Instruction: Generate impression based on findings.

Input: 25 years Female (DOB:8/8/1990) PROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is a large Tarlov cyst present in the sacral spinal canal measuring 36 x 24 mm sagittal dimensions which previously measured similar dimensions. It is centered at S3.At L5-S1 there is loss of disc space height, disc desiccation and a broad-based right paracentral disc protrusion associated with ligamentum flavum hypertrophy and some effacement of the fat at the lateral recesses bilaterally which is worse on the right compared to the left side. When compared to the previous exam there is not appear to be a significant change.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a central disc protrusion present at this level which is unchanged since the prior exam. There is loss of disc space height and disc desiccation. Overall there is no change compared to the prior exam.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a large Tarlov cysts present within the sacral spinal canal which is associated bony remodeling. Overall this remains stable compared to the prior exam.2.There is a right paramedian disc protrusion at L5-S1 is associated with encroachment of the nerve roots at the lateral recess bilaterally but worse on the right when compared to the left side. Overall this remains stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Metastatic esophageal adenocarcinoma. Assess for brain metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. A few punctate T2 hyperintense foci in the frontoparietal white-matter are nonspecific. There is a small left superior frontal gyrus developmental venous anomaly. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is trace mucosal thickening in the paranasal sinuses.

Output: No evidence of intracranial metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of bronchus and lung, unspecified site Other malignant neoplasm without specification of siteClinical question: looking for brain mets given metastatic lung cancer, possible candidate for WBRTSigns and Symptoms: metastatic lung cancer There are punctate foci of diffusion weighted imaging signal hyperintensity present one in the subcortical white matter of the right precentral gyrus another one in the right centrum semiovale and another one in the subcortical white matter of the right inferior parietal lobule another is present in the left frontal lobe subcortical white matter and middle frontal gyrus and another one is present in the left posterior temporal lobe subcortical white matter in the couple more are present in the cerebellar hemispheres. Some of these are associated with some subtle perceptible diffusion restriction by ADC map but this is not evident on all of the lesions. These lesions can also be identified on FLAIR and T2 MRI and are not associated with any susceptibility effect. There is no associated contrast enhancement appreciated with these lesions.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.Incidental note is made of partial empty sella

Output: There are multiple lesions scattered in the subcortical and periventricular white matter as well as the cerebellar hemispheres numbering approximately 15. These are nonspecific and of unclear etiology. It's possible that these represent vascular events in the late subacute stage. Given the patient's history of the lung cancer a follow-up exam would help exclude the possibility is these are related to metastatic disease. Another possibility is that these are related to septic emboli.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with new right leg numbness and weakness, and pancytopenia. Evaluate for nerve root compression, new or worsening vertebral compression fracture, hematoma or infection/abscess. Patient with history of myelofibrosis status post MUD stem cell transplant. Multiple heterogeneously T2 hyperintense cysts or lobules are seen involving the right sacral ala and right posterior iliac bone. These lesions were not evident on a hip MRI from 6/5/15, and no definite correlating lesions are seen on CT examinations from 8/26/14 or 2/12/2016. The lesions approach but do not appear to frankly encroach upon the sacral foramina.Vertebral body marrow signal is diffusely low on all sequences, findings compatible with myelofibrosis. A small area of fat signal intensity within the L3 vertebral body may represent a focus of presumed fatty marrow or a hemangioma.A compression deformity of the L2 vertebral body is seen with approximately 40% loss of vertebral body height. No marrow edema is detected suggesting that this is a chronic abnormality. The compression is new, however, when compared to a CT examination from 2014. There is mild posterior bowing of the compressed vertebral body, but this causes only mild narrowing of the spinal canal.No other compression deformities are seen. No areas of marrow edema are suspected. Apart from a mild kyphotic angulation centered at the compressed L2 body, spinal alignment is unremarkable.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural fluid collection or pathologic soft tissue process is seen. Prominent dorsal epidural fat is evident from L1 through L4.L1-2: No significant spinal canal or foraminal stenosis. Just below the disc level, posterior osseous bowing or retropulsion does cause mild effacement of the ventral thecal sac. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet arthropathy. No significant spinal canal or neuroforaminal stenosis. L4-5: Mild facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Mild facet arthropathy. Mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: 1.Multiple T2 hyperintense cysts or lobules are evident involving the right sacral ala and right iliac bone. No clear correlating lesions are seen on a recent CT examination from 2/12/2016, nor are any such lesions seen on older MRI examinations from 2015 and 2014. These lesions appear to be confined within the marrow space of the bone and do not significantly encroach upon the sacral nerve roots. One possible explanation is that these lesions represent intraosseous hemorrhage, possibly secondary to bone marrow biopsy or some other mild trauma. Follow-up CT of the pelvis can be considered to reevaluate for osseous integrity. In addition, the patient could return for postcontrast MRI imaging to assess for the possibility, albeit unlikely, of a neoplastic process.2.Bone marrow signal characteristics are diffusely abnormal compatible with patient's diagnosis of myelofibrosis. A moderate compression deformity of the L2 vertebral body is seen, though there is no marrow edema suggesting that it is chronic. No significant epidural pathology is suspected. No high-grade spinal canal or neuroforaminal stenosis is observed.


Instruction: Generate impression based on findings.

Input: Female, 22 years old, with trigeminal neuralgia and atypical facial pain, and nonspecific T2 lesions in the right periventricular area. Brain:A scattering of small round and curvilinear T2 hyperintense lesions is again seen in the periventricular regions, more so on the right than on the left. The overall distribution of these lesions is unchanged relative to the prior examination. While some of these lesions appear more conspicuous on today's examination, this can reflect the differences in imaging at 3T versus 1.5T. One lesion in the right corona radiata demonstrates punctate associated enhancement. Several lesions in the bilateral periventricular regions show punctate associated susceptibility.No restricted diffusion is seen. There is no evidence of parenchymal edema or mass effect. Other than that mentioned above, no additional pathologic parenchymal or extra-axial enhancement is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is normal in size.C-spine:Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement, marrow edema or pathologic marrow enhancement is seen.The cervical spinal cord shows normal signal intensity and morphology throughout. No pathologic intramedullary or leptomeningeal enhancement is seen.There may be a very small central annular fissure at C5-6. The intervertebral discs are otherwise within normal limits. No significant spinal canal or neuroforaminal stenosis is seen.

Output: 1.Multiple small T2 hyperintense lesions are again seen in the periventricular white matter. No definite interval change is seen, though some of these lesions appear more conspicuous than on the prior examination. This difference could, however, simply represent the effect of imaging at 3T. One lesion, in the right corona radiata, demonstrates punctate associated enhancement which may indicate an active process. Several lesions show evidence of associated microhemorrhage. Findings are nonspecific and the differential diagnosis would include a vascular etiology, including both vasculitis and ischemia, as well as other inflammatory conditions and demyelination.2.The cervical spine is free of significant abnormalities. In particular, the spinal cord is unremarkable.


Instruction: Generate impression based on findings.

Input: 61-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 6.4 x 3.9 x 5.8 cmPeripheral Zone: Patchy areas of low T2 signal may be related to chronic prostatitis. No dominant suspicious lesion is evident.Central Gland: BPH nodulesSeminal Vesicles: No significant abnormality notedExtracapsular Extension: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings suggesting chronic prostatitis without a dominant suspicious lesion.2.Enlarged prostate with BPH nodules.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with myokymia status post radiotherapy for nasopharyngeal cancer, evaluate for metastases. Apart from slight straightening of the cervical lordosis, sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or enhancement is seen.Similar to prior examinations, a focus of susceptibility is redemonstrated within the medulla. The visualized spinal cord inserts normal signal intensity and morphology throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: Left facet arthropathy. No significant spinal canal or foraminal stenosis. No interval changes.C3-4: No significant spinal canal or foraminal stenosis. No interval changes.C4-5: Left uncovertebral hypertrophy with moderate left foraminal narrowing. No significant spinal canal stenosis. No interval changes.C5-6: Posterior disc-osteophyte complex formation with a small focal component centrally. No significant spinal canal stenosis or cord impingement. No significant foraminal narrowing. No interval changes.C6-7: No significant spinal canal stenosis or foraminal narrowing. No interval changes.C7-T1: No significant spinal canal stenosis or foraminal narrowing. No interval changes.

Output: 1.No evidence of metastatic disease in the spine.2.No interval change in scattered degenerative findings as above.


Instruction: Generate impression based on findings.

Input: History of liver transplant and previous stroke now presenting with headache. There is no evidence of acute ischemic or hemorrhagic lesions. There is a small area of high T2 signal in the left superior frontal gyrus subcortical white matter on as well as focal tissue loss on the right cerebellar hemisphere. There is trace nonspecific periventricular white matter T2 hyperintensity diffusely. The ventricles, sulci and cisterns are unchanged in size. There is no intracranial mass, mass effect, or midline shift. There is moderate mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic infarcts in the right cerebellar hemisphere and left superior frontal gyrus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right parotid mass. There is a well-defined, avidly and diffusely enhancing mass with restricted diffusion in the right parotid gland, which measures up to 40 mm. There an ovoid nodule with similar characteristics in the tail of the right parotid gland, which measures up to 18 mm. In addition, there are prominent right level 2 lymph nodes, which measure up to 29 mm. The left cervical lymph nodes are unremarkable. There is a small right sphenoid retention cyst. The orbits and imaged intracranial structures are unremarkable.

Output: The right parotid lesions likely represent lymphadenopathy, which along with additional enlarged right suprahyoid lymph nodes may represent a lymphoproliferative or lympho-reactive process.


Instruction: Generate impression based on findings.

Input: Male, 8 years old, status post DNET tumor resection, three-month follow-up exam. Redemonstrated is evidence of right temporal tumor resection. The previously seen acute postoperative changes have resolved. The resection cavity is slightly smaller and contains fluid which has cleared becoming identical to CSF. Thin nonspecific T2 hyperintensity along the cavity margins is seen. No evidence of significant parenchymal edema or mass effect is detected. No pathologic enhancement is identified in the vicinity of the resection or elsewhere. No acute intracranial hemorrhage is seen. There is mild hemosiderin staining of the resection cavity, and linear tracts of susceptibility related to prior depth electrode placement.

Output: Expected evolution of postoperative findings compatible with tumor resection from the right temporal lobe. No new or growing lesions are seen.


Instruction: Generate impression based on findings.

Input: Ms. Kerulis is a 37-year-old female with triple negative breast cancer in the left breast currently on neoadjuvant chemotherapy (after 3 weeks of paclitaxel). She presents today for MR evaluation for treatment response. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left upper outer breast, there has been an interval decrease in size of known malignancy, now measuring approximately 5.3 x 3.5 x 3.1 cm (AP x ML x SI), compared to 7.4 x 3.9 x 6.0 cm. Susceptibility artifact from biopsy marker clip is seen within the central aspect of this malignancy. There is no additional abnormal enhancement identified in the left breast.At least 4 abnormal lymph nodes continue to be seen in the left axilla, the largest of which now measures approximately 2.4 cm, compared to 3.6 cm. Susceptibility artifact from biopsy marker clip is seen within one of these lymph nodes, compatible with biopsy-proven metastatic left axillary lymph node.RIGHT BREAST: No abnormal enhancement is seen in the right breast.No abnormal axillary lymph nodes are identified in the right axillary region. .

Output: (1) Interval decrease in size of biopsy proven malignancy of the left breast and metastatic left axillary lymph nodes. (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: Pain in left arm, left cervical radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is grade 1 retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics. There is mild multilevel disc desiccation, as well as endplate marrow signal changes at the C5-C6 level.There is mild diffuse congenital narrowing of the cervical spinal canal with superimposed degenerative changes as described below:C2-3: Right paracentral disc protrusion with mild spinal canal stenosis. No significant neural foraminal stenosis. C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Mild retrolisthesis and left paracentral and foraminal disc bulge. There is mild spinal canal stenosis involving the left aspect of the spinal canal. There is also mild left-sided neural foraminal stenosis. No significant right neural foraminal narrowing. C6-7: There is a central disc protrusion and ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis at this level. No significant neural foraminal narrowingC7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine as detailed above. There is mild to moderate spinal canal stenosis at the C6-C7 level and to a lesser degree at C5-C6 and C2-C3 levels. There is mild left C5-C6 neural foraminal stenosis which may be effecting the left C6 nerve root. Cervical neural foramina are otherwise patent.


Instruction: Generate impression based on findings.

Input: Low back pain [M54.5] / Pelvic and perineal pain [R10.2], Reason for Study: ^Reason: evaluate left sided low back pain History: left sided low back pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The 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: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: flattening of posterior aspect of intervertebral disc may indicate minimal bulging of disc, however, there is no evidence disc degeneration. no neuroforaminal narrowing or spinal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Minimal bulging of disc is suggested. Otherwise unremarkable lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar radiculopathy. Signs and symptoms: Right sciatica. Nonenhanced lumbar MRI:Examination demonstrates mild dextroscoliosis centered at L3-L4 level and weight grade 1 right lateral listhesis at L3-4 level.On sagittal images there is also evidence of grade 1 anterolisthesis at L3-L4 level.T11-T12 is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild disc disease and facet/ligamentum flavum hypertrophy and result in mild central spinal stenosis without neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy without significant facet hypertrophy. There is however bilateral facet space widening and effusion. Constellation of changes results seen moderate central spinal stenosis with mild right and moderate to significant left neural foraminal compromise.L3-L4 demonstrate advanced degenerative disc with significant loss of disc height, moderate bilateral ligamentum flavum hypertrophy, mild bilateral facet disease. There is evidence of grade 1 anterolisthesis as well as right lateral listhesis at this level. Constellation of changes results in significant central spinal and bilateral (L>R) stenosis.L4-L5 demonstrate mild disc disease, moderate bilateral ligamentum flavum hypertrophy without significant facet hypertrophic changes. There is however mild bilateral facet effusion present. There is increased dorsal epidural fat at this level and constellation of changes results in mild central spinal stenosis at this level with mild to moderate left and significant right neural foraminal compromise.L5-S1 demonstrate mild disc disease and mild bilateral facet and ligamentum flap and degenerative changes without spinal stenosis or neural foraminal compromise.

Output: 1.Advanced degenerative changes at L3-L4 and including grade 1 anterolisthesis as well as right lateral listhesis results in significant central spinal stenosis and significant bilateral neural foraminal compromise.2.Degenerative changes at L2-L3 results in moderate central spinal stenosis and bilateral neural foraminal compromise as detailed above.3.Degenerative changes at L4-L5 level results in mild central spinal stenosis with significant right and mild to moderate left neural foraminal compromise.4.Please review detailed report per level above for additional findings.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:5/18/1998)Reason: enhancing lesion? History: head and neck ticsPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Incidental note is made of a developmental venous anomaly in the right frontal lobe.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: No abnormal mass lesions are appreciated within the brain parenchyma. MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: There is no restricted diffusion. There is susceptibility signal along the anterior interhemispheric fissure in the right frontal lobe; when compared with the previous head CT this susceptibility signal is suggestive of calcification.There are no T2/FLAIR abnormalities. Ventricular and the sulci are slightly prominent, age-related volume loss. There is a redemonstration of right frontal closed lip schizencephaly. There is staphyloma of the right eye globe.The septum pellucidum is not seen on this scan. The optic chiasm and bilateral optic nerves are identifiable, although appear to be a bit smaller than usual. Thus, these findings may suggest mild form of septo optic dysplasia (septo optic dysplasia plus). These findings do not show any significant interval change since prior scan performed in 2008. There is bilateral lens prostheses.

Output: 1. No evidence for acute intracranial hemorrhage, mass effect, or edema. No acute infarct.2. No change of closed lip right frontal schizencephaly, staphyloma of the right eye globe, and mild form of septo-optic dysplasia since prior scan.


Instruction: Generate impression based on findings.

Input: T4b N2b parotid gland carcinoma with skull base and facial nerve invasion s/p parotidectomy with right radical neck dissection which revealed carcinoma originating from ex-pleomorphic adenoma with positive margins, perineural invasion and 10/50 positive lymph nodes, here for a regular follow up after C5/5 of TFHX completed on 2/28/13. There are unchanged post-treatment findings related to radiotherapy, as well as right parotidectomy and neck dissection. There is persistent diffuse enhancement and mild enlargement of the mastoid, tympanic, and geniculate ganglion segments of the right facial nerve. There is no evidence of measurable mass lesions in the neck or significant upper cervical lymphadenopathy. The remaining major salivary glands are unremarkable. There is persistent right tympanomastoid fluid. The major cervical flow voids are grossly intact. There is mild degenerative cervical spondylosis without significant spinal canal stenosis. There is T2 hyperintense signal within the subcutaneous tissues of the face bilaterally, which likely represents cosmetic filler.

Output: 1.Post-treatment findings in the neck with persistent right enhancement of a portion of the facial nerve, which is compatible with perineural tumor involvement.2. No evidence of significant lymphadenopathy in the upper neck.3. Right tympanomastoid fluid may be related to Eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: There is a partially empty sella. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The adenoid are prominent, which is likely reactive in nature.

Output: A partially empty sella may indicated idiopathic intracranial hypertension. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of breast cancer, presents with neck pain and spinal tenderness rule out brain metastasis and cord compression. Brain: There is a 5 mm wide enhancing lesion in the right subcortical occipital lobe and a 4 mm wide enhancing lesion in the left posterior parietal lobe. There is an enhancing lesion in the left frontal bone with associated thin dural and periosteal enhancement. There is also an enhancing lesion involving the right occipital bone, in the region of the condyle, with mild dural extension. There are patchy and scattered periventricular and subcortical white matter hyperintensities without associated enhancement, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration, including cavum septum pellucidum and vergae. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a small amount of fluid in the posterior ethmoid sinuses, posterior nasal cavity, and nasopharynx, likely related to intubation. The orbits are grossly unremarkable.Spine: There is considerable thoracic dextroscoliosis and lumbar levoscoliosis. There is multilevel degenerative spondylosis in the cervical spine and lower lumbar spine without significant narrowing of the spinal canal. The spinal cord displays normal signal characteristics. There are multiple osseous metastatic lesions scattered throughout much of the spine, without discernible epidural extension or loss of vertebral body heights. There is a moderate right pleural effusion and scattered lung opacities. There is also extensive mediastinal and hilar lymphadenopathy. There is trace ascites. There are numerous lesions in the liver.

Output: 1. Subcentimeter metastases in the right occipital and left parietal lobes. 2. Skull metastasis with dural extension.3. Extensive osseous metastatic lesions throughout much of the spine, without spinal cord compression or apparent vertebral body collapse.4. Considerable thoracic dextroscoliosis and lumbar levoscoliosis and multilevel degenerative spondylosis in the cervical spine and lower lumbar spine without significant narrowing of the spinal canal. 5. Right pleural effusion and scattered lung opacities, as well as mediastinal and hilar lymphadenopathy, which represent metastases. Please refer to the recent CT chest report for additional details.6. Partially imaged multiple metastatic lesions in the liver and trace ascites. Please refer to recent CT abdomen from for additional details. 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 years, Male, Reason: recurrent lipoma right flank History: weight gain, contour change. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic cyst is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the right flank without lipoma or fluid collection evident.OTHER: No significant abnormality noted.

Output: Postsurgical changes in the right flank without underlying lipoma or fluid collection.


Instruction: Generate impression based on findings.

Input: Patient is a 48-year-old female patient who presents with history of Chiari I decompression in 1998 and a constellation of symptoms including holocephalic pressure-like headache, perioral numbness, tingling and numbness in her fingers and hands bilaterally, weakness in her legs with difficulty walking, and confusion and slow thinking. Brain:Postsurgical changes of suboccipital craniotomy and resection of posterior arch of C1 are noted. CSF spaces at the neo-foramen magnum are preserved. CSF flow study demonstrates preserved biphasic CSF flow through the foramen magnum, greater ventrally than dorsally.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Small cystic lesion along the superior aspect of the right hippocampal head with mild local mass effect likely represents a choroidal fissure cyst. No abnormal parenchymal or meningeal 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. Cervical spine:There is slight loss of cervical lordosis, which may be in part positional. Otherwise the alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. There is no cervical cord abnormality. There appears to be a small disc extrusion at the C5-C6 level, which is suboptimally evaluated due to motion degradation, but results in mild spinal canal stenosis without cord signal abnormality. The remainder of the levels are unremarkable. No abnormal enhancement is noted. No evidence of syrinx. Incidental note is made of subcentimeter thyroid nodules bilaterally.Thoracic spine:Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. No cord signal abnormalities identified. No significant degenerative changes or spinal canal or neural foraminal stenosis is seen. No evidence of syrinx.

Output: 1.Postoperative changes related to Chiari decompression. Foramen magnum is well decompressed with preserved biphasic CSF flow. No evidence of syrinx in the cervical or thoracic cord.2.Right choroidal fissure cyst with mild local mass effect on the hippocampus. This finding is of doubtful clinical significance. 3.Small disc extrusion at C5-6 with mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 43 years, Female, brain metastases. Treatment planning MRI for SRS.. Again seen are multiple enhancing lesions consistent with metastatic disease with evidence of progression since 4/16/2016. Note slight differences in imaging plane slightly limit comparison of measurements with 7/19/2016 study. Lesions with measurements on the post gadolinium axial 3-D T1 series 4 are as described below:Right frontal lobe lesion measures 6 x 5 mm, previously 6 x 4 mm. Image 85. There is small amount of hemorrhage associated with this lesion has before. There is mild interval increase in surrounding edema.Left cerebellar lesion measures 7 x 11 mm, previously 6 x 9 mm. Image 54. There is mild associated edema which appears slightly increased in the interval.Two adjacent right occipital lesions, one measuring 8 x 9 mm previously 7 x 7 mm, and the other measuring 8 x 5 mm, previously 6 x 5 mm. Images 85 through 94. Lesions appear to be along the cortical surface and possibly along the leptomeninges as noted before. There is susceptibility effect compatible with small amount of hemorrhage associated with these lesions, which is new versus subtly present previously and increased in the interval. There is also increase in edema associated with these lesions.Dural based enhancing lesion along the right frontal convexity appears slightly larger as well measuring approximately 12 mm in thickness, previously 9 mm. Image 23. No significant intracranial mass effect associated with the above-mentioned lesions. No midline shift or herniation.

Output: 1. Examination for treatment planning. There appears to be slight enlargement of multiple metastatic lesions compared to 7/19/2016 and more notable progression when compared to 4/12/2016.2. As noted before right occipital lesions are along the cortical surface and may involve the leptomeninges. There is also a right frontal dural based lesion.


Instruction: Generate impression based on findings.

Input: History of multiple sclerosis presenting with bilateral numbness and weakness. Bowel incontinence. Rule out transverse myelitis. The examination is limited, partly by patient motion.Cervical spine:The peripheral left-sided cord T2-hyperintense lesion at C2-C3 is unchanged and remains non-enhancing. A larger lesion with more pronounced volume loss at C7 level is also unchanged and non-enhancing. A more centrally located left-sided lesion at the C3-C4 level is slightly more pronounced than the previous examination with more volume loss but it remains non-enhancing. Apparent contrast enhancement superimposed on the ventral spinal cord at the lower C5 level on sagittal imaging does not correlate with definite enhancement on axial imaging and is likely artifactual. The marrow is heterogeneous but without suspicious focal lesion. There is straightening of the cervical spine. There is preservation of the vertebral body heights. Multilevel degenerative disease has slightly progressed at the C6-C7 level where a central disc-osteophyte complex mildly to moderately narrows the spinal canal and indents the ventral aspect of the spinal cord. Similar degenerative disease at C4-C5 has not significantly changed since the previous examination. The cervical carotid arteries course medially in the retropharyngeal space.Thoracic spine:Assessment of the upper thoracic spinal cord is limited by artifact. A small T2-hyperintense non-enhancing lesion without involving the posterior spinal cord at T11 was present previously though is now more conspicuous but this may relate to technical differences between the examinations. Other cord lesions are probably present but the suboptimal nature of the examination does not allow for accurate or definitive assessment. There is no definite contrast-enhancing thoracic spinal cord lesion. There is a small but new right paracentral disc protrusion at T11-T12 but no significant spinal canal or neuroforaminal stenosis. There is no significant degenerative disease at the other levels. The marrow is heterogeneous but without suspicious focal lesion. There is preservation of the vertebral body heights and alignment is anatomic.Small pleural effusions are present.Lumbar spine:The conus medullaris is normal in signal and morphology. There is no abnormal intrathecal contrast enhancement.There is 3 mm of degenerative anterior subluxation of L4 relative to L5. The vertebral body heights are preserved. Marrow signal is mildly heterogeneous but without suspicious focal lesions. There is multilevel facet arthropathy with effusions and inflammatory contrast enhancement, most pronounced and L2-L3. L1-L2 disc is preserved while the other lumbar discs show desiccation and mild bulges. The spinal canal is preserved but there is multilevel neural foraminal stenosis as described below.The uterus is enlarged with multiple T2-hypointense mural masses, compatible with calcified leiomyomata. The largest of the lesions measures up to 9.3 cm. Multiple T2-hyperintense, T1-hypointense renal lesions are not completely characterized but were present on a previous CT scan from April 20, 2015.L1-L2: Mild disc bulge and facet arthropathy but no significant spinal canal or neuroforaminal stenosis.L2-L3: Mild disc bulge causing mild mass-effect on the subarticular recessrd. There is moderate facet arthropathy and ligament thickening as well as mild bilateral neuroforaminal stenosis. There is no significant central spinal canal stenosis.L3-L4: Disc bulge along with moderate facet arthropathy causes mild narrowing of both subarticular recesses and both neural foramina. There is no significant central spinal canal stenosis.L4-L5: The disc bulge/uncovering associated with the anterior subluxation and bilateral facet arthropathy and ligament flavum thickening resulting in left subarticular recess stenosis in addition to mild-to-moderate bilateral neural foraminal stenoses but no significant central spinal stenosis.L5-S1: Disc bulge with associated left foraminal protrusion as well as bilateral mild-to-moderate facet arthropathy result in mild stenosis of the left subarticular recess and moderate-to-severe stenosis of the left neural foramen.

Output: 1.The examination is significantly limited, in part by patient motion.2.It is difficult to accurately compare the current and the previous examinations given different imaging parameters. There is increased conspicuity of the spinal cord lesion at C3-C4 and at T11 while the other cervical and thoracic spinal cord lesions remain grossly unchanged. There is no definite abnormal contrast enhancement in the spinal cord.3.There has been progression of the degenerative disease at C6-C7 level resulting in mild-to-moderate spinal canal stenosis as described above. A new small right paracentral T11-T12 disc protrusion has developed but causes no significant spinal canal or neuroforaminal stenosis. Multilevel degenerative lumbar spine disease results in no significant spinal canal stenosis but results in subarticular recess and foraminal stenoses as described above, most pronounced at the left L5-S1 neural foramen.4.There are small pleural effusions. There are multiple renal lesions, which are likely cysts and not significantly changed since April 2015 CT scan. Multiple calcified uterine leiomyomata.


Instruction: Generate impression based on findings.

Input: Pt with baseline ataxia with episodic exacerbations, evaluate cerebellum FLAIR images are degraded due to motion artifact. Within this limitation there are scattered foci periventricular white matter FLAIR hyperintensity. The fissures of the cerebellar vermis are prominent suggesting atrophy of the vermis.No abnormal diffusion restriction. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, and cisterns are normal in size without evidence of ventriculomegaly. Gray-white matter differentiation is preserved. Left maxillary mucous retention cyst. Nonspecific mild ethmoid air cell mucosal thickening. Mastoid air cells are clear. The orbits are intact. The osseous structures and scalp soft tissue appear unremarkable.

Output: 1.Findings suggestive of atrophy of the cerebellar vermis. 2.Scattered foci of white matter signal abnormality are nonspecific.


Instruction: Generate impression based on findings.

Input: Obsessive-compulsive disorder [F42], Reason for Study: ^Reason: anterior capsulotomy ablation History: ocd Redemonstration of post laser ablation (bilateral anterior capsulotomy) status of the bilateral internal capsule and caudate nucleus head areas demonstrating restricted diffusion, susceptibility artifacts and surrounding edema.The size of those lesions and the extent of surrounding edema and appears to be slightly increased since prior scan.There are intra lesional enhancements, the extent of enhancing portion are bigger than prior scan. There is no other new ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post bilateral LASER ablation status.2. Interval increase in size and extent of post ablation lesions. In particular, the size of restricted diffusion, the size of susceptibility artifacts and the extend of surrounding edema and the Gad enhancing portion since prior scan.3. No other acute ischemic or hemorrhagic lesion is seen.


Instruction: Generate impression based on findings.

Input: New diagnosis of lung cancer with metastasis to L1. New back pain. The marrow is heterogeneous and demonstrates numerous T1-hypointense, STIR-hyperintense, contrast-enhancing lesions that are most consistent with metastatic disease. Both the anterior and posterior elements are involved as well as the included pelvic bones. The most prominent involvement is at the vertebral bodies of L1, L2 and S1 levels. There is also minimal abnormal contrast enhancement in the anterior and left lateral paraspinous soft tissues at the L1 level. No evidence of osseous retropulsion or epidural tumor.There are changes of previous L4 laminectomy. Sagittal alignment is notable for straightening and minimal posterior subluxation of L3 relative to L4. There is mild left-sided L1 and L3 vertebral body height loss/compression fractures associated with rightward convex curvature. There is mild central spinal canal stenosis at L2-L3. The conus medullaris shows no gross abnormality and its termination lies at mid L1 level. There is no abnormal contrast enhancement along the conus medullaris or cauda equina roots.There are few T1-hypointense, T2-hyperintense, non-contrast-enhancing lesions in the kidneys that probably represent cysts but are not completely assessed.T12-L1: There is mild facet arthropathy and ligamenta flava thickening but no significant spinal canal or neuroforaminal stenosis.L1-L2: Mild disc bulge is eccentric to the left resulting in mild narrowing of the left subarticular recess and neural foramen. There is no significant central spinal canal stenosis.L2-L3: Disc uncovering as well as eccentric to the left bulge in addition to mild ligamentum flavum thickening and facet arthropathy result in mild left subarticular recess and mild central canal narrowing. There is no significant neural foraminal stenosis.L3-L4: Disc bulge along with mild-to-moderate facet arthropathy results in moderate left and mild-to-moderate right neural foraminal stenosis but no significant central spinal canal stenosis.L4-L5: Disc bulge along with severe right/moderate left facet arthropathy result in moderate right and mild left neural foraminal stenoses. There is also mild central spinal canal stenosis.L5-S1: Mild disc bulge results in no significant central canal stenosis. There is mild facet arthropathy but no significant neural foraminal stenosis.

Output: 1.Diffuse osseous metastasis involving the lumbosacral spine and the included pelvic bones. There is minimal contrast enhancement in the paraspinal soft tissues adjacent to L1 vertebral body metastasis. No epidural tumor.2.Mild left-sided L1 and L3 vertebral body compression fractures. 3.Multilevel spondylosis resulting in mild spinal canal stenosis at L2-L3 and variable neural foraminal stenoses at L3-L4 and L4-L5 as described above.


Instruction: Generate impression based on findings.

Input: Gait imbalance. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is an enhancing lobulated lesion in the subcutaneous tissues of the right cheek overlying the zygomatic arch that measures up to approximately 20 mm. Cervical Spine: The spinal cord displays normal signal and morphology. There is no abnormal enhancement within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are multiple partially-imaged heterogeneous right thyroid nodules that collectively measure up to at least 25 mm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or demyelinating lesions.2. Multiple partially-imaged nonspecific right thyroid nodules. A thyroid ultrasound may be useful for further evaluation.3. A lesion in the right cheek may represent a vascular malformation or hemangioma. Ultrasound may also be useful for further evaluation of this.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's ptosis and left-sided tinnitus.


Instruction: Generate impression based on findings.

Input: History of recurrent prostate cancer. 4/20/2015 radical prostatectomy. No lymph node metastases. 4+3 disease with positive margins and perineural invasion. No evidence of seminal vesicle invasion. PELVIS:PROSTATE: Status post pedicle prostatectomy. At the cystourethral anastomosis there is a 9 x 7 mm focus of asymmetric arterial enhancement suspicious for tumor recurrence at this site (series 1 301/1 613.BLADDER: See discussion above.LYMPH NODES: Nonspecific right external iliac 1.3 x 1.1 cm lymph node (series 1 401/77).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Suspicious asymmetric arterial enhancement at the anterior aspect of the cystourethral anastomosis suspicious for tumor recurrence at this site.


Instruction: Generate impression based on findings.

Input: 69 years, Male, mesothelioma, now with hypoglossal nerve route. Evaluate for tumor involvement. There is an enhancing mass involving the left occipital bone including the left occipital condyle, inferior aspect of the clivus, and the left hypoglossal canal. There is a small soft tissue component. Mass measures approximately 2.4 x 5.5 cm in the axial plane, series 2801 image 49, and approximately 3 cm in the craniocaudal dimension, coronal STIR series 1901 image 27. No abnormal enhancement or masses within the brain parenchyma are appreciated. No evidence of acute ischemia or hemorrhage. There is a focus of susceptibility in the right occipital lobe consistent with chronic microhemorrhage. No extra-axial collections. No hydrocephalus. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. There is opacification of the left mastoid air cells. Minimal mucosal thickening is seen involving the paranasal sinuses. No additional lesions within the calvarium within the limits of MRI are appreciated. There is a 15 mm x 4 mm raised skin lesion involving the left frontotemporal scalp.There is mild ptotic appearance of the left posterior tongue. Images of the neck are mildly motion degraded but demonstrate left supraclavicular lymphadenopathy, measuring up to 16 mm in the short axis. Diffuse nodular pleural thickening involving the left hemithorax related to known mesothelioma as well as mediastinal extension of tumor is again seen and better assessed on recent chest CT from 11/12/2015.There is an enhancing lesion measuring 11 x 9 mm involving the left upper sternocleidomastoid muscle, axial post gadolinium series 2301 image 29.There is edema involving the C3 and C4 vertebral bodies along the endplates favored to be degenerative in etiology. Diffuse low T1 marrow signal is seen in the cervical spine, which is nonspecific with no large destructive lesions within the cervical spine are appreciated within the limitations of motion degradation.

Output: 1. Osseous metastasis involving the left posterior skull base measuring approximately 2.4 x 5.5 x 3.0 cm with involvement of the left hypoglossal canal.2. There is posterior drooping of the left tongue base compatible with cranial nerve palsy.3. 11 x 9 mm enhancing lesion involving the left upper sternocleidomastoid muscle suspicious for metastasis.4. Metastatic left supraclavicular lymphadenopathy.5. Extensive nodular pleural thickening involving the left hemothorax extending into the mediastinum consistent with known mesothelioma and better assessed on recent chest CT from 11/12/2015.6. No abnormal enhancement or masses within the brain parenchyma.7. 15 x 4 mm raised skin lesion along the left frontotemporal scalp which is nonspecific and can be correlated with direct visualization.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 20 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 46 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the left knee for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: 55 year old with left breast cancer, completed chemotherapy. There is scattered fibroglandular tissue in both breasts. Scattered cysts are noted.Mild parenchymal enhancement is noted bilaterally.There is extensive non-mass and mass like enhancement spanning 9.2 cm AP in the left outer breast. This approaches to within about 1 cm of the nipple (note the nipple projects relatively medially on these images). The largest mass like component is along the posterior aspect of the area of enhancement and measures up to 1.0 cm. The next largest mass measures 0.6 cm in mid depth. The non-mass enhancement is strongest in the anterior depth where a large clumped area measures 2.1 x 1.2 x 2.7 cm. There are additional linear areas of non-mass enhancement and foci of enhancement extending posteriorly towards the region of the masses. Clip artifact from the inferior breast biopsy is seen along the medial aspect of the enhancement. No abnormal enhancement is seen in the right breast. No abnormal lymph nodes are identified in either axillary region. Clip artifact is noted in the 1:00 posterior depth from the second outside biopsy (VISTA image 136). However, only mild enhancement is present adjacent to the clip. A very small lymph node could potentially be present and obscured by the clip artifact, though this is doubtful.

Output: Mass and non-mass like enhancement in the left outer breast spans up to 9.2 cm AP. No abnormal axillary lymph nodes are noted at this time. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. Paresthesias. Follow-up/assess for progression. Brain: Accounting for differences in technique, there is no significant change in the few T2 hyperintense and T1 hypointense cerebral white matter lesions. The cerebellar tonsils are minimally low-lying. 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 and skull are unremarkable. There is mild mucosal thickening in the paranasal sinuses. There is cosmetic filler material in the forehead and cheeks. Cervical Spine: The T2-hyperintense posterior spinal cord lesion at C3 level is unchanged. The smaller posterior spinal cord lesion at the inferior C7 level is unchanged. The right-sided peripheral cord lesions extending from mid C5 through lower C6 level and also at C3-C4 level are unchanged as well. There is multilevel cervical degenerative spondylosis, which is most pronounced at C5-C6, where a disc protrusion that indents the ventral aspect of the thecal sac and abuts the spinal cord and results in right foraminal stenosis. The vertebral column alignment is unchanged.

Output: 1. Accounting for differences in technique, no significant change in the few cerebral white matter lesions and multiple cervical spinal cord lesions are not changed.2. Multilevel degenerative spondylosis, which is most pronounced at C5-C6.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other specified disorders of muscleClinical question: rule out strokeSigns and Symptoms: R sided upper and lower extremity weakness 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.

Output: There is no evidence for acute ischemic cerebral infarction. There is no evidence for acute intracranial hemorrhage mass or edema.


Instruction: Generate impression based on findings.

Input: Finger mass Within the volar soft tissues of the fifth digit at the level of the mid diaphysis of the proximal phalanx is a well-defined dumbbell-shaped lesion measuring approximately 1 x 1 x 1 cm. This lesion demonstrates homogeneously high signal intensity on T2-weighted sequences, homogeneously low signal intensity on T1-weighted sequences and demonstrates minimal if any peripheral enhancement. No additional lesions are identified.The underlying flexor tendon is normal in signal intensity and caliber. The marrow signal of the fifth digit is also normal. A small focus of signal abnormality within the head of the first metacarpal may represent a small cyst or other benign entity.

Output: Well-circumscribed mass within the volar soft tissues overlying the proximal phalanx of the fifth finger demonstrates imaging characteristics most consistent with a ganglion cyst.


Instruction: Generate impression based on findings.

Input: Postsurgical changes of anterior cervical discectomy and fusion are noted from C5 to C6. Limited evaluation of the cervical spine demonstrates disc bulges at C3-C4, C4-C5, and C6-C7 with mild spinal canal narrowing suspected.There is T2 hyperintensity involving the left C7 nerve root and to a lesser degree the left C6 nerve root. Artifact making makes evaluation for signal abnormality involving the left C8 and T1 nerve roots difficult; however no definite signal abnormality associated is appreciated. There is a 3 to 4 cm area of ill-defined soft tissue in the left retroclavicular region above the level of the left lung apex and at the level of the left first rib without mass effect which likely represents scarring. Evidence of prior left first rib resection. The brachial plexus trunks course through this region particularly involving left C8 and T1 nerve roots, as well as the C6 and C7 nerve roots along the anterior aspect of this region. There is volume loss involving the left scalene musculature which may partly reflect surgical resection. No other masses within this region

Output: There is a 3 to 4 cm area of soft tissue in the left retroclavicular region compatible with scarring presumably related to surgery within this region. The brachial plexus trunks, particularly the middle and inferior trunks, course through this region and may be affected. There is edema involving the left C7 nerve root and to a lesser degree the C6 nerve root. Would be helpful to compare with preoperative MRI study, if available, if this edema involving these nerve roots is new or in fact related to postoperative scarring.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: history of prostate cancer, in focal ablation clinical trial History: see above PELVIS:PROSTATE:Prostate Size: 4.0 x 4.8 x 4.4 cmPeripheral Zone: Post ablation changes in the right mid peripheral zone of the prostate.Central Gland: Enlarged central gland, unchanged.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post ablation changes in the right mid peripheral zone of the prostate.


Instruction: Generate impression based on findings.

Input: 5 year old female with neuroblastoma. Follow up MRI after chemotherapy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are incompletely characterized post-treatment findings in the left mandible at the site of prior tumor.

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


Instruction: Generate impression based on findings.

Input: Reason: ischemia, SAH History: sentinel HA, hx of postpartum CM The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal emass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for ischemic cerebral infarction. MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: 52 year old female patient with left leg pain. Evaluate for lumbar radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. Mild facet arthropathy and mild left neuroforaminal stenosis. No spinal canal stenosis.L2-L3: No significant disc disease. Bilateral facet arthropathy and ligamentum flavum thickening without spinal canal or neuroforaminal stenosis.L3-L4: There is disc dessication and loss of height. There is posterior disc bulge, bilateral ligamentum flavum thickening, and facet arthropathy causing mild spinal canal stenosis and left greater than right neuroforaminal stenosis. L4-L5: There is disc dessication and loss of height. There is posterior disc bulge, bilateral ligamentum flavum thickening, and advanced facet degeneration causing moderate spinal stenosis and mild to moderate neuroforaminal stenosis. There is some crowding of the cauda equina. There are small synovial cysts projecting posteriorly.L5-S1: No significant disc disease. Minimal posterior disc bulge and mild facet arthropathy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Spondylosis of the lumbar spine most particularly affecting L4/L5 with moderate spinal canal stenosis and mild to moderate neuroforaminal stenosis.


Instruction: Generate impression based on findings.

Input: 75-year-old male with right arm weakness and slurred speech. Evaluate for acute stroke. Reidentified is a focal area of hypoattenuation involving the left temporoparietal region compatible with encephalomalacia secondary to prior infarct. No new hemorrhage identified. There is mild ex vacuo dilation of the left occipital horn secondary to adjacent volume loss. No evidence of hydrocephalus.No evidence of acute ischemia, however, CT is insensitive for the evaluation of early ischemic change; if there is clinical concern for acute ischemia, an MRI may be considered.There is no evidence of intracranial hemorrhage, mass or edema. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities are present including hemorrhage, mass-effect, or edema.2. No evidence of acute ischemia, however, CT is insensitive for the evaluation of early ischemic change; if there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Progressive vision loss left eye after head trauma, in context of poor visual acuity with retinitis pigmentosa. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered areas of high T2 signal in the cerebral white matter, particularly in a periventricular distribution. There is also a more focal punctate area of T2 hyperintensity in the left caudate head. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is an enhancing subcentimeter nodule in the superficial right parotid gland.Orbits: There are bilateral lens implants, The globe and ocular adnexa are otherwise grossly unremarkable. There is no evidence of intraorbital mass lesions or abnormal enhancement in the orbits. The bilateral optic nerves display normal signal characteristics.

Output: 1. Probable chronic small vessel white matter ischemic disease and a chronic lacunar infarct versus prominent perivascular space in the left caudate, but no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Aside from bilateral lens implants, the orbital contents appear grossly unremarkable. 3. An enhancing subcentimeter nodule in the right parotid gland may represent a lymph node or salivary gland neoplasm, for example.


Instruction: Generate impression based on findings.

Input: Evaluate for ischemia, etiology of R sided weakness and numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a non-enhancing 9x38mm axial dimension well circumscribed lesion located at the left putamen which is low signal on T1 and FLAIR imaging and high signal on T2 with associated susceptibility effect along its periphery and to a lesser degree centrally.There is an 8mm non-enhancing lesion present in the right periventricular white matter of the right frontal lobe. It is centrally low signal on T1 and FLAIR and high signal on T2 but peripherally high signal on T2 and FLAIR and low signal on T1. There is minimal susceptibility effect associated with it.There is an 8 x 3mm lesion in the subcortical white matter of the insular cortex adjacent to the anterior limb of the sylvian fissure. This is associated with susceptibility effect and low signal on T2, T1 and FLAIR.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and left 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. There is abnormal luminal signal in the right vertebral artery which may represent narrowing of this vessel.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings suggest a large evolving left putamen hematoma now in the early chronic stage as well as a smaller more chronic stage hematoma in the right insular subcortical white matter.2.A right frontal lobe periventricular white matter lesion is likely vascular related 3.Findings suggest luminal compromise of the intracranial right vertebral artery. If clinically appropriate an angiographic study (MRA or CTA) may help further assess this.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Male, 41 years old, with multiple sclerosis, CHORDS study. Multiple scattered T2 hyperintense lesions are again seen in the cerebral hemispheres and to a lesser extent the thalami, the capsular white matter, the brainstem, and cerebellum. A lesion in the cervical spinal cord at the C2 level is only visualized on the sagittal images. Accounting for differences in technique, the size and morphology of these lesions have not significantly changed. No new lesions are identified. The lesions demonstrate moderate to marked T1 hypointensity. On postcontrast images, there is faint wispy apparent enhancement along the roofs of the lateral ventricles which could reflect true enhancement, vascular structures or artifact. No evidence of parenchymal edema is seen. Ventricular size and morphology are within normal limits. Overall brain parenchymal volume is preserved.

Output: Scattered parenchymal lesions are identified compatible with the history of multiple sclerosis. There has been no significant interval change in the size or number of these lesions.


Instruction: Generate impression based on findings.

Input: Male, 15 years old, with neurofibromatosis type II who had a thoracic laminectomy in April for compression, now with some upper back pain. Since the prior examination, the acute postoperative findings compatible with laminectomy at T3-T5 have resolved. The thecal sac is expanded and there is no longer any significant epidural fluid. The large intradural tumor seen at the T4 level on preoperative imaging was resected and there is no evidence of residual or recurrent tumor. There is, however, a progressive kyphotic angulation of the upper thoracic spine with the maximum curvature centered at T3-T6.An intradural extramedullary tumor within the left lateral aspect of the spinal canal at C4 is unchanged. Multiple smaller enhancing lesions are also seen likely affecting the nerve roots including a lesion at C7 on the right and multiple small foci along the conus and partially visualized cauda equina. None of these lesions have significantly changed. Also redemonstrated are multiple enhancing lesions within the substance of the spinal cord. The superiormost of these lesions at the C2 level appears slightly more conspicuous but this may be due to differences in technique. None of the lesions demonstrates a convincing change in size, and no new lesions are detected. Apart from the exaggerated upper thoracic kyphosis, spinal alignment is anatomic. Vertebral body heights are preserved. Marrow signal characteristics remain within normal limits.T2 signal abnormality abnormality is partially visualized in the right cerebellum, probably unchanged.

Output: 1.Since the prior examination, acute postoperative findings compatible with laminectomy and tumor resection from T3 through T5 have resolved. No evidence of residual or recurrent meningioma is seen at the operative site.2.A worsening kyphotic angulation of the upper thoracic spine is noted which could potentially relate to the patient's symptoms.3.Multiple additional intradural extramedullary lesions are redemonstrated without significant interval change.4.Multiple intramedullary enhancing lesions are again seen which most likely represent ependymomas. No convincing interval change is seen in these lesions and no new lesions are detected.


Instruction: Generate impression based on findings.

Input: Diagnosis: CervicalgiaClinical question: radiculopathySigns and Symptoms: pain The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.There is ill-defined T2 signal hyperintensity and T1 signal hypointensity within the C6 vertebral body centered anteriorly.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is a fairly large right lateral recess disc extrusion present with disc material extending into the ventral aspect of the spinal canal. It is centered in the right hemicanal where it compresses the thecal sac as well as the nerve roots at the right lateral recess. Disc material extends across the midline and effaces spinal fluid ventral to the spinal cord. Some disc material tracks behind the C6 vertebral body and effaces CSF space ventral to the spinal cord at the C6 vertebral body level. A small amount of disc material also extends behind the lower and right aspect of the C5 vertebral body especially at the right lateral recess. Overall there is a moderate degree of spinal stenosis present at this level. There is also encroachment of the right-sided exiting nerve roots within the right lateral recess and neural foramen at C5-6.At C6-7 there is a disc bulge present associated with mild narrowing of the neural foramina - right side more than left.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a large disc extrusion present at the C5-6 level which extends behind the C6 and to a lesser degree C5 vertebral bodies along the right hemicanal which encroaches on the right-sided exiting nerve roots at C5-6 and also creates spinal stenosis at the C5-6 level and the C6 vertebral body level.2.Signal changes within the C6 vertebral body can be explained on the basis of reaction to the patient's disc extrusion.3.There is a disc bulge at C6-7 which mildly encroaches on the exiting nerve roots (right worse than left)


Instruction: Generate impression based on findings.

Input: A 70 year old female with history of coronary artery disease, s/p coronary artery bypass (2000), hypertension, hyperlipidemia, chronic obstructive pulmonary disease, pulmonary hypertension.MEDICATIONS: aspirin, benazepril, carvedilol, clonazepam First Pass PerfusionDuring hyperemia, there are two distinct perfusion defects. The first is large and severe, involving the basal and mid infero-septum, inferior and inferolateral walls. The second is also large but mild and involves the basal to mid anterior wall and the mid anteroseptal and anterolateral walls. The overall ischemia score is 12 out of a possible 32. 38% of the LV is ischemic. Viability/ Myocardial ScarThere is a non-transmural myocardial infarction involving the basal to mid inferolateral wall. These segments have an intermediate probability of viability. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size and systolic function. There is thinning and hypokinesis of the basal to mid inferior and inferolateral walls and the basal inferoseptum. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 84 ml/m2 (normal range: 65+/-11), the LVEDV is 132 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 44 g/m2, and the LV mass is 69 g. Left AtriumThe left atrium is mildly dilated (121ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVEDV is 117 ml (normal range 110+/-24), the RV end systolic volume index is 28 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). 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 severe mitral regurgitation with an eccentric jet. The posterior leaflet is tethered and the possibility of flail anterior leaflet can not be excluded.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain 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 FindingsSternal wires were noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is extensive myocardial ischemia in a multivessel coronary distribution with evidence of a large amount of myocardial viability.2. There is a small non-transmural myocardial infarction in the basal to mid inferolateral wall.3. Normal LV size and systolic function (LVEF 62%) with thinning and hypokinesis as described above.4. Normal RV size and systolic function (RVEF 62%).5. There is severe mitral regurgitation with a tethered posterior leaflet. Additionally, the possibility of a flail anterior mitral leaflet can not be excluded. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 53 year-old male with a history of pulmonary sarcoidosis who was noted to have a right-bundle branch on ECG and was subsequently referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 72 ml/m2 (normal range: 74+/-15), the LVEDV is 142 ml (normal range 142+/-34), the LV end systolic volume index is 32ml/m2 (normal range 25+/-9), the LVESV is 64 ml (normal range 47+/-19), the LV mass index is 44 mg/m2 (normal range 85+/-15), and the LV mass is 88 mg (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no evidence of myocardial iron overload. The pre-contrast native myocardial T1 relaxation times is normal (1025 ms). 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 52%, the RV end diastolic volume index is 92 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 45 ml/m2 (normal range 31+/-9), and the RVESV is 89 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated (38-40mm)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 FindingsThere is mediastinal lymphadenopathy noted. Bilateral interstitial lung markings (see recent CT scan for more details). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 55%).2. The right ventricle is normal in size with normal systolic function (RVEF 52%).3. There is no myocardial late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.4. Extracardiac findings as noted above. 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 weakness and numbness and generalized pain after episode of syncope and a traumatic fall 10 days ago. Rule out stroke and cervical spine traumatic change. The study is mildly limited by patient motion.BRAIN MRI:There is no acute brain infarct or intracranial hemorrhage. There is no abnormal brain signal. The ventricles and the subarachnoid spaces are not dilated. There is no midline shift or brain herniation. The major intracranial vascular flow voids are preserved, reflecting gross patency. Following contrast demonstration, there is no abnormal intracranial contrast enhancement. A partial empty sella is probably incidental. There are no abnormal enhancing foci.There is no gross orbital abnormality. Mastoid air cells are clear. There is trace maxillary and ethmoid sinus mucosal thickening, most likely of no significance. There is no destructive skull lesion.CERVICAL SPINE MRI:Alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal shows no suspicious abnormality, accounting for mild irritative changes subjacent to the endplates, most pronounced at C4-C5. There is disc desiccation at most levels. The spinal canal is fairly preserved. The spinal cord shows normal shape and signal. There is no abnormal spinal cord, nerve root or leptomeningeal contrast enhancement. Redemonstrated is advanced periodontal disease.C2-C3: Minimal disc bulge but no spinal canal or foraminal stenosis.C3-C4: Very shallow disc-osteophyte complex with underlying uncovertebral arthropathy result in no significant spinal canal or foraminal stenosis.C4-C5: Shallow disc-osteophyte complex causes no spinal canal stenosis. Uncovertebral and facet arthropathy results in mild bilateral foraminal stenoses.C5-C6: There is no spinal canal or foraminal stenosis.C6-C7: There is shallow ventral indentation of the thecal sac by disc-osteophyte complex but no spinal canal stenosis. There is mild-to-moderate left facet arthropathy but no foraminal stenosis.C7-T1: There is no spinal canal or foraminal stenosis.

Output: 1.The study is mildly limited by patient motion.2.No acute brain infarct. No abnormal intracranial contrast enhancement. 3.Mild multilevel degenerative cervical spine disease without significant spinal canal or foraminal stenosis.4.Redemonstrated is advanced periodontal disease.


Instruction: Generate impression based on findings.

Input: 28 years Female, evaluate response to therapy in patient with metastatic breast cancer to brain. At least nine small enhancing lesions are evident within both cerebral hemispheres and the right cerebellum which are stable to minimally enlarged. Most are situated along the periphery of the brain as noted before. The largest lesion is found in the inferior right cerebellum. Examples of slightly enlarged lesions include the lateral right frontal parietal lesion measuring 16 x 9 mm, previously 15 x 7 millimeters, and a 5 mm right frontal lesion (series 5 image 26), previously 4 mm in size.Minimal surrounding edema persists around many of the lesions. No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collections are identified. There are no findings to suggest acute intracranial hemorrhage, and the above-mentioned lesions do not appear to be hemorrhagic themselves. The ventricles are stable and normal in size.The visualized paranasal sinuses and mastoid air cells are clear.

Output: Multiple scattered metastatic lesions are again seen which are overall stable although few measure minimally larger in the interval. Slight enlargement may be related to recent treatment or perhaps related to slight differences in technique, although progression is not entirely excluded. No definite evidence of metastatic disease progression.


Instruction: Generate impression based on findings.

Input: Clinical question: Dizziness. Signs and symptoms: Dizziness. Nonenhanced head CT:No detectable activity intracranial process.There is evidence of ectopia of cerebellar tonsils through the foramen magnum of approximately 3 mm. There is resultant partial effacement of subarachnoid space at the level of foramen magnumRecommend follow-up with MRI exam.Unremarkable cerebral cortex, cortical sulci, ventricular system and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits mastoid air cells and paranasal sinuses.

Output: Mild ectopia of cerebellar tonsils and unremarkable study otherwise. Follow-up with MRI and CSF flow study is recommended


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:3/15/1964)Reason: ischemic stroke History: right sided weaknessPROVIDER/ATTENDING NAME: KOUROSH L REZANIA KOUROSH L REZANIA Small foci of diffusion restriction are present along the cerebellar hemispheres with involvement of the inferior aspect of the left cerebellar hemisphere anteromedially and posterior medially as well as smaller foci of diffusion restriction in the medial aspect of the right cerebellar hemisphere and the vermis. Additional foci of diffusion restriction are present along the left caudate nucleus, left putamen small portion of the left insular cortex and punctate foci in the left parietal lobe and frontal lobe. These are associated with T2 and FLAIR signal hyperintense foci. Small foci of susceptibility effect are present along the inferomedial aspect of the left cerebellar hemisphere and along the left external capsule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are multiple small foci of subacute infarction involving the cerebellum and left middle cerebral artery territory as detailed above. There are small foci of hemorrhage present in the left external capsule and in the left inferior medial cerebellar hemisphere.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Shoulder pain The evaluation of the shoulder is limited by metallic susceptibility artifact resulting from a screw within the glenoid. Multiple foci of signal void are also noted within the soft tissues anteriorly reflecting artifact from prior surgery.ROTATOR CUFF: There is linear increased signal within the distalmost fibers of the supraspinatus tendon at its insertion upon the greater tuberosity, representing insertional tearing. This extends along the majority of the thickness of the tendon and probably disrupts the articular surface fibers although the bursal surface fibers appear intact. The tear measures 1.5 cm in the AP dimension and there is no retraction of the tendon. There is mild edema and degenerative cysts within the underlying greater tuberosity. The supraspinatus muscle is normal.There is perhaps minimal insertional tearing of the infraspinatus tendon although there is no evidence of a full-thickness tear. The infraspinatus muscle is normal. The teres minor tendon and muscle are normal. There is perhaps mild insertional tendinosis of the subscapularis tendon without discrete tear. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. A trace amount of fluid is noted within the subacromial bursa which is not necessarily of any clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Evaluation of the glenoid and labrum is limited by susceptibility artifact. There appears to be fragmentation of the anterior labrum with perhaps degenerative fraying of the superior labrum.BICEPS TENDON: No significant abnormality noted.

Output: Limited examination secondary to metallic susceptibility artifact from glenoid screw. There is a near full-thickness rim rent tear of the distal fibers of the supraspinatus tendon without retraction. Other findings are described above.


Instruction: Generate impression based on findings.

Input: 57-year-old male with a history of multiple skin cancers presents with a vocal cord paralysis. There are postoperative findings related to left left lateral temporal bone resection with myocutaneous graft reconstruction. There has been interval increase in the degree of a peripherally enhancing area with scattered foci of susceptibility effect and surrounding edema in the left temporal lobe with effacement of the third and left lateral ventricles, but dilatation of the right lateral ventricle. The defect in the left tegmen with mild herniation of the inferior temporal lobe is unchanged. There is minimal residual fluid extra-axial fluid along the floor of the left middle cranial fossa. There is no evidence of acute territorial infarction. There is a nonspecific punctate focus of susceptibility effect in the right anterior cingulate gyrus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributed to degenerative changes with subchondral sclerosis. There has been interval resolution of the enhancement in the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal.

Output: 1. Continued evolution of what likely radiation necrosis in the left temporal lobe with increase in localized mass effect and incipient obstructive hydrocephalus of the right lateral ventricle.2. Persistent defect in the left tegmen with mild herniation of the inferior temporal lobe and minimal residual extra-axial fluid collection along the floor of the left middle cranial fossa.3. Resolved enhancement of the left cochlea and cranial nerves in the left internal auditory canal, but new T1 hyperintensity in the left vestibule and semicircular canal, which may be related to proteinaceous debris or hemorrhage.


Instruction: Generate impression based on findings.

Input: Diagnosis: Melanoma of skin, site unspecified Unspecified psychosisClinical question: pt with new onset confusion - please eval for metastatic diseaseSigns and Symptoms: met melanoma The patient is status post left parietal craniotomy for removal of a lesion in the left parietal lobe since the previous exam from July the lesion located in the left parietal lobe has decreased in size now measures 18 x 16 mm axial dimensions and previously measured 20 x 18 mm axial dimensions. It is associated with blood products and spotty contrast enhancement. The associated vasogenic edema has significantly decreased compared to the July exam.There is redemonstration of a 6 mm enhancing focus along the lateral aspect of the right superior frontal gyrus just anterior to the paracentral lobule which is associated susceptibility effect.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 a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A hemorrhagic lesion in the left parietal lobe has decreased in size compared to the prior exam. This is known to represent metastatic disease.2.A hemorrhagic lesion in the right superior frontal gyrus is stable compared to the prior exam. This compatible with hemorrhagic metastasis.


Instruction: Generate impression based on findings.

Input: 60 year-old female with renal cell carcinoma with brain metastases and change in mental status. Evaluate for edema, hemorrhage, and additional metastases. Right parietal shunt catheter with tip lying in the midline of lateral ventricles is unchanged. Completely collapsed the right lateral ventricle and prominent left lateral ventricle are unchanged. Remaining ventricles are unremarkable.Two midline, hyperattenuating lesions in superior suprasellar cistern are reidentified and consistent with hemorrhagic metastases. Larger more anterior lesion is now more heterogeneous in appearance and measures 12.4 x 12 .3 mm, previously measured 11.7 x 13.2 mm. Mild interval enlargement of smaller posterior lesion measuring 6.4 x 7 .3 mm, previously measured 5.4 x 5.9 mm. There has been interval enlargement and increased heterogeneous attenuation of prominent pineal gland measuring 12.4 x 7 .8 mm, previously measured 10.9 x 5.9 mm (series 3, image 14).Right cerebellar hemisphere hypoattenuation consistent with vasogenic edema secondary to metastatic focus seen on most recent MRI.Region of encephalomalacia in the right superior frontal gyrus is unchanged.There is no evidence of intracranial hemorrhage, mass or edema. Postsurgical changes in the frontal bone and right parietal catheter. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Prominent, heterogeneous pineal gland with mild interval enlargement that could be related to difference in technique between the current and previous scans or could represent underlying lesion. MRI is recommended for better evaluation if clinically indicated.2. Two partially hemorrhagic suprasellar cistern region metastases, with mild increase in size. 3. Hypoattenuation in right cerebellar hemisphere consistent with vasogenic edema from small metastatic focus seen on recent MRI.4. No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: History of uterine artery embolization. PELVIS:UTERUS, ADNEXA: Anteverted uterus with lobular contour. The uterus measures approximately 10.9 x 7.7 cm in the sagittal plane.It contains numerous well-defined T1 and T2 weighted hypointense masses compatible with fibroids. The largest is an intramural fundal fibroid measuring 6.7 x 7.7 cm in the sagittal plane. Additional 3.0 x 2.7 and 2.8 x 1.9 intramural and submucosal fibroids are noted in the uterine body. The fibroids demonstrate no significant postcontrast enhancement, significantly decreased from the prior. The endometrium/endometrial canal is distorted by the large fibroids but is normal in thickness. The inner myometrium/junction is similarly distorted but does not appear thickened. No hemorrhagic or cystic changes in the myometrium to suggest adenomyosisThe left ovary measures approximately 3.3 x 2.3 cm and contains physiologic cysts/follicles and a T1-weighted hyperintense non-enhancing dermoid cyst measuring 2.0 cm, unchanged. The right ovary measures 3.0 x 1.8 cm with physiologic cysts/follicles.The cervical stroma and parametrial soft tissues are unremarkable.Within the upper anterior vaginal canal there is a cystic lesion measuring 2.5 x 1.7 cm containing debris and thin non-enhancing septations, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific unchanged right pelvic wall prominent lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant enhancement of the uterine fibroids.2.Unchanged 2.0 cm left ovarian dermoid cyst.3.Unchanged upper anterior vaginal canal minimally complex cyst, likely a Gartner's duct cyst.


Instruction: Generate impression based on findings.

Input: 49-year-old male with labile blood pressure and flushing as well as history of adrenal mass, evaluate for pheochromocytoma. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: In the region of the right adrenal gland, there is a well circumscribed mass measuring 4.5 x 5.4 cm in the axial plane x 4.6 cm in the craniocaudal dimension. The lesion is predominantly solid with several central cystic components. The solid components demonstrate moderately increased T2 signal and intermediate T1 signal. The solid components demonstrate avid enhancement on postcontrast images with some apparent washout on more delayed images. The lesion does not appear to contain macroscopic or microscopic fat. Mild to moderate mass effect on adjacent IVC noted.Left adrenal gland appears within normal limits.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is rightward curvature of the thoracic spine and leftward curvature of the lumbar spine.OTHER: No significant abnormality noted.

Output: Right adrenal tumor measuring 4.5 x 4.6 x 5.4 as described above. Given imaging features and clinical scenario including a history of hypertension and a lack of a primary malignancy, favor a pheochromocytoma. Other differential considerations such as metastatic disease or an adrenocortical carcinoma considered much less likely.