Instruction: Generate impression based on findings.

Input: Female, 75 years old, with left sixth nerve palsy and known cavernous sinus mass. Additional patient history includes multiple myeloma. There is a 3.1 x 2 7 x 2.5 cm well-defined, homogeneously enhancing lobulated mass with intermediate T1 and T2 signal centered on the left petroclival ligament. The lesion extends into the sella, left cavernous sinus and Meckel's cave, left middle cranial fossa and left prepontine cistern. A normal pituitary gland is not identified separately, though the pituitary stalk deviates slightly to the right as it enters this mass . There is enlargement of the sella turcica with infiltrative changes to the left aspect of the tuberculum sella and anterior superior aspect of the clivus. The mass completely encases a majority of the cavernous segment and part of the distal petrous segment of the left internal carotid artery, which are mildly narrowed. There is mild mass effect on the left aspect of the pons. The left cranial nerve VI is not well seen at the level of the exiting right cranial nerve VI. The mass also likely impinges encases the cisternal trigeminal nerve. The fourth ventricle is patent. There is no evidence of mass effect on the optic chiasm or other cranial nerves. Mild mass effect is present in the medial aspect of the left inferior anterior temporal lobe. No additional enhancing lesions are identified. The internal auditory canal structures appear normal. No abnormal fluid signal is demonstrated in the middle ear cavities, mastoid air cells or external auditory canals. Generalized cerebral volume loss is noted in the visualized portion of the brain. There is no evidence of hydrocephalus. No diffusion restriction is evident in the brain parenchyma.Asymmetric low T1 signal is noted in the region of the left parietal bone, best seen on coronal precontrast T1 imaging (series 12 image 29). Elsewhere, the marrow spaces peppered with numerous tiny abnormal foci of low signal.

Output: 1. Enhancing mass centered on the left petroclival ligament invading the skull base, left cavernous sinus and Meckel's cave, left middle cranial fossa, and left prepontine cistern. The location and imaging characteristics are fairly typical of a meningioma. Given the patient's history, the possibility of a myelomatous deposit or plasmacytoma would have to be considered as well. A pituitary macroadenoma would also be in the differential diagnosis, though this is probably less likely. 2. Replacement of fatty marrow in the left parietal bone is seen along with innumerable small foci of marrow signal abnormality. Findings would be compatible with patient's diagnosis of multiple myeloma.


Instruction: Generate impression based on findings.

Input: Clinical question: History of brain lesion-occipital, evaluate for change. History of Chiari decompression. Signs and symptoms: Surveillance scan. Nonenhanced cervical spine MRI:There is evidence of postoperative changes of Chiari decompression which is often expansion of subarachnoid space at the level of foramen magnum. There is resultant resolution of previously noted flattening deformity of the cerebellar tonsils and effacement of subarachnoid space at the level of foramen magnum.There is also interval significant decreased size of a severely dilated syrinx of entire cervical cord and with extension into the superior most visualized thoracic cord to T3 level.The remaining small syrinx at C2 level measures approximately at 4 x 2 mm in transaxial dimensions compared to prior study measurement of 16 x 11 mm. The syrinx at C5 level measures at 3.5 x 1.2 mm compared to prior study measurement of 13 x 7 mm. The syrinx at T2 level measures approximately 2 x 2.3 mm compared to prior study compared to prior study measurement of 11.5 x 11 millimeter.Decreased size of syrinx results in better visualization of subarachnoid space. Degenerative changes at C6/C7 level and including a central and left paramedian disc protrusion demonstrate no significant change. Mild degenerative changes at C5-C6 with shallow bulging disc also remains is stable since prior exam.CSF flow study demonstrate normal appearing biphasic flow through the foramen magnum anteriorly. Trace biphasic flow through the foramen magnum posterior to the cord and through the fourth ventricle and aqueduct is also detected. There is significant interval improvement of CSF flow study at the level of foramen magnum since prior exam.Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination redemonstrates stable right occipital region tumor in signal pattern, size and uniform pattern of enhancement. This mass lesion measures approximately 10 x 11 mm which is not significantly different than prior study measurement. Similar to prior exam this mass demonstrate no evidence of internal hemorrhagic changes, surrounding edema or appreciable mass effect. Differentials of primary brain tumor and less likely possibility of a metastatic lesion should be considered. Additionally possibility of a dural base benign tumor such as a meningioma should also be considered. Recommend continued follow-up studies. There is no evidence of any additional foci of abnormal parenchymal or leptomeningeal enhancement.Stable few scattered tiny foci of FLAIR hyperintensity in the periventricular and subcortical white matter is a nonspecific finding however in proper clinical setting could represent minute chronic small vessel ischemic strokes.Expected postoperative changes of suboccipital craniectomy as reported on cervical MRI is again noted.

Output: 1.MRI of cervical spine demonstrate interval expected postoperative changes of suboccipital craniectomy with resultant expansion of subarachnoid space. Significant interval decreased size of the expanded syrinx of entire cervical cord with extension into the upper most visualized thoracic cord as detailed/measured above. Significant interval improvement of CSF flow study through the foramen magnum anteriorly and a trace flow posteriorly through the foramen magnum, fourth ventricle and the aqueduct.2.Brain MRI demonstrate stable right occipital enhancing lesion which although could represent a primary brain tumor and less likely a metastases focus other differential of a benign extra-axial tumor such as a meningioma cannot be entirely excluded and continued further follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Lateral knee pain MENISCI: There is abnormal signal and morphology of the posterior horn of the medial meniscus at and near its root indicating complex tearing and fragmentation. As a result, there is mild medial extrusion of the body of the meniscus into the medial gutter. These changes are superimposed upon additional increased signal within the meniscus representing intrasubstance degeneration. Furthermore, there is vertically oriented abnormal signal at the junction of the body and posterior horn of the meniscus which extends to the tibial articular surface, representing an additional small tear.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate degenerative articular cartilage loss with areas of full-thickness loss along both the medial and lateral patellar facets. There is associated underlying subchondral cystic change. Focal degeneration of the articular cartilage of the medial facet of the femoral trochlea is also noted inferiorly.There is partial thickness articular cartilage loss of the medial femoral condyle anterior to the posterior horn of the medial meniscus. There is focal full-thickness degeneration of the weightbearing portions of the medial tibial plateau with associated underlying degenerative marrow signal.There is thinning of the articular cartilage of the lateral femoral condyle at the level of the anterior horn of the meniscus. Otherwise the cartilage of the lateral compartment is preserved.LIGAMENTS: There is slightly increased signal of the ACL representing mucoid degeneration with extension of this abnormal signal to the ACL insertion on the tibial plateau. The ACL and remaining ligamentous structures are intact. EXTENSOR MECHANISM: There are enthesopathic changes of the quadriceps tendon upon the superior aspect of the patella. The extensor mechanism is otherwise intact.ADDITIONAL

Output: 1. Intact lateral meniscus.2. Medial meniscal tears as described above.3. Articular cartilage loss and degeneration of the medial and patellofemoral compartments further detailed above.4. Small joint effusion and Baker's cyst. 5. Mucoid degeneration of the ACL with other findings described above.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. Small scattered foci of T2/FLAIR hyperintensity in the white matter are nonspecific. Brain parenchymal volume is within normal limits. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Punctate foci of T2/FLAIR hyperintensity in the white matter which are nonspecific but may represent chronic microvascular ischemic disease or other possible etiologies such as prior inflammatory or vascular processes. Otherwise, no significant volume loss or any other findings to account for patient's symptoms.


Instruction: Generate impression based on findings.

Input: Disturbance of skin sensation [782.0], Reason for Study: ^Reason: T10 sensory level There is normal thoracic kyphosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass.

Output: Normal thoracic MRI scan.


Instruction: Generate impression based on findings.

Input: Clinical question: MS flare. Signs and symptoms: Gait instability, slow speech. Pre-and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a single new focus of flair hyperintensity in the posterior upper medulla with evidence of subtle increased parenchymal volume and enhancement. Findings consistent with a new active enhancing demyelinating plaque. This finding measures approximately at 7 x 11 x 10-mm on flare images.The previously noted a large enhancing plaque in the upper pons and with extension into the right cerebral peduncle demonstrates interval decrease in size and with resultant decreased caliber of pons and right cerebral peduncle. This lesion however demonstrate patchy foci of enhancement although less conspicuous and smaller in size compared to prior exam.Few additional foci of flare hyperintensities consistent with chronic demyelinating plaques in bilateral cerebral hemispheres demonstrate no change.

Output: 1.There is a single new enhancing plaque in the dorsal aspect of medulla as detailed/measured above.2.Interval decreased size and extent of the enhancement of a large plaque in the pons since prior exam.3.Stable mild additional chronic findings of demyelinating disease since prior study.


Instruction: Generate impression based on findings.

Input: History of nasopharyngeal carcinoma with new liver lesion. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. Within segment 2 there is a focal lesion measuring 2.3 x 1.8 cm which has increased T2 signal as well as prominent diffusion restriction. The lesion is hypoenhancing relative to the background liver.No additional focal lesions. The hepatic vasculature is patent. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvises. No hydronephrosis. No focal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a focal lesion the left aspect of the T12 vertebral body that has increased T2 signal, mildly increased T1 signal, and postcontrast enhancement compatible with an intraosseous hemangioma.OTHER: Partial visualization of multiple sacral cystic structure seen only on the large field-of-view coronal T2 images; possibly representing Tarlov cysts.

Output: 1.Focal lesion in segment 2 of the liver as described above most compatible with a hypovascular metastasis.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9] / Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: s/p crani for tumor History: speech changes Limited exam due to patient's motion, gradient-echo scans was not obtained and post enhancement scan was also not obtained.Previously seen left parietal opercular mass is again seen with the significant surrounding edema. The extent of mass effect appears to be slightly increased results midline shift toward right side at the level of foramen of Monro, on axial scan, the degree of midline shift is measured about 7 mm.The size of mass itself has been decreased (22.7mm x 24.4mm x 25.6mm) with the increased component of low signal intensity especially posterior inferior aspect of the mass lesion indicating intralesional blood products.There is also about 9 mm thickness extra axial, intracranial blood products on the operation site.No change of right parieto-occipital lesion with the prior hemorrhageNormal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval partial resection status of the left parietal opercular mass.2. Intra-lesional blood products with postoperative increased surrounding edema and mass effects since prior scan.3. Extra axial, intracranial fluid collection likely represent blood products overlying the operation site as described above.


Instruction: Generate impression based on findings.

Input: Female, 83 years old, headache with history of esophageal cancer. Assess for metastases. Patchy periventricular and subcortical T2 hyperintensity is again seen. Lesions are mildly increased in both size and number.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. On postcontrast images, no pathologic parenchymal or extra-axial enhancement is detected.There is no evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles and sulci are within normal limits for size and morphology.

Output: 1.Mild interval progression of chronic microvascular ischemic disease.2.No acute intracranial abnormality.3.No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Clinical question:Evaluate status post tumor resection. Signs and symptoms: Brain tumor resection. Pre-and post-enhanced head CT:There is chronic postoperative changes of a right posterior temporal parietal craniotomy with underlying focus of parenchymal low attenuation representing surgical cavity. Tiny air bubble within the surgical cavity is noted. There is no detectable enhancement and no appreciable mass-effect.There is a large focus of vasogenic pattern of low-attenuation in the left posterior temporal and extensively extending into the left parietal lobe. Residual postsurgical air and small patchy foci of hemorrhage within the surgical cavity at the site is noted. There is no convincing evidence of abnormal enhancement to suggest residual tumor. This however needs to be confirmed with an MRI examination of brain. Postoperative changes of a recent left craniotomy evident by residual pneumocephalus and expected overlapping soft tissues of the scalp thickening is noted. Changes on the left results in mass effect on the left lateral ventricle and with trace midline shift to the right.

Output: 1.Postoperative changes of left parietal -- posterior temporal craniotomy without convincing evidence of residual tumor. Follow-up with an MRI exam is recommended for better assessment.2.Postoperative changes of right posterior temporal craniotomy without convincing evidence of abnormal enhancement.3.Extensive residual edema and postop changes in the left hemisphere results in mass effect on the left lateral ventricle and trace midline shift to the right.


Instruction: Generate impression based on findings.

Input: T4N0 adenoid cystic carcinoma of minor salivary gland/maxillary sinus with intracranial extension. There are postoperative findings related to partial left maxillectomy. There is diffuse mild left maxillary sinus mucosal thickening, with slightly more prominent infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region. There is also persistent perineural tumor extension involving the left infraorbital nerve, pterygopalatine fossa, Vidian canal, foramen rotundum, foramen ovale, cavernous sinus, and Meckel cave, measuring up to 5mm in thickness, previously also 5 mm. There is no evidence of intraparenchymal extension. There is increased enhancing tumor within the medial left extraconal orbit, which measures up to 10 mm in width, previously 6 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is an enhancing lesion in the T1 vertebral body, which measures approximately up to 10 mm.

Output: 1. Post-treatment findings in the left sinonasal region with persistent perineural tumor involving the left trigeminal nerve branches with intracranial extension2. Infiltrative tumor involving the left maxillary alveolus, premalar subcutaneous tissue, and retromaxillary region appears to be slightly more prominent. 3. Increased left medial orbit extraconal tumor.4. No evidence of brain parenchymal metastases.5. A lesion in the T1 vertebral body may represent a metastasis.


Instruction: Generate impression based on findings.

Input: 24-year-old female with abdominal pain ABDOMEN:LIVER, BILIARY TRACT: No cholelithiasis or choledocholithiasis is present. The common bile duct measures 5 mm. No intrahepatic or extrahepatic 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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No cholelithiasis or choledocholithiasis is present.


Instruction: Generate impression based on findings.

Input: 85 year-old female with history of myocardial infarction and subsequent cath showing significant coronary disease. MRI to assess for viability. Of note, due to limited ability to follow breath holding instructions, this study quality is sub-optimal limiting quantification of ventricular volumes, ejection fraction and valvulopathy.Left VentricleThe left ventricle is mild to moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%, the LV end diastolic volume index is 97 ml/m2 (normal range: 65+/-11), the LVEDV is 174 ml (normal range 109+/-23), the LV end systolic volume index is 71 ml/m2 (normal range 18+/-5), the LVESV is 128 ml (normal range 31+/-10). There is akinesis of the inferoseptal and antero septal walls from base to apex. There is apical dyskinesis. There is hypokinesis of the anterior wall. The inferior and inferolateral walls are the only segments that have close to normal wall motion. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 83 ml/m2 (normal range 69+/-14), the RVEDV is 148 ml (normal range 110+/-24), the RV end systolic volume index is 55 ml/m2 (normal range 22+/-8), and the RVESV is 99 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe quality of the study limits assessment of mitral regurgitation. Suggest alternative imaging to quantify mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mild to moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%2. There is akinesis of the inferoseptal and antero septal walls from base to apex. There is apical dyskinesis. There is hypokinesis of the anterior wall. The inferior and inferolateral walls are the only segments that have close to normal wall motion. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The entire myocardium is viable.3. The right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 33%4. Severely dilated left atrium. Mildly dilated right atrium.5. This was a technically challenging study due to limited patient cooperation with breath-holds. 6. See extra-cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Demyelinating disease: right sided numbness and hyperreflexia. Brain: Thre are multiple, greater than 10, supratentorial and infratentorial T2 hyperintense white matter lesions. A lesion in the right superior frontal gyrus demonstrates patchy enhancement and a lesion in the right corona radiata demonstrates open ring enhancement directed away from the ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There are subcentimeter T2 hyperintense lesions within the spinal cord involving the bilateral dorsal columns at C3-4 and in the left hemicord at C6. There is straightening of the cervical spine alignment in the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple intracranial white matter lesions are compatible with demyelinating disease, such as multiple sclerosis, with signs of active inflammation is a few lesions.2. Lesions in the cervical spinal cord are also compatible ith demyelinating disease, such as multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: assess for new stroke History: right hand weakness, dysarthria, and facial droop Brain MRIThere is restricted diffusion lesion on the left periventricular white matter indicating acute ischemic infarction without evidence of hemorrhagic conversion.Scattered focal tissue lordosis on bilateral basal ganglia and thalami indicating altered focal chronic lacunar infarct.Patch and scattered high signal intensities on periventricular white matter indicating underlying nonspecific small vessel ischemic disease.There are susceptibility lesions on bilateral lateral ventricles' ependymal surfaces which indicate calcifications.There is also focal small susceptibility lesion on the right cerebellar hemisphere indicating chronic petechial hemorrhage.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collectionThe midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tortuous courses of bilateral ICAs, MCAs, ACAs and vertebrobasilar system without evidence of focal significant (more than 50%) luminal stenosis. No aneurysm was seen.Left vertebral artery is dominant.

Output: 1. Acute ischemic infarction on the left periventricular white matter without evidence of hemorrhagic conversion.2. Atherosclerotic intracranial arterial system without evidence of focal luminal stenosis. No intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Cirrhosis. Cyst found on recent ultrasound. Evaluate for lesion. ABDOMEN:LIVER, BILIARY TRACT: Mild left hepatic lobe hypertrophy and fissural prominence.Punctate cysts are noted.No focal suspicious liver lesion. No biliary ductal dilatation. The vessels are patent.Normally distended gallbladder.SPLEEN: The spleen is normal in size.PANCREAS: Pancreas divisum (series 5, image 21). Several punctate cystic foci in the pancreatic body and tail without definite communication with the main pancreatic duct which is normal in caliber. The largest is a bilobed/septated cystic lesion in the body measuring 1.1 cm. No suspicious post-contrast enhancement. No parenchymal atrophy or suspicious lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing cysts. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality noted.

Output: 1. 1.1 cm bilobed/septated cystic lesion in the pancreatic body without definite communication with the main pancreatic duct which is normal in caliber. No suspicious postcontrast enhancement. Additional punctate pancreatic cystic foci are noted pancreatic tail. This may be followed with serial imaging to document stability. 2. No suspicious liver lesion.3. Pancreas divisum without specific stigmata of acute or chronic pancreatitis.


Instruction: Generate impression based on findings.

Input: Status post liver donor transplant 2/08 for PSC, elevated AP 483 and CA 19-9 112. Evaluate for biliary dilatation, assess hepatic vessel patency, evaluate for evidence of cholangiocarcinoma. ABDOMEN:LUNG BASES: Left lung base nodule. Prominent right cardiophrenic lymph node, unchanged.LIVER, BILIARY TRACT: Postsurgical findings of liver transplant with hepaticojejunostomy. Geographic mass-like areas of hypoenhancing T2 hypointensity and T1 hyperintensity in the posterior right hepatic lobe and caudate lobe, significantly increased in size dating back from 2/2010. These may represent perfusion abnormalities; tumor is felt to be unlikely as vessels course through these areas without attenuation or mass effect and there is no associated diffusion restriction. No signal loss on opposed phase images in these areas to suggest fat.No definite suspicious hepatic mass is identified. Hepatic arteries, portal vein, hepatic veins are patent. Diminutive left portal vein, unchanged.Mild intrahepatic biliary ductal dilatation with scattered foci of narrowing, not significantly changed.SPLEEN: Splenomegaly with prominence of the splenic vein, unchanged. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent porta hepatis lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace abdominal ascites.

Output: 1.Stable mild intrahepatic biliary ductal dilatation with scattered areas of narrowing. Patent hepatic vasculature.2.Geographic areas of signal abnormality involving the right posterior hepatic lobe and caudate lobes progressively increased in size from 2010, possibly representing perfusion abnormalities. 3.No definite suspicious hepatic mass is identified.4.Left lung base nodule, for which CT chest is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Pain, questioned rotator cuff or biceps tendon tear ROTATOR CUFF: Supraspinatus tendon and muscle are within normal limits. There is a tiny (1-2 mm) concealed insertional tear of the anterior fibers of the infraspinatus tendon. Mild tendinosis is present posteriorly with underlying cyst formation in the humeral head. The teres minor and subscapularis tendons and muscles are within normal limits.SUPRASPINATUS OUTLET: Trace amount of fluid in the subacromial/subdeltoid bursa. Mild AC joint degenerative changes.GLENOHUMERAL JOINT AND GLENOID LABRUM: No joint effusion. Their superior labrum is absent, presumably representing a chronic tear.BICEPS TENDON: The tendon of the long head of the biceps is identified within the bicipital groove. However, abnormal signal intensity is seen within the tendon at its transition from the bicipital groove to the rotator interval likely representing tearing. Its origin from the glenoid is poorly defined on the sagittal sequences suggesting biceps anchor tear. ADDITIONAL

Output: 1. Superior labral and biceps anchor tear. This could be better delineated with MRI arthrogram if clinically warranted.2. Small concealed insertional rotator cuff tear as described.3. Mild AC joint osteoarthritis.


Instruction: Generate impression based on findings.

Input: Redemonstrated are numerous, scattered areas of T2 hyperintensity throughout the supratentorial white matter with particular prominence at the level of the peri-atrial regions and additional conspicuous areas of subcortical signal abnormality which spares the cortex, including in the anterior temporal poles. Also involved is the subinsular white matter and notably the subcortical white matter of the paramedian superior frontal lobes. These are not significantly changed in appearance. Note is again made of diffusely prominent perivascular spaces.No restricted diffusion is present to indicate an acute ischemic event. No susceptibility weighted abnormalities to indicate hemorrhage. The ventricles and sulci are unchanged in size or shape without dilatation. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Unchanged extensive parenchymal signal abnormality which is somewhat unique in that it involves the subcortical white matter, sparing the cortex, as well as the anterior temporal poles and paramedian superior frontal lobes. The pattern is atypical for routine age-related small vessel disease. There are, however, some features which are fairly specific for CADASIL. Other atypical vascular etiologies may also be considered such as vasculitis. The pattern is not typical for demyelinating disease.


Instruction: Generate impression based on findings.

Input: 71 year old female with acute change in mental status. Evaluate for bleed. Extensive vasogenic edema of right cerebral hemisphere is again identified. There is significant midline shift to the left secondary to mass effect. In comparison with prior MRI the midline shift on the current exam has increased and measures 10.5-mm. Minimal increase in the size of lateral ventricles is also suspected. There is however no evidence of hemorrhage as clinically is questioned.

Output: 1.No evidence of hemorrhage as clinically is questioned.2.Increase in the amount of midline shift and slight increase in the size of ventricular system since prior MRI exam.


Instruction: Generate impression based on findings.

Input: Brain:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within bilateral maxillary sinuses and the single left ethmoid air cell. Otherwise the paranasal sinuses and mastoid air cells are clear. Thoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. 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.A small Schmorl's node is present involving the inferior endplate of T12.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates a tiny right paracentral disc protrusion causing very slight anterior right hemicord flattening without intrinsic cord signal abnormality.T6/7 demonstrates a small right paracentral disc protrusion causing anterior right hemicord flattening without intrinsic cord signal and amount. T7/8 demonstrates a small right paracentral disc protrusion without cord deformation.T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Numbering the spine starting at C2 demonstrates lumbarization of S1 with a well-formed S1/2 disc.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. The visualized intra-abdominal and paraspinal contents are unremarkable.A small Schmorl's node is present involving the superior endplate of L2.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: UnremarkableL5/S1:UnremarkableS1/2: Unremarkable

Output: 1.Mucosal thickening is present within bilateral maxillary sinuses and the single left ethmoid air cell. Otherwise negative noncontrast brain primary.2.T5/6 demonstrates a tiny right paracentral disc protrusion causing very slight anterior right hemicord flattening without intrinsic cord signal abnormality.3.T6/7 demonstrates a small right paracentral disc protrusion causing anterior right hemicord flattening without intrinsic cord signal and amount. 4.T7/8 demonstrates a small right paracentral disc protrusion without cord deformation.5.Negative noncontrast lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: 96 year-old woman with history of CVA and new onset aphasia, right facial droop. Questionable left-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. No acute cortical stroke is seen. If acute infarction is suspected clinically, MRI can be obtained. A large area of encephalomalacia is seen in the distribution of the right posterior cerebral artery consistent with old stroke. There is ex vacuo dilatation of the posterior and temporal horns of the right lateral ventricle. Focal encephalomalacia is also seen in the bilateral cerebellar hemispheres consistent with old strokes. Extensive areas of periventricular white matter hypoattenuation are also noted consistent small vessel ischemic disease, of indeterminate age.

Output: 1. Multiple old strokes.2. Extensive small vessel ischemic disease, age indeterminate.


Instruction: Generate impression based on findings.

Input: Postop follow-up. Posterior fossa arachnoid cyst fenestration surgery. There is no evidence of acute ischemic lesion.There is evidence of suboccipital craniotomy with intra or acoustic cyst hemorrhage indicating postoperative status.The size of intracystic blood clot is about 11 x 9 mm.Estimated major size of subarachnoid cyst on sagittal scan at the level of quadrigeminal plate was 22.5 mm x 24.2 mm, on today's scan, it is measured 16.4 mm x 21. 2 mm indicating interval size decrease especially cranial caudal direction.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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: Postoperative status, suboccipital craniotomy and fenestration of posterior fossa subarachnoid cyst.Interval size reduction of posterior fossa subarachnoid cyst especially cranial caudal direction (22.5 mm x 24.2 mm to 16.4 mm x 21.2 mm).Demonstration of intracystic blood clot likely related to surgical procedure, 11 mm x 9 mm.Otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: h/o L hand weakness and cervical radiculopathy on EMG; eval for disc The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature present as well as multilevel disc desiccation and loss of disc space height predominantly at C4-5, C5-6 and C6-7.There are signal changes present within the C7 and C6 vertebral bodies which given the degenerative changes are most likely degenerative in nature and represent inflammatory change..At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy at this level associated with encroachment of the left-sided exiting nerve roots.At C3-4 there is no significant compromise to the spinal canal. There is mild left-sided facet hypertrophy at this level. There is a small left-sided lateral disc protrusion at this level which mildly encroaches on the left-sided exiting nerve root within the neural foramen.At C4-5 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present associated with a diffuse disc bulge. There is bilateral neural foramen encroachment of exiting nerve roots at this level.At C5-6 there is loss of disc space height, disc desiccation, endplate and uncovertebral osteophytes as well as posterior ligamentous hypertrophy. There is effacement of spinal fluid ventral and posterior to the spinal cord at this level and encroachment of the neural foramina. The encroachment is worse on the left when compared to the right side and is related to a combination of osteophytes and disc material. Overall there is moderate spinal stenosis at this level.At C6-7 there is loss of disc space height, diffuse disc bulge and small uncovertebral osteophytes associated with encroachment of the neural foramina bilaterally and effacement of spinal fluid ventral and posterior to the spinal cord. Overall there is moderate spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine associated with moderate degrees of spinal stenosis at C5-6 and C6-7 and multilevel neural foramen encroachment of exiting nerve roots as detailed above.


Instruction: Generate impression based on findings.

Input: Female 19 years old with a history of pancreatitis s/p stent placement. ABDOMEN:LIVER, BILIARY TRACT: The liver is mildly enlarged measuring 22 cm in craniocaudal dimension. Diffuse loss of signal within the hepatic parenchyma on out of phase images indicates hepatic steatosis. There is no enhancing liver lesion. The common bile duct and pancreatic duct are narrowed at the level of the pancreatic head over an approximate length of 3 cm. There is mild to moderate intrahepatic ductal dilatation and dilation of the pancreatic duct within the body and tail similar to the previous exam. The pancreatic and common duct stent are not definitely identified.The hepatic vasculature is patent.SPLEEN: The splenic vein is thrombosed.PANCREAS: There is patchy enhancement patchy enhancement of the pancreatic head indicating some residual inflammation. The intrinsic T1 signal the pancreas is diminished. No pancreatic stent is visualized. The pancreatic pseudocyst has resolved. The pancreatic duct is dilated with dilated side branches. The parenchyma has mild atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Note is made of a wind sock diverticulum of the duodenum. No bowel obstruction. The stomach is not distended.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There is evidence of mild residual inflammation within the pancreatic head consistent with the history of acute on chronic pancreatitis. The pancreatic pseudocyst has resolved.2.New splenic vein thrombosis.3.Narrowing of the common bile duct and pancreatic duct at the head of the pancreas with resulting dilation of the intrahepatic biliary ducts and pancreatic duct appears similar to the previous exam.4.Pancreatic and common duct stents are not visualized. A plain film is suggested if evaluation for stent migration is clinically warranted.5.Duodenal wind sock diverticulum as detailed above.


Instruction: Generate impression based on findings.

Input: 4-year-old boy. Past medical history of craniosynostosis, status post surgery. Presented with complex partial seizure. The head is elongated anteroposteriorly, compatible with a previous history of sagittal craniosynostosis.There is a 3 mm focal T2 hyperintensity in the right frontal white matter (involving the deep middle frontal gyrus white matter just superior to the inferior frontal sulcus). The focus is barely visible on T1 weighted images. At least one other similar though smaller focus is present in the right parietal subcortical white matter. These are nonspecific. There are also dilated perivascular spaces, most pronounced in the parietal white matter. There is no sign of cortical maldevelopment. The ventricular system and the other CSF-containing spaces are normal in size. The flow voids of the major intracranial vessels are preserved. The orbits are normal. The paranasal sinuses and the mastoid air cells are clear.

Output: 1.Two tiny white matter T2 hyperintense foci which may relate to a remote process versus persistent FLAIR T2 signal within a dilated perivascular space. They are nonspecific and of uncertain clinical significance.2.There is no sign of cortical maldevelopment or brain mass.3.Skull changes related to previous sagittal craniosynostosis.


Instruction: Generate impression based on findings.

Input: 72-year-old female with leg pain. Evaluate for osteomyelitis versus fasciitis of the right leg. Degenerative changes affect the right knee. Vascular calcifications and phleboliths are identified in the overlying soft tissues. Note is made of diffuse soft tissue swelling about the leg. There is apparent periosteal reaction along the lateral aspect of the proximal fibula. No definite osteolysis, sinus tract or foci of deep subcutaneous gas density are identified to suggest acute osteomyelitis. If strong clinical concern for osteomyelitis, further evaluation with MRI could be considered.

Output: Extensive soft tissue swelling and apparent periosteal reaction along the lateral aspect of the proximal fibula which is nonspecific. Chronic osteomyelitis cannot be excluded. If strong clinical concern for osteomyelitis, further evaluation with MRI could be considered.


Instruction: Generate impression based on findings.

Input: 31 years Female (DOB: 7/21/1984)Reason: Eval for progression; CLIPPERS History: gait ataxiaPROVIDER NAME: ADIL JAVED ADIL JAVED 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. There are several punctate foci of FLAIR signal hyperintensity in the subcortical white matter of the right hemisphere and to a lesser degree left hemisphere which are not clearly associated with any contrast enhancement. The largest appears to be in the left middle temporal gyrus subcortical white matter. Compared the prior exam the have not changed substantially.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses 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. Multiple punctate foci of enhancement are present along the peripheral surface of the spinal cord at the from the cervical medullary junction down to the C6 vertebral level. These were also present on the prior exam . Some patchy foci of spinal cord signal hyperintensity along the posterior lateral aspects of the spinal cord especially at the C2 and C3 vertebral body levels but also at C5 are somewhat less conspicuous than on prior exams.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.There is a mild degree of periventricular, internal capsule and subcortical white matter lesions are stable relative to the prior exam.2.Since prior exams the number of enhancing spinal cord lesions and lesions which are also present on the prior exams which are associated with a less T2 signal hyperintensity on the current prior exam.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of other parts of brainClinical question: h/o astrocytoma; now with possible progressionSigns and Symptoms: preop planning for biopsy The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post right-sided parietal craniotomy for right right lobe surgery. There is heterogeneous but predominantly increased T2 signal at the surgical site associated with multiple foci of susceptibility and a patchy enhancement which is similar in extent and signal characteristics when compared to the prior exam. In general the right lateral ventricle is enlarged.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a right parietal lobe infiltrating mass present similar in extent when compared to the 6/22/2015 exam.2.Examination is performed for the purpose of imaging guidance during surgery.


Instruction: Generate impression based on findings.

Input: Reason: testicular cancer, evaluate for mets 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: Left hydronephrosis is again seen.RETROPERITONEUM, LYMPH NODES: Right para-aortic lymphadenopathy there is decrease in size. Nonspecific soft tissue fullness is also decreased in size. Reference measurements as below. Previously seen calcified region of the right pelvic wall mass also appears decreased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Decreased reference lesion size as above. 2.For follow-up, recommend contrast-enhanced study.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder labral tear History: right shoulder pain. ROTATOR CUFF: Mild tendinopathy of the distal supraspinatus tendon without discrete tear. The infraspinatus, subscapularis, and teres minor tendons are intact. No significant muscle atrophy or edema. SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is anatomic. The glenoid labrum is intact without tear. BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: 1.Mild supraspinatus tendinopathy without discrete tear. 2.No labral tear.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified fallClinical question: change SDHSigns and Symptoms: SDH MRI brain:There is a right frontal lobe hemorrhagic focus present associated with fluid fluid levels and surrounding vasogenic edema. The hemorrhage measures approximately 21 x 30 mm axial dimensions. It is associated with susceptibility effect. There is subarachnoid distribution of susceptibility effect along the convexities present suggestive of siderosis. A small amount of intraventricular susceptibility effect layers in the occipital horns of the lateral ventricles left more than rightThere is a right-sided subdural collection present which measures 10 mm in thickness and is associated with mild mass effect. It extends to surround the right occipital lobe medially and laterally and is also adjacent to the right parietal lobe. There is approximately 4 mm shift of the septum pellucidum towards the left side. There are bilateral posterior fossa subdural collections present measuring up to 6mm thickness. There is no herniation appreciated.There are multiple punctate foci of susceptibility present in the subcortical and periventricular white matter.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 some mucosal thickening in the right maxillary sinus and opacification of ethmoid air cells and sphenoid sinuses.. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells and middle ear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is signal change within the spinal cord at the C3 and C4 vertebral body levels. There is multilevel disc desiccation present.There is a mild superior endplate compression present at T3 associated with high T2 signal and low T1 signal in the adjacent vertebral body. There is no compromise to the spinal canal at this level. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is diffuse disc bulge associated with mild posterior ligamentous hypertrophy and bilateral uncovertebral osteophytes. There is effacement of spinal fluid ventral and posterior to the spinal cord at this level. Overall there is a moderate degree of spinal stenosis at this level. There is narrowing of the neural foramina bilaterally (right worse than left) at this level with some encroachment of right sided exiting nerve roots. There is associated T2 hyperintensity with low signal on T1 at the adjacent vertebral bodies neck to the endplatesAt C4-5 there is a diffuse disc bulge present associated with narrowing of the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and to a lesser degree posterior to the spinal cord.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level which narrow the neural foramina bilaterally.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present at this level which narrow the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a right sided subdural hematoma surrounding the right hemisphere associated with stable 5mm midline shift and mass effect on the right lateral ventricle.2.There is a right frontal intraparenchymal hematoma present.3.There is subarachnoid blood along the convexities of the right frontal and parietal lobes and in the right sylvian fissure.4.A small amount of intraventricular blood is present5.There are multiple microhemorrhages present in the periventricular and subcortical white matter. In the context of extensive hemorrhage elsewhere this is nonspecific.6.There is opacification of the right mastoid. No underlying fracture is identified, however, detection of a subtle fracture may require dedicated temporal bone imaging if it is clinically suspected.7.Cord signal change at the C3 and C4 vertebral body levels could be related to spinal stenosis at this level and represent spondylitic myelopathy but it is nonspecific and could be related to a different cause.8.There are multilevel degenerative changes present in the cervical spine worse at C3-4 where there is a moderate degree of spinal stenosis. There is neural foramen encroachment at other levels with encroachment of exiting nerve roots as detailed above. The cervical spine exam is somewhat compromised by motion artifact which may obscure subtle abnormalities.9.Mild T3 superior endplate compression with findings suggestive of subacute change


Instruction: Generate impression based on findings.

Input: Unspecified dementia without behavioral disturbance [F03.90], Reason for Study: ^Reason: Patient with progressive cognitive decline - assess for signs of CJD and/or cerebrovascular disease. History: progressive decline in memory and behavior. Significant motion artifact degraded image quality.There are subtle diffusion image high signal intensities on bilateral superior parietal lobules and right side inferior parietal lobule. Corresponding FLAIR images show subtle high signal intensities but T2 weighted images do not demonstrate those lesions. Thus, above described lesions could be artifactual or subacute ischemic lesions.Gradient echo images do not show definitive focus of susceptibility lesion, however, again due to significant motion artifact, thorough evaluation is not possible.There are patchy FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating possible small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, or midline shift. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Left mastoid air cells show opacifications.

Output: 1. Significant motion artifacts degraded image quality.2. Subtle FLAIR high signal intensity lesions on bilateral parietal lobes are seen which could be artifacts or subacute ischemic lesions.3. No evidence of mass, mass effects or definitive hemorrhagic focus on this scan.Comment: the imaging request includes DTI scan as well as post contrast MR scans. However, considering significant motion artifacts, it was decided not to proceed for the DTI and post contrast scan today. Instead, it might need to be rescheduled for more detailed examination. This was discussed with Dr.Dellaria who is a resident of Dr Mastrianni at the time of this dictation.


Instruction: Generate impression based on findings.

Input: History of breast cancer with new indeterminate liver lesions on recent CT. Further characterize. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology.Within segment 4A and segment 8 there are nonenhancing simple cysts correlating to the hypodensities seen on CT scan. No abnormal enhancing foci or other evidence of metastases.No intrahepatic or extrahepatic biliary ductal dilatation. Sludge/debris layering dependently in the gallbladder. The hepatic vasculature is patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post surgical changes along the anterior chest wall bilaterally. There is trace soft tissue edema in the right reconstructed breast. Along the left chest wall deep to the flap there is a 13.8 x 1.7 cm fluid collection, likely seroma.OTHER: There is questionable partially visualized bilateral pleural nodularity versus subsegmental atelectasis (series 8 image 1). Close attention to this area on follow-up CT scans is recommended. Basilar atelectasis and trace pleural fluid.

Output: 1.Benign simple cysts in the liver correlating to the hypodensities seen on recent CT. No evidence of metastatic disease in the upper abdomen.2.There is questionable, partially-visualized, bilateral subsegmental atelectasis versus pleural nodularity in the superiormost aspect of the exam. Close attention to this area on follow-up CT scans is recommended.3.Postoperative changes from bilateral breast reconstructions. There is a simple fluid collection deep to the left-sided flap compatible with a postoperative seroma.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer with abnormality in the sphenoid area: difficulty concentrating and tremors. There is an unchanged enhancing lesion centered in the sphenoid triangle with epidural extension into the left middle cranial fossa that measures up to 5 mm in thickness, with mild mass effect upon the anterior pole of the temporal lobe and associated mild vasogenic edema. There is no evidence of intracranial hemorrhage or acute infarct. There is minimal periventricular white matter T2 hyperintensity, which is nonspecific. There is mild diffuse cerebral volume loss. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening in the maxillary sinuses. There is a partially-imaged cystic lesion in deep lobe of the parotid gland that projects into the right parapharyngeal space that measures at least 15 mm. There are also multiple persistent subcentimeter cystic foci in the superficial portions of the right parotid gland. There are small scalp lipomas in the occipital region.

Output: 1. Unchanged lesion centered in the left sphenoid triangle with epidural extension into the left middle cranial fossa and associated mild vasogenic edema in the anterior temporal lobe.2. No evidence of intraparenchymal mass lesions, acute intracranial hemorrhage, or cerebral infarction.3. Multiple cystic lesions in the right parotid gland, which may be sequela of an inflammatory or autoimmune process versus a neoplastic condition, such as Warthin tumors. Follow up with dedicated parotid imaging may be useful if clinically warranted.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Unspecified convulsions [R56.9], Reason for Study: ^Reason: increasing headaches and possible seizures in past. Eval for structural lesion History: headaches/seizures No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered bihemispheric FLAIR high signal intensity lesions on periventricular white matter and centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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: Nonspecific small vessel ischemic disease as described above.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: History of C5 fracture. Neck pain. There is reversal of cervical lordosis. Chronic wedging deformity of C5 and C6 vertebrae is present. There is extensive degenerative disease of the cervical spine. At C2 - C3 intervertebral level, there are facet arthropathic changes. At C3 - C4 intervertebral level, there are facet and uncovertebral joint arthropathic changes. There is disk protrusion causing spinal canal stenosis. At C4 - C5 intervertebral level, there is disc-osteophyte complex, causing spinal canal stenosis. There are degenerative changes of the uncovertebral joints and facet joints, causing bilateral neural frontal narrowing which is greater on the left. At the C5 - C6 intervertebral level, there is posterior disc-osteophyte complex, causing spinal canal stenosis. There is facet and uncovertebral joint degenerative disease, causing bilateral neuroforaminal narrowing, greater on the right. At the C6-C7 intervertebral level, there is posterior disc-osteophyte complex, causing spinal canal stenosis. There is facet and uncovertebral joint degenerative disease, causing bilateral neuroforaminal narrowing.The thyroid glands appear enlarged, with nodularity and calcifications.

Output: 1. Degenerative disease of the cervical spine as described above. Please also refer to MRI of the cervical spine findings for further correlation.2. Enlarged thyroid glands, with nodules and calcifications. This may represent goiter, but malignancy is difficult to be excluded. Please also correlate with thyroid imaging study and other clinical parameters.


Instruction: Generate impression based on findings.

Input: There is stable ill-defined patchy T2/FLAIR hyperintensity along the medial right basal ganglia and the right frontal lobe medial orbital gyrus posterior aspect. There is no significant residual enhancement in this area. Previously seen FLAIR hyperintensity along the cerebellar tonsils in September 2015 is not appreciated, unchanged since July 2016 scan. The previously noted enhancement along the left optic nerve is not seen. A subtle area of ill-defined somewhat branching pattern enhancement in the proximal right precentral sulcus (series 51, image 25) without associated abnormal FLAIR signal intensity nor mass effects are seen. This lesion appears unchanged since prior examination thus may represent adjacent cortical vein enhancement. There is a stable right frontal approach Ommaya catheter with its tip in stable position along the right foramen of Monro. Ventricular caliber is unchanged.There is trace mucosal thickening in the right maxillary sinus and in scattered ethmoid air cells bilaterally. Flow-voids within the major intracranial vascular structures are present.SPINE MRI:There is no evidence of pathological enhancement within the thecal sac.There is reversal of the normal cervical lordosis, as well as straightening of the normal thoracic kyphosis and lumbar lordosis. There is no significant subluxation within the spine, with stable minimal grade 1 anterolisthesis of C2 on C3. The vertebral body and disc heights are stable, with multilevel degenerative changes most conspicuously involving the cervical spine although with only up to mild central spinal canal stenosis. No marrow signal abnormality is appreciated, other than scattered endplate degenerative marrow changes especially at L2-L3. The spinal cord is of normal caliber and signal. There is up to scattered moderate foraminal narrowing in the lumbar spine as well as scattered moderate severe foraminal narrowing within the cervical spine.

Output: 1. Stable examination with persistent ill-defined abnormal T2/FLAIR signal involving the medial right basal ganglia and right frontal lobe medial orbital gyrus posterior aspect.2. No evidence of leptomeningeal disease within the spine.


Instruction: Generate impression based on findings.

Input: Vertebral body heights are intact. Alignment is anatomic. Postsurgical changes of C4-C6 laminectomy with expansion of the canal and posterior fluid appearing similar to the prior exam. The cord is diminutive from C4 to C6 with increased signal which appears similar to the prior exam and likely reflects myelomalacia. No abnormal signal in the thoracic or lumbar cord. No abnormal marrow signal. The lumbar spinal canal is narrowed at all levels, likely congenital. Multilevel disc desiccation and mild disc space loss in the lower thoracic spine. There may be partial sacralization of L5. Moderate diffuse disc bulges at L2-L3 and L3-L4 producing moderate narrowing of the canal.

Output: 1.Postsurgical changes and myelomalacia of the cervical spine appears grossly similar to the prior exam without evidence of cord compression.2.Narrowing of the lumbar spine at all levels is likely congenital. Diffuse disc bulges at L2-L3 and L3-L4 produce moderate narrowing of the canal.


Instruction: Generate impression based on findings.

Input: History of pituitary adenoma status post resection and radiation. There is no significant interval change in the pituitary mass with extension in to the right cavernous sinus that measures 21 AP x 22 RL x 15 SI mm. The normal pituitary tissue and infundibulum are deviated to the left. There is no mass effect upon the optic apparatus. The internal carotid artery flow voids are intact.

Output: No significant interval change in the pituitary mass.


Instruction: Generate impression based on findings.

Input: Epigastric pain. Episodic cramping RUQ pain, status post cholecystectomy. Bilirubin elevated from baseline. ABDOMEN:LIVER, BILIARY TRACT: Small hepatic cyst. Minimally dilated intrahepatic biliary duct in the right hepatic lobe running adjacent to a diminutive portal vein, unchanged from recent CT (series 502, image 59), unlikely to be of clinical significance and possibly related to post-cholecystectomy state. No other biliary ductal dilatation. No choledocholithiasis. Patent hepatic vasculature. No suspicious hepatic mass.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum variant. 5 x 3 mm cystic focus in the uncinate process that appears to connect to the pancreatic duct, likely a side branch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings to explain the patient's symptoms. No choledocholithiasis or CBD dilatation.2.Subcentimeter cystic focus in the pancreatic uncinate process, likely an IPMN.


Instruction: Generate impression based on findings.

Input: 35 year old woman with history of congenital pulmonic stenosis s/p valvuloplasty, with echocardiogram suggestive of possible intracardiac shunt, referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 62%, the LV end diastolic volume index is 69ml/m2 (normal range: 65+/-11), the LVEDV is 127ml (normal range 109+/-23), the LV end systolic volume index is 26ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 41 g/m2 (normal range 67+/-11), and the LV mass is 76 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. There is no obvious interatrial septal defect. Qp:Qs <1 (0.94), which is not suggestive of significant intracardiac shunt. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 56%, the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVEDV is 132 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 74ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a likely normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumNo significant abnormality.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size LV with normal systolic function (EF 62%). 2. No evidence of late gadolinium enhancement. 3. Normal size RV with normal systolic function (EF 56%).4. No obvious interatrial septal defect noted. Qp:Qs not suggestive of intracardiac shunt.


Instruction: Generate impression based on findings.

Input: History of left parotid region squamous cell carcinoma with radiation necrosis of the temporal bone status post resection and reconstruction concern for abscess/cerebritis: pain, fever, and AMS. There are postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction. There is interval decrease in size of the heterogeneous fluid within the anterior portion of the resection bed. There appears to be a defect in the left tegmen, with mild herniation of the inferior temporal lobe, where there is patchy cortical and subcortical T2 hyperintensity and enhancement, as well as diffuse, confluent T2 hyperintensity of the white matter. There also appears to be a fluid collection that measures up to 3 mm in thickness along the floor of the left middle cranial fossa. There is no evidence of acute territorial infarction. There is mild enhancement of the left cochlea and cranial nerves in the left internal auditory canal. There appears to be persistent mild asymmetric prominence of the left cavernous sinus. There are denervation changes in the left masticator and facial expression muscles. Low T1 and T2 bone marrow signal in the irregular left mandibular condyle may be attributable to degenerative changes with subchondral sclerosis. There is mucosal thickening and secretions in the left posterior ethmoid sinus and a small retention cyst in the right sphenoid sinus.

Output: 1. Postoperative findings related to left lateral temporal bone resection with myocutaneous graft reconstruction with interval decrease in size of the fluid collection within the anterior portion of the surgical bed.2. Apparent defect in the left tegmen, with mild herniation of the inferior temporal lobe, with persistent vasogenic edema, which likely represents radiation necrosis, perhaps with superimposed cerebritis, as well as an apparent small extra-axial fluid collection along the floor of the left middle cranial fossa.3. Persistent enhancement of the left cochlea and cranial nerves in the left internal auditory canal may represent infectious and/or radiation-induced labyrinthitis and neuritis.


Instruction: Generate impression based on findings.

Input: Patient with history of poorly differentiated carcinoma of liver with known lytic lesion at T12, evaluate for other spinal lesions . Patient complaining of back and abdomen pain. Cervical Spine: There is a punctate focus of fat signal in the C7 vertebral body, which is suggestive of a hemangioma or focal fat deposition. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Thoracic Spine: There are expansile tumors arising from the medial right third rib and sternum. There is also a lesion within the T12 vertebral body with extension of tumor into the epidural space, which has increased in size and associated with mild indentation of the spinal cord and severe left neural foraminal stenosis. There is no discernible signal abnormality in the spinal cord. There is also mild loss of height of the T12 vertebral body. There is also mild T6 superior endplate deformity, without evidence of underlying tumor. Otherwise, the alignment is anatomic. There are bilateral pleural effusions, ascites, and multiple bilateral lung and liver lesions.Lumbar Spine: There are small foci of T1 hypointensity and T2 hyperintensity, demonstrating enhancement in the L1 vertebral body. The lumbar vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Metastatic disease progression involving the axial skeleton, including a right third rib lesion, a sternal lesions, a T12 vertebral lesion with associated mild spinal cord indentation and severe left neural foraminal compromise, and a small lesions in the L1 vertebral body2. Numerous liver and lung metastatic lesions, as well as ascites and pleural effusions, are partially imaged. Please refer to the prior body CT for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Back pain. Signs and symptoms: Back pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column. No evidence of fracture.The signal intensity of vertebral column is abnormal with uniformly hypodense T1 and hypo-T2/T2 STIR signal likely due to systemic process. Correlate with history.Minimal degenerative disc disease at L4-L5 is noted and unremarkable at other levels.At L4-L5 there is mild degenerative disc disease and a small far lateral broad-based disc protrusion projecting into the right neural foramina and it is often mild compromise. No spinal stenosis and patent left neural foraminal.Mild hypertrophic changes of the ligamentum flavum at the L5-S1 is noted.Unremarkable images at other levels.Unremarkable perispinal soft tissues.

Output: 1.Uniformly hypointense T1 and hypointense T2 signal intensity of bone marrow of all visualized bony structures of region of exam suggestive of a systemic process. No fracture or malalignment.2.Mild degenerative disc disease at L4-L5 and a small right lateral disc protrusion with resultant mild compromise of right neural foraminal.3.Minimal degenerative changes of posterior elements in the lower lumbar spine.4.Unremarkable exam otherwise and without evidence of spinal canal or neural foraminal compromise at any level.


Instruction: Generate impression based on findings.

Input: Reason: intracranial stenosis? History: imbalance MRI of the brainThere is a 5 mm thick by 22-mm wide extra-axial lesion which is bright on flair and T1 weighted imaging.Small focus of encephalomalacia present along the right orbital gyrus which is associated with some susceptibility effect and superficial siderosis .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is small in. The posterior communicating arteries are identified. The left posterior communicating artery is fairly large whereas the right posterior communicating artery is a very small. The vertebral arteries are similar in size.

Output: 1.A small extra-axial lesion is present adjacent to the left frontal lobe. There is no associated mass effect. Differential considerations include a small subacute hematoma.2.Small focus of encephalomalacia and he right orbital gyrus is present. This specific location and is often associated with posttraumatic injury.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: There are no T2/flair abnormalities. There are no diffusion or susceptibility abnormalities. There is no abnormal enhancement. No evidence of acute hemorrhage, mass effect, or edema. There is no midline shift. Ventricular size is normal. There are normal vascular flow voids.

Output: Unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: Vertebral body heights in the cervical spine are normal. There is mild anterolisthesis of C2 on C3, C3 on C4, and C4 on C5 and mild retrolisthesis of C4 on C5 and C5 on C6. No high-grade spinal canal stenosis or frank cord compression is identified. Bone marrow signal is benign. Degenerative changes are seen throughout with loss of disc height, worst at C4-C5 and C5-C6. There is facet arthropathy throughout the cervical spine, worst at the left C5-C6 level.Individual levels as below:C2-3: Minimal disc bulge and ligamentum flavum thickening. No significant compromise to the spinal canal or right neural foramen. There is mild to moderate left neural foraminal stenosis.C3-4: Small disc osteophyte complex. There is mild right and moderate left neural foraminal stenosis. No significant spinal canal stenosis. C4-5: Small disc osteophyte complex with effacement of the ventral thecal sac. Dorsal thecal sac is patent. There is moderate to severe left neural foraminal stenosis and minimal right foraminal narrowing. C5-6: Small disc osteophyte complex, and ligamentum flavum thickening. There is mild spinal canal stenosis with effacement of the ventral and dorsal thecal sac. No evidence of frank cord compression or cord signal abnormality. There is moderate to severe left neural foraminal stenosis and mild right neural foraminal narrowing.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.THORACIC SPINE

Output: 1. Degenerative changes in the cervical spine with mild spinal canal stenosis at the C5-C6 level. No evidence of cord compression or cord signal abnormality. Moderate to severe neural foraminal stenosis on the left at multiple levels in the cervical spine as detailed above.2. No significant spinal canal stenosis in the thoracic spine. There is minimal dorsal scalloping involving the upper thoracic cord raising the possibility of an arachnoid cyst posteriorly, but is of doubtful clinical significance given absence of significant cord flattening or signal abnormality.3. Advanced degenerative changes in the lumbar spine with scoliosis as seen on prior radiographs. There is moderate L2-L3 spinal canal stenosis and to a lesser degree mild to moderate L3-L4 spinal canal stenosis. There is moderate right L3-L4 and severe right L4-L5 neural foraminal stenosis.4. Please note transitional lumbosacral junction with 4 lumbar type vertebral bodies and sacralized transitional segment labeled L5 for the purposes of numbering.


Instruction: Generate impression based on findings.

Input: 53 years Male (DOB:7/15/1962)Reason: seizure protocol History: seizure since 2012PROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical white matter lesions present which are high signal on T2 and FLAIR MRI. There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia and thalami as well as the brainstem.There is a focus of encephalomalacia in the inferior aspect of the right cerebellar hemisphere and another one along the right superior frontal gyrus. These are associated with some punctate foci of susceptibility effect. A small focus of encephalomalacia is present in the right occipital lobeThere are multiple foci of signal loss and susceptibility imaging involving the thalami bilaterally as well as some of the subcortical white matter of the temporal lobes and the brainstem.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 demonstrated minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a focus of encephalomalacia involving the right superior frontal gyrus which is suspected to be the result of prior ischemic events.2.A focus of encephalomalacia along the inferior aspect of the right cerebellar hemisphere is suspected to be a result of a a prior ischemic event. It is associated with a small lesion in the right medulla suspected to represent an old lacunar infarct.3.A small focus of encephalomalacia is present in the right occipital lobe also likely related to prior ischemic event.4.There are multiple punctate lesions in the basal ganglia and brainstem suspected represent old lacunar infarcts5.Multiple microhemorrhages present, involving the thalami and brainstem as well as a bit of the temporal lobes. These are suspected to have resulted from hypertension based on the pattern.6.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Female, 32 years old. Reason: check for change in nodules, also 9/2013 ultrasound mentions two extrathyroidal nodules superiorly - please comment on these RIGHT LOBE MEASUREMENTS: 2.7 x 1.8 x 7.0 cmLEFT LOBE MEASUREMENTS: 2.5 x 1.9 x 5.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Mildly heterogeneous echotexture. A right lower pole nodule measures 0.8 x 0.5 x 0.6 cm, cystic, without significant internal vascularity. A previously described slightly hypoechoic nodule in the right thyroid lobe is not clearly visualized on this exam.LEFT LOBE: Mildly heterogeneous echotexture. A left midpole nodule measures 0.5 x 0.4 x 0 .5 cm, cystic, nonvascular. A left lower pole nodule measures 0.7 x 0.4 x 0.5 cm, cystic, nonvascular. These lesions appear unchanged from the prior exam.ISTHMUS: Mildly heterogeneous echotexture, without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 1.4 x 0.5 x 0.8 cm, hypoechoic, without definite fatty hilum identified. It is unclear whether this lymph node corresponds with that seen on the previous exam, as peripheral calcification is not visualized on this lesion.OTHER: An additional nodule identified in the right neck superior to the medial aspect of the thyroid measures 0.7 x 0.5 cm, hypoechoic and heterogeneous, without significant vascularity. This lesion appears similar to the prior exam. A previously described additional adjacent smaller hypoechoic nodule is not clearly identified on this exam.

Output: 1. Subcentimeter cystic thyroid nodules as detailed above.3. A right level 2 lymph node is indeterminate, without definite fatty hilum.2. A hypoechoic nodule in the medial aspect of the right neck, superior to the thyroid, appears similar to prior. If not already performed, fine needle aspiration of this lesion is recommended to exclude metastatic adenopathy. Thyroglobulin washing may be performed at that time.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with weakness and concern for multiple sclerosis. Axial T2-weighted images are somewhat motion degraded. Within this limitation, the following observations are made.Central cord T2 hyperintensity is suspected at the C3 level. The lower cervical and upper thoracic spinal cord appears somewhat slender which could be artifactual or which could reflect some underlying volume loss. A few additional areas of questionable spinal cord signal abnormality are seen, but these are not definite due to image degradation.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. Marrow signal characteristics are unremarkable. No evidence of any pathologic marrow space, epidural, intramedullary or leptomeningeal enhancement is seen.Mild degenerative disc disease is seen at L5-S1 with loss of T2 signal, mild loss of height and with a subtle disc bulge and left paracentral/foraminal protrusion. No significant spinal canal stenosis is seen at this level. The left neural foramen is mildly narrowed.The remaining intervertebral discs are relatively preserved with no significant spinal canal stenosis or neuroforaminal narrowing.Intestinal note is made of small bilateral pleural effusions.

Output: 1.One fairly definite area of pathologic cord signal is seen at the C3 level which is nonspecific but in the context of the brain MRI findings would be compatible with demyelinating disease. 2.There may be a few additional areas of cord signal abnormality, and furthermore, the caliber of the cord appears to be somewhat reduced at the lower cervical and upper thoracic region suggesting volume loss. However, image quality on many sequences is degraded by motion artifact and it is difficult to diagnose these additional findings with confidence.3.Degenerative disc findings are seen at L5-S1. No significant spinal canal stenosis is seen at any level of the spine.


Instruction: Generate impression based on findings.

Input: Thoracic: The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. There is mild diffuse heterogeneity of the bone marrow which is nonspecific, but without discrete lesion to definitively suggest myelomatous involvement. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There are mild degenerative changes in the thoracic spine including small disc bulges, facet arthropathy, and ligamentum flavum thickening. No significant disc herniation, spinal canal stenosis, or neural foraminal stenosis is appreciated.Advanced endplate degenerative changes are noted at the partially imaged C6-C7 level and to a lesser degree C7-T1 level, better assessed on prior complete spine study. No associated high-grade spinal canal stenosis is appreciated at this level.Lumbar: For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights in the lumbar spine are normal. Alignment is grossly maintained. There is a 13 x 12 mm round T2 hyperintense lesion involving the posterior aspect of the left L2 pedicle/transverse process junction which is unchanged since 9/25/2014. There is otherwise diffuse heterogeneity of the bone marrow without a discrete destructive lesion to definitively suggest myelomatous involvement. Scattered foci of T1 hyperintensity are seen which may represent foci of fat or small hemangiomas. Schmorl's nodes are present involving the superior endplate of L3 and L4 and inferior endplate of L2, similar to prior. There is no significant spinal canal stenosis at any level. Conus demonstrates normal signal characteristics and terminates at a normal position.Mild degenerative changes include mild disc bulges at L2-L3, L3-L4, L4-L5, and L5-S1, mild facet arthropathy, and ligamentum flavum thickening. These findings are not appreciably changed since 9/25/2014. There is no significant spinal canal stenosis at any level. There is mild bilateral L3-L4 neural foraminal stenosis. There is mild right greater than left L4-L5 neural foraminal stenosis. No significant L5-S1 neural foraminal stenosis.Paraspinous soft tissues are grossly unremarkable.

Output: 1. There is no significant spinal canal stenosis at any level in the thoracic or lumbar spine to suggest compression of the cord or cauda equina.2. Diffuse heterogeneity of the brain marrow which is nonspecific and can be correlated with prior bone marrow biopsy. No definite imaging evidence of myelomatous lesions. There is a 13 x 12 mm T2 hyperintense lesion involving the posterior elements of L2 on the left which remains unchanged since 9/25/2014, which is nonspecific and may represent an atypical hemangioma--although myelomatous lesion remains a less likely possibility.3. Mild degenerative changes in the thoracic and lumbar spine including mild bilateral neural foraminal stenosis at L3-L4 and L4-L5, not significantly changed since 9/25/2014.4. More advanced degenerative changes in the cervical spine are better assessed on prior dedicated cervical spine MRI from 9/25/2014, including cervical cord signal abnormality related to myelomalacia.


Instruction: Generate impression based on findings.

Input: 40 years, Female, increased headache, history of generalized epilepsy. Brain parenchyma appears within normal limits. No significant parenchymal T2/FLAIR signal abnormality. No evidence of cortical dysplasia, gray matter heterotopia, or other lesions to suggest seizure focus. Bilateral hippocampi are symmetric in size and signal characteristics with preserved internal architecture. Cerebellar tonsils are borderline low measuring up to 4 mm below the foramen magnum without evidence of Chiari malformation. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass effect, midline shift, or herniation. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. 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.

Output: 1. MRI brain is essentially unremarkable.2. Borderline low cerebellar tonsils without clear evidence of Chiari I malformation.


Instruction: Generate impression based on findings.

Input: 53-year-old female with history of pancreatic cyst. ABDOMEN:LIVER, BILIARY TRACT: Fatty liver. Stable 2.1 cm right hepatic lobe hemangioma (series 10/22) and additional subcentimeter T2 hyperintense right hepatic lobe lesion, likely due to a small flash filling hemangioma (series 4/13).SPLEEN: No significant abnormality noted.PANCREAS: Stable focal outpouching of the distal main pancreatic duct measuring up to 1.2 cm (series 9/16), compatible with side branch IPMN. There is a single thin septation, but there is no enhancing mural nodularity. The remainder of the main pancreatic duct is normal in caliber. Normal physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable 1.2 cm side-branch IPMN at the distal main pancreatic duct.2.Stable hepatic hemangiomas.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma is heterogeneous with a nodular contour consistent with cirrhosis.Demonstrated again are multiple nodules throughout the liver demonstrating homogeneous intrinsic T1 weighted hyperintensity without associated arterial enhancement or washout compatible with multiple dysplastic nodules, not significantly changed in size or number.The portal vein is patent. Hepatic veins are unremarkable. No biliary ductal dilatation.SPLEEN: Stable nonspecific enhancing lesion along the inferior margin of the spleen measuring 1.5 x 1.2 cm (series 14/106).PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination with a cirrhotic liver morphology and multiple probable dysplastic nodules, similar to prior study. No lesion meeting strict HCC criteria.


Instruction: Generate impression based on findings.

Input: 37-year-old woman with history of Roux-en-Y gastric bypass in 2009, now with bloating and diarrhea. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. The patient is status post cholecystectomy.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: Patient is status post Roux-en-Y gastric bypass. A number of loops of proximal and distal jejunum are not distended and therefore difficult to evaluate. However, there is no abnormal enhancement and no definite wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Patient status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant stool burden in the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of trace pelvic free fluid.

Output: No etiology for the patient's symptoms on this study.


Instruction: Generate impression based on findings.

Input: Months of right lower extremity and right upper extremity muscle spasm and contraction. Brain: Again seen are postsurgical changes related to prior left parietal parasagittal meningioma resection. There has been interval development of a 2.1 x 2.2 x 2.4 cm lesion involving the left paracentral lobule with susceptibility effect and focus of T1 hyperintensity indicating subacute hemorrhage. There is heterogeneous enhancement associated with this lesion. There is interval increase in surrounding FLAIR hyperintensity consistent with vasogenic edema. Prior study demonstrated a subcentimeter enhancing nodule in this region which appears to be present along the posterior aspect of this lesion and minimally more prominent. No abnormal parenchymal or meningeal enhancement is seen elsewhere in the brain. 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. Mild cerebellar tonsillar ectopia is again seen. No evidence of acute ischemia. No extra-axial collections. No hydrocephalus. Major flow-voids are preserved. Complete spine:CERVICAL SPINE

Output: 1. Postoperative changes related to left parietal meningioma resection are again seen. Compared to 3/15/2016, there has been interval development of a 2.4 cm heterogeneously enhancing hemorrhagic lesion in the left paracentral lobule treatment bed with increase in surrounding edema. A nonspecific subcentimeter enhancing nodule which was present previously is again seen and is minimally more prominent; this nodule is just posterior to the new hemorrhage/hemorrhagic lesion. A relatively rapidly enlarging, recurrent meningioma does not seem likely although the etiology of the new hemorrhage is unclear. 2. No high-grade spinal canal stenosis or cord signal abnormality in the spine. No abnormal enhancing lesions.3. Degenerative changes in the cervical spine with mild to moderate spinal canal stenosis at the C4-C5 and C5-C6 levels. There is also a disc extrusion at the L2-L3 level. Additional details as above.