Question MRI BRAIN (TUMOR WITH PERFUSION) W W/O CONTRAST (XPD)

ltassin

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Can anyone help me with this report? This is my first time seeing this documented like this. Does this get another CPT or Modifer? 70553 & 76948? TIA!


TECHNIQUE:​


Multiplanar multisequence MR imaging of the brain was performed before and after the administration of mL Clariscan intravenous contrast. SYNAPTIVE Diffusion Tensor Imaging protocol was also performed.

COMPARISON:​

MRI brain with without contrast, 03/17/2022.

FINDINGS:​



INTRACRANIAL:​

Postoperative changes from right temporoparietal craniotomy for resection of right temporoparietal glioblastoma are again demonstrated. Slightly increased size of nodular enhancing area at the medial anterior margin of the resection
cavity now measuring approximately 15 x 16 mm compared to 11 x 11 mm on prior study. More lateral nodular area along the anterior margin now measures 8 x 9 mm compared to 7 x 8 mm on prior study. There is also slightly increased in thick nodular
enhancement along the inferior and posteroinferior margin of the resection cavity. No significant change in band of restricted diffusion along the posterior and medial margin of the resection cavity which is favored to correspond to blood products.
Near complete resolution of enhancement posterior to the resection cavity in the area of involving infarct. Some residual intrinsic T1 hyperintensity remains which could represent cortical laminar necrosis. Abnormal T2 FLAIR hyperintense signal around
the resection cavity is unchanged. No associated significant intracranial mass effect.

Interval development of a 28 x 22 x 12 mm lesion along the right frontal convexity superior to the resection site which appears to be dural based with a thin dural tail (series 28, image 8, series 29, image 105).

No new parenchymal restricted diffusion. No new intracranial hemorrhage. Stable ventricular caliber. Visualized major intracranial vascular structures are normal in course and caliber.

SINUSES:​

Trace bilateral ethmoid and left maxillary sinus mucosal thickening. T2 FLAIR hyperintense T1 mildly hyperintense opacity in the right petrous apex which does not demonstrate enhancement or restricted diffusion. This may represent
proteinaceous fluid.

ORBITS:​

Bilateral lens replacements.

PERFUSION:​


When compared to normal contralateral white matter, relative blood volume is increased in areas corresponding to areas of enhancement along the margins the resection cavity anteriorly, inferiorly and posteroinferiorly (series 29 image 8-11). The new
enhancing lesion along the right frontal convexity also demonstrates increased rCBV

IMPRESSION:​



1. Postsurgical changes of prior right temporoparietal glioblastoma resection. Stable T2 FLAIR hyperintense signal long the right margins of the resection cavity.
2. Slightly increased size of nodular enhancement along the anterior, inferior and posteroinferior margins of the resection cavity with corresponding increased relative blood flow suggestive of progression of disease.
3. New 28 x 22 x 12 mm right frontal convexity lesion which appears to be dural based with a dural tail. This lesion also demonstrates increased or rCBV. This could represent a meningioma or spread of glioblastoma.
 

rosse126

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If I'm not mistaking, SYNAPTIVE Diffusion Tensor Imaging protocol is a type of technique that the Radiology Tech follow; is not an ultrasound. I would just use 70553.
 
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