Instruction: Generate impression based on findings.

Input: 54 year old woman with history of lymphoma treated with chemotherapy, mild LV dysfunction, referred for stress cardiac MRI prior to stem cell transplant.MEDICATIONS: Allopurinol, synthroid, lisinopril First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no evidence of prior myocardial infarction. There is however a small amount of epicardial late gadolinium enhancement involving the basal inferior and inferolateral walls in a pattern atypical for prior myocardial infarction suggesting the presence of myocardial fibrosis, inflammation, or infiltration. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 164 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 81 ml (normal range 31+/-10), the LV mass index is 27 g/m2, and the LV mass is 58 g. There is subtly hypokinesis of the basal inferior wall. Left 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 56%, the RV end diastolic volume index is 75 ml/m2 (normal range 69+/-14), the RVEDV is 164 ml (normal range 110+/-24), the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8), and the RVESV is 81 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a psuedo-bovine brachiocephalic branching pattern.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 trace pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable. 3. Normal LV size with low normal systolic function (LVEF 51%). There is a small amount of epicardial late gadolinium enhancement involving the basal inferior and inferolateral walls in a pattern atypical for prior myocardial infarction suggesting the presence of myocardial fibrosis, inflammation, or infiltration. 4. Normal RV size and normal systolic function (RVEF 56%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 86 years Male (DOB:1/27/1930)Reason: eval for preoperative planning, OR am on 3/24 History: eval for preoperative planning, OR am on 3/24PROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE There is an 8 x 6 mm sagittal dimension nonenhancing lesion just above the tectal plate associated with some depression of the tectal plate and narrowing of the aqueduct. This could be a source of obstructive hydrocephalus. It abuts the junction of the vein of Galen and internal cerebral veins on one side and the tectal plate on the other side is associated with punctate foci of signal loss and has heterogeneous signal on T2 imaging. The adjacent portion of the aqueduct is nearly obliterated.There is redemonstration of ventriculomegaly. Biventricular diameter is 15 mm on the current exam and was 50 mm on the prior exam. The third ventricle width is 11 mm on the current exam and 11 mm on the prior exam.There are subdural effusions present bilaterally which were also present on the prior exam. These are also stable.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate focus of T2 and FLAIR signal hyperintensity is present in the right basal ganglia. Several punctate foci of signal hyperintensity are present in the pons.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.There is a small lesion interposed between the tectal plate and the junction of the vein of Galen and internal cerebral veins. The aqueduct is narrowed immediately adjacent to this lesion. This could potentially represent pineal gland but its location is rather odd. Signal characteristics indicated that they may be associated with calcifications. Its location suggesting may be a potential cause for significant narrowing of the aqueduct and explain the patient's ventriculomegaly. It is associated with near obliteration of the aqueduct at its site.2.Periventricular and subcortical white matter lesions of a mild degree and scattered lesions in the brainstem and right basal ganglia are nonspecific. At this age they are most likely vascular related. 3.Subdural effusions are stable compared to prior exam. This could be related to atrophy.


Instruction: Generate impression based on findings.

Input: 63 year old female with breast cancer and brain METs presents after having a focal seizure in her right arm. There is no evidence of intracranial hemorrhage. Exam is limited for metastatic disease due to lack of post contrast enhancement. Focal area of well-defined hypodensity in the left posterior parietal region along the high convexity is consistent with vasogenic edema. There is mild effacement of the sulci within this region and may be further evaluated with MRI with contrast as clinically indicated. No acute cortical ischemia is seen.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses cells are normally pneumatized.The left mastoid air cells appear opacified. The internal auditory canals are patent bilaterally.

Output: Left posterior parietal region of vasogenic edema may be further evaluated with contrast enhanced MRI as clinically indicated.


Instruction: Generate impression based on findings.

Input: New onset ataxia, difficulty with ambulation Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Multilevel disc osteophyte complexes are seen. There is loss of intervertebral disc height, particularly at C5-C6 and C6-C7. There is effacement of the ventral and dorsal thecal sac at the C3-C4 and C4-C5 levels. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild congenital narrowing of the cervical spinal canal with superimposed degenerative changes, with individual levels as below:C2-3: Small disc osteophyte complex. Mild left facet arthropathy with mild left foraminal narrowing. No significant compromise to the spinal canal or right neural foramen. C3-4: Disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis as well as moderate left and mild right neural foraminal narrowing. C4-5: Disc osteophyte complex, uncovertebral hypertrophy, and ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis as well as moderate left and mild right neural foraminal narrowing. C5-6: Small disc osteophyte complex and uncovertebral hypertrophy resulting in mild spinal canal stenosis as well as moderate right and mild left neural foraminal narrowing. C6-7: Disc osteophyte complex and uncovertebral hypertrophy resulting in mild spinal canal stenosis as well as mild to moderate bilateral neural neural foraminal narrowing. C7-T1: Small disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild right foraminal narrowing. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. Extensive encephalomalacia involving the right greater than left parieto-occipital lobes is partially visualized.

Output: Multilevel degenerative changes in the cervical spine as detailed above, relatively worse at C3-C4 and C4-C5 levels, where there is mild to moderate spinal canal stenosis. No cord signal abnormality or evidence of frank cord compression at any level.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cervicalgia Other chronic painClinical question: evaluate for persistent neck pain with scalp, shoulder radiculopathySigns and Symptoms: neck pain, radiculopathy The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is a 7 mm well-circumscribed lesion within the odontoid at its junction with the C2 vertebral body which is bright on T2 and low signal on T1. It is adjacent to the C2 fusion plate. It is associated with marrow replacement within the right aspect of the C2 vertebral bodyAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height at this level as well as small endplate osteophytes and a minor disc bulge.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a diffuse disc bulge present at this level associated with some mild posterior ligamentous hypertrophy. There is effacement of spinal fluid ventral but not posterior to the spinal cord at this level. There are uncovertebral osteophytes present associated with disc material bilaterally which mildly narrow the neural foramina but do not significantly compromise the exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery is very small.

Output: 1.There are some degenerative changes present in the cervical spine without significant compromise to the cervical spinal canal or exiting nerve roots.2.There is a C2 vertebral body cystic appearing lesion present. If clinically appropriate a CT of the cervical spine may be of benefit to further evaluate this as her is some infiltration of the adjacent bone marrow. It is suspected to be degenerative in nature. Alternatively it could represent a solitary bone cyst.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: Female, 32 years old. Right shoulder pain ROTATOR CUFF: There is moderate tendinosis of the supraspinatus tendon without discrete tear identified. The supraspinatus muscle is intact. The infraspinatus and teres minor tendons and muscles are intact. There is marked tendinosis involving the subscapularis tendon, but no discrete tear is clearly identified. The subscapularis muscle is intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is suboptimally evaluated on nonarthrographic images, and slight signal irregularity involving the superior labrum is nonspecific and may be related to motion artifact.BICEPS TENDON: The tendon of the long head of biceps is intact. ADDITIONAL

Output: Rotator cuff tendinosis, particularly involving the subscapularis tendon, without discrete rotator cuff tear identified.


Instruction: Generate impression based on findings.

Input: Ms. Hoffmann is a 73 year old female with a strong family history of breast cancer in mother, two sisters, and daughter. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Severe low back pain, radiating down both legs. Concern for sciatica/nerve compression. There is transitional anatomy at the lumbosacral junction with 5 conventional lumbar type vertebral bodies and a sixth transitional segment labeled L6 for the purposes of this report which articulates with the sacrum on the left.Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is a thin linear T1 hyperintense structure within the thecal sac likely related to radicular vein and normal variant.Multilevel degenerative changes are seen, as described 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: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-L6: There is moderate bilateral facet arthropathy, worse on the left than the right. There is also a small right central disc extrusion with mild cranial migration. There is partial effacement of the lateral recesses with contact of the descending nerve roots, relatively greater on the right than the left. No significant central spinal canal stenosis. There is fairly mild narrowing of the bilateral neural foramina.L6-S1: No significant disc disease. Spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Transitional lumbosacral anatomy with a transitional lumbarized segment which articulates with the sacrum on the left labeled L6 for the purposes of this report.2. Moderate facet arthropathy at the L5-L6 level, relatively worse on the left than the right.3. Small disc extrusion at the L5-L6 level which along with facet arthropathy contribute to partial effacement of the lateral recesses and contact of the descending nerve roots, relatively greater on the right than the left. There is very mild narrowing of the L5-L6 neural foramina, and no high-grade neural foraminal stenosis at any level. There is also no significant central spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for epidural abscess History: lumbar pain+ tenderness,. Five lumbar-type vertebrae are identified. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The tip of the conus terminates at the level of L2. No pathological enhancement is identified.There is mild nonspecific edema within the posterior subcutaneous fat without discrete fluid collection. The paravertebral soft tissues are otherwise unremarkable.At L1-L2, there is mild facet hypertrophy on the left without associated stenosis. At L4-L5, there is a mild disc bulge and bilateral mild facet hypertrophy with associated minimal foraminal stenosis without significant central canal stenosis. At L5-S1, there is a mild disc bulge and bilateral mild facet hypertrophy without significant stenosis. Otherwise, no significant disc pathology or stenosis within the lumbar spine.

Output: Mild degenerative changes without evidence of epidural abscess.


Instruction: Generate impression based on findings.

Input: Periorbital abscess with pneumocephalus. Signal artifact in the paranasal sinuses presumably related to recent endoscopic sinus surgery. The previously noted subperiosteal abscess involving the medial wall of the right orbit is no longer identified. There remains partial opacification of the ethmoid air cells, right greater than left, as well as within the right maxillary sinus however this is improved compared to prior. The previously noted epidural collection in the right anterior cranial fossa no longer contains appreciable fluid, however there is signal void related to continued pneumocephalus. There remains enhancement of the overlying dura but there has been resolution of the reactive edema in the right mesial orbital gyrus. No evidence of an intraparenchymal abscess. Remainder of the brain parenchyma is unremarkable. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The visualized mastoid air cells are clear.

Output: 1. Post surgical changes involving the medial wall of the orbit. No residual subperiosteal abscess is identified. 2. Residual focus of susceptibility artifact in the right anterior cranial fossa epidural space presumably related to pneumocephalus. No residual epidural fluid collection is identified. Interval improvement in the reactive edema in the overlying inferior orbital gyrus. No evidence of intraparenchymal abscess.3. Postsurgical changes involving the right paranasal sinuses which may be better evaluated on CT scan. There has been interval decrease in opacification of the right ethmoid and maxillary sinuses.


Instruction: Generate impression based on findings.

Input: Female, 15 years old. Hashimoto's thyroiditis. RIGHT LOBE MEASUREMENTS: 1.6 x 1.4 x 4.0 cmLEFT LOBE MEASUREMENTS: 1.5 x 1.4 x 3.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous echotexture without focal lesion.LEFT LOBE: Diffusely heterogeneous echotexture without focal lesion.ISTHMUS: Diffusely heterogeneous echotexture without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal size and morphology of identified cervical lymph nodes. For example, a lymph node just inferior to the left lobe measures 1.2 x 0.4 x 0.7 cm, with a normal fatty hilum.OTHER: No significant abnormality noted.

Output: 1.Diffusely heterogeneous thyroid without focal lesion identified.2.Normal cervical lymph nodes.


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with two weeks of new biparietal headache associated with nausea in the a.m., also with photophobia on exam. No evidence of restricted diffusion is seen. Scattered small foci of FLAIR hyperintensity are demonstrated within the cerebral white matter. No edema or mass effect is detected. No evidence of acute or chronic intracranial hemorrhage is seen and there are no abnormal extra-axial fluid collections. The ventricular system is normal in size and morphology. A partially empty sella is noted. On postcontrast images, the pattern of intracranial enhancement is within normal limits. Staphylomatous deformity of the right globe is demonstrated.

Output: 1.No acute intracranial abnormalities.2.Multiple scattered small foci of FLAIR hyperintensity are evident in the cerebral hemispheres somewhat more numerous than expected for age. This is a nonspecific finding but can reflect microvascular ischemia, vasculitis, sequelae of migraine headache or demyelination among other possibilities.3.Partially empty sella is seen, also a nonspecific finding which can potentially be within normal limits for age. However, it is also seen in conditions of elevated intracranial pressure including idiopathic intracranial hypertension.


Instruction: Generate impression based on findings.

Input: Clinical question: Subdural hematoma. Signs and symptoms: Subdural hematoma. Nonenhanced CT of brain:There is no evidence of new bleed since prior exam. There is revisualization of patient's known right frontal and parietal subdural collection. This results in subtle mass effect and buckling of the cortex of right frontal and parietal lobes. In greatest dimension of subdural measures approximately 14 mm which is fairly similar to prior examination. Minimal discrepancy in measurements however could be secondary to slice positioning.No abnormality of brain parenchyma is detected. Cortical sulci and ventricular system are within normal range for patient's stated age. Burr hole is in the left frontal bone secondary to prior surgical intervention for drainage of subdural is again identified. A small left frontal -- temporal subdural is again identified. There is no evidence of interval change in the size or the extent of this lesion since prior study.Revisualization of bilateral extra conal well-demarcated high density lesions with no interval change. Findings could represent metastatic lesions. On prior examination the clinical date no included metastatic carcinoma. He above extraconal findings are not associated with any bony changes. Further evaluation with an MRI examination is recommended.

Output: 1.No evidence of new hemorrhage.2.Stable bilateral subdurals as detailed above.3.Stable bilateral extraconal retro-orbital masses as described.4.No detectable parenchymal abnormality on this non-infused CT of brain.


Instruction: Generate impression based on findings.

Input: 64 year old female with a newly diagnosed left breast DCIS grade 2 presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There are multiple cysts in both breast. Multiple benign appearing enhancing foci and small masses are present bilaterally.In the left breast, a known malignant lesion is seen at 3:00 position as an irregularly shaped mass, measuring 24 x 20 x 16 mm (AP x LR x CC). A marker clip is identified at the lateral aspect within this mass.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Unifocal left breast cancer. A single wire localization can be performed for breast conservation surgery.2. No MRI evidence of malignancy in right breast.3. No abnormal lymph nodes in either axillary region.Follow up MRI in 6 months is recommended for multiple benign-appearing enhancing foci and small masses in both breasts. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 60 years old, history of lung cancer with brain metastases, evaluate and compare to previous. A single punctate focus of susceptibility effect within the right postcentral gyrus is unchanged. No enhancing lesions are seen. A small developmental venous anomaly within the left superior cerebellum is unchanged. Confluent ill-defined periventricular T2 hyperintensity is unchanged and likely related to prior radiotherapy. No evidence of acute intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected. The ventricles remain normal in size and morphology. Mild opacification is seen in the right ethmoid air cells.

Output: Treatment related effects with no evidence of any new or progressive intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: History of meningioma resected, evaluate recurrence or change. Signs and symptoms: None surveillance imaging. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates stable postoperative changes of a high convexity bilateral paramedian parietal craniotomy.Stable underlying uniform epidural thickening and enhancement since prior exam without convincing evidence of residual or recurrence of tumor.Small focus of underlying cortical and subcortical encephalomalacia/gliosis on the right since prior exam.The underlying superior sagittal sinus demonstrate no convincing evidence of signal abnormality or abnormal enhancement. The superior sagittal sinus however can be further assessed with dedicated MRV imaging.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise and without abnormal parenchymal or leptomeningeal enhancement.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.No diffusion weighted abnormalities.2.Stable postoperative changes of bilateral paramedian posterior parietal craniotomy with revisualization of a stable uniform dural/epidural thickening and enhancement and minimal right underlying parietal encephalomalacia as detailed.3.No detectable signal abnormality or abnormal enhancement of the underlying superior sagittal sinus.4.Stable and unremarkable pre and postcontrast enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 71-year-old female with right hip and femur pain. History of metastatic head and neck cancer. There is a poorly defined lucency within the proximal femoral diaphysis at the level of the inferior margin of the lesser trochanter. This is nonspecific, but could conceivably represent a small metastatic focus. This could be further evaluated with either MRI or skeletal scintigraphy if clinically warranted. We see no lesions within the distal femur. The right hip joint appears normal. Mild osteoarthritis affects the sacroiliac joint.

Output: 1 cm poorly defined lucency in the proximal femoral diaphysis is nonspecific, but could conceivably represent a small metastatic focus, and could be further evaluated with MRI if clinically warranted.


Instruction: Generate impression based on findings.

Input: Low back painIMAGE ACQUISITIONS: Lumbar spine CT without contrast Lumbar spinal alignment is normal. Vertebral body heights are intact. Intravertebral disk spaces are normal.T12-L1: No neuroforamina or central canal stenosis.L1-2: No neuroforamina or central canal stenosis.L2-3: There neuroforamina worse central canal stenosis.L3-4: Diffuse disk bulge without central canal stenosis. No neuroforamina stenosis.L4-5: Diffuse disk bulge without central canal stenosis. Questionable right lateral disk protrusion. Neural foraminal narrowing bilaterally.L5-1: Diffuse disk bulge without central canal or neuroforamina stenosis.In the sacrum, there is a large low attenuation lesion with extension into the retroperitoneum. This is a biopsy-proven schwannoma. We would prefer MRI with contrast to further evaluate this lesion if clinically warranted.

Output: 1. Degenerative disease as described above2. Sacrum schwannoma


Instruction: Generate impression based on findings.

Input: 50-year-old female with right arm pain. Evaluate for causes of right C5 cervical radicular symptoms. Somewhat motion limited exam. There is straightening of the cervical lordosis and the spinal canal is developmentally narrowed. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. There is mild disc narrowing at the C4-5 level and diffuse disc desiccation throughout the cervical spine. A hemangioma or focal fat is seen in the posterior superior T1 vertebral body. The bone marrow signal is otherwise within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: Trace diffuse disc osteophyte complex with left paracentral prominence as well as mild uncovertebral hypertrophy contributes to mild-moderate left neural foraminal narrowing. There is also mild spinal canal stenosis.C3-4: Mild diffuse disc osteophyte complex with some central prominence and left greater than right uncovertebral hypertrophy contributes to moderate right and moderate to severe left neural foraminal stenosis. There is also mild to moderate spinal canal stenosis.C4-5: Trace diffuse disc osteophyte complex and bilateral uncovertebral hypertrophy contributes to moderate right and moderate to severe left neural foraminal stenosis. There is mild to moderate spinal canal stenosis. There is flattening of the right ventral cord with likely impingement of the right ventral C5 nerve root.C5-6: Small diffuse disc osteophyte complex with a right. Central disc protrusion which contributes to mild spinal canal stenosis. There is no significant compromise to the neural foramina. C6-7: Trace diffuse disc osteophyte complex without significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is caudal extension of the slightly pointed left cerebellar tonsil to 6 mm below the foramen magnum, without significant crowding.

Output: 1.Developmental narrowing of the cervical canal with superimposed spondylotic change most prominent at the C4-5 level resulting in mild-moderate spinal canal stenosis at this level. There is also up to moderate to severe left and moderate right foraminal stenosis at the C4-5 level, with flattening of the right ventral cord and likely impingement of the right ventral C5 nerve root.2.Caudal extension of the left cerebellar tonsil to 6 mm below the foramen magnum with a slightly pointed configuration and no significant crowding, favoring left tonsillar ectopia.


Instruction: Generate impression based on findings.

Input: Pineal parenchymal tumor. There has been interval laser ablation of the pineal region mass with increase non-enhancement centrally, but no significant change in size, measuring approximately up to 40 mm. There is a small amount of intraventricular hemorrhage. A right frontal approach ventriculostomy catheter extending into the anterior horn of the right lateral ventricle. There is no significant change in size of the ventricular system. There is mild diffuse dural enhancement. There is a small varix in the left orbital apex. There is an unchanged left occipital scalp nodule.

Output: 1. Interval laser ablation of the pineal region mass with resultant increased central necrosis, but no significant change in size.2. Small amount of intraventricular hemorrhage. 3. No significant change in size of the shunted ventricular system.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: evaluate for renal recurrence or metastasis History: hx of renal cell carcinoma, sp partial nephrectomy ABDOMEN:LIVER, BILIARY TRACT: Scattered hepatic cysts. No suspicious hepatic lesions. Gallbladder and biliary tree are normal in caliber.SPLEEN: No significant abnormality noted.PANCREAS: Multiple cystic lesions in the pancreas. The dominant lesion measures 2.1 x 1.9cm previously 2.2 x 2.2cm.Some of the lesions have complex features. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes in the right kidney from a partial right nephrectomy.Complex cystic mass in the upper pole of right kidney with enhancing septations measures 5.8 x 5.0 cm previously 5.6 x 4.4. . There are other smaller cystic lesions in the right kidney that are complex.Solid enhancing medially located mass measures 1.5 x 1.5 cm.Postsurgical changes in the left kidney with two mass lesions having been resected. Residual enhancing lesion along the lateral aspect measures 3.0 x 2.9 cm. There are multiple smaller solid lesions with complex features, also suspicious for small renal cell carcinomas.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.Complex cystic mass of the upper pole the right kidney with enhancing septations represents at least a Bosniak 3 lesion.2.1.5 cm solid enhancing right renal mass is compatible with a renal cell carcinoma3.3 cm solid enhancing left renal mass is compatible with a renal cell carcinoma.4.Cystic lesions in the pancreas, some of them having complex features.


Instruction: Generate impression based on findings.

Input: Reason: On US pt was seen to have a 6x5x6mm lt ovarian lesion, concern is teratoma coausing paraneoplastic syndrome. History: pt with subacute on chronic neurocognitive decline (neuropsych syndromes years ago, now progressive dementia and dysphagia) PELVIS:UTERUS, ADNEXA: Nabothian cysts are present. There is a 8 x 4 mm left Bartholin's gland cyst.. Bilateral fat-containing inguinal hernias.The right ovary appears normal with several small follicles. There is a cyst in the left ovary measuring 5.5 x 4.1 x 4.5 cm (701/23, 901/13). No abnormal enhancement. No evidence of a teratoma as clinically questioned.BLADDER: Foley catheter. Air is present in the bladder.LYMPH NODES: Mildly enlarged inguinal lymph nodes measuring up to 1.0 x 0.9 cm on the right. Enlarged pelvic lymph nodes with an enlarged left external iliac node measuring 1.8 x 1.0 cm (701/15). Additional enlarged external iliac and obturator nodes are present.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis is likely physiologic

Output: 1.No dermoid cyst is identified.2.Simple appearing left ovarian cyst measuring up to 5.5 cm.3.Pelvic and inguinal lymphadenopathy is of uncertain etiology.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a mixed signal T1 and T2 intensity lesion within the medial rolandic brain involving both sensory and motor cortices, measuring 17 mm AP by 13 mm transverse dimensions (as measured on axial T2 technique), unchanged in size or morphology. This is associated with susceptibility hypointense abnormality, however without perilesional edema. Postcontrast images demonstrate an associated developmental venous anomaly which drains posteriorly, superiorly, and medially. There are no other foci of susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no other masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: Stable cerebral cavernous malformation involving left medial rolandic brain involving both sensory and motor cortices with an associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: There is no acute infarct or midline shift. There is area of T2 hyperintensity corresponding to the right frontal lobe hypoattenuation seen on prior CT with mild regional mass effect. There is also asymmetric hyperintense T2 signal diffusely involving the right putamen with mild expansion, and to a somewhat lesser degree in the left putamen. The patient was not administered gadolinium due to low GFR of 11. There is a background of mild periventricular and subcortical white matter T2 signal abnormality which is nonspecific. There is nonspecific irregular and somewhat nodular thickening of the superficial perioral and nasal soft tissues.

Output: Nonspecific hyperintense T2 signal diffusely involving the bilateral putamen (right greater than left), and right frontal lobe subcortical white matter, associated with mild mass-effect. These are superimposed on additional nonspecific moderate subcortical and periventricular white matter T2 signal abnormalities. Evaluation limited due to lack of contrast. Provided the history, the differential diagnosis primarily includes cryptococcosis, although other infectious etiologies such as tuberculosis, toxoplasmosis, inflammatory, and neoplastic etiologies are possible. Continued imaging follow-up is suggested as clinically warranted.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, with right-sided radiculopathy. Evaluate for amyloid infiltration of the lumbosacral plexus or sciatic nerve. The lumbosacral plexi are well visualized bilaterally. The constituent nerve roots are symmetric in caliber and free of pathologic signal abnormality. In addition, dedicated high-resolution imaging of the right sciatic nerve shows no convincing evidence of edema or abnormal thickening. No impingement or compressive lesion is demonstrated. No marrow edema is present in the osseous structures of the pelvis or hips.

Output: No evidence to suggest abnormal nerve root thickening or infiltration affecting the lumbosacral plexus or the right sciatic nerve. No other specific findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Examination is limited by motion artifact.Right frontal craniotomy changes related to resection of right frontal lobe mass are again demonstrated. Subtle micronodular areas of enhancement with extensive restricted diffusion involving the posterior margin of the cavity in the right frontal lobe as well as the anterior body of the corpus callosum appear similar to prior examination and again do not demonstrate elevated relative cerebral blood volume. However, compared to prior examinations, the body of the corpus callosum appears slightly more thickened, with subtle gradual increased enhancement and heterogeneous signal extending to the left of midline.In addition, there is new restricted diffusion with subtle enhancement extending along the lateral margin of the left lateral ventricular body. This area demonstrates questionable increased relative cerebral blood volume which may be related to an adjacent blood vessel. Overall, there is subtle increase in FLAIR signal extending posteriorly and cranially along the posterior aspect of the right frontal lobe, compared to multiple prior exam. Gradient susceptibility likely related to hemosiderin deposition along the surgical cavity is again demonstrated with 2-3 new scattered punctate foci of susceptibility, for example in the left frontal centrum semiovale.

Output: Comparing to older exams, there has been gradual subtle increased expansion of the corpus callosal body with subtle progression of speckled enhancement and abnormal heterogeneous signal extending across midline, including extension now along the lateral margin of the left lateral ventricular body with associated diffusion restriction. Overall, the areas of abnormal signal/speckled enhancement now demonstrate any significant hyperperfusion and appear to demonstrate decreased rCBV. Linear hyperperfusion along the left lateral ventricular body is noted, possibly relating to an adjacent blood vessel. Continued follow-up is recommended, as findings may in large part relate to post treatment changes although a component of tumor is not entirely excluded.


Instruction: Generate impression based on findings.

Input: 58-year-old man with history of elevated hyperbilirubinemia and bleeding from rectosigmoid varices. ABDOMEN:LIVER, BILIARY TRACT: Simple cyst at the liver dome, otherwise no focal hepatic lesions identified. There is widening of the fissures with hypertrophy of the left lobe suggestive of cirrhosis. TIPS noted and appears patent. Additionally, there are large splenorenal varices and numerous perigastric varices.Patient status post cholecystectomy. There is moderate, diffuse, smooth intrahepatic biliary ductal dilatation and the extrahepatic bile duct is dilated to 11 mm to level of ampulla.SPLEEN: Innumerable subcentimeter splenic cysts identified. The spleen is enlarged.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right superior pole and left mid pole renal cysts noted. Proximal ureters are nondilated.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Partially visualized loops of small bowel are dilated and there is a small amount of free intraabdominal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Degree of intra and extrahepatic biliary ductal dilatation in this patient status post cholecystectomy could be within normal limits, however an ampullary stenosis cannot be excluded.2.Cirrhotic morphology of liver with patent TIPS and large splenorenal collaterals.3.Small bowel ileus with small amount of ascites.


Instruction: Generate impression based on findings.

Input: Neuroblastoma with spinal involvement. There is an enhancing retroperitoneal mass that measures up to approximately 9 cm, which abuts the lumbar spine at multiple levels. In particular, the mass extends into the widened left L2-L3 and L3-L4 neural foramina with slight left epidural extension at these levels, but there is no spinal cord compression. The tumor also abuts the lateral aspects of the left L1-L2 and L4-L5 neural foramina, without intraforaminal extension at these levels. The spinal cord displays normal signal and morphology. There are no intrathecal contrast enhancing lesions. There is straightening of the lumbar spine alignment in the sagittal plane. Otherwise, the vertebral body heights are preserved and there is no evidence of tumor invasion into the vertebral bone marrow. However, the tumor encases and displaces the aorta and inferior vena cavity.

Output: The large retroperitoneal mass that corresponds to neuroblastoma is associated with left-sided L2-L3 and L3-L4 neural foraminal extension and slight right epidural spinal canal extension, but no spinal cord compression. Please refer to the chest, abdomen and pelvis CT report form July 1, 2015 for associated intra-abdominal findings.


Instruction: Generate impression based on findings.

Input: Concern for atherosclerotic Parkinson's, has history of TIA: tremor, history amaurosis fugax in the left eye. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are mild scattered foci of cerebral white mater T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Mild scattered foci of cerebral white mater T2 hyperintensity may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or cerebral edema. Please refer to the concurrent DaTSCAN report for additional findings regarding the question of Parkinson disease.


Instruction: Generate impression based on findings.

Input: 45 years Female (DOB:11/24/1971)Reason: meningioma, yearly follow up History: yearly surveillancePROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM There is a 19 x 15 x 23 mm sized extra-axial mass which previously measured 18 x 21 x 13 mm. It is located adjacent to the right superior frontal gyrus posteriorly just anterior to the paracentral lobule. There is a central area of signal loss and susceptibility imaging associated with this mass. It is somewhat hyperintense relative to gray matter lateral to the gray matter. It enhances homogeneously following gadolinium administration.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Compared to July 2014 exam there is mild interval enlargement of a right parafalcine posterior frontal extra-axial mass compatible with meningioma.


Instruction: Generate impression based on findings.

Input: There is thick pial enhancement as well as possibly a dura/arachnoid component within the right frontal lobe centered within the precentral sulcus. There is some probable subtle contrast leakage within the adjacent brain parenchyma as well as surrounding T2 hyperintensity compatible with edema that does involve the right precentral gyrus. There is also associated parenchymal susceptibility effect compatible with blood products. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: Focal meningeal thickening and enhancement centered within the right precentral gyrus with associated adjacent parenchymal involvement. These findings are most compatible with metastasis but infection could have a similar appearance.


Instruction: Generate impression based on findings.

Input: Reason: Patient with diabetic foot ulcer, bacteremia, and likely osteomyelitis of right foot with severe lower back pain on the left side. Our current differential for the back pain is osteomyelitis of lumbar spine, infectious abdominal abscess, nephrolithiasis History: Back pain on left side Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. There is heterogeneous low T1 marrow signal which is nonspecific and may be related to anemia patient's or chronic renal disease. The conus medullaris is normal in position.There is ill-defined extrathecal fluid collection involving the lumbar spinal canal extending from the T12-L1 level to the L5-S1 level. There is a component extending from the T12-L1 to the L1-L2 level without prior for enhancement and appears to be within the subdural space. There is ventral displacement of the cauda equina nerve roots at this level. More inferiorly from the L2-L3 level to the L5-S1 level, the fluid collection appears more heterogeneous, demonstrates mild heterogeneous enhancement, and appears to involve the epidural space and possibly also the subdural space. There is moderate to severe narrowing of the thecal sac worst at the L3-L4 and L4-L5 levels which is at least in part related to a background of congenital spinal canal narrowing and epidural lipomatosis.There is facet arthropathy at the L4-L5 level with a 9 x 6 mm structure involving the dorsal epidural space at the L4-L5 level which may represent a synovial cyst.There is minimal bilateral L3-L4 neural foraminal narrowing and moderate bilateral L4-L5 neural foraminal stenosis related to disc bulge and facet arthropathy. Remainder of the neural foramina are patent.. Paraspinous soft tissues demonstrate no paraspinous fluid collections or abscess.

Output: 1. There is ill-defined thin extrathecal fluid collection involving the lumbar spinal canal extending from the T12-L1 level to the L5-S1 level. Superior component extending from the T12-L1 to the L1-L2 level without peripheral enhancement appears to be within the subdural space and may represent CSF versus old hematoma. There is ventral displacement of the cauda equina nerve roots at this level. More inferiorly from the L2-L3 level to the L5-S1 level, the fluid collection appears more heterogeneous, demonstrates mild heterogeneous enhancement, and appears to involve the dorsal epidural space and possibly the subdural space. Overall the enhancement associated with the thin fluid collection may represent infection/abscess or chronic blood products. Correlate for history of any lumbar puncture or other spinal injection. There is moderate to severe narrowing of the lumbar thecal sac at the L3-L4 and L4-L5 levels, which is at least in part related to a background of congenital spinal canal narrowing and epidural lipomatosis with the superimposed thin fluid collection contributing to the stenosis. 2. No evidence of discitis-osteomyelitis or paraspinous fluid collection.3. L4-L5 facet arthropathy with 9 x 6 mm structure in the epidural space at this level which may represent a synovial cyst or given the adjacent abnormal epidural enhancement described above, infection is not excluded. 4. Moderate L4-L5 neural foraminal stenosis bilaterally on a degenerative basis.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:2/21/1960)Reason: new back pain with radiation down right leg, history surgery, please evaluate for changes History: new back and leg pain with radiation right legPROVIDER/ATTENDING NAME: JAVAD HEKMATPANAH JAVAD HEKMATPANAH Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation and a disc bulge at this level without significant compromise spinal canal and neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. Since prior exam a right sided broad-based lateral disc protrusion has regressed. There is some loss of disc space height and disc desiccation at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is some disc desiccation and a disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level.

Output: There are some degenerative changes present in the lower lumbar spine without significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: 72-year-old male patient with cirrhosis and lesion on previous imaging suspicious for HCC. Assess for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. Bandlike increased T2 signal within the porta hepatis with delayed enhancement is compatible with fibrosis, unchanged. No intra- or extrahepatic biliary ductal dilatation. Cholelithiasis without evidence of acute cholecystitis. A 7 mm enhancing focus with apparent washout on delayed images within segment five of the liver appears similar in size to the prior study (image 32, series 9). Additional nonenhancing lesions likely represent cysts. No new hepatic lesion is identified.Redemonstration of occlusion of the posterior branch of the right portal vein with eccentric thrombus with a portion of the main portal vein. There is recannulization of the umbilical vein and periumbilical varices. The splenic vein is occluded, unchangedSPLEEN: Splenomegaly measuring 17.3 cm in the craniocaudal dimension. A peripheral wedge-shaped region of T2 hyperintensity likely represents an infarct, unchanged. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing, hyperintense renal lesions likely representing cysts are unchanged. A subcentimeter left upper pole hemorrhagic cyst cyst is stable.RETROPERITONEUM, LYMPH NODES: Small linear signal abnormality in the proximal celiac artery likely represents a small dissection.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Subcentimeter arterially enhancing focus with washout in segment 6 of the liver is stable in size, but remains suspicious for HCC.2.Unchanged thrombosis of the splenic vein, posterior branch of the right portal vein, and eccentric thrombus within the main portal vein.


Instruction: Generate impression based on findings.

Input: Increased headaches and previous possible history of syrinx. Brain: There cerebellar tonsils display a normal morphology and are not low-lying. There is intact CSF flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is mild asymmetry of the lateral ventricles, which can represent an anatomic variant. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of Chiari malformation or cervical spinal cord syrinx.2. Scattered paranasal sinus mucosal thickening may indicate sinusitis.


Instruction: Generate impression based on findings.

Input: There is cortical diffusion restriction and T2 hyperintensity within the left precentral gyral cortex as well as an additional focus within the left subcentral lobule cortex. There are scattered additional patchy foci of T2 hyperintensity within the supratentorial white matter that are most compatible with chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage. 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 and scalp soft tissues are unremarkable. There is a small retention cyst within the right maxillary sinus.

Output: Left precentral gyrus cortical infarct as well as an additional small left inferior subcentral lobule cortical infarct.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with multiple sclerosis. Assess for progression. Image quality is degraded by motion artifact. Within this limitation, the point observations are made.Numerous T2 hyperintense lesions are redemonstrated within the periventricular and juxtacortical white matter. An extensive lesion is also seen encompassing nearly the entire right medial temporal lobe. Lesions are also seen at the right cranial nerve V root entry zone and within the right middle cerebellar peduncle which shows volume loss.These lesions show no evidence of interval growth and no new lesions are detected. The parenchymal lesions do not enhance. Enhancement of the right cisternal cranial nerve V is unchanged. Most of the parenchymal lesions demonstrate moderate to marked T1 hypointensity which is also similar to prior.

Output: No significant interval change in the size or number of demyelinating lesions.


Instruction: Generate impression based on findings.

Input: NSCLC - high prolactin level. The pituitary gland is not enlarged or atrophy and there is no evidence of mass lesions in the sellar region. The pituitary infundibulum and bright spot are intact. The optic apparatus and cavernous sinuses are unremarkable.

Output: No evidence of pituitary lesions.


Instruction: Generate impression based on findings.

Input: 44 years Female (DOB:6/26/1972)Reason: Episode of numbness in right arm in July. History of stroke and sinus thrombosis. EValuate for new pathology History: Episode of numbness in right arm in July. History of stroke. EValuate for new pathologyPROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU There is encephalomalacia centered along the right post central gyrus along its medial aspect. No foci of diffusion restriction are appreciatedThere are several 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 demonstrate small mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is encephalomalacia involving the medial aspect of the right postcentral gyrus.2.There is no evidence for acute ischemic cerebral infarction.3.The examination is somewhat limited due to technical difficulties.


Instruction: Generate impression based on findings.

Input: Male, 54 years old, with GBM status post subtotal resection and adjuvant RT/TMZ. Again seen are findings reflective of craniotomy involving the right frontoparietal region. A small resection cavity is seen within the right frontal lobe, subjacent to the craniotomy, which has decreased in size relative to the prior examination. The degree of T2 hyperintensity within and around this cavity, including hyperintensity involving the adjacent cortex, is stable to slightly improved. The cavity is mildly hemosiderin stained and shows mild thin peripheral enhancement.A second craniotomy is also seen more posteriorly within the right parietal bone. Subjacent to the craniotomy, there is a peripherally enhancing, centrally T2 hyperintense lesion which has expanded in size since the prior examination, now measuring 27 x 24 mm, previously 19 x 16 mm. Perfusion imaging shows patchy elevated rCBV corresponding to some but not all of the enhancing rim of this lesion. The degree of surrounding T2 hyperintensity has expanded relative to the prior examination now encompassing most of the parietal lobe, part of the frontal lobe, and a small part of the temporal lobe.No additional lesions are seen. The right lateral ventricle is somewhat more effaced than on the prior examination due to progressive edema in the right parietal lobe, but otherwise the ventricular system is within normal limits.

Output: 1. A peripherally enhancing lesion within the right parietal lobe has increased in overall dimensions with an associated increase in the degree of surrounding parenchymal T2 signal abnormality likely representing edema. Perfusion assessment of this lesion is equivocal in that some parts of the enhancing rim correlate with elevated rCBV while other parts do not. The differential must therefore include both pseudoprogression and true progression. Close interval follow up is suggested.2. A resection cavity in the right frontal lobe has decreased in size. T2 signal abnormality around this cavity, including signal which involves the adjacent brain cortex, is stable to slightly reduced. A thin rim of enhancement around this cavity persists, but again, is overall smaller than on the prior exam.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with lumboperitoneal shunt for pseudotumor with syrinx, presenting with new onset weakness and sensory changes in the lower extremities. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Robust biphasic CSF flow is seen through the foramen magnum.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.Spine:A spinal cord syrinx is redemonstrated beginning at approximately the C7 level and continuing down to the T3 level. While the craniocaudal extent of the syrinx has not significantly changed, the maximal caliber has increased. The syrinx now measures up to 6 x 6 mm, previously 5 x 4 mm.Apparent mass effect upon the mid thoracic spinal cord is again seen displacing the cord anteriorly without significant interval change. The etiology for this finding is uncertain but may represent the presence of an intradural arachnoid cyst or some other CSF loculation.Cord morphology and signal characteristics are otherwise unremarkable. The conus tip terminates at T12 which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. A lumbar peritoneal drain is visualized entering the thecal sac posteriorly at approximately the L3 level.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement or marrow edema is detected.No significant degenerative disk disease is identified. The spinal canal and neural foramina are patent.

Output: 1. Unremarkable evaluation of the brain.2. Mild interval increase in the caliber of the low cervical/upper thoracic cord syrinx. The craniocaudal extent of the syrinx is unchanged.3. Stable apparent mass effect upon the mid thoracic cord which displaces the cord anteriorly.


Instruction: Generate impression based on findings.

Input: History of low-grade low volume right and left apex prostatic adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 5.0 x 2.5 x 4.2 cmPeripheral Zone: The peripheral zone demonstrates homogeneous T2 weighted hyperintensity without a discrete dominant lesion.Central Gland: At the right mid gland/apex anteriorly there is a 1.7 x 0.7 cm (series 903/264; series 1201/12) asymmetric focus of T2 weighted hypointensity with associated restricted diffusion which may represent a site of prostatic adenocarcinoma.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right mid gland/apex lesion appears to bulge the capsule anteriorly.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.7 x 0.7 cm lesion in the right mid gland/apex anteriorly is suspicious for a site of prostatic adenocarcinoma. This is amenable to MRI/ultrasound fusion of biopsy.


Instruction: Generate impression based on findings.

Input: Reason: Pancreatic head tumor mentioned on OSH CT History: Pancreatic head tumor , pelvic tumor, gastric wall thickening mentioned on OSH CT ABDOMEN: Please note that the left hemiabdomen is partially obscured due to susceptibility artifact from a metal BB within the left abdominal wall.LIVER, BILIARY TRACT: Mild perihepatic ascites. No focal hepatic lesions are evident. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: There is a cyst within the pancreatic head measuring 1.3 x 0.9 cm which is adjacent to the main pancreatic duct without definite communication. There is a possible focus of nodular enhancement within the cystic lesion. The main pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left-sided hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially visualized large fibroid uterus

Output: 1.Cystic lesion within the pancreatic head measuring up to 1.3 cm with a focus of possible nodular enhancement. Differential includes a small sidebranch IPMN, complex cyst or other cystic neoplasm.2.Mild left-sided hydronephrosis.3.Cholelithiasis without evidence of cholecystitis.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of upper lobe, right bronchus or lung [C34.11], Reason for Study: ^Reason: lung cancer, metastatic? History: lung cancer, metastatic? There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no abnormal enhancement either.Multifocal scattered FLAIR/T2 high signal intensity lesions on periventricular white matter centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement. 3. Nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 54-year-old female patient with pancreatic head lesion seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent. No intra or extrahepatic biliary ductal dilatation.SPLEEN: Nonspecific enhancing lesion in the mid spleen is isointense on T2 imaging (series 1602 image 362).PANCREAS: The lesion previously seen on CT scan at the pancreatic head corresponds to a portion of the common bile duct. There is no pancreatic ductal dilatation. Irregular contour of the pancreatic duct and a small nonobstructive stone in the pancreatic duct likely from chronic pancreatitis. The pancreas is severely atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is mild bilateral hydronephrosis that appears to be new compared to prior CT.BOWEL, MESENTERY: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No pancreatic head mass identified. Lesion previously seen appears to correlate with a portion of the nondilated common bile duct.2.Chronic pancreatitis.3.New mild bilateral hydronephrosis.4.Nonspecific enhancing lesion in the mid spleen is favored to be benign in etiology.


Instruction: Generate impression based on findings.

Input: There has been slight interval progression in the size of multiple foci of T2 hyperintensity within the supratentorial white matter. There multiple unchanged foci susceptibility effect throughout the cerebral and cerebellar hemispheres, mostly likely secondary to radiotherapy. There is minimal unchanged punctate enhancement within the previously treated left precentral gyrus lesion. There is otherwise no significant enhancement in the locations of the previously treated brain metastases. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: No significant change in the post-radiotherapy appearance of the brain, including treated brain metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Glioblastoma multiforme. On CCNU. Status post 4 cycles. There has been no significant change in size or morphology of the resection cavity incorporating the right anterior temporal lobe, a portion of the right insula, and the right inferior frontal lobe. T2/FLAIR abnormality surrounding the resection cavity is also unchanged. Associated ex vacuo enlargement of the right lateral and the third ventricles is again noted. Accounting for the increased susceptibility involving the right lentiform nucleus and the right mid brain, including the cerebral peduncle, there is no significant hyperperfusion in the treatment bed.Thin enhancement along the medial edge of the resection cavity is unchanged. The thin, nodular ependymal enhancement along the right frontal horn and minimally at the right atrium shows no significant or convincing interval change. A small ill-defined area of enhancement along the anterior body of the left lateral ventricle (1301/118) is slightly more conspicuous and more solidly contrast enhancing especially when compared to more remote exams, with suggestion of mild, focal elevation of the cerebral blood volume on the color-coded map. Otherwise, these foci of contrast enhancement are too small to accurately resolve by perfusion.Otherwise, there is no new enhancing or T2 hyperintense lesions are seen. Mild periventricular T2 hyperintensity along the left lateral ventricle is unchanged and probably related to treatment. Ventricular size and morphology are stable.The major intracranial arterial flow voids are preserved otherwise. There are small retention cysts in the maxillary sinuses. Chronic fluid signal in the right mastoid air cells is still present.

Output: 1.No convincing disease progression around the resection cavity. 2.The nodular ependymal contrast enhancement along the left lateral ventricular anterior body along the corpus callosum has gradually slightly increased in conspicuity and confluence of enhancement as described above. Close attention on follow-up examination is recommended. The other foci of ependymal contrast enhancement on the right remain unchanged.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of brainClinical question: h/o brain tumorSigns and Symptoms: preop planning for resection The CSF spaces are appropriate for the patient's stated age with no midline shift. There is thickening of the right parietal bone associated with an extra-axial mass which invades into the right parietal lobe. There is vasogenic edema present within the right parietal lobe. The extra-axial mass measures 33 x 19 mm axial dimensions is associated with some infiltration into the adjacent calvarium. There is some associated enhancement along the right parietal lobe measuring 16 x 11 mm axial dimensions.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate scattered opacities in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Examination is performed for the purpose of stereotactic guidance and an surgery and is therefore limited exam. There is a mass involving the right parietal calvarium right sided meninges and extending into the right parietal lobe which is associated with vasogenic edema. This has not changed significantly since the 6/29/2015 exam. Differential considerations include granulomatous lesion as well as neoplasm.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of meniscal tear. Evaluate. MENISCI: There is a complex tear of the medial meniscus which consists of blunting of the inner one third of the posterior horn of the medial meniscus just medial to its root indicating a partial thickness radial tear, which is contiguous with a more horizontally oriented tear. The horizontally oriented tear propagates into the body of the meniscus and it extends to the free edge of the meniscus as well as the femoral articular surface and the probably the tibial articular surface. Furthermore, the posterior aspect of the body of the medial meniscus appears abnormally small suggesting additional chronic attritional tear assuming no prior meniscectomy. More anteriorly, the body of the medial meniscus appears slightly medially extruded. Mild intrasubstance degeneration of the lateral meniscus without tear.ARTICULAR CARTILAGE AND BONE: There is moderate degenerative thinning of the articular cartilage at the medial compartment, particularly involving the medial tibial plateau where there is associated underlying subchondral signal abnormality. Degeneration of the articular cartilage of the far posterior aspect of the medial femoral condyle with underlying low signal intensity in the subchondral bone is also present.Articular cartilage of the lateral compartment appears intact. Articular cartilage of the patella appears intact. There is a small near full thickness or full thickness fissure within the articular cartilage of the medial facet of the femoral trochlea.LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial and lateral collateral ligaments are intact.EXTENSOR MECHANISM: The patellar and quadriceps tendons are intact.ADDITIONAL

Output: 1.Complex tear of the medial meniscus. 2.Osteoarthritis changes as above.


Instruction: Generate impression based on findings.

Input: Finger swelling/dactylitis, evaluate for inflammatory arthritis Right hand: No evidence of inflammatory arthritis.Left hand: No evidence of inflammatory arthritis.

Output: No evidence of inflammatory arthritis.


Instruction: Generate impression based on findings.

Input: Female 61 years old; Reason: thyroid nodule History: Patient has graves disease. r/o cancer RIGHT LOBE MEASUREMENTS: 3.1 x 1.9 x 1.0 cmLEFT LOBE MEASUREMENTS: 3.0 x 1.4 x 1.1 cmISTHMUS MEASUREMENT: No significant abnormality noted. 2 mmRIGHT LOBE: There is no abnormal nodularity.LEFT LOBE: There are 3 distinct hypoechoic nodules which appear adjacent to the inferior pole of the left thyroid gland. The largest of these measures 1.1 x 0.9 x 0.7 cm and does not demonstrate increased vascularity. 2 additional, smaller nodules are seen on the transverse images immediately medial to the carotid artery.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Hypoechoic nodules without increased vascularity adjacent to the inferior pole of the left thyroid lobe, indeterminate, the largest of which may be considered for biopsy.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. The myelination is appropriate for age. The hippocampi are symmetric and normal in appearance. The midline structures and craniocervical junction are within normal limits. 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: No evidence for mass, structural abnormality, or mesial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with history of Chiari malformation, pseudomeningocele, low-lying conus, evaluate for tethered cord. Evidence of suboccipital craniectomy is seen with expansion of the CSF space at the level of the foramen magnum and no crowding of the brainstem or cerebellar tonsils. Robust biphasic CSF flow is seen both anteriorly and posteriorly through the foramen magnum.The visualized spinal cord is within normal limits. No evidence of syrinx formation is seen. The conus tip terminates at the L1-2 level which is within normal limits. No evidence of fatty filum terminale is noted. On prone imaging, there is clear anterior shifting of the conus and cauda equina.A full complement of normally formed vertebral bodies is seen. Spinal alignment is anatomic. Marrow signal characteristics are within normal limits. The intervertebral discs are preserved. No compromise of the spinal canal or neural foramina is detected.

Output: 1.Evidence of suboccipital craniectomy for Chiari decompression is seen. The CSF space at the foramen magnum is well decompressed with no evidence of crowding and with adequate CSF flow both anteriorly and posteriorly.2.The remainder of the examination of the spine is within normal limits. No imaging evidence to suggest tethered cord is seen.


Instruction: Generate impression based on findings.

Input: Reason: elevated LFT's with cholelithiasis ABDOMEN:LUNG BASES: Trace pleural effusions. LIVER, BILIARY TRACT:The liver demonstrates normal parenchymal signal intensity and enhancement. No suspicious hepatic lesions are identified. Area of decreased early enhancement along the interlobar fissure compatible with normal perfusional variation. Trace periportal edema. The hepatic vasculature appears patent. There is a trace amount of perihepatic ascites.Cholelithiasis including a large gallstone measuring up to 2.6 cm. There is mild gallbladder wall thickening as well as a small amount of pericholecystic fluid. There is mildly increased enhancement of the gallbladder mucosa. The intra and extrahepatic biliary ducts are not dilated. There is mild thickening and increased enhancement of the common bile duct. The common bile duct measures up to 6 mm. No choledocholithiasis is identified.SPLEEN: The spleen is mildly enlarged. PANCREAS: The pancreatic parenchyma demonstrates normal signal intensity and enhancement without suspicious focal lesions. The pancreatic duct is nondilated. There is no significant peripancreatic edema.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: There is trace edema within the subcutaneous soft tissues of the back.OTHER: No significant abnormality noted.

Output: Findings compatible with acute cholecystitis without evidence of associated choledocholithiasis. Mild mucosal thickening of the common bile duct may reflect cholangitis.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, history of NF2, history spinal schwannoma resection, meningioma, one year follow-up Brain: Redemonstrated is a mildly hemosiderin stained area of encephalomalacia involving the left pons appearing similar to the prior examination. Tract like T2 hyperintensity is seen coursing through the left frontal lobe, also unchanged compatible with prior instrumentation. No evidence of mass effect is seen. No abnormal fluid collections are detected. Ventricles are normal in size and morphology.Multiple areas of dural thickening and enhancement are again demonstrated including a plaque like region along the anterior right frontal convexity, as well as more nodular areas along the high right convexity, the anterior interhemispheric falx, along the right transverse sinus, and the left tentorial leaf. There is stable to minimal enlargement compared to prior. For example a left tentorial lesion measures 8 x 14 mm, previously 6 x 12 mm.A nodular enhancing lesion within the right IAC measures 10 x 5 mm, previously 8 x 5 mm. An enhancing nodule in the left IAC measures 14 x 8 mm previously 12 x 6 mm.A small enhancing nodule in the right parietal scalp measuring 8 x 5 mm, previously also 8 x 5 mm.Cervical Spine: Spinal lesions are as follows:1. Extramedullary intradural lesion within the left posterolateral thecal sac at C1 measuring 9 x 5 mm, previously 8 x 5 mm.2. Right C2-3 foraminal lesion measuring 16 x 8 mm, previously 13 x 10 mm. Minimal extension into the right lateral aspect of the epidural space without mass effect on the cord. 3. Left C3-4 foraminal lesion measuring 26 x 10 mm, previously 25 x 10 mm. The more medial intraspinal component measures 10 mm in the oblique dimension, previously 7 mm. The enlargement involving the medial intraspinal component results in mass affect on the cord which is stable to minimally worse.As above, the spinal cord is impinged at the C3-4 level, but at no point is there any evidence of increased cord T2 signal to suggest edema.The cervical lordosis is mildly reversed. Vertebral body heights are preserved. Marrow signal characteristics are unremarkable.There remains a disk osteophyte complex asymmetric towards the right at the C5-6 level which results in at least mild spinal canal stenosis and impression on the ventral cord; there is also mild right greater than left neural foraminal stenosis. Minimal T2 hyperintensity within the right ventral aspect of the cord at this level is suspected and possibly also present previously; finding may represent myelomalacia.Numerous small nodular lesions within the soft tissues of the neck which may reflect lymph nodes or nerve sheath tumors appear similar to prior.Thoracic Spine:Redemonstrated is evidence of posterior approach surgery with changes spanning from T3 to T7 for resection of a previously noted schwannoma at the T6 level. No evidence of residual tumor is seen in the operative region. Subtle foci of nodular enhancement are seen along the ventral aspect of the thoracic cord at the T6-T7 level on the sagittal images and not well appreciated on the axial images. These are not seen on the prior study. T2 hyperintensity within the cord is noted at T6 compatible with myelomalacia and present previously.At the T12 level, an enhancing extramedullary intradural mass is redemonstrated in the right lateral aspect of the thecal sac measuring 6 x 4 x 8 mm, previously 5 x 5 x 7 mm.Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow replacement is seen. No significant spinal canal or neuroforaminal stenosis is detected.Lumbar Spine:Intradural lesion within the posterior left aspect of the distal cord surface at L1 measures approximately 5 x 4 mm, previously 5 x 4 mm. Intradural enhancing lesion nearly filling the thecal sac at the L3-4 level measures 10 x 12 x 13 mm, previously 10 x 11 x 12 mm. This lesion displaces the adjacent nerve roots of the cauda equina posteriorly and laterally.The lumbar lordosis is slightly straightened. Alignment is otherwise unremarkable. Vertebral body heights are normal. No concerning marrow signal alteration is demonstrated.Mild degenerative disk disease seen at L3-4 without significant degenerative spinal canal or foraminal narrowing. Moderate degenerative disease is seen at L4-5 and L5-S1 with disk bulging and facet hypertrophy resulting in mild thecal sac narrowing and at most mild foraminal narrowing, not significantly changed.

Output: 1. Multiple areas of nodular or plaque-like dural thickening are redemonstrated compatible with meningiomas and stable to minimally larger than prior from 6/23/2014.2. Encephalomalacia in the left pons is unchanged.3. Bilateral vestibular schwannomas are reidentified and are minimally larger than prior.4. A mass within the right C2-3 neural foramen is not significantly changed. Minimal epidural extension without mass effect on the cord again seen.5. A mass centered in the left C3-4 neural foramen with intraspinal extension has slightly increased in size with stable to slight worsening in mass effect on the adjacent cervical cord. No associated cord signal abnormality. 6. Disc osteophyte complex at C5-C6 with mild impression on the right ventral aspect of the cord and small focus of associated cord signal abnormality which may represent myelomalacia. No significant change since prior.7. Redemonstration of surgical sequelae following resection of a previously seen posterior intradural lesion at T6. No evidence of recurrent tumor is seen at this site. There remains some abnormal T2 signal in the cord at this level which likely reflects myelomalacia and which is unchanged. There is however nodular enhancement at the T6-T7 level along the ventral aspect of the cord seen only on the sagittal images which may be related to a new lesion and can be assessed on follow-up studies.8. Remaining lesions in the thoracic and lumber spine are stable to minimally larger as above. Largest of these is at the L3-L4 level and fills the thecal sac.


Instruction: Generate impression based on findings.

Input: 66-year-old female with a history of rheumatoid arthritis and effusion. MENISCI: The medial meniscus appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the lateral facet of the patella with large areas completely devoid of articular cartilage. There is underlying degenerative subchondral signal abnormality and subchondral cyst formation. There is near full-thickness to full-thickness articular cartilage degeneration along the median eminence of the patella and medial facet with underlying subchondral signal abnormality. There is full-thickness articular cartilage degeneration along the lateral facet of the femoral trochlea with large areas completely devoid of articular cartilage. There is focal full-thickness articular cartilage degeneration along the weightbearing portion of the lateral tibial plateau and lateral femoral condyle, as seen on the coronal images.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Borderline tibial tubercle to trochlear groove distance, patella alta, edema within the superolateral aspect of Hoffa's fat pad, and patellofemoral joint articular cartilage degeneration may be seen in patient's with patellofemoral instability.2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 43-year-old male with neurogenic claudication. Assess stenosis. There are defects in the bilateral pars interarticularis at L4 with minimal anterolisthesis of L4 on L5. The vertebral bone marrow signal is otherwise unremarkable. The imaged portions of the spinal cord and cauda equina are unremarkable. At L1-2, there is mild ligamentum flavum hypertrophy and facet hypertrophy with no significant spinal canal stenosis or neural foramen narrowing. At L2-3 there mild ligamentum flavum and facet hypertrophy without significant spinal canal stenosis or neuroforaminal narrowing. At L3-4, there is mild disc bulge and disc desiccation with annular fissuring, as well as mild ligamentum flavum and facet hypertrophy with minimal effacement of the ventral thecal sac and mild bilateral neuroforaminal narrowing. At L4-5, there is a disc bulge and disc desiccation with mild loss of disc height, ligamentum flavum hypertrophy, and facet hypertrophy, resulting in mild spinal canal stenosis as well as moderate to severe bilateral neural foramen narrowing. At L5-S1, there is a disc bulge, moderate facet and ligamentum flavum hypertrophy, resulting in mild spinal canal stenosis, as well as minimal to mild right and mild left neural foramen stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Multilevel degenerative spondylosis most prominent at L4-5, with mild central canal stenosis and moderate to severe bilateral neural foramen narrowing at this level.2. Bilateral pars interarticularis defects at L4, which are more conspicuous on the prior radiographs.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 29-year-old female with right shoulder pain. ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is increased signal abnormality and fluid sensitive sequences within the acromioclavicular joint with associated erosion/osteolysis of the distal clavicle. There is bone marrow signal abnormality within the distal clavicle.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a linear focus of increased signal abnormality traversing the anterior superior glenoid labrum at the 1 o'clock position extending to the 3 o'clock position consistent with a normal variant sublabral foramen.BICEPS TENDON: The tendon of long head of the biceps appears intact. ADDITIONAL

Output: Erosion/osteolysis of the distal clavicle is nonspecific. Differential considerations include rheumatoid arthritis, hyperparathyroidism, post traumatic osteolysis.


Instruction: Generate impression based on findings.

Input: History of trauma Exam is mildly limited by patient body habitus.ACETABULAR LABRUM: Small paralabral cyst noted adjacent to the anterior superior labrum, raising the question of labral tear. ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small paralabral cyst adjacent to the anterior superior labrum, raising the question of labral tear. If clinical question of femoral acetabular impingement, then MRI arthrogram to the study of choice.


Instruction: Generate impression based on findings.

Input: Reason: R hip labral tear History: R hip pain ACETABULAR LABRUM: There is a full thickness tear in the anterior and superolateral acetabular labrum. Small paralabral cysts are noted along the superior lateral labrum. ARTICULAR CARTILAGE AND BONE: There are small areas of full thickness cartilage loss along the acetabular roof with adjacent bone marrow edema. There is an underlying osteophyte along the superolateral acetabulum. There is a mild cam type deformity of the right femoral head neck junction.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Tearing of the acetabular labrum with osteoarthritis of the right hip.


Instruction: Generate impression based on findings.

Input: 41-year-old with newly diagnosed left breast DCIS. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.LEFT BREAST:Signal void artifact from biopsy clip in the central left breast mid to posterior depth. Extending from this point anteriorly and superiorly towards the nipple there is clumped nonmass enhancement in a linear distribution. Anterior to the clip this measures 5.2 x 3.2 cm (AP by transverse). There is additional clumped nonmass enhancement immediately lateral to the biopsy clip and also extending posteriorly for a length of 1.5 cm. The total extent of nonmass enhancement measures 6.4 x 3.3 x 6.0 cm (AP x ML X SI). The most anterior extent is 5 mm from the nipple.Scattered benign-appearing parenchymal enhancing foci. No focal enhancing mass.RIGHT BREAST:There is clumped nonmass enhancement with a linear distribution in the 9:00 radian mid depth. This measures 2.7 x 1.4 x 1.2 cm (AP x ML X SI).Scattered benign-appearing parenchymal enhancing foci. No focal enhancing mass.LYMPH NODES:There is a moderately enlarged left retropectoral lymph node with thickened cortex measuring 9 mm in maximum dimension. Scattered benign-appearing bilateral axillary lymph nodes. No enlarged internal mammary lymph nodes.OTHER:Within the mid thoracic spine there is a T2 bright nonenhancing right paraspinal focus likely representing a meningocele.

Output: 1. Extensive non mass enhancement extending anterior and posterior to the clip in the central left breast suspicious for DCIS. Few scattered calcifications are noted anteriorly on the mammogram extending towards the nipple. If additional tissue sampling is necessary, ultrasound behind the nipple can be performed to look for an invasive component or stereotactic biopsy can be performed targeting the calcifications behind the nipple.2. Although low suspicion, area of non mass enhancement in the right breast 9:00 position needs further evaluation with MR directed ultrasound. If no correlate is seen on ultrasound, MR guided biopsy is recommended.3. Asymmetric left prominent retropectoral lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71 years, Female, Reason: liver mets? History: ovarian mass along with liver abnormalities on CT. ABDOMEN:LUNG BASES: Small right and trace left pleural effusions are increased from the prior exam.LIVER, BILIARY TRACT: There is a 4.1 x 3.3 cm ill-defined lesion involving the gallbladder fundus and adjacent right hepatic lobe. There is soft tissue components along the gallbladder fundus with adjacent areas of peripheral enhancement within the liver parenchyma. The majority of the hepatic component is hypointense on T1-weighted images with heterogeneous T2 signal. No additional hepatic lesions are present. No intrahepatic or extra hepatic biliary ductal dilatation. Large stone within the gallbladder.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: Lesion within the hepatic hilum with peripheral enhancement likely represents an enlarged portacaval lymph node and measures 2.9 x 2.4 cm (1005/285). Additional large para-aortic nodes.BOWEL, MESENTERY: No evidence of obstruction. No peritoneal implants are identified.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large pelvic mass is partially visualized and coronal sequences. Small amount of ascites. Fat containing peri-umbilical hernia.

Output: 1.Lesion involving the gallbladder fundus and adjacent liver. Neoplasm is suspected, although this would be an unusual appearance for a metastatic lesion. The appearance is more consistent with a primary gallbladder adenocarcinoma with liver invasion. Biopsy may be considered.2.Retroperitoneal lymphadenopathy.3.Large pelvic mass is partially visualized.4.Increased small right and trace left pleural effusion.


Instruction: Generate impression based on findings.

Input: Comparing to more remote exams, there again does not appear to be significant change in the appearance of the diffuse nonenhancing bilateral hypothalamic-optic glioma allowing for differences in technique, as current orbital images are somewhat degraded by patient motion. The suprasellar CSF signal intensity collection with greater right paramedian prominence has further increased in size, now measuring 23 mm AP x 17 mm CC compared to previous measurement of 20 mm AP x 18 mm CC on sagittal images. This appears contiguous with the right lateral ventricle on 501/16. There is persistent mass effect upon the underlying tectum which again was previously thickened. No definite abnormal signal is seen within the tectum. There is stable focal effacement of the aqueduct of Sylvius associated with stable lateral and third ventricular dilatation as well as periventricular T2/FLAIR hyperintensity likely relating to chronic transependymal CSF flow. There is stable T2 hyperintensity along the previous right transfrontal surgical tract, likely related to prior endoscopic third ventriculostomy. The floor the third ventricles not well delineated, although on CSF flow imaging there appears to be a small area of biphasic CSF flow through the expected location of the third ventriculostomy into the prepontine region. There are stable foci of non-enhancing T2 hyperintensity in the anterior left frontal lobe and cerebellar white matter which are nonspecific, although the cerebellar findings likely represent FASI of NF-1. There is no diffusion abnormality or extra-axial collection.There is slight increased CSF space at the level of the crowded foramen magnum and surrounding the slightly pointed cerebellar tonsils, with slightly improved biphasic CSF flow along the dorsal aspect of the foramen magnum. There appears to be slight decreased dorsal convexity of the mildly T2/STIR hyperintense cervicomedullary mass, which now measures 16 mm AP compared to prior 17 mm on the 3-D T2 weighted images. On sagittal STIR imaging, the ill-defined lesion appears similar the prior dedicated cervical spine imaging. Mild retroflexion of the dens with platybasia also contributes to the above narrowing.

Output: 1.Slight further increased size of CSF signal intensity collection in the supracerebellar location with slight right paramedian extension, which appears contiguous with the right lateral ventricle. Continued mass effect upon the underlying tectum, previously noted to be thickened although without abnormal signal.2.Stable dilatation of the lateral and third ventricles, with suggestion of biphasic CSF flow through the expected location of the third ventriculostomy.3.Stable appearance of bilateral diffuse hypothalamic optic glioma.4.Subtle improved CSF space and biphasic CSF flow at the level of the crowded foramen magnum with slightly pointed cerebellar tonsils with underlying expansile cervicomedullary mass appearing slightly decreased in dorsal convexity on comparison of 3-D T2 weighted images, although this may relate to differences in patient head positioning.