Self Instructional Manual for Cancer Registrars - SEER - National ...

EXAMPLEE16
MRI CONSULTATIONREPORT
Name: ]na Gateway DOB: 1/10/41
m
10020261 mr018 abdomen/180-22-33 Referring Service, Clinic or FLoor IDATE: 3/20/91
[] Ambulatory [] Bed [] 0z [] OR [] Wheelchair [] PortabLe
[] Isotation
PROCEDURESREQUESTED PRIMARYDIAGNOSIS (REQUIRED) OUTPATIENTICO-9
MRi of Abdomen
CODE
CLINICAL HISTORYPERTINENTTO THIS RA_!nLOGYCONSULTATION(REQUIRED)
I
(INCLUDE PRECAUTIONS:DIABETES, ALLERGIES, ETC.) IserumCreatinine or BUN for CT,
JIVP, Angio
E T ATTENDING PHYSICIANNAME
Report witt be sent to PhysicianOffice, Clinic, Ftoor & Medical
Records
Address (Street, City, State)
Exam
Time
Date & Time Procedure Completed TechnoLogist I.D. Part FiLm Count kVp Ftuoro
8 14 Distance MR
contrast supplies & comments 710 11 PCR MAS Sequences
RADIOLOGY CONSULTATION REPORT
MRN: 180-22-33 Name: Ina Gateway
Proc: MRI OF ABDOMEN (3-20-91)
MRI was performed on a GE Sigma 1.5 Tesla MRI machine. Axial images with TR of 500 and TE
15, slice thickness of 5 mm were taken from the dome of the diaphragm to the iliac wings. Also taken
were axial images with TR 2000 and TE 30/80 with 5-mm thick sections. Coronal sections with TR
500 and TE 15. In addition, axial sections with TR 10 and TE 2.9 with 5-mm thick sections were also
included.
CONCLUSION:
1. A left suprarenal perirenal mass with mixed intermediate signal on T1 and T2 with areas of
peripheral high signal on T1 and T2. The mass measures approximately 2.5 x 2 x 2 cm. This
most likely represents a neuroblastoma with hemorrhage in the left adrenal.
2. No evidence of liver or spleen involvement or metastases.
3. The mass is displacing the left kidney posteriorly, however.
4. No identified skin involvement.
Date 3/20/91 John Doe. M.D.
91