Instruction: Generate impression based on findings.

Input: Clinical question : brain lesion. Signs and symptoms : Same Nonenhanced head CT :Examination demonstrate large area of vasogenic edema in the left cerebellum measuring 28.5 x 36.2-mm in size. There is subtle mass effect on the fourth ventricle.Additional large focus of vasogenic edema in the right inferior frontal lobe measuring 32.6 x 33-mm with evidence of focal mass effect. The findings are highly suspected for peritumoral edema of metastatic lesions and recommend further follow-up with a dedicated pre-and post infused brain MRI.This examination is otherwise unremarkable.Calvarium is intact. Mastoid air cells and middle ear cavities are pneumatized and unremarkable.

Output: 1.Two foci of vasogenic edema one in the left cerebellum and a second one in the right inferior frontal lobe concerning for metastatic disease. Recommend further follow-up with pre-and post enhanced brain MRI for better characterization.2.Negative examination otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Mononeuritis of unspecified siteClinical question: evaluate for structural lesionsSigns and Symptoms: BUE numbness and tinglingComments: S/p spine surgeries with spine hardware Since the prior examination the patient is undergone cervical spine surgery with a left-sided laminoplasty is at C3, C4, C5 and C6.The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is disc desiccation and a diffuse disc bulge redemonstrated associated with hypertrophy partial effacement of spinal fluid ventral to the spinal cord. There is no compromise of the exiting nerve roots appreciated at this level. There is mild narrowing of the spinal canal at this level.At C3-4 there is disc desiccation and a diffuse disc bulge associated with the uncovertebral osteophytes bilaterally and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots.At C4-5 there is disc desiccation and a diffuse disc bulge associated with the uncovertebral osteophytes bilaterally and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots.At C5-6 there is disc desiccation and a diffuse disc bulge associated with the uncovertebral osteophytes bilaterally and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots.At C6-7 there is disc desiccation and a diffuse disc bulge associated with the uncovertebral osteophytes bilaterally and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is partial opacification of the mastoid air cells present.

Output: 1.The patient is status post multilevel laminoplasty with the reduction of the prior spinal stenosis.2.There are degenerative changes present in the cervical spine with multilevel neural foramen encroachment due to degenerative changes.


Instruction: Generate impression based on findings.

Input: 16-year-old male with a abnormality in the frontal area on CT unimpressive on MR. History of amnestic episode questionable history of trauma and seizure. The appearance of the current CT scan versus the prior is slightly different. There are foci of hypodensity present along knee left the superior frontal gyrus and right precentral gyrus subcortical white matter. Relating to the recent MRI it appears that this potentially represents sulcation and volume averaging. AThere is some asymmetry in the size of the sigmoid sinuses right larger than left and attendant asymmetry in the size of the junction of transverse and sigmoid sinuses.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage.2.Small hypodense foci superimposed on the left superior frontal gyrus and the right precentral gyrus. These were also identified on the previous exam. The possibility of these represent subcortical abnormality cannot be excluded. It's conceivable that these are related to sulcation and volume averaging. These findings were discussed with the clinical service. The MRI performed recently does not confirm this.


Instruction: Generate impression based on findings.

Input: Left shoulder pain Examination is limited by motion artifactROTATOR CUFF: There is high-grade near full-thickness to full-thickness tearing of the distal fibers of the supraspinatus without significant retraction and a few fibers of the supraspinatus appear to insert upon the greater tuberosity. This tearing appears to extend posteriorly to involve a portion of the anterior fibers of the infraspinatus. There is mild fatty atrophy along the myotendinous junction of the supra and infraspinatus muscles. The teres minor tendon and muscle and the subscapularis tendon and muscle are intact. The distal fibers of the infraspinatus appear intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Degenerative tearing of the superior labrum is noted. Alignment of the glenohumeral joint is anatomic.BICEPS TENDON: The biceps tendon is not visualized within the intertubercular groove consistent with tearing.ADDITIONAL

Output: 1. High-grade near full-thickness to full-thickness tearing of the supraspinatus with possible extension posteriorly to involve some anterior fibers of the infraspinatus. There is mild fatty atrophy of both the supra and infraspinatus muscles.2. Ruptured biceps tendon.3. Trace amount of heterogeneous joint fluid likely indicating mild synovitis.


Instruction: Generate impression based on findings.

Input: NF-1 and precocious puberty needing to evaluate for tumor. Brain: There is mild high T2 signal and enhancement of the cisternal and canalicular portions of the left optic nerve, without significant expansion of the nerve. There is an arachnoid cyst in the anterior left middle cranial fossa that measures up to 18 mm in thickness. There is flattening of the adjacent left anterior temporal pole. There is a punctate focus of high T2 signal in the right globus pallidus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The pituitary appears to be unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.Orbit: The bilateral intraorbital optic nerves are intact. The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.

Output: 1. Probable small glioma of the cisternal and canalicular portions of the left optic nerve.2. Arachnoid cyst in the anterior left middle cranial fossa. 3. A punctate focus of high T2 signal in the right globus pallidus likely represents stigmata of neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression with new symptoms of balance and headache changes Brain: There are postsurgical changes of suboccipital craniectomy and resection of the posterior arch of C1 for Chiari decompression. There has been partial cauterization of the cerebellar tonsillar tissue. There is biphasic CSF flow ventrally at the foramen magnum. CSF flow dorsally is not well assessed due to technique, however, is grossly preserved. CSF space dorsally at the neoforamen magnum remains widely patent with no evidence of crowding.There is no evidence of acute infarct, hemorrhage, or other parenchymal signal abnormality. No intracranial mass or mass effect, midline shift, or herniation. Ventricles remain normal in size. Bone marrow signal and remainder of the extracranial soft tissues are grossly unremarkable.Cervical spine: Cervical spine images are moderately motion degraded, and patient had difficulty tolerating the full study. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.

Output: 1. Postsurgical changes of Chiari I surgery with posterior fossa structures at the foramen magnum appearing well-decompressed.2. Motion degraded cervical spine study without evidence of syrinx or other significant abnormality.


Instruction: Generate impression based on findings.

Input: An extra-axial enhancing mass with dural tails is noted overlying the right parietal lobe measuring up to 6 cm in maximal transaxial dimension. This causes mass effect upon the underlying brain parenchyma with sulcal effacement, however without significant right to left midline shift. Given the limitation of two sequences, the adjacent sagittal sinus appears intact, however the lesion does abut it and involvement cannot be excluded.A surgical defect is present involving the right frontal lobe with overlying calvarial changes from craniotomy including thinning. Additionally, the CSF space appears to extend inferiorly in the right anterior cranial fossa to the level of the ethmoid air cells, displacing bilateral rectus dry right left laterally which may suggest the presence of an meningocele.Expected vascular flow voids are demonstrated. There are no findings of hydrocephalus. The paranasal sinuses and mastoid air cells are clear.

Output: 1.An extra-axial enhancing mass is noted overlying the right parietal lobe measuring up to 6 cm in maximal transaxial dimension.2. MRI findings suggestive of right anterior cranial fossa meningocele extending to the level of the ethmoid air cells.


Instruction: Generate impression based on findings.

Input: There are multiple scattered punctate foci of T2 hyperintensity in the cerebral white matter, which appear to be unchanged. There is no evidence of acute infarction or abnormal intracranial enhancement. There is no evidence of intracranial mass lesions either. The ventricles and sulci are unchanged is size and configuration. There is no midline shift or mass effect. There is an unchanged enhancing lesion in the left aspect of the clivus, measuring up to approximately 12 mm.

Output: 1. Multiple scattered punctate foci of T2 hyperintensity in the cerebral white matter, which appear to be unchanged, may represent chronic small vessel ischemic disease, but no evidence of acute infarction.2. Unchanged nonspecific enhancing osseous lesion of the left aspect of the clivus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 73 years old Reason: rectal cancer staging History: As per chart, status post anterior resection for stage I rectosigmoid carcinoma in 2006, then with anastomotic recurrence and revision anterior resection and abdominoperineal resection in 2007. Overall image quality: FairPELVIS:PROSTATE/SEMINAL VESICLES: Numerous brachytherapy seeds are noted in the prostate.BLADDER: A pigtail catheter is noted extending from the right ureter, otherwise the bladder is unremarkable.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Patient is status post sigmoidectomy.There are multiple heterogeneous, peripherally enhancing lesions in the pelvis (series 7, image 21 and 26; series 12, images 148 and 157). The largest of these lesions lies between the right iliac vessels and right ureter, displaces the ureter medially, and measures 68 x 55 mm. There is internal septation with heterogeneous, dependent low T2 signal within this lesion. A second lesion sits immediately anterior to the sacrum, superior to the seminal vesicles, and measures 32 x 29 mm. This lesion also contains heterogeneous T2 hypointense signal. There is no masslike or nodular enhancement within these lesions. Additional, smaller lobulated areas of T2 hyperintensity (series 5, image 25) are also noted in the left hemipelvis along the pelvic wall.BONES, SOFT TISSUES: Small bilateral hydroceles.OTHER: No significant abnormality noted.

Output: Heterogeneous, peripherally enhancing complex cystic masses in the pelvis which are suspicious for disease recurrence, particularly of the mucinous subtype.


Instruction: Generate impression based on findings.

Input: Reason: R knee chondromalacia History: R knee pain MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the medial facet of the patella including a near full-thickness cleft. There is focal signal heterogeneity within the articular cartilage along the lateral aspect of the medial femoral condyle likely representing focal degeneration. There is also mild signal heterogeneity within the posterior aspect of the lateral tibial plateau, but this is equivocal. We see no fluid-filled cartilage defect. There is a 1 cm low signal intensity band within the medial tibial plateau which may represent a healed stress fracture that is not currently associated with any bone marrow edema.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. The Insall Salvati ratio measures approximately 1.3-1.4 suggesting patella alta. There is edema within the superolateral aspect of Hoffa's fat pad which can be seen in patellofemoral instability.ADDITIONAL

Output: Cartilage degeneration most pronounced along the medial facet of the patella with other findings as described above.


Instruction: Generate impression based on findings.

Input: 66-year-old male with spinal cord cavernous malformation experiencing hand weakness. There has been interval C4 and C5 laminectomy with partial C3 laminectomy. A previously demonstrated T2 hyperintense intramedullary lesion is smaller measuring 14 mm craniocaudal by 6 mm AP (previously 18 mm x 9 mm). Redemonstrated is adjacent spinal cord hypointensity extending both above and below the lesion, which is unchanged in appearance. Extradural fluid is present which causes mild mass effect upon the dura, resulting in new mild to moderate central stenosis at C5-6. Enhancement is noted involving the soft tissues along the operative tract, as within the superior most aspect of the intramedullary lesion.C2/3 is unremarkable and unchanged.C3/4 demonstrate mild to moderate degenerative changes of the disk and the posterior elements. Additionally there is a prominent broad-based disk protrusion at this level. Constellation of findings of degenerative disease and larger disk protrusion results in mass effect, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is inferior migration of disk fragment posterior to the body of C4 with associated mass effect and flattening deformity of the cord and central spinal stenosis as well. There is also moderate bilateral neural foraminal compromise. There is no convincing evidence of associated cord T2 hyperintensity at this level. These findings are unchanged.C4/5 mild disk disease and moderate bilateral facet hypertrophic changes and mild ligamentum flavum hypertrophy. There is a small broad-based disk protrusion also present at this level which results in flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is present at this level. These findings are unchanged.C5/6 demonstrate degenerative changes with result in mild-to-moderate left and mild right neural foraminal compromise.C6/7 demonstrate mild disk and facet disease with resection of ligamentum flavum. No spinal stenosis or neural foraminal compromise, unchanged.C7/T1 is unremarkable with the exception of mild facet and ligamentum flavum hypertrophy, unchanged

Output: There has been interval C4 and C5 laminectomy with partial C3 laminectomy. A previously demonstrated T2 hyperintense intramedullary lesion is smaller measuring 14 mm craniocaudal by 6 mm AP (previously 18 mm x 9 mm). Redemonstrated is adjacent spinal cord hypointensity extending both above and below the lesion, which is unchanged in appearance. Extradural fluid is present which causes mild mass effect upon the dura, resulting in new mild to moderate central stenosis at C5-6. Enhancement is noted involving the soft tissues along the operative tract, as within the superior most aspect of the intramedullary lesion.


Instruction: Generate impression based on findings.

Input: Neck/shoulder pain with finger numbness. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained, aside from mild straightening and minimal retrolisthesis of C4 on C5, C5 on C6, and C6 on C7. Bone marrow signal is benign. There is trace prominence of the central canal from the C6 to C7 levels and can be normal variant. The cervical spinal cord has otherwise normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Left-sided facet arthropathy.C3-4: Small disc osteophyte complex with effacement of the ventral thecal sac. Overall no significant spinal canal stenosis at this level. There is mild narrowing of the bilateral neural foramina.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy with mild to moderate left and mild right neural foraminal narrowing. There is effacement of the ventral thecal sac without overall significant spinal canal stenosis. C5-6: Disc osteophyte complex and bilateral uncovertebral hypertrophy with effacement of the ventral thecal sac. There is moderate bilateral neural foraminal stenosis. No significant spinal canal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is moderate left neural foraminal stenosis. Right neural foramen is patent. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Multilevel degenerative changes in the cervical spine with small multilevel disc osteophyte complexes. There is overall no significant spinal canal stenosis at any level. There is multilevel neural foraminal narrowing which may be contributing to patient's radiculopathy as detailed above.2. Trace prominence of the central canal in the lower cervical cord, which is of doubtful clinical significance.


Instruction: Generate impression based on findings.

Input: Headache with a history of ALL. Question metastases or mass. There is suggestion of a small subdural hematoma at the vertex. There is no evidence of mass effect, edema or midline shift. Lack of intravenous contrast limits the evaluation for metastases. If there is clinical concern for metastases, an MRI with contrast is recommended for better evaluation.The ventricles and sulci appear prominent for the patient's age, consistent with volume loss. This is more prominent than on the prior study.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Suggestion of a small subdural hematoma at the vertex. If there is clinical concern for metastases, an MRI with contrast is recommended for evaluation.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with history of right-sided cholesterol granuloma, slow tumor regrowth status post resection, yearly surveillance examination. No new symptoms. Prior history of hearing loss. Redemonstrated is evidence of right middle cranial fossa and mastoid approach surgery for the right petrous apex lesion. As before, a small amount of the right cerebellum prolapses into the mastoid surgical defect.A lobular T1 hyperintense, T2 heterogeneous lesion is again seen affecting a majority of the right petrous apex. This lesion seems to have increased slightly in size now measuring 31 x 24 mm (on axial image 9 of series 1001), previously 29 x 22 mm.As before, this lesion exerts mass effect upon the right aspect of pons as well as the cisternal segment of the right cranial nerve five and the right seventh/eighth nerve complex. The lesion also encroaches upon the right Meckel's cave.As on prior examinations, the right IAC is deformed by this lesion. Also noted is lack of complete visualization of the fluid-filled structures of the right cochlea and vestibular system.A bubbly T2 hyperintense lesion with a rim of hemosiderin staining in the right centrum semiovale is unchanged and compatible with a cavernoma. No other significant parenchymal lesions are seen. No pathologic parenchymal enhancement is detected. The ventricular system is stable in size and configuration.

Output: 1.Slight interval increase in the size of a right petrous apex cholesterol granuloma.2.No other significant interval changes.


Instruction: Generate impression based on findings.

Input: Reason: characterize lucent lesion on humeral head History: asymptomatic lesion on left humeral head There is thickening and intermediate signal intensity within the supraspinatus indicating mild to moderate tendinosis. No full-thickness tear or retraction is evident. The infraspinatus muscle and tendon appear intact. The teres minor and subscapularis muscles and tendons appear intact. Although this examination was not protocol for detailed evaluation of the labrum, there is increased signal abnormality within the inferior labrum indicating degeneration. There is a small amount of fluid within the joint without evidence of a large effusion. There is a small amount of fluid within the subacromial subdeltoid bursa which may represent a mild bursitis. There are cysts within the humeral head. Otherwise no bone marrow signal abnormality is identified. The glenohumeral joint alignment is anatomic. The acromial clavicular joint appears normal. No enhancing lesions are identified within the humeral head as clinically questioned.

Output: Rotator cuff tendinosis. No lesions are identified within the humeral head as clinically questioned. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 46 years, Female, Reason: 46F with HCV and abnormal ultrasound. Cross sectional imaging to better evaluate History: HCV. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Large gallstone. Smaller subcentimeter left hepatic cyst.There is a lesion in segment 4a/b which measures 1.3 x 1.7 cm (11/260) and likely corresponds to lesion seen on ultrasound. This lesion is T2 isointense, does not enhance and washes out on delayed images. No loss of signal on out of phase images is evident to suggest focal steatosis. Overall these are indeterminate features.There is an additional lesion in segment 3 which is only seen on portal venous and delayed phase images where it is hypointense to the background liver and measures 1.4 x 1.2 cm (11/266), also with indeterminate features.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Two lesions are identified in the left hepatic lobe, one of which corresponds to lesion seen at ultrasound. Both of these lesions have indeterminate features as above and MRI follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Reason: H/O DLBCLymphoma with CNS involvement s/p 3/5 cycles of MTR now with mental status changes History: NHL with Mental status chenges Since the prior exam a mass centered along the anterior commissure has enlarged. It previously measured approximately 20 by 10 mm axial dimensions and now measures 36 x 33 mm sagittal dimensions. It infiltrates into adjacent basal ganglia, septum pellucidum, hypothalamus and bulges into the suprasellar cistern, lateral ventricles and third ventricle. The internal cerebral veins are displaced posteriorly. The anterior septal veins are splayed. The right A1 segment is displaced inferiorly The mass is eccentric towards the right side. A small focus of susceptibility along the right half of the lesion likely represents hemosiderin from the biopsy site.A burr hole is present along the right frontal bone.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Since the prior exam the patient's midline mass compatible with the diagnosis of lymphoma has enlarged as detailed above.


Instruction: Generate impression based on findings.

Input: 28-year-old male with pain. Evaluate for ulnar collateral ligament tear. LIGAMENTS: There is thinning and increased signal abnormality consistent with partial thickness tearing of the distal undersurface fibers of the ulnar collateral ligament at the level of its insertion on the base of the proximal phalanx of the thumb, which appears to remain deep to the adductor pollicis tendon/muscle. There is no evidence of significant retraction or medialization of the proximal tendon fragments to suggest a Stener lesion. TENDONS: The imaged flexor and extensor tendons of the thumb are normal in appearance. BONES: No bone marrow signal abnormality is identified. ADDITIONAL

Output: Partial thickness tearing of the ulnar collateral ligament without evidence to suggest a Stener lesion as described above.


Instruction: Generate impression based on findings.

Input: 75 years, Male, Reason: history of metastatic basal cell carcinoma with new brain metastases on outside MRI (cerebellum and occipital lobe); please evaluate for radiosurgery planning Limited sequences of the brain for treatment planning protocol including post gadolinium 3-D T1 as well as susceptibility weighted sequences. There is a subtle enhancing lesion in the right occipital lobe measuring approximately 7 mm. There is also a larger enhancing lesion in the left cerebellar hemisphere measuring up to 15 mm in diameter. Please note due to the mild enhancement of the lesions and the limited available sequences, the lesions are difficult to discern. There appears to be mild surrounding edema.No evidence of hemorrhage associated with the lesions. There is a punctate focus of susceptibility in the left parietal lobe without associated enhancement evident and compatible with chronic microhemorrhage. No significant intracranial mass effect, midline shift, or herniation. There are scattered foci T1 hypointensity in the periventricular and subcortical white matter likely reflective of mild chronic small vessel ischemic disease. Vascular structures are patent. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Prior MRI is not available for comparison, and current examination is limited to sequences per treatment planning protocol. Enhancing lesions are seen in the left cerebellar hemisphere and right occipital lobe with approximate measurements as above. Please note due to the relatively mild enhancement of these lesions, would suggest obtaining prior study to review additional sequences and better assess the size of the lesions.


Instruction: Generate impression based on findings.

Input: Reason: newly diagnosed lung cancer, initial staging, eval for mets History: none There is a small subdural effusion present in the posterior fossa suspected to be a result of some atrophy.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are partially opacified left more than right. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Quintanilla is made of some cystic lesions in the pharyngeal mucosal space and represent Thornwaldt cyst unchanged from the CT from 3/15/15

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for brain metastases appreciated.


Instruction: Generate impression based on findings.

Input: Altered mental status. Seizures. Evaluate for acute CVA. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. Again seen are extensive areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter as well as the pons most likely representing advanced chronic small vessel ischemic disease. There is asymmetric, greater involvement extending into the left superior frontal gyrus. Small lacunar infarcts also noted involving the corona radiata and bilateral basal ganglia. Small areas of volume loss also noted within the bilateral cerebellar hemispheres which may also be related to prior ischemia. Small scattered foci of susceptibility consistent with chronic microhemorrhages are noted including in the left pons, right putamen, and the left superior frontal gyrus. Global parenchymal volume loss is noted, which appears advanced for age. Volume loss involving the hippocampi, particularly on the right, also noted. No hydrocephalus. There is mucosal thickening involving the right maxillary sinus as small amount of scattered fluid in the right ethmoid and sphenoid sinus. Secretions fill the nasopharynx, and there is opacification of the bilateral mastoid air cells, findings which may be related to intubation.

Output: 1. No evidence of acute infarct. No intracranial mass effect.2. Advanced chronic small vessel ischemic disease.3. Advanced parenchymal volume loss for age.4. Small scattered foci of chronic microhemorrhage with foci in the pons and right putamen suggestive of of chronic hypertension as the etiology.


Instruction: Generate impression based on findings.

Input: Redemonstrated is the patient's right ventriculostomy catheter with its tip in the medial right frontal horn, appearing slightly retracted and more medially when compared to the prior CT. There has been no significant change in lateral or third ventriculomegaly. A small amount of edema is again noted around the ventriculostomy catheter. As before, there are postoperative changes from previous suboccipital craniectomy and occipital craniotomy for debulking the patient's posterior fossa mass. As before, residual right-sided tumor results in associated mass effect on the upper cervical spine, medulla, pons, and midbrain with near effacement of the fourth ventricle. As before, fluid is noted within mastoid air cells.

Output: Residual right-sided tumor results in associated mass effect on the upper cervical spine, medulla, pons, and midbrain with near effacement of the fourth ventricle.


Instruction: Generate impression based on findings.

Input: 30 years Female (DOB: 10/14/1985)Reason: MS; f/u progression History: paresthesiasPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:There is redemonstration of multiple periventricular and subcortical white matter lesions as well as scattered in the cerebellum and brainstem. Some of the lesions are perpendicularly oriented to the lateral ventricles some extend into the corpus callosum. Compared to the prior exam from March these do not appear to have changed substantially. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the right maxillary sinus and a minor opacity in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There are patchy foci of signal hyperintensity throughout the cervical spinal cord compared to 3/7/2016 exam these have not changed substantially in extent. Differences in the magnet used for differences conspicuity of lesions.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine. There is a noted enhancing punctate focus in the spinal cord at the C2 level is not identified on the current exam.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem and corpus callosum appear to be stable compared to the prior exam.2.Accounting for differences in MRI technique lesions identified in the cervical spinal cord also appear to be stable. A previously noted punctate focus of enhancement within the upper cervical spinal cord does not enhance on the current exam.3.Please note that because this is not an MRI of the orbits previously noted prechiasmatic left optic nerve enhancement would not be readily detected.


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: malignant neoplasm of kidney History: f/u scan ABDOMEN:LIVER, BILIARY TRACT: Signal dropout on out of phase images compatible with diffuse hepatic steatosis. Multiple subcentimeter T2 hyperintensities are compatible with hepatic cysts. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Clustered/multiseptated cystic lesions in the uncinate process measures 2.4 x 2.1 (series 6, image 23), remeasured on prior study at 2.4 x 2.1 cm and unchanged in size or appearance.An additional cystic lesion is identified in the pancreatic tail and is stable, measuring 1.2 x 1.6 cm (series 6, image 17), previously 1.1 x 1.7 cm.There is no pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative changes from a right partial nephrectomy are again noted. Multiple bilateral mixed T1 and T2 signal intensity lesions are identified consistent with simple and hemorrhagic cysts. Multiple lesions are too small to characterize.The previously identified T1/T2 hypointense, mildly enhancing lesion in the interpolar region of the left kidney measures 1.4 cm, (series 12, image 69) increased from prior study where it measured 1.2 cm. A previously identified T1/T2 hypointense nonenhancing left inferior pole lesion is unchanged measuring 1.0 cm (series 12, image 71), previously 1.0 cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Stable uncinate process and distal pancreatic tail sidebranch cystic lesions, likely representing IPMNs.2. Status post partial right nephrectomy. The mildly enhancing lesion in the interpolar region of the left kidney demonstrates a slight increase in size and is suspicious for a renal malignancy. A second T1/T2 hypointense lesion within the left inferior pole while unchanged in appearance remains suspicious.


Instruction: Generate impression based on findings.

Input: Bilateral knee pain. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is mildly increased T2 signal within the inferior aspect of the patella compatible with mild bone marrow edema. Bone marrow signal is otherwise within normal limits. A multipartite patella is present, a normal variant. The articular cartilage within the tibiofemoral and patellofemoral compartments is intact. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: There is mild abnormally increased T2 signal within the proximal patellar tendon with associated tendon thickening compatible with mild tendinosis.ADDITIONAL

Output: Bilateral mild patellar tendinosis. Ligaments and menisci are intact.


Instruction: Generate impression based on findings.

Input: Stage IV melanoma. Worsening lower back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. The conus medullaris is normal in position. There is diffuse heterogeneity of the bone marrow with multiple osseous lesions throughout the lumbar spine consistent with known metastatic disease. Several of these lesions demonstrate minimal enhancement and no significant edema, which may represent treated lesions. The largest enhancing lesions are seen involving the L4 and S1 vertebral bodies and are also associated with STIR hyperintensity/edema. There is no evidence of pathologic compression fracture. No evidence of epidural tumor. The right sacral lesion abuts the right S1 nerve root in the neural foramen, without significant foraminal stenosis.Multilevel degenerative changes are seen with mild disc desiccation throughout the lumbar spine, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with a central protrusion component and annular fissure. There is fairly mild spinal canal narrowing. There is also minimal narrowing of the bilateral neural foramina. L4-L5: There is a disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening which contribute to moderate spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: Disc bulge and bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis. Partially imaged pelvis demonstrates multiple lesions involving the sacrum and bilateral iliac bones. Please refer to separate for findings in the pelvis.

Output: 1. Multiple osseous lesions in the lumbosacral spine consistent with known metastatic disease. Relatively larger enhancing lesions are evident at the L4 and right S1 levels. No evidence of pathologic compression fractures or epidural tumor. 2. There is moderate spinal canal stenosis at the L4-L5 level which is on a degenerative basis.3. Please refer to separate for findings in the pelvis.


Instruction: Generate impression based on findings.

Input: cT4N1Mx left tongue squamous cell carcinoma. There is a heterogenously enhancing infiltrative mass centered in the left tongue extends across the midline, into the tongue base, left tonsillar fossa, and soft palate that measures up to approximately 5.5 cm x 4.0 cm x 4.0 cm. There also appears to be slight invasion of the left pterygoid musculature. There is an enlarged left level 2A lymph node that measures 13 x 17 mm. The thyroid and major salivary glands are unremarkable. The osseous structures and paranasal sinuses are unremarkable. The imaged intracranial structures are unremarkable.

Output: 1. An infiltrative mass centered in the left tongue measures up to 5.5. cm and extends across the midline, into the tongue base and tonsillar fossa, as well as into the soft palate is compatible with squamous cell carcinoma.2. Left suprahyoid lymphadenopathy likely represents metastatic disease.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with GBM, status post tumor resection. Since the prior examination, a large right parietotemporal craniotomy has been performed with mesh cranioplasty. Postoperative findings are seen compatible with resection of a recently progressive enhancing lesion in the right anterior temporal lobe. The resection cavity is fluid and debris-filled with susceptibility effect along the cavity margins. Scattered areas of diffusion restriction around the cavity margins likely reflect postoperative cytotoxic edema. Postcontrast images are degraded by motion artifact and are further complicated by the presence of intrinsically T1 hyperintense tissue/fluid in the operative region. As such, it is difficult to accurately assess the degree of residual enhancing tissue. Some residual tissue is likely present posteriorly and medially, but it does appear that the majority of the previously quite extensive enhancement has been resected.A pre-existing resection cavity more posteriorly within the right temporal lobe does not appear to have changed significantly. Extensive T2 hyperintensity spreading through the right cerebral hemisphere is redemonstrated appearing similar to the preoperative study. There is partial effacement the right lateral ventricle and perhaps a septation in the right occipital horn. Mild periventricular T2 hyperintensity on the left is unchanged. A focus of diffusion restriction within the right splenium of the corpus callosum is unchanged. No new enhancing lesions are seen within the limitations of this examination. The right mastoid air cells are newly opacified.

Output: Postoperative findings are seen compatible with resection of the recently progressive enhancing lesion in the right anterior temporal lobe. It appears that a majority of the enhancing lesion has been removed, though some residual enhancement is suspected posteriorly and medially.No new lesions are seen. Extensive T2 signal abnormality spreading through the right cerebral hemisphere with associated mass effect is unchanged.


Instruction: Generate impression based on findings.

Input: 76-year-old male patient status post fall with pain on right side with moving. Question of occult hip fracture. Some sequences are limited by patient motion artifact and the patient was not able to complete study. Given this limitation, we see the following findings:There is vertically oriented linear signal abnormality within the right greater trochanter indicating a nondisplaced fracture with edema extending from the fracture into the intertrochanteric region, but the lesser trochanter itself appears intact. Mild edema is noted in the adjacent soft tissues. Mild osteoarthritis affects the right hip with a small amount of fluid in the right hip joint. Please note this study was not protocoled for detailed evaluation of the labrum.Mild osteoarthritis affects the left hip. Degenerative arthritic changes affect the lower lumbar spine.

Output: Non-displaced fracture of the greater trochanter of the right femur.


Instruction: Generate impression based on findings.

Input: Headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Mild nonspecific cerebral white matter T2 hyperintensities, which may represent chronic small vessel ischemic disease, but no evidence of intracranial mass lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Worsening L4 on L5 the spondylolisthesis? Signs and symptoms: Low back pain with radiculopathy. Nonenhanced lumbar MRI:Lower most visualized thoracic spine and thoracic cord is unremarkable.T12 -- L1 is unremarkable.L1 -- L2 it is unremarkable.L2 -- L3 is unremarkable.L3 -- L4 is unremarkable with the exception of mild degenerative changes.L4 -- L5 demonstrate mild disk desiccation without significant change since prior exam. Minimal grade 1 retrolisthesis remain similar to prior study. Examination demonstrates widening bilateral articulating facets with T2/T2 stir increased signal intensity consistent with bilateral facet inflammatory changes/effusion. This finding demonstrate interval progression since prior exam from 10 -- 7 -- 14. There is no evidence of a spinal stenosis. Moderate to severe bilateral neural foramina compromise is again identified.L5 -- S1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.

Output: 1.No acute findings since prior study.2.Widening of bilateral facet spaces with fluid signal intensity at the L4 -- L5 level with interval worsening since prior exam. Moderate bilateral neural foraminal compromise and without convincing evidence of central spinal stenosis stable since prior exam. Mild grade 1 anterolisthesis also remains stable since prior study.3.Unremarkable images at other levels and without evidence of spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sickle-cell disease without crisisDiagnosis Edits: Clinical question: sickle cell ds Signs and Symptoms: eval for moya moya/stenosis MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial cerebrovascular occlusion. The anterior communicating artery is identified. The posterior communicating arteries are asymmetric. The right posterior communicating artery is almost is large in diameter as the right P1 segment the left posterior communicating artery is small. The right posterior communicating artery is larger than the left posterior communicating artery. The vertebral arteries are similar in size.Low marrow signal is a nonspecific finding but expected in a patient with sickle cell disease.

Output: 1.No evidence for cerebrovascular occlusive disease. There is no evidence for moyamoya.2.No evidence for cerebral infarction.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute compression of the thoracic cord or conus, or significant thoracic spinal canal stenosis. There is low T1 and high T2 signal abnormality within the T7 vertebral body extending to the left pedicle, right T8 pedicle and facet, left T10 inferior articulating facet and spinous process, as well as bilateral T11 pedicles facets and spinous process with involvement of the right T11 vertebral body as well. There is also signal abnormality in the bilateral T12 facets and spinous process. Evaluation is limited due to lack of IV contrast. However, these lesions correspond to hypermetabolism on the recent PET, and therefore consistent with metastases. There is expansion of the affected pedicles and facets with epidural tumor invasion causing severe stenoses of the right T7-8, T8-9, and T12-L1 neural foramina, as well as moderate stenoses of the left T7-8, and T9-10, and T10-11 neural foramina. There is severe bilateral stenoses of the T11-12 neural foramina. There is an incompletely imaged mass measuring up to 6.3 CC x 1.8 AP x 5.4 ML cm in the subcutaneous soft tissues superficial to the right paraspinous musculature with hypermetabolic activity on PET, consistent with subcutaneous metastasis. There is desiccation of the intravertebral discs from C6-7 through T10-11 with loss of disc height. There are mild left L2-3 and L3-4 neural foraminal stenoses from disc bulge, facet arthropathy and ligament flava thickening, incompletely imaged. The conus terminates at L1-2. The kidneys are markedly atrophic and contain numerous cysts bilaterally. There is a large cyst in the right posteromedial aspect of the liver without hypermetabolic activity on prior PET.

Output: 1.Numerous thoracic vertebral body and posterior element osseous metastases without evidence of acute fracture, compression of the thoracic cord or conus, or significant thoracic spinal canal stenosis.2.Tumoral expansion of the posterior elements at multiple levels with epidural tumor extension results in moderate to severe neural foraminal stenoses at multiple levels of the thoracic spine, as described in the findings section.3.A large, but incompletely characterized subcutaneous tissue mass in the lower back is consistent with a metastasisI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Previous foci of restricted diffusion involving the anterior body of the left corpus callosum, the anterior limb of the left internal capsule extending into the left corona radiata, and along the right and midline posterior body/splenium of the corpus callosum have resolved. There is no new restricted diffusion.Redemonstrated is prominence of the extra-axial spaces as seen on recent head CT, although better demonstrated by MRI to containtwo different processes within the extra-axial compartment. One of these would include CSF isointense prominence of the subarachnoid spaces, also extending along the anterior falx. Overlying this are more T1 hyperintense crescentic and nearly hemispheric collections (more T1 hyperintense on the right), which are both T2 hyperintense, representing slightly different aged subdural hemorrhages. The overall depth of both of these processes has not significantly changed (when compared to the more recent head CT and given differences in technique), and there is no significant underlying mass effect, although there is slight flattening of right parietal gyri.Redemonstrated are foci of punctate susceptibility along the right caudothalamic groove and lateral ventricular margin of the mid body of the right lateral ventricle. Additional punctate foci of susceptibility are seen dependently in the occipital horns bilaterally. These are stable in appearance.The right lateral ventricle remains slightly larger than the left. The basal cisterns remain patent. Overall, myelination pattern appears appropriate for the patient's corrected age, although as before the expected T2 hypointense findings in the posterior limb of the internal capsule and ventrolateral nucleus of the thalami appear slightly less distinct than as expected.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is persistent opacification of the left middle ear cavity and mastoid air cells.

Output: 1.Redemonstrated is prominence of the extra-axial spaces as seen on recent head CT, although better demonstrated by MRI to contain two different processes within the extra-axial compartment. One of these would include CSF isointense prominence of the subarachnoid spaces, also extending along the anterior falx, representing benign enlargement of the subarachnoid spaces which typically resolves by 2 years of age. Overlying this are more T1 hyperintense crescentic and nearly hemispheric collections representing slightly different aged subdural hemorrhages. The overall depth of both of these processes has not significantly changed, and there is no significant underlying mass effect, although there is slight flattening of right parietal gyri.2.Overall, myelination pattern appears appropriate for the patient's corrected age, although as before the expected T2 hypointense findings in the posterior limb of the internal capsule and ventrolateral nucleus of the thalami appear slightly less distinct than as expected.3.There is persistent opacification of the left middle ear cavity and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 44yo with ESRD on dialysis, extensive lymphadenopathy, has altered mental status and ataxia with h/o reports for stool incontinence There is no evidence of cord compression or cauda equina compression. There is diffuse low T1 marrow signal which may be related to chronic renal disease. There are mild multilevel degenerative changes changes with relatively more prominent disc osteophyte complexes in the cervical spine at the C5-C6 and C6-C7 levels with mild associated narrowing of the spinal canal. There is loss of cervical lordosis. Vertebral body heights and alignment are otherwise maintained.

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


Instruction: Generate impression based on findings.

Input: 67 year old female with previous lung cancer treated with left lung pneumonectomy and chemotherapy. Referred for interval assessment of RV size, function. Height: 152cmWeight: 57kgBSA: 1.6 m sq.Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 62 ml/m2 (normal range: 65+/-11), the LVEDV is 93 ml (normal range 109+/-23), the LV end systolic volume index is 26 ml/m2 (normal range 18+/-5), the LVESV is 40ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 47 g (normal range 114+/-24). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mild-moderately increased in size with mildly decreased systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 111 ml/m2 (normal range 69+/-14), the RVEDV is 168 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 78 ml (normal range 35+/-13). Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.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 severe tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsThe right upper and lower pulmonary veins drain normally into the left atrium. There are no left sided pulmonary veins present.Pulmonary ArteryThe main pulmonary artery is normal in size. The left pulmonary artery ends in a blind pouch.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPost-left lung pneumonectomy with displacement of the heart into the left hemithorax. There is a well circumscribed mass in the liver consistent with cyst. This mass is similarly visualized on CT abdomen on 6/3/15. 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 LV size and systolic function (LVEF 57%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Mild-moderately increased RV size and mildly decreased systolic function (RVEF 46%).3. Severe TR.4. Post-left lung pneumonectomy with displacement of the heart into the left hemithorax.5. Please see extracardiac findings for description of liver mass.6. Compared to prior cardiac MRI of 1/28/2011, RA and RV size has increased and RV function is mildly decreased. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (11/5/14, 11/21/14), images from stereotactic core needle biopsy of the right breast and post procedural right digital mammographic images (12/3/14), images from needle localization of the right breast and specimen radiograph (1/6/15), breast MRI (1/28/15) performed at Edward Hospital. DIGITAL MAMMOGRAPHIC IMAGES (11/5/14, 11/21/14):The breast parenchyma is composed of scattered fibroglandular elements. There are pleomorphic calcifications at 6 o'clock position, at anterior - posterior depth. Distribution of calcifications measures 81 x 49 mm (AP x CC) on ML view, and 73 mm in transverse on CC view.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. IMAGES FROM STEREOTACTIC CORE NEEDLE BIOPSY OF THE RIGHT BREAST AND POST PROCEDURAL RIGHT DIGITAL MAMMOGRAPHIC IMAGES (12/3/14):Stereotactic biopsy of the right breast calcifications was performed. Specimen radiograph demonstrates target calcifications within the specimens. Post procedural right mammographic images show a marker clip placed at the posterior 7 o'clock position. Per outside radiology report, the pathology result was malignant.IMAGES FROM NEEDLE LOCALIZATION OF THE RIGHT BREAST AND SPECIMEN RADIOGRAPH (1/6/15):Double wire localization (bracketed with anterior and posterior wires) was performed for the right breast calcifications. Anterior wire is placed to the marker clip and posterior wire is placed approximately 2.5-cm posterior to the anterior wire. Both wires are placed by inferior approach. Specimen radiographs demonstrate multiple calcifications within the specimen, along with a marker clip and two localizing wires. Those calcifications appear extending toward the specimen margins.BREAST MRI (1/28/15):The study was performed with a protocol outlined in the outside radiology report. Images could not be processed with our DynaCAD workstation. Because the images cannot be reviewed on the dedicated MRI workstation, limited interpretation is made.An elongated seroma cavity is present at 6 o'clock position in the right breast from anterior toward the pectoralis muscle. There is focal non mass enhancement, measuring 22 x 20 mm (AP x LR), locating immediate lateral to the seroma cavity at middle depth, suggesting residual cancer vs. fat necrosis. No abnormal enhancement is seen in left breast. There are a few mildly enlarged lymph nodes in the right axilla. Considering post operative status, those lymph nodes may be reactive.No abnormal axillary lymph nodes are identified in left axillary region.

Output: Status post lumpectomy for right breast malignancy. Suspicious non mass enhancement in the right breast, lateral to the seroma cavity.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 55 years, Male, rising PSA PELVIS:PROSTATE:Prostate Size: 6.5 x 4.2 x 3.4 cmPeripheral Zone: Focus of low ADC/T2 signal with early enhancement in the mid gland, left peripheral zone, immediately left of midline measures 6 x 4 mm (801/13) suspicious for adenocarcinoma.Additional focus of low ADC/T2 signal without early enhancement in the left apex measuring 10 x 9 mm (801/9) is also suspicious for adenocarcinoma.There are multiple ill-defined areas of low ADC/T2 signal in the left peripheral zone extending from the mid gland to base which are suspicious for adenocarcinoma.Central Gland: Heterogeneous and enlarged nodules within median lobe protruding into the bladder, suggestive of benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: NoneBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left peripheral zone lesion in the mid gland suspicious for adenocarcinoma.2.Left apical lesion suspicious for adenocarcinoma.3.Ill-defined signal in the left peripheral zone extending from the mid gland to the base are also suspicious for adenocarcinoma.4.The above lesions lesions would be amenable for MRI guided biopsy.


Instruction: Generate impression based on findings.

Input: 3-year-old female with episodes of syncope, please evaluate for mass or hemorrhage. There is no evidence of. mass or edema. The ventricles and basal cisterns are normal in size and configuration. Small area of low attenuation measuring 1.4 x 1.2 cm (image 24/48, series 2) just below the torcula is of uncertain significance and can be further characterized with MRI.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Region of low attenuation just inferior to the torcula of uncertain etiology as detailed above. MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Posterior heel pain TENDONS: No significant abnormality noted. Specifically, the Achilles tendon appears normal.LIGAMENTS: No significant abnormality noted.ARTICULAR SURFACES AND BONE: Increased T2 signal is noted within the posterior calcaneus with a low signal serpiginous line evident as well. Similar increased signal is noted within the middle cuneiform and a small portion of the navicular although no discrete line is identified. There is no malalignment. ADDITIONAL

Output: 1. Nondisplaced fracture of the posterior calcaneus.2. Edema within the middle cuneiform and navicular without discrete fracture line. Findings may represent additional stress injuries.3. Normal appearance of the Achilles tendon.Findings discussed with RN on behalf of Dr. Pincavage at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Reason: Assess for tendon/ligamentous injury to R long finger History: Long finger PIP flexion deficit and block to ROM; radial soft tissue mass -- does this represent torn tendon? There is poorly defined edema-type signal within the subcutaneous tissues radial to the PIP joint of the middle finger, but we see no well-defined mass. LIGAMENTS: Adjacent to the area of edema-type signal, there is minimal hyperintensity of the radial collateral ligament, which could conceivably represent a mild sprain but this is equivocal. The ulnar collateral ligament appears intact. The volar plate appears normal. TENDONS Although the extensor tendon is difficult to resolve dorsal to the middle phalanx, we see no findings to suggest extensor tendon injury. The flexor tendon apparatus appears normal. We see no specific findings to suggest pulley dysfunction.BONES: There is no evidence of fracture. Bone marrow signal intensity is normal.

Output: Mild edema within the subcutaneous tissues lateral to the PIP joint of the finger is nonspecific. While there may be a sprain of the radial collateral ligament, this is equivocal and we see no tendon injury to account for the patient's flexion deficit.


Instruction: Generate impression based on findings.

Input: 47 year old female with a personal history of right breast lumpectomy for IDC in 2015 status post neoadjuvant therapy and radiation therapy. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Mild skin thickening and post-surgical changes are seen in the right breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 7 years, Male, left-sided paresthesias. BRAIN MRI: Brain parenchyma appears within normal limits. No signal abnormality or intracranial mass is appreciated. No evidence of intracranial mass effect, midline shift, or herniation. No evidence of recent ischemia or hemorrhage. No hydrocephalus. No extra-axial collections. Sella and orbits are grossly within normal limits. There is trace mucosal thickening in the paranasal sinuses, which are otherwise clear. Mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. BRAIN MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.

Output: MRI of the brain appears within normal limits.MRA of the brain appears within normal limits.


Instruction: Generate impression based on findings.

Input: Female 79 years old Reason: staging for rectal cancer History: none Overall image quality: ExcellentPELVIS:UTERUS, ADNEXA: The patient is status post hysterectomy. The vaginal cuff is unremarkable. BLADDER: The urinary bladder is partially distended with normal thickness and no focal abnormality.LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: 1.0 x 0.9 cm enlarged round lymph node within the pericolonic fat adjacent to the left anterolateral aspect at the level of the upper-rectal mass (series 4/20). The mesorectal fascia is not clearly defined at this level. More superolaterally is a 5 mm lymph node (series 4/16).Otherwise punctate sub-5 mm lymph nodes are noted adjacent to the mid and lower rectum.Lymph nodes outside the mesorectal fascia: Scattered non pathologically enlarged pelvic lymph nodes. BOWEL, MESENTERY: Rectal Tumor:Size: 4.1 x 1.8 x 3.6 cm (series 4/25 and series 5/29)Tumor appearance on T2-weighted images: Intermediate T2-weighted signal hyperintensity.Tumor location: Middle to upper third. No evidence of proximal colonic dilatation/obstruction. (For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Approximately 10 cm.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Approximately 7 cm.Circumference of the rectum involved: The lesion appears to involve the majority of the wall circumference. Relationship and proximity of the tumor to adjacent structures (uterus, cervix, vagina): The mass lesion is approximately 1.3 cm from the left anterolateral presumed mesorectal fascia. The mural wall is ill-defined at the left lateral aspect of the lesion with subtle soft-tissue spiculations. There is minimal peri-rectal fluid. MRI T-stage: T3b - Tumor invades 0.5cm to 1cm into perirectal fat or extramural.Tumor Distance to Mesorectal Fascia: Approximately 1.3 cm from the right anterolateral mesorectal fascia (series 4/25). BONES, SOFT TISSUES: In the dorsal mesorectal fat there is ill-defined tubular structures (series 5/29) which may represent extramural vascular invasion. OTHER: No significant abnormality noted.

Output: Mid to upper rectal tumor with adjacent peri-rectal lymphadenopathy and extramural tumor extension as described above. Findings suggestive of extramural vascular invasion.


Instruction: Generate impression based on findings.

Input: Clinical question: Removal of cystic lesion at L3 -- L4 and L4 -- L5 levels in September of 2012. Follow-up for any recurrence. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:Examination demonstrates an ill-defined increased T2 stir signal intensity in the left paraspinal soft tissues posterior to L4 and L5 level at the site of prior tumor resection. Post enhanced images also demonstrate a very faint subtle enhancement at the site. There is interval improvement (less conspicuous enhancement and signal abnormality) of the finding since prior exam highly suggestive of improvement of post operative changes. There is no convincing evidence of residual tumor. The alignment of the vertebral column remains anatomical and the signal intensity of vertebral column demonstrate changes related to degenerative disease. Post enhanced images demonstrate expected enhancement of degenerated/hypertrophied facet complexes at L3 -- L4 through L5 -- S1 levels of varying degree.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise or interval change since prior exam.L2 -- L3 demonstrate mild degenerative disease a mild bilateral facet and ligamentum flavum hypertrophy without central spinal stenosis or neural foraminal compromise or interval change.L3 -- L4 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. Constellation of above changes results in moderate central spinal stenosis without convincing evidence of interval change since prior exam. No neural foraminal compromise.L4 -- L5 demonstrate mild disk disease and loss of disk height, moderate to severe bilateral facet and mild bilateral ligamentum flavum hypertrophic changes are noted. Mild central spinal stenosis and mild right neural foraminal compromise similar to prior exam.L5 -- S1 demonstrate mild disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise or interval change since prior exam.

Output: 1.Post operative changes in the soft tissues of the posterior lower back at L3 -- L4 and L4 -- L5 levels at the site of previously resected tumor without evidence of residual tumor.2.Stable degenerative changes of the lower lumbar spine with evidence of moderate central spinal L3 -- L4 and mild at L4 -- L5 levels. No significant neural foraminal compromise. stenosis


Instruction: Generate impression based on findings.

Input: Male, 13 days old, full-term twin, with tuberous sclerosis. Evaluate for subependymal giant cell astrocytoma and cortical tubers. Cardiac rhabdomyoma on fetal imaging. Brain parenchymal morphology is within normal limits for a term infant. The degree of gyration is appropriate. No structural abnormalities are identified.No evidence of any focal lesion, edema or mass effect is detected. No acute intracranial hemorrhage or abnormal extra-axial fluid is seen. The ventricles are normal in size and morphology.The pituitary gland is within normal limits. The corpus callosum is fully formed and intact. The brainstem, cerebellar vermis and cerebellar hemispheres are within normal limits. The pattern of white matter myelination is appropriate for gestational age.

Output: Unremarkable evaluation of the brain with no acute abnormalities and no stigmata of tuberous sclerosis identified.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for postop hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT: Examination demonstrates a surgical cavity in the right frontal lobe containing fluid and air density as well as very minimal blood product. It measures approximately 35 x 36 -mm in size.There is a small focus of high density measuring approximately 4 x 4.5-mm in size suspected of a small acute hematoma immediately lateral to the surgical cavity in the right frontal lobe.Extensive residual surrounding vasogenic edema and very minimal subarachnoid hemorrhage is present. A small residual vasogenic edema in the left frontal lobe is also present and unchanged since prior brain MRI from 5 -- 3 -- 13. The overall mass effect of this finding and resultant midline shift to the left immediately adjacent to the tumor remains fairly similar to preoperative study. Stable normal size of the supratentorial ventricular system and unchanged since prior study.Expected postoperative changes of right frontal craniotomy.

Output: 1.Surgical cavity at the site of previously known right frontal lobe tumor with fluid/air and very minimal blood content.2.Minimal subarachnoid hemorrhage in the vicinity of surgical cavity and an approximately 4 x 4.5-mm accurate hematoma lateral to the surgical cavity.3.Postop changes and residual vasogenic edema extensively in the right frontal and minimally in the left frontal and associated mass effect remains similar to prior study.


Instruction: Generate impression based on findings.

Input: A 61 year old male with poorly controlled hypertension, diabetes mellitus, hyperlipidemia, s/p hip replacement. Recent onset shortness of breath. Recent echocardiography showed normal left and right ventricular systolic function with concentric hypertrophy. Referred for stress cardiac MRI for further evaluation.MEDICATIONS: amlopidine, aspirin, clonidine, furosemide, olmesartan, sotalol, atorvastatin First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no late gadolinium enhancement. The entire myocardium is viable.Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 288 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 119 ml (normal range 47+/-19), the LV mass index is 91 g/m2, and the LV mass is 234 g. The septum measures 15 mm at the base. There is concentric left ventricular hypertrophy. There is infero-lateral wall hypokinesis from base-mid segments. T1-times of the mid to apical septum are borderline increased (~1050-1100ms). No intracavitary thrombus. No myocardial iron overload.Left AtriumThe left atrium is moderately dilated (143ml). Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 101 ml/m2 (normal range 82+/-16), the RVEDV is 257 ml (normal range 142+/-31), the RV end systolic volume index is 38 ml/m2 (normal range 31+/-9), and the RVESV is 97 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root measures 42mm. There is a left sided aortic arch with a normal brachiocephalic branching pattern. The ascending aorta at the level of the main PA bifurcation is 42.4mm. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is no late gadolinium enhancement. All segments of the the myocardium are viable.3. Moderate LVH. 4. Mildly dilated LV with normal systolic function (LVEF 58%).5. Normal RV size and systolic function (RVEF 62%).6. Bilateral moderate atrial dilatation.7. Mild main PA dilatation.8. Mildly dilated aortic sinus of valsalva. See above measurements.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:2/6/1971)Reason: right vestibular schwannoma, history resection with yearly follow up for growth History: yearly follow up for tumor growthPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM The patient status post right posterior fossa surgery for removal of an acoustic neuroma. There is a punctate focus of enhancement redemonstrated deep within it currently measures approximately 2 x 4 mm and previously measured approximately the same in axial dimensions. The right internal auditory canal.There is some mild encephalomalacia along the right cerebellar hemisphere which has been stable since prior exams. There are some postoperative changes present along the right posterior fossa. These are also stable.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is stable. The patient status post right posterior fossa surgery for removal of an acoustic schwannoma. There is a small focus of enhancement within the deep portion of the right internal auditory canal. This could represent scar tissue or residual tumor. It has been stable since prior exams. There are also some associated postoperative changes and mild encephalomalacia along the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Treatment planning for SRS to caudate lesion. There is a 6 mm diameter lesion in the right caudate nucleus. There are also punctate enhancing lesions in the hand region of the left precentral gyrus and in the right postcentral gyrus. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.

Output: Treatment planning MRI for a subcentimeter right caudate nucleus metastatic lesion. Punctate enhancing lesions in the hand region of the left precentral gyrus and right postcentral gyrus are also compatible with metastases.


Instruction: Generate impression based on findings.

Input: Evaluate left meningeal enhancement. History of seizure. There is decreased FLAIR hyperintensity and leptomeningeal enhancement involving predominantly the left frontal and parietal sulci. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts within the maxillary sinuses bilaterally. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Improving leptomeningeal disease involving predominantly the left frontal and parietal sulci and to a lesser degree right sided counterparts. Differential diagnoses include meningitis and meningoencephalitis.


Instruction: Generate impression based on findings.

Input: Low back pain and bilateral sciatica. Evaluate for canal stenosis. For the purpose of level numbering, there are 5 lumbar-type vertebrae with the last well-formed disc considered L5-S1. Alignment is notable for straightening which may reflect positioning. There is mild height and T2 signal loss at L4-5 with relative preservation at the other levels. The spinal canal is preserved. The tip of the conus medullaris is at the mid L1 level. The conus medullaris shows normal signal and shape.T12-L1, L1-L2, L2-L3 and L3-L4: No significant disc herniation. No spinal canal or foraminal stenosis.L4-L5: Minimal disc bulge and mild ligamenta flava thickening but no significant spinal canal stenosis. Moderate left facet arthropathy, along with disc bulge, result in mild left foraminal stenosis. The left facet arthropathy is associated with edema-like signal in the adjacent marrow including the left L5 pars interarticularis which is also associated with sclerosis. An underlying L5 pars defect would be difficult to reliably exclude.L5-S1: Minimal disc bulge but no spinal canal or foraminal stenosis.There are multiple small T1-hypointense, T2-hyperintense liver and kidney lesions that are not completely assessed though may represent cysts.

Output: 1.At L4-L5, there is mild degenerative disc and moderate left facet changes resulting in mild left neural foraminal stenosis but no spinal canal stenosis. 2.There is mild subjacent marrow edema-like signal involving the left L5 pars interarticularis associated with sclerosis. This may relate to the left L4-L5 facet arthropathy but an underlying pars interarticularis defect would be difficult to reliably exclude by MRI. CT scan of the lumbar spine would more reliably assess for spondylolysis. 3.There is no significant degenerative disease at the other levels.4.Small liver and kidney lesions are not completely assessed but may represent cysts.


Instruction: Generate impression based on findings.

Input: Reason: Left wrist pain History: above LIGAMENTS: Although this examination was not protocoled for detailed evaluation of the intrinsic ligaments of the wrist, the scapholunate and lunotriquetral ligaments appear grossly intact, although there is apparent slight widening of the scapholunate interval which may represent ligamentous laxity.TRIANGULAR FIBROCARTILAGE COMPLEX: Although this examination was not protocoled for detailed evaluation of the triangular fibrocartilage complex, the triangular fibrocartilage complex appears intact. There is a small amount of nonspecific fluid within the distal radioulnar joint.TENDONS: The flexor and extensor tendons appear intact. There is a small amount of fluid within the tendon sheath of the extensor carpi radialis which is likely of no current clinical significance.BONES: There is subchondral cyst formation and edema type signal abnormality within the proximal and ulnar aspect of the lunate bone which is nonspecific, but can be seen in ulnar abutment syndrome.ADDITIONAL

Output: 1. Subchondral cyst formation and edema within the lunate in a pattern which is nonspecific but can be seen in ulnar abutment syndrome.2. 13 mm ganglion along the volar aspect of the wrist as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: 60-year-old with AML undergoing treatment with RT-chemotherapy with history of chronic back pain, now with worsening back pain after LP. Evaluate for causes of pain. Signs and symptoms: Significant back pain status post LP. Nonenhanced complete spine MRI:MRI of cervical spine demonstrate normal signal intensity and alignment of vertebral column. Unremarkable images through foramen magnum. No evidence of central spinal stenosis or neural foraminal compromise at any level. Unremarkable. Spinal soft tissues.Nonenhanced MRI of thoracic spine:Examination demonstrates normal signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord.There is no evidence of a spinal stenosis or neural foraminal compromise at any level.No evidence of epidural or perispinal soft tissue abnormalities.Nonenhanced lumbar MRI:There is normal anatomical alignment and signal intensity of the vertebral column.No evidence of abnormal epidural widening or signal abnormality.Normal signal intensity of the lower most visualized thoracic spine, conus or the cauda equina.At L4-L5 there is mild disc disease and loss of disc height, extensive bilateral facet and ligamentum flavum hypertrophy and including right facet effusion. There is mild grade 1 anterolisthesis. There is a broad base central to far right lateral disc protrusion resulting in significant right neural foraminal and right lateral recess compromise. Mild central spinal stenosis and moderate to severe left neural foraminal compromise is also present.At L5-S1 mild disc disease and mild to moderate facet and ligamentum flavum hypertrophy is noted. Tiny right lateral annular fissure is present. No central spinal stenosis although moderate left neural foraminal compromise is detected.Mild increased T2 STIR signal in the soft tissues of lower back could represent changes from recent help ease.

Output: 1.Unremarkable nonenhanced MRI of cervical spine.2.Unremarkable nonenhanced thoracic MRI.3.Nonenhanced MRI of lumbar spine demonstrate degenerative changes at L4-L5 and including a right lateral and far lateral broad-based disc protrusion with significant right neural foraminal compromise and very mild central spinal stenosis. Degenerative changes of posterior elements at the L4-L5 and mild disc disease is also noted.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with brain lesion for evaluation. The left basal ganglia ring enhancing lesion persists, with perhaps a mild interval decrease in size, now measuring up to 23 mm in diameter, previously up to 25 mm. Internal diffusion restriction seen on prior exams continues to diminish. Subtle developing peripheral T1 hyperintensity is seen aroung this lesion. Some progression of surrounging T2 signal abnormality is seen, particularly at the level of the left caudate body which now shows progressive cystic degeneration. Along the left ventricular atrium, T2 signal abnormality is improved. A separate 4 mm linear focus of enhancement along the left posterior limb of the internal capsule is unchaged. Scattered calcified lesions as represented by areas of T1 hyperintensity and/or susceptibility effect have not changed. Smooth dural thickening and enhancement along the left parietal convexity is also unchanged. No new lesions are seen. Numerous patchy areas of white matter T2 hyperintensity and cortical encephalomalacia are stable. Ventricular size and morphology are unchanged.

Output: 1.Persistent ring enhancing lesion in the left basal ganglia with perhaps a mild interval decrease in size. A rim of T1 hyperintensity continues to development around this lesion. 2.Diffusion restriction internal to the above lesion is reduced. Some progression of surrounding T2 signal abnormality is seen, at least along the left caudate body which shows progressive cystic degeneration.3.A separate small enhancing focus in the posterior limb of the left internal capsule is stable. Numerous calcified lesions, and other areas of white matter and cortical injury, are stable. Dural thickening and enhancement along the left parietal convexity is unchaged as well.4.Although no real evidence of progression of the basal ganglia lesion is seen, and some findings would suggest evolution towards chronicity, the findings are still not sufficient to distinguish between infectious and neoplastic etiologies.


Instruction: Generate impression based on findings.

Input: 20 year-old female one year status post right labral repair ACETABULAR LABRUM: There is thickening and intermediate signal intensity involving the anterosuperior labrum without fluid-filled defect. The remaining labrum appears unremarkable.ARTICULAR CARTILAGE AND BONE: Status post right femoral head neck junction osteotomy. The bone marrow signal is within normal limits.SOFT TISSUES: The muscles and tendons about the hip appear normal. ADDITIONAL

Output: Thickening and intermediate signal involving the anterosuperior labrum at the site of prior labral repair without fluid-filled cleft which we suspect represents postoperative changes and granulation tissue rather than new tear.


Instruction: Generate impression based on findings.

Input: Further assessment of a T11 lytic lesion with possible extension into the spinal canal. Cervical spine: There is reversal of the normal lordosis. The vertebral body height is relatively preserved accounting for the due to spondylosis. The vertebral bone marrow signal is diffusely heterogeneous with loss of the normal fatty signal, but there is no osseous expansion. There is a similar appearance of the clivus and sphenoid body. There is no significant spinal canal stenosis. The spinal cord shows normal signal and morphology.Thoracic spine: The vertebral column alignment is within normal limits. There is mild loss of T2 signal and height at the T4-T5 disc. Otherwise, the disc space heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included ribs. There is a more intensely T1-hypointense, T2 hyperintense abnormality replacing the T11 vertebral body/pedicle marrow with mild, predominantly left sided posterior expansion/retropulsion but no significant spinal canal narrowing. This is also associated with central compression/intravertebral disc herniations along the superior and inferior endplates indicating bone softening but without overall vertebral body height loss. The appearance is unchanged since the CT scan. The other vertebral body heights are preserved. A T1 and T2 hyperintense lesion in T9 vertebral body is probably a hemangioma. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Lumbar spine: There is minimal anterior subluxation of L4 relative to L5 which is degenerative, without spondylolysis. The alignment is otherwise anatomic. The vertebral body heights are preserved. The marrow is heterogeneous with loss of the normal fatty signal. Similar involvement is present in the included pelvic bones. There is nonspecific mild T1-hypointense, T2 hyperintense signal just posterior to the lumbar vertebral bodies, displacing the epidural fat posteriorly. There is degenerative stenosis of the spinal canal, which is severe at L4-L5 and moderate at L5-S1, superimposed on congenitally narrow spinal canal. The conus medullaris has normal morphology and signal. The tip of the conus medullaris is at mid L1 level. The paravertebral soft tissues are unremarkable.LEVEL-BY-LEVEL

Output: 1.Diffuse marrow infiltrating process with more focal, destructive involvement of the T11 vertebral body and pedicles associated with mild retropulsion, but no spinal cord compression or significant canal narrowing. The appearance is more suggestive of multiple myeloma rather than prostate cancer metastasis, although the assessment is somewhat limited by the lack of intravenous contrast.2.Multilevel cervical and lumbar degenerative spondylosis, including severe spinal canal narrowing at L4-L5.


Instruction: Generate impression based on findings.

Input: 75-year-old female with pain and swelling, damage of right fifth MCP history of rheumatoid arthritis LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: Mild thickening of the extensor digiti minimi although no abnormal signal is evident. Otherwise the tendons are within normal limits.BONES: Small cyst in the head of the third metacarpal. No abnormal marrow signal.ADDITIONAL

Output: Mild soft tissue swelling on the ulnar surface of the fifth MCP joint. No specific findings of rheumatoid arthritis.


Instruction: Generate impression based on findings.

Input: 58 year-old the female status post craniotomy for epilepsy, complaint of headache There is post craniotomy change at the right temporal region. Images demonstrate subcutaneous soft tissue edema, small amount of extra axial fluid collection and pneumocephalus along the surgical incision, and patchy hyperattenuation blood and low attenuation air bubbles in the right temporal lobe surgical site. Hypodense signal in the right temporal lobe is likely a mixture of surgery cavity and vasogenic edema secondary to the surgical manipulation. All are expecting post surgery change. There is no evidence of large hematoma formation or hydrocephalus. The findings are similar to the MRI study done on 9/21/11.The gray-white matter differentiation is preserved in the remainder structure. However, the cortical sulci of the right cerebral hemisphere is effaced when compared to the contralateral side. There is minimal midline shift to the left approximately 3mm and mild compression of the right lateral ventricle. The findings are suggestive of parenchyma edema on the right, which is relative new when compare to previous MR study. In addition, there is small patchy hypoattenuation in the right frontal lobe cortex (image 18,19). This can be secondary to positioning, however, small ischemic change can not be completely excluded.There is large calcification along the anterior interhemispheric falx and the right frontal dura. The superior sagittal sinus appears hypoattenuation in density, which may secondary to blood loss. Except for craniotomy, the remainder calvarium is unremarkable. Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: 1. Effacement of the cortical sulci with preserved gray-white matter differentiation of the right cerebral hemisphere, minimal midline shift and partial compression of the right lateral ventricle. The findings are suggestive of parenchyma edema.2. Expected post surgery change as detailed above.3. There is small patchy hypoattenuation in the right frontal lobe cortex. This can be secondary to positioning, however, small ischemic change can not be completely excluded. Non-infusion CT is not sensitive to detect early parenchyma ischemia. If cortical ischemia is suspected on clinical setting, a MRI study may help further evaluate.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:8/14/1947)Reason: ro stroke History: ataxiaPROVIDER/ATTENDING NAME: RAYMOND ROOS RAYMOND ROOS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The AP dimension of the left eye is significantly longer than the right eye measures approximately 30 mm whereas right measures approximately 22 mm AP dimension. The left eye is somewhat irregular in shape.Incidental note is made of partial empty sella. Incidental note is made of hyperostosis frontalis interna.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and are medium-sized. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Right thyroid lobe is larger than the left thyroid lobe. The thyroid glands are heterogeneous in signal intensity.

Output: 1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for extracranial cerebrovascular occlusive disease.3.The left eye is deformed. Please correlate with ophthalmoscopic findings4.The thyroid gland is enlarged and heterogeneous suggestive of a multinodular goiter. Please note that MRA is not accurate in evaluation of the thyroid gland and additional investigation is necessary to confirm the of these findings if clinically appropriate. Please correlate with clinical history.