Instruction: Generate impression based on findings.

Input: 43 years Female (DOB: 2/11/1973)Reason: Hx of DLBCL, assess for lumbar lesions History: as abovePROVIDER NAME: JUSTIN P KLINE CARA ANN ROSENBAUM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.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.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are heterogeneous ill-defined lesions present at T6 and T7 associated with some peripheral enhancement. On at T6 is approximately 10 mm and the one at T7 approximately 12 mm in size. One at the left posterior lateral aspect of T1 measures 7 mm. One at the right posterior lateral aspect of T5 measures 8 mm.Findings raise the question of hilar adenopathy. Lymph nodes are identified within the mediastinum.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is disc desiccation present at L4-5 and L5-S1.There is a heterogeneously enhancing lesion present at L1 measuring approximately 16 x 13 mm in sagittal dimensions. It is bright on T2 and does not suppress on inversion recovery.There is an enhancing intrathecal lesion present at the right lateral recess at L2-3 which involves the nerve roots. It measures approximately 10 x 6 mm in axial dimensions and is associated with some enhancement of the involved nerve roots.Some patchy foci of enhancement are present in the sacrum and iliac bones associated with patchy marrow replacement. This involves the left sacral alla predominantly and to a lesser degree the adjacent iliac bones.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a small right paramedian disc protrusion present at this level which mildly impresses on the nerve root at the right lateral recess but does not efface the fat surrounding it.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is a leptomeningeal-based lesion present within the lumbar spinal canal at the right lateral recess at L2-3 which is associated with enhancement of the adjacent nerve roots. This is suspicious for leptomeningeal involvement of disease. In this case lymphoma could potentially be a cause.2.There are multiple patchy lesions present in the thoracic and lumbar spine at T1, T5, T6, T7, L1 as well as some patchy lesions in the sacrum. The underlying cause is unclear. The possibility that this is related to lymphoma is suggested.3.There are findings suggestive of hilar lymphadenopathy as well as mediastinal lymphadenopathy as clinically appropriate a CT of the chest may help further assess this.


Instruction: Generate impression based on findings.

Input: No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size for age. There is symmetric T2 hyperintense signal involving the bilateral hippocampi. Brain parenchymal volume is within normal limits for age.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Again seen are small cystic lesions in the nasopharynx which may represent small mucous retention cysts or Tornwaldt cyst.

Output: 1. No structural lesions are appreciated to suggest seizure focus. No intracranial mass or abnormal enhancement. 2. There is mild symmetric T2/FLAIR hyperintensity in the bilateral hippocampi without significant volume loss and similar to prior from 11/18/2013. No clear findings of mesial temporal sclerosis. 3. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 26 years Male (DOB:3/26/1990)Reason: hx of brain tumor s/p resection p/w HA, dizziness; eval for tumor recurrence, increased ICP History: HA, dizzinessPROVIDER/ATTENDING NAME: MURRAY J KEENE DAVID HOWES The patient status post right parietal craniotomy for removal of a right parietal lobe neoplasm. There is encephalomalacia involving the right parietal lobe and the right cuneus as well as a small portion of the right lingual gyrus associated with ex vacuo effect on the right lateral ventricle. There is a couple punctate foci of signal loss at the area of encephalomalacia. Some nodular enhancement is present at the surgical site. These are unchanged compared to the previous examThere is nodular enhancement present within the right internal auditory canal measuring 6 x 5 mm axial dimensions which previously measured similar dimensions. There are small foci of signal loss and susceptibility imaging in the lateral ventricles especially along the frontal horns as well as in the fourth ventricleThere are several punctate foci of signal loss and susceptibility in the subcortical white matter of the left cingulate gyrus and left parietal lobe.Ventriculostomy tube courses through the right parietal lobe into the trigone of the right lateral ventricle and has its tip in the temporal horn of the right lateral ventricle. Its tip is embedded into the right hippocampus. As a punctate focus of susceptibility effect at the tip of the ventriculostomy tube in the right hippocampus.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 mucous retention cyst in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post right parietal lobe surgery. There is encephalomalacia centered in the right parietal lobe. The appearance of the surgical bed is stable compared to prior exams2.Ventriculostomy tube is present in the right lateral ventricle. Its tip is located in the right hippocampus. The lateral ventricles are stable.3.Stable right internal auditory canal lesion suspicious for schwannoma.


Instruction: Generate impression based on findings.

Input: cT1N0 nasopharynx squamous cell carcinoma treated with radiation therapy. There are post-treatment findings in the neck. There has been interval decrease in size of the right posterior nasal cavity mass, which now measures up to approximately 6 mm, previously 26 mm. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is elevated T2 signal in the trapezius muscles bilaterally, which may be due to denervation effects. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with interval decrease in size of the nasal cavity mass.


Instruction: Generate impression based on findings.

Input: There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. The basal cisterns are patent and no obstructing lesions are identified. There is patchy, scattered periventricular white matter FLAIR and T2 signal abnormality, likely related to small vessel ischemic disease. Moderate supratentorial and infratentorial parenchymal volume loss. The lateral, third, and fourth ventricles are prominent and size. There is no diffusion weighted abnormality to indicate acute ischemic stroke. There is no susceptibility weighted artifact to suggest hemorrhagic lesion. There are no areas of abnormal enhancement. The major intracranial vascular structures enhance normally.

Output: 1.No abnormal parenchymal or meningeal enhancement to suggest intracranial metastatic disease.2.There is ventriculomegaly which is at least predominantly related to moderate global parenchymal volume loss. Component of communicating hydrocephalus/NPH is not excluded and can be correlated with clinical findings.3.Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of cervical cancer status post right colectomy. Recent transabdominal cerclage. Assess for recurrent disease. PELVIS: UTERUS, ADNEXA: Post surgical changes from trachelectomy. There is no evidence of recurrent mass lesion. The uterus is normal in size and morphology. The adnexa are unremarkable.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy. There is a stable mildly enlarged left inguinal lymph node measures 1.5 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the low anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Post surgical changes from trachelectomy and cerclage without evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: A 21 year old female with a history of Trisomy 21, left dominant unbalanced AV septal defect with hypoplastic right heart, over-riding AV valve, and bilateral SVC. At age 2, patient underwent AV septal defect patch closure, Left AV valve repair, and a modified Glenn shunt (right SVC to right PA). At age 8, the patient developed recurrent cyanosis and was found to have recurrent VSD. At that time, her Glenn shunt was taken down and her RPA and SVC were reconstructed. Her VSD and mitral valve were re-repaired. She had a cardiac MRI performed in 2009 and another in 2013. She is referred to cardiac MRI for further follow-up. Overall anatomy. See aboveLeft VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The LVEF is 49%, the LV end diastolic volume index is 105 ml/m2 (normal range 69+/-14), the LVEDV is 211 ml (normal range 110+/-24), the LV end systolic volume index is 54 ml/m2 (normal range 22+/-8), and the LVESV is 108 ml (normal range 35+/-13). There is hypokinesis of the apical lateral wall. The LV apical lateral wall has prominent trabeculations. There is no late gadolinium enhancement present to suggest underlying myocardial fibrosis, inflammation, or infiltration. No significant difference compared to the CMR of 2013. No intracardiac thrombus.Right VentricleThe right ventricle is mildly dilated with mildly reduced systolic function. There is abnormal motion of the apical free wall. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 114 ml/m2 (normal range 69+/-14), the RVEDV is 228 ml (normal range 110+/-24), the RV end systolic volume index is 59 ml/m2 (normal range 22+/-8), and the RVESV is 119 ml (normal range 35+/-13). No significant difference compared to the CMR of 2013. Shunts. An ASD and VSD patch are noted. On first pass contrast imaging, there is no evidence of right to left or left to right shunting. There is evidence of a muscular VSD which has "spontaneously" closed. No evidence of Fontan anatomy. No significant difference compared to the CMR of 2013. Left AtriumThe left atrium is mild to moderately dilated (112ml). The left-sided SVC (see below) forms a "belt" around the mid-level of the left atrium, separating it into 2 portions. Three right pulmonary veins and two left pulmonary veins drain into the proximal portion of the left atrium and the effectively tunnelled to the distal portion of the left atrium. No significant difference compared to the CMR of 2013. Right AtriumThe right atrium is severely enlarged (136ml). The right atrium directly receives drainage from the right-sided SVC, left-sided SVC, coronary sinus, and a single IVC. The right-sided SVC has a stenosis with a minimum diameter of 10mm, just before entering the right atrium. No significant difference compared to the CMR of 2013. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Atrio-Ventricular valvesIt appears that there may have been a single over-riding Atrio-Ventricular valve, which was then reconstructed into two separate AV valves, with portions of the previous common Atrio-Ventricular valve indistinguishable from the VSD patch.The mitral valve is opens widely and has moderate to severe MR. The mitral valve leaflets are thickened.The tricuspid valve annulus is hypoplastic (diameter 29x35mm). The tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The maximum diameter of the ascending aorta is 20mm. There is no thoracic aortic aneurysm or thoracic aortic dissection. There is no coarctation of the aorta. Pulmonary Arteries The main pulmonary artery has an upper normal diameter (27mm). There are no proximal stenoses of the left and right pulmonary arteries; however, their caliber is small. The left pulmonary artery measures 10mm. The right pulmonary artery measures 10mm.PericardiumThere is no pericardial effusion or enhancement.Extracardiac FindingsThere is a midline sternotomy. Stable segmentation defect (butterfly vertebrae) of a mid thoracic vertebral body. The spleen measures 13 mm in craniocaudal dimension, upper limits of normal, stable.

Output: 1. No evidence of Fontan circulation. No evidence of residual ASD or VSD. No significant difference compared to the CMR of 2013.2. The left ventricle is mildly dilated with mildly reduced systolic function (LVEF 49%). There is hypokinesis of the apical lateral wall which is also thinned and associated with prominent trabeculation. There is no underlying myocardial fibrosis, inflammation, or infiltration. No significant difference compared to the CMR of 2013.3. The right ventricle is mildly dilated with mildly reduced systolic function (RVEF 48%). There is abnormal motion of the apical free wall.4. There is a persistent left-sided SVC which drains directly into the right atrium and forms a tightened "belt" around the mid level of the left atrium. No significant difference compared to the CMR of 2013.5. The right-sided SVC has a stenosis with a minimum diameter of 10mm, just before entering the right atrium. No significant difference compared to the CMR of 2013.6. The right atrium is severely dilated. No significant difference compared to the CMR of 2013.7. It appears that there may have been a single over-riding AV valve, which was then reconstructed into two separate AV valves. No significant difference compared to the CMR of 2013. 8. The mitral valve leaflets are thickened and somewhat distorted and there is moderate to severe mitral regurgitation. No significant difference compared to the CMR of 2013.9. The tricuspid valve annulus is hypoplastic (diameter 29x35mm). No significant difference compared to the CMR of 2013.10. The main pulmonary artery has an upper normal, the left and right pulmonary arteries are relatively small in caliber.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of uterine fibroids. Undergoing evaluation prior to uterine fibroid embolization. PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged measuring 14.2 x 12.3 x 10.4 cm. There are numerous leiomyomas. There is a single dominant ventral submucosal fibroid in the mid uterine segment which measures 9.1 x 9.2 x 8.4 cm. The next largest lesion is an intramural dorsal fibroid which measures 3.0 x 2.2 x 2.7 cm. The postcontrast images show mild heterogeneous arterial enhancement of the fibroids which is less than the adjacent endometrium.Endometrium is distorted by the underlying fibroids but is otherwise unremarkable.A 9 mm simple cystic focus in the right labia majora compatible with a bartholin duct cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple uterine fibroids as described. There is mild heterogeneous arterial enhancement of the fibroids which is less than the background myometrium.


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with hemoptysis, innumerable opacities on chest x-ray, extensive smoking history. Within the limitations of a motion degraded examination, the following observations are made.No restricted diffusion is seen. Scattered foci of white matter T2 hyperintensity are seen. The left basal ganglia is particularly affected. No evidence of edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology. Opacification of the right sphenoid sinus is demonstrated.

Output: Within the limitations of a motion degraded examination, no definite evidence of intracranial metastatic disease, infection or any other acute abnormality is noted. Findings are seen compatible with chronic microvascular and lacunar ischemic disease.


Instruction: Generate impression based on findings.

Input: MS compare to prior evaluate for progressionSigns and Symptoms: restless legs and tingling in legs MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular white matter lesions present and several subcortical white matter lesions which have been identified on prior exam from 2008 and do not appear to have changed. Other lesions in the corpus callosum were also present on the prior exam and also appear relatively stable. A small lesion along the ventral aspect of the medulla was also present on the prior exam.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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. A lesion along the right posterior lateral aspect of the spinal cord at the T1 vertebral body level was also present on the prior exam and has not changed. Another one at the left posterior lateral aspect of the spinal cord at the C4-5 disc space level vertebral body level was also present on the prior exam and is unchanged. One at the right posterior lateral aspect at C3-4 was not clearly visualized on the prior 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.Since the prior examination lesions identified within the brain parenchyma appear to be stable. These are nonspecific but can be explained by demyelination.2.There are multiple lesions scattered throughout the cervical spinal cord compatible with demyelination. Since the prior exam the majority of the lesions identified on the prior exam are also identified on the current exam however can't appears to be a new right sided lesion at the C3-4 level.


Instruction: Generate impression based on findings.

Input: Full term female with meconium aspiration, perinatal depression treated with cooling protocol. There is apparently a small area of mildly restricted diffusion in the left corona radiata and anterior limb of the left internal capsule, perhaps with minimal T1 hyperintensity in parts of this area. The corpus callosum is borderline thin, but there is otherwise an expected degree of myelination. There are several small scattered areas of T1 hyperintensity along the posterior cerebral convexity subdural spaces bilaterally. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. The visualized mastoid air cells are clear. There is mild prominence of the left lacrimal sac. The orbits are otherwise unremarkable.

Output: 1. Apparent small area of mildly restricted diffusion in the left corona radiata and anterior limb of the left internal capsule may represent a perinatal infarct.2. Several small scattered areas of T1 hyperintensity along the posterior cerebral convexity subdural spaces bilaterally likely represent subacute hemorrhages. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of HIV/AIDS. Left-sided weakness and altered mental status. A punctate focus of restricted diffusion with associated FLAIR hyperintensity is visualized along the right paracentral lobule indicating a very small region of acute infarct. There is no mass effect in this area or evidence of edema. There is no evidence of intracranial hemorrhage.A couple of scattered punctate nonspecific foci of signal susceptibility abnormality are noted. There is an unchanged old lacunar stroke in the right thalamus, encephalomalacia in the left peritrigonal region, and diffuse patchy periventricular and subcortical white matter T2/FLAIR signal abnormality which are stable compared to prior exams. 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.Again seen is a deformity of the anterior and lateral walls of the left maxillary sinus which was also present on prior studies and better described on the previous CT.

Output: 1.Punctate focus of restricted diffusion in the right paracentral lobule indicating a very small acute infarct. There is no significant edema, abnormal enhancement or mass effect in this region.2.Other underlying white matter changes are stable compared to prior exams.


Instruction: Generate impression based on findings.

Input: Dysarthria and anarthria [R47.1], Reason for Study: ^Reason: please rule out acute infarct History: new dysarthria in known vasculopath There is focal restricted diffusion area on the left frontal lobe precentral gyrus without evidence of hemorrhagic conversion indicating acute ischemic infarction.Underlying brain shows multiple scattered T2/FLAIR high signal intensities on bilateral centrum semiovale and periventricular white matter indicating non specific small vessel ischemic disease.There is susceptibility lesion on the right periventricular white matter indicating prior hemorrhagic lesion. Scattered susceptibility lesions on bilateral insular and right thalamus suggest petechial hemorrhages or calcifications.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Acute ischemic infarction without hemorrhagic conversion on the left frontal lobe precentral gyrus.2. Underlying brain shows non specific small vessel ischemic disease.3. Chronic hemorrhagic lesion on the right periventricular white matter.


Instruction: Generate impression based on findings.

Input: 52 years Female (DOB: 8/30/1963)Reason: ? Disc herniation; neck and arm pain History: painPROVIDER/ATTENDING NAME: LEWIS L SHI LEWIS L SHI The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal . There are uncovertebral osteophytes present bilaterally associated with disc material and narrowing of the neural foramina bilaterally with mild encroachment of exiting nerve roots bilaterally.At C5-6 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present bilaterally associated with disc material and narrowing of the neural foramina bilaterally with encroachment of exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a perineural cyst present in the right neural foramen at this levelAt C7-T1 there is no significant compromise to the spinal canal. There is a diffuse disc bulge present at this level associated bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots bilaterally at C6-7, C7-T1 and to a lesser degree C4-5.


Instruction: Generate impression based on findings.

Input: Clinical question: Cerebral edema. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. No evidence of any new findings since prior study. Considering provided clinical date of bone these last two CT examinations and negative CTs of the brain follow with an MRI is recommended.Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Status post right knee arthroscopy microfracture of medial femoral condyle and trochlea. MENISCI: There is fragmentation of the body of the lateral meniscus with a prominent horizontal tear extending from the body into the anterior horn. The posterior horn of the medial meniscus appears small, which likely relates to prior partial meniscectomy. Abnormal fluid signal between the medial meniscus and MCL may also be related to previous procedure.ARTICULAR CARTILAGE AND BONE: Marrow signal abnormality at the lateral femoral condyle is increased in prominence from the prior study, with overlying cartilage thinning with small focal full-thickness defect. There is diffuse cartilage thinning elsewhere in the medial and lateral compartments, without additional full-thickness defect identified. There is a full-thickness cartilage defect at the femoral trochlea near the apex measuring up to 7 mm, with underlying mild marrow signal abnormality which may in part relate to prior microfracture procedure. Patellar cartilage is grossly intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Tear of the body and anterior horn of the lateral meniscus. Changes compatible with prior partial meniscectomy of the medial meniscus.2. Focal cartilage defects involving the lateral femoral condyle and the trochlea with additional mild scattered cartilage thinning as above.


Instruction: Generate impression based on findings.

Input: There is a large enhancing mass with heterogeneous T2 hyperintensity and intense heterogeneous enhancement filling the left maxillary sinus and extending medially into the left nasal cavity. There is mass effect on the left middle and inferior turbinates. The mass measures approximately 5.2 x 5.3 x 5.2 cm in the AP, transverse, and craniocaudal dimensions. There is minimal bulging of the left orbital floor without evidence of intraorbital extension. Areas of osseous expansion and dehiscence are better seen on recent CT. Particularly large osseous defect involving the floor of the left maxillary sinus measures up to 2.3 cm in the transverse dimension. No intracranial extension is evident. There is osseous bulging posteriorly of the posterior wall of the left maxillary sinus without findings to suggest tumor invasion into the left masticator space. Minimal opacification of the bilateral anterior ethmoid air cells. Paranasal sinuses are otherwise clear.Visualized brain parenchyma is unremarkable. No intracranial mass or mass effect. No evidence of infarct. No extra-axial collections. No hydrocephalus. No abnormal parenchymal or meningeal enhancement in the brain.MRA neck demonstrates separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion in the neck. Visualized intracranial circulation is grossly patent.MRA images of the neck only partially include the region of the left maxillary sinus tumor. However no large feeding artery is evident.

Output: 1. 5.2 x 5.3 x 5.2 cm left maxillary sinus mass compatible with known neoplasm. There is medial extension into the left nasal cavity. No intraorbital or intracranial extension. Areas of osseous expansion from remodeling as well as dehiscence better appreciated on recent CT. There is particular osseous defect of the left maxillary sinus floor measuring up to 2.3 cm in the transverse plane.2. MRA neck demonstrates patency of the vasculature. Note MRA neck images only partly include region of the maxillary sinus tumor but demonstrate no obvious large feeding artery within the field-of-view. Conventional MRI sequences which do include the left face demonstrate no large flow voids in this region, but if clinically warranted further imaging with CTA or MRA centered at the left maxillary sinus may be considered.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, with history of benign brain tumor, hearing malformation, spina bifida, and tethered cord. Follow-up for worsening symptoms. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. Parenchymal enhancement is within normal limits.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage The ventricular system is normal in caliber and morphology. Findings related to Chiari decompression are seen including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space remains well expanded at this level and the cerebellar tonsils are neither crowded nor peglike. CSF flow is seen through both the anterior and posterior aspects of the foramen magnum, similar to prior. There is minimal deformation of the dorsal surface of the medulla which may reflect prior tumor at this location. There has been no significant interval change.C-spine:Straightening of the cervical lordosis may be positional. No significant malalignment is seen. Vertebral body height and morphology are within normal limits. No marrow replacement or marrow edema is seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No spinal canal stenosis or neuroforaminal narrowing is detected.L-spine:Surgical findings are redemonstrated including multilevel laminectomy beginning at L2 and extending down into the sacral region. The thecal sac is expanded from L3 down, similar to the prior exam. There remains a small amount of fatty material along the posterior aspect of the thecal sac at the S1 level which is stable.The distal spinal cord remains very closely apposed to the posterior aspect of the thecal sac from the L2 level down. At lower levels the cord spreads and adheres along the posterior thecal sac and becomes inseparable from numerous septations and presumed areas of scar tissue. The overall appearance of these findings has not significantly changed.Spinal alignment is anatomic. Vertebral body morphology is within normal limits. No marrow replacement or marrow edema is suspected.No new intraspinal lesions are seen. The spinal canal and the neural foramina remain widely patent.The appearance of a skin dimple within the left aspect of the posterior soft tissues at approximately L4-5, along with an associated somewhat curvilinear tract which extends more deeply to the paraspinal tissues, is unchanged.

Output: 1. Redemonstration of findings related to Chiari decompression. The appearance of the tissues at the foramen magnum is stable. CSF flow is present along both the ventral and dorsal aspects of the foramen magnum.2. Minimal residual deformation of the dorsal medulla, at the site of prior tumor, is unchanged. No evidence of new tumor growth is seen.3. Evaluation of the cervical spine is otherwise unremarkable.4. Redemonstration of findings related to tethered cord and surgical correction in the lumbar spine. There has been no significant interval change in the appearance of these findings.


Instruction: Generate impression based on findings.

Input: Reason: rule out RTC tear History: pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is no significant fluid within the subacromial subdeltoid bursa. Mild osteoarthritic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. No fluid-filled labral tear is evident within the limitations of this non arthrogram study.BICEPS TENDON: There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect a mild tenosynovitis. There is minimal intermediate signal intensity within the intra-articular portion of the long head of the biceps which may reflect a mild tendinosis, however, the tendon itself appears intact.ADDITIONAL

Output: 1. Findings suggestive of a mild tenosynovitis and tendinosis of the long head of the biceps. No evidence of a full-thickness rotator cuff tear or retraction.2. Mild osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: assess for extent of ischemia, R ICA ischemia History: LUE weakness Multifocal various sized restricted diffusion areas on the right frontal, parietal, temporal as well as basal ganglia including the caudate nucleus indicating acute ischemic infarct.On the right cerebellar hemisphere, there is a linear restricted diffusion which also indicates acute ischemic infarct.There is no evidence of acute hemorrhagic lesion including evidence of hemorrhagic conversion.There are localized signal voids of subgaleal area on the right frontal lobe vertex, this is corresponding to multiple calcific densities identified on CT scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Right maxillary sinus mucosal thickening with retention cyst.

Output: 1. Multifocal acute ischemic infarcts involving right cerebral and cerebellar hemisphere as described above.2. No evidence of acute hemorrhagic lesion including hemorrhagic conversion.


Instruction: Generate impression based on findings.

Input: Male 70 years old Reason: 70 History: PSA 9.6. Gleason 3+ 4 prostate cancer. Positive perineural invasion. PELVIS:PROSTATE: Intrinsic T1 hyperintense signal within the prostate gland consistent with hemorrhage. Prostate Size: 6.6 x 5.3 x 5.4 cm.Peripheral Zone: There is a 1.3 x 1.1 cm of T2 hypointense signal within the left prostatic apex (series 601, image 32) with a suggestion of mild hyper enhancement on postcontrast images. There is no definite correlate on diffusion weighted imaging however this may represent a focus of prostatic carcinoma. Central Gland: Enlarged and heterogeneous.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly prominent bilateral femoral lymph nodes measuring up to 1.0 cm in maximum short axis dimension.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral fat-containing inguinal hernias.

Output: 1.Possible focus of prostatic adenocarcinoma in the left prostatic apex. No evidence of extracapsular extension or seminal vesicle invasion.


Instruction: Generate impression based on findings.

Input: 68-year-old female status post ERCP for common bile duct stone removal. ABDOMEN:LUNG BASES: Small pleural effusions, partially visualized.LIVER, BILIARY TRACT: No focal hepatic lesions. Status post cholecystectomy with trace amount of free fluid in the gallbladder fossa. Mild central intrahepatic and proximal common bile duct dilation with the proximal common duct measuring up to 12 mm, unchanged since prior exam. No choledocholithiasis is evident.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts and other too small to characterize T2 hyperintense foci, likely additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastric bypass. Interval decreased distention of the excluded stomach. Percutaneous gastrostomy tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable dilation of the biliary tree when compared to prior CT. No choledocholithiasis is evident. Ampullary stricture cannot be excluded.


Instruction: Generate impression based on findings.

Input: Mental status changes, homicidal thoughts. Off Zoloft. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is no evidence of intracranial hemorrhage, mass, midline shift or extra axial fluid collection. The ventricles and basal cisterns appear symmetric.A fixation plate in the left periorbital region is noted which would not preclude the patient from getting an MRI. An old buckle fracture of the right zygomatic arch is again noted. There is partial opacification of the left maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable examination without acute intracranial abnormality. Small vessel ischemic disease, age indeterminate.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with remote history of parapharyngeal space cancer (1995), disease free until 04-2015 when a second primary left tonsillar cancer was detected (tentative staging T4N2c), status post induction chemotherapy. Assess for response. Evidence of prior left neck surgery is demonstrated. Soft tissue thickening with ill-defined associated enhancement within the left parapharyngeal space has not significantly changed even when comparison is made to an MRI from 2009.The immediate prior MRI examination dated 4/15/2015 contains limited sequences and as such an accurate comparison can only be made on the basis of fat-suppressed T2-weighted images. Given this limitation, a mild interval decrease in the thickness of the left oropharyngeal mucosa is seen. A reference measurement on today's examination yields 2 mm (image 15 series 9), while the same area on the prior examination measured proximally 5 mm in thickness. Mucosal thickening extending across the midline to the right has also improved to a similar degree.T2 hyperintensity involving the left pterygoid muscles and the left longus coli muscle is unchanged.A left level II lymph node, immediately subjacent to the region of prior mucoasal thickening, measures 6 mm short axis (image 14 series 9), stable dating back to 2009. Subcentimeter level Ia and Ib lymph nodes also show no significant interval change.No concerning mass or pathologic adenopathy is evident elsewhere in the neck. Bone marrow signal characteristics are within normal limits allowing for cervical spondylosis. T2 hyperintensity filling the left mastoid air cells and middle ear cavity is unchanged.

Output: Comparison with the prior MRI examination dated 4/15/2015 is limited to fat suppressed T2-weighted images. Given this limitation, there seems to have been an interval reduction in thickness of the left oro-pharyngeal mucosa.Soft tissue thickening and ill-defined enhancement within the adjacent left parapharyngeal space shows little if any significant change dating back to 2009 and may be related to the patient's remote history of cancer. T2 hyperintensity involving the left pterygoid and longus coli muscles is unchanged compared to the immediate prior examination and nonspecific, possibly related to ongoing therapy.No definite evidence of pathologic adenopathy is detected in the neck.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1:53

Output: Technically successful right hip arthrogram without complications.


Instruction: Generate impression based on findings.

Input: 56 year old female with focal liver lesion noted on prior CT scan. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour, fissural widening, and caudate lobe hypertrophy are compatible with cirrhosis. No suspicious focal lesions are identified. The region in segment 8 described on prior CT demonstrates increased signal on T2 and diffusion weighted images as well as delayed enhancement; imaging findings are compatible with an area of fibrosis secondary to cirrhosis rather than a focal lesion. Patent hepatic vasculature. Status post cholecystectomy with associated prominence of the common bile duct. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal cyst. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Gastrostomy tube balloon in the stomach. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver morphology with an area of fibrosis in segment 8 that corresponds to the abnormality seen on prior CT. 2.No focal lesions identified that meet criteria for HCC.


Instruction: Generate impression based on findings.

Input: 61 year-old female with a history of right mastectomy for high grade DCIS, followed by right breast reconstruction, left breast reduction, radiation and chemotherapy. Benign left breast biopsy in 2010. No new breast complaints. History of breast cancer in sister. There is scattered fibroglandular tissue in the left breast. Status post right mastectomy and reconstruction.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in either the left breast or the right reconstruction. Scattered enhancing foci are seen in the left breast, however no focus is uniquely suspiciously enhancing. A Hydromark clip is present in the central left breast, unchanged in position. Postreduction changes in the left breast are stable. No suspicious enhancing mass is seen.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: Right-sided weakness and paresthesia. There is severe degenerative disc disease at C6-7, and moderate degenerative disease at C5-6. There is mild (grade 1) anterolisthesis of C5 which is stable between flexion, extension, and neutral positioning. There is heterotopic ossification in the soft tissues posterior to the lower cervical spine. Note is made of a broken sternotomy wire and what is presumably an embolization coil overlying the upper thorax.

Output: Degenerative disc disease of the lower cervical spine with mild C5 anterolisthesis and no frank instability.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post stroke, rule out hemorrhagic transformation. Signs and symptoms: Aphagia. Nonenhanced CT of brain:A subacute nonhemorrhagic right frontal lobe cortical stroke with subtle associated mass effect on the adjacent cortical sulci is identified. This finding was poorly visible on prior CT study, however it was well identified on prior MRI.Subacute left posterior temporal -- occipital nonhemorrhagic cortical stroke is again identified and with no appreciable change. Extensive findings of small vessel disease. No evidence of any new foci of cortical stroke, hemorrhage, mass-effect is identified. Prominence of cortical sulci and ventricular system as well as in the folia of the cerebellum and vermis are again identified and with no change. Old lacunar infarct of pons is again identified.

Output: 1.Redemonstration of right frontal and left posterior temporal -- occipital nonhemorrhagic subacute cortical stroke.2.Advanced small vessel disease of indeterminate age.3.No evidence of acute new findings and in particular no evidence of breakthrough hemorrhage of above described subacute cortical strokes.


Instruction: Generate impression based on findings.

Input: Followup of spinal cord injury with re-tethered spinal cord at the site of his gunshot wound, status post surgery. There are postoperative findings related to multilevel lower thoracic posterior element resection, with fluid collections in the paraspinal soft tissues, along the incision plane. There is severe atrophy of the spinal cord at the T10 level. There are also areas of high signal in the spinal cord at the T11 level, where the spinal cord abuts the anterior aspect of the thecal sac. In addition, there is persistent clumping of the cauda equina nerve roots at T11-T12. There are bilateral pars interarticularis defects at L5 without spondylolisthesis. The vertebral column alignment is otherwise within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is multilevel degenerative spondylosis, but no significant spinal canal or neural foraminal stenosis. There are small bilateral pleural effusions. There is a probable right renal cyst.

Output: Recent postoperative findings in the lower thoracic spine with stigmata of gunshot wound injury, including severe atrophy of the spinal cord at the T10 level and areas of encephalomalacia in the spinal cord at the T11 level, where the spinal cord abuts the anterior aspect of the thecal sac, which is suggestive of persistent tethering. In addition, persistent clumping of the cauda equina nerve roots at T11-T12 also suggests the presence of adhesions.


Instruction: Generate impression based on findings.

Input: Ms. Messmacher is a 45 year old female with left breast lumpectomy in Aug 2016 for DCIS with negative final margins. She presents for MRI imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally.In the left upper outer breast, anterior depth, there are minimal postsurgical changes compatible with provided history of left breast lumpectomy. There is no abnormal enhancement identified in the lumpectomy bed or elsewhere in the left breast.There is no abnormal enhancement seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Expected postsurgical changes of the left breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with brain lesion. Preoperative evaluation. A heterogeneous, irregularly marginated rim-enhancing mass is present within the paramedian right frontal lobe. The enhancing lesion extends nearly from the brain surface to the level of the corpus callosum and right lateral ventricular ependyma. The size of the enhancing lesion and the degree of surrounding vasogenic edema appear to have decreased mildly which may reflect the influence of steroids. Nevertheless, substantial mass effect persists with subfalcine herniation and midline shift to the left, effacement of the right lateral ventricle and the left frontal horn, and entrapment of the remainder of the left lateral ventricle. As on the prior examination, the genu of the corpus callosum is abnormally T2 hyperintense and thickened with perhaps a blush of pathologic enhancement. Elsewhere, no definite pathologic enhancement is seen.

Output: Redemonstration of a rim-enhancing tumor in the paramedian right frontal lobe with significant associated edema and mass effect. Since the prior examination, the size of the enhancing lesion and the degree of surrounding edema have slightly improved which may reflect the influence of steroids.


Instruction: Generate impression based on findings.

Input: Patient used prophylactic antibiotics before and after the procedure as prescribed. The patient received antibiotic prophylaxis with oral Ciprofloxacin 500mg and Vantin 200mg. The patient took 1 tablet of Ciprofloxacin 500mg the night before and morning of the procedure. The patient also took 2 tablets of Vantin 200mg the morning of the procedure. After the procedures, the patient will take 2 tablets of Ciprofloxacin 500mg and 2 tablets of Vantin 200mg.Following the discussion of the risks, benefits, and alternatives of the procedure, informed consent was obtained. DynaCad was used to localize right anterior mid gland lesion in the prostate at the site of the T2 hypointense enhancing lesion. Using the Dynatrim guidance system an 18-gauge MR- compatible needle was inserted into the right side of the prostate. Upon confirmation of the tip of the needles close to the suspected lesion, MR guided biopsy using an 18 gauge biopsy needle was performed and 3 cores were obtained.The cores were hand delivered to the pathology lab.The patient tolerated the procedure well and was discharged without any immediate complications.ESTIMATED BLOOD LOSS: Less than 5 cc.

Output: 1. Successful core-biopsies of the right anterior mid gland prostate gland peripheral zone lesion.


Instruction: Generate impression based on findings.

Input: 66-year-old female presents with a new onset headache, evaluate for space-occupying lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered periventricular and subcortical white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal mucosal thickening in the bilateral maxillary sinuses. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is left mastoid air cell fluid.

Output: 1. Nonspecific cerebral white matter abnormality may represent chronic small vessel ischemic disease. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Left mastoid air cell fluid may represent mastoiditis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Other specified congenital malformations of circulatory system [Q28.8], Reason for Study: ^Reason: history of CCM having numbness in left arm and leg History: numbness to left arm and leg, history of CCM Brain MRIThere are multifocal bihemispheric mulberry shaped intra-axial lesions with the surrounding hemosiderin deposition indicating multiple cavernous malformations. The largest lesion is located on the left caudate head and left anterior thalamic area measured around 19.3 mm x 22 mm. This lesion shows subtle internal enhancement on post enhancement scan.There is no evidence of developmental venous anomaly.The ventricles, sulci and cisterns are unremarkable except a slight mass effect toward the left lateral ventricle frontal horn. However, there is no evidence of ventriculomegaly. There is no evidence of acute ischemic lesion. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-spine MRI.COMPARISON: None.TECHNIQUE: The University of Chicago adult cervical spine MRI protocol without contrast was followed.

Output: 1. Multiple cavernous malformations involving bilateral hemispheres. The largest lesion is located at the left caudate nucleus head and anterior thalamus which is measured about 19.3 mm x 22 mm.2. Single superficial and posteriorly located spinal cord cavernous malformation without evidence of surrounding edema at the level of C3. The lesion is measured about 7.9 mm x 3 mm.


Instruction: Generate impression based on findings.

Input: Male, 60 years old, with HIV, hypertension, end-stage renal disease, presents with seizures. Image quality is significantly limited by motion artifact. No restricted diffusion is seen. No areas of significant parenchymal edema or mass effect are observed. Asymmetric susceptibility effect is evident in the right basal ganglia which may reflect hemosiderin staining or mineralization. In addition, there appears to be some volume loss of the right basal ganglia. T2 hyperintense foci in the left basal ganglia could represent either lacunar infarcts or prominent perivascular spaces. Periventricular T2 hyperintensity is seen. No large abnormal fluid collections are detected. Allowing for mild ex vacuo dilatation of the right frontal horn, the ventricular system is unremarkable.

Output: 1.Significantly limited examination due to motion artifact.2.No definite evidence of any acute intracranial abnormality.3.Hemosiderin staining and volume loss of the right basal ganglia may represent prior ischemia.4.Findings are noted compatible with chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: History of peritoneal mesothelioma. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again is a subcapsular T2 weighted hyperintense lesion in segment 6 of the liver (series 4/20) measuring approximately 1.6 x 0.7 cm without associated restricted diffusion or enhancement, compared to 1.9 x 1.0 cm previously. No additional focal liver lesion. No intra or extrahepatic biliary ductal dilatation.Mild bulging of the right hepatic dome is unchanged and is isointense to the remainder of the liver.SPLEEN: Normal splenic size without a focal lesion.PANCREAS: Pancreatic tail focus matches the spleen on all imaging sequences, compatible with a benign intrapancreatic accessory spleen. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change in the segment 6 benign appearing hepatic cyst.


Instruction: Generate impression based on findings.

Input: Left arm weakness and dizziness, evaluate for ischemia No diffusion restriction is seen to suggest acute ischemia. Increased FLAIR signal in the periventricular white matter and small foci in the subcortical white matter is compatible with mild small vessel ischemic disease. The CSF spaces are appropriate for the patient's stated age. The brain parenchyma is otherwise normal in signal intensity without mass or mass effect. Extracranial soft tissues are grossly unremarkable.

Output: MRI with limited sequences demonstrates no evidence of acute infarct. No intracranial mass or mass effect. Mild chronic small vessel ischemic disease again seen.


Instruction: Generate impression based on findings.

Input: Male, 70 years old, with numbness on the left side of the body. History of ruptured aneurysm. Evaluate for change in basilar outpouching. A slitlike hemosiderin stained cavity is redemonstrated spanning the right subinsular and basal ganglia regions, without significant interval change. A punctate focus of susceptibility along the posterior limb of the left internal capsule is unchanged as well.Scattered patchy periventricular and subcortical white matter T2 hyperintensities are again seen without significant interval change. No edema or mass effect is detected. No restricted diffusion is seen. No abnormal extra axial fluid collections are present. The ventricles are normal in size and morphology.Mild/moderate narrowing of the cavernous ICAs is again seen. The ACOM artery is prominent and within normal limits. A moderate focal stenosis of the left A1 segment is unchanged. The left ACA is also generally of smaller caliber than the right, a stable finding. Scattered mild focal stenoses are probably present in the MCA distributions, similar to prior.The right vertebral artery is dominant. The left vertebral artery primarily supplies the PICA. Mild irregularity of the basilar artery is again seen. A 2 mm medially directed apparent outpouching is redemonstrated from the basilar artery at approximately the origin of the left AICA. This finding has not significantly changed. The basilar tip and PCAs are unremarkable. A moderately sized right and small left PCOM artery are present.

Output: 1.Stable hemosiderin-stained slitlike cavity in the right subinsular and basal ganglia regions likely representing an old cerebral hemorrhage or hemorrhagic infarct.2.Scattered T2 hyperintensities are not significantly changed likely representing moderate chronic small vessel ischemic disease.3.2 mm outpouching from the mid basilar artery is unchanged.4.Scattered intracranial atherosclerotic disease is unchanged.


Instruction: Generate impression based on findings.

Input: 12 month old male with unilateral group D retinoblastoma status post to intra-arterial chemotherapy injections, evaluate disease status Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: Redemonstrated is minimally enhancing lesion that measures approximately 2 x 7 mm in transaxial imaging along the posterolateral aspect of the right globe with apparent episcleral irregularity. The right optic nerve appears to be intact. These findings are unchanged. The left orbit is unremarkable.

Output: 1.Stable subcentimeter right intraocular retinoblastoma with suggestion of possible episcleral extension. 2.No evidence of left orbital tumor.3.No evidence of intracranial tumor to suggest trilateral retinoblastoma.


Instruction: Generate impression based on findings.

Input: 86-year-old male with hyperreflexia and weakness on examination. Please rule out mass or stroke. Two areas of restricted diffusion are visualized within the right MCA territory. A right area of hyperintensity just adjacent to the right lateral ventricle in the right frontal cortex and a small focus just superior to the right frontal horn. There is minimal, if any, associated edema. The ventricles are within normal limits in size and configuration and there is no sulcal effacement. There is no midline shift. There is no intracranial hemorrhage. These areas demonstrate FLAIR/T2 hyperintensity, consistent with subacute rather than hyperacute stroke.There remains asymmetric expansion right greater than left of the postcentral sulci. There is minimal effacement of the right central gyrus. Given differences in technique, this is largely unchanged from prior CT scan. Additionally, there is diffuse volume and prominent ventricles loss likely related to advanced age.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Diffusely prominent sulci and ventricles are within normal limits for advanced age.Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Retained mucous cyst within the left maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial hemorrhage or mass effect.2. Two areas of diffusion restriction with associated T2/FLAIR abnormality are consistent with subacute stroke. Both of these lesions appear within the right frontal lobe and within the right MCA territory.3. Redemonstration of asymmetric expansion of the CSF spaces overlying the post-central sulci, right greater than left. These findings are unchanged from recent CT scan and likely represent chronic, rather than acute findings.


Instruction: Generate impression based on findings.

Input: Left temporal/insular anaplastic astrocytoma, status post surgery, radiation therapy/TMZ and 12 cycles of TMZ. There is a new punctate focus of diffusion hyperintensity in the left parietal subcortical white matter with associated FLAIR hyperintensity and mild enhancement. Redemonstrated is nonenhancing high T2 signal abnormality with gyral thickening in the left medial and anterior temporal lobe, amygdala and insular cortex. There is no new mass effect. There is an unchanged left thalamic developmental venous anomaly and adjacent T1 shortening and enhancement. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is diffuse low T1 marrow signal in the calvarium which is unchanged.

Output: 1. Stable lesion in the left medial anterior temporal lobe and insular cortex without evidence of tumor progression.2. New punctate focus of diffusion hyperintensity in the left parietal subcortical white matter with associated FLAIR hyperintensity and enhancement likely representing a tiny subacute infarct. Findings conveyed to Dr. Lukas by EPIC mail at the time of dictation.


Instruction: Generate impression based on findings.

Input: 33-year-old female with right ischium pain. Evaluate for right ischium pathology, previous right groin pain. BONE MARROW: There is bone marrow edema of the pubic symphysis. There is residual red marrow noted elsewhere.SOFT TISSUES: Soft tissues appear normal. The muscles and tendons about the pelvis appear normal.JOINTS: The hip joints and sacroiliac joints appear normal.ADDITIONAL

Output: Findings suggestive of pubalgia ('early sports hernia) as described above.


Instruction: Generate impression based on findings.

Input: Blurry vision and pituitary tumor. The lesion does not appear to exert mass effect upon the optic apparatus. There is enlargement of the pituitary gland, which measures up to 15 mm overall. There does not appear to be mass effect upon the adjacent optic apparatus. There is expansion of the sella with protrusion inferiorly into the sphenoid sinuses. The mass also protrudes slightly into the cavernous sinuses. In addition, the posterior pituitary bright spot is displaced superiorly and the pituitary stalk is deviated to the left. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is diffuse cerebral volume loss, with disproportionate involvement of the medial temporal lobes. There are multiple foci of cerebral white matter T2 hyperintensity. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: 1. A pituitary tumor may represent an adenoma, but is incompletely characterized due to the lack of intravenous contrast. The lesion does not appear to exert mass effect upon the adjacent optic apparatus.2. Diffuse cerebral volume loss, with disproportionate involvement of the medial temporal lobes, which may indicate Alzheimer's disease.3. Multiple foci of cerebral white matter T2 hyperintensity are nonspecific, but may represent the results of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Other benign neoplasm of connective and other soft tissue of unspecified site [215.9], Reason for Study: ^Reason: history of schwannoma History: history of schwannoma Redemonstration of prior T12-L2 laminectomies for the resection of schwannoma.There is no evidence of residual or recurrence of the tumor on this scan.There is focal protrusion of disc at the level of T10-T11 which abuts thecal sac, no change of the degree of protrusion since prior exam. There is focal high signal intensity within the spinal cord at the level of T12 on T2 weighted image indicating focal myelomalacia, no change since prior exam.Although there are some degenerative changes, the thoracic and lumbar spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the L1-L2 level. There is no evidence of abnormal enhancement, cord compression or mass. Mild degenerative changes such as disc dessication, diffuse bulging of disc were seen along the lumbar spine, no change since prior exam.

Output: 1. Post laminectomy status from T12 to L2, no unusual finding.2. No evidence of abnormal enhancement indicating residual or recurrent tumor on this scan.3. Focal disc protrusion at the level of T10-T11, no change since prior exam.4. Mild degenerative changes of lumbar spine, no change since prior exam.


Instruction: Generate impression based on findings.

Input: Cervicalgia. There is exaggeration of the normal cervical lordosis. No focal abnormal bone marrow signal. The visualized cord demonstrates normal caliber and signal intensity. There is multilevel mild-moderate loss of disc height at C5-6 and mild loss of disc height at C6-7 and C7-T1.C2-3: No significant central canal or neural foraminal stenosis.C3-4: Mild facet hypertrophy and left uncovertebral spurring results in mild left neural foraminal narrowing but no significant central canal stenosis.C4-5: Posterior disc osteophyte complex results in minimal central canal stenosis, and uncovertebral and facet hypertrophy with mild right and severe left neural foraminal narrowing.C5-6: Posterior disc osteophyte complex, eccentric to the right and uncovertebral hypertrophy results in moderate-severe bilateral neural foraminal narrowing and mild central canal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy results in moderate bilateral neural foraminal narrowing but no significant central canal stenosis.C7-T1: Posterior disc osteophyte complex, eccentric to the right without significant central canal or neural foraminal narrowing.

Output: Multilevel spondylosis within multilevel neural foraminal narrowing, and mild central canal stenosis at C5-6 as detailed above.


Instruction: Generate impression based on findings.

Input: 49-year-old female. Fibromatosis. Ovarian cysts. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: Mildly T2 hyperintense arterially enhancing lesions in segment 2 and 7 of the liver that retains contrast on delayed imaging, unchanged and most likely benign, possibly FNHs. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mass abutting the inferior aspect of the pancreatic body measures 7.1 x 4.3 x 7.7 cm, previously 7.1 x 5 x 7.7 cm (series 1002, image 41). Again, the mass is noted to encase and attenuate the SMV and SMA, which remain patent.BOWEL, MESENTERY: Two broad-based ventral hernias in the central and right abdomen containing unobstructed bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Compared to 2013 MRI, some of the multiple uterine masses have increased in size. Most of these masses have signal characteristics consistent with fibroids with the exception of a 5.5 x 3.9 cm well-defined T2 intermediate signal intensity lesion at the right aspect of the uterine fundus, which is indeterminate (series 13, image 37; previously measured 4.1 x 2.9 cm on 3/2013 MRI). Multiple nabothian cysts are noted, some with fluid-fluid levels.The endometrial cavity is distended to 1.8 cm in AP diameter, which is likely related to menstruation in a premenopausal woman.Bilateral ovarian cystic foci are most likely physiologic follicles; the largest follicle is in the left ovary measuring 3.7 cm. No internal septations or enhancing mural nodules to suggest malignancy.Trace free pelvic fluid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right Bartholin cyst.

Output: 1.Slight decrease in size of patient's known mesenteric based desmoid tumor.2.Indeterminate right fundal uterine mass, which has slowly increased in size from 3/2013. Further evaluation with pelvic ultrasound is recommended.3.Bilateral cystic foci in the ovaries are likely physiologic follicles.


Instruction: Generate impression based on findings.

Input: Thoracic spine: Alignment is anatomic. There are no fractures or subluxations. Marrow signal intensity is benign throughout. The spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. There are no masses. There are mild degenerative changes including mild disc bulges in the upper thoracic spine without significant central canal stenosis or neuroforaminal narrowing. There is T2 hyperintensity within the left lung measuring 7mm (T2 axial series 10 image 14), which may be lung nodule but not well evaluated on MR. Lumbar spine: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. Counting from the cervical spine down, there is stable mild anterolisthesis of L4 over L5 (L5 over S1 per numbering from below as done on prior study) and disc bulge with mild bilateral neuroforaminal narrowing without significant central canal stenosis. Moderate facet arthropathy of the lower lumbar spine. Small right mid-kidney cyst is noted.

Output: 1.No evidence of syrinx or thoracic cord signal abnormality as clinically questioned.2.Stable mild anterolisthesis of L5 on S1 (numbering done as on prior study) and disc bulge with mild bilateral neuroforaminal narrowing at this level. No significant spinal canal stenosis. 3.Moderate facet arthropathy in the lower lumbar spine.4.7 mm T2 hyperintensity in the left lung which may represent a lung nodule but not well assessed by MRI.


Instruction: Generate impression based on findings.

Input: Female, 73 years old, with worsening back pain. Trace anterolisthesis of L3 relative to L4 and L4 relative to L5 is again seen without significant change. Alignment is otherwise unremarkable.A subcentimeter focus of nonspecific marrow replacement within the L1 vertebral body shows no significant interval change. Marrow signal characteristics remain diffusely heterogeneous.Concavity of the L2 inferior endplate is similar to the prior examination. No adjacent marrow edema is seen.Mild edema is evident within the L3 vertebral body without significant endplate concavity or loss of vertebral body height.Since the prior examination, the L4 and L5 vertebral bodies demonstrate a mild generalized loss of vertebral body height. The L5 vertebral body demonstrates mild associated edema as well.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Facet arthropathy and ligamentum flavum thickening. Mild disc bulging. Mild generalized spinal canal narrowing with slight crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing which appears to be slightly progressed from the prior examination. Mild bilateral foraminal narrowing, unchanged. L4-5: Facet arthropathy. Ligamentum flavum thickening. Disc bulging. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L5-S1: No significant spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Since the prior examination, mild compression deformities have developed at L4 and L5. Also noted is new edema within the L3 vertebral body which could indicate an impending compression deformity.2.Chronic concavity of the L2 inferior endplate is seen without evidence of marrow edema.3.A subcentimeter focus of marrow replacement within the L1 vertebral body is unchanged and nonspecific. Likewise, diffuse marrow heterogeneity is again seen which, on its own, is nonspecific. However, given the development of multiple compression deformities over the prior examinations, the possibility of more widespread osseous myelomatous involvement should be considered.4.Degenerative disc disease is seen, most severely affecting the L2-3 and L3-4 levels where there is spinal canal narrowing and some degree of nerve root crowding.


Instruction: Generate impression based on findings.

Input: 19 year old male with a history of small bowel polyps complicated by intussusception status post small bowel resection. Somewhat suboptimal distention of the proximal small bowel limits evaluation for small polyps.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is gastroduodenal dilation to the level of the 3rd portion of the duodenum. Oral contrast is noted to pass beyond this point into the distal small bowel. No definite polyps are identified in the imaged portions of the small bowel or colon. PELVIS: Somewhat suboptimal distention of the proximal small bowel limits evaluation for small polyps.PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered mesenteric lymph nodes.BOWEL, MESENTERY: There is gastroduodenal dilation to the level of the 3rd portion of the duodenum. No definite polyps are identified in the imaged portions of the small bowel or colon. BONES, SOFT TISSUES: Note is made of multiple foci of metal susceptibility artifact in the soft tissues along the midline of the abdomen and pelvis, consistent with postoperative changes/clips.

Output: 1.Postoperative changes without definitive evidence of small bowel polyps, as clinically questioned. Further evaluation with a CT enterography should be considered to further evaluate for small bowel polyps, if there is continued clinical concern. 2.Gastroduodenal dilation to the level of the 3rd portion of the duodenum is nonspecific but has been described in patients with SMA syndrome. Alternatively, given the patient's surgical history, this could also represent an anastomotic stricture or adhesive disease and clinical correlation is indicated. Further evaluation with an upper GI fluoroscopic examination may be considered if clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass or demyelination. Signs and symptoms: Seizure. Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted images and without evidence of acute ischemic stroke.There is normal anatomical development/morphology of brain parenchymal. There is normal signal intensity of brain on MR I sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Negative post enhanced images of brain parenchyma, leptomeninges, calvarium, soft tissues of the scalp and bilateral orbits.

Output: Unremarkable pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Female, 3 years old, nonverbal with development delay and seizures, with a white matter lesion in the left frontal lobe on prior MRI. Please reevaluate. Again seen is ill-defined T2 hyperintense, T1 hypointense signal within the white matter along the lateral margin of the left frontal horn. Accounting for differences in technique, there has been no convincing interval change in the size or appearance of this abnormality. No definite abnormality of the overlying cortex is seen. On postcontrast images, there is no associated pathologic enhancement.Elsewhere, the appearance of the brain is unremarkable. No restricted diffusion is seen. No parenchymal edema or mass effect is detected. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. No pathologic parenchymal or extra-axial enhancement is seen.Paranasal sinus mucosal inflammation evident on the prior examination has resolved.

Output: Since the prior examination, there has been no significant or convincing interval change in the size or appearance of the ill-defined signal abnormality along the left frontal horn. No associated pathologic enhancement is seen. The differential diagnosis would continue to include chronic sequela of prior infection, inflammation or ischemia. The possibility of some form of focal cortical dysplasia is less likely given the normal appearance of the overlying cortex.


Instruction: Generate impression based on findings.

Input: History of squamous cell carcinoma of the cervix IB1 status post radical abdominal trachelectomy 8/7/14. More recently patient underwent partial bilateral salpingo-oophorectomy. 3/7/2016 endometrial curettage was negative for carcinoma. PELVIS:UTERUS, ADNEXA: Postsurgical changes from trachelectomy . The 4.5 x 4.1 cm in the sagittal plane. The adnexa are unremarkable with several follicles and a left ovarian cyst. No evidence of local recurrence in the trachelectomy bed.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with no evidence of recurrent disease or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: T4aN0 nasal cavity cancer s/p debulking 11/2014. Please eval extent of residual disease in comparison to MRI 1/2015. There are postoperative findings related to resection of a sinonasal mass with an subcentimeter enhancing lesion in the region of the olfactory recesses. There is also persistent slight epidural enhancement in the left olfactory groove. There are residual scattered secretions and mucosal thickening within the paranasal sinuses. There is a dural based lesion along the posterior falx cerebri that measures up to 3 mm in width, which is unchanged. There is diffuse cerebral volume loss. There are bilateral lens implants and staphylomatous deformity of the globes. There is no evidence of tumor extension into the orbits.

Output: 1. Postoperative findings related to resection of a sinonasal mass with an unchanged subcentimeter lesion in the region of the olfactory recesses that appears to have slight epidural extension along the floor of the anterior cranial fossa, which may represent residual tumor.2. A dural based lesion along the posterior falx cerebri that measures up to 3 mm in width is unchanged and may represent a meningioma.


Instruction: Generate impression based on findings.

Input: History of primary sclerosing cholangitis. Evaluate for cholangiocarcinoma. History of left hepatectomy for suspected cholangiocarcinoma with negative pathology and cholecystectomy. ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy with cholecystectomy. The right hepatic lobe is normal in morphology and size without a discrete lesion. The hepaticojejunostomy anastomosis appears patent. There is moderate irregular intrahepatic biliary ductal dilatation appearing similar to the prior study without a new dominant stricture or discrete lesion. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable right intrahepatic biliary ductal dilatation without a discrete obstructive mass.


Instruction: Generate impression based on findings.

Input: Pain in knee popping. Check for ligamentous injury MENISCI: The lateral meniscus is intact and unremarkable. The medial meniscus however demonstrates pronounced globular signal and loss with mild extrusion of the body of the meniscus extending into the posterior horn. Relative preservation of the anterior horn/aspect. Although there is no definite distinct linear component, a somewhat more oblique tear through the body extending to the inferior articular surface is suggested. Both menisci remain well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: Moderate osteophytic changes with small subchondral cysts and osteophytes involving both medial and lateral compartments, with underlying mild edema. Minimal thinning of the lateral compartment, however near complete cartilaginous loss in the medial compartment, specifically overlying the condylar surface with underlying changes. Or mild to moderate changes are also observed in the patellofemoral compartment with a small fissural shallow cleft observed in the lateral facet (image 22 series 1301).LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Medial meniscal tear and destruction with underlying moderate to marked osteoarthritic changes, as described.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:9/27/1971)Reason: MS, f/u progression History: HeadachesPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical white matter lesions present. When compared to the November 2015 exam these have not changed.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: Periventricular and subcortical white matter lesions of a moderate degree are present which are stable when compared the prior exam. This patient has a reported history of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 56 year old female with history of left buttock abscess status post I&D 2 weeks ago now with increased drainage in the setting of chronic immunosuppression on steroids and a history of total hip replacement with revision (2002, 2012). Assess extent of abscess cavity and possible joint involvement. Evaluation of the hip and surrounding soft tissues is limited due to metallic susceptibility artifact resulting from the patient's total arthroplasty and acetabular reconstruction. There is a nonenhancing collection of heterogeneous signal intensity on T2-weighted images along the medial margin of the left gluteus maximus muscle that extends through the skin best seen on image 33 of series 1102 which presumably represents residua of the patient's known draining buttock abscess perhaps containing packing material. The collection is approximately 4 cm x 1 cm in transverse dimension and 6-7 cm in oblique craniocaudal dimension tracking from the skin towards the ischial tuberosity; however we see no signal abnormality within the ischium to indicate osteomyelitis. There is surrounding soft tissue inflammation involving the skin, subcutaneous fat and the gluteus maximus muscle. This inflammation also extends anteriorly and laterally to involve the quadratus femoris and adductor muscles of the hip but we see no direct communication with the hip joint itself.The conjoined tendon of the hamstrings is avulsed from its origin on the ischial tuberosity and there is a tear of the proximal semimembranosus tendon such that only a few strands are seen extending to the ischium. Edema extends inferiorly along the hamstrings however this may reflect a chronic tear rather than an acute tear.There is bandlike signal abnormality tracking through the subcutaneous fat of the lateral hip region which likely represents a scar related to the patient's prior surgery. There is edema in the adjacent subcutaneous fat. Small collection of near-fluid signal intensity with thin enhancing margins and septa in the soft tissues along the cranial extent of the hardware measuring 2 cm x 1 cm x 3 cm which we suspect likely represents a small seroma, with a small abscess considered less likely. There is atrophy of the left gluteus minimus and medius muscles as well as fatty atrophy of the left iliopsoas muscle.There is a collection of heterogeneous high signal intensity on T2-weighted images along the medial aspect of the proximal femur extending inferiorly off the field of view of the study. It is surrounded by a rim of low signal intensity which corresponds to ossification seen on recent radiographs. We suspect that this finding represents a prior subperiosteal hemorrhage with subsequent bone formation rather than representing an infectious process as it does not appear to communicate with the aforementioned abscess cavity.A few mildly enlarged inguinal lymph nodes are noted on the left. Evaluation of the right hip on the large field-of-view images is limited by metallic susceptibility artifact resulting from the patient's total hip arthroplasty. Note is made of heterotopic ossification along the gluteal tendons. Degenerative arthritis affects the visualized lower lumbar spine.

Output: 1.Postoperative changes as described above.2.Draining buttock abscess cavity and surrounding inflammation as described above. We see no evidence to suggest joint involvement.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: 22 year-old female with elevated INR and dilated pupils. Evaluate for brain hemorrhage, status post cardiac arrest. Focal hypodensity in the right cerebellar hemisphere is of unclear etiology. There is no evidence of intracranial hemorrhage, mass, or midline shift. Gray-white differentiation is preserved. The ventricles and basal cisterns are normal in size and configuration.The skull and other osseous structures are diffusely thickened and heterogeneous in appearance, which was noted on 2009 MRI. Maxillary sinuses, sphenoid sinuses, ethmoid air cells, and mastoid air cells are opacified bilaterally. Stranding in the soft tissues of the face is consistent with anasarca. Linear calcifications scattered throughout the scalp likely represent vascular calcifications.ET tube is noted.

Output: 1.No evidence of intracranial hemorrhage, hydrocephalus, mass effect or edema.2.Bilateral paranasal sinus and mastoid air cell opacification.3.Focal hypodensity in the right cerebellum is of unclear etiology or significance; MRI is recommended for further characterization if clinically indicated.4.Diffuse thickening and heterogeneity of osseous structures is nonspecific but may be related to systemic process such as renal osteodystrophy, hyperparathyroidism, or chronic severe anemia.


Instruction: Generate impression based on findings.

Input: Clinical question: CNS Nocardia. Signs and symptoms: Persistent personality changes. Pre and post enhanced brain MRI:Examination demonstrates no evidence of an acute or convincing evidence of new finding since prior exam.A well-demarcated T2 hypointense mass in the splenium of corpus callosum, extensive surrounding vasogenic edema and with uniform enhancement(presumably Nocardia) is again identified. Multiple measurements of mass on nonenhanced as well as postcontrast images demonstrate no change to possible minute interval decrease since prior exam.Extensive surrounding FLAIR hyperintensity/edema demonstrate no change.Tiny cluster of enhancement in the right paramedian posterior pons with subtle FLAIR hyperintensity also in the identical to prior exam.Multiple patchy foci of FLAIR hyperintensity on the in the periventricular and subcortical white matter of bilateral cerebral hemispheres some with susceptibility signal changes remain nearly identical to prior exam and without abnormal enhancement. Findings are likely representing mild degree of chronic small vessel ischemic strokes. There is no detectable additional foci of abnormal parenchymal or leptomeningeal enhancement.The ventricular system remains within normal size and with normal pattern of enhancement.

Output: 1.No evidence of an acute or convincing evidence of new finding since prior study.2.Focus of enhancement in the splenium of corpus callosum presumed Nocardia demonstrate no change to possible minute decreased size since prior exam.3.Stable tiny cluster of enhancement in the right para median posterior pons since prior exam.4.Stable FLAIR hyperintensity/vasogenic edema surrounding the lesion in the splenium of corpus callosum.5.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes demonstrate no change.


Instruction: Generate impression based on findings.

Input: Reason: history of prostate cancer s/p surgery in 4/2015, now with PSA recurrence; please evaluate for recurrent disease History: prostate cancer with biochemical recurrence after prostatectomy. History of Gleason 9 cancer with perineural invasion and extracapsular extension. Lymph node negative. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy. No measurable residual or recurrent disease.Central Gland: Status post prostatectomy.Seminal Vesicles: Not present.Extracapsular Extension: Not applicableBLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac nose measures 0.9 x 0.9 cm (1701/41), previously 0.8 x 0.8 cm. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post prostatectomy without measurable disease.2.Subcentimeter pelvic nodes lymph nodes are not significantly changed.


Instruction: Generate impression based on findings.

Input: TIA with left hand numbness Noncontrast CT scan brain demonstrates periventricular hypodensity which given the patient's age and history most likely are present small vessel ischemic disease. There is no evidence of acute cortical infarct. If ischemia remains of clinical concern MRI would allow more sensitive evaluation of possible acute ischemic changes.Bone windows demonstrate opacification of a single posterior right ethmoid air cell. No other bony abnormality is identified.

Output: Small vessel ischemic disease with no evidence of acute ischemic change. If there is clinical concern MRI would allow more sensitive evaluation.


Instruction: Generate impression based on findings.

Input: Neck pain, prior cervical fusion There are postsurgical changes of remote laminectomy from C4 to C6 with posterior spinal fusion. Hardware and osseous fusion are better appreciated on prior CT. Craniovertebral junction appears within normal limits aside from degenerative changes at the median atlantoaxial joint and mild retroodontoid soft tissue. The cervical vertebral bodies are appropriate in height. There is mild straightening of the cervical spinal curvature as well as minimal retrolisthesis of C5 on C6, which appears partially fused at the intervertebral level based on prior CT. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Mild spinal canal stenosis related to small disc osteophyte complex and ligamentum flavum thickening. There is also mild right-sided neural foraminal narrowing related to uncovertebral hypertrophy. Neural foramina are otherwise patent.C3-4: Spinal canal is well decompressed. There is mild to moderate left and mild right neural foraminal stenosis related to uncovertebral hypertrophy.C4-5: Spinal canal is well decompressed. Neural foramina are patent.C5-6: There is a disc osteophyte complex which contacts the ventral aspect of the cord. Spinal canal is otherwise decompressed at this level. There is mild right neural foraminal stenosis.C6-7: There is a small disc osteophyte complex with small central protrusion as well as mild ligamentum flavum thickening contributing to mild anterior displacement of the cord and overall fairly mild narrowing of the thecal sac. There is moderate left and mild right neural foraminal stenosis. C7-T1: There is mild anterior displacement of the cord related to prominent facet arthropathy and ligamentum flavum thickening. There is also uncovertebral hypertrophy. There is mild bilateral neural foraminal stenosis. Minimal narrowing of the spinal canal.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes of laminectomy and posterior fusion from C4 to C6. There is fairly mild spinal canal narrowing at the C2-C3, C6-C7, and C7-T1 levels. There is multilevel neural foraminal stenoses as described above.2. Spinal hardware and osseous fusion better assessed on prior neck CT dated 3/5/2015.