Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:7/23/1973)Reason: CCM Protocol, 3T Scanner History: known CCM diseasePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The origin of the right frontal polar artery gives the appearance of the anterior communicating artery fenestration.. There is an infundibulum present along the left A2 segment. There is a 1 mm aneurysm versus infundibulum along the left A2 segment more distally.MRI brain:There is a 6 mm lesion present within the lower midbrain which has peripheral susceptibility effect and a popcorn-like appearance associated with a large draining vein within the pons. There are associated punctate foci of signal loss at the adjacent pons and lower midbrain not readily appreciated on the other sequences. When compared to the previous exam there is not a significant interval change.Small lesion present within the right superior frontal gyrus subcortical white matter is associated with susceptibility effect and some punctate T1 signal hyperintensity and measures approximately 4 mm in size. Another similar-appearing lesion is present within the left occipital lobe along the lingual gyrus subcortical white matter. When compared to the previous exam there is not a significant interval change.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Findings are compatible with a small cerebral cavernous malformation centered within the lower midbrain which is stable compared to prior exam. It is associated with a developmental venous anomaly. Punctate lesions in the surrounding tissue could represent small cavernomas or microhemorrhages. This is stable compared previous exam.2.Lesions also present in the right frontal lobe and in the left occipital lobe are also compatible with a small cavernomas. These are also stable when compared to the previous exam.3.1 mm infundibulum versus aneurysm along the left A2 segment.


Instruction: Generate impression based on findings.

Input: No restricted diffusion abnormalities are seen.There is no evidence of intracranial hemorrhage, mass effect, or acute infarct. Extensive confluent bilateral cerebral white matter T2 hyperintensity is seen. No midline shift. Ventricular size is normal.There is enhancement of the right cisternal cranial nerve V which was very subtly present on the prior exam and not seen on older exams.There is a right frontal approach Ommaya catheter that terminates in the right lateral ventricle.Mucous retention cyst is seen in the left maxillary sinus.The visualized cerebral arteries and the visualized internal carotid arteries appears within normal limits.

Output: 1. There is enhancement of the cisternal right cranial nerve V, slowly progressive over the past 2 studies, concerning for recurrence of intracranial lymphoma.2. There is stable extensive T2 hyperintensity of the white matter, which is likely treatment related.3. Right frontal Ommaya catheter with the distal tip in the right lateral ventricle, unchanged.


Instruction: Generate impression based on findings.

Input: Clinical question: altered mental status. Signs and symptoms: Nonenhanced head CT:Technique.Axial 5 mm CT images of the head without administration of contrast is obtained. Sagittal and coronal 2-D reformatted images rendered.There is paucity of cortical sulci, small supratentorial ventricular system and in the CSF cisterns. Although this finding may be well within normal for patient stated age of 19 possibility of subtle increase intracranial pressure/edema cannot be entirely ruled out. The gray -- white matter differentiation remains well within normal. Images through posterior fossa demonstrate crowding of the cerebellar tonsils which is suspected for Chiari malformation. This finding is best appreciated on sagittal reformatted images in particular on number 26. Recommend follow-up with an MRI examination.There is no evidence of hemorrhage or midline shift.

Output: 1.Ectopia of cerebellar tonsils evident by crowding of the foramen magnum. Recommend follow-up with an MRI exam.2.No definitive evidence of density abnormality of brain parenchymal or morphologic abnormality. Paucity of cortical sulci and the small size of ventricular system and CSF cisterns are noted which could still be within normal range for patient stated age of 18. Subtle intimal may present with this appearance.


Instruction: Generate impression based on findings.

Input: 23-year-old female with 10-cm pelvic mass on outside CT. Interpretation of outside exam requested. ABDOMEN:LUNG BASES: Single right lower lobe micronodular on image one of 89. No other abnormalities in the lung bases. Small hiatal hernia is noted.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unremarkable.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild prominence of the left renal collecting system. No evidence of stone.RETROPERITONEUM, LYMPH NODES: Please see below.BOWEL, MESENTERY: Thickening of the lateral gastric wall extending towards the GE junction. Ill-defined soft tissue density between the greater curvature of the stomach and spleen measuring 3.5 x 1.3 cm. Etiology of this soft tissue mass is unknown and may be related to gastric wall thickening. No abnormality of the small bowel. Colon is unremarkable except for mass-effect as is mentioned below.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Uterus and adnexa are displaced by and abut the 10-cm mass that will be described further below.BLADDER: Bladder is distended and displaced by the pelvic mass.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mass effect on the rectum, displacing it to the right of the pelvic mass. No evidence of bowel obstruction. No evidence of invasion into bowel, as the fat planes between the mass and bowel are preserved.BONES, SOFT TISSUES: No significant abnormality noted. Specifically, no involvement of the pelvic bones or sacrum by the pelvic mass.OTHER: 10-cm pelvic mass which has centrally low density likely due to necrosis. It is most likely that the mass arises from the posterior wall of the vagina (better appreciated on the companion MRI study) as the adjacent pelvic bones as well as the uterus and adnexa are not clearly contiguous with the mass (this is also better seen on the outside MR images).

Output: 1. 10-cm pelvic mass which has mass-effect on the rectum, bladder and adnexa. We favor a sarcoma with origin of this lesion likely the posterior wall of the vagina (this is better appreciated on the companion MRI). 2. Soft tissue density adjacent to the splenic hilum and gastric wall thickening as described above . Upper endoscopy is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Ms. Bourke is a 57 year old female with biopsy-proven DCIS. She presents today for MR guided wire localization for the left breast prior to surgery, since the MRI findings were more extensive than the mammographic findings. On subtraction images, the area of clumped non-mass enhancement in the left lateral breast is again identified. The anterior and posterior extent of this enhancement is identified as targets for the bracketed wire localization. PROCEDURE:Coordinates of the anterior and posterior extent of non-mass enhancement were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. An MR-compatible needle with wire was placed at the anterior extent and posterior extent. Adequate positioning of the needles were confirmed after adjusting depth so the needle tips were approximately 2cm deep to the center of the targets. Subsequent MR images confirmed satisfactory positioning of the needles. Spring wires were then deployed.Two view orthogonal mammograms reveal the two spring wires to be in the expected position, when compared to the imaging from the recent MRI examination. Of note, the biopsy clip is located medial to the area of clumped non-mass enhancement identified on MRI. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sheth performed the procedure under direct supervision of Dr. Kulkarni, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the two wires, calcifications to be within the specimen. A marking clip was noted separately along the periphery of the specimen. Few calcifications noted along the medial margin. Per conversation with Dr. Jaskowiak, additional tissue from the superior and medial margins will be removed but no radiographed.

Output: Successful MR-guided bracketed wire localization of the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 48-year-old male with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.0 x 3.1 x 3.4 cm.Peripheral Zone: Volume loss of the right base consistent with prior ablation therapy. No new foci of low T2 hypointensity. Mild heterogeneous signal in the left mid gland is similar to prior study.Central Gland: No significant abnormality noted.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant interval change in findings consistent with prior ablation therapy. No evidence of residual or new tumor in the area of ablation.


Instruction: Generate impression based on findings.

Input: 56 years Male (DOB:6/4/1960)Reason: evolution of stroke, r/o blood History: rt side weaknessPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER There is diffusion restriction associated with susceptibility effect involving left basal ganglia and adjacent left centrum semiovale. It is compatible patient's known area of infarction. On T1-weighted imaging it is hypointense in signal with the exception of a couple minor foci of signal hyperintensity. This suggests that potentially this is related to contrast rather than blood products. This corresponds to the area of diffusion restriction on the prior exam and extends to involve more of the lentiform nuclei and the current exam.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: There is diffusion restriction associated with susceptibility effect involving left basal ganglia and adjacent left centrum semiovale. It is compatible patient's known area of infarction. This susceptibility effect could be a result of contrast given the signal characteristics.


Instruction: Generate impression based on findings.

Input: 10 year old female. Evaluate brain for abscess/ICP issues. Patient with fever and mental status changes. Increased seizure frequency. Microcephaly is noted. Extensive diffuse encephalomalacia appears similar to prior MRI. Parenchymal calcifications are noted. The ventricles are stably enlarged. There is no evidence of acute intracranial hemorrhage. There is no evidence of abscess formation given the limitations of noncontrasted CT.No acute abnormalities are noted in the calvaria and skull base. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive encephalomalacia and enlarged ventricles that appears unchanged when compared to prior MRI.


Instruction: Generate impression based on findings.

Input: Flatfoot deformity ANKLE:TENDONS: Increased signal replaces the posterior tibialis tendon as it courses beneath the medial malleolus compatible with full-thickness/near-full-thickness tearing. Proximally, the tendon is enlarged with increased signal intensity likely reflecting a combination of retraction and degeneration. Additional tendinosis is noted within the distal fibers of the tendon which appear to reach the insertion upon the navicular.There is a small amount of fluid adjacent to the flexor digitorum longus and flexor hallucis longus tendons along the posterior margin of the talus and at the knot of Henry which may reflect mild tenosynovitis but is of questionable clinical significance.The tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons are intact and demonstrate a normal course. The peroneal tendons are intact. The Achilles tendon is intact. LIGAMENTS: The lateral collateral ligament complex and distal tibiofibular ligament complex are intact. The tibiospring ligament appears slightly thickened but is intact and the remaining spring ligament is also intact. Mild heterogeneity of the deep fibers of the deltoid ligament may reflect old sprain injury.JOINTS: Mild osteoarthritis affects the talonavicular articulation, subtalar joint, and midfoot. Marrow edema within the posteromedial tibial epiphysis is likely reactive, related to the aforementioned abnormalities of the posterior tibialis tendon.MUSCLES/SOFT TISSUES: There is no muscle atrophy. There is mild superficial edema and edema adjacent to the FHL. A tiny amount of fluid is noted within the tibiotalar joint but there is no sizable effusion.FOOT:There is a moderate hallux valgus deformity with moderate osteoarthritis of the first MTP joint. Mild osteoarthritis affects the Lisfranc joint, specifically the second tarsometatarsal articulation. The Lisfranc ligament is intact. The remaining marrow signal of the foot is otherwise normal.There is no muscle atrophy or tear.

Output: 1. Near-full-thickness to full-thickness tear of the posterior tibialis tendon with additional ankle findings described above.2. Moderate hallux valgus deformity and osteoarthritis of the foot.


Instruction: Generate impression based on findings.

Input: The ventricles are normal in size and shape without evidence of hydrocephalus.

Output: The ventricles are normal in size and shape without evidence of hydrocephalus. Given the patient's history, if diagnostic imaging is desired, MRI with contrast would be recommended.


Instruction: Generate impression based on findings.

Input: Please evaluate for brain metastases 70-year-old femaleTechnique: 100 mL Omnipaque 350 was used and injected at two mL/sec via the right wrist using a 22-gauge needle. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. There are subcortical and periventricular white matter hypodensity is present which are also identified on the MRI from 12/08. A calcific lesion is present along the faults cerebri and the right side measuring 1 cm in size and is suspected to represent a burned out meningioma.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear with the exception of a minor opacity in the left posterior ethmoid air cells unchanged since the 5/03 exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Compared to the exam of 5/29/03 there is no change in the appearance of the calvarium.

Output: No evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 45-year-old female with right upper quadrant pain, hyperbilirubinemia, fever, transaminitis ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. Hydropic gallbladder with cholelithiasis. No choledocholithiasis. No extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cyst in the interpolar right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atelectatic changes in the lung bases. Small pleural effusions.

Output: 1.Hydropic gallbladder with cholelithiasis. There is no choledocholithiasis.


Instruction: Generate impression based on findings.

Input: Anoxic brain injury: comatose. Drug overdose with UTOX positive for cocaine, opioids, and THC. There is extensive diffuse white matter restricted diffusion and T2 hyperintensity in the cerebral hemispheres bilaterally. The brainstem and cerebellum appear unremarkable. The lateral ventricles are asymmetric, in which the right lateral ventricle is smaller than the left. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or mass. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is diffuse paranasal sinus mucosal thickening and retention cyst formation. There is also a small amount of mucosal thickening and fluid in the mastoid air cells bilaterally. The patient is intubated. There is a punctate T2 hyperintense focus in the skin of the right temporal region, which may represent a cyst.

Output: Extensive bilateral cerebral white matter abnormality is compatible with acute drug-induced leukoencephalopathy.


Instruction: Generate impression based on findings.

Input: 60-year-old female with knee pain. Assess for lateral meniscus tear. MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial and femoral articular surfaces consistent with a complex tear with both a vertical and horizontal component. The anterior horn of the lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle above the posterior horn of the meniscus. There is relative sparing of the articular cartilage of the medial compartment. There is fraying of the articular cartilage of the patella, centrally.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tear of the lateral meniscus as described above.2. Articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: Vertebrobasilar occlusion, ataxia and leg weakness There are multiple restricted diffusion areas on the right middle cerebellar peduncle and right cerebellar hemispheres as well as pontomedullary junction indicating acute ischemic infarctions. Comparing to prior exam, these lesions are new ischemic infarctions.There is no evidence of hemorrhagic transformation.Multiple high signal intensity lesions on bilateral periventricular white matter and centrum semiovale on FLAIR images indicate non-specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. 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: Multiple new acute ischemic infarction on the right cerebellum without evidence of hemorrhagic transformation as described above.Non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 12 year-old male with hypotension and hypoxia. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.The patient is intubated. There are fluids in the paranasal sinuses and soft tissue emphysema in the neck, which may be procedure related.

Output: No acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 0:47 minutes

Output: Successful arthrogram of the right hip. MRI to follow.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:4/7/1949)Reason: 67 y/o lady w/ a hx of liver transplant who p/w back pain History: 67 y/o lady w/ a hx of liver transplant who p/w back painPROVIDER/ATTENDING NAME: JONAH N RUBIN JONAH N RUBIN 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 loss of disc space height, disc desiccation and a broad-based right lateral recess disc extrusion which extends into the right neural foramen and encroaches on the nerve roots at the right lateral recess as well as nerve roots within the right neural foramen. It is additional mild facet hypertrophy present at this level bilaterallyAt L4-5 there is loss of disc space height, disc desiccation. There is a broad-based right lateral disc protrusion present which extends into the right neural foramen and encroaches on the right-sided exiting nerve root as well as the nerve roots of the right lateral recess.. There is facet hypertrophy present at this level which appears be worse on the right when compared to the left side.At L3-4 there is a left far lateral disc protrusion associated with facet hypertrophy. There is extension of disc material into the left neural foramen at this level with a result in encroachment of left-sided exiting nerve roots within the neural foramen and as of the exit the left neural foramen..At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion present at this level which narrows the left neural foramen.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are degenerative changes present in the lumbar spine with multiple disc protrusions and extrusions as well as facet hypertrophy resulting in encroachment of the nerve roots at the right lateral recess at L4-5 and L5-S1 as well as the right neural foramen at L4-5 and L5-S1 and the left neural foramen at L3-4.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:8/19/1955)Reason: evaluate for progression of retroclival idiopathic pachymeningitis seen on previous MRI History: headache, photophobia, neck painPROVIDER/ATTENDING NAME: AIMEE A. MAYUGA SERVICES ANCILLARY There is an extra-axial mass present adjacent to the clivus extending from the level of the foramen magnum to the inferior aspect of the posterior clinoid process measuring 51 x 11 mm axial dimensions. Superiorly it is eccentric towards the right side. On the prior exam it measured 1 x 11 mm sagittal dimensions as well.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.A posterior fossa extra-axial mass adjacent to the clivus isn't stable compared to prior exam. Pathologic description on 8/26/2015 suggests that it could represent a granulomatous process including idiopathic pachymeningitis which would be a diagnosis of exclusion. The MR findings would support this.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling with activity, evaluate for recurrent meniscal tear versus chondromalacia. MENISCI: The lateral meniscus appears intact. The body and posterior horn of the medial meniscus are not visualized. The anterior horn of the medial meniscus is diminutive.ARTICULAR CARTILAGE AND BONE: There is mild diffuse thinning of the articular cartilage of the lateral tibiofemoral compartment without full-thickness focal defects. There is diffuse thinning of the articular cartilage of the medial tibiofemoral compartment with small foci of full-thickness or near full-thickness cartilaginous defects (for example weightbearing portion of medial femoral condyle series 9, image 22 measuring 9 mm in AP dimension). There are full-thickness cartilage defects both within the median patellar eminence (series 4, image 12) as well as the medial aspect of the femoral trochlea with underlying reactive bone marrow signal changes. Bone marrow signal intensity is otherwise within normal limits.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Absence of the body and posterior horn of medial meniscus which may reflect a combination of postoperative and degenerative etiologies.2.Cartilaginous degenerative changes most pronounced in the medial tibiofemoral and patellofemoral compartments as described above.


Instruction: Generate impression based on findings.

Input: 79-year-old female with knee pain. MENISCI: There is deformity and truncation of the inner fibers of the posterior horn of the lateral meniscus extending into the body and possibly the anterior horn, consistent with a complex, likely degenerative meniscal tear. There is fraying of the undersurface fibers of the posterior horn of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is significant thinning of the articular cartilage of the posterior weightbearing surface of the lateral femoral condyle. There is also mild thinning of the articular cartilage of the lateral patellar facet. No full-thickness cartilaginous defects are seen.LIGAMENTS: The anterior collateral and posterior collateral ligaments are intact. The lateral collateral and medial collateral ligaments are intact as well. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complex, likely degenerative tearing of the lateral meniscus as detailed above.2.Thinning of the articular cartilage of the posterior weightbearing surface of the lateral tibiofemoral compartment as well as mild thinning of the articular cartilage of the lateral patellar facet.3.Tricompartmental osteophytosis consistent with mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: Female, 14 years old, with episodes of falling. No evidence of parenchymal edema or mass effect is seen. No focal parenchymal lesions are detected. Diffusion-weighted images are normal. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. The ventricles are normal in size and morphology. The region of the pituitary gland is within normal limits. The cerebellar tonsils descend 3 to 4 mm below the plane of the foramen magnum, but they maintain a round contour and there is little if any significant crowding.

Output: 1.No acute intracranial abnormality or other definite findings to account for the patient's symptoms.2.Cerebellar tonsillar ectopia is of uncertain significance


Instruction: Generate impression based on findings.

Input: 40-year-old female with a fracture of the right fibula. Evaluate for healing. MENISCI: The medial and lateral meniscus appear intactARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage cleft along the weightbearing surface of the medial tibial plateau with underlying subchondral signal abnormality likely representing a small nondisplaced subchondral fracture (image 20; series 7). There is linear signal abnormality traversing the proximal fibula at the insertion of the conjoined tendon consistent with the stated history of a nondisplaced fracture. There is a full-thickness articular cartilage cleft along the median eminence of the patella with underlying subchondral signal abnormality. There is partial-thickness articular cartilage degeneration along the medial facet of the patella. Increased signal abnormality within the medial femoral condyle and medial tibial plateau may reflect resolving bone contusions.LIGAMENTS: There is increased signal abnormality within the proximal fibers of the superficial band of the MCL indicating partial tearing (image 14; series 7). The LCL appears intact. The ACL and PCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Nondisplaced fracture of the proximal fibula at the insertion of the conjoined tendon.2. Full-thickness articular cartilage cleft along the medial tibial plateau with probable small underlying nondisplaced subchondral fracture of the tibia.3. Bone contusions as described above.4. Partial-thickness tearing of the MCL.5. Full-thickness articular cartilage cleft along the median eminence of the patella. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 64-year-old man with CLL, SIADH with acute mental status changes x 7 days. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. However, if there is concern for an acute stroke, an MRI may be considered for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. There is rightward deviation of the nasal septum.

Output: No acute findings. If there is concern for acute ischemia, an MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: 48 year old with a suspicious left breast mass initially detected on screening mammogram, presents for research MRI scan. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:There are multiple small cysts in the right breast.At posterior 6 o'clock position, there is an oval shaped mass measuring 16 x 12 x 14 mm (AP x LR x CC), with heterogenous enhancement. LEFT BREAST:At posterior 3 o'clock position, there is a spiculated mass measuring 12 x 16 x 10 mm, corresponding to the suspicious mass seen on mammogram and ultrasound.No abnormal lymph nodes are identified in either axillary region.

Output: 1. Spiculated mass in the left breast, corresponding to the suspicious mass seen on mammogram and ultrasound. Ultrasound guided biopsy was performed for this mass later today.2. Oval shaped mass at posterior 6 o'clock position in the right breast. MR-directed ultrasound detected a correlate and ultrasound guided biopsy was performed later today.3. No abnormal lymph nodes in either axillary region.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with new headache and lymph node positive breast cancer. No evidence of parenchymal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is noted. A small incidental left frontal developmental venous anomaly is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricles are normal in size and morphology. The osseous structures show normal signal characteristics.

Output: Unremarkable evaluation with no evidence of metastatic disease or any other specific findings to account for the patient's headaches.


Instruction: Generate impression based on findings.

Input: There is decreased white matter volume adjacent to the occipital horns as well as increased T2 signal with resultant enlargement of the occipital horns. There is also subtle increased T2 signal in the posterior bilateral thalami. The corpus callosum is thinned posteriorly, compatible with Wallerian degeneration. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The craniocervical junction are within normal limits.

Output: Periventricular white matter volume loss and signal abnormality is compatible with leukomalacia/encephalomalacia. Abnormal T2 signal is also noted in the posterior bilateral thalami.


Instruction: Generate impression based on findings.

Input: Chronic ulceration. Question of osteomyelitis. There is complete destruction of the third metatarsal head with abnormal low T1, high T2 signal, and enhancement extending to the base compatible with osteomyelitis. Additionally, there is destruction of the third digit proximal phalanx. Abnormal signal within the third digit middle phalanx is compatible with osteomyelitis. There is low T1 signal along the lateral aspect of the second metatarsophalangeal joint, however, no definitive T2 signal abnormality or enhancement. Bone marrow signal within the remaining bones appears within normal limits. There is a 1.5 cm collection in the location of the third metatarsal head with peripheral enhancement and central low signal compatible with an abscess. An enhancing tract is seen communicating from the plantar skin surface to this collection.

Output: Osteomyelitis with abscess formation as described above.


Instruction: Generate impression based on findings.

Input: 53-year-old female patient with pseudomyxoma peritonei. ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is absent. Prominence of the central intra and extra hepatic biliary ductal system without evidence of an obstructing lesion is likely secondary to postcholecystectomy state.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus and ovaries are absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No measurable solid disease in the abdomen or pelvis. CT may be considered to better evaluate for peritoneal disease.


Instruction: Generate impression based on findings.

Input: Reason: severe left hip pain s/p fall; x-ray shows OA; missed fracture or labral tear? History: severe left hip pain s/p fall; x-ray shows OA; missed fracture or labral tear? ACETABULAR LABRUM: There is heterogeneity and intermediate signal intensity within the superior, anterior, and posterior labrum likely representing a combination of degeneration and degenerative tearing.ARTICULAR CARTILAGE AND BONE: There is increased bone marrow signal abnormality on fluid sensitive sequences within the intertrochanteric, subtrochanteric, and proximal metadiaphysis of the left femur. There is equivocal linear decreased signal abnormality within the intertrochanteric region of the left femur. No definite cortical disruption is identified. There is extensive inflammatory changes in the surrounding soft tissues. There is articular cartilage degeneration and osteophyte formation indicating moderate to severe osteoarthritis of the left hip.SOFT TISSUES: There is inflammatory change in the soft tissues about the trochanteric region of the left femur. There is partial thickness tearing of the hamstring tendon at the level of its origin on the initial tuberosity. There is no significant retraction. There is small interstitial tearing of the left gluteus medius muscle at the level of the myotendinous junction. ADDITIONAL

Output: Extensive bone marrow signal abnormality within the left femur with nonspecific soft tissue inflammatory change as described above. These findings may represent a large bone infarction, although there is equivocal linear signal abnormality in the intertrochanteric region of the left femur raising the possibility of a nondisplaced fracture. CT examination is recommended to further evaluate for the possibility of fracture. A medullary process such as osseous metastatic disease cannot be completely excluded by this noncontrast examination, particularly in the setting of a known primary malignancy, but this is felt to be less likely. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Tingling left arm, paresthesia, shoulder. Nonenhanced cervical spine MRI:There is normal signal intensity and alignment of the vertebral column.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.There is no evidence of central spinal stenosis or mass effect on the cord at any level.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate mild compromise of the left neural foramina and unremarkable otherwise.C5-C6 demonstrate mild degenerative disc and minimal ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise. There is a shallow central disc protrusion resulting in subtle flattening of ventral aspect of the cord without spinal stenosis or cord signal abnormality.C7-T1 demonstrate minimal degenerative changes are unremarkable otherwise.Upper most visualized thoracic spine and cord is unremarkable.

Output: 1.Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord and without evidence of mass effect.2.Small central shallow disc protrusion at C6/C7 without spinal stenosis.3.No spinal stenosis at any level. 4.Mild left neural foraminal compromise at C4-C5 secondary to degenerative disease and patent all other neural foraminal.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of endometrium. There are numerous supratentorial and infratentorial peripherally enhancing lesions predominate at the gray-white matter interface suspicious for metastatic disease. Several of these lesions demonstrate intrinsic T1 shortening angriness susceptibility likely related to hemorrhage. The largest lesion is located in the right cerebellum measuring up to 3.4 cm. There is significant surrounding vasogenic edema and mass effect compressing the fourth ventricle and brainstem anteriorly with associated cerebellar herniation. The largest supratentorial lesion is located in the right posterior temporal lobe. This lesion creates significant surrounding Visigenic edema and mass effect. There is associated 5 mm left of midline shift and mild right uncal herniation. There is deformity of the right lateral ventricle with mild prominence of the temporal horn of the left lateral ventricle. There is an empty sella.

Output: 1. There are numerous hemorrhagic supratentorial and infratentorial metastases with significant mass effect/edema and associated cerebellar tonsillar herniation, right uncal herniation, and mild subfalcine herniation.2. There is compression of the fourth ventricle with mild prominence of the temporal horn of the left lateral ventricle.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate etiology of alteration of mental status. Signs and symptoms: Alteration of mental status. Nonenhanced brain MRI:No acute intracranial process and in particular no evidence of acute ischemic stroke.Ventricle and to a lesser degree subcortical patchy foci of flair/T2 hyperintensity on the in bilateral hemispheric white matter are nonspecific however considering the patient's stated age likely representing sequela of microvascular chronic ischemic changes of mild degree without hemorrhage.The cerebral cortex and cortical sulci are slightly prominent however without detectable signal abnormality.Bilateral basal ganglia, thalami, pons and cerebellum/vermis demonstrate normal morphology and signal intensity on all MRI sequences.Calvarium, orbits, paranasal sinuses and mastoid air cells demonstrate no abnormalities.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: 50-year-old male with headache, elevated BP and diplopia. Elevate for CVA. There is no evidence of intracranial hemorrhage, mass or edema. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Reason: Please evaluate for seizure focus History: Electrographic status epilepticus in sleep resulting in cognitive decline, right parietal/occipital interictals The brain parenchyma appears unremarkable. No heterotopic gray matter, cortical dysplasia or other findings to suggest seizure focus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Midline structures are intact. Hippocampi are symmetric without evidence of atrophy or abnormal signal. The major cerebral flow voids are intact. Bone marrow signal and extra cranial soft tissues are unremarkable.

Output: No structural lesion to suggest seizure focus is appreciated.


Instruction: Generate impression based on findings.

Input: Headache(784.0) [784.0], Reason for Study: ^Reason: headaches, no prior brain imaging in UCMC system (1998-2005) History: see above No evidence of acute ischemic or hemorrhagic lesion.There is a focal high signal intensity on FLAIR imaging on the left parietotemporal deep white matter which is nonspecific.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.There is partial opacification on the right mastoid air cells.

Output: No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. There are focal areas of T1 hyperattenuation in the L1 and L5 vertebral bodies likely representing hemangiomas or focal fat. The vertebral bone marrow signal is otherwise unremarkable. The spinal cord displays normal signal and morphology. The conus terminates at the lower L1 level. The paravertebral soft tissues are unremarkable. However, there is a subcentimeter T1 and T2 hypointense lesions in the body of the uterus. At T12/L1, there is no significant spinal canal or neural foraminal stenosis. At L1/L2, there is mild facet arthropathy and ligamentum flavum hypertrophy without significant spinal canal or neural foraminal stenosis. At L2/L3, there is facet arthropathy and ligamentum flavum hypertrophy without significant spinal canal or neural foraminal stenosis. At L3/L4, there is facet arthropathy and ligamentum flavum hypertrophy and a slight disc bulge with mild spinal canal stenosis. No significant neural foraminal stenosis. At L4/L5, there is a disc bulge with superimposed eccentric right protrusion and facet arthropathy and ligamentum flavum thickening with moderate spinal canal stenosis with apparent impingement of the nerve roots in the right lateral recess and minimal bilateral neural foraminal stenosis. At L5/S1, there is mild facet arthropathy and ligamentum flavum hypertrophy without significant spinal canal or neural foraminal stenosis.

Output: 1. Multilevel degenerative spondylosis, which is most pronounced at the L4/L5 level.2. A subcentimeter lesion in the uterus likely represents a fibroid. However, ultrasound of the pelvis may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57-year-old female with hypertension, diabetes, heroine use with seizures. Altered mental status. There is no evidence of intracranial hemorrhage, mass or midline shift. Questionable subcortical white matter hypodensities may represent small vessel ischemic disease, and an MRI may be considered for further evaluation if clinically indicated.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute abnormality. Questionable small vessel changes, MRI may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a right frontal approach deep brain stimulator, which courses in the right frontal lobe and terminates at the right medial temporal lobe. There is a branching pattern of enhancement with susceptibility effect and punctate T2 hyperintensity in the right thalamus and cerebral peduncle, which is unchanged. There is no associated mass effect. There is no evidence of a large acute intracranial hemorrhage or acute infarct. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Unchanged developmental venous anomaly in the right thalamus and cerebral peduncle. While associated microhemorrhages cannot be entirely excluded, there is no evidence of large acute intracranial hemorrhage. 2. Right frontal approach deep brain stimulator.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Follow-up of right temporal mass. Nocturnal seizures and +ANA. The well-circumscribed, cortically-based, round, 9 mm T2 hyperintense lesion involving the posterior right middle temporal gyrus has not changed in size. However, it is more conspicuous on FLAIR sequence, despite the last exam being performed at 3T. T2 appearance is similar. It continues to show relative mild T1 hyperintensity centrally. A smaller teardrop-shaped lesion measuring 5 mm is located just deep to this lesion in the posterior right temporal lobe. While this also has not changed in size, it has become more FLAIR hyperintense. The lesions show very minimal, if any, central contrast enhancement, most convincing on the most delayed sagittal T1 postcontrast images. The lesion seems to be less contrast-enhancing than on the previous examination although this is favored to relate to differences in timing acquisition after contrast administration. Perfusion imaging does not demonstrate any hyperperfusion in the area of the dominant lesion, although evaluation is perhaps slightly limited due to the lesion's small size.There are a few scattered foci of right cerebral white matter apparent FLAIR hyperintensity, which appear to be artifactual from scalp vessel pulsation, as no definite corresponding T2 abnormality is seen.Remainder of the brain appears unremarkable with no other areas of abnormal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is asymmetry in size involving the lateral ventricles which is a normal variant. No hydrocephalus. No extra-axial collections. Bone marrow signal is within normal limits. Major flow-voids are preserved.

Output: The 2 adjacent lesions in the right temporal lobe have not changed in size although they are better delineated on FLAIR images when compared to June 2015. They are also less contrast enhancing although this can be due to differences in technique. As discussed previously, the lesions may relate to a DNET, with the differential also including ganglioglioma, low grade astrocytoma, less likely.


Instruction: Generate impression based on findings.

Input: Reason: Osteomyelitis of the heel History: Ulceration There is soft tissue irregularity and ulceration along the plantar aspect of the calcaneus and cuboid which extends dorsally to the level of the calcaneocuboid articulation. There is increased signal abnormality within the lateral and plantar aspect of the calcaneus and cuboid on fluid sensitive sequences with associated decreased signal abnormality on T1-weighted images, situated about the calcaneocuboid articulation consistent with osteomyelitis, corresponding to findings seen on recent radiographs. There is a moderate sized joint effusion within Chopart's joint which appears to communicate with the aforementioned soft tissue ulceration which is concerning for a septic arthritis. There is a small amount of fluid within the tibiotalar and subtalar joints. There is extensive subcutaneous edema about the ankle and dorsal aspect of foot. There is increased signal abnormality within the plantar musculature of the foot which is nonspecific but can be seen in diabetic patients although myositis cannot be excluded. There is loss of the normal fat within the sinus tarsus which may be related to the aforementioned effusion. There are foci of increased signal abnormality within the talus, including the head neck and body, which may be degenerative in etiology. Note is made of postsurgical changes of prior intramedullary rod in screw fixation of the imaged portion of the distal tibia. There is fusion of the cuneiforms and first through third metatarsals.

Output: Osteomyelitis of the calcaneus and cuboid as described above. Moderate sized joint effusion within Chopart's joint which appears to communicate with the plantar soft tissue ulceration, which is concerning for a septic arthritis.


Instruction: Generate impression based on findings.

Input: 75-year-old female with history of right breast lumpectomy in 2014 for DCIS and ADH, and left lumpectomy for IDC and DCIS in 2011. Patient also has history of CLL. Patient was found to have mildly enlarged left neck lymph nodes on ultrasound evaluation, here for sonographic evaluation. No family history of breast cancer. Targeted ultrasound was performed for area of concern, corresponding to the location of left level IV cervical lymph nodes. Multiple cervical lymph nodes are reidentified measuring up to 1.9 cm in longest dimension, again demonstrating diffuse mild cortical thickening, stable in size as compared with sonographic evaluation of 6/2/2016. These are just lateral to the jugular vein. On prior neck MRI study of 12/2014, a few left level IV lymph nodes likely corresponding to these lymph nodes, suggesting chronicity of the finding, though the sonographic measurements this year are somewhat larger than the prior size on MRI.

Output: Mildly prominent left level IV cervical lymph nodes, stable in appearance and size as compared with sonographic evaluation of 6/2/2016. If further imaging evaluation is clinically warranted, a PET scan could be considered. The patient will be seen in surgery clinic today. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with multiple sclerosis and paresthesias. Brain:Numerous foci of T2 hyperintensity are seen within the juxtacortical and periventricular tissues. These lesions demonstrate mild to moderate T1 hypointensity, particularly a large cluster of lesions along the left ventricular atrium. The brainstem and cerebellum are spared.No evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits. Overall brain volume is relatively well-preserved.Spine:Spinal cord signal intensity and morphology are within normal limits. At no point is any focal cord lesion suspected. No epidural abnormalities are seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The intervertebral discs are preserved. The spinal canal and neural foramina are patent.

Output: 1.Multiple supratentorial lesions are seen compatible with demyelinating disease.2.No specific evidence of demyelinating disease is seen in the spinal cord.


Instruction: Generate impression based on findings.

Input: 13-year-old male with history of lesion of the medulla oblongata s/p chemotherapy Off therapy evaluation MRI brain:Redemonstrated is an approximately 30 x 14 mm sagittal dimension medullary lesion which is heterogeneous yet predominately hyperintense on T2 weighted imaging, slightly hypointense on T1, with no convincing contrast enhancement.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are no diffusion abnormality. There are no extra-axial fluid collections. Normal vascular flow voids are present. Sporadic foci mucosal of thickening can be found within bilateral ethmoid and right sphenoid sinuses with near complete opacification of the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spineThe cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear intact.

Output: 1.Stable mass in the medulla oblongata2.Unremarkable contrast-enhanced cervical spine MRI without evidence of involvement from the patient's lesion in the medulla.


Instruction: Generate impression based on findings.

Input: Pain along the lateral aspect of the right knee, evaluate for meniscal pathology. MENISCI: There is minimal fraying of the inner edge of the lateral meniscus. There is minimal globular signal in the posterior horn towards the attachment of the lateral meniscus, but no specific findings to suggest a tear. The menisci are well anchored posteriorly.ARTICULAR CARTILAGE AND BONE: The cartilage is intact; specifically, there are no focal defects. The bone marrow signal is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Minimal fraying and globular signal in the menisci as described, but no specific findings to suggest a tear.2. Very small Baker's cyst without internal contents.


Instruction: Generate impression based on findings.

Input: Acute neck and back pain. Follow-up of syrinx. Cervical spine: Alignment is anatomic. Vertebral bodies are preserved in height. The spinous processes of C3-C5 are small/hypoplastic. Marrow signal is normal. Intervertebral disks show no significant herniation. There is no spinal canal or foraminal stenoses. The cervical spinal cord shows normal morphology and signal. The included posterior fossa structures/lower brain show no gross abnormality. There is no Chiari malformation or crowding at the level of foramen magnum. The craniocervical and cervicothoracic articulations are anatomic.Thoracic spine: Alignment is anatomic. The vertebral bodies are present in height. There is no suspicious marrow signal abnormality. There is mild disc height loss at T7-T8 without significant disc herniation. The spinal canal and the neural foramina are preserved.There is mild diffuse dilatation of the thoracic spinal central canal extending from the mid T5 level into the conus medullaris to mid T12 level. Compared to the previous examination, this has slightly improved. The canal at C5-C6 level now measures in the axial plane 2.5 mm x 2 mm compared to 3.5 mm x 3 mm previously. Also, previously the dilatation has started at T3 level while it now starts at T5 level. There is no other signal abnormality within the spinal cord. Lumbosacral spine: Alignment is anatomic. The vertebral bodies are preserved in height. Of note, L5 is partially sacralized. The spinal canal and the neural foramina are preserved. Intervertebral disks are normal. The tip of the conus medullaris as lower L1 level. The conus shows normal morphology and signal, accounting for mild dilatation of the central canal described above. The cauda equina roots are normally, symmetrically distributed in the thecal sac. Fatty signal within the filum terminale at L2-L3 has not changed and remains very thin and short segment.

Output: 1.Mild dilatation of the central canal of the thoracic cord has slightly improved since December 2014. There is no new signal abnormality in the spinal cord.2.Short segment of fatty filum terminale at L2-L3 level has not changed.


Instruction: Generate impression based on findings.

Input: Female, 82 years old, with lung cancer metastases, planning examination for radiotherapy. A rim-enhancing lesion in the left inferior frontal lobe is redemonstrated with satellite nodularity along its anterior margin. The overall size of the lesion has not significantly changed though internally the lesion appears somewhat more cystic or necrotic. Moderate regional edema appears unchanged.No additional intracranial enhancing lesions are seen. Numerous scattered white matter lesions are evident compatible with microvascular ischemic disease. No significant generalized mass effect is seen. The ventricles remain normal in size and morphology.

Output: Redemonstration of a rim-enhancing metastatic lesion in the left frontal lobe without significant interval change in size.


Instruction: Generate impression based on findings.

Input: Ex 39 weeks 2 days, one day old female, with history of intrauterine fetal demise of unknown etiology, diagnosed with fetal right and left hydronephrosis with duplicated collecting system and intrauterine growth retardation. Congenital musculoskeletal deformities of the skull, face and jaw. Asymmetry of the mouth while crying. Evaluation is mildly limited due to motion artifact. There are foci of susceptibility effect in the bilateral caudothalamic grooves, with slight extension along the centrum semiovale on the left side. There is trace extra-axial sheet-like T2 and T1 hyperintensity along the right posterior occipital convexity. There is no restricted diffusion to suggest acute ischemia. There is no intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There appears to be mild T1 hyperintensity in the white matter of the perirolandic regions bilaterally, although to a lesser extent than might be expected. The corpus callosum appears to be intact. The pituitary gland is unremarkable. There is no midline shift or herniation. The major cerebral flow-voids are preserved. The orbits, skull, paranasal sinuses are grossly unremarkable. There is a posterior parietal subgaleal fluid collection that measures up to 3 mm in thickness.

Output: 1. Stigmata of presumable bilateral germinal matrix hemorrhages, left larger than right. 2. The degree of myelination in the perirolandic region may be slightly delayed. 3. Expected birth-related findings, including mild posterior scalp subgaleal fluid and apparent trace posterior occipital convexity subdural hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thyroid cancer. Status post surgery and RT. CHEST:LUNGS AND PLEURA: Multiple bilateral small noncalcified pulmonary nodules are present ranging up to approximately 5 mm in diameter. These are indeterminate but suspicious for metastases.MEDIASTINUM AND HILA: Surgical clips and may thyroid bed.No significant mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Focal hypodensity in segment 7 measuring approximately 29 x 29 mm. The differential diagnosis includes metastasis and hemangioma. If clinically indicated further evaluation could be performed with an MRI scan. Surgical clips in the gallbladder bed.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small midline anterior hernia.

Output: 1. Multiple small pulmonary nodules which are indeterminate but suspicious for metastases.2. Indeterminate hepatic lesion.


Instruction: Generate impression based on findings.

Input: Right trigeminal neuralgia. MRI: The right superior cerebellar artery appears to course along the superior aspect of the cisternal segment of the right trigeminal nerve with negligible indentation upon the nerve. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions or cerebral saccular aneurysms.

Output: The right superior cerebellar artery appears to course along the superior aspect of the cisternal segment of the right trigeminal nerve with negligible indentation upon the nerve.


Instruction: Generate impression based on findings.

Input: 46 years, Female, resected brain metastasis status post SRS, restaging evaluation.. Again seen are postsurgical changes of right occipital craniotomy for tumor resection. No residual or recurrent enhancing tumor is identified. There is minimal FLAIR hyperintensity and volume loss involving the right occipital cortex compatible with encephalomalacia. No significant change in enhancement at the craniotomy site favored to represent granulation tissue. No new parenchymal or meningeal enhancing lesion is appreciated in the brain. No suspicious calvarial lesions.No evidence of recent ischemia or hemorrhage. No intracranial mass effect, midline shift, or herniation. Vascular flow-voids are preserved. No hydrocephalus. No extra-axial collections. Diffuse right maxillary sinus opacification again seen.

Output: Postoperative changes of resection of right occipital metastasis. No residual or recurrent tumor in the surgical bed is appreciated. No new lesions to suggest metastatic disease elsewhere in the brain are appreciated.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out mass lesion. Signs and Symptoms: Dystonia and myoclonus. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical development of brain and with normal signal intensity on all MRI sequences.There is mild prominence of the cerebral cortical sulci and the cerebellar and the vermian folia for patient's stated age of 52 years. Unremarkable cerebral cortex, ventricles, CSF spaces and the brain myelination.Unremarkable calvarium, scalp, orbits, paranasal sinus and mastoid air cells.\Nonenhanced cervical MRI:The alignment of the vertebral column is within normal however there is significant reversal of cervical lordosis secondary to extensive degenerative changes at C5-C6, C6-C7 and to a lesser degree at C4-C5 levels.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrates a large central and left paramedian broad-based disc protrusion with resultant significant mass effect, flattening deformity and posterior displacement of the cord resulting in moderate to significant central spinal stenosis and no neural foraminal compromise. There is questionable subtle T2 STIR hyperintensity of the cord.C5-C6 demonstrate moderate disc disease and loss of disc height and mild bilateral (L>R) facet and uncovertebral hypertrophic changes. Constellation of changes results in moderate to severe central spinal stenosis and mild right and significant left neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, moderate bilateral facet and mild ligamentum hypertrophy. There is mass effect, flattening and posterior displacement of the cord and severe central spinal stenosis, severe left and moderate right neural foraminal stenosis. Small focus of T2 stir hyperintensity of the cord at this level concerning for myelopathy.C7-T1 demonstrate mild degenerative disease without spinal canal or neural foraminal stenosis.

Output: 1.Unremarkable nonenhanced brain MRI as detailed. Please see above comments.2.Cervical spin MRI demonstrate extensive degenerative changes at C4-C5 through C6-C7 with resultant reversal of cervical lordosis and moderate to severe central spinal stenosis and neural foraminal stenosis. There is a central and leftward disc protrusion at C4-C5 level which significantly contributing to central spinal stenosis which is worst at this level. Small focus of cord T2 stir hyperintensity at C6-C7 and questionable focus at C4-C5 levels concerning for myelopathy. Please review detailed report above.


Instruction: Generate impression based on findings.

Input: 59-year-old female with history of right breast cancer status post mastectomy and chemoradiation in 2000. Status post right mastectomy.There is heterogeneous amount of fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 76-year-old female with pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology without focal liver lesions. The gallbladder is within normal limits. The common bile duct measures up to 5 mm.SPLEEN: No significant abnormality noted.PANCREAS: Redemonstrated is a subcentimeter T2 hyperintense focus in the pancreatic body indicating that the main pancreatic duct, unchanged since the prior exam. Subcentimeter T2 hyperintense focus in the uncinate process measuring 4 mm is also unchanged. These are favored to be sidebranch IPMNs (intraductal papillary mucinous neoplasms). ADRENAL GLANDS: Left adrenal gland nodularity is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Unchanged T2 hyperintense foci within the uncinate process and pancreatic body dating back to 6/4/2013, favored to be sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Female, 69 years old. New metastatic brain lesion with decrease perineal sensation, bowel and bladder incontinence - assess for cord compression. For the purposes of numbering, there are five lumbar-type vertebral bodies. Vertebral body heights are normal. Alignment is within normal limits. No suspicious focal marrow signal abnormality.The conus is normal in signal and morphology and terminates at L1-2. Lipomatous change involving the filum terminale is again noted, with thickening up to 4 mm in maximal transaxial dimension, unchanged. There are mild multilevel disc degenerative changes and facet hypertrophy. There is mild bilateral neural foraminal narrowing at L3-4 and L4-5, without significant central canal stenosis at any level.There are no pathologic foci of enhancement.

Output: Mild degenerative changes of the lumbar spine, without evidence of metastatic lesions or cord compression. Fatty filum. Conus in normal position.Findings were discussed via telephone with Dr. Steiman at 11:55 PM on 03/11/2016.


Instruction: Generate impression based on findings.

Input: 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. There is no significant degenerative disease, disc pathology, or stenosis. The previously described signal abnormality compatible with epidural/subdural blood products dorsally at C4 as well as ventrally at C5-T1 has nearly resolved with minimal remaining T1 hyperintensity ventrally along the posterior longitudinal ligament. No new hemorrhage or mass effect is identified. No abnormal flow voids within the cervical spine are identified within the limitations of technique.Thoracic Spine:The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. Several discs are mildly desiccated. Several scattered small Schmorl's nodes are present. No suspicious bone marrow lesions are present. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. No abnormal epidural signal is identified.T1-T2, T2-T3, T3-T4, T4-T5, T5-T6: No significant central canal or foraminal stenosis.T6-T7: Right paracentral disc protrusion without significant central canal or foraminal stenosis.T7-T8: Minimal central disc protrusion without significant central canal or foraminal stenosis.T8-T9, T9-T10, T10-11: No significant central canal or foraminal stenosis.T11-T12: Minimal disc bulge without central canal or foraminal stenosis.T12-L1: No significant central canal or foraminal stenosis.

Output: 1.Interval near resolution of previously seen epidural/subdural blood products within the cervical spine. No new hemorrhage.2.Minimal degenerative changes in the thoracic spine without significant central canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 52 year old male patient with a tumor of right palm. There is a round, well-circumscribed mass along the volar surface of the hand at the level of the second and third metacarpal diaphyses. The mass measures 2.7 x 1.6 x 2.4 cm (transverse x AP x craniocaudal) and displaces the flexor tendons of the second and third digit dorsally. It is isointense to muscle on T1, somewhat heterogeneous high intensity on T2 weighted images, and demonstrates minimal, if any, peripheral enhancement.

Output: Palmar mass which likely represents an unusual ganglion with debris. A soft tissue sarcoma would be unlikely due to the lack of significant enhancement on post-contrast imaging.


Instruction: Generate impression based on findings.

Input: 46-year-old male with uncontrolled hypertension, elevated metanephrines ABDOMEN:LIVER, BILIARY TRACT: Multiple scattered T2 hyperintense foci throughout the right lobe of the liver are too small to further characterize but likely reflect benign cysts. Cholelithiasis within a contracted gallbladder is present. The common bile duct is normal in caliber. There is mild enlargement of the caudate lobe and left lobe of liver with prominence of the fissures raising the question of cirrhotic liver morphology.SPLEEN: Top normal splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is a right adrenal gland nodule measuring 1.8 x 1.5 cm (series 7, image 31). There is a left adrenal gland nodule measuring 1.3 x 1.3 cm (series 7, image 28). An additional left adrenal gland nodularity measures approximately 2.4 x 1.7 cm (series 7, image 22). This dropout of signal on out of phase images of all three adrenal nodules.KIDNEYS, URETERS: T2 hyperintense cyst in the inferior pole of the left kidney.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.Right adrenal gland nodule and two left adrenal gland nodules with imaging characteristics more consistent with adenoma. 2.Mild enlargement of the caudate lobe and left lobe of liver with prominence of the fissures raises the question of cirrhotic liver morphology. Clinical correlation is advised.


Instruction: Generate impression based on findings.

Input: Thigh mass There is diffusely increased T2 signal involving the majority of the vastus medialis muscle which appears slightly enlarged compared to the remaining thigh musculature. Following contrast enhancement, there is mild diffuse enhancement within the midportion of the muscle although there is no discrete mass identified. Further inferiorly is additional enhancement which again appears nonmass-like in nature. There is no discrete neurovascular involvement or mass effect.The underlying marrow signal of the femur and remaining visualized osseous structures is normal. The remaining posterior compartment and subcutaneous signal is also unremarkable. There is mild increased signal within the right gluteus muscle as well.

Output: Nonspecific increased signal and mild enhancement of the vastus medialis muscle without discrete mass lesion or mass effect. Although nonspecific, this may reflect a myositis although correlation with laboratory values and serial imaging may be of benefit.


Instruction: Generate impression based on findings.

Input: Memory impairment, cognitive decline, and paresthesias. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity. There is also a subcentimeter defect in the left pons. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are bilateral parotid gland nodules, which are grossly unchanged from 2009. There is moderate mucosal thickening in the right maxillary sinus. There is mild fluid within the right mastoid air cells.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct. Mild scattered nonspecific cerebral white matter disease suggestive of chronic small vessel ischemic disease and a chronic lacunar infarct in the pons, but no findings to suggest a particular neurodegenerative condition. 2. There are bilateral parotid gland nodules, which are grossly unchanged from 2009 and likely represent lymph nodes.


Instruction: Generate impression based on findings.

Input: Evaluate for etiology of increased seizures, cognitive and memory problemsSigns and Symptoms: Increased myoclonic seizures, cognitive and memory disturbancesComments: Seizure 2 protocol. Please perform Friday after EEG leads are disconnected | In general, the CSF spaces are somewhat larger than once expected at age 25,No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is larger than the right vertebral artery.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Given the patient's stated age they're may be a mild degree of generalized brain atrophy present.


Instruction: Generate impression based on findings.

Input: Past history of T1N2aM0 right piriform sinus status post treatment, with more recent left tongue base mass, also status post treatment. There are post-treatment findings in the left tongue base with diffuse mucosal enhancement, including within the left tongue base treatment bed. There is also enhancement of the left hyoid bone, which may be treatment-related. There is also diffuse mucosal enhancement in the hypopharynx, without gross measurable tumor otherwise. There is no evidence of significant lymphadenopathy in the neck. There are postoperative findings in the right neck related to neck dissection. The remaining salivary glands and thyroid are unchanged. There are retention cysts in the right maxillary and sphenoid sinuses. There is a disc-osteophyte complex at C3-4, which compresses the spinal cord. There is fluid within the left mastoid air cells. There is a right maxillary sinus retention cyst.

Output: 1. Post-treatment findings in the left tongue base region, without evidence of tumor progression, accounting for differences in technique.2. No evidence of gross measurable tumor in the hypopharynx. 3. No evidence of significant lymphadenopathy in the neck.4. A disc-osteophyte complex at C3-4 compresses the spinal cord.


Instruction: Generate impression based on findings.

Input: Ms. Smoke is a 35 year old female with a personal history of left breast lumpectomy in 03/2015 for IDC treated with radiation, chemotherapy and hormonal therapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is diffusely increased parenchymal enhancement seen throughout the left breast, which is asymmetric when compared to the contralateral breast. However, there is no discrete enhancing focus/mass within the left breast which is more suspicious than the rest. Expected postsurgical distortion is seen in the left superior breast, compatible with history of recent lumpectomy.There is no abnormal enhancement seen in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Diffusely increased parenchymal enhancement in left breast, likely related to post-therapy changes. However, a short-term follow-up MRI is recommended in order to confirm stability/resolution of these findings. One year follow-up time period is adequate, assuming patient is to get annual surveillance MRI examinations. (2) No MRI evidence for malignancy in the right breast. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: Brain:Note that a FLAIR sequence was not obtained. The patient will be invited back to complete this sequence and an addendum will be issued at that time.The ventricles, sulci and cisterns are symmetric and unremarkable. Note is made of hemosiderin staining in the high right frontal lobe without associated enhancement or evidence of acute hemorrhage. The gray-white matter differentiation is normal. There is no mass, midline shift, intra or extra-axial fluid collection/acute 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.Lumbar spine: There is loss of the normal lumbar lordosis. Vertebral body heights and disk spaces are maintained. There is no significant neuroforaminal or spinal canal stenosis. T1 hypertensity is noted within the filum terminale. The conus medullaris is normal in appearance and location at L1. The signal of the visualized lower spinal cord is within normal limits.

Output: 1. Hemosiderin staining in the high right frontal lobe, which may reflect prior contusive injury.2. Fatty filum terminale, which is an occasional incidental finding, although correlation with symptomatology is recommended. The visualized spinal cord and conus are normal in appearance and location.Note that a FLAIR sequence was not obtained and the patient will be invited back to complete this sequence. An addendum to this report will be issued at that time.


Instruction: Generate impression based on findings.

Input: 81 year old female with left masticator space sarcoma, follow-up A large heterogenous enhancing soft tissue mass is identified centered at the left masticator space. The medial and lateral pterygoid muscles are involved. The masseter muscle has been displaced laterally. No clear margin is seen between the lesion and the masseter muscle. Posteriorly, the mass infiltrates the left parotid space and displaced the retromandibular vein posteriorly. Both lateral and medial cortex of the mandible are eroded, including the left mandibular foramen. Medially, the parapharyngeal space is partially effaced. Superiorly, the lesion extends along the CN V mandibular nerve, through the foramen ovale and filling the left Meckel's cave. The foramen ovale is enlarged and cortex is eroded. The lesion is measuring 4.4 x 4.7 x 5.1 cm on axial image 28 series 3 and image 33 series 80248. No pathologic lymphadenopathy is appreciated based on the size criteria for lymphadenopathy. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. Tiny hypodense lesions in the thyroid glands. Correlate with ultrasound exam. The parotid and submandibular glands are unremarkable. The carotid arteries and jugular veins are patent. Scarring and small nodules are noted in the lung apices. Please refer to the dedicated chest CT for more comments. There is redemonstration of extensive degenerative change in the cervical spine including grade I retrolisthesis of C5 on C6, C4/5 to C6/7 multilevel neural foramina narrowing and C4/5 and C5/6 central canal stenosis. Please refer to dedicated MRI of the cervical spine acquired at other institute for more details. A large intraosseous hemangioma is again noted in the C6 vertebral body.

Output: 1. Large heterogenous enhancing soft tissue mass centered at the left masticator space with perineural extension into the Meckel's cave. A MRI study is recommended to further evaluate intracranial spread.2. There is no pathologic lymphadenopathy.3. Extensive degenerative change in the cervical spine with multilevel neural foramina narrowing and central canal stenosis. Please refer to dedicated MRI of the cervical spine acquired at other institute for more details. 4. Scarring and small nodules are noted in the lung apices. Please refer to the dedicated chest CT for more comments.


Instruction: Generate impression based on findings.

Input: Again seen is restricted diffusion involving the right paramedian frontal lobe including the posterior aspect of the superior frontal gyrus extending into the medial aspect of the precentral gyrus as well as portions of the right cingulate gyrus. There is associated T2/FLAIR hyperintensity as seen on MRI dated 12/1/2016. Susceptibility-weighted sequence demonstrates no evidence of hemorrhage within the areas of the acute infarct. As seen on earlier study from 12/1/2016 there is moderate degree of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is nonspecific but compatible with moderate chronic small vessel ischemic disease. There is volume loss along the left caudate head and anterior body with susceptibility compatible with chronic infarct with mineralization or hemosiderin deposition. There is no hydrocephalus. No extra-axial collections. Bone marrow signal and extracranial soft tissues are grossly unremarkable.MRA HEAD

Output: 1. Earlier brain MRI study from 12/1/2016 was incomplete and patient returned for additional sequences. Again demonstrated are multiple acute infarcts in the right paramedian frontal lobe in the distal right ACA territory including the medial aspect of the right precentral gyrus.2. Moderate chronic small vessel ischemic disease with chronic lacunar infarct involving the left caudate head.3. MRA head demonstrates abrupt occlusion of the right anterior cerebral artery at the distal A2 segment.4. The right distal intracranial vertebral artery is not clearly seen and may be partially related to hypoplasia. There is however flow related enhancement just adjacent to the mid to lower basilar artery on the right suggestive of a residual stump, possibly related to an occluded distal right vertebral artery. CTA head and neck can be considered for further delineation of the posterior circulation.


Instruction: Generate impression based on findings.

Input: Tuberosclerosis. Complex partial seizures (epilepsy). Multiple findings compatible with the known diagnosis of tuberous sclerosis including cortical/subcortical tubers and transmantle T2/FLAIR hyperintense lesions as well as the multiple subependymal nodules, which show susceptibility effect probably from calcification, remain unchanged. Some of these subependymal nodules show suggestion of mild contrast enhancement. No definite lesions are identified at the foramina of Monro. Otherwise, there is no abnormal contrast enhancement. There is asymmetric enlargement of the right temporal horn which is associated with mild hippocampal volume loss but no definite increased T2 signal. The ventricles and other CSF-containing spaces are unchanged. There is no midline shift or brain herniation. The tiny serpentine vascular flow voids in relation to the posterior aspect of the left cingulate sulcus remain unchanged and may reflect a dural arteriovenous fistula. The major intracranial vascular flow voids are preserved, reflecting gross patency.There is no gross orbital abnormality. Maxillary sinus retention cysts as well as ethmoid and sphenoid mucosal thickening on the sympathetic chain since the previous examination. There is no destructive skull lesion. A prominent left lateral retropharyngeal lipoma is partially included and was present previously. It causes mild-to-moderate mass-effect on the nasopharynx.

Output: 1.Findings compatible with the diagnosis of tuberous sclerosis remain unchanged since the previous examination of March 2014. No definite MR evidence of SEGA.2.Volume loss without increased T2 signal involving the right hippocampal head remain unchanged. 3.Small serpentine vessels along the posterior aspect of the left cingulate sulcus probably reflect dural arteriovenous fistula which is unchanged.


Instruction: Generate impression based on findings.

Input: 86-year-old female with altered mental status and history of transient ischemic attack x 2. Rule out ischemia. There is no evidence of intracranial hemorrhage, mass or edema. Small lacunae in the right basal ganglia. Few diffuse hypodensities consistent with minimal small vessel disease, age indeterminate, essentially within normal limits for the patient's age. If there is clinical concern for acute ischemia an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Minimal small vessel disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 38 years Male (DOB:8/14/1977)Reason: ? extent of resection History: panhypopituitarismPROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE MRI pituitary:Since prior examination patient has undergone transsphenoidal surgery for a pituitary mass. On the current exam the overall dimensions of the patient's mass were 29 x 20 x 24 mm. On the prior exam the mass measured 36 x 24 x 26 mm. There is a central nonenhancing component which has T1 signal hyperintensity within it suggestive of blood products. There is suprasellar extension. The mass is 1 or 2 mm below the level of the optic chiasm on the current exam whereas previously it was abutting the. There is opacification of the sphenoid sinus and there is mucosal thickening in the maxillary sinuses and ethmoid air cells.

Output: Since the prior exam there is been surgical debulking of the patient's pituitary mass suspected to represent pituitary adenoma. There is somewhat less mass effect on the current exam when compared to the prior.


Instruction: Generate impression based on findings.

Input: Reason: patellar chondromalacia History: R knee pain Suboptimal evaluation secondary to patient body habitus and inability to use a dedicated knee coil due to the patient's body habitus.MENISCI: Suboptimal evaluation of the menisci secondary to the aforementioned limitations. There is globular increased signal abnormality within the anterior horn of the lateral meniscus indicating intrasubstance degeneration. Some of this signal extends to the tibial articular surface consistent with degenerative tearing/superficial fraying. The posterior horn appears intact. There is undulation of the free edge of the body of the meniscus indicating meniscal flounce.There is superficial fraying of the free edge of the posterior horn of the medial meniscus. No fluid-filled tear is evident.ARTICULAR CARTILAGE AND BONE: There is subjective thinning of the articular cartilage of the medial and lateral compartments. There is full-thickness articular cartilage degeneration along the lateral facet of the patella with underlying degenerative subchondral signal abnormality. The femoral trochlea is shallow, superiorly, indicating a mild femoral trochlear dysplasia. Note is made of a Wiberg type III patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is intermediate signal intensity within the distal fibers of the patellar tendon which may indicate a mild tendinosis.ADDITIONAL

Output: Full-thickness articular cartilage degeneration along the lateral facet of the patella with mild femoral trochlear dysplasia and borderline tibial tubercle to trochlear groove distance. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 7 years, Male, new tics, right temporal headaches. Evaluate for basal ganglia or white matter abnormality. Examination is motion degraded. No intracranial mass or mass effect is appreciated. Bilateral basal ganglia appear within normal limits. No evidence of cortical dysplasia or gray matter heterotopia. No evidence of infarct or hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: Examination is motion degraded, which slightly limits evaluation. Brain parenchyma however appears unremarkable.


Instruction: Generate impression based on findings.

Input: 19 year-old female with left hip pain ACETABULAR LABRUM: There is abnormal linear signal extending within the superior acetabular labrum, consistent with a tear.ARTICULAR CARTILAGE AND BONE: Osteophyte formation and diffuse joint space narrowing and articular cartilage loss with foci of full-thickness cartilage degeneration consistent with moderate degenerative changes. Moderate osteoarthritis also affects the right hip. Pin tracts are identified consistent with prior femoral head fixation bilaterally. The femoral neck appears foreshortened with coxa vara deformity bilaterally. Linear sclerosis along the foreshortened femoral neck without associated edema consistent with healed fracture deformity.SOFT TISSUES: The muscles and tendons about the hip appear intact. ADDITIONAL

Output: 1. Moderate osteoarthritis as described above with associated superior labral tear. 2. Postoperative changes of prior femoral head fixation with foreshortening of the femoral head and coxa vara deformity.


Instruction: Generate impression based on findings.

Input: 60-year-old male with HCC and HBV. Evaluate liver lesions, masses. HCC status post TACE/RFA done 8/11-12/16. Evaluate for liver vessel patency and ascites. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology with sequelae of portal hypertension including splenomegaly and splenic varices. The segment 8 ablation cavity without evidence for a residual enhancing nodular component. The T1 hyperintense signal intensity within the cavity is suggestive of blood products. The portal and hepatic veins are patent. Partially distended gallbladder without wall thickening. Scattered subcentimeter nonenhancing T2 hyperintense foci compatible with cysts.SPLEEN: Mild splenomegaly measuring 14.3 cm in length.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No ascites.BONES, SOFT TISSUES: Small rounded foci of T1 and T2 hyperintense signal of the T8 and T9 vertebral bodies are compatible with osseous hemangiomas (coronal series 5 images 34, 32).OTHER: No significant abnormality noted.

Output: 1.Segment 8 ablation cavity without evidence for residual hyperenhancing focus.2.Cirrhotic morphology and sequelae of portal hypertension. No ascites.


Instruction: Generate impression based on findings.

Input: Dense breasts, right MRI on 6/3/2015. Final path IDC grade 2, 2.1 cm 7 out of 27 nodes positive, largest tumor deposit is 5 mm, extranodal extension noted is 2 mm. ER positive PR negative HER-2 positive by IHC. Status post neoadjuvant chemotherapy status post radiation (8/2015). ypT 2(m), N2 MX There is heterogeneous amount of fibroglandular tissue in the left breast. Patient is status post right mastectomy.Mild parenchymal enhancement is noted in the left breast.No abnormal enhancement is seen in left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Male, 65 years old, with history of brain metastases from primary salivary gland adenocarcinoma, status post stereotactic radiosurgery to a left occipital lesion, follow-up exam. A 7 mm linear focus of intrinsic T1 hyperintensity and mild enhancement at the junction of the left temporal and occipital lobes is redemonstrated without significant interval change. No new enhancing lesions are seen. No significant parenchymal edema or mass effect is detected. Scattered punctate foci of nonspecific FLAIR hyperintensity are unchanged. No intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are stable and normal in size.

Output: Stable findings status post stereotactic radiosurgery to a lesion at the left temporal-occipital junction. No evidence of lesion recurrence or any new lesions.