tfrick2
Networker
Can I bill for separate MRI & MRA for the following report?
Examination: MRA HEAD W AND WO CONTRAST
Exam Number:
EXAMINATION:
MRI BRAIN WITH AND WITHOUT CONTRAST,
MRA HEAD WITHOUT AND WITH CONTRAST,
MR VENOGRAM HEAD WITH CONTRAST:
HISTORY:
Headaches, prior surgical resection of a lesion - verbal report of an
AVM with connection to superior sagittal sinus.
COMPARISON:
CT brain without contrast
TECHNIQUE:
Sagittal T1, axial T1, FLAIR, GRASE T2, gradient echo, diffusion
weighted images with ADC map reconstruction, and post-gadolinium T1
axial, sagittal and coronal images, post-gadolinium axial T1-weighted
3D MPRAGE and axial T1 postcontrast fat-suppressed images of the
brain. MultiHance 4 mL i.v.
Routine 3D time-of-flight MRA of the head and gadolinium-enhanced MRA
and MRV of the head are evaluated with source images and MIP
reconstructions.
FINDINGS:
Metallic artifact from the plate in the parietal bones limits the
examination. A persistent falcine sinus is noted. The left sigmoid
sinus is atrophic. On the postcontrast images there is a small
outpouching from the superior sagittal sinus to the region of the
plate seen on 1601-119.
The soft tissue nodular density is seen to be rim enhancing on the
post-contrast fat saturated examination seen on series 1701 image 27.
There additionally multiple scalp veins in this region surrounding
the lesion. It is not clear on this examination if any of these
veins traverse parietal sulci to the sagittal sinus.
No intra axial mass, hemorrhage or mass effect. The ventricles, sulci
and basal cisterns are not effaced. No brain parenchymal signal
abnormality or abnormal enhancement.
The orbits and visualized sinuses appear unremarkable.
No focal suspicious bone marrow signal abnormality.
IMPRESSION:
There is postsurgical change with a metallic plate covering the small
midline parietal skull defect better demonstrated on CT.
There is a 1 cm soft tissue nodule in the scalp posterior to the
plate with mild peripheral enhancement based on fat-suppressed
post-contrast sequence (series 1701, image 27). Enhancement may be
secondary to granulation tissue or vs residual/recurrent lesion. No
abnormal flow voids in this area.
There are several small adjacent vessels in the scalp - communication
with the superior sagittal sinus is not definitely demonstrated,
however, there may be limitation due to susceptibility artifact from
the metallic plate. The skull is thin with a small outpouching of the
superior sagittal sinus underlying the plate - this is best
demonstrated on post-contrast MP RAGE images (series 1601, image
124).
Post-contrast sagittal images and the MR Venogram demonstrate a
persistent falcine sinus (variant course of the straight sinus). No
dramatically enlarged vessels in the scalp.
MR venogram demonstrates relatively hypoplastic left transverse and
sigmoid sinuses and internal jugular vein. No evidence of venous
sinus thrombosis.
Sulci, ventricles and cisterns are otherwise unremarkable. No
parenchymal signal abnormality, intra-axial or extra-axial mass,
hemorrhage or infarct is detected. No abnormal parenchymal or
meningeal enhancement is detected following contrast administration.
MRA exams of the head without and with contrast are within normal
limits. Signal loss of the right ICA as it enters the skull base is
consistent with artifact related to pneumatized petrous apex. No
abnormal vascularity noted on MRA in the region of the scalp lesion.
IMPRESSION:
Post-operative changes and nonspecific midline parietal scalp nodule.
These findings are nonspecific and correlation with prior pathology
report and pre/post-operative imaging will be important. Differential
includes sinus pericranii or atretic parietal encephalocele with
persistent falcine sinus.
Examination: MRA HEAD W AND WO CONTRAST
Exam Number:
EXAMINATION:
MRI BRAIN WITH AND WITHOUT CONTRAST,
MRA HEAD WITHOUT AND WITH CONTRAST,
MR VENOGRAM HEAD WITH CONTRAST:
HISTORY:
Headaches, prior surgical resection of a lesion - verbal report of an
AVM with connection to superior sagittal sinus.
COMPARISON:
CT brain without contrast
TECHNIQUE:
Sagittal T1, axial T1, FLAIR, GRASE T2, gradient echo, diffusion
weighted images with ADC map reconstruction, and post-gadolinium T1
axial, sagittal and coronal images, post-gadolinium axial T1-weighted
3D MPRAGE and axial T1 postcontrast fat-suppressed images of the
brain. MultiHance 4 mL i.v.
Routine 3D time-of-flight MRA of the head and gadolinium-enhanced MRA
and MRV of the head are evaluated with source images and MIP
reconstructions.
FINDINGS:
Metallic artifact from the plate in the parietal bones limits the
examination. A persistent falcine sinus is noted. The left sigmoid
sinus is atrophic. On the postcontrast images there is a small
outpouching from the superior sagittal sinus to the region of the
plate seen on 1601-119.
The soft tissue nodular density is seen to be rim enhancing on the
post-contrast fat saturated examination seen on series 1701 image 27.
There additionally multiple scalp veins in this region surrounding
the lesion. It is not clear on this examination if any of these
veins traverse parietal sulci to the sagittal sinus.
No intra axial mass, hemorrhage or mass effect. The ventricles, sulci
and basal cisterns are not effaced. No brain parenchymal signal
abnormality or abnormal enhancement.
The orbits and visualized sinuses appear unremarkable.
No focal suspicious bone marrow signal abnormality.
IMPRESSION:
There is postsurgical change with a metallic plate covering the small
midline parietal skull defect better demonstrated on CT.
There is a 1 cm soft tissue nodule in the scalp posterior to the
plate with mild peripheral enhancement based on fat-suppressed
post-contrast sequence (series 1701, image 27). Enhancement may be
secondary to granulation tissue or vs residual/recurrent lesion. No
abnormal flow voids in this area.
There are several small adjacent vessels in the scalp - communication
with the superior sagittal sinus is not definitely demonstrated,
however, there may be limitation due to susceptibility artifact from
the metallic plate. The skull is thin with a small outpouching of the
superior sagittal sinus underlying the plate - this is best
demonstrated on post-contrast MP RAGE images (series 1601, image
124).
Post-contrast sagittal images and the MR Venogram demonstrate a
persistent falcine sinus (variant course of the straight sinus). No
dramatically enlarged vessels in the scalp.
MR venogram demonstrates relatively hypoplastic left transverse and
sigmoid sinuses and internal jugular vein. No evidence of venous
sinus thrombosis.
Sulci, ventricles and cisterns are otherwise unremarkable. No
parenchymal signal abnormality, intra-axial or extra-axial mass,
hemorrhage or infarct is detected. No abnormal parenchymal or
meningeal enhancement is detected following contrast administration.
MRA exams of the head without and with contrast are within normal
limits. Signal loss of the right ICA as it enters the skull base is
consistent with artifact related to pneumatized petrous apex. No
abnormal vascularity noted on MRA in the region of the scalp lesion.
IMPRESSION:
Post-operative changes and nonspecific midline parietal scalp nodule.
These findings are nonspecific and correlation with prior pathology
report and pre/post-operative imaging will be important. Differential
includes sinus pericranii or atretic parietal encephalocele with
persistent falcine sinus.
