Instruction: Generate impression based on findings.

Input: New lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity in the cerebral hemispheres and pons. There is no abnormal intracranial enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. The bilateral maxillary sinuses are atelectatic with mild inferior bowing of the inferior orbital wall and contain mucosal thickening and secretions.

Output: 1. No evidence of intracranial metastases.2. Mild scattered cerebral white matter T2 hyperintensity in the cerebral hemispheres and pons is nonspecific, but likely represents chronic small vessel ischemic disease.3. Findings suggestive of bilateral silent sinus syndrome.


Instruction: Generate impression based on findings.

Input: 55-year-old female with hip impingement syndrome. ACETABULAR LABRUM: There is mild globular intermediate signal within the anterior/superior acetabular labrum, without a discrete linear component or extension to the bony surface.ARTICULAR CARTILAGE AND BONE: There is redemonstration of mild osteoarthritis affecting the right hip including focal cartilage thinning along the lateral aspect of the femoral head. The sacroiliac joints appear unremarkable.SOFT TISSUES: No significant abnormality noted. Iliopsoas tendon is intact with normal signal and morphology. Adductor, gluteal, and hamstring insertions are unremarkable. There is no muscular fatty atrophy or edema.

Output: 1.Findings suggestive of a small tear of the anterior/superior acetabular labrum, without a discrete linear component or extension to the bony surface.2.Mild degenerative changes of the right hip.


Instruction: Generate impression based on findings.

Input: Right base of tongue mass seen on endoscopy and right parotid mass seen on recent CT scan. Right sided sore throat, referred pain to right ear. The submandibular glands and parotid glands are unremarkable. A heterogeneously enhancing mass centered in the right tongue base measures up to approximately 4 cm. The mass extends across midline, extends posteriorly to involve the right lateral glossoepiglottic fold, right vallecula, and epiglottis, and extends anteriorly into the root of the tongue. There is no cervical lymphadenopathy by size criteria. The thyroid gland is unremarkable. There are intact flow voids in the major neck vasculature. Moderate degenerative changes affect the cervical spine, with mild central canal stenosis from C5 to C7, but no significant neuroforaminal compromise.

Output: 1.A mass centered in the right base of tongue measures up to approximately 4 cm and likely represents a squamous cell carcinoma.2.No parotid mass is identified.


Instruction: Generate impression based on findings.

Input: History of endometrial cancer with frequent headaches. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Grossly unchanged approximately 5 mm left distal vertebral artery aneurysm.Sella and orbits are grossly within normal limits. Evidence of intraocular lens replacement. There are scattered subcentimeter paranasal sinus mucus retention cysts. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial metastatic disease. 2. Grossly unchanged approximately 5 mm left distal vertebral artery aneurysm which can be better assessed with follow-up MRA studies. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 39-year-old male with left knee pain and inability to extend knee. Evaluate for meniscus tear versus chondral injury. MENISCI: There is intrasubstance signal within the body and posterior horn of the medial meniscus indicating degeneration. Although the signal is predominantly horizontally oriented and intrasubstance in nature, it also extends in a vertical fashion to the tibial articular surface within the posterior horn, at the red-white junction, suggesting an undersurface tear. Please note that we cannot determine whether this represents an acute or chronic tear in the absence of prior imaging for comparison. We see no frank fluid signal intensity within the medial meniscus. There is attenuation of the anterior horn of the lateral meniscus which may represent prior partial meniscectomy. There is also a small defect along the free edge of the junction of the anterior horn and body of the lateral meniscus compatible with a radial tear, although it is conceivable that this could be related to prior surgery. There are also multiple vertically oriented linear foci of intermediate signal intensity within the posterior horn extending to the tibial and femoral articular surfaces compatible with multiple vertical tears, although we cannot determine whether these are acute or chronic in etiology. We see no frank fluid signal intensity within the posterior horn.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the femoral trochlea centrally suggesting mild degeneration. There is near-full-thickness to full-thickness degeneration of the articular cartilage of the lateral femoral condyle above the posterior horn of the lateral meniscus. There is slight prominence of the subchondral bone at this site which raises the possibility of prior microfracture at this location. The articular cartilage of the posterior aspect of the tibial plateau appears slightly thinned.LIGAMENTS: The patient has undergone ACL reconstruction. The ACL graft appears intact. The PCL and collateral ligaments appear intact. EXTENSOR MECHANISM: There is a defect within the central patellar tendon with associated mild deformity of the inferior patella and tibial tuberosity indicating the donor site of the patient's ACL graft.ADDITIONAL

Output: 1. Medial and lateral meniscal tears as described above. Please note that we cannot determine whether these represent acute or chronic tears without the presence of prior imaging for comparison.2. Articular cartilage degeneration as described above.3. Subcentimeter loose body within the posterior aspect of the knee.4. Postoperative changes of prior ACL reconstruction.


Instruction: Generate impression based on findings.

Input: 72-year-old male with left knee pain. MENISCI: There is a horizontal cleavage tear through the body of the medial meniscus that extends into the posterior horn of the meniscus. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss along the weightbearing portion of the medial femoral condyle and medial tibial plateau with underlying degenerative subchondral signal abnormality. There is superficial degeneration of the articular cartilage of the medial facet of the patella. There is focal full-thickness degeneration of the articular cartilage of the trochlea centrally and extending into the lateral facet. There is a small focus of degenerative subchondral signal abnormality within the patella along the lateral facet, inferiorly.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Osteoarthritis most severely affecting the medial tibiofemoral compartment.2. Medial meniscus tear as described above.3. Large joint effusion with extension into a Baker's cyst.4. Fluid collection along the myotendinous junction of the popliteus may represent a ganglion.5. Edema and mild fluid signal intensity within the subcutaneous fat anterior to the patellar tendon is nonspecific but may represent a mild bursitis.


Instruction: Generate impression based on findings.

Input: 12 years Female (DOB:7/4/2004)Reason: headache History: headache Ocular pain, right eyePROVIDER/ATTENDING NAME: MICHELE R MCKEE JULIA M HENRY MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a subcortical white matter and FLAIR signal hyperintensity redemonstrated in the right temporal lobeNo abnormal enhancing mass lesions are appreciated within the brain parenchyma. 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 only minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI orbits:The eyeballs are intact. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact.There is some infiltration of fat planes on the retro-orbital fat within the right orbit.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is reversal of the normal cervical curvature presentNo abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There is a subcortical white matter lesions and right temporal lobe which in isolation is of unknown clinical significance. It is not changed since prior exam.2.There is subtle infiltration of the retro-orbital fat in the right orbit raises the question of an infiltrating lesion such as pseudotumor of the orbit or inflammation due to other cause. It is nonspecific.3.Reversal of the normal cervical curvature could be related to patient positioning in the scan or muscle spasm. There is no compromise to cervical spinal canal or exiting nerve roots appreciated.


Instruction: Generate impression based on findings.

Input: 57 year old woman with HIV and NSVT, prior syncopal episode, referred for evaluation of underlying structural abnormalities or fibrosis. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 85 ml/m2 (normal range: 65+/-11), the LVEDV is 153 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 78 g/m2 (normal range 67+/-11), and the LV mass is 140 g (normal range 114+/-24). There is mild concentric left ventricular hypertrophy. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No evidence of myocardial iron overload. The native myocardial T1 time is borderline elevated (1,088ms).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 96 ml/m2 (normal range 69+/-14), the RVEDV is 175 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 70 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is mild systolic anterior motion of the mitral leaflets with evidence of mild flow acceleration in the left ventricular outflow tract. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate 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 mild-moderately dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 73%. There is mild concentric left ventricular hypertrophy without evidence of underlying replacement myocardial fibrosis, inflammation, or infiltration. No evidence of myocardial iron overload. The native myocardial T1 time is borderline elevated suggesting the presence of early interstitial fibrosis, likely related to the left ventricular hypertrophy. 2. The right ventricle is normal in size with normal systolic function . The overall RV ejection fraction is 60%.3. There is mild systolic anterior motion of the mitral leaflets with evidence of mild flow acceleration in the left ventricular outflow tract. 4. Mild to moderate dilation of the main pulmonary artery.5. Mild right atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 18 year-old male with anterior pain and stiffness four months post trauma, evaluate for talar dome lesion TENDONS: The extensor and flexor tendons appear intact.LIGAMENTS: Few strands of the ATFL are visualized, which is at least partially torn. The anterior and posterior inferior tibiofibular ligaments are intact. ARTICULAR SURFACES AND BONE: There is increased patchy increased signal within the body of the talus, navicular, and medial cuneiforms without discrete fracture. The talar dome appears within normal limits.ADDITIONAL

Output: 1. At least partial ATFL tear.2. The talar dome appears intact without focal lesion.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. 12/21/2015 Right apex lateral 3+4 2mm 10%. PELVIS:PROSTATE:Prostate Size: 3.5 x 5.9 x 5.1 cmPeripheral Zone: Poorly defined T2-weighted hypointense lesion in the right lateral mid-gland/apex (series 901/14) with associated restricted diffusion measuring 8 x 6 mm (series 1004/224). This is contiguous with a 1.4 x 1.1 cm focus of T2-weighted hypointensity and mild restricted diffusion extending towards the base without associated enhancement.Wedge-shaped T2-weighted foci in the right and left apex para-medially are well encapsulated without definite restricted diffusion or post-contrast enhancement.Central Gland: BPHSeminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right lateral mid gland/apex lesion abuts the prostatic boundary without definite extracapsular extension. BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific 5 mm left pelvic wall lymph node. No enlarged pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 8 mm right mid-gland/apex lesion and 1.4 cm right base lesion are suspicious for prostatic adenocarcinoma. Non-specific T2 weighted hypointense foci in the apex without restricted diffusion or abnormal enhancement.The right base lesion abuts the prostatic margin without definite extraprostatic extension. No enlarged pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Right wrist mass The exam is limited by motion artifact and inhomogeneous fat saturation. Tendons: The extensor tendons are intact. The flexor tendons are intact. There is no tenosynovitis.Ligaments: The scapholunate ligament is intact. The lunotriquetral ligament is intact. The triangular fibrocartilage complex is intact.Joints: There is no dislocation or subluxation. There is no joint effusion. There is no significant arthrosis.Muscles: There is no muscle tear or atrophy of the flexor or extensor compartments.Bone marrow: The bone marrow signal is normal. There is no fracture or contusion. There is no marrow replacing lesions.Soft tissues: A vitamin E marker was used due to indicate the mass in question. Within the ulnar soft tissues of the distal forearm is a well-defined mass which measures 1.4 x 1 x 2 cm in greatest transaxial and craniocaudal dimensions. The mass follows fat signal characteristics on all sequences and following contrast does not demonstrate internal enhancement. Inhomogeneous fat saturation likely accounts for the signal discrepancies on fat saturated sequences. No additional soft tissue masses are identified.

Output: Soft tissue mass within the ulnar soft tissues consistent with simple lipoma. Remaining evaluation of the wrist is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: MS, follow-up progression. History of paresthesias. There are several punctate and curvilinear T2/flair hyperintensities demonstrated in the periventricular and subcortical white matter which are unchanged in size, appearance, and location compared to the prior MRI. A stable punctate T2/flair hyperintensity is noted within the left superior pons. No new lesions are identified. There is no evidence of intracranial hemorrhage or mass. The pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in size and number of scattered T2/FLAIR hyperintensities seen in the subcortical and periventricular distribution, compatible with history of demyelinating disease.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right acromioclavicular joint was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 22-gauge needle was advanced into the joint. Attempted aspiration yielded minimal straw-colored fluid. Next, 5 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 33 seconds

Output: Successful injection of the right AC joint for MR arthrogram. Please refer to the subsequent MRI report for further information.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with history of neurofibromatosis type I, presenting with low back pain, unable to stand for prolonged periods, prior tumor of the buttocks. Also presenting with migraines, strabismus, Chiari, double vision, with midbrain tumor. Brain:A T2 hyperintense nonenhancing lesion is evident within the midbrain measuring 21 x 18 mm in the axial plane (image 12 series 21) and up to 15 mm in the coronal plane (image 22 series 22). This lesion expands the midbrain to a mild degree and may cause some narrowing of the cerebral aqueduct. No significant interval change is seen when comparison is made to prior exams.A nonspecific 4 mm focus of T2 hyperintensity is seen within the right superior frontal gyrus. No other significant parenchymal signal abnormality is seen. No pathologic parenchymal or extra-axial enhancement is noted. There are no abnormal extra-axial fluid collections and no findings to suggest acute intracranial hemorrhage. The ventricular system remains within normal limits for size. The cerebellar tonsils descend 2 to 3 mm below the level of the foramen magnum. Although not a dedicated orbital examination, no definite lesions are seen within the orbits or along the optic apparatus. A 2 mm focus of hypoenhancement within the posterior pituitary is nonspecific and was probably present on the prior examination.Lumbar:There is a mild levocurvature of the lower lumbar spine. Sagittal alignment is otherwise unremarkable.Vertebral bodies are diffusely narrowed in the AP dimension but otherwise show normal morphology and signal characteristics. A transitional L5 vertebral body is noted.The visualized distal spinal cord and conus are unremarkable. The conus tip terminates at the L1 level which is within normal limits. The nerve roots of the cauda equina are evenly distributed through the thecal sac. Note is made of marked ectasia of the thecal sac in the sacral region with ectatic extension into the sacral foramina. No definite evidence of any foraminal or intracanalicular tumor is seen.No evidence of significant disc bulging or disc herniation is seen. Facet hypertrophy is noted at L4-5 and L5-S1. However, no significant spinal canal or neuroforaminal stenosis is seen at any level.Diffuse abnormal T2 signal is seen in the right gluteal region, partially visualized on this examination and perhaps related to prior surgery. Numerous cutaneous and subcutaneous nodules are evident compatible with neurofibromas.

Output: 1.A nonenhancing masslike lesion within the midbrain shows no significant interval change in size from prior exams. This lesion mildly expands the brainstem and may encroach upon the cerebral aqueduct, though the ventricular system remains within normal limits. The cerebellar tonsils are mildly low-lying, similar to prior.2.Elsewhere in the brain, no concerning lesions are seen. A nonspecific focus of signal abnormality is unchanged in the right superior frontal gyrus. Likewise, a nonspecific focus of hypoenhancement in the posterior pituitary was evident on prior examinations and can be better assessed with dedicated imaging if clinically warranted.3.Marked ectasia of the thecal sac is seen in the region of the sacrum, similar to prior.4.No evidence of any intracanalicular or foraminal tumor is seen. No significant compromise of the spinal canal or neural foramina is noted.


Instruction: Generate impression based on findings.

Input: Personal history of other diseases of the circulatory system [Z86.79], Reason for Study: ^Reason: evaluate for aneurysm History: headache Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan. A small foci of susceptibility lesion on the right frontal lobe is likely represent prior ventriculostomy tube track, unchanged since prior 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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal except the distal right vertebral artery area cannot be evaluated due to metallic artifacts.Neck MRA2D and 3D TOF MRA neck images with maximum intensity projections of the cervical vasculature were obtained. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Aortic arch and proximal portion of major arteries including bilateral vertebral artery ostia are not well visualized.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of intracranial arterial aneurysm.3. No evidence of extracranial arterial luminal stenosis.4. Metallic artifacts on the right distal vertebral artery consistent with prior surgical clipping.


Instruction: Generate impression based on findings.

Input: 25 year old female with MRI findings of subtalar joint coalition. Assess middle facet coalition versus trauma from old fracture.IMAGE ACQUISITIONS: CT examination of the right foot, noncontrast Again seen is the abnormal articulation of the middle facet of the subtalar joint. The middle facet is more vertically oriented than normal with mild atrophy of the sustentaculum. Additionally, there is slight subchondral sclerosis and cyst formation at this joint. It is unclear whether these findings are secondary to fibrous coalition or prior trauma.Small ossicles are again seen distal to the lateral and medial malleoli, compatible with post traumatic sequelae. Please refer to report for recent MRI for further evaluation of soft tissue pathology.

Output: Reidentification of the abnormal articulation at the medial facet of the subtalar joint which again may be secondary to old trauma versus fibrous coalition.


Instruction: Generate impression based on findings.

Input: MRI BRAIN:There is no restricted diffusion to suggest acute infarct. Evidence of prior right frontal ventriculostomy catheter noted. Minimal intraventricular blood products. There are multiple T2/FLAIR hyperintense foci in the subcortical and periventricular white matter compatible with mild-to-moderate chronic small vessel ischemic changes. There is no midline shift. The ventricular size is stable. There is no abnormal enhancement. There is extensive susceptibility effect along the surface of the brainstem, cerebellum, and along the basal cisterns and sulci consistent with superficial siderosis related to prior subarachnoid hemorrhage.Perfusion images demonstrates prolonged mean transit time in the right anterior cerebral hemisphere.MRA BRAIN:The MRA is degraded by motion artifacts.There is nonfilling of the previously coiled aneurysm in the right P-comm artery.There is mild narrowing of the bilateral cavernous segments of the internal carotid arteries, right worse than the left, without flow-limiting stenosis. The right A1 is diminutive. Otherwise there is no flow-limiting stenosis in the intracranial circulation.

Output: 1. No evidence of acute infarct or intracranial mass effect.2. Diffuse superficial siderosis consistent with history of subarachnoid hemorrhage.3. There is mild narrowing of the bilateral cavernous internal carotid arteries, right worse than the left, without flow-limiting stenosis. The right A1 is diminutive, which may be related to hypoplasia with superimposed stenosis. Otherwise there is no flow-limiting stenosis in the intracranial circulation. The perfusion images demonstrate prolonged mean transit time in the right anterior cerebral hemisphere. This finding may be related to be the mild cavernous right internal carotid stenosis and diminutive right A1 segment; however consider vascular imaging of the neck to exclude higher grade proximal right carotid stenosis. MRA otherwise demonstrates no flow-limiting stenosis in the intracranial situation.4. Nonfilling of the previously coiled aneurysm in the right P-comm.


Instruction: Generate impression based on findings.

Input: Reason: spinal cord ganglioglioma, resection,multiple non-enhancing nodular lesions within the lateral ventricles, suprasellar cistern, and cisterna magna. History: 6 month follow up evaluation for changes, left arm weakness. MRI Brain: There are stable findings related to suboccipital craniotomy. There are several unchanged nonenhancing T2 hyperintense nodules along the septum pellucidum, lateral margin of the left ventricle, in the suprasellar cistern, and along the dura of the cisterna magna. There is no acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The scalp soft tissues and orbits are unchanged. Cervical Spine: There are stable findings related to suboccipital craniotomy and posterior arch of C1 resection for posterior fossa decompression and laminoplasty from C2 through T1. There is no significant interval change in the exophytic enhancing tumor along the ventral aspect of the spinal cord at the C4 through C6 levels, which measures up to 23 mm. There is volume loss of the cervical cord between the craniocervical junction and C4-5. There is also a stable syrinx in the upper cervical spinal cord that measures up to 2 mm in width. There is unchanged loss of the usual cervical lordosis. The vertebral body heights are preserved. There is no significant spinal canal stenosis. The paraspinal soft tissues are unchanged.Thoracic Spine: There is no significant change of the syrinx that extends from C7 through T5, which measuring up to 2 mm in width. The diffuse contour deformity of the spinal cord is also unchanged. There is normal alignment of the thoracic spinal column. The vertebral heights are preserved. There is no significant spinal canal stenosis. The paraspinal soft tissues are unchanged.

Output: 1.Stable enhancing mass associated with the ventral aspect of the cervical cord, as well as multiple non-enhancing nodular intracranial lesions, which may represent metastases.2.No significant change in the cervicothoracic syringohydromyelia.


Instruction: Generate impression based on findings.

Input: 20-year-old male with elbow pain. Evaluate ulnar nerve and medial elbow. LIGAMENTS: The ulnar collateral ligament appears intact. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: The flexor and extensor tendons appear intact. Heterogeneity of the common flexor tendon at the level of its insertion likely represents a combination of postoperative changes and tendinosis. There are linear foci of signal void along the medial aspect of the medial epicondyle likely representing postsurgical changes. No fluid-filled tear is identified. The triceps tendon appears intact. The biceps and brachialis tendons are normal in appearance.ARTICULAR SURFACES AND BONE: There is a focus of decreased signal abnormality within the medial epicondyle of the humerus likely representing a prior screw tract. There is a focal articular cartilage defect along the capitellum, posteriorly, that likely represents a normal anatomic variant. SURROUNDING STRUCTURES: The imaged musculature of the left elbow is normal in appearance.ADDITIONAL

Output: Postoperative changes about the common flexor tendon as described above. No evidence of disruption of the intrinsic ligaments of the elbow, as clinically questioned. More specifically, the ulnar collateral ligament appears intact.


Instruction: Generate impression based on findings.

Input: Male; 55 years old. Reason: Right renal mass, evaluate for change in size or metastatic disease. Abdomen:LIVER, BILIARY TRACT: Solitary focus in the right liver demonstrates low T1 and increased T2 signal with diffusion restriction and persistent enhancement on postcontrast sequences. Findings are suggestive of a flash-filling hemangioma. No additional hepatic lesions or biliary ductal dilatation. SPLEEN: Status post splenectomy. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic right lower pole renal nodule measures 11 mm and demonstrates increased T1 signal but low T2 signal and no diffusion restriction or enhancement (series 7, image 31). Findings are most compatible with a proteinaceous or hemorrhagic cyst. Scattered simple cysts are also noted bilaterally. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small septated right pleural effusion with pleural thickening, bronchiectasis and basilar atelectasis/scarring. Please see chest CT report from October 2014 for further details. Pelvis:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Imaging findings compatible with hemorrhagic or proteinaceous cyst in the right kidney as described above. 2.T2 hyperintense right liver lesion demonstrating persistent enhancement is suggestive of a flash-filling hemangioma. 3.Small septated right pleural effusion with basilar bronchiectasis and scarring, for which correlation with recent prior chest CT reports is suggested.


Instruction: Generate impression based on findings.

Input: Reason: Patient with possible seizure please look for structural abnormality History: as above. There is confluent T1 hyperintensity involving the bilateral basal ganglia and thalami. There are multiple foci of susceptibility effect within the basal ganglia as well as the subcortical regions of the bilateral frontal lobes, which are abnormal and may represent mineralization or calcification. There is an additional focus of susceptibility in the left frontal corona radiata.No associated periventricular nodules or parenchymal signal abnormalities to suggest cortical tubers. No evidence of intracranial mass or mass effect. No findings to suggest cortical malformation, gray matter heterotopia, or other structural abnormalities to suggest seizure focus. Hippocampi appear symmetric and signal in size. The ventricles and sulci are normal in size. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There is mild mucosal thickening of the left maxillary sinus.

Output: Multiple foci of susceptibility effect in the subcortical white matter, particularly in the frontal lobes. Additional foci of susceptibility effect are seen in the left frontal corona radiata and basal ganglia. There is also abnormal T1 hyperintensity in the bilateral basal ganglia and thalami. The constellation of findings raises possibility of metabolic/endocrine disease with resulting mineralization/calcification producing the aforementioned susceptibility effect. CT can better confirm/assess extent of calcifications. Other differentials include prior infection or ischemic injury although no volume loss to support the latter.


Instruction: Generate impression based on findings.

Input: Patient presenting with bilateral upper extremity tremor, evaluate. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are punctate foci of T2/FLAIR hyperintensity in the subcortical and periventricular deep white matter, which are nonspecific but suggestive of chronic microvascular ischemic disease. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Punctate foci of T2/FLAIR hyperintensity in the subcortical and periventricular deep white matter, which are nonspecific but suggestive of chronic microvascular ischemic disease.


Instruction: Generate impression based on findings.

Input: 90 year-old female with past medical history of ESRD on hemodialysis, end hypertension. Presents with new, right lid ptosis and concern for TIA. There is no evidence of intracranial hemorrhage, mass or edema. Multiple patchy areas of hypodensity in a periventricular and subcortical distribution consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

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


Instruction: Generate impression based on findings.

Input: 23 years, Female, with headache for 3 years. Brain parenchyma appears within normal limits. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Ventricles are within normal limits. No extra-axial collections. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: Unremarkable brain MRI


Instruction: Generate impression based on findings.

Input: 8-year-old male with history of laceration to mid body/tail of pancreas, blunt abdominal trauma. Elevated amylase and lipase. EXAMINATION: MRCP without and with IV contrast 12/02/16 ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesion is identified. No intrahepatic or extrahepatic biliary ductal dilatation. No evidence of cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Decreased T1-weighted signal and increased T2 weighted signal of the distal body and tail of the pancreas, distal to the known laceration, and compatible with inflammation. On contrast enhanced images, there is heterogeneous pancreatic parenchymal enhancement with relatively increased enhancement of the distal body and tail. The main pancreatic duct appears dilated distal to the laceration with visualization of a few dilated side branches.Small amount of peripancreatic fluid. No loculated intraparenchymal or peripancreatic fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Stricture of the main pancreatic duct at the site of injury, with dilatation of the duct distally.2. Pancreatitis of the tail, distal to the site of injury. Small amount of peripancreatic fluid.


Instruction: Generate impression based on findings.

Input: Status post tonsillectomy and neck drainage now with fevers and increased WBC's. Evaluate for abscess. There are postoperative findings related to bilteral tonsillectomy and left deep neck incision and drainage with decrease in inflammatory changes since the prior CT. There is minimal fluid that may represent oropharyngeal secretions and residual soft tissue thickening along the left pharyngeal wall and the previously demonstrated left pharyngocutaneous fistulous tract is less conspicuous compared to the prior CT, accounting for differences in techniques. However, there is no evidence of residual drainable fluid collections within the neck soft tissues, although evaluation for abscess is limited by lack of intravenous contrast. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands appear unremarkable. The major cervical vessels demonstrate normal flow voids. The osseous structures are unremarkable. The imaged intracranial structures and orbits are unremarkable. There is mild mucosal thickening in the maxillary sinuses.

Output: Postoperative findings related to bilateral tonsillectomy and left deep neck incision and drainage with minimal probable oropharyngeal secretions and residual mucosal thickening along the left pharyngeal wall. Likewise, the previously demonstrated left pharyngocutaneous fistulous tract and surrounding inflammatory changes are less conspicuous, accounting for differences in techniques. However, the evaluation is somewhat limited by lack of intravenous contrast, acknowledging the patient's renal insufficiency.


Instruction: Generate impression based on findings.

Input: Worsening left eye ptosis and possible fungal infection. Orbits: There is focal high T2 signal and enhancement in the right medial rectus muscle, left superior rectus-levator complex, There are also focal enhancing lesions in the right temporal fossa, left masticator space, along the levator labii superioris in the right medial check, and possibly the right frontal scalp, along the frontalis muscle. Some of the lesions display a punctate area of central non-enhancement.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable.

Output: 1. Multifocal lesions involving the bilateral extraocular muscles, as well as several other maxillofacial muscles. These lesions may represent an infectious process, such a disseminated fungal disease, possibly with microabscesses, or perhaps a manifestation of leukemia.2. Paranasal sinus inflammatory changes with secretions that could represent fungal disease. 3. No evidence of acute intracranial abscess or tumor.


Instruction: Generate impression based on findings.

Input: Diagnosis: Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus. Headache(784.0)Clinical question: Eval for sarcoid lesionsSigns and Symptoms: headaches MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:The pituitary gland is appropriate in overall height. There is asymmetry in the appearance of the pituitary gland with a 3mm lesser enhancing focus along its left inferior aspect. There is a scalloped appearance to the adjacent bone. The infundibulum of the pituitary gland is midline and within normal limits.. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.

Output: 1.No abnormal lesions are appreciated intracranially that are suggestive of neurosarcoid. The infundibulum of the pituitary gland is within normal limits.2.There is some asymmetry in the appearance of the pituitary gland which is nonspecific with a 3mm lesser enhancing focus along the left half of the pituitary gland. This is non-specific. Please correlate with patient's endocrine findings.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with a left parotid gland mass increasing in size over three weeks, with pain and weight loss. A slightly heterogeneous, mildly enhancing mass is evident at the left parotid tail measuring 28 x 23 x 25 mm. Multiple similar-appearing but smaller nodules are evident adjacent to the dominant lesion.The lingual tonsillar tissues are slightly prominent but this may reflect normal variation. The aerodigestive mucosa is otherwise unremarkable. The remaining salivary glands are unremarkable. The thyroid as partially visualized is free of obvious focal lesions. Marrow signal characteristics are unremarkable.

Output: A mass is evident at the tail of the left parotid gland with multiple smaller surrounding nodules which may represent lymph nodes. Findings are concerning for a malignant process. This could reflect a primary parotid neoplasm with adenopathy or perhaps lymphoma.


Instruction: Generate impression based on findings.

Input: Reason: R hip pain s/p fall, labral tear? History: R hip pain s/p fall ACETABULAR LABRUM: Linear defect through the anterior superior labrum is consistent with tearing and appears similar to that seen on the prior study. There also appears to be a tear of the anterior superior labrum on the contralateral side.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Bilateral anterior superior labral tears as above.


Instruction: Generate impression based on findings.

Input: Only dementia. Myoclonus, concern for normal pressure hydrocephalus versus subdural fluid collection. No evidence of acute ischemic or hemorrhagic lesion.Minimal to mild diffuse brain atrophy.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Minimal to mild diffuse brain atrophy.No abnormal enhancement. No mass.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, with pain in the right thigh and knee on walking, improved with rest. Spinal alignment is anatomic. Marrow signal characteristics are slightly heterogeneous but predominantly fatty replaced. No evidence of marrow edema is seen.Central endplate concavity is seen inferiorly at L1, inferiorly at L2, and superiorly at L5. A generalized compression deformity of the T12 vertebral body with approximately 30-40% loss of vertebral body height and trace retropulsion is seen, but there is no evidence of marrow edema. The visualized distal spinal cord, conus and cauda equina are unremarkable.Hyperintense T1/T2 signal within the T10-11, T11-12 and L1-2 intervertebral discs may represent disc mineralization. Level specific degenerative findings are as follows:L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Minimal bulging disc. No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Minimal bulging disc. No significant spinal canal. Mild bilateral foraminal narrowing. L4-5: Facet hypertrophy. Ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Minimal bulging disc. No significant spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. Within the lumen of the aorta at the T12 level, an area of undulating irregular signal density is seen (see image 1 series 8).

Output: 1.Degenerative findings but no significant spinal canal stenosis.2.Scattered mild-to-moderate foraminal narrowing.3.Scattered central endplate cavities are noted as well as generalized compression deformity of the T12 vertebral body which is likely chronic.4.Incidental note is made of undulating irregular signal within the aortic lumen at the T12 level. This could potentially be artifactual but dedicated vascular imaging can be considered to exclude true vascular pathology.


Instruction: Generate impression based on findings.

Input: 54-year-old female with pancreatitis and hyperbilirubinemia and elevated transaminases ABDOMEN: Significant motion artifact limits evaluation of the pancreatic parenchyma. LIVER, BILIARY TRACT: Marked intrahepatic and extrahepatic biliary ductal dilatation. Common bile duct measures up to 16 mm in diameter with filling defect in the distal CBD. The gallbladder is normal in appearance. No cholelithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Atrophic and calcified (calcifications better delineated on prior CT) pancreatic parenchyma with significantly dilated main pancreatic duct in body/tail, findings consistent with chronic pancreatitis. Pancreatic divisum anatomy is noted. There are filling defects noted within the main pancreatic ducts compatible with stones (55/7). There is mass-like enlargement of the pancreatic head with equivocal diffusion restriction. No definitive abnormal enhancement pattern is present but evaluation is suboptimal due to extensive motion artifact. Multiple T2 hyperintense foci arising from the main duct in the setting of chronic pancreatitis most likely related to sidebranch ectasia. Clustered subcentimeter increased T2 signal foci at the pancreatic head and neck (series 5, image 19).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with acute on chronic pancreatitis at level of pancreatic head. No definite enhancing lesion is noted in the pancreatic head however the exam is severely limited secondary to motion artifact and a small lesion cannot be entirely excluded. Correlation with results of recent endoscopic ultrasound exam recommended. 2.Clustered subcentimeter increased T2 signal foci at the pancreatic head and neck. Differential includes septated IPMN, interdigitating fluid, or possibly serous cystadenoma. 3.Severe intrahepatic and extrahepatic ductal dilation, and pancreatic duct dilation with sidebranch ectasia. Small stones in the main pancreatic duct and the distal CBD suspected to contribute to aforementioned significant duct dilation. Underlying ductal stricturing not entirely excluded.


Instruction: Generate impression based on findings.

Input: Pain in the right knee. Exam limited with only 2 projections provided.There is mild osteoarthritis, as demonstrated by mild medial joint space narrowing and osteophyte. Additionally, the lateral projection mild flattening of the anterior aspect of the medial condyle raising concern for a questionable underlying cartilage abnormality. An MRI would be helpful if further characterization is needed clinically.There is a 4 mm round calcific density in the posterior aspect of the joint. A loose body ossicle in this limited two-view study.Lastly, there are no lytic or blastic lesions in this limited two-view study given the relayed history.

Output: Mild osteoarthritis and possible loose body of the right knee with a questionable anterior defect of the medial condyle, MRI would be helpful for characterization.


Instruction: Generate impression based on findings.

Input: postoperative epidural hematoma evaluation Limited exam due to significant metallic artifacts from L2 to L5.Extensive soft tissue swellings likely related to recent operation.Evaluation of epidural space is not possible due to metallic artifacts.Thus, examination has been cancelled after T1 and T2 sagittal scans.

Output: Incomplete examination with significant metallic artifacts due to instrumentations from L2 to L5 with extensive soft tissue swelling. However, the scan has been cancelled after T1 and T2 sagittal scans due to metallic artifacts related non diagnostic images.However, above (above T12 level) and below (L5 level) the extent of the instrumentations, spinal cord appears to be normal in shape and signal intensity and spinal canal appears to be normal.


Instruction: Generate impression based on findings.

Input: Prolactinoma, history of brain cyst. Neck pain, back pain. MRI PITUITARY: There is expansion of the sella which is filled with CSF signal. There is enhancing soft tissue involving the sella anteriorly which likely represents normal pituitary gland which is anteriorly displaced. The small size of the pituitary gland limits assessment for pituitary microadenoma. There is however no appreciable micro or macro adenoma or any other suspicious sellar mass. There is minimal smooth enhancement involving the margin of the sella posteriorly and inferiorly. No mass effect on the optic chiasm. Infundibulum is midline. MRI CERVICAL SPINE: Examination is slightly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign.The cervical spinal cord has normal signal characteristics and overall morphology.Minimal degenerative changes are seen in the cervical spine with multilevel disc desiccation. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: Minimal disc osteophyte complex with effacement of the ventral thecal sac. No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.MRI LUMBAR SPINE:Examination slightly motion degraded. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. Fatty endplate changes are seen at the superior T12 level likely on a degenerative basis. The conus medullaris is normal in position.Individual levels as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild to moderate facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild to moderate facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Smooth expansion of the sella which is filled with CSF, and the pituitary gland is anteriorly displaced. Findings are compatible with a partially empty sella with suggestion of arachnoid cyst, although no perceptible cyst wall is appreciated. No prior MRI is available for comparison. There is no mass effect on the optic chiasm. There are no suspicious lesions involving the sella or evidence of microadenoma or macroadenoma.2. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.3. Mild degenerative changes in the lumbar spine without significant spinal canal or neural foraminal stenosis at any level. There is facet arthropathy at L4-L5 and L5-S1 which may be contributing to patient's back pain.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with history of multiple sclerosis and ataxia. Brain:Extensive, confluent T2 hyperintensity is evident within the juxtacortical and periventricular white matter of the cerebral hemispheres. Lesions are associated with moderate to marked T1 hypointensity. Lesions in the pons and cerebellum are much more subtle. Marked callosal thinning and generalized cerebral volume loss is noted with corresponding ventricular prominence. No abnormal fluid collections are seen.C-spine:Patchy ill-defined T2 hyperintensity is evident throughout the visualized cervical spinal cord. A more focal appearing T2 hyperintense lesion dorsally at C6-7 could represent a small area of cystic degeneration or simply a more circumscribed lesion. A small focal central disc osteophyte complex at C3-4 mildly impinges on the spinal cord. A small focal central disc osteophyte complex at C6-7 is present without cord impingement. No significant foraminal narrowing is detected.

Output: Evidence of extensive long-standing demyelinating disease is seen in the brain and in the visualized spinal cord.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: Assess for presence of osteomyelitis secondary to interdigital wounds on right foot/toes History: Right foot interdigital wounds, pain, swelling, erythema There is a thin concentric collection of nonenhancing fluid in the subcutaneous fat lateral to the interphalangeal joint of the great toe which presumably represents an interdigital wound, perhaps with a thin subcutaneous draining abscess. Small rounded foci of signal abnormality in the head of the proximal phalanx of the great toe likely represent cysts or perhaps chronic erosions but we see no edema to suggest osteomyelitis.There are additional foci of nonenhancing fluid signal intensity in the web spaces between the first and second toes and third and fourth toes representing interdigital wounds with extension into the underlying soft tissues. Enhancement of the surrounding soft tissues indicates inflammation but there is no marrow signal abnormality to indicate osteomyelitis. There is additional soft tissue edema along the dorsum of foot.

Output: Interdigital wounds with soft tissue extension as described above but no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Acute onset of dizziness, unsteadiness and difficulty with word finding. Images through posterior fossa are unremarkable.Images through supratentorial space demonstrate findings consistent with small vessel disease of indeterminate age. No evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Considering provided clinical data an MRI examination is recommended.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Clinical question: 60-year-old female with left lateral leg and foot numbness that courses with walking. Eased with sitting. Mild back pain. Signs and symptoms: Back pain, left leg radicular symptoms. Nonenhanced lumbar MRI:Examination at T11-T12 through L2-L3 levels are unremarkable with the exception of mild degenerative changes.L3-4 demonstrate moderate disc disease and loss of disc height, and mild bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is a far lateral broad-based shallow disc protrusion on the right with resultant mild right neural foraminal and lateral recess compromise. No spinal stenosis.L4-L5 demonstrate mild disc disease and loss of disc height, shallow asymmetric right-sided lateral and far lateral bulging disc with resultant moderate right neural foraminal compromise without central spinal stenosis and patent left neural foramina.L5-S1 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet hypertrophy changes and mild bilateral ligamentum flavum hypertrophy. There is no central spinal stenosis however severe left neural foraminal and mild left lateral recess compromise is present. Right neural foramina remains patent.Visualized SI joints demonstrate no significant degenerative changes.There is spinal soft tissues are unremarkable.

Output: 1.Degenerative changes of lumbar spine primarily at L5-S1 level and to a lesser degree at L4-L5 and L3-4 levels are present.2.There is no evidence of central spinal stenosis at any level.3.Multilevel neural foraminal and lateral recess compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: Right lower extremity pain and weakness. Evaluate for spinal canal and neural foraminal stenosis. Please note for the purposes of numbering there are 5 nonrib-bearing lumbar type vertebral bodies and a 6th transitional segment labeled L6. There is mild depression involving the superior endplate of L2 and unchanged from prior CT from 2/25/2010. Vertebral body heights are otherwise within normal limits. There is heterogeneous bone marrow signal without discrete suspicious lesions. There is grade 1 anterolisthesis of L4 and L5 and minimal anterolisthesis of L5 on L6. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Disc bulge and ligamentum flavum thickening. No spinal canal or right neural foraminal stenosis. Mild left neural foraminal narrowing.L2-L3: Disc bulge with ligamentum flavum thickening and mild spinal canal stenosis. Mild bilateral neural foraminal narrowing.L3-L4: Disc bulge, ligamentum flavum thickening with mild to moderate spinal canal stenosis. Mild bilateral neural foraminal narrowing.L4-L5: Disc uncovering and disc bulge, anterolisthesis, facet arthropathy, and ligamentum flavum thickening. There is resulting severe spinal canal stenosis, moderate right and severe left neural foraminal stenosis.L5-L6: Disc uncovering and disc bulge, advanced bilateral facet arthropathy, anterolisthesis, and ligamentum flavum thickening. There is resulting moderate spinal canal stenosis. There is mild bilateral bilateral neural foraminal narrowing. L6-S1: Transitional anatomy with articulation with the sacrum greater on the left than the right. No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Please note for the purposes of numbering, there is transitional anatomy with nonrib-bearing 5 lumbar type vertebral bodies and a transitional segment labeled L6.2. Advanced degenerative changes in the lumbar spine with severe spinal canal stenosis at L4-L5 and to a lesser degree at L5 -L6 and L3-L4. Neural foraminal narrowing as detailed above, worst at L4-L5 where there is severe left and moderate right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Other speech disturbance Clinical question: acute ischemic strokeSigns and Symptoms: left sided weakness and slurred speech MRI of the brainThere are small (36x10 mm axial dimension) patchy foci of diffusion restriction along the lateral aspect of the right precentral gyrus extending to the centrum semiovale adjacent to the right middle frontal gyrus. There is associated FLAIR and T2 signal hyperintensity. There is a punctate DWI signal hyperintense focus along the right occipital lobe which is too small to characterize on ADC maps.A focus of encephalomalacia is present in the right middle frontal gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening and a right maxillary sinus mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and are small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 67%stenosis along the origin of the right vertebral artery. There is 50%stenosis along the origin of the left vertebral artery.

Output: 1.Small acute cerebral infarction along the lateral aspect of the right precentral gyrus and adjacent white matter as described above.2.Encephalomalacia along the left middle frontal gyrus.3.67% stenosis at the origin of the RVA.4.50% stenosis at the origin of the LVA.5.No evidence for intracranial cerebrovascular occlusive disease.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for brain lesion in posterior fossa. Signs and symptoms: Occipital neuralgia pain right side. Blurry vision. Nonenhanced brain MRI:Negative diffusion weighted images.Images through posterior fossa are unremarkable. Images through supratentorial space demonstrate two tiny nonspecific foci of flair hyperintensity in right frontal subcortical white matter. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF ascites is and brain myelination otherwise.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable images through the orbits. No detectable calvarial or soft tissues of the scalp abnormalities.Bilateral mastoid air cells and middle ear cavities are unremarkable in signal intensity.Frothy content of the left larger chamber of the sphenoid sinus and complete opacification of right chamber are consistent with sinusitis and likely acute on the left. The rest of the paranasal sinuses are unremarkable.Nonenhanced cervical MRI:There is normal anatomical alignment the vertebral column similar to prior exam.There is moderate degenerative disease throughout the cervical spine.There is mild retroflexion of dense similar to prior study. There is hypertrophic changes of the dens and surrounding ligaments which results in subtle mass-effect and posterior displacement of cervicomedullary junction of the cord. There is progression of hypertrophic changes since prior exam. There is however no evidence of spinal stenosis at this level and the with normal signal intensity of the cord. There is extensive degenerative and hypertrophic changes at the level of right occipital condyle and C1 articulation. This finding could explain patient's right sided occipital neuralgia.C2 -- C3 demonstrate mild degenerative changes and unremarkable otherwise.C3 -- C4 demonstrate degenerative changes with resultant moderate left neural foraminal compromise.C4 -- C5 demonstrate degenerative disk disease with loss of disk height and mild hypertrophic changes of posterior elements. There is resultant significant left and moderate right neural foraminal compromise. C5 -- C6 demonstrate moderate disk disease and loss of disk height and mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease, shallow broad-based bulging disk, mild facet and ligamentum flavum degenerative changes. No spinal stenosis and moderate left neural foramina compromise.C7 -- T1 demonstrate moderate asymmetric left facet hypertrophic changes without spinal stenosis or neural foraminal compromise.Upper most visualized thoracic spine and cord is unremarkable with the exception of mild degenerative disk disease. Unremarkable paraspinal soft tissues.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process, two tiny nonspecific foci of flair hyperintensity in the subcortical white matter right frontal lobe and unremarkable nonenhanced brain MRI otherwise and in particular no detectable abnormality in the posterior fossa as clinically is questioned. Sphenoid sinusitis.2.Nonenhanced MRI of cervical spine demonstrate mild dorsiflexion of the dens, hypertrophic changes of the dens and the surrounding ligaments with interval progression since prior study however without spinal stenosis. There is asymmetric extensive degenerative and hypertrophic changes of right occipital condyles / C1 articulation which could explain patient's right occipital neuralgia. Moderate degenerative changes of the disks and to a lesser degree posterior elements throughout the cervical spine without central spinal stenosis. Neural foraminal compromise however are present as detailed per level above.


Instruction: Generate impression based on findings.

Input: Bilateral lower extremity and upper weakness, known metastasis in the thoracic spine CERVICAL: There is evidence of diffuse osseous metastatic disease throughout the cervical spine affecting all levels and grossly similar in distribution to prior studies. Vertebral body heights in the cervical spine are grossly maintained. There is loss of cervical lordosis. There is abnormal enhancement involving the right ventral epidural space at the C4-C5 level suspected to represent small amount of epidural tumor. There is effacement of the ventral thecal sac at this level without evidence of cord compression. No signal abnormality is seen in the cervical cord. Mild multilevel degenerative changes are present without high-grade spinal canal or neural foraminal stenosis at any level.LUMBAR:Numbering is performed as per prior studies with 5 lumbar type vertebral bodies and a sixth transitional segment labeled S1 for the purposes of this study.There is diffuse osseous metastases throughout the lumbar spine, pelvis, visualized chest wall. There is minimal loss of height involving the L1 vertebral body and relatively greater loss involving the T11 vertebral body. Vertebral body heights in the lumbar spine are otherwise grossly preserved. Alignment in the lumbar spine is grossly preserved. There is no evidence of spinal canal stenosis at any level in the lumbar spine. There is T2 hyperintensity within the distal cord related to intramedullary metastasis at the T12-L1 level as seen on recent thoracic spine study. There is associated enhancement which extends to the ventral leptomeningeal surface of the cord.There is no definitive evidence of epidural tumor in the lumbar spinal canal within the limitations of the artifact. There is no significant spinal canal stenosis in the lumbar spine at any level. There is bilateral paraspinous tumor centered at the L1 level left greater than right. Tumor is suspected in the neural foramina at the right L1-2 and right L2-L3 level. There is mild neural foraminal narrowing at the right L5-S1 level which may be related to disc disease versus small amount of epidural tumor but is not well assessed due to artifacts.Right-sided hydronephrosis and retroperitoneal lymphadenopathy again noted and better imaged on prior abdominal CT.

Output: 1. Diffuse osseous metastatic disease affecting all levels in the cervical and lumbar spine. Mild pathologic compression fractures including the T11 level and to a lesser degree at the L1 level. No associated osseous retropulsion. 2. Thin epidural tumor is suspected in the cervical spine at the right C4-C5 level without mass effect on the cord. No significant spinal canal stenosis is seen in the cervical spine or lumbar spine.3. Intramedullary metastasis involving the distal cord at the T12-L1 level again seen with enhancement extending to the leptomeningeal surface. 4. There appears to be small amount of tumor involving the neural foramina such as a the right L1-L2 and right L2-L3 levels which is not well evaluated due to artifact. Tumor involving the thoracic neural foramina and epidural space better assessed on recent thoracic spine MRI study.5. Right-sided hydronephrosis and retroperitoneal lymphadenopathy again noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pituitary tumor. There is an enhancing low T1 and high T2 signal right sellar tumor with suprasellar extension, as well as possible peritumor cyst formation along the superior aspect of the mass, which overall measures up to 26 mm and exerts marked mass effect upon the optic apparatus, mainly on the right side, and upon the inferior right frontal lobe. There is also mass effect upon the right cavernous sinus, where the tumor abuts and perhaps encases a portion of the right internal carotid artery. Furthermore, the mass expands the sella inferiorly, with protrusion into the right sphenoid sinus.

Output: A right sellar tumor with suprasellar extension measuring up to 26 mm exerts mass effect upon the optic apparatus and likely represents a pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 32 seconds.

Output: Successful fluoroscopic guided injection of dilute gadolinium into the right hip for subsequent MRI arthrogram.


Instruction: Generate impression based on findings.

Input: Pain, history of transverse myelitis Anterior cervical fusion hardware is partially imaged. No obvious cervical spinal canal stenosis on the limited sequences covering the cervical spine.Thoracic:Cord signal abnormality involving the right upper thoracic cord on prior study from 12/2/2013 is no longer seen. No cord signal abnormality is appreciated on the current study. The thoracic spine is in normal alignment. The vertebral body heights are well-maintained. Minimal degenerative changes are seen with minimal disc bulges. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. No worrisome focal marrow signal abnormality is appreciated. Small scattered perineural cysts incidentally noted.Lumbar:Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with mild disc bulge without significant spinal canal stenosis. Mild right and minimal left neural foraminal narrowing. L4-L5: Disc desiccation with central and right foraminal disc protrusion which appears more prominent since prior MRI from 12/2/2013. There is contact of the right L4 nerve root in the right neural foramen. There is no significant spinal canal stenosis. There is mild to moderate right neural foraminal stenosis and minimal left neural foraminal narrowing. Mild facet arthropathy.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Previously seen thoracic cord signal abnormality involving the right upper thoracic cord seen on prior study has resolved. No abnormal signal or spinal canal stenosis in the thoracic spine is appreciated.2. Mild degenerative changes in the lumbar spine. There is a central and right foraminal disc protrusion at the L4-L5 level which appears progressed since prior study from 12/2/2013 and contacts the exiting right L4 nerve root. There is no significant spinal canal stenosis at any level in the lumbar spine. Please see additional details above.


Instruction: Generate impression based on findings.

Input: CT of the lumber spine without effusion. The construct parallel to the disks. Finding pedicular screw placement. Fusion at L4 -- L5. Non-infused CT of lumber spine:Axial 1.0-mm CT images of the entire lumbosacral spine were performed. Sagittal and coronal 2-D reformatted images were also acquired.The alignment the vertebral column is unremarkable.Examination demonstrates advanced degenerative disk disease at L1 -- L2 with significant loss of intravertebral disk height and extensive adjacent endplate sclerosis.Minimal degenerative changes of disks at the other levels are noted.There is significant hypertrophic changes of posterior elements in particular of the ligamentum flavum with heavy calcification at multiple levels. This is more severe at L4 -- L5 level with evidence of mass-effect by hypertrophied ligamentum flavum on the thecal sac and results in central spinal stenosis. There is a focus of low attenuation of the bone with internal thick articulation in the left pedicle of L5 vertebrae highly suspected of skeletal hemangioma. This finding a is also visible on prior MRI examination. On the current exam this finding is most noticeable on axial image 43 of series 80228. On prior MRI exam this finding was visible on sagittal T2 weighted image 12 of series 2 and axial T2-weighted image 31 of series 5.

Output: 1.Extensive degenerative changes of posterior elements throughout the lumber spine in particular of the ligamentum flavum with heavy calcification and resultant central spinal stenosis at L4--L5.2.Small hemangioma of left L5 pedicle measuring approximately 9.6 x 8.6-mm in size.


Instruction: Generate impression based on findings.

Input: 53-year-old female with metastatic lung carcinoma, status post chemo, please compare to the previous study and evaluate for disease status CHEST:LUNGS AND PLEURA: Right pleural effusion and peripheral airspace consolidation/atelectasis not significantly changed.Reference right middle lobe mass (image 45 series 5) measures 24 mm previously measuring 27 mm.Adjacent satellite reference lesion (image 44 series 5) now measures 9 mm previously measuring 7 mm.Left lower lobe reference nodule (image 35 series 5) now measures 14 mm x 15 mm previously measuring 9 mm x 9 mm.MEDIASTINUM AND HILA: Right internal mammary lymph node previously described is stable at 3 mm in short axis (image 30 series 3).Subcarinal lymph node (image 42 series 3) is stable measuring 9 mm.No new hilar or mediastinal lymphadenopathy.Calcified left hilar lymph nodes compatible with previous granulomatous disease.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: Sclerotic rib lesions unchanged.Carotic L1 for T12 lesion unchanged.A superior endplate compression deformity of T11 is new. No definite evidence of underlying metastatic involvement. MRI of the lumbar spine would be of value.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of the aorta and iliac arteriesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Interval increase in size of left lower lobe nodule and right middle lobe satellite nodule suggestive of progression of metastatic disease.2.Stable right middle lobe mass, right pleural effusion and peripheral consolidation/atelectasis.3.Stable L1 sclerotic lesion.4.New superior endplate compression deformity of the T11 vertebrae.


Instruction: Generate impression based on findings.

Input: Dissection of vertebral artery. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a 12 x 5 mm extra-axial lesion adjacent to the left parietal lobe which enhances following contrast administration.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses and demonstrate that the left maxillary sinus is opacified and small. The visualized portions of the mastoid air cells are clear. The floor of the left orbit droops into the left maxillary sinus and is suggestive of a prior blowout fracture. There is mild enophthalmus suspected on the left .

Output: 1.There is no evidence of acute ischemic cerebral infarction. 2.There is a small extra-axial lesion adjacent to the left parietal lobe. One possibility is that this represents a meningioma. 3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.4.Findings suggest an old left-sided orbital bloout wall fracture with silent sinus syndrome on the adjacent left side.5.The patient's reported vertebral dissection is not appreciated on this exam, though, the entire vertebral artery courses are not included on this exam.


Instruction: Generate impression based on findings.

Input: 76-year-old female with new onset weakness. MRI Brain: There is a small amount of layering material in the posterior horn of the left lateral ventricle which demonstrates associated susceptibility artifact, compatible with blood products. There is also a punctate focus of susceptibility in the posterior left thalamus. There are extensive periventricular and subcortical T2 hyperintensities. There are no areas of restricted diffusion to indicate acute infarction. There is mild cerebral parenchymal volume loss. There is asymmetry of the lateral ventricles, left greater than right, which may be related to ex vacuo dilatation secondary to a prior infarct. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.MRI Cervical Spine: There is straightening of the cervical spine, but no spondylolisthesis. The vertebral body height is preserved. The vertebral bone marrow signal is unremarkable. There is multilevel degenerative spondylosis, which is most pronounced at C5-C6 and C6-7, where posterior disc-osteophyte complexes slightly indent the spinal cord and result in mild to moderate neural foraminal stenoses. There is no abnormal spinal cord signal. There is no evidence of abnormal enhancement or mass. The paraspinal soft tissues are unremarkable.

Output: 1. Acute hemorrhage within the posterior horn of the left lateral ventricle and focal susceptibility effect in the left posterior thalamus, which may represent a mildly prominent normal vessel, hypertensive hemorrhage, or perhaps a microarteriovenous malformation. Further evaluation with CTA is recommended.2. Mild white matter chronic ischemic disease, but no evidence of acute infarction.3. Degenerative spondylosis of the cervical spine, which is most pronounced at C5-6 and C6-7.


Instruction: Generate impression based on findings.

Input: Reason: Headache and vision disturbance, rule out brain pathology. History: Headache and vision disturbance, rule out brain pathology. Recent LP on 1/26/2015. MRI of the brainNo diffusion weighted abnormalities are appreciated.Incidental note is made of partial empty sellaThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left transverse and sigmoid sinuses are smaller than the right side counterparts.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Knee pain. Fracture seen on previous MRI Examination of the left knee reveals no radiographic abnormalities.

Output: Negative left knee examination


Instruction: Generate impression based on findings.

Input: Brain cyst, follow-up evaluation. There is no diffusion weighted or susceptibility weighted abnormality. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift. There is prominence of the extra-axial space along the posterior aspect of the left posterior fossa which is of CSF signal intensity without diffusion restriction. This measures approximately 6.2 cm x 2.5 cm in AP and transverse dimensions and unchanged. There is mild associated mass effect on the left cerebellar hemisphere and mild scalloping of the occipital calvarium. There is also unchanged slight prominence of the supracerebellar cistern. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: Unchanged cystic lesion in the posterior fossa on the left likely representing an arachnoid cyst. MRI of the brain is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Shin pain, check for stress fracture Exam mildly limited in the proximal tibia due to artifact from the ACL repair and anchoring metaphyseal site. Within this limitation, the remainder of the right lower leg is otherwise unremarkable. Specifically no abnormal signal throughout the tibia or fibula including the marrow and cortical bone. No periosteal reactionSurrounding soft tissues, musculature and compartments are also unremarkable other than minimal questionable stranding in the immediately adjacent soft tissues along the anteromedial aspect of the distal tibial metaphysis. Please correlate with patient's specific site of pain and possible mild soft tissue contusion. Again no underlying immediate osseous associated abnormality. No abnormal fluid collections

Output: Partially visualized right ACL repair without additional definite discrete tibial, fibular or lower leg soft tissue abnormalities. Specifically the posterior soft tissues and calf were well visualized


Instruction: Generate impression based on findings.

Input: Weakness [R53.1], Reason for Study: ^Reason: weakness History: weakness There is no evidence of acute ischemic or hemorrhagic lesion.There are multiple chronic lacunar infarcts involving bilateral thalami, bilateral basal ganglia left midbrain and right side lower pons, unchanged since prior scan. Multiple patchy scattered high signal T2/FLAIR intensities on periventricular white matter indicate underlying non specific small vessel ischemic disease, unchanged. Several susceptibility artifacts on the right thalamus, basal ganglia and pons indicating possible chronic petechial hemorrhages or calcifications, unchanged.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.Retention cyst in sphenoid sinus, unchanged.

Output: No evidence of acute ischemic or hemorrhagic lesion.Multifocal chronic lacunar infarction, several susceptibility lesions and underlying non specific small vessel ischemic disease, unchanged.


Instruction: Generate impression based on findings.

Input: Cellulitis and foot ulcer The fourth metatarsal and a portion of the proximal phalanx have been resected as seen on prior radiographs. There is abnormal signal intensity on both T1 and T2 sequences within the remaining base of the fourth metatarsal as well as the second, third, and fifth metatarsals proximally which contains several small rounded foci of enhancement. A chronic appearing erosion is also noted at the head of the third metatarsal. The signal intensity of the first metatarsal is normal. There is also abnormal signal intensity and enhancement of the bones of the midfoot with multiple subchondral cysts/erosions, some of which enhance following gadolinium administration. Bony fragments dorsal to the midfoot are better seen on recent radiographs. There is mild edema and enhancement of the adjacent/surrounding soft tissues but we see no discrete overlying wound or sinus tract extending to the midfoot. Although we cannot completely exclude a superimposed infection, these findings are more in keeping with neuropathic arthropathy. There is a small collection of rim-enhancing fluid dorsal to the medial cuneiform which we suspect represents a synovial cyst or ganglion about the cannot entirely exclude a small abscess. The signal intensity of the phalanges is normal and there is mild edema and enhancement lateral to the distal phalanx of the fifth toe which may reflect focal inflammation. Note is made of a bipartite lateral sesamoid which is a normal variant.

Output: 1. Abnormal signal intensity of the bones of the midfoot and metatarsal bases as described above. Although it is impossible to exclude superimposed infection, the regional nature of these findings is more in keeping with neuropathic arthropathy. If there is strong clinical concern for osteomyelitis, a tagged white blood cell scan can be considered.2. Additional findings described above.


Instruction: Generate impression based on findings.

Input: Male, 16 months old, with neck stiffness status post fall. Evaluate for ligamentous injury. The prevertebral space is significantly thickened suggestive of soft tissue edema and/or tracking fluid/blood product. The anterior atlanto-occipital ligament is not visualized. The anterior atlanto-axial ligament is thickened and not obviously adherent to the C2 vertebral body. The apical ligament is not well visualized and the soft tissues above the odontoid tip are edematous. The tectorial membrane appears to be intact.Below the level of C2, no injury to the anterior longitudinal ligament is suspected. The intervertebral disc spaces are intact. No injury to the posterior longitudinal ligament, posterior atlanto-occipital and atlantoaxial ligaments, the supraspinous ligament or the nuchal ligament is suspected.No significant compromise of the spinal canal or neural foramina is seen. The spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of cord edema or cord contusion is seen. No epidural collections are detected.

Output: Findings are seen compatible with ligamentous injury at the anterior cranio-cervical junction. Specifically, the anterior atlanto-occipital and atlanto-axial ligaments appear to be strained or frankly torn. The apical ligament is also not well seen and may be injured.The anterior and posterior longitudinal ligaments otherwise appear to be intact and there is no evidence to suggest traumatic disc injury. Likewise, the posterior ligamentous structures are intact. No evidence of traumatic spinal cord injury is demonstrated.


Instruction: Generate impression based on findings.

Input: 56-year-old female with history of right breast mastectomy in 2007 for IDC followed by adjuvant chemotherapy and right breast reconstruction. History of left breast reduction. Family history of breast cancer in 2 paternal aunts. No current breast related complaints. Stable findings related to right breast mastectomy and reconstruction. There is no abnormal enhancement seen in the reconstructed right breast or axilla.The left breast parenchyma is almost entirely fat. There is minimal background parenchymal enhancement noted in the left breast. There is no abnormal enhancement seen in the left breast or axillary region.

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


Instruction: Generate impression based on findings.

Input: 66 yo male with new onset vertigo and cerebellar ataxia MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2/FLAIR hyperintense lesion in the right posterior limb of the internal capsule.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is hypoplastic. The posterior communicating arteries are intact. There is fetal origin of the right PCA. The right p1 segment is hypoplastic. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is almost 50% stenosis at the origin of the left vertebral artery and mild narrowing at the origin of the right vertebral artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is a small left posterior limb of internal capsule lesion present which is nonspecific but suspected to be vascular related.3.There is a 50% stenosis at the origin of the left vertebral artery.


Instruction: Generate impression based on findings.

Input: Clinical question: History of lung cancer, evaluate for eye pain. Signs and symptoms: Left eye pain. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Changes consistent with mild chronic nonhemorrhagic small vessel ischemic strokes primarily in bilateral cerebral hemispheres demonstrate no interval change since prior study.Mildly prominent supratentorial ventricular system and the cortical sulci similar to prior exam. This finding although could be at the upper limits of normal for patient's stated age possibility of mild underlying parenchymal volume loss should also be considered.Post contrast images demonstrate no detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable images through the orbits and including 3 mm thin axial fat sat post enhanced series.The signal intensity of the calvarium is within normal and without detectable abnormal enhancement.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.

Output: 1.No acute intracranial process and no convincing evidence of new finding since prior MRI from February 2015.2.Stable mild chronic nonhemorrhagic small vessel ischemic strokes.3.Stable mildly prominent cortical sulci and supratentorial ventricular system.4.Negative images through the orbits and including thin axial post enhanced fat sat series.5.Calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells are unremarkable.