Instruction: Generate impression based on findings.

Input: Female, 69 years old, with falls and changes of handwriting. Assess for cervical myelopathy. Trace retrolisthesis is seen of C4 on C5 and C5 on C6. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous, but no evidence of any concerning marrow replacement or marrow edema is seen.Patchy areas of abnormal signal are evident within the brainstem and the visualized cervical spinal cord. For example, ill-defined abnormal signal is evident within the ventral and left medulla. Additional foci are seen in the left dorsal cord at C3-4, the right dorsal cord at C4-5, and the right lateral cord at C6. At these sites of abnormal cord signal, no evidence of cord swelling is seen, and in fact, some areas show relative volume loss. Of note, many of these areas of abnormal cord signal are located where the spinal canal remains widely patent.Multilevel cervical spondylosis is seen with loss of disc height and endplate irregularity particularly affecting C4-5, C5-6 and C6-7. Additional level specific findings are as follows:C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation which may just contact the ventral cord. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. C5-6: Broad posterior disc-osteophyte complex formation which contacts and indents the ventral cord. Mild to moderate generalized spinal canal narrowing. Moderate to severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation which contacts and perhaps mildly indents the ventral cord. Mild to moderate spinal canal narrowing. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. No significant spinal canal or foraminal stenosis. Incidental note is made of tubular cystic structures within both parotid glands which somewhat resemble focally dilated ducts.

Output: 1. Multiple scattered areas of brainstem and spinal cord signal abnormality are seen. These lesions are not associated with cord swelling, and if anything, there is evidence of cord volume loss which would suggest chronicity. Given that these lesions are found at sites where there is no significant disc disease or canal stenosis, including in the medulla, a systemic process is favored. This could reflect the sequelae of demyelination, prior infection or post infectious/autoimmune myelopathy, sarcoid or SLE among others.2. Multilevel disc degeneration is seen most severely affecting C4-5 through C6-7. There are mild to moderate areas of spinal canal stenosis through this region, and at C5-6, the neural foramina are significantly narrowed.3. Incidental note is made of tubular cystic structures within the parotid glands which could represent focally dilated ducts. The etiology for this finding is uncertain though such lesions can be associated with connective tissue disorders.


Instruction: Generate impression based on findings.

Input: Left parietal progressive glioblastoma and history of facial soft tissue rhabdomyosarcoma. There are postoperative findings related to left parietal craniotomy. There has been interval increase of the residual focus of nodular enhancement that measures up to 12 x 17 mm in the axial plane along the medial aspect of the resection cavity. Diffuse linear enhancement along much of the posterior margins of the resection cavity and the surrounding confluent T2 hyperintensity appear stable to slightly more prominent. Furthermore, there is interval increase in size of an enhancing extra-axial lesion along the left lateral temporal lobe convexity, which measures 14 x 16 mm in the axial plane. There is an unchanged anterior left middle cranial fossa arachnoid cyst. There is no significant midline shift. There is no evidence of acute territorial infarction. There is right tympanomastoid fluid. The regional extracranial structures are unchanged.

Output: 1. Findings suggestive of interval tumor progression in the left parietal lobe region treatment bed.2. Interval increase in size of the extra-axial lesion, which may represent a radiation-induced meningioma


Instruction: Generate impression based on findings.

Input: 56-year-old male status post syncope. There is no evidence of intracranial hemorrhage, mass or edema. Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Periventricular and deep white matter diffuse hypodensities consistent with small vessel ischemic disease, age indeterminate. If there is clinical concern for stroke, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Study is significantly limited due to motion artifact.There is no evidence of cord compression. There is normal alignment of the vertebral body with no major vertebral body collapse seen. There is exaggerated cervical lordosis and thoracic kyphosis.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: 18-year-old boy with history of gunshot wound and swelling, evaluate for osteomyelitis. BONES: There is abnormal T1 and STIR signal involving the first metatarsal diaphysis with loss of the normal cortex along the dorsal and plantar aspects (series 601, image 27; series 401, image 11). Additionally, this area enhances indicating active inflammation.There is also abnormal T1 and STIR signal with enhancement involving the base of the second metatarsal (series 701, image 31; series 1101, image 32) and the middle cuneiform (series 701, image 37; series 1101, image 38). No cortical destruction is identified.SOFT TISSUES: Abnormal decreased T1 and increased signal is seen extending from these areas of cortical loss to the skin on both the dorsal and plantar surfaces of the foot. There is a small amount of fluid tracking along the medial aspect of the second metatarsal base (series 701, image 28) but no discrete, drainable fluid collection is identified. The muscles and tendons of the foot appear normal.

Output: Osteomyelitis involving the first metatarsal diaphysis with extension into the second metatarsal base and middle cuneiform.


Instruction: Generate impression based on findings.

Input: 73 years Female (DOB:2/17/1943)Reason: Headaches with + romberg. ? mass History: + Romberg, dull headache daily. History of lung cancer. Possible metastatic diseasePROVIDER/ATTENDING NAME: RENUKA MALIK RENUKA MALIK The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of tobacco and alcohol use, history of pancreatitis (2014) with abnormal MRCP, no follow-up ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: Parenchymal atrophy with diffuse dilation of the main pancreatic duct measuring 6 mm in the mid body. No pseudocyst is present. Edema type signal surrounds the distal body and tail suggestive of a component of acute pancreatitis. There is a 4 mm filling defect within the distal dural pancreatic duct at the level of the ampulla that may represent a stone. Additional smaller filling defects are noted in the distal pancreatic duct. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcentimeter T2 hyperintense lesions in the left L1 vertebral body is unchanged.OTHER: Right greater than left small pleural effusions. Small aneurysmal dilations of the branches of the GDA measuring 4 x 6 mm and 5 x 7 mm. Rind of T2 hypointense signal with mild enhancement surrounding the SMA is slightly increased since the prior examination.

Output: 1.Acute on chronic pancreatitis with small stones in the main pancreatic duct as described above. 2.Rind of T2 hypointense signal with mild enhancement surrounding the SMA is slightly increased since the prior examination may represent vasculitis or fibrosis.3.Small aneurysmal dilations of the branches of the GDA measuring 4 x 6 mm and 5 x 7 mm. Follow up is recommended - with a CTA4.Right greater than left small pleural effusions.


Instruction: Generate impression based on findings.

Input: There are expected postoperative changes from a Chiari decompression and revision. The neoforamen magnum is patent and the cerebellar tonsils are unchanged in position. There is residual T2 signal abnormality along the tract of a prior right frontal ventriculostomy catheter. The ventricles and sulci are normal in size. There are no intracranial masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There is no abnormal intracranial enhancement. A faint focus of susceptibility in the left parietal white matter is nonspecific and unchanged. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. There is preseptal edema and enhancement in the lateral periorbital tissue of the left eye. Additionally, there is a small focus of abnormal T2 signal behind the left globe. There is a subperiosteal collection measuring 2.2 x 1.2 x 2.6 cm (transverse by craniocaudal by AP) along the superior left orbital wall which displaces the superior rectus muscle inferiorly and flattens the superior aspect of the globe. This collection is predominately low signal on T2 weighted images and has layering high T1 signal. However, it only minimally enhances and does not restrict on diffusion-weighted imaging.

Output: 1. Left preseptal edema and enhancement is consistent with preseptal cellulitis with a small focus of post septal extension indicating orbital cellulitis.2. Left superior orbital subperiosteal collection, with mass effect on the adjacent superior rectus muscle, with internal layering high T1 signal; given location and clinical history, this could represent an abscess with internal hemorrhage. A fungal etiology should also be considered given a significant amount of T2 hypointense signal. If there is clinical concern for osseous involvement, CT of the orbits may be considered for further evaluation of the bony structures. 3. Postsurgical changes of a Chiari decompression without evidence of intracranial edema, infarct, or hemorrhage.Findings discussed via telephone by Dr Katzman with Dr Frim prior to this dictation on 1/16/2016.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with ataxia, status post surgery, assess for spinal cord compression. Findings are redemonstrated compatible with T7-T12 instrumented posterior fusion with laminectomy from T8 through T10, partial T9 corpectomy, and T9-10 discectomy.Although orthopedic instruments are not well assessed on MRI, they do appear to be in grossly stable position, and there is no evidence of any significant edema within the instrumented vertebral bodies.Since the prior examination, a superficial soft tissue fluid collection running along the operative bed has resolved. No new subcutaneous or epidural collections are suspected. Soft tissue prominence within the laminectomy bed on the prior examination has also resolved, and with it, the spinal canal from T8 through T10 has expanded.There remains some thinning of the spinal cord centered at the T9 level with perhaps mild associated cord T2 hyperintensity compatible with myelomalacia. Elsewhere, no significant cord signal abnormality is seen. Spinal alignment is anatomic. Aside from postoperative findings, no significant marrow signal abnormal is seen.A disc protrusion at T3-4 continues to exert mild mass effect upon the left ventral spinal cord similar to prior. Narrowing of the spinal canal does persist at T11-12 secondary to degenerative disc disease and posterior element hypertrophy.

Output: 1.Redemonstration of postoperative findings with no evidence to suggest acute disruption of the orthopedic instruments.2.Since the prior examination, epidural swelling in the T8-T10 laminectomy bed has improved with resultant expansion of the spinal canal.3.A disc protrusion at T3-4 causing mild mass effect upon the spinal cord, and generalized spinal canal narrowing at T11-12 due to disc and posterior element degeneration, have not significant changed. No new areas of spinal canal stenosis or cord compression are seen.


Instruction: Generate impression based on findings.

Input: Reason: patient with sub-acute weakness, and muscle wasting, elevated CK, CRP c/f myositis. Obtaining MR to look for myositis. History: above Left femur:On the fat-saturated T2-weighted images, there is edema type signal abnormality within the adductor musculature of the left hip and thigh as well as within the hamstrings, with relative sparing of the semitendinosus muscle. There is perhaps also mild edema within the rectus femoris and vastus medialis, proximally, but we see no additional edema within the quadriceps musculature. Overall the muscles appear slightly atrophic, which is not unusual considering the patient's age. Severe osteoarthritis affects the left knee. Moderate osteoarthritis affects the left hip. There is patchy intermediate signal intensity within the proximal femur likely representing residual islands of red marrow. There is a small to moderate knee joint effusion.Right femur:On the fat saturated T2-weighted images there is edema of the adductor musculature of the right hip and thigh as well as within the hamstring musculature, with relative sparing of the semitendinosus muscle. There is mild edema of the vastus medialis, proximally. The remainder of the quadriceps appears spared. The sartorius appears spared. Severe osteoarthritis affects the right knee. There is a moderate sized right knee joint effusion. There is fatty atrophy of the musculature of the hip and thigh which is not unusual considering the patient's age. There is prominence of fat along the anterolateral aspect of the distal femur deep to the lateral retinaculum, representing a lipoma.

Output: Largely symmetric myositis pattern of the hip and thigh musculature as described above.


Instruction: Generate impression based on findings.

Input: Follow-up exophytic right renal lesion. ABDOMEN:LIVER, BILIARY TRACT: Normal morphology without a focal lesion on this limited nonenhanced study. Status post cholecystectomy. Mild common and central bile duct dilatation likely reflects postcholecystectomy state. It tapers smoothly at the ampulla without a focal lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic right renal T2 hyperintense 1.2 cm lesion is incompletely characterized without contrast but is most compatible with a simple cyst. It has minimally grown from the 2012 study. No suspicious mural nodularity or signal intensity. No hydroureteronephrosis or other suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Limited noncontrast study. The exophytic right renal cystic lesion is most compatible with a simple cyst, minimally increased from the 2012 study without suspicious imaging characteristics.


Instruction: Generate impression based on findings.

Input: 68-year-old female with pain on ambulation and right foot swelling. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is within normal limits.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. ARTICULAR SURFACES AND BONE: There is subchondral cyst formation within the medial tibial plafond. Osteoarthritis affects the tibiotalar joint. Severe osteoarthritis affects the second tarsometatarsal joint with underlying bone marrow signal abnormality likely degenerative in etiology. There is soft tissue swelling in the surrounding area. Additionally, there is also increased bone marrow signal abnormality identified more distally within the proximal metadiaphysis of the second metatarsal which is suspicious for stress reaction. There is no definite cortical disruption to confirm a stress fracture.ADDITIONAL

Output: 1. Osteoarthritis of the second tarsometatarsal joint and dorsal soft tissue swelling in the surrounding area.2. Possible stress reaction within the proximal metadiaphysis of the second metatarsal.


Instruction: Generate impression based on findings.

Input: Redemonstration of postoperative changes from a suboccipital craniotomy with resection of the posterior C1 arch. A postoperative extradural fluid collection is again seen within the overlying soft tissues now measuring 2.9 x 0.7 x 0.9 cm (previously 4.5 x 7.0 cm x 2.8 cm, which has significantly decreased in size. As before there is no significant mass effect upon the adjacent neo-dura. There is irregular, peripheral enhancement about this fluid collection, as well as within the soft tissues along the operative path, however there is no intradural enhancement. The cerebellar tonsils retain a pointed configuration and a previously demonstrated thin process extending through the posterior CSF space appears less anteriorly bowed, thus resulting in an increase of the CSF space posterior to the cerebellar tonsils. Commensurate with this is an increase in the amount of biphasic CSF flow at the level of the cerebellar tonsils.There are no fractures or subluxations. The marrow signal is benign, including a stable benign hemangioma within the C6 vertebral body. C2/3: Unremarkable and unchanged.C3/4: Unremarkable and unchanged.C4/5: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis. These findings are unchanged.C5/6: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis. These findings are unchanged.C6/7: Unremarkable and unchanged.C7/T1: Unremarkable and unchanged.

Output: 1.A postoperative extradural fluid collection is again seen within the overlying soft tissues now measuring 2.9 x 0.7 x 0.9 cm (previously 4.5 x 7.0 cm x 2.8 cm, which has significantly decreased in size. As before there is no significant mass effect upon the adjacent neo-dura. There is irregular, peripheral enhancement about this fluid collection, as well as within the soft tissues along the operative path, however there is no intradural enhancement. 2.A previously demonstrated thin process extending through the posterior CSF space appears less anteriorly bowed, thus resulting in an increase of the CSF space posterior to the cerebellar tonsils. Commensurate with this is an increase in the amount of biphasic CSF flow at the level of the cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Male; 49 years old. Reason: hx of prostate cancer, surgery to follow History: see above PELVIS:PROSTATE:Prostate Size: 2.8 x 4.7 x 4.9-cmPeripheral Zone: Small focus of T2 hypointense signal with restricted diffusion in the posterior mid gland near the central gland and just to the right of the midline is similar to prior study (series 904/264). No additional focus suspicious for prostate cancer.Central Gland: Heterogeneous.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing right inguinal hernia.OTHER: No significant abnormality noted.

Output: No significant interval change in probable small focus of prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is interval decrease in extensive mucosal thickening and fluid in the ethmoid air cells, left frontal, bilateral maxillary and sphenoid sinuses. There is also interval decrease in fluid within the bilateral middle ears and mastoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of PRES.2. Decrease in extensive mucosal thickening and fluid within the paranasal sinuses and mastoid air cells since the prior MRI, although signs of acute sinusitis persist.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of renal carcinoma status post partial nephrectomy. Evaluate renal cyst and for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: Steatosis. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable enhancing left adrenal nodule with signal loss on out of phase images measuring 1.6 cm (series 10 image 23), consistent with a lipid rich adrenal adenoma.KIDNEYS, URETERS: Postsurgical changes from a right renal inferior pole partial nephrectomy with adjacent susceptibility artifact. There is no evidence of recurrent or residual tumor locally. No regional lymphadenopathy. The right renal vein is patent. There is a subcentimeter right renal interpolar cyst with a thin septation, unchanged.Minimally complex cyst with several enhancing septations in the left renal upper pole measuring 2.2 x 2.0 cm (series 7 image 17), unchanged. Additional left renal simple cysts are again noted.RETROPERITONEUM, LYMPH NODES: A few nonspecific subcentimeter retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable left upper pole renal cyst with enhancing septations.2.Postsurgical changes from a right renal inferior pole partial nephrectomy without evidence of residual/recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6] / Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: pituitary adenoma, 6 month follow up eval for changes History: 6 month follow up No evidence of acute ischemic or hemorrhagic lesion.There are pituitary macroadenoma sized about 32.3mm x 40.3mm on sagittal post contrast scan, unchanged since prior scan. The MR characteristics do not show any interval change either.Right frontal craniotomy is again seen with underlying encephalomalacia unchanged. Multiple meningiomas including tentorial based left occipital location, right frontal convexity, left anterior sylvian fissure area, and anterosuperior aspect of the falx, do not show any interval change in terms of size, configuration and MR characteristics since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Pituitary Gland MRIPost transsphenoid surgery status.There is a large pituitary gland mass which does not show any interval change in terms of size, configuration and MR characteristics since prior scan.In particular, there is no change regarding suprasellar and bilateral cavernous sinus extensions since prior scan.There is no midline shift or herniation.The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. Slightly diminutive optic chiasm and bilateral optic nerves indicating atrophic changes are again seen, unchanged.

Output: 1. Post right frontal craniotomy and post transspehnoidal surgery status.2. No change of multiple meningiomas and pituitary macroadenoma since piror scan.3. Slightly atrophic both optic chiasm and bilateral optic nerves, unchanged.


Instruction: Generate impression based on findings.

Input: Further assessment of a sellar mass. Pituitary MRI: The sella is expanded by a heterogeneous mass that measures up to 3.5 cm. The mass demonstrates predominantly peripheral enhancement and contains areas that are T1 and T2 hyperintense superiorly. The suprasellar component of the tumor exerts mass effect upon the optic chiasm. The tumor protrudes into cavernous sinuses, left greater than right. There is effacement of the sphenoid sinuses by the expanded sella.Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There are nonspecific scattered T2 hyperintense cerebral white matter foci that may reflect mild chronic microvascular ischemia. There is no midline shift or herniation. A small retention cyst is present in the left maxillary sinus. Mild ethmoid mucosal thickening is also nonspecific. There are bilateral lens implants.Brain MRA: The sellar and suprasellar mass abuts the cavernous internal carotid arteries, with partial encasement on the left side. The mas also abuts and mildly displaces the A2 segments of the anterior cerebral arteries. There is no evidence of significant steno-occlusive lesions. There is no evidence of cerebral aneurysms.

Output: 1. The sellar and suprasellar mass may represent a craniopharyngioma versus a pituitary adenoma with cystic change and hemorrhage.2. The sellar and suprasellar mass abuts the cavernous internal carotid arteries, with partial encasement on the left side, but no evidence of significant stenosis.


Instruction: Generate impression based on findings.

Input: Male, 94 years old, with gait impairment. Evaluate for spinal stenosis, metastatic disease. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are somewhat heterogeneous but overall benign. Mild endplate edema is seen at the inferior L3 endplate with an associated Schmorl's node deformity. A small focus of STIR hyperintensity within the S2 vertebral body is nonspecific.The visualized distal spinal cord, conus and cauda equina are within normal limits. No epidural abnormalities are suspected.Note is made of severe hydronephrosis and hydroureter on the right. In addition, there are a number of enlarged retroperitoneal lymph nodes. A masslike lesion is partially visualized in the right pelvis.L1-2: Mild facet arthropathy and ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. Moderate disc bulging. Mild spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Moderate facet arthropathy and ligamentum flavum thickening. Mild bulging disc. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L5-S1: Moderate facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Relatively mild degenerative disease of the lumbar spine with no areas of high-grade spinal canal or foraminal stenosis.2.Severe hydronephrosis and hydroureter is evident on the right, in the context of retroperitoneal adenopathy and a probable right pelvic mass which is only partially visualized. Further evaluation with dedicated pelvic imaging is recommended. Findings were discussed with Dr. Campbell at 1:00 PM on 08/03/16.3.No definite osseous metastases are seen. A small focus of signal abnormality in the S2 vertebral body is nonspecific. If concern for osseous metastases persists, further evaluation with a nuclear medicine bone scan may provide additional information.


Instruction: Generate impression based on findings.

Input: 14-year-old female with pain. Evaluate for stress fracture. The distal tip of the second and third metatarsals are incompletely included in the field of viewTENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normalLIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. There are no findings to suggest stress reaction. No linear signal abnormality is identified to suggest a stress fracture.ADDITIONAL

Output: Normal appearing MRI without findings to suggest stress reaction/fracture.


Instruction: Generate impression based on findings.

Input: 83 years Female (DOB:3/20/1933)Reason: rule out posterior circulation issue History: HA, unsteadinessPROVIDER/ATTENDING NAME: RIMAS V. LUKAS THOMAS J. KELLY Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Scattered patchy FLAIR/T2 high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 4.7 x 4.2 mm sized medially projecting lesion at the cavernous sinus segment of the left ICA indicate the possibility of aneurysm arising from the left ICA cavernous sinus. The lesion is a little too proximal and inferiorly direction comparing to typical superior hypophyseal artery aneurysm.There is suspicious fenestration of proximal basal artery which is associated with a small focal outpouching indicate possible small aneurysm (1.6 mm).Otherwise right ICA, bilateral MCAs and ACAs as well as bilateral distal vertebral arteries and bilateral PCAs appear to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. About 4.7mm sized left cavernous sinus segment aneurysm and 1.6mm sized proximal basilar artery aneurysm likely arising from the basilar artery fenestration.


Instruction: Generate impression based on findings.

Input: 54-year-old male with cutaneous T-cell lymphoma. Presents with right eye swelling and purulent drainage. Please evaluate for orbital cellulitis, sinusitis or abscess. Images of the retroseptal space of both orbits remain within normal limits. There is no evidence of any edematous changes of retro-orbital fat. The morphology and density of the globe remains within normal limits bilaterally in both their anterior and posterior chambers. The lens are in normal location.The extraocular musculature and optic nerves remain normal bilaterally.Extensive periorbital preseptal soft tissue thickening anterior to the right orbit is identified. No definitive evidence of any cavity formation or a sinus tract can be identified. The paranasal sinuses are well pneumatized and demonstrate no evidence of acute or chronic sinus disease.Limited images through the brain parenchyma demonstrates large area of low density in the left frontal lobe with no definitive evidence of enhancement. There are no prior CT examination or MRI examination of the brain on this patient's radiology file. This above finding may represent an area of old stroke and encephalomalacia however this should be further evaluated with dedicated CT of brain or an MRI for better evaluation.

Output: 1.Extensive right-sided preseptal periorbital cellulitis. No evidence of abscess formation or a sinus tract2.No evidence of any retroseptal abnormality.3.No evidence of acute or chronic sinusitis..


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of Chiari mouth and patient status post decompression Study limited by patient motion. CERVICAL SPINE:Vertebral body heights and disk spaces are maintained. No abnormal marrow signal.There are postsurgical changes of Chiari decompression with suboccipital craniotomy and resection of the posterior arch of C1 appearing similar to the prior exam. No evidence of tonsillar herniation. There is edema and areas of encephalomalacia within the inferior cerebellum which overall appear similar to the prior exam. A catheter extending from the superior fourth ventricle passing through the dorsal myelotomy defect and terminating with its tip in the dorsal aspect of the upper cervical spine is unchanged in position. Mild dilatation of the fourth ventricle is unchanged.A large septated syrinx extending from C1 to C6 has increased in size proximally but is similar in extent. For example, at the level of C1, the syrinx cavity measures 16 x 14 mm (9/10), previously 12 x 11 mm. At the level of C5, the central canal measures approximately 10 x 7 mm (9/27), previously 11 x 8 mm.Evaluation is limited due to motion, however multilevel cervical spondylotic changes appear similar to the prior exam without significant spinal canal stenosis.THORACIC SPINE:Superior endplate deformities of T7, T8 and T10 appear similar to the prior exam with minimal endplate degenerative changes. Disk spaces are maintained. Small hemangioma within the T7 vertebral body. No significant spinal or neural foraminal stenosis.There is a prominent central canal with a syrinx at the level of C6-C7 which is slightly increased since the prior exam, measuring 5 x 4 mm (18/24). Morphology of the cord throughout the lumbar spine appears distorted, possibly due to traction or atrophy, similar to the prior exam.

Output: Postsurgical changes of Chiari decompression with increasing syrinx at the cervicomedullary junction. A small syrinx within the mid thoracic cord is also slightly increased.


Instruction: Generate impression based on findings.

Input: Right nasal dorsum pain following surgery on 10/24/14. There are partially imaged postoperative findings in the right frontal bone related to resection of a calvarial lesion with mild depression of the scalp into the defect and diffuse areas of T2 hyperintensity and enhancement in the surgical bed. There is moderate diffuse paranasal sinus mucosal thickening. However, the region of the nasal dorsum appears unremarkable. The orbits and imaged intracranial structures also appear unremarkable.

Output: 1. Partially imaged postoperative findings in the right frontal bone with nonspecific signal characteristics within the surgical cavity, which likely represents granulation tissue, although small amounts of residual hemangioma cannot be entirely excluded. However, the nasal dorsum appears unremarkable.2. Findings suggestive of sinusitis.


Instruction: Generate impression based on findings.

Input: Ex-FT female with cardiac arrest on DOL 1 (was down 90 mins), vEEG shows activity concerning for a hypoxic ischemic episode. There are scattered areas of high T1 signal in the cerebral cortex, particularly involving the bilateral perirolandic regions, bilateral hippocampi, bilateral posterior cingulate gyri, and left insula. There is also prominent T1 signal in the bilateral basal ganglia. There is deficiency of white matter T1 hyperintensity in the posterior limbs of the internal capsules and perirolandic regions. There is a punctate focus of susceptibility effect in the left occipital horn. There is high T1 signal and restricted diffusion in the bilateral transverse sinuses. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings compatible with subacute hypoxic ischemic injury in a central and peripheral distribution with delayed myelination.2. Findings suggestive of dural venous thrombosis involving the bilateral transverse sinuses versus flow artifact. An MRV may be useful fir further evaluation.3. Punctate blood products in the left lateral ventricle.Discussed with Dr. Jaideep Singh at 4 PM on 9/28/15.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other idiopathic scoliosis, site unspecifiedClinical question: evaluate for neurological injurySigns and Symptoms: signals lost during surgeryComments: Non infused MRI complete spine. Patient status post surgery for spinal fusion. Signals lost during surgery. All hardware removed. Patient to be in PICU | Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is dextroscoliosis present. There is no compromise of thoracic spinal canal or exiting nerve roots appreciated. The patient is status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a compensatory levocurvature to the lumbar spine. The conus medullaris on sagittal imaging is grossly intact.Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is no compromise to the spinal cord appreciated. No spinal cord compression is identified.2.No abnormal lesion is identified in the spinal cord. Please note that no diffusion sequences were performed for the detection of acute spinal cord infarction.3.Findings were discussed with Dr Sullivan at around 7pm on 11/13/15.4.Status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are identified in the bilateral pedicles of T11, T12, L1 and L2.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions. This is a motion degraded exam affecting several sequences. There are minimal nonspecific scattered punctate bilateral cerebral white matter hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is left maxillary and left ethmoid sinus mucosal thickening. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Minimal nonspecific scattered punctate bilateral cerebral white matter hyperintensity. Otherwise, no evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Please refer to the subsequent MRI report for further information.Exposure time: 58 seconds

Output: Successful fluoroscopic guided left wrist arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: 41-year-old female patient with history of Crohn's disease, ileocolitis, perianal abscess. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense lesion in the right lobe of the liver is too small to characterize but likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 6 cm segment of markedly thickened and enhancing terminal ileum, appearance consistent with active inflammation, lumen narrowed and underlying element of chronicity a consideration. There is mild fibrofatty proliferation at the terminal ileum. No evidence of small bowel obstruction. No evidence of large bowel involvement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Endometrial stripe measures 2.0 cm. Recommend correlation with menstruation. Nabothian cyst formation. Left adnexal cyst is likely physiologic. Trace pelvic free fluid likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a transsphincteric tract that arises from the posterior anus at the 7:00 position, extends into the intersphincteric space, traverses the external anal sphincter and terminates in a collection containing air in the ischioanal fat that measures 1.8 x 1.2 cm (series 20 image 45), compatible with history of perianal abscess with transanal drainage. Intervening more linear appearing fluid-containing tract measures 1.6 x 0.7 cm on image 50 series 20. There are mild adjacent inflammatory changes (series 20 image 45).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acutely inflamed terminal ileum, luminal narrowing seen may be primarily secondary to aforementioned inflammation but an element of underlying chronicity is a consideration, adjacent fibrofatty proliferation present. No additional areas of inflammatory change seen.2.Right perianal transsphincteric fistula with associated abscess formation as described above.3.Likely physiologic thickening of the endometrium and adnexal cyst.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of astrocytoma presenting with headache. Extensive vasogenic edema bilaterally appears similar when compared to recent MRI. No evidence of intracranial hemorrhage. The right subdural hematoma that is seen on prior MRI is no longer identified on current study. The ventricles and basal cisterns are normal in size and configuration. Postoperative changes of the calvarium remain unchanged. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable vasogenic edema. No acute intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Low back pain. The exam is somewhat motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild retrolisthesis of L2 on L3. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below. There is disc desiccation throughout the lumbar spine with relative sparing of L5-S1 level.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There are degenerative changes with significant endplate irregularity and moderate-severe disc narrowing. There is a disc bulge with left greater than right foraminal prominence. There is moderate left and mild right foraminal narrowing. There is prominent epidural fat at this level contributing to moderate spinal canal stenosis. There is thickening and redundancy of cauda equina nerve roots due to spinal canal stenosis.L3-L4: There are shallow biforaminal disc protrusions. Mild to moderate bilateral neural foraminal narrowing is seen. There is mild spinal canal stenosis at this level. There is evidence of facet arthropathy and ligamentum flavum thickening.L4-L5: There is diffuse disc bulge causing mild to moderate foraminal stenosis bilaterally. Mild lateral recess narrowing is also seen bilaterally. There is mild central canal stenosis at this level. There is evidence of facet arthropathy and ligamentum flavum thickening.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Multilevel mild-moderate degenerative changes. Findings are most pronounced at the L2-L3 level causing moderate central spinal canal stenosis and moderate left as well as mild right foraminal narrowing. Associated redundancy and thickening of cauda equina nerve roots. Underlying developmental central spinal canal narrowing secondary to prominence of dorsal epidural fat.


Instruction: Generate impression based on findings.

Input: altered mental status There are multifocal various sized restricted diffusion lesions indicating acute ischemic infarctions on bilateral frontal lobes, bilateral parietal lobes, left caudate nucleus, bilateral insular cortex, left basal ganglia, right temporal lobe, right occipital lobe and left cerebellar hemisphere.Patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicate non specific small vessel ischemic disease.Multifocal various sized susceptibility artifacts on bilateral hemispheres indicate amyloid angiopathy but could also represent parenchymal calcifications. However, the possibility of petechial hemorrhage would be low.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Acom artery is patent but bilateral Pcom arteries are not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate mild (about 20%) of luminal narrowing of the left extracranial ICA just above the carotid bulb. The distal right VA is hypoplastic and the left VA is dominant. Otherwise there is no evidence of major arterial occlusion or stenosis.

Output: 1. Multifocal acute ischemic infarctions as described above without evidence of hemorrhagic transformation.2. No significant luminal stenosis or occlusion intracranially or extracranially. About 20% of luminal stenosis was seen on the left extracranial ICA just above the bifurcation.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. Mild scattered paranasal sinus mucosal thickening presumably related to inflammation.


Instruction: Generate impression based on findings.

Input: resection of sacrococcygeal teratoma as newborn, now with mild elevation in alpha fetoprotein -rule out recurrence ABDOMEN:LIVER, BILIARY TRACT: The liver appears normal. No focal masses are identified.SPLEEN: The spleen appears normal. No focal masses are identified.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal in size and morphology.KIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No retroperitoneal or pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes following sacrococcygeal resection are seen. No enhancing solid or cystic lesions are identified in the abdomen or pelvis to suggest recurrent disease. There is mild enhancement of the soft tissues along the resection tract in the lower posterior pelvis extending to the rectum, likely representing expected postoperative sequelae. OTHER: No significant abnormality noted.

Output: Mild enhancement of a soft tissue tract in the lower pelvis extending from the posterior skin surface to the rectum, likely representing postoperative changes. No specific evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: The evaluation of the study for infection is limited due to the study performed without contrast.The vertebral bodies demonstrate stable mild anterior wedging of L1. Along the anterior superior endplate of L4 there is a small area of low T1 signal with high T2 signal, with no definite corresponding lesion on the previous CT although there is minimal marginal sclerosis noted. This may represent early degenerative changes or an atypical hemangioma. The neural foramina are normal and there is no spinal stenosis at any level of the lumbar spine. There is no evidence of nerve root thickening. There is no epidural fluid collection. No marrow signal abnormality is identified concerning for infection. There is no diffusion restricted "claw sign" to suggest discitis/osteomyelitis. The discs appear normal with no evidence of degenerative changes.The conus ends at the level of L1-L2. Incidentally a thin linear T1 weighted hyperintensity is seen along the dorsal aspect of the distal thecal sac at the level of S1 that represent an incidental fatty filum.There is a small round lesion of CSF signal along the left S2 foramen that measures 6 mm in diameter, and represents a Tarlov cyst.The common bile duct is prominent for age with a diameter of 8 mm. Atrophic kidneys are seen. There is a transplanted kidney that is seen in the right hemipelvis.

Output: 1. No evidence of spinal infection within limitations of noncontrast technique.2. Incidental fatty filum, most likely a normal variant but can be associated with tethered cord. Recommend clinical correlation. 3. Mild stable anterior wedging of L1.


Instruction: Generate impression based on findings.

Input: Reason: suboptimal MRI CSF flow study on 1/3/2015. Radiologist recommended to repeat flow sequence with no additional change to the patient. History: Chiari malformation. There are mildly low-lying cerebellar tonsils. There is intact CSF flow across the anterior foramen magnum, but blunted CSF flow posteriorly at the level of the cerebellar tonsils.

Output: Intact CSF flow across the anterior foramen magnum, but blunted CSF flow posteriorly at the level of the cerebellar tonsils. Please refer to the prior brain MRI report for additional details.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out intracranial mass. Signs and symptoms: Proximal muscle weakness. Nonenhanced head CT:There are few very subtle nonspecific foci of low attenuation in the subcortical white matter of the cerebral hemispheres. Considering patient's age possibility of a small was ischemic disease and demyelinating disease should be considered. Recommend further follow-up with a dedicated brain MRI.There is no evidence of hemorrhage, edema, mass effect or midline shift or hydrocephalus. Calvarium, paranasal sinuses and mastoid air cells are unremarkable.

Output: Very few subtle nonspecific foci of subcortical low attenuation of bilateral cerebral hemispheres. Please follow-up with an MRI exam.


Instruction: Generate impression based on findings.

Input: Female, 80 years old. Limited range of motion. ROTATOR CUFF: There is moderate tendinosis of the supraspinatus tendon, with fibers that appear to run the full extent of the tendon. Questionable partial intrasubstance slitlike tears and articular surface fraying are noted. The supraspinatus muscle appears normal. There is mild to moderate tendinosis of the infraspinatus tendon with bursal surface fraying near the articulation but no full-thickness tear is identified. The infraspinatus muscle is normal. The teres minor tendon and muscle appear normal. There is moderate tendinosis of the subscapularis tendon, without discrete tear identified. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: There is mild to moderate acromioclavicular joint osteoarthritis. There is no significant fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small subchondral cyst in the humeral head. Within the limits of unaugmented exam, the labrum is partially visualized and likely diffusely degenerated.BICEPS TENDON: There is moderate tendinosis of the extra-articular tendon of the long head biceps. The intra-articular portion of the tendon of the long head biceps is not well visualized, likely reflecting additional tendinopathy. ADDITIONAL

Output: 1.Rotator cuff tendinopathy with possible partial intrasubstance tearing and fraying of the supraspinous and infraspinatus tendons as above.2.Tendinopathy of the long head biceps.3.Osteoarthritis of the glenohumeral joint with diffuse labral degeneration.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a retention cyst within right maxillary sinus.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct.2.No evidence of intracranial aneurysm or significant steno-occlusive lesion within the head or neck.


Instruction: Generate impression based on findings.

Input: There is a large area of diffusion restriction involving the right occipital lobe extending into the posterior right temporal lobe. Small area of diffusion restriction is also demonstrated in the left parietal lobe. Punctate areas of diffusion restriction are demonstrated in the bilateral frontal lobes, left occipital lobe, and cerebellum. These foci of restricted diffusion have matching ADC hypointensity. Small areas of gradient susceptibility with T1 hyperintensity are visualized in the right occipital/temporal lobe. Additional small areas of gradient susceptibility likely related to chronic hemosiderin deposition. The ventricles and sulci are prominent, consistent with age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter without restricted diffusion, consistent with chronic small vessel ischemic changes. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.

Output: 1. Findings are consistent with acute/subacute infarction in multiple vascular territories, most prominent in the posterior circulation involving the right occipital/temporal lobes as well as left parietal lobe. Additional numerous scattered foci of ischemia are demonstrated throughout the parenchyma. This distribution is most consistent with an embolic origin.2. Small petechial hemorrhage is visualized in the anterior aspect of the right occipital temporal lobe infarction.3. Additional small areas scattered areas of gradient susceptibility likely related to chronic hemosiderin deposition or other etiology such as amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: Female, 11 months old, with macrocephaly. Assess for hydrocephalus or tumor. Parenchymal morphology and pattern of gyration are normal. The degree of white matter myelination is appropriate for the stated age. No areas of concerning signal abnormality are detected.The pituitary region is within normal limits. The corpus callosum is fully formed and normal. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. No mass or mass-effect is seen. The pattern of intracranial enhancement is within normal limits. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: Axial images are motion greater. Given this caveat:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Ligamentum flavum thickening without stenosis.C6/7: Minimal posterior osteophyte disc complex and uncinate hypertrophy as well as ligamentum flavum thickening. There are no significant stenoses.C7/T1: Unremarkable

Output: Minimal cervical spine spondylosis without significant stenosis.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: eval for pathology, c/o midline/paraspinal pain History: midline/paraspinal pain Thoracic spine MRIThere is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.Lumbar spine MRIThere is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Minimal bulging disc. No neuroforaminal narrowing or spinal stenosis. L5-S1: Minimal bulging disc. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Minimal bulging of disc facet the level of L4-5 and L5-S1.2. No evidence of neuroforaminal stenosis or spinal stenosis on thoracolumbar spine.3. Spinal cord signal intensity is normal.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness Other convulsions. Please follow MRI STEALTH PROTOCOL for surgical planning. Thank you. There is a ring-enhancing lesion measuring 23 x 18 mm axial dimensions located in the right parietal lobe. It is associated with surrounding T2 and FLAIR signal hyperintensity. This T2 and FLAIR signal hyperintensity was also present on the prior exam and is of similar extent.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucous retention cysts which are unchanged since the prior exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Ring-enhancing lesion in the right parietal lobe in general appears to be stable compared to the prior exam.2.Examination was obtained for surgical planning


Instruction: Generate impression based on findings.

Input: 61-year-old female with altered mental status and right facial droop. Evaluate for CVA. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse, mild periventricular hypodensities likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate without acute cortical stroke.If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: The study is limited secondary to motion especially in the upper cervical region.The mild abnormal cord signal at C3-C4 level with mild decreased caliber of the cord appears stable from prior exam. An area of myelomalacia centered at C5-C6 with cord thinning is also unchanged. The signal intensity and caliber of the rest of the cord is otherwise unremarkable. There is evidence of instrumented anterior cervical fusion at C5-C6 with osseous fusion. Vertebral body heights and alignment are unremarkable. There is revisualization of slight straightening of cervical lordosis similar to prior exam.C2-C3: Stable small posterior disk osteophyte complex with minimal bilateral neural foraminal compromise, unchanged since prior study. There is no cervical canal narrowing at this level.C3-C4: Demonstrates large posterior disk osteophyte complex with bilateral uncovertebral joint hypertrophy. There is resultant significant compromise of bilateral neural foramina and at least moderate central spinal stenosis which may have slightly progressed since the prior examination. A hyperattenuating on T1 and T2 lesion is seen within the C4 vertebral body that is consistent with hemangioma.C4-C5: Demonstrates large posterior disk osteophyte complex with bilateral uncovertebral joint hypertrophy. There is moderate narrowing of bilateral neural foramina, unchanged compared to the prior examination. There is no spinal canal stenosis.C5-C6: There is complete fusion of the disk space and placement of fixating screws at C6 and C7. There is no spinal canal stenosis. There is stable moderate left and mild right compromise of neural foramina at this level. Not significantly changed since prior study.C6-C7: Demonstrate mild to moderate degenerative disk disease with resultant mild compromise of bilateral neural foramina and no significant central spinal stenosis.C7-T1: Mild degenerative changes changes with disc osteophyte complex and small central protrusion without significant central canal or neural foraminal narrowing.Partially visualized upper thoracic cord and spine to T3 level is unremarkable.

Output: 1. Stable myelomalacia at C3-C4 and C5-C6 level. No new cord lesions are seen.2. Spondylotic changes, perhaps minimally progressed at C3-4, elsewhere stable, and post-operative findings of the cervical spine as described above.


Instruction: Generate impression based on findings.

Input: There are multiple enhancing lesions through much of the axial skeleton superimposed upon a background of fat signal in portions of the thoracic and lumbar spine, likely related to radiation therapy. There are postsurgical findings related to recent laminectomy at L3 and L4, with diffuse enhancement of the soft tissues in the surgical bed. There is mild protrusion of tumor posteriorly from the L3 vertebral body, which in conjunction with degenerative spondylosis markedly narrows the left L3-4 neural foramen. Otherwise, degenerative spondylosis results in narrowing of the right L3-4 and bilateral L4-5 neural foramina, as well as right lateral recess narrowing at L5-S1. There is a small central disc extrusion at T7-8 with no significant central spinal or foraminal stenosis. There are defects in the T12 through L4 endplates associated with tumor, most pronounced at L1 with 50 % loss of height centrally. The spinal cord appears unremarkable. There is no spondylolisthesis. There are bilateral renal cysts.

Output: 1.Lesions throughout the axial skeleton are compatible with multiple myeloma. The lesion at L3 is slightly expansile and narrows the left L3-4 neural foramen and left lateral recess in association with degenerative spondylosis. 2.Postoperative findings related to recent laminectomy at L3 and L4, with narrowing of the bilateral L3-4 and L4-5 neural foramina due to degenerative spondylosis.3.Defects in the T12 through L4 endplates associated with tumor, most notably at L1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 33 years old Reason: R/O Rotator Cuff Derogate (?). History: Right shoulder injury, one month ago while lifting a patient ROTATOR CUFF: There is mildly increased signal intensity in the supraspinatus tendon and anterior fibers of the infraspinatus suggesting mild tendinosis. Minimal irregularity of the bursal surface fibers may represent mild bursal surface fraying but we see no discrete rotator cuff tear. Supraspinatus and infraspinatus muscles are normal in appearance. Teres minor muscle and tendon as well as subscapularis muscle and tendon are normal in appearance.SUPRASPINATUS OUTLET: AC joint alignment is within normal limits however there is edema along the joint capsule suggesting sprain. There is also mild edema within the distal clavicle but we see no fracture. Mild edema in the subdeltoid bursa may reflect mild inflammation but no frank fluid collection is evident. There is also mild edema along the coracoclavicular ligament which may reflect mild sprain.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. Given the limitations of a nonarthrographic study the glenoid labrum appears normal. No joint effusion.BICEPS TENDON: The long head of the biceps tendon appears normal.

Output: 1.Sprain of the AC joint capsule and coracoclavicular ligament.2.Very mild rotator cuff tendinosis and other findings as described above but no discrete rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Clinical question: Encephalopathy. Signs and symptoms: AMS. Pre and post enhanced brain MRI:Diffusion weighted series demonstrate numerous tiny foci of restricted diffusion involving subcortical, periventricular, corpus callosal, bilateral basal ganglial (R>L), left occipital and left inferior cerebellum consistent with the scattered foci of acute stroke in the distribution of small vessels.Examination additionally demonstrate extensive periventricular and subcortical as well as bilateral basal ganglia, left thalamus and pontine foci of FLAIR and T2 hyperintensity consistent with extensive chronic small vessel ischemic strokes. Few of the chronic ischemic changes demonstrate susceptibility signal consistent with minimal hemorrhage.The cortical sulci, ventricular system and CSF spaces are within normal for patient of stated age and with maintained midline.Post contrast images demonstrate a single punctate focus of enhancement of a minimally hemorrhagic right basal ganglia acute stroke and unremarkable otherwise.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat postcontrast enhanced series. Bilateral mastoid air cells and middle ear cavities as well as all paranasal sinuses demonstrate normal pneumatization signal patterns. Note however is made of severe leftward deviation of nasal septum.Pre- and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C3-C4 demonstrate degenerative changes with asymmetric left facet and the left uncovertebral hypertrophy changes. Findings result seen significant left neural foraminal compromise and without compromise of the right neural foramina or spinal canal.C4-C5 demonstrate moderate disc disease and loss of disc height, mild bilateral (L>R) facet and ligamentum flavum hypertrophy. No spinal stenosis, patent left and moderate right neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet hypertrophy and mild asymmetric left uncovertebral hypertrophy. Constellation of changes results in mild to moderate left neural foraminal compromise, patent right neural foraminal and no central spinal stenosis.C6-C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Postcontrast images demonstrate mild expected enhancement of degenerative changes in particular of the endplates at C4-C5 level and unremarkable otherwise.

Output: 1.Brain MRI demonstrate diffuse scattered tiny foci of cortical, subcortical, corpus callosal, bilateral basal ganglia, left occipital and left cerebellar restricted diffusion consistent with acute ischemic strokes. Extensive chronic small vessel ischemic strokes both in supra and infratentorial parenchyma is also noted with few demonstrating minimal internal hemorrhagic changes. There is no detectable abnormal enhancement. No appreciable mass effect or midline shift. Please see above comments.2.Cervical MRI demonstrate degenerative changes without evidence of central spinal stenosis. Multilevel neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of cervical and upper most visualized thoracic cord. Postcontrast images demonstrate expected enhancement of degenerative changes and unremarkable otherwise.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity in subcortical and periventricular white matter without associated mass effect, strict diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening can be found throughout the paranasal sinuses without superimposed fluid levels. The mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of a subcutaneous lipoma in the left paramedian cervico-occipital region.

Output: Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 63 year old male s/p cardiac transplant. Referred for vasodilator stress MRI to evaluate for transplant vasculopathy.MEDICATIONS: Metoprolol, Pravastatin, Amlodipine, Prograf, Cellcept, Keppra, Synthroid, Aspirin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 55 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 18 ml/m2 (normal range 25+/-9), the LVESV is 39 ml (normal range 47+/-19), the LV mass index is 54 g/m2, and the LV mass is 118 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Transplant morphology present.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 59 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 48 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (31mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 68%).4. Normal RV size and systolic function (RVEF 63%).5. Mild dilation of main pulmonary artery.


Instruction: Generate impression based on findings.

Input: An 82 year old male with personal history of coronary artery disease and persistent atrial fibrillation s/p ablation, referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 76 ml/m2 (normal range: 74+/-15), the LVEDV is 185 ml (normal range 142+/-34), the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9), the LVESV is 104 ml (normal range 47+/-19), the LV mass index is 49 g/m2 (normal range 85+/-15), and the LV mass is 119 g (normal range 164+/-36). There is global hypokinesis. There is late gadolinium enhancement at the basal segment of the inferior and infero-lateral walls in a pattern that spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. Left AtriumThe left atrium is severely dilated (166ml). Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 99 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function, the LVEF is 44%. 2. There is late gadolinium enhancement at the basal segment of the inferior and infero-lateral walls in a pattern that spares the endocardium. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. 3. The left atrium is severely dilated. 4. The right ventricle is normal in size with mildly reduced systolic function, the RVEF is 48%. 5. The right atrium is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Contrast opacified the radiocarpal joint in the expected manner. Contrast also traversed the articular disc of the triangular fibrocartilage complex near the radial attachment, extending into the distal radioulnar joint. No contrast was seen in the midcarpal space. Please refer to the subsequent MRI report for further information.Exposure time: 1:49

Output: Successful left wrist arthrogram with tear of the articular disc of the triangular fibrocartilage complex.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, history of metastatic breast cancer with right-sided headache and vision changes. Assess for metastases. On comparison with the prior examination, marrow signal intensity on precontrast images is somewhat diffusely lower than what was seen on the prior examination. This is particularly notable in the clivus, but the calvarium, occipital condyles, and visualized cervical spine also show similar features. These areas of marrow signal change show no evidence of frankly pathologic enhancement.A few scattered small T2 hyperintense lesions are evident within the cerebral hemispheres, unchanged. No parenchymal edema, mass effect or pathologic enhancement is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. A focus of susceptibility along the posterior body of the left lateral ventricle is unchanged and of uncertain significance. Ventricular size and morphology are unchanged.

Output: 1. No definite evidence of brain parenchymal metastasis is seen. No findings to suggest leptomeningeal disease are evident.2. A generalized reduction in bone marrow signal intensity, most notable within the clivus, and could represent marrow reconversion secondary to treatment-related anemia, or perhaps a technical artifact due to differences in imaging parameters. The nondestructive and fairly uniform nature of these findings, along with lack of concerning findings in these areas on a recent PET CT, argue against bony metastatic disease. If clinical concern warrants, CT imaging can be considered to verify osseous integrity.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for HNP. Signs and symptoms: Low back pain radiating down left leg with DF plus PF thickness. Nonenhanced lumbar MRI:The alignment of vertebral column remains anatomical.The signal intensity of the vertebral column is unremarkable other than changes related to degenerative disease.Unremarkable lower most visualized thoracic spine and thoracic cord.T12-L1 demonstrate minimal degenerative disease without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate mild disc disease without spinal stenosis or neural foraminal compromise.L2-L3 is unremarkable.L3-L4 is unremarkable other than mild degenerative changes.L4-L5 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes including minimal bilateral facet effusion. There is a large left-sided disc extrusion with significant mass effect and posterior displacement of left S1 nerve root in the left lateral recess, subtle mass effect on the thecal sac without central spinal stenosis. There is also subtle mass effect by the herniated disc on the right S1 nerve root.

Output: 1.At L5-S1 there is a large left-sided disc extrusion with resultant significant mass effect on the left lateral recess and left S1 nerve root and minimal mass effect on the right S1 nerve root. No spinal stenosis or appreciable neural foraminal compromise.2.Mild degenerative changes at other levels however without spinal stenosis or neural foraminal compromise as detailed per level above.3.Unremarkable lower most visualized thoracic spine and thoracic cord.


Instruction: Generate impression based on findings.

Input: Reason: Glioblastoma sp/Clinical Investigation History: GBM Exam is somewhat motion limited. There is been interval expected evolution of previously seen postoperative changes relating to left parietal occipital craniotomy for resection of underlying mass, with decreased hemosiderin along the left occipital surgical tract. Overall, the rind of nodular enhancement surrounding the irregular resection cavity has increased in thickness. Perfusion imaging does demonstrate prominence of elevated are CVP especially along the medial margin of the area of peripheral enhancement. There is similar extent of ependymal enhancement along the left occipital horn.The vasogenic pattern of T2/FLAIR hyperintensity within the left temporal and occipital lobe white matter has slightly further progressed, with increased medial extension along the splenium of the corpus callosum as well as in the left paramedian posterior parietal subcortical white matter (401/18-19). There is mild dural enhancement and thickening underlying the craniotomy flap, likely postoperative. Enhancement along the surgical tract extending to the bone is slightly more conspicuous.A subtle subcortical enhancing curvilinear structure is again seen in the right temporal lobe, likely a developmental venous anomaly. There is effacement of the occipital horn of the left lateral ventricle, similar to prior. There is no midline shift. The basal cisterns are maintained. The major cerebral flow voids are intact.Incidental note is made of a small area of enhancement along the left lateral frontal scalp which now extends to the skin surface, previously more ring-enhancing appearance. This resides in the left temporalis muscle, and correlation with physical exam is recommended as this may correlate with previous site of stereotactic frame attachment.

Output: 1.Interval expected evolution of postoperative changes related to recent left parieto-occipital tumor recent reexcision. Interval increased thickness of peripheral heterogeneous and nodular rind of enhancement, with hyperperfusion suggested along the medial margin, concerning for tumor progression.2.No significant interval change in left occipital ependymal enhancement. 3.Slight medial progression of vasogenic pattern of nonenhancing nonspecific T2/FLAIR hyperintensity within the left posterior cerebral white matter, which remains nonspecific.


Instruction: Generate impression based on findings.

Input: 87 years Male (DOB:12/6/1928)Reason: Outside Request: pt has pacemaker known to Dr. Moss of cardiac EP service. Scan to be coordinated w/FNA of lesion by Dr. Christoforidis; surface coil sequences per Dr. Ginat History: Disorder of trigeminal nerve, unspecified| Disorder of facial nerve, unspecified| Sixth (abducent) nerve palsy, unspecified eye| Third (oculomotor) nerve palsy, right eye|PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY MRI cavernous sinuses:An infiltrating lesion is present along the lateral aspect of the right cavernous sinus which extends into the right foramen of volume as well as the right foramen rotundum and the right superior orbital fissure. The extent of the lesion is relatively stable compared to the November exam. The lesion within the right orbital apex appears a little before on the current exam compared to the prior and extends adjacent to the optic nerve sheathThere is new enhancement of the right trigeminal nerve along its cisternal segment and Meckel's cave.There is enhancement and thickening of the nerve root within the foramen rotundum and foramen ovale as well as nerve roots coursing the right superior orbital fissure.There is no abnormal enhancement appreciated along the course of the seventh cranial nerve.MRI orbits:An infiltrating lesion is present along the lateral aspect of the right cavernous sinus which extends into the right foramen of volume as well as the right foramen rotundum and the right superior orbital fissure. The lesion does appears to involve the Meckel's cave and the cisternal segment of the trigeminal nerve. There is enhancement and thickening of the nerve root within the foramen rotundum and foramen ovale as well as nerve roots coursing the right superior orbital fissure.The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .There is a T2 signal hyperintensity and contrast enhancement along the right-sided muscles of mastication.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and the visualized portions of the superior sagittal sinus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense patchy lesions are present in the brainstem. These are all stable when compared to the prior examThe visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Findings suggest an infiltrating lesion centered along the lateral aspect of the right cavernous sinus and extending into the right foramen ovale, and partially into the right foramen rotundum and right superior orbital fissure. There is associated enhancement along the right trigeminal nerve including cisternal segment as well as components in the Meckel's cave and cavernous sinus and the branches in the foramen ovale, foramen rotundum and superior orbital fissure. The lesion appears a little more fall within the right orbital apex on the current versus prior exam which could represent some subtle interval progression. Differential considerations include infiltrating neoplasm and granulomatous disorder. 2.Findings compatible with dilatation atrophy of right-sided muscles of mastication.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Patchy lesions in the brainstem are likely vascular related.


Instruction: Generate impression based on findings.

Input: Left hip pain ACETABULAR LABRUM: Note that evaluation of the acetabular labrum is limited by lack of intra-articular contrast. Within these limits, there is no gross labral detachment.ARTICULAR CARTILAGE AND BONE: There is no abnormal marrow signal within the left hip. There is no fracture or malalignment. Mild osteoarthritis affects the hip.SOFT TISSUES: Mild amount of edema is noted along the greater trochanters bilaterally which is not necessarily of any clinical significance. The musculature of the pelvis is normal in signal intensity and caliber.ADDITIONAL

Output: Unremarkable MRI of the left hip.


Instruction: Generate impression based on findings.

Input: Male, 66 years old, with worsening mental status in the setting of hyponatremia correction. Diffusion-weighted images are unremarkable. No significant parenchymal edema or mass effect is detected.Patchy periventricular T2 hyperintensity is seen along with chronic basal ganglia and pontine lacunar infarcts.No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The frontal horns of the lateral ventricles are mildly prominent likely reflecting ex vacuo dilatation. Otherwise the ventricular system is within normal limits.A large left frontal scalp lipoma is seen. Marrow signal characteristics are unremarkable.

Output: 1. No evidence of acute ischemia or any other definite acute intracranial abnormality.2. No findings to suggest osmotic demyelination or any other process which would account for the patient's worsening mental status.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for extension of CVA signs and symptoms: Dysphagia Nonenhanced CT of brain: Bilateral cerebellar strokes with no evidence of hemorrhagic conversion.Multiple supratentorial subcortical and periventricular white matter low attenuation consistent with patient's known prior strokes remains similar. There is a small left parietal nonhemorrhagic cortical stroke since prior exam. This may represent extension of the previously noted stroke or a new cortical stroke. Review of prior MRI examination demonstrated a small cortical stroke at this site on 8 -- 10 -- 2010.No evidence of intracranial hemorrhage, mass effect, midline shift or hydrocephalus.

Output: 1.No definitive evidence of any new stroke.2.No evidence of hemorrhagic transformation.3.Better delineation of areas of stroke secondary to further evolution of multiple strokes.


Instruction: Generate impression based on findings.

Input: 69 years, Male, Reason: prostate cancer History: prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.8 x 2.8 x 3.8 cmPeripheral Zone: There is a large lesion in the in the left peripheral zone, extending from the base to apex which is dark on T2/ADC with early hyperenhancement and extension through the left lateral capsule. Smaller punctate foci of low ADC/T2 signal in the right peripheral zone, mid gland, are also suspicious for adenocarcinoma.Central Gland: Heterogeneous well circumscribed lesions likely represent benign prosthetic hypertrophy.Seminal Vesicles: No definite involvement.Extracapsular Extension: Extension through the left lateral capsule.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large left peripheral zone lesion with extracapsular extension likely corresponds to patient's known prostatic adenocarcinoma. Smaller punctate foci of low signal on the right also are suspicious for adenocarcinoma.2.No lymphadenopathy.


Instruction: Generate impression based on findings.

Input: History of SLE and chronic low back pain assess for disk disease On sagittal reconstructed images there is disk space narrowing with vacuum disk phenomena at the L4-5 disk space.The remainder of the visualized levels demonstrate preservation of disk height. Vertebral bodies are within normal limits in height.Axial images through the L1-2 level demonstrate minimal facet hypertrophic changes no significant central or foraminal stenosis.At the L2-3 level there is no significant central or foraminal stenosis. Incidental note is made of a stent within the left renal artery at this level.At the L3-4 level mild facet hypertrophic changes with mild bulge of the disk causing minimal effacement of ventral thecal sac but no significant central or foraminal stenosis.At L4-5 there is a diffuse bulging disk as well as ligamentous hypertrophy and facet joint hypertrophic changes. These result in a mild to moderate degree of central canal stenosis as well as mild bilateral foraminal narrowing.At the L5-S1 level central bulging disk is present with mild effacement of ventral thecal sac but no significant central canal stenosis.

Output: Degenerative changes of the lumbar spine which are most severe at L4-5 where there is disk space narrowing and vacuum disk phenomena. Diffuse bulge of the disk is present which in conjunction with ligamentous hypertrophy and facet hypertrophic changes causing mild to moderate degree of central canal stenosis and mild bilateral foraminal narrowing. These findings are without significant change in comparison to the prior study.At the L5-S1 level small central disk protrusion is present without significant confines of the central canal or neural foramen.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain. Rising conjugated bilirubin/LFTs. Evaluate cholelithiasis, cholecystitis. ABDOMEN:LUNG BASES: Trace bilateral pleural effusions are present.LIVER, BILIARY TRACT: Sludge is present within the gallbladder with gallbladder wall thickening and small amount of pericholecystic fluid, suggestive of cholecystitis. Trace ascites is also noted. No evidence of intra or extrahepatic biliary ductal dilatation. Multiple lobulated T2 hyperintense bilobar hepatic lesions are incompletely evaluated without intravenous contrast, though likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited exam by lack images postcontrast.2.Findings suggestive of cholecystitis.


Instruction: Generate impression based on findings.

Input: 2-year-old male with CP now with altered mental status and abnormal eye and tongue movement Low attenuation regions are seen in the deep white matter bilaterally and may represent areas of the gliosis secondary to ischemia as seen on recent MRI. Ventricles and subarachnoid spaces are prominent suggestive of mild brain volume loss, unchanged. There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute intracranial abnormality


Instruction: Generate impression based on findings.

Input: History of recurrent astrocytoma treated with chemotherapy and radiation therapy, currently off therapy for 15 1/2 years. There are postoperative findings related to suboccipital craniectomy and upper cervical laminectomies. There is unchanged non-enhancing, diffuse, patchy, infiltrative T2 hyperintense signal that extends from the lower medulla to the C5 level with associated expansion of the spinal cord, particularly at the upper to mid C2 levels. There are also unchanged subcentimeter cystic cavities within the mass at the C1 and C2 levels. The vertebral column alignment is unchanged. The upper cervical vertebral bodies remain relatively small in size and there is persistent T1 hyperintense signal in the bone marrow of C2 and C3, which is likely related to radiation therapy. There is an unchanged focus od low T2 and T1 signal in the C5 vertebral body. There is no significant central spinal stenosis or neural foraminal narrowing. There is an unchanged nonspecific prominent left supraclavicular lymph node.

Output: No evidence of cervicomedullary astrocytoma progression and stable associated treatment effects.