Instruction: Generate impression based on findings.

Input: Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: acoustic neuroma, RT planning History: RT planning This is limited study for RT planning protocol.There is about 11.2mm x 15mm sized right CP angle mass which extends toward right IAC. On Gad enhanced images, the lesion including intra canalicular portion shows intense enhancement with internal non enhancing areas indicating cystic or necrotic components. These findings are consistent with acoustic neuroma.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.

Output: Right CPA tumor which extends toward right IAC, consistent with acoustic neuroma.


Instruction: Generate impression based on findings.

Input: Postoperative changes are present from interval suboccipital craniotomy with resection of the posterior C1 arch. A postoperative extradural fluid collection is present within the overlying soft tissues measuring 3.3 cm AP x 6.8 cm craniocaudal x 2.67 m transverse, which does not exert mass effect upon the dura. A reconstructed CSF space is now present posterior to the cerebellar tonsils which retain a pointed configuration. Sagittal, thin section, high-resolution T2 images best demonstrate a thin process extending through the posterior CSF space (for example series 301, image 21/51) with the imaged biphasic CSF flow present only anterior to this. The cervical cord remains normal in signal.There are no fractures or subluxations. The marrow signal is benign, including a stable benign hemangioma within the C6 vertebral body. C2/3: Unremarkable and unchanged.C3/4: Unremarkable and unchanged.C4/5: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis. These findings are unchanged.C5/6: Mild posterior osteophyte disc complex causing minimal anterior cord flattening. There is no resulting stenosis. These findings are unchanged.C6/7: Unremarkable and unchanged.C7/T1: Unremarkable and unchanged.

Output: Postoperative changes are present from interval suboccipital craniotomy with resection of the posterior C1 arch. A postoperative extradural fluid collection is present within the overlying soft tissues measuring 3.3 cm AP x 6.8 cm craniocaudal x 2.67 m transverse, which does not exert mass effect upon the dura. A reconstructed CSF space is now present posterior to the cerebellar tonsils which retain a pointed configuration. Sagittal, thin section, high-resolution T2 images best demonstrate a thin process extending through the posterior CSF space (for example series 301, image 21/51) with the imaged biphasic CSF flow present only anterior to this.


Instruction: Generate impression based on findings.

Input: Female 64 years old Reason: cirrhosis of the liver History: PBC ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No focal enhancing lesion. No biliary ductal dilatation. Cholelithiasis without evidence of cholecystitis.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: Multiple nonspecific mildly enlarged retroperitoneal lymph nodes, not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Cirrhotic liver morphology with no focal enhancing lesions.2. Multiple nonspecific mildly enlarged retroperitoneal lymph nodes are not significantly changed. These may be reactive and related to chronic liver disease.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, history of lung adenocarcinoma with decreased appetite and dysphagia, assess for metastases. No evidence of parenchymal edema or mass effect is seen. Moderately extensive scattered foci of FLAIR hyperintensity are demonstrated in the subcortical and periventricular tissues. On postcontrast images, no pathologic parenchymal or leptomeningeal enhancement is seen. Faint gyriform susceptibility effect is noted scattered along the cerebral hemispheres, particularly the bilateral parietal and occipital lobes. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size.The pituitary gland is enlarged and somewhat heterogeneously enhancing measuring up to 11 mm in craniocaudal dimension. Bone marrow signal characteristics are within normal limits.

Output: 1.No definite evidence of intracranial metastases or any other specific findings which would account for the patient's symptoms. Scattered small lesions likely reflect chronic microvascular ischemia. Faint susceptibility effect is of uncertain etiology and may represent the sequelae of a prior hemorrhagic event.2.The pituitary gland is enlarged for age and somewhat heterogeneously enhancing. Metastases to the pituitary gland are quite rare and as such this is favored to represent an unrelated and incidental pituitary lesion such as an adenoma or a cyst. Dedicated pituitary imaging can be considered for further evaluation as clinically warranted.


Instruction: Generate impression based on findings.

Input: 15 years Male (DOB:3/18/2001)Reason: Evaluate for remote TBI History: Psychiatric issues, behavioural outbursts, learning disability, ADHDPROVIDER/ATTENDING NAME: CAROL J. MACMILLAN CAROL J. MACMILLAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 28-year-old girl with history of liver transplant, now off medications. ABDOMEN:LIVER, BILIARY TRACT: The patient is status post liver transplant with biliary enteric anastomosis. The liver is normal in signal and morphology. There is no intra or extrahepatic biliary ductal dilatation. The portal vasculature is patent.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Patient status post liver transplant without abnormality or biliary duct dilatation.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for quadriceps tendon rupture History: left knee pain, swelling, inability to actively extend MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage is grossly intact. No fractures are present.LIGAMENTS: The ACL, PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: There is a high-grade complete tear through the superficial fibers of the rectus femoris and vastus medialis tendons with approximately 1.8 cm of retraction of the torn fibers. Posteriorly, the deep fascial layers of the vastus intermedius and lateralis remain intact. The patellar tendon is intact.ADDITIONAL

Output: Near full-thickness tear of the quadriceps tendon with a large subcutaneous and intra-articular hematoma.


Instruction: Generate impression based on findings.

Input: Fifty year-old male with history of L4 plasmacytoma status post resection and radiation. Worsening left foot drop. Exam is limited by artifact related to orthopedic hardware, which includes wire cage device placement at L4 as well as posterior stabilization rods and transpedicular screws at L3 and L5. Sagittal T1 fat saturated images are also limited due to hardware artifact. Axial images, however, demonstrate new T1 and T2 hyperintense signal involving the L3, L4, and L5 vertebral bodies diffusely; likely representing radiation-related changes. Within the L4 vertebral body, there are also irregular, lobulated areas of T1 hypointensity which extend through the pedicles bilaterally, and which enhance on postcontrast images; these signal characteristics are similar to that seen of the entire L4 vertebral body on the previous exam.The conus medullaris on sagittal imaging is grossly intact.At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is minimal disk bulge and posterior element hypertrophy without significant compromise to spinal canal or neural foramina.At L3-4 in addition to postoperative changes, there is a mild diffuse disk bulge with left-sided prominence. There is no significant central canal stenosis and or neuroforaminal compromise. At L4-5 in addition to postoperative changes, there is mild disk bulge with left-sided prominence as well as posterior element hypertrophy. There is no significant central canal stenosis but moderate left neuroforaminal stenosis.At L5-S1 there is mild disk bulge and moderate bilateral facet hypertrophy, with mild right and mild to moderate left neuroforaminal stenosis, slightly progressed from the previous exam. No significant central canal stenosis.

Output: 1.Slightly progressed mild to moderate L5-S1 left neuroforaminal stenosis. Redemonstrated moderate left L4-5 neuroforaminal stenosis.2.New radiation-related marrow changes in the L3, L4, and L5 vertebral bodies. Upon this background, there are nonspecific, stable areas of enhancement in the L4 vertebral body; given complete stability, would favor this to represent granulation tissue and/or other post-treatment changes.3.Orthopedic hardware, as above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified cord compressionClinical question: cause of motor weaknessSigns and Symptoms: cannot move right leg MRI thoracic spine:Please note that there are 4 lumbar-type vertebrae with hypoplastic ribs at T12. There are pedicle screws present at T6, T7, T10 and T11 bilaterally associated with interconnecting rods and multilevel laminectomies at the T7, T8, T9 and T10 there is a drainage tubing extending from the subcutaneous tissues into the laminectomy sites.Since the prior exams posterior vertebral mass previously involving predominantly left-sided posterior elements, epidural space and perivertebral space has been debulked. The spinal cord is no longer compressed at this time. There is encroachment of the left-sided neural foramina at the T8-9 and T9-10 due to neoplasm which is less impressive than on the prior exam. There are some associated encroachment of exiting nerve roots.There are some patchy signal changes within the spinal cord which were previously present and do not appear to have changed substantially in extent compared to this 12/2/2015 exam.There is some residual neoplastic tissue present at the origin of site of the tumor within the left posterior lateral aspect of the T9 and T8 vertebral body levels.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a left-sided pleural effusion present.Lumbar spine:Four lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. Hypoplastic ribs are present at T12. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy present this level as well as disc desiccation and a diffuse disc bulge. This appearance is stable compared to the prior exam.At L4-5 there moderate bilateral facet and ligamentum flavum hypertrophy present associated with a diffuse disc bulge and mild anterior subluxation of L4 on L5. There is partial effacement of fat at the lateral recesses bilaterally. Overall there is a mild degree of spinal stenosis present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a minor disc bulge at this level. There are Schmorl's nodes at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note the infiltration of the thoracic vertebrae and lumbar vertebrae. There are 4 lumbar-type vertebrae present. There are hypoplastic ribs present at T12.2.Since the prior exam the patient is undergone multilevel laminectomies and posterior instrumentation in the lower thoracic spine where there has been tumor debulking. There is no spinal cord compression appreciated on the current exam. There is narrowing of the left-sided neural foramina at T8-9 and T9-10. Signal changes within the thoracic spinal cord were also present on the preoperative exam. These do not appear to have changed significantly compared to the 12/2/2015 exam.3.There are multilevel degenerative changes present lumbar spine which are worse at L4-5 where there is mild to moderate spinal stenosis.4.Left-sided pleural effusion.


Instruction: Generate impression based on findings.

Input: 71-year-old male with recurrent prostate cancer after radical prostatectomy. Evaluate for pelvic recurrence.PSA of 0.13 ng/mL per EPIC on 3/22/2016 PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Seminal Vesicles: Status post prostatectomy.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Foci of susceptibility in the left inguinal region, likely from prior herniorrhaphy.

Output: Status post radical prostatectomy without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: eval for hemorrhage, mass History: intractable HA No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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 mastoid air cells are clear. There is a retention cyst on the right maxillary sinus. Another T2 high signal and T1 low signal lesion within the right pterygoid process which is likely represent another retention cyst in an extension of sphenoid sinus. If clinically indicated, maxillofacial CT scan can be considered.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 64-year-old male with follicular lymphoma. A status post fall this a.m. landed on left side of face. Swelling over left mandible. Pain with opening jaw. Evaluate for hematoma CT of brain without infusion.CT examination of brain is negative in particular no evidence of an acute post traumatic finding is detected.No evidence of hemorrhage, edema, mass effect, hydrocephalus or midline shift is detected.CT of maxillofacial.No evidence of fracture is detected in particular no evidence of fracture of mandible is detected. The fascial planes of the soft tissues of the maxillofacial region are preserved.Images at the level of C2 demonstrates extensive loculated area of lucency in a well demarcated fashion involving the left aspect of the body of C2 and extending posteriorly to the posterior elements. There is no evidence of destruction of the bone or cortical break. This finding is believed to represent a hemangioma. Likelihood of metastatic disease is considered less likely however cannot be entirely ruled out. This area would be best evaluated with an MRI examination if clinically desired.

Output: 1.Unremarkable CT of brain and in particular with evidence of post traumatic findings.2.No evidence of fracture in the CT of maxillofacial.3.Findings likely representing hemangioma involving C2 all were to exclude less likely possibility of metastatic disease an MRI would be helpful.


Instruction: Generate impression based on findings.

Input: Thunderclap headache with multiple aneurysms please provide embolic coil occlusion of basilar artery aneurysm and anterior choroidal artery aneurysm and identify any additional aneurysms.OPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 91 minutesFrontal: 5098.27 mGyLateral: 2433.26 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial right anterior choroidal artery cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery. 4) Intracranial left anterior inferior cerebellar artery basilar cerebral aneurysm coil embolization with balloon assistance.5) 3-D reconstructions of right vertebral artery 6) thrombolysis of anterior choroidal artery thrombus 7) thrombolysis of anterior inferior cerebellar artery thrombus. Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There is a 7 mm bilobed aneurysm present at the origin of the right anterior choroidal artery. The anterior choroidal artery originates at the base of the aneurysm.There is a 2 mm irregular aneurysm at the origin of the right ophthalmic artery.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. There is an infundibulum at the origin of the left posterior communicating arteryVenous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is a 4 mm aneurysm at the origin of the left anterior inferior cerebellar artery. The left anterior inferior cerebellar artery originates from the base of the aneurysm.There is a 1 mm aneurysm at the origin of the left superior cerebellar artery.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is a 4 mm aneurysm at the origin of the left anterior inferior cerebellar artery. The left anterior inferior cerebellar artery originates from the base of the aneurysm.There is a 1 mm aneurysm at the origin of the left superior cerebellar artery.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the right anterior choroidal artery aneurysm aneurysm using balloon remodeling. There is transient partial occlusion of the right prefrontal artery which resolved after heparin administration. The balloon remained across the neck of the aneurysm. There was thrombus formation at the base of the aneurysm extruded into the right internal carotid artery and the one lobe of the aneurysm only had a couple coil loops buttock was thrombosed. There was transient occlusion of the right anterior choroidal artery aneurysm which resolved after thrombolytic treatment.Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the left anterior inferior cerebellar artery/basilar artery aneurysm using balloon remodeling. A small amount of nonocclusive thrombus which formed at the origin of the left anterior inferior cerebellar artery resolved.Final RVA arteriogram :There is opacification of the basilar artery and both posterior cerebral arteries. The mid basilar artery aneurysm at the origin of the left anterior inferior cerebellar artery is occluded. No thromboembolic events are appreciated. There is a 1 mm left superior cerebellar artery aneurysm present.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events. No new thromboembolic events are appreciated.Right common iliac artery: No contraindications to closure device.

Output: 1.Right anterior choroidal artery aneurysm.2.Basilar artery aneurysm at the origin of the left anterior inferior cerebellar artery.3.Right ophthalmic artery aneurysm measures approximately 2 mm in size and is rather fusiform and irregular4.Left superior cerebellar origin 1 mm aneurysm.5.Embolic coil occlusion of a right anterior choroidal artery aneurysm using MRI compatible (up to 3T) coils. This aneurysm partially thrombosed. At the end of the procedure was completely occluded and no coils were placed in the thrombosed portion.6.Embolic coil occlusion of the basilar artery aneurysm at the origin of the left anterior inferior cerebellar artery.7.Transient occlusion of the right anterior choroidal artery during the procedure was treated with intraarterial thrombolytic infusion (ReoPro). There was a thrombus formation at the base of both aneurysms but predominantly the anterior choroidal artery aneurysm. The patient received a total 5000 units of heparin during the procedure, 7mg ReoPro and 5 mg verapamil in order to help treat thrombus formation.8.The findings were discussed with Dr. Goldenberg and Dr Yamini. The patient will be capped mildly anticoagulated overnight.


Instruction: Generate impression based on findings.

Input: History of multifocal papillary thyroid carcinoma status post total thyroidectomy in 2013, but now with pain on the right with outside imaging reporting nodule. Please evaluate and compare to outside MRI. There is no evidence of mass lesions. There is redemonstration of the right level 2 lymph node measuring 8 x 12 x 16 mm (AP x TR x CC), previously 7 x 11 x 16 mm. There are additional scattered small cervical lymph nodes, which are not enlarged by size criteria. The thyroid is surgically absent. The major salivary glands are unchanged. The major cervical vessels are patent. There are degenerative changes of the cervical spine with disc desiccation and disc bulge at C5-C6 and C6-C7 contributing to mild spinal canal stenosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.

Output: 1.Status post total thyroidectomy without evidence of neck mass.2.No significant interval change in the right level 2 lymph node compared to outside MRI dated 12/19/2013 and is nonspecific. Additional scattered small cervical lymph nodes, which are not enlarged by size criteria.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46-year-old female who had abdominal wound breakdown 4 months ago. Presenting with increasing pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal stone, unchanged from previous study. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described metallic density is unchanged and is located in the hepatic flexure. This likely represents a metallic structure impacted in colon. Correlation with history of previous capsule study history is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postsurgical changes at result. Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the anterior pelvic wall has almost completely resolved. Small amount of fat stranding persists.There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.OTHER: No significant abnormality noted

Output: Interval resolution of postsurgical changes in the pelvis and anterior abdominal wall. There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.Persistent metallic linear density in the hepatic flexure. Correlation with previous ingestion of capsule or other metallic structures recommended.


Instruction: Generate impression based on findings.

Input: Lower extremity edema Note that the exam is significantly limited by motion artifact. The patient also prematurely terminated the exam and all sequences were not able to be performed.Within the limits of this exam, there is no abnormal marrow signal of the right tibia/fibula to suggest osteomyelitis. There is mild diffuse edema of the soft tissues and muscles of the lower extremity, particularly proximally. There is no evidence of a discrete fluid collection. There is abnormal marrow signal within the left proximal tibia which is identified on the standing coronal views. A rounded focus of high T2/low T1 signal is present within the proximal tibial metadiaphysis which appears to extend outside the cortex and may represent prominent vessel.

Output: 1. No evidence of osteomyelitis within the right tibia/fibula.2. Abnormal marrow signal within the left proximal tibial metadiaphysis may represent early bone infarction but close follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Lung adenocarcinoma with new headache, on anticoagulation. There is no evidence of intracranial hemorrhage or acute infarct. There is a 9 x 7 mm enhancing focus in the right superior frontal gyrus cortex, with mild associated T2 hyperintensity, suggestive of a metastatic lesion. There are mild scattered foci of nonspecific cerebral white matter T2 hyperintensity without associated enhancement. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. An 8 x 7 mm enhancing focus in the left frontal calvarium is suggestive of osseous metastasis. The orbits and scalp soft tissues are grossly unremarkable. There is moderate bilateral maxillary sinus mucosal thickening with air-fluid levels, as well as mild scattered ethmoid opacification and sphenoid sinus mucosal thickening. The mastoids and middle ears are clear.

Output: 1.Subcentimeter lesions in the right frontal lobe and left frontal calvarium are suggestive of metastases.2.Findings suggestive of acute sinusitis.3.No evidence of intracranial hemorrhage or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Questionable right renal lesion on CT scan. History of non-small cell lung cancer stage IA. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size. No suspicious liver lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Homogeneous left adrenal nodule measuring 1.5 x 1.2 cm (series 12/176), stable from recent prior and decreased from the 2005 study.KIDNEYS, URETERS: In the dorsal aspect of the right renal inferior pole there is a 1.2 cm partially exophytic lesion demonstrating extrinsic T1 weighted hyperintensity without evidence of postcontrast enhancement compatible with a proteinaceous/hemorrhagic cyst. Immediately inferiorly within the renal cortex there is an arterially enhancing 1.2 cm round lesion with intrinsic T2 weighted hyperintensity without macroscopic fat, suspicious for a renal cell carcinoma, clear cell type. No evidence of invasion into the collecting system or renal vein. No significant locoregional lymphadenopathy. The 1.4 cm exophytic lesion described on the recent prior CT in the left inferior pole demonstrates intrinsic macroscopic fat signal intensity and is compatible with a benign entity such as angiomyolipoma.No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Small peripancreatic lymph nodes measuring less than 1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. 1.2 cm heterogeneously enhancing right inferior pole lesion suspicious for RCC, clear cell type. Adjacent 1.2 hemorrhagic/proteinaceous cyst.2. Left renal exophytic lesion described on recent CT demonstrates intrinsic macroscopic fat signal intensity and is compatible with a benign entity such as an angiomyolipoma, measuring 1.4 cm. It is stable from the CT portion of the PET/CT dated 10/8/2015.3. Stable left adrenal nodule; however, it does not demonstrate MR signal characteristics of a lipid rich adenoma.


Instruction: Generate impression based on findings.

Input: Preoperative planning for resection: memory difficulty. There is an irregular peripherally enhancing mass in the left parietal lobe, which measures up to approximately 5 cm. There is surrounding edema and effacement of the posterior left lateral ventricle. There is also slight midline shift to the right. There are skin fiducial markers.

Output: Preoperative planning for a left parietal lobe mass.


Instruction: Generate impression based on findings.

Input: History of hyperprolactinemia and nipple discharge: rule out pituitary adenoma. MRI brain: There is no evidence of intracranial hemorrhage. The brain parenchyma appears unremarkable. There is a subcentimeter cystic pineal gland. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI pituitary: The pituitary gland is not enlarged or atrophic. There is no discernible discrete mass within the pituitary gland. The posterior pituitary bright spot is intact. The pituitary stalk lies in the midline. The suprasellar cistern, optic apparatus, and cavernous sinuses appear unremarkable.

Output: No evidence of discernible lesions in the pituitary gland.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Carotid stenosis: headache left sided weakness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia in the right parietal and posterior right frontal lobes, with a few small scattered areas of susceptibility effect. There is a background of scattered cerebral and pontine white matter T2 hyperintensity. 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.MRA: There is significant stenosis at the origin of the right carotid artery with markedly diminutive flow-related enhancement throughout the right internal carotid artery, but flow is reconstituted at the circle of Willis. There is no evidence of other significant steno-occlusive lesions in the head and neck arteries. There is no evidence of cerebral aneurysms.

Output: 1. Chronic right cerebral hemisphere infarcts and small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Significant stenosis at the origin of the right carotid artery with diminutive flow-related enhancement throughout the right internal carotid artery.


Instruction: Generate impression based on findings.

Input: History of pT4aN1 right conjunctival squamous cell carcinoma with local recurrence.. There are postsurgical changes of right orbital exenteration, right parotidectomy, and right neck dissection. There is an enhancing nodule measuring 19 x 16 x 22 mm in the AP, transverse and craniocaudal dimensions along the superior aspect of the right zygomatic arch. No obvious osseous destruction, but can be better assessed by CT. Slightly more inferior to the zygomatic arch, there is a enhancing nodule measuring 17 x 11 x 15 mm which extends along the surface of the right masseter muscle. Abnormal enhancement extends posteriorly to the right parotid space which may represent granulation tissue and can be compare with prior MRI if available. There is however a more nodular area measuring 15x10 mm in the pre-auricular region which is suspicious. Abnormal enhancement is also noted along the medial and posterior aspect of the right orbital exenteration site at the level of the optic canal and superior and inferior orbital fissures which may represent granulation tissue.Intracranially, there is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. There are multiple foci of T2/FLAIR hyperintensity in the supratentorial periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No evidence of acute infarct, hemorrhage, or extra-axial collections. No hydrocephalus.There is opacification of the right anterior ethmoid air cells is favored to be inflammatory. Major flow-voids are preserved.Evaluation of the neck demonstrates no other masses or evidence of pathologic enhancement. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. No suspicion osseous lesions are seen.

Output: 1. Enhancing nodule along the superior surface of the right zygomatic arch, one inferior to the zygomatic arch along the masseter muscle surface, and one posteriorly in the pre-auricular region are highly suspicious for tumor recurrence. Abnormal enhancement involving the parotid space more diffusely as well as along the medial and posterior margins of the right orbital exenteration site is nonspecific and may represent granulation tissue. Relatively mild FDG uptake is noted within these regions on recent PET. Comparison with prior MRI would be helpful if available.2. Status post orbital exenteration and right parotidectomy.3. Status post right neck dissection. No suspicious cervical lymphadenopathy is appreciated.4. No intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:3/9/1984)Reason: 32yo w/CF, Admitted for AMS (resolved) with new seizure w/mri showing watershed infarct w/concern for PRESS. Has been stable for several days. Now with HA and blurred vision. Neuro requesting brain MRI and head MRA History: headache and blurred vision.PROVIDER/ATTENDING NAME: LAURA J CARLSON BRYAN A CAMPBELL MRI of the brainThere is redemonstration of FLAIR and T2 signal hyperintensity involving the right middle frontal gyrus and right precentral gyrus and small portions of the right superior frontal gyrus and right postcentral gyrus as well as a separate focus along the medial aspect of the right superior parietal lobule. Since the prior exam diffusion restriction associated with this has subsided.Previously noted diffusion restriction and FLAIR signal hyperintensity along the small portion of gray matter adjacent to the left superior frontal sulcus and some portions of the right parietal lobe are not identified on the current exam. Currently no FLAIR or T2 signal hyperintensity is clearly appreciated at these locations.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells demonstrate some scattered opacities in the left ethmoid air cells. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are identified. The left posterior communicating artery has an infundibulum and is small to medium sized. The right posterior communicating artery is tiny. The anterior choroidal arteries can also be identified. There is some fenestration of the distal left A1 segment. The anterior communicating artery is medium-sized. The anterior communicating artery is fenestrated. The left vertebral artery is larger than the right vertebral artery.

Output: 1.There are findings compatible with subacute infarction involving the watershed zone along the right hemisphere which includes frontal lobe and parietal lobe.2.Since the prior exam diffusion restriction in the left frontal lobe and portions of the right parietal lobe have not progressed to any significant permanent FLAIR signal hyperintensity.3.There is no evidence for intracranial cerebrovascular occlusive


Instruction: Generate impression based on findings.

Input: Acute lymphoblastic leukemia, in relapse [C91.02] / Stiffness of unspecified joint, not elsewhere classified [M25.60], Reason for Study: ^Reason: 20 yo with history of relapsed ALL. Evaluate for intracranial hemorrhage, mass or infarct History: 30 minute episode of right-sided arm and neck stiffness, memory loss, headache. Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.Previously seen bilateral (left greater than right) preseptal swelling appear to be improved. However, precise evaluation is challenging due to motion artifacts. There is no evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Interval improvement of bilateral preseptal thickening since prior scan.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Imaging was done as part of dense breast MRI research. No contrast was administered. Research scanning of both breasts was performed with the research protocol. The images are stored for research analysis. Formal interpretation was not performed, existing data are not to be used for clinical purposes.

Output: This study was completed for research purposes only. Formal interpretation was not performed, existing data are not to be used for clinical purposes.


Instruction: Generate impression based on findings.

Input: There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no evidence of abnormal enhancement.About 5mm cerebellar tonsilar ectopia through the foramen magnum.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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 mastoid air cells are clear.Mild mucosal thickening on ethmoid sinus and a couple of retention cysts in the left maxillary sinus.

Output: About 5mm cerebellar tonsilar ectopia through the foramen magnum.Otherwise unremarkable brain MRI scan.


Instruction: Generate impression based on findings.

Input: 54 year old woman with AL amyloid who presents for cardiac MRI to evaluate for cardiac involvement. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 61%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 133 ml (normal range 109+/-23), the LV end systolic volume index is 25 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10), the LV mass index is 53 g/m2 (normal range 67+/-11), and the LV mass is 110 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Measured T1 value of myocardium 1150msLeft AtriumThe left atrium is mildly dilated. There is lipomatous hypertrophy of the interatrial septumRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 67%, the RV end diastolic volume index is 42 ml/m2 (normal range 69+/-14), the RVEDV is 124 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 43 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function[LVEF 61%]2. Measured T1 value of myocardium 1150ms3. The right ventricle is normal in size and systolic function [RVEF 67%]4. Mild biatrial enlargement5. Lipomatous hypertrophy of interatrial septumI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Osteomyelitis There are surgical changes relating to debridement of the first phalanx to the level of the distal metatarsal with foci of susceptibility artifact within the surgical bed. There is decreased T1 signal of the distal most aspect of the remaining first metatarsal with associated increased T2 signal consistent with osteomyelitis. There is additional increased signal in the heads of the second and third metatarsals however there is no associated T1 abnormality to suggest osseous. Similar reactive edema is noted within the midfoot.There is diffuse soft tissue edema particularly of the plantar musculature but also of the soft tissues of the first ray. A mild amount of retrocalcaneal fluid is noted.

Output: Osteomyelitis of the distalmost aspect of the remaining first metatarsal. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Headache: headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered punctate foci of T2 hyperintensity in the subcortical white matter of the bilateral frontal lobes. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct. A few scattered punctate foci of T2 hyperintensity in the subcortical white matter of the bilateral frontal lobes are nonspecific, but could be associated with migraine disorder.


Instruction: Generate impression based on findings.

Input: 17 year-old female, identify neurofibroma along back on right A skin marker was placed along the right lower back. A small 1.0 x 0.8 cm T2 bright ovoid mass is noted in the posterior right abdominal wall superficial to the right paraspinal muscles. Numerous additional T2 bright masses compatible with neurofibromas are noted within the abdomen, soft tissues and abdominal wall.

Output: Superficial neurofibroma posterior to the right paraspinal muscles at the site of concern as well as innumerable additional neurofibromas.


Instruction: Generate impression based on findings.

Input: 61-year-old female with lower extremity wounds, assess for osteomyelitis. Left foot: There is diffuse edema of the subcutaneous soft tissues without evidence of discrete fluid collection or sinus tract. Marrow signal of the forefoot and midfoot appears within normal limits, without evidence of osteomyelitis. There is no pathologic enhancement on postcontrast images.Right foot: There is diffuse edema of the subcutaneous soft tissues without evidence of discrete fluid collection or sinus tract. There is focal edema type signal signal along the dorsal aspect of the base of the first metatarsal adjacent to the tarsometatarsal joint with small cystic spaces, which is favored to be degenerative or post-traumatic in etiology. There is no pathologic enhancement on postcontrast images.

Output: Diffuse soft tissue swelling and degenerative changes without specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Intraop ablation. Signs and symptoms: Intraop ablation. Pre- and postenhanced treatment planning MRI:Study is performed utilizing treatment planning protocol and is not a true diagnostic exam.Examination redemonstrates a tectal plate mass with a thick rim of enhancement and measuring approximately 21 x 21 mm in transaxial dimensions.The lesion demonstrates a defect within its posterior right lateral rim likely secondary to ablation. There is a large central necrosis which is new since prior exam from 4-29-50.The mass demonstrates slight interval increased size since prior study which could be treatment related. Severely dilated supratentorial ventricular system demonstrate no appreciable interval change.Small CSF signal intensity right hemispheric subdural collection demonstrate no appreciable change since prior exam. No detectable new foci of abnormal parenchymal or leptomeningeal enhancement.

Output: 1.Interval significant central necrosis of a tectal plate tumor and a defect along its left posterior wall believed to be secondary to ablation.2.The tumor measures 21 x 21 mm in transaxial dimensions which is slightly larger than prior study and likely treatment related.3.Stable enlarged supratentorial ventricular system.


Instruction: Generate impression based on findings.

Input: 30-year-old female with history of recurrent left upper extremity AV malformation. Large lesion with extensive infiltrating signal abnormality and enhancement is seen predominantly within the extensor musculature of the proximal and mid forearm, including extensor digitorum, extensor carpi ulnaris, and extensor digitorum minimi. The lesion also involves anconeus muscle, supinator muscle, extensor pollicis longus, and abductor pollicis longus. The lesion extends across the interosseous membrane to mildly enter the anterior compartment. The lesion is predominantly high in T2 signal and T1 isointense to skeletal muscle with peripheral and septal fat signal seen. Scattered low signal intensity rounded foci within the lesion are presumably related to phleboliths, as seen on prior CTA. Overall, this lesion compatible with venous malformation ("hemangioma"). Prominent vasculature is seen within the proximal ulnar diaphysis, indicating intraosseous involvement, with involvement of the proximal radial diaphysis to a lesser degree. Overall, the lesion measures up to 5.5 x 4.5 cm in transverse dimension and 16 cm in longitudinal dimension.Additional smaller infiltrating lesion is seen in the distal forearm soft tissues just proximal to the wrist predominantly within the pronator quadratus muscle with the lesion seen crossing the interosseous membrane to enter the dorsal compartment beneath the extensor digitorum tendons. This lesion measures up to 3.5 x 2.5 cm in transverse dimension and 3.5 cm in longitudinal dimension. This lesion has similar signal characteristics but with no significant bone involvement.Prominent vessels are noted within the subcutaneous fat along the dorsum of the wrist, as well as in the subcutaneous fat in the lateral aspect of the forearm, most compatible with draining vessels. Signal void is seen at the dorsal aspect of the wrist and in the lateral soft tissues of the forearm, presumably related to surgical change.No edema-like signal is seen adjacent to the lesions to suggest infection or inflammation. No evidence of soft tissue abscess. No acute fracture or malalignment.

Output: Extensive venous malformation ("hemangiomata") of the left forearm as detailed above and similar to prior CTA. No acute abnormality is evident.


Instruction: Generate impression based on findings.

Input: A 32 year old male with prune belly syndrome and renal transplantation, with bicuspid aortic valve, mild aortic stenosis, mild aortic coarctation, ascending aortic dilatation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 136 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 50 ml (normal range 47+/-19), the LV mass index is 58 g/m2 (normal range 85+/-15), and the LV mass is 101 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 141 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is bicuspid with fusion of the right and non-coronary cusps. There is mild stenosis and trace regurgitation, stable. 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 branching pattern. The ascending thoracic aortic is dilated but is stable. The proximal descending thoracic aortic diameter is unchanged, with minimum diameter of 18mm. The axial (non orthogonal) measurements of the thoracic aorta are as follows, using same measurement technique with the prior exam: - Sinuses of Valsalva: 35mm- Sinotubular Junction: 28mm - Ascending Aorta: 38mm - Aortic Arch: 36mm AP Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThe right lobe of the thyroid gland is mildly enlarged.

Output: 1. The left ventricle is normal in size and systolic function, the LVEF is 63%. There are no regional wall motion abnormalities present. 2. The right ventricle is normal in size and systolic function, the RVEF is 54%. 3. The aortic valve is bicuspid with fusion of the right and non-coronary cusps. There is mild stenosis and trace regurgitation. 4. The aortic root is dilated, but remains stable.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Eval for TIA/stroke like symptoms History: transient paresthesias, dyscoordination, numbness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a small T2 and flair signal hyperintensity present along the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries and the proximal anterior, middle and posterior cerebral arteries.The right vertebral artery demonstrates normal antegrade flow beyond the origin of the right posterior inferior cerebellar artery. The left vertebral artery is diminutive distally. The basilar artery appears to be occluded or near occluded beginning at the vertebrobasilar junction. The posterior communicating arteries appear to be the main supply to the posterior cerebral arteries and the P1 segments.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. The left common artery originates from the innominate artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing of the proximal right internal carotid artery with approximately 20% focal narrowing approximately 15 mm from the origin of the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.Findings are compatible with occlusion or near occlusion of the distal right vertebral artery intracranially as well as the basilar artery with reconstitution of posterior circulation flow via collaterals from the anterior circulation as well as the posterior inferior cerebellar arteries.2.There is no evidence for acute ischemic infarction appreciated.3.Findings suggest an old lacunar infarct in the right pons


Instruction: Generate impression based on findings.

Input: Reason: evaluate for renal recurrence/metastasis History: Hx of renal cell ca, sp left partial nephrectomy. ABDOMEN: Limited examination without the administration of intravenous contrast.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: 1.4 cm cystic lesion in the pancreatic head likely represents a pancreatic cyst or IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes of a partial left nephrectomy. Multiple bilateral renal cysts, some of which demonstrate increase intrinsic T1 signal compatible with hemorrhagic or proteinaceous material. Right renal cyst demonstrates T1/T2 hypointense rim compatible with hemosiderin. Previously noted left renal mass with enhancing nodule on CT has slightly increased in size in its distal component, it solid component remains stable in size. Limited examination of the cysts without contrast.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Significant extra scoliosis and associated degenerative changes.OTHER: Small amount of ascites.

Output: Significantly limited examination without contrast. Multiple bilateral renal cysts some of which are proteinaceous or hemorrhagic. Left renal cyst has increased in size in its cystic component, with its solid component (which enhanced on prior CT) stable, remaining suspicious renal malignancy.


Instruction: Generate impression based on findings.

Input: 50 years Male (DOB: 7/7/1965)Reason: Evaluate for urinary retention x 3 months; thus far MRI L spine has been completed but no signs of cord compression History: Evaluate for urinary retention x 3 months; thus far MRI L spine has been completed but no signs of cord compressionPROVIDER/ATTENDING NAME: RIMAS V LUKAS RIMAS V LUKAS MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal. There is a disc bulge present at this level associated with some disc desiccation and right-sided uncovertebral osteophytes with narrowing of the neural foramina worse on the right than the left side. There is some encroachment of the exiting nerve roots on the right side.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge at this level associated with uncovertebral osteophytes and some endplate osteophytes and narrowing of the neural foramina bilaterally with encroachment of the exiting nerve roots within the neural foramina bilaterally worse on the left than the right side.At C7-T1 there is no significant compromise to the spinal canal. There is a right-sided small perineural cyst present measuring 5 mm in diameter within the outlet of the right neural foramen.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a T1 hyperintense lesion within the posterior and inferior aspect of the right half of the T6 vertebral body. Most likely this represents a hemangioma.

Output: 1.There are degenerative changes present in the cervical spine worse at C3-4 and C6-7 where there is encroachment of exiting nerve roots within the neural foramina as detailed above.2.There are no findings which explain the patient's urinary retention on the basis of this exam.3.There is no compromise to the thoracic spinal canal or exiting nerve roots. There are no abnormal lesions thoracic spinal cord appreciated.4.No abnormal mass lesions are appreciated within the brain parenchyma.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, pain and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left knee was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using a 25-gauge needle.Under fluoroscopic guidance, a 21-gauge needle was advanced into the joint. Next, 20 mL of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and the patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute 6 seconds

Output: Successful arthrogram of the left knee.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder dislocations History: pain ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Minimal osteoarthritis affects the acromioclavicular joint. We see no fluid or gadolinium within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior labrum is detached from the underlying glenoid indicating a large Bankart lesion extending from the superior labrum to the inferior labrum. There is also a cleft through the posterior inferior labrum suggesting further extension of this tearing. There may be a tiny cleft, centrally within the articular cartilage of the glenoid, but this is equivocal. There is a Hill-Sachs deformity, as suggested on the prior shoulder radiographs, with edema in the underlying humeral head. The inferior capsule of the glenohumeral joint appears patulous and is unusually low-lying which could reflect prior trauma to the humeral attachment of the glenohumeral ligament, but this is equivocal.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: Findings indicating prior anterior dislocation including a Hill-Sachs fracture of the humeral head and a cartilaginous Bankart lesion that appears to extend to involve the posterior inferior labrum as well. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 58-year-old female with history of bilateral cysts, calcifications and dense breast tissue. History of right ductal excision for nipple discharge in 1992. MRI strongly recommended for follow-up screening secondary to breast density and complex mammogram. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Small enhancing skin lesion at left 5:00 position is unchanged.No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Examination is limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space with T2 hyperintense signal with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. There is no significant change in residual abnormal T2/STIR hyperintensity involving the bone marrow and intervertebral disc. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral L1-L2 foraminal stenosis. No other worrisome marrow signal is appreciated. There is persistent but decrease in diffuse edema, with poor definition of the bilateral psoas muscles, the right greater than left iliacus muscles, as well as the paravertebral muscles, which may represent a component of atrophy/degeneration superimposed upon edema. There are areas of T1 and T2 hypointensity involving the right greater than left psoas musculature which are again seen and not significantly changed compared to 4/1/2015; these correspond to sites of previously seen abscesses and may represent areas of cavitation/necrosis or possibly minimal residual fluid collections with low T2 signal. The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Again noted is prominence of the epidural fat including focal epidural fat along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts. There is clumped appearance of the cauda equina nerve roots suggestive of arachnoiditis and more prominent than prior.

Output: 1. Lack of contrast again limits evaluation. Compared to 5/6/2015, there is no significant change in residual signal abnormalities related to L1-L2 discitis-osteomyelitis and associated compression fractures of the L1 greater than L2 vertebral bodies. No significant change in osseous retropulsion at L1 with associated moderate spinal canal stenosis as well as moderate to severe bilateral L1-L2 neural foraminal stenosis. 2. Mild interval decrease in edema involving the bilateral psoas musculature. Otherwise signal abnormality involving the iliopsoas and paraspinous musculature is not significantly changed and compatible with edema and possible superimposed atrophy/degeneration. Focal areas of low T1 and T2 signal involving the bilateral psoas musculature corresponding to sites of previously seen abscesses may represent areas of cavitation/necrosis or possibly minimal residual fluid collections with low T2 signal. No new or enlarging fluid collections or worsening marrow or disc signal abnormalities to suggest progression of infection. 3. Clumping of the cauda equina nerve roots, which appears more prominent than prior, and consistent with arachnoiditis.


Instruction: Generate impression based on findings.

Input: 64 year old woman with history of HF with preserved EF, CAD and asthma admitted with heart failure exacerbation, now referred for cardiac MRI to evaluate for possible infiltrative disease. Left VentricleThe left ventricle is mildly dilated with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 195 ml (normal range 109+/-23), the LV end systolic volume index is 43 ml/m2 (normal range 18+/-5), the LVESV is 88 ml (normal range 31+/-10), the LV mass index is 74 g/m2 (normal range 67+/-11), and the LV mass is 151 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is mild hypertrophy (wall thickness 11-12mm). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. However, the native T1 time is elevated (1080ms in the basal slice, and 1100ms in the mid ventricular slice). The ECV fraction is 42%, which is also elevated. This speaks to a possible early infiltrative (amyloid) process.No intracardiac thrombus. Left AtriumThe left atrium is moderately dilated. The interatrial septum is thickened.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 36 ml/m2 (normal range 69+/-14), the RVEDV is 71 ml (normal range 110+/-24), the RV end systolic volume index is 144 ml/m2 (normal range 22+/-8), and the RVESV is 39 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve are thickened but open widely. There is mild mitral regurgitation which appears eccentric. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is a small pericardial effusion with dimpling of the right atrium during diastole but no frank diastolic collapse of the RA or RV.

Output: 1. Mildly dilated LV with normal systolic function (EF 55%)2. No late gadolinium enhancement is seen. However, there is an elevated native T1 relaxation time (1080-1100ms) in the myocardium, and an elevated ECV (42%), which speak to the presence of a possible early infiltrative disease, consider amyloidosis).3. Normal size RV with mildly reduced systolic function (EF 45%).4. Mild mitral regurgitation. 5. Small circumferential pericardial effusion with dimpling of the right atrium during diastole.


Instruction: Generate impression based on findings.

Input: 22-year-old male. Right hip pain. Evaluate for right hip labral tear. ACETABULAR LABRUM: The labrum is intact without evidence of a discrete tear.ARTICULAR CARTILAGE AND BONE: Prominence of the anterior and lateral aspect of the femoral head/neck junction consistent with a CAM deformity. Bone marrow signal intensity is normal. Articular cartilage of the hip is intact.SOFT TISSUES: Small amount of injected gadolinium within the soft tissues anterior to the hip.ADDITIONAL

Output: Right CAM deformity. No evidence of an acetabular labrum tear.


Instruction: Generate impression based on findings.

Input: Cervicalgia with history of VACTERL BRAIN: The cortical sulci are in proportion to the cerebral ventricles. The gray-white matter differentiation is preserved. No midline shift or mass effect is appreciated. No gradient abnormality is identified. There is no diffusion restriction to suggest acute ischemia. The right internal carotid artery is not developed and the right middle cerebral artery originates from the P1 segment of the right posterior cerebral artery. The right anterior cerebral artery appears hypoplastic.CERVICAL SPINE: There is partial agenesis of the right posterior C1 vertebral body with fusion of the anterior aspect of the right C1 arch and occiput. The C2 vertebral body appears dysplastic. There is associated basilar invagination and moderate to severe narrowing at the foramen magnum with deformity of the medulla. However, no signal abnormality is demonstrated within the medulla or spinal cord. The cervical spine appears slightly straightened. The remainder of the vertebral body heights and intervertebral disc spaces are maintained. The left cerebellar tonsil appears pointed however does not extend below the foramen magnum. There is no syrinx.There is asynchronous prepontine biphasic flow, with diminished flow at the foramen magnum, particularly along the dorsal aspect.

Output: 1. Basilar invagination with moderate to severe narrowing at the foramen magnum and associated deformity of the medulla secondary to partial agenesis of C1 and dysplasia of C2 vertebral bodies as described above however without brainstem or spinal cord signal abnormality at this time.2. There is asynchronous prepontine flow with diminished flow at the foramen magnum, worse dorsally.3. The right internal carotid artery is not developed and the right middle cerebral artery originates from the P1 segment of the right posterior cerebral artery. The right anterior cerebral artery is hypoplastic.


Instruction: Generate impression based on findings.

Input: 66 yo F h/o sciatica found down x several hours after a fall; significant R hip pain on admission but negative CT hip; now with flaccid RLE but intact sensation; concern for spinal cord injury. Was neurologically intact at time of admission. The vertebral bodies are appropriate in the overall alignment and height. Mild multilevel degenerative changes are seen in the cervical, thoracic, and lumbar spine. There is no evidence of cord compression or high-grade spinal canal stenosis. No obvious cord signal abnormality within the limitations of the study. There is edema involving the anterior aspect of the L1 and L2 vertebral bodies which is favored to be on a degenerative basis. There is a Schmorl's node involving the superior endplate of T7. There is at least moderate left L5-S1 neural foraminal stenosis. There also appears to be mild to moderate right L1-L2 neural foraminal stenosis.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression or evidence of high-grade spinal canal stenosis in the cervical, thoracic, or lumbar spine is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: Vestibular schwannoma: vison changes and history of Familial Mediterranean fever. Internal Auditory Canals: There is an ovoid enhancing lesion in the left internal auditory canal, which measures up to 10 mm in length and 5 mm in width. There is mildly diminished fluid signal in the left inner ear structures, which are otherwise intact. The right cranial nerve 7 and 8 complexes are intact, without evidence of associated mass lesions. The right inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear grossly unremarkable.Brain: There is no evidence of intracranial hemorrhage or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity bilaterally, mainly in a periventricular distribution. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is a 10 mm thick apical scalp lipoma.

Output: 1. A left internal auditory canal vestibular schwannoma measures up to 10 mm.2. Mild scattered cerebral white matter T2 hyperintensity bilaterally may represent a demyelinating disease, perhaps related to Familial Mediterranean fever, but are nonspecific.


Instruction: Generate impression based on findings.

Input: There is abnormal T2 hyperintensity involving the left prechiasmatic optic nerve extending from just anterior to the chiasm and into the intracanalicular segment. The optic nerve more anteriorly is within normal limits. Previously seen enhancement of the optic nerve in these segments on outside MRI from 6/2/2015 has essentially resolved without definite residual enhancement on the current study. Bilateral orbits are otherwise unremarkable. Brain parenchyma demonstrates no T2/FLAIR hyperintense lesions in the white matter to suggest demyelinating disease. No abnormal parenchymal or meningeal enhancement. Ventricles and sulci appear within normal limits. Major flow-voids are preserved. Calvarium and extracranial soft tissue structures are grossly unremarkable.

Output: 1. Compared to MRI orbit study from 6/2/2015, there has been interval resolution of enhancement involving the left optic nerve with persistent abnormal T2 signal involving the left prechiasmatic and intracanalicular segments. Findings are compatible with treated/resolving optic neuritis.2. Brain parenchyma is unremarkable without evidence of white matter lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess metastases. Signs and symptoms: Headache, nausea, new brain metastases. Pre and post enhanced brain MRI:There is a mildly hemorrhagic enhancing metastatic lesion along the superior-anterior left cerebellum measuring approximately at 18 x 19 mm in transaxial dimensions, demonstrate surrounding vasogenic edema and resultant mass effect.There is a smaller minimally hemorrhagic and enhancing tumor in the vermis measuring approximately at 14 x 19 mm in transaxial dimensions, mild surrounding basal genic edema and mass effect. There is a larger nonhemorrhagic and poorly enhancing additional metastatic lesion in the right posterior-inferior cerebellar measuring approximately at 26 x 23 mm in transaxial dimensions, extensive surrounding vasogenic edema and mass effect. Constellation of findings results in increased mass effect in the posterior fossa, decreased fourth ventricle, mild crowding of the foramen magnum however without mass effect on the corticomedullary plate cistern.Images through the supratentorial space demonstrate normal anatomical morphology of the brain with normal signal intensity on all MRI sequences. There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic lesion.Ventricular system remain within normal size and it maintained midline.Unremarkable images through the orbits and including axial fat sat post enhanced series.Calvarium demonstrates normal signal intensity and without abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Multiple metastatic lesions in the posterior fossa with mild hemorrhagic changes and enhancement with resultant mass effect causing crowding of the foramen magnum however with no mass effect at the level of quadrigeminal plate cistern.2.Unremarkable pre and post enhanced brain MRI otherwise.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma status post chemotherapy and transplant. Prior cerebellar signs. There are otherwise unchanged post-treatment and post-biopsy findings with patchy T2 hyperintensity and associated susceptibility effect in the right cerebellar hemisphere. There are new areas of high T2 signal in the right frontoparietal white matter that measure up to 20 mm in length. Otherwise, scattered punctate foci of T2 hyperintensity elsewhere in the white matter are unchanged. There are also unchanged foci of susceptibility effect in the left anterior cingulate gyrus and right globus pallidus. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. 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, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: 1. No evidence of recurrent CNS lymphoma amidst post-treatment findings, particularly in the right cerebellar hemisphere.2. New areas of white matter signal abnormality in the right frontoparietal region are nonspecific, but may represent small vessel ischemic disease or perhaps chemotherapy effects, for example.


Instruction: Generate impression based on findings.

Input: Unsteady gait, auditory symptoms. Neck pain. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there are facial cosmetic fillers. Cervical Spine: There is multilevel degenerative spondylosis. At C3-4, a posterior disc-osteophyte complex and uncovertebral hypertrophy result in mild spinal cord impingement and at least moderate bilateral neural foraminal narrowing. At C4-5, a posterior disc-osteophyte complex and uncovertebral hypertrophy also result in mild spinal cord impingement and at least moderate bilateral neural foraminal narrowing. At C5-6, a posterior disc-osteophyte complex and uncovertebral hypertrophy result in mild bilateral spinal canal narrowing and at least moderate bilateral neural foraminal narrowing. At C6-7, a posterior disc-osteophyte complex and uncovertebral hypertrophy result in mild spinal canal narrowing and at least mild bilateral neural foraminal narrowing. There is no significant degenerative change at C2-3 and C7-T1. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Mild diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Multilevel degenerative cervical spondylosis with variable degree of neural foraminal stenosis and spinal canal narrowing, with mild impingement upon the spinal cord at C3-4 and C4-5.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with new onset numbness and pain shooting down left leg. Signs and symptoms: Sharp shooting pain left leg, and hip, also numbness Pre and post enhanced lumbar MRI:There is normal signal intensity and anatomical alignment of vertebral column.Unremarkable lower most visualized thoracic spine and thoracic cord.T12-L1, L1-L2, L2-L3 levels are unremarkable exception of mild hypertrophic changes of posterior elements.L3-L4 demonstrate mild disc desiccation, moderate bilateral ligamentum flavum hypertrophy and mild facet disease without spinal canal or neural foraminal compromise.L4-L5 demonstrates mild disc desiccation, mild bilateral ligamentum flavum hypertrophy and mild bilateral facet disease. There is a linear T2/T2 STIR hyperintensity within the annulus of the disc in the midline consistent with an annular fissure. No spinal stenosis or neural foraminal compromise.L5-S1 demonstrate a large central and rightward broad base disc protrusion with resultant significant right lateral recess compression and mass effect on the right S1 nerve root. There is moderate right neural foraminal compromise secondary to degenerative disease and partial extension of the protruded disc. No spinal stenosis and patent left neural foramina.Unremarkable post enhanced images.Unremarkable partially visualized SI joints.Unremarkable paraspinal soft tissues.

Output: 1.Central and rightward broad-based disc protrusion at L5-S1 with resultant significant mass effect on the right lateral recess and right S1 nerve root and the moderate compromise of right neural foramina. No spinal stenosis.2.With the exception of mild degenerative changes examination is unremarkable all other levels. A midline annular fissure at L4-L5 is noted as detailed above.


Instruction: Generate impression based on findings.

Input: 36-year-old with history of palpable left breast mass and family history of breast cancer in her mother at age 40. FNA of the left breast in November 2014 was consistent with fibroadenoma. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally. Multiple high T2 signal cysts are scattered in each breast. No suspicious enhancement is seen in either breast. This includes no distinct enhancing mass in the left breast 12:00 position. The degree of enhancement at that site is similar to the background parenchyma. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. If there is clinical concern for change of the left breast 12:00 mass since the prior imaging studies, I would suggest a follow up ultrasound to evaluate for stability. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: right side weakness, right visual disturbance, evaluate for ischemia or evidence of tumor, history of CEA left in 2014 There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Scattered bihemispheric patchy high signal intensities on FLAIR images indicate non specific small vessel ischemic disease.Encephalomalacia on the left occipital lobe indicate chronic ischemic infarction. 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, 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the right internal carotid artery. The right ICA is reconstituted through the patent right Pcom artery and Acom artery. The left ICA, bilateral MCAs and bilateral ACAs appear to be normal. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate complete occlusion of the right ICA just above the bifurcation. The left distal CCA appears to be significantly narrowed (about 90%) with evidence of endarterectomy. The right vertebral artery is dominant and shows about more than 50% of luminal stenosis at its ostium.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Complete occlusion of the right ICA just above the bifurcation. Intracranial right ICA is reconstituted via right Pcom and Acom artery.3. Post endarterectomy status of the left extracranial carotid system with evidence of more than 90% stenosis on the distal left CCA.4. More than 50% luminal stenosis, left vertebral artery ostium.5. Non specific small vessel ischemic disease with chronic ischemic infarction on the left PCA territory.


Instruction: Generate impression based on findings.

Input: 29-year-old male with ulnar sided pain A skin marker was placed along the ulnar aspect of the wrist, without underlying abnormality evident.The exam is limited to due to patient motion.LIGAMENTS: The intrinsic scapholunate and triquetral ligaments are intact.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC appears grossly intact. There is a small amount of fluid within the distal radioulnar joint, within normal limits.TENDONS: The extensor and flexor tendons are intact without evidence of tenosynovitis. BONES: The bone marrow signal is within normal limits.ADDITIONAL

Output: Suboptimal exam due patient motion with grossly intact triangular fibrocartilage complex. If there is high clinical suspicion for TFCC injury, magnetic resonance arthrogram may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: There are mild scattered nonspecific T2 hyperintensities in the cerebral white matter. There is also a nonspecific punctate focus of susceptibility effect in the posterior right temporal lobe. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: 1. Mild scattered nonspecific T2 hyperintensities in the cerebral white matter may represent chronic small vessel ischemic disease. 2. A nonspecific punctate focus of susceptibility effect in the posterior right temporal lobe may represent a chronic microhemorrhage. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: vessels History: stroke Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.No evidence of intracranial arterial aneurysm.No evidence of intracranial arterial luminal stenosis or irregularity.C-Spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.Degenerative changes are followedC12: within normal limitsC23: within normal limitsC34: diffuse bulging of disc with minimal left neuroforaminal narrowing due to disc bulging.C45: within normal limitsC56: diffuse bulging of disc, otherwise unremarkableC67: minimal bulging of disc, otherwise unremarkable.C7T1: within normal limits.

Output: 1. Normal brain MRA2. Minimal degenerative changes of cervical spine as described above, otherwise no remarkable finding.


Instruction: Generate impression based on findings.

Input: There is a 12 mm transverse x 9 mm AP x 7 mm craniocaudal lesion within the mesial left temporal lobe demonstrating primarily central T2 hyperintensity, T1 hypointensity, with surrounding parenchymal T2 hypointensity, also demonstrating susceptibility abnormality. There is no perilesional edema or associated developmental venous anomaly. There are no other similar appearing lesions.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present in the left maxillary sinus. Otherwise the remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Left mesial temporal lobe cavernous reformation.


Instruction: Generate impression based on findings.

Input: Left ankle pain TENDONS: No significant abnormality noted.LIGAMENTS: There is is bowing, irregularity, and increased signal at the fibular attachment at the the anterior talofibular ligament suggesting the presence of at least a partial tear versus full thickness tearing with associated scarring. There is adjacent fluid. The calcaneofibular and posterior talofibular ligaments are intact. The distal tibiofibular syndesmotic complex is intact. The deep portion of the deltoid ligament appears slightly edematous but without discrete tear.ARTICULAR SURFACES AND BONE: Increased marrow signal is noted within the medial half of the talus. A discrete fracture line is not seen however. There is a small tibiotalar joint effusion.ADDITIONAL

Output: 1. Tear of the anterior talofibular ligament as above. The remaining ligaments of the ankle are otherwise intact.2. Nonspecific edema within the medial half of the talus which may reflect a bone contusion.


Instruction: Generate impression based on findings.

Input: 56-year-old male with history of left knee arthroscopy, patellofemoral femoral trochlea MFC, medial meniscectomy with ongoing pain. Please evaluate for healing microfracture or new chondral injury/meniscal tear. MENISCI: Again demonstrated is blunting of the posterior horn/body of the medial meniscus from prior postsurgical change along with likely degeneration/tearing. Linear increased signal abnormality with involvement of the femoral articular surface within the posterior horn is not significantly changed from prior examination, remaining suspicious for horizontal tear. The lateral horn appears intact..ARTICULAR CARTILAGE AND BONE: Partial-thickness articular cartilage degeneration along the medial femoral condyle, especially of the femoral aspect appears minimally advanced in comparison to prior examination. The lateral compartment is unchanged from prior. Again demonstrated is full-thickness chondromalacia along the medial patella with degeneration the femoral aspect of the patellofemoral articular cartilage.LIGAMENTS: Increased amounts of abnormal T2 signal and thickening of the anterior cruciate ligament, especially within the proximal aspect likely represents further mucoid degeneration/tearing of the ACL. The PCL, MCL, and LCL complex appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. A small Baker's cyst is again demonstrated.ADDITIONAL

Output: 1. Blunting of the posterior horn and body of the meniscus representing sequelae of degeneration, postsurgical change, prior tearing that is not significantly changed in comparison to prior examination.2. Osteoarthritis of the knee with articular cartilage degeneration minimally advanced in the medial tibiofemoral compartment.3. Mucoid degeneration/tearing of the ACL has significantly advanced in comparison to prior examination.4. Moderate joint effusion, increased from prior.


Instruction: Generate impression based on findings.

Input: 14-month-old female with newly diagnosed neuroblastoma. Neck CT:Due to the lack of body fat, the lesions seen on prior MRI study are more difficult to delineate on this CT study. Again noted are masses in bilateral neck, primarily at level 2 of the internal jugular chain, consistent with lymphadenopathy. There is also a mass measuring 16 x 12 mm in the right lower neck, probably in the carotid space at the level of the thyroid. These findings are compatible with history of neuroblastoma.The osseous structures and limited view of the upper lungs appear unremarkable.There is nonspecific opacification of the paranasal sinuses, left middle ear and mastoid air cells.

Output: 1. Right neck mass, and bilateral adenopathy, compatible with history of neuroblastoma. The findings are similar to recent MRI study, and are actually better visualized on the prior MRI due to the lack of body fat.2. Nonspecific paranasal sinus, left middle ear and mastoid air cells inflammatory changes.


Instruction: Generate impression based on findings.

Input: Reason: pain History: lateral epicondylitis LIGAMENTS: Although this examination was not optimized for detailed evaluation of the intrinsic ligaments of the elbow, the ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is thickening and intermediate signal abnormality within the common extensor tendon at the level of the lateral epicondyle indicating moderate tendinosis. There is also increased fluid signal intensity within the common extensor tendon at the level of its insertion on the lateral upper condyle indicating partial thickness tearing. Some of the fibers of the common extensor tendon can be traced to the level of its insertion. The flexor tendons appear intact. The biceps and brachialis muscles and tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: There is bone marrow signal abnormality in the lateral epicondyle at the level of the insertion of the common extensor tendon which may reflect reactive osteitis or degenerative change. Otherwise no bone marrow signal abnormality is identified.SURROUNDING STRUCTURES: The ulnar nerve is normal in appearance.ADDITIONAL

Output: Tendinosis and partial-thickness tearing/strain of the common extensor tendon as described above. No full-thickness tear or retraction is identified.


Instruction: Generate impression based on findings.

Input: Male 56 years old Reason: eval for change in HCC History: HCC, cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology. In segment 8 of the liver, there is a focal T1 hyperintense lesion that measures 1.6 x 1.3 cm (image 30/series 9) previously, 1.1 x 1.0 cm. The lesion is less enhanced than background liver on delayed phase imaging and will be considered washout.The hepatic and portal veins are patent.Subcentimeter sessile enhancing polypoid lesion in the gallbladder fundus is unchanged.Cholelithiasis.SPLEEN: Spleen is borderline enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Small bilateral renal cysts.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with a 1.6 cm hepatocellular carcinoma in segment 8 of the liver.