Oklahoma University Medical Center - Radiology Report
------------------------------------------------------------------------------OU MEDICAL CENTER - OU PHYSICIANS BUILDING
825 N.E. 10th
MAGNETIC RESONANCE IMAGING
PHONE: (405) 271-1654
Oklahoma City, OK 73104
CONSULTATION REPORT
FAX: (405) 271-1977
------------------------------------------------------------------------------LOC/RM: EA.MRI/
CAMPUS: AU
MRN:
E002397674
PT. TYPE: REG CLI
RAUN,WILLIAM ROBERT
ACCT#: E00635858066
DOB: 06/21/1957 AGE: 53
SEX: M
------------------------------------------------------------------------------ORD PHYSICIAN: Algan MD,Ozer
EXAM STARTED: 04/13/11 1024
ATT PHYSICIAN: Algan MD,Ozer
EXAM COMPLETED: 04/13/11 1024
ADMISSION CLINICAL DATA: 191.5 MAL NEO CEREB VENTRICLE
EXAMS:
003093833
003093834
003093835
003093844
CPT:
MR
MR
MR
MR
C SPINE W WO
T SPINE W WO
L SPINE W WO
BRAIN W WO INF
72156
72157
72158
70553
MRI brain with and without contrast dated Apr 13, 2011 10:25:00 AM.
MRI C-spine, T-spine, and L-spine with and without contrast dated Apr
13, 2011 10:25:00 AM.
Comparison: 10/9/2010.
Reason for study: Malignant neoplasm ventricle.
Technique: Multiplanar imaging of the brain was performed in a routine
fashion utilizing a 1.5T magnet. 15 cc of Magnevist IV contrast was
administered during the post infusion portion of the exam, with
postcontrast T1 sequences added. Pulse sequences obtained include:
Axial: T1, T2, FLAIR, DWI, ADC, E ADC
Sagittal: T1
Coronal: T2
Postcontrast: Postcontrast T1 axial/coronal/sagittal.
Multiplanar MRI of the cervical, thoracic, and lumbar spine was
obtained with the following pulse sequences: Sagittal T1, T2, STIR,
axial T2, T2 *, T1, postcontrast T1 axial and sagittal with fat
saturation.
Findings:
Midline structures are nondisplaced. Ventricular enlargement remains
stable in appearance with some volume loss and sulcal prominence
demonstrated. Basilar cisterns are preserved. Scattered nonspecific
punctate hyperintense/T2 FLAIR signal is no evidence of subcortical
and periventricular white matter, which has not significantly changed
since the comparative study. No abnormal extra axial fluid collections
are noted. No evidence of restricted diffusion to suggest acute
ischemia.
Suboccipital craniectomy changes are again noted with mesh
reconstruction. Postcontrast enhancement involving the fourth
ventricle is unchanged in signal and size compared to the most recent
MRI. No evidence of other abnormal postcontrast enhancement is
identified along the ependyma or elsewhere within the brain.
The cerebellum is unremarkable. Major cerebrovascular flow voids are
present suggesting patency by T2 criteria. A small amount fluid signal is
noted within right mastoid air cells. Patchy mucosal thickening is
noted within the paranasal sinuses.
CERVICAL SPINE:
Alignment: Normal cervical lordosis is maintained. There is no
evidence of listhesis or subluxation.
Marrow signal: Heterogeneous bone marrow signal with patchy
postcontrast enhancement is noted within the C6 and T1 vertebral
bodies, and along the posterior corner of C7. Similar changes are
noted at these levels within the posterior elements, minimally
progressed in the interim, and may reflect post radiation changes with
reactive red marrow replacement.
Cord/Canal: The spinal cord is normal in signal and morphology. No
abnormal medullary or meningeal postcontrast enhancement is present.
Soft tissues: The surrounding soft tissues are unremarkable.
Multilevel degenerative changes of the spine are again noted, without
significant interval change. These are most pronounced at the C5/6 and
C6/7 levels.
THORACIC SPINE:
Alignment: Normal thoracic kyphosis is maintained. There is no
evidence of listhesis or subluxation.
Marrow signal: Heterogeneous bone marrow signal with patchy
postcontrast enhancement at multiple thoracic vertebral body levels
are again identified, relatively unchanged in appearance.
Cord/Canal: The spinal cord is normal in signal and morphology. No
abnormal postcontrast medullary or meningeal enhancement is noted.
Soft tissues: Dependent atelectasis is demonstrated within both lung
fields.
Levels: There is no evidence for significant disc bulge or protrusion.
There is no demonstration for spinal stenosis, neural foraminal
narrowing, or pars defects.
LUMBAR SPINE:
Alignment: There are presumed to be 5 lumbar-type vertebrae, with the
most inferior being labeled as L5. Normal lumbar lordosis is
maintained. There is no evidence of listhesis or subluxation.
Marrow signal: Heterogeneous patchy marrow signal with postcontrast
enhancement is noted throughout all lumbar vertebral levels.
Cord/Canal: The conus medullaris terminates at the level of L1. The
spinal cord is normal in signal and morphology. No abnormal
postcontrast medullary or meningeal enhancement is noted.
Soft tissues: The surrounding soft tissues are unremarkable.
Levels:
Facet degenerative changes are most pronounced at the L3/4, L4/5, and
L5/S1 levels.
L1-L2: Broad-based annular disc bulge resulting in mild central canal
narrowing. Disc desiccation is present with annular disc tear noted.
There is no significant neural foraminal stenosis.
L2-L3: Facet hypertrophy is present without significant neural
foraminal or central canal stenosis.
L3-L4: Mild broad-based annular disc bulge without significant central
canal stenosis. Mild right-sided neural foraminal narrowing is noted.
L4-L5: Broad-based annular disc bulge with lateral recess narrowing is
noted and facet hypertrophy. Mild bilateral neural foraminal narrowing
is present. No significant central canal stenosis.
L5-S1: Broad-based disc bulge with lateral recess stenosis is more
pronounced on the left. Mild/moderate bilateral neural foraminal
narrowing is noted. There is no significant central canal stenosis.
IMPRESSION:
1. Stable MRI examination of the brain with postcontrast enhancement
along the floor of the fourth ventricle, compatible with known history
of ependymoma. Otherwise, no abnormal parenchymal or leptomeningeal
enhancement demonstrated. Generalized volume loss is noted with
persistent prominence of the ventricular system.
2. No evidence of abnormal medullary or meningeal enhancement of the
spinal cord.
3. Heterogeneous bone marrow signal with patchy postcontrast
enhancement within multiple vertebral body levels. Findings have
minimally progressed in the interim, and may reflect post radiation
changes and/or red marrow conversion.
4. Multilevel degenerative disc disease as described above, worst at
L1/2 with mild central canal narrowing.
***************************************************************
I have viewed the images and/or data and approve the report.
** Electronically Signed by D.O. 159 JACK R. LAKE **
**
on 04/13/2011 at 1228
**
RESIDENT: JACK D. MARKIEWICZ, M.D.
Reported and signed by: JACK R. LAKE, D.O.
159
------------------------------------------------------------------------------DICTATED: 04/13/2011 @ 1129
TRANSCRIBED: 04/13/11 @ 1228
TYPIST: RAD.VR
PRINTED: 04/13/2011 @ 1244
ELECTRONIC SIGNATURE DATE/TIME: 04/13/2011 @ 1228
BATCH#: N/A
PAGE 4
Authored by
Approval Date
Signed Report
:
: