Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar polyradiculopathy; rule out spondylolysis, rule out spinal stenosis. Signs and symptoms: Numbness in lower extremities, weakness in distal lower extremities. LBP. EMG showed polyradiculopathy (cervical, thoracic and lumbar). Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate mild disc desiccation and loss of height and moderate hypertrophic changes of posterior elements. There is resultant mild central spinal stenosis, moderate right and severe left neural foraminal compromise.C3-C4 demonstrate mild disc disease and loss of disc height and mild facet and ligamentum flavum hypertrophy. There is also hypertrophic changes of posterior longitudinal ligament throughout the cervical spine. Constellation of finding at this level results in moderate central spinal stenosis, significant right and moderate to significant left neural foramina compromise.C4-C5 demonstrate moderate disc disease and mild bilateral facet and ligamentum flavum hypertrophy as well as posterior longitudinal ligament hypertrophy. Constellation of changes results in mild central spinal stenosis and severe bilateral neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, ventral disc/osteophyte complex and mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis, significant bilateral (L>R) neural foraminal compromise.C6-C7 demonstrate fusion at the level of the disc likely secondary to degenerative changes without central spinal stenosis. There is however moderate bilateral neural foraminal compromise secondary to degenerative disease.C7-T1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.The signal intensity of the cervical and upper most visualized thoracic cord remains within normal.Partially visualized images through posterior fossa demonstrate atrophic changes of the right inferior cerebellum suspected of a chronic ischemic stroke.Nonenhanced lumbar MRI:The lower most visualized thoracic spine and thoracic cord from T10 inferiorly is unremarkable.T12-L1 is unremarkable.L1-L2 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L2-L3 demonstrate moderate disc disease and loss of disc height, moderate bilateral facet and mild bilateral ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and moderate left neural foraminal compromise.L3-L4 demonstrate mild disc disease with loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is increased dorsal epidural fat pad with resultant mass effect on the thecal sac. Constellation of changes results in moderate central spinal stenosis, significant right and moderate left neural foraminal compromise.L4-L5 demonstrate mild disc disease and loss of disc height, significant bilateral ( R>L) facet and ligamentum flavum hypertrophy and with increased dorsal epidural fat pad. Degenerative changes also results in mild grade 1 anterolisthesis. Constellation of changes results in severe central spinal stenosis, significant right and moderate left neural foraminal compromiseL5-S1 demonstrate mild disc disease and loss of disc height, significant left and moderate right facet and ligamentum flavum hypertrophy. No central spinal stenosis however moderate to severe right neural foraminal compromise is detected.The signal intensity of cauda equina remains within normal.AP spinal soft tissues are unremarkable.Partially visualized bilateral SI joints demonstrate mild degenerative changes.

Output: 1.Nonenhanced MRI of cervical spine demonstrate extensive degenerative and hypertrophic changes with resultant multilevel mild to moderate central spinal stenosis and multilevel bilateral significant neural foraminal compromise (some significantly) as detailed per level above. There is normal signal intensity of the visualized cord. There is disc space fusion at C6-C7 likely secondary to degenerative disease. Atrophic changes of the inferior right cerebellum suggestive of chronic stroke.2.Nonenhanced lumbar MRI demonstrate degenerative changes and including mild grade 1 anterolisthesis at L4-L5 which in combination with increased dorsal epidural fat results in multilevel central spinal stenosis and neural foraminal compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: A patient with biopsy proven right breast cancer submitted outside study for review. Submitted for review are breast MRI (3/18/15) performed at Southwest Hospital MRI center. Breast MRI was performed with a protocol outlined in the outside radiology report. There is an irregularly shaped enhancing mass at anterior 12 o'clock position in the right breast, consistent with a biopsy proven cancer. A clip artifact is present within the mass. An enhancing focus in the right anterior lower outer quadrant appears to be an intramammary lymph node.No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Unifocal right breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: No significant MRI abnormality noted. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe T2 hyperintense enhancing lesion compatible with hemangiomas, unchanged. No intrahepatic or extrahepatic biliary dilatation. The portal vein and hepatic veins are patent.SPLEEN: Spleen is normal in size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No evidence of intraperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES:L1 vertebral body hemangioma, unchanged.PELVIS:PROSTATE, SEMINAL VESICLES: Right scrotal hydrocele, partially visualized. BLADDER: No significant abnormality notedLYMPH NODES: Enlarged pelvic lymph nodes as detailed below.Reference left external iliac node measures 1.9 x 1.2 cm (series 34/54), previously 1.9 x 1.2 cm and not significantly changed.Reference left femoral node measures 2 x 1.3 cm (series 23/32), previously 2.1 x 1.5 cm and not significantly changed.Reference left inguinal node measures 3.8 x 3.5 cm (series 20/50), previously 3.4 x 2.9 cm (9/72) and mildly increased.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild edema in the right paraspinal musculature is unchanged.OTHER: No significant abnormality noted

Output: Referenced left inguinal lymph node has mildly increased in size. Otherwise, no significant interval change. No new sites of disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o osteomyelitis History: fever, back pain MRI thoracic spine:At T10-T11 there is loss of vertebral body height, irregularity of the endplates and heterogeneous signal within the disk space as well as marrow replacement within the vertebral bodies and posterior elements. There is epidural extension of disk material associated with the compression of the thecal sac and mild compression of the spinal cord. There is a CT of the abdomen study from 7/16/14 which indicates that the endplates were intact at that time. There is a peri-vertebral infiltration present.The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine: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.No abnormal enhancing lesions are appreciated in the lumbar spine.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.

Output: 1.Findings are compatible with diskitis and osteomyelitis at T10-T11 associated with epidural extension and some mild compression of the spinal cord. There is both the anterior and posterior element involvement associated with compression deformities of T10 and T11. Post-contrast imaging of the thoracic spine may help further assess the extent of involvement.2.Exam is somewhat limited due to inability on for the patient to tolerate the exam.3.Findings were discussed with Dr Pulimi at the time of this interpretation at approximately 9:40 a.m.


Instruction: Generate impression based on findings.

Input: Male 63 years old with lateral joint line pain. Evaluate for lateral meniscus tear. MENISCI: The anterior horn of the lateral meniscus appears small with globular and linear intermediate signal intensity in its substance likely representing a combination of degeneration and chronic fraying but we see no discrete fluid-filled tear. This degeneration extends into the body of the lateral meniscus and there is mild intrasubstance degeneration of the posterior horn but again, no discrete fluid-filled tear. A small collection of fluid signal intensity adjacent to the body of the lateral meniscus could represent a joint recess or parameniscal cyst and contains a 3 mm round focus of low signal intensity perhaps representing a small cartilage fragment.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the weightbearing portion of the lateral compartment with near full-thickness and full-thickness clefts and cartilage loss particularly affecting the lateral tibial plateau with underlying subchondral cyst formation. There is a small full-thickness defect of the articular cartilage of the weightbearing surface of the medial femoral condyle with relative preservation of the articular cartilage of the medial tibial plateau. There is full-thickness loss of articular cartilage along the median eminence of the patella with underlying subchondral cyst formation and delamination of the adjacent articular cartilage of the lateral facet. There is additional partial thickness degeneration of the articular cartilage of the medial facet. There is relatively mild degeneration of the articular cartilage of the femoral trochlea.There is a small focus of abnormal signal intensity within the medial tibial plateau anteriorly just beneath the root of the medial meniscus which appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degeneration and perhaps fraying of the lateral meniscus (particularly the anterior horn) but we see no discrete meniscal tear.2.Tricompartmental osteoarthritis as described above.3.Joint effusion other findings as above.


Instruction: Generate impression based on findings.

Input: Elevated PSA. 2 prior negative biopsies. PELVIS:PROSTATE:Prostate Size: The prostate measures 6.1 x 4.2 cm.Peripheral Zone: Within the left mid anterior peripheral zone, there is an area of T2 hypointensity with mild enhancement, which is favored to be extension of the transition zone.Central Gland: The transition zone is nodular in appearance, consistent with benign prostatic hypertrophy.Seminal Vesicles: The seminal vesicles are normal in appearance.Extracapsular Extension: Not applicable.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No suspicious lesion identified.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with GBM status post RT/TMZ. The prior MRI was the post RT exam with question of pseudoprogression. Patient is MGMT promotor unmethylated. A heterogeneous lesion is again seen involving the left inferior and middle frontal gyri with evidence of prior biopsy or partial resection. Nodular enhancement is again seen at the operative site, along with a rim-enhancing lesion located deep to the operative site within the left centrum semiovale. The superficial enhancement is relatively unchanged from the immediate prior examination. The deeper centrum semiovale enhancement, however, has increased in size by 1 or 2 mm. The areas of enhancement correlate with mildly elevated rCBV which appears to be less than that seen on the prior examination.Confluent fairly extensive FLAIR hyperintensity surrounding the above-mentioned lesions has mildly progressed extending through the left frontal and anterior parietal parenchyma as well as the operculum. However, there is only minimal associated mass effect. This area of signal abnormality correlates with low rCBV.Ill-defined periatrial T2 hyperintensity and scattered more focal T2 hyperintense lesions within the cerebral white matter, show no significant interval change. This includes a small focus of signal abnormality corresponding to the right corticospinal tract within the pons. No new pathologic intracranial enhancement is seen. Ventricles remain normal in size and morphology.

Output: Enhancing lesions within the left frontal lobe are redemonstrated. The more superficial lesion demonstrates no significant change in size while the deeper rim-enhancing lesion has increased in size but only by 1 or 2 mm. Both areas of enhancement correlate with mildly elevated rCBV which appears reduced from the prior examination. FLAIR hyperintensity surrounding these lesions has increased but with only minimal mass effect.One possible interpretation of these findings is that the areas of enhancement represent partially treated tumor while the more extensive FLAIR abnormality may reflect pseudoprogression. Ultimately, both viable tumor and treatment effect remain in the differential, though the slowed expansion of enhancement is somewhat encouraging.


Instruction: Generate impression based on findings.

Input: 62-year-old with history of right breast cancer status post lumpectomy, radiation and chemotherapy. Three standard views of both breasts and lumpectomy magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Postsurgical changes in the right breast are seen, with distortion, density and multiple surgical clips. Benign dystrophic calcifications have continued to develop. Skin thickening compatible with radiation therapy to the right breast also noted. Several asymmetries in the left breast are unchanged, including in the left medial breast. It is noted that this mammographic appearance is unchanged since before the time of her staging MRI in 2012.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of hepatitis C and cirrhosis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. No specific stigmata of portal hypertension.No biliary ductal dilatation. The vessels are patent.New segment 4A 7 mm and segment 2 8-mm T2 hyperintense lesions with associated restricted diffusion but no arterial enhancement or washout.Several punctate and peripheral wedge-shaped foci of arterial enhancement without washout or associated signal abnormality are likely perfusional anomalies, mostly unchanged.Normally distended gallbladder with small gallstones.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts.RETROPERITONEUM, LYMPH NODES: Mildly prominent periportal lymph nodes are nonspecific in the setting of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two new subcentimeter T2 hyperintense restricting lesions do not meet imaging criteria for HCC as they have no arterial enhancement or washout. Short-interval follow-up imaging is recommended to ascertain stability of these new lesions.


Instruction: Generate impression based on findings.

Input: 24-year-old female experiencing left-sided weakness, history of multiple sclerosis Redemonstrated are periventricular and subcortical white matter T2 hyperintense lesions, some of which are perpendicularly oriented to the lateral ventricles. There were also similar-appearing lesions within the right posterior medulla and middle cerebellar peduncles. There is a definite new large lesion adjacent to the frontal horn of the left lateral ventricle. None demonstrate contrast enhancement, including the new left frontal lobe lesion.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: There is redemonstration of multiple white matter lesions as well as brainstem lesions. There is a definite new large lesion adjacent to the frontal horn of the left lateral ventricle. None demonstrate contrast enhancement, including the new lesion.


Instruction: Generate impression based on findings.

Input: 59-year-old male with known pancreatic pseudocysts. Evaluate fistula. The review of medical records reveals recent MRI showing multiple pancreatic pseudocysts, one of which possibly communicates with the left renal vein. LUNG BASES: No significant abnormality noted.ABDOMEN: LIVER, BILIARY TRACT: Scattered hypoattenuating lesions, some of which are likely benign cysts while others are too small to characterize.SPLEEN: Splenic vein thrombosis with perigastric collaterals.PANCREAS: Three pancreatic pseudocysts as seen on recent MRI, with the largest seen at the pancreatic tail measuring 2.4 x 4.5 cm. The pancreatic tail pseudocyst extends towards and abuts the left renal vein, which is thrombosed. No blood products are identified in the pancreatic cyst to suggest active communication.Dilated pancreatic duct was better visualized on prior MRI. Please refer to that report.Parenchymal calcifications are compatible chronic pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Thrombosed left renal vein with stranding around the left kidney. No hydronephrosis. There is slight asymmetric delay in the corticomedullary differentiation of the left kidney, the venous drainage of which appears to be compensated via collaterals, suggesting that this is a chronic process. No evidence of fistula between the left renal vein and adjacent pancreatic pseudocyst.Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the descending aorta and iliac arteries.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy nodular sclerosis with areas of lucency are noted in the sacrum, appearing similar to prior studies. While this may represent an atypical form of Paget disease, further evaluation with MRI may be considered for further characterization.

Output: 1. Findings compatible with chronic pancreatitis with 3 pancreatic pseudocysts. The largest is in the pancreatic tail, which abuts left renal vein. However, there is no evidence of fistula at this location.2. Thrombosis of the left renal vein with slight asymmetric delay in the corticomedullary differentiation of the left kidney. Venous drainage of this kidney is compensated via collaterals, suggesting that this is a chronically evolving process.3. Patchy nodular sclerosis with areas of lucency in the sacrum. While this may represent an atypical form of Paget disease, further evaluation with MRI pelvis is recommended for further characterization.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type 1 with moyamoya and brainstem mass.. There is an unchanged heterogenously enhancing mass centered within the right midbrain, which measures 22 AP x 20 RL x 18 SI mm. There is no evidence of intracranial hemorrhage or acute infarct. There is unchanged encephalomalacia with subcentimeter cystic defects in the left frontal deep and periventricular white matter and within the right temporal occipital region. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are postoperative findings related to bilateral pial synangiosis. There is steno-occlusive disease involving the internal carotid arteries with associated collateral vessels. There is a probable right basal ganglia developmental venous anomaly. There is a partially-imaged left cleft palate and associated postoperative findings.

Output: 1. Unchanged right brainstem mass, accounting for differences in technique.2. Unchanged areas of encephalomalacia in the left frontal deep and periventricular white matter and within the right temporal occipital region are compatible with chronic infarcts. No evidence of acute cerebral infarction.3. Postoperative findings related to bilateral pial synangiosis and steno-occlusive disease involving the internal carotid arteries are better depicted on the prior MRA.


Instruction: Generate impression based on findings.

Input: Chiari with cord/medullary compression MRI brain:There is redemonstration of Chiari I malformation with a small posterior fossa and inferiorly pointed cerebellar tonsils. The inferior tip of the cerebellar tonsils is at the level of the C1 vertebra.The sulci and lateral ventricles are relatively small. There is diffuse pachymeningeal meningeal enhancement present which was also present to some degree on the previous exam.No foci of diffusion restriction are appreciated.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 opacified to a large degree.. The visualized portions of the mastoid air cells and middle ears are opacified. The patient is status post intubation. The visualized portions of the orbits are intact.MRI cervical spine:The patient was positioned poorly in the magnet.Since the prior exam the signal hyperintensity centrally within the cervical spinal cord has receded but not resolved. There is redemonstration of a small syrinx at the C3 vertebral body level. There is redemonstration of Chiari I malformation.There is redemonstration of diffuse and predominantly ventral epidural thickening and enhancement suspected to represent epidural venous plexus. This is associated with effacement of the CSF space surrounding the spinal cord from C1-2 down to C4-5. In general this has not changed substantially since the prior exam.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine or cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is accumulation of a collection behind and around the cord which is high signal on T1 and T2 but heterogeneous signal on T2 STIR throughout the thoracic spine but predominantly along the upper thoracic spine. In general there is lower signal within this collection on the T2 STIR images on the current exam compared to the prior exam. This is associated with the diffuse heterogeneous enhancement. There is effacement of spinal fluid ventral and posterior to the spinal cord especially at the T3 vertebral body level. The previously noted abnormal signal within the spinal cord centrally from the cervical cord down to T8 level has significantly regressed.The thoracic vertebral bodies are appropriate in the overall alignment and height. There are bilateral pleural effusions. Pulmonary opacities have significantly regressed. Lumbar spine: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. No abnormal enhancing lesions are appreciated in the lumbar spine.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.Since the prior exam enlargement of the renal pelves and ureter has resolved.

Output: 1.Suspect combination of epidural lipomatosis and fluid centered at T3-5 associated with compression of the thecal sac.2.Suspect epidural venous engorgement centered at C2-4 associated with compression of the thecal sac.3.Since the prior exam central cord signal abnormality (C3-T8) has regressed but not resolved. 4.Focal syrinx at C3 is unchanged.5.Chiari I malformation6.Mild pachymeningeal thickening. This is nonspecific. It could relate to low CSF pressure or be reactive to recent lumbar puncture.7.Bilateral pulmonary opacities with pleural effusions. Please correlate with chest x-ray findings.


Instruction: Generate impression based on findings.

Input: Female, 43 years old, with pituitary adenoma. Evaluate for changes. A small area of heterogeneity is again seen along the inferior left aspect of the pituitary gland measuring approximately 6 mm TV x 4 mm AP x 3 mm SI. The lesion has not significantly changed from the prior examination. The remainder of the gland is within normal limits. The pituitary stalk enhances normally and enters the gland at midline. No abnormalities of the suprasellar cistern or cavernous sinuses are seen.

Output: Stable small lesion along the inferior left aspect of the pituitary gland.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a right greater than left maxillary mucosal sinus thickening.MRA Brain: Motion obscures full evaluation of the circle of Willis. Within these limitations, there is moderate atherosclerotic narrowing of the cavernous segment of the left ICA and mild narrowing of the cavernous segment of the right ICA. The remaining intracranial internal, middle and anterior cerebral arteries are patent without significant stenosis. There is no flow related signal within the left vertebral artery likely indicating occlusion. A 2 mm outpouching projecting from the proximal basilar artery could represent the stump of the occluded vertebral artery versus a small aneurysm. The right vertebral artery, basilar artery, and posterior cerebral arteries also are patent without significant stenosis. MRA Neck: The origin of the left vertebral artery is visualized but shortly thereafter the vertebral artery does not opacify likely indicating occlusion. There is minimal if any opacification of the remaining left cervical vertebral artery segments. The right vertebral artery is patent although there is mild luminal irregularity likely secondary to atherosclerotic disease.The common carotid arteries and cervical internal carotid arteries are normal in course and caliber.

Output: 1.No evidence of acute intracranial hemorrhage, mass or infarct.2.Likely chronic atherosclerotic occlusion of the left vertebral artery beginning shortly after its origin and extending intracranially.3.2 mm outpouching from the proximal basilar artery could represent either the stump of the occluded V4 segment versus a small aneurysm.4.Scattered areas of atherosclerotic disease involving the remaining arteries of the neck and intracranial circulation without significant flow-limiting stenosis as described above.5.Scattered mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Girl with NF1 and markedly accelerated growth. Brain: There is unchanged enlargement of the bilateral optic nerve cisternal segments with sparing of the optic chiasm. There is persistent patchy T2 hyperintensity in the supratentorial and infratentorial deep grey matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a newly apparent punctate focus of enhancement in the right temporal scalp, just posterior to the orbital rim.Orbits: There is unchanged diffuse expansion, T2 hyperintensity, and enhancement of the bilateral intraorbital optic nerve segments, measuring up to 6 mm in diameter on the left and 5 mm in diameter on the right. There is also unchanged expansion of the intraorbital and canalicular optic nerve segments.

Output: 1. Unchanged optic nerve gliomas and intracranial stigmata of neurofibromatosis type 2.2. A newly apparent punctate focus of enhancement in the right temporal scalp, just posterior to the orbital rim, may represent a peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Stage IV lung cancer now with increasing right lower back pain. Evaluate extent of bone metastases. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The bone marrow is diffusely heterogeneous which may be secondary to treatment change. In addition, there are multiple T2 hyperintense foci throughout the visualized thoracolumbar spine are compatible with osseous metastases. The largest lesion is incompletely visualized within the posterior T11 vertebral body which extends to partially involve the right pedicle. There are also additional lesion suspicious for metastasis in the posterior superior endplate of the L3 vertebral body, the posterior S1 vertebral body and S3 vertebral body. There is no extraosseous spread of tumor, pathologic fracture or central spinal canal compromise. The conus medullaris on sagittal imaging is grossly intact.T12-L1 through L2-L3: There is no significant compromise to spinal canal or neural foramina.L3-L4: Mild disc disease is noted with evidence of a small midline posterior annular fissure. There is minimal grade 1 retrolisthesis of L3 on L4 which causes mild to moderate right and mild left neural foraminal stenosis as well as mild central canal stenosis.L4-5: Mild disc disease is noted with a tiny linear T2 hyperintense signal within the posterior annulus of the disc compatible with a fissure. There is mild bilateral facet hypertrophy with small facet joint effusions as well as moderate bilateral ligamentum flavum thickening. This causes mild central canal stenosis. There is also moderate bilateral right greater than left neural foraminal stenosis as well as bilateral lateral recess compromise which may impinge the L5 nerve root. A degenerative Schmorl's node is noted in the inferior endplate of L4.L5-S1: No significant disc disease and mild bilateral facet hypertrophy. No neuroforaminal or central spinal canal stenosis.Two enhancing lesions are noted within the left iliac wing compatible with metastases.

Output: 1.Metastatic osseous lesions involving several lower thoracic and lumbosacral vertebral levels as well as the left iliac wing.2.Multilevel degenerative changes as described above, most severe at the L3-4 and L4-5 levels.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other idiopathic scoliosis, site unspecifiedClinical question: assess stenosisSigns and Symptoms: degen scoli, LBP 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. No abnormal enhancing lesions are appreciated in the lumbar spine. There is a rotatory dextrocurvature to the lumbar spine. Incidental note is made of fatty filum.Postcontrast imaging demonstrates infiltrative-type enhancement in the right neural foramen and paraspinous tissues at L5-S1 and the left paraspinous tissues and neural foramen at L2-3 and L3-4.At L5-S1 there is loss of disc space height, as well as a right far lateral broad-based disc protrusion with extension into the right neural foramen and behind the adjacent endplates. There is effacement of the fat surrounding the exiting nerve roots within the right neural foramen at this level. There is some displacement of the nerve roots at the right lateral recess at this level. Compared to the previous exam this has not changed substantiallyAt L4-5 there is loss of disc space height and disc desiccation, endplate reactive changes and a diffuse disc bulge associated with Schmorl's nodes. The Schmorl's nodes appear to be new since prior exam. There is redemonstration of small right lateral translation of L4 on L5.. There is effacement of the fat at the right lateral recess at this level with encroachment of the nerve roots at the right lateral recess. There is also some effacement of fat at the left lateral recess at this level with encroachment of the nerve roots at the left lateral recess. The fat surrounding the right-sided exiting nerve root within the left neural foramen at this level is partially effacedAt L3-4 there is a diffuse disc bulge present associated with the area of the neural foramina worse on the left side the right. The fat surrounding the left-sided exiting nerve root within the left neural foramen at this level is partially effaced. Extruded disc material behind the L4 vertebral body at this level has regressed in volume. There is less encroachment of the left lateral recess on the current exam when compared to the prior. There is right lateral translation of L3 on L4. There are some new Schmorl's nodes present at this level. The endplate reactive changes appear to have mildly progressed. There are endplate reactive changes on the left side at this level with T2 signal hyperintensity and contrast enhancement.At L2-3 there is a new left far lateral disc protrusion and encroachment of the left-sided exiting nerve roots within the neural foramen and encroachment of the nerve roots at the left lateral recess. There are endplate reactive changes on the left side at this level with T2 signal hyperintensity and contrast enhancement.At L1-2 there is loss of disc space height, disc desiccation and disc bulge.

Output: 1.There is redemonstration of multilevel degenerative changes in the lumbar spine with a rotatory dextroscoliotic curvature to the lumbar and right lateral translation of L3 on 4 and L4 and L5. In general degenerative changes in the lower lumbar spine continued to progress compared to the prior exam.2.Since the prior exam a disc extrusion at L3-4 has regressed. It is associated with inflammatory changes in the left neural foramen at this level along the left-sided exiting nerve roots.3.Since the prior exam a left far lateral disc protrusion at L2-3 has developed. It is associated with encroachment of the nerve roots within the left neural foramen at this level. It is associated with inflammatory type changes along the left-sided.4.There is encroachment of nerve roots at the lateral recess bilaterally at L4-5 due to degenerative changes. The effacement at the right lateral recess due to disc material has mildly increased on the current exam when compared to the prior exam.5.Encroachment of the right-sided exiting nerve roots at L5-S1 stable since the prior exam. This is now associated with inflammatory change along the right-sided exiting nerve roots.6.Encroachment of the nerve roots at the right lateral recess and right neural foramen at L4-5 is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with history of T2 and one squamous cell cancer of the right tongue status post partial glossectomy, neck dissection and radiation followed by recurrence. Image quality is degraded by motion artifact which is present on all sequences despite multiple repeat attempts. There is also loss of signal in the anterior inferior neck of uncertain etiology. Within these limitations, the following observations are made.Anatomic distortion of the tongue is seen with a defect involving the right anterior aspect, possibly postsurgical in nature. The remainder of the anterior oral tongue is thickened and abnormally T2 hyperintense. This tissue measures up to 48 x 33 mm (image 38 series 701). This tissue extends superiorly to encompass all of the anterior oral tongue, and it extends inferiorly to some degree into the floor of mouth. Posteriorly the oral tongue demonstrates normal morphology and signal intensity.A presumed submental lymph node is poorly visualized on the present examination. No definite additional pathologic adenopathy is seen, though for reasons discussed above, the concurrent and prior CTs provide a better assessment in this regard.Extensive presumably treatment related findings are seen including subcutaneous reticulation and infiltrative edema which affects the soft tissues of both sides of the neck. There is a sizable retropharyngeal effusion. The supraglottic laryngeal mucosa and the soft palate are edematous.No focal lesions of the parotid glands are suspected. The submandibular glands are not well delineated on this study. The thyroid is somewhat obscured by artifact and not adequately assessed. Patchy airspace opacities are seen in the right upper lung.

Output: Image quality is significantly limited by motion artifact and loss of signal affecting the anterior inferior neck. Postoperative findings are seen in the anterior right tongue. The remainder of the anterior oral tongue is thickened and demonstrates pathologic T2 signal compatible with extensive local residual or recurrent tumor. This tumor fills the anterior oral tongue and potentially extends down into the floor of mouth.Extensive presumed treatment related findings are again seen including diffuse infiltrative edema of the soft tissues of the neck, a retropharyngeal effusion, and edema of the aerodigestive mucosa. Adenopathy is better assessed on concurrent and prior CTs.


Instruction: Generate impression based on findings.

Input: 19 year-old male with history of persistent left ankle pain and swelling, prednisone, concern for avascular necrosis. TENDONS: The Achilles' tendon appears normal. The medial, peroneal, and anterior tendons appear normal as well. LIGAMENTS: The lateral collateral ligament complex is intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is serpentine signal abnormality within the distal tibial metaphysis, extending into the distal tibial epiphysis, with surrounding marrow edema, compatible with osteonecrosis. No subchondral fracture or articular surface collapse is identified. An additional small focus of osteonecrosis is present within the posterolateral aspect of the talar dome, without associated edema or articular surface collapse. There is a tibiotalar joint effusion, which appears to extend into the flexor hallucis longus tendon sheath. Mild edema along the periosteum of the distal tibia and the adjacent soft tissues is noted. ADDITIONAL

Output: 1.Osteonecrosis of the distal tibia with edema, a joint effusion, and adjacent soft tissue swelling.2.Small focus of osteonecrosis in the talar dome, without associated edema.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Mild degenerative changes of the cervical spine are incidentally noted on the scouting sequence, with disc osteophyte complex formation.Thoracic Spine: The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine. Lumbar Spine: 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 no significant disc disease, spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits, with mild dependent edema.

Output: No spinal stenosis. No evidence of postprocedural complication status post lumbar puncture.


Instruction: Generate impression based on findings.

Input: Reason: eval for pseudomeningiocele. CINE flow studies History: incision leak The exam is stable compared to the 4/23/15 exam as well as the 10/28/14 exam.The patient is status a suboccipital craniectomy and C1 posterior arch resection for Chiari malformation. There is redemonstration of a small focus of enhancement just behind the spinal cord at that level over the craniectomy site which measures 8 x 84 mm sagittal dimensions. It is unchanged since the 10/28/14 exam.The fourth ventricle and is thin and long. The corpus callosum is abbreviated at the level of the splenium. The cerebellum wraps around the brainstem. There is some evidence for tectal beakingThere is a focus of encephalomalacia in the right parietal lobe .The patient is status post ventriculostomy tube placement for shunt. A ventriculostomy tube course through the right parietal lobe into the right lateral ventricle with the tip along the anterior horn of the right ventricle. Another ventriculostomy tube courses through the left parietal calvarium into the body of the left lateral ventricle through the trigone and into the cingulate sulcusThe aqueduct of Sylvius is not readily identified.No abnormal enhancing mass lesions are appreciated in the brain parenchyma. No edema is identified within the brain parenchyma. Susceptibility artifact is present adjacent to ventriculostomy tubes and along the right parietal lobe focus of encephalomalacia.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery appears to be hypoplasticThe visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The examination is stable. There is redemonstration of stigmata of Chiari two malformation as well is status post suboccipital craniectomy and shunt placement. The aqueduct of Sylvius is not readily identified. There is encephalomalacia in the right parietal lobe.2.A small focus of enhancement behind the cervical medullary junction is nonspecific but could relate to scar formation.3.The CSF flow study was not performed due to technical reasons.


Instruction: Generate impression based on findings.

Input: 14 years, Male, delusional behavior, paranoia. MRI of the brain is within normal limits. No intracranial mass or mass effect. Ventricles and sulci are within normal limits. No focal parenchymal signal abnormality is appreciated. No evidence of ischemia or hemorrhage. Major flow-voids are preserved. No abnormal parenchymal or meningeal enhancement. There is opacification of the right anterior ethmoid air cell with mild osseous remodeling. Right frontal sinus is under pneumatized. Mastoid air cells are clear. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. MRI of the brain is within normal limits. 2. Opacification of the right anterior ethmoid air cells with mild smooth osseous expansion suggestive of mucocele, as seen on recent CT.


Instruction: Generate impression based on findings.

Input: Pain Three views of the left shoulder appear normal. No findings are seen to account for the patient's pain.

Output: No findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Susceptibility near the left inferior temporal gyrus represents expected hemosiderin in the surgical cavity. A 7 x 7 mm area of enhancement seen immediately anterior to the surgical site corresponds to an area of diffusion restriction on the immediate postoperative MR from 3/4/15. No additional abnormal foci of enhancement are identified. There is no significant midline shift. The ventricles and basilar cisterns appear normal. There is normal enhancement of the major intracranial vascular structures.

Output: Limited MR performed for treatment planning demonstrates postoperative findings of tumor resection in the left inferior temporal lobe with interval increase in enhancement anterior to the surgical cavity most consistent with evolution of postsurgical change.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated.Corresponding to the prior questioned abnormality seen on MRI brain, there is abnormal decreased AP dimension of the upper thoracic cord extending down to at least the T9 level. Cord thickness is as low as 1 mm AP at the mid C5 level, as compared to more normal caliber along the distal thoracic cord 3 mm AP. Overall, the cord contour appears flattened and the cord is ventrally located within the spinal canal. There is a low conus termination at the mid L3 level. No abnormal fat signal is identified within the distal thecal sac. There is trace ill-defined apparent T2 hyperintensity in the center of the cord extending from the cervicomedullary junction down to at least the C6-C7 level on the axial images, although sagittal 3-D T2 weighted images do not demonstrate a corresponding abnormality and this is felt to be artifactual in etiology. Thin section 3-D T2 weighted images demonstrate normal thickness of the tectum, although it appears slightly elongated, with slight decreased conspicuity of T2 signal along the narrowed cerebral aqueduct, although it is grossly patent. There is suggestion of linear T2 hypointensity along its mid portion. There is mass effect from significantly dilated supratentorial ventricles upon the brainstem and diminutive posterior fossa structures. Upon CSF flow imaging, there is evidence of biphasic CSF flow along the prepontine cistern and ventral upper spinal canal, with diminished dorsal upper cervical spinal canal biphasic flow. No significant biphasic flow is identified through the expected location of the cerebral aqueduct. Minimal flow is suggested in the region of the fourth ventricle and its outlets.Prominence fluid signal seen within the visualized paranasal sinuses. There are patchy pulmonary opacities predominantly in the dependent left lung which are nonspecific but may represent areas of atelectasis. Please see prior brain MRI report for more details regarding intracranial abnormalities.

Output: 1.Confirmation of abnormal flattening of the cord contour with thinning of caliber along the majority of the thoracic cord. Given its central location within the spinal canal, there may be dorsal arachnoid septations or arachnoid cyst resulting in mass effect.2.Tectum appears be elongated with suboptimal visualization of the T2 signal in the narrowed cerebral aqueduct, although it is grossly patent with potential septations along its midportion. This may result in the supratentorial severe hydrocephalus. There may also in part be mass effect from the dilated ventricles upon the brainstem as well as diminutive posterior fossa structures. CSF flow appears diminished dorsally along the upper cervical spinal canal without definite identified flow in the expected location of the cerebral aqueduct.3.No definite abnormal cord signal, with previously questioned abnormality likely artifactual.4.Abnormal low conus termination at the mid L3 level without other MR findings of tethered cord although prone imaging was not obtained. Please correlate clinically.5.Patchy pulmonary opacities in the left lung which are nonspecific but may represent areas of atelectasis.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of pain. Evaluate for herniated disc or spinal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is slight straightening of the lumbar spine. Bone marrow signal is benign. The conus medullaris is normal in position terminating at the level of T12-L1. No abnormal enhancement is appreciated.Multilevel degenerative changes are seen, as described below:T12-L1: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is a mild disc bulge with a slight right paracentral extrusion component without significant spinal canal stenosis. There is mild ligamentum flavum hypertrophy. No neuroforaminal stenosis.L3-L4: There is a mild disc bulge without significant spinal canal stenosis. There is mild ligamentum flavum and facet hypertrophy. There is mild neuroforaminal narrowing bilaterally.L4-L5: There is a significant disc bulge resulting in moderate spinal canal stenosis and crowding of the cauda equina. There is mild ligamentum flavum and facet hypertrophy. Facet joint effusions are present. There is moderate neuroforaminal narrowing bilaterally.L5-S1: There is mild disc bulge. Mild facet hypertrophy. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: Degenerative disc disease as above, worse at the L4-L5 level, with moderate spinal canal stenosis, facet joint effusions and neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: Headache, sinusitis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings related to sinusitis.


Instruction: Generate impression based on findings.

Input: Right knee pain status post valgus stress. Meniscus versus ligamentous injury. MENISCI: We see no meniscal tear. There is mild irregularity of the posterior medial meniscocapsular structures that we suspect is of no current clinical significance.ARTICULAR CARTILAGE AND BONE: There is a nondisplaced and nondepressed fracture of the lateral aspect of the lateral tibial plateau with the fracture fragment measuring approximately 2 cm in the AP dimension, 1 cm in the medial-lateral dimension, and approximately 7 to 8 mm in depth. There is minimal edema in the medial aspect of the medial tibial plateau. There is edema within the fibular head with somewhat bandlike orientation that conceivably could represent a hairline fracture, but this is equivocal.The articular cartilage of the lateral and medial compartments appears intact. There is heterogeneity of the patellar articular cartilage indicating degeneration with full-thickness degeneration along the lateral facet near the median eminence and superficial delamination along the medial facet.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Nondisplaced/nondepressed lateral tibial plateau fracture.2. Patellar chondromalacia.Findings communicated via phone to Dr Gao at 1017 hrs on 3/13/2015.


Instruction: Generate impression based on findings.

Input: Memory loss [780.93], Reason for Study: ^Reason: evaluate for structural lesions History: memory decline No evidence of acute ischemic or hemorrhagic lesion on the scan.Underlying brain shows minimal brain atrophy which is age appropriate.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.Right mastoid air cells show partial opacification

Output: No evidence of acute ischemic or hemorrhagic lesion. No evidence of structural abnormality.


Instruction: Generate impression based on findings.

Input: Newly diagnosed organ-confined intermediate risk prostate cancer. He was recently noted to have a rise in his PSA to 5.49 ng/mL with 13% free on 9/7/2016. He had previously had a rising PSA (4.6 in 2/2016, 5.0 3/2016). This prompted a transrectal ultrasound and prostate biopsy which revealed a Gleason 3+4 =7 in 1 of 12 cores and Gl 3+3=6 in 5/12 cores. The positive finding was on the right lobe (R apex) with maximum involvement of 80%. PELVIS:PROSTATE:Prostate Size: 4.5 x 2.6 x 3.5 cmPeripheral Zone: There is a 7 x 5 mm T2 low (series 301 image 88) ADC low (series 408 image 304) focus in the right peripheral zone with early enhancement.Central Gland: Multiple hypoplastic nodules noted.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Signal abnormality in the right peripheral zone as above, PIRADS 4.PI-RADS™ v2 Assessment Categories:PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be present) PIRADS 2 – Low (clinically significant cancer is unlikely to be present)PIRADS 3 – Intermediate (the presence of clinically significant cancer is equivocal)PIRADS 4 – High (clinically significant cancer is likely to be present) PIRADS 5 – Very high (clinically significant cancer is highly likely to be present)https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/PIRADS/PIRADS%20V2.pdf


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: ParesthesiasComments: 3T, please ask Dr Saad Ali for the specifics of the MS protocol | MRI brain:There is redemonstration of multiple periventricular and subcortical white matter lesions which are hyperintense on FLAIR MRI imaging and hypointense on T1-weighted imaging. An additional lesion is present in the right thalamus which is high signal on FLAIR and T2 MR imaging and is unchanged since January 2015. Certainly since 2003 there is been significant progression of accumulation of more lesions. Since 2013 there has been some progression as well.A new lesion is present in the subcortical white matter of the right frontal lobe which is not as conspicuous on the prior exam on FLAIR MRI images 39 of 70 series 801.There is a FLAIR hyperintense lesion present in the medulla which was also present on the prior exam and is unchanged. Another one is present in the pons and is also unchanged.A lesion in the subcortical white matter of the right parietal lobe at the inferior parietal lobule and another at the right frontal periventricular white matter are a little smaller on the current exam when compared to the priorThe 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:There is a T2 hyperintense lesion extending from the medulla down to the upper cervical spinal cord at the C1 vertebral level. This was also present on prior exams.The cervical vertebral bodies are appropriate in overall alignment and height. \There is multilevel disc desiccation present.A small lesion is present in the right thyroid lobe measuring 4 mm in size which is hyperintense on T2 weighted imaging.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.A couple lesions in the right hemisphere are somewhat smaller on the current exam whereas another one is a little bit larger indicating some mild waxing and waning of the patient's white matter lesions. This is consistent with a demyelinating process (Multiple sclerosis in this case). Overall the demyelinating process appears to have progressed over the years.2.No new lesions are identified in the cervical spinal cord. There is a lesion contiguous with the medulla lesion extending to the upper cervical spinal cord.3.There is a small right thyroid lobe lesion present which is nonspecific. Please note that MR is not accurate in evaluation of thyroid lesions. If clinically indicated ultrasound may be of benefit in evaluating this.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are breast MRI (5/22/2016), images from MRI guided right breast biopsy with postprocedural right mammographic images (5/31/2016), images from mammographic guided wire localization for right breast (6/13/2016), digital mammographic images of right breast (6/30/2016) performed at outside institution. Patient has a proven right breast cancer at 6:00 position. BREAST MRI (5/22/2016):Breast MRI was performed with a protocol outlined in the outside radiology report. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is an area of significant signal loss in the right breast at retroareolar region. A marker clip is visualized on T2-weighted images at inferior retroareolar region. There is a regional non-mass enhancement at right retroareolar region medial to the marker clip, measuring 18 x 31 x 15 mm (AP x LR x CC), likely a primary tumor with post biopsy changes. A benign appearing focal non-mass enhancement is seen in the right breast at upper outer quadrant, measuring 6 x 7 x 8 mm. No abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.IMAGES FROM MRI GUIDED RIGHT BREAST BIOPSY WITH POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (5/31/2016):MRI guided biopsy was performed for the regional non-mass enhancement in the right retroareolar region and the focal non-mass enhancement at upper outer quadrant in the right breast. Postprocedural mammographic images show a marker clip at inferior retroareolar region, 2.4 cm inferior and posterior to the marker clip of the known cancer, and the other marker at posterior central breast. Per outside radiology report the results were benign.IMAGES FROM MAMMOGRAPHIC GUIDED WIRE LOCALIZATION FOR RIGHT BREAST (6/13/2016):Single wire localization was performed for the known cancer by lateral approach. Wire placement appears good.DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST (6/30/2016):The study was performed after a lumpectomy for the right breast cancer. Postsurgical distortion with surgical clips are seen in the right breast. There are surgical clips within the right axilla from sentinel node biopsy. Mild skin thickening is seen. Interval removal of the marker clip within the tumor in the right retroareolar region. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast.

Output: Status post benign MRI guided biopsy in the right breast and status post lumpectomy for right breast cancer.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.he patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. An image capture was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 39 seconds

Output: Successful fluoroscopic guided right hip arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: Evaluate for cord compression, patient presenting with bilateral lower extremity, left greater than the right weakness and decreased sensation below umbilicus. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compression of the spinal cord. Disc osteophyte complex and mild spinal canal stenosis is noted at the cervical spine level. There is slight loss of height of C5 vertebral body, likely degenerative in nature. Mild narrowing of the spinal canal due to disc abnormalities in the lumbar spine are better evaluated on the MRI of the lumbar spine. Hyperintense focus in the T1 vertebral body is nonspecific but is suggestive of a hemangioma.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. 2.Multilevel degenerative findings in the cervical and lumbar spine, as above. Please refer to the concomitant dedicated MR of the lumbar spine for additional findings.


Instruction: Generate impression based on findings.

Input: Male 28 years old Reason: evaluate for perirectal/pelvic abscess History: Swelling, pain, erythema left buttock. History fistula in ano currently with seton in place. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a branching left perianal fistula that extends from approximately the 3:00 position in the anorectum with a component that extends anteriorly to the base of the penis and exits the skin surface at the midline near the base of the penis. There is a seton in place. A larger component extends posteriorly into the left gluteus fat medially but doesn't have a clear exit point to the skin. This tract terminates in an abscess measuring 3.4 x 2.3 cm.Separate from this, there is a focal area of signal abnormality measuring 1.4 x 2.2 cm posterior to the coccyx in the skin representing a second small abscess. This is localized to the subcutaneous tissues without extending to the underlying bone gastrointestinal tract. This is located at the superior aspect of the gluteal cleft.OTHER: No significant abnormality noted.

Output: 1.Findings of a large left perianal fistula with a blind-ending pocket in the left medial gluteal adipose tissue.


Instruction: Generate impression based on findings.

Input: There is redemonstration of significant prominence of extra-axial space along the cerebral hemispheres bilaterally. This is most notable anteriorly along the right frontal lobe, where there is suggestion of a more focal collection with differential flow characteristics with respect to a more superficial thin subdural collection. The more superficial collection which is subtly FLAIR hyperintense with respect to CSF again measures up to 6-7 mm in greatest thickness, with the oval area of CSF signal intensity measuring approximately 3.6 x 5.6 cm in greatest axial dimensions x 3.7 cm CC. Overall, this collection appears progressed since prior CT exams, with more comparable comparison on sagittal imaging where it currently measures up to 3.6 cm in greatest thickness on 401/21, compared to previous 3.1 cm on 8/29/2016 and 3.2 cm on 9/9/2016. There remains moderate mass effect upon the underlying parenchyma with focal concavity of the frontal lobe on the sagittal images.On the left, for ease of reference as the subarachnoid vessels are visualized at this level on the previous noncontrast CT exams better defining the subdural collection margins, the left lateral subdural collection measures up to 14 mm in greatest thickness on 501/16, compared to previous 6 mm. This collection is also slightly greater than CSF signal intensity on FLAIR imaging, with only subtle flattening of the left frontal lobe parenchyma. There is trace midline shift to the right measuring 2 mm. There is redemonstration of moderate dilatation of the lateral and third ventricles, although similar in caliber to the more recent CT exams. Previously, third ventricle measured 6 mm transverse, and it now measures 14 mm transverse. The fourth ventricle is normal size. Sagittal images do not demonstrate any significant posterior fossa crowding, although patency of the cerebral aqueduct cannot be confirmed on this exam.The previously seen bilateral frontal periventricular CSF signal intensity cysts are again seen, nearly resolved on the left, but increased size on the right compared to the more remote MRI. The right-sided cyst now measures 1.6 cm AP x 1.5 cm CC, compared to previous 1.2 x 0.8 cm. There remains mild flattening of the lateral aspect of the right frontal horn. Previous abnormal signal with susceptibility along the supracerebellar cistern is no longer appreciated, consistent with resolved blood products.There is a minimal residual cavum septum pellucidum et vergae. The basal cisterns remain patent. There is no diffusion abnormality. Myelination appears relatively appropriate for corrected age except for slight decreased prominence of intrinsic T1 signal along the anterior aspect of the anterior limb of the internal capsules.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There is redemonstration of a midline fluid-filled cleft palate. There is diffuse fluid opacification of mastoid air cells and middle ears. There is suggestion of hypertelorism.

Output: 1. Compared to more recent CT imaging, there has been slight interval progression of the right-sided extra-axial collection, with more focal oval component along the anterior right frontal lobe resulting in moderate mass effect. This is of CSF signal intensity although with differential flow characteristics the remainder of the right-sided collection, and most likely represents an acquired arachnoid cyst.2. No significant interval change in the more superficial component of the subdural collection, slightly greater than CSF signal intensity on FLAIR images.3. Interval increased size of left lateral subdural collection, also slightly greater than CSF on FLAIR imaging.4. Essentially near resolved left and increased size of right frontal periventricular cysts which are favored to represent a benign entity such as connatal or subependymal cyst.5. Redemonstration of moderate dilatation of lateral and third ventricles which is progressed since the remote prior MRI. Normal sized fourth ventricle. Consideration could be made for CSF flow imaging to evaluate patency of the cerebral aqueduct.6. Interval resolution of previously seen blood products along the supracerebellar cistern.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for ishemic events History: L face and arm numbness. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a linear FLAIR signal hyperintensity along the gray matter of the left post central gyrus appproximately 20mm length along the expected location of the hand and arm region of the homunculusThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is fenestration of the right A1 segment.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse and sigmoid sinuses are larger than their left counterparts.

Output: 1.There is a subtle cortically based lesion along the left post-central gyrus. The cause is not known. In general this appears to be in a chronic stage. 2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.4.MR venogram of the brain is within normal limits5.No evidence for acute ischemic infarction.6.The patient refused contrast administration.


Instruction: Generate impression based on findings.

Input: Chronic and severe FTT, vomiting with hypertonicity, and hyperreflexia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and brainstem appear unremarkable. There is a normal degree of myelination. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or Chiari malformation.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is perhaps mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts in the sphenoid sinuses. There is fluid within the mastoid air cells, left more than right. The orbits are grossly unremarkable. The calvarial bone marrow appears to be heterogeneous. There is an ovoid T2 hyperintense lesion in the right lateral periorbital subcutaneous tissues that measures up to 12 mm and may represent an inclusion cyst.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Fluid within the mastoid air cells, left more than right may represent mastoiditis. 3. The calvarial bone marrow appears to be heterogeneous, which is nonspecific.


Instruction: Generate impression based on findings.

Input: Female 10 years old Reason: History of osteomyelitis, concerning lesion on x-ray on proximal medial tibia Patchy decreased T1 and increased T2 signal of the left tibial proximal metaphysis extending down to the diaphysis. This lesion enhances and is consistent with osteomyelitis. There is similar but less prominent changes in the contralateral side. There is soft tissue edema surrounding the tibia, more prominent on the left.

Output: Findings consistent with osteomyelitis of both proximal tibias, left greater than right. Bilateral presentation raises the question of chronic recurrent multifocal osteomyelitis.


Instruction: Generate impression based on findings.

Input: Osteomyelitis There are surgical changes relating to amputation of the first ray to the level of the mid metatarsal. There is some lucency and bony irregularity at the surgical margin concerning for osteomyelitis. Diffuse vascular calcifications are noted and the bones appear slightly demineralized.

Output: Irregularity and lucency of the surgical margin of the first metatarsal concerning for osteoarthritis


Instruction: Generate impression based on findings.

Input: Other abnormal findings on diagnostic imaging of central nervous system [R90.89], Reason for Study: ^Reason: interval change MS vs. post gastric bypass nutritional mayhem History: weak legs Multifocal scattered various size T2/FLAIR high signal intensity lesions are seen on bilateral periventricular and subcortical white matter, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal.

Output: Stable multifocal scattered bihemispheric white matter FLAIR/T2 high signal intensity lesions since prior scan.


Instruction: Generate impression based on findings.

Input: 64-year-old male patient with altered mental status, increased frequency of seizures. Suspect meningeal enhancement.. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is ventricular enlargement predominately affecting the temporal and occipital horns bilaterally. There is also global parenchymal atrophy. There is a diminished appearance of the right frontal horn, though no discrete mass. There is inferior cerebellar vermian hypoplasia with resulting increase in size of the fourth ventricle and retrocerebellar space. Additionally, there is cerebellar atrophy out of proportion to the supratentorial brain. Abnormal periventricular T2 signal likely represent small vessel ischemic disease. Incidental note of a cavum of septum pellucidum. There is hippocampal volume loss bilaterally, left greater than right, with loss of the internal architecture and increased T2 signal within the left hippocampus. There is no abnormal intracranial enhancement. 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.There are degenerative changes of the upper cervical spine causing significant canal stenosis at the level of C2 and below.

Output: 1. Moderate global parenchymal atrophy without evidence of mass or abnormal enhancement.2. Left greater than right hippocampal volume loss with loss of internal architecture and T2 hyperintensity involving the left hippocampus consistent with left mesial temporal sclerosis.3. Inferior cerebellar vermian hypoplasia.4. Degenerative changes of the imaged cervical spine with severe canal stenosis; if there are clinical symptoms referable to this finding, additional dedicated cervical spine imaging with MRI may be considered.


Instruction: Generate impression based on findings.

Input: 48-year-old female with CF, status-post bilateral lung transplant, with worsening hypoxia, lethargy. Please evaluate for intracranial fungal infection or other potential etiologies of encephalopathy. Limited examination secondary to motion artifact and the use of portable scanner. Interval placement of nasoenteric tube and endotracheal tube.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection or acute hemorrhage. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses again demonstrate partial opacification in the maxillary sinuses, ethmoid air cells, and hypoplastic frontal sinuses and sphenoid sinuses. This appears increased compared to prior CT examination. Opacification of the right mastoid air cells also appears increased compared to prior CT examination, although similar to prior MRI brain. The visualized left mastoid air cells are clear.Atherosclerotic calcification again identified along the distal left acute artery and the distal internal carotid arteries.

Output: 1. Limited examination secondary to motion artifact and the use of portable scanner. Within this limitation, there is no evidence of acute intracranial abnormality. 2. Increased opacification of the right mastoid air cells and paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Positive McMurray. Catching x 2 months. Prior meniscus repair 2011. MENISCI: There has been interval surgical repair including partial meniscectomies of both the medial and lateral menisci, reflected by their abnormal and diminutive morphology. Only a thin rim of the medial meniscus remains. There are multidirectional complex tears of the posterior horns of both the medial and lateral menisci.ARTICULAR CARTILAGE AND BONE: Articular cartilage appears intact in the patellofemoral as well as medial and lateral tibiofemoral compartments. Minimal red marrow changes in the distal femoral metaphysis are noted. Otherwise bone marrow signal is unremarkable.LIGAMENTS: Postsurgical findings related to prior ACL reconstruction without evidence of complication. The PCL and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1.Interval medial and lateral meniscectomies.2.Multidirectional complex tearing of the posterior horns of the medial and lateral menisci.3.ACL reconstruction without evidence of complication.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory loss. Signs and symptoms: Memory loss. Nonenhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates mild periventricular and subcortical foci of FLAIR/T2 hyperintensity with minimal interval progression since prior exam and suggestive of mild nonhemorrhagic chronic small vessel ischemic strokes.The signal intensity of cerebral cortex, bilateral basal ganglia, pons and bilateral cerebellar hemisphere and the vermis remains within normal and similar to prior exam. Punctate focus of T2 hyperintensity however in the left thalamus is noted which was also detected on prior exam.There is revisualization of stable supratentorial ventriculomegaly and prominence of cortical sulci.The signal voids of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses are within normal.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits and visualized paranasal sinuses.

Output: 1.Negative diffusion-weighted images.2.Mild chronic nonhemorrhagic small vessel ischemic strokes with minimal interval progression since prior exam.3.Stable prominence of supratentorial ventricular system and cortical sulci since prior study.


Instruction: Generate impression based on findings.

Input: Female, 32 years old, with headache and shunt tract tenderness. Assess for abnormalities along the VP shunt. Brain:Please note that artifact from the patient's shunt apparatus does obscure visualization of some right-sided structures, particularly on the diffusion and susceptibility sequences.A right frontal approach ventricular shunt catheter is evident, tip situated at the level of the foramina of Monro. This portion of the catheter system is in stable position. The caliber of the ventricular system is unchanged relative to recent prior CTs, and slightly smaller compared to an older MRI from 2013. Mild gliosis and encephalomalacia are demonstrated along the catheter tract as it traverses the frontal lobe.The remaining parenchyma demonstrates normal signal intensity and morphology. No restricted diffusion or other significant signal abnormality is seen. No evidence of intracranial hemorrhage or any abnormal fluid collection is seen. Where images are not degraded by artifact, no definite pathologic enhancement is detected. Neck:The right-sided shunt system is visualized as it courses down though the posterior neck soft tissues, into the supraclavicular region, over the clavicle and down the anterior subcutaneous tissues of the right chest. At no point along this pathway is any fluid collection, mass, pathologic enhancement or evidence of inflammation detected.Small benign-appearing lymph nodes are evident on both sides of the neck. The mucosal tissues of the pharynx, larynx and trachea appear unremarkable. Salivary glands and the thyroid seem to be free of focal lesions. The marrow signal characteristics are unremarkable. Spinal alignment is anatomic and the spinal cord as visualized is unremarkable.

Output: 1.Limited examination of the brain due to artifact from the patient's shunt apparatus. Within this limitation, no acute abnormalities are suspected, and no shunt complications are seen.2.No specific abnormality is detected along the pathway of the right-sided shunt catheter as it traverses the soft tissues of the neck.


Instruction: Generate impression based on findings.

Input: Radicular low back pain. History of spinal stenosis. Left lower extremity pain and weakness. The study is limited mildly by patient motion and body habitus. Five lumbar type vertebral bodies are present, which are appropriate in overall alignment and height, accounting for straightening. There is diffusely hypointense vertebral bone marrow signal that is probably reflective of red marrow reconversion. The lower spinal cord and conus medullaris are unremarkable. At L4-5, there is a disk bulge without significant central canal stenosis. There is moderate to severe left and moderate right neural foraminal narrowing, unchanged. At L5-S1, an eccentrically right-sided disc extrusion results in compression of the right subarticular recess and to a lesser extent the left lateral recess, as well as severe right and moderate left neural foraminal narrowing. There is bilateral facet productive changes and mild bilateral ligamentum flavum hypertrophy and buckling, which also contribute to spinal canal narrowing at this level.

Output: An L5-S1 disc extrusion with compression of the right subarticular recess results in severe narrowing of the right neural foramen, although this has not significantly changed since September 2013.


Instruction: Generate impression based on findings.

Input: Hyperparathyroidism, unspecified. Evaluate for parathyroid adenomas RIGHT LOBE MEASUREMENTS: 2.0 x 1.5 x 4.8 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.6 x 4.1 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Slightly heterogeneous nodule inferior to the right lower pole of the thyroid measuring 0.7 x 0.9 x 1.2 cm and presumably representing an enlarged parathyroid gland. A second similar-appearing nodule is identified on the left posterior to the upper pole and measures 1.6 x 1.5 x 2.5 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Two possible parathyroid adenomas, one inferior to the right lower pole of the thyroid and the other superior to the left upper pole of the thyroid. Correlate with nuclear medicine study of today.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of trauma, thumb pain and swelling about the flexor tendon. The visualized portion of the flexor pollicis longus tendon is intact as traced from the level of the the first metacarpal to its insertion on the distal phalanx. There is abnormal signal intensity replacing the subcutaneous fat between the volar margin of the flexor pollicis longus and the overlying skin at the crease of the interphalangeal joint. This is of intermediate signal intensity on T1 and T2 weighted sequences and slightly increased signal intensity on fat suppressed T2-weighted images. While this is nonspecific, this may represent focal edema or possibly scar tissue. The volar plate deep to the tendon appears sightly prominent, but we see no evidence to suggest a volar plate injury and this may simply reflect mild osteoarthritis and slight flexion at the interphalangeal joint. There is mild thickening and increased signal intensity of the radial collateral ligament of the interphalangeal joint which we suspect is chronic in etiology. There is also small bony excrescence arising from the metacarpal head which likely reflects old trauma. We see no fluid within the interphalangeal joint, however there is an elongated collection of fluid signal intensity dorsal to the extensor pollicis tendon along the proximal phalanx which likely represents a ganglion cyst which measures approximately 1 cm in the longest dimension.

Output: 1.Abnormal signal intensity volar to the flexor pollicis longus tendon volar to the interphalangeal joint. This is nonspecific and may represent edema or scar tissue. The possibility of an A2 pulley injury is also a consideration. The flexor pollicis longus tendon appears normal.2.Degenerative arthritic and possible old posttraumatic changes as above.3.Ganglion cyst dorsal to the proximal phalanx as above.


Instruction: Generate impression based on findings.

Input: 80-year-old male with history of COPD, CKD, DM with lung nodules and mediastinal lymphadenopathy concerning for sarcoidosis vs lymphoma. Referred for cardiac MRI to evaluate for possible cardiac sarcoid. Left VentricleThe left ventricle is normal in size with normal systolic function. There is no LV hypertrophy. The overall LV ejection fraction is 58%. The LVEDV is 171 ml (normal range 142+/-34), the LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVESV is 71 ml (normal range 47+/-19) and the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9). The LV mass is 112 g (normal range 164+/-36) and the LV mass index is 44 g/m2 (normal range 85+/-15). No evidence of inflammation/edema of the myocardium on T2 STIR images. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.There is no LV thrombus. Left AtriumThe left atrium is mildly dilated. Lipomatous inter-atrial septum.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 50%. The RVEDV is 219 ml (normal range 142+/-31), RV end diastolic volume index is 86 ml/m2 (normal range 82+/-16), the RVESV is 108 ml (normal range 54+/-17), and the RV end systolic volume index is 43 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is trivial aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is thickening and prominence of the pericardial sac. On T2 STIR images there is notable hyperintensity of the pericardium. This is suggestive of underlying edema/inflammation of the pericardium and is consistent with pericarditis. There is also trace pericardial effusion.Extracardiac FindingsMediastinal adenopathy. Axillary nodes also noted in the left axillae. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. No evidence of inflammation/edema of the myocardium on T2 STIR images. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.2.The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 50%.3.There is thickening and prominence of the pericardial sac. On T2 STIR images there is notable hyperintensity of the pericardium. This is suggestive of underlying edema/inflammation of the pericardium and is consistent with pericarditis. There is also trace pericardial effusion.4.Lipomatous inter-atrial septum.5.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: Multiple sclerosis [G35], Reason for Study: ^Reason: MS; f/u progression History: paresthesias Brain MRIMultiple scattered bilateral FLAIR/T2 high signal intensity lesions are seen bilateral corpus callosum, subcortical white matter, and periventricular white matter. The lesions are non specific but can be seen in demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-spine MRIThere are multilevel patchy T2/PD high signal intensity lesions on cervical spinal cord. The lesions are seen from C2 to C5 involving anterior and posterior aspect of the cord. These lesions in conjunction with brain parenchymal lesions are consistent with demyelinating lesion such as multiple sclerosis.There is normal cervical lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance.There is no evidence of spinal canal stenosis or neuroforaminal stenosis.No evidence of intervertebral disc herniation.

Output: Supratentorial and cervical spinal multifocal patchy T2/FLAIR/PD high signal intensity lesions indicate consistent with demyelinating disease such as multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Please note, this is a limited exam due to patient motion.Frontal sinus: There is complete opacification of the bilateral frontal sinuses. Frontoethmoidal recesses are opacified. There is a small focus of restricted diffusion in the left paramedian frontal sinus consistent with hypercellular material, likely due to inspissated secretions.Anterior ethmoids: There is moderate to severe opacification of the anterior ethmoid air cells.Maxillary sinuses: There is complete opacification of the left maxillary sinus as well as partial opacification of the right maxillary sinus. The right ostiomeatal unit is partially opacified. The left ostiomeatal unit is opacified.Posterior ethmoids: There is moderate to severe opacification of the posterior ethmoid air cells.Sphenoid sinus: There is partial opacification of sphenoid sinuses. There is no nasal septal deviation. There are scattered secretions within the nasal cavity particularly in the middle meatus.The lamina papyracea are intact. The roof of the left ethmoid is slightly higher than the right.There is complete opacification of the bilateral mastoid air cells as well as opacification of the middle ears.The visualized portions of the brain parenchyma demonstrates prominent ventricular system as well as cortical sulci for a patient of this age, compatible with moderate to severe parenchymal volume loss.

Output: 1. Near complete opacification of the paranasal sinuses with small focus of restricted diffusion in the frontal sinus related to an area of hypercellularity, possibly inspissated secretions. Please correlate clinically for acute sinusitis.2. Severe opacification of bilateral mastoid air cells and middle ears. Please correlate clinically for symptoms related to otomastoiditis.3. Moderate to severe parenchymal volume loss.


Instruction: Generate impression based on findings.

Input: Transient arterial occlusion of retina [362.34], Reason for Study: ^Reason: pt with fleeting vision loss, need MRI/MRA head and neck to r/o intracranial or vascular lesion History: pt with fleeting vision loss, need MRI/MRA head and neck to r/o intracranial or vascular lesion. Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.Multiple scattered high signal intensity on FLAIR imaging on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, 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.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery origins is normal. The left vertebral artery originated from the aortic arch directly.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal nonspecific small vessel ischemic disease.3. Normal brain MRA, normal neck MRA.


Instruction: Generate impression based on findings.

Input: 46-year-old female with known DCIS in the left breast presents for breast MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is a susceptibility artifact in the left breast at 1:00 position, corresponding to a marker clip from recent biopsy of DCIS. There is a small focal non-mass enhancement around this clip, measuring 6 x 6 x 5 mm (AP x LR x CC). Size of this area of enhancement is smaller than that of the distribution of pleomorphic calcifications on mammogram.There are no other suspicious enhancing lesions elsewhere in the left breast.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Small focal non-mass enhancement around the marker clip in the left breast at 1:00 position, corresponding to the biopsy-proven DCIS. Because the size of non-mass enhancement is smaller than that of pleomorphic calcifications on mammogram, bracketed wire localization with mammographic guidance is recommended, if conservation surgery is planned.2. No MRI evidence for malignancy in the right breast or either axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.