Instruction: Generate impression based on findings.

Input: 29 year old male, with a history of renal failure, pulmonary hypertension, right ventricular enlargement, tricuspid regurgitation, and PFO with right to left shunt on echocardiogram bubble study. Presents for cardiovascular MRI to evaluate cardiac structure and function. Left VentricleThe left ventricle is normal in size and systolic function. There is severe concentric left ventricular hypertrophy. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 102 ml/m2 (normal range: 74+/-15), the LVEDV is 161 ml (normal range 142+/-34), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 160 g/m2 (normal range 85+/-15), and the LV mass is 252 g (normal range 164+/-36). Septal thickness is 15mm. Posterior wall thickness is 15mm. There are no regional wall motion abnormalities present. No ventricular septal defect is noted. Right VentricleThe right ventricle is severely dilated with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 239 ml/m2 (normal range 82+/-16), the RVEDV is 377 ml (normal range 142+/-31), the RV end systolic volume index is 150 ml/m2 (normal range 31+/-9), and the RVESV is 237 ml (normal range 54+/-17).AtriaThe left atrium is normal in size. The right atrium is moderate to severely dilated. The inter-atrial septum bows to the left, suggesting increased right atrial pressure. No obvious atrial septal defect is noted; however, image quality is limited by the patient's inability to cooperate with breath-holds.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation. The valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation. The valve is trileaflet.Tricuspid ValveThe tricuspid valve opens widely. There is moderate to severe tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (33mm).Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSignificant abdominal ascites is 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. Normal left ventricular size and systolic function (LVEF 63%), with severe concentric left ventricular hypertrophy.2. Severely dilated right ventricle with moderately reduced systolic function (RVEF 37%).3. Mild mitral insufficiency.4. Moderate to severe tricuspid insufficiency.5. Moderate to severe right atrial dilation.6. No obvious atrial septal defect is noted; however, image quality is limited by patient's inability to cooperate with breath-holds. No anomalous pulmonary venous drainage noted. No ventricular septal defect noted. 7. Significant abdominal ascites present.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Compared to prior MRI lumbar spine dated 1/18/2016, there is worsened diffusely heterogeneous and infiltrative signal abnormality throughout the lumbar spine, partially imaged T11 and T12 levels, and partially imaged pelvis including the bilateral sacrum and iliac bones. There is also associated multifocal STIR hyperintensity and enhancement related to diffuse osseous metastatic disease which has significantly progressed. The degree of enhancement involving the S1 vertebral body has decreased in the interval as has the epidural tumor dorsal to the S1 vertebral body consistent with prior radiation treatment. For example at the L5-S1 level, previously seen epidural tumor measuring up to 5 mm in thickness now measures less than 1 mm. More ill-defined epidural enhancement along the anterior and right lateral aspect of the epidural space from the L5-S1 to S1-S2 levels also appears decreased. T1 hyperintensity involving the pelvis and lower aspect of the L5 vertebral body is consistent with prior radiation. Conjoined right L5, S1, and S2 nerve roots incidentally noted. There is increase in enhancement along the left anterolateral aspect of the L5 vertebral bodies suspicious for paraspinous tumor. There is minimal epidural enhancement along the dorsal aspect of the lumbar vertebral bodies which may represent venous plexus and less likely epidural tumor. There is no definite evidence of new epidural tumor since the prior study or leptomeningeal disease.There is linear T1 and T2 signal involving the S1 vertebral which is new and likely represents a pathologic fracture. Vertebral body heights are grossly preserved although there is progressive endplate deformity involving the inferior L5 and superior S1 endplates. The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. There is no significant disc disease or spinal canal or neural foraminal stenosis.

Output: 1. Compared to MRI dated 1/18/2016, there has been marked progression of diffuse osseous metastatic disease throughout the lumbar spine and partially imaged pelvis. Previously seen enhancement associated with the S1 metastasis has decreased, and there is also decrease in epidural tumor at this level. There is however interval development of pathologic fracture involving the S1 vertebral body without significant loss of height.2. There is mild paraspinous tumor extension suspected along the left anterolateral aspect of the L5 vertebral body which is increased. No new epidural tumor is definitively appreciated. 3. There is no significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 68-year-old female with memory disorder. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are several punctate hippocampal sulcus remnant cysts bilaterally. The hippocampi are otherwise unremarkable. There is a nonspecific punctate focus of increased T2 signal in the posterior left superior frontal gyrus. 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. There is a punctate possible Thornwaldt cyst.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 55-year-old female with left knee pain. MENISCI: There is a radial tear of the posterior horn of the medial meniscus near its root. The anterior horn appears intact. The lateral meniscus appears intactARTICULAR CARTILAGE AND BONE: There is focal full thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle. There is superficial fraying of the articular cartilage along the medial facet of the patella. There is a partial-thickness articular cartilage cleft along the lateral facet of the patella with delamination. There are tricompartmental osteophytes.LIGAMENTS: There is diffuse increased signal abnormality about the medial aspect of the MCL as well as within the proximal fibers of the superficial band of the MCL, indicating a sprain. The ACL and PCL appear intact. The LCL appears intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Radial tear of the posterior horn of the medial meniscus, near its root, as described above.2. Osteoarthritis of the left knee with articular cartilage degeneration/clefts as described above.3. Sprain of the MCL.


Instruction: Generate impression based on findings.

Input: Clinical question: History of major neuroblastoma status post craniotomy, chemotherapy and radiation therapy. Signs and symptoms: Off therapy evaluation. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a large focus of cystic encephalomalacia involving primarily the lateral aspect of the right cerebellum with resultant expansion of the cerebellar folia and the fourth ventricle. Post enhanced images demonstrate no detectable abnormal enhancement. Findings are similar to prior study from 2-13-15.Images through the supratentorial space demonstrate a subtle focus of FLAIR hyperintensity in the right coronal radiata without enhancement or interval change since prior study. Finding likely representing post treatment/radiation change.Mild prominence of cerebral cortical sulci for patient of stated age is noted. Post enhanced images demonstrate no detectable or abnormal enhancement of brain parenchyma or leptomeninges.Calvarium demonstrate postoperative changes of a right suboccipital craniotomy/craniectomy and unremarkable otherwise.Unremarkable images through the orbits including axial fat sat post enhanced series.

Output: 1.No acute intracranial process and no detectable new finding since prior exam.2.Right cerebellar encephalomalacia and resultant cerebellar parenchymal volume loss consistent with post surgical/treatment changes and without evidence of residual or recurrence of tumor.3.Stable small focus of nonenhancing FLAIR hyperintensity in the right coronal radiata likely representing posttreatment changes.4.Prominence of the supratentorial cortical sulci for patient's stated age as detailed and unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 36 year old female with a history of bicuspid aortic valve. ?Aortopathy. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), the LVEDV is 203 ml (normal range 109+/-23), the LV end systolic volume index is 35 ml/m2 (normal range 18+/-5), the LVESV is 76 ml (normal range 31+/-10). The left ventricular mass index is 58g/m2, and the left ventricular mass is 127g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 94 ml/m2 (normal range 69+/-14), the RVEDV is 204 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 80 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is bicuspid with fusion of the non-coronary and right coronary cusps. The is no significant aortic stenosis. There is trace aortic regurgitation (regurgitant fraction 3%, regurgitant volume 4ml), stable when compared to the previous exam.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is dilated. There is no evidence of coarctation. The aortic measurements are as follows:Aortic annulus: 28mmSinus of valsalva: 39.4mmSinotubular junction: 31.5mmAscending aorta (4cm from annulus) : 34.4mmProximal aortic arch: 35mmDescending aorta: 22mmPulmonary 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 a trace pericardial effusion. Extracardiac FindingsThere are scattered lymph nodes most evident in the left axilla, the largest of which is <1cm. This was seen on the previous examination as well. 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 mildly dilated with systolic function. The overall LV ejection fraction is 60%.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%. 3. Bicuspid aortic valve without significant stenosis or regurgitation.4. No aortic coarctation.5. The aortic root is mildly dilated but measurements largely stable when compared to the previous exam of 12/2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Mild posterior osteophyte disc complex and slight ligamentum flavum thickening. There are no stenoses.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and left facet hypertrophy. There is mild to moderate left neural foraminal stenosis.C4/5: Posterior osteophyte disc complex asymmetric to the right causing anterior right hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and ligamentum flavum thickening. There is mild central and severe bilateral neural foraminal stenosis.C5/6: Posterior osteophyte disc complex asymmetric to the right causes minimal anterior right hemicord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and left facet hypertrophy. There is mild left neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate left and mild right neural foraminal stenosis.C7/T1: Posterior aspect disc complex and bilateral uncinate hypertrophy. There is severe left and moderate to severe right neural foraminal stenosis.

Output: 1.C3/4: Mild to moderate left neural foraminal stenosis.2.C4/5: Mild central and severe bilateral neural foraminal stenosis.3.C5/6: Mild left neural foraminal stenosis.4.C6/7: Moderate left and mild right neural foraminal stenosis.5.C7/T1: Severe left and moderate to severe right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 27 year old woman family history of hypertrophic cardiomyopathy, referred for further risk stratification with cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 145 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 46 ml (normal range 31+/-10), the LV mass index is 43 g/m2 (normal range 67+/-11), and the LV mass is 77 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The interventricular septal thickness is 10mm. There is no evidence of an apical aneurysm. There is an outpouching in the basal inferior wall which could represent a intramuscular crypt which can be a phenotypic manifestation of hypertrophic cardiomyopathy.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 64%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 157 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 56 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. There is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%. There is no evidence of left ventricular hypertrophy.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%.3. Regarding evaluation of hypertrophic cardiomyopathy, the maximum interventricular septal thickness is 10mm. There is an outpouching in the basal inferior wall which could represent a intramuscular crypt. This can be a phenotypic manifestation of hypertrophic cardiomyopathy.There is no evidence of an apical aneurysm. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Redemonstrated are postsurgical findings of the lower lumbar spine related to biopsy of a sacral spinal canal lesion and radiation therapy. There is decrease in size of the fluid collection within the operative bed, abutting the dura. There is an enhancing mass within the spinal canal at the S1 and S2 levels, which is stable to slightly decreased in size. There are multiple vertebral body compression fractures again noted, most severe at T12 with nearly 70% loss of height. There is slight progression of central collapse of the L2 vertebra. The compression deformities at L3 and L4 have not significantly changed. There is unchanged mild anterior wedge deformity of T11. The marrow signal of the lumbar vertebral body is heterogeneous with scattered subtle areas of enhancement. Fatty replacement of L5 and the sacrum is consistent with radiation change. The imaged spinal cord and conus are unremarkable. The nerve roots of the cauda equina disperse evenly up to the point of the sacral tumor where there is some clumping.L1-2: Mild disc bulge and unchanged small superimposed left paracentral disc extrusion with superior migration posterior to the L1 vertebra. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Mild right foraminal narrowing. L3-4: Mild facet and ligament flavum hypertrophy. Mild disc bulge. Unchanged prominent epidural fat contributes to mild generalized canal narrowing. Mild to moderate bilateral foraminal narrowing. L4-5: Postsurgical change. Moderate facet and ligamentum flavum hypertrophy. Mild disc bulge. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing. L5-S1: Postsurgical change. Moderate facet and ligament flavum hypertrophy. Mild disc bulge with a small superimposed central protrusion. No significant spinal canal stenosis. Minimal to mild bilateral neural foramen stenosis.

Output: 1. Stable to slightly decreased size of residual enhancing tumor within the sacral spinal canal.2. Multiple vertebral body compression deformities and scattered subtle abnormal marrow signal, which is compatible with known myelomatous disease and pathological fractures, which has mildly progressed at L2.3. Multilevel degenerative spondylosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Syncope. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered supratentorial and infratentorial white matter T2 hyperintensity. There is a partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarction. Nonspecific mild scattered supratentorial and infratentorial white matter T2 hyperintensity may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of pancreatic adenocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is a 1.7 x 1.4 cm focus adjacent to the gallbladder fossa which demonstrates signal dropout on out of phase imaging consistent with focal fatty infiltration. Additional 1.2 and 1.4 cm foci adjacent to the right portal vein demonstrates signal dropout on out of phase imaging consistent with focal fatty infiltration. No focal suspicious hepatic lesion, biliary ductal dilatation or vascular abnormality.SPLEEN: The spleen is normal in morphology without a discrete lesion. The splenic artery and vein are unremarkable.PANCREAS: Best appreciated on series 4 image 6 is a hypointense lesion in the pancreatic body measuring 2.1 x 1.8 cm which demonstrates heterogeneous enhancement on postcontrast imaging sequences and mild restricted diffusion. The distal pancreatic body and tail are mildly atrophic with decreased T1-weighted signal intensity.The lesion involves and nearly completely occludes the superior mesenteric vein (series 18 image 19 through 25). The lesion abuts the superior mesenteric artery (series 18 image 18). The lesion abuts the ventral aspect of the splenic vein (series 18 image 25) just proximal to the portal vein confluence.No suspicious peripancreatic or retroperitoneal lymphadenopathy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal subcentimeter cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 2.1 cm pancreatic body mass with distal pancreatic parenchymal atrophy consistent with patient's stated history of pancreatic adenocarcinoma. Near complete occlusion of the superior mesenteric vein. Abutment of the superior mesenteric artery without frank encasement. No suspicious peripancreatic or retroperitoneal lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Again seen is resection cavity in the right temporal lobe. Most of the surrounding FLAIR hyperintensity in the right temporal lobe is not significantly changed. There is however slight increase in FLAIR hyperintensity and more prominent increase in nodular enhancement which demonstrates restricted diffusion along the medial aspect of the resection cavity. This area of enhancement abuts the lateral ventricle. Perfusion images demonstrate no clear elevation in cerebral blood volumes in the regions with new enhancement.The ventricular system remains mildly enlarged but unchanged. Mild periventricular T2/FLAIR hyperintensity as well as additional scattered nonspecific foci of T2/FLAIR are not significantly changed. The right temporoparietal craniotomy flap with small underlying extra-axial fluid collection remains unchanged. No associated mass effect. No evidence of midline shift or herniation.

Output: Compared to the previous examination of 9/16/2015, there is increase in nodular enhancement along the medial aspect of the right temporal resection cavity, slight increase in associated FLAIR hyperintensity, and restricted diffusion. No clear elevated CBV in these regions is demonstrated although volume averaging and relatively small areas of new enhancement makes assessment on the perfusion sequence limited. As such, findings may be related to recent re-irradiation although early tumor progression is not excluded. Would suggest close follow-up evaluation.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, with drifting to the left side on ambulation. Examination for radiosurgery planning. An enhancing mass within the right aspect of the medulla is unchanged in size. Also unchanged is a punctate focus of enhancement within the right internal auditory canal. No definite additional masslike enhancing lesions are seen. An area of strong susceptibility effect is redemonstrated within the left posterior cingulate gyrus. Prominent enhancing veins which course adjacent to this area are compatible with a developmental venous anomaly.

Output: 1.No significant change in the size of an enhancing right medulla mass.2.No change in a punctate focus of enhancement within the right IAC which may represent an incidental schwannoma, less likely an additional metastatic lesion.3.Strong susceptibility effect is redemonstrated within the left posterior cingulate gyrus with an associated developmental venous anomaly. Although not entirely typical, this constellation of findings may represent a cavernous malformation with evidence of prior bleeding. Other etiologies are not excluded.


Instruction: Generate impression based on findings.

Input: 15-year-old male with right knee pain. No acute fracture or malalignment. No soft tissue swelling or joint effusion. The Insall Salvati ratio measures 1.3, suggesting patella alta. The patellar tendon appears grossly intact. This finding could be further evaluated with a dedicated MRI examination if clinically indicated.

Output: Patella alta can be seen in patellofemoral instability, which could be further evaluated with a dedicated MRI examination if clinically indicated.


Instruction: Generate impression based on findings.

Input: 21 years, Male, history of myxopapillary ependymoma status post radiation therapy. Also history of cavernous malformations. Evaluate for changes.. MRI brain:Redemonstrated are innumerable punctate foci of susceptibility throughout the brain which are not appreciably changed since prior brain MRI on 3 Tesla at 3/21/2016. No enlarging lesions. No new edema or acute or subacute blood products to suggest new hemorrhage. More prominent hemosiderin staining involving the left precuneus is again seen related to hematoma seen in this location on MRI dated 12/8/2015. No evidence of acute infarct. A few nonspecific scattered punctate foci of FLAIR hyperintensity are again seen. No abnormal enhancement. No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. Visualized calvarium and extracranial soft tissues are grossly unremarkable.MRI spine:There are punctate foci of T2 hypointensity in the cervical cord including the right lateral C2 level right dorsolateral C3 level. There is more questionable subtle linear low T2 signal along the surface of the cord at the C5 level and C6-C7 level although artifact remains a possibility. These findings are not definitively appreciated on prior study although slight differences in technique/scanner may account for this.Diffuse postradiation marrow changes are again noted. A 12 mm STIR hyperintense enhancing lesion in the posterior-superior aspect of C7 vertebral body is unchanged since at least 11/23/2014. There is also a stable region of irregular marrow enhancement and STIR hyperintensity in the left posterior T6 vertebral body minimally extending into the left pedicle, again appearing similar back to at least 11/23/2014. The left ventral C1 level focus of enhancement along the surface of the cord is stable. Foci of enhancement along the dorsal and lateral surface of the distal thoracic cord appear slightly decreased in conspicuity although slight differences may reflect contrast timing. Linear focus of enhancement in the thecal sac at the L1 level is not appreciably changed. A small rounded enhancing lesion along the left cauda equina at the L2 level measuring 8 x 5 mm mm is not significantly change. Small enhancing nodule at the S1 level is also not significantly changed. More ill-defined diffuse enhancement in the lumbar thecal sac is favored to reflect differences in contrast timing and similar to study from 6/22/2015. Postoperative changes relating to lumbar laminectomies are redemonstrated. Small central disc protrusion at the T4-T5 level is also similar to prior. Lumbar degenerative changes including disc bulges and facet arthropathy which contribute to multilevel mild to moderate neural foraminal stenosis again seen. Mild narrowing of the thecal sac at the L3-L4 also again seen. No high-grade spinal canal stenosis at any level.

Output: 1. Brain MRI again demonstrates innumerable foci of susceptibility effect throughout the brain which may represent cavernous malformations related to radiation therapy. No significant change since MRI brain at 3 Tesla on 3/21/2016. No findings to suggest interval hemorrhage.2. Punctate foci of low T2 signal in the cervical cord are also compatible with posttreatment change/cavernous malformations. These are not appreciable on the prior spine MRI from 12/8/2015. Given their small size, this finding may reflect technique/scanner differences.3. Overall no significant change in nodular foci of enhancement within the thecal sac which given stability are favored to represent treated leptomeningeal disease. Slight differences in thecal sac enhancement compared to 12/8/2015 are favored to be related to contrast timing, with the overall appearance on current study not appreciably changed since 6/22/2015. No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: MRI Brain:Redemonstrated is extensive cystic encephalomalacia involving most of the right frontal lobe, right superior and middle temporal gyri, and extending into the right parietoccipital fissure. There is associated right-sided Wallerian degeneration and ex vacuo dilatation of the right lateral ventricle. There is also some scattered susceptibility abnormality in a curvilinear gyriform pattern more posteriorly in the region of old infarct on the right. Additional periventricular and subcortical FLAIR hyperintensities are noted consistent with chronic small vessel ischemic changes. There is no evidence of acute intracranial hemorrhage, mass effect, midline shift, herniation, hydrocephalus or extra-axial fluid collection. Again seen is edema within the right superior periorbital soft tissues which is unchanged.MRA Brain: Exam is limited by motion artifact. There is asymmetric decreased caliber of the right ICA, MCA and ACA, with only a few right MCA branches visualized. The left MCA and ACA are patent. The AComA and right PComA are not visualized. The distal right PCA is slightly decreased in caliber, while the left PCA is within normal limits. There is chronic severe stenosis of the more proximal cervical right vertebral artery with the distal right V4 segment possibly partially retrograde opacified from the basilar artery to the mid right V4 segment near the expected location of the PICA origin. Evaluation of right PICA and AICA are limited secondary to the motion artifact.MRA Neck: Motion artifact is present. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is focal narrowing of the origin of the distal right carotid bulb which could be artifactual, with asymmetric decreased caliber of the right ICA as it extends intracranially given the chronic right-sided infarct. There is mild eccentric plaque along the proximal left carotid bulb. The common carotid arteries and left cervical internal carotid artery are otherwise normal in course and caliber.The right vertebral artery is is not well visualized at its origin along the right proximal V1 segment. Thready contrast opacification is identified throughout the cervical right vertebral artery, although evaluation is limited secondary to motion artifact and likely surrounding mild venous contamination. There is significant irregularity of the proximal to mid right V4 segments with improved visualization following apparent PICA origin.

Output: 1.No evidence of an acute infarct.2.Extensive encephalomalacia of the right MCA and ACA territories, with underlying mild-moderate chronic small vessel ischemic disease and associated diminutive caliber of right anterior circulation vessels.3.Severe stenosis of the right vertebral artery origin and the proximal right V1 segment is not well visualized, although the remainder of the vessel is seen but thready, with more focal areas of narrowing intracranially. It is difficult to determine if there is collateral vascular supply to the vessel given the extensive artifact.4.No other significant extracranial vascular stenosis, although evaluation is significantly limited due to extensive motion artifact.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. Encephalomalacia is again demonstrated involving the left inferior parietal lobule.

Output: Unremarkable evaluation of the intracranial vasculature through the circle of Willis.


Instruction: Generate impression based on findings.

Input: Status post right hip scar revision now with possible wound infection. History of osteomyelitis of hip. Pain, erythema, swelling.IMAGE ACQUISITIONS: Computed tomography of the pelvis performed following intravenous administration of 120 cc of Omnipaque 350, with transverse, coronal, and sagittal reformatted images of the pelvis and right hip. Absence of the right femoral head and neck with tubular sclerosis in the proximal femoral diaphysis likely represents the sequela of removal of a total hip arthroplasty device. Within the subcutaneous fat just lateral to the proximal aspect of the right femur and iliotibial band is a fluid collection that is approximately 7.5 x 5.5 cm in transverse dimension and nearly 20 cm in craniocaudal dimension. Multiple foci of air density are noted within this collection, which may be due to recent intervention, although we cannot exclude an abcess with a gas forming organism. On coronal image 61 of series 80240, the fluid appears to communicate via a thin track with a smaller collection of fluid in the hip joint. While no gross bone destruction is evident at this time, portions of the posterior cortex of the proximal femur are indistinct; the relatively fatty appearance of the underlying marrow, however, argues against active osteomyelitis. Please note that MRI would be more sensitive for detection of osteomyelitis than CT.Mild osteoarthritis affects the left hip. Mild to moderate degenerative disk disease affects the visualized lower lumbar spine. Moderate facet joint osteoarthritis affects the visualized lower lumbar spine.There is diffuse fatty atrophy of the musculature of the right hip and proximal thigh. A few mildly enlarged inguinal lymph nodes are noted on the right.The visualized intrapelvic structures are unremarkable given limitation of lack of enteric contrast material.

Output: Fluid collection in the lateral aspect of the proximal thigh and as described above which may represent an abscess.


Instruction: Generate impression based on findings.

Input: History of back pain. gait impairment. Assess for worsening of lumbar stenosis. There is multilevel degenerative spondylosis, which has progressed slightly at L2-3 and has regressed slightly at L3-4. Additional details by level as follows:L1/2: Asymmetric bulge to the left and bilateral mild facet hypertrophy with mild central canal stenosis with moderate left and mild right neural foraminal stenosis.L2/3: Interval development of a large Schmorl's node in the upper endplate of L3 and more extensive endplate degenerative bone marrow signal alterations. There is also slight interval increase in size of the disc bulge, ligamentum flavum thickening, prominent posterior epidural fat, and mild to moderate bilateral facet hypertrophy. There is moderate central, moderate bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis.L3/4: There has been interval involution of the left paracentral and foraminal disc extrusion with a residual underlying disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is severe central and mild right and moderate left neural foraminal stenosis. There is also evidence of Baastrup's disease.L4/5: There is unchanged grade 1 anterolisthesis of L4 on L5, a disc bulge, ligamentum flavum thickening, moderate to severe left facet hypertrophy, and moderate right facet hypertrophy. There is mild spinal canal and mild bilateral neural foraminal stenosis. There is also evidence of Baastrup's disease.L5/S1: There is a mild disc bulge and mild left facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing.Miscellaneous: There is a new T10 superior endplate Schmorl's node. There are multilevel anterior disc-osteophyte complexes. There is a large gallstone. There is diffuse fatty atrophy of the paraspinal muscles.

Output: 1.Multilevel degenerative spondylosis, which has progressed slightly at L2-3 and has regressed slightly at L3-4, where there is severe and moderate spinal canal stenosis, respectively. Refer to the findings section for additional details.2.Gallstone. A dedicated ultrasound may be useful for further evaluation, if clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There are findings related to an acute large parenchymal hematoma within the left occipital lobe with surrounding vasogenic edema that results in unchanged mass effect on the local sulci, the left atrium and left occipital horn, as well as a 3-mm rightward midline shift. The size of the hematoma is unchanged, measuring 4.5 x 2.9 cm. There is no intraventricular hemorrhage and the ventricles are unchanged in size. There is a 1.6 x 1.7 cm ill-defined round area of T2/FLAIR hyperintensity along the left cerebellar folia corresponding to an area of low density on CT, with mild mass effect along the gray white matter junction. This has a slightly striated appearance on coronal T2 weighted images (71/9), without significant disruption of the underlying cerebellar architecture which can still be discerned. There are additional nonspecific foci of subcortical FLAIR hyperintensity in the bilateral paramedian parietal regions at the convexity.There is FLAIR signal hyperintensity throughout multiple frontal and parietal sulci bilaterally, right greater than left with minimal associated susceptibility effect, corresponding to areas of sulcal hyperdensity on CT. There are scattered areas of sulcal FLAIR hyperintensity elsewhere without susceptibility which may relate to artifactual signal from sedation/oxygenation.There is no evidence of acute infarct. The major cerebral flow voids are intact. There is a moderate-sized air-fluid right maxillary sinus. There is non-mucosal thickening within the sphenoid sinuses.

Output: 1.Left occipital acute parenchymal hematoma is unchanged in size with unchanged mass effect and minimal midline shift.2.Rounded area of abnormal signal in the left cerebellum with mild mass effect. The differential diagnosis includes infectious/inflammatory etiologies such as a focal cerebellitis, demyelinating, and ischemic etiologies. Follow-up imaging with contrast is recommended, also to exclude possibility of neoplasm.3.Mild subarachnoid hemorrhage over the bilateral frontal and parietal lobes.4.Nonspecific subcortical FLAIR hyperintensity in the bilateral paramedian parietal lobes may represent additional subarachnoid hemorrhage or sedation artifact.5. Moderate sized air-fluid level within the right maxillary sinus. Please correlate clinically for acute sinusitis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for meniscal tear versus ligamentous injury History: Pain, buckling Due to the patient's body habitus, the high-definition coil could not be utilized resulting in suboptimal image quality.MENISCI: Patient motion artifact limits evaluation of the menisci. There is increased signal abnormality within the posterior horn and body of the medial meniscus which may reflect intrasubstance degeneration, however, this is suboptimally evaluated due to extensive patient motion artifact. There may be a small undersurface tear of the posterior horn and body of the medial meniscus but this is equivocal. The lateral meniscus appears intact, although evaluation is again suboptimal.ARTICULAR CARTILAGE AND BONE: There is bone marrow signal abnormality within the posterior aspect of the lateral tibial plateau.LIGAMENTS: There is disruption of the proximal and mid substance fibers of the ACL. The PCL appears intact. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intactADDITIONAL

Output: 1. Severely limited examination secondary to patient body habitus and motion artifact. There is disruption of the proximal and mid substance fibers of the ACL with a bone contusion in the lateral tibial plateau.2. Small joint effusion. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 38 year-old female history of left knee pain and swelling. Evaluate for ligamentous injury. MENISCI: There is a large complex tear of the posterior horn of the medial meniscus which consists predominantly of a complete/near-complete radial tear. The tear is seen on multiple consecutive sagittal images. Additionally, there is increased signal abnormality within the body of the medial meniscus which likely represents degeneration and likely extension of the tear. There is medial extrusion of the body of the medial meniscus.We see no discrete tear of the lateral meniscus, although the inferior popliteomeniscal fascicles are not seen and could be torn.ARTICULAR CARTILAGE AND BONE: There is near full thickness articular cartilage loss along the medial femoral condyle just above the torn meniscus. Additionally, there is subjective thinning of the articular cartilage of the remaining weight-bearing portions of the knee. There is near-full-thickness cartilage loss along the femoral trochlea centrally and inferiorly. There is moderate degenerative articular cartilage loss along the medial patellar facet. There are tricompartmental osteophytes.There is mild bone marrow edema within the posterior aspect of the lateral tibial plateau and lateral femoral condyle above the anterior horn of the lateral meniscus, possibly representing bone contusions.LIGAMENTS: Although the visualized distal fibers of the anterior cruciate ligament appear intact with a normal slope, the ligament cannot be followed to its insertion on the femur and therefore we cannot exclude a tear. The PCL, MCL, and lateral collateral ligament complex are is intact.EXTENSOR MECHANISM: The extensor mechanism is intact. There is mild edema along the subcutaneous tissues anterior to the patellar tendon, nonspecific.ADDITIONAL

Output: 1.Complex tear of the posterior horn of the medial meniscus as above.2.Findings suggestive of ACL tear at its femoral attachment.3.Osteoarthritic changes and other findings as above.


Instruction: Generate impression based on findings.

Input: AVM treated with SRS in May 2015: please evaluate for post-radiation change. MRI: There is interval decrease in size of the enhancement surrounding the site of the treated left temporo-occipital region arteriovenous malformation. There is also substantial decrease in the extent of surrounding vasogenic edema. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no discernible arterialized flow at the site of the treated arteriovenous malformation. There is no evidence of significant steno-occlusive lesions in the regular cerebral arteries. There is no evidence of aneurysms.

Output: 1. Interval decreased edema associated with radiation necrosis at the site of the treated left temporo-occipital region arteriovenous malformation. 2. No gross recurrence of the treated left temporo-occipital region arteriovenous malformation, within the limits of MRA.


Instruction: Generate impression based on findings.

Input: 33-year-old male, presenting with nausea vomiting abdominal pain ABDOMEN:LUNG BASES: Small bilateral pleural effusions, new from previous study. pleuralLIVER, BILIARY TRACT: Stable thrombosis of the right anterior portal vein.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites. Postsurgical changes around the ileostomy takedown in the right lower quadrant. Mild dilatation of the distal small bowel loops without any obvious transitional point may represent ileus. Multiple enlarged mesenteric lymph nodes which are slightly increased in size compared to previous study.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Possible collection posterior to the pouch which was drained previously. Interval removal of drainage catheter. The collection cannot be clearly differentiated from the anterior pouch. MRI of the pelvis may be helpful for better evaluation of this collection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Postsurgical changes reflecting the ileostomy takedown.Patient's known presacral collection is again noted, however, this cannot be well differentiated from the anterior pouch. MRI of the pelvis may be helpful for further evaluation.Dr. Kosoko was notified technologist and acknowledged about these findings at the time of the patient.


Instruction: Generate impression based on findings.

Input: 79-year-old female with left-sided numbness and dysarthria. There is effacement of the gray-white matter differentiation involving the cortex of right insula and portion of the right temporal lobe which is highly concerning for an acute cortical stroke. Further follow-up with an MRI is highly recommended. Minimal small vessel disease is present. No evidence of hemorrhage, midline shift or mass effect is detected.

Output: 1.Highly suspected acute right MCA stroke. Further evaluation with an MRI.2.A small vessel disease of undetermined age.3.No evidence of hemorrhage.


Instruction: Generate impression based on findings.

Input: Lack of contrast enhancement limits examination.No evidence of a mass, mass effect, or midline shift. Mild prominence of the ventricles and sulci, likely age related volume loss. Mild-to-moderate periventricular and subcortical white matter T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease. No evidence of acute intracranial hemorrhage or diffusion weighted abnormalities to suggest acute ischemia. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Within the limitation of a noncontrast examination, no evidence of intracranial or IAC abnormality to explain the patient's tinnitus.


Instruction: Generate impression based on findings.

Input: Left frontal mass with edema. Rule-out metastatic lesion. A non-infused CT examination of brain from St. Catherine Hospital dated 2 -- 18 -- 08 is submitted for interpretation. Patient's name is confirmed on the images.Large area of vasogenic edema in the left frontal lobe with mass effect on the frontal horn and possible extension of edema into the corpus callosum is noted. Within the area of edema a necrotic appearing tumor in the loculated fashion measuring approximately 32 by 19 mm in transaxial dimension.This is highly suspected of the tumor and can be further evaluated with a dedicated MRI.No hemorrhage or hydrocephalus is detected.

Output: Necrotic left frontal lobe tumor with extensive surrounding vasogenic edema


Instruction: Generate impression based on findings.

Input: 56 year old male with a history of hypertension, hyperlipidemia, past smoking who presents for a evaluation for episodes of atypical anginaMEDICATIONS: Aspirin, simvastatin, valsartan First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 72%, the LV end diastolic volume index is 53 ml/m2 (normal range: 74+/-15), the LVEDV is 99 ml (normal range 142+/-34), the LV end systolic volume index is 15 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 99 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 115 ml (normal range 142+/-31), the RV end systolic volume index is 26 ml/m2 (normal range 31+/-9), and the RVESV is 49 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 trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 72%).4. Normal RV size and systolic function (RVEF 58%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cervical spine:Vertebral body heights and intervertebral disc spaces are preserved. Alignment is anatomic. No spinal cord signal abnormalities are identified. Bone marrow signal is within normal limits. The paraspinal soft tissues are unremarkable. Minimal multilevel facet joint arthropathy is noted, with a subcentimeter cystic structure adjacent to the left C5 facet joint at the C4-C5 level, likely degenerative in nature. There is a minimal central disc bulge at the C6-C7 level with no significant spinal canal or neural foraminal stenosis. The remainder of the levels are unremarkable with no significant spinal canal or neural foraminal stenosis is identified.Lumbar spine:For numbering purposes, there are 5 lumbar type vertebral bodies. Vertebral body heights are preserved. Again noted is grade 1 retrolisthesis of L5 on S1 and mild straightening of the lumbar lordosis, otherwise the alignment is anatomic. There are no fractures. Bone marrow signal is benign with edematous changes involving the L5 and S1 endplates related to degenerative disease, unchanged as compared to prior exam. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: No spinal canal neural foraminal stenosis.L1/2: Minimal facet joint arthropathy with no significant spinal canal or neural foraminal stenosis.L2/3: Minimal central disc bulge with no significant spinal canal stenosis. Bilateral facet joint arthropathy results in minimal bilateral neural foraminal narrowing.L3/4: Minimal disc bulge with no significant spinal canal stenosis. Facet joint arthropathy results in mild bilateral neural foraminal stenosis.L4/5: Minimal disc bulge with bilateral facet joint arthropathy resulting in minimal left neural foraminal narrowing and no significant spinal canal stenosis.L5/S1:Again noted are postsurgical changes of right-sided laminotomy. Again noted is diffuse disc bulge and facet joint arthropathy without evidence of significant spinal canal stenosis. Mild left and moderate to severe right neural foraminal narrowing again noted. There continues to be contact of the disc bulge with the left S1 nerve root and the left lateral recess at the L5-S1 level.Conjoined left L5 and S1 nerve roots in the thecal sac are again noted.

Output: 1.Minimal degenerative changes of the cervical spine with no evidence of spinal cord signal abnormalities.2.Multilevel degenerative changes of the lumbar spine, as detailed above and not significantly progressed as compared to prior exam.


Instruction: Generate impression based on findings.

Input: 23-year-old female with chronic ankle pain. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. There is a small amount of fluid within the distal peroneus longus tendon sheath which may reflect a very mild tenosynovitis versus fluid extension from the joint.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. No full-thickness or near full-thickness articular cartilage defects are seen. The alignment is anatomic.ADDITIONAL

Output: Small ganglion along the posterior aspect of the subtalar joint. Otherwise normal appearing ankle.


Instruction: Generate impression based on findings.

Input: 67-year-old female with outside CT demonstrating 5-mm groundglass nodule left upper lobe LUNGS AND PLEURA: Mild apical pleural scarring.A 5-mm groundglass nodules identified left upper lobe (image 38 series 4). Previous outside imaging is not available for review at the time of reporting.Mild basilar scarring bilaterally.MEDIASTINUM AND HILA: No evidence of hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Intraspinal calcification at T10 level on the left appears be extradural in location may represent a calcified small meningioma. There is mild displacement and compression of the spinal cord from left to right. MRI of the thoracic spine is recommended for further evaluation.UPPER ABDOMEN: Cholelithiasis.

Output: 1.Small 5-mm groundglass nodule within the left upper lobe. Follow up examination in one year is advised.2.Intraspinal probable extradural calcification at T10 on the left of uncertain clinical significance. MRI of the thoracic spine is advised for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, history of GBM, baseline exam prior to starting new systemic therapy. Evidence of a left temporal craniotomy is again seen. Redemonstrated is a thickly rim enhancing lesion which occupies the anterior left temporal lobe, tracking superiorly along the lateral ventricular margin to extend into the left parietal lobe. On comparison with the prior examination, portions of the enhancing rim of this lesion show progressive thickening and the overall size is probably somewhat larger. A substantial portion of this enhancing lesion demonstrates elevated rCBV. Also redemonstrated is thin subependymal enhancement along the left ventricular atrium, temporal and occipital horns.Extensive T2 hyperintensity surrounding this lesion and occupying the entire left temporal lobe, most of the left occipital lobe and most of the left parietal lobe, is not convincingly changed in geographic extent. There remains substantial regional mass-effect with sulcal effacement, left lateral ventricular effacement and partial effacement of the left quadrigeminal plate cistern.Ill-defined bilateral periventricular T2 hyperintensity is again seen, not substantially changed and likely related to therapy. Signal abnormality is evident tracking into the posterior limbs of the internal capsules. Nonspecific patchy T2 hyperintensity is also evident within the pons.

Output: 1. Mild progressive thickening of tumor which spans the left temporal and parietal lobes.2. No significant interval change in the degree of associated edema or mass effect.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are images from MRI guided biopsy of the right breast with specimen radiograph and post procedural right mammographic images (4/1/15) performed at Northwestern Memorial Hospital. For comparison, breast MRI (3/18/15) are available. MRI guided biopsy for the enhancing lesion at the right posterior upper outer quadrant, and another enhancing lesion at the right anterior lower inner quadrant was performed. Targeting appears good for each lesion. Specimen radiograph for each lesion shows multiple solid cores without calcifications. Post procedural right mammographic images show two marker clips; M shaped clip at anterior lower inner quadrant and rectangular shaped clip at posterior upper outer quadrant. Per outside radiology report, results for both biopsies are benign, and concordant.

Output: Status post benign MRI guided biopsy of right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 12-year-old with history of left lower extremity pain and swelling LEFT KNEE:MENISCI: The medial and lateral menisci are normal.ARTICULAR CARTILAGE AND BONE: No focal articular cartilage thinning or tear identified. Bone marrow signal is normal. Fabella is noted.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. The popliteus muscle and tendon are intact. EXTENSOR MECHANISM: Slightly increased T2 signal at the proximal patellar tendon (series 8, image 12) is noted. The extensor mechanism is otherwise intact. The patella appears normal.ADDITIONAL

Output: 1.Myositis involving the left soleus muscle.2.Proximal patellar tendinitis without rupture.


Instruction: Generate impression based on findings.

Input: 25-year-old woman with history of endometriosis, preoperative planning. PELVIS:UTERUS, ADNEXA: Follicles are noted in the ovaries which otherwise appear normal. The patient has a C-section scar, otherwise the uterus and cervix appear normal.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a 15 x 6 mm T2 hypointense, mildly enhancing soft tissue immediately anterior to the right pubic ramus (series 1, image 7).OTHER: There is a small amount of free pelvic fluid.

Output: 1.No intrapelvic abnormality.2.Nonspecific soft tissue lesion immediately anterior to the right pubic ramus. This could conceivably represent a focus of endometriosis in a hernia.


Instruction: Generate impression based on findings.

Input: Known lesions, calcifications versus AVMs, please evaluate MRI Brain: Intrinsic T1 hyperintensity is seen in the left geniculate nucleus and in the right superior colliculus. The left geniculate nucleus lesion again measures 7 mm and the right superior collicular lesion measures 4 mm. These areas correlate with calcifications seen on the prior CT. It is difficult to assess for enhancement given the intrinsic T1 hyperintensity, however no significant enhancement is noted. No rim of susceptibility related artifacts or flow voids are seen within these lesions. No diffusion restriction is seen to suggest acute ischemia. The tectal plate is prominent without signal abnormalities, unchanged from the prior study. No mass effect or hydrocephalus.The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA Brain:The intracranial anterior and posterior circulations are patent without evidence of aneurysm, stenosis, or dissection. No evidence of arteriovenous malformation.

Output: 1.No change in left thalamic or right superior colliculus calcified lesions. No specific findings to suggest underlying arteriovenous malformation or cavernous malformation. As such these may represent sequela of prior injury such as inflammation or infection or possibly metabolic abnormality. 2.The tectal plate is prominent in size without signal abnormalities or discrete mass effect. Finding may be developmental. No hydrocephalus. Long term follow-up of the above findings can be considered as clinically indicated.3.MRA is unremarkable without evidence of aneurysms or vascular malformations.


Instruction: Generate impression based on findings.

Input: Clinical question: Any sign of bleed or worsening mass in the head. Signs and symptoms: Weakness Unenhanced CT of brain:Images through posterior fossa demonstrate an old left cerebellar stroke with no interval change.Images through the supratentorial space demonstrate prominence of cortical sulci and ventricular system for patient's age similar to prior exam.Area of low-attenuation involving the white matter of the left posterior temporal and parietal consistent with vasogenic edema/encephalomalacia. The distribution of this finding is fairly similar to prior exam. A subtle mass effect with the above findings. There is revisualization of a mass along the falx on the left in the posterior parietal -- occipital region. This mass appears slightly smaller than prior exam however without dedicated enhanced imaging precise comparison is not possible.No attenuation of periventricular white matter of right hemisphere is similar to prior exam and may represent postradiation change.There is no evidence of intracranial hemorrhage, midline shift or hydrocephalus. Follow-up with an MRI or an enhanced CT is recommended.Stable post craniotomy changes of the left parietal.Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: 1.Revisualization of a mass in the left occipital -- posterior parietal lobe with extensive surrounding vasogenic edema/encephalomalacia with no evidence of interval hemorrhage. Without an enhanced study precise comparison is not possible.2.There is no evidence of acute intracranial hemorrhage or midline shift.3.Prominence of ventricular system and cortical sulci for patient of stated age of 56 this is stable since prior exam.


Instruction: Generate impression based on findings.

Input: 78 year-old female with history of basilar tip thrombus and multiple strokes. There is no evidence of intracranial hemorrhage, mass or edema. Mild, patchy areas of hypoattenuation in the periventricular and subcortical white matter may represent small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Atherosclerotic calcifications noted in the intracranial vasculature.

Output: 1.No CT evidence of intracranial hemorrhage or other acute abnormality.2.Evidence of small vessel ischemic disease.3.The previously known small infarcts reported on prior MRI and basilar tip thrombosis are not well appreciated on this study.


Instruction: Generate impression based on findings.

Input: 79-year-old male with pain. Evaluate for spinal stenosis. For the purposes of numbering, there are 5 lumbar-type vertebral bodies. There is grade 1 anterolisthesis of L3 on L4 as well as mild levocurvature of the lumbar spine with apex at the L3-L4 level. There is severe multilevel degenerative disc disease at L3-4, L4-5, and L5-S1 which results in severe central canal stenosis and compression of nerve roots at these levels. There is endplate related degenerative marrow signal abnormality without acute fracture. There is redundancy of the nerve roots due to central stenosis, but the distal spinal cord and conus medullaris appear unremarkable. Additional level specific findings are as follows:T12-L1: No significant degenerative disc disease, central canal, or neural foraminal stenosis.L1-L2: No significant degenerative disc disease, neural foraminal, or central canal stenosis.L2-3: Mild degenerative disc disease with disc bulge and mild facet degenerative changes result in mild central canal stenosis. There is no significant neural foraminal stenosis.L3-4: Moderate degenerative disc disease with superior disc extrusion along the posterior inferior L3 vertebral body. These findings along with severe facet hypertrophic degenerative changes result in severe central stenosis and compression of nerve roots at this level. There is severe right and mild left neural foraminal stenosis.L4-5: Moderate degenerative disc disease with disc bulge and severe hypertrophic facet degenerative changes results in severe central canal stenosis with compression of nerve roots at this level. There is severe left neural foraminal narrowing. There is no significant right neural foraminal narrowing.L5-S1: Degenerative disc disease and severe hypertrophic facet degenerative changes result in moderate central canal stenosis and severe bilateral neural foraminal stenosis.

Output: 1. Severe lumbar degenerative disc disease and hypertrophic facet degenerative changes results in severe central canal stenosis at L3-4 and L4-5. There is also mild to moderate canal stenosis at L2-3 and L5-S1.2. Severe neural foraminal stenosis on the right at L3-4, on the left at L4-5, and bilaterally at L5-S1.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 70 years old, with back pain. Alignment is anatomic. Vertebral body height and morphology are within normal limits. Mild degenerative endplate edema is seen at L5-S1. No other areas of concerning marrow replacement or edema are demonstrated. The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis. No interval changes. L3-4: Facet arthropathy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. Minimal disc bulging. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L4-5: Facet arthropathy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. Mild disc bulging. No significant spinal canal stenosis. Severe left foraminal narrowing has progressed. Mild right foraminal narrowing is unchanged. L5-S1: Facet arthropathy and ligamentum flavum thickening. Loss of disc height and disc bulging. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing, both progressed.

Output: Mild to moderate multilevel disc degeneration is seen along with facet arthropathy. No high-grade spinal canal stenosis is demonstrated. However, severe progressive foraminal narrowing is demonstrated on the left at L4-5 and on the right at L5-S1.


Instruction: Generate impression based on findings.

Input: Male 75 years old with GBM status-post tumor resection and radiotherapy Post-surgical changes of a left parieto-occipital craniotomy with underlying dural thickening and enhancement as well as blood products surrounding the resection bed, not significantly changed from prior exam. Foci of enhancement extending from the medial aspect of the resection bed in the parietal lobe to the medial aspect of the left temporal horn, not significantly changed from prior exam. A rim of restricted diffusion surrounds the resection bed and likely represents post-surgical cytotoxic edema. Confluent areas of increased T2/FLAIR signal surrounding the resection bed appears similar to prior exam, however, there is increased T2/FLAIR signal surrounding the left temporal horn with partial effacement of the left lateral ventricle. There is also mildly increased ventriculomegaly. Additional punctate foci periventricular and subcortical T2/FLAIR hyperintensity is non-specific.The pituitary gland appears unremarkable. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Post-surgical changes of a left parieto-occiptal craniotomy with areas of enhancement along the anterior aspect of the surgical bed has not significantly changed from prior exam. However, there is increase in the T2/FLAIR hyperintensity extending from the tumor bed adjacent to the temporal horn of the left lateral ventricle (associated with increased ventriculomegaly). Differential considerations include treatment related changes, non-enhancing tumor, or edema / transependymal migration of CSF.2.Since prior exam the lateral third ventricles have enlarged


Instruction: Generate impression based on findings.

Input: History of breast cancer now with headacheIMAGE ACQUISITIONS: Brain CT without and with contrast. 100 cc nonionic Omnipaque 350. There is questionable punctate foci of enhancement which likely represent volume averaging from the vessels in the deep sulci. However, small metastases cannot be excluded. We recommend a brain MRI without and with contrast to further evaluate.Remainder of the cerebrum, cerebellum, and brainstem show normal morphology and attenuation. There are no other areas of abnormal enhancement. No intracranial hemorrhages or abnormal extra-axial fluid collections. Visualized paranasal sinuses and mastoid air cells are pneumatized normally.

Output: Questionable foci of abnormal enhancement. Although these are likely artifactual, we recommend brain MRI without and with contrast given patient's history of breast cancer.


Instruction: Generate impression based on findings.

Input: Tongue squamous cell carcinoma with neck lymphadenopathy. There is an enhancing mass in the left oral tongue, which measures up to approximately 40 mm. The tumor extends into the left sublingual space, but does not appear to involve the root of the tongue or the mandible. There are multiple abnormal left level 1, 2, and 3 lymph nodes. In particular, there is a cystic or necrotic left level 2B lymph node with ill-defined margins that measures 30 x 35 mm in axial cross-section. The lymph node tumor appears to infiltrate into a small portion of the adjacent left parotid gland. A left level 1B lymph node also displays ill-defined margins and measures 12 x 16 mm in axial cross-section. The lymph node tumor appears to slight infiltrate into the adjacent left submandibular gland. The left lateral retropharyngeal lymph node is asymmetrically prominent and measures 5 x 7 mm in axial cross-section. There is a right level 2A lymph node with a rounded morphology, which measures 7 x 10 mm in axial cross-section, which is not enlarged by size criteria. The other right neck lymph nodes are unremarkable. There is a cystic right thyroid nodule that measures up to 9 mm. There are small maxillary sinus retention cysts. There are also secretions in the left sphenoid sinus. The orbits and imaged intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6 that mildly indents the spinal cord.

Output: Left oral tongue mass compatible with squamous cell carcinoma with associated extensive left cervical lymphadenopathy, with signs of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Preoperative MR examination prior to clival biopsy. There is motion limiting the T2 sequence images. Within this limitation, the lobulated high T2/low T1 signal, nonenhancing lesion which extends from the right lateral aspect of the clivus to involve the Petrus apex at the petro-clival junction is again demonstrated. This has a nonaggressive appearance on CT demonstrating a sclerotic rim and thinning of the bone which separates it from the CP angle posteriorly (difficult to assess for breakthrough given the progressed thinning ) and anteriorly where it is closely opposed to the posterior aspect of the carotid artery. There is no associated flow void and aneurysm is felt to be unlikely. This measures up to 3.2 by 1.2 x 2.2 cm (previously 2.9 x 1.4 by 2.1 cm in similar dimension). There is no associated mass effect on adjacent structures.Intracranially, there is no other visualized mass, fluid collection, hemorrhage or hydrocephalus. The midline is intact. Limited views of the orbits are unremarkable. Paranasal air sinuses, including the sphenoid, are unremarkable.

Output: Demonstration of the nonaggressive appearing intra-osseous lesion at the right petro-clival junction which, given features such as remodeling of bone, absence of matrix and signal characteristics most likely represents a cephalocele. Differential considerations could include cholesteatoma, neurenteric cyst, or possibly cystic fibrous dysplasia.


Instruction: Generate impression based on findings.

Input: 50 year-old male with swelling and pain after soccer Best seen on the T1 axial post contrast images is thickening and enhancement of the synovium along the head and neck of the talus, along the plantar and lateral aspect of the navicular, and to a lesser degree along the calcaneocuboid joint, indicating synovitis. There is edema signal in the navicular and cuboid bones that is likely reactive in etiology. The cuneiforms and 5th metatarsal are incompletely imaged, although edema in these bones is also likely reactive in etiology. No discrete erosions are identified. A small amount of fluid in the tibiotalar joint is identified without frank effusion. There is mild edema along the superior aspect of the posterior calcaneal tuberosity with a thin curvilinear band of low T1 signal intensity that may represent a nondisplaced fracture, perhaps a stress fracture, albeit in a somewhat peculiar location. There is mild retrocalcaneal bursitis as well.The Achilles tendon appears normal. The medial ankle tendons are intact, although distally the flexor digitorum longus is obscured by synovitis. The peroneal tendons appear normal. The anterior tendons are intact. The lateral collateral ligament complex and distal tibiofibular syndesmotic complex appear normal.

Output: 1. Midfoot synovitis and bone marrow edema consistent with the patient's diagnosis of JIA. Please note that the distal extent of disease is not included on this ankle MRI exam.2. Findings suggesting a nondisplaced fracture (perhaps a stress fracture) of the superior aspect of the posterior calcaneal tuberosity with mild adjacent bursitis.


Instruction: Generate impression based on findings.

Input: History of HCC. LUNG BASES: Non-specific right lower lobe pulmonary nodule. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour consistent with cirrhosis. No biliary ductal dilatation.Demonstrated again is the segment IV ablation cavity with high intrinsic T1 weighted signal. There is postcontrast enhancement along the posterolateral wall of the ablation cavity measuring 1.8 x 1 point cm (series 9 image 120) demonstrating T2 hyperintensity, restricted diffusion, and delayed washout compatible with a marginal recurrence unchanged from the prior study. The lesion abuts and possibly invades the middle hepatic vein. No new suspicious arterial enhancing lesion.The portal vein is patent.Numerous T2 hyperintense nonenhancing well-defined foci compatible with benign cysts are again noted. Contracted gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stable appearance of the suspected marginal recurrence along the right posterolateral aspect of the segment IV ablation cavity.2. Non-specific right lower lobe pulmonary nodule.


Instruction: Generate impression based on findings.

Input: Reason: evaluate right shoulder for rotator cuff tear/assess quality of rotator cuff muscle and tendon History: right shoulder pain and weakness. ROTATOR CUFF: Complete full thickness tears of the supraspinatus and infraspinatus tendons with retraction of the tendons to the glenohumeral joint. Severe fatty atrophy of the supraspinatus and infraspinatus muscles. The teres minor tendon and muscle are intact. There is also a complete or near complete tear of the subscapularis tendon with retraction to the glenohumeral joint, although a few inferior fibers may extend to the humeral neck. Mild fatty atrophy of the subscapularis muscle.SUPRASPINATUS OUTLET: Moderate to severe acromioclavicular joint osteoarthritis. Small amount of fluid within the subacromial/subdeltoid bursa. The humeral head is high riding and appears to abut the undersurface of the acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: As previously mentioned, the humeral head is high riding, but we see no frank dislocation. Mild osteoarthritis affects the glenohumeral joint. There is a small joint effusion. Small foci of signal abnormality in the lesser trochanter and along the posterior aspect of the humeral head likely are secondary to overlying rotator cuff pathology. We see no fluid signal intensity anteriorly in the labrum, although intermediate intrasubstance signal intensity may reflect mild degeneration.BICEPS TENDON: The long head of the biceps tendon is dislocated medially from the bicipital groove. Mild increased signal intensity within the tendon suggests mild tendinosis.ADDITIONAL

Output: Massive rotator cuff tear with marked fatty atrophy of the supraspinatus and infraspinatus muscles and other findings as described above.


Instruction: Generate impression based on findings.

Input: Renal mass seen on CT. History of lymphoma. ABDOMEN:LIVER, BILIARY TRACT: Multiple bilateral hepatic cysts. No biliary ductal dilatation. Cholelithiasis within a normally distended gallbladder without evidence of acute gallbladder inflammation. The liver is normal in size and signal intensity.SPLEEN: Normal splenic size and intensity without a focal lesion.PANCREAS: Several cystic foci in the pancreatic tail appear to communicate with the main pancreatic duct which is normal in caliber. The largest measures 1 cm (series 7/24). Moderate atrophy of the pancreas without a focal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several bilateral renal lesions are noted, some of which demonstrate slow growth over several years.Some of these lesions measure less than 1 cm, therefore making accurate characterization difficult. There is some suggestion of post-contrast enhancement, such as the lesion in the anterior cortex of the inferior right renal pole (series 11/66).The left renal superior pole 3.5 x 3.5 cm lesion is heterogeneous in signal intensity on T2-weighted imaging. The lesion is intrinsically bright on T1-weighted imaging. The subtraction images are degraded by patient respiratory motion making accurate assessment of postcontrast enhancement difficult with portions of the lesion appearing to enhance. Bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.The left superior pole lesion is intrinsically bright on T1-weighted imaging and demonstrates slow growth over several years. The subtraction images are degraded by patient respiratory motion making accurate assessment of postcontrast enhancement difficult with portions of the lesion appearing to enhance. A dedicated renal protocol CT may be helpful to better characterize the enhancement of this lesion.2.Two right renal lesions measuring less than 1 cm with some suggestion of postcontrast enhancement. Follow-up imaging is recommended to monitor these lesions.3.Subcentimeter pancreatic tail cystic foci likely represent side branch IPMNs.


Instruction: Generate impression based on findings.

Input: 46-year-old female with right shoulder pain ROTATOR CUFF: There increased signal within the distal supraspinatus tendon near its insertion consistent with moderate tendinopathy without evidence of full-thickness tear or retraction. The remaining tendons and muscles of the rotator cuff are intact. No muscular atrophy.SUPRASPINATUS OUTLET: The AC joint is essentially within normal limits for the patient's age. Fluid within the subacromial, subdeltoid bursa suggests bursitis given the lack of visualized rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum is grossly intact.BICEPS TENDON: Normally situated within the bicipital groove.ADDITIONAL

Output: Moderate insertional tendinosis of the supraspinatus and mild subacromial-subdeltoid bursitis. No full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: MRI brain:Redemonstrated are post surgical changes in the right temporal region with encephalomalacia of the right anterior temporal lobe which is not significantly changed. There is no change in the FLAIR signal surrounding the surgical defect end the right temporal lobe, insula, and external capsule. An additional punctate focus of increased FLAIR signal immediately superior to the surgical cavity in the inferior gyrus of right frontal lobe as well as a thin, linear FLAIR abnormality in white matter along right lateral ventricle are also unchanged. There is mild mucosal sinus thickening in the involving the ethmoid air cells and minimally involving the maxillary sinuses, left greater than right.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no acute diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI Orbits:No abnormal mass is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal. Intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1.No discrete findings to explain the patient's visual field defect.2.Stable postsurgical changes in the right temporal region and stable surrounding FLAIR signal abnormality consistent with gliosis.


Instruction: Generate impression based on findings.

Input: 72-year-old female with multiple compression fractures in thoracic and lumbar spine (T4/T7/L1/L3) also with history of neurogenic claudication. Please examine for central canal stenosis. This examination has limited value for evaluation of central spinal stenosis. MRI is the modality of choice for evaluation of central spinal stenosis since he visualized the soft tissues with better advantage.Approximately 50% compression fracture of L1 with biconvex deformity is noted. There is also compression along the superior endplate of L3. Very subtle compression deformity of the superior endplate of L4 is also noted. There is minimal grade 1 anterolistheses at L4 -- L5 level. Extensive vacuum phenomenon within the intervertebral disk space at T12 -- L1 and to lesser degree at the L1 -- L2 is noted. Partially visualized intervertebral disk space at T11 -- T12 also demonstrates vacuum phenomenon.T12 -- L1. Degenerative changes are noted. Mild compromise of the left neural foramina is present. No central spinal stenosis.L1 -- L2.Minimal compromise of bilateral neuroforamina. No central spinal stenosis.L2 -- L3. No central spinal stenosis. There is subtle for broad-based bulge of disk material at this level. Minimal compromise of bilateral neural foramina.L3 -- L4. Hypertrophic changes of posterior elements and bulge of disk material causes deformity of the thecal sac all were but no central spinal stenosis. Minimal compromise of bilateral neural foramina is suspected.L4 -- L5. Extensive hypertrophic changes of posterior elements and bulge of disk material is noted. No measurable central spinal stenosis. Minimal grade 1 anterolisthesis. Minimal compromise of bilateral neural foramina.L5 -- S1.Extensive degenerative changes of posterior elements. No central spinal stenosis or definitive evidence of neural foramina compromise.

Output: 1.Multiple compression fractures as detailed.2.No measurable central spinal stenosis.3.Multi-level minimal neural foramina compromise bilaterally as detailed.4.For precise evaluation of central spinal stenosis MRI is in the modality of choice.


Instruction: Generate impression based on findings.

Input: There is approximately 22 x 22 mm transaxial dimension lesion at the left parieto-occipital junction, demonstrating a fluid-heme level. Contents anteriorly are T1 and T2 hyperintense, most consistent with extracellular methemoglobin. Posteriorly, contents are somewhat mixed between isointense and hyperintense on T1 and hyperintense on T2 suggesting a mixture of intracellular deoxyhemoglobin and intracellular met hemoglobin. Far posteriorly, there is a small area with susceptibility and enhancement which may suggest a small vascular nidus. There is mild regional mass effect upon sulci. There is no resulting midline shift.There are scattered foci of T2 hyperintensity in the white matter without restricted diffusion, mass effect, susceptibility abnormality, or enhancement representing mild chronic small vessel ischemic diseaseThe ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within bilateral maxilla sinuses, and fluid is noted within a few dependent mastoid air cells.

Output: There is approximately 22 x 22 mm transaxial dimension hemorrhagic lesion at the left parieto-occipital junction. Far posteriorly, there is a small area with susceptibility and enhancement which may suggest a small vascular nidus. There is mild regional mass effect upon sulci. There is no resulting midline shift. Given patient age and history of urothelial cancer, this most likely represents a hemorrhagic metastasis, with other etiologies considered less likely.


Instruction: Generate impression based on findings.

Input: There is an area of restricted diffusion with associated increased T2/FLAIR signal involving the posterior aspect of the left basal ganglia with extension into the left corona radiata compatible with an acute infarct. There is no significant associated mass effect. No additional foci of restricted diffusion are identified. There is a small focus of increased T2/FLAIR signal within the left postcentral gyrus involving the cortex with associated volume loss compatible with encephalomalacia related to chronic infarction. There is a chronic lacunar infarct within the right corona radiata with associated minimal susceptibility artifact compatible trace mineralization or hemosiderin. There are additional punctate and confluent foci of increased T2/FLAIR signal within the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are within normal limits for age. There is no midline shift or herniation. There is trace mucosal thickening within the paranasal sinuses.MRA HEAD

Output: 1.Acute infarct involving the posterior left basal ganglia and posterior left frontal periventricular white matter.2.Small chronic infarction involving the left post central gyrus.3.Additional mild chronic small vessel ischemic changes.4.MRA of the head and neck without evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Left sides tingling, numbness. There is a small area of encephalomalacia along the anterior and inferior aspect of the right precuneus. There are a few unchanged scattered punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is an unchanged subcentimeter right choroid fissure cyst. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The pituitary gland appears unremarkable. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Chronic small right precuneus infarct. No evidence of acute intracranial hemorrhage or new cerebral infarction.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with left C6 numbness. Straightening of the cervical lordosis is seen. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of edema or marrow replacement is seen. The visualized spinal cord shows normal signal intensity and morphology. No epidural lesions are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Left uncovertebral hypertrophy. No spinal canal stenosis. Mild left foraminal narrowing. C5-6: Left uncovertebral hypertrophy and minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild left foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: Mild degenerative changes are seen with no areas of high-grade spinal canal stenosis. At most, the left C4-5 and C5-6 neural foramina are mildly narrowed.


Instruction: Generate impression based on findings.

Input: Left knee pain MENISCI: There is mild intrasubstance degeneration of the posterior horn of the medial meniscus. There is no evidence of lateral or medial meniscal tear.ARTICULAR CARTILAGE AND BONE: There is thinning and partial-thickness loss of the articular cartilage of the lateral compartment, particularly posteriorly along the tibial plateau. The articular cartilage of the medial and patellofemoral compartments is relatively preserved. LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Mild articular cartilage loss of the lateral compartment and intrasubstance degeneration of the medial meniscus t. Remaining evaluation of the knee is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 70 year-old male with metastatic lung cancer and known metastasis, please do violate for progression. No evidence of acute intracranial hemorrhage. There is a 5-mm focus of high attenuation in the peripheral cortex of the right frontal lobe (image 22/30, series 2) which may correlate with a previously seen metastatic lesion at this site on the previous brain MRI. Other metastasis there were previously demonstrated and not well seen given the lack of intravenous contrast on this examination.There are a few foci of subtle low attenuation in a periventricular distribution compatible with small vessel ischemic disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection.The calvaria and skull base are radiographically normal. The left frontal sinuses are completely opacified. There is partial opacification of the ethmoid air cells and sphenoid sinuses. There is slight erosion of bone of the posterior right lamina papyracea near the orbital apex. The soft tissue density previously seen in the ethmoid air cells in this region has partially resolved. Please see recent MRI for further detail. The mastoid air cells are appropriately pneumatized. The maxillary antra are not visualized on the current exam.

Output: 1. Stable noncontrast CT of the head without new acute abnormality. Please note that the lack of intravenous contrast limits the sensitivity of this examination for metastatic disease.


Instruction: Generate impression based on findings.

Input: Known cavernoma discovered on outside MRI in July, 2015. There is a subcentimeter lesion in the left parietal lobe with circumferential susceptibility effect and internal mixed T1 and T2 signal and apparent enhancement, compatible with a cavernous malformation. There is no evidence of surrounding edema to suggest acute hemorrhage. A faint linear area of enhancement just deep to the lesion may represent an associated developmental venous anomaly. No other focal lesions are identified. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. There is no evidence of acute infarct. The orbits are unremarkable. There is a subcentimeter right maxillary sinus retention cyst.

Output: Findings compatible with a subcentimeter cavernous malformation in the left parietal lobe, with a probable associated small developmental venous anomaly, but no evidence of acute hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: New left lower extremity weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 retrolisthesis of L5 on S1 and mild straightening. Alignment is otherwise within normal limits. Bone marrow signal is benign with edematous changes involving the L5 and S1 endplates related to degenerative disease. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Minimal disc bulge. No spinal canal stenosis. Minimal bilateral neural foraminal narrowing. Mild facet arthropathyL3-L4: Minimal disc bulge. No spinal canal stenosis. Mild to moderate left and mild right neural foraminal stenosis. Mild facet arthropathyL4-L5: Minimal disc bulge. Bilateral facet arthropathy. No spinal canal or right neural foraminal stenosis. Minimal left neural foraminal narrowing.L5-S1: Disc desiccation and mild retrolisthesis. Evidence of prior right-sided laminotomy. Previously seen (2012) large right-sided disc protrusion is no longer evident. There is diffuse disc bulge and facet arthropathy without significant spinal canal stenosis. There is moderate to severe right and mild left neural foraminal narrowing. There is also contact of the disc bulge with the left S1 nerve root in the left lateral recess at the L5-S1 level. Conjoined left L5 and S1 nerve roots in the thecal sac at the mid L5 level incidentally noted and a normal variant.

Output: Multilevel degenerative changes in the lumbar spine as described above. There is no significant spinal canal stenosis at any level. Given history of left-sided symptoms, left-sided neural foraminal narrowing is relatively worse at the left L3-L4 and left L5-S1 levels. There is also effacement of the lateral recess on the left at the L5-S1 level.