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1996 RSNA DICOM Medical Image Set

Study index: 96-1

Vendor: Picker

Modality: NM

Examination: Renal Scan

History: Question renal function abnormality. Prior renal calculi.

Procedure: Following the administration of Tc-99m DTPA dynamic renal scan images were acquired.

Findings: There is symmetric excretion of contrast for the kidneys. No perfusion abnormality is detected. There is an extra-renal pelvis on the right. There is rapid passage of contrast activity into the bladder. Normal renal perfusion examination. Right kidney extra-renal pelvis.

Study index: 96-2

Vendor: Picker

Modality: NM

Examination: Total body bone scan

History: 65 year old man recently diagnosed with prostate carcinoma

Procedure: Following the administration of Tc-99m MDP total body bone scan images were acquired.

Findings: There is homogenous uptake of radiopharmaceutical throughout the osseous skeleton. Mild increased uptake is present within the right acromioclavicular joint and the left L5/S1 facet joint consistent with degenerative disease. There is symmetrical excretion of contrast from the kidneys. No evidence of prostate metastasis.

Study 96-3

Vendor: Picker

Modality: CT

Examination: CT: Spiral Angiography of the Thorax

History: 46-year-old male presented to the emergency room with parasternal and epigastric pain. A chest X-ray showed widening of the mediastinum. R/O thoracic aneurysm

Findings: There is an aneurysm of the entire thoracic aorta measuring up to 6.2 cm in diameter. Also, there is an intimal flap creating two lumens which is evident on all views extending from the aortic base through the ascending aorta, the aortic arch, and the descending aorta including that portion of the abdomen which is on the films. There are no pulmonary masses identified. The emergency room was immediately notified on this finding and a copy of the films were given to the emergency room so that they could accompany the patient.

Aneurysm of thoracic aorta with dissection affecting ascending and descending aorta.

Study 96-4

Vendor: Picker

Modality: MR

Examination: MRI: Knee

History: 16 year old with right knee pain after an injury playing basketball.

Findings: The bony structures are intact and normally aligned. There is bruising of the medial femoral condyle with some intrasubstance injury to the medial collateral ligament. The lateral collateral ligament in intact. The anterior cruciate ligament is irregular and slightly lax suggesting a partial tear. It does not appear to be completely torn. The posterior cruciate ligament is intact. The suprapatellar tendons are normal.
There is a tear of the posterior limb of the medial meniscus which communicates with the superior articular surface. The lateral meniscus is intact. There is a Baker's cyst and moderate joint effusion.

Internal derangement of the right knee with marked injury and with partial tear of the ACL; there is a tear of the posterior limb of the medial meniscus. There is a Baker's Cyst and joint effusion and intrasubstance injury to the medial collateral ligament.

Study 96-5

Vendor: Picker

Modality: MR

Examination: MRI - Cervical Spine

History: Right arm pain following car accident

Findings: There are normal intervertebral disks identified with no evidence of herniation or degeneration. The spinal cord is normal. The marrow signal within vertebral bodies is normal. Paravertebral soft tissues are normal.

Normal Cervical Spine

Study 96-6

Vendor: Picker

Modality: MR

Examination: MRI: L-spine

History: Low back and bilateral hip pain which goes down into the right hip.

Findings: There is a decrease in the usual lumbar lordosis with advanced degenerative change of the endplates at L4-5. This has an active appearance suggesting an active degenerative process of the disc at this level. There is narrowing and desiccation of the disc with bulging of the annulus. This extends to and slightly narrows the neuroforamina bilaterally, although I do not see a disc herniation. The remainder of the disc spaces are normal. The conus medullaris terminates normally at T 12. There are no abnormal masses in the pre or perivertebral regions. Degenerative disc at L4-5 with reactive degenerative change in the adjacent end-plates. Bulging of the annulus gives mild compromise of the neuroforamina bilaterally at this level.

Study 96-7

Vendor: KODAK

Modality: CR

Examination: Portable chest x-ray dated 07/30/95 at 0603 hours

Findings: The endotracheal tube has been advanced and is now just above the carina. Multiple chest tubes, NG tube, median sternotomy wires, and pacers are unchanged. Again noted is a hydropneumothorax on the left with the pleural effusion probably increased slightly. There has now been interval development of a right-sided small pneumothorax. The right chest tube may be in the minor fissure and the ward team was notified of this result. Advancement of ET. Development of right pneumothorax.

Study 96-8

Vendor: KODAK

Modality: CR

Examination: Portable chest x-ray

History: Six month old, with a history of tetralogy of Fallot.

Findings: This film was reviewed in comparison with the previous radiographs, including the most recent prior study.

The lungs are well aerated, with the remaining pneumothorax evident in the lateral portion of the right lung, with no significant change since the previous study. A small right retrocardiac density is evident on this examination at the site of the prior placement of the chest tube. This could represent blood, an infiltrate, or atelectasis in that region. The resolution of the left pneumothorax evident on the study of 07/31/1995 is again noted.

  1. A pneumothorax in the lateral right lung, with no change from the previous study.
  2. Absence of the chest tube previously evident in the medial right lung, with remaining retrocardiac density, possibly bleeding, infiltrate, or atelectasis.
  3. Resolution of a prior left pneumothorax.

Study 96-9

Vendor: Acuson

Modality: US

Examination: Ultrasound: Right lower quadrant

History: Right lower quadrant pain r/o appendicitis

Findings: A retrocecal appendix is present, and markedly enlarged to a diameter of 4.5 mm. There is a central area of decreased echogenicity, possibly representing fluid within the appendix, and there is a somewhat eccentrically placed fluid collection near the appendiceal tip which may represent a very early perforation. There is inflammation of peri-appendiceal fat and a marked increase in blood flow seen on Doppler imaging.

The liver, spleen, kidneys, gallbladder, and pancreas are normal.

Thickening of appendix with surrounding inflammation consistent with appendicitis.

Study 96-10

Vendor: Acuson

Modality: US

Examination: Ultrasound: Liver

Findings: Within the previously identified hepatic artery aneurysm there is now an echogenic focus consistent with embolization coils and less echogenic material representing thrombus within the aneurysm. A focal 1 CM hypoechoic area is seen adjacent to the area of echogenicity. Flow is seen within this area consistent with minimal residual aneurysm flow. The flow is seen to have an arterial wave form.

Hepatic Artery Aneurysm with predominant clot within lumen following embolization. 1 CM residual focus with arterial flow present.

Study 96-11

Vendor: Acuson

Modality: US

Examination: Ultrasound - OB

History: Elevated AFP

Findings: There is a defect in the abdominal wall which appears lateral to the umbilical cord. No membrane is demonstrated covering the abdominal contents, which appear to float freely within the amniotic fluid. The appearance is consistent with the diagnosis of gastroschisis.

The remaining fetal anatomy is normal. Normal cardiac motion is noted with normal cardiac anatomy. The spine is visualized and appears normal without evidence of dysraphism; specifically there is no evidence of spina bifida occulta. Two normal appearing kidneys are present. Fetal measurement are compatible with a 18-19 week gestation.

18-19 weeks gestation.

Study 96-12

Vendor: Toshiba

Modality: MR

Examination: Cerebral MRA

History: Headache, question aneurysm

Findings: There is normal visualization of the cerebral vessels associated with the Circle of Willis. There is no evidence of aneurysm or focal occlusive disease.

Normal cerebral MRA

Study 96-13

Vendor: Toshiba

Modality: MR

Examination: MRI myelogram

History: Right radicular leg pain.

Findings: Examination demonstrates normal appearance of paraspinal vasculature. here is no evidence of focal spinal cord abnormality. Normal MR myelography.

Study 96-14

Vendor: Toshiba

Modality: US

Examination: Ultrasound: Thyroid

History: 30 year old woman with 6-months of weight loss and palpitations.

Findings: The left and right thyroid glands are visualized and appear normal. There is no focal hyper or hypoechic mass. The thyroid glands are normal in size. Normal thyroid ultrasound.

Study 96-15

Vendor: G.E.

Modality: CT

Examination: CT: Abdomen

History: Patient is a 45 year old male with abnormal liver function test. Ultrasound evaluation demonstrated a 3 cm lesion in the medial aspect of the right lobe of the liver. The question was raised regarding potential hemangioma.

Procedure: Serial imaging was obtained in the upper abdomen with the administration of oral and intravenous contrast.

Findings: The examination demonstrates a well circumscribed 3 cm lesion present within the medial aspect of the inferior right liver lobe. Initial evaluation demonstrates lack of contrast enhancement. Subsequent imaging (not shown) demonstrated typical contrast enhancement pattern of a benign hemangioma of the liver. The remaining contrast enhancement pattern in the liver is normal. There is normal appearance of the adrenal glands, spleen, kidneys, and pancreas. There is no evidence of liver metastasis. 3 cm nodule present in the inferior medial aspect of right liver lobe. Contrast enhancement pattern consistent with the diagnosis of hemangioma.

Study 96-16

Vendor: G.E.

Modality: MR

Examination: MRI: Wrist

History: Wrist pain. Question tear triangular fibrocartilage.

Procedure: SPGR coronal images are acquired.

Findings: The triangular fibrocartilage is visualized with normal signal architecture. The scapholunate and lunotriquetral ligaments are visualized and appear unremarkable. There is normal marrow intensity present within the carpal bones without evidence of disruption. Intercarpal cartilage is identified and appears unremarkable.

Normal appearance of triangular fibrocartilage. No evidence of internal derangement of wrist. Cartilage preserved.

Study 96-17

Vendor: GE

Modality: MR

Examination: MRI: Brain

History: Headaches

Procedure: Fast spin echo T2 weighted sagittal and axial images are acquired.

Findings: Images demonstrate normal gray-white differentiation. Cerebral and cerebellar architecture is normal. The ventricles are normal in size. No space occupying lesion is present within either gray or white matter. No inflammatory changes are seen within the paranasal sinuses. The vascular structures are normal.

Normal brain MRI

Study 96-18

Vendor: G.E.

Modality: MR

Examination: MRI: L-spine

History: Patient is a 40 year old male with left radicular symptoms and an L5 distribution.

Procedure: MRI evaluation with fast spin echo axial and sagittal images.

Findings: At the L5 S1 interspace there is a left lateral disk herniation. It presses upon the L5 nerve root sheath. The herniation does not extend into the neuro foramen. The left L5 nerve root is not affected. The remaining intervertebral disks are normal. There is homogenous signal within vertebrae bodies. Left sided herniation L5/S1 interspace impinging upon the L5 nerve root.

Study 96-19

Vendor: G.E.

Modality: MR

History: Rule out internal derangement.

Procedure: Sagittal T1 and T2 weighted images and fast spin echo and coronal T2 weighted images are acquired.

Findings: Within the posterior horn of the medial meniscus there is minimal increase in signal intensity; however, this does not extend to a joint surface and therefore does not represent a tear. The lateral meniscus is normal. The anterior and posterior cruciate ligaments are visualized and are normal. There is a joint diffusion present with a small superior joint plicae. No interarticular loose bodies are identified. There is no focal marrow edema. The collateral ligaments appear normal.

Opinion: 1) Joint diffusion with superior joint plicae. Minimal increased signal within the posterior horn of medial meniscus consistent with intermeniscal degeneration. No evidence of meniscal tear.

Study 96-20

Vendor: G.E.

Modality: MR

Examination: MRI angiography: Brain

History: Rule out vascular occlusion in patient with recent transient ischemic attack.

Procedure: Magnetic resonance cerebral angiography was obtained with SPGR imaging and maximal intensity projection images then acquired.

Findings: There is normal appearance of vasculature of the Circle of Willis. The vertebral arteries as well as middle cerebral arteries are well demonstrated as they pass into the temporal regions bilaterally. The anterior cerebral arteries are well demonstrated. There is no evidence of occlusion or focal aneurysm.

Normal magnetic resonance angiography of brain.

Study 96-21

Vendor: Algotec

Modality: CT

Examination: CT angiogram (Brain)

History: 33 year old male with headaches.

Findings: There is a hypervascular mass in the superior aspect of the left parietal cortex. Multiple dominant draining veins are present. The pattern suggest a cerebral arteriovenous malformation. There is no evidence of focal brain edema or hemorrhage.

Left parietal cortex arteriovenous malformation.

Study 96-22

Vendor: Algotec

Modality: CT

Examination: CT angiography (Renal)

History: 60 year old male with non-controlled hypertension.

Findings: CT angiography images demonstrate a focal stenosis at the origin of the left renal artery. The right renal vasculature is normal. There are atherosclerotic changes present in the aorta. There is a hypodense focus at the base of the left kidney consistent with renal cyst. Degenerative changes are present in the dorsal spine.

Focal atherosclerotic narrowing at origin of left renal artery.

Study 96-23

Vendor: Siemens

Modality: MR

Examination: MRI: Pelvis

History: 44 year old female patient, clinical status: known cervix carcinoma assess extent.

Findings: Visualization of a cervix carcinoma, almost completely permeating into the anterior and posterior labia and extending into the parametrium on the right side. No indication of bladder or rectal involvement. The pelvic wall is free. The tumor does not extend caudally to the vagina. In the vicinity of the left iliac vessel an approximately 1.5 cm round structure can be seen in today«s examination, most probably representing the left ovary. If this has been removed because of the ectopic pregnancy, then it is a pathologically enlarged lymph node. There is an ovarian cyst on the right with individual solid contents.

Cervical carcinoma permeating into the anterior and posterior labia and extending into the parametrium on the right side.

Study 96-24

Vendor: Siemens

Modality: CT

Examination: CT Angiography: Renal

History: 42 year old female patient, clinical status: hypertensive crisis with blood pressure values 200/120. Query for renal artery stenosis.

Findings: There is symmetrical visualization of the renal arteries. No documented hemodynamic resultant stenosis. Contrast media absorption and elimination equal for both kidneys.
No tumor detected.

Normal renal CTA

Study 96-25

Vendor: Siemens

Modality: DS

Examination: Angiography: Renal

History: 50 year old female patient, clinical status: uncontrolled hypertension question renal artery stenosis

Procedure - Angiography:
Puncture of the Right Common femoral artery and advancement of 4F pigtail catheter via a 0.035 inch guide wire into the abdominal aorta at the level of the renal arteries.
Three DSA studies with injections of 25 ml Ultravist 300.

Findings: Right Renal artery:
Normal location, single vessel supply, high-grade renal artery stenosis approximately 5 mm distal from the origin of the aorta.
Left Renal artery: Single vessel supply, significantly larger organ size, no apparent stenosis.

Documented single hemodynamic resultant stenosis of the right renal artery, Angioplasty suggested.

Study 96-26

Vendor: Siemens

Modality: DR

Examination: Myelogram

History: 22 year old male patient, clinical status: sudden pain in complete left extremity, sensitivity loss thigh and lower leg

Findings: High-grade impression of the contrast column caused by probable herniated nucleus pulposis at L4/5 level. The remaining levels are normal. The conus is normally located at T12

Herniated L4/5 disk.

Study 96-27

Vendor: Siemens

Modality: DR

Examination: ERCP

History: 67 year old male patient, clinical status: two month Jaundice. Query space occupying lesion of the bile duct.

Findings: The pancreaticus major as well as a small accessory duct are well contrasted. Discrete variations in caliber are visible in the region of the pancreatic duct suggestive of chronic inflammatory changes. Variations in caliber are also visible in the multiple small branches. No indications of contrast media depots suggestive of cysts or pseudocysts. No signs of intraluminal concrements.

Well contrasted bile duct and left and right hepatic ducts. Here there are smooth contours without indication of changes in diameter or stenosis. There are no signs of intraluminal concrements.
The discrete changes of caliber in the pancreaticus major, accessory ducts and multiple small branches are suggestive of chronic inflammatory changes.

Normal appearance of the bile duct, cystic duct and gall bladder with good drainage of the contrast medium into the duodenum after the endoscopic examination.

Study 96-28

Vendor: FUJI

Modality: CR

Examination: Upper GI - double contrast stomach

History: Gastric pain.

Procedure: Double contrast technique of the stomach was performed.

Findings: Demonstrated is a gastric wall lesion along the greater curvature of the stomach. Radiating gastric folds are seen extending into the lesion without significant surrounding edema. No additional abnormalities are detected. Given the lack of surrounding edema of this single lesion within the stomach the primary diagnosis of gastric carcinoma remains the main differential diagnosis and must be excluded. Gastric ulcer, although a possibility, is thought to be less likely given the lack of surrounding edema.

Gastric wall mass lesion along greater curvature of the stomach. Pattern compatible with gastric carcinoma.

Study 96-29

Vendor: FUJI

Modality: CR

Examination: Chest PA

History: Cough

Findings: PA evaluation of the chest demonstrates the lungs to be expanded and clear. Cardiac and mediastinal contours are normal. The osseous thorax is intact.

Normal PA chest x-ray.

Study 96-30

Vendor: FUJI

Modality: CR

Examination: Tibia AP Findings: AP evaluation of the right tibia and fibula demonstrate a focal expansive lesion with the distal right tibia. The lesion is eccentrically located within the medial aspect of the distal tibia diaphysis. It measures approximately 5 cm in length and 3 cm in transverse dimension. It has a radiographic appearance consistent with a non-ossifying fibroma. There is no associated fracture. There are no additional bony abnormalities detected. Soft tissues are intact. Although the cortex is slightly bowed secondary to the expansive nature of this lesion, there is no evidence of periosteal extent.

Expansive bubbly lesion distal to right tibia diaphysis consistent with the typical radiographic appearance of a non-ossifying fibroma

Study 96-31

Vendor: FUJI

Modality: CR

Examination: Chest PA

History: Cough

Findings: This examination demonstrates a 3 cm nodular density present in the right upper lobe. There is no evidence of associated hilar adenopathy. The pattern is consistent with a primary lung carcinoma. The remaining portions of the lungs are expanded and clear. There is no evidence of plural effusion. Cardiac and mediastinal contours are normal. Osseous thorax is intact.

3 cm right upper lobe lung mass consistent with lung carcinoma. CT evaluation is recommended.

Study 96-32

Vendor: ATL

Modality: US

Examination: Breast ultrasound

History: Assess palpable mass detected on mammography in the upper outer quadrant of breast in patient with intermittent bloody breast discharge.

Findings: The mass is identified in the upper outer quadrant on the breast corresponding to the size and location of the palpable mass. There are internal echoes indicating that this is a solid mass. Hyperechoic foci are present likely indicating that calcifications are present (confirmed on magnification mammography).
In the retroareolar region there was identified an intraductal mass with proximal mild ductal dilatation. This is consistent with an intraductal pappiloma.

Solid breast mass with calcifications. Intraductal pappiloma.

Study 96-33


Modality: US

Examination: Spinal cord ultrasound

History: R/O Tethered Cord

Findings: The spinal cord is well visualized and is normal throughout its course. The conus is visualized in its expected position in the mid-lumbar region. The filum terminale is normal thickness. There is no evidence of tethered cord, syrinx, or occult spinal dysraphism.

Normal spinal cord with no evidence of tethered cord.

Study 96-34

Vendor: ATL

Modality: US

Examination: Liver ultrasound

History: Patient presented following blunt trauma to abdomen with a rupture of echinococcal cyst. Repeat ultrasound examination to monitor response to therapy.

Findings: Hypoechoic spherical masses are present in the liver consistent with the patient's known echinococcal disease. These appear slightly decreased in size compared to the examination of one month ago. No new lesions are detected. There is no ascites.

Echinococcal cyst again visualized with slight reduction in size since the prior examination.

Study 96-35

Vendor: ATL

Modality: US

Examination: Cardiac ultrasound History: 30 year old man with fever of unknown origin and heart murmur. Findings: Mixed echogenicity masses are identified on both the tricuspid and mitral valves. The appearance is consistent with endocarditis. There is no evidence of either atrial or ventricular thrombus. Normal cardiac motion is present. There is no pericardial effusion.

Endocarditis with vegitations identified on both mitral and tricuspid valves.