Instruction: Generate impression based on findings.

Input: Benign neoplasm of meninges, unspecified [D32.9], Reason for Study: ^Reason: S/p tumor resection 4/2013 and SRS for residual History: Surveillance. Abnormal smell and taste, vision blurriness, unsteady gait, memory problems. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Evidence of prior bifrontal craniotomy is seen.Encephalomalacia on bilateral rectus gyri (left more than right), left medial orbital gyrus and left anterior orbital gyrus are seen, no change since prior scan. In addition, bilateral inferior frontal gyri show increased signal intensity lesions on FLAIR indicating postoperative changes.There are relatively intense enhancements involving planum sphenoidale, bilateral cavernous sinus (right more than left), clivus and pituitary fossa which again do not show any significant interval change since prior scan. In particular there is asymmetric focal enhancement on the right posterior aspect of the clivus, again no change since prior scan. Scattered high signal intensity lesions on FLAIR on bilateral white matter are non-specific.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post bilateral frontal craniotomy with associated postoperative changes as described above, no change since prior scan.2. No change of anterior cranial fossa, clivus and pituitary fossa enhancing lesions since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Right shoulder pain. Evaluate for rotator cuff pathology. ROTATOR CUFF: Marked atrophy is noted of the rotator cuff. The supraspinatus and infraspinatus muscles in particular are very atrophied. The subscapularis muscle is mildly atrophic. The teres minor muscle is intact. There is a partial tear of the supraspinatus tendon near its insertion. However there is no definite full-thickness tear or communication with the subdeltoid/subacromial bursa. The infraspinatus, subscapularis and teres minor tendons are intact.SUPRASPINATUS OUTLET: There is a very high riding humeral head which is thought to be more likely related to the marked atrophy of the rotator cuff.GLENOHUMERAL JOINT AND GLENOID LABRUM: A tear is noted within the posterior inferior glenoid labrum. There is subchondral cyst formation especially noted about the humeral head anteriorly.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

Output: 1.Marked atrophy of the rotator cuff with a resultant very high riding humeral head.2.Probable partial tear of the supraspinatus tendon without evidence of a full-thickness tear.3.Posterior inferior glenoid labral tear.


Instruction: Generate impression based on findings.

Input: History of multiple myeloma. Pre-autologous stem cell transplant evaluation. SKULL: Again seen are numerous punched-out lytic lesions in the calvarium consistent with multiple myeloma appearing similar to prior study.CERVICAL SPINE: There are equivocal lucent lesions involving cervical spine. Severe degenerative disc disease affects the lower cervical spine. Slight kyphosis of the cervical spine is also present. THORACIC SPINE: Bones appear slightly demineralized, but we see no focal lytic lesions.LUMBAR SPINE: Bones appear demineralized, but we see no focal lytic lesions. Severe degenerative disc disease affects L4-L5. Moderate facet joint osteoarthritis affects the lower lumbar spine.RIBS: Multiple subacute and chronic rib fractures bilaterally likely reflecting underlying multiple myeloma.PELVIS: There is an angular deformity at the interface of S1/S2 vertebral bodies which may reflect a chronic fracture. We see no focal/discrete lytic lesions.UPPER EXTREMITY: Small poorly defined lucencies in the proximal humeral diaphysis bilaterally which may represent multiple myeloma. Poorly defined lucencies in the radius and ulna bilaterally may reflect multiple myeloma but is equivocal.LOWER EXTREMITY: Small lucency in the mid right femoral diaphysis likely represents myelomatous deposit. Soft tissue opacity seen on lateral view of the distal right femur along the anterior and posterior margins is suspicious for a juxtafemoral soft tissue mass, which may be further evaluated with MRI if clinically warranted. Poorly defined lucencies in the neck and diaphysis of the left femur likely represent multiple myeloma. Poorly defined lucencies in the right fibular diaphysis likely represent myelomatous deposits.

Output: Multiple myeloma as described above appearing similar to the relatively limited outside study accounting for differences in technique. However, there is mild angular deformity of the upper sacrum that is new compared to the prior study and suspicious for a subacute fracture, as well as new soft tissue opacity along the distal right femur concerning for a soft tissue mass which can be further evaluated with MRI if clinically warranted.


Instruction: Generate impression based on findings.

Input: Reason: patellar instability. Assess for loose bodies, chondral lesions, MPFL History: left knee patellar instability Exam is suboptimal due to patient body habitus.MENISCI: Lateral and medial menisci are within normal limits. ARTICULAR CARTILAGE AND BONE: No bone marrow edema. Articular cartilage appears intact.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: No significant abnormality.


Instruction: Generate impression based on findings.

Input: A 54 year old male with a clinical picture of myocarditis 1 month ago with normal coronary arteries in the catheterization, severe left ventricular dysfunction was shown in the echocardiography. Now referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is severely dilated with severe systolic dysfunction. The overall LV ejection fraction is 18%, the LV end diastolic volume index is 168 ml/m2 (normal range: 74+/-15), the LVEDV is 326 ml (normal range 142+/-34), the LV end systolic volume index is 137 ml/m2 (normal range 25+/-9), the LVESV is 266 ml (normal range 47+/-19), the LV mass index is 75 g/m2 (normal range 85+/-15), and the LV mass is 145 g (normal range 164+/-36). There is global hypokinesis with regional variation. There is late gadolinium enhancement: atypical mid-myocardial pattern in the mid septum, transmural pattern at the apex in the lateral and inferior segments. This finding suggest the presence of fibrosis, inflammation, or infiltration. Although, the apical abnormality could represent a prior myocardial infarction, given the fact that there is another associated region of LGE which is not of myocardial infarction pattern, the most likely etiology is that both regions of LGE are secondary to the same phenomenon and consistent with the diagnosis of myocarditis. There is minimal residual increased myocardial T2-signal suggesting that the myocarditis is no longer in the acute phase and not very actively inflamed. A mural thrombus at the apex was noted (6X11mm).Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 36%, the RV end diastolic volume index is 111 ml/m2 (normal range 82+/-16), the RVEDV is 216 ml (normal range 142+/-31), the RV end systolic volume index is 71 ml/m2 (normal range 31+/-9), and the RVESV is 138 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch. There is anomalous origin of the right subclavian artery, which originates just distal to the left subclavian artery and travels posterior to the esophagus as it courses to the right arm. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac 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 severely dilated with severe systolic dysfunction, the LVEF is 18%. There is global hypokinesis with regional variation.2. There are 2 distinct patches of late gadolinium enhancement. The first involves the mid septum and is in a non-coronary pattern. The segment is associated with small areas of mildly increased T2-signal suggesting it most likely represents sub-acute myocarditis. The second region involves the apical inferior and apical lateral walls. It is transmural in pattern. Although the finding usually suggests prior myocardial infarction, in the setting of his other non-MI pattern LGE, it probably is also due to myocarditis. This region does not have increased T2-signal and is not likely to have residual inflammation. 3. A mural thrombus is noted in the LV apex.4. The left atrium is moderately dilated. 5. The right ventricle is normal in size with moderately reduced systolic function, the RVEF is 36%. 6. There is mild to moderate mitral regurgitation. 7. There is mild tricuspid regurgitation.8. Anomalous origin of the right subclavian artery (Lusoria anomaly).After reviewing study with his clinic physician's team, patient was asked to report to ER to consider initiation of anticoagulation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Ms. Hymon is a 66 year old female presenting for MRI evaluation of screen detected lesion in the left breast. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: In the left breast 12:00 location, there is an irregular enhancing mass is identified measuring 0.9 x 0.8 x 1.1 cm. This likely corresponds to the mammographically detected area of architectural distortion.Seen just less than one centimeter posterior to this lesion is an enhancing focus measuring 0.5 cm, suspected to be a satellite lesion. The total span of abnormal enhancement (index malignancy + suspected satellite lesion) measures 2.2 cm in the AP dimension. RIGHT BREAST:There is no abnormal enhancement seen in the right breast. AXILLAE:No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 1.1 cm enhancing mass in the left superior breast, corresponding to the mammographically detected area of architectural distortion. A percutaneous biopsy with clip placement is recommended for further evaluation.(2) An enhancing focus seen just posterior to the index malignancy is suspected to be a satellite lesion. An MR-directed ultrasound with possible biopsy is recommended for further evaluation.(3) No MRI evidence for malignancy in the right breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: 67 year old woman with history of right breast carcinoma s/p right mastectomy There is scattered fibroglandular tissue in the left breast.Mild parenchymal enhancement is noted in the left breast.Retropectoral silicone implant on the right appears intact. No abnormal enhancement seen in the right breast.Few, scattered T2 hyperintense cysts are noted in the left breast, similar to the prior examination. No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 60-year-old woman with history of cirrhosis and dilated intrahepatic biliary ducts seen on ultrasound, evaluate for PSC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology and low in signal. There is significant, intrahepatic biliary duct dilatation throughout both left and right hepatic lobes measuring up to 14 mm on the left and 15 mm on the right. Of note, the proximal tertiary hepatic ducts are not visualized. The gallbladder is contracted and the extrahepatic biliary ducts are not well seen.At the hepatic hilum, there is abnormally increased T2 signal with delayed enhancement seen at the confluence of the intrahepatic bile ducts (series 301, image 20; series 1401, image 249). Although ill-defined, this area measures approximately 46 x 26 mm (series 1401, image 249).A 7 mm progressively enhancing lesion in segment 8 of the liver (series 1401, image 29) is likely a hemangioma. The portal vein is not visualized past the splenic/SMV confluence.SPLEEN: The spleen is enlarged and measures 163 mm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: A 12 x 9 mm left upper pole lesion (series 1401, image 181) is T1 hyperintense without significant enhancement. A 10 mm lesion in the inferior pole of the left kidney has layering T1 and T2 hyperintensity and does not enhance (series 701, image 1). Additionally a nonenhancing 8 mm T2 hyperintense focus is seen in the mid left pole (series 701, image 3).The right kidney is normal.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted of the partially visualized small bowel or colon. Specifically, there does not appear to be colonic thickening.BONES, SOFT TISSUES: Small perineural cysts are noted in the spine.OTHER: There is a moderate to large amount of ascites.

Output: 1.Mass at the hepatic hilum with appears to occlude the proximal tertiary biliary ducts and results in intrahepatic biliary duct dilatation. This mass enhances on delayed phase imaging and is suggestive of an infiltrating cholangiocarcinoma.2.Cirrhosis and portal vein occlusion with collateralization.3.Left renal hemorrhagic and simple cysts.4.Findings paged to ordering provider (p2693) at 11:45 AM on 11/2/2015.


Instruction: Generate impression based on findings.

Input: 6 years old, Male, Reason: Concern for structural abnormalities and cerebellar abnormalities History: staring spells, hypotonia, lack of coordination No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is normal for age. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: No evidence of structural lesion as clinically questioned. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Evaluate for aneurysm and potential coilings. LICA and RICA aneurysms. This patient is an 87 years old woman with acute diffuse subarachnoid hemorrhage. She has multiple aneurysms based on CTA. It is not clear based on the CTA which aneurysm ruptured. Angiography would help further assess this and decision to coil should be made following angiography.OPERATORS: Greg ChristoforidisFLUOROSCOPY TIME: 102.8 minutesFrontal: 2611.72 mGyLateral: 2996.65 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial right PCOMA cerebral aneurysm coil embolization with balloon assistance. 3) Intracranial left PCOMA cerebral aneurysm coil embolization with balloon assistance. 4) 3-D reconstructions of intracranial right internal carotid artery 5) 3-D reconstructions of intracranial left internal carotid artery AORTA with iliac runoffs: No contraindication to closure device deployment.Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. The right A1 segment is small. There is a 50% irregular stenosis at the posterior bend of the cavernous RICA. There is a 4mm wide neck right PCOMA aneurysm with a pointed tip on it which is directed posteriorly. The right PCOMA originates at the base of the aneurysm. There is a 2mm right MCA aneurysm present at the distal m1 segment at the bifurcation which is directed inferiorly.There is fetal origin of the right PCA with minor contribution from p1segment. A meningeal branch arises from the opthalmic artery.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There is a left PCOMA aneurysm present which has a relatively small neck. The left PCOMA originates from the base of the aneurysm. The left A1 segment is dominant and supplies the left ACA and partly the right ACA. There is opacification of the left PCA which has a fetal origin with inflow of unopacified blood from the left p1 segment.There is a prominent anterior falx artery present.Left subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the cerebellar vasculature. The PCAs fill transiently the right p1 segment is very small. The left p1 segment does provide some supply to the left p2 segment and beyond.Right subclavian artery: No evidence for arteriovenous fistula. No evidence for vertebral dissection.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the cerebellar vasculature. The PCAs fill transiently the right p1 segment is very small. The left p1 segment does provide some supply to the left p2 segment and beyond.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysms using balloon remodeling. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is no opacification of the majority of the aneurysm with preservation of the PCOMA and anterior choroidal artery. There is opacification of the base of the aneurysm. There is occlusion of a branch of the parietoccipital artery with collateralization from the posterior parietal artery.Final LICA arteriogram :At the end of the procedure there is no opacification of the aneurysm with preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Repeat RICA arteriogram :At the end of the procedure there is no opacification of the majority of the aneurysm with preservation of the PCOMA and anterior choroidal artery. There is opacification of the base of the aneurysm. There is improved opacification of the right parietoccipital artery with partial reperfusion.Right common iliac artery: No contraindications to closure device.

Output: 1.6mm left PCOMA aneurysm2.4mm right PCOMA aneurysm3.2mm right MCA aneurysm4.50% stenosis of the right cavernous ICA5.Embolization of right PCOMA aneurysm with MRI compatible embolic occlusion coils and balloon assistance technique. There is a residual opacification of the base of the aneurysm6.Embolization of left PCOMA aneurysm with MRI compatible embolic occlusion coils and balloon assistance technique. 7.Small thromboembolic event of a branch of the right parietoccipital artery of the PCA was treated with mild anticoagulation. More aggressive treatment was not pursued based on risk/benefit assessment.8.Findings were discussed with Dr Awad and Dr Cueva at the end of the procedure.


Instruction: Generate impression based on findings.

Input: There is slight reversal of upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Biphasic CSF flow is noted posteriorly at the level of the foramen magnum and cerebellar tonsils.A lobular 2-cm lesion is noted within the subcutaneous tissues of the left paramedian neck which appears heterogeneous on both T1 and T2 sequences. There is also nonspecific T2 hyperintensity within the inferior-most visualized aspect of the left thyroid lobe, which is incompletely visualized given cervical spine MRI acquisition technique. Otherwise the Visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: Minimal posterior osteophyte disc complex and left uncinate hypertrophy. There is mild to moderate left neural foraminal stenosis.C5/6: Minimal posterior osteophyte disc complex and left uncinate hypertrophy. There is mild to moderate left neural foraminal stenosis.C6/7: Minimal posterior osteophyte disc complex and left uncinate hypertrophy. There is mild left neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.A lobular 2-cm lesion is noted within the subcutaneous tissues of the left paramedian neck which appears heterogeneous on both T1 and T2 sequences most likely representing a sebaceous cyst.2.There is also nonspecific T2 hyperintensity within the inferior-most visualized aspect of the left thyroid lobe, which is incompletely visualized given cervical spine MRI acquisition technique.3.C4/5: Mild to moderate left neural foraminal stenosis.4.C5/6: Mild to moderate left neural foraminal stenosis.5.C6/7: Mild left neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: eval herniation History: left lumbar back pain, with LLE weakness and knee pain Examination is mildly 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 mildly heterogeneous without focal suspicious lesions. There is a rounded lesion associated with the inferior L5 endplate on the left with surrounding edema most compatible with Schmorl's node. 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: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L5-S1: There is disc desiccation and bulge with a small central protrusion. There is also ligamentum flavum thickening and mild facet arthropathy. There is partial effacement of the lateral recesses, worse on the left than the right. There is mild left neural foraminal narrowing. No significant right neural foraminal narrowing. Paraspinous soft tissues are within normal limits. Bilateral renal cysts are noted.

Output: 1. Mild degenerative changes in the lumbar spine. There is a disc protrusion at the L5-S1 level which may be impinging on the left S1 nerve root in the lateral recess. There is also mild left neural foraminal narrowing at this level. Spinal canal and neural foramina in the lumbar spine are otherwise patent.2. Rounded lesion associated with the inferior L5 endplate with surrounding edema is favored to represent an acute Schmorl's node.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: astroblastoma resection/ seizures, yearly follow up, evaluate for changes History: yearly follow up for changes There is no evidence of acute ischemic or hemorrhagic lesion. Localized susceptibility lesion on the posterior aspect of resection cavity located on the left superior frontal gyrus is again seen, unchanged.There is no evidence of abnormal enhancement on the scan.High signal intensities on T2/FLAIR images surrounding resection cavity indicating postoperative changes, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no evidence of recurrent or residual mass, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post resection status of left superior frontal gyrus lesion with postoperative changes, unchanged since prior scan.2. No evidence of recurrent or residual mass. No abnormal enhancement.3. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Hypoxic, cardiac arrest, patient's obtunded. Evaluate for stroke. There is no evidence of intracranial hemorrhage, mass or edema. There is apparent volume loss in the right aspect of the cerebellar vermis which correlates with an area of signal abnormality on the MRI dated 3/6/2008 and is suggestive of atrophy.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The right mastoid air cells and maxillary sinus are completely opacified. Extensive mucosal thickening is also seen in the remaining visualized paranasal sinuses.

Output: 1. No evidence of acute cortical stroke or intracranial hemorrhage.2. Probable atrophy of the right cerebellar vermis.3. Pansinus inflammatory changes.


Instruction: Generate impression based on findings.

Input: Male, 69 years old. Neck and arm pain. Four views of the cervical spine demonstrate severe degenerative disc disease at C4/C5, C5/C6, and C6/C7. There is moderate degenerative disc disease at C3/C4. There is a grade 1 retrolisthesis of C4 which is stable on flexion, neutral, and extension views. There is also moderate facet joint osteoarthritis.

Output: Severe degenerative disc disease and other findings as above.


Instruction: Generate impression based on findings.

Input: 12-year-old female with neurofibromatosis type I, evaluate for change in tumor. Left humerus:Again noted is large plexiform neurofibroma coursing inferiorly, predominantly in the posterior aspect of the arm, overall appearing similar to prior exam from 1/29/2014 in length and transverse diameter relative to the growth in humerus size. Scattered plexiform neurofibromas in the soft tissues of the left neck and the left upper arm are unchanged.Left forearm:Again noted is large plexiform neurofibroma coursing along the posterior ulnar aspect of the forearm, appearing similar in length and transverse diameter and compared to prior exam given the change in bone size. Scattered plexiform neurofibromas in the soft tissues are unchanged.

Output: 1.Redemonstration of large proximal plexiform neurofibroma involving the left posterior arm and ulnar aspect of the forearm, with no significant changes as compared to prior exam.2.Multiple small plexiform neurofibromas in the soft tissues of the left neck, upper arm and forearm are not significantly changed.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, with grade 2 astrocytoma, off therapy. The expansile T2 hyperintense tumor asymmetrically involving the right aspect of the cervical cord shows no significant change in size and morphology. As before, the lesion spans from C4 through T1 and measures approximately 15 x 12 mm in the axial plane. A faint tract of T2 hyperintensity within the left lateral aspect of the cord at these levels is also unchanged. There may be minimal faint enhancement within the tumor but this is equivocal. Postoperative findings are redemonstrated consistent with lower cervical laminectomies.The expansile T2 hyperintense mass asymmetrically involving the left aspect of the spinal cord from T4 through T8 is also redemonstrated showing no significant interval change in size or extent. The lesion continues to measure up to 12 x 9 mm in the axial plane. One or two small foci of enhancement at the T5 level are unchanged. No new cord lesions are detected.Marrow signal changes are evident consistent with radiotherapy. Enhancement within the T2, T3 and T4 vertebral bodies is similar to that seen on the prior examination and nonspecific but potentially related to therapy. Mild scattered degenerative disc disease is evident without change. Vertebral body heights are preserved.

Output: Spinal cord astrocytoma involving the cervical and thoracic regions is redemonstrated showing no significant interval change in size, morphology or signal characteristics.


Instruction: Generate impression based on findings.

Input: 69 year old woman with history of multiple myeloma, admitted with drug reaction and referred for evaluation of newly diagnosed heart failure.MEDICATIONS: lasix, prednisone First Pass PerfusionDuring hyperemia, no perfusion defects consistent with ischemia were present. However, fixed perfusion defect was noted in the basal inferoseptum and inferior walls and the mid inferolateral and anterolateral walls.Viability/ Myocardial ScarThere are two large areas of late gadolinium enhancement noted, one in the basal to mid anterior, anteroseptal and anterolateral walls and the second in the basal to mid inferolateral wall. They are both have an epicardial and mid myocardial pattern which is atypical for myocardial infarction and is suggestive of an underlying fibrosing, infiltrative, or inflammatory process. This pattern suggests the diagnosis of myocarditis. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 129 ml (normal range 109+/-23), the LV end systolic volume index is 40 ml/m2 (normal range 18+/-5), the LVESV is 67 ml (normal range 31+/-10), the LV mass index is 42 g/m2, and the LV mass is 71 g. There is hypokinesis of the mid inferolateral, anterolateral and anterior walls. 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 65%, the RV end diastolic volume index is 49 ml/m2 (normal range 69+/-14), the RVEDV is 83 ml (normal range 110+/-24), the RV end systolic volume index is 17 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal drain normally into the right atrium. There is a catheter in the SVC.PericardiumThere is a small pericardial effusion.Extracardiac FindingsModerate bilateral pleural effusions are present. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No "ischemia" is noted; however, the above fixed perfusion defects were noted, most likely related to the below described late gadolinium enhancement.2. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 48%. There is hypokinesis of the mid inferolateral, anterolateral, and anterior walls. 3. There are two large areas of late gadolinium enhancement noted, one in the basal to mid anterior, anteroseptal and anterolateral walls and the second in the basal to mid inferolateral wall. They are both have an epicardial and mid myocardial pattern which is atypical for myocardial infarction and is mostly likely represents the diagnosis of myocarditis. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%.5. Small pericardial effusion is noted.6. See extra cardiac findings.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Follow-up evaluation for cerebral aneurysms. MRI Brain: There are scattered foci of periventricular and cortical white matter T2 hyperintensities, which may represent chronic small vessel ischemic disease. There are prominent right inferior basal ganglia perivascular spaces. There is no evidence of acute infarction or mass lesions. The ventricles are unchanged in size. The imaged paranasal sinuses and mastoid air cells are unremarkable. The orbits are intact. There is hyperostosis frontalis interna with areas of prominent fatty marrow. MRA Brain: There is unchanged fusiform dilation of the right middle cerebral artery and the distal right internal carotid artery. There is a 5 mm wide aneurysm at the right carotid terminus. The base of the aneurysm also measures approximately 5 mm. There is an unchanged prominent infundibulum at the origin of the right lenticulostriate artery. There is no evidence of significant steno-occlusive lesions.

Output: 1. No evidence of acute infarction.2. Unchanged fusiform dilation of the right middle cerebral artery and the distal right internal carotid artery and a 5 mm wide aneurysm at the right carotid terminus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The exam is degraded by motion and other artifacts, which considerably limits the evaluation of the thoracic spine. There are diffuse osseous metastases throughout the thoracic spine. There is epidural extension of tumor at the T6 level, which appears to result in spinal cord compression, but no gross signal abnormality in the spinal cord. Due to the limited nature of the exam, more subtle epidural extension of tumor elsewhere in the thoracic spine cannot be excluded. The vertebral body heights are intact and the alignment is anatomic. There is multilevel spondylosis in associated with degenerative changes in the cervical spine with spinal canal stenosis, which is incompletely characterized.

Output: The exam is degraded by motion and artifact but there is widespread metastatic disease involving the imaged axial skeleton with apparent epidural extension of tumor at the T6 level with compression of the spinal cord. More subtle epidural tumor extension may be present at other levels of the thoracic spine, but the exam is limited for detailed assessment of this possibility. Spinal canal stenosis associated with multilevel degenerative cervical spondylosis is incompletely characterized on this exam. Please refer to the recent prior spine MRI report for additional details.The services (Dr. Boyle, pager 1006) was notified of the limited quality of the exam and spread of tumor into the epidural space.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, status post tumor resection. Findings are seen compatible with recent right temporal craniotomy and resection of a large tumor centered on the anterior right temporal lobe. Extensive pneumocephalus is an expected finding.The anterior temporal resection cavity contains predominantly fluid mixed with blood product and small amount of debris. A majority of the previously seen rim-enhancing tumor has been resected. The more inferior margins of the resection cavity demonstrate linear T1 hyperintensity compatible with blood product. Along the superior margin, there is some residual ill-defined enhancing tumor which spreads up into the corona radiata and posterior subinsular region similar to the prior exam. Also redemonstrated is subtle subependymal enhancement along the right ventricular atrium.Extensive T2 hyperintensity tracking superiorly from the resection bed is again seen involving the occipital lobe, basal ganglia and frontal and parietal centrum semiovale, without significant interval change. Generalized mass effect persists with sulcal effacement and midline shift to the left of up to 10 mm. The right lateral ventricle is partially effaced, though slightly improved from prior. The left lateral ventricle is mildly prominent, similar to prior. The basal cisterns remain patent. Volume loss of the cerebellum is also redemonstrated.

Output: Expected findings are seen status post resection of a large right anterior temporal tumor. A majority of the tumor has been resected with only a small amount of residual enhancing tissue at the superior cavity margin involving the corona radiata and posterior subinsular regions. Also redemonstrated is subtle subependymal disease spread along the right ventricular atrium. Significant generalized mass effect is perhaps minimally improved from the prior exam.


Instruction: Generate impression based on findings.

Input: Reason: PSC, eval for strictures History: PSC ABDOMEN:LIVER, BILIARY TRACT: Nodular cirrhosis with areas of T2 hyperintensity compatible with fibrosis. No suspicious arterially enhancing lesions. Similar appearance of beaded intrahepatic bile ducts likely secondary to multifocal strictures. Trace progression of the stricturing of the common bile duct (series 7 image 59, 60, and 63) without significant change in bowel duct caliber. No dominant stricture.No new dominant stricture.SPLEEN: Splenomegaly measuring 14.3 cm with extensive splenorenal shunt.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Similar-appearing retroperitoneal and porta hepatis lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Partially visualized right lower quadrant anterior abdominal wall hernia/ostomy.OTHER: Small pericardial cyst or a cardiophrenic lymph node.

Output: 1.Cirrhotic morphology of the liver and multifocal biliary strictures. There may be slight interval progession of common bile duct stricturing without significant change in bile duct caliber. Intrahepatic stricturing appears similar to prior study. 2.No dominant stricture or suspicious mass.


Instruction: Generate impression based on findings.

Input: Other specified disorders of brain [G93.89], Reason for Study: ^Reason: preop planning for craniotomy for tumor... Pt will take premeds PT will bring MRI clearance for Bladder stim device and heart plug History: preop planning for tumor resection Multiple fiducial markers attached on the scalp for the preoperative localization.28 mm x 24.1 mm sized enhancing right cerebellar hemispheric intra-axial mass with surrounding edema is seen. There is no other abnormal enhancement. Considering the patient history of gastrointestinal tract cancer, this lesion is consistent with metastatic lesion.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Enhancing right cerebellar hemispheric intra-axial mass with the surrounding edema, consistent with metastatic lesion.


Instruction: Generate impression based on findings.

Input: Left sensorineural hearing loss. Right: There is a 3 mm diameter lesion in the fundus of the right internal auditory canal, along the course of the inferior vestibular nerve. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. Left: The cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable.Miscellaneous: There are bilateral maxillary sinus retention cysts, right larger than left.

Output: 1. A 3 mm diameter lesion in the fundus of the right internal auditory canal likely represents a schwannoma. 2. No evidence of left retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: History of bladder cancer status post cystectomy nephrectomy and chemoradiation. PELVIS:UTERUS, ADNEXA: The uterus is atrophic. The endometrium is normal in thickness. No focal abnormality.BLADDER: Status post cystectomy with right lower quadrant ileal conduit. Multiple bowel loops have descended into the surgical bed. No specific evidence of recurrence in the cystectomy bed.LYMPH NODES: No enlarged pelvic lymph nodes. In the proximal right external iliac chain there is a 1.6 cm cystic structure which may represent a postsurgical seroma. Similar finding along the left internal iliac chain.Aortic bifurcation lymph node measures 15 x 14 mm (series 1504/569). Additional prominent mesenteric lymph nodes.BOWEL, MESENTERY: Thin-walled loculated perirectal fluid collection measuring 6.9 x 4.0 cm, unchanged from previous day CT and 2/19/2015 CT.Distended fluid-filled small bowel is partially imaged. Fluid distended proximal ascending colon is partially seen. The distal rectosigmoid is decompressed. There is abrupt transition point in the pelvis where there is abnormal thickening, enhancement and restricted diffusion of the matted loops of bowel (series 1504, image 514; series 1302/408) with mass likely thickening and stellate soft tissue appearance measuring up to 4.1 x 3.3 cm suspicious for tumor. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No significant change from the prior day's CT study, including small bowel obstruction with transition point in the pelvis where there is stellate mass-like soft tissue thickening which is suspicious for tumor. Adhesive disease is also a consideration but felt to be less likely. Stable bland-appearing loculated fluid collection in the pelvis. Aortic bifurcation and mesenteric lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Knee pain MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness cartilage loss of the medial patellar facet. The remaining articular cartilage of the patellofemoral, medial, and lateral compartments is preserved. The bone marrow signal of the knee is normal.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Large nonspecific joint effusion without evidence of meniscal injury.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate healing of microfracture areas, trochlea, and medial femoral condyle 2 years ago, with continue pain and swelling. History: left knee pain MENISCI: There is linear and globular fluid signal abnormality within the posterior horn of the medial meniscus which appears to extend to the femoral articular surface indicating a horizontal tear with probable meniscal cyst formation. There is increased globular signal abnormality within the posterior horn of the medial meniscus indicating intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: There is increased signal abnormality within the articular cartilage along the weightbearing surface of the medial femoral condyle likely representing the site of prior microfracture. There are foci of low signal intensity in this area which likely represent fibrocartilage formation related to prior microfracture. There is bone marrow signal abnormality in the underlying medial femoral condyle. No full-thickness defect is identified.There is subjective thinning of the articular cartilage of the lateral compartment. There is increased signal abnormality within the articular cartilage along the medial facet of the femoral trochlea which may represent a combination of articular cartilage degeneration and postsurgical change from prior microfracture. No full-thickness defect is identified. There is partial-thickness articular cartilage degeneration along the medial facet of the patella.LIGAMENTS: There is partial tearing of the distal fibers of the anterolateral band of the ACL. There is minimal, if any, increased signal abnormality on fluid sensitive sequences suggesting that this is likely chronic in etiology. The PCL appears intact. The MCL and LCL appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings indicating a tear of the posterior horn of the medial meniscus as well as postsurgical change2. Chronic appearing partial thickness tearing of the ACL.3. Articular cartilage signal abnormality along the medial femoral condyle and patellofemoral articulation which likely represents a combination of degeneration and postsurgical change from prior microfracture. No full-thickness articular cartilage defects are identified.4. Large Baker's cyst.


Instruction: Generate impression based on findings.

Input: 56-year-old female. SLE on chronic steroids. Please evaluate for AVN of the hips. Normal signal intensity of the femoral heads without evidence of avascular necrosis. A couple of tiny foci of abnormal signal intensity in the left femoral neck are nonspecific and unchanged, may represent small cartilaginous rests. Right iliac fossa transplant kidney is noted. There is a 2 cm round periurethral fluid signal intensity focus mostly around the right aspect of the urethra, new from prior exam, likely a urethral diverticulum (series 601, image 8). Mild degenerative disk disease of the visualized lower lumbar spine, refer to same day lumbar spine report for further details.

Output: 1. No evidence of avascular necrosis.2. Small periurethral diverticulum.


Instruction: Generate impression based on findings.

Input: 40 year old female with clicking on range of motion. Evaluate for loose bodies. LIGAMENTS: There is linear intermediate signal intensity partially separating the distal fibers of the ulnar collateral ligament from the sublime tubercle of the coronoid process which may represent a partial undersurface tear of uncertain current clinical significance. The radial collateral ligament appears intact. The lateral ulnar collateral ligament appears intact.TENDONS: There is thickening and heterogeneity of signal of the common flexor tendon at its origin compatible with chronic tendinosis, but we see no fluid signal intensity within the tendon to indicate a tear. There are small foci of signal void adjacent to the tendon as well as bandlike scarring in the overlying subcutaneous fat, suggesting prior surgery to this area. The common extensor tendon appears intact. The biceps and brachialis tendons appear intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: There is edema type signal abnormality within the distal humerus concentrated in the capitellum. There is curvilinear subchondral fluid signal intensity within the anterior margin of the capitellum indicating a subchondral fracture. The articular surface fracture fragment is in near-anatomic alignment at this time. There is low signal intensity of the bone underneath the subchondral fracture which likely represents sclerosis. These findings are compatible with osteonecrosis.ADDITIONAL

Output: 1. Avascular necrosis of the capitellum of the distal humerus with large subchondral fracture. The articular surface fragment is in near-anatomic alignment at this time.2. Moderate-sized elbow joint effusion. Although we see no definite loose body within the joint, we cannot completely exclude the possibility of a cartilaginous loose body adherent to the capsule as described above.3. Postoperative changes of prior ulnar nerve transposition.4. Tendinosis of the common flexor tendon.5. Partial undersurface tear of the ulnar collateral ligament as described above, of questionable clinical significance.


Instruction: Generate impression based on findings.

Input: 39-year-old male with pelvic abscesses and JP drains. Evaluate abscesses. Evaluation suboptimal without IV contrast.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again noted is a loculated air-containing fluid collection located just superior to the bladder which measures 4.5 x 3.5 cm (series 6, image 17); this collection measured 4.2 x 5.0 cm on the recent CT and is decreased in size compared to the previous MRI examination. No definite fistulization with the adjacent bowel is identified however confirmation with fluoroscopy is recommended. At site of previously seen left lower quadrant fluid collection is a drainage catheter, collection has essentially resolved. Presacral fluid collection measures 3.1 x 2.5 cm (series 6, image 26), previously measuring 3.1 x 2.6 cm on the recent CT examination. There is a JP drain within this collection. Originating at the 6:00/posterior anal canal is a fistula tract which bifurcates and progresses dorsally in the bilateral gluteal subcutaneous fat. On the right the tract bifurcates with one component terminating along the medial right gluteal cleft (series 901/17). The other component on the right progresses dorsally and terminate at an additional paramedial site on the skin. This right tract is not significantly changed.The left sided fistulous tract that terminated along the left medial gluteal fold has resolved compared to the previous examination.BONES, SOFT TISSUES: Partially imaged scrotal fluid, suspicious for hydrocele formation.OTHER: No significant abnormality noted.

Output: 1. Evaluation suboptimal without IV contrast. 2. When compared to most recent CT exam and accounting for differences in technique, stable to mildly decreased size of pelvic collections in presacral space (associated drainage catheter seen) and superior to bladder. Latter collection now contains more fluid and less air. No definite fistulization to the adjacent bowel is identified, however evaluation with fluoroscopic examination should be considered for further assessment. Additional left lower quadrant collection at site of a second drainage catheter has essentially resolved. 3. Complex right-sided fistulous tract originating at the 6:00/posterior aspect of the anal canal is not significantly changed.4. Interval resolution of the left sided fistulous tract that terminated along the left medial gluteal fold.


Instruction: Generate impression based on findings.

Input: 10-year-old female with history of T6 osteoblastoma, 2 year evaluation for recurrence Redemonstrated are post operative changes of spinal fusion extending from T5 to T7. There is evidence of bilateral transpedicular screw placement at T5, left-sided transpedicular screw placement at T6 and bilateral transpedicular screw placement at T7, similar to prior exam. Artifact from the metallic hardware renders images nondiagnostic for immediately adjacent tissues. Partially visualized vertebral bodies and posterior elements at these levels demonstrate no definite evidence of signal abnormality or abnormal enhancement. Redemonstrated is mild chronic compression deformity of T5 vertebrae right laterally, unchanged. The signal intensity and morphology of the thoracic spine from C7 to T4 remains normal in appearance without abnormal enhancement. The signal intensity and caliber of the cord at these levels is also within normal and without enhancement.The signal intensity and morphology of thoracic spine from T8 to L3 levels remains normal in appearance without abnormal signal intensity or enhancement. The signal intensity and caliber of thoracic cord at these levels, as well as conus and partially visualized cauda equina, also remains normal in appearance and without abnormal in enhancement.No definitive evidence of perispinal soft tissue abnormality with the exception of expected postop changes which are stable in appearance.

Output: Limited exam at the level of prior surgery and fusion from T5 to T7 due to metallic hardware artifact. Within this limitation there is no definitive evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Left vocal cord paralysis, elevation of the left hemidiaphragm. History of polymyositis.. Brain: Brain parenchyma appears within normal limits for age. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. There is mild nonspecific prominence of the nasopharyngeal soft tissues which may be related to lymphoid hyperplasia. There is also nonspecific low T1 marrow signal without suspicious lesions.IAC: The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.

Output: MRI of the brain appears within normal limits. Specifically no mass or abnormal enhancement is appreciated within the brain stem, involving the cranial nerves, or at the skull base. Please note patient chose to reschedule MRI neck study and is pending.


Instruction: Generate impression based on findings.

Input: 31-year-old male with pain. Evaluate PD tendon ring finger for adhesion versus re-rupture. Evaluation of the flexor digitorum profundus tendon distally is limited due to the relatively poor signal.The flexor digitorum profundus can be traced on the axial sequences to the level of the neck of the middle phalanx at which point the tendon is replaced with intermediate signal intensity. We suspect that this represents adhesions/scarring as we see no fluid-filled gap to indicate re-rupture. On the sagittal sequence, low signal intensity tendon appears to extend to the volar aspect of the distal phalanx. Multiple foci of signal void are noted within the soft tissues along the tendon within the finger, perhaps representing surgical suture material. There is increased space between the flexor tendon apparatus and the proximal phalanx, which is suggestive of of at least a partial tear of the A2 pulley. The bone marrow signal intensity is within normal limits.

Output: 1. Limited study due to poor signal. We will attempt to have the patient return for further images, at which point an addendum will be logged.2. Low to intermediate signal in the vicinity of the flexor digitorum profundus tendon likely represents adhesions/scarring. We see no fluid-filled defect to indicate a re-rupture.3. Findings suggestive of at least a partial tear of the A2 pulley of the ring finger of the left hand.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with new headaches and episodes of falling and trouble speaking. No evidence of edema, mass effect or restricted diffusion is seen. Scattered foci of nonspecific T2 hyperintensity are seen throughout the cerebral hemispheres. No intracranial hemorrhage or any abnormal extra-axial fluid collections are observed. Ventricular size and morphology are within normal limits. The mesial temporal structures are symmetric and unremarkable.

Output: 1.Scattered nonspecific foci of T2 hyperintensity are seen.2.No abnormalities of the mesial temporal lobes are seen.3.No other specific findings are identified which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Again seen is an arachnoid cyst in the right posterior fossa extending into the right cerebellopontine angle cistern that currently measures 5.1 x 2.8 cm, previously 5.2 x 3.2 cm. There is a stable mass effect on the right cerebellar hemisphere and right cerebellar peduncle. There are no areas of abnormal signal in the parenchyma. Evidence of prior small right lateral suboccipital craniotomy for cyst fenestration. No evidence of acute infarct or hemorrhage. No other mass or mass effect. No hydrocephalus. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: No significant interval change in arachnoid cyst in the right posterior fossa.


Instruction: Generate impression based on findings.

Input: Evaluate for partial thickness rotator cuff tear given mechanical trauma to shoulder during fall two years ago with residual weakness and positive physical exam findings for rotator cuff weakness. ROTATOR CUFF: There is a complete tear of the supraspinatus tendon with retraction to the level of the glenohumeral joint. There is mild atrophy and fatty infiltration of the supraspinatus muscle. There is also a near-complete/complete tear of the infraspinatus tendon with similar retraction. There is moderate to severe atrophy of the infraspinatus muscle. The teres minor muscle and tendon appear intact. Although the inferior fibers of the subscapularis tendon can be followed to their humeral insertion, more superiorly the fibers are largely replaced with intermediate signal intensity likely representing a combination of severe tendinosis and insertional tearing. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. The humeral head is high riding with the acromiohumeral interval measuring 2 mm at its most narrowed point.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint. There is tearing of the superior labrum that extends inferiorly into the anterior labrum. There is a small amount of fluid in the joint, but I see no large effusion.BICEPS TENDON: There is increased signal intensity within the tendon of long head of the biceps at its transition from the rotator interval to the intertubercular groove indicating focal tendinosis and possibly partial thickness tearing. A small amount of fluid within the biceps tendon sheath may reflect a mild tenosynovitis.

Output: 1.Full-thickness retracted tears of the supraspinatus and infraspinatus tendons, with severe tendinosis and insertional tearing of the subscapularis tendon as described above.2.Osteoarthritis as described above.3.Labral tearing and biceps tendinosis as described above.


Instruction: Generate impression based on findings.

Input: 54-year-old man with history of NASH cirrhosis, preliver transplant evaluation. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. The splenic vein and SMV are patent. The extrahepatic portal vein is markedly narrowed (series 14, image 41) measuring less than 3 mm. The intrahepatic right and left portal veins are patent, however they are also attenuated in caliber.No focal hepatic lesion is identified. Specifically, the previously seen segment 7 lesion is not identified on today's study, possibly a perfusional abnormality. Trace perihepatic ascites is noted.SPLEEN: Spleen is mildly enlarged, but otherwise unremarkable.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcapsular left midpole cystic lesion unchanged. The kidneys are otherwise normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: There are loops of bowel within a right lower quadrant ventral hernia, but no evidence of incarceration or obstruction. The remaining small bowel and colon appear normal.BONES, SOFT TISSUES: Scoliosis with thoracic compression fractures unchanged.OTHER: No significant abnormality noted.

Output: 1.Cirrhotic liver. Previously seen hepatic lesion not identified on today's study, probably perfusional.2.Portal vein is markedly attenuated from the level of the confluence and appears narrower than the prior study. Finding discussed with Dr. Te by phone at 11:20 on 11/12/2015.3.Growing right lower quadrant ventral hernia, now containing loops of bowel without evidence of incarceration.


Instruction: Generate impression based on findings.

Input: 70 year old man with history of CAD s/p CABG, bioprosthetic AVR, pulmonary hypertension with evidence of possible pulmonary AVM on echocardiogram, referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with mild to moderately reduced systolic function. The overall LV ejection fraction is 40%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 190 ml (normal range 142+/-34), the LV end systolic volume index is 52 ml/m2 (normal range 25+/-9), the LVESV is 114 ml (normal range 47+/-19), the LV mass index is 52 g/m2 (normal range 85+/-15), and the LV mass is 112 g (normal range 164+/-36). There is abnormal septal motion. There is no definitive late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no LV thrombus.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is moderately dilated with moderately reduced systolic function. The overall RV ejection fraction is 33%, the RV end diastolic volume index is 125 ml/m2 (normal range 82+/-16), the RVEDV is 272 ml (normal range 142+/-31), the RV end systolic volume index is 83 ml/m2 (normal range 31+/-9), and the RVESV is 181 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThere is a bioprosthesis in the aortic position with some evidence of flow acceleration. No significant regurgitation noted.Mitral ValveThe mitral valve opens widely. There is thickening of the leaflet tips. There is at least moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least 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 mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. The pericardial does not appear thickened or inflamed. Real time imaging did not reveal interventricular dependence with deep inspiration. Although there may be some myocardial to pericardial tethering along the posterior aspect of the ventricle, there is no obvious hemodynamic evidence of pericardial constriction. Extracardiac FindingsPrevious sternotomy wires with associated artifact. Increased interstitial lung markings. Large left renal cyst. Mediastinal lymphadenopathy noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with mild to moderately reduced systolic function (EF 40%) without obvious evidence of infiltrative, inflammatory, or fibrotic process. 2. Moderately dilated RV with moderately reduced systolic function (EF 33%).3. Although there may be some myocardial to pericardial tethering along the posterior aspect of the ventricle, there is no obvious hemodynamic evidence of pericardial constriction. 4. At least moderate mitral and tricuspid regurgitation.5. Mild main pulmonary artery dilation. 6. No evidence of obvious pulmonary AVMs or fistulas. 7. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of right lumpectomy for IDC in 2002 followed by radiation therapy and chemotherapy. MRI guided biopsy of a central right breast enhancing lesion was performed in 2004 with pathology result of fibrotic breast parenchyma. Patient has had interval right breast reconstruction and left breast reduction July 2013. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There are stable postsurgical changes in the lower inner quadrant of the right breast. There is a stable enhancing 10 x 5 x 8 mm lesion (AP x LR X CC) at 12 o'clock in the right breast, mid depth, with a biopsy clip artifact, corresponding to the previously biopsied benign lesion. No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: 55-year-old female with lateral shoulder pain. Evaluation is limited by artifact of unknown etiology.ROTATOR CUFF: There is a full thickness tear of the supraspinatus tendon at its insertion on the greater tuberosity with just under 1 cm of proximal retraction. The tear is just over 1 cm in the AP dimension. There are subchondral cysts in the underlying humeral head. The supraspinatus muscle appears intact. The infraspinatus tendon appears intact. The infraspinatus muscle appears intact, although there is mild fatty infiltration along the myotendinous junction of the infraspinatus muscle. The teres minor and subscapularis muscles and tendons appear intact. SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa likely related to the full-thickness supraspinatus tear. There are foci of intermediate signal intensity within the bursal fluid, likely representing synovitis or debris. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no joint effusion. There is intermediate signal intensity within the posterior aspect of the superior labrum that may reflect degeneration or degenerative tearing, but we see no fluid-filled labral tear.BICEPS TENDON: The long head of the biceps tendon appears intact. ADDITIONAL

Output: 1. Full-thickness mildly retracted tear of the supraspinatus tendon.2. Mild osteoarthritis of the acromioclavicular joint.3. Lipoma and other findings as described above.


Instruction: Generate impression based on findings.

Input: History of lung cancer, evaluate for possible brain metastases. There are multiple adjacent subcentimeter nodular areas of intraparenchymal enhancement in the right frontal lobe adjacent to the right superior frontal sulcus that are not appreciably changed from the prior study. There is surrounding hyperintense T2/FLAIR signal compatible with edema that is stable to slightly decreased. A subtle, curvilinear enhancing focus in the lateral aspect of right temporal lobe is also unchanged. No new or enlarging lesions.Scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are compatible with mild chronic small vessel ischemic disease. There is a stable focus of susceptibility in the right frontal lobe compatible with chronic microhemorrhage. There is no new mass or mass effect. There is no new parenchymal or meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. A T1 hyperintense lesion in the left occipital condyle is unchanged and may represent a treated metastasis or benign lesion such as a hemangioma.

Output: No significant change in size or appearance of enhancing lesions in the right frontal and right lateral temporal lobes with stable to slight decrease in edema surrounding the right frontal lobe lesion. No new or enlarging enhancing lesions to suggest progression of metastatic disease. Suggest continued follow-up.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right parotid mass, possible lipoma. History of completion thyroidectomy with neck dissection and mediastinal mass excision for metastatic medullary thyroid cancer. The patient also had a right buccal space tumor excised from right parotidectomy approach in 2012. There are postoperative findings related to partial right parotidectomy. There is a well-defined ovoid fat signal structure that contains vessels anterior to the right parotid gland. The lesions measures 31 x 15 mm in the axial cross-section, which appears to be similar in size compared to prior exams, accounting for differences in positioning. The remaining portions of the salivary glands are otherwise unremarkable. There is no measurable buccal mucosa tumor. There are postoperative findings related to thyroidectomy, without evidence of recurrent tumor in the thyroidectomy bed. There are postoperative findings related to neck dissection, without evidence of significant cervical lymphadenopathy. There is multilevel degenerative cervical spondylosis. There are partially imaged postoperative changes related to mediastinal mass resection.

Output: 1. Postoperative findings related to partial right parotidectomy with what likely represents a lipoma anterior to the remaining portions of the right parotid gland.2. Postoperative findings related to thyroidectomy, without evidence of recurrent tumor in the thyroidectomy bed.


Instruction: Generate impression based on findings.

Input: Chronic pain wakes up from sleep Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position. There is mild motion degradation.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Disc desiccation with mild bulge. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.There is also mild facet arthropathy throughout the lumbar spine, relatively worse at the L3-L4 and L4-L5 levels. Paraspinous soft tissues are within normal limits.

Output: Mild multilevel degenerative changes in the lumbar spine as described above. There is no significant disc herniation or spinal canal or neural foraminal stenosis at any level.Mild multilevel facet arthropathy, relatively worse at the L3-L4 and L4-L5 levels, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Cervical spine: There is congenital fusion of C4-C6 and anterior fusion hardware fusing C5-C6. There is no evidence of hardware complication. There is exaggerated lordosis of the cervical spine with apex at C5. There are no fractures or subluxations. The marrow signal is benign. There is no definitive evidence of myelopathy. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: There is moderate disc disease with a disc osteophyte complex encroaching the left lateral recess. There is significant left neuroforaminal narrowing and moderate right neuroforaminal narrowing. There is mild central spinal canal narrowing.C3/4: There is no significant spinal canal stenosis. There is bilateral mild neuroforaminal narrowing.C4/5: There is no significant spinal canal stenosis. There is moderate bilateral neuroforaminal narrowing.C5/6: There is uncovertebral hypertrophy without significant spinal canal narrowing. There is moderate right and mild to moderate left neuroforaminal narrowing.C6/7: There is no significant spinal canal stenosis. There is bilateral facet hypertrophy and resultant significant bilateral neuroforaminal narrowing.C7/T1: No significant spinal canal or neuroforaminal narrowing.Thoracic spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. There are multilevel degenerative changes in the thoracic spine with multiple level disc dessication. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is a partially visualized left renal cyst that measures up to 7 cm in AP dimension and was present on prior CT lumbar spine 4/23/2003.T1/2: No significant spinal canal stenosis. There is mild left neuroforaminal narrowing.T2/3: No significant spinal canal stenosis. There is mild right neuroforaminal narrowing.T3/4: There is a shallow central disc bulge without significant stenosis. There is uncovertebral hypertrophy without significant neuroforaminal narrowing.T4/5: No significant spinal canal stenosis. Mild left neuroforaminal narrowing.T5/6: No significant spinal canal stenosis. Mild left neuroforaminal narrowing.T6/7: No significant spinal canal stenosis or neuroforaminal narrowing.T7/8: No significant spinal canal stenosis. Mild left neuroforaminal narrowing.T8/9: No significant spinal canal or neuroforaminal stenosis.T9/10: No significant spinal canal or neuroforaminal stenosis.T10/11: No significant spinal canal stenosis. Moderate to severe right neuroforaminal narrowing.T11/12: No significant spinal canal stenosis. There is mild to moderate left neuroforaminal narrowing.T12/L1: No significant spinal canal stenosis. There is significant right neuroforaminal narrowing.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1.Multilevel degenerative changes in the cervical and thoracic spine with mild spinal canal stenosis at C2/C3 and severe neuroforaminal narrowing at multiple levels.2.Partially visualized left renal cyst measures up to 7 cm in AP dimension and was present on prior CT lumbar spine 4/23/2003.


Instruction: Generate impression based on findings.

Input: Episodes of forgetting over the last year. No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is mild global parenchymal volume loss with slightly greater involvement of the bilateral parietal lobes. No disproportional volume loss involving the hippocampi is appreciated.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.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: 1. No intracranial mass or mass-effect. No abnormal enhancement.2. Mild global parenchymal volume loss. 3. Several scattered 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.


Instruction: Generate impression based on findings.

Input: Left floor of mouth swelling with concern for a ranula. The patient also has a history of perennial allergic rhinitis and the possibility of mild past vestibular neuritis. There is no evidence of a ranula or floor of mouth tumors. A right mylohyoid boutonierre deformity with minimal prolapse of the right sublingual gland is an anatomic variant. The submandibular and parotid glands appear unremarkable. There are mildly prominent upper cervical lymph nodes. For example, a left level 2 lymph node measures up to 15 mm in short axis. However, the lymph nodes display homogeneous signal characteristics. There is a left cerebellar hemisphere developmental venous anomaly. There is mild scattered paranasal sinus mucosal thickening and prominence of the nasal turbinate mucosa diffusely. There is torus mandibularis. The orbits and temporal bone regions bilaterally appear grossly unremarkable.

Output: 1. No evidence of ranula.2. Nonspecific mildly prominent upper cervical lymph nodes, which may be reactive.3. Mild scattered paranasal sinus mucosal thickening and prominence of the nasal turbinate mucosa diffusely are likely related to allergic rhinitis.


Instruction: Generate impression based on findings.

Input: Grade 2 astrocytoma s/p RT and now on TMZ. There is an unchanged non-enhancing mass in the posterior right gyrus rectus region, which measures up to approximately 30 mm. There are postoperative findings related to right transfrontal biopsy There is no evidence of 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 major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Unchanged size of the astrocytoma in the posterior right gyrus rectus region


Instruction: Generate impression based on findings.

Input: Developmental delay with hypotonia: difficulty walking. Brain: No structural lesions within the brain parenchyma are appreciated. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a normal degree of myelination. Asymmetric T2 hyperintensity in the left periatrial region without volume loss is likely related to incomplete myelination rather than gliosis from prior injury. The ventricles and basal cisterns are normal in size and configuration for age. 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.Spine: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The conus medullaris is normally situated at the lower L2 vertebral body level. No filar lipoma or other masses within the lumbar spinal canal are appreciated. The paravertebral soft tissues are unremarkable.

Output: 1. No structural lesions within the brain parenchyma are appreciated.2. No evidence of tethered cord.


Instruction: Generate impression based on findings.

Input: Sciatica, right side [M54.31], Reason for Study: ^Reason: Progressive right sciatica History: as above. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L2-L3: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L3-L4: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: there is broad based disc bulging toward right neural foramen (series 701, image 7/30) which results minimal to mild right side neuroforaminal narrowing. There is also focal central bulging of disc which abuts thecal sac, otherwise no neuroforaminal narrowing. L5-S1: focal central protrusion of disc which abuts thecal sac, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Broad based disc bulging toward right side neural foramen of L45 .2. Multilevel various degree disc bulging of lumbar spine.3. Central disc protrusion at the level of L5S1 which abuts thecal sac.


Instruction: Generate impression based on findings.

Input: Clinical question: Sepsis. Signs and symptoms: Altered mental status Nonenhanced head CT:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Low attenuation of white matter of bilateral cerebral hemispheres are within normal for patient stated age of 12 days. Ventricular system remain within normal.Mastoid air cells and middle ear cavities are pneumatized and unremarkable. Calvarium is intact. If clinical concern persists an MRI is recommended.

Output: Negative nonenhanced CT of brain. If clinical concern persist recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: History pf meningioma resection 2013: surveillance. Pituitary: There are postoperative findings related to frontal craniotomy for partial resection of a mass along the planum sphenoidale. There is no significant interval change in size of the residual enhancing extra-axial mass within the sella, basal cistern, bilateral cavernous sinuses, along the dorsal aspect of clivus and minimally along the planum sphenoidale. Indeed, the mass measures up to approximately 4 cm in traverse dimension, previously also 4 cm. The mass encases the pituitary gland and bilateral carotid siphons without significant narrowing of the vessels. There is also enhancement of the bone marrow of the clivus. There is associated mass-effect upon the bilateral prechiasmatic optic nerves and anterior optic chiasm. Brain: There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma appears unremarkable. There is no abnormal intracranial enhancement. The ventricles are normal in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No significant interval change in the residual sellar and parasellar meningioma.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There is no significant interval change in the multiple supratentorial and infratentorial high T2 signal lesions. Some of the lesions have low T1 signal. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a retention cyst in the right maxillary sinus. There is a disc osteophyte complex at C2-3 that abuts the spinal cord.

Output: No significant interval change in the demyelinating lesions related to multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Diagnosis: Low back painClinical question: Persistent left sided low back pain. ? Etiology. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.A small amount of fluid is present in the uterus and in the peritoneum.

Output: 1.No compromise to lumbar spinal canal or neural foramina.2.Fluid in the uterus and peritoneum at this age is non-specific and may be simply related to menses. Please correlate with the clinical history.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, history of anaplastic astrocytoma, status post radiation, on temozolomide. The T2 hyperintense lesion within the thalamus shows no significant interval change in size or morphology over multiple prior examinations. A biopsy marker remains evident in the center of the lesion. The lesion demostrates intrinsic T1 hyperintensity with little if any true superimposed enhancement.A subcentimeter enhancing focus along the margin of the left ventricular atrium has decreased in size and conspicuity relative to prior exams.Ill-defined periventricular white matter T2 hyperintensity along the left lateral ventricle is stable when compared to the immediate prior examination, but shows slight expansion in geographic extent when compared to older exams. Some of this signal abnormality was evident on the patient's initial pretreatment studies.A 6 mm curvilinear area of T2 hyperintensity is seen within the left paramedian precentral gyrus, not definitely changed in size when compared to the immediate prior examination but slightly more prominent than on older studies. Of note, however, is the fact that this lesion now enhances whereas previously it did not.Numerous additional scattered small foci of T2 signal abnormality are seen throughout both cerebral hemispheres, without significant or convincing interval change. No new mass effect or parenchymal edema is detected. Ventricles are stable in size including mild ex vacuo dilatation of the left lateral ventricle.

Output: 1.No significant interval change in the size or appearance of the left thalamic lesion.2.Decrease in size and enhancement of a nodule of enhancement along the left lateral ventricular atrium.3.Ill-defined left periventricular white matter T2 hyperintensity is stable relative to the immediate prior examination but slightly more extensive when compared to older exams. It should be noted that some of this signal abnormality was present on the initial pretreatment examinations and therefore it cannot be attributed entirely to treatment effect. The possibility that some of this signal abnormality may reflect non-enhancing tumor must be considered.4.A curvilinear region of T2 hyperintensity within the left paramedian precentral gyrus is unchanged in size relative to the immediate prior examination but slightly more conspicuous when compared to older studies. Of note, however, is the fact that this lesion shows new enhancement on today's examination. The lesion is too small to accurately characterize, but for the reasons indicated in impression point number 3, the possibility of viable tumor in this location must be considered. Other etiologies including treatment related vascular injury are not excluded. Close interval follow-up is suggested.


Instruction: Generate impression based on findings.

Input: 47 years Female (DOB: 5/3/1969)Reason: please do Dr. Javed MS protocol and compare to prior History: progression MS, paresthesias and fatiguePROVIDER NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD MRI brain: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. These were also present on the prior exam. There is a new lesion present in the right parietal lobe subcortical white matter adjacent to an older lesion. It is associated with some ring-like contrast enhancement.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 cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. Within the spinal cord there is a signal hyperintense lesion redemonstrated at the C1 vertebral level centrally and posteriorly. This was also present on the prior exam. There is redemonstration of a right posterior lateral T2 signal hyperintense lesion at the C3 vertebral body level No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small left posterior lateral disc protrusion present this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present this level.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 redemonstration of multiple lesions present in the periventricular subcortical white matter with the addition of a new lesion in the right parietal lobe subcortical white matter which appears to be in the subacute or acute stage.2.There is redemonstration of multiple white matter lesions in the cervical spinal cord which are stable compared to the prior exam.3.There are degenerative changes present cervical spine without significant compromise to spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Resection of a left occipital lesion consistent with carcinoma. There are postoperative findings related to recent left occipital lobe tumor resection, with areas of high T1 signal and susceptibility effect in the resection cavity. There is also persistent surrounding vasogenic edema. There are small areas of restricted diffusion surrounding the resection cavity related to ischemia. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants.

Output: Expected postoperative findings related to recent left occipital lobe tumor resection.


Instruction: Generate impression based on findings.

Input: Limited treatment planning MRI again demonstrates an unchanged heterogeneously enhancing mass in the right perirolandic region that measures up to 25 mm. There is associated vasogenic edema and mild regional mass effect. There is also an unchanged area of susceptibility effect within the mass, likely representing hemosiderin deposition from chronic microhemorrhage. The previously seen enhancing lesion in the left occipital lobe that measures up to 5 mm is less conspicuous compared to prior study but this may be related to technique. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: Limited MRI for treatment planning with unchanged enhancing right perirolandic and left occipital lobe lesions.


Instruction: Generate impression based on findings.

Input: 54-year-old female with right renal mass who presents for evaluation of differential function. The posterior abdominal radionuclide angiogram demonstrates absent perfusion involving a region within the superior pole of the right kidney, which likely corresponds to the mass identified on recent MRI. On sequential imaging, there is a lack of uptake within this region as well. There is normal uptake and excretion of tracer within the left kidney and lower pole of the right kidney. The estimated contribution of the right kidney to total renal function is 44% and that of the left kidney is 56%. There are no abnormalities of the ureters or bladder.

Output: Area of decreased perfusion, uptake, and excretion within the superior pole of the right kidney likely corresponds to the mass identified on recent MRI. Normal perfusion, uptake, and excretion of the left kidney and lower pole the right kidney.


Instruction: Generate impression based on findings.

Input: Clinical question: Status post cervical fusion. Signs and symptoms: Same Nonenhanced CT of cervical spine:Routine non-infused axial 3-mm CT images of the entire cervical spine were obtained. Sagittal and coronal 2-D reformatted images were also obtained.Examination demonstrates very advanced degenerative disk disease at C3 -- C4 through C6 and C7 levels.Antral listhesis of C3 in respect to C4 is again identified with no appreciable change since prior MRI exam.There is evidence of posterior fusion with placement of bilateral trans-facet fixating screws at C3 level. There is also wide bilateral laminectomy at this level.Evidence of bilateral trans-facet screws placement at C4. No evidence of laminectomy. Fixating metallic rods bilaterally at C3 there C4 levels are also present.There is no evidence of any fracture of the instruments. The appropriateness of the position of the screws should be decided by referring clinical physician.Expected postoperative changes of air in the surgical site. No evidence of intracanalicular air.

Output: 1.Expected postoperative changes of posterior fusion of C3 and C4 and wide bilateral laminectomy of C3.2.Stable anterolistheses of C3 in respect to C4 and extensive degenerative changes of cervical spine.


Instruction: Generate impression based on findings.

Input: Right hip pain Vertebral body heights and intervertebral disc spaces are within normal limits. Alignment is within normal limits. I see no specific findings to account for the patient's right hip pain.

Output: Normal-appearing lumbar spine without findings to account for the patient's right hip pain.


Instruction: Generate impression based on findings.

Input: Changes from ACDF and corpectomy are evident at C6/7. Edematous discogenic reactive endplate changes (Modic type I) are also noted at C6/7. Fatty discogenic reactive endplate changes (Modic type II) are noted elsewhere.There are no fractures or subluxations. The marrow signal is benign. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Endplate spurring asymmetric to the right and mild right facet hypertrophy cause mild right neural foraminal stenosis.C3/4: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is moderate to severe left and moderate right neural foraminal stenosis.C4/5: Posterior osteophyte disc complex asymmetric to the right and bilateral uncinate hypertrophy. There is flattening of the anterior right hemicord without intrinsic cord signal abnormality. There is mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.C5/6: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is severe left neural foraminal and moderate right neural foraminal stenosis.C6/7: Posterior osteophyte disc complex and bilateral uncinate hypertrophy. There is mild focal cord atrophy with associated intrinsic cord T2 signal hyperintensity consistent with myelomalacia. There is mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.C7/T1: Unremarkable

Output: 1.C2/3: Mild right neural foraminal stenosis.2.C3/4: Moderate to severe left and moderate right neural foraminal stenosis.3.C4/5: Mild central, moderate to severe left neural foraminal, and severe right neural foraminal stenosis.4.C5/6: Severe left neural foraminal and moderate right neural foraminal stenosis.5.C6/7: Mild focal cord atrophy with associated intrinsic cord T2 signal hyperintensity is consistent with myelomalacia. There is mild central, moderate to severe left neural foraminal, and mild right neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Reason: Patient has metastatic adenoid cystic carcinoma now complaining of right hip pain. Evaluate for bone metastases There is a lesion within the subtrochanteric region of the proximal right femoral diaphysis which demonstrates increased signal abnormality on fluid sensitive sequences and enhances on postcontrast sequences consistent with a focus of osseous metastatic disease, corresponding to the finding seen on recent radiographs. Additionally, note is made of an large enhancing lesion within the right acetabulum which extends into the right inferior and superior pubic rami also consistent with osseous metastatic disease. There is a linear focus of decreased signal abnormality traversing the anterior column of the acetabulum consistent with a pathologic fracture. Additionally, note is made of a linear focus of decreased signal abnormality traversing the right inferior pubic ramus indicating a second pathologic fracture. There is an additional focus of osseous metastatic disease involving the right iliac bone with associated cortical destruction/penetration and extension into the right iliacus and gluteus minimus musculature. There is an additional small round focus of osseous metastatic disease identified within the right iliac bone adjacent to the sacroiliac joint.Additional foci of signal abnormality are identified in the left iliac bone as well as within the lesser trochanter of the left femur, as seen on the large field-of-view images, which are incompletely characterized but are also suspicious for osseous metastatic disease. Severe degenerative disc disease affects image lower lumbar spine. Moderate osteoarthritic changes affect the hips bilaterally. There is a small amount of fluid within the hips without evidence of a large effusion. There is a small amount of peritrochanteric inflammation on the right which is nonspecific.

Output: Osseous metastatic disease affecting the bones of the pelvis and right femur with associated pathologic fractures of the right acetabulum and inferior pubic ramus. Other findings as described above.