Instruction: Generate impression based on findings.

Input: Exam is motion limited despite reported sedation and swelling.There is significant abnormal intrinsic T1 hyperintensity throughout the transverse and sigmoid sinuses slightly more extensive on the left. There is also abnormal intrinsic T1 hyperintensity to a lesser degree in the superior sagittal sinus there is corresponding prominent susceptibility in these areas consistent with thrombus. On SWI, although motion limited, there are areas of patchy susceptibility along the right greater than left parieto-occipital regions representing petechial hemorrhage. Addition, there are curvilinear areas of intrinsic T1 hyperintensity susceptibility along the ventricular margins, especially along the atria and body of the lateral ventricles which likely relate to terminal and medullary veins with associated thrombosis. There is prominent susceptibility along the confluence of the deep cerebral veins. Internal cerebral veins bilaterally appear to demonstrate intrinsic T1 hyperintensity and susceptibility concerning for thrombosis.Diffusion weighted images are somewhat limited as the ADC images despite reprocessing do not appear fully diagnostic. There is no evidence of corresponding large area of diffusion-weighted abnormality to suggest frank venous infarct at this time. There is mild diffusion restriction within the splenium of the corpus callosum as well as along the right genu of the corpus callosum likely representing sequela of acute neuronal insult. There is also questioned mild diffusion restriction within the deep cerebral white matter bilaterally. T2-weighted images demonstrate a few asymmetric peripheral flow-voids which may represent venous collaterals. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Myelination appears appropriate for stated age.Normal flow-voids are demonstrated in the major intracranial arterial vascular structures. The midline structures and craniocervical junction are within normal limits. Visualized paranasal sinuses are opacified with fluid signal.MRV is also limited by patient motion and appears to demonstrate minimal if any flow related enhancement in left greater than right transverse and sigmoid sinuses, although the contour slightly irregular especially on the left side which may indicate collaterals. No flow related enhancement detected in the superior sagittal sinus. There appears be flow related enhancement in the inferior sagittal sinus although possibly discontinuous posteriorly, as well as suggestion of a discontinuous straight sinus. There appear to be collaterals between the thrombosis superior sagittal sinus and inferior sagittal sinus. The internal jugular veins are not well assessed on this MRV head exam.Dedicated images through the sella are significantly motion limited, although demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is grossly 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 grossly unremarkable. However, assessment for cavernous sinus thrombosis is not possible on this noncontrast exam. After discussing with referring service, postcontrast images were elected to not be obtained given significant findings on MRI/MRV and recent renal compromise.

Output: 1.Limited exam due to patient motion and technical factors. Diffuse dural venous sinus thrombosis, which may be partial in the transverse and sigmoid sinuses bilaterally, while more extensive in the superior sagittal sinus. Inferior sagittal sinus does appear to be patent as do portions of the straight sinus, with evidence of scattered venous collaterals.2.Prominent susceptibility along the confluence of deep cerebral veins, which may indicate additional thrombosis. In addition, there are scattered medullary and terminal veins with associated abnormal signal suggestive of thrombosis. Cavernous sinus not fully assessed on this noncontrast exam.3.Diffusion-weighted imaging limited due to technical factors, although no definite evidence of large venous infarct at this time. Areas of minimal petechial hemorrhage in the right greater than left posterior cerebral hemispheres.4.Mild diffusion restriction in portions of the corpus callosum which likely represents sequela of acute neuronal insult. Additional questioned mild diffusion restriction the deep white matter which could represent venous congestion, early venous ischemia.


Instruction: Generate impression based on findings.

Input: Evaluate the biliary system. History of metastatic renal cell carcinoma and rising bilirubinemia. The examination is limited by respiratory motion.ABDOMEN:LIVER, BILIARY TRACT: Moderate volume perihepatic ascites. At the junction of the right and left hepatic ducts there is an ill-defined intermediate T2-weighted signal intensity lesion measuring approximately 2.8 x 2.6 cm (series 501/26). The signal abnormality appears to extend along the portal branches. This is associated with moderate intrahepatic biliary ductal dilatation.There are additional intermediate T2-weighted signal foci in the liver suspicious for metastatic disease (series 401/11). The common bile duct is minimally prominent but tapers smoothly to the level of the ampulla without a discrete filling defect.Gallbladder sludge. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst. Post-surgical changes of a partial left nephrectomy. RETROPERITONEUM, LYMPH NODES: Periaortic lymphadenopathy, see reference measurements from prior CT.BOWEL, MESENTERY: Moderate volume ascites.BONES, SOFT TISSUES: Extensive body wall edema/anasarca. Numerous enhancing osseous metastases most prominently involving the pelvis.OTHER: Large right greater than left pleural effusion. There appears to be loculation/complexity of the left pleural effusion. Adjacent consolidation/atelectasis. A left lateral chest tube is noted.

Output: 1. Interval increase in the metastatic lesion involving the junction of the right and left hepatic ducts with worsening now moderate intrahepatic biliary ductal dilatation. No choledocholithiasis. Additional liver metastases are noted.2. Extensive osseous metastases and retroperitoneal metastatic lymphadenopathy.3. Large right greater than left loculated pleural effusions with associated consolidation and/or atelectasis.


Instruction: Generate impression based on findings.

Input: Headaches, CT shows tightening at the foramen magnum As seen on recent CT study there is prominent retroodontoid soft tissue thickening without erosion. There is a cystic component involving the posterior and superior aspect of the lesion. There is mass effect with deformity and kinking at the cervicomedullary junction. No abnormal parenchymal signal abnormality is appreciated. There is also effacement of the dorsal thecal sac at the level of the posterior C1 arch which narrows the spinal canal which contributes to the moderate spinal canal stenosis at the C1-C2 level.Vertebral body heights in the cervical spine are maintained. There is borderline widening of the anterior atlantoaxial joint with predental space measuring 2.5 mm, slightly more prominent than on recent cervical spine study. Radiographs may be considered to assess for instability at this level.Vertebral body heights in the cervical spine are normal. No cord signal abnormality. There is loss of cervical lordosis with mild retrolisthesis of C5 on C6. Again seen are multilevel degenerative changes with severe loss of disc space at the C5-C6 level and to a lesser degree C6-C7 and T1-T2 level. Individual levels as below:C2-3: No significant spinal canal stenosis. There is bilateral facet arthropathy, right worse than left, with mild to moderate right and mild left left neural foraminal stenosis. C3-4: There is right paracentral disc osteophyte complex, uncovertebral hypertrophy, and right worse than left facet arthropathy. There is no significant spinal canal narrowing. There is moderate to severe right and mild to moderate left neural foraminal stenosis. C4-5: There is disc osteophyte complex, ossification along the posterior longitudinal ligament, and right worse than left facet arthropathy. There is mild to moderate spinal canal narrowing. There is also moderate bilateral neural foraminal stenosis. Vacuum phenomena at the disc space.C5-6: Left paracentral osteophyte complex, mild ossification of the posterior longitudinal ligament, and bilateral uncovertebral hypertrophy, which results in moderate to severe spinal canal stenosis involving the left aspect of the spinal canal. There is severe left and moderate to severe right neural foraminal stenosis. There is severe loss of disc height at this level with vacuum phenomena.C6-7: There is disc osteophyte complex and mild ossification of the posterior longitudinal ligament. There is mild to moderate spinal canal stenosis. There is moderate to severe left neural foraminal stenosis. No significant right neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy. There are multiple cystic and solid nodules involving the bilateral thyroid lobes which were better assessed on prior thyroid ultrasound. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Prominent retroodontoid soft tissue is again seen which is likely on a degenerative basis. There is a cystic component along its posterior-superior aspect, which is favored to represent a synovial cyst. There is associated mass effect with contour deformity and impression on the ventral cervicomedullary junction. No associated parenchymal signal abnormality. 2. There is borderline widening of the atlantoaxial distance. Consider dynamic radiographs to assess for atlantoaxial instability. 3. Multilevel degenerative changes with moderate to severe spinal canal stenosis involving the left aspect of the thecal sac at the C5-C6 level. There is also significant neural foraminal stenosis at multiple levels, as detailed above.


Instruction: Generate impression based on findings.

Input: MENISCI: The menisci appear normal.ARTICULAR CARTILAGE AND BONE: There is a small partial-thickness tear of the articular cartilage of the lateral femoral condyle (series 5, image 12). The remainder of the articular cartilage appears normal. Visualized bones have normal marrow signal.LIGAMENTS: The ligaments of the knee appear normal. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small partial-thickness tear of the lateral femoral condyle articular cartilage. No other acute abnormality. Specifically, the menisci appear normal.


Instruction: Generate impression based on findings.

Input: Neck pain after MVA Cervical spine: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 disk desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small left-sided uncovertebral osteophytes present at this level resulting in mild encroachment on the left-sided exiting nerve roots..At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are endplate and uncovertebral osteophytes present at this level associated with a disk bulge and narrowing of the left neural foramen and some mild encroachment of the left-sided exiting nerve roots.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge present at this levelAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is mild multilevel disk desiccation present. The marrow signal is rather heterogeneous .At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this levelAt L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are chronic degenerative changes present in the cervical spine resulting in mild encroachment of left-sided exiting nerve roots at C4-5 and C5-6.2.There are mild degenerative changes present in the lumbar spine.3.Heterogeneous marrow signal is a nonspecific finding.


Instruction: Generate impression based on findings.

Input: 74 ? HCM Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 133 ml (normal range 142+/-34), the LV end systolic volume index is 21 ml/m2 (normal range 25+/-9), the LVESV is 43 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is mild-moderate concentric LVH (13-14 mm).Left AtriumThe left atrium is mildly enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 56 %, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 63 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. No SAM is noted.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Maximal ascending aortic dimension 29-31 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 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. Normal LV systolic function with concentric mild-moderate LVH. No MRI evidence for HCM.2. Normal sized ascending aorta.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess midbrain left paramedian stroke vs demyelinationSigns and Symptoms: Outside scan from last spring shows what appears to a small right paramedian stroke Diplopia and eye pain. Pre ans post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates no evidence of chronic ischemic stroke as is clinically questioned.The anatomical morphology and signal intensity of brain parenchyma remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.The signal intensity in the intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarium and soft tissues of the scalp without abnormal enhancement.Unremarkable paranasal sinuses and well pneumatized bilateral mastoid air cells and middle ear cavities.

Output: Negative pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: 79 years Female (DOB:9/11/1936)Reason: 79 yo female with newly diagnosed possible metastatic lung CA with reports of confusion, evaluate for brain metastases History: confusionPROVIDER/ATTENDING NAME: SHANNON K MARTIN SHANNON K MARTIN There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These have progressed since the prior exam. There is redemonstration of additional T2 hyperintense foci in the brainstem, thalami and basal ganglia which were present to a lesser degree on the prior exam.A focus of susceptibility effect is present in the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. Probably related to remote hemorrhage this has progressed since 2003.2.Multiple old lacunar infarcts in the basal ganglia, thalami and brainstem have increased in number relative to the prior exam from 2003.3.Hemorrhagic focus right centrum semiovale.4.No evidence for brain metastases.5.Examination is mildly degraded by patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: MRI Brain:There are multifocal punctate foci of restricted diffusion seen in the supratentorial subcortical and deep white matter bilaterally, medial anterior left thalamus, and infratentorially involving the right lateral cerebellar hemisphere. There is associated FLAIR signal abnormality but no abnormal parenchymal enhancement, focal mass effect, midline shift, herniation or evidence of hemorrhagic conversion.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: Severely limited exam secondary to motion. The origins of the major arteries arising from the aortic arch are not visualized secondary to technique. In addition, the proximal to mid right carotid vessels are not well visualized and cannot be reliably assessed. The left-sided carotid vessels and the vertebral vessels show no gross abnormality.

Output: 1.Multifocal punctate nonhemorrhagic infarcts involving the supratentorial subcortical and deep white matter bilaterally, medial anterior left thalamus, and infratentorially involving the right lateral cerebellar hemisphere. There is no focal mass effect, midline shift, herniation or evidence of hemorrhagic conversion.2.No significant intracranial vascular abnormality.3.Limited MRA of the neck. In particular the right carotid system is not reliably assessed. No gross abnormality of the left carotid system or the vertebral arteries is seen.


Instruction: Generate impression based on findings.

Input: Evaluate for intracranial mass: New onset headache for 2 months duration, increasing in frequency. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is mild cavum septum pellucidum. The ventricles are otherwise normal in size and configuration. 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 within the right maxillary sinus.

Output: No evidence of acute intracranial hemorrhage, mass, or hydrocephalus.


Instruction: Generate impression based on findings.

Input: History of gallstone pancreatitis status post cholecystectomy now with rising LFTs. ABDOMEN:LIVER, BILIARY TRACT: Borderline enlarged liver measuring 23 cm in craniocaudal dimension. No intra or extrahepatic biliary ductal dilatation with the common duct measuring up to 6 mm which tapers smoothly to the ampulla. No filling defect to suggest a stone.Status post cholecystectomy with minimal fluid in the surgical bed.Minimal perihepatic fluid, likely postsurgical.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas parenchyma demonstrates mildly decreased T1-weighted signal intensity, however it enhances homogeneously without evidence of necrosis. There is mild peripancreatic inflammatory fluid without a loculated fluid collection. No evidence of arterial pseudoaneurysm or venous thrombosis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes.BOWEL, MESENTERY: Small volume abdominopelvic ascites.BONES, SOFT TISSUES: Postsurgical changes of the right anterolateral abdominal wall.OTHER: Bibasilar atelectasis and small effusions. Note is made of mild cardiomegaly and increased size of the inferior vena cava and hepatic veins.

Output: 1.Interval cholecystectomy. Findings of mild acute interstitial edematous pancreatitis without a significant peripancreatic fluid collection arterial or venous complication. No choledocholithiasis.2.Small effusions and basilar atelectasis.3.Perihepatic ascites.4.Cardiomegaly and findings suggestive of increased right sided heart pressures.


Instruction: Generate impression based on findings.

Input: 52 year old female with left sided weakness. Evaluate for CVA. White matter changes present with area of low attenuation found in the right internal capsule and subinsular white matter. An additional area of white matter change is located periventricularly on the left. Age of the lesions is indeterminate. This may represent microangiopathic disease, however cannot rule out other white matter disease. Further evaluation with MRI is recommended.

Output: White matter changes in the right internal capsule, subinsular region, and the left periventricular region. Further evaluation with MRI is recommended.


Instruction: Generate impression based on findings.

Input: Male, 69 years old, with sudden right-sided hearing loss. Scattered foci of periventricular and subcortical T2 hyperintensity are seen without edema or mass effect. No restricted diffusion is demonstrated. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. Ventricular size and morphology are within normal limits. High-resolution imaging of the IACs demonstrates a normal appearance of cranial nerves VII and VIII. The IACs are patent and free of mass lesions. The fluid-filled structures of the inner ear are within normal limits.

Output: 1.Scattered small parenchymal lesions are seen which most likely reflect chronic microvascular ischemia.2.No evidence of acute ischemia or any other specific finding which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: ComaClinical question: lesions in brainSigns and Symptoms: altered LOC MRI of the brainThe CSF spaces are appropriate for the patient's stated age with no midline shift. There are foci of diffusion restriction present along the right and left parietal lobe which extend to the occipital lobes bilaterally. There are numerous small or punctate foci of diffusion restriction scattered in the cerebellar hemispheres as well as the thalami and splenium of the corpus callosum. There are patchy foci of diffusion restriction along the watershed zones bilaterally between anterior middle cerebral arteries. Compared to the prior exam there is new or diffusion restriction present along the left occipital lobe which was not present on the prior exam and more patchy foci of diffusion restriction left frontal lobe watershed zone and right frontal lobe watershed zone in the more punctate lesions in the cerebellar hemispheres.On susceptibility imaging there are punctate foci of signal loss scattered in the occipital lobes and parietal lobes and the foci of diffusion restriction. Additionally there is gyriform T1 signal hyperintensity bilaterally along the foci of diffusion restriction in the left and right occipital lobes and parietal lobes.There is gyriform and leptomeningeal enhancement present adjacent to areas of infarction in the frontal lobes parietal lobes and occipital lobes and to a lesser degree cerebellar hemispheres.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The right A1 segment is small compared to the left A1 segment. The right posterior communicating artery is medium-sized. The left posterior communicating artery is not readily identified. The MRA images are somewhat degraded by patient motion which may obscure more subtle abnormalities.

Output: 1.Large foci of infarction are present in multiple stages in both parietal lobes and both occipital lobes. Additional smaller foci of infarction are scattered in the watershed zones bilaterally and involve frontal lobes and parietal lobes as well as in the cerebellar hemispheres bilaterally with a few punctate foci in the corpus callosum and thalami. Compared to the 8/23/2015 exam there is progression with new areas of infarction especially in the left occipital lobe and scattered in the same regions with continued evolution of infarctions and other territories. There are some small foci of hemorrhage associated with some of these infarctions.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for intracranial cerebrovascular occlusion.


Instruction: Generate impression based on findings.

Input: Ataxia. Subacute cerebellar degeneration. There is redemonstration of substantial disproportionate diffuse cerebellar volume loss and scattered areas of mild T2 hyperintensity. There are also a few unchanged nonspecific foci of T2 hyperintensity in the cerebral white matter. The brainstem and supratentorial structures are otherwise unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the findings related to cerebellar degeneration.


Instruction: Generate impression based on findings.

Input: Chiari malformation, pseudotumor cerebri with LP shunt: headache, neck pain. Thre is unchanged extension of the cerebellar tonsils inferior to the foramen magnum up to 5 mm. Nevertheless, the cerebellar tonsils display rounded morphologies. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged mildly low lying cerebellar tonsils.


Instruction: Generate impression based on findings.

Input: Disorder of trigeminal nerve, unspecified [G50.9], Reason for Study: ^Reason: evaluate for structural abnormality or demyelinating disease History: bilateral trigeminal neuropathy There is no evidence of abnormal enhancement.Bilateral fifth nerve were identified with normal configuration without evidence of abnormal signal intensity.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 or abnormal contrast enhancement. 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: No evidence of abnormal signal intensity.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Clinical question: Cord compression? Enhancing lesion? Signs and symptoms: Bilateral lower extremity weakness. Enhanced cervical MRI:Examination demonstrates no detectable abnormal enhancement of the cord or the leptomeninges.There is enhancement along the adjacent endplates to C3-C4 disc space representing expected enhancement of degenerative changes.There is evidence of prior laminectomy at C4, C5 and C6 levels with resultant expansion of thecal sac and the expected minimal enhancement of postoperative changes posteriorly. There is revisualization of a focus of myelomalacia with decreased cord caliber similar to prior exam extending from C4 through C6.No evidence of a spinal canal compromise and no detectable abnormal enhancement of the cord or the meninges.Pre and post enhanced thoracic MRI:Examination demonstrates normal anatomical alignment of vertebral, without concerning detectable signal abnormality. No evidence of abnormal enhancement of the vertebral column is detected.Mild degenerative changes however without evidence of central spinal stenosis is detected.The signal intensity and caliber of the thoracic cord remains within normal limits and without detectable abnormal enhancement.Unremarkable perispinal soft tissues.

Output: 1.Post contrast cervical MRI exam demonstrate minimal expected enhancement of degenerative changes. Revisualization of myelomalacia and decreased cord caliber and without detectable cord or meningeal enhancement.2.Unremarkable pre and post enhanced MRI of thoracic spine.


Instruction: Generate impression based on findings.

Input: Reason: any change in pelvic mass? History: girl with NF1 and known pelvic mass Metal susceptibility artifact from the patient's lumbar spine fixation device limits evaluation of the surrounding area. Again seen is a reference enhancing mass within the pelvis that extends slightly through the left sciatic notch situated along the anterior aspect of the left piriformis muscle. It is again noted to abut the posterior aspect of the left acetabulum and anterior aspect of the left sacral wing and lies posterior to the left iliac vasculature. The mass measures 5.5 x 5.3 cm, previously 4.5 x 4.3 cm (image 23; series 3), slightly increased in size when compared to the prior examination. There is a small amount of fluid within the hips bilaterally, right greater than left, which is not necessarily of any clinical significance. The remainder of the imaged musculature of the pelvis is unremarkable. There are tiny foci of cutaneous nodular enhancement likely representing cutaneous neurofibromas, unchanged. Although this examination was not protocoled for detailed evaluation of the pelvic viscera, no additional abnormality is identified. Note is made of multiple bilateral ovarian follicles.

Output: Slight interval increase in the reference left sacrosciatic notch mass with measurements provided above. While a malignant peripheral nerve sheath tumor cannot be completely excluded, this likely represents a benign neurofibroma.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with back pain and leg weakness. No evidence of acute cord compression is seen. No pathologic epidural fluid collection is suspected.Spinal alignment is notable for a reversal of the cervical lordosis which may be positional. Mild multilevel cervical spondylosis is seen but without any areas of high-grade spinal canal stenosis. Degenerative disc disease is evident at L5-S1 with loss of disc height and mild disc bulging. Mild marrow edema is also seen along the L5-S1 endplates on the left. A round lesion is evident within the anterior aspect of the L4 vertebral body with rim and speckled internal T1 hyperintensity likely representing a hemangioma.

Output: 1.No evidence of acute cord compression.2.Relatively mild degenerative findings in the cervical and lumbar region.3.Marrow edema along the left aspect of the L5-S1 endplates may be related to degenerative disc disease.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with 20 pound weight loss, vertigo, dysautonomia, suspicion for paraneoplastic syndrome. Motion artifact significantly reduces image quality on all sequences. Within this limitation, the following observations are made.No definite parenchymal edema or mass effect is seen. No large areas of parenchymal signal abnormality are suspected. No restricted diffusion is seen. No pathologic enhancement is observed. The ventricles are normal in size and morphology. No large intracranial hemorrhage or any abnormal extra-axial fluid collection is seen.

Output: Within the limitations of a significantly motion degraded examination, no definite findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Pain. Follow-up labral tear left hip. ACETABULAR LABRUM: Please note this examination is not protocoled for the evaluation of the labrum. There still appears to be a defect within the anterior labrum. ARTICULAR CARTILAGE AND BONE: There is interval significant progression of degenerative changes of the left hip. There are multiple subchondral cysts, the largest measuring 9 mm, in the acetabulum with surrounding bone edema. There is marked loss of articular cartilage with bone on bone apposition of the acetabulum with the femoral head. Additionally, there is subchondral cyst formation and bone edema within the femoral head. No acute fracture is evident. SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Significantly progressed degenerative changes of the left hip as described above.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of CLL presenting with tachycardia and AMS. Hypoattenuating area in the gray and white matter in the region of the right parietal lobe may represent a subacute infarction from ischemia. If further imaging is clinically warranted, an MRI may be obtained.Prominence of the ventricular system and cortical sulci are consistent with volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Hypoattenuating area in the region of the right parietal lobe consistent with a subacute infarction. Dr. Jeffrey Jacobson was notified of this finding at the time of dictation.


Instruction: Generate impression based on findings.

Input: Reason: assess for patellofemoral pathology vs medial meniscal pathology History: assess for patellofemoral pathology vs medial meniscal pathology MENISCI: There is increased signal abnormality within the posterior horn of the medial meniscus likely representing intrasubstance degeneration. There is linear signal abnormality which extends to both the tibial and femoral articular surfaces indicating a complex tear of the posterior horn which extends into the body of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of fraying of the articular cartilage of the patella along the median eminence. The articular cartilage of the lateral tibiofemoral compartment appears relatively spared. There is partial-thickness articular cartilage degeneration along the posterior aspect of the medial tibial plateau beneath the posterior horn of the meniscus. There are foci of decreased signal abnormality within the medial and lateral femoral condyle likely representing benign bone islands.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus and other findings as described above.2. Superficial fraying of the articular cartilage along the median eminence of the patella.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with angiosarcoma of the scalp. A defect of the cutaneous and subcutaneous tissues is seen at the midline forehead compatible with prior surgery. The underlying frontal bone, mainly to the left of midline, demonstrates abnormal marrow replacement which could reflect prior surgery or prior tumor invasion.Beginning at the left edge of the surgical defect, the cutaneous and subcutaneous tissues of the scalp are thickened and edematous. Cutaneous thickening continues posteriorly to the parietal region. Within the parietal scalp, there is a dominant cutaneous nodule measuring 33 x 31 x 12 mm which appears to extend in depth to the level of the galea. Numerous additional small scattered nodules are seen within the subcutaneous tissues between this dominant nodule and the anterior surgical resection bed. All of these lesions demonstrate mild diffusion restriction. Subgaleal fluid or edema is demonstrated along the left frontal scalp, possibly reactive. Apart from findings in the left frontal bone as above, no clear osseous involvement is seen.The cutaneous layer of the right scalp is also thickened but to a lesser degree than that of the left. Within the posterior right frontal scalp, at least two subcentimeter subcutaneous nodules are demonstrated (see image 32 series 501) which also demonstrate mild diffusion restriction.Intracranially, no evidence of parenchymal edema or mass effect is seen. A few scattered small foci of FLAIR hyperintensity are demonstrated within the cerebral hemispheres which are nonspecific as is mild periventricular hyperintensity. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is suspected. The ventricles are normal in size and morphology.

Output: Sequelae of prior tumor resection are demonstrated at the midline forehead. The frontal bone underlying this surgical defect demonstrates marrow replacement which could be postoperative in nature but may also reflect prior or current tumor invasion.Beginning at the surgical defect margin, the left scalp cutaneous layer is diffusely thickened extending posteriorly to the parietal region which may reflect prior treatment change but could also indicate diffuse tumor spread. Within the parietal region, there is a dominant subcutaneous soft tissue nodule which correlates with the hypermetabolic lesion on PET compatible with tumor.Between the resection bed and this dominant parietal nodule, there are numerous scattered smaller subcutaneous nodules which are also suspicious for tumor spread. Within the right posterior frontal scalp, at least two small similar-appearing nodules are demonstrated which are nonspecific, but given the overall imaging context, are suspicious for sites of tumor spread as well.


Instruction: Generate impression based on findings.

Input: Reason: CHF, CAD, new conduction abnormailities, ?viable myocardium History: DOE Left VentricleThe left ventricle is normal in size. There is global mild hypokinesis. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 180 ml (normal range 142+/-34), the LV end systolic volume index is 50 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 72g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest myocardial infarct.No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 87 ml/m2 (normal range 82+/-16), the RVEDV is 158 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 70 ml (normal range 54+/-17). No evidence of right heart strain.Right AtriumThe right atrium is normal in size. 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. The anterior leaflet is thickened. There is mitral regurgitation, estimated to be mild. 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 tricuspid regurgitation directed posteriorly, reported to be severe on recent echocardiogram. 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. Within the right inferior lobar pulmonary artery and several lower lobe segmental branches, non occlusive foci of low signal are highly suspicious for pulmonary emboli (401/16 and (501/32). Potential small segmental and subsegmental pulmonary artery filling defects cannot be entirely excluded.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsModerate right and small left pleural effusions. A peripheral triangular high signal focus is suspicious for pulmonary infarct (2201/1). There is apparent bronchial wall thickening in the right lower lobe with right upper and lower lobe parenchymal areas of high signal. This may be sequelae of aspirated blood.

Output: 1. No left ventricular myocardial enhancement to suggest an infarct. LVEF = 50% due to global mild hypokinesis.2. Low signal foci within the right inferior lobar and segmental pulmonary arteries highly suspicious for pulmonary emboli. This can be confirmed with CTA PE thorax if clinically appropriate.3. There is apparent bronchial wall thickening in the right lower lobe with parenchymal areas of high signal. This may be sequelae of aspirated blood.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of right kidney mass seen on prior MRI. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral nonenhancing simple cysts.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: Bilateral benign-appearing renal cysts. No evidence of a right renal mass.


Instruction: Generate impression based on findings.

Input: Seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of gross seizure foci.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression/cauda equina. Signs and symptoms: Bowel incontinence and metastatic breast cancer. Nonenhanced complete spine MRI:Examination demonstrate diffuse patchy foci of marrow signal changes consistent with previously known diffuse osseous metastases disease.There is also evidence of mild compression deformity of T6, T7, T8, T11 and L1 vertebral bodies. There is mild expansion of compressed vertebrae at the one into the spinal canal with resultant complete effacement of the subarachnoid space and flattening and posterior displacement of the cord and central spinal stenosis. There is no evidence of cord signal abnormality.Compared to prior CT examination from February 3rd of 2015 there is no convincing evidence of internal progression of this finding. Very minimal bulge of compressed T6 vertebrae into the spinal canal with mild compromise of the spinal canal is also present. There is also a shallow ventral epidural soft tissue density at the level of compressed T8 vertebrae which is suggestive of small epidural spread of tumor. There is no evidence of any significant spinal canal compromise at these levels. The signal intensity of the cord also remains normal.There is significant exaggeration of thoracic kyphosis secondary to multilevel compression deformity without change since prior chest CT.There is evidence of bilateral pleural effusion which are only partially visualized and measure maximum of 16 mm in thickness on the right.MRI of thoracic spine:Axial T2 weighted images of thoracic and spine were also acquired which demonstrate the small focus of epidural spread of tumor on the left at T5 level without spinal stenosis and shallow ventral epidural spread of tumor at T8 as detailed above.MRI of lumbar spine:Additional axial T2-weighted images of the lumbar spine were also acquired for her assessment of one compression fracture. These images confirm mass effect on the cord and complete effacement of subarachnoid space and spinal stenosis. Compromise of bilateral neural foramina at this level is also detected.

Output: 1.Examination demonstrate diffuse osseous metastatic lesions involving the entire visualized lower cervical, thoracic and lumbosacral spine as detailed.2.Significant compression fracture of L1 with extension into the spinal canal results in mass-effect and posterior displacement of the cord and central spinal stenosis as detailed. The fracture demonstrates no significant change since prior studies.3.There is no detectable signal abnormality of the cord or the conus. 4.Multi-additional levels of mild compression fractures of the thoracic spine without significant compromise of canal or mass effect on the cord. There is however result in significant kyphotic deformity of the thoracic spine.5.Bilateral pleural effusions are detected.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no intracranial mass, pathologic enhancement, acute infarct, mass effect or midline shift. There are mild nonspecific periventricular and subcortical white matter T2 signal abnormalities. There are numerous supratentorial foci of punctate susceptibility effect in the bilateral basal ganglia, but mostly at the peripheral gray-white junction. There is a right globe prosthesis. There are scattered high T1 signal intensity foci in the calvarium, which may represent scattered hemangiomas. There is mild diffuse heterogeneous calvarial marrow signal which may be secondary to renal osteodystrophy given patient's end-stage renal disease.CERVICAL SPINE: There is normal cervical alignment and vertebral body height. There is multilevel disc desiccation. There is no abnormal enhancement in the cervical spine. There are mild multilevel disc and endplate degenerative changes at C2-3 through C4-5 levels with minimal spinal stenosis. There is a right C5-6 paramedian disc protrusion with mild spinal canal stenosis, and a shallow left-sided C6-7 disc protrusion without significant spinal canal stenosis. There is no significant neural foramen stenosis at any level. There is no spinal cord signal abnormality.THORACIC SPINE: There is normal alignment and vertebral body height. There is multilevel disc desiccation in the upper thoracic levels without significant loss of disc height. There is no significant disc herniation or spinal stenosis at any level. The spinal cord signal is within normal limits without a discrete lesion. There is no abnormal enhancement.LUMBAR SPINE: There is normal alignment and vertebral body height. There is mild disc desiccation at L5-S1, without significant loss of disc height. The conus terminates at lower L1 level. There is mild facet arthrosis and ligamenta flavum thickening at multiple levels without disc herniation or significant spinal stenosis. There is a subcentimeter sacral perineural cyst. There is no pathologic enhancement in the lumbar spine. The kidneys are atrophic with numerous nonenhancing bilateral cysts.

Output: 1.No evidence of acute infarct or intracranial mass. 2.Mild probable chronic microvascular ischemic changes and numerous nonspecific supratentorial punctate foci of susceptibility effect suggesting remote microhemorrhages versus less likely cerebral amyloid angiopathy.3.Mild cervical spondylosis with mild spinal canal stenosis at C5-6, but otherwise no significant spinal stenosis at others level of the spine.4.Atrophic kidneys with numerous nonenhancing bilateral cysts, consistent with end-stage renal disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of complex partial seizures. Low lying cervical tonsils compatible with Chiari I malformation. The hippocampi are symmetric in size with normal signal intensity and architecture. There is no evidence of intracranial hemorrhage, mass or edema. There is mild asymmetry of the lateral ventricles which could be an anatomic variant and is of doubtful clinical significance. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mucosal thickening in the left maxillary sinus, the right nasal cavity in the anterior ethmoids. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1.No evidence of seizure focus.2.Findings compatible with Chiari I malformation.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with HIV infection and CT findings concerning for JC virus infection. Numerous scattered foci of subcortical T2 hyperintensity are seen within the bilateral cerebral hemispheres. These lesions are most notable in the parietal lobes, but are present to a lesser degree in the frontal lobes as well, and are distributed fairly symmetrically. The temporal lobes, basal ganglia and posterior fossa are spared.The lesions do not exert significant mass effect and there is no associated restricted diffusion or susceptibility. The lesions appear not to involve the subcortical U fibers. While there may be some mild increased vascularity in the affected parenchyma, the lesions themselves do not enhance.The overall morphology of the brain is unremarkable. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricular system is within normal limits.

Output: Numerous symmetrically scattered foci of white matter signal abnormality are detected, predominantly in the parietal lobes but also affecting the frontal lobes to a lesser degree. There is no evidence of significant mass effect and the lesions themselves do not enhance although there may be mild increased vascularity in the affected regions.The differential diagnosis for these findings would include encephalitis in general, and HIV encephalitis in particular. Although not excluded, JC virus/PML is considered less likely as PML typically presents with asymmetric involvement of the hemispheres and involvement of the subcortical U fibers. Additional considerations would include PRES, ADEM, vasculitis.


Instruction: Generate impression based on findings.

Input: Knee effusion, knee pain Motion degrades sensitivityMENISCI: Vertical signal under maladies observed posteriorly of the lateral meniscus concerning for a radial tear. The remainder of the lateral meniscus is otherwise intact and well visualized other than fraying of the inner edge. The medial meniscus however demonstrates more pronounced changes including a complex tear and degeneration of the posterior horn with extension to both the superior and inferior articular surfaces and moderate extrusion. The medial anterior meniscal body and anterior horn are otherwise intact, as well as the more midline portion of the posterior horn and anchoring element.ARTICULAR CARTILAGE AND BONE: Extensive cartilaginous thinning throughout all compartments. No discrete focal solitary specific defect involving the medial and lateral compartments, however severe erosion and destruction of the medial patellar facet is observed. Underlying marrow signal is grossly intact throughout.LIGAMENTS: Mild sprain of the MCL is observed with otherwise ligaments are intact throughout. Please note however that retinaculum, specifically the medial aspects are poorly visualized secondary to above-mentioned motion. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Large knee effusion with underlying moderate to severe degenerative changes including the medial meniscus and cartilaginous surfaces. See details above


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with neuroendocrine lung cancer metastases to the brain, status post whole brain RT, follow-up exam. At least five enhancing lesions are redemonstrated scattered throughout both cerebral hemispheres. Since the prior examination, all of these lesions demonstrate a very slight, 1 to 2 mm increase in overall size. For example. The dominant left frontal lobe lesion now measures 15 x 14 mm, previously 14 x 13 mm. This lesion also demonstrates a more conspicuously rim-enhancing morphology.It is difficult to determine if any of these lesions exert local edema because there has been a substantial progression in bilateral white matter T2 hyperintensity likely reflecting treatment related change. However, no significant generalized mass effect is observed. No new lesions are detected. The ventricles are stable and normal in size.

Output: The previously demonstrated scattered enhancing lesions are again seen in both cerebral hemispheres, all showing a slight interval increase in size. As this is the first posttreatment examination, it is possible that this change may represent reaction to radiotherapy. Findings on subsequent follow-up examinations will more accurately assess for the possibility of tumor progression. No entirely new lesions are seen, and there is no evidence of any significant generalized mass effect. Progressive generalized white matter signal abnormality likely represents treatment related change.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with intracranial metastases, functional examination requested for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. The epicenter of hand motor activity maps posterior and inferior to the precentral gyrus metastatic lesion.

Output: Technically successful functional MRI with sensorimotor mapping as above.


Instruction: Generate impression based on findings.

Input: 57-year-old female with lateral elbow pain for 2 years status post surgery Diluted gadolinium is noted within the elbow joint. Additional dilute gadolinium is noted infiltrating the triceps musculature and the subcutaneous fat posterior to the triceps as seen on the fluoroscopic arthrogram images, presumably iatrogenic. There is heterogeneity of the anterior fibers of the common extensor tendon likely representing a combination of tendinosis, partial-thickness tearing, and prior intervention. Although the majority of the lateral collateral ligament proper appears intact, gadolinium is identified within the anterior fibers of the common extensor tendon (presumably the extensor carpi radialis brevis) as well as along the myotendinous junction of the extensor carpi radialis brevis suggesting that there might be a small defect of the anterior fibers of the ligament itself. The lateral epicondyle itself appears normal. There are osteoarthritic changes affecting the radiocapitellar articulation which appear to have progressed slightly when compared to the prior study with a new subchondral cyst within the radial head. The ulnar collateral ligament and common flexor tendon appear normal as does the ulnotrochlear articulation. Other than the aforementioned iatrogenic infiltration, the triceps appears intact. The biceps and brachialis tendons appear normal. Gadolinium also courses along the ulnar nerve, but we suspect this is iatrogenic as well. The remaining of the visualized musculature is normal.

Output: 1. Heterogeneity of the anterior fibers of the common extensor tendon likely representing a combination of tendinosis, partial thickness tearing and prior intervention, which is comparable to that seen on the prior study from 10/13/2014 when accounting for differences in technique. Although the majority of the lateral collateral ligament appears intact, gadolinium is seen entering the anterior fibers of the common extensor tendon, suggesting a small defect in the anterior fibers of the ligament.2. Slight progression of radiocapitellar osteoarthritis.


Instruction: Generate impression based on findings.

Input: 49-year-old female with headache, Chiari, rule out CSF hypotension Compared to prior MRI brain study dated 10/27/2014 there has been improvement in cerebellar tonsillar descent from 9 mm to 5 mm on the current study. There is no significant dural enhancement, prominence of the venous sinuses or sella, or significant brain sagging to indicate intracranial hypotension. There is interval increase in CSF space involving the suprasellar cistern. The CSF flow sequences are technically degraded, however there is good CSF flow ventrally at the foramen magnum and mildly diminished CSF flow posteriorly. Overall these findings suggest improvement in previously seen intracranial hypotension.The brain parenchyma otherwise is unremarkable. There is no evidence of restricted diffusion. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.

Output: Compared to 10/27/2014, findings including improvement in cerebellar tonsillar descent suggest improvement in intracranial hypotension. No definite evidence of intracranial hypotension is however demonstrated on the current study. The cerebellar tonsils remain mildly low (5 mm below the foramen magnum) with mild reduction in CSF space/CSF flow dorsally at the foramen magnum; these changes may reflect an underlying component of mild Chiari 1.


Instruction: Generate impression based on findings.

Input: History of hepatitis B with HCC. Interval radiofrequency ablation of suspected HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.Posttreatment changes from segment V radiofrequency ablation. The ablation cavity has been extended medially in the region of the previously seen 1.2 cm suspected HCC. There is no residual arterial enhancement or washout. There were mild hyperemic changes surrounding the ablation cavity without a discrete lesion.Stable wedge-shaped peripheral arterial enhancement in segment 5 without washout or discrete lesion likely represents a perfusional anomaly.No new liver lesion is identified. No biliary ductal dilatation. The vessels appear patent.Subcentimeter segment 6 cyst.SPLEEN: No significant abnormality noted.PANCREAS: Stable subcentimeter T2 hyperintense lesion in the uncinate process of the pancreas, likely a side branch IPMN. No ductal dilatation or suspicious lesion.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: Interval ablation of the previously seen suspected hepatocellular carcinoma recurrence. No measurable arterial enhancement or washout.Cirrhotic liver morphology without suspicious lesion.


Instruction: Generate impression based on findings.

Input: Straightening of the spine is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. There are no osseous dysplasias or stenoses. There is no MRI evidence of ligamentous injury.There are partially imaged T2 hyperintense foci with central areas of hypointensity within bilateral inferior frontal lobes.

Output: 1.There are partially imaged T2 hyperintense foci with central areas of hypointensity within bilateral inferior frontal lobes, most consistent with hemorrhagic contusions given the history of altercation.2.Otherwise negative noncontrast cervical spine MRI.3.Findings were discussed with Dr. Walsh on 6/10/2016 at approximately 4:05 PM.


Instruction: Generate impression based on findings.

Input: Paresthesias. Prior history of L5 NHL. Brain:No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is mild parenchymal volume loss. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. No destructive lesions within the calvarium. Cervical:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine with tiny disc protrusions at C4-5 and C5-6. No significant spinal canal or neural foraminal stenosis at any level in the cervical spine. Tiny perineural cysts are incidentally noted at multiple levels.Lumbar:There is a disc bulge at T11-T12 which is partially imaged and mildly effaces the ventral thecal sac. There is mild compression deformity involving the L5 vertebral body with Schmorl nodes at the endplates. There is lesion involving the L5 vertebral body with heterogenous signal including STIR hyperintensity. There is T1 shortening involving the L4, L5 and sacrum which may be related to prior radiation. Remainder of the vertebral body heights and alignment are unremarkable.There is no significant disc herniation. No spinal canal or neural foraminal stenosis at any level in the lumbar spine. Tiny perineural cysts incidentally noted. Mild lumbar facet arthropathy.Distended urinary bladder noted as well as a partially visualized 3 cm cystic structure possibly adnexal or bladder diverticulum but incompletely evaluated.

Output: 1. No evidence of intracranial mass or mass effect. No evidence of infarct. 2. Minimal degenerative changes in the cervical spine. No cord signal abnormality. No spinal canal or neural foraminal stenosis.3. No spinal canal or neural foraminal stenosis in the lumbar spine.4. Heterogeneous lesion at the L5 vertebral body with mild compression deformity of L5. Findings are compatible with history of treated lymphoma but consider comparison with prior studies if available.5. Partially imaged distended urinary bladder and adjacent 3 cm cystic structure posterolaterally on the left. Ultrasound can be considered for better visualization if clinically indicated.


Instruction: Generate impression based on findings.

Input: History of right mastectomy for invasive lobular carcinoma. Currently taking tamoxifen. History of bilateral breast implantation. There is scattered fibroglandular tissue in the left breast. Patient is status post right mastectomy.Minimal parenchymal enhancement is noted in the left breast. Bilateral retropectoral implants (saline on the left and silicone on the right) are again noted.No abnormal enhancement is seen in either the left breast or right chest surrounding the implants. No abnormal axillary lymph nodes are identified in either axillary region.Note is made of enhancement within and surrounding multiple left ribs. The enhancement is located at nearly the same position in the chest wall in each of the ribs, a pattern suggesting a traumatic etiology.

Output: 1. Stable findings related to previous right mastectomy and bilateral breast implantation. No MRI evidence for malignancy in the breasts. 2. Enhancement in and around left ribs in a pattern suggesting a post-traumatic etiology. Clinical correlation for any trauma to the chest wall is recommended. Correlation with a musculoskeletal rib series can be considered to evaluate the ribs for pathology such as fractures. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: Normal MRA. If there is continued clinical concern for vasculitis, a catheter angiogram would be recommended.


Instruction: Generate impression based on findings.

Input: 56-year-old female with degenerative menisci and IT band infection syndrome. MENISCI: Intrasubstance signal within the posterior horn of the medial meniscus compatible with intrasubstance degeneration. No definite tear. Apparent increased signal intensity within the root of the posterior horn of the lateral meniscus likely represents pulsation artifact. No definite tear.ARTICULAR CARTILAGE AND BONE: There is superficial delamination of the articular cartilage of the lateral facet of the patella. Focal blistering of the articular cartilage of the medial facet likely degenerative in etiology. Articular cartilage of the medial and lateral tibiofemoral compartments appears normal for age Bone marrow signal intensity is within normal limits.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Findings compatible with mild IT band friction syndrome.2.Degeneration of the articular cartilage of the patella.3.Mild meniscal degeneration.


Instruction: Generate impression based on findings.

Input: Reason: concern for acute CVA History: as above; L sided facial droop. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity bilaterally. There are also a few punctate foci of susceptibility effect in the bilateral basal ganglia and cerebellar hemispheres. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary and left frontal sinuses. There are bilateral lens implants.MRA: There is no evidence of significant steno-occlusive lesions in the major head and neck arteries. There is no evidence of cerebral aneurysms. There are bilateral retropharyngeal internal carotid arteries.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered cerebral white matter T2 hyperintensity bilaterally may represent chronic small vessel ischemic disease, while a few punctate foci of susceptibility effect in the bilateral basal ganglia and cerebellar hemispheres may represent chronic microhemorrhages.2. No evidence of significant steno-occlusive lesions in the major head and neck arteries.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of right mastectomy in 2010 with a silicone implant, and left silicone implant placement. The patient had positive axillary lymph node. Family history of breast cancer in her mother, maternal grandmother, and a maternal aunt. There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Status post right mastectomy and breast reconstruction. Bilateral retropectoral silicone implants are intact.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: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Grade 2 astrocytoma diagnosed in 2009, status post RT/TMZ Again seen are postsurgical changes of prior left parietal craniotomy with biopsy tract extending into the left superior frontal gyrus. There is no significant change in appearance of masslike FLAIR hyperintensity involving the posterior aspect of the left superior frontal gyrus with additional also unchanged FLAIR hyperintensity involving the left precentral gyrus and extending deeper into the left hemispheric periventricular white matter. There is no significant enhancement. Multiple foci of susceptibility effect in the left frontal lobe remain unchanged.Again seen is a right posterior falcine dural based mass compatible with a meningioma and measures 16 x 14 x 17 mm in the AP by TR by CC dimensions and unchanged allowing for sampling error. The mass appears to encroach on the superior sagittal sinus. Additional nonspecific focus of FLAIR hyperintensity in the right superior frontal gyrus is unchanged. No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus or extra-axial collections. Benign-appearing focus of enhancement involving the right frontal calvarium also remains unchanged. No suspicious calvarial lesions are appreciated.

Output: 1. Compared to 6/11/2014, there is unchanged appearance of the nonenhancing, expansile mass centered at the posterior aspect of the left superior frontal gyrus consistent with known low-grade glioma. No evidence of tumor progression.2. Stable right posterior falcine meningioma.


Instruction: Generate impression based on findings.

Input: Reason: compare aneurysm History: TIA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.Incidental note is also made of congenital fusion of C2 on C3.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.No intracranial stenosis is appreciated. There is a 2.8 x 2 mm right communicating segment aneurysm present which is directed laterally and anteriorly. This is stable compared to the September exam. There is a 3 mm x 2.5 mm left posterior communicating artery aneurysm present. This is stable compared to the September exam. The origin of the left posterior communicating artery comes off the base of the aneurysm along its medial aspect. There is a 2.5mm infundibulum at the origin of the right PCOMA. There is an extracranial origin of the right posterior inferior cerebellar artery.The anterior communicating artery is a small to medium-sized and the posterior communicating arteries are identified and are small but are intact.

Output: 1.Findings indicate small bilateral communicating segment aneurysms. These are stable since 1/31/13.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 75 years old. Patient with hearing loss and gait disturbance. Prior MRI findings of an acoustic neuroma. History of cardiac defibrillator. Review of patient's chart indicates history of right intracanalicular acoustic neuroma measuring approximately 7 mm. A subtle area of asymmetric intracanalicular enhancement identified in the right IAC that likely corresponds to small schwannoma referenced patient's clinical history. The lesion measures approximately 4 x 9 mm (image 72, axial series 80832; image 105, coronal series 80833).Nonspecific white matter hypoattenuating foci are seen in bilateral cerebral white matter and the brainstem likely secondary to chronic small vessel disease. No other areas of abnormal enhancement are identified. Mucosal thickening identified in the ethmoid air cells and frontoethmoid recess. The ventricles and basal cisterns are normal in size and configuration.

Output: Subtle area of intracanicular enhancement in the right internal auditory canal likely corresponding to patient's schwannoma per the clinical history.


Instruction: Generate impression based on findings.

Input: 7-month-old girl with hypotonia. Pregnancy complicated by twin-twin transfusion. Born prematurely at 28 gestation. History of periventricular leukomalacia. Also history of pulmonic stenosis. There is no acute brain infarct or intracranial hemorrhage. There is moderate-to-severe enlargement of the lateral ventricles, especially posteriorly, associated with severe white-matter volume loss. The deep gray nuclei are small. The corpus callosum is diffusely, severely thinned. The third ventricle is widened again likely due to ex vacuo effect, but the fourth ventricle is normal in size. The brainstem and cerebellum are unremarkable. Despite the significantly diminished volume of the cerebral white-matter, there is a suggestion of delayed myelination even accounting for the adjusted gestational age. There is no definite myelination on T1 imaging in the perirolandic areas.There is fluid intensity in the mastoid air cells and middle ear cavities. There is also fluid intensity in the maxillary and ethmoid sinuses but this is nonspecific at this age.

Output: Severe cerebral white-matter volume loss, especially posteriorly, most compatible with severe white matter injury of prematurity. Delayed myelination for adjusted gestational age is also suspected.


Instruction: Generate impression based on findings.

Input: Female 17 years old with worsening knee pain and weakness, 4-5 year duration, evaluate for ligament or soft tissue damagee MENISCI: The menisci are intact without significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Small focus of cartilage and cortical discontinuity along the lateral facet of the femoral trochlea with increased central T2 signal as well as surrounding increased T2 and decreased T1 signal suggestive of an osteochondral defect. No intra-articular cartilage fragment identified. Mildly increased T2 signal is also noted within the lateral patellar facet suggestive of chondromalacia.LIGAMENTS: The ACL, LCL complex, MCL, and PCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Chronic osteochondral defect along the lateral facet of the femoral trochlea.2. Chondromalacia of the lateral patellar facet.


Instruction: Generate impression based on findings.

Input: Concussion: word finding difficulties, personality changes after blunt head trauma early July. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No gross stigmata of traumatic brain injury.


Instruction: Generate impression based on findings.

Input: 21 year old male. Evaluate for perirectal infection. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Perianal rectal soft tissue thickening with subtle 1 cm diameter left anterolateral hypodensity, suspicious for a small abscess. If indicated, pelvic MRI would be helpful for further evaluation. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Small fluid collection in peranal region is suspicious for a small abscess. No intrapelvic extension. ER MD notified by RROC.


Instruction: Generate impression based on findings.

Input: 45-year-old male with right-sided weakness. Evaluate for bleed, ischemia. Ill-defined area of low attenuation in the pons is new since prior study. The more well-defined focus of low attenuation in the right middle cerebellar peduncle was also not seen on prior study. Further evaluation with MRI is recommended if clinically warranted.Chronic infarct in the posterior limb of the left internal capsule involving the corona radiata is again seen. Nonspecific calcification in the pons has been seen since prior study from November 2009.There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Ill-defined low attenuation in the pons is new since prior study. More well-defined focus of low attenuation in the right middle cerebellar peduncle was also not seen on prior study. Recommend evaluation with MRI if clinically needed.2. Old infarct in posterior limb of left internal capsule. No acute hemorrhage.


Instruction: Generate impression based on findings.

Input: A 69 years old female with recent diagnosis of heart failure and no coronary artery disease. Echocardiography showed severe biventricular dysfunction. Referred to cardiac MRI to rule out infiltrative heart disease. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 16%, the LV end diastolic volume index is 155 ml/m2 (normal range: 65+/-11), the LVEDV is 330 ml (normal range 109+/-23), the LV end systolic volume index is 131 ml/m2 (normal range 18+/-5), the LVESV is 278 ml (normal range 31+/-10), the LV mass index is 69 g/m2, and the LV mass is 147 g. There is global hypokinesis with dyssynchrony. There is very small, atypical patch of late gadolinium enhancement in the mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.T2-star sequence is negative for myocardial iron deposition. There is no intracardiac thrombus.Left AtriumThe left atrium is severely dilated Right VentricleThe right ventricle is severely dilated with severely reduced systolic function The overall RV ejection fraction is 18%, the RV end diastolic volume index is 148 ml/m2 (normal range 69+/-14), the RVEDV is 315 ml (normal range 110+/-24), the RV end systolic volume index is 121 ml/m2 (normal range 22+/-8), and the RVESV is 258 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation visualized. Mitral ValveThe mitral valve opens widely and there is moderate mitral regurgitation visualized. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation visualized. Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation visualized. AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.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 pericardial thickening or effusion.Extracardiac FindingsA small nodule in the right lower lung can not be excluded, suggest correlation with chest x-ray. Small bilateral pleural effusions are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (LVEF 16%). There is global hypokinesis with dyssynchrony. 2. There is very small, atypical patch of late gadolinium enhancement in the mid inferior wall. The pattern is atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process3. The right ventricle is severely dilated with severely reduced systolic function (RVEF 18%). 4. The left atrium is moderately dilated. 5. There is moderate mitral regurgitation. 6. Mild dilation of the main pulmonary artery. 7. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: 36-year-old female status post trauma with acute pain and weakness of the right knee. Rule out MCL tear. MENISCI: There is minimal signal abnormality within the posterior horn of the body of the medial meniscus indicating mild intrasubstance degeneration, but no tear is evident. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: The bone marrow signal intensity is within normal limits. There is mild heterogeneity of the articular cartilage of the medial facet of the patella but we see no fluid-filled articular cartilage defects.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Small Baker's cyst.2. Mild degeneration of the articular cartilage of the patella, but we see no fluid-filled articular cartilage defects.3. No evidence of ligamentous or meniscal tear.


Instruction: Generate impression based on findings.

Input: 27 year old female with rectal cancer. Evaluate disease status. CHEST:LUNGS AND PLEURA: Numerous bilateral pulmonary nodules are stable in size and number, the largest measures 1.5 x 1.5 cm (image 53, series #4).MEDIASTINUM AND HILA: No evidence of adenopathy. CHEST WALL: The right-sided venous port terminates within the right atrium. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: A fibroid projects from the uterine fundus, better visualized on MRI 8/31/09.BLADDER: No significant abnormality noted.LYMPH NODES: 4.5 x 8.1 cm left adnexal mass lesion (image 169, series #3) likely conglomerate adenopathy with ovary. Complex cystic mass in the right adnexa is stable on the current examination.BOWEL, MESENTERY: Ill-defined rectal thickening remains.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace ascites.

Output: 1. Stable adnexal masses. 2. Stable pulmonary metastases.


Instruction: Generate impression based on findings.

Input: Monoplegia of upper arm affecting unspecified site, acute onset weakness, sensory loss after fall. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal cord.There is facet arthropathy in the lower lumbar spine. No significant neuroforaminal or spinal canal stenosis.

Output: No cord compression is identified. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: NF 2 with vestibular and cervical spine schwannomas. Brain: There are unchanged enlarged perivascular spaces in the left middle frontal gyrus with confluent surrounding T2 hyperintensity. There is a similar finding to a lesser extent in the right middle frontal gyrus. There are unchanged mildly low-lying cerebellar tonsils. The orbits, skull, and scalp soft tissues are unremarkable. There is no evidence of acute intracranial hemorrhage or infarction. There is no midline shift. Internal Auditory Canals: There has been interval increase in size of an enhancing extra-axial mass in the right internal auditory canal with extension through the porus acusticus into the cerebellopontine angle cistern, which now measures 12 x 16 mm in axial cross-section, previously 9 x 12 mm. There is mild mass-effect upon the adjacent right middle cerebellar peduncle and right cerebellar hemisphere. There has also been interval increase in size of an enhancing extra-axial mass in the left internal auditory canal, with slight extension medially through the porus acusticus, which now measures 6 x 9 mm in axial cross-section, previously 4 x 7 mm.Cervical Spine: There is an unchanged right anterolateral intradural, extramedullary, tubular, enhancing lesion at the C6-7 level that measures 6 x 2 mm in axial cross-section, which is unchanged. 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 no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. The bilateral vestibular schwannomas have further increased in size.2. Unchanged prominent perivascular spaces in the bilateral middle frontal gyri, left greater than right, with what may represent surrounding gliosis. 3. Unchanged mildly low-lying tonsils.4. Unchanged presumed schwannoma at the C6-7.


Instruction: Generate impression based on findings.

Input: VHL. Evaluate for hemangioblastomas and ESLT. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are multiple enhancing nodules along the cauda equina nerve roots, which appear to have increased in size. For example, the largest of these lesions situated at L1 now measures up to 16 mm, previously 11 mm in April 2014. There are prominent flow voids within the thoracolumbar spinal canal. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. There are postoperative findings related to bilateral adrenalectomy. There are incompletely characterized subcentimeter nodules in the left retroperitoneal region and at the aortic bifurcation. There are bilateral renal cysts.

Output: 1. No evidence of intracranial mass lesions.2. Increase in size of multiple lesions within the lumbar spinal canal, which are compatible with hemangioblastomas.3. Incompletely characterized nodules in the left retroperitoneal region and at the aortic bifurcation, which may correspond to paragangliomas. Follow up via dedicated abdominal and pelvis imaging may be useful.


Instruction: Generate impression based on findings.

Input: Left hip arthroplasty, wound drainage The examination is limited secondary to metallic susceptibility artifact relating to the patient's left total hip arthroplasty.There is a crescentic rim-enhancing fluid collection within the soft tissues along the greater trochanter posteriorly, anterior to the gluteus maximus muscle. This collection measures approximately 4 x 2 cm in the transverse dimension and approximately 3 cm in the craniocaudal dimension and appears to drain to the posterolateral skin surface. Although there is edema within the obturator externus and iliopsoas muscles extending into pelvis, we see no definite extension of this fluid collection itself into the joint space and we are not convinced of the presence of a joint effusion. We see minimal increased signal intensity on T2-weighted images within the greater trochanter with relative preservation of fat signal on T1 sequences. These findings may reflect osteitis but we see no definite imaging features of osteomyelitis. Osteoarthritis affects the right hip with degenerative disc disease and facet joint osteoarthritis of the lower lumbar spine.

Output: 1. Limited examination secondary metallic susceptibility artifact as a result of the left total hip arthroplasty.2. Draining fluid collection posterior to the greater trochanter with other findings described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Subdural hematoma. Signs and symptoms: Subdural hematoma. Nonenhanced CT of brain:There is no evidence of new bleed since prior exam. There is revisualization of patient's known right frontal and parietal subdural collection. This results in subtle mass effect and buckling of the cortex of right frontal and parietal lobes. In greatest dimension of subdural measures approximately 14 mm which is fairly similar to prior examination. Minimal discrepancy in measurements however could be secondary to slice positioning.No abnormality of brain parenchyma is detected. Cortical sulci and ventricular system are within normal range for patient's stated age. Burr hole is in the left frontal bone secondary to prior surgical intervention for drainage of subdural is again identified. A small left frontal -- temporal subdural is again identified. There is no evidence of interval change in the size or the extent of this lesion since prior study.Revisualization of bilateral extra conal well-demarcated high density lesions with no interval change. Findings could represent metastatic lesions. On prior examination the clinical date no included metastatic carcinoma. He above extraconal findings are not associated with any bony changes. Further evaluation with an MRI examination is recommended.

Output: 1.No evidence of new hemorrhage.2.Stable bilateral subdurals as detailed above.3.Stable bilateral extraconal retro-orbital masses as described.4.No detectable parenchymal abnormality on this non-infused CT of brain.


Instruction: Generate impression based on findings.

Input: Male, 33 years old, with severe headaches, history of HIV. No restricted diffusion is seen. No evidence of focal parenchymal signal abnormality, edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: Unremarkable evaluation with no specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 66 year old female with altered mental status. Redemonstrated and no interval change is a prominent lateral ventricles. As compared to prior exam an MRI is recommended to evaluate for possible obstructive lesion. Small area of encephalomalacia and high convexity left parietal remains stableno evidence of hemorrhage, edema, mass effect, midline shift is detected this exam is essentially stable since prior study.

Output: No new finding since prior exam.


Instruction: Generate impression based on findings.

Input: Slurred speech and left arm weakness. Rule out acute stroke. The examination is limited by patient motion, which is most pronounced on the post contrast images.There is no acute infarct or intracranial hemorrhage, accounting for cortical mineral deposition in the chronic infarcts. The encephalomalacia and gliosis from the chronic right posterior cerebral artery infarct, involving the right occipital, temporal and parietal lobes, has not changed. The smaller infarct involving the inferior right cerebellum is also unchanged. Patchy and confluent cerebral white-matter T2 hyperintense lesions also remain unchanged. Also, the focal T1-hypointense, T2-hyperintense signal in the upper right pons is unchanged. The ventricles as well as the other CSF-containing spaces remain enlarged moderately, reflecting underlying brain volume loss which is most prominent in the anterior and medial temporal lobes. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are preserved, accounting for diminutive right posterior cerebral artery, which probably reflects the chronic nature of its territorial infarct. Accounting for limitation caused by motion, there is no abnormal gross intracranial contrast enhancement.There is mild mucosal thickening in the ethmoid sinuses. The mastoid air cells are clear. There is no gross orbital abnormality. There is no destructive lesion of the mildly thickened skull.

Output: 1.Examination is limited by patient motion, especially on postcontrast imaging.2.No acute infarct or intracranial hemorrhage. No definite brain metastasis.3.Unchanged chronic right posterior cerebral artery and small right cerebellar and right pontine infarcts as well as moderate diffuse cerebral white-matter changes of chronic microvascular ischemia. 4.Brain volume loss remains most prominent in the anterior and medial temporal lobes.


Instruction: Generate impression based on findings.

Input: 21-year-old female with primary sclerosing cholangitis with abdominal pain. Evaluate for stricture. ABDOMEN:LUNG BASES: Minimal bilateral basilar atelectasis, left greater than right.LIVER, BILIARY TRACT: Irregularity of the intra and extrahepatic biliary ducts compatible with patient's history of PSC is stable in appearance. The common bile duct measures 10 mm. No dominant biliary stricture.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation or pancreatic mass.ADRENAL GLANDS: Adrenal glands are normal in size and morphology bilaterally.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.Biliary ductal irregularity and dilatation appears similar compared to the previous examination, compatible with history of primary sclerosing cholangitis. No dominant new stricture.2.No focal hepatic lesion or pancreatic mass.


Instruction: Generate impression based on findings.

Input: 4 day old female with symmetric IUGR and congenital abnormalities; evaluate for calcifications or brain abnormalities There is no evidence of intracranial hemorrhage, mass or edema. No abnormal intracranial calcifications are identified.Subtle asymmetric hypoattenuation is seen extending to the cortex in the left posterior parietal lobe which may be artifactual; however infarction or encephalomalacia cannot be excluded. MRI may be obtained for further evaluation if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No cephalohematoma or other scalp soft tissue abnormality is identified. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage, mass, or abnormal calcifications.2. Asymmetric hypoattenuation in the left posterior parietal lobe is subtle and may be artifactual; however infarction or encepahlomalacia cannot be excluded. MRI may be obtained for further evaluation if clinically warranted.