Instruction: Generate impression based on findings.

Input: word finding difficulties No evidence of acute ischemic or hemorrhagic lesion on this scan.There is encephalomalacia with hemosiderin deposition on the left precentral gyrus, left insular as well as left superior temporal gyrus indicating prior hemorrhagic infarction.Patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. 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 flow enhancement in bilateral 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 normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin is normal. The right vertebral artery origin appears to be a bit narrowed but this could well be an artifactual. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Chronic hemorrhagic infarction involving the left insular, inferior aspect of frontal lobe (precentral gyrus) and superior temporal lobe as described above.2. Non specific small vessel ischemic disease.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain and neck MRAs.


Instruction: Generate impression based on findings.

Input: Motor neuron disease, unspecified [G12.20], Reason for Study: ^Reason: Any intracranial lesion? Also do 3T CCD MRI Javed MS protocol with DTI History: Weakness of UEs with hyperreflexia There are multifocal scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter, centrum semiovale, subcortical white matter and pons. In addition, T2/FLAIR high signal intensity lesions also seen on bilateral basal ganglia.These lesions are nonspecific, however, at this age, nonspecific small vessel ischemic disease is a possibility in addition to demyelinating disease. Clinical correlation is recommended.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal nonspecific bihemispheric T2/FLAIR high signal intensity lesions. Differential diagnosis include nonspecific small vessel ischemic disease and demyelinating disease.


Instruction: Generate impression based on findings.

Input: 5-week-old male with apparent life threatening episode and reported cyanosis. Rule out bleed or skull fracture. There is no evidence of intracranial hemorrhage, mass or midline shift. Hypodensity in the subcortical white matter along the convexities and in the frontal and parietal regions bilaterally is slightly lower T1 signal than expected for unmyelinated parenchyma and could represent gliosis from prior ischemia. An MRI is recommended for better visualization of these areas, if clinically indicated.The ventricles and basal cisterns are normal in size and configuration for the patient's age.The calvaria and skull base are radiographically normal without evidence of fracture.

Output: Subcortical white matter hypodensity in the frontal and parietal regions bilaterally shows lower T1 signal than expected for unmyelinated parenchyma. An MRI is recommended for better visualization of these areas, as clinically indicated.


Instruction: Generate impression based on findings.

Input: Male, 35 years old. Reason: primary hyperparathyroidism. evaluate for parathyroid adenomas RIGHT LOBE MEASUREMENTS: 2.0 x 1.8 x 6.3 cmLEFT LOBE MEASUREMENTS: 2.1 x 2.0 x 4.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mildly heterogeneous echotexture. Questionable hypoechoic thyroid nodule at the inferior aspect of the right thyroid lobe measuring 0.9 x 0.6 x 1.0 cm, without significant internal vascularity.LEFT LOBE: Mildly heterogeneous echotexture. No focal lesion.ISTHMUS: Mildly heterogeneous echotexture. No focal lesion.PARATHYROID GLANDS: No parathyroid candidate is identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No parathyroid candidate is identified in the normal orthotopic location.


Instruction: Generate impression based on findings.

Input: 29 years Male (DOB:6/18/1986)Reason: epilepsy History: seizurePROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There are multiple foci of heterotopic gray matter in the periventricular white matter which bulges into the lateral ventricles. There is no associated contrast enhancement with these lesions. There is no significant interval change compared to the prior exam.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.

Output: There are multiple foci of heterotopic gray matter along the periventricular white matter. Examination is performed for stereotactic guidance during surgery. There is no significant interval change compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Other conditions of brain(348.89) [348.89], Reason for Study: ^Reason: pre-op for today biopsy History: pre-op for today biopsy Redemonstration of right parietal operculum intra axial mass like lesion with peripheral enhancement with surrounding vasogenic edema, the size of the lesion was measured about 25.4mm x 19mm x 16mm. No change since prior scan.There is subtle mass effects toward right lateral ventricle, no change since prior scan. Otherwise, the ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal.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.

Output: Brain MRI performed with brain fusion protocol demonstrated right parietal opercular intra axial lesion as described above, no change since prior scan.


Instruction: Generate impression based on findings.

Input: 42 y/o female with a history of hyperlipidemia, coronary artery disease status post percutaneous intervention to the right coronary artery and obtuse marginal branch of left circumflex, presenting for evaluation of coronary artery disease and cardiac function. MEDICATIONS: aspirin and clopidogrel. First Pass PerfusionDuring hyperemia, perfusion defects were present in the basal anterior, septal and inferior , mid inferior septal and antero-lateral, and apical inferior wall. Viability/ Myocardial ScarThere no late gadolinium enhancement noted. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 58 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 78 ml/m2 (normal range 69+/-14), the RVEDV is 126 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 59 ml (normal range 35+/-13). Right AtriumThe right atrium is not well seen. Aortic ValveThe aortic valve opens widely and there is at least mild 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.AortaThe aortic root is mildly dilated. The maximum diameter at the sinus of Valsalva is 45 mm. There is a left sided aortic arch with a normal brachiocephalic branching pattern.The sinus of valsalva measures 45 x 44 x 45 mmThe ST junction measures 37 x 35 mmThe ascending aorta measures 37 x 35 mmDescending thoracic aorta measures 25 x 25 mm.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 are normal in size and 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. Perfusion defects were present in the basal anterior, septal and inferior , mid inferior septal and antero-lateral, and apical inferior wall.2. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 53%).


Instruction: Generate impression based on findings.

Input: Sports injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Tiny cyst along the posterior aspect of the medial meniscus and PCL of questionable clinical significance but otherwise a normal appearing left knee.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate a normal size of the pituitary gland. There is a somewhat heterogeneous appearance to the signal in the pituitary gland which is similar to that seen on the prior exam. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Stable somewhat heterogeneous signal in the pituitary gland without obvious discrete signal abnormality or abnormal enhancement to clearly indicate the presence of a microadenoma.


Instruction: Generate impression based on findings.

Input: Reason: History of sacral chordoma with multiple lesions within the pelvis. Need MRI sacrum to evaluate extent of disease. Compare to prior imaging, which has been uploaded into PACS. History: History of surgical resection of a 15 cm sacral chordoma, now with multiple lesions with the pelvis and palpable mass in buttocks. There are postoperative changes of a partial sacrectomy extending from the level of S2 down with displacement of the rectum posteriorly, appearing similar to the prior study. Edema-type signal within the bones along the pubic symphysis is likely degenerative in etiology. The bones are otherwise within normal limits. There is a small fluid collection within the scar tissue posteriorly, perhaps slightly smaller than that seen on the prior study. Innumerable nodular masses are noted within the gluteus maximus musculature bilaterally as well as within the adjacent subcutaneous fat of the buttocks bilaterally. Additional nodular masses are situated along the posterior column of the acetabula adjacent to the obturator internus muscles, more so on the left than on the right. One of the larger masses within the left gluteus maximus muscle measures just over 6 cm in its greatest dimension on the coronal series 9, similar in size to that seen on the prior study. A second mass within the subcutaneous fat between the intergluteal cleft and the medial margin of the left gluteus maximus is approximately 2.5 x 2.3 cm, previously measuring approximately 2.0 x 1.5 x 2.3 cm. A smaller mass within the medial fibers of the right gluteus medius muscle measures approximately 1.5 x 1.0 cm, previously 1.0 x 0.8 cm.

Output: Innumerable masses within the posterior soft tissues as described above, presumably representing spread of the patient's chordoma with some lesions having increased in size compared to the prior study.


Instruction: Generate impression based on findings.

Input: Female, 18 years old, with headache and Chiari malformation. Postoperative findings are seen compatible with Chiari decompressive surgery. The cervical tonsils are similar in morphology to the prior exam. The CSF space at the level of the foramen magnum is widely patent. Robust biphasic CSF flow is evident through the anterior foramen magnum with a blush of flow related signal seen posteriorly. These findings are not significantly changed from prior.The brain parenchyma otherwise demonstrates normal morphology. No pathologic signal abnormality is seen. No intracranial hemorrhage or abnormal extra-axial fluid is detected. Ventricular system is patent and normal in size.

Output: 1.Stable findings consistent with Chiari decompressive surgery.2.The CSF space at the level of the foramen magnum remains widely patent. Robust CSF flow is seen anteriorly with a blush of flow posteriorly, similar to the prior exam.


Instruction: Generate impression based on findings.

Input: Patient with skull fracture, CT concerning for subacute hemorrhage. There are minimal foci of subarachnoid hemorrhage in the bilateral posterior frontal and anterior parietal convexities near the vertex as seen on recent CT. No evidence of intraparenchymal hemorrhage or edema. There is mild prominence of extra-axial CSF spaces along the cerebral convexities which are favored to represent mildly prominent subarachnoid spaces. No findings to suggest an acute subdural hemorrhage. There is redemonstration of left parietal convexity subgaleal hematoma measuring up to approximately 5 mm in greatest thickness. Skull fractures are better appreciated on prior CT. Myelination is appropriate for the stated age. Brain parenchyma appears within normal limits. 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.

Output: 1. Minimal foci of subarachnoid hemorrhage are again seen along the superior frontoparietal convexities near the vertex. No evidence of parenchymal hemorrhage or edema.2. Mild prominence of the extra-axial spaces along the cerebral convexities likely represent normal subarachnoid spaces. FLAIR sequences were not obtained and may be helpful to exclude the less likely possibility of subdural hemorrhage.3. Calvarial fractures are better evaluated on prior CT dated 4/8/2016.4. Left parietal scalp hematoma, similar to prior.


Instruction: Generate impression based on findings.

Input: 48-year-old male. The provided clinical data on the consultation form is illegible. Patient's previous consultation form from CT dated 7 -- 16 -- 08 is reviewed which indicates history of sphenoid sinus cancer status post treatment chemo/RT. Images through the skull base demonstrates extensive surgery at the level of the sphenoid sinus, right ethmoid air cells and nasal cavity. Minimal residual soft tissue densities within this surgical cavity may represent mucosal thickening. There is no evidence of any abnormal enhancement. The cavernous sinuses on this exam appear normal however this should be further evaluated if clinical concern exists with an MRI examination. The bony periphery of the area of surgery remains intact. Extensive chronic sinus disease of the maxillary sinuses is noted.All of the above findings have remained stable since prior study from 7 -- 16 -- 2008.Images through the soft tissues of the neck demonstrates stable left posterior triangle lymph node without enhancement which measures approximately 10.7 mm x 6 .8 millimeter identical to the prior study.No evidence of a mass or pathologic adenopathy is detected. Few additional left cervical nonenhancing non-pathologic lymph nodes are again identified also with no interval change.Limited images of the apices of the lungs are negative for metastatic lesions. No definitive mediastinal lymphadenopathy is detected. Both of these areas would be better evaluated with dedicated CT of chest. Please review report of the CT performed the same date. Bony density of area of exam is negative for metastatic lesions.CT of brain with infusion.No evidence of intracranial metastatic lesion to the brain or the leptomeninges. Extensive postsurgical changes of the sphenoid sinus would residual mucoperiosteal thickening.

Output: 1.Stable post therapy changes of the head and neck with no interval change and no evidence of recurrence of disease.2.Unremarkable CT of brain.


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis. Pancreatic cyst seen on prior MRI. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute gallbladder inflammation.The liver is minimally lobular, normal in signal intensity and size. The vessels are patent. No suspicious lesion.SPLEEN: Splenomegaly measuring 18 cm in craniocaudal dimension.PANCREAS: Stable pancreatic tail cyst measuring approximately 9 mm without ductal dilatation, unchanged. Several other tiny T2 hyperintensities are seen in the pancreatic tail, unchanged.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.No suspicious hepatic lesion.2.Stable 9 mm pancreatic tail cystic lesion may represent a sidebranch IPMN.


Instruction: Generate impression based on findings.

Input: 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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's altered mental status.


Instruction: Generate impression based on findings.

Input: 48-year-old female patient with right shoulder pain. Some sequences are limited by patient motion artifact.ROTATOR CUFF: There is diffuse thinning of the supraspinatus tendon likely representing a combination of chronic attritional tearing and prior surgery. However, the remaining tendon can be followed to its insertion on the greater tuberosity and we see no full-thickness tear. There does appear to be retraction of the undersurface fibers suggesting delamination that we suspect was present on the prior study. There is intermediate signal intensity of the tendon distally suggesting tendinosis. There is mild atrophy of the supraspinous muscle. There is intermediate signal intensity of the infraspinatus tendon likely reflecting tendinosis. Increased signal intensity along the undersurface fibers of the infraspinatus tendon seen on image 14, series 4 may represent undersurface fraying or tearing, but is not clearly visualized on the sagittal oblique view and may represent volume averaging with adjacent fluid in the joint. We see no full-thickness tear. There is mild atrophy of the infraspinatus muscle. The teres minor minor muscle and tendon is intact. There is perhaps mild tendinosis of the distal subscapularis tendon, but the muscle appears normal. Multiple suture anchor tracks are again noted in the humeral head. One within the posterior portion of the greater tuberosity is new from the prior study. One of the anchors seen in one of the larger tracks on the prior study is no longer evident.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle and acromial process representing interval surgery. A small amount of fluid is noted in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior labrum appears blunted which may reflect surgical debridement or tearing. There is deformity the posterior inferior labrum likely representing degenerative tearing, appearing similar to the prior study. Glenohumeral alignment is within normal limits. There is a small amount of fluid in the joint, but no large effusion.BICEPS TENDON: The patient has undergone a biceps tenodesis since the prior study. ADDITIONAL

Output: 1. Surgical changes of rotator cuff repair, acromioclavicular joint resection, and biceps tenodesis. 2. There is thinning of the supraspinatus tendon that we suspect represents a combination of chronic tearing and surgical changes, but we see no full-thickness tear.3. Additional rotator cuff tendinosis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma: paresthesias and headaches. There is a cystic focus in the right pituitary gland that measures up to 6 mm. There pituitary gland is otherwise not particularly enlarged. The optic apparatus and cavernous sinuses are intact. There is no evidence of intracranial hemorrhage or acute infarct. There are unchanged mild punctate foci of high T2 signal in the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter cystic lesion in the right pituitary gland may represent a cystic microadenoma.


Instruction: Generate impression based on findings.

Input: Reason: Eval for demyelinating disease History: paresthesias MRI brain:There is redemonstration of punctate signal hyperintensities located in the pons which are stable compared to the prior exam.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.MRI 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. There is right-sided facet hypertrophy present. This is unchanged compared to the prior examAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level associated with some disk materialAt C4-5 there are endplate and uncovertebral osteophytes present associated with a diffuse disk bulge and posterior ligamentous hypertrophy. There is associated effacement of spinal fluid ventral and posterior to the spinal cord. There are bilateral uncovertebral osteophytes present at this level associated disk material and narrowing the neural foramina bilaterally. Compared to the prior exam these findings at the this level have progressed. There are endplate reactive change is present at this level which may be subacute with some bright signal on T2 and dark signal on T1.At C5-6 there is loss of disk space height and disk desiccation, endplate and uncovertebral osteophytes with effacement of spinal fluid ventral and posterior to the left hemicord and encroachment of the exiting nerve roots left more than right. Overall this appears relatively stable compared to the prior exam.At C6-7 there is a loss of disk space height, disk desiccation and diffuse disk bulge associated with endplate and uncovertebral osteophytes and partial effacement of spinal fluid ventral and posterior to the spinal cord and encroachment of the left-sided exiting nerve roots within the neural foramen.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Pontine lesions are stable when compared to the prior exam in general the are suggestive of vascular related lesions, however, they are nonspecific and could relate to other cause such as vasculitis or demyelination.2.Since the prior exam degenerative changes at the C4-5 have progressed and now there is a moderate degree of spinal stenosis present at this level associated encroachment of the exiting nerve roots bilaterally.3.Since the prior exam degenerative changes at C5-6 and C6-7, where there is encroachment of left-sided exiting nerve roots and encroachment of the left hemicord at C5-6 and a mild to moderate degree of spinal stenosis C5-6, have remained relatively stable.


Instruction: Generate impression based on findings.

Input: Cervical spine:There is minimal degenerative retrolisthesis of C4 on C5 and C5 on C6, otherwise alignment is within normal limits. There is no evidence of acute fracture. There is extensive multilevel cervical spondylosis with disk space narrowing and central canal stenosis, with level specific findings as follows:C2-3: No significant neuroforaminal or central canal stenosis.C3-4: Disk osteophyte complex results in mild central canal stenosis. Uncovertebral joint hypertrophy results in mild right and moderate left neuroforaminal stenosis.C4-5: Disk osteophyte complex results in severe central canal stenosis without discrete cord signal abnormality. There is severe bilateral neuroforaminal narrowing. There is a small rounded focus of high T2/STIR signal along the posterior-inferior aspect of the C4 vertebral body with questionable enhancement, favored to be degenerative in etiology. C5-6: Disk osteophyte complex results in moderate-severe central canal stenosis without discrete cord signal abnormality. Uncovertebral joint hypertrophy results and mild left and severe right neuroforaminal stenosis.C6-7: Disk osteophyte complex results in severe central canal stenosis without discrete cord signal abnormality. There is severe bilateral neuroforaminal narrowing. Otherwise, there is no pathologic enhancement noted. Sagittal images obtained via the acute cord compression protocol through the thoracic spine are unremarkable. Lumbar spine: There is mild lumbar scoliosis, otherwise alignment is within normal limits. Postoperative changes of laminectomy at L4 and L5 are again noted. A T1 and T2 hyperintense focus in the L2 vertebral body without enhancement is most consistent with a vertebral hemangioma, and likewise smaller foci of T1/T2 hyperintensity also do not demonstrate pathological enhancement. The spinal cord terminates at L1-2. The visualized distal cord and conus medullary as demonstrated normal signal and morphology. There is loss of disk height at L4-5 and L5-S1, with additional level specific findings as follows:L1-2: No significant central canal or neuroforaminal stenosis.L2-3: Right greater than left facet hypertrophy. No significant central canal or neural foraminal narrowing.L3-4: Severe bilateral facet and ligamentum flavum hypertrophy. Mild disk bulge without significant central stenosis. No significant neuroforaminal narrowing.L4-5: Severe facet hypertrophy. Mild disk bulge without significant central canal stenosis. Mild bilateral neuroforaminal stenosis.L5-S1: Severe facet hypertrophy. Mild disk bulge without significant central stenosis. Severe bilateral neuroforaminal narrowing.

Output: 1. Severe degenerative cervical spondylosis with severe central canal and neuroforaminal stenosis at multiple levels as detailed above. 2. Small rounded focus of high T2 signal along the posterior-inferior aspect of the C4 vertebral body with questionable enhancement does not have a typical appearance for metastatic disease and is most likely degenerative in etiology. There is no convincing evidence of osseous metastatic disease. 3. Postoperative changes of L4 and L5 laminectomy and multilevel lumbar degenerative changes as detailed above, without significant interval change since 2013.


Instruction: Generate impression based on findings.

Input: The patient has a personal history of DCIS, status post lumpectomy in 2011. She reports a family history of breast cancer in her brother at the age of 40. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are postsurgical findings in the left breast related to prior lumpectomy, which are unchanged dating back to 2012 examination. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable post surgical changes of the left breast. No MRI evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 47 seconds.

Output: Successful injection of contrast into the left hip.


Instruction: Generate impression based on findings.

Input: Family history of breast cancer and personal history of left breast pain. Density in the left upper outer quadrant. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. In the anterior depth of the right central breast, an 8 mm oval enhancing mass with a dark internal septation is present. The appearance is compatible with a small fibroadenoma. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy or finding to explain her left breast pain. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: MRCP to evaluate possible biliary leak s/p IR direct liver biopsy History: elevated transaminases and bili s/p liver biopsy, abd pain (now resolved) Several sequences are limited by motion artifact.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Small perihepatic ascites. Again seen is a distended gallbladder with mild wall thickening, compatible with acute cholecystitis. There appears to be septated debris, and in conjunction with recent ultrasound findings, this raises the possibility of gangrenous cholecystitis. Gallbladder sludge and stones again seen. Apparent irregularity of the common bile duct is likely due to motion, if there is clinical concern for stricture, consider ERCP. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Multiple subcentimeter IPMNs in the head, body, and tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Partially visualized mildly dilated loops of small bowel may represent reactive ileus or related to post-colectomy state. If there is clinical concern for obstruction, continue follow-up.BONES, SOFT TISSUES: Degenerative changes of the lower lumbar spine.OTHER: Trace right and small left pleural effusion. Extensive anasarca.

Output: 1.Again seen are findings suggestive of acute cholecystitis. Septated debris in the gallbladder raises the possibility of gangrenous cholecystitis. No intrahepatic or extrahepatic ductal dilatation.2.Small side branch pancreatic IPMN's not fully characterized without contrast but with no obvious suspicious features.3.Findings discussed with Dr. Gampa at 11:13AM on 12/27/16.


Instruction: Generate impression based on findings.

Input: Female; 71 years old. Reason: Evaluate for hamstring pathology. Patient has pain worst at the ischial origin, but pain and tenderness over the entire medial hamstrings to insertion. History: Evaluate for possible hamstring tear or avulsion. ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. Normal appearance of the conjoined and semimembranosus tendons bilaterally at their ischial insertions. No increased fluid signal to indicate acute inflammation or tear.ADDITIONAL

Output: Normal appearance of the hamstring tendons bilaterally. No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 41-year-old female with history of metastatic renal cancer status post RFA in January. Follow-up new 5 mm nodule. ABDOMEN:LIVER, BILIARY TRACT: Previously noted segment 4a five mm arterially enhancing focus is no longer visualized. Postablation changes in the inferior right hepatic lobe without evidence of recurrent disease. Additional fat containing nonenhancing subcentimeter focus in segment 7 is noted. No arterially enhancing lesions are present.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes of left nephrectomy without evidence of recurrent disease.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.Previously noted segment 4a arterial enhancing focus is no longer visualized. This may represent treatment effect. Correlate with clinical history.2.No evidence of recurrent tumor in the right inferior hepatic lobe ablation cavity. No suspicious arterially enhancing lesions.3.Postoperative changes of left nephrectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient hypoechoic, concern for cord paralysis. Signs and symptoms: Hypotonia. Enhanced CT of the soft tissues of the neck:Limited images of intracranial space demonstrated ring enhancing lesions in bifrontal lobes at the site of previously noted large parenchymal hemorrhages. There is complete resolution of head CT of blood product at this site since prior head CT from 10 -- 4 -- 10.Images through the skull base, cavernous sinuses, paranasal sinuses and bilateral petrous bones are within unremarkable.Examination demonstrates edematous changes of the left piriform sinus with partial effacement of sinus and subtle enhancement. There is also evidence of left vocal cord paralysis and thickening. There is no evidence of a mass. The above findings could be result of trauma and extended duration of intubation. There is evidence of a sclerotic changes of left aspect of thyroid cartilage with some irregularity. This finding could represent a healing fracture. Further evaluate an MRI of larynx is recommended. There is no evidence of compromise of the airway. The thyroid lobes are within normal size and density. Trachea is intact. No definitive abnormality of the cervical spine is noted. Limited images of the apices of the lungs and mediastinum are within normal limits.60 cc of Omnipaque 350 is administered.

Output: Edematous changes of the left piriform sinus with asymmetrical enhancement of the mucosal compared to the left may represent inflammatory change. There is evidence of left vocal cord paralysis with soft tissue thickening of the vocal cord. Above changes could be result of long term intubation. The sclerotic changes of the left aspect of thyroid cartilage compared to the right may be an anatomical variation however possibility of a posttraumatic fracture and healing process cannot be ruled out. Follow-up with a dedicated MRI of larynx is recommended if patient's symptoms do not resolve.


Instruction: Generate impression based on findings.

Input: 90-year-old female with a history of soft tissue sarcoma adjacent to the left elbow treated with resection, free flap reconstruction and postoperative radiation therapy. Suboptimal evaluation secondary to the patient's refusal to receive intravenous contrast. A vitamin E capsule overlies the soft tissues along the posterior aspect of the elbow. Note is made of soft tissue irregularity along the medial aspect of the left elbow which may represent postoperative change versus ulceration and correlation with physical examination is recommended. There is associated increased signal abnormality on fluid sensitive sequences most pronounced along the posterior and medial aspect of the elbow. While these findings may represent postsurgical/post radiation therapy change, given the lack of intravenous contrast, residual or recurrent tumor cannot be completely excluded by this examination. There is a small joint effusion. No bone marrow signal abnormality is identified.

Output: Soft tissue irregularity and signal abnormality about the posteromedial aspect of the left elbow presumably represents posttherapy change, although residual or recurrent tumor cannot be excluded on this noncontrast examination. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: There is complex branching signal within the body of the medial meniscus reflecting complex tear. Similar findings are also noted within the body of the lateral meniscus compatible with a tear.ARTICULAR CARTILAGE AND BONE: There is severe articular cartilage loss of the medial compartment, particularly the anterior femoral condyle with full-thickness cartilage loss. There is underlying degenerative marrow signal of both the femoral and tibial components. Milder changes are noted within the lateral compartment. There is fissuring of the articular cartilage of the patellofemoral compartment with areas of full-thickness articular cartilage loss of the trochlea. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Complex tearing of the medial and lateral menisci.2. Moderate to severe osteoarthritis with varying degrees of articular cartilage loss which is worst in the medial compartment.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with headaches and history of Chiari malformation. Diffusion-weighted sequences are obscured by metallic artifact, but no definite restricted diffusion is suspected. Numerous scattered foci of T2 hyperintensity are seen in the bilateral cerebral hemispheres without mass effect. No evidence of intracranial hemorrhage is seen. No abnormal extra axial fluid collections are detected. The ventricles are normal in size and morphology. Incidental note is made of a partially empty sella.The cerebellar tonsils are pointed and descend at least 10 mm below the plane of the foramen magnum. Fairly robust CSF flow is seen through the anterior foramen magnum, but no appreciable flow is seen posteriorly along the cerebellar tonsils.A focus of T2 hyperintensity is evident within the central spinal cord at the C2 level. This lesion measures up to 2 mm in diameter and 4 mm in craniocaudal length. The remainder of the spinal cord is unremarkable.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of significant degenerative disc disease, spinal canal or neuroforaminal stenosis is seen.

Output: 1.Findings compatible with Chiari I malformation with pointed cerebellar tonsils which descend at least 10 mm below the plane of the foramen magnum. No CSF flow is detected along the posterior foramen magnum or around the cerebellar tonsils.2.A 2 x 4 mm focus of T2 hyperintensity within the central spinal cord at the C2 level is compatible with a very small syrinx. The remainder of the visualized spinal cord is unremarkable.3.No other abnormalities of the cervical spine are seen.


Instruction: Generate impression based on findings.

Input: Clinical question: 26-year-old male with leukemia and. Acute intracranial hemorrhage, evaluate for progression. Signs and symptoms: Acute intracranial hemorrhage. Unenhanced head CT:Examination demonstrate a small acute hematoma in the cortex of the right frontal lobe measuring 8.2 x 4 0.9-mm in size similar to prior MRI exam. Very subtle surrounding vasogenic edema is present.A second smaller left paramedian high convexity frontal hematoma measuring 6 x 4.4-mm in size and very minimal surrounding edema is also similar to prior exam.There is no evidence of any additional foci of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The ventricular system remains within normal limits and midline is maintained.A small arachnoid cyst at the level of pineal cistern is also similar to prior MRI exam finding.

Output: 1.Stable size and minimal surrounding edema of bilateral frontal parenchymal hematomas when compared with prior MRI exam.2.No evidence of any additional new findings since prior studies.


Instruction: Generate impression based on findings.

Input: 68-year-old female with joint pain. Evaluate for fracture.IMAGE ACQUISITIONS: CT through the right ankle performed without contrast enhancement and reformatted images obtained for sagittal, coronal and axial reconstructions. In addition, 3-D reconstruction was done at an independent work station. Non-infused CT of the right ankle shows no evidence of acute fracture. Severe osteoarthritis affects the talonavicular joint, with bone-on-bone apposition and prominent subchondral cysts. Subchondral cysts are also seen at the subtalar and calcaneocuboid joints. Mild osteoarthritis at the tibiotalar joint. There is a large os trigonum posterior to the talus. The navicular appears to be slightly inferiorly subluxed with respect to the talus. There is eversion of the calcaneus with resultant osteoarthritic changes of the calcaneofibular articulation. There are small loose bodies in the lateral gutter of the ankle. Recent radiographs suggest a severe planovalgus deformity.Soft tissue attenuation along the head of the talus and the distal fibula may represent edema or scar tissue, and obscures the ligamentous structures of the ankle. The Achilles tendon is intact and the remaining ankle tendons are grossly intact, given the inherent limitations of CT or examination; however, we cannot exclude a partial-thickness tendon tear on CT, and if further imaging is warranted clinically, MRI can be considered.

Output: 1. No evidence of acute fracture.2. Arthritic changes as described above, including eversion of the calcaneus and plantar subluxation of the navicular, which may reflect a neuropathic arthropathy or chronic posterior tibialis tendon dysfunction.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS; f/u progression History: paresthesias. There are multifocal various sized high signal intensity lesions on bilateral periventricular periventricular and deep white matter on FLAIR images. The lesion locations include right cerebral peduncle, right midbrain especially periaqueductal gray matter and median raphe, upper pons, left middle cerebellar peduncle as well as bilateral cerebellar hemispheres. Comparing to prior scan, overall number and location of these lesions do not show any significant interval change.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal high FLAIR high signal intensity lesions involving bilateral hemispheres, brain stem and bilateral cerebellar hemispheres which do not show any significant interval change in terms of number of lesions and size of each lesions since prior scan.


Instruction: Generate impression based on findings.

Input: 14-year-old female with left hip pain for 10 months. No improvement with physical therapy. Evaluate for labral tear. ACETABULAR LABRUM: Intra-articular contrast material enters a linear defect within the anterior superior acetabular labrum consistent with a labral tear (image 7; series 1301).ARTICULAR CARTILAGE AND BONE: No bone marrow signal abnormalities are identified.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Left acetabular labral tear, as described above.


Instruction: Generate impression based on findings.

Input: Reason: R/o biceps tendon tear and cubital tunnel syndrome History: pain and numbness. LIGAMENTS: No significant abnormality noted.TENDONS: No significant abnormality noted. Particularly, the biceps tendon is intact. ARTICULAR SURFACES AND BONE: No significant abnormality noted. SURROUNDING STRUCTURES: Abnormal signal within the ulnar nerve within the cubital tunnel suspicious for neuritis. ADDITIONAL

Output: 1.Increased signal within the ulnar nerve within the cubital tunnel suspicious for ulnar neuritis.2.Intact biceps tendon.


Instruction: Generate impression based on findings.

Input: 61 year old male with floor of mouth cancer. Please evaluate extent of disease and adenopathy. Rule out lung metastases. MRI CT of soft tissues of the neck.Images through the skull base are within normal limits. An enhancing mass in the left pleura the mouth is detected. The mass appears to contain a small air density which may be either secondary to necrosis or recent biopsy. The mass appears to minimally extend across the midline to the right side. The most anterior component of the mass measures approximately 3 mm by 17-mm. On coronal images the mass measures approximately 21 mm times 17-mm.The mass is essentially anterior in location and is not associated with any bony changes. Some dilatated of left submandibular gland duct may indicate partial obstruction.An enhancing lymph nodes on the left at the level of floor of the mouth measures approximately 14.7 x 8 0.6-mm. No evidence of any pathologic lymph nodes by size criteria is detected.The bony density of the area of exam is unremarkable for metastatic disease.Extensive emphysematous changes a limited view of the apices of the lung is noted. No definitive evidence of metastatic lesion in the lung is present.CT of brain with infusion.This examination is essentially unremarkable and in particular no evidence of metastatic lesion is detected.

Output: 1.Left-sided floor of the mass tumor as detailed.2.Unremarkable CT of brain.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings in the right frontal lobe with unchanged mild confluent T2 hyperintensity surrounding the resection cavity and slight interval decrease in size of the extra-axial collection deep to the craniotomy flap. There is no evidence of abnormal intraparenchymal enhancement. There is no evidence of acute infarction or intracranial hemorrhage. The ventricles, sulci, and cisterns are unchanged in appearance. There is no significant midline shift. The extracranial structures are unchanged.

Output: Post-treatment findings in the right frontal lobe without evidence of gross tumor recurrence.


Instruction: Generate impression based on findings.

Input: Male 19 years old Reason: Please evaluate for progression of PSC, cirrhosis, or dominant stricture History: 18 yo w ulerative colitis and IBD ABDOMEN:LIVER, BILIARY TRACT: The intrahepatic biliary ducts demonstrate an irregular appearance with areas of focal narrowing and dilatation. This is best appreciated on series 5, image one. The common hepatic, left main and right main ducts are irregular. The common bile duct is normal in caliber. A focal stricture in the common hepatic duct appears increased compared to prior study however the dilatation above this is not significantly changed.The liver is normal in morphology.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.

Output: 1.Findings compatible with primary sclerosing cholangitis with intrahepatic ductal involvement. Increasing narrowing in the distal common hepatic ducts without significantly increased superior duct dilatation. Attention can be paid to this on additional surveillance imaging.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Neck injury. The spinal cord displays normal signal and morphology. There is no evidence of hematomas in the spinal canal. There is no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.

Output: No evidence of gross spinal cord injury.


Instruction: Generate impression based on findings.

Input: 48 year old woman with history of aortic coarctation repair, referred for cardiac MRI for interval assessment of repair. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 153 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 98 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 66 ml/m2 (normal range 69+/-14), the RVEDV is 155 ml (normal range 110+/-24), the RV end systolic volume index is 25 ml/m2 (normal range 22+/-8), and the RVESV is 58 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve is tri-leaflet and opens widely. There is mild 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 mild tricuspid regurgitation.AortaThe aortic arch vessels are in a bovine configuration (i.e. the innominate artery gives rise the the left carotid artery, right carotid artery, and the right subclavian artery). There are no focal aortic aneurysms or dissection in the thoracic aorta. There appears to be a stenosis of the proximal left carotid artery; however, the area is contaminated by imaging artifact, recommend correlation with exam or a dedicated carotid ultrasound study. There is evidence of an end-to-end coarctation repair of the descending aorta. A mild residual aortic coarctation is noted just distal to the left subclavian artery. There is mild flow acceleration through the narrowed region. The descending aorta is mildly enlarged. The aortic measurements are:Sinus of Valsalva: 33x34x35 mmST Junction: 25x26mmAscending aorta (proximal to innominate artery): 27x27mmDescending aorta proximal to coarctation: 24x24mmAortic coarctation: 20x20mmDescending thoracic aorta distal to coarctation: 28x26mmDistal descending thoracic aorta: 24x23mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and 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 normal systolic function. The overall LV ejection fraction is 58%. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%.3. There is evidence of an end-to-end aortic coarctation repair. There is a mild residual descending aortic coarctation (minimum diameter 20x20mm) with mild dilation just proximal and distal to the coarctation. The dimensions are listed above. There are no focal aneurysms or dissections of the thoracic aorta. 4. Mild biatrial dilation.5. Mild main pulmonary artery dilation.6. Can not exclude stenosis of proximal left carotid artery, recommend correlation with vascular ultrasound study if clinically indicated. 7. Overall, there is no significant change in aortic dimensions or ventricular function since prior MRI on 3/15/2010.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 2-year-old with history of brain abscess and hemorrhage. Follow-up exam. There is decreased in size of the right temporo-occipital region hemorrhagic lesion, which now measures approximately 8 x 4 mm, previously 12 x 8 mm. There is a stable to slightly decreased focus of enhancement in the left inferior parietal lobule. There are unchanged scattered punctate foci of susceptibility within the cerebellum. The ventricles are unchanged in size and there is no midline shift. There is no evidence of acute infarction. The skull and extracranial structures are unchanged.

Output: 1. Expected interval evolution of the right temporo-occipital region intraparenchymal hemorrhagic lesion.2. Stable to slight decrease in size of a punctate focus of enhancement in the left inferior parietal lobule.3. Unchanged punctate microhemorrhages or calcifications in the cerebellum.


Instruction: Generate impression based on findings.

Input: 49 years Male (DOB: 8/11/1966)Reason: spinal canal narrowing History: left arm numbnessPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present. Straightening of the normal cervical curvature is a nonspecific findingAt 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. There is a mild disc bulge at this level. There is mild facet hypertrophy at this level. There are chronic endplate reactive changes present at this level. There is some partial effacement of spinal fluid surrounding the spinal cord at this level and overall a mild degree of spinal stenosis.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disc bulge at this level. There is mild facet hypertrophy at this level. There are chronic endplate reactive changes present at this level.At C5-6 there is no significant compromise to the spinal canal. There is a mild disc bulge at this level. There is mild facet hypertrophy at this level. There is mild narrowing of the left neural foramen at this level. There are chronic endplate reactive changes present at this level.At C6-7 there is no significant compromise to the spinal canal. There is mild encroachment of left-sided exiting nerve roots at this level due to a disc bulgeAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are multilevel degenerative changes present cervical spine. There is a mild to moderate degree of the encroachment of the left-sided exiting nerve roots within the neural foramen at C6-7 related to a disc bulge and there is mild narrowing of the left neural foramen at C5-6 due to disc material. There is a mild degree of spinal stenosis at C3-4.


Instruction: Generate impression based on findings.

Input: History of meningioma, post surgery follow-up. There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Redemonstration of postoperative changes including suboccipital, left craniotomy encephalomalacia on the cerebellar vermis and left cerebellar hemisphere, no change since prior scan.Homogeneously enhancing thickened medial left side the tentorium represent residual meningioma is measured around 12 mm x 20 mm x 12 mm, no change since prior scan.Multifocal scattered bihemispheric high signal intensities on white matter on FLAIR imaging indicating nonspecific small vessel disease, no change 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 mastoid air cells are clear.Retention cyst on the left maxillary sinus, no change since prior scan.

Output: 1. Stable postoperative status of tentorial meningioma.2. No change of the size and MR characteristics of residual lesion on the medial left tentorium comparing to prior scan.


Instruction: Generate impression based on findings.

Input: 61-year-old female with left knee swelling and history of diabetes. Evaluate for osteomyelitis. There is a large knee joint effusion with enhancement of the synovium. Small foci of gas density within the effusion could either reflect attempted aspiration or infection. Little if any fluid concentrates posteriorly within the joint. The joint effusion herniates anteriorly through a full-thickness defect in the quadriceps tendon that we suspect represents a chronic tear, with retraction of the proximal fibers by at least 6 cm relative to the distal fibers. The signal intensity of the marrow of the patella, distal femoral epiphysis, and proximal tibia is normal.The distal intramuscular tendinous structures of the quadriceps appear thickened, possibly due to chronic scarring. Increased signal intensity within the mid to distal vastus medialis, intermedius, and lateralis muscles on fat suppressed T2-weighted images is suggestive of edema, but minimal enhancement is seen within these structures on postcontrast images. There is mild edema in the subcutaneous fat of the distal thigh and in the deep fat posterior to the distal femur. Other than the aforementioned joint effusion, there is no discrete drainable abscess or soft tissue fluid collection.Patchy areas of signal abnormality within the mid to distal femoral diaphysis are iso to hyperintense compared to skeletal muscle on T1 and T2-weighted images and show minimal enhancement following contrast administration. These findings are nonspecific and while osteomyelitis cannot be entirely excluded, the likelihood is low based on signal characteristics, distribution, and relative lack of surrounding edema/enhancement. Other differential considerations include peculiar foci of reconverted red marrow or small areas of ischemic or infarcted bone.Small amount of fluid within both hip joints on large FOV images. Moderate osteoarthritis affects the right knee.

Output: 1.Large knee joint effusion with foci of gas density that may reflect infection or attempted aspiration.2.Full-thickness quadriceps tendon tear, presumably chronic in etiology, with edema and scarring of the quadriceps musculature.3.Small foci of signal abnormality within the mid to distal femoral diaphysis. These foci are nonspecific but would be an unusual appearance of osteomyelitis, and may instead reflect residual red marrow or areas of bone marrow ischemia/infarction.


Instruction: Generate impression based on findings.

Input: Nuchal rigidity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are extensive areas of encephalomalacia in the bilateral basal ganglia and thalamic regions, with associated Wallerian degeneration. There are also small areas of encephalomalacia in the cerebellar hemispheres. There is diffuse cerebral volume loss with superimposed ex vacuo dilatation of the right lateral ventricle. There is mild nonspecific periventricular white matter T2 hyperintensity diffusely. There is no abnormal intracranial enhancement, although the assessment is limited by the weak contrast distribution. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the right frontal sinus.

Output: 1. No evidence of intracranial abscess or abnormal meningeal enhancement, although the assessment is limited by the weak contrast distribution. 2. Multiple chronic lacunar infarcts in the bilateral basal ganglia and thalamic regions, as well as the cerebellar hemispheres, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: Again seen is a lesion in the right frontal bone which is T2 hyperintense, T1 hypointense, and enhancing, without diffusion restriction measuring approximately 19 x 8 x 9 mm (series 1001, image 26; series 1101, image 25) in the axial and sagittal planes. This lesion abuts the dura, is primarily intraosseous, extending across the calvarium, and does not have mass effect on the subjacent parenchyma. There is an additional intracranial lesion that appears to be dural based overlying the right frontal lobe, which is T1 hypointense and enhancing, measuring 7 x 8 mm (series 1001, image 17), with mild adjacent mass effect on the brain parenchyma and no resulting vasogenic edema.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute infarction. No diffusion-weighted abnormalities are identified. The major vessels appear patent. There is an extra fluid and ethmoid mucosal thickening. There is no abnormal enhancement within the brain.

Output: 1.Lesion in the right frontal calvarium is is favored to represent a plasmacytoma, metastatic disease or osseus malignancy.2.Right frontal dural based subcentimeter lesion is favored to represent a meningioma.


Instruction: Generate impression based on findings.

Input: Recurrence of ALL in brain: Right eye visual field deficit. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There is asymmetric protrusion of the right optic disc, as well as enhancement of the anterior right optic nerve. There is perhaps mildly elevated T2 signal in the affected portions of the right optic nerve. The rest of the right orbital contents and left orbit are unremarkable.

Output: 1. Enhancement of the right optic nerve with papilledema may represent leukemic involvement. Differential considerations may include drug reaction or other forms of optic neuritis.2. No evidence of intracranial mass.


Instruction: Generate impression based on findings.

Input: Clinical question: Sudden onset of right wrist extensor weakness. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrates several tiny foci of restricted diffusion in bilateral cerebral hemispheres. Findings are present in the right occipital lobe, few in right hemispheric periventricular white matter and a tiny focus in the left hemispheric parietal white matter consistent with acute ischemic stroke lesions demonstrate no associated susceptibility signal changes.Additionally there are diffuse confluent FLAIR and T2 hyperintensity of bilateral hemispheric white matter as well as bilateral basal ganglia and minimally in the right thalamus and mild to moderate in the pons all consistent with advanced chronic nonhemorrhagic small vessel ischemic strokes.Incidental note is made of a tiny well-demarcated near CSF signal intensity lesion of the pituitary on the left highly suggestive of a cyst or pituitary adenoma. Finding measures approximately 6 x 4 mm and without detectable mass effect.Mild prominence of supratentorial ventricular system and diffuse uniform prominence of cortical sulci which are believed to be at least partially secondary to underlying parenchymal volume loss secondary to chronic small vessel ischemic strokes.There is no detectable cortical signal abnormality.Signal void of all major intracranial arterial branches are identified and unremarkable.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and middle ear cavities. Significant leftward deviation of nasal septum and highly suspected leftward projecting bony septal spur is noted.

Output: 1.Several scattered hemispheric white matter (R>L) tiny foci of restricted diffusion/acute stroke without hemorrhage as detailed.2.Extensive chronic nonhemorrhagic small vessel ischemic strokes with resultant mild ex vacuo ventriculomegaly and prominence of cortical sulci.3.T2 hyperintense lesion 6 x 4 mm of pituitary likely a cyst or adenoma without mass effect.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, new headaches and history of breast and lung cancer. No restricted diffusion is seen. A few scattered nonspecific small foci of T2 hyperintensity are evident in the cerebral white matter. No edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.

Output: 1.No acute intracranial abnormality.2.No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: There is a redemonstration of a right frontal burr hole.There are FLAIR/T2 hyperintensities in the subcortical and the periventricular white matter, and the right centrum semiovale, which are nonspecific, but most likely consistent with chronic small vessel ischemic changes. There are a few foci of dark susceptibility signal in the left parietal, bilateral basal ganglia, and the temporal lobes, consistent with blood products from old microhemorrhages.There is no evidence of acute hemorrhage, mass effect, or edema. The ventricular system is stable.Findings are seen compatible with prior transsphenoidal pituitary surgery. Irregular enhancing tissue within the sella and perhaps also the right cavernous sinus appears similar to prior exams.An oval nodule is again seen within the right parotid gland without change. The extracranial tissues are otherwise unremarkable.There is hypoplastic right maxillary sinus.

Output: 1. No evidence to suggest recurrent primary CNS lymphoma.2. Stable appearance of the postoperative sella.3. Stable nonspecific right parotid nodule.


Instruction: Generate impression based on findings.

Input: 59-year-old with history of right mastectomy for breast cancer with implant reconstruction. Status post right mastectomy and retropectoral silicone implant, which appears intact.No edema is seen in the right reconstructed breast.There is heterogeneous amount of fibroglandular tissue in the left breast.Minimal parenchymal enhancement is noted in the left breast.A catheter port is placed at left medial superior chest wall.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:5/4/1967)Reason: please do dr javed MS protocol compare to prior History: progression MSPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and PD images. Some of these are perpendicularly oriented to the lateral ventricles. Many of these are associated with signal loss on T1-weighted imaging. There are also lesions involving the corpus callosum and cerebellum. Comparing to the prior exam from 3/12/2015 periventricular and subcortical white matter lesions as well as corpus callosum lesions appear to be relatively stable. Similarly the cerebellar lesions appear to be stable. There is a FLAIR hyperintense focus present within the upper cervical spinal cord at the C1 vertebral level. This particular focus is not clearly identified on the axial images nor the prior exam. There is associated artifact present. As a result is felt to represent artifact.The pituitary gland is at the upper limits of normal in height measuring approximately 8 mm in height. It has not changed substantially when compared to the prior examNo abnormal enhancing 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.

Output: 1.There are periventricular, subcortical, corpus callosum and cerebellar lesions present which in general appears stable compared to 3/12/2015. These are compatible with patient's diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with history of metastatic ovarian cancer presenting with progressive upper back pain. Evaluate for cord compression, impending fracture. Complete marrow replacement of the C5, C6, C7 and T1 vertebral bodies is demonstrated. A small focal marrow replacing lesion is also present within the C4 vertebral body. Mild ventral epidural extension of disease is evident at C5 and C6, contributing to spinal canal narrowing at C5 but no frank cord compression. The T1 vertebral body bows posteriorly which also contributes to mild spinal canal narrowing, but again no compression is seen.Near complete marrow replacement of the T8 vertebral body is seen with mild posterior bowing. No evidence of epidural spread or cord compression is seen. An additional smaller lesion is seen within the T7 vertebral body. Subcentimeter foci of enhancement within the T9 and T12 vertebral bodies are nonspecific. No definite evidence of metastatic disease is seen in the lumbar spine.The visualized spinal cord demonstrates normal morphology and signal intensity throughout. No evidence of pathologic intramedullary or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body heights are maintained. Mild degenerative findings are seen in the cervical region without any associated spinal canal or foraminal compromise. No significant degenerative findings are evident in the thoracic region. In the lumbar spine, there is loss of disc height, endplate degenerative signal change and mild disc bulging at L5-S1 with mild bilateral foraminal narrowing but no significant spinal canal stenosis.Multiple enlarged lymph nodes are seen within the lower neck, the mediastinum, and intra-abdominal. Patchy opacification is also seen at the right lung base. A subcentimeter nodule is demonstrated in the right upper lobe.

Output: Multiple metastatic lesions are evident within the cervical and thoracic vertebral bodies. At C5 and C6, there is mild ventral epidural disease involvement which results in mild spinal canal stenosis at C5 but no cord compression. At T1, and to a lesser extent at T8, posterior bowing of vertebral body results in mild spinal canal narrowing, but again there is no evidence of cord compression.No definite evidence of metastatic disease is seen in the lumbar region. No definite evidence of intrathecal disease is noted. Extensive adenopathy is incidentally visualized in the neck, mediastinum and abdomen.


Instruction: Generate impression based on findings.

Input: knee pain which is getting worse with possible subluxation and instability. Evaluate for MCL sprain. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. The articular cartilage within all three compartments is intact.LIGAMENTS: The anterior and posterior cruciate ligament are intact. The medial and lateral collateral ligaments are intact. The popliteus muscle and tendon are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 67-year-old female status post left lumpectomy for DCIS. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There are postsurgical changes in the left breast of lumpectomy and axillary lymph node dissection. The seroma cavity measures 6.0 x 3.7 x 3.3 cm (AP x ML x CC). There is residual chronic blood products within the dependent aspect of the cavity. There is mild left breast skin thickening.There is asymmetric clumped non-mass enhancement along the medial, superior and anterior aspects of the seroma cavity which extends to the nipple area. This abnormality measures approximately 3.5 x 1.7 x 1.4 cm (AP x ML x CC).There is a benign-morphology focus within the right central breast.No abnormal axillary lymph nodes noted bilaterally.

Output: Postoperative changes in the left breast and axilla of lumpectomy and lymph node dissection. Non-mass enhancement along the superior, anterior, and medial aspects of the seroma cavity extending to the nipple is suspicious for residual disease, especially given pathologic findings, although postsurgical fat necrosis cannot be entirely excluded.These results were discussed with Dr. Jaskowiak on 7/21/14 at 1045.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder pain, eval for rotator cuff tear History: see above. ROTATOR CUFF: Mild intermediate signal intensity within the supraspinatus tendon suggests mild tendinosis, similar to prior. There is an elongated focus of fluid signal intensity measuring just under 2 cm in length along the myotendinous junction of the supraspinatus tendon, representing an intrasubstance cyst, but we see no full-thickness or discrete surface tear of the supraspinatus tendon. The supraspinatus muscle is otherwise normal.Tiny focus of high signal intensity within the distal infraspinatus tendon at its insertion, representing a concealed interstitial tear measuring 2 to 3 mm, new from prior. The infraspinatus muscle is normal.The teres minor tendon and muscle are normal. The subscapularis tendon and muscle are normal.SUPRASPINATUS OUTLET: There is perhaps minimal spurring along the the acromion, otherwise, the AC joint appears normal. There is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is within normal limits. Within the limits of this non-arthrographic study, the glenoid labrum appears intact.BICEPS TENDON: There is minimal increased signal intensity within the intra-articular tendon of the long head of the biceps, which may reflect mild tendinosis, not necessarily of any clinical significance.

Output: 1.Small cyst within the supraspinatus tendon with mild tendinosis, but no discrete surface or full-thickness tear.2.Tiny concealed insertional tear of the infraspinatus tendon, of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: Male 3 years old Reason: Pulmonary artery flow History: H/O hypoplastic PA, supravalvar AS and PS. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 51.2%, the LV end diastolic volume index is 57.14 ml/m2 (normal range: 74+/-15), the LVEDV is 40.07 ml (normal range 142+/-34), the LV end systolic volume index is 27.91 ml/m2 (normal range 25+/-9), the LVESV is 19.54 ml (normal range 47+/-19), the LV mass index is 34.91 g/m2 (normal range 85+/-15), and the LV mass is 24.44 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. .Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 57.4%, the RV end diastolic volume index is 42.82 ml/m2 (normal range 82+/-16), the RVEDV is 29.98 ml (normal range 142+/-31), the RV end systolic volume index is 18.22 ml/m2 (normal range 31+/-9), and the RVESV is 12.76 ml (normal range 54+/-17). Right AtriumThe right atrium is slightly dilated. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Left pulmonary artery stent again noted.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac Findings no abnormality noted.

Output: 1. Stable cardiac function with no evidence of supravalvar aortic stenosis.2. Stable stent on the proximal left main pulmonary artery with a partially no flow obstruction.3. Qualitatively symmetrical pulmonary flow.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings.


Instruction: Generate impression based on findings.

Input: Reason: assess for metastatic sarcoma History: left axillary and flank painAdditional history collected from electronic medical record: 28-year-old man with history of low-grade fibromyxoid sarcoma of the left shoulder, located about the left brachial plexus. He is status post radiation therapy and surgical excision, with positive surgical margins. The field of view was increased to include more of the axilla, although the postoperative and inflammatory changes described below extend medially off the field of view of this study.There are multiple foci of signal void within the anterior soft tissues, reflecting metallic susceptibility artifact from prior surgery. There is also metal susceptibility artifact along the clavicular diaphysis, representing a plate and screw device seen on prior CT scan. There is reticular band-like signal abnormality and enhancement within the deep fat anterior to the subscapularis, which we suspect reflects scar tissue and/or changes from radiation therapy, with similar enhancement noted along the deltopectoral groove. There is an amorphous collection of heterogeneous signal intensity anterior to the subscapularis muscle and adjacent to the lateral margin of the axillary artery, with foci of high signal intensity on T1-weighted images suggesting fat, and with mild increased signal intensity on T2-weighted images and mild enhancement after gadolinium administration. There is a focal signal void representing a surgical clip in this region. This corresponds to a low density focus in the same location seen on chest CT dated 4/16/2016. Given its signal characteristics, relative lack of enhancement, and similarity in size to CT the study from April 2016, this could represent treated tumor or scar tissue, but we see no dominant nodular focus to confirm viable tumor recurrence or metastatic disease. The rotator cuff itself appears intact. There is perhaps minimal enhancement of the synovium of the glenohumeral joint, which may reflect prior radiation therapy, but we see no joint effusion. We see no bone marrow signal abnormalities.

Output: Post-therapy changes of sarcoma resection and radiation as described above. An amorphous collection of heterogeneous signal anterior to the subscapularis along the lateral margin of the axillary artery likely corresponds to a low density collection on CT scan dating back to April 2016 and could conceivably reflect treated tumor, but we see no dominant nodular focus to confirm viable tumor recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: History of CVA, dementia, schizophrenia, presenting with subacute AMS consistent with catatonia, requiring ECT. There is ring-like restricted diffusion that measures up to 10 mm in the subcortical white matter anterior to the right precentral sulcus. There is also a punctate focus of restricted diffusion in the subcortical white matter of the left precentral gyrus. There is a background of extensive cerebral white matter confluent T2 hyperintensity. There is no evidence of intracranial tumors. There is no abnormal intracranial enhancement. There appear to be scattered foci of susceptibility effect in the cerebral hemispheres, although precise delineation is limited by patient motion. There is diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes. There is no midline shift or herniation. The major cerebral flow voids are intact. There are secretions within the posterior paranasal sinuses. There is mild hyperostosis of the skull, particularly in the left temporal region. The orbits are grossly unremarkable.

Output: 1. Ring-like restricted diffusion that measures up to 10 mm in the subcortical white matter anterior to the right precentral sulcus and a punctate focus of restricted diffusion in the subcortical white matter of the left precentral gyrus likely represent recent infarcts superimposed upon a background of extensive chronic small vessel ischemic disease. Dedicated head and neck vascular imaging may be useful for further evaluation, if clinically warranted.2. Diffuse cerebral volume loss, which is most pronounced in the bilateral medial temporal lobes is suggestive of Alzheimer's disease. 3. Apparent scattered foci of susceptibility effect in the cerebral hemispheres may represent chronic microhemorrhages, perhaps related to amyloid angiopathy, for example, although precise delineation is limited by patient motion. Discussed with Dr. Davey at 9:15 AM on 3/26/15.


Instruction: Generate impression based on findings.

Input: 33-year-old woman with history of uterine fibroids. PELVIS:UTERUS, ADNEXA: The uterus is anteverted. Multiple T2 hypointense lesions are seen within the uterus, the largest of which is intramural in the left body of the uterus (series 1001, image 17). Additionally, there is a T2 hypointense intramural lesion in the right fundus of the uterus (series 1001, image 11). Additional similar-appearing, smaller intramural and subserosal fibroids are noted. These lesions enhance with the myometrium.BLADDER, URETHRA: The bladder is normal. There is a 19 x 9 mm collection of fluid in a saddle configuration surrounding 180 degrees of the right urethra (series 901, image 10) with apparent communication with the lumen.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The rectosigmoid colon is decompressed but appears normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple intramural and subserosal fibroids as described above.2.Urethra diverticulum.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for any intraventricular hemorrhage, infectious causes or brain pathology. Signs and symptoms cord full-term female presenting with seizures (lip smacking and left arm twitching and flexing) on DOL one. Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. The overall appearance of brain is within normal for patient's stated age of two days. Ventricular system remains within normal size. Calvarium is intact. Median cavities are pneumatized. No pneumatization of visualized sinuses. Follow up with an MRI is recommended if clinical symptoms persist.

Output: Negative CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 18-year-old female with right upper and lower extremity numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchymal signal appears unremarkable. There is no abnormal intracranial enhancement. There is a 10 mm wide arachnoid cyst medial to the anterior temporal lobe on the right side. There is mild flattening of the pituitary gland. 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 mucosal thickening in the bilateral maxillary sinuses, right more so than left, right anterior ethmoid air cells, and right frontal sinus. There is again nonspecific prominence of the adenoids. Anterior dislocation and deformity of the left mandibular condyle is again noted, as on CT of the maxillofacial bones from 4/7/2016. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: 1. Incidental right middle cranial fossa arachnoid cyst. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.2. Mild flattening of the pituitary gland may indicate pseudotumor cerebri, although this appears to be an otherwise isolated finding.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Abdominal pain. History of ETOH abuse. Abnormal ultrasound. ABDOMEN:LIVER, BILIARY TRACT: There is mild fissural prominence and enlargement of the left hepatic lobe. The liver is otherwise normal in signal intensity and enhancement. No focal suspicious hepatic lesion. No vascular abnormality.The gallbladder is normal in appearance. No biliary ductal dilatation or gallstones.SPLEEN: 1.2 x 1.2 cm peripheral splenic T2 weighted nonenhancing hyperintensity, likely a cyst.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 2.5 x 2.2 cm left adrenal nodule (series 5 image 23) which is homogeneously mildly hyper relative to muscle and demonstrates signal dropout on out of phase imaging compatible with a lipid rich adrenal adenoma. Additional 1.3 cm left adrenal body nodule with similar imaging characteristics.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. No suspicious focal hepatic lesion.2. Left adrenal nodules with signal characteristics compatible with lipid-rich adrenal adenomas.


Instruction: Generate impression based on findings.

Input: Renal mass seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size without a focal lesion. Normally distended gallbladder. No biliary ductal dilatation. Mild steatosis.SPLEEN: The spleen is normal in size and morphology. Note is made of a 1.8 cm splenule adjacent to the inferior margin of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 2.7 x 2.0 cm lesion along the dorsomedial aspect of the right renal interpolar region demonstrates T2 weighted isointensity to the renal cortex (series 4/21) and intrinsic T1 weighted hyperintensity (series 12/57). It has intrinsic T1 weighted hyperintensity. The subtraction images appear well aligned and show that there is no definite post-contrast enhancement of the lesion. The wall of the lesion is relatively smooth without distinct mural nodularity.Additional subcentimeter renal cysts are noted.No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm measuring 3.1 cm in AP dimension with extensive asymmetric atherosclerotic plaque.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The right renal lesion is intrinsically T1 hyperintense without evidence of enhancement on subtraction imaging, compatible with a hemorrhagic or proteinaceous cyst without suspicious nodularity.2.Infrarenal abdominal aortic aneurysm measuring 3.1 cm in AP dimension.


Instruction: Generate impression based on findings.

Input: Redemonstrated are multiple foci of T2 hyperintensity primarily within the periventricular white matter, however also within the pons and bilateral middle cerebellar peduncles, appearing similar to the 2009 comparison and suggestive of multiple sclerosis. There is no associated enhancement. Pontine lesions are associated with small foci of susceptibility hypointensity and thus may represent a component of small vessel ischemic disease with microhemorrhage.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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Redemonstrated are multiple foci of T2 hyperintensity primarily within the periventricular white matter, however also within the pons and bilateral middle cerebellar peduncles, appearing similar to the 2009 comparison and suggestive of multiple sclerosis. There is no associated enhancement. Pontine lesions are associated with small foci of susceptibility hypointensity and thus may represent a component of small vessel ischemic disease with microhemorrhage.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:10/1/1983)Reason: 3 t scanner brain mass History: haPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE There is a T2 hyperintense mass involving the left optic tract and the optic chiasm which abuts the left hypothalamus and is visually contiguous with the and also displaces the left for next. It appears to abut the left carotid terminus and anterior cerebral artery. It is hypointense on T1 and hyperintense on T2 and does not enhance and has a more less a cystic type appearance.There is depression of the right half of the cribriform plate. The olfactory bulbs are not well visualized. CSF space prolapses into the right ethmoid sinusNormal 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 scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a cystic type lesion involving the left optic tract and the optic chiasm associated with local mass effect. Please correlate with the patient's visual exam.2.The olfactory bulbs are not readily identified and there is depression of the right cribriform plate with a prolapse of CSF space into the right ethmoid sinus.


Instruction: Generate impression based on findings.

Input: Reason: epidural abscess History: LBP There is no abnormal enhancement to suggest an epidural abscess. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild disc bulging at L2-3, L3-4 and L4-5 without significant stenoses. There is mild left L4-5 neural foraminal narrowing. There is mild facet joint hypertrophy at the lower levels. Scattered perineural root sleeve cysts are seen, including in the sacral region. The spinal cord displays normal signal and morphology. There is edema and enhancement involving the posterior paraspinal muscles, right greater than left. There is also involvement of the right iliopsoas muscle. No discrete fluid collection is seen.

Output: 1. There is no abnormal enhancement to suggest an epidural abscess.2. There is edema and enhancement involving the posterior paraspinal muscles, as well as the right iliopsoas muscle. These findings may reflect an underlying myositis or some other inflammatory process. No discrete fluid collection.Findings were discussed with Dr. Mulliken, attending physician in the emergency room, on 5/11/2016 at 9:40am.


Instruction: Generate impression based on findings.

Input: Poor mental status, recent fever following LP, epidural hematoma or abscess? For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There 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 epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L2-L3 level.The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T11-T12: There is central focal protrusion of disc which abuts thecal sac. No spinal stenosis. No neural foraminal stenosis.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: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: broad based central to central to left disc protrusion which abuts thecal sac and minimal to moderate narrowing of the left side lateral recess. L5-S1: broad based disc protrusion central to right which narrows right lateral recess.

Output: 1. Relatively low lying conus medullaris without evidence of cord tethering.2. Disc protrusion (herniation) at the level of T11-12, L45 and L5S1 as described above.


Instruction: Generate impression based on findings.

Input: Reason: Prostate cancer History: see above PELVIS:PROSTATE:Prostate Size: 6.4 x 5.7 x 6.7 cmPeripheral Zone: No focal suspicious lesions.Central Gland: There is a focus of low T2/ADC signal in the left posterior transitional zone of the mid gland (603/384) which measures 1.0 x 0.8 cm. BPH nodules.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter pelvic and inguinal lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Lesion in the posterior left mid gland peripheral zone is of indeterminate.2.Enlarged prostate with BPH nodules.