Instruction: Generate impression based on findings.

Input: Male, 68 years old, history of metastatic melanoma, assess for brain metastases. No edema, mass effect or pathologic enhancement is seen to suggest the presence of a metastases. Incidental note is made of a small developmental venous anomaly within the left frontal lobe.Scattered small foci of T2 hyperintensity are seen within the periventricular and subcortical white matter, a nonspecific finding. No restricted diffusion is seen.No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are normal in size and morphology.

Output: 1.No evidence of intracranial metastases.2.Scattered small white matter lesions are nonspecific but likely represent chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: Evaluate for nerve root involvement. History of acute lymphocytic leukemia. There is no significant enhancement or nodularity involving the cauda equina nerve roots. An isolated right-sided linear enhancing structure likely represents a radicular vein. The conus medullaris is normal in position.There is heterogeneous appearance of the bone marrow. Multiple new nodular enhancing lesions are identified involving the lumbar spine and pelvis, the largest involving the left S1 segment, measuring 2.0 cm (series 10, image 49). Additional lesions are identified involving the inferior endplate of L3, the posterior T11 vertebral body and bilateral iliac bones.Vertebral body heights are within normal limits. Alignment is notable for unchanged minimal retrolisthesis of L1 relative to L2, which is associated with desiccation and mild disc height loss. The other intervertebral discs are preserved in height. There is no significant neuroforaminal or spinal canal stenosis at any level. Sequela from prior iliac biopsies are again noted.Paraspinous soft tissues are within normal limits.

Output: 1.Multiple new enhancing osseous lesions are highly suspicious for metastases. 2.No abnormal epidural or leptomeningeal enhancement in the lumbar spine. No abnormal nerve root enhancement.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: Is there a lateral meniscus tear, articular cartilage injury or occult fracture? History: pain and tenderness lateral joint line after axial loading injury MENISCI: There is a large complex tear of the lateral meniscus at the junction of the anterior horn and body which includes a large radial component. Although the tear appears to extend through the entire thickness of the meniscus, some of the peripheral fibers remain intact with propagation of the radial component beneath them. There is a 1 cm bandlike focus of intermediate signal intensity, just lateral to the ACL, which we suspect represents a displaced fragment of meniscal tissue. The posterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of increased bone marrow signal abnormality within the posterior aspect of the lateral tibial plateau likely representing a bone contusion. There is no definite linear signal abnormality to confirm a subchondral fracture. We see no full-thickness or near full-thickness articular cartilage defect.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a 12 mm ossicle within the distal patellar tendon which appears slightly edematous on the fluid sensitive sequences, but the clinical significance of this is uncertain.ADDITIONAL

Output: Complex predominantly radial tear of the lateral meniscus as described above.


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, unspecified side [M54.40], Reason for Study: ^Reason: eval stenosis v disk v ddd History: midline low back pain with sciatica For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild spinal stenosis and mild bilateral neuroforaminal stenosis. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: Mild spinal canal stenosis and mild bilateral neuroforaminal stenosis at the level of L45 with disc dessication.


Instruction: Generate impression based on findings.

Input: Ms. McAvoy is a 55 year old female with a personal history of right breast mastectomy in 2010 for IDC/DCIS with implant based reconstruction. Family history of breast cancer in mother, maternal grandmother, and maternal aunt. She presents for high-risk MR screening evaluation. The patient is status post right breast mastectomy with implant based reconstruction. There is no abnormal enhancement in the right reconstructed breast or chest wall.There is heterogeneous amount of fibroglandular tissue in the left breast. Minimal parenchymal enhancement is noted. There is no abnormal enhancement seen in the left breast. Bilateral retropectoral silicone implants are intact.No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 55-year-old male with a history of multiple myeloma presenting with sepsis and left lower extremity weakness. Please assess for epidural abscess. No large epidural collection is visualized. There is diffuse heterogeneous signal abnormality within the vertebral marrow. Diffuse spondylotic changes are visualized, especially affecting the thoracic and lumbar spine including compression fractures in T2, T5, T7, T9, T10, T12, L2, and L4. The T2 vertebral body appears mildly STIR hyperintense with slight progressive loss of height when compared to the prior exam, with new dorsal convexity of the cortex. There is no adjacent spinal canal stenosis. At L2 the retropulsion continues to measure 5 mm and there is moderate effacement of the anterior thecal sac. No gross abnormal cord signal is visualized. Kyphoplasties of T11, L1, and L4 are again seen. The conus appears to terminate at the L1 level.

Output: 1. No large epidural collection is visualized. There is grossly normal cord signal.2. Mild progression of compression deformity with associated marrow edema at T2, with minimal retropulsion.3. Persistent retropulsion of the compressed L2 vertebra is unchanged.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with inflammatory lesions in the posterior fossa. Evaluate. Changes related to prior left cerebellar biopsy are again seen. A focus of susceptibility in the left cerebellar hemisphere at the site of biopsy is unchanged. No edema or pathologic enhancement is observed. T2 hyperintensity in the pons, with associated minimal susceptibility effect, also shows no convincing interval change.Minimal scattered periventricular T2 hyperintense foci are unchanged. No new intracranial lesions are detected. No evidence edema, mass effect or restricted diffusion is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collections. The ventricles are normal in size and morphology.

Output: 1.Findings related to left cerebellar biopsy are unchanged.2.Signal abnormality in the pons is also unchanged.3.No pathologic enhancement or edema is seen to suggest active inflammation.


Instruction: Generate impression based on findings.

Input: 29-year-old male with history of testicular cancer. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant interval change in the right hepatic lobe T2 hyperintense lesions which likely represent hemangiomas. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Persistent splenomegaly which may be slightly increased compared to the 9/17/2015 examinationPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Shotty subcentimeter retroperitoneal lymph nodes are relatively stable and not enlarged by CT size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant interval change in the subcentimeter retroperitoneal lymph nodes, which are not enlarged by CT size criteria.2.T2 hyperintense liver lesions are not significantly changed, likely benign. 3.Persistent splenomegaly which may be slightly increased compared to the 9/17/2015 examination.


Instruction: Generate impression based on findings.

Input: C2 lesion. Additional history per chart, newly diagnosed left kidney cancer with metastases to lung and bone. There is an enhancing mass measuring approximately 3 cm x 3 cm x 2.5 cm in the AP, transverse, and craniocaudal dimensions centered at the level of the right transverse foramen of C2 with likely encasement of the right vertebral artery. There is osseous destruction and adjacent soft tissue extension. There is involvement of the right C2-C3 neural foramen as well as the right prevertebral muscle structure. There is no extension into the spinal canal. The dens and lamina of C2 remain intact. No additional lesions are seen in the cervical spine.There are small foci of T2 signal abnormality involving the cervical cord including the dorsal paramedian C2-C3 level, right lateral C3 level, and ventral C4 level in the midline.Vertebral body heights in the cervical spine are normal. There is grade 1 anterolisthesis of C3 on C4 as well as minimal retrolisthesis of C5 on C6. There are multilevel degenerative changes as described below: C2-3: No significant compromise to the spinal canal or left neural foramen. Right neural foramen is diffusely involved with tumor.C3-4: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C4-5: Small disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: Disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1. 3 x 3 x 2.5 cm enhancing mass at the right lateral C2 level with involvement of the right C2-C3 neural foramen and encasement of the right vertebral artery is highly suspicious for metastasis. No medial extension into the spinal canal or evidence of mass effect on the cord.2. Small foci of cord signal abnormality from the to C2 to the C4 levels are nonspecific but may be related to demyelinating disease or prior inflammatory myelitis and can be correlated with history. 3. Mild to moderate multilevel degenerative changes in the cervical spine as detailed above.


Instruction: Generate impression based on findings.

Input: 18-year-old male with history of Crohn's disease with increasing right lower quadrant pain and tenderness. ABDOMEN:Please note that the most superior portion of the abdomen was the out of the field-of-view, which included small portions of the liver, spleen, and fundus of the stomach.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach, jejenum and proximal ileum are well distended and seen as normal. Colon appears normal. Mild bowel wall thickening with increased enhancement of the terminal ileum most compatible with active inflammatory bowel disease -- see discussion in Pelvis section below. No free peritoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild bowel wall thickening with increased enhancement of the terminal ileum spanning a length of approximately 5 to 8 cm, most compatible with active inflammatory bowel disease. Peristalsis is preserved. No evidence of fistula or abscess. Mild fatty proliferation is seen in the right lower quadrant. Colon through the rectum appears normal. No free peritoneal fluid or other abnormalities seen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild active inflammatory bowel disease affecting the terminal ileum. No evidence of fistula or abscess.


Instruction: Generate impression based on findings.

Input: 52 year old patient with thyroid cancer. Metastatic brain lesion. History of tumor resection and radiation. Tumor recurred and current trauma patient complains of increasing headaches and probable determining things. Nonenhanced head CT:There is a new interval area of extensive vasogenic edema in the left frontal lobe near the site of previously noted metastatic lesion on prior exam from 12 -- 13 -- 2010. This finding is associated with mass effect and effacement of adjacent cortical sulci as well as mass effect on the left frontal horn of the left lateral ventricle and midline shift of approximately 8 mm at the level of septum pellucidum. The finding is highly concerning for metastatic lesion and recommend follow with a dedicated enhanced MRI of brain. There are no additional foci of abnormal density of brain parenchyma. Ventricular system are within normal range of size.Above findings were discussed with the clinical service Dr. Postma Kelly at the time of interpretation of the exam.

Output: Large new focus of vasogenic edema in the left anterior frontal lobe with associated mass effect. Recommend follow up with enhanced CT or an enhanced MRI for evaluation of metastatic disease. Rightward midline shift of approximately 8 mm.


Instruction: Generate impression based on findings.

Input: Status post ERCP for hilar obstruction (presumed metastatic ovarian cancer) with bilateral stenting, but with persistent conjugated hyperbilirubinemia - rule out dilated intrahepatic ducts. History: rule out dilated (undrained) intrahepatic bile ducts ABDOMEN:LIVER, BILIARY TRACT: There is ill-defined soft tissue encasing the hepatic hilum without discrete measurable mass. The hepatic veins appear patent. There is attenuation of the main portal vein at the bifurcation (4/238) and also attenuation of the central bile ducts. There is bilateral intrahepatic biliary ductal dilatation which is most prominent in the posterior segment of the right hepatic lobe (segment 6) which measures up to 7 mm. The common bile duct is nondilated. The gallbladder is mildly distended. There is a dependent filling defect within the gallbladder which is favored to reflect sludge or stones and does not demonstrate enhancement.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates normal parenchymal signal intensity and enhancement. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are several enlarged retroperitoneal lymph nodes as seen on recent CT.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Ill-defined soft tissue at the hepatic hilum suspicious for metastasis with associated narrowing of the central portal veins and bile ducts as well as moderate intrahepatic biliary ductal dilatation bilaterally (up to 7 mm) despite biliary stents. 2.Layering debris within the gallbladder which is favored to reflect sludge/cholelithiasis rather than focal wall thickening as questioned on prior ultrasound.


Instruction: Generate impression based on findings.

Input: 57 years Male (DOB:3/21/1959)Reason: stroke History: Left hemiparesis and hemiataxiaPROVIDER/ATTENDING NAME: JAMES R. BRORSON JAMES R. BRORSON MRI of the brainThere is encephalomalacia present along the medial aspect of the left cerebellar hemisphere. No foci of diffusion restriction are currently appreciated intracranially.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility imaging there are 2 or 3 subcortical and periventricular punctate foci of signal hypointensity. In isolation these don't clearly establish a pattern given their small number..The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is occluded. There appears be some reverse filling of the distal left vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the posterior cerebral arteries bilaterally. The P1 segments are small. The anterior communicating artery is very small.

Output: 1.Chronic stage infarction involving the left cerebellar hemisphere. 2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 50 year-old female with difficulty talking and mouth pain. History of previous acute coronary syndrome. There is no evidence of intracranial hemorrhage, mass or edema. Bifrontal low attenuation is present most likely secondary to encephalomalacia from previous ischemic event. However, the right frontal region demonstrates vague hypoattenuation extension to the cortex may be artifactual but acute ischemic change is not completely excluded. Low-attenuation region in the right cerebellar hemisphere may represent an area of ischemic change, also age indeterminate.Increased density material is present within the anterior falcine region/left frontal hemisphere consistent with surgical clip metallic artifact from prior intervention. Please correlate with prior surgical history. Superior to this metallic artifact is an ovoid high-density structure measuring 5 x 10 mm, (series 3, image 20) which may represent a meningioma however could also potentially represent an aneurysm. Further examination with MRA/MRI with contrast is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.Postsurgical changes of a left frontal craniectomy are noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No definite acute intracranial abnormality.2. Bifrontal low attenuation with questionable image artifacts versus ischemic change of indeterminate age of the right frontal hemisphere.3. Ovoid subcentimeter high-density structure adjacent to the anterior falx which may represent a meningioma however could potentially represent an aneurysm. Further evaluation with MRA/MRI with contrast is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Clinical question: 30-year-old male with headaches with associated epistaxis and blurry vision. Non-enhanced CT of brain:Images through supratentorial space demonstrate no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The gray/white matter differentiation is well preserved.Images through posterior fossa demonstrate a large heavily calcified lesion in the right cerebellum posteriorly. This lesion measures approximately 21 mm in transverse axis and 26-mm in transverse axis (image 8 of 31). This finding is not associated with any vasogenic edema. Etiology of this finding is not certain the finding however could represent a dystrophic calcification, cavernoma or a partially calcified neoplasm. Further evaluation with an MRI is recommended.The folia of the cerebellum and vermis appears more pronounced than is expected for patient's stated age of 30 and this is concerning for underlying parenchymal volume loss.The calvarium, paranasal sinuses, mastoid air cells and middle ear cavities are well pneumatized and unremarkable.

Output: 1.26-mm x 21 mm irregularly shaped heavily calcified lesion in the posterior aspect of right cerebellum. Dystrophic calcification, cavernoma or a partially calcified neoplasm is suspected and follow-up with a enhanced dedicated MRI of brain is recommended.2.Suspected parenchymal volume loss of the cerebellum and vermis for patient stated age.3.No abnormality in the supratentorial space.4.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: 68 years Female (DOB:4/18/1948)Reason: severe back pain, AMS - h/o recent s/p L3-4, L4-5 XLIF on 7/25 History: As aboveReferring Attending: DRAGANA D RADOVANOVIC The conus medullaris on sagittal imaging is grossly intact. 5 lumbar type vertebral bodies are presumed to be present. The patient is status post posterior fusion using pedicle screws and interconnecting rods at the L3, L4 and L5. Patient's also status post anterior instrumentation at L3-4 and L4-5 disc spacers.The prior exam ring-enhancing lesions in the psoas muscles bilaterally have decreased in size. Axial measurements of enhancing lesions in the current exam on the right psoas are 20 x 9 mm and on the prior exam 26 x 14 mm on the left psoas muscle and measures approximately 20 x 17 mm and previously measured 5 x 32 mm.Since the prior examination subcutaneous fluid collections have also decreased. One in the left side at the C4 level measures 14 x 8 mm in the current exam and the 21 x 10 mm on the prior.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is facet moderate hypertrophy present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy 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.Ring-enhancing lesions suspicious for infection in the psoas muscles and subcutaneous tissues have decreased in size since the prior exam but have not resolved. Please note the patient's metal artifact from instrumentation may obscure abnormalities adjacent to these devices.2.Status post anterior and posterior instrumentation for fusion.3.Degenerative changes are present in the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: 55 years, Male, rising PSA, negative biopsy PELVIS:PROSTATE:Prostate Size: 5.4 x 3.5 x 4.0 cmPeripheral Zone: Lesion in the left mid gland peripheral zone measuring 5 x 4 mm (801/19) has low signal on ADC/T2 with early enhancement, suspicious for prostate adenocarcinoma. Region in the right peripheral zone mid gland measuring 7 x 3 mm (604/284) with low signal on ADC is suspicious for prostate adenocarcinoma. A well-circumscribed hypodense lesion in the left base most likely represents BPH nodule.Central Gland: No significant abnormality noted.Seminal Vesicles: No involvementExtracapsular Extension: No evidence of extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Two subcentimeter lesions in the mid gland peripheral zone are suspicious for prostate adenocarcinoma. These would be amenable for MR guided biopsy.


Instruction: Generate impression based on findings.

Input: 53-year-old male with history of prostate cancer. Left lateral mid 3+3, left lateral apex 3+3, left apex 3+3, right lateral gland 3+4. PELVIS:PROSTATE:Prostate Size: The prostate measures 4.1 x 2.6 cm.Peripheral Zone: Right base lateral T2 hypointense lesion with corresponding decreased ADC measures 15 x 10 mm. Additional similarly appearing focus at the left base measures 6 x 5 mm.Central Gland: BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is extra capsular extension of the right base lesion with possible neurovascular invasion.BLADDER: No significant abnormality noted.LYMPH NODES: Prominent external iliac nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right base peripheral lesion with extracapsular extension and possible neurovascular invasion. Additional smaller focus in the left base also suspicious for carcinoma.


Instruction: Generate impression based on findings.

Input: 49 year old African-American female with hypertension, venous thrombo-embolic disease with known anti-phospholipid antibody syndrome and newly diagnosed diffuse large b-cell lymphoma presenting for pre-chemotherapy cardiac evaluation. Left VentricleThe left ventricle is moderately enlarged with mildly reduced systolic function. The overall LV ejection fraction is 50%, the LV end diastolic volume index is 115 ml/m2 (normal range: 65+/-11), the LVEDV is 234 ml (normal range 109+/-23), the LV end systolic volume index is 58 ml/m2 (normal range 18+/-5), the LVESV is 117 ml (normal range 31+/-10), the LV mass index is 55 g/m2 (normal range 67+/-11). There is basal infero-lateral akinesis with myocardial thinning. The lateral apex appears thin. There is transmural late gadolinium enhancement at the basal infero-lateral wall in a pattern consistent with coronary artery disease. The remaining myocardium is viable. There is no left ventricular thrombus. Left AtriumThe left atrium is severely enlarged. No obvious ASD or PFO on first pass perfusion imaging. Right VentricleThe right ventricle is severely enlarged with mildly reduced systolic function. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 183 ml/m2 (normal range 69+/-14), the RVEDV is 371 ml (normal range 110+/-24), the RV end systolic volume index is 99 ml/m2 (normal range 22+/-8), and the RVESV is 202 ml (normal range 35+/-13). Right AtriumThe right atrium is severely enlarged. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is severe tricuspid regurgitation.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 severely enlarged (main PA 46 mm) while the right and left PA branches are normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. The IVC is enlarged. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is moderately enlarged with mildly reduced systolic function (LVEF 50%). There is basal infero-lateral akinesis with myocardial thinning with transmural late gadolinium enhancement in a pattern consistent with coronary artery disease. The remaining myocardium is viable. 2. The right ventricle is severely enlarged with mildly reduced systolic function (RVEF 45%)3. There is severe tricuspid regurgitation and at least moderate mitral regurgitation. 4. There is severe dilation of the main pulmonary artery (MPA 46 mm). 5. Severe biatrial enlargementI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 49 years old, with history of colorectal cancer, prior scan showing soft tissue thickening within the right pelvis surrounding the ureter. Patient with pain in that area. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow signal abnormality or enhancement is observed. A T1/T2 hyperintense area within the L3 vertebral body likely represents a benign hemangioma.The distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina are slightly disorganized but otherwise unremarkable. No pathologic spinal cord or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.At L4-5, facet arthropathy, mild disc bulging and a small right foraminal annular fissure are demonstrated. No significant spinal canal stenosis is seen. The right neural foramen is slightly narrowed.At L3-4 and L5-S1, only minimal disc bulging is seen with no significant spinal canal or foraminal compromise.Please note that due to the field-of-view prescription of a lumbar spine MRI, the questioned soft tissue mass in the pelvis is only minimally visualized if at all on this examination.

Output: 1.Minimal degenerative findings in the lumbar spine without significant spinal canal or foraminal stenosis.2.The questioned soft tissue mass in the pelvis is minimally visualized if at all on this examination due to field of view limitations. An MRI pelvis with and without contrast would provide more appropriate coverage for the area of concern.


Instruction: Generate impression based on findings.

Input: Evaluate pancreatic ductal dilation, status post Whipple procedure for IPMN 4/11/2014 ABDOMEN:LUNG BASES: Right basilar scarring / atelectasis.LIVER, BILIARY TRACT: Subcentimeter T2 hyperintense focus in the right hepatic lobe, unchanged. The hepatic vasculature is patent. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple procedure. The main pancreatic duct measures 9 mm in maximal diameter, previously 8 mm (series 3, image 15). No evidence of parenchymal or intraductal mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes related to prior Roux-en-Y.BONES, SOFT TISSUES: Stable T2 hyperintensities within lower thoracic vertebral bodies are compatible with vertebral hemangiomas.

Output: Mildly increased pancreatic ductal dilation without evidence of ductal or parenchymal mass. Given the findings and surgical history, an anastomotic stricture is the favored etiology; main duct IPMN is considered less likely.


Instruction: Generate impression based on findings.

Input: Urothelial cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There appears to be a 2 mm wide outpouching of the right internal carotid artery ophthalmic segment. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a midline cystic lesion in the posterior nasopharynx that measures up to 12 mm, which may represent a Thornwaldt or retention cyst.

Output: 1. No evidence of intracranial metastases.2. An 2 mm wide outpouching of the right internal carotid artery ophthalmic segment may represent an aneurysm versus prominent infundibulum or artifact. Further evaluation via dedicated angiographic imaging may be useful for further characterization.


Instruction: Generate impression based on findings.

Input: 85 year-old female with mental status changes. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal patchy areas of diffuse hypoattenuation in the periventricular distribution consistent with small vessel ischemic disease, age indeterminate. There is clinical concern for acute ischemia, an MRI may be considered. No acute cortical stroke is seen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Sinus disease affects the right maxillary sinus.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with multiple sclerosis, assess for progression. Brain:Scattered, at least 10, T2 hyperintense lesions are evident within the periventricular and juxtacortical white matter as well as at the root entry zone of the left fifth cranial nerve. One lesion, along the body of the right lateral ventricle, appears to be new from prior (see image 53 series 701), while the remaining lesions show no significant interval change. Most demonstrate moderate T1 hypointensity which does not seem to have changed significantly. On postcontrast images, there is a vague vascular pattern of enhancement within the right corona radiata. Also noted is a developmental venous anomaly in the right parietal lobe. The new right periventricular lesion noted above demonstrates a central enhancing vein. Otherwise, no definite enhancing lesions are seen, and in particular, none of the discrete white matter lesions described above show inflammatory-type enhancement.C-spine:Small areas of cord T2 hyperintensity are seen centrally at the level of the odontoid process and right posterolaterally at the C2 level. There is no associated enhancement at these locations or elsewhere in the cervical spinal.The cervical lordosis is straightened but sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. With the exception of degenerative endplate signal change at C6-7, no concerning or pathologic marrow replacement is observed.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C6-7: Posterior disc-osteophyte complex formation with effacement of the ventral thecal sac but no significant spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.Multiple lesions are evident within the brain compatible with demyelinating disease. One lesion, along the body of the right lateral ventricle, is new from prior while the remaining lesions are unchanged. No enhancing lesions are seen to suggest active or ongoing demyelination.2.Two small areas of signal abnormality are evident within the spinal cord, but again, there are no enhancing lesions to suggest active or ongoing myelination.3.Multilevel cervical spondylosis is seen but without high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 25-year-old female with history of Crohn's status post ileocecectomy. Narrowing at anastomosis on recent colonoscopy. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic mass. Gallbladder sludge/stones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical findings of ileocecectomy. Just proximal to the bowel anastomosis, there is approximately 5 cm of most distal terminal ileum mild wall thickening and hyperenhancement consistent with IBD related enteritis (series 20, image 90). Proximal to this segment, around 10 cm of mild wall hyperenhancement suggestive of quiescent disease.No fistulae or abscess identified. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free pelvic fluid, likely physiologic in a premenopausal woman.

Output: Inflammatory bowel disease involving approximately 5 cm of most distal terminal ileum. Possible additional 10 cm of quiescent bowel disease immediately proximal to this segment.


Instruction: Generate impression based on findings.

Input: 41 year old female patient with newly diagnosed cervical cancer pre-op vs chemotherapy. Vaginal discharge. PELVIS:UTERUS, ADNEXA: There is a mass at the cervical os extending externally, more towards the right than left. The mass extends into the endometrial canal, the superior extent of which is not clearly delineated. The lesion however does not demonstrate significant enhancement. There is no parametrial extension. In the left adnexa, there is a complex mass with an enhancing soft tissue component and multiple mural enhancing nodules. A tubular component of this mass in part likely represents a dilated fallopian tube. The right ovary is also enlarged with an enhancing soft tissue component, though smaller than the left side. These adnexal findings are suspicious for primary tumor or metastatic disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A T2 hyperintense, enhancing lesion within the L5 vertebral body appears to demonstrate intralesional fat and likely represents a hemangioma.OTHER: There is moderate ascites. The peritoneum appears thickened without discrete mass.

Output: 1.Cervical mass compatible with provided history of malignancy.2.Bilateral complex adnexal masses, left greater than right, are suspicious for primary malignancy or metastatic disease.


Instruction: Generate impression based on findings.

Input: Melanoma with new brain metastases on CT scan. There is a medial left cerebellar enhancing lesion that measures up to 18 mm, a left lateral cerebellar enhancing lesions that measures up to 10 mm, a left middle frontal gyrus enhancing lesion that measures up to 9 mm, a left superior frontal gyrus lesion that measures up to 6 mm, a left hippocampal tail enhancing lesion that measures up to 4 mm, and a right medial cerebellum enhancing lesion that measures up to 4 mm. There is confluent T2 hyperintensity surrounding the lesions. There is no evidence of intracranial hemorrhage or acute infarct. There is partial effacement of the fourth ventricle. The third and lateral ventricles are not particularly enlarged. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is an apical scalp lipoma that measures 7 mm in thickness. There are small bilateral maxillary sinus retention cysts.

Output: Multiple supratentorial and infratentorial metastases with vasogenic edema, but no midline shift or herniation.


Instruction: Generate impression based on findings.

Input: 50 year-old female with difficulty talking and mouth pain. History of previous acute coronary syndrome. There is no evidence of intracranial hemorrhage, mass or edema. Bifrontal low attenuation is present most likely secondary to encephalomalacia from previous ischemic event. However, the right frontal region demonstrates vague hypoattenuation extension to the cortex may be artifactual but acute ischemic change is not completely excluded. Low-attenuation region in the right cerebellar hemisphere may represent an area of ischemic change, also age indeterminate.Increased density material is present within the anterior falcine region/left frontal hemisphere consistent with surgical clip metallic artifact from prior intervention. Please correlate with prior surgical history. Superior to this metallic artifact is an ovoid high-density structure measuring 5 x 10 mm, (series 3, image 20) which may represent a meningioma however could also potentially represent an aneurysm. Further examination with MRA/MRI with contrast is recommended for further evaluation.The ventricles and basal cisterns are normal in size and configuration.Postsurgical changes of a left frontal craniectomy are noted. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No definite acute intracranial abnormality.2. Bifrontal low attenuation with questionable image artifacts versus ischemic change of indeterminate age of the right frontal hemisphere.3. Ovoid subcentimeter high-density structure adjacent to the anterior falx which may represent a meningioma however could potentially represent an aneurysm. Further evaluation with MRA/MRI with contrast is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Pre-operative evaluation for cranial stimulator placement. There are multiple left hemisphere depth electrode in unchanged position. There is confluent T2 hyperintensity surrounding portions of the depth electrodes in the left parietal lobe, where there is also volume loss.

Output: Preoperative planning MRI shows left hemisphere depth electrodes in position and left parietal lobe encephalomalacia.


Instruction: Generate impression based on findings.

Input: 58-year-old female with left wrist pain at the distal radioulnar joint after healed fracture of fifth metacarpal base. Evaluate TFCC. LIGAMENTS: There is contrast extending from the radiocarpal joint into the midcarpal joint via a defect in the membranous portion of the scapholunate ligament. The volar and dorsal components of the scapholunate ligament appear intact. There may be a small perforation of the membranous portion of the lunotriquetral ligament, but this is equivocalTRIANGULAR FIBROCARTILAGE COMPLEX: We see no gadolinium traversing the triangular fibrocartilage complex to indicate a tear.TENDONS: The dorsal tendons appear intact. Gadolinium surrounds the second and third compartment tendon which is iatrogenic. The volar tendons appear normal. BONES: There is mild deformity of the base of the fifth metacarpal indicating a healing/healed fracture as seen on prior radiograph. There is mild medial subluxation of the fifth metacarpal in relation to the hamate. There is a small (3 mm) ununited fragment between the bases of the fourth and fifth metacarpals. There are defects in the base of the fifth metacarpal and medial aspect of the body of the hamate likely related to posttraumatic erosion from altered mechanics. Mild bone marrow edema is present within the base of the fifth carpal as well as the hamate. Addition mild osteoarthritic changes affect the wrist with cysts noted in multiple carpal bones. Osteoarthritis also affects the basilar joint with a small ossicle along the base of the first metacarpal which may represent old trauma. In addition, there is a small ossicle distal to the ulnar styloid which may be related to old trauma. There is slight dorsal translation of the ulna in relation to the sigmoid notch of the radius which may represent an artifact due to patient positioning during the MR examination.ADDITIONAL

Output: 1. No finding to suggest a tear of the triangular fibrocartilage complex.2. Healing fracture of the base of the fifth metacarpal with osteoarthritic changes as described above.3. Tear of the membranous portion of the scapholunate ligament.


Instruction: Generate impression based on findings.

Input: Ulcerative proctitis, GERD, HLD, presenting for evaluation of headaches -- throbbing headaches that occur in the back of head and neck, with occasional radiation to the front of the head with occasionally associated nausea. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nasal septal deviation to the left with a spur that appears to contact the left inferior turbinate.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.2. Nasal septal deviation to the left with a spur that appears to contact the left inferior turbinate.


Instruction: Generate impression based on findings.

Input: History of lung adenocarcinoma. CHEST:LUNGS AND PLEURA: No substantial change in the right paramediastinal and parahilar fibrosis consistent with radiation fibrosis. No new pulmonary nodule, mass or consolidation.Stable nonspecific apparent focus of restricted diffusion along the posterior aspect of the right paramediastinal radiation fibrosis in the right upper lobe (series 13/83), unchanged.Trace loculated fluid in the lung apex and right paramedial base, unchanged. No pleural nodularity or enhancement.MEDIASTINUM AND HILA: Cardiac size is within normal limits without significant pericardial effusion. Aorta and great vessels are normal in caliber.No mediastinal or hilar lymphadenopathy. Residual thymic tissue is identified in the anterior mediastinum.CHEST WALL: No lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology without a discrete lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Normal adrenal morphology without a discrete lesion.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in the right paramediastinal and perihilar fibrosis including the nonspecific small focus of apparent restricted diffusion in the posterior aspect of the right paramediastinal radiation fibrosis changes in the right upper lobe.No evidence of metastatic disease to the abdomen.


Instruction: Generate impression based on findings.

Input: Reason: evaluate soft tissue mass of L distal fibula History: new onset nonpainful mass, L distal fibula. History of PVNS of R foot The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is normal in appearance. Skin markers overlie the medial and lateral aspect of the ankle. There is soft tissue prominence along the lateral aspect of the distal fibula. No focal mass lesion is identified. No enhancing mass lesions are seen. These findings may represent a lipoma, which is difficult to accurately measure due to lack of inherent contrast with surrounding subcutaneous fat. Note is made of a focus of bone marrow abnormality within the anterior aspect of the talar dome which is likely degenerative in etiology. Otherwise no bone marrow signal abnormality is identified. No osteochondral defects are seen. The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The imaged components of the deltoid ligament appear intact. There is a small amount of fluid within the tibiotalar and subtalar joints without evidence of a large effusion.

Output: Soft tissue prominence about the ankle without a focal enhancing mass lesion. These findings likely represent a lipoma.


Instruction: Generate impression based on findings.

Input: Reason: Brachytherapy planning History: Brachytherapy planning. PELVIS:UTERUS, ADNEXA: Interval placement of tandem and ovoid apparatus. Cervical mass compatible with patient's history cervical cancer has significantly decreased in size with no detectable disease on T2 sequences. Small focus of enhancement measures 2.5 x 1.7 cm (series 1101 image 279), previously 2.9 x 2 cm and may represent inflammatory reaction or small residual disease. The mass remains in close proximity to the rectum. Previously noted loss of fat plane between the mass and the left pelvic side wall is again appreciated. Uterine fibroids and nabothian cysts have not significantly changed.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right pelvic sidewall lymph node measures 1.5 x 0.6 cm (series 801 image 83), previously 1.6 x 0.8 cm. Previously referenced left pelvic sidewall rounded lymph node has also slightly decreased in size (series 801 image 34).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially visualized large left renal cyst extending into the pelvis is again noted.

Output: Cervical mass and bilateral pelvic sidewall lymphadenopathy have decreased in size compared to prior.


Instruction: Generate impression based on findings.

Input: Clinical question: NMO patient. Signs and symptoms: Previous longitudinal transverse myelitis in cervical spine. Pre-and post enhanced brain MRI:There are no prior exams for comparison.Diffusion-weighted images are negative.Examination demonstrates a single focus of flair hyperintensity in a linear fashion in the periventricular white matter of left anterior temporal lobe which demonstrates enhancement in a multi-branch pattern and with a prominent main consistent with a very small developmental venous anomaly.The overall anatomical morphology and signal intensity of brain parenchyma remains otherwise within normal on all MRI sequences. Post enhanced images are also negative for any additional foci of parenchymal or leptomeningeal enhancement.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Pre-and post enhanced cervical MRI:No prior exams for comparison.Examination demonstrates a large focus of T2/T2 stir hyperintensity of the cervical cord and extending from mid C3 inferiorly to T1. The finding is associated with significant decreased cord caliber and consistent with myelomalacia. There is no evidence of abnormal enhancement of the cervical or the uppermost visualized thoracic cord.There is evidence of prior multilevel posterior laminectomy from C3 through C6.The signal intensity and the alignment of vertebral column is otherwise unremarkable. There is no evidence of spinal canal or neural foraminal compromise/stenosis at any level.Pre-and post enhanced thoracic MRI:There is normal caliber and signal intensity to thoracic cord and without detectable abnormal enhancement.There is normal signal intensity and alignment the vertebral column without abnormal enhancement.There is no evidence of neural foraminal or central spinal compromise or stenosis at any level.Unremarkable perispinal soft tissues.

Output: 1.Pre-and post enhanced brain MRI demonstrate no evidence of demyelinating disease. A small left anterior temporal developmental venous anomaly is identified. Unremarkable pre-and post enhanced brain MRI otherwise.2.Pre-and post enhanced cervical MRI demonstrates a long segmental myelomalacia and decreased cord caliber extending from C3 to T1 and without abnormal enhancement. Findings consistent with chronic changes of a prior multilevel transverse myelitis. Expected postoperative changes of multilevel posterior laminectomy without spinal canal or neural foraminal compromise at any level.3.Unremarkable pre-and post enhanced thoracic MRI.


Instruction: Generate impression based on findings.

Input: Neck pain. Evaluate spine stability. Evaluation the cervicothoracic junction is limited on the lateral views due to overlying anatomy. There is deformity of the odontoid process of C2 as well as the anterior arch of C1, as noted in the report of the prior MRI examination. Although the bony margins of the dens/C1 complex are in part difficult to define, I suspect that there is approximately 3 mm of anterior subluxation of the dens relative to the body of C2. Furthermore, the degree of subluxation appears to increase to approximately 6 mm with flexion. A minimal (1 mm) anterolisthesis of C4 is also elicited on flexion, but I otherwise see no frank instability of the cervical spine. Intervertebral disc spaces are preserved.

Output: Deformity of the odontoid process of C2 and anterior arch of C1 is better appreciated on prior MRI. There appears to be anterior subluxation of the dens-C1 complex relative to the body of C2 as described above.


Instruction: Generate impression based on findings.

Input: Pleural mesothelioma, baseline MRI. No findings to suggest intracranial metastatic disease. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. There is a right parietal developmental venous anomaly which is incidentally noted. There is also an enhancing nodular focus measuring approximately 8 mm at the vertex which may represent a small varix. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Thoracic spine pain. Compared to prior CT chest of 8/17/2011, there has been slight interval progression of diffuse metastatic disease involving the thoracic spine, from T1 to T8 levels. For example, there is increased lytic lesion at T2 level. There is involvement of both anterior and posterior columns. There is soft tissue mass component of the spine metastasis, with epidural components extending into the spinal canal and neural foramina, with likely impingement of spinal cord and exiting nerves. These findings can be further characterized with MRI.There is compression fracture of T6 and T4 levels, which appears unchanged. Endplate depression of T5 is also noted, and also appears unchanged.Rib metastasis is present.There is tortuous thoracic aorta, with atherosclerotic changes.

Output: 1. Progression of diffuse metastatic disease in the thoracic spine, with epidural components that likely result in spinal cord and nerve impingement. Correlation with MRI thoracic spine is recommended.2. Pathological compression fractures at T4, T5, and T6 levels, not significantly changed. No evidence of new fracture.3. Rib metastasis. Please correlate with CT chest.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered very small foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with mild chronic small vessel ischemic disease or age related white matter changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The midline structures and craniocervical junction are within normal limits. The major cerebral flow voids are intact.

Output: 1.No evidence of hydrocephalus.2.Mild chronic small vessel ischemic disease / age-related white matter changes.3.No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Hip by car on 4/25/2016 status post 2 knee surgeries for patellar tendon rupture. The tear appears swollen with tenderness over the MCL and positive laxity. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Bony contusion of the lateral femoral condyle.LIGAMENTS: The ACL and TCL are intact. The LCL complex and MCL appear within normal limits. EXTENSOR MECHANISM: Postoperative findings from patellar tendon rupture including orthopedic fixation devices and thickening of the patellar tendon.ADDITIONAL

Output: Postoperative findings related to patellar tendon reinsertion. The MCL appears within normal limits. There is a large joint effusion.


Instruction: Generate impression based on findings.

Input: Sacral dimple within the gluteal cleft. Assess for cord tethering. There is a fine hypointense band that extends from the intergluteal cleft to the posterior aspect of the tip off the coccyx. However, there is no evidence of associated mass or cyst. There is also no gross spinal morphologic abnormality, such as an open spinal dysraphism. The tip of the conus medullaris is located at the L2 level and has normal morphology and signal. Furthermore, the spinal cord translates appropriately between the supine and prone positions. There is no thickening or fatty signal along the filum terminale. The cauda equina roots are normally distributed in the thecal sac. The imaged vertebral column alignment is anatomic. The vertebral bone marrow signal is unremarkable. The vertebral body heights are preserved.

Output: 1. A fine hypointense band that extends from the intergluteal cleft to the posterior aspect of the tip off the coccyx may represent a fibrotic component of a pilonidal dimple, without associated cyst, mass, or gross dysraphism.2. The conus medullaris is not low-lying and does not appear to be tethered.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 72-year-old male with new onset diabetes. Evaluate for pancreatic cancer. ABDOMEN:LUNG BASES: Small hiatal hernia.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild nodularity of both adrenal glands with loss of signal on opposed phase images, most compatible with small adenomas.KIDNEYS, URETERS: Small focal cortical defects of both kidneys, most suggestive of scarring from prior infarcts or infection. Subcentimeter T2 hyperintense lesions in both kidneys are too small to characterize but likely due to cysts. Subcentimeter T1 hyperintense lesion in the left kidney inferior pole is also too small to characterize but likely due to a hemorrhagic or proteinaceous cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. No focal pancreatic lesions.2. Small bilateral adrenal adenomas.


Instruction: Generate impression based on findings.

Input: History of chronic hepatitis C. Evaluate for hepatocellular carcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with multiple regenerative nodules and reticular T2-hyperintensity consistent with fibrosis. 3.1 x 3.2 cm late arterial enhancing segment 6 lesion (series 1002/397) demonstrating washout and capsule on portal venous and delayed phase imaging.Additional punctate arterial enhancing foci are noted including segment 8 (series 1002/572) without definite washout which may represent perfusional anomalies.Stigmata of portal hypertension including extensive perisplenic collateral vessels and splenomegaly.SPLEEN: Marked splenomegaly measuring 17.4 cm in the craniocaudal dimension. Splenorenal shunt.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild dependent atelectasis.OTHER: No significant abnormality noted.

Output: 1.3.2 cm segment 6 lesion meeting imaging criteria for hepatocellular carcinoma. No additional lesion meeting imaging criteria for HCC.2.Cirrhosis with multiple regenerative nodules and fibrosis.3.Splenomegaly and parasplenic collateral vessel formation.


Instruction: Generate impression based on findings.

Input: Reason: r/o bilateral iliopsoas abscesses encroaching on spinal cord. R/o osteo, epidural abscess History: bilateral iliopsoas abscesses w/ proximal LE weakness. Five lumbar type vertebral bodies are presumed to be present. There is no abnormal enhancement or edema involving the lumbar spine. No abnormal epidural enhancement or fluid collections to suggest intraspinal abscess. No evidence of discitis-osteomyelitis. There is extensive enhancement involving the left iliopsoas musculature with multiple pockets of fluid, which are incompletely imaged. Pigtail catheter is in place. Fluid collection seen on prior MRI from 5/14/2015 appears to have markedly decreased with residual enhancement involving the right iliopsoas musculature noted. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Degenerative changes are again seen including disc desiccation at L4-L5 and L5-S1 and moderate loss of disc height at the L5-S1 level with associated endplate marrow signal changes. The spinal canal appears congenitally narrow, worse inferiorly, with superimposed degenerative changes as described below: L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No significant spinal canal or neural foraminal stenosis.L3-L4: There is minimal spinal canal stenosis, predominantly on a congenital basis and prominence of the epidural fat. There is mild disc desiccation with small right foraminal disc protrusion and mild right neural foraminal narrowing. No significant left neural foraminal stenosis.L4-L5: There is moderate spinal canal stenosis, predominantly on a congenital basis, prominence of the epidural fat, as well as a superimposed ligamentum flavum thickening, mild disc bulge with annular fissure. Minimal bilateral foraminal narrowing.L5-S1: There is narrowing of the spinal canal which is predominantly on a congenital basis with superimposed prominence of the epidural fat and mild degenerative changes including disc desiccation, ligamentum flavum thickening, mild disc bulge and endplate osteophytes. There is effacement of the lateral recesses and mild to moderate central canal stenosis. No significant foraminal stenosis.

Output: 1. No evidence of extension of infection into the lumbar spinal canal. No evidence of discitis-osteomyelitis or epidural abscess.2. Residual fluid collection/abscess involving the left iliopsoas musculature is better imaged on recent CT study. There is improvement/resolution of the previously partially imaged right iliopsoas abscess on prior MRI from 5/14/2015. There may be impingement of the peripheral course of the lumbosacral nerve roots/plexus to explain the given history of lower extremity weakness but not well evaluated on this lumbar spine study.3. Degenerative changes are again seen including moderate spinal canal stenosis at L4-L5 and L5-S1 as detailed above.


Instruction: Generate impression based on findings.

Input: Previous surgery in right forearm. Right forearm pain. Markers are placed along the skin surface to denote the patient's sites of pain.Bone marrow signal is within normal limits. The soft tissues and musculature appear within normal limits. No enhancing mass is identified.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of thyroid gland. History of metastatic thyroid cancer to thoracic and lumbar spine. Evaluate for disease progression. NECK: Evidence of total thyroidectomy is seen. No suspicious soft tissue lesions are demonstrated in the thyroidectomy bed. Scattered small lymph nodes are present in the neck but none of these meets imaging criteria for pathologic enlargement. The aerodigestive mucosa is unremarkable. The right submandibular gland has been resected. The remaining salivary glands are unremarkable. The aerodigestive mucosa is free of any masslike lesion.THORACIC SPINE: Enhancing slightly expansile lesions within the left transverse process and pars interarticularis of T5 and T6 are unchanged. Postsurgical findings are redemonstrated from T10 to T12 including left lateral fusion and partial corpectomy of T11. The residual T11 vertebral body continues to show diffuse marrow replacement and enhancement. A mild kyphotic deformity centered at T11 is unchanged. Fatty replacement of the marrow in the lower thoracic spine is redemonstrated compatible with prior radiation. No new lesions are identified.LUMBAR SPINE: Enhancing lesions are redemonstrated within the L2, L3 and L5 vertebral bodies. No significant interval change in size is noted. The reference L5 lesion continues to measure 18 x 16 mm in the axial plane.Fatty replacement of the vertebral body marrow is again seen compatible with prior radiation. No new lesions are detected. Mild degenerative findings are stable and unchanged with no areas of significant spinal canal or foraminal stenosis.

Output: 1. Thyroidectomy changes without evidence for recurrent tumor within the neck.2. Stable metastatic lesions in the thoracic and lumbar spine. No new osseous lesions are identified.3. Status post thoracic spine surgery with multilevel corpectomy and fusion


Instruction: Generate impression based on findings.

Input: 58-year-old female with biopsy proven left breast cancer presents for staging MRI. Personal history of right lumpectomy in 2007 for DCIS. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted in the right breast.Mild parenchymal enhancement is noted in the left breast.In the left breast at 3 o'clock position, there is an enhancing mass, measuring 11 x 12 x 11 mm (AP x LR x CC), with metallic artifact from marker clip, consistent with biopsy proven carcinoma. No other abnormal enhancement is seen in the left breast.A scar from prior surgery is present at 12 o'clock position in the right breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal carcinoma in the left breast.2. No MR evidence for malignancy in the right breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 51-year-old female. Right knee pain, pain posteriorly. Evaluate for chondral injury versus meniscal tear. MENISCI: Blunting of the free edge of the posterior horn of the lateral meniscus consistent with a partial radial tear. Medial meniscus is intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Diffuse moderate cartilage thinning of the lateral tibiofemoral compartment with full thickness cartilage defects at the tibial and femoral weight-bearing articular surface. There is associated mild subchondral edema in the lateral femoral condyle and tibial plateau.Medial tibiofemoral and patellofemoral compartment articular cartilage is intact without focal defects.LIGAMENTS: Post surgical findings of ACL repair with an intact graft. PCL and LCL is intact. Mild edema adjacent to the MCL without evidence of a tear. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Likely ruptured Baker's cyst.2. Partial radial tear of the posterior horn of the lateral meniscus.3. Full thickness cartilage loss in the lateral tibiofemoral compartment.


Instruction: Generate impression based on findings.

Input: Clinical question:syncope. Signs and symptoms: Syncope with altered mental status. Nonenhanced head CT:Examination demonstrate a well demarcated area of low attenuation in the left caudate and globus pallidus highly suspect that of an acute left basal ganglial infarct. There is no appreciable mass effect but this finding. Recommend follow-up with an MRI. There is no evidence of hemorrhage. Examination also demonstrate mild bilateral patchy areas of low attenuation of subcortical white matter highly suspected for small vessel ischemic disease of indeterminate age.Ventricular system and the CSF cisterns remain within normal.There is mild calcification and tortuosity of bilateral cavernous carotid.There is severe tortuosity and aneurysmal dilatation of the basilar artery (dolichoectatic basilar) representing atherosclerotic disease. Follow up with an MRA or a CTA is recommended.

Output: 1.Highly suspected acute nonhemorrhagic lacunar infarct of left caudate and globus pallidus. 2.Mild small vessel ischemic strokes of indeterminate age in the supratentorial brain parenchyma.3.Dolichoectatic basilar artery with calcification.4.Recommend follow-up with an MRI and MRA.


Instruction: Generate impression based on findings.

Input: a 61 year old female with pulmonary sarcoid and recent decreased in left ventricular ejection fraction assess by echocardiography. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 67%, the LV end diastolic volume index is 64 ml/m2 (normal range: 65+/-11), the LVEDV is 123 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 40 ml (normal range 31+/-10), the LV mass index is 34 g/m2 (normal range 67+/-11), and the LV mass is 66 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.No myocardial iron overload was noted.No intracavitary thrombus was notedLeft AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 134 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 59 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 opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSmall right lung nodule noted, better characterized on same date PET/CT. A liver cyst is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 67%. There are no regional wall motion abnormalities present. 2. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle is normal in size with normal systolic function, the RVEF is 55%. 4. See extracardiac findings.


Instruction: Generate impression based on findings.

Input: Evaluate complex hepatic cyst for any changes ABDOMEN:LIVER, BILIARY TRACT: Left hepatic cystic mass measuring 8.1 x 6.5 x 7.3 cm in craniocaudal dimension, previously measured 8.1 x 6.2 x 6.7 cm. Thin nonenhancing septations seen within structure, similar to earlier study. Additional bilobar subcentimeter cystic foci without significant change.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged thin septation-containing left upper pole renal cyst. Additional nonenhancing renal lesions, likely simple and complex cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Slight interval growth of left hepatic cystic lesion containing thin nonenhancing septations, appearance suggestive of mildly complex hepatic cyst or biliary cystadenoma. Additional hepatic and renal cystic foci unchanged.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:1/15/1963)Reason: Evaluate for ischemia History: L facial droop, L arm and leg weaknessPROVIDER/ATTENDING NAME: MICHAEL A WARD SHASHA J WU MRI of the brainThere are patchy foci of diffusion restriction present in the right middle cerebral artery territory scattered in the right parietal lobe, right frontal lobe right basal ganglia, insular cortex and temporal lobe. Relative volume percentage of the territory is approximately 10%.There is encephalomalacia involving the right inferior parietal lobule. There are subcortical white matter T2 and FLAIR signal hyperintense foci adjacent to the superior frontal gyri bilaterally. There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia and thalami. There are smaller and fewer ill-defined foci of T2 to and FLAIR signal hyperintensity in the brainstem and right cerebellar hemisphere.There is a 4 mm T2 hyperintense focus with surrounding T2 hypointensity and T1 hyperintensity centrally as well as susceptibility effect located in the left basal ganglia.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.Some imaging is degraded due to patient motion which will obscure more subtle abnormalities. On sagittal imaging appears to be some narrowing of the cervical spinal canal which is not adequately imaged on this exam.MRA brain:There is occlusion of the right middle cerebral artery at its origin. The right vertebral artery is smaller than the left vertebral artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left 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 not readily identified. The vertebral arteries are similar in size.

Output: 1.There is occlusion of the right middle cerebral artery at its origin.2.There are patchy foci of the diffusion restriction scattered in the right middle cerebral artery territory3.There is a 4 mm subacute hemorrhage is suspected in the left basal ganglia.4.A focus of encephalomalacia in the right parietal lobe is most likely a result of prior infarction.5.There are subcortical, periventricular, basal ganglia, thalamic and to a lesser degree brainstem and cerebellar lesions present which are likely vascular related.6.Some imaging is degraded due to patient motion which will obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: There is mild straightening of the normal cervical lordosis. Increased T2 signal along the inferior endplates of C2 and superior endplate of C3 is likely degenerative. Multilevel degenerative disc disease and mild disc space loss, most prominent at C5-C6 and C6-C7. Postsurgical changes of C4-C6 laminectomy with expansion of the thecal sac posteriorly and fluid posterior to the dura appears similar to the prior exam. The cord is again small in caliber from C4 to C6 with increased T2 signal, likely reflecting myelomalacia and appearing similar to the prior exam. No new areas of abnormal signal within the cord.C2-C3: Small disc osteophyte complex and ligamentum flavum thickening. No significant spinal or neural foraminal stenosis. Overall unchanged.C3-C4: Small disc osteophyte complex, asymmetric to the left, slightly increased. Mild ligamentum flavum thickening and uncovertebral hypertrophy. Mild spinal canal narrowing may be slightly increased. Mild left neural foraminal stenosis is unchanged.C4-C5: Moderate central disc osteophyte complex is unchanged. Mild uncovertebral joint hypertrophy. No significant spinal canal stenosis. Moderate bilateral neural foraminal stenosis.C5-C6: Mild disc osteophyte complex is unchanged. Mild uncovertebral joint hypertrophy. No significant spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis.C6-C7: No significant spinal canal stenosis. Mild uncovertebral joint hypertrophy. Severe left and moderate right neural foraminal stenosis. C7-T1: No significant spinal or neuroforaminal stenosis.

Output: Postsurgical changes of prior laminectomy. There is mildly increased disc disease at C3-C4 with a slightly increased disc osteophyte complex and spinal canal narrowing. Otherwise, cervical spine is similar to the prior exam, including mid cervical myelomalacia.


Instruction: Generate impression based on findings.

Input: Clinical question: Hemorrhage. Signs and symptoms: Seizure this a.m. Old left cerebellar stroke is again identified and no change. No new findings within the posterior fossa.Images through the supratentorial space are again demonstrates large area of vasogenic edema in the left frontal -- parietal region with a high density mass. Review of prior examination (MRI of brain from 7 -- 16 -- 2009) reveal presence of a metastatic tumor in the left occipital posterior parietal region. Direct comparison for size is not possible since no post infusion images were obtained. There is no evidence of hemorrhage with this mass. Extensive vasogenic pattern of low density in the right hemisphere is also noted which may represent postradiation edema. The ventricular system and supratentorial space are slightly prominent and may represent underlying parenchymal volume loss. This finding however remains relatively stable since prior study. Postoperative changes of left frontal -- parietal craniotomy. Further evaluation with a post infusion study is recommended. In comparison with prior non-infused CT examination from 6 -- 17 -- 2009 the mass appears to slightly larger.

Output: 1.Left parietal mass which appears a slightly larger on this non-infused study since the prior examination from 6 -- 17 Ash 2009.2.No evidence of hemorrhage.3.Extensive vasogenic edema left hemisphere. No hydrocephalus or midline shift.


Instruction: Generate impression based on findings.

Input: There is moderate atrophy of the right hippocampal head, body, and tail, as well as the right fornix without associated signal abnormality. There are also multiple patchy foci of T2 hyperintensity throughout the supratentorial white matter. No other cortical lesions are seen. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.Findings compatible with right sided mesial temporal sclerosis. 2.Non-specific patchy foci of T2 hyperintensity throughout the supratentorial white matter and may be related to prior infection/inflammation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left back and left lateral thigh pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Minimal disc bulge. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Minimal disc bulge. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthrosis.L5-S1: Minimal disc bulge. Otherwise no significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthrosis, relatively greater on the left.Paraspinous soft tissues are within normal limits.

Output: Minimal degenerative changes as above. No spinal canal stenosis or neural foraminal stenosis is seen at any level in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Study limited due to due to the artifacts from the orthopedic fusion hardware.Posterior fusion screws are seen at L3, L4, L5, and S1. The conus medullaris ends at the level of L1-L2. The spinal canal at the L1-2 and L2-3 levels is vaguely appreciated without significant stenosis. Elsewhere, the spinal canal is not well assessed.The level of T12-L1 demonstrates no disc bulge with no spinal or neural foraminal compromise.The level of L1-L2 demonstrates minimal disc bulging with no foraminal or spinal compromise.The lower level of the disks could not be assessed due to artifact from the fusion hardware.Note is made that of the orthopedic screws appear intact.

Output: Limited study due to artifacts from the orthopedic hardware. The spinal canal at L1-L2 and L2-L3 is vaguely discerned with no significant stenosis. Elsewhere, the spinal canal is not well assessed.


Instruction: Generate impression based on findings.

Input: Evaluate for recurrence of medulloblastoma. There are post-treatment findings in the posterior fossa, including diffuse right greater than left cerebellar hemisphere encephalomalacia, but no evidence of measurable tumor in this region. There are unchanged scattered nonspecific foci of susceptibility effect in the brain and cerebellum. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. 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 orbits are grossly unremarkable.

Output: Unchanged post-treatment findings without evidence of measurable tumor recurrence.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: eval brain History: new onset seizure No evidence of acute ischemic or hemorrhagic lesion.There are, however, 3 focal low signal intensity lesions on anterior aspect of upper medulla and left cerebellar hemisphere on T2 image (series 601, image 24). Those lesions are not seen on coronal T2 image, nor on FLAIR images and not showing susceptibility artifacts on Gradient echo image. Therefore, they are most likely to be artifacts.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Left maxillary sinus retention cyst.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Unspecified psychosis Unspecified psychosisClinical question: strokeSigns and Symptoms: confusionHistory of obesity, anemia, headache, bacteremia, fall, gastroesophageal reflux, fever, anxiety, sleep disorder, depression, constipation, hemodialysis, Benign lymphogranulomatosis of Schaumann, Diabetes mellitus type 2, noninsulin dependent, H/o kidney transplant, Disseminated lupus erythematosus 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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 to the extent of visualization possible on this limited exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Examination is degraded by patient motion.

Output: 1.Examination is limited due to patient's inability to cooperate and motion artifact. As a result any small or subtle lesions would be easily overlooked. If there is persistent concern an examination the patient is able to cooperate or with the help of anesthesia may be helpful.2.There is no evidence for acute cerebral infarction.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related (most likely given the PMH), related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: 12-year-old female patient with tuberous sclerosis. Evaluate for renal angiomyolipomas.EXAMINATION: MR kidneys without and with IV contrast 11/13/2015 ABDOMEN:LIVER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Few bilateral T2 hyperintense foci in the bilateral kidneys are too small to characterize. No fat-containing lesions in the kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace free fluid in the pelvis observed on coronal images.

Output: Few bilateral T2 hyperintense foci in the kidneys are too small to characterize. No fat containing lesions in the kidneys.


Instruction: Generate impression based on findings.

Input: Altered mental status The trigones and occipital horns of the lateral ventricles as well as the posterior aspects of the bodies of the lateral ventricles are asymmetrically enlarged.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional patchy foci of signal hyperintensity on T2 and FLAIR MRI are present in the brainstem - predominantly the pons.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 the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Flow void is identified in the left vertebral artery but not as well on the right vertebral artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Loss of the right vertebral artery flow-void is somewhat nonspecific and could represent stenosis or occlusion of the right vertebral artery. If clinically appropriate additional imaging of intracranial vasculature such as CT angiogram or MR angiogram may the helpful to further evaluate this.2.Ventriculomegaly, involving the posterior aspects of the lateral ventricles is a nonspecific finding but suspect to be a result of some volume loss of the cortical mantle posteriorly. This was present on the prior CT exams and is remote in time from leukomalacia.3.Periventricular and subcortical white matter changes as well as lesion in the pons of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 64-year-old female with knee pain. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus consistent with intrasubstance degeneration. There is branching linear signal abnormality within the posterior horn of the medial meniscus which extends to the femoral and tibial articular surfaces consistent with complex degenerative tearing, which also extends into the body of the meniscus. There is blunting of the anterior horn of the meniscus which may reflect degeneration/tearing. There is deformity and linear branching signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface consistent with complex degenerative tearing. The anterior horn appears intact.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow. There is full-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality. There is subjective thickening of the articular cartilage of the lateral compartment. There is full-thickness articular cartilage degeneration affecting the patellofemoral joint with portions of the lateral facet of the patella and femoral trochlea completely devoid of articular cartilage with underlying degenerative subchondral signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is perhaps mild thickening of the patellar tendon suggesting mild tendinosis.ADDITIONAL

Output: 1. Severe osteoarthritic changes of the knee with associated full-thickness articular cartilage degeneration most pronounced along the patellofemoral and medial tibiofemoral compartments.2. Complex degenerative tearing of the medial and lateral meniscus as described above.3. Small joint effusion with foci of internal fat signal intensity suggesting lipoma arborescens.


Instruction: Generate impression based on findings.

Input: 59-year-old male with history of ventral hernia now with mental status changes. Possibly blood seen on CT. Rescan for concern for hemorrhage. Focus of high attenuation in the left frontal region is less conspicuous. This may represent cortical hemorrhage or possibly a dural based calcified meningioma. If clinically indicated, an MRI could be considered for follow-up.Small vessel disease and corticomedullary volume loss as described in prior exam.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Focus of high attenuation is less conspicuous in the left frontal region. This may represent a cortical hemorrhage or a small calcified dural based meningioma. MRI is recommended for follow-up if clinically warranted.


Instruction: Generate impression based on findings.

Input: 39-year-old male with a history of an epidermoid cyst presents with headaches. There is slight interval increased scalloping along the medial aspect of the right basal cistern epidermoid cyst, without significant overall change in size otherwise. There is no associated edema. There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is mucosal thickening in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Slight interval increased scalloping along the medial aspect of the right basal cistern epidermoid cyst, without significant overall change in size otherwise.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 92 year-old male with altered mental status, found down. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of patchy hypoattenuation are present in a subcortical and periventricular deep white matter distribution, nonspecific; however, most likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are mildly enlarged secondary to diffuse volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities.2. Multifocal regions of patchy hypoattenuation compatible with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Other specified disorders of muscle [M62.89] / Headache [R51], Reason for Study: ^Reason: avm, History: headache with left sided weakness 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. Left distal vertebral artery is hypoplastic. Bilateral Pcom arteries and Acom artery are patent.There is no evidence of arterial aneurysm. No intracranial arterial luminal stenosis.Spine MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy. The conus medullaris terminates at the level of L1. The paraspinal soft tissues and musculature are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. There is diffuse bulging of disc at the level of L45 otherwise unremarkable intervertebral discs.

Output: 1. Normal brain MRA.2. Diffuse bulging of disc at the level of L45, otherwise no remarkable Cervical, thoracic and lumbar MRI. Spinal cord appears to be normal.


Instruction: Generate impression based on findings.

Input: Dedicated images through the sella demonstrate diminutive pituitary tissue along the posterior inferior aspect of the sella, consistent with incidental partially empty sella. Glandular tissue measures4 mm in greatest height. Grossly, this appears similar to the prior MRI brain. There is a tiny area of relative hypoenhancement along the right paramedian posterior aspect of the gland measuring 1 mm CC x 2 mm AP x 3 mm transverse (8/9, 7/9). The pituitary stalk lies in the midline, although is likely adhesed to the posterior inferior aspect of the sella as it is placed posteriorly in the AP dimension. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.

Output: Redemonstration of a partially empty sella, with a punctate focus of hypoenhancement along the right paramedian posterior glandular tissue. Please correlate with serum hormone levels for possibility of tiny microadenoma.