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again there are multiple metastatic lesions demonstrating mild increase in size and also larger pattern of vasogenic edema more evident on the left temporo-occipital region 4 12 also on the left frontal lobe involving the orbitary gyrus 4 10 the left cerebellar lesion also appears slightly larger and with similar patte... | mild enlargement of the previously demonstrated metastatic lesions larger pattern of vasogenic edema new area of abnormal enhancement noted on the left frontal lobe possibly consistent with a new metastatic lesion and areas of abnormal enhancement demonstrated in the right internal capsule and right caudate nucleus lik... |
the current examination demonstrates increased signal in both thalamic region as well as in the perirolandic region on diffusion and flair images these findings are consistent with anoxic brain injury in addition there is subtle increased signal identified in the cerebellum with bilateral patchy areas of low signal on ... | 1 bilateral thalamic hyperintensities with low signal on adc indicative of ischemia high signal in the perirolandic region bilaterally the combination of changes are suggestive of hypoxic brain injury slow diffusion is seen bilaterally in the cerebellar hemispheres suspicious for infarcts no abnormal enhancement mucosa... |
again noted is the large intraparenchymal hematoma in the right cerebral hemisphere in the frontoparietal and temporal lobes with mild mass effect on the adjacent body of the right lateral ventricle multiple flair hyperintense areas are noted in the white matter some of which likely represent sequelae of chronic small ... | 1 unchanged large right intraparenchymal hematoma in the right cerebral hemisphere with mild mass effect 2 no definite focus of restricted diffusion in the pons to suggest acute infarct however to correlate with clinical findings as dwi is less sensitive for brainstem infarctions |
there is a surgical defect in the right posterior frontal lobe and extending into the corpus callosum there is residual air in this location minimal enhancement is identified at the surgical site the appearance of these changes is stable since the previous study no new areas of abnormal signal or enhancement are identi... | stable appearance of the brain since the previous study of ___ no evidence of acute infarction |
the ventricles and extra-axial spaces are normal in size there is no evidence of midline shift mass effect or hydrocephalus there are no abnormalities seen on diffusion images or susceptibility images to indicate diffuse axonal injury no areas of brain contusion seen suprasellar and craniocervical regions are unremarka... | no significant abnormalities on mri of the brain without gadolinium |
the brain parenchyma has normal ___-white matter differentiation there is no evidence of acute infarction intracranial hemorrhage space-occupying lesion or mass effect also there are no signs of demyelination no abnormality is noted with regard to basal ganglia brainstem cerebellum and craniocervical junction the paren... | 1 small csf isointense discrete mass in the right posterior fossa likely representing a subarachnoid cyst no enhancing lesions in the brain 2 slightly lobulated focus of contour irregularity of left cavernous carotid segment-correlate with mra head without contrast 2 bilateral small retention cysts involving the maxill... |
the cerebral sulci ventricles and extraaxial csf containing spaces are enlarged in keeping with age-related generalized volume loss there is no shift of the midline structures the brain parenchyma has normal ___-white matter differentiation multiple flair and t2 white matter foci are seen in the corona radiata perivent... | 1 t2 hypointense focus in the posterior aspect of the left thalamus with slowed diffusion and mild contrast enhancement most likely representing a subacute infarct with regard to enhancement a followup study should be scheduled in four to six weeks to definitely rule out underlying mass such as lymphoma 2 evidence of g... |
"the study is compared with the most recent cect of ___ as well as previous examination of ___ and a series of studies dating to ___ the study is somewhat limited by persistent patient motion artifact as above as well as the extensive post-surgical changes status post extensive right frontotemporoparietal craniectomy a... | "study somewhat limited by difficulties with patient positioning and motion as well as the extensive post-surgical changes with abundant residual blood products 1 the right-sided extra-axial and scalp fluid collections demonstrate ""simple"" fluid with only thin and discontinuous rim enhancement more suggestive of post... |
the residual left parietal occipital mass measures 3 5 x 3 4 x 6 9 cm today si x ml x ap this shows moderate rim enhancement with subependymal enhancement extending anteriorly into the body of the left lateral ventricle the rim of susceptibility with foci of susceptibility within the residual mass and size are similar ... | 1 rim-enhancing mass in the left parietal occipital lobes with central restricted diffusion similar to prior the restricted diffusion within this mass is similar to the postoperative and preoperative examinations likely representing blood products and residual tumor superinfection of this cavity remains a possiblity th... |
diffusion images demonstrate no evidence of slow diffusion to indicate acute infarct there is severe dilatation of the lateral and third ventricles with a normal fourth ventricle the aqueducts appeared small in its lower portion there is hyperintense foci in the periventricular white matter there is no midline shift se... | severe hydrocephalus with small aqueduct indicative of aqueduct stenosis periventricular white matter hyperintensities could be indicative of small vessel disease no midline shift increased signal along the sulci in occipital lobe could be artifactual or due to increased protein in the csf no evidence of abnormal enhan... |
a shunt has been placed into the frontal ___ of the right lateral ventricle the temporal horns of the lateral ventricles are less dilated compared to the head ct of three hours prior overall the lateral ventricles third ventricle and cerebral aqueduct remain prominent and there is transependymal edema the fourth ventri... | 1 diffuse edema in the cerebellar and occipital white matter concerning for hypertensive encephalopathy clinical correlation recommended 2 small acute infarction in the left parietal subcortical white matter no evidence of acute infarction in the cerebellum 3 slight decrease in dilatation of the lateral ventricles pers... |
again identified are postsurgical changes consistent with right hemicraniotomy and cranioplasty there is marked leftward shift of normally midline structures of approximately 1 3 cm of midline shift this is not significantly changed when compared to prior exam there is no evidence of acute hemorrhage or infarct there a... | 1 persistent leftward shift of normally midline structures by approximately 1 3 cm 2 no evidence of acute infarct or new hemorrhage findings were discussed with dr ___ ___ by telephone at 1 30 p m |
again seen in the medulla of the spinal cord is a 8-mm lesion demonstrating low-signal intensity on t1-weighted images there is no definite enhancement again noted is minimal expansion of the right medulla at this level no other intraaxial lesions are identified the brain parenchyma is unchanged in appearance the ventr... | 8 mm lesion in the medulla is without significant enhancement given this finding and the findings on the mri head from earlier today and the subsequent cervical spine mr diagnostic considerations include a cavernoma that has bled although a metastatic lesion cannot be entirely excluded |
patient is status post right craniotomy and frontal lobe resection compared to the previous examination there is now less mass effect resulting from the resection cavity on the right frontal lobe hemorrhagic material still persists along the margins of the resection cavity 3 17 and on post-contrast imaging there remain... | 1 interval decreased compression upon the right lateral ventricle due to decreased mass effect from a right frontal surgical resection and decreased peri-lesional edema however there remains some enhancement along the margin of the resection cavity concerning for residual tumor although a component of this could be pos... |
there is no evidence of acute infarct seen on diffusion images there is no evidence of midline shift mass effect or hydrocephalus the ventricles and extra-axial spaces are normal in size without midline shift mass effect or hydrocephalus there are no territorial infarcts except for subtle periventricular hyperintensiti... | no evidence of acute infarct or enhancing brain lesions no other significant abnormalities on mri of the brain with and without gadolinium |
again areas of encephalomalacia are redemonstrated in the left occipital lobe causing ex vacuo dilatation of the left occipital ventricular ___ there is persistent uniform hyperintense pattern along the left occipital lobe likely consistent with mineralization from prior chronic infarction unchanged small chronic infar... | sequelae of prior infarction identified in the left occipital lobe and right frontal lobe as described above no new areas of restricted diffusion are noted to indicate acute or subacute ischemic changes |
status post right frontal craniotomy the study is somewhat limited due to motion artifacts there is mild decrease in the flair hyperintense focus in the right frontal region compared to ___ there is also some enhancement noted at the prior surgical site which appears to be smaller compared to the most recent study ther... | 1 mild decrease in the flair hyperintense area and enhancement in the right frontal region at the site of prior surgery 2 no change in the left insular lesion 3 no new lesions 4 left maxillary moderate mucosal thickening |
the study is slightly limited by motion artifact there are no areas of abnormal diffusion to indicate acute stroke susceptibility images demonstrate a focus of low signal in the right subcortical white matter corresponding to the lesion seen on the patient's recent ct study of ___ the post-contrast images demonstrate m... | 1 right parietal lobe lesion with susceptibility and questionable adjacent tiny area of enhancement corresponding to the lesion seen on the patient's prior ct study of ___ this likely represents a small focus of hemorrhage possibly with reactive enhancement 2 brain atrophy likely due to hiv disease |
artifacts obscure the right posterior temporal lobe in the posterior fossa on the diffusion images no acute infarct seen in the visualized portions of the brain extensive hyperintensities are visualized in both cerebellum and in the periventricular region with chronic lacunes in both thalami and increased signal in the... | 1 bilateral shunt catheters identified with slight decrease in ventricular size compared with ___ ct but remains slightly larger compared to the mri of ___ 2 no acute infarct seen or mass effect noted 3 extensive white matter hyperintensities in shunt catheters |
there are post-surgical changes noted in the right frontal region with areas of gliosis in the right frontal lobe with ex vacuo dilation of the frontal ___ of the right lateral ventricle in addition there are fluid signal intensity areas noted in the inferior frontal lobes likely related to cystic changes there are als... | 1 post-surgical changes with mild dural enhancement and a tiny extra-axial fluid collection in the right frontal and the parietal regions t1 hyperintense areas along with cystic areas are noted in the right inferior frontal lobe without definite enhancement to suggest of enhancing tumor these may represent part of the ... |
motion artifact limits evaluation of detail there are a few small areas of increased flair and t2 signal in the subcortical and periventricular white matter of both cerebral hemispheres these may be related to microvascular ischemia and infarction there is no associated enhancement no diffusion signal abnormality is ev... | no sign of an enhancing intracranial abnormality or infarction to suggest septic emboli from endocarditis dfdgf |
on the flair sequence there are several areas of increased signal intensity in bilateral frontal parietal temporal and occipital white matter predominantly in the frontoparietal white matter there is also subtle increased signal in the adjacent cortex however there is no mass effect or enhancement in these lesions on t... | 1 multiple areas of flair hyperintensity in bilateral frontal parietal temporal and occipital white matter predominantly in the frontal and parietal lobes with some restricted diffusion no mass effect or enhancement this could most likely represent changes associated with reversible leukoencephalopathy or progressive m... |
there are several foci of increased signal on diffusion images some of which appear to have low intensity on adc map but evaluation of the adc map is limited secondary to small size of the abnormality seen on diffusion images these lesions are seen in both occipital lobes and also in the left frontal and parietal regio... | multiple foci of signal abnormalities on diffusion images with occipital lobe with questionable low adc changes and could suggest acute infarcts some of these infarcts are likely subacute in nature seen in the left frontal and parietal region none of this foci demonstrate enhancement no mri signs of an abscess formatio... |
the examination is limited secondary to motion artifact again seen is the heterogeneous 4 4 ap x 4 9 tv x 4 2 cc cm mass centered within the right temporal lobe with surrounding vasogenic edema exerting mass effect on the right lateral ventricle the degree of leftward subfalcine and uncal herniation is unchanged the ma... | 1 heterogeneous right temporal lobe mass with leftward subfalcine herniation and uncal herniation 2 small focus of increased flair signal within the left occipital lobe which is not completely evaluated repeat mri is recommended for further evaluation |
the patient is now status post resection of the left posterior frontal mass post-surgical changes are present in this region there is no definite evidence of residual enhancement no other enhancing lesions are seen within the brain there is a moderate amount of residual edema in the surgical bed | no evidence for residual enhancement in the operative bed |
there are numerous small foci of slow diffusion involving the cortex and white matter of the cerebral hemispheres the lentiform nuclei the right cerebellar peduncle and the cerebellum bilaterally these are consistent with acute infarctions since multiple bilateral vascular territories are involved the etiology is likel... | numerous small acute infarctions throughout the supratentorial and infratentorial brain in multiple vascular territories suggestive of central embolic etiology findings reported to dr ___ at 3 40 p m on ___ |
the patient is status post right suboccipital craniotomy with associated post- surgical changes including blood products slightly decreased when compared to the prior exam surgical mesh is seen covering the osseous defect there is stable predominantly linear enhancement surrounding the resection cavity site there is a ... | 1 stable focus of enhancement along the posterior superior aspect of the resection cavity site adjacent to the right transverse sinus most consistent with residual tumor 2 status post right suboccipital craniotomy with associated post- surgical changes |
limited study due to motion artifact there are subtle dwi signal in the pons with no evidence of abnormal signal on adc likely artifaact there are no foci of slow diffusion to suggest acute ischemia no foci of susceptibility artifact to represent hemorrhage there is no abnormal enhancement there are numerous subcortica... | 1 no evidence of acute hemorrhage infarct or abnormal enhancement 2 bilateral mastoid and ethmoid fluid clinical correlation is recommended |
the study is moderately limited due to motion artifacts especially on the sagittal t1 and axial flair sequences on the axial flair sequence there are multiple hyperintense areas in the bilateral cerebral white matter subcortical and periventricular in location without significant change on the diffusion-weighted sequen... | 1 three tiny foci hyperintense on the diffusion-weighted sequence in the right parietal lobe white matter left posterior temporal and left parietal lobe without corresponding abnormality on the adc sequence which can represent acute infarcts normalized on the adc these are new since the prior study done on ___ given th... |
patient is status post resection of known lesions within the left parietal as well as the right parietal and temporal lobes there are post- surgical changes with foci of hemorrhage and air within the resection cavities and residual vasogenic edema post-operative pneumocephalus overlies the right frontal lobe within the... | 1 enhancement along the margins of the resection cavities in the left parietal and right temporal parietal lobes similar to the pre- operative mri studies while this may represent post- surgical enhancement unusual given the time course residual tumor cannot be excluded 2 nodular focus of enhancement within the right r... |
there is partial interval resorption of the left parietal hematoma with short t1 effect on the flair sequences suggesting expected interval physiological evolution of blood products minimal interval resolution of flair signal changes surrounding the hematoma is demonstrated there are multiple patchy and confluent foci ... | interval partial resorption of the left parietal hematoma and stable ventricular dimension without evidence of new hemorrhage or infarction no evidence of a mass lesion |
as noted on the prior ct scan there is a small subdural hematoma on the left overlying the left occipital and left parietal lobes posteriorly the maximum thickness of the hematoma is approximately 5 mm in greatest diameter there is a scalp hematoma overlying the right parietal bone in addition there is mucosal thickeni... | findings consistent with small subdural collection on the left posteriorly as well as subarachnoid blood and small foci of parenchymal hemorrhage |
"within the ventral aspect of the left midbrain a minimally enhancing lesion meaures 1 6 x 1 1cm there is little surrounding edema while there is little overall enhancement of lesion there is a more avidly enhancing central ""nidus "" this lesion is located near the sylvian aqueduct however there is no mass effect or e... | new 1 6-cm lesion within the ventral midbrain located near the aqueduct very likely a metastasis and explaining the patient's symptoms though the patient may be at risk for developing obstructive hydrocephalus there is no evicence of such at this time |
axial flair and t2-weighted sequences demonstrate area of hyperintensity involving the cortex and subcortical white matter seen within the left occipital lobe right posterior temporal right parietal as well as the frontal lobe convexities on both sides none of these demonstrate enhancement there are also no areas of co... | 1 multiple cortical and subcortical white matter changes as mentioned above which do not demonstrate any enhancement or restricted diffusion however an underlying vasculitic process is suspected with multiple infarcts resulting from this abnormality 2 extensive soft-tissue swelling on the left side of the face as menti... |
comparison is made to a head mr from ___ as well as a head ct from ___ again seen is an enhancing mass involving the right frontal lobe with central area of apparent cavitation the mass measures approximately 2 7 x 2 7 x 3 1 cm in its traverse ap and craniocaudal dimensions this appears to have minimally increased in s... | large right frontal mass with surrounding edema again visualized the mass may have minimally increased in size compared to ___ |
mri head there are multiple small foci of restricted diffusion and flair hyperintensity scattered within the left mca distribution involving the left corona radiata and subcortical white matter and cortex of the hemisphere no evidence of hemorrhage demonstrated on the gradient sequences within these lesions a subtle fo... | 1 multiple scattered foci of increased dwi signal are present involving the left mca distribution to include the corona radiata and the subcortical white matter and cortical ___ matter some of these foci have corresponding decreased adc some of the foci are seen to enhance no evidence of hemorrhage significant edema or... |
patient is status post right frontotemporal craniotomy with post-surgical changes again noted in the resection bed the resection cavity now measures 22 x 33 x 16 mm not significantly changed with thin marginal enhancement without nodularity or other suspicious features there is no significant change in amount of surrou... | stable appearance of right temporal resection bed with thin marginal enhancement without suspicious features no new enhancing lesions |
the ventricles sulci and cisterns are enlarged since the mri from ___ likely representing post treatment changes there are areas of t2 and flair hyperintensity in the periventricular white matter which are more pronounced than in ___ also likely representing post- treatment related changes scattered foci of t2 and flai... | 1 no evidence of mass lesion or infection there is no abnormal enhancement 2 mild enlargement of the ventricles and sulci since ___ likely reflecting post treatment related changes periventricular white matter hyperintensities are also likely reflective of post treatment changes 3 stable t1 hyperintense lesion in the s... |
there is no evidence of acute infarct mass lesion shift of midline structures or hemorrhage the previously identified hemorrhage seen on prior ct exams have resolved the ventricles and sulci are unchanged in appearance there is normal ___-white matter differentiation scattered t2 flair hyperintense foci are identified ... | no evidence of acute hemorrhage or mass lesion |
the corpus callosum is present and normal appearing along its extent there is no evidence of hemispheric interdigitation the foramen magnum and its contents are within normal limits no intracranial mass lesion hydrocephalus shift of normally midline structures or infarction is apparent signal intensity values of the br... | 1 no evidence of midline defect calvarial deformity is consistent with molding 2 mr spectroscopy is not adequate for interpretation |
comparison is made to ___ and ___ accounting for technical differences there has been no significant change in the size and extent of the enhancement anterior to the right frontal surgical resection cavity involving the precentral gyrus the degree of surrounding t2 signal hyperintensity is unchanged no new enhancing le... | no significant change since ___ with stable small area of enhancement anterior to the right frontal resection cavity stable amount of surrounding t2 signal abnormalities these findings may represent post- treatment changes and followup is recommended |
the multiple areas of restricted diffusion on the diffusion weighted sequence are reduced in extent and number compared to the preivous exam there still is some evidence of restricted diffusion in the splenium of the corpus callosum and in both occipital lobes also in the right periventricular superior to the thalamus ... | evolving posterior circulation infarcts when compared to the previous exam no evidence of mass effect or hemorrhage basilar irregularity consistent with the angiographic appearance |
there are expected post-surgical changes of right parietal craniotomy there are blood products and likely air foci seen within the surgical cavity and in the extra-axial space on the right no abnormal enhancement is seen to suggest residual tumor there is unchanged vasogenic edema around the surgical cavity there is no... | apparent complete resection of right parietal lobe lesion with expected post-operative changes attention on followup imaging is recommended |
there is no evidence of acute intracranial hemorrhage mass mass effect or shifting of the normally midline structures the ventricles and sulci are prominent likely related with age involutional changes no diffusion abnormalities are detected to suggest acute or subacute ischemic changes there is no evidence of abnormal... | 1 there is no evidence of abnormal enhancement to indicate leptomeningeal disease or metastasis 2 no diffusion abnormalities are detected to suggest acute or subacute ischemic changes 3 subtle areas of magnetic susceptibility are identified at the parietal lobes and right frontal convexity possibly representing chronic... |
as previously noted there are numerous small foci of increased t2 signal in the brain primarily involving the subcortical white matter of the cerebral hemispheres but also observed in the deep ___ structures and brain stem there is a large focus of increased t2 signal in the left occipital lobe all of these areas conti... | stable multiple areas of signal abnormality and enhancement in the brain most located in the white matter but some also in the deep ___ structures and along the cortical surface infection is the most likely etiology |
there has been interval increase in size of the left extraaxial supratentorial along the superior aspect of the left tentoria cerebelli focus of enhancement which now measures 8 4 x 4 1 mm previously measuring 4 4 x 4 1 mm there is associated surrounding perilesional flair hyperintensity within the left occipital subco... | 1 interval slight increase in size in nodular enhancement and surrounding hyperintensity involving the superior aspect of the left tentoria cerebelli 2 interval decrease in nodular enhancement along the left superior cerebellar resection cavity site which may represent involuting post-surgical changes however given the... |
the patient is status post right frontal and left parietal craniectomy with unchanged postsurgical changes in the form of dural dehiscence thickening and enhancement the previously reported supratentorial metastatic lesions demonstrate mixed response the largest right frontal lesion is stable in size 20 x 18 mm on axia... | 1 mixed response of three supratentorial metastatic foci with interval growth of the left occipital lesion and reduction of perilesional edema or contrast enhancement with regard to the largest right frontal metastasis 2 no evidence of new lesions no acute abnormalities such as infarct or significant hemorrhage |
there is no intracranial hemorrhage mass effect or shift of normally midline structures there is no hydrocephalus the basal cisterns are intact there are multiple punctate foci of t2 hyperintensity within the periventricular and juxtacortical white matter of both cerebral hemispheres there is no slow diffusion these fi... | 1 scattered punctate t2 hyperintense foci within the bilateral cerebral hemispheres in the periventricular and juxtacortical white matter which is a nonspecific finding and may represent demyelinating process vasculitis post- infectious or inflammatory etiology or chronic microangiopathic ischemic change but atypical d... |
there is re-demonstration of left frontal craniotomy and partial left frontal lobectomy with a residual post-operative cavity and stable ex vacuo dilatation of the frontal ___ of the left lateral ventricle there is stable pachymeningeal thickening and enhancement surrounding the resection bed previously noted nodular f... | 1 stable left frontal resection cavity with interval decrease in degree of nodular enhancement at its posterior-inferior margin there is no finding to suggest residual or recurrent disease though attention to this region on follow-up studies is recommended 2 likely treatment-related changes in the frontal subcortical w... |
in the interval since the previous examination the degree of enhancement and mass effect in the surgical bed of the right cerebellar metastasis has decreased there is volume loss in this area with slight expansion of the fourth ventricle toward the right cerebellar hemisphere a somewhat nodular area of enhancement pers... | post operative changes in the right cerebellar hemisphere and likely a small area of residual tumor the degree of enhancement and mass effect has decreased compared to the previous study of ___ no new findings in the brain are detected there is sinusitis |
the two ring-enhancing lesions have decreased in size and associated edema has markedly improved no new lesions are seen the right globus pallidus lesion now measures 12 mm x 7 mm compared to 16 mm x 14 mm previously the left frontal subcortical lesion now measures 12 mm x 9 mm compared to 12 mm x 12 mm previously ther... | interval improvement of the ring-enhancing lesions in the right globus pallidus and left frontal lobe indicating improving infection no new lesions |
status post right parietal craniotomy the previously noted surgical resection cavity in the right parietal region is smaller on the present study the enhancement noted along the margins of the surgical cavity on the previous examination appears to be decreased and less intense on the present study however two new lesio... | 1 two new lesions most likely representing new metastatic lesions one of which is a 3-mm enhancing nodule in the right parietal region and another one measuring 7 mm ring enhancing lesion in the left posterior parietal corticomedullary junction 2 decrease in the size of the previously resected surgical cavity in the ri... |
unchanged flow related foci of enhancement inferior aspect of the coiled aneurysm adjacent to the anterior communicating artery series 9 image 91 the icas mcas and vertebrobasilar arteries are patent without stenosis occlusion or aneurysm >3-mm within the resolution of mra unchanged | 1 resolution of the intraparenchymal hemorrhage with interval hemosiderin deposition both medial frontal lobes other findings as described above unchanged 2 unchanged small focus of flow within the coiled aneurysm 3 unchanged mild ventriculomegaly |
on flair images there are foci of high signal intensity at the grey white matter junction in the parietal lobes bilaterally as well as in the right frontal lobe these areas are of low signal intensity on the t1 weighted and high signal intensity on the t2 weighted images the right frontal lesion demonstrates susceptibi... | 1 signal abnormalities in the parietal lobes bilaterally and the right frontal lobe these can be traumatic in origin and represent diffuse axonal injury the lesion in the right frontal lobe is consistent with an area of chronic hemorrhage differential diagnosis for these lesions includes ischemia in the watershed areas... |
previously seen complex mass within the left basal ganglia extending superiorly to the corona radiata and inferior to the temporal lobes appears slightly smaller and now measures 3 6 x 4 9 x 3 1 cm additionally there is a reduction in the peritumoral edema there is also reduction of the mass effect on the left lateral ... | interval decrease in the size of previously seen complex mass centered within the left basal ganglia extending into the corona radiata and temporal lobe there is also decrease in the surrounding peritumoral edema now more apparent white matter lesion within the right corona radiata and along the occipital ___ of the ri... |
again identified is a right frontal craniotomy defect with a ventriculostomy catheter with tip in the third ventricle there is minimal enhancement surrounding the shunt catheter tract there are multiple enhancing lesions some of which are larger some of which are less conspicuous and some of which are new as follows th... | 1 mixed-response to treatment with interval enlargement of some enhancing lesions interval decreased conspicuity of other lesions and a few new punctate lesions as detailed above 2 no acute infarction 3 diffuse white matter flair-hyperintensity stable consistent with radiation-related effect |
there are moderate-sized extra-axial fluid collections along the frontal convexities bilaterally right greater than left there is flattening of the subjacent sulci on the right the width measures up to 1 6 cm and on the left up to 1 4 cm there is minimal leftward deviation of the septum pellucidum these collections are... | 1 bilateral subdural fluid collections which are larger compared to the ___ study and were not apparent on the ___ study the signal characteristics are suggestive of hygromas or subacute-to-chronic hematomas rather than acute blood products much smaller posterior subdural fluid collections more suggestive of acute subd... |
there has been interval removal of the right frontal catheter and interval placement of a left frontal catheter which terminates at the level of the foramen magnum there has been slight interval decrease in size of the lateral ventricles when compared to the prior exam there is a stable ventricular shunt catheter tract... | 1 stable subependymal nodules of enhancement as detailed above most consistent with previously described abscesses 2 stable focus of enhancement within the inferior aspect of the cerebral aqueduct causing obstruction of outflow and therefore non-communicating hydrocephalus this is further confirmed with lack of csf flo... |
there is a large venous angioma draining to a superficial vein in the region of the high attenuation seen on the ___ ct small veins extend laterally converging on the large draining vein corresponding to the flow void seen on the ___ study the pattern of enhancement is otherwise unremarkable | there is a large right frontal venous angioma draining laterally |
left frontal post-gyrus lesion is no longer seen which may be related to slice selection there is an apparent new lesion in the right frontal subcortical white matter series 100 image 89 there is an apparent new lesion in the right inferior cerebellum abutting the fourth ventricle in the posterior aspect of the medulla... | mixed response with interval decrease in size of some lesions multiple new lesions and some stable lesions |
there are changes from left parietal craniotomy there has been progression of signal abnormality and enhancement compared to the prior study enhancement in the left parietal operative bed is relatively stable with areas of necrosis however there is increase in the associated nonenhancing infiltrative abnormality which ... | progression of enhancing and nonenhancing signal abnormality in the bilateral cerebral hemispheres findings are concerning for tumor recurrence |
today's examination is compared to the prior from ___ overall there has been no change there are post-surgical changes in the left posterior frontoparietal region from the prior glioblastoma resection there is no significant change in the enhancement pattern within the surgical bed there are surrounding areas of conflu... | no change from the prior examination with stable enhancement in the post-surgical bed of the left frontoparietal region unchanged t2-signal abnormality within bilateral periventricular white matter regions area of slow diffusion within the left internal capsule is also unchanged and the differential continues to includ... |
the patient is status post left temporoparietal craniotomy with expected post-surgical changes in the form of pneumocephalus left frontal extra-axial fluid collection measuring 6 mm in maximal thickness and large fluid-filled resection cavity at the tip of the left temporal lobe with sedimentation and fluid-fluid level... | 1 status post resection of right temporal lesion with postoperative changes in the form of dural enhancement extra-axial fluid 6 mm in maximal thickness pneumocephalus and moderate hemorrhage at the resection site 2 gyriform hyperintensity on the dwi images # 12 13 14 series #9 involving the posterior aspect of the res... |
persistent and unchanged dilatation of the ventricular system is again noted as well as periventricular white matter t2 and flair signal hyperintensities likely reflecting chronic microvascular ischemic changes there is no evidence of acute infarction no diffusion abnormalities are noted no areas of abnormal susceptibi... | there is no evidence of acute infarction in comparison with the prior study again ventricular dilatation is noted the differential diagnosis will include normal pressure hydrocephalus please correlate clinically persistent signal abnormality within the left maxillary sinus with central calcification suggesting chronic ... |
there is an extra-axial right frontal lesion measuring 2 2 x 1 7 cm it is isointense to ___ matter on t1- and t2-weighted images and enhances diffusely underlying parenchymal edema is seen in the right frontal lobe there are no other appreciable enhancing lesions there is no hydrocephalus or acute ischemia | 2-cm right frontal mass with characteristics suggestive of meningioma differential diagnosis includes hemangiopericytoma and dural based metastasis |
again postoperative changes are seen in the right frontal region with an area of encephalomalacia and a ventricular catheter tract periventricular increased signal is also identified which is more predominant in the frontal region with also evidence of encephalomalacia and increased t1 and t2 signal in the right tempor... | overall stable appearance of the brain compared with the previous mri examination no definite area of abnormal enhancement seen as described above to indicate tumor recurrence no evidence of mass effect or hydrocephalus |
on diffusion weighted images no evidence of an area of restrictive diffusion is seen to indicate acute infarct subtle increased signal is seen in the both frontal regions with blood products on the right frontal region probably at the site of previous placement of the ventricular drains the ventricles are normal in siz... | no evidence of an acute infarct seen on diffusion images |
patient is status post left-sided craniotomy there is a lesion hematoma 4 7x2 3cm not significantly changed in size and appearance in the left parietal ___ with areas of subacute hemorrhage within - hyperintense on the t1- and the t2-weighted sequences with a t2 hypointense rim and moderate surrounding vasogenic edema ... | 1 unchanged appearance of the left parietal lesion with subacute hemorrhage within partly extending into the left occipital ___ with moderate surrounding vasogenic edema and mass effect on the atrium of the left lateral ventricle 2 white matter changes and moderate dilation of the lateral ventricles likely related to w... |
there has been interval progression of enhancing intracranial lesions with the pre-existing lesions in the left temporal lobe and right parietal lobe having enlarged and several new lesions many of which are in the subependymal location along the ventricles there is also a suprasellar lesion in the hypothalamus which i... | interval progression of metastatic disease with several new lesions many of which are in a subependymal periventricular location |
there is no midline shift there is no mass or mass effect there is no evidence for restricted diffusion there is a 0 3 cm round focus of susceptibility in the left cerebellum s7 i6 there is no associated edema the ventricles and sulci appear appropriate for the patient's age the midline structures are unremarkable ther... | 0 3 cm foci of magnetic susceptibility in the left cerebellum this could represent a small punctate foci of hemorrhage or cavernoma or calcification recommend follow up examination |
re-demonstrated are innumerable lesions scattered throughout all lobes of the brain and cerebellar parenchyma with ring and nodular enhancement several of these lesions again demonstrate susceptibility artifacts related to hemorrhage several of the enhancing lesions have decreased in size edema around several larger le... | 1 while many of the innumerable metastatic lesions have slightly decreased in size there is a new 3 mm enhancing lesion in the right posterior thalamus 2 abnormal marrow signal in the visualized portions of the cervical vertebrae is nonspecific and could be related to metastatic involvement 3 interval decrease in pachy... |
when compared to the most recent mri there has been interval resection of the largest enhancing mass within the left frontal calvarium with associated cranioplasty innumerable additional calvarial masses are similar to that seen on the prior examination with the exception of several lesions which have a slightly larger... | 1 interval resection of the largest intraosseous lesion within the left frontal calvarium with associated cranioplasty and otherwise generally stable appearance of the innumerable osseous masses with only minimal increased bulging of several lesions as detailed 2 stable intra-axial findings with no interval change 3 si... |
there has been interval resection of the previously identified right temporal lobe mass there is increased signal intensity at the periphery of the resection site in both the pre and post contrast images likely relating to areas of hemorrhage no definite enhancement is identified in this region the remainder of the sma... | 1 status post resection of the right temporal mass no definite evidence for residual enhancement in this region 2 areas of signal abnormality within the nasopharynx and within the parapharyngeal space bilaterally metastatic disease cannot be excluded and a dedicated study of the neck should be considered these findings... |
the low attenuation areas demonstrated on the prior head ct represent vasogenic edema extending along the periventricular region corpus callosum basal ganglia and involving the midbrain and pons as demonstrated on the axial flair sequences additionally multiple areas with abnormal enhancement are identified involving t... | extensive areas of vasogenic edema involving the basal ganglia corpus callosum midbrain pons and temporal lobes with heterogeneous areas of enhancement bilaterally with combined pattern of restricted diffusion and t2 shining-through effect on the dwi and adc maps given the constellation of findings the possibility of c... |
there is reduction in the amount of mass effect associated with the resection bed in the right cerebellar hemisphere compared to the prior study there is some reduction in the amount of hemorrhagic product in the resection bed and also reduction in the amount of gas there is new contrast enhancement superiorly and post... | improvement of mass effect in the resection bed compared to the prior study contrast enhancement suspicious for recurrent malignancy adjacent to the operative bed see above comment regarding the appearance of the cervicomedullary junction |
as seen on the prior examination there is an extra-axial mass overlying the right temporal and frontal lobes which is diffusely enhancing and extends to involve the calvarium the mass overall measures 3 0 cm in its long axis x 3 0 cm superior-inferior x 1 9 cm in its short axis this correlates with the lytic lesion see... | 1 extra-axial mass overlying the right frontal and temporal lobes extending to involve the calvarium which is stable in size and appearance since the prior study differential considerations again include multiple myeloma plasmacytoma as well as metastatic disease a meningioma is considered less likely given the lack of... |
no prior studies are available for comparison there are no intracranial hemorrhages masses or areas of abnormal enhancement there is no evidence of abscess formation within the head there are two tiny foci of slow diffusion involving the superior right frontal lobe as well as a single small focus of slow diffusion invo... | no abscesses of the head three small acute to early subacute infarcts involving the right superior frontal lobe and the right inferior cerebellum which likely are embolic or watershed infarcts sinus changes as described above in the setting of intubation |
in the location of the previously identified right frontal lobe area of signal abnormality there is no definite residual t2 signal hyperintensity and there is no enhancement the brain appears morphologically normal other tiny foci of increased t2 signal identified in the subcortical white matter and a small focus of t2... | no residua of the previously identified right frontal lobe abnormal focus is identified on today's examination there are no new abnormalities there is no abnormal intracranial enhancement |
"the study is compared with the more remote non-enhanced mr examination of ___ as well as the extremely motion-degraded and incomplete outside mr examinations labeled ""main "" and dated ___ and ___ again demonstrated is extensive both discrete and confluent t2- flair-hyperintensity in bihemispheric subcortical and per... | significantly motion-limited examination despite several attempts with 1 no definite acute intracranial abnormality specifically there is no evidence of edema slow diffusion or abnormal enhancement to specifically support the apparently established diagnosis of varicella zoster encephalitis 2 no pathologic focus of enh... |
there is a linear tract of hemorrhagic products extending from the right posterior parietal lesion to near the right periatrial region probably representing a needle tract from biopsy contrast enhancement is again visualized around the right ventricle in the peri-atrial region and extending across the midline to the ad... | enhancing lesion in the peri-atrial region on the right extending through the corpus callosum to the left peri-atrial region probably unchanged from the prior study of ___ given differences in technique |
the patient is status post exenteration of the left orbit and left ethmoid sinuses the exenteration cavity on the left extends to the left sphenoid sinus there is extensive mucosal thickening and fluid opacification of the remaining paranasal sinuses including the right frontal right sphenoid right ethmoid and right ma... | 1 status post exenteration of the left orbit and ethmoid sinuses extensive sinus disease within the remaining paranasal sinuses 2 abnormal meningeal enhancement a finding that suggests inflammation versus csf leak 3 additional finding of debris within the lateral ventricles bilaterally raises the question of possible v... |
the patient is status post resection of a right cerebellar hemisphere metastasis with post-surgical mild dura enhancement but no evidence of suspicious recurrent nodular enhancement or residual tumor there is no mass effect on the fourth ventricle and there is no evidence of new suspicious intracranial lesions the righ... | stable right cerebellar hemisphere post-surgical changes without evidence of tumor recurrence or new lesions |
there has been enlargement of the nodular area of enhancement along the posterior margin of the right temporal lobe surgical site this suggests progression of tumor no other areas of abnormal intracranial enhancement are detected this area of soft tissue enhancement is relatively isointense to cortex on ___ images incr... | progressive abnormal soft tissue enhancement along the posterior margin of the right temporal lobe surgical defect likely representing progressive tumor dfdgf |
within the left frontal lobe is a peripherally enhancing mass measuring 3 9 ap x 2 8 trv x 3 4 cc cm there is extensive vasogenic edema surrounding this lesion additionally within the left cerebellar hemisphere is a peripherally-enhancing 8 x 10 x 8 mm lesion with surrounding edema both these lesions demonstrate marked... | 1 left frontal and left cerebellar hemispheric enhancing lesions demonstrating marked slow diffusion in the setting of the findings on the recent chest ct these intracranial lesions would be most suggestive of metastases from primary small cell carcinoma of the lung 2 additional round focus of slow diffusion and relati... |
again noted are residual meningiomas in the planum sphenoidale and along the right tentorial reflection unchanged from the prior examination there is persistent enhancement in the right occipital operative bed a residual high right parietal meningioma is also seen best visualized on the post-gadolinium sagittal images ... | residual meningiomas in the planum sphenoidale along the right tentorium and high right parietal vertex are unchanged persistent enhancement in the right occipital lobe likely some combination of evolving pca infarction and postoperative edema the time course of this enhancement is somewhat unusual for an evolving infa... |
on the left temporal lobe significant vasogenic edema is demonstrated causing effacement of the sulci and also narrowing of the perimesencephalic cisterns on the left there is mild-to-moderate midline shifting towards the right with approximately 3 8 mm of deviation the diffusion-weighted sequences on the dwi maps demo... | vasogenic edema and abnormal enhancement is demonstrated on the left temporal lobe extending superiorly at the centrum semiovale with multiple dilated perimedullary and transcortical veins with no frank evidence of restricted diffusion there is effacement of the sulci and subfalcine herniation towards the right approxi... |
there is an acute infarct in the left thalamus there are no other acute infarction identified there are chronic lacunar infarcts involving the bilateral caudate body and left lentiform nucleus there are punctate and patchy foci of t2 flair hyperintensity involving the bifrontal subcortical white matter centrum semioval... | 1 left thalamic acute infarction 2 bilateral caudate body and left lentiform nucleus chronic infarcts 3 moderate chronic microangiopathic small vessel ischemic changes mild diffuse parenchymal volume loss 4 left mca bifurcating aneurysm better evaluated on the previously performed cta |
there are small lobulated enhancing areas within the left parietal left occipital and right frontal regions there is also a small focus of enhancement just adjacent to the right lateral ventricle within the right centrum semiovale these findings have adjacent t2 signal hyperintensity on the flair sequence however surro... | multiple bilateral foci of lobulated enhancement with negligible adjacent increased t2 signal given the history a concern is for septic emboli a followup mri should be performed to document any changes which would be expected with ischemic lesions there is no evidence of slow diffusion associated with these lesions |
there is an area of intraparenchymal hemorrhage in the right parieto-occipital region the area shows increased signal both on t1 and t2 weighted images with a well defined low signal rim on the gradient echo images there is also an area of linear decreased signal medial to the abnormality on both t2 and gradient echo i... | lobar hematoma in the right parieto-occipital region with evidence of blood products of various ages and enhancement at the anterior margin consistent with an underlying neoplasm no other definite areas of enhancement identified |
status post right parietal craniotomy with postoperative dural thickening enhancement and increased flair signal in the surgical bed unchanged the left parietal parasagittal lesion is again noted susceptibility artifacts are noted within suggesting hemorrhage with some resolution compared to before the lesion measures ... | 1 no significant change in the size of the left frontal parasagittal lesion and the marked perilesional white matter hyperintensity consistent with edema evolution of the hemorrhage within the lesion seen on the gradient echo sequences 2 right parietal enhancement and increased signal on the flair in the surgical bed n... |
there is a questionable area for restrictive diffusion in the medial aspect of the right cerebellar hemisphere please correlate clinically for cerebellar infarct again noted are inreased signal on the flair images on the temporoparietal occipital region on the right and parietal occipital and left frontal region on the... | questionable area of restricted diffusion in the right cerebellar hemisphere please correlate clinnically no other significant changes noted |
compared with the multiple prior exams there is progression of the right frontal cortical swelling and enhancement presumably related to radiation necrosis as this appears to be an intraparenchymal infiltrative mass as opposed to an extraaxial process there is progression of the abnormal flair signal in the left fronta... | progression of the swelling and enhancement within the right frontal cortex without new extraaxial lesions or abnormal blood flow these findings are most consistent with radiation necrosis and there is no evidence of tumor recurrence |
there are no areas of restricted diffusion to suggest an acute ischemic stroke there is no acute hemorrhage mass effect midline shift or hydrocephalus few small foci of t2 hyperintensities in supratentorial deep subcortical white matter are most consistent with microvascular chronic infarcts the mra images are very lim... | 1 no acute ischemic infarct 2 findings consistent with chronic microvascular infarcts in the supratentorial 3 limited evaluation of the vasculature without definite occlusions or aneurysms seen hypoplastic right vertebral artery |
this is a limited study with motion degraded t1 sagittal images obtained the area of hemorrhage is identified in the right posterior temporoparietal region as seen on the ct of ___ | limited study without diagnostic information hemorrhage is again seen as seen on the ct of ___ in the right posterior temporoparietal region |
contrast enhanced images demonstrate multiple areas of enhancement within the brain parenchyma and along the leptomeningeal surfaces there are multiple cerebellar metastases the largest of which is in the left cerebellar hemisphere and measures roughly 3 cm in maximal dimension there are at least two enhancing masses i... | multiple cerebral and cerebellar metastases as well as extensive leptomeningeal carcinomatosis mild ventriculomegaly |
diffusion images demonstrate no evidence of acute infarct there is no mass effect midline shift or hydrocephalus seen no focal signal abnormalities within the brain suprasellar and craniocervical regions are normal on the sagittal images | no evidence of acute infarct mass effect or hydrocephalus identified |
there is evidence of left frontal craniotomy with underlying dural enhancement there is no evidence of a residual mass previously noted postoperative extra-axial fluid collection has resolved left frontal vasogenic edema with associated shift of midline structures to the right have also resolved there is mild left fron... | 1 no evidence of residual or recurrent tumor 2 resolution of postoperative left frontal lobe edema and associated mass effect 3 normal head mra dfdkq |
there is no structural lesion involving the trigeminal nerve symmetric vessels course near the bilateral trigeminal nerves there are extensive areas of increased flair signal in the periventricular and subcortical white matter bilaterally which appears similar to the prior exam allowing for differences in technique and... | 1 no trigeminal structural lesion 2 white matter changes compatible with the patient's given history of multiple sclerosis no enhancing lesions |
again demonstrated within the right periatrial subependymal region is a rounded lesion which is similar in size since the prior study since the prior study this lesion now is homogeneously hyperintense on pre gadolinium t1 weighted images without demonstrable susceptibility artifact these findings are suggestive of new... | right periatrial subependymal metastatic focus which has developed interval hemorrhage into this lesion since the prior study size of this lesion is stable since the prior study however there has been increasing surrounding edema since the prior study no other areas of abnormal enhancement demonstrated |
the study is compared with the nect performed the previous day there is no intra- or extra-axial hemorrhage the midline structures are in the midline and the ventricles and cisterns are normal in size and contour for age there is no focus of restricted diffusion to suggest an acute ischemic event and the principal intr... | "1 no acute intracranial abnormality specifically there is no evidence of acute territorial infarction in either the territory of the aca as queried or that of the right mca given the mra findings above 2 mild-moderate global atrophy particularly bifrontal cortical and central with diffuse prominence of virchow-___ spa... |
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