Instruction: Generate impression based on findings.

Input: dysesthesia in the limbs, assess for demyelinating disease Brain MRI:There are multifocal scattered asymmetric bihemispheric more likely punctate or nodular high signal intensities on FLAIR images.High signal intensity lesions were seen on white matter and subcortical white matter of bilateral frontal, parietal and temporal lobes.These lesions do not show perpendicular arrangement, however, considering the patient's age, likelihood of being "nonspecific small vessel disease" is unlikely. 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.Cervical spine:The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical 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 or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Multifocal bihemispheric white matter high signal intensity lesions on FLAIR images as described above. Demyelinating disease is a diagnostic possibility and non specific small vessel disease is unlikely.2. Cervical spine MRI is within normal limits


Instruction: Generate impression based on findings.

Input: Multiple myeloma with metastatic disease: headache. There is an enhancing lesion within the clivus, eccentric tot the left, which measures up to approximately 30 mm. There is perhaps slight epidural extension. There is also an enhancing lesion in the right sphenoid triangle, which measures up to approximately 15 mm, with extraosseous extension. In addition, there is an enhancing lesion right parapharyngeal space and pterygoid process that measures up to 20 mm. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There are bilateral maxillary sinus retention cysts and probable mild mucosal thickening in the posterior left sphenoid sinus.

Output: 1. Lesions in the clivus, right sphenoid triangle, and in the right parapharyngeal space and pterygoid process are compatible with multiple myeloma.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Right oral tongue squamous cell carcinoma status post treatment. There are postoperative findings related to excision of a left oral tongue tumor, without evidence of gross residual tumor. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is multilevel prominent anterior cervical disc-osteophytosis. There is mild mucosal thickening in the maxillary sinuses bilaterally. The imaged intracranial structures and orbits are unremarkable.

Output: No evidence of gross residual oral cavity tumor and no significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 49 year-old female with pituitary prolactinoma Redemonstrated is a heterogeneously enhancing lesion within the left lobe of the pituitary gland which is unchanged in signal characteristics, enhancement pattern, size, or morphology. There are persistent T2 hyperintense components within the lesion, which may represent post-treatment change. The infundibulum is deviated slightly to the right, but is not thickened, unchanged. There is no mass effect upon the optic apparatus. There is unchanged, mild effacement of the medial compartment of the left cavernous sinus, but no frank invasion of the cavernous sinus.

Output: Stable left pituitary adenoma. Please note the patient became ill during dynamic contrast injection however the study could be completed and the patient discharged without complication.


Instruction: Generate impression based on findings.

Input: Antiphospholipid syndrome, transient lightheadedness, and left arm numbness. Brain MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions.Neck MRA: There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of intracranial hemorrhage, mass, or cerebral edema.2. No significant steno-occlusive lesions in the head and neck.


Instruction: Generate impression based on findings.

Input: Testicular cancer. Left testicular cancer status post radical orchiectomy showing mixed germ cell tumor. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement. No suspicious lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder with cholelithiasis.SPLEEN: The spleen is normal in morphology and size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Very small non-specific subcentimeter left paraaortic lymph nodes just inferior to the left renal vein, the largest measuring 9 x 6 mm, unchanged. Non-specific subcentimeter gastrohepatic ligament and mesenteric lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Non-specific subcentimeter left paraaortic lymph nodes located just inferior to the left renal vein are unchanged.


Instruction: Generate impression based on findings.

Input: 63-year-old male with worsening gait There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are T2 hyperintense foci within the brainstem, periventricular and subcortical white matter, some of which have a radiating appearance, not significantly changed. However, there is a new focus within the anteromedial right thalamus which demonstrates susceptibility artifact suggesting interval, yet remote in appearance, microhemorrhage. There is stable mild volume loss and prominence of the cerebellar folia. The corpus callosum appears to be focally thinned in certain areas, unchanged in extent. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. As before, there are maxillary retention cysts, opacification of the right sphenoid sinus and mucosal thickening within a posterior ethmoid air cell, stable. There is new opacification within a pneumatized air cell located just anterior to the right glenoid fossa.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Redemonstrated is T2 brainstem, periventricular and subcortical hyperintensity, stable in appearance. The morphology is suggestive of a demyelinating disease, but other etiologies such as vascular disease and prior inflammation are not excluded.3.There is a new focus within the anteromedial right thalamus which demonstrates susceptibility artifact suggesting interval, yet remote in appearance, microhemorrhage.


Instruction: Generate impression based on findings.

Input: PRE-OP STEALTH: Seizures. There is a lesion with surrounding susceptibility effect in the anterior temporal lobe that measures up to approximately 15 mm. The previously demonstrated T2 hyperintensity involving the left medial temporal lobe appears to have subsided. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are skin fiducial markers present.

Output: Preoperative planning MRI demonstrates a probable cavernous malformation in the anterior left temporal lobe.


Instruction: Generate impression based on findings.

Input: Clinical question: Please evaluate for. Signs and symptoms: Headaches, lethargy and on anticoagulant Nonenhanced CT of brain: Examination demonstrates a large area of low-attenuation primarily in the subcortical white matter of right posterior frontal -- parietal with atrophic changes of overlapping cortex. This finding could represent an ischemic stroke however the appearance may also be secondary to edema from malignancy. There is no definitive mass effect with the above finding and to exclude other possibilities an MRI examination is recommended. There is no evidence of hemorrhage, mass effect, midline shift or hydrocephalus.

Output: 1.Area of low-attenuation in the subcortical white matter of right posterior frontal could represent an old stroke however to exclude possibility of an underlying malignancy MRI examination is recommended.2.There is no evidence of intracranial hemorrhage midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Reason: evaluate CORD History: trauma and fracture in L3 transverse process There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of cord compression or myelopathy.There is no evidence of tethered cord or spinal dysraphism. The filum terminale is normal in size and signal intensity. The paraspinal soft tissues and musculature are unremarkable.Nondisplaced fracture through the left transverse process of L3 is again noted, better seen on CT of the abdomen and pelvis from the same date.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: Right foraminal disc protrusion at L4-L5 which moderately narrows the right neural foramen and may mildly impinge the exiting nerve root at this level.L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Right foraminal disc protrusion at L4-5 with moderate right foraminal narrowing and probable mild nerve root impingement at this level.2. Fracture through the left transverse process of L3.


Instruction: Generate impression based on findings.

Input: 31-year-old male with pain. Evaluate PD tendon ring finger for adhesion versus re-rupture. The patient returned for additional sequences on 8/12/2015 in an attempt to better depict the flexor apparatus of the ring finger. There is intermediate signal intensity of the flexor digitorum profundus at the level of the head/neck of the middle phalanx, which may reflect degeneration or the sequela of prior tear and surgery, but we see no frank gap within the tendon to indicate re-rupture. There is low signal intensity material adjacent to the flexor digitorum profundus tendon distally, likely representing scar tissue. The radial slip of the flexor digitorum superficialis tendon can be traced to its insertion on the middle phalanx. The ulnar slip appears to be disrupted, but we suspect this is surgical in etiology based on the patient's operative report. There is slightly increased distance between the flexor apparatus and the proximal phalanx. The A2 pulley is stretched and of high signal intensity, but appears grossly intact.

Output: Low to intermediate signal within the flexor digitorum profundus tendon presumably representing scarring. We see no specific findings to suggest re-rupture. Other findings as described above.The patient returned for additional sequences to complement the MRI examination performed on 8/7/15, accession number 15284613. The patient will not be billed for this examination.


Instruction: Generate impression based on findings.

Input: There are stable postoperative changes from prior resection of the right temporal lobe with encephalomalacia. There is slight asymmetry in the size of the ventricles with the right ventricle slightly larger than the left, as well as mild ex vacuo midline shift to the right, stable since the previous MRI dated 2/29/2008.There is a cranioplasty plate that severely distorts the diffusion images. However, in the visualized field of the diffusion images, there are no abnormalities. There are punctate susceptibility foci in the right middle cranial fossa that likely represent chronic blood products from previous surgery.There is a punctate enhancement in the pons with questionable curvilinear enhancement anteriorly that may represent a tiny capillary telangiectasia and possible adjacent developmental venous anomaly.There is a chronic fluid in the right mastoid.

Output: 1. Stable MRI of the brain. Encephalomalacia seen in the right temporal lobe, unchanged. No abnormal enhancement.2. Stable chronic opacification of the right mastoid.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:3/21/1947)Reason: evaluate for structural brain lesion History: hx dysphagiaPROVIDER/ATTENDING NAME: NITASHA SARSWAT NITASHA SARSWAT The CSF spaces are appropriate for the patient's stated age with no midline shift. There are punctate foci of signal loss and susceptibility weighted imaging along the subcortical white matter of the supratentorial brain as well as in the cerebellum. There is a larger cassette signal loss and susceptibility in the left cerebellar hemisphere and also be identified on the T2 and FLAIR images is signal loss. There is a punctate focus of signal loss on susceptibility weighted imaging in the lower brainstem as well.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially.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.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Multiple microhemorrhages are present in the brain whose pattern is rather mixed in the etiology is uncertain. Subcortical microhemorrhages are known to be associated with amyloid angiopathy, however, this is nonspecific. There are also a few cerebellar microhemorrhages present as well one in the loser brainstem which can be seen with hypertensive type hemorrhage among other causes.


Instruction: Generate impression based on findings.

Input: 12 year old female with congenital dysplastic tricuspid valve and tricuspid regurgitation referred for cardiovascular MRI as part of a research study Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 77 ml/m2, the LVEDV is 118 ml, the LV end systolic volume index is 34 ml/m2, the LVESV is 52 ml, the LV mass index is 63 g/m2, and the LV mass is 56 g. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is moderately dilated with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RV end diastolic volume index is 111 ml/m2, the RVEDV is 170 ml, the RV end systolic volume index is 60 ml/m2, and the RVESV is 91 ml. Right AtriumThe right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve is thickened with elongated leaflets, and mild prolapse of the anterior and posterior leaflets. The coaptation point and the septal leaflet a mildly apically displaced. There is severe tricuspid regurgitation. AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size and systolic function (LVEF 56%)2. Moderately dilated right ventricle with mildly reduced systolic function (RVEF 46%, RVEDVi 111 mL/m2)3. The tricuspid valve is thickened with elongated leaflets, mild prolapse of the anterior and posterior leaflets, The coaptation point and the septal leaflet a mildly apically displaced. There severe tricuspid regurgitation4. Severe right atrial enlargement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Two month progressive onset of intermittent mutism, social withdrawal, and minimally interactivity. Additional acute onset of borderline delusional content. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a cluster of high T2 signal in the right parietal deep and periventricular white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A cluster of high T2 signal in the right parietal deep and periventricular white matter is nonspecific. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: HIV (CD4 250) with new bony nodule on the forehead, dizzy spells, blurry vision and new headache. There is a 9 x 2 mm T1 and T2 hyperintense crescentic mass beneath the left frontal galea with loss of signal on fat suppression sequence, most likely representing a lipoma. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable without evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are T1 hypointense and T2 isointense lesions within the right greater than left parotid glands, largest measuring 12 x 7 mm on the right. The skull and extracranial soft tissues are otherwise unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. A 9 mm lesion with imaging characteristics most consistent with a left frontal subgaleal lipoma.3. Small lesions within the right greater than left parotid glands, which may represent intraparotid lymph nodes or benign lymphoepithelial lesions in the setting of HIV.


Instruction: Generate impression based on findings.

Input: Headache [R51] / Fever, unspecified [R50.9], Reason for Study: ^Reason: Rule out meningitis/infection, intracranial bleed, CVA History: headaches, fevers, immune suppression No evidence of acute ischemic or hemorrhagic lesion on the scan.There is evidence of chronic ischemic infarct with encephalomalacia on the left MCA territory including left frontal lobe with subtle ex vacuo changes. There are multi focal lacunar infarcts on the left thalamus and bilateral caudate nuclei.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. 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: Chronic ischemic infarction on the left frontal lobe with multiple lacunar infarcts as described above.No evidence of acute ischemic or hemorrhagic lesion on this scan.No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 44 year old man with recent diagnosis of severe multivessel CAD, bicuspid aortic valve and reduced ejection fraction who was referred for cardiac MRI to evaluate for viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function. The overall LV ejection fraction is 14%, the LV end diastolic volume index is 256 ml/m2 (normal range: 74+/-15), the LVEDV is 465 ml (normal range 142+/-34), the LV end systolic volume index is 219 ml/m2 (normal range 25+/-9), the LVESV is 399 ml (normal range 47+/-19), the LV mass index is elevated at 121 g/m2 (normal range 85+/-15), and the LV mass is 220 g (normal range 164+/-36). There is global hypokinesis with regional variation; notably the inferior wall is thinned and akinetic. There is no apical thrombus noted. There is late gadolinium enhancement which is predominately transmural, suggestive of previous myocardial infarction, which involves the extent of the inferior and inferolateral walls, suggesting non-viability. There is additionally an atypical pattern (mid-wall stripe) of late gadolinium enhancement involving the basal to septum. This pattern is not consistent with prior myocardial infarction and suggests the presence of a concomitant non-ischemic/ dilated cardiomyopathy. The remainder of the myocardium (left anterior descending) is free of late gadolinium enhancement and likely to be viable. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 102 ml/m2 (normal range 82+/-16), the RVEDV is 186 ml (normal range 142+/-31), the RV end systolic volume index is 75 ml/m2 (normal range 31+/-9), and the RVESV is 136 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is bicuspid with fusion of the left and right coronary cusps. There is at least moderate aortic regurgitation, which appears eccentric. The regurgitant fraction is 35%.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is mildly dilated The sinus of valsalva is dilated (44x43mm). The ascending aorta measures 37x37mm, and the proximal transverse arch measures 29mm. There is no evidence of coarctation or aortic dissection.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated (34mm at the level of the ascending aorta).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is severely dilated with severely reduced systolic function (EF 14%). 2. There is a transmural myocardial infarction in the usual territory of the left circumflex or a large right coronary artery. This territory is not viable. The LAD territory is free of myocardial infarction and is likely to be viable. 3. There is additionally evidence of myocardial fibrosis involving the mid-wall of the basal to mid septum which is not due to a myocardial infarction and suggests that there is also a concomitant non-ischemic cardiomyopathy present.4. Normal size RV with severely reduced function (RVEF 27%). 5. Bicuspid aortic valve with at least moderate aortic regurgitation. 6. Mildly dilated aortic root without evidence of thoracic aortic dissection or coarctation.7. Biatrial dilatation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Von Hippel Lindau. History of renal cell carcinoma and pancreatic tumor/cysts. Evaluate growth of existing pancreatic lesions and presence of new lesions. Prior left upper pole resection for renal cell carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Stable appearance of a lobulated and septated segment 7 hepatic cystic lesion. The common bile duct is displaced anteriorly by a large pancreatic cyst which may account for the slight increase in biliary ductal dilatation, now moderate.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic parenchyma is completely replaced by multiple cystic lesions, some of which contain proteinaceous fluid/hemorrhage. An enhancing lesion within the pancreatic tail measures 2.0 x 1.7 cm (series 100, image 67), unchanged. Medial to this lesion there is an additional enhancing lesion that measures 1.4 x 1.2 cm, not substantially changed from prior (series 100, image 60). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple cysts bilaterally. Status post partial left nephrectomy, with no evidence of local recurrence. Increased size of a complex cystic lesion within the right inferior pole measuring 2.0 x 1.8 cm (series 102, image 20), previously 1.7 x 1.6 cm, suspicious for renal cell carcinoma. Additional subcentimeter lesion within the midpole contains mural and septal enhancement and remain suspicious (series 1202, image 39).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.Slightly increased size of an enhancing nodular lesion within the right lower pole, probable renal cell carcinoma. Additional suspicious right midpole lesion is unchanged. 2.Status post left partial nephrectomy, without evidence of local recurrence. 3.Increased biliary ductal dilatation due to pancreatic head cyst.4.Unchanged enhancing pancreatic lesions suspicious for islet cell tumors.


Instruction: Generate impression based on findings.

Input: 60-year-old female with diffuse abdominal pain and pain when laying down on the right side, feels something is catching posterior rib cage. There is vertebral kyphoplasty at T12. Compression fracture deformity at L2 as seen on prior MRI. Average stool burden with a nonobstructive bowel gas pattern. No intramural or free air. Lung bases are clear.

Output: Nonobstructive bowel gas pattern.


Instruction: Generate impression based on findings.

Input: Ms. Bennett is a 56 year old female with a personal history of right breast lumpectomy in 2004 for IDC treated with radiation, chemotherapy and hormonal therapy. Personal history of Li Fraumeni syndrome, sarcoma x2 and melanoma. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.Stable postsurgical changes seen in the right breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Multiple stable non-enhancing cysts are seen within the liver.

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


Instruction: Generate impression based on findings.

Input: Headache. Left posterior approach ventriculostomy is unchanged, with the tip terminating medial to the left occipital horn. Unchanged dilated dysmorphic lateral ventricles. Persistent diminutive fourth ventricle and small vermis. Caudal extension of the cerebellar tonsils below the foramen magnum, unchanged from prior.There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Dysplastic cerebellum, with caudal extension below the foramen magnum, small vermis, compatible with Chiari I malformation.2.Unchanged left posterior approach ventriculostomy with tip terminating medial to the left occipital horn and dysmorphic dilated lateral ventricles.


Instruction: Generate impression based on findings.

Input: Known perirectal abscess status post seton, persistent rectal pain and leukocytosis (WBC=17.9) despite antibiotics PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Heterogeneously T2 hyperintense, peripherally enhancing tract / collection arising from the right lateral wall of the rectum at the 9 o'clock position does not communicate with the skin (series 4, image 42). A seton is present within the tract.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Suprasphincteric perirectal fistula as described above with associated abscess.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis. There is no appreciable interval change in the numerous predominantly subcortical areas of T2 hyperintensity and multiple subependymal nodules, the largest of which are located adjacent to the bilateral foramina of Monro. The ventricles are unchanged in size and configuration, without evidence of obstructive hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged.

Output: No significant interval change of the intracranial stigmata of tuberous sclerosis complex.


Instruction: Generate impression based on findings.

Input: 50-year-old female with history of head and neck cancer and chemoradiation with right hepatic lobe lesion found on CT 11/20/2015. Evaluate liver lesion. ABDOMEN:LIVER, BILIARY TRACT: There is a subcentimeter segment 8 T2 hyperintense nonenhancing focus compatible with a cyst. Segment 6 T2 hyperintense focus with internal enhance septations; this lesion measures 1.1 x 1.1 cm (series 3, image 26).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.Segment 6 hepatic lesion as detailed above may represent benign complex cyst versus benign atypical hemangioma.2.Segment 8 subcentimeter hepatic cyst.


Instruction: Generate impression based on findings.

Input: 51-year-old male with acute psychosis, history of pituitary adenoma There is redemonstration of a large sellar lesion measuring 4.1 x 3.3 x 2.2 cm in sagittal and coronal planes (sagittal image 28, coronal image 32). While the size of the sellar lesion is similar to 2004, the mass appears heterogeneously hypodense on CT which is surprising based on prior MRI appearance which was more solid appearing. This may suggest interval treatment. As before, there is remodeling of the sella by the mass, with distortion of the posterior walls of the sphenoid sinus. Relationship to the chiasm is poorly defined based on this CT.There is no acute intracranial hemorrhage with special attention to the abnormal sella turcica. There is also no focal fluid collection. Ventricles and sulci retain normal size/configuration.Gray-white matter differentiation is preserved. There is no focal parenchymal lesion or mass. There is no midline shift or basal cistern effacement.Unremarkable visualized portions of the orbits. Paranasal sinuses are clear to the extent visualized. Mastoid air cells are also clear. Probable small quantities of cerumen in the external auditory canals.

Output: 1.No acute intracranial abnormality. Specifically no acute intracranial hemorrhage or generalized mass effect.2.Redemonstration of remodeled sella consistent with previously seen pituitary adenoma. The contents of the sella are now predominately hypodense which raises possibility of interval treatment. MRI would be required to evaluate extent of remaining tumor and to define relationship to surrounding structures.


Instruction: Generate impression based on findings.

Input: 9-year-old female with purulent congestion for two weeks. Mucoperiosteal thickening is seen in the maxillary sinuses, ethmoid sinuses, and sphenoid sinuses. The right ostiomeatal unit is occluded. A defect in the medial wall of the left maxillary sinus likely represents the sequela of previous antrostomy, and less likely may represent a focal erosion.The ventricles and basal cisterns are symmetrically increased in volume. These findings likely represent volume loss, however, increased intraventricular pressure cannot be excluded. Please correlate clinically. MRI examination may be considered if clinically indicated.The calvaria and skull base are radiographically normal.

Output: Sinus disease as described above.1.Symmetrically enlarged ventricles and basal cisterns. These findings likely represent volume loss, however, increased intraventricular pressure cannot be excluded.


Instruction: Generate impression based on findings.

Input: 52-year-old male with fever. Right hip and back pain with incontinence today. The bony density of the vertebral column and the alignment remains within normal limits. The bony density of posterior elements and soft tissue density of the lumber region are unremarkable. The spinal canal appears patent and no evidence of any masses is detected.Considering provided clinical data and unremarkable CT of lumber spine, MRI may be a better test for further evaluation. No spinal stenosis or neural foramina compromise is detected with certainty.

Output: 1.Essentially unremarkable CT examination of lumber spine.2.Further follow-up with an MRI examination is recommended.


Instruction: Generate impression based on findings.

Input: LUE and LLE numbness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia with gyriform susceptibility effect in the right posterior parietal and occipital lobes with ex vacuo dilatation of the right occipital horn. There is also mild scattered nonspecific cerebral white matter T2 hyperintensity. There is no midline shift or herniation. There is mild aneurysm dilatation of the left distal middle cerebral artery. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Encephalomalacia in the right posterior parietal and occipital lobes related to chronic infarction and mild scattered nonspecific cerebral white matter T2 hyperintensity that may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Mild aneurysm dilatation of the left distal middle cerebral artery.


Instruction: Generate impression based on findings.

Input: Female 21 years old Reason: hepatic adenomas vs FNH, change in size since last visit. **FNH PROTOCOL** History: liver lesions ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There is diffuse hepatic steatosis. No intra-extrahepatic ductal dilatation. Status post cholecystectomy.Segment two lesion measures 5.4 x 4.6 cm (image 26/series 16) previously, 5.4 x 4.7. cm. lesion is mildly hyperintense on T2 weighted imaging and does not contain intralesional fat and shows retention of contrast on the delayed images. Imaging features are most compatible with an FNH.Segment 7 lesion measures 1.3 x 1.2 cm (image 24/series 16) previously, 1.4 x 1.1 cm. is only mildly hyperintense on T2-weighted imaging demonstrates early arterial enhancement and retention of contrast on the delayed phase imaging. Imaging features are most compatible with an FNH.Segment 7/8 lesions are hyperintense on T2 weighted imaging shows arterial enhancement and washout. The lesions measures 2.2 x 2.0 cm (image 33/series 16) previously, 2.4 x 2.0 cm and 1.2 x 1.1 cm (image 35/series 16) previously, 1.2 x 1.1 cm. The imaging features are most compatible with an adenomas.The lesion at the hepatic dome is T2 isointense which shows arterial enhancement and washout measures 1.2 x 0.9 cm (image 14/series 16) previously, 1.2 x 0.9 cm and is compatible with an adenoma.Other subcentimeter arterial enhancing foci as seen on image 46/series 7 show enhancement and washout and are suspicious for small adenomas.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 significant size change in hepatic lesions with features of adenomas and focal nodular hyperplasia.


Instruction: Generate impression based on findings.

Input: 66-year-old male with bilateral upper/lower extremity weakness and paresthesias. Evaluate for cord signal abnormality. C-Spine MRI:There is straightening of the cervical spine. The vertebral body heights are maintained. There is multilevel disc height loss most prominently involving the C4-5 and C5-6 levels. There is no worrisome focal marrow signal abnormality. There is cord T2 signal abnormality posterior to C4, posterior to C5 and to a milder degree posterior to C3 which is likely secondary to long standing spinal canal narrowing from disc disease. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: Small disc osteophyte complex. No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex and small superimposed central disc protrusion. Facet arthropathy. Mild-moderate neuroforaminal narrowing and mild to moderate spinal canal stenosis.C4-5: Prominent disc osteophyte complex. Facet arthropathy and ligamentum flavum thickening. Severe spinal canal stenosis. Moderate right and moderate to severe left neuroforaminal narrowing. C5-6: Disc osteophyte complex. Moderate spinal canal stenosis. Moderate right and moderate to severe spinal canal stenosis. C6-7: Small disc osteophyte complex. Facet arthropathy. Minimal left neuroforaminal narrowing. No right neuroforaminal or spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.Cord compression protocol:Cervical spine findings as described above. Within the thoracic and lumbar spine, the spinal cord has normal signal characteristics and overall morphology. There are mild degenerative changes and multi-level Schmorl's nodes involving the lower thoracic and lumbar spine.

Output: 1.Cord signal abnormality in the cervical spine which likely reflects myelomalacia in association with likely long-standing spinal canal narrowing and cord impingement from degenerative changes and disc disease.2.Multi-level degenerative changes in the cervical spine with severe spinal canal narrowing involving the C4-5 level which also has moderate right and severe left neuroforaminal narrowing.3.Evaluation of the thoracic and lumbar spine were performed for exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified in the thoracic or lumbar spine.


Instruction: Generate impression based on findings.

Input: 52-year-old male with history of the effusion and pain. MENISCI: There is branching signal abnormality within the posterior horn of the medial meniscus extending into the body which contacts both articular surfaces compatible with a complex tear. There is an additional vertical component within the posterior horn extending to the femoral articular surface which fills with fluid suggesting an unstable defect. There is additional globular signal abnormality within the remaining meniscus which is likely degenerative in etiology. There is attenuation and mild deformity of the body and anterior horn of the medial meniscus which may reflect prior partial meniscectomy. If there is no surgical history, then this likely represents chronic attritional tearing. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Mild focal increased signal abnormality within the articular cartilage along the inferior aspect of the patella indicating mild degeneration. We see no discrete fluid filled defects of the articular cartilage. There are small tricompartmental osteophytes.LIGAMENTS: The PCL is abnormally thickened which may represent prior injury or mild mucoid degeneration. There is mild thickening and increased signal abnormality within the lateral collateral ligament which may reflect mild degeneration, however we see no discrete ligamentous tear. The ACL and MCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Moderate-sized joint effusion.2.Complex tear of the posterior horn of the medial meniscus.3.Mild degenerative changes and other findings as above.


Instruction: Generate impression based on findings.

Input: 51-year-old male presents with right hip pain. ACETABULAR LABRUM: There is linear high signal in the anterior superior labrum of the right hip consistent with a labral tear. Adjacent fluid collection may represent a paralabral cyst.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Anterior superior labral tear with an adjacent paralabral cyst.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a left precentral gyrus intra-axial T2 hyperintense lesion which has slightly increased its transverse width now measuring 15 mm, previously 13 mm. Additionally, it now contains a new ring enhancing portion which measures 13 mm transverse by 7 mm AP by 13 mm craniocaudal dimensions.Cavum septum pellucidum is again noted incidentally. There is no diffusion abnormality to suggest the presence of acute ischemia. The ventricles and sulci are within normal limits. The basal cisterns remain patent. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Redemonstrated is a left precentral gyrus intra-axial T2 hyperintense lesion which has slightly increased its transverse width now measuring 15 mm, previously 13 mm. Additionally, it now contains a new ring enhancing portion which measures 13 mm transverse by 7 mm AP by 13 mm craniocaudal dimensions.2.Findings were discussed Dr. Kohrman on 4/29/2015 approximately 12:40 p.m.


Instruction: Generate impression based on findings.

Input: 54 years, Female, Reason: history of breast CA, and abdominal adenopathy of ? cause. Followup scan of IPMN. History: IPMN. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Nonenhancing cystic lesion in the pancreatic head without definite communication with the pancreatic duct is unchanged measuring 8 mm (4/76).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Axillary lymph nodes seen previously is not visualized.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Artifact is seen in the mid abdomen.

Output: Cystic lesion in the pancreatic head is unchanged, likely a side branch IPMN.


Instruction: Generate impression based on findings.

Input: Anaplastic meningioma left parietal region, status post STR and XRT.. Redemonstrated are postoperative findings related to left parietal convexity meningioma resection. There is been continued evolution of postsurgical changes including development of an area of encephalomalacia involving the medial aspect of the left precentral gyrus and decrease in enhancement within this region. Chronic blood products in this region are again evident. Extent of FLAIR hyperintensity related to gliosis in the left posterior frontal lobe and in the left parietal lobe is not significantly changed. There remains enhancement along the left mid posterior aspect of the superior sagittal sinus which may represent minimal residual tumor, but is decreased in prominence since immediate postoperative study from 7/29/2015 likely related to decrease in associated postoperative changes. Superior sagittal sinus remains patent. No new or enlarging mass is appreciated. Small extra-axial collection at the level of the left parietal craniotomy is slightly decreased with adjacent enhancement which is likely reactive. Ventricles are normal in size. No midline shift or herniation. Major flow-voids are preserved. Evidence of mild global parenchymal volume loss is again evident. Mild mucosal thickening/mucous retention cysts involving the floor of the maxillary sinuses again seen.

Output: Continued evolution of postsurgical changes. Minimal residual tumor involving the superior sagittal sinus is again suspected. No new or enlarging lesion to suggest tumor progression.


Instruction: Generate impression based on findings.

Input: Reason: right ankle and shin pain for 2 weeks, s/p lung transplant, diabetic, r/o Charcot joint. History: as noted above The flexor, extensor, and peroneal tendons appear intact. The Achilles tendon is normal in appearance. The distal tibiofibular syndesmotic complex appears intact. The lateral collateral ligament complex appears intact. The imaged components of the deltoid ligament appear intact. As seen on the recent radiographs, there is periosteal reaction along the distal tibial metadiaphysis which is most prominent medially. There is patchy edema type signal within the distal tibial diaphysis that extends off of the field of view of this study. This signal abnormality is most prominent along the medial aspect of the distal tibial metadiaphysis where it assumes a somewhat curvilinear orientation, perhaps representing a stress fracture, but this is equivocal. The remaining bone marrow signal intensity is normal. There is a small amount of fluid within the tibiotalar joint, but no large effusion. We see no findings to suggest neuropathic arthropathy. There is diffuse subcutaneous edema which extends along the dorsum of the foot, appearing similar to the prior study.

Output: 1. Nonspecific subcutaneous edema.2. Edema within the distal tibia which extends off of the field of view of this ankle study is nonspecific, but is associated with a poorly defined curvilinear focus of signal abnormality, raising the possibility of a stress fracture. This could be followed with repeat radiographs if clinically warranted.


Instruction: Generate impression based on findings.

Input: 52-year-old female status post liver transplant with elevated bilirubin. Evaluate biliary tree. ABDOMEN:LUNG BASES: Moderate right and small left pleural effusions with underlying bibasilar atelectasis, partially visualized.LIVER, BILIARY TRACT: Postsurgical changes from liver transplantation. No focal hepatic lesions.Mild to moderate bilobar intrahepatic biliary ductal dilation with dilation of the common duct measuring up to 8 mm. There is an apparent transition point at the biliary enteric anastomosis, which appears narrowed.Hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Mild atrophy of the pancreas. There are multiple small cystic foci throughout the pancreas, several of which demonstrate connection to the main pancreatic duct. These are most compatible with small branch type intraductal papillary mucinous neoplasms. No suspicious features. Normal caliber of the main pancreatic duct. For future reference, the largest at the posterior aspect of the pancreatic head measures 16 x 13 mm (series 5/26).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube tip in distal duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild upper abdominal ascites and body wall anasarca.

Output: 1.Intra and extrahepatic biliary ductal dilation with narrowing at the biliary enteric anastomosis, which may be due to edema given recent transplantation.2.Multiple small pancreatic branch type IPMNs, for which follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: Reason: ro tumor, index finger PIP History: above Note is made of nonenhancing soft tissue prominence along the dorsal aspect of the PIP joint of the index finger of the left hand which is nonspecific, but of questionable clinical significance, and may represent scarring. No enhancing mass lesions are identified. There is a small amount of fluid within the PIP joint of the index finger which is not necessarily of any clinical significance. The flexor and extensor tendons appear intact. There is heterogeneous bone marrow signal abnormality within the phalanges of the middle and ring fingers likely representing residual islands of red marrow. Otherwise no bone marrow signal abnormality is identified. The remainder of the imaged soft tissues are unremarkable.

Output: Nonenhancing soft tissue prominence along the dorsal aspect of the PIP joint of the index finger of the left hand of questionable clinical significance. No enhancing or focal mass lesions are identified.


Instruction: Generate impression based on findings.

Input: Back pain. History of breast carcinoma. Lytic lesions in the vertebral bodies of T1, T7, and L1 levels are seen, correlating with abnormalities seen on prior MRI. The lesion at L1 involves both anterior and posterior elements. In addition, there are also lytic lesions in T2, T3, T4, T10, T11 and T12 vertebrae. There is also a lesion at the medial head of the right eighth posterior rib.There is pathological fracture of L1, with retropulsion and epidural mass causing spinal canal stenosis. These findings are better seen on the prior MRI study. There is no evidence of kyphoplasty changes in the thoracic spine.

Output: Lytic lesions in multiple vertebral levels and right 8th rib, consistent with metastasis. There are additional lesions seen compared to prior MRI study. Pathological fracture of L1 with epidural mass, causing compromise of the spinal canal.


Instruction: Generate impression based on findings.

Input: Diagnosis: LumbagoClinical question: eval s/p laminotomy.Signs and Symptoms: right buttock pain radiating down right lateral thigh Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. Since the prior exam, the patient has undergone right hemilaminectomy at the L4-5 level.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with some loss of disc space height. The fat surrounding the nerve roots at the lateral recesses sees is not effaced. The fat surrounding the exiting nerve roots within the neural foramina is not effaced. There is mild facet hypertrophy at this level.At L4-5 the patient is status post right hemilaminectomy and partial facetectomy. There is a large right lateral recess disc extrusion present at this level which extends across the midline and is associated with obliteration of the fat at the lateral recesses bilaterally. There is compression and obliteration of the cerebral spinal fluid surrounding the nerve roots within the thecal sac at this level. To some degree this appearance of severe spinal stenosis was also present on the prior exam and has not improved. There are associated endplate reactive changes at this level which have progressed since the prior exam. There are bright on T2 and dark on T1 on the current exam.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild disc bulge present at this level. This is unchanged compared to the previous exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a right far lateral disc protrusion present at this level which mildly displaces the right-sided exiting nerve root after it exits the neural foramen. This is unchanged compared to the previous exam.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There is severe spinal stenosis present at L4-5 predominantly due to a large disc extrusion eccentric towards the right hemicanal. 2.The patient is status post recent right sided posterior elements surgery at the L4-5 level. Endplate reactive changes are present at this level are suspected to be related to this and likely reactive and inflammatory in nature.3.Degenerative changes are also present at other levels in the lumbar spine as detailed above.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB: 9/24/1972)Reason: MS, eval for progression History: paresthesiasPROVIDER NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion, a left thalamus lesion and a right deep cerebellar lesion which are bright on FLAIR MRI and low signal on T1 that are smaller on the current exam compared to the prior exam. There is T2 signal hyperintense lesion present at the junction of medulla and spinal cord. This has not changed relative to the prior exam.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. There is T2 signal hyperintense lesion present at the junction of medulla and spinal cord. This has not changed relative to the prior exam.Foci of signal hyperintensity are present along the cervical spinal cord at the C2 vertebral body level measuring 9 mm by 5 mm sagittal dimensions, another located posteriorly at the C2-3 level measuring 4 mm axial dimensions along the left posterolateral aspect of the spinal cord which appears to have regressed relative to the prior exam. Additional smaller lesion is present in the left hemicord at C4 which is stable. Focal signal hyperintensity is also present along the thoracic spinal cord at the T1-2 level measuring 7 mm x 4 mm sagittal dimensions which is stable.At C2-3 there is a small central disk protrusion without significant compromise of spinal canal or exiting nerve rootsAt C3-4 there is redemonstration of a small central disk extrusion which compresses the thecal sac and effaces spinal fluid ventral to the spinal cord and is associated with flattening of the spinal cord. This has regressed relative to the prior exam.At C4-5 there is a diffuse disc bulge at this level associated with partial effacement of spinal fluid ventral to the spinal cord. There is encroachment of the right-sided exiting nerve roots at C4-5. This has progressed relative to the prior with a new encroachment of the right-sided exiting nerve roots.At C5-6 there is a diffuse disk bulge present associated with endplate reactive changes and effacement of spinal fluid ventral and posterior to the spinal cord. This was also present on the prior exam. There is bilateral neural frontal encroachment of the exiting nerve roots at this level. Since the prior exam endplate reactive changes at this level have converted to a chronic stage. Encroachment of the right-sided exiting nerve roots at this level appears to have worsened.At C6-7 there is a diffuse disk bulge present associated with some narrowing of the neural foramina bilaterally. This is stable since the prior examAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There is a T2 hyperintense lesion present within the right lobe of the thyroid measuring 7 mm in size. This was also present on the prior exam and does not appear to have changed substantially.

Output: 1.There is a mild degree of small periventricular white matter lesions, a small right internal capsule lesion and left thalamus lesion which are stable relative to the prior exam from 6/2/15.2.Since the previous examination the patient's spinal cord lesions compatible with demyelination are appear to have remained stable in number. A lesion in the spinal cord at C3 has regressed in size.3.Since the prior examination disc extrusion at C3-4 has regressed and now does not create spinal stenosis.4.Since the prior examination spinal stenosis at C5-6 associated with neural foramina encroachment has endplate reactive changes which are in the chronic phase but is otherwise relatively stable. The neural foramen encroachment at this level is worse on the right relative to the left side.5.Since the prior examination mild to moderate spinal stenosis at C6-7 due to disk protrusion and encroachment of exiting nerve roots remains stable.6.The right thyroid lobe lesion remains stable.


Instruction: Generate impression based on findings.

Input: 52-year-old female with newly diagnosed left breast DCIS. In January 2014 she had a screening mammogram which revealed calcifications in the left breast. Stereotactic biopsy showed DCIS. She underwent wire localized lumpectomy on 3/3/14 in Michigan which revealed a close margin (<1 mm). Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. An intramammary lymph node is noted in the right outer breast, similar to the prior MRI. Post surgical changes with architectural distortion, increased density, and surgical clips are noted in the left retroareolar breast. No dominant mass, suspicious microcalcifications, or areas of architectural distortion are present in either breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: This is a limited exam performed for the purposes of surgical localization. There is an unchanged left anterior middle cranial fossa arachnoid cyst that results in mild bowing of the posterior lateral wall of the left orbit and mild left proptosis. There is a tiny developmental venous anomaly in the brainstem. There is unchanged T1 hyperintense retention cyst within the left sphenoid sinus. There is no evidence of abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and scalp appear unremarkable.

Output: 1.No evidence of intracranial metastases. If there is concern for recurrent melanoma elsewhere, a PET-CT is suggested.2.Unchanged left middle cranial fossa arachnoid cyst with mass effect upon the left orbit and mild left proptosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Vertebral body heights in the lumbar spine are normal. Alignment is anatomic. There are no fractures or subluxations. The conus is normal in signal and morphology and terminates at an appropriate level. Again seen are endplate irregularities involving the endplates of all of the vertebral bodies from the T11 to the S1 levels, most compatible with multiple Schmorl's nodes. Compared to 11/24/2015, there is increase in STIR hyperintensity and enhancement involving the inferior endplate of the L5 vertebral body likely on a degenerative basis and probably reflecting developing Schmorl's node. Increased enhancement is also noted in the right paravertebral region. Also seen is slight increase in endplate irregularity involving the superior endplate of the L1 vertebral body with slight increase in previous seen STIR hyperintensity and enhancement at this level. Remainder of the foci of STIR hyperintensity and enhancement involving the endplates are not appreciably changed.Again seen is a subtle enhancing lesion in the posterior thecal sac at the L1-L2 level, sagittal post gad image 9/17, measuring 8 x 5 mm, which may represent a small nerve sheath tumor and unchanged since 11/11/2013. No evidence of metastatic disease within the lumbar spine.There are multilevel degenerative changes, as described below:T12/L1: No significant central canal stenosis or neuroforaminal compromise.L1/2:No significant disk disease, spinal canal or neural foramina stenosis. L2/3: Disc bulge with small left paracentral disc protrusion is again seen which partially effaces the left lateral recess slightly less prominent than prior studies. Minimal left neural foraminal narrowing. Right neural foramen is patent. Minimal central spinal canal stenosis related to ligamentum flavum thickening, epidural fat, and facet arthropathy.L3/4: Disc bulge, facet hypertrophy and ligamentum flavum hypertrophy without significant spinal canal stenosis or neuroforaminal narrowing.L4/5: Disc bulge, facet hypertrophy and ligamentum flavum hypertrophy resulting in partial effacement of the right lateral recess, mild central canal stenosis, and mild to moderate right neuroforaminal narrowing. Mild left neural foraminal narrowing. L5/S1: Disc bulge and facet hypertrophy resulting in moderate right neural foraminal stenosis. The right-sided stenosis is similar to 11/24/2015 but worse than 11/14/2014. There is mild left neural foraminal narrowing. No significant spinal canal narrowing.

Output: 1. No evidence of metastatic disease in the lumbar spine.2. Multiple Schmorl's nodes throughout the lumbar spine again seen. Compared to 11/24/2015, there is worsened signal abnormality involving the inferior L5 endplate likely reflecting increased edema associated with developing Schmorl's node. More subtle worsening of endplate signal abnormality is seen associated with the Schmorl's node at the the superior L1 endplate.3. Subtle enhancing lesion in the thecal sac at the L1-L2 level, sagittal post gad image 9/17, measuring 8 x 5 mm is not significantly changed since 11/11/2013 and may represent an intradural extramedullary lesion such as a small nerve sheath tumor or perhaps meningioma. 4. Mild to moderate degenerative changes of the lumbar spine as detailed above. There is mild to moderate right L4-L5 and moderate right L5-S1 neural foraminal stenosis. Mild spinal canal stenosis at L4-L5 is also present.


Instruction: Generate impression based on findings.

Input: 49-year-old female with right knee pain. Evaluate for right knee meniscus tear. MENISCI: There is horizontally oriented intermediate signal abnormality within the anterior horn of the lateral meniscus which extends to the body of the meniscus as well as the femoral and tibial articular surfaces, appearing similar to the prior study. There are also subcentimeter foci of fluid signal intensity along the anterior aspect of the anterior horn consistent with parameniscal cyst formation, appearing decreased in size when compared to the prior study. These findings may represent a combination of postsurgical change related to the patient's history of prior partial meniscectomy and prior tearing. There is no gadolinium filled defect to suggest a re-tear. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a near full-thickness articular cartilage fissure along the medial facet of the patella. The remainder of the articular cartilage of the patellofemoral compartment appears intact. The articular cartilage of the medial and lateral tibiofemoral compartments appears intact without evidence of near full-thickness or full-thickness articular cartilage defects. The bone marrow signal intensity is normal.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Postsurgical changes of prior partial meniscectomy and prior tearing of the lateral meniscus without definite evidence to suggest a re-tear of the meniscus.


Instruction: Generate impression based on findings.

Input: 42-year-old female with inguinal mass. Compared to the previous exam. PELVIS:UTERUS, ADNEXA: Again noted are multiple uterine fibroids. The largest subserosal fibroid extends anteroinferiorly from the uterus and measures 2.7 x 2.2 cm (series 301, image 24).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ill-defined enhancing soft tissue mass in the left inguinal area which measures 2.7 x 2.9 cm (series 1/1/2001, image 114), previously measuring 3.3 x 2.8 cm.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the ill-defined enhancing mass in left inguinal region. Given patient history of cyclical pain corresponding to her menstrual cycle, this most likely represents endometriosis.2.Leiomyomatous uterus.


Instruction: Generate impression based on findings.

Input: 42 year old female patient with right hip pain status post scope and piriformis pain. ACETABULAR LABRUM: There is a fissure in the anterior superior labrum best seen on the radial images (image 11, series 1301) and a fissure within the anterior mid labrum (image 20, series 701). ARTICULAR CARTILAGE AND BONE: Bone marrow signal is within normal limits. A non-metallic screw is noted within the greater trochanter.SOFT TISSUES: Signal within the visualized musculature and soft tissues is within normal limits. ADDITIONAL

Output: Two fissures within the labrum as described above.


Instruction: Generate impression based on findings.

Input: 42-year-old female strong family history of breast carcinoma. Family history of breast cancer in her mother diagnosed at age 37, and a maternal aunt. There is heterogeneous amount of fibroglandular tissue in both breasts. Scattered high T2 signal cysts are present.Moderate to marked parenchymal enhancement is noted bilaterally. This is increased compared to prior studies and somewhat of a limitation. No suspicious enhancement is seen in either breast. The 8 mm inferior left breast mass is stable in size and typically benign in appearance, though less conspicuous today due to a relative increase in background enhancement. A few of the scattered enhancing foci in the right breast are more enhancing, though none uniquely suspicious. Their kinetic profiles are typically benign once slight motion is accounted for. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Please schedule future MRI follow up studies during the 2nd week of the patient's menstrual cycle to limit the effect of background enhancement.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with left upper extremity contractures. Evaluate for etiology. The cervical lordosis is straightened, but sagittal alignment is otherwise unremarkable. Vertebral body morphology is unremarkable allowing for mild degenerative loss of height of C5, C6 and C7. No evidence of concerning marrow replacement or marrow edema is seen.Spinal cord morphology is altered by multilevel disc osteophytes as discussed below. No convincing evidence of cord signal abnormality is seen. No epidural abnormality is suspected.C2-3: Left greater than right facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Left greater than right facet hypertrophy. Posterior disc-osteophyte complex formation with a large superimposed central disc extrusion impinges on the ventral spinal cord and causes a moderately severe canal stenosis. Moderate bilateral foraminal narrowing. C4-5: Left facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the right. Effacement of the ventral thecal sac with a moderate spinal canal stenosis and minimal if any cord deformation. Moderate bilateral foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with a small central component which mildly impinges on the cord and causes a mild to moderate spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation with a small central component which minimally impinges on the cord and causes a mild spinal canal stenosis. Mild bilateral foraminal narrowing. C7-T1: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing.

Output: Multilevel degenerative disc findings are seen. This is most severe at the C3-4 level where disc osteophyte formation and a superimposed central extrusion causing spinal cord impingement and a moderately severe stenosis of the spinal canal.Less severe cord impingement and spinal canal stenosis is seen at C4-5, C5-6 and C6-7. Scattered mild to moderate foraminal narrowing is also demonstrated as detailed above.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the normal lumbar lordosis which may be due to positioning. Alignment is otherwise within normal limits without sagittal spondylolisthesis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement within the spine. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L2 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There is partial visualization of the known area of left piriform abscess, further detailed on the concurrent MRI of the pelvis.

Output: No acute abnormalities or evidence of infection within the lumbar spine. Please see accompanying MRI of pelvis for further details regarding the pelvic abscess.


Instruction: Generate impression based on findings.

Input: 57-year-old female with elevated alkaline phosphatase and abdominal pain. ABDOMEN:LUNG BASES: Multiloculated right and left pleural effusions are again noted and not significantly changed compared to the 4/14/2016 CT chest examination. Additionally, again noted is partially visualized right lower lobe opacities.LIVER, BILIARY TRACT: Hepatomegaly with liver measuring approximately 20 cm. Again noted is a mildly distended gallbladder with sludge. No gallbladder wall thickening or pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation. The common bile duct tapers smoothly to the level of the ampulla without evidence of choledocholithiasis or stricture.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 definite MRI evidence of acute cholecystitis.2.No intra or extrahepatic biliary ductal dilatation.3.Multiloculated right and left pleural effusions are not significantly changed compared to 2/14/2016 CT examination. Right lower lobe opacity is again noted and may represent infection versus drug reaction.


Instruction: Generate impression based on findings.

Input: Evaluate ventricular size: Grade III intraventricular hemorrhage and ventriculomegaly. There is marked dilatation of the entire ventricular system. There are persistent punctate foci of susceptibility effect within the bilateral caudothalamic grooves, left cerebellar hemisphere, and diffusely along the ventricular margins. The degree of myelination may be slightly delayed. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Marked ventriculomegaly and stigmata of prior germinal matrix hemorrhage with intraventricular extension.


Instruction: Generate impression based on findings.

Input: Status post right CCM resection Non-infused CT of brain:Examination demonstrate a foci of increased density measuring approximately 30 x 14.6-mm in trans-axial dimensions in the right basal ganglia. There are no prior CT examination for comparison. This finding is believed to represent patient's known cavernous malformation at this site. There is evidence of surgery and with extension of surgical tract to the right lateral aspect of this lesion. Although the above finding could represent patient's known cavernoma and does not particular area appeared like acute hemorrhage possibly itself subtle associated hemorrhage cannot be ruled out. The configuration of right frontal horn is identical to prior MRI exam which demonstrated extension of tumor into the right caudate nucleus and bulge into the right frontal horn.Postoperative changes of a right anterior frontal craniotomy and resultant air within the anterior cranial fossa bilaterally and minimal epidural collection under the craniotomy flap. There is no evidence of subarachnoid hemorrhage or definitive acute parenchymal hemorrhage. Ventricular system remains within normal size and unchanged since prior exam. There is no midline shift.

Output: 1.Postoperative changes of right frontal craniotomy for partial resection of right basal ganglial cavernoma.2.High density material within the right basal ganglia as measured could represent residual cavernoma. No definite postoperative hemorrhage is detected however high density of the mass can obscure small amount of hemorrhage.3.There is no evidence of hydrocephalus or midline shift.4.Residual air and minimal epidural hemorrhage under the craniotomy flap.


Instruction: Generate impression based on findings.

Input: History of recurrent UTI. PELVIS:UTERUS, ADNEXA: The uterus is anteverted and anteflexed and is normal in size measuring 8.6 x 4.6 x 5.1 cm. A defect within the anterior lower uterine segment is compatible with a cesarean section scar. The endometrial stripe is normal thickness measuring 10 mm. A subcentimeter bulge of the anterior uterine wall at the fundus is favored to reflect a submucosal fibroid. The junctional zone measures up to 11 mm which is nonspecific but can be seen with adenomyosis.The ovaries contain normal-appearing follicles. The right ovary measures 3.9 x 2.6 x 1.8 cm. The left ovary measures 2.0 x 3.4 x 2.0 cm. No abnormal adnexal masses are identified.BLADDER: The bladder and urethra appear within normal limits. No bladder or urethral diverticuli identified.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.Normal appearance of the lower urinary tract without specific findings to account for patient's recurrent urinary tract infections.2.Thickening of the uterine junctional zone which is nonspecific but can be seen with adenomyosis.3.Suspected subcentimeter submucosal fibroid.


Instruction: Generate impression based on findings.

Input: 25 year old female with MRI findings of subtalar joint coalition. Assess middle facet coalition versus trauma from old fracture.IMAGE ACQUISITIONS: CT examination of the right foot, noncontrast Again seen is the abnormal articulation of the middle facet of the subtalar joint. The middle facet is more vertically oriented than normal with mild atrophy of the sustentaculum. Additionally, there is slight subchondral sclerosis and cyst formation at this joint. It is unclear whether these findings are secondary to fibrous coalition or prior trauma.Small ossicles are again seen distal to the lateral and medial malleoli, compatible with post traumatic sequelae. Please refer to report for recent MRI for further evaluation of soft tissue pathology.

Output: Reidentification of the abnormal articulation at the medial facet of the subtalar joint which again may be secondary to old trauma versus fibrous coalition.


Instruction: Generate impression based on findings.

Input: Cerebral palsy. There is a 12 mm wide defect in the inferior right frontal lobe, with abnormal cortex along the margins of the defect. The lateral ventricles are mildly enlarged and display angulated margins. In addition, there is absence of the septum pellucidum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is a posterior pituitary bright spot in the normal location. There is no midline shift or herniation. There is a persistent falcine sinus. The major cerebral flow voids are otherwise intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The bilateral optic nerves appear to be hypoplastic.

Output: 1. Right inferior frontal lobe schizencephaly with associated findings suggestive of septo-optic dysplasia and a persistent falcine sinus.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: There are multiple nonspecific confluent and scattered foci of T2/FLAIR hypointensities in the subcortical and periventricular white matter, and in the pons, and most likely represent a chronic small vessel ischemic disease. There is no diffusion restriction. There is round susceptibility signal in the posterior aspect of the left external capsule representing mineralization versus old blood products. There is no abnormal enhancement. Ventricular size is normal with no midline shift. There is no acute hemorrhage. There is no mass effect. Vascular structures are unremarkable.

Output: 1. There is no evidence of acute intracranial hemorrhage, acute infarction, or mass effect.2. Nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter, most likely representing chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Gastroesophageal cancer and multiple episodes of syncope. There is a punctate (2 mm) focus of enhancement in the superior right postcentral gyrus grey-white junction. There is no evidence of intracranial hemorrhage or acute infarct. There are a few nonspecific punctate foci of cerebral white matter T2 hyperintensity. There is a cystic lesion that measures up to 10 mm in the anterior right temporal lobe. 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 are grossly unremarkable. There is a non-enhancing ovoid lesion in the left occipital scalp that measures up to 22 mm, which likely represents an inclusion cyst. There is an intrinsically T1 hyperintense lesion in the left parietal calvarium, which may represent a hemangioma.

Output: 1. A punctate focus of enhancement in the superior right postcentral gyrus grey-white junction may represent metastatic disease. 2. A cystic lesion that measures up to 10 mm in the anterior right temporal lobe may represent a neuroglial cyst or prominent perivascular space, for example.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate for etiology of new onset of severe headaches and epistaxis. Signs and symptoms: Complains a one week history of severe headaches No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and CSF cisterns remain within normal. There is apparent crowding of cerebellar tonsils at the level foramen magnum which may represent ectopia of the cerebellar tonsils. This finding can be further evaluated with an MRI exam. Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: Negative CT of brain for any acute findings. Possible ectopic cerebellar tonsils as detailed.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with sciatica, increased back pain with history of fall, works in the construction business. Thoracic:Vertebral body morphology is within normal limits. Edematous endplate degeneration is partially visualized at C7-T1. Minimal endplate edema is seen anteriorly at T11-12 with small Schmorl's nodes at this level as well. No concerning marrow replacement or evidence of significant marrow edema is seen. The spinal cord demonstrates normal signal intensity and morphology.Very small central disk protrusions are seen at T1-2 and T2-3. No significant spinal canal or neuroforaminal stenosis is seen.Lumbar:The L1 vertebral body is wedged anteriorly with about 40% loss of height. No increased STIR signal is seen within the L1 vertebral body.Remaining vertebral bodies demonstrate normal morphology and signal characteristics. A mild focal kyphotic angulation is evident centered at the L1 vertebral body, but otherwise, lumbar spine alignment is anatomic.Visualized conus and nerve roots of the cauda equina are unremarkable.T12-L1: Loss of disk height but no significant disk bulging or herniation. No spinal canal or neuroforaminal stenosis.L1-2: Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Mild laterally bulging disk. No significant generalized spinal canal stenosis. No significant neuroforaminal narrowing. L3-4: Moderate facet hypertrophy with small facet effusions and ligamentum flavum thickening. Mild laterally bulging disk. No significant generalized spinal canal stenosis. Minimal bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy with facet complex edema, particularly on the left, and perhaps a small left ligamentum flavum cyst. No significant spinal canal or neuroforaminal stenosis. L5-S1: Moderate facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: 1. Degenerative endplate disease is partially visualized at C7-T1. Elsewhere in the thoracic spine, only minimal degenerative disease is seen with no areas of high-grade spinal canal or neuroforaminal stenosis.2. Anterior wedging of the L1 vertebral body is probably chronic given lack of marrow edema.3. Mild disk degeneration through the lumbar region is seen. Moderate posterior element hypertrophy is also present at several levels. However, no areas of high-grade spinal canal or neuroforaminal stenosis are seen.


Instruction: Generate impression based on findings.

Input: There is redemonstration of a small area of diffusion restriction along the lateral aspect of the posterior right dorsal medulla with associated T2 hyperintensity. There is no evidence of intracranial hemorrhage. The ventricles and sulci are unchanged in size and configuration. The basal cisterns remain patent. There is no midline shift or mass effect. The distal right vertebral artery flow-void appears to be markedly narrowed. There is mild mucosal thickening in the right maxillary sinus with suggestion of chronic inflammatory changes.

Output: Right dorsolateral medulla recent infarct without evidence of hemorrhagic transformation. Associated with steno-occlusive disease of the distal right vertebral artery, which is better depicted on the recent CTA.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

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


Instruction: Generate impression based on findings.

Input: New left sided weakness, recent seizure. There is no evidence of acute infarct. There are multiple areas of encephalomalacia involving the bilateral cerebellar hemispheres, and right occipital and parietal lobes . There is no abnormal intracranial enhancement. There is moderate scattered patchy cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: Chronic infarcts in multiple vascular territories and chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: BRAIN: The enhancing focus in the left midbrain is again seen and is hyperintense on T1, heterogeneous with a hypointense rim on T2, and demonstrates blooming artifact on susceptibility weighted images. This lesion measures 6 x 5 mm, previously 6 mm. There is no adjacent mass effect or FLAIR signal to indicate edema.Additional curvilinear enhancement in the inferior right frontal gyrus extends to a focus of susceptibility artifact which was present on prior examinations but now demonstrates blooming artifact. There is no adjacent mass effect or FLAIR signal to indicate edema. This is likely a developmental venous anomaly with a small associated cavernoma which has bled in the interval from 12/2014.Focal dural thickening adjacent to the left middle frontal gyrus demonstrates enhancement and is not significantly changed from the prior examinations.There is susceptibility artifact along the anterior cranial fossa bilaterally which, although there is no CT to correlate, may represent mineralization of the dura. An additional, questionable small round focus of susceptibility is noted near the cerebral vertex which is nonspecific but may represent a small cavernoma or possible focus of mineralization.There are no new enhancing masses. There is no diffusion abnormality to suggest acute infarct. Prominent left choroid is unchanged. The ventricles and sulci are within normal limits. The major intracranial vascular structures enhance normally.NECK: The fat saturation portions of this examination are inhomogeneous, slightly limiting evaluation. There are postoperative changes related to thyroid isthmusectomy and neck dissection with susceptibility artifact from surgical clips. There is no evidence of recurrent tumor in the thyroid bed. No nasopharyngeal mass is identified. There is no significant lymphadenopathy.The salivary glands appear normal. The parapharyngeal soft tissues appear normal. The larynx appears normal. Flow voids are noted in the major cervical vasculature. The marrow signal of the cervical and upper thoracic vertebrae is normal. Area of fan-like opacity in the left upper lobe corresponds to areas of ground glass opacity seen on CT from 3/18/15.

Output: 1.Stable lesion in the left midbrain, compatible with cavernoma.2.Likely developmental venous anomaly with associated cavernoma in the right frontal lobe with interval hemorrhage since 12/10/14 but no edema.3.Probable left frontal meningioma stable.4.Postoperative findings of thyroid isthmusectomy and neck dissection without recurrence or lymphadenopathy.5.No evidence of recurrent nasopharyngeal carcinoma or lymphadenopathy.6.Left upper lobe opacity better characterized on concurrent CT chest.


Instruction: Generate impression based on findings.

Input: 55yo M with stage III NSCLC s/p neoadjuvant chemoRT. Intermittent left leg numbness. MRI brain to rule out metastases. There is motion degradation on multiple sequences which may limit detection of subtle lesions. There is a 3 mm focus of enhancement in the right paramedian frontal lobe, series 13 image 24, series 14 image 16 suspicious for tiny metastasis. This lesion is not evident on prior study from 8/12/2016. There is otherwise no intracranial mass or abnormal parenchymal or meningeal enhancement elsewhere to indicate metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. No extra-axial collections.Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Focal T2/FLAIR hyperintensity involving the left superior frontal gyrus is unchanged and may be related to prominent perivascular spaces or possibly remote ischemia. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.There is a right maxillary sinus mucus retention cyst which is again seen. There is nonspecific heterogeneity of the bone marrow without discrete destructive osseous lesion evident. Orbits and remainder of the extracranial soft tissues are grossly unremarkable.

Output: 1. There is a subtle 3 mm focus of enhancement in the right paramedian frontal lobe which is suspicious for a metastasis. Note examination is motion degraded which limits assessment for subtle lesions. Short-term follow-up/repeat post gadolinium sequences can be considered as clinically warranted.2. Minimal chronic small vessel ischemic changes. No evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Male, 56 years old, with severe degenerative disease presenting with bilateral lower extremity pain, numbness and tingling, chronic for one year, with new knee buckling. Sagittal alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate edema is seen at L3-4. A benign hemangioma is evident within the left aspect of the L1 vertebral body. Elsewhere, no significant marrow signal abnormality is detected. The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate to severe spinal canal stenosis with near complete effacement of the CSF and crowding of the cauda equina. Moderate right and mild left foraminal narrowing. L3-4: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a superimposed central disc protrusion. Severe spinal canal stenosis with effacement of the CSF and likely impingement of the cauda equina. Moderate left and mild right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disc bulging with a right paracentral protrusion. Moderate generalized spinal canal stenosis. Severe right and moderate left foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. Bulging disc asymmetric to the left. No spinal canal stenosis. Moderate left and mild right foraminal narrowing.

Output: 1.Disc degeneration at L3-4 along with posterior element hypertrophy contribute to produce a severe spinal canal stenosis with impingement of the cauda equina.2.Left severe spinal canal narrowing is evident on the right at L4-5.3.Severe foraminal narrowing is seen on the right at L4-5. Scattered mild-to-moderate foraminal narrowing is evident as discussed above.


Instruction: Generate impression based on findings.

Input: 79-year-old female with new onset leg weakness, rule out stress fracture, possible AVN Evaluation is limited due to patient motion artifact and inability to complete the scan. We see no findings to indicate avascular necrosis of the femoral head or stress fracture of the proximal femur. On the large field of view images there is replacement of the anterior aspect of the right iliac crest with low to intermediate T1- and high T2-signal intensity as well as mild edema in the adjacent musculature. This is nonspecific, although upon review of prior pelvis radiographs from January 22 there is a short linear lucency traversing the iliac crest which could conceivably represent a nondisplaced fracture. However, we cannot exclude the possibility of a metastasis or marrow infiltrating process like multiple myeloma on the basis of this MRI. Additionally, a couple of small (5-mm and 3-mm) rounded foci situated more posteriorly within the right ilium are nonspecific, but could represent metastatic deposits or myelomatous lesions. Heterogeneity of the remaining marrow of the axial skeleton and proximal femora we suspect is due to residual red marrow.Mild osteoarthritis affects the hip. Evaluation of the labrum is limited, but we suspect there is a least a partial thickness tear through the anterosuperior labrum. A small amount of fluid is present within both hip joints without frank effusion. Small Tarlov cysts are noted along the right S1 nerve roots. There is severe fatty atrophy of the lower paraspinal muscles and also fatty atrophy of the gluteus minimus musculature, left greater than right.

Output: Replacement of the anterior aspect of the right iliac crest with abnormal signal intensity which could possibly represent edema from a nondisplaced fracture, but we cannot exclude metastatic disease or a myelomatous lesion, particularly given that there are a couple of nonspecific foci of signal abnormality present more posteriorly within the iliac wing. If further evaluation is clinically warranted, CT scan of the chest, abdomen and pelvis may be considered to evaluate for primary primary malignancy (e.g., lung, renal) and simultaneously for an occult fracture of the right ilium. Serum protein electrophoresis may be considered to evaluate for multiple myeloma.


Instruction: Generate impression based on findings.

Input: Past history of right breast DCIS and pagets disease, status post mastectomy presents for routine surveillance There is scattered fibroglandular tissue in left breast. Patient is status post right mastectomy.Moderate parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast and right chest wall. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate the Small Bowel History: H/o Crohn's Disease Evaluate the Small Bowel ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a narrowed segment in the distal ileum on postcontrast exam in the region of prior inflammation, however this region appears normal on T2 weighted sequences. No evidence of active inflammation. No abscesses or fistulas.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of active disease.


Instruction: Generate impression based on findings.

Input: Right cavernous sinus meningioma. Status post resection and posterior technical radiosurgery. Follow-up. Also, increased pressure and pain at the incision site. There are changes of previous right pterional craniotomy and right cavernous meningioma resection. The residual enhancing tumor involving the right cavernous sinus and extending into the right orbital apex through the optic canal and into the pterygopalatine fossa via the foramen rotundum and inferior orbital fissure is unchanged. There is associated compression of the right optic nerve with atrophy of the remainder of the retrobulbar segment. Dural thickening in the anterior aspect of the right middle cranial fossa is unchanged. The anterior right temporal encephalomalacia adjacent to the resection cavity is unchanged. Likewise, scattered nonspecific T2 hyperintense foci in the cerebral white-matter are unchanged. There is no evidence of new intracranial hemorrhage, mass, or acute infarct. There is an unchanged small left precentral development of venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The left orbit is grossly unremarkable. There is a right maxillary retention cyst. Otherwise, there is minimal scattered mucosal thickening in the paranasal sinuses.

Output: 1.The residual right cavernous sinus meningioma with orbital and pterygopalatine extension appears to be unchanged since December 2014.2.Anterior right temporal encephalomalacia and mild cerebral white-matter probable chronic microvascular ischemia are also unchanged.