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:         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 LEFT LOWER EXTREMITY WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE LEFT LOWER EXTREMITY WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:         Cystic mass in the superior left ankle, which was marked.  Soft tissue swelling.  Previous ultrasound examination from XXXXXXX showing a cystic mass measuring up to 2.3 cm.

FINDINGS:               Multiplanar and multisequence imaging was obtained on the Open MRI with and without contrast.  The area of concern was marked.  The patient appears to have some artifact from metallic densities.  The patient also has significant motion artifact on some of the coronal images limiting the examination.  The area of concern is identified and shows no significant abnormal enhancement.  The bony structures appear within normal limits.  There appears to be slight chronic edema in the soft tissues.  The marker was seen on approximately image 8 of series 7 on the post-contrast images.  The cystic area identified on the ultrasound is also identified on the MRI on image 8 of series 6 and image 8 of series 7.  This cystic collection may represent a small hematoma and would recommend clinical correlation.  There does not appear to be solid enhancing lesion or mass.  Given the chronic edema it appears in the soft tissues, it is hard to evaluate, but would recommend clinical correlation and question if there is inflammatory clinical findings to suggest cellulitis.  The possibility of small abscess cannot completely be excluded.  There is no other significant abnormality to the soft tissues, bony structures, or muscle planes clearly identified.

IMPRESSION:         Small cystic mass identified, which correlates with what was seen on the ultrasound examination and on the MRI, it measures approximately 1.5 cm in a craniocaudal direction and 8 mm in the anterior and posterior direction and approximately 2 cm in length.  This correlates with what was seen on the ultrasound examination.  There are some surrounding vessels.  This does not appear vascular in nature.  There is no significant abnormal enhancement once again.

Small cystic collection noted in the subcutaneous soft tissues, which may represent small hematoma.  There appears to be chronic edema in the soft tissues.  Would recommend clinical correlation.  The remainder of the evaluation shows no other significant abnormality or abnormal enhancement and there is no significant solid component.

If there is any further concern, surgical consult and aspiration may be considered if clinically necessary.  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:         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