Instruction: Generate impression based on findings.

Input: Male, 3 years old, history of medulloblastoma status post craniotomy, chemotherapy and stem cell transplant x3. End of therapy evaluation. Brain:Again seen are postoperative findings compatible with prior suboccipital midline craniectomy and mesh placement for tumor resection. No evidence of tumor recurrence is seen in the operative bed. A small region of FLAIR hyperintensity just above the right cerebellar tonsil remains nonenhancing and is less conspicuous than on the prior examination. No new intracranial lesions are seen. The pattern of parenchymal enhancement is within normal limits. No evidence of edema or mass effect is detected. Ventricles are stable in size and morphology showing mild prominence of the atria. Mild periventricular T2 hyperintensity is also unchanged.Spine:The spinal cord, conus and cauda equina show normal signal intensity and morphology. No pathologic intramedullary or leptomeningeal enhancement is seen.Spinal alignment is anatomic. Vertebral body morphology and signal characteristics are within normal limits. No pathologic marrow enhancement is seen.

Output: 1.Redemonstration of postoperative findings in the posterior fossa with no evidence of recurrent tumor.2.No evidence of metastatic disease to the spine.


Instruction: Generate impression based on findings.

Input: There are multiple new foci of restricted diffusion with matching ADC hypointensity throughout both bilateral supratentorial and infratentorial vascular territories. Given the known history of endocarditis, this is most consistent with multiple small embolic infarctions. These have correlated to T2 hyperintensity but no susceptibility abnormality.Redemonstrated are patchy areas of T2 FLAIR hyperintensities in the subcortical and the periventricular white matter and in the pons, which are nonspecific, but most consistent with chronic small vessel ischemic changes. There is a small chronic infarct involving the left precentral gyrus that was seen in the previous study of 5/12/2015. Ventricular size is normal. No midline shift. The basal cisterns are patent. No evidence for acute intracranial hemorrhage, mass effect, or edema.Incidentally noted small lipoma in the left periorbital scalp. Visualized paranasal sinuses and the right mastoid air cells are clear. New fluid is present within a few dependent left mastoid air cells. Redemonstrated is a postinflammatory nasopharyngeal cyst (aka Tornwaldt cyst), unchanged in appearance.

Output: There are multiple new foci of restricted diffusion with matching ADC hypointensity throughout both bilateral supratentorial and infratentorial vascular territories. Given the history of endocarditis, this is most consistent with multiple small embolic infarctions.


Instruction: Generate impression based on findings.

Input: Left side weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multiple small nodular signal void lesion on bilateral hemispheres on gradient echo images. Diagnostic possibilities include amyloid angiopathy, multiple small hemorrhages, multiple cavernous malformations or calcifications.Multifocal patchy high signal intensities on bilateral periventricular white matter and centrum semiovale on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal distal ICAs, MCAs and ACAs.Acom artery and right Pcom artery are patent but the left Pcom artery is not seen.There is no evidence of intracranial aneurysm.There is no evidence of intracranial arterial luminal stenosis or occlusion.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Non specific small vessel ischemic disease as described above.3. Multifocal bi-hemispheric signal voids on gradient echo images indicating possible amyloid angiopathy, multiple small hemorrhages, multiple cavernous malformations or calcifications.


Instruction: Generate impression based on findings.

Input: Male, 63 years old, with history of glioblastoma multiforme, status post redo craniotomy for tumor resection. There are postsurgical changes of recent left-sided craniotomy for tumor re-resection in the left temporal lobe. Most of the nodular enhancement surrounding the resection cavity has been resected. Small nodular enhancement is noted along the anterior-inferior and medial aspect of the resection cavity. Focus of enhancement more superiorly involving the left periatrial white matter also remains unchanged.Expected postsurgical changes include pneumocephalus and small extra-axial collection beneath the craniotomy. No significant infarct, large hemorrhage, or new mass effect is appreciated. FLAIR hyperintensity surrounding the resection cavity as well as milder generalized FLAIR hyperintensity involving the bilateral centrum semiovale and corona radiata appears similar. There is mild diffuse sulcal effacement involving the left cerebral hemisphere. No midline shift or herniation. There is ex vacuo dilatation of the left lateral ventricle. No hydrocephalus. Right cerebellar hypoplasia is again noted.

Output: Expected postsurgical changes of redo left-sided craniotomy for tumor reresection. Small residual areas of nodular enhancement are seen along the medial and anterior inferior aspect of the left temporal resection cavity.


Instruction: Generate impression based on findings.

Input: Female 18 years old Reason: Evaluate for abnormality in the location of mass/pain History: Persistent right subcostal pain and mass ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma demonstrates homogeneous signal intensity, and no focal mass lesions are identified. No intrahepatic or extrahepatic biliary ductal dilatation is present. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or hydroureter is seen. The bilateral renal parenchyma shows normal signal intensity.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A skin marker was placed in the area of palpable abnormality. The chest wall soft tissues are normal in appearance and no abnormal enhancement is evident. The bone marrow signal is normal.OTHER: No significant abnormality noted.

Output: Normal examination. Specifically, no mass evident in the area palpable abnormality.


Instruction: Generate impression based on findings.

Input: Blurry vision and intermittent paresthesia. Evaluation for demyelination. No evidence of acute ischemic or hemorrhagic lesion on the scan.No evidence of abnormal signal intensity on FLAIR imaging.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI scan.


Instruction: Generate impression based on findings.

Input: Intractable headache, acute; onset January 1, 2016. History of ALL, status post intrathecal methotrexate, in clinical remission off therapy. The extensive confluent white matter T2 hyperintensity has diminished since 2012, with a higher proportion of residual abnormality in the bilateral parietal lobes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small right superior frontal sulcus region developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The extensive confluent white matter abnormality likely related to treatment effects has diminished since 2012, with a higher proportion of residual abnormality in the bilateral parietal lobes. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Right sided gaze preference, fever, and lethargy. MRI: There is a right transparietal ventricular shunt catheter that terminates in the brain parenchyma adjacent to the left lateral ventricle. The imaged portions of the catheter appear to be intact. There has been decrease in size of the bilateral supratentorial small subdural fluid collections since August 2014, but concomitant slight increase in size of the third and lateral ventricles. There is gyriform T2 hyperintensity and swelling in the right posterior temporal lobe. There are scattered foci of punctate susceptibility effect in the bilateral cerebral hemispheres. There is a 5 mm wide left inferior parietal convexity mass. There is predominantly periventricular bilateral cerebral white matter T2 hyperintensity. There are punctate foci of encephalomalacia in the right caudothalamic groove region and corona radiata. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged, including postoperative findings related to biparietal craniotomy.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. There is no evidence of saccular cerebral aneurysms.

Output: 1. Decrease in size of the bilateral supratentorial small subdural fluid collections since August 2014 with concomitant slight increase in size of the shunted third and lateral ventricles, which may be compensatory in nature. 2. Gyriform edema in the right posterior temporal lobe may represent recent infarction or an infectious process. Assessment is limited by the lack of intravenous contrast and artifact related to the overlying reservoir.3. Small probable meningioma along the left inferior parietal convexity.4. Punctate foci of encephalomalacia in the right caudothalamic groove region and corona radiata likely represent chronic lacunar infarcts. 5. Scattered foci of punctate susceptibility effect in the bilateral cerebral hemispheres may represent chronic microhemorrhages, septic emboli, or cavernous malformations.6. No evidence of significant steno-occlusive lesions in the head and neck arteries.


Instruction: Generate impression based on findings.

Input: Diffusion images are negative for acute stroke. Again as in the previous study there is demonstration of numerous varying sized foci of increased signal intensity on FLAIR and T2-weighted images in the periventricular and subcortical white matter of the bilateral cerebral hemisphere. High signal is again seen in the bilateral caudate nuclei and basal ganglia.Since the previous study the foci that were seen in the pons are progressed and more conspicuous and currently seen in the right more than the left.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Empty sella is seen; however, there no other associated MR signs of pseudotumor cerebri.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the left ethmoid and the maxillary sinuses bilaterally, left more than the right.

Output: 1. There is mild progression of subtle T2 and FLAIR hyperintensity in the right greater than left pons, likely representing chronic small vessel ischemic changes.2. Numerous stable variably sized foci of abnormal signal in the periventricular and subcortical white matter of the bilateral cerebral hemisphere without any abnormality in the posterior fossa. Findings again, may represent chronic small vessel disease or the sequela of SLE.


Instruction: Generate impression based on findings.

Input: Pituitary lesion surveillance. There no significant interval change in the enhancing sellar mass with extension into the right cavernous sinus and right sphenoid sinus, measuring up to 18 mm. There is no mass effect upon the optic apparatus. The infundibulum is midline. The internal carotid artery flow voids are intact. There is unchanged cerebral volume loss and mild scattered nonspecific cerebral white matter T2 hyperintense lesions.

Output: No interval change in the invasive pituitary mass, which likely represents a macroadenoma.


Instruction: Generate impression based on findings.

Input: 28-year-old female status post left nephrectomy and left adrenalectomy in 2013 for a renal spindle cell sarcoma. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy. No recurrent lesion is identified in the surgical bed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Gradient echo artifacts likely related to a left lateral laparotomy incision.OTHER: No significant abnormality noted.

Output: 1.No evidence for a recurrent lesion in the left nephrectomy bed. No evidence for metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with spinal metastases, neck pain. Signs and symptoms: Neck pain Nonenhanced CT of the cervical spine:Previously described on prior MRI of the cervical spine with the study the lesion to the vertebral body of C5 is not identified on this study. There is subtle low attenuation of C7 vertebral body consistent with patient's known metastatic lesion. There is no evidence of fracture of this vertebrae and the alignment of vertebral column is unremarkable.Nonenhanced CT of thoracic spine:The alignment the vertebral column is within normal limits. Examination identifies previously detected metastatic lesion to T1 with mild compression deformity and minimal bulge of vertebrae into the spinal canal. There is no involvement of the pedicle of T1. The alignment remains intact. Mild compression deformity of vertebral body of T5 along its superior aspect and the internal lytic changes. There is no definitive involvement of the pedicles of T5. No definitive evidence of any additional lytic changes of vertebral column is detected.No definitive metastatic lesion to the facets of the pedicles of vertebral column.Nonenhanced CT of the lumber spine:The alignment of vertebral column is unremarkable. No definitive for the study kidneys to the lumber spine is detected.No evidence of central spinal stenosis or neural foramina compromise.There is very subtle low-attenuation involving S2 vertebral body however been no distinct destruction of the cortex or any perispinal soft tissue abnormality. Possibility of metastatic disease cannot be entirely ruled out.

Output: 1.Multiple metastatic disease to the thoracic spine and a suspected metastatic lesion to as to as detailed.2.There is mild compression fracture of T1 and T5 and mid no involvement of the pedicles of T1 or T5.The alignment of the vertebral column throughout the spine remains normal.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to left L5-S1 hemilaminectomy and ligamentum flavectomy. There is vacuum disc phenomenon, loss of disc space height, endplate irregularity, and a mild eccentric left disc herniation with annular fissuring, which in conjunction with soft tissue that may represent scar formation, effaces the left lateral recess. Otherwise, there is minimal bilateral neural foraminal narrowing at this level. There is a mild central disc protrusion and bilateral facet and ligamentum flavum thickening at L4-5 without significant spinal canal or neural foraminal stenosis. There is no significant spinal canal or neural foraminal stenosis at T12 through L4. The vertebral body heights are preserved. There is no spondylolisthesis. The imaged portions of the spinal cord are unremarkable. There are findings related to right hip arthoplasty.

Output: Postoperative findings related to left L5-S1 hemilaminectomy and ligamentum flavectomy with degenerative spondylosis and what may represent scar tissue that efface the left lateral recess. Degenerative spondylosis is also present at L4-5 with minimal bilateral neural foraminal narrowing at this level. No significant spinal canal or neural foraminal stenosis at T12 through L4. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left sided PTA. Neck CT:There is soft tissue thickening and enlargement of the left palatine tonsil, with soft tissue thickening and edema extending to the rest of the oropharynx and hypopharynx resulting in effacement of the left piriform sinus. The edematous soft tissue abnormality extends into the left submandibular and sublingual space. Cervical lymphadenopathy is seen in the neck bilaterally, greater on the left.No discrete fluid collection is seen to suggest abscess.There is mild diffuse sclerosis of the cervical spine bony structures, but no focal lesion is seen.There is a cystic lesion in the right middle cranial fossa, and may represent an arachnoid cyst. It is incompletely visualized, and can be further evaluated with MRI brain.

Output: 1. Extensive soft tissue abnormality involving the left palatine tonsils, oro- and hypopharynx, with edematous soft tissue thickening extending into the left submandibular and sublingual space. Findings suggest most likely infectious / inflammatory process. Please also correlate clinically.2. Cerivcal adenopathy greater on the left, probably reactive.3. Mild diffuse sclerosis of cervical spine may be seen in patients with metabolic and endocrine disease. Please correlate with clinical parameters.4. Right middle cranial fossa arachnoid cyst. Further imaging can be obtained with MRI brain.


Instruction: Generate impression based on findings.

Input: Evaluate for cervical spine stenosis. 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. There is a partially-empty sella. 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, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst. Cervical Spine: There is straightening of the usual cervical lordosis. There is multilevel degenerative cervical spondylosis with up to mild spinal canal and neural foramen stenosis. The vertebral body are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Multilevel mild degenerative cervical spondylosis.


Instruction: Generate impression based on findings.

Input: Evaluate parotid gland enlargement. Possible sarcoidosis. None in views CT of soft tissues of neck:Limited value exam due to lack of intravenous contrast. This study was performed without the benefit of contrast as it was requested by clinical service.Images through the skull base, paranasal sinuses and bilateral petrous bones are unremarkable.Examination demonstrates normal low attenuation of parotid glands bilaterally. The left parotid gland appears a slightly larger than the right however with similar normal appearing density. Very small nodes within the left parotid measuring approximately 5 mm in size are identified. These findings were observed on prior MRI examination and show no change. The fascial planes surrounding the parotid glands remain within normal limits.Images through the rest of the neck demonstrate no evidence of a mass or any pathologic adenopathy.

Output: Essentially unremarkable CT of soft tissues of neck and without enhancement. Minimally larger left parotid gland however the normal density and morphology. Very small sub-centimeter lymph node in the left parotid is noted.


Instruction: Generate impression based on findings.

Input: New onset of dizziness and history of metastatic breast cancer. There is a heterogeneously enhancing mass with small areas of susceptibility effect in the right cerebellar hemisphere that measures up to 35 mm, with extensive surrounding edema and marked effacement of the fourth ventricle, as well as mild inferior cerebellar herniation. There is also a 5 mm wide left cerebellar hemisphere enhancing lesion with associated vasogenic edema. There is a punctate enhancing lesion at the grey white matter junction of the left posterior occipital lobe. There appears to be a small developmental venous anomaly in the left inferior frontal gyrus. There is dilatation of the third and lateral ventricle with diffuse periventricular T2 hyperintensity. There is no evidence of acute infarct. There is dilatation of the bilateral optic nerve sheaths, which attests to elevated intracranial cerebrospinal fluid pressure. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Bilateral cerebellar hemisphere metastases, right larger than left with extensive vasogenic edema associated with effacement of the fourth ventricle, acute obstructive hydrocephalus and mild inferior cerebellar herniation.2. A punctate enhancing lesion at the grey white matter junction of the left posterior occipital lobe likely represents a metastasis as well. Discussed with Dr. Nanda at 10:30 AM on 1/28/16.


Instruction: Generate impression based on findings.

Input: Female, 52 years old, with headache and nausea, history of breast cancer status post metastasis. Since the prior examination, numerous small enhancing lesions have diminished in size or become undetectable. For reference, the left temporal lobe lesion which previously measured up to 7 mm now measures only 3 mm.No new enhancing lesions are detected. No significant parenchymal edema or mass effect is seen. A single small focus of T2 hyperintensity is seen within the right frontal white matter which may reflect a prior treated lesion or treatment effect. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricular system is normal in size and morphology.Bone marrow signal characteristics are unremarkable. Patchy opacification of the mastoid air cells is seen.

Output: Since the prior examination, multiple parenchymal metastatic lesions have diminished in size or become undetectable. No new lesions are seen. No intracranial findings are noted to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Seizure, evaluate for structural lesion No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. The brain parenchyma is of normal signal intensity without mass lesion. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.The imaged portions of the paranasal sinuses are clear. The imaged portions of the mastoid air cells are clear. The imaged portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of metastatic lung adenocarcinoma. Evaluate for etiology of ongoing seizures. There is a tiny punctate focus of restricted diffusion within the right middle frontal gyrus which is of uncertain etiology or clinical significance. There are no large areas of restricted diffusion to suggest a territorial infarction. Postoperative changes of right craniotomy and tumor resection are redemonstrated. Rim enhancement along the superior aspect of the surgical cavity and adjacent dura appears similar to the prior study. Surrounding flair signal abnormalities suggestive of edema also appears unchanged. There is extensive periventricular T2/FLAIR hyperintensity which may be related to treatment/radiation and/or chronic small vessel ischemic disease. There is no midline shift. No additional areas of enhancement are appreciated. Normal flow voids are appreciated within the major intracranial vessels. The paranasal sinuses, mastoid air cells and orbits are unremarkable.

Output: 1. Stable postoperative changes of right parietal craniotomy and tumor resection with residual enhancement along the superior aspect of the surgical bed and adjacent dura.2. Tiny punctate focus of restricted diffusion within the right middle frontal gyrus which is of uncertain etiology or clinical significance. 3. Extensive periventricular T2/FLAIR hyperintensity which may be related to treatment/radiation and/or chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: 54F s/p pancreas transplant now with headaches History: Headaches There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are, however, multifocal scattered small high signal intensity lesions on bilateral white matter on FLAIR images indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Non specific small vessel ischemic disease.No evidence of acute ischemic or hemorrhagic lesion.No abnormal enhancement seen on this scan.


Instruction: Generate impression based on findings.

Input: Ms. Hunt is a 67 year old with recently diagnosed left breast cancer. She presents for MRI for further evaluation. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Bilateral retropectoral silicone implants appear intact.In the left lower inner breast, 7:00 position, there is an irregular enhancing mass identified measuring 1.3 x 1.8 x 1.4 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen just postero-medial to the lesion, compatible with biopsy-proven malignancy. The malignancy abuts against the implant. There is no additional abnormal enhancement seen in the left breast.There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy of the left breast, with malignancy abutting against the implant. Of note, the biopsy marker clip is noted just postero-medial to the lesion. If breast conservation therapy is desired, the clip can be used for targeting for preoperative surgical guidance.(2) No MRI evidence of malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: New onset migraine. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is flattening of the pituitary gland. 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: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Flattening of the pituitary gland is nonspecific, but can potentially represent a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: New shoulder and upper arm pain. Rotator cuff tear? Multiple foci of signal void within the soft tissues of the shoulder represent metallic susceptibility artifact related to prior surgery. Suture anchors are again noted within the humeral head posteriorly.ROTATOR CUFF: The infraspinatus tendon appears thickened. Its posteroinferior fibers extend toward the aforementioned suture anchors and I suspect are intact. The anterosuperior fibers of the tendon however, appear to terminate between the humeral head and acromion process resulting in a cuff defect along the posterior margin of the supraspinatus. Increased signal intensity within the posterior fibers of the supraspinatus tendon likely represent a continuation of this defect. The remainder of the supraspinatus tendon is intact. Overall, these findings are similar to those on the prior examination, and might reflect the expected surgical outcome rather than a postoperative tear. Atrophy of the infraspinatus muscle appears similar to that seen on the prior study. There is mild fatty infiltration of the supraspinatus muscle along the myotendinous junction that also appears similar to that seen on the prior study. The teres minor tendon and muscle appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint appearing similar to that seen on the prior study.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. Fluid separates the superior labrum from the underlying glenoid, but I suspect that this represents a sublabral recess rather than a labral tear. Mild heterogeneity of signal of the anterior labrum likely reflects degeneration. The posterior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps is not visualized which may reflect a chronic tear or prior tenodesis/tenotomy.

Output: Rotator cuff defect involving the anterosuperior fibers of infraspinatus tendon as described above appears similar to the prior study and may reflect the expected surgical outcome rather than a postoperative tear. Acromioclavicular joint osteoarthritis and other findings as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Numb and painful feet, loss of vibratory sense, former football player. Signs and symptoms: Has 4 fused vertebrae. Nonenhanced lumbar MRI:Please note that the numbering of the lumbar vertebral levels is performed utilizing prior cervical and thoracic MRI images for accuracy.T12 -- L1 is unremarkable with the exception of degenerative changes.L1 -- L2 it is unremarkable other than mild degenerative changes.L2 -- L3 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. There is a right lateral disk osteophyte complex with resultant significant right lateral recess compromise and mild right neural foraminal compromise. There is mild central spinal stenosis.L3 -- L4 demonstrate moderate disk disease and loss of disk height, moderate left facet and ligamentum flavum hypertrophy and mild on the right. Asymmetric left-sided hypertrophy changes of posterior elements and in combination with a small disk osteophyte complex on the left results in significant left lateral recess and moderate left neural foraminal compromise. Mild to moderate central spinal stenosis and moderate right neural foraminal compromise is also noted.L4 -- L5 demonstrate mild disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy is present. There is no evidence of central spinal stenosis. There is however significant bilateral neural foraminal compromise secondary to degenerative changes.L5 -- S1 demonstrate mild disk desiccation without loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. There is no central spinal stenosis. There is however moderate bilateral neural foramina compromise.Lowermost visualized thoracic spine and cord is unremarkable.Unremarkable perispinal soft tissues.

Output: 1.Degenerative changes of lumbar spine results in mild central spinal stenosis at L2 -- L3 and moderate at L3 -- L4 levels.2.Multilevel bilateral neural foraminal and lateral recess compromise as detailed per level.3.Unremarkable lowermost visualized thoracic spine and cord other than mild degenerative changes.


Instruction: Generate impression based on findings.

Input: History of antral gastric cancer status post resection, now with local recurrence. Staging CT 3/6/15 showed stable subcentimeter liver lesions and steatohepatitis. Now with sudden onset hyperbilirubinemia. Evaluate for obstructive process and also liver lesions. EPIC history: EGD 2/26/15 showed malignant appearing gastric tumor in lesser curvature of stomach. ABDOMEN:LIVER, BILIARY TRACT: Diffuse mild intrahepatic and extrahepatic biliary ductal dilatation, measuring up to 9 mm, with transition point at irregular narrowing at the biliary-enteric anastomosis (series 602, image 3). This is due to extrinsic compression of the duct by an enhancing 2.5 x 2.8 x 4 cm mass at the enteric anastomosis (series 1602, image 73; series 801, images 17 and 18), centered in the pancreaticoduodenal groove; it is unclear if this mass is of pancreatic or bowel origin.Previously noted subcentimeter right hepatic lobe lesion is too small to characterize, unchanged (series 1602, image 114).SPLEEN: No significant abnormality noted.PANCREAS: Markedly atrophic pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral parapelvic cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical findings of distal gastrectomy and Roux-en-Y gastrojejunostomy.Eccentric wall thickening of the lesser curvature with associated diffusion restriction compatible with known locally recurrent tumor (series 1602, image 94).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild diffuse dilatation of the biliary tree due to an obstructing mass at the biliary-enteric anastomosis highly suspicious for tumor, unclear if this is of bowel or pancreatic origin. Differential is metastatic lesion versus a primary malignancy of the bowel or pancreas.2.Lesser curvature of the stomach eccentric wall thickening consistent with known local recurrence.3.Unchanged subcentimeter right hepatic lobe lesion, too small to characterize; special attention on follow up scans.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5], Reason for Study: ^Reason: assess for cause of urinary retention and back pain History: urinary retention and back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are evidence of subtle linear enhancement on both superior endplate of L1 and inferior endplate of L2 with surrounding soft tissue enhancement especially on the left side. In addition, there is a small nodular enhancement of the L2 vertebral body left posterior superior aspect adjacent to the L12 disc space. The L12 disc demonstrates high signal intensity on T2. However, there is no definitive enhancement of the L12 disc.Constellation of above findings indicate the possible diagnosis of degenerative changes but cannot exclude possibility of discitis.In addition, there is T1 high signal intensity lesion within the thecal sac especially conus area indicating subacute blood products which most likely represent redistribution of acute SAH. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow demonstrates a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L1-L2: Subtle enhancement of inferior endplate of L1 and superior endplate of L2 vertebral body with surrounding soft tissue. This indicates possible degenerative change related enhancement however possibility of associated discitis cannot be completely excluded. No neuroforaminal narrowing or spinal stenosis. L2-L3: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation. Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. Bilateral facet joints show subchondral sclerosis with subchondral cyst formation especially on the left side indicating minimal to mild facet arthritis.L5-S1: Diffuse bulging of disc with bilateral ligamentum flavum thickening results minimal spinal canal stenosis. Otherwise unremarkable..

Output: 1. Subtle enhancement of endplates around L12 disc space likely represents degenerative changes related findings but associated early discitis cannot be completely excluded.2. Intrathecal especially sacral area subacute blood products indicate redistribution of acute SAH.3. Minimal degenerative changes of lumbar spine.


Instruction: Generate impression based on findings.

Input: 61-year-old male with metastatic malignant melanoma of the skin. There has further been interval decrease in size of the right sinonasal mass involving the inferior nasal terminate, right lateral nasal wall, and right maxillary sinus. For example, the maxillary sinus extension is decreased from 6 mm in transverse dimension on 7/9/2016 to 3-mm in transverse dimension on the current exam. The right lateral nasal wall thickness has gone from 10 mm to 4 mm. The lesion in the left lateral rectus muscle has also decreased in size from 10 mm to 7 mm in transverse dimension.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.

Output: 1. No evidence of intracranial metastases.2. Interval decreased size of the right sinonasal and left lateral rectus muscle metastases since 7/9/2016. Current examination is performed as a brain MRI. Subsequent follow-up MRI studies tailored to the sinuses/face may be helpful to assess for more subtle changes.


Instruction: Generate impression based on findings.

Input: 41-year-old female with medial left knee pain. Evaluate for medial meniscus tear. MENISCI: The medial lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No evidence of bone marrow edema. No significant thinning of the articular cartilage.LIGAMENTS: No evidence of ligamentous injury.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate sized joint effusion without underlying ligamentous or meniscal pathology.


Instruction: Generate impression based on findings.

Input: Hand pain swelling Note that the examination is limited by motion artifact and inability to optimally position the patient.Wrist: There is no abnormal marrow signal to suggest osteoarthritis or gout. There is questionable widening of the scapholunate interval which may reflect a disruption of the scapholunate ligament although this is only appreciated on the coronal T1 sequence.There is diffuse soft tissue edema particularly along the dorsum of the wrist. There is fluid identified within the radiocarpal joint, midcarpal space and DRUJ.Hand: There is no abnormal marrow signal to suggest osteoarthritis or gout. A small focus of increased T2 marrow signal is present within the PIP joint of the ring finger which is nonspecific in nature. Diffuse soft tissue edema is again noted along the dorsum of hand.

Output: 1. No evidence of osteomyelitis or active gout within the hand or wrist.2. Diffuse soft tissue edema particularly along the dorsum of the wrist. A small amount of fluid is noted within the wrist as well which is nonspecific but could be reactive in nature.3. Small focus of abnormal marrow within the PIP joint of the ring finger which may be degenerative in nature.


Instruction: Generate impression based on findings.

Input: Right frontal GBM, IDH wt, MGMT promoter unmethylated; s/p biopsy, RT/TMZ, TMZ+TTF x1 cycle, craniotomy with extensive resection (7/19/16). There are findings related to right frontoparietal craniotomy with right posterior frontal lobe paramedian resection cavity. There is decreased enhancement along the margins of the resection cavity, which is now negligible. There is unchanged confluent high T2 signal surrounding vasogenic edema. A few scattered foci of T2 hyperintensity elsewhere in the cerebral white matter are nonspecific. There is no evidence of acute ischemia or intracranial hemorrhage. There is no midline shift. The skull and extracranial structures are unchanged.

Output: Further interval decreased enhancement surrounding the right paramedian frontal lobe resection cavity.


Instruction: Generate impression based on findings.

Input: 64 year old female with history of cavernous hemangioma of the liver and secondary portal vein thrombosis, HTN here for pre-liver transplant cardiac MRI evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 62%. The LVEDV is 105 ml (normal range 109+/-23), LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), LVESV is 40 ml (normal range 31+/-10), and LV end systolic volume index is 22 ml/m2 (normal range 18+/-5). Sigmoid septum present. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 myocardial relaxation time is normal (1040-1080 ms). This is not suggestive of underlying diffuse fibrosis or infiltration. There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 121 ml/m2 (normal range 69+/-14), the RVEDV is 66 ml (normal range 110+/-24), the RV end systolic volume index is 49 ml/m2 (normal range 22+/-8), and the RVESV is 27 ml (normal range 35+/-13). Right AtriumThe right atrium is externally compressed by the liver mass. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary Veins3 pulmonary veins drain normally into the left atrium. LUPV not well seenPulmonary 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 FindingsMassively enlarged right lobe of the liver which appears to be elevating the right hemi-diaphragm to at least the mid right lung. 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.Normal sized left ventricle with normal systolic function and no hypertrophy (LVEF 62%).2.Normal sized right ventricle with normal systolic function and no hypertrophy (RVEF 59%).3.Massively enlarged right lobe of the liver with compressive effects on the right atrium and minimally on the right ventricle as well.4.No late Gadolinium enhancement to suggest fibrosis, inflammation or infiltration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: patient with ulcerative colitis with low back pain with inflammatory description. Normal SI joints xrays outside. Evaluate for any sacroiliitis changes History: patient with ulcerative colitis with low back pain with inflammatory description. Normal SI joints xrays outside. Evaluate for any sacroiliitis changes We see no fluid within or enhancement of the sacroiliac joints. Below the level of the sacroiliac joints, there is a small focus of edema and enhancement within the lateral portion of the S4 segment, that is nonspecific. We otherwise see no bone marrow abnormalities. The visualized portions of the lower lumbar spine are unremarkable.

Output: Small focus of nonspecific edema and enhancement in the lateral portion of the S4 segment, inferior to the right sacroiliac joint, of uncertain significance. The sacroiliac joints themselves appear normal.


Instruction: Generate impression based on findings.

Input: 84-year-old female with constipation, unable to disimpact. Concern for mass or fecolith per ER. ABDOMEN: The exam is not sensitive detection of lesions in the solid organs due to the lack of intravenous contrast. Given that limitation, the following observations are made.LUNG BASES: Left mastectomy.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta no evidence of aneurysm.BOWEL, MESENTERY: Bilateral hypoattenuating foci in the kidneys likely cysts. Left lower pole lesion stable but does not have characteristics of simple cyst. See prior evaluation with ultrasound on MRI.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of stool in the colon and in the rectum. There is distinct rectal wall thickening to about .8 cm as seen on series 4 image 129. Correlate for possible stercoral colitis limited to the rectum. There is mild stranding of the perirectal fat. Ischio rectal fossa fat is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic disease.

Output: Possible proctitis. Moderate amount of stool in the rectum. Renal lesions likely cysts including one atypical lesion which is stable.


Instruction: Generate impression based on findings.

Input: Reason: ? Cuff tear; ? Subscap tear History: pain ROTATOR CUFF: The supraspinatus tendon appears thinned, suggesting chronic attritional tearing. There is also a focus of linear high signal intensity separating the tendon from its insertion on the greater tuberosity indicating an insertional tear. While this insertional tear appears to involve the majority of the thickness of the tendon, it is only seen on one image and measures approximately 3 mm in the AP dimension and it spares the bursal surface fibers. We see no retraction or evidence of a full-thickness rotator cuff tear. Additionally, there is perhaps mild interstitial tearing of the supraspinatus tendon more proximally. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is focal increased signal intensity along the undersurface fibers of the subscapularis proximal to its insertion suggesting mild fraying with a tiny defect along the anterolateral margin overlying the humeral head, but we see no full-thickness tear. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. The acromioclavicular joint appears normal for age.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. Given the limitations of a non-arthrogram study, the labrum appears normal for age. We see no fluid-filled articular cartilage defects.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Thinning of the supraspinatus tendon suggesting chronic attritional tearing as well as a partial-thickness insertional tear as described above.2. Focal undersurface fraying of the subscapularis, but we see no discrete tear.


Instruction: Generate impression based on findings.

Input: 61-year-old female with bladder cancer, status post ileostomy. Fever and shock. Indiana pouch with ileostomy. Evaluate for GI source of infection. Pulmonary embolism CT scan examination was performed in conjunction with this study, but will be reported separately. ABDOMEN:LUNG BASES: CT scan of the thorax for pulmonary embolism was performed and will be reported separately.LIVER, BILIARY TRACT: There are multiple benign-appearing simple hepatic cysts, unchanged from the recent MRI examination. There is diffuse gallbladder wall thickening with mucosal enhancement suggesting cholecystitis.SPLEEN: There is a splenic hemangioma unchanged since the recent MRI examination.PANCREAS: No evidence of pancreatitis was found.KIDNEYS, URETERS: Mild left hydronephrosis is found, as expected in this patient who is status post Indiana pouch ilial conduit. There is a focal left mid pole cortical thinning, probably due to prior infarct. No acute changes are found and compared with the prior examination.ADRENAL GLANDS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is focal fat stranding in the right or quadrant, especially axial image 81/162, adjacent to the ilial conduit and a drainage tubing at axial image 97 / 162.PELVIS:UTERUS, ADNEXAE: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is a left lower quadrant ileostomy at axial image 91/ 158.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: New gallbladder wall thickening suggests interval development of cholecystitis. Multiple postoperative changes. No abscess or ascites. Multiple additional findings, as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate cause of transient left inferior quadrant black spots. Signs and symptoms: As above. Nonenhanced brain MRI:No diffusion weighted abnormalities. The anatomical morphology and signal intensity of brain parenchyma is within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for age.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium and soft tissues of the scalp.Unremarkable limited images through the orbits.Mild acute right maxillary sinus disease and minimal bilateral anterior ethmoid and frontal sinus disease. Bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.Nonenhanced MRI of orbits:There is normal signal intensity and retro-orbital fat.There is normal signal intensity, morphology and size of the extraocular musculature bilaterally.Normal signal intensity and caliber of the bilateral optic nerves in the retrocrural space as well as their cisternal component and the chiasm.Normal signal intensity, morphology and signal intensity at bilateral globes and bilateral lacrimal glands. Normal signal intensity, size and morphology of bilateral cavernous sinuses. Unremarkable images through the basal cistern and pituitary. Unremarkable pre-septal periorbital soft tissues.Nonenhanced brain MRA:Unremarkable bilateral internal carotid arteries across the skull base and in their supraclinoid segments. Unremarkable bilateral anterior and middle cerebral arteries and their branches.Unremarkable bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, superior cerebellar and bilateral posterior cerebral arteries.

Output: 1.Unremarkable nonenhanced brain MRI. Mild acute on chronic sinusitis as detailed.2.Unremarkable nonenhanced MRI of the orbits.3.Unremarkable nonenhanced brain MRA.


Instruction: Generate impression based on findings.

Input: Clinical question: History of breast cancer, questionable C6-C7 lesion versus osteoarthritic changes. Signs and symptoms: Neck pain. Pre and postcontrast enhanced cervical MRI:Examination redemonstrates extensive degenerative changes of cervical spine with resultant multilevel central spinal stenosis worse at C6-C7 similar to prior exam. Increased T2 signal intensity within the cord at C6-C7 consistent with associated myelitis secondary to degenerative disease without change.Multilevel neural foraminal compromise without change since prior study.Extensive degenerative changes of posterior elements most notably at C6-C7 and C5-C6 levels on the left with diffuse patchy enhancement without change. Patchy enhancement within the vertebral bodies of C6 and C7 is also identical to prior exam and representing enhancement of degenerative changes.There is no evidence of an enhancing metastatic lesion of the vertebral column, cervical cord or the leptomeninges.

Output: 1.Extensive degenerative changes of cervical spine with resultant multilevel central spinal stenosis and associated myositis as detailed above and without change since prior exam.2.Expected patchy enhancement of severely degenerated articulating facets and degenerated vertebral endplates without change since prior exam.3.No convincing evidence of enhancing metastatic lesion of the vertebral column, cervical cord or the leptomeninges.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness bilaterally There is interval increase in destructive changes at the C6-C7 disc level including the adjacent C6 and C7 vertebral bodies with loss of vertebral body height. T2 hyperintensity involving the disc space and bone marrow compatible with edema is stable to minimally increased in the interval. There is a dorsally projecting osteophyte/osseous retropulsion which results in flattening of the cord which is worse since prior. There is also increased T2 hyperintensity in the cord compatible with edema. Prevertebral edema is improved since prior. Moderate spinal canal stenosis at the C2-C3 C3-C4, C4-C5, and C5-C6 levels is similar to prior. There is T2 hyperintensity in the ventral epidural space extending from C5 to C7 which is favored to represent engorged epidural venous plexus.Diffuse low T1 and T2 bone marrow signal may be related to renal osteodystrophy and/or chronic anemia. Vertebral body heights and alignment in the thoracic and lumbar spine are maintained. Small Schmorl's nodes are incidentally noted. No significant spinal canal stenosis in the thoracolumbar spine is appreciated.

Output: Examination is limited to sequences per cord compression protocol. Compared to 12/29/2014, there has been worsening of endplate destructive changes at the C6-C7 level, worsening vertebral body height loss, stable to slight worsening of disc/bone marrow edema at this level, and worsening of osseous retropulsion, which now results in severe spinal canal stenosis. There is edema in the cord at this level which is new since prior. Possibilities of this destructive process include dialysis-related spondyloarthropathy and chronic discitis-osteomyelitis. Epidural tissue in the C5-C6 level is favored to represent engorged venous plexus. Please refer to separate cervical spine MRI for additional findings.No significant spinal canal stenosis in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Multiple myeloma with back pain. Signs and symptoms: As above. Pre-and post-enhanced cervical MRI:Examination demonstrates advanced degenerative disk disease at C3 -- C4 through C7 -- T1 levels.There is no focus of signal abnormality to suggest presence of tumor and there is no detectable abnormal enhancement.Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative disk disease and moderate ligamentum flavum hypertrophy. Changes results in mild central spinal stenosis and no neural foraminal compromise.C3-C4 demonstrates advanced disk disease and fusion at the level disk. There is significant right and mild left neural foramina compromise and no definitive central spinal stenosis.C4 -- C5 demonstrate advanced disk loss of disk height and disk effusion at this level. There is significant bilateral neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate advanced disk disease and loss of disk height and broad-based hypertrophic spur. Findings resulting subtle flattening and posterior displacement of the cord and moderate central spinal stenosis. Significant bilateral neural foraminal compromise (right greater than left).C6 -- C7 demonstrate advanced disk disease with significant loss of disk height, mild retrolisthesis, mild hypertrophic changes of posterior elements. Constellation of above findings results in mild central spinal stenosis, moderate bilateral neural foraminal compromise.C7 -- T1 demonstrate advanced disk disease and significant loss of disk height, grade 1 anterolisthesis, mild to moderate ligamentum flavum and severe right and moderate left facet hypertrophic changes. Constellation of above findings results in mild to moderate central spinal stenosis and significant bilateral (right greater than left) neural foraminal compromise.The signal intensity of the cord remains within normal and without evidence of abnormal enhancement.Pre-and post-enhanced thoracic MRI:The examination demonstrates normal anatomical alignment the vertebral column however with mild exaggeration of thoracic lordosis.There is no detectable focus of abnormal signal intensity or enhancement of vertebral column to suggest metastatic disease.The signal intensity of the thoracic cord also remains within normal and without detectable abnormal enhancement. There is subtle increased T2 stir signal change with this finding and with subtle enhancement suggestive of subacute fracture.Mild compression fracture of the superior endplate of T12 with subtle increased T2 stir signal intensity and enhancement which likely indicate subacute fracture.There is moderate to advanced degenerative changes of disks throughout the thoracic spine with multilevel shallow ventral hypertrophic spurs. There is however no evidence of central spinal stenosis at any level. There is also no significant neural foraminal compromise present.The perispinal soft tissues are unremarkable.Pre-and post-enhanced lumbar MRI:The above described mild compression fracture of the T12 superior endplate is concave from C1 inferiorly. However on MRI of lumbar spine counting from below the fracture endplate appears to be at L1 level. This could be result of patient movement.Examination demonstrates fairly extensive degenerative changes of disks and posterior elements.The alignment the vertebral column remains anatomical however there is straightening of lumbar lordosis.Examination demonstrates no focus of marrow signal change or abnormal enhancement to suggest metastatic disease.The signal intensity of the conus and cauda equina also remains within normal and without detectable abnormal enhancement other than expected subtle enhancement of mildly compressed fracture of superior endplate of L1 (counting from below and T12 from counting from above) as detailed above.L1 -- L2 demonstrate extensive degenerative changes however without spinal stenosis. Mild right neural foraminal compromise is present.L2 -- L3 demonstrate advanced disk disease with near complete loss of disk height mild to moderate bilateral ligamentum flavum hypertrophy. No central spinal stenosis or significant neural foraminal compromise is present. There is over mild left lateral recess compromise.L4 -- L5 demonstrate advanced disk disease with loss of disk height and advanced bilateral facet and ligamentum flavum hypertrophic changes. Constellation of changes results in moderate to severe central spinal stenosis and significant left and moderate right neural foraminal compromise.L5 -- S1 demonstrate advanced disk disease, loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy. No spinal stenosis. There is however a significant right and moderate left neural foraminal compromise.

Output: 1.Pre-and post-enhanced MRI of the cervical spine demonstrate no evidence of metastatic disease. There is extensive degenerative disk disease with resultant minimal grade 1 retrolisthesis at C5 -- C6 and mild grade 1 anterolisthesis at C6 -- C7 levels. There is evidence of central spinal stenosis at C2 -- C3, C5 -- C6, C6 -- C7 and C7 -- T1 levels. There are also multilevel neural foraminal compromise (some significantly) as detailed per level.2.Pre-and post-enhanced MRI of thoracic spine demonstrate no evidence of metastatic disease. There is normal signal intensity and caliber of the thoracic cord without abnormal enhancement. There is no evidence of central spinal stenosis at any level. Mild compression fracture of the superior endplate of T12 with subtle increased T2 stir signal intensity and enhancement which likely indicate subacute fracture.3.Pre-and post-enhanced MRI of the lumbosacral spine demonstrate no evidence of metastatic disease. Extensive degenerative changes of lumber spine results in significant central spinal stenosis at L4 through 5 level as detailed. Note should be made that the above detailed compression fracture of superior endplate of T12 (counted from C1 inferiorly) appears to represent L1 vertebrae when counted from below on MRI of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer with treated brain metastases. Please compare to outside MRI 4/1/2015 to evaluate disease status. There is redemonstration of the scattered foci of intrinsic T1 shortening involving the medial right superior frontal gyrus, posterior right superior frontal gyrus, right inferior parietal lobule, left precentral gyrus, and left medial thalamus. No other abnormal enhancing lesion is identified. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. Many of these lesions demonstrate a morphology and distribution often seen with demyelinating disease. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No significant interval change in multiple scattered foci of intrinsic T1 shortening as described above, compared to 2/26/2015. No findings to suggest progression of metastatic disease.2.Scattered T2 hyperintense lesions in the white matter, which are nonspecific and unchanged. Differential considerations include chronic demyelinating (favored), inflammatory, or ischemic etiology. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 22-year-old male with worsening pain and drainage while on antibiotics. Assess status of osteomyelitis of the coccyx and adjacent fluid pocket. Again seen is ulceration of the soft tissues posterior to the coccyx. Inflammation extends from this ulceration into the subcutaneous fat along the gluteal crease which abuts the inferior margin of the bones of the coccyx. Although this inflammation appears similar to that seen on the prior study, the fluid pocket seen on the prior study has decreased in size. There is a small focus of gas within this collection. A discrete C1 segment, visible on the prior study, is not evident on the current examination, presumably related to interval destruction from osteomyelitis. Although there is mild residual edema within the C2 segment on the fluid sensitive sequences, the marrow appears largely fatty on T1-weighted images suggesting some interval healing. Enhancing inflamed tissue extends between the S5 and C2 segments. There is mild edema within the S5 segment on the fluid sensitive sequences but preservation of normal bone marrow signal on T1-weighted images, suggesting reactive osteitis rather than osteomyelitis.There is a small collection of rim-enhancing fluid adjacent to the inferior aspect of the ischial tuberosity that appears to communicate with the overlying skin surface via an enhancing sinus tract. This small amount of fluid appears to have decreased when compared to the prior study. There is no evidence of osteomyelitis of the ischium. A similar sinus tract is noted on the right that likely contacts the ischial cortex, but we see no associated fluid collection or evidence of osteomyelitis. We see no additional foci of osteomyelitis. There is loss of the soft tissue posterior to the right greater trochanter with mild enhancement along the trochanters bilaterally, suggesting inflammation, but we see no findings to suggest osteomyelitis. There is free fluid within the pelvis which is nonspecific.

Output: 1. Decubitus ulcer as described above with decrease in size of "fluid pockets" seen on the prior study.2. Sinus tract extending to both ischia without evidence of osteomyelitis.3. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There is an avidly enhancing extra-axial mass overlying the anterior left temporal lobe measuring approximately 4 cm. The tumor bulges into the left optic nerve canal. There is associated mass effect and extensive vasogenic edema in the adjacent left temporal lobe. There is a 6 mm of left to rightward midline shift and left uncal herniation. There is a small developmental venous anomaly in the left midbrain. There is no evidence of acute intracranial hemorrhage or infarction. The skull appears to be grossly intact. The orbital contents are grossly unremarkable. There are skin-based fiducial markers.

Output: Left middle cranial fossa mass that measures up to 4 cm with vasogenic edema in the compressed anterior left temporal horn likely represents a meningioma. The tumor bulges into the left optic nerve canal and there is 6 mm of midline shift to the right.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, status post tumor resection. Evidence of laminectomy is seen at least at T5 and possibly at T4 and T6 as well though these areas are obscured by metal artifact. Instrumented posterior spinal fusion has been performed with bilateral pedicle screws in the T4 and T6 vertebral bodies affixed to posterior stabilization rods.A previously seen bulky tumor involving the left T5 pedicle, transverse process, a small part of the vertebral body and the adjacent rib head appears to have been at least partially resected. The transverse process and part of the vertebral body are absent. Part of the adjacent left rib head may also have been resected. The tumor bed does remain filled with soft tissue material of uncertain composition, possibly representing a combination of residual tumor and surgical packing material. Of note, it does appear that epidural encroachment and deformation of the left lateral thecal sac seen on the prior examination has been relieved.There appears to be a fracture of the proximal left T4 rib, with T1 hypointensity in the adjacent marrow possibly reflecting edema or marrow replacement. This finding was present on the prior examination.Evaluation of the spinal cord is limited in the region of the pedicle screws, but elsewhere the cord shows normal signal intensity and morphology. No areas of significant spinal canal stenosis or cord impingement are suspected.Vertebral bodies are normally aligned with a slightly exaggerated thoracic kyphosis. Vertebral body heights are preserved.

Output: Findings are seen compatible with at least partial resection of a tumor deposit involving the T5 pedicle, transverse process and rib head. Posterior instrumented spinal fusion has also been performed from T4 through T6.Soft tissue material in the tumor bed is of uncertain etiology and could represent a combination of both residual tumor and surgical packing. Epidural encroachment and deformation of the left lateral thecal sac seen on the prior examination have been relieved.A fracture through the proximal left T4 rib is suspected, unchanged from the prior examination. It is unclear if this is a benign fracture or a fracture through a metastatic deposit.


Instruction: Generate impression based on findings.

Input: History of urothelial cancer. Status post right nephroureterectomy. ABDOMEN:LIVER, BILIARY TRACT: No focal lesion. SPLEEN: Borderline splenomegaly measuring 14 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephroureterectomy without evidence of residual or recurrent disease in the nephrectomy bed.RETROPERITONEUM, LYMPH NODES: Subcentimeter mesenteric and retroperitoneal lymph nodes are unchanged.Stable subcentimeter periportal lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: 15-year-old male with history of generalized seizures. The hippocampi are unremarkable. There is no evidence of heterotopic gray matter or mass effect. There is no midline shift or herniation. There is no evidence of acute ischemia. The ventricles and sulci are age-appropriate. There is near complete filling of the left maxillary sinus and anterior ethmoid air cells with mucosal thickening and secretions. The calvarium and scalp soft tissues are normal. The orbits are unremarkable.

Output: 1.No convincing evidence of potential seizure foci.2.Persistent left osteomeatal unit complex sinus disease that likely represents chronic sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 30 years old, with history of ganglioneurocytoma of the left frontal lobe status post resection and radiation. Redemonstrated is a left frontal lobe resection cavity which is stable in size and morphology. The degree of T2 hyperintensity surrounding this cavity, and to a lesser extent, along the frontal horn of the right lateral ventricle, is also unchanged. No pathologic enhancement is seen within or around the resection cavity.Elsewhere in the brain, no new areas of signal abnormality or pathologic enhancement are detected. No restricted diffusion is seen. There is no evidence of mass effect or parenchymal edema. Ex vacuo dilatation of the left lateral ventricle is unchanged.

Output: Stable examination with no evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: 27-year-old male with 4 week history of right knee pain status post ACL repair 5 years ago, evaluate graft MENISCI: The medial meniscus is intact. There is attenuation of the posterior horn of the lateral meniscus which may reflect chronic attritional tearing or prior partial meniscectomy. Linear signal abnormality within the posterior horn extending to the articular surface may represent tearing or intrasubstance degeneration that pre-existed the partial meniscectomy. There is also blunting of the free edge of the body of the lateral meniscus with focal signal intensity which may reflect sequela of prior partial meniscectomy or degenerative radial tearing. The anterior horn of the lateral meniscus is intactARTICULAR CARTILAGE AND BONE: There is a focal full-thickness defect in the articular cartilage along the weightbearing portion of the lateral femoral condyle measuring 5 mm with associated edema in the underlying lateral femoral condyle. The remainder of the articular cartilage is intact.LIGAMENTS: There are findings of ACL reconstruction and the graft appears intact with small adjacent ganglia which are not necessarily of any clinical significance. Heterogeneous, intermediate to low signal intensity lesion along the anterior fibers of the intra-articular portion of the graft may represent residual fibers of a torn native ACL and/or focal arthrofibrosis. The MCL and lateral collateral ligament complexes are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Postoperative changes of ACL reconstruction. The graft appears intact, although heterogeneous signal intensity along the anterior fibers of the intra-articular portion of the graft may represent residual fibers of a torn native ACL and/or focal arthrofibrosis.2.Focal full-thickness defect in the articular cartilage along the lateral femoral condyle with edema in the underlying bone which may represent the source of the patient's pain. 3.Meniscal abnormalities as described above which may reflect either chronic degenerative tearing and/or partial meniscectomy changes.


Instruction: Generate impression based on findings.

Input: Recent TACE RFA. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology.The segment 5 ablation cavity measures 3.7 x 3.3 cm (series 8/250). No evidence of marginal recurrent or residual disease.The segment 7/8 ablation cavity measures 3.1 x 2.1 cm (series 8/267). Faint enhancement along the anterosuperior aspect of the ablation cavity may be treatment related and is not significantly changed accounting for technical differences.No new suspicious arterial enhancing or washout lesion.Status post cholecystectomy. No biliary ductal dilatation.SPLEEN: Spleen measures 14.7 cm in length without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild left adrenal nodularity is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymphadenopathy. Likely reactive porta hepatis lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with postablation changes of segment 5 and 7/8 without specific evidence of marginal recurrent or residual disease. Faint enhancement adjacent to the segment 7/8 cavity is unchanged and may be treatment related. Continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: 29 years, Female, blurred vision, paresthesias. Follow-up progression. Demyelinating disease. Per medical record, patient has history of respiratory infection following which patient developed multiple lesions within the spinal cord, brain, and orbits. Brain: Examination is limited to sequences per demyelinating disease protocol. No lesions within the brain to suggest chronic demyelinating disease are appreciated. Previously seen signal abnormality involving the left pons and middle cerebellar peduncle appears to have resolved. Brain parenchymal volume is maintained. No evidence of intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are grossly unremarkable. Dedicated orbital sequences were not obtained however, there is asymmetric FLAIR hyperintensity involving the right optic nerve which may represent sequela of prior optic neuritis, which is more evident on prior MRI orbit study.Cervical spine: Multiple patchy foci of T2 hyperintensity in the cervical cord seen on prior imaging, particularly at the C3-C4 and C5-C7 levels are no longer appreciated. There is perhaps minimal residual T2 hyperintensity; however no discrete residual lesion is definitively appreciated. Cord parenchymal volume is maintained. Vertebral body heights and alignment are maintained. No significant disc disease. No spinal canal or neural foraminal stenosis. Bone marrow signal is benign.Thoracic spine: Patchy T2 hyperintensity seen in the thoracic cord is also essentially resolved. No discrete residual lesion in the thoracic cord is appreciated. Thoracic cord volume is preserved. Vertebral body heights and alignment are maintained. Bone marrow signal is benign. No spinal canal or neural foraminal stenosis is appreciated.

Output: Compared to outside MRI from December 2015, there is marked improvement in previously seen extensive signal abnormality in the infratentorial brain, cervical cord and thoracic cord. No discrete residual lesion within the brain, cervical spine, or thoracic spine is appreciated. As such, prior findings may have represented a postinfectious inflammatory process/ADEM but can be correlated with clinical/lab findings. Dedicated orbital imaging was not obtained; however there is residual FLAIR signal abnormality involving the right optic nerve which may represent sequela of prior optic neuritis.


Instruction: Generate impression based on findings.

Input: Weakness of all 4 limbs There is moderate degree of spinal canal stenosis at the C4-C5 and C5-C6 levels related to disc osteophyte complexes and ligamentum flavum thickening. There is otherwise no high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine. There are additional mild degenerative changes including a disc bulge at the L4-5 level with mild bilateral neural foraminal stenosis.There is diffuse low T1 and T2 marrow signal abnormality which is nonspecific but may represent marrow reconversion or related to renal osteodystrophy. The vertebral bodies are appropriate in the overall alignment and height. No gross cord signal abnormality.

Output: 1. This is a limited exam specific for the exclusion of cord compression only. There is no evidence of acute cord compression.2. Degenerative changes in the cervical spine with moderate spinal canal stenosis at the C4-C5 and C5-C6 level. 3. Note this examination does not exclude subtle lesions such as intrinsic cord abnormalities and dedicated cervical or thoracic spine studies can be obtained as clinically warranted.


Instruction: Generate impression based on findings.

Input: altered mental status with new dysphasia, postoperative status of right temporal lobe oligodendroglioma. There are bihemishperic subdural hematoma with mild mass effects especially on the left hemisphere. Midline shift toward right side was seen with the degree of about 14mm at the level of foramen of Monroe.Surgical defect on the right anterior temporal lobe does not show any interval change nor evidence of recurrence of tumor. No evidence of abnormal enhancement. Stable multiple small hemorrhagic lesion on the left frontal lobe since prior exam.FLAIR images show multifocal scattered patchy high signal intensities bilaterally indicating non specific small vessel disease, no change since prior exam.There is no evidence of acute ischemic lesion on this scan.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.There are fluid collections on the right mastoid air cells, slightly progressed since prior exam.

Output: 1. Bihemispheric subdural hematoma with mass effects toward left hemisphere and midline shift toward right side.2. No evidence of acute ischemic lesion.3. No evidence of tumor recurrence.4. Non specific small vessel disease, stable since prior exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 65 year old with history of coronary artery disease with drug eluting stent to the proximal right coronary artery, hypertension, dyslipidemia, known mitral regurgitation and COPD presenting prior to potential shoulder surgery. MEDICATIONS: amlodipine, aspirin, atorvastatin, metoprolol, symbicort, tamsulosin and spiriva. First Pass PerfusionDuring hyperemia, there is a large perfusion defect which involves the basal anterolateral and inferolateral walls; the mid anterolateral, inferolateral, and inferior walls; and the apical lateral and inferior walls. The overall ischemia score is 8 out of a total of 32 and involves 25% of the myocardium.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. There is mild hypokinesis of the mid anterolateral, inferolateral, and inferior walls; and the apical inferior wall. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 154 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 67 g/m2, and the LV mass is 144 g. Left AtriumThe left atrium is mildly dilated (111ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 60 ml/m2 (normal range 82+/-16), the RVEDV is 129 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 57 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is moderate to severe mitral regurgitation. There is both evidence of mild mitral prolapse and also "ischemic" mitral regurgitation via tethering of the posterior leaflet due to the above mentioned wall motion abnormalities.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is mildly dilated (Sinus of Valsalva 42mm and Ascending Aorta 41mm). There is a left sided aortic arch with a pseudo-bovine brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThe lungs are hyper-inflated. 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. There is a large amount of ischemia, as described above.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 56%) with mild hypokinesis of the mid anterolateral, inferolateral, and inferior walls and the apical inferior wall.4. Normal RV size and systolic function (RVEF 56%).5. There is moderate to severe mitral regurgitation, likely secondary to both mitral valve prolapse and ischemic mitral regurgitation.


Instruction: Generate impression based on findings.

Input: History of elevated PSA. Previous negative biopsy. PELVIS:PROSTATE:Prostate Size: 2.5 x 5.0 x 4.4 cmPeripheral Zone: Mild diffuse decrease in T2 weighted signal intensity. No discrete focal abnormality.Central Gland: No suspicious abnormality.Seminal Vesicles: No suspicious abnormality.Extracapsular Extension: No suspicious abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild diffuse decrease in T2-weighted signal intensity of the peripheral zone suggesting prostatitis.2.No discrete focal abnormality.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of upper lobe, unspecified bronchus or lung. Secondary malignant neoplasm of brain. Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm. Disseminated malignant neoplasm, unspecified Encounter for examination for normal comparison and control in clinical research programClinical question: mets lung cancer, brain mets, s/p RT. S/p 4 cycles of chemo. pls c/w previous study and evaluate tx response.Signs and Symptoms: brain mets There is redemonstration of multiple foci of susceptibility effect where there were previously enhancing lesions on the 4/22/2015 exam. On the postcontrast T1 weighted images enhancing lesions are identified. A lesion on the surface of the left superior frontal gyrus currently measures 8 x 5 mm and previously measured 9 x 8 mm axial dimensions. The lesion along the right parietal lobe inferior parietal lobule adjacent to the occipital lobe measures 13 x 13 mm axial dimensions and on the September exam measured 14 x 14 mm. On the April exam it measured 20 x 23 mm. A 3 mm enhancing nodule is present in the splenium of the corpus callosum at its junction with the septum pellucidum. This lesion previously measured similar size. Lesions which currently do not enhance but are associated with susceptibility effect include a left cerebellar lesion as well as the right temporal lobe lesion, right hippocampal lesion, right occipital lobe lesion, left precentral gyrus lesion.There continues to be T2 and FLAIR signal abnormality surrounding the above described lesions which appears stable when compared to the prior exams.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 mild mucosal thickening along the left maxillary sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: 1.Multiple lesions scattered throughout the brain are compatible with hemorrhagic metastases. The examination is essentially stable compared to the September exam. There appears to be subtle continued regression of some of the metastatic lesions when compared to the September 8 exam. Associated FLAIR signal abnormalities are stable.


Instruction: Generate impression based on findings.

Input: history of soft tissue Ewing's sarcoma of the left hip status post resection. Large field-of-view images demonstrates interval decrease in size of a resection cavity in the subcutaneous fat of the upper left hip. Small field-of-view images demonstrate a T2 hyperintense, T1 hypointense resection cavity measuring approximately 3.9 x 3.5 x 2.3 cm TR x AP x CC (series 6, image 18 and series 8, image 22), previously 3.9 x 5.8 x 3.3 cm. There is no involvement of the underlying gluteus muscles. Susceptibility artifact from metal is noted within the resection cavity. There is minimal enhancement without nodular enhancement on postcontrast images.The visualized intrapelvic structures are within normal limits. No osseous abnormality is noted.

Output: Interval decrease in size of resection cavity in the upper left hip without nodular enhancement to suggest residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: 4-year-old male with developmental delays, autism, exotropia. There is no restricted diffusion to suggest acute ischemia. No acute intracranial hemorrhage, mass effect or edema. Gray-white matter differentiation is well preserved.The CSF spaces are appropriate for patient's age. The imaged paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable.

Output: MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: Shoulder dislocations. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. The injected contrast remains within the glenohumeral joint, without communication to the subacromial or subdeltoid bursae.BICEPS TENDON: No significant abnormality noted. The bicipital labral complex is unremarkable.ADDITIONAL

Output: Large Hill-Sachs deformity and cartilaginous-osseous Bankart lesion compatible with prior humeral head dislocation.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for ligamentous injury. Signs and symptoms: Trauma and fall from third floor. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column.There is marrow signal replacement (diminished fatty signal intensity on T1 weighted series however isointense on T2 and T2 STIR) of the clivus adjacent to the spheno-occipital synchondrosis concerning for edema.There is also increased T2 and T2 STIR signal intensity superior to the dens at the level of apical tendon which is concerning for injury. A small localized hypointense T2 and T2 STIR collection posterior to the dens with subtle mass effect on the thecal sac is suspected of a small hematoma. Increased soft tissue with hypointense signal intensity extending along the anterior/inferior aspect of the clivus inferiorly to approximate the C2-C3 disc level suspicious for small hematoma. On sagittal T2/T2 STIR subtle hyperintense signal in the articulating space between occipital condyles and C1 as well as C1-C2 articulation as well is concerning for soft tissue injury and possible cranio-cervical dissociation.No convincing evidence of cord signal abnormality. No evidence of spinal stenosis at any level.Findings and concern on this exam were discussed by phone with the referring clinical physician Platt Andrew #6875 at the time of review.Enhanced neck MRA:Examination demonstrates patent bilateral vertebral arteries through the neck and in the intracranial component. No evidence of change in their caliber or evidence of dissection.Bilateral common carotids, internal carotids and external carotid arteries are patent and unremarkable.

Output: 1.Nonenhanced MRI of cervical spine demonstrate findings highly suspected for craniocervical dissociation as detailed above. Please see report above.2.Enhanced neck MRA is unremarkable and without detectable vascular injury.


Instruction: Generate impression based on findings.

Input: dizziness, near syncope, positional vertiginous symptomsr/o cvaSyncope and collapseFuch endothelial dystrophyAsteroid hyalosis of right eyeType 2 diabetes mellitusHypertensionDyslipidemia MRI of the brainNo diffusion weighted abnormalities are appreciated.There are several periventricular white matter lesions which are bright on T2 and FLAIR MRI present which at this age are not unusual and likely of little clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.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. There is fetal origin of the posterior cerebral artery bilaterally with hypoplastic P1 segments. The left vertebral artery is larger than the right vertebral artery.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Reason: eval for etiology of R shoulder pain History: R shoulder pain ROTATOR CUFF: Note is made of a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 8 mm in the AP dimension. There is no significant retraction. There is thickening and intermediate signal intensity within the supraspinatus indicating tendinosis. There is an interstitial tear of the infraspinatus extending from the level of the muscle belly to the level of the myotendinous junction. There is perhaps mild undersurface fraying of the subscapularis. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. The acromioclavicular joint is normal in appearance.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is full-thickness articular cartilage degeneration along the glenoid with associated underlying subchondral cyst formation. There is branching linear increased signal abnormality within the superior labrum which likely represents a combination of degeneration and degenerative tearing. There is small osteophyte formation.BICEPS TENDON: There is thickening and intermediate signal intensity within the intra-articular portion of the long head of the biceps tendon indicating moderate tendinosis. The tendon appears intact. ADDITIONAL

Output: 1. Full-thickness tear of the supraspinatus without retraction as described above. Interstitial tearing of the infraspinatus. Tendinosis of the rotator cuff. 2. Apparent degeneration and degenerative tearing of the glenoid labrum within the limitations of a non arthrogram study. 3. Moderate osteoarthritis of the glenohumeral joint with articular cartilage degeneration and subchondral cyst formation. Other findings as above.


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 P1 segments are hypoplastic and the ACOM artery is not well seen and may be hypoplastic/aplastic which are developmental variants. Again seen is irregularity and moderate segmental narrowing of the left mid to distal P2 segment which is unchanged. The vertebral arteries, basilar artery, and right posterior cerebral artery are normal in course and caliber. There is no other evidence of flow-limiting stenosis or aneurysm.

Output: Irregularity and moderate multifocal narrowing of the left mid to distal P2 segment which is unchanged. No changes compared to the MRA from 5/4/2016.


Instruction: Generate impression based on findings.

Input: Ms.Mitzie Jennings, 57 years old, submitted outside MRI study performed at Northwestern hospital for review. She was diagnosed with a biopsy-proven right breast cancer. Breast MRI was performed to evaluate the extent of the disease.Images submitted for comparison:Correlate with mammogram 12/21/2015, 12/29/2015 and ultrasound 9/20/2015. Multisequence MRI of both breasts was performed with and without IV contrast as per outside breast MRI protocol.There is scattered fibroglandular tissue in both breasts. There is mild background parenchymal enhancement bilaterally. An enhancing mass with irregular shape and margin is noted in the right breast 12:00 position measuring 1.9 x 1.1 x 2.0 cm (AP x ML X SI), which is consistent with the biopsy-proven malignancy. Susceptibility artifact from the biopsy marking clip is noted in the center of this enhancement. No additional suspicious enhancement is noted in either breast. The bilateral axillary lymph nodes are unremarkable.

Output: 2 cm unifocal malignancy in the right breastBIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.