Question

Location: Outpatient Hospital

RADIOLOGY REPORT

EXAMINATION OF: MRI of brain with contrast

CLINICAL SYMPTOMS: Slurred speech, right arm weakness

MAGNETIC RESONANCE EXAMINATION OF THE BRAIN without contrast was performed prior to contrast utilizing T1-weighted sagittal views as well as spin density and T2-weighted sequences in the axial plane. These were supplemented with axial T1-weighted sequence following intravenous infusion of paramagnetic contrast material. Diffusion sequence was also performed.

In the spin density and T2-weighted sequences (images 17 and 18 of series 3), there is a small localized area of occipital cortex that shows increased intensity. This is also bright in the diffusion sequence. This area is not hyperintense in the ADC map.

I do not appreciate significant abnormal increased or decreased intensity within brain parenchyma of the remainder of the supratentorial brain. However, there is bilateral irregularly shaped increased intensity within the pontine tegmentum. This is not hyperintense in the diffusion sequence.

Ventricles are of normal size. Normal gray-white matter delineation. No abnormal contrast enhancement of brain parenchyma.

IMPRESSION: Small hyperintense area of the cortex of the right occipital lobe, as described above. This is also hyperintense in the diffusion sequence but not in the ADC map. This would indicate that this represents limited subacute infarction. I do not appreciate other areas of subacute infarction. Remainder of supratentorial portion of the brain is unremarkable.

Hazy increased intensity within the pontine tegmentum. This is not unusual in the older age group (8th and 9th decades) and is sometimes thought to represent evidence of microvascular ischemic change. However, it is rarely indeterminate. In this case, I do not appreciate evidence of enlargement of the brainstem, nor is there abnormal enhancement to suggest neoplasm. I cannot elucidate further.

CPT Code: __________

Answer 1

The radiology report describes an outpatient MRI that reveals a likely subacute infarction in the right occipital lobe, along with signs of microvascular ischemic change in the pontine tegmentum, which is common in older age groups.

Step-by-step explanation:

The provided radiology report describes an MRI of the brain with contrast performed on an outpatient basis. The patient presented with slurred speech and right arm weakness. The MRI findings include a small hyperintense area on the right occipital lobe, suggesting a subacute infarction, and bilateral increased intensity within the pontine tegmentum, which may indicate microvascular ischemic changes common in the elderly. This examination exploits the different relaxation times of hydrogen protons in various tissues after the application of a strong magnetic field to produce detailed images of the brain. In this context, contrast enhancement is used to better differentiate between normal and abnormal tissues, which is crucial when assessing brain pathologies. The MRI is a non-invasive, powerful diagnostic tool for identifying structural changes in the brain, such as those caused by stroke, microvascular disease, or neurodegenerative diseases like Alzheimer's.