Gentleman - Oklahoma State University–Stillwater



Oklahoma University Medical Center - Radiology Report

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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

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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

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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: CPT:

003093833 MR C SPINE W WO 72156

003093834 MR T SPINE W WO 72157

003093835 MR L SPINE W WO 72158

003093844 MR BRAIN W WO INF 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.

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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

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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 Signed Report

Authored by :

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