CP angles show no gross abnormality.  The brain parenchyma bilaterally shows no other significant acute area to suggest infarct, bleed, midline shift, or other abnormal enhancing lesion or mass.  The periventricular regions also appear without significant abnormality.  A preliminary report was discussed with Dr. Aldana.

IMPRESSION:         Enhancing mass measuring 2 x 2 x 2.5 cm as discussed above.  This appears in the region of the left cavernous sinus and extends posteriorly to touch upon the brainstem region.  This enhances significantly.  It appears almost isointense on the non-contrast T1 weighted images.  This may represent a meningioma, but other etiologies cannot be excluded.

 

The pituitary appears separate and so does the sphenoid sinus region.  There is a small air-fluid level in the right sphenoid sinus.  The remainder of the brain parenchyma shows no other significant abnormality.  Please see comments above.

Thank you for the referral.

XXXXXXXXX

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:         Stroke.

FINDINGS:               Multiplanar and multisequence imaging was obtained on the Open MRI at XXXXXXX.  The examination shows an area of infarct in the right parietal region predominantly.  This appears chronic in nature.  There is slight increased signal on the T2 weighted images surrounding this area of infarct, which also may be chronic, but the possibility of slight peri‑infarct ischemia cannot be excluded and would recommend clinical correlation.  There are age-related changes consistent with atrophy and small-vessel ischemic disease.  There also appears to be an old area of infarct in the posterior left temporal and occipital region.  There is concern for an area of ischemia on the left in the temporal lobe seen from images 7 through 9 of series 7, on image 10 of series 6, and on image 4 of series 2.  This appears to represent an area of subacute ischemia most likely.  It does not appear to represent an area of bleed.  There are no extraaxial fluid collections.  There is no midline shift or herniation.  The remainder of the brain parenchyma shows no abnormal enhancement and does show slight age-related changes as does the posterior fossa region, but no other acute abnormality.

IMPRESSION:         An area of subacute ischemia noted in the left temporal regions somewhat anteriorly as discussed.  Old areas of infarct in the right parietal region and posterior left temporal and occipital region.  Age-related changes.  No other significant abnormal enhancement.  There is slight enhancement in the area of subacute ischemia along the gyri and sulci, which may suggest somewhat an embolic event and would recommend clinical correlation.  There is no significant extraaxial fluid collection or bleed otherwise identified.  Please see comments above.  Would recommend correlation with any prior studies.  A preliminary report was discussed with Dr. XXXXXXX at the time of evaluation.

Thank you for the referral.

XXXXXXX

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:         389.16, right greater than the left hearing loss.  Mastoiditis.

FINDINGS:               Multiplanar and multisequence imaging with and without contrast was performed on the Open MRI at XXXXXX.  There is no significant abnormality to the brain parenchyma.  There is no abnormal enhancing lesion or mass.  There is no evidence of infarct, bleed, midline shift, or extraaxial fluid collection.  The cerebellum and CP angles show no gross abnormality.  In the mastoid air cell regions, there is concern for slight mastoiditis bilaterally.  This may appear slightly more prominent on the right than the left, but overall is not prominent.  This is seen on the axial T2 weighted images.  If there is any further concern, would recommend CT evaluation or further evaluation as needed.  There is slight nasal septal deviation with convexity to the right.

IMPRESSION:         No significant abnormality to the brain parenchyma or abnormal enhancement.  Changes consistent with slight mastoiditis bilaterally as discussed.  Would recommend further evaluation or follow-up as needed.

Thank you for the referral.

XXXXXXXX