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 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

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 LUMBAR SPINE WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE LUMBAR SPINE WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:           Pain.  Radiculopathy.

FINDINGS:               Prior attempted evaluation with only sagittal T2 weighted images was performed on XXXXXXXX on the 1.5 Tesla GE MRI and prior MRI examination was performed on XXXXXXXX.  Sagittal T1 and T2, axial T1 and T2, and post-contrast sagittal and axial T1 weighted images on the Open MRI were performed.  There is continued evidence of significant degenerative changes and degenerative disc disease at the level of L2-L3.  There is slight offset of the vertebral bodies at L4-L5 of few millimeters.  There is desiccation of the disc.  The conus and nerve roots within the thecal sac show no gross abnormality.  There is no significant abnormal enhancement to the vertebral bodies or thecal sac region.

At the level of L1-L2, there is no significant disc herniation, central canal stenosis, or neuroforaminal narrowing.

At the level of L2-L3, there is degenerative disc disease and disc space loss.  There is indentation on the anterior thecal sac and mild central canal stenosis.  There are degenerative changes of the facet joints and slight disc disease causing left neuroforaminal narrowing.  There is no significant right neuroforaminal narrowing.  There is no significant abnormal enhancement around the thecal sac or neuroforaminal region.  These changes are best seen on image 4 and 5 of series 7.

At the level of L3-L4, there is diffuse disc herniation, degenerative changes, and ligament flavum hypertrophy overall causing mild central canal stenosis.  There is indentation on the exiting nerve roots slightly bilaterally, but no significant impingement.  There is no significant abnormal enhancement around the thecal sac or neuroforaminal regions.

At the level of L4-L5, there are degenerative changes and slight offset of few millimeters as previously discussed.  There is diffuse disc herniation, degenerative changes, and ligament flavum hypertrophy overall causing mild-to-slightly-moderate central canal stenosis, which is also seen previously, but does not appear significantly changed.  There is continued evidence of slight indentation on the exiting nerve roots bilaterally, but no significant impingement, slightly greater on the right than the left.

There is no significant abnormal enhancement around the thecal sac or neuroforaminal regions.

At the level of L5-S1, there is slight indentation on the anterior thecal sac.  There is no significant central canal stenosis or neuroforaminal narrowing.  There are degenerative changes.  There is no significant abnormal enhancement around the thecal sac or neuroforaminal regions.  Overall, the examination does not appear significantly changed compared to previously and would recommend clinical correlation or further evaluation as necessary.  Would recommend reference to the patient’s plain film reports also.

Thank you for the referral.

XXXXXXXX