Instruction: Generate impression based on findings.

Input: HeadachePRES VS SVTCervical compression versus demyelination. Patient has neck pain and numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an ill-defined focus of a contrast enhancement in the right pons measuring 14 mm in diameter which was seen on the prior exam which is identified on the susceptibility weighted imaging as a serpiginous signal voids. Most likely this represents capillary telangiectasia.There is a punctate T2 and FLAIR signal hyperintensity are present in the left external capsule anteriorly which has not changed since the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the right sphenoid sinus which was also present on the previous exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal 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. There are perineural cysts present at this level just outside the neural foramina.There is a pseudoaneurysm present at the left vertebral artery at the level of the thecal sac at the atlanto-occipital level associated with approximately 50% stenosis at the distal left vertebral artery as it enters the thecal sac.

Output: 1.Capillary telangiectasia in the right pons is stable compared to the prior exam.2.There is a pseudoaneurysm present at the left vertebral artery at the level of the thecal sac at the atlanto-occipital level associated with approximately 50% stenosis at the distal left vertebral artery as it enters the thecal sac which is best seen on the recent CTA. Please refer to CTA of the same date for further comments.3.There are no stigmata of posterior reversible encephalopathy syndrome appreciated4.No evidence for compression of the cervical spinal cord


Instruction: Generate impression based on findings.

Input: Female, 44 years old, with left hand pain radiating from the neck to the middle finger. Alignment is anatomic. Vertebral body heights are preserved. No concerning marrow signal abnormality or marrow edema is detected.The visualized spinal cord demonstrates normal signal characteristics throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis or neuroforaminal narrowing. C7-T1: Facet hypertrophy. Mild left foraminal narrowing. No significant spinal canal stenosis.

Output: Mild degenerative findings as discussed above with no areas of high-grade spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Alternate status. History of cerebrovascular accident, seizure disorder as well as dementia.. There is confluent and patchy T2 hyperintensity involving the cerebral white matter, most pronounced in the frontal and parietal lobes, but without associated with diffusion restriction or mass effect. This is probably related to chronic microvascular ischemia and has increased compared to the 2014 examination. Some of the foci involving the overlying cortex, especially in the left frontal lobe. These are related to chronic left MCA infarcts. There is a slitlike abnormality involving the region of the left external capsule without associated stability, probably reflect previous infarct. Otherwise, there is no diffusion restriction or susceptibility effect to indicate recent hemorrhage, accounting for basal ganglia calcifications. Progression of the white matter abnormality since 2014 is associated with progressive cerebral volume loss manifested by further expansion of the ventricles and the other CSF-containing spaces. There is no midline shift or herniation. There is no abnormal extra-axial fluid collection.Orbits are grossly normal. The mastoid air cells and paranasal sinuses are clear. There is no destructive skull lesion.

Output: 1.There is no acute infarct or acute intracranial hemorrhage. 2.Extensive white matter abnormality probably reflect chronic microvascular ischemia has increased since February 2014. 3.The more focal abnormalities in the left external capsule region and the left frontal cortex may represent previous/chronic infarcts.


Instruction: Generate impression based on findings.

Input: Evaluate aortic valve stenosis. Left VentricleThe left ventricle is normal in size. The overall LV ejection fraction is 61%. There is no late gadolinium enhancement. No intracardiac thrombus.Left AtriumThe left atrium is unremarkable. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 59%.Right AtriumThe right atrium is unremarkable.Aortic ValveTechnical limitations prevent complete evaluation of the aortic valve.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aorta is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. No evidence of coarctation.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsNo significant abnormality noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Nondiagnostic exam for evaluation of the aortic valve due to technical limitations. The patient has been contacted for repeat no charge examination for additional imaging of this region. Additional cardiac parameters and aortic valve velocities will be generated upon further imaging and will be listed as an addendum.2. Normal left ventricular morphology and function. No evidence of ischemia. The ejection fraction is 61%.


Instruction: Generate impression based on findings.

Input: Ms. Swift is a 47-year-old female with newly diagnosed left breast cancer, solely detected on ultrasound. There is heterogeneous amount of fibroglandular tissue in both breasts.There is extensive bilateral, symmetric background parenchymal enhancement identified. Although marked in nature, there is no one focus that is more suspicious than the rest. There are multiple T2 hyperintense non-enhancing cysts identified bilaterally. Susceptibility artifact from biopsy marker clip is identified in the left lower inner breast with faint surrounding enhancement, measuring approximately 0.5 x 0.5 x 0.6 cm, compatible with biopsy-proven malignancy. There is no additional abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal biopsy proven malignancy in the left breast.(2) Marked background parenchymal enhancement, which limits the sensitivity of MRI BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 47 year old female with history of shoulder pain. ROTATOR CUFF: There is intermediate signal abnormality within the supraspinatus tendon compatible with moderate tendinosis. There is an additional tiny full thickness longitudinal tear near its insertion (20/6). The supraspinous muscle belly is within normal limits. There is no evidence of tendon retraction or muscular atrophy. The muscles and tendons of the infraspinatus, teres minor, and subscapularis appear normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial or subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact. Moderate osteoarthritis affects the glenohumeral joint. There are small subchondral cysts present within the humeral head and glenoid, likely degenerative in etiology.BICEPS TENDON: The biceps tendon is unremarkable. ADDITIONAL

Output: 1.Moderate supraspinatus tendinopathy with a tiny full thickness longitudinal tear near its insertion.2.Degenerative changes as above.


Instruction: Generate impression based on findings.

Input: Subdural hemorrhage and retinal hemorrhages. Suspicion of nonaccidental trauma. Assess for diffuse axonal injury. Brain:The anterior subdural collections overlying the frontal, parietal, and temporal lobes have slightly increased in size. On the coronal images, the maximum thickness on the left side is 12 mm compared to 6 mm previously while on the right it is 9 mm compared to 6 mm previously. These collections are only minimally more hyperintense than CSF on T2/FLAIR and T1 but they show scattered foci of T1 hyperintensity associated with susceptibility effect reflecting their hemorrhagic nature. They extend minimally along the anterior falx, with mild mass effect on the underlying frontal lobes. A more focal T1 hyperintense, T2 hypointense component is present just superficial to the left central sulcus and is associated with confluent susceptibility effect. This component has decreased in size/retracted and likely represents evolving clot. On coronal T2-weighted images, it now measures 22 mm x 12 mm compared to 26 mm x 11 mm. It causes minimal mass effect on the underlying brain.The thin posterior subdural collection overlying the parietal and occipital lobes as well as the posterior fossa are heterogeneous but only mildly T1 hyperintense. These do extend along the posterior aspect of the falx. Compared to the previous CT scan, this have undergone some redistribution but have not significantly changed in overall volume.There are tiny superficial foci of diffusion restriction in the anterior corpus callosal body and genu, probably reflecting shear injury. Some are associated with susceptibility effect. Foci along the paramedian vertex frontal lobe cortex may relate to the callosal areas of injury, or could represent blood products relating to gliding contusion.There is a larger superficial area of more confluent mild diffusion restriction with associated blurring of the gray-white matter differentiation on T2WI involving the inferior aspect of the posterior left temporal lobe and the adjacent occipital lobe. This is associated with curvilinear T1 hyperintensity as well as peripheral contrast enhancement that is more pronounced on the delayed imaging. There is no significant susceptibility in this location.There is no midline shift or herniation.There is mild fluid in the mastoid air cells bilaterally. There is questioned left optic nerve head elevation with enhancement and perhaps trace diffusion abnormality.Cervical spine:Cervical spinal alignment is anatomic. The vertebral bodies are preserved in height. There is no abnormal marrow signal. The discs are also preserved in height and signal. The paraspinal soft tissues show no significant edema. The spinal canal is preserved as well as the neural foramina. The spinal cord is normal. There is peripheral opacity in the right lower lobe's apical segment which is probably atelectatic.

Output: 1.Tiny foci of scattered diffusion restriction and susceptibility effect involving the corpus callosum are most probably related to shear injury (diffuse axonal injury pattern). Foci along the paramedian frontal lobe cortex could represent superimposed gliding contusions.2.A slightly larger and more confluent area of abnormality involving the peripheral posterior inferior left temporal lobe and adjacent occipital lobe is associated with peripheral contrast enhancement. The differential would include an evolving ischemic insult possibly venous and likely subacute given the associated contrast enhancement, minimally hemorrhagic contusion given mild T1 hyperintensity, and an area of postictal change if clinically applicable.3.Bilateral subdural collections are slightly larger than on the previous CT scan. They show foci of hemorrhage but are otherwise largely near CSF in intensity, suggesting greater chronicity. The more focal probable clot of the subdural hematoma which overlies the left central sulcus has retracted since the previous examination.4.The trace posterior fossa subdural collections are not significantly changed in overall volume though have undergone some redistribution compared to the previous CT scan. Stable trace more recent blood products within the dependent portions of the supratentorial collections.5.Questioned left optic nerve head elevation and enhancement. Please correlate with physical exam for papilledema.6.Unremarkable MRI of the cervical spine.


Instruction: Generate impression based on findings.

Input: 72-year-old male with Gleason 6 prostate cancer on active surveillance, left lateral mid prostate PELVIS:PROSTATE:Prostate Size: 6.0 x 5.7 x 4.8 cm.Peripheral Zone: There is a 9 x 7 mm T2 hypointense focus corresponding restricted diffusion in the mid gland (frozen (series 1201, image 15).Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: There is mild discontinuity of the low T2 signal capsule adjacent to the left mid gland peripheral zone lesion raising suspicion of extracapsular extension (series 401, image 66).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.T2 hypointense focus in the left mid gland peripheral zone with findings suspicious for micro-extracapsular extension.


Instruction: Generate impression based on findings.

Input: right hand numbness and slurred speechspeech disturbanceClinical question: stroke The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate foci of diffusion restriction scattered in the watershed zone in the left hemisphere. Additionally a punctate focus of diffusion restriction is present in the right centrum semiovale. Several other punctate foci of diffusion restriction are present in the left caudate nucleus and the left putamen.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.There are punctate foci of cerebral infarction in the left and right hemispheres but no large infarction. Bilaterality and tiny size of infarcts suggests these are possibly due to a small shower of emboli.


Instruction: Generate impression based on findings.

Input: 37 years, Male, multiple sclerosis. Ataxia. Brain: There is moderate degree of confluent T2/FLAIR hyperintensity in the periventricular and subcortical white matter which is nonspecific but compatible with extensive demyelinating disease. There is also moderate degree of global parenchymal volume loss with diffuse thinning of the corpus callosum. There is also a moderate burden of T1 hypointense lesions in the supratentorial brain. Several infratentorial lesions are also evident including the right middle cerebellar peduncle and bilateral cerebellar hemispheres. Small midbrain and pontine lesions are also suspected. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus.Cervical spine: There is motion degradation on multiple cervical spine sequences significantly limiting evaluation of demyelinating disease. There is however suggestion of small patchy areas of T2 signal abnormality throughout the cervical cord. Cervical cord volume is grossly preserved. There is no significant spinal canal stenosis or neural foraminal stenosis at any level. Vertebral body heights are maintained. Alignment is maintained aside from straightening which may be in positional. Bone marrow signal is benign.There is an ovoid subcutaneous lesion in the left lower neck posteriorly measuring approximately 3 cm in the transverse dimension and 12 mm in the AP dimension with T1 and T2 hyperintensity and suggestion of chemical shift artifact, findings which favor a lipoma. There is apparent high signal on the STIR sequence which appears to be along the lateral margin of the lesion.

Output: 1. Extensive white matter signal abnormality involving the supra and infratentorial brain which is compatible with advanced demyelinating disease. There is also a moderate degree of global parenchymal volume loss and burden of T1 hypointense lesions. Addendum can be issued if comparison study is made available.2. Cervical spine sequences are significantly motion degraded although there is suggestion of multiple small lesions throughout the cervical cord compatible with demyelinating disease.3. Benign-appearing lesion in the subcutaneous tissues of the left lower neck posteriorly, favored to represent a lipoma with proteinaceous cyst an alternative possibility. Lipoma can be confirmed with an axial T1 fat-sat sequence through this lesion if clinically warranted.


Instruction: Generate impression based on findings.

Input: Female 51 years old. Reason: left knee medial meniscus tear. History: left knee pain MENISCI: The menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a small focal full thickness cartilage defect in the hyaline cartilage of the lateral femoral condyle which extends to the underlying bone.LIGAMENTS: The ACL, PCL, and MCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Small focal full thickness cartilage defect of the lateral femoral condyl


Instruction: Generate impression based on findings.

Input: Male 52 years old Reason: Right dorsal surface of Shoulder History: Painful with movement ROTATOR CUFF: Tendinopathy affects the supraspinatus tendon. Subchondral cysts are present adjacent to the insertion of the supraspinatus. The remainder of the rotator cuff is intact. However, there is moderate fatty atrophy of the teres minor.SUPRASPINATUS OUTLET: Type I acromionGLENOHUMERAL JOINT AND GLENOID LABRUM: There is irregularity of the anterior through posterior labrum consistent with chronic labral degeneration. Decreased signal within the hyaline cartilage of the glenoid is consistent with chondrocalcinosis.BICEPS TENDON: Biceps tendon is well seated within the bicipital groove. ADDITIONAL

Output: 1.Tendinopathy of the supraspinatus tendon and moderate fatty atrophy of the teres minor.2.Chronic appearing labral degeneration and chondrocalcinosis of the glenoid hyaline cartilage.3.Focal synovitis adjacent to the coracohumeral ligament.


Instruction: Generate impression based on findings.

Input: Reason: prior sustentaculum tali fracture now with recurrent pain History: prior sustentaculum tali fracture now with recurrent pain TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The achilles tendon is normal in appearance. LIGAMENTS: The lateral collateral ligament complex appears intact. The visualized portions of the deltoid ligament appear intact. ARTICULAR SURFACES AND BONE: There is a fracture line through the sustentaculum tali of the calcaneus, extending to the middle facet of the subtalar joint. The previously noted edema at this region has decreased.ADDITIONAL

Output: Fracture of the sustentaculum tali of the calcaneus again noted but the edema at this region has decreased compared to prior exam.


Instruction: Generate impression based on findings.

Input: Status post kyphoplasty. Review of the patient's prior study also indicates a history of multiple myeloma. The bones appear demineralized likely representing a combination of osteoporosis and multiple myeloma. There is a compression fracture of L2 with cement in the vertebral body compatible with the stated history of kyphoplasty. There is also a compression fracture of L1 as seen on recent MRI. Facet joint osteoarthritis affects the lower lumbar spine. Severe osteoarthritis affects the right hip joint.

Output: Compression fractures and L2 kyphoplasty as described above.


Instruction: Generate impression based on findings.

Input: Knee pain The examination is limited by motion artifact.MENISCI: Within the limits of the exam, there is no discrete meniscal tear identified.ARTICULAR CARTILAGE AND BONE: There is mild articular cartilage thinning throughout the knee which is most evident at the patellofemoral compartment and posterolateral tibial plateau. Focal partial-thickness defects of the articular cartilage are noted within the medial patellar facet and there is associated degenerative marrow signal within the patella as well as the lateral tibial plateau. Overall this appears similar to the prior exam.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Although limited by motion artifact, there is no discrete meniscal tear identified.2. Redemonstration of tricompartmental articular cartilage thinning which is most evident at the posterior portion of the lateral compartment and the patellofemoral compartment. Overall this appears similar to the prior exam.


Instruction: Generate impression based on findings.

Input: There is a pituitary mass that measures up to approximately 12 mm, which is grossly unchanged. The infundibulum is mildly deviated to the right. There is no mass effect on the optic apparatus. The posterior pituitary bright spot is intact. There is no evidence of cavernous sinus invasion. There is partially imaged cerebral volume loss. There is an unchanged 4 mm wide outpouching along the lateral aspect of the left cavernous carotid artery. The known left ophthalmic artery aneurysm is barely discernible on this exam due to technique. There are prominent arachnoid granulations in the right greater wing of the sphenoid with slight herniation or the intracranial contents.

Output: 1. No significant interval change in the pituitary mass that measures up to 12 mm, which likely represents a macroadenoma.2. The small left internal carotid artery aneurysms are better depicted on the recent CTA. 3. Prominent arachnoid granulations in the right greater wing of the sphenoid with slight herniation or the intracranial contents.


Instruction: Generate impression based on findings.

Input: Polyradiculopathy, rule out compressive cervical myelopathy. Decreased mobility and neuropathy. Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Multilevel degenerative changes are seen in the cervical spine with multilevel disc height loss and small disc osteophyte complex formation. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex. No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C5-6: Small disc osteophyte complex. No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy.C6-7: Disc osteophyte complex and uncovertebral hypertrophy. No significant compromise to the spinal canal. Minimal bilateral neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar Spine:Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is levocurvature of the lumbar spine with apex at the L2-L3 level. Bone marrow signal is benign. The conus medullaris is normal in position. Multiple small perineural cysts in the sacrum are incidentally noted.Multilevel degenerative changes are seen with disc height loss from L2-L3 to L5-S1 with suggestion of vacuum phenomena at the L2-L3, L4-L5, and L5-S1 levels. Individual levels as described below:L1-L2: Minimal disc bulge, ligamentum flavum thickening, and facet arthropathy. There is no significant spinal canal or neural foraminal stenosis.L2-L3: Moderate disc height loss and mild bulge. There is also ligamentum flavum thickening and facet arthropathy. There is no significant spinal canal stenosis. There is mild right neural foraminal stenosis. Left neural foramen is patent.L3-L4: There is disc height loss and disc bulge with a right dorsal annular fissure. There is also ligamentum flavum thickening and facet arthropathy. Partial effacement of the right lateral recess. No significant central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis.L4-L5: There is moderate to severe disc height loss and disc bulge including a small central protrusion component. Ligamentum flavum thickening and bilateral facet arthropathy. There is partial effacement of the lateral recesses. No significant central canal stenosis. There is mild to moderate right and mild left neural foraminal stenosis. There may also be impingement of the extraforaminal left L4 nerve root at this level. L5-S1: There is disc height loss with mild bulge. Ligamentum flavum thickening and bilateral facet arthropathy. No significant spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.

Output: 1. Mild multilevel degenerative changes in the cervical spine. There is no significant spinal canal stenosis at any level or cord signal abnormality. Mild multilevel neural foraminal narrowing as detailed above.2. Mild to moderate multilevel degenerative changes in the lumbar spine. There is no significant spinal canal stenosis at any level. There is neural foraminal narrowing at multiple levels as detailed above. At the L4-L5 level, there may also be impingement of the extraforaminal left L4 nerve root.


Instruction: Generate impression based on findings.

Input: Metastatic small cell lung cancer with brain mets, on immunotherapy. There are postoperative findings related to right frontal craniotomy, with underlying confluent high T2 signal with encephalomalacia and susceptibility effect in the right frontal lobe, with an unchanged subcentimeter area of enhancement. Otherwise, there has been interval increase in size and number of multiple supratentorial and infratentorial lesions and associated vasogenic edema. For example, a left middle frontal gyrus lesion measures up to 12 mm in diameter, previously 6 mm, a right perirolandic lesion measures 20 mm, previously 9 mm, a left cerebellar lesion measures up to 14 mm, previously 7 mm, and a posterior medullary lesion measures 7 mm in diameter, previously 5 mm. In addition, there is a newly apparent anterior left frontal lobe lesion that measures up to 4 mm. Many of the lesions contain hemorrhagic components levels, some of which have evolved. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1. Overall interval increase in size and number of multiple intracranial metastases with associated vasogenic edema.2. Postoperative findings related to right frontal craniotomy, with an unchanged nonspecific subcentimeter area of enhancement.


Instruction: Generate impression based on findings.

Input: Pineal cyst 6 month evaluation: headache. There is a cystic pineal gland that measures up to approximately 10 mm. There is no evidence of intracranial hemorrhage 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, and scalp soft tissues are grossly unremarkable. There are postoperative findings related to endoscopic sinus surgery.

Output: A cystic pineal gland that measures up to approximately 10 mm is likely benign.


Instruction: Generate impression based on findings.

Input: 50 year old female patient with history of left breast cancer s/p chemotherapy and RT presents for 6 month follow up for non-mass enhancement in the right breast at 2 o'clock position s/p biopsy that demonstrated PASH. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Clip artifact is identified in the noted along the anterior aspect of the previously seen non-mass enhancement in the right upper inner breast at posterior depth at 2 o'clock position that measures approximately 0.3 x 0.3 cm, previously 1.2 x 0.7 x 1.2 cm (AP x LM x CC). Postsurgical changes in central medial left breast lumpectomy including skin thickening and seroma that measures 6.7 x 1.5 cm is noted that demonstrates homogenous rim enhancement.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: Postsurgical changes in the left breast. Clip from prior stereotactic biopsy within a tiny residual focus in the right breast 2 o'clock position, which is much smaller in size from prior MRI examination. No further 6 month follow up is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, with pain, pre-DBS insertion. Imaging was acquired with the patient head in a nonstandard oblique position due to patient range of motion limitations. The source images were reformatted into standard axial, coronal and sagittal planes for easier interpretation, but please note that these corrected images will likely not be compatible with the surgical navigation system.A cystic lesion is evident occupying and expanding the third ventricular space, though it may not actually be intraventricular but rather suprasellar in origin. The lesion is closely associated with both the optic chiasm and the pituitary infundibulum. The lesion abuts and exerts some mass effect upon the thalami, particularly on the right where a small fingerlike projection of the cyst may extend into the thalamic parenchyma. The lesion extends superiorly, between the forniceal columns, where there appears to be a 10 mm solid nodule with possible mild associated enhancement. On review of prior CT examinations dating back to 2011, this lesion was probably present, though it was substantially smaller and barely detectable at that time.No other pathologic enhancement is observed intracranially. The ventricles are not dilated. No additional abnormal extra-axial collections are seen. Scattered T2 hyperintense foci are evident within the periventricular and subcortical white matter.

Output: 1.The original images were acquired in a nonstandard oblique plane due to patient limitations. Although reformatted images were generated in standard anatomical planes, these corrected sequences will likely not be compatible with the surgical navigation system. The patient will be brought back to rescan with proper positioning.2.Incidentally noted is a cystic lesion with a small associated solid nodule which occupies and expands the third ventricular space, but which may actually be suprasellar in origin. This lesion was likely present in 2011, but has increased in size in the interval. The lesion exerts mass effect upon the thalami, right side more than left, and may even slightly invade the right thalamus. The imaging features favor a neoplastic process including a craniopharyngioma spectrum lesion. Findings were discussed with Dr. Warnke at 3:00 PM on 12/16/16.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is extensive degeneration and tearing of the lateral meniscus. In particular, the posterior aspect of the lateral meniscal body and lateral aspect of the posterior meniscal horn are not visualized, presumably reflecting near complete maceration of the meniscus. There is additional globular signal abnormality within the anterior and posterior horns of the remainder of the meniscus indicating intrasubstance degeneration. In the posterior horn this signal abnormality extends to the tibial articular surface representing additional undersurface tearing.There is globular intrasubstance signal within the posterior horn of the medial meniscus indicating mucoid degeneration. This appears to extend to the femoral articular surface on both coronal and sagittal sequences, compatible with degenerative tearing; it may also extend to the tibial articular surface, but this is equivocal. Additional degenerative tearing extends through the root of the posterior horn of medial meniscus, which decompress into a small multilobulated para-meniscal cyst. Signal abnormality also extends through the peripheral fibers of the posteromedial aspect of the meniscus to form a tiny para-meniscal cyst. ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage along the lateral tibial plateau with cyst formation and degenerative signal abnormality in the underlying bone. Additional near full-thickness cartilage loss is noted along the lateral tibial plateau. There is also thinning of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus with additional fissuring and degeneration of the articular cartilage more posteriorly. There is perhaps mild subjective thinning of the articular cartilage of the medial tibiofemoral compartment, but I see no discrete fluid-filled cartilage defect. A small subchondral cyst is seen anteriorly within the medial tibial plateau. There is a full-thickness cartilage fissure along the medial facet of the patella, as well as a small focus of degenerative signal abnormality in the subchondral marrow. Increased signal intensity within the articular cartilage of the femoral trochlea centrally and superiorly may reflect focal degeneration, and more inferiorly the articular cartilage of the femoral trochlea appears slightly thinned. There are tricompartment osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Extensive degeneration and tearing of the lateral meniscus as described above. There is also degenerative tearing of the posterior horn of the medial meniscus.2.Cartilage degeneration and osteoarthritic changes as described above most severely affecting the lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: Reason: S/p Adrenalectomy. Follow up exam. History: S/p Adrenalectomy. Follow up exam. (Adrenocortical neoplasm resected 1/23/2014). ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.Mild intrahepatic and extrahepatic biliary ductal dilatation is unchanged and likely related to cholecystectomy. T1 hypointensity in the right hepatic lobe that corresponds with coarse calcifications on CT is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Postsurgical changes of a right adrenalectomy. Heterogeneous soft tissue interspersed with abdominal fat in the surgical bed is again noted. The reference enhancing soft tissue focus measures 17 mm (series 11 image 147), previously 15 mm, and demonstrates similar signal characteristics to the patient's original mass.KIDNEYS, URETERS: Left renal cyst, unchanged.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: Interval increase in size of soft tissue focus in the right adrenalectomy bed with similar signal characteristics to the patient's original mass. Findings are suspicious for enlarging residual tumor/recurrence.


Instruction: Generate impression based on findings.

Input: 66 year old female with altered mental status and memory loss x 10 days Examination demonstrates a large suprasellar mass a well-demarcated round appearance measuring approximately 31.7 mm times 31.6-mm. Mass applies mass effect on the third ventricle with superior elevation and causes hydrocephalus bilaterally. No transependymal exudate of CSF is detected. There is possibility of some hemorrhage within the mass at its base. The epicenter of the tumor appears to be in the basal cistern. There is however subtle enlargement of the sella. Further evaluation with an MRI for better evaluation and etiology is recommended.

Output: Large likely partially hemorrhagic suprasellar mass.Obstructive hydrocephalus.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and stiffness. ROTATOR CUFF: There is thickening and intermediate signal intensity of the supraspinatus tendon indicating mild-moderate tendinosis. In addition, there is high signal intensity within the distal fibers of the tendon indicating insertional tearing that appears predominantly interstitial in nature though may have small branching component that extend through both the articular and bursal surface fibers. We see no frank retraction of the supraspinatus tendon. We estimate the tear measures approximately 2 cm in the AP dimension. The supraspinatus muscle appears intact. There is thickening of the distal infraspinatus tendon indicating mild tendinosis with longitudinally increased signal intensity suggesting mild interstitial tearing. The infraspinatus muscle appears intact. The teres minor and subscapularis muscle and tendons are intact.SUPRASPINATUS OUTLET: There is mild-moderate osteoarthritis of the acromioclavicular joint with capsular hypertrophy associated with mild impression of the superior fibers of the supraspinatus. An os acromiale is present. A small amount of fluid is present in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. No joint effusion. Abnormal signal intensity within the superior labrum is compatible with a tear. The inferior labrum appears intact.BICEPS TENDON: Given limitations of a non arthrogram study, the tendon of long head of the biceps appears normal.

Output: 1.Insertional tear of the supraspinatus tendon without retraction and other rotator cuff findings as described above.2.Osteoarthritis of the acromioclavicular joint.3.Tear of the superior labrum.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is mild straightening of the lumbar curvature, alignment is otherwise maintained. Bone marrow signal is benign. There are degenerative endplate marrow signal changes including type 1 Modic changes/edema at the L5-S1 and anterosuperior L3 endplates. There is disk desiccation at all levels with moderate loss of disk height at L5-S1. The conus shows normal caliber and signal and terminates at L2, within normal limits.T11-12: No disk herniation or spinal stenosis.T12-L1: No disk herniation or spinal stenosis.L1-2: No disk herniation or spinal stenosis.L2-3: Minimal disk bulge with no significant central spinal canal stenosis or neural foraminal stenosis.L3-4: Mild disk bulge and facet arthropathy with no significant central spinal canal or neural foraminal stenosis.L4-5: Mild disk bulge, facet arthropathy and ligamentum flavum thickening with no significant central spinal canal or neural foraminal stenosis. There is mild degenerative marrow edema in the left sided articulating facets. L5-S1: Diffuse disk bulge with small posterior central/left paracentral disk protrusion and annular fissure causing no significant central spinal canal or neural foraminal stenosis.

Output: 1.Degenerative changes in the lumbar spine, relatively worse at the L5-S1 level. There is no significant spinal canal or neural foramina stenosis at any level.2.Mild multilevel facet arthropathy relatively worse at the left L4-L5 level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: Cavernous sinus meningioma follow up following radiation therapy History: Cavernous sinus meningioma follow up following radiation therapy The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of thickening of the cavernous sinuses bilaterally which is unchanged substantially since the previous exam. There is infiltration into the sella turcica and along the posterior aspect of the clivus. Enhancing tumor surrounds the pituitary gland and involves both cavernous sinuses.A burr hole is present along the right frontal bone medially. Immediately below this there is a tract of signal change within in the right superior frontal gyrus, underlying white matter and basal gagnglia presumably related to stereotactic biopsy.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: Stable enhancing lesion known to represent en plaque meningioma involving the cavernous sinuses, clivus and sella.


Instruction: Generate impression based on findings.

Input: 53-year-old female with elevated AP status post OLT 5/15 status post biliary stent placement for biliary stricture. ABDOMEN:LIVER, BILIARY TRACT: Status post orthotopic liver transplant. The vasculature is patent although the left portal vein is attenuated in appearance, unchanged. Redemonstrated is significant stenosis at the aortic graft to hepatic artery anastomosis. Unchanged small eccentric filling defect within the graft. Mild intrahepatic and extrahepatic biliary ductal dilatation with narrowing at the biliary anastomosis, traversed by interval placement of 2 internalized CBD stents extending into the right hepatic duct. Mild enhancement of the biliary walls. Fatty infiltration. SPLEEN: No significant abnormality noted.PANCREAS: T2 hyperintense cysts in the uncinate process and multiple in the body of the pancreas communicating with the main pancreatic duct compatible with sidebranch IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic left renal cyst. Small subcentimeter right cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diastases of the right oblique muscles.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Significant stenosis at the aortic graft to hepatic artery anastomosis. Quantification of the stenosis can be done by CTA if needed.2.Mild intrahepatic and extrahepatic biliary ductal dilatation with narrowing at the biliary anastomosis, now traversed by internalized stents. Mild enhancement of the biliary walls may reflect changes from recent stent placement although cholangitis can also be seen in this setting.


Instruction: Generate impression based on findings.

Input: 33-year-old male with a history of meniscal repair failure status post surgery last year in 2014. Presents with medial joint line tenderness. MENISCI: Note is made of branching linear increased signal abnormality within a fragmented/deformed posterior horn of the medial meniscus which extends into the body of the meniscus and fills with intra-articular contrast, consistent with a complex re-tear. There is mild blunting of the anterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of a partial thickness defect affecting the articular cartilage of the trochlea. No full thickness articular cartilage defects are identified.LIGAMENTS: The cruciate and collateral ligaments appear intact EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Complex re-tear of the medial meniscus as described above.


Instruction: Generate impression based on findings.

Input: 40 year old man with cutaneous amyloidosis, hypertension referred for cardiac MRI to evaluate for potential amyloid involvement of the heart. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 130 ml (normal range 142+/-34), the LV end systolic volume index is 20 ml/m2 (normal range 25+/-9), the LVESV is 40 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 111 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Gadolinium kinetics appear normal. The native T1 myocardial relaxation time in the basal, mid and apical septum is within normal limits (920-940ms).Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 69 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsRight hemidiaphragm elevation noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (EF 69%). The left ventricular function is more vigorous on today's study. There is no abnormal late gadolinium enhancement to suggest the presence of cardiac amyloidosis. Furthermore, the native T1 myocardial relaxation times are within normal limits. 2. Normal size right ventricle with normal systolic function (EF 60%).3. Unusually elevated right hemidiaphragm. Correlate with concern for diaphragmatic dysfunction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. There is a cavum septum pellucidum et vergae. There are prominent cystic areas in the frontal periventricular white matter corresponding to the questioned abnormality on recent fetal MRI. The one on the left measures up to 1.6 cm while the one on the right measures up to 1.2 cm, located along the superolateral aspect of the frontal horns, with mild mass effect on the presumed ventricular margins. These are of CSF signal intensity on all sequences. The basal cisterns remain patent. There is no midline shift or mass effect. There is irregular T1 hyperintensity, T2 hypointensity, and associated susceptibility in the supracerebellar cistern, appearing below the tentorium, felt to relate to likely subacute blood products. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Myelination appears appropriate for corrected age.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a questioned defect along the posterior aspect of the palate, which may represent a cleft palate.

Output: 1. Redemonstration of eft greater than right nonenhancing CSF signal intensity cystic structures along the superolateral aspects of the frontal horns, with mild mass effect on the adjacent ventricular margin. These are favored to represent periventricular cysts of the newborn, such as connatal or subependymal cysts, and not felt to relate to periventricular leukomalacia. Follow-up imaging may be obtained as clinically indicated.2. Prominent subacute blood products just under the tentorium in the supracerebellar cistern. While somewhat unusual in location, these may be related to subdural hemorrhage from birth.3. Cleft palate suggested. Please correlate with direct inspection.


Instruction: Generate impression based on findings.

Input: Female, 31 years old, with headaches, history of hydrocephalus and VP shunt in place. A right frontal approach ventricular catheter is redemonstrated, terminating at the level of the right lateral ventricle. T2 hyperintensity has progressed within the parenchyma surrounding the catheter as it traverses the right frontal lobe. In association with this progressive signal abnormality, there appears to be a new subcentimeter pocket of fluid surrounding a small portion of the catheter (see image 20 of series 401).The ventricles are uniformly small and, since the prior examination, the caliber of the ventricular system has further decreased. The basal cisterns remain patent.T2 hyperintensity and swelling within the body of the corpus callosum has progressed since the prior examination. Scattered additional nonspecific foci of T2 hyperintensity within the cerebral hemispheres are unchanged. No evidence of restricted diffusion is seen, though the diffusion sequences are significantly degraded by susceptibility artifact. A few scattered punctate foci of susceptibility are evident through the cerebral hemispheres compatible with microhemorrhage, but again, a large portion of the susceptibility sequence is degraded by artifact from the shunt system.

Output: 1.An area of progressive T2 hyperintensity is seen along a portion of the right frontal ventricular catheter. This is associated with a subcentimeter pocket of fluid which surrounds the catheter. Findings could represent either a reactive or an infectious process.2.Progressive signal abnormality and swelling of the body of the corpus callosum is seen. This is an occasional reported complication of shunting, though the exact etiology for it has not been established.3.The ventricular system is small in caliber and has further decreased in size and the prior MRI.


Instruction: Generate impression based on findings.

Input: 70 years, Male, history of pineal tumor, pseudogout, Rickham, third ventriculostomy. Altered mental status. Multiple sequences are motion degraded. Partially necrotic pineal tumor, status post laser ablation, is better assessed on recent post gadolinium brain MRI from 11/20/2016 but grossly unchanged. There is slight decrease in edema in the adjacent thalami and midbrain. Blood products within the tumor as well as within the ventricular system are again evident. There is no restricted diffusion to suggest acute ischemia. Again seen is a right transfrontal ventriculostomy catheter with the tip in its unchanged position in the anterior right lateral ventricle along the septum pellucidum. Mild ventriculomegaly is not significantly changed since 11/28/2016. Patency of the third ventriculostomy is not adequately assessed on the current study. Extra-axial collection along the right frontotemporal convexity measuring up to 10 to 12 mm is minimally larger. Adjacent local sulcal effacement is similar to prior. There is minimal leftward midline shift as before. No uncal herniation. T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter is not significantly changed. Right occipital lobe encephalomalacia again seen.There is nonspecific opacification of the mastoid air cells, left greater than right. Left occipital exophytic scalp nodule is again seen and can be correlated with direct examination.

Output: 1. No evidence of acute infarct.2. Partially necrotic pineal tumor, status post laser ablation, is not well assessed without contrast but grossly unchanged since 11/20/2016. Edema involving the adjacent thalami and midbrain appears minimally improved. Hemorrhage within the tumor as well as within the ventricular system again seen.3. Mild ventriculomegaly is not significantly changed. 4. Subdural collection along the right frontotemporal convexity is minimally larger in the interval.


Instruction: Generate impression based on findings.

Input: Male, 74 years old, with metastatic esophageal cancer and brain metastasis detected on outside imaging. Evaluate for radiosurgery planning. An enhancing nodule is evident within the right superior parietal lobule measuring 12 x 10 mm in the axial plane and situated at the gray-white junction. The lesion induces moderately extensive vasogenic edema in the underlying parenchyma. However, no significant generalized mass effect is seen. The lesion is not hemorrhagic.Scattered small white matter lesions are present but poorly visualized on this exam. No additional enhancing lesions are seen. No significant generalized mass effect is seen. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.

Output: Isolated metastasis in the right superior parietal lobule.


Instruction: Generate impression based on findings.

Input: Constant headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are are scattered areas of high T2 signal in the cerebral white matter bilaterally. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Probable chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 70 year old female with pulmonary sarcoidosis with chest pain and palpitations. Evaluation for cardiac involvement. First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%. The LVEDV is 93 ml (normal range 109+/-23), LV end diastolic volume index is 50 ml/m2 (normal range: 65+/-11), LVESV is 44 ml (normal range 31+/-10), and LV end systolic volume index is 23 ml/m2 (normal range 18+/-5). The LV mass is 103 g (normal range 114+/-24) and the LV mass index is 55 g/m2 (normal range 67+/-11). There is abnormal septal motion consistent with bundle branch block. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 56 ml/m2 (normal range 69+/-14), the RVEDV is 106 ml (normal range 110+/-24), the RV end systolic volume index is 21 ml/m2 (normal range 22+/-8), and the RVESV is 39 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is extensive mediastinal lymphadenopathy. There are increased lung markings/ infiltrates, as previously noted on CT. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No evidence of myocardial ischemia or infarction.2. Normal LV size with low normal systolic function (LVEF 53%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal RV size and systolic function (RVEF 63%). 4. See extracardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, 21 weeks gestational age, with abnormal prenatal ultrasound, neck teratoma suspected. A multiloculated, T2 hyperintense, predominantly cystic-appearing lesion is evident centered on the right parotid and masticator spaces. This lesion measures up to 27 x 23 x 18 mm. The lesion extends up to the floor of the middle cranial fossa but does not invade the intracranial space. There may, however, be some invasion of the temporal bone structures. Inferiorly, the lesion extends into the submandibular space. Medially, the lesion does appear to enter and encroach upon the nasopharynx. It is difficult to determine how much of the nasopharynx may be occupied by the lesion. The trachea is visualized and does not appear to be directly compressed or invaded by the lesion.

Output: A multiloculated, predominantly cystic appearing lesion is evident with the largest component centered on the right parotid and masticator spaces. Smaller lesion components are seen within the submandibular space, and it does appear that the lesion encroaches to some degree on the nasopharynx. It does not appear that the trachea is directly compressed by this lesion, but some degree of obstruction at the level of the pharynx cannot be excluded.Given the predominantly cystic appearance of this lesion, and its trans-spatial distribution, the differential diagnosis would include a lymphatic or veno-lymphatic malformation. Teratoma would also be reasonable consideration, though these typically show more discrete areas of solid tissue.


Instruction: Generate impression based on findings.

Input: 30-year-old with history of gunshot wound to the left side of the head with increased tone in spasticity with question of previous stroke and question of new seizure. A bullet or structural abnormality left in the brain. There is no evidence of intracranial hemorrhage, mass or edema. Large left-sided encephalomalacia throughout the frontal parietal and temporal lobes with ex vacuo dilatation of the adjacent ventricles. Patient appears to be status post craniotomy. No acute cortical stroke identified. If there is clinical concern for acute ischemia, an MRI may be considered.The basal cisterns are normal in size and configuration.With exception of postsurgical craniotomy the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.No evidence of retained intracranial metallic fragments.

Output: 1. Left frontoparietal and temporal extensive encephalomalacia without evidence of acute ischemia. If there is clinical concern for acute ischemia, an MRI may be considered.2. No evidence of retained intracranial metallic fragments.


Instruction: Generate impression based on findings.

Input: 57-year-old man with history of rising PSA. PELVIS:PROSTATE:Prostate Size: 63 x 43 mm.Peripheral Zone: There is a 17 x 6 mm area of T2 hypointensity and ADC abnormality (401/55 and 508/164) in the left mid gland. Additionally, in the left apex (401/46) there is a 5 x 5 mm area of T2 hypointensity and markedly ADC abnormality.Central Gland: There is a marked enlargement of the transitional zone with nodules and cystic foci impressing upon the bladder base.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: No evidence of extracapsular tumor extension.BLADDER: No significant abnormality noted.LYMPH NODES: There is a left obturator node (401/94) measuring 4 mm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Signal abnormality in the left mid gland and left apex peripheral zone suspicious for tumor.2.Left obturator lymph nodes which are nonspecific but could represent nodal metastasis.


Instruction: Generate impression based on findings.

Input: 54-year-old female with right lower quadrant pain and fluid collection. Evaluate fluid.Per EPIC, patient with history of multiple abdominal surgeries. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a loculated T1 hypointense, T2 hyperintense, nonenhancing collection in the right lower quadrant measuring 5.5 x 9.6 cm; this fluid collection extends into the left pelvis.OTHER: Sacral decubitus ulcer is noted without evidence of signal abnormality in the underlying osseous structures.

Output: 1.Findings most consistent with a right lower quadrant simple fluid collection measuring up to 10 cm.2.Sacral decubitus ulcer.


Instruction: Generate impression based on findings.

Input: The cranial-cervical junction is normal. There is hypertrophy of the atlantoaxial ligaments and loss of the normal cervical lordosis. The vertebral bodies, marrow and end plates are unremarkable. There is no evidence of fracture or spondylolisthesis. C2-3: Minimal degenerative disk disease without significant neuroforaminal or spinal canal stenosis.C3-4: Minimal degenerative disk disease and mild facet hypertrophy without significant neuroforaminal spinal canal stenosis.C4-5: Asymmetric left facet hypertrophy and uncovertebral joint hypertrophy with mild left neuroforaminal stenosis.C5-6: Moderate degenerative disk disease with right greater than left uncovertebral joint hypertrophy and facet hypertrophy. Moderate right and mild left neuroforaminal stenosis.C6-7: Hypertrophy of the posterior longitudinal ligament and right paramedian disk osteophyte complex with effacement of the anterior subarachnoid space and flattening of the cord. There is also effacement of the posterior CSF space with moderate central spinal stenosis. Moderate bilateral neuroforaminal stenosis. A punctate focus of increased T2 signal signal within the cord is seen only on the sagittal T2 weighted sequence.C7-T1: No significant neuroforaminal or spinal canal stenosis. The visualized upper thoracic spine is unremarkable. The paraspinal soft tissues are within normal limits.

Output: 1. Moderate bilateral neuroforaminal narrowing and spinal canal stenosis at C6/7 as described above with a punctate focus of increased T2 signal intensity seen within the cord only on the sagittal T2-weighted sequence.2. Additional multilevel degenerative changes and neuroforaminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Benign intracranial hypertension [G93.2], Reason for Study: ^Reason: CSF flow, h/o of Chiari History: HA, n/v Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Post suboccipital cranium activity with dominant displacement of cerebellar tonsils appear to be unchanged since prior scan.Pontine FLAIR/T2 high signal intensity lesions are again seen, unchanged since May 11 2016.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.CSF flow study shows cranial and caudal CSF flow through anterior and posterior aspect of foramen magnum as well as herniated cerebellar tonsil.Cervical spine MRIRedemonstration of suboccipital craniectomy with cerebellar tonsillar herniation, unchanged since prior scan. There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy.

Output: 1. Post suboccipital craniectomy status with bilateral cerebellar tonsilar herniation, unchanged since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion. Unchanged non specific pontine FLAIR/T2 high signal intensity lesions.3. Demonstration of cranial and caudal CSF flows through the anterior and posterior aspects of foramen magnum level.4. No evidence of syrinx of cervical spinal cord.


Instruction: Generate impression based on findings.

Input: Clinical question: Epilepsy protocol 2. Evaluate for hippocampal sclerosis. Signs and symptoms: Epilepsy since 1992. Nonenhanced brain MRI:Examination demonstrate very few punctate size post left hyperintensity on the in the subcortical white matter of cerebral hemispheres.The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. In particular there is no evidence of signal or morphological abnormality of the hippocampal region.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for age.Normal visualization of the signal void of major intracranial arterial branches.Normal signal intensity of intracranial venous sinuses.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: Nonenhanced brain MRI is within normal limits for patient's stated age. Very few nonspecific punctate foci of flair hyperintensity only in the subcortical white matter of cerebral hemispheres are identified.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with cerebral infarction. MRI brain:A segment of cortical restricted diffusion is evident within the right precentral gyrus. Several foci of restricted diffusion are also seen within the left corona radiata immediately adjacent to the lateral ventricle. The prior MRI demonstrated diffusion restricting lesions in similar areas as well.Severe encephalomalacia of the left basal ganglia, insula, operculum and periventricular white matter is seen with ex vacuo dilatation of the left lateral ventricle. Mild encephalomalacia affects the left parietal lobe and both occipital lobes. There is evidence of multiple scattered small chronic infarcts in the cerebellum. Near confluent FLAIR hyperintensity is demonstrated through much of the remaining left MCA territory, and to a lesser extent in the right periventricular white matter, both sides showing interval progression. No significant generalized edema or mass effect is seen. In fact, there is a moderate degree of generalized parenchymal volume loss. The left basal ganglia shows evidence of hemosiderin staining compatible with chronic microhemorrhage deposition. A few additional scattered small foci of chronic microhemorrhage are also seen. No evidence of acute intracranial hemorrhage is demonstrated.MRA brain:Atherosclerotic irregularity of the left cavernous ICA and left M1 MCA is seen without definite focal high-grade stenosis. The more distal left MCA branches are attenuated relative to the right, and more so than that seen on the prior MRA. No high-grade focal stenosis is detected within the visualized right MCA branches. The ACAs are likewise unremarkable. No high-grade stenosis or occlusion is suspected within the visualized posterior circulation vessels.MRA neck:Common origin of the brachiocephalic and left common carotid arteries is seen. The origins of the great vessels are patent. The carotid arteries take a tortuous, retropharyngeal course, though no significant carotid stenosis is detected by NASCET criteria. Likewise, no evidence of significant stenosis or occlusion is seen within the vertebral vessels of the neck.

Output: 1.Small areas of acute ischemia are identified involving the right precentral gyrus and the left periventricular corona radiata. Both of these territories demonstrated ischemic lesions on the prior examination as well.2.Evidence of extensive chronic ischemic injury is seen, particularly affecting the left MCA distribution, with smaller chronic lesions scattered elsewhere throughout the cerebral hemispheres. Findings compatible with chronic microvascular ischemia are also noted.3.MRA imaging of the head demonstrates a generalized attenuation of MCA vessels on the left compatible with chronic ischemic injury. No other high-grade stenosis or occlusion is suspected.4.MRA imaging of the neck shows no evidence of significant vascular compromise.


Instruction: Generate impression based on findings.

Input: Female, 57 years old. Pain. ROTATOR CUFF: There is a focal full-thickness tear of the anterior fibers of the supraspinatus tendon at their insertion on the greater tuberosity with up to 1 cm of retraction. The tear is approximately 1 cm in AP dimension. Increased signal intensity more proximally within the tendon represents mild tendinosis. There is minimal if any fatty atrophy of the supraspinatus muscle. There is a small undersurface tear of the infraspinatus tendon at its insertion on the greater tuberosity involving less than 50% of the tendon thickness. The tear itself is approximately 5 mm in diameter with cyst formation in the underlying humeral head. There is mild tendinosis of the infraspinatus tendon more proximally and perhaps minimal fatty atrophy of the infraspinatus muscle. The teres minor tendon and muscle appear normal. The subscapularis tendon and muscle appear normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal for age. There is a small amount of fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. The superior labrum appears blunted posteriorly likely reflecting degenerative tearing. The inferior labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps appears normal.

Output: Full-thickness tear of the anterior insertional fibers of the supraspinatus tendon and a small undersurface insertional tear of the infraspinatus tendon. Other findings as above.


Instruction: Generate impression based on findings.

Input: Evaluate for fractures in anticipation of surgery. ESRD on dialysis. There is loss of vertebral body height at C4 and mild posterior subluxation of C4 on C5. There is prevertebral soft tissue swelling with T2 signal hyperintensity.The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is T2 signal hyperintensity along the C3 vertebral body.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is T2 signal hyperintensity along the C3 vertebral body. The endplates are irregular at this level and there is adjacent bone T2 signal hyperintensity. There are small uncovertebral osteophytes at this level. There is mild narrowing of the right neural foramen.At C4-5 there is increased T2 disk signal associated with increased C4 and C5 vertebral body signal on T2 imaging. There are bilateral uncovertebral osteophytes and end plate osteophytes at this level. There is loss of disk space height. The endplates are irregular. There is loss of vertebral body height at C4 and mild posterior subluxation of C4 on C5. There is narrowing of the spinal canal with mild spinal stenosis and moderate bilateral exiting nerve root encroachment within the neural foramina. There is T2 signal hyperintensity along the interspinous ligaments.At C5-6 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes (right more than left) and end plate osteophytes at this level. There is loss of disk space height. There is encroachment of right exiting nerve roots. The right side of the endplates are irregular at this level and there is adjacent bone T2 signal hyperintensity. There is T2 signal hyperintensity along the interspinous ligaments.At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes (left more than right) and end plate osteophytes at this level. There is loss of disk space height. There is encroachment of left sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The left vertebral artery flow void is partly obscured.

Output: 1.Findings suggest dialysis related spondyloarthropathy at C3-4, C4-5 and the left side at C5-6 which appears worse at C4-5. The possibility of superimposed diskitis cannot be excluded. Please correlate with clinical findings.2.There is prevertebral soft tissue swelling present which is non-specific but could be inflammatory in nature.3.Degenerative changes are assocated with encroachment of exiting nerve roots on the left at C6-7, on the right at C5-6 and bilaterally at C4-54.Findings suggests left vertebral artery occlusive disease.


Instruction: Generate impression based on findings.

Input: 59-year-old male with elevated PSA, prior negative biopsy. PELVIS:PROSTATE:Prostate Size: 5.1 x 5.7 x 4.5 cm.Peripheral Zone: Midline utricle cyst measuring 8 x 8 mm (series 901, image 17). Linear T2 hypointensity throughout the peripheral zone may reflect the background of chronic prostatitis. There is a 1.2 x 1.3 cm T2 hypointense focus in the right base peripheral zone (series 901 image 17) with corresponding restricted diffusion (series 608 image 284).Central Gland: Severe degree benign prostatic hypertrophy. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Dominant lesion in the right peripheral zone base measuring 1.2 x 1.3 cm, best characterized as PI-RADS 4.


Instruction: Generate impression based on findings.

Input: 62 year old female with shoulder pain. ROTATOR CUFF: There is thickening of and intermediate signal abnormality within the supraspinatus tendon consistent with moderate tendinosis. There is also focal increased signal intensity along the undersurface fibers of the supraspinatus tendon suggesting fraying/mild degenerative tearing. We see no full-thickness rotator cuff tear. The supraspinatus muscle appears intact. There is thickening and intermediate signal intensity of the infraspinatus tendon indicating moderate tendinosis, but we see no fluid-filled tear. There is mild atrophy of the infraspinatus muscle. The teres minor muscle and tendon are within normal limits. There is thickening and intermediate signal intensity affecting the subscapularis tendon at its insertion, indicating moderate tendinosis, appearing similar to the prior study.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. No frank fluid is identified in within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint, but no frank effusion. Mild osteoarthritis affects the glenohumeral joint. Portions of the anterior labrum are not well visualized, which may represent tearing. There is mild increased signal intensity within the posterior superior labrum, which may reflect degenerative tearing.BICEPS TENDON: There is marked thickening and increased signal intensity of the tendon of the long head of the biceps within the rotator interval and at its transition to the intertubercular groove, suggestive of severe tendinosis, which may have progressed slightly when compared to the prior study. ADDITIONAL

Output: 1. Severe tendinosis of the tendon of the long head of biceps.2. Moderate tendinosis of the rotator cuff with perhaps slight progression of undersurface fraying/degenerative tearing of the supraspinatus tendon. We see no fluid-filled full-thickness tear of the rotator cuff.3. Mild osteoarthritis and other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for cord compression, disc disease, nerve root compression. New onset left leg pain Alignment is within normal limits. There is multilevel lumbar spondylosis most severely affecting L4-5, with level specific findings as described below. The imaged portions of the distal cord are normal in signal and caliber. There is some redundancy of the cauda equina which is unchanged. Multiple renal cysts are partially imaged. Additional level specific findings are as follows: T12-L1: No significant degenerative disk disease, central canal, or neuroforaminal stenosis. L1-L2: No significant degenerative disk disease, central canal, or neuroforaminal stenosis. L2-L3: No significant degenerative disk disease, central canal, or neuroforaminal stenosis. Mild hypertrophic facet degenerative changes. L3-L4: Mild disk bulge without significant central canal, or neuroforaminal stenosis. Moderate hypertrophic facet degenerative changes. L4-L5: The right paracentral disk protrusion seen on 5/2012 is decreased, with improved central canal stenosis which is now moderate. However, the degree of disk space narrowing has increased, with new extruded foraminal components. These along with moderate facet degenerative changes result in moderate-severe right and severe left neuroforaminal stenosis, increased since 2012. L5-S1: Minimal degenerative changes with minimal narrowing of both neural foramina and no significant central stenosis.

Output: 1. Severe degenerative disk disease at L4-L5. The degree of disk space narrowing has increased, with new extruded foraminal components resulting in moderate-severe right and severe left neuroforaminal stenosis which has progressed since 2012. The right paracental disk protrusion seen on the prior study has somewhat improved, now with moderate central stenosis. 2. Mild degenerative spondylosis affecting L3-L4 and multilevel facet degenerative changes otherwise appear similar to the 2012 study.


Instruction: Generate impression based on findings.

Input: Invasive squamous cell carcinoma of the supraciliary ridge. There are postoperative findings in the left supraciliary region. There is an infiltrative enhancing lesion in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion measures up to approximately 20 mm. The right orbit is unremarkable. There is moderate right maxillary sinus thickening and a subcentimeter left maxillary sinus retention cyst.

Output: Findings compatible with squamous cell carcinoma in the left supra-orbital subcutaneous tissues with extension into the left orbital roof, traversing the frontal bone along the lateral aspect of the left frontal sinus with slight epidural extension and extraconal left orbital extension. Overall, the lesion measures up to approximately 20 mm.


Instruction: Generate impression based on findings.

Input: 81-year-old female with CBD dilation and liver cysts on ultrasound. Rule out malignancy. Exam limitations are related to respiratory motion artifact and the paucity of intra-abdominal fat.ABDOMEN:LIVER, BILIARY TRACT: Few scattered simple hepatic cysts. No suspicious enhancing parenchymal lesions. There is stable tortuosity and mild dilatation of the common bile duct measuring 1.1 cm in diameter, and there is stable mild dilatation of the left intrahepatic bile duct. No obstructing lesion is identified. Elongated gallbladder containing tiny stones.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly dilated at the ampulla. No obstructing lesion is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left upper pole renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Thoracolumbar scoliosis. Artifact from lower sternotomy wire.OTHER: No significant abnormality noted.

Output: 1.There is stable tortuosity and mild dilatation of the common bile duct measuring 1.1 cm in diameter, and there is stable mild dilatation of the left intrahepatic bile duct. No obstructing lesion is identified. May be due to stricture at the ampulla.2.Few simple hepatic cysts.


Instruction: Generate impression based on findings.

Input: SEGA and cortical tubers for change: Tuberous sclerosis and seizures. There are multiple unchanged supratentorial cortical and subcortical lesions with T2 hyperintensity in predominantly linear configurations. There are also multiple unchanged heterogeneously enhancing subependymal lesions with susceptibility effect, the largest of which is located along the atrium of the left lateral ventricle that measures up to approximately 15 mm. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are small retention cysts in the left maxillary and right sphenoid sinuses.

Output: No significant interval change in the intracranial stigmata of tuberous sclerosis, including the left peritrigonal presumed SEGA and multiple zones of cortical dysplasia.


Instruction: Generate impression based on findings.

Input: History of pituitary microadenoma, now off cabergoline for over one year. Assess for change in size of the pituitary microadenoma. There is slight interval decrease in size of a focus of signal abnormality within the right pituitary lobe measures approximately up to 5 mm. There is no compromise of the optic apparatus or cavernous sinuses. The posterior pituitary bright spot is intact. The infundibulum is not thickened.

Output: No significant interval change in size of the right pituitary microadenoma.


Instruction: Generate impression based on findings.

Input: Reason: Workup for nonspecific symptoms concerning for MS History: paresthesias, weakness, fatigue. There is a small, solitary wedge-shaped T2 and FLAIR hyperintense area immediately beneath the cortex of the posterior superior right temporal lobe without associated mass effect, enhancement, susceptibility or diffusion restriction. No additional abnormal T2 signal, specifically no pericallosal lesions.There is no evidence of intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Small very peripheral right temporal T2 hyperintense region is nonspecific. The location is not typical for MS or other common demyelinating processes. This could possibly represent a prominent, although atypical, perivascular space. Otherwise, the differential is broad, including atypical demyelinating disease, sequela of prior trauma, and vasculitis among other etiologies.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: HA's that wake from sleep History: HA's waking from sleep There is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.There are localized fluid collections at the left sphenoid sinus as well as bilateral maxillary sinuses with minimal mucosal thickening on bilateral maxillary sinuses.

Output: No evidence of acute ischemic or hemorrhagic lesion.There is no mass or mass effects on this scan.


Instruction: Generate impression based on findings.

Input: Evaluate for multiple sclerosis. Spastic lower extremities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal periventricular T2 hyperintensity, which is nonspecific, but may represent small vessel ischemic disease. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of multiple sclerosis or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for etiology of chronic neck and right parascapular pain History: pain in posterior shoulder, neck and right parascapular region Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild retrolisthesis of C5 on C6. Alignment is otherwise maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Bilateral facet arthropathy.C3-4: Minimal disc bulge and ligamentum flavum thickening. Minimal spinal canal narrowing. No significant neural foraminal stenosis. Mild facet arthropathy.C4-5: No significant compromise to the spinal canal or neural foramina. Mild facet arthropathy.C5-6: Disc osteophyte complex, ligamentum flavum thickening, and uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis. There is mild right sided neural foraminal stenosis. No significant left neural foraminal narrowing.C6-7: Disc osteophyte complex, ligamentum flavum thickening, and uncovertebral hypertrophy. There is mild to moderate spinal canal stenosis. There is mild right sided neural foraminal stenosis. No significant left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina. Facet arthropathy, particularly on the left.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild multilevel degenerative changes in the cervical spine as detailed above. There is mild to moderate spinal canal stenosis at C5-C6 and C6-C7. There is mild right C5-C6 and C6-C7 neural foraminal stenosis. No high-grade neural foraminal narrowing at any level. There is also facet arthropathy at multiple levels which may be contributing to patient's neck pain.


Instruction: Generate impression based on findings.

Input: 70-year-old female with advanced stage small cell lung cancer presenting with diffuse pain. Assess for progressive neoplastic disease. CHEST:LUNGS: There is moderate centrilobular emphysema with a predominantly upper lobe distribution. Abnormal soft tissue surrounds the structures of the right hilum, representing lymphadenopathy and/or the primary tumor. This appears similar to the prior CT dated 6/4/2010.Several new nodular lesions suspicious for metastases are present in the right lung. A reference lesion in the right middle lobe (series 5, image 65) measures 0.9 x 0.8 cm.MEDIASTINUM: Enhancing mediastinal lymph nodes and right hilar lymphadenopathy remains. A reference pre-carinal lymph node (series 3, image 37) now measures 1.7 x 1.7 cm compared to 0.8 x 0.8 cm on the scan dated 6/4/2010.Coronary artery calcifications.CHEST WALL: Scattered sclerotic lesions are present in the ribs and thoracic vertebral bodies. These are not appreciably changed in comparison to the prior CT and likely reflect the patient's known diffuse osseous metastases.ABDOMEN: LIVER, BILIARY TRACT: The liver metastases appear increased in size and number in comparison to the prior CT but are not as extensive as on the scan dated 5/3/2010. The reference lesion in segment 7 (series 3 image 82) now measures 1.7 x 1.6 cm. This lesion was not clearly visible on the scan dated 6/4/2010 and measured 1.8 x 1.7 cm on the scan dated 5/3/2010.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple-appearing left renal cysts remain.RETROPERITONEUM, LYMPH NODES: Extensive aortic atherosclerosis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is heterogeneous sclerosis throughout the vertebral bodies of the cervical, thoracic, and lumbar spine as well as the bones of the pelvis -- reflecting the diffuse osseous metastases seen on the recent MRI.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: As above.OTHER: No significant abnormality noted.

Output: 1. Interval progression of pulmonary metastases and mediastinal lymphadenopathy.2. Interval progression of hepatic metastases.3. Diffuse osseous metastases.


Instruction: Generate impression based on findings.

Input: Reason: Abnormal LFTs History: Nausea; Constipation; Fatigue. History of breast cancer ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity in the right hepatic lobe, likely a cyst. Mild intrahepatic biliary ductal dilatation with pneumobilia, similar to the prior CT. Prominent common bile duct measuring 7 mm, within normal limits for age. Status post cholecystectomy. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense lesions, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right pleural effusion, unchanged.

Output: 1.No suspicious hepatic lesion or other acute abnormalities.2.Small right pleural effusion.


Instruction: Generate impression based on findings.

Input: Spina bifida with hydrocephalus, unspecified region [741.00] / Syringomyelia and syringobulbia [336.0] / Disorders of meninges, not elsewhere classified [349.2], Reason for Study: ^Reason: Chiari malformation decompression, syrinx, pseudomeningocele, 3 month follow up postoperatively. Previously seen about 15 mm sized pseudomeningocele on prior to compressive suboccipital craniectomy site is not demonstrated on today's scan. Low signal intensity lesions on both T1 and T2 weighted image on the area of pseudomeningocele resection site implying postoperative scar tissue.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. No evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Interval complete to resection status of previously seen suboccipital pseudomeningocele. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Check for possible meniscal tear. Knee injury and pain MENISCI: Menisci are largely intact bilaterally other than minimal fraying of the inner edge is observed involving the medial meniscus. Menisci specifically appear well anchored posteriorlyARTICULAR CARTILAGE AND BONE: Mild red marrow replacement with cartilage that's otherwise unremarkable, specifically no focal defects observed.LIGAMENTS: Mild overlying signal adjacent to the MCL may be related to recent partial mild sprain, however the underlying ligament is otherwise intact without significant internal signal and/or thickening. The LCL, ACL and PCL are otherwise intact EXTENSOR MECHANISM: The patellar tendon demonstrates mild redundancy with an underlying low lying patella. Mild hyper extension is partially comfortable although mild focal signal is observed within the patellar tendon just proximal to the tuberosity insertion. A mild sprain and/or a more distant remote injury is suggested in the absence of more acute findings. Extensor complex is otherwise intactADDITIONAL

Output: Mild ligamentous injury suggesting more remote sprain of the MCL and patellar ligament. Please see details provided. Specifically no discrete superimposed meniscal focal acute abnormality


Instruction: Generate impression based on findings.

Input: 12-year-old female with wrist pain. LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: Small focus of increased T2 signal and enhancement in the dorsal aspect of the hamate likely reflects a bone contusion.ADDITIONAL

Output: Small focus increased T2 signal and enhancement in the dorsal aspect of the hamate, likely reflecting a bone contusion. No evidence of synovitis or ligamentous injury, per clinical query.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, 22 weeks gestational age, with severe fetal ventriculomegaly noted on ultrasound. The lateral ventricles are dilated with measurements at the level of the atria of 18 mm on the right and 17 mm on the left. The third ventricle is mildly prominent. The fourth ventricle is within normal limits. Image quality is not adequate to assess for patency of the cerebral aqueduct.While there may be mild parenchymal thinning in the parieto-occipital regions, the gross morphology of the brain is within normal limits for gestational age. No focal parenchymal signal abnormality is suspected. The cavum septum pellucidum is not clearly visualized, though the corpus callosum is likely present. The brainstem and posterior fossa structures are within normal limits. No evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No intracranial masses are appreciated.

Output: Marked dilatation of the lateral ventricles is demonstrated with mild prominence of the third ventricle. The fourth ventricle remains within normal limits. Image quality does not allow for accurate assessment of cerebral aqueduct patency. No additional specific underlying etiology for the ventriculomegaly is identified on this examination.