Instruction: Generate impression based on findings.

Input: 4 day old female with symmetric IUGR and congenital abnormalities; evaluate for calcifications or brain abnormalities There is no evidence of intracranial hemorrhage, mass or edema. No abnormal intracranial calcifications are identified.Subtle asymmetric hypoattenuation is seen extending to the cortex in the left posterior parietal lobe which may be artifactual; however infarction or encephalomalacia cannot be excluded. MRI may be obtained for further evaluation if clinically warranted.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. No cephalohematoma or other scalp soft tissue abnormality is identified. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial hemorrhage, mass, or abnormal calcifications.2. Asymmetric hypoattenuation in the left posterior parietal lobe is subtle and may be artifactual; however infarction or encepahlomalacia cannot be excluded. MRI may be obtained for further evaluation if clinically warranted.


Instruction: Generate impression based on findings.

Input: H/o AML. S/p intrathecal methotrexate. There is a redemonstration of bilateral hemispheric subcortical and white matter edema. In comparison with prior brain MRI, the extent of the edema has been grossly unchanged. A right frontal Omaya catheter is in place with its tip in the left lateral ventricle. Air is present in bilateral frontal horns. There is no intracranial hemorrhage, mass, midline shift or abnormal extraaxial fluid collection. The ventricles are normal in volume and are symmetric. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Grossly stable subcortical and white matter edema likely represent drug related change in light of clinical history provided.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for tear of the biceps tendon History: Pain, limited flexion with arm supinated, no improvement TENDONS: There is intermediate signal intensity within the distal biceps tendon at the level of its insertion on the radial tuberosity indicating tendinosis. There is a linear fluid signal intensity at the level of the insertion of the biceps tendon indicating a partial thickness tear (image 24; series 9). The brachialis tendon appears intact. The triceps tendon appears intact.ARTICULAR SURFACES AND BONE: No bone marrow signal abnormality is identified. SURROUNDING STRUCTURES: There is nonspecific subcutaneous edema along the dorsal aspect of the olecranon.ADDITIONAL

Output: Biceps tendinosis with a partial-thickness insertional tear without evidence of a full-thickness tear or retraction. Supracondylar process without findings to suggest a median nerve neuritis/entrapment.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:2/20/1958)Reason: assess for metastatic ovarian cancer History: quadrantanopsia on MEK inhibitor for ovarian cancerPROVIDER/ATTENDING NAME: SEIKO DIANE YAMADA SEIKO DIANE YAMADA The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. It is not clear whether there is any optic nerve enhancement on this exam.

Output: 1.There is no evidence for brain metastases. It is not clear whether there is any optic nerve enhancement on this exam. Although no orbital lesion is clearly appreciated on this exam, this is not a dedicated study for evaluating orbits and optic nerves. As a result, small or subtle lesions in the orbits may be overlooked. If clinically appropriate MRI orbits further benefit. 2.Several periventricular and subcortical white matter lesions are nonspecific. They are frequently seen at this age and given their small number are of little clinical significance.


Instruction: Generate impression based on findings.

Input: Clinical question: Concern for encephalitis. Signs and symptoms: AMS, unclear etiology. Nonenhanced brain MRI:Examination is severely compromised due to extensive motion artifact secondary to patient's status. Multip MRI sequences were repeated without significant improvement.Diffusion-weighted images are grossly unremarkable.Examination demonstrates patchy confluent foci of periventricular and minimally subcortical Flair/T2 hyperintensity in bilateral cerebral hemispheres which are nonspecific however considering patient's stated age of 74 likely representing chronic changes of microvascular ischemic disease. There is subtle enlargement (ex vacuo) of ventricular system without deviation of midline.No detectable signal abnormality of cerebral cortex, mildly prominent cortical sulci within normal for stated age and unremarkable CSF spaces. The signal void of major intracranial arterial branches are identified. No gross abnormality of calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.

Output: 1.Severely limited exam due to extensive motion artifact.2.No convincing evidence of an acute intracranial process, edema, bleed, mass effect or midline shift.3.Findings of chronic small vessel ischemic strokes of moderate degree.


Instruction: Generate impression based on findings.

Input: Reason: eval for femur lesions / please do in and out of phase imaging History: lesion Limited examination secondary to patient motion artifact and patient's inability to tolerate the examination. Please note that this was the third separate attempt to obtain MR imaging of this patient. Note is made of diffuse nonspecific bone marrow signal abnormality within the imaged bones of the pelvis and femora bilaterally. Differential considerations include red marrow reconversion due to anemia as well as myeloproliferative disorders. No acute fracture is evident. There is mild fatty infiltration of the imaged musculature of both thighs and the pelvis. There is a small amount of fluid within the hips without evidence of a large effusion. There is a focus of low signal intensity within the left superficial femoral vein proximal to the level of the adductor hiatus which may represent thrombus formation, however, this is incompletely characterized on this examination. Please consider a dedicated ultrasound with Doppler interrogation if clinically warranted.

Output: 1. Diffuse nonspecific bone marrow signal abnormality affecting the imaged bones of the pelvis and femora as described above. Differential considerations include red marrow reconversion due to anemia as well as myeloproliferative disorders.2. Focus of low signal intensity within the left superficial femoral vein proximal to the level of the adductor hiatus may represent thrombus formation, consistent with the patient's known history of DVT although this is incompletely characterized on this examination. The patient is reported to be currently on Coumadin. This could be further evaluated with a dedicated ultrasound examination with Doppler interrogation if clinically warranted.UTCCS


Instruction: Generate impression based on findings.

Input: Evaluate for head injury. Right middle temporal gyrus lesion measuring 1.2 x 0.8 cm (series 501, image 15) with hemosiderin deposition, mulberry shape, and associated developmental venous anomaly, compatible with a cavernous malformation. No significant associated edema. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of traumatic injury. Right middle temporal gyrus cavernous malformation and associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: Liver protocol. Abdominal pain in patient with physical and lab values suggestive of pancreatitis. Alk phosp elevated (bili okay) evaluate for stones vs infiltrative liver process History: Liver protocol. Abdominal pain in patient with physical and lab values suggestive of pancreatitis. Alk phosp elevated (bili okay) evaluate for stones vs infiltrative liver process ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Mild fatty infiltration of the liver. The hepatic and portal veins are patent. No intrahepatic biliary ductal dilatation. Common bile duct is normal in caliber.There is some sludge within the gallbladder and small calculi are not excluded.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is low in T1 signal compatible with chronic pancreatitis. There is dilatation of the pancreatic duct up to 1 cm through the neck, body and tail. There are dilated side branches. The pancreatic tail is bifid. In the mid pancreatic body is a focal narrowing with a small filling defect most likely due to a stone measuring 7 mm.There is a possible small stone near the ampulla.There is mild edematous changes involving the pancreatic head and pancreaticoduodenal grooveNo pseudocyst formation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is extensive inflammation surrounding the second portion of the duodenum with a thickened wall and edema that extends to the gallbladder fossa.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild acute on chronic pancreatitis predominantly of the pancreatic head. No pseudocyst formation or evidence of necrosis.2.Pancreatic duct stone measuring 7 mm.3.Edema of the second portion of the duodenum possibly due to adjacent pancreatitis or duodenitis.


Instruction: Generate impression based on findings.

Input: Thoracolumbar scoliosis. There is severe scoliosis at the thoracolumbar spine, with a left convexity, apex at thoracolumbar junction. There is left lateral subluxation of L2 over L3. Degenerative changes are seen in the lumbar spine, with facet arthropathic changes, osteophytes, ligamentum flavum hypertrophy and disk bulging / herniation at multiple levels. There is spinal canal and neuroforaminal narrowing at multiple levels, as a result of the scoliosis and degenerative spine disease. There is resultant nerve impingement, which is better visualized on the MRI of same date.No evidence of segmentation anomalies, fracture, or par-interarticularis defect is seen.There is a large calcified lesion posterior to the left aspect of the uterus and may represent a fibroid. A large right renal cyst is noted.

Output: 1. Severe thoracolumbar scoliosis and degenerative disease of the lumbar spine resulting in spinal canal and neuroforaminal narrowing. Nerve impingement is present at multiple levels and is better defined on the MRI of same date. Please refer to MRI report for details.2. Right renal cyst.3. Uterine fibroid.


Instruction: Generate impression based on findings.

Input: 53-year-old male with history of CVA presents with dizziness, upward deviation of the left eye and dizziness. Please evaluate for intracranial hemorrhage, CVA. There is no evidence of intracranial hemorrhage, mass or edema. Loculated lacunar infarct within the left basal ganglia and head of the caudate with adjacent ex vacuo dilatation of the frontal horn. Multiple scattered low densities noted with the bilateral cerebellar hemispheres. There is a small focus of encephalomalacia within the posterior aspect of the right occipital lobe which is too small to determine age. If there is clinical concern for acute ischemia, an MRI may be considered.Multiple is areas of intracranial vascular calcifications. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Multiple hypodensities in the distribution of the bilateral superior cerebellar arteries are suspicious for small strokes which are too small to determine age. MRI is recommended for further evaluation, if clinically warranted.


Instruction: Generate impression based on findings.

Input: 79 years Male (DOB:10/3/1936)Reason: evaluate for metastasis. History: sarcomaPROVIDER/ATTENDING NAME: SAMIR D. UNDEVIA SAMIR D. UNDEVIA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of signal loss is present in the isthmus of the right cingulate gyrus just medial to the trigone of the right lateral ventricle. In isolation this is of unknown clinical significance.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. The right eye lens is thin.

Output: 1.There is no evidence for intracranial mass lesion and no evidence for acute ischemic cerebral infarction. There is no evidence for brain metastases.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of papillary serous carcinoma status post brain biopsies. There are postoperative findings related to right occipital lobe biopsy without evidence of residual enhancing lesion. There is residual surrounding confluent T2 hyperintensity. There is an unchanged enhancing dural based lesion that measures up to 5 mm along the inferior surface of the left tentorium, near the apex. There are punctate foci of susceptibility effect without associated enhancement in the right cerebellum, left frontal lobe periventricular white matter, and medial right occipital lobe. There is no evidence of acute infarct. There are scattered foci of cerebral white matter T2 hyperintensity without associated enhancement. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral lens implants. The skull and scalp soft tissues are grossly unremarkable. There is fluid in the left maxillary and right sphenoid sinuses and scattered paranasal sinus mucosal thickening. There is also fluid within the bilateral mastoid air cells.

Output: 1. Post-treatment findings in the right occipital lobe, without evidence of recurrent tumor. 2. An unchanged enhancing dural based lesion that measures up to 5 mm along the inferior surface of the left tentorium may represent a meningioma or metastasis.3. Punctate foci of susceptibility effect without associated enhancement in the right cerebellum, left frontal lobe periventricular white matter, and medial right occipital lobe are nonspecific and may represent chronic microhemorrhages, perhaps related to amyloid angiopathy.4. Findings suggestive of acute sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Medial joint pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: A focus of low signal intensity is noted within the articular cartilage of the femoral trochlea centrally reflecting degeneration. Otherwise the articular cartilage of the lateral, medial, and patellofemoral compartments is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact. There is heterogeneous signal intensity within the prepatellar soft tissues which could reflect chronic bursitis or the sequela of prior trauma (e.g., chronic hematoma).ADDITIONAL

Output: 1. No evidence of meniscal pathology.2. Soft tissue swelling and heterogeneous signal intensity anterior to the patella which could reflect chronic bursitis or the sequela of prior trauma (chronic hematoma).3. Focal degeneration of the articular cartilage of the femoral trochlea.


Instruction: Generate impression based on findings.

Input: Shoulder pain ROTATOR CUFF: There is minimal increased signal intensity within the supraspinatus tendon which extends to the anterior fibers of the infraspinatus tendon. These findings reflect mild tendinosis but there is no discrete fluid-filled tear identified. The supraspinatus and infraspinatus muscles are normal in signal and caliber. The teres minor tendon and muscle are normal. There is mild undersurface fraying of the distal fibers of the subscapularis tendon with no discrete tear identified. The subscapularis muscle is normal in signal and caliber. Mild signal changes within the humeral head are likely degenerative in nature. SUPRASPINATUS OUTLET: There is mild osteoarthritis and spurring of the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The superior labrum is attenuated reflecting degenerative fraying.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild tendinosis and fraying of the rotator cuff without discrete tear. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis, MS, dizziness follow up progression. There are numerous foci of T2/FLAIR hyperintensity involving the supratentorial white matter as well as at least one lesion in the right superior cerebellar peduncle. These appear similar in size and distribution compared to prior examination. There is preservation of the gray-white matter interface. No midline shift or mass effect is appreciated. The ventricular morphology is normal. No intracranial fluid collections are visualized. The midline structures and craniocervical junction are unremarkable. Normal flow-voids are identified in the major intracranial vessels.

Output: Multiple foci of white matter signal abnormality appear similar to prior examination without evidence for disease progression.


Instruction: Generate impression based on findings.

Input: 73-year-old male with prostate cancer status post prostatectomy (5/2014) with biochemical recurrence PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy.Central Gland: Status post prostatectomy.Seminal Vesicles: Surgically absent.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged sclerotic focus in the right anterior column of the acetabulum.OTHER: No significant abnormality noted.

Output: 1.No evidence of local recurrence. No significant lymphadenopathy.2.Unchanged sclerotic focus in the right anterior acetabulum may represent a benign bone island. Provided history prostate cancer, a bone scan may be of benefit.


Instruction: Generate impression based on findings.

Input: Brain metastases from cervical cancer: urinary incontinence. There are postoperative findings related to right parietal craniotomy. There is decrease in size of the right inferior parietal lobule resection cavity with mild residual linear enhancement along the margins of the cavity, but no discrete tumor. There is an unchanged resection cavity in the right posterior cingulate gyrus, without evidence of tumor in this region either. There is persistent nonspecific confluent high T2 signal surrounding the resection cavities. There is no residual enhancing tumor in the left parietal and frontal lobes or within the left cerebellum, although there appear to be punctate foci of susceptibility effect at the sites of some of the tumors. No new enhancing intracranial lesions are apparent. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild mucosal thickening in the left maxillary sinus.

Output: Postoperative findings in the right parietal lobe region without evidence of measurable tumor. No residual enhancing tumor in the left parietal and frontal lobes or within the left cerebellum.


Instruction: Generate impression based on findings.

Input: Reason: hx aml s/p allogenic stem cell transplant on long term steroids for GVHD. Hx osteoporosis History: bilateral groin pain, increased pain with weight bearing There is abnormal signal intensity and deformity within the inferior pubic rami bilaterally indicating mildly displaced fractures. There is a small collection of abnormal signal intensity and enhancement within the left obturator externus muscle adjacent to the left inferior pubic ramus fracture perhaps representing hematoma formation and associated inflammatory changes. There is also bandlike signal abnormality extending through the superior pubic rami bilaterally indicating additional nondisplaced fractures. There is mild edema and enhancement of the soft tissues adjacent to the fracture of the left superior pubic ramus. There is also bandlike signal intensity extending transversely through the posteromedial aspect of the right iliac wing indicating a fracture with edema in the surrounding marrow. There is mild edema and enhancement of the adjacent soft tissues. There is also branching signal abnormality within the left sacral wing abutting the first and second neuroforamina indicating a fracture with surrounding marrow edema and enhancement. There is also branching low signal intensity on T1-weighted images within the medial aspect of the left femoral neck likely representing a chronic fracture; there is no edema or enhancement to suggest an acute injury. There is also patchy intermediate signal intensity within the femoral diaphyses bilaterally. This is nonspecific and may simply represent treatment effect; leukemic infiltration is considered less likely due to lack of significant contrast enhancement.. Mild osteoarthritis affects both hips. Moderate to severe degenerative disc disease affects L5/S1.

Output: Multifocal signal abnormalities as described above likely representing stress fractures of varying ages.


Instruction: Generate impression based on findings.

Input: 54-year-old female with history of right breast IDC and low grade DCIS status post lumpectomy in 2004. Patient received radiation, chemotherapy and hormonal therapy. Personal history of sarcoma and melanoma. Li Fraumeni. No current complaints. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Mild post-surgical distortion in the right breast. No abnormal lymph nodes are identified in either axillary region.Multiple high signal lesions on T2 W sequence within the liver most likely hemangiomas or cysts.

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


Instruction: Generate impression based on findings.

Input: Unqualified visual loss, one eye. Optic neuritis, Sensory disturbance, of limbs, in past Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is straightening of the normal cervical curvature. There is multilevel disk dessication present.There is a 7mm T2 hyperintense lesion along the posterior aspect of the spinal cord a the C2 vertebral level.There is a 4mm T2 hyperintense lesion along the posterior aspect of the spinal cord a the C3-4 disk space level.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. There are T2 hyperintense lesions along the posterior aspect of the spinal cord at the C6-7 level, the T8-9 level , the T10 level and the T11-T12 level.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.Multiple lesions are present along the central posterior aspect of the cervical and thoracic spinal cord as detailed above. There is no associate contrast enhancement to suggest acute lesion. These are consistent with the clinical suspicion of demyelinating disorder.2.There is no compromise to the lumbar, thoracic or cervical spinal canal.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with new seizures and a lesion in the temporal lobe. A lesion is present peripherally within the inferior temporal gyrus on the right measuring 12 mm TV, 11 mm AP and 10 mm CC. The lesion involves the cortex and underlying white matter and appears to be partially solid with interspersed areas of spongy or cystic tissue, some of which suppresses on FLAIR imaging. Mild T2 hyperintensity is evident within the surrounding white matter and cortical gray matter.Spectroscopic assessment of this lesion was challenging due to the proximity of calvarium and skull base. This necessitated the use of a small voxel which compromises the signal-to-noise ratio. Nevertheless, short TE spectra were obtained over the lesion and, for comparison, over the contralateral normal temporal lobe. Lesional tissue demonstrates reduced NAA and no significant choline elevation. Lipid and lactate are not present in significant quantities.Elsewhere, the morphology and signal characteristics of the brain are within normal limits. No diffusion restriction is seen. No additional areas of focal signal abnormality are detected. The mesial temporal lobe structures are symmetric. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: A lesion is present peripherally within the inferior right temporal lobe involving the cortex and subcortical white matter. Signal characteristics suggest a mixture of solid and spongy or cystic tissue. The differential diagnosis would include a low-grade tumor such as a ganglioglioma, DNET, or PXA. Lack of significant choline elevation on spectroscopy would argue against a high-grade neoplastic process, and lack of lipid/lactate would argue against on-going cellular damage as might be seen with active inflammation. A nonneoplastic process, such as a cortical dysplasia, is considered less likely based on the morphology of the lesion.


Instruction: Generate impression based on findings.

Input: Female, 29 years old, with abnormal prenatal ultrasound, 23 weeks gestational age. Failure of hemispheric separation is seen with a smooth band of cortex which spans the midline anteriorly. The interhemispheric falx has not developed anteriorly, though there may be a partial falx posteriorly. Neither the corpus callosum nor the septum pellucidum have developed. A single communicating ventricle is seen. The deep nuclei including the basal ganglia and thalami are at least partially if not completely fused. Partial temporal lobe development is seen. The cortical mantle thins posteriorly where there is prominence of the CSF space. The cerebellum appears to have developed normally. No definite evidence to suggest intracranial hemorrhage is seen.

Output: Findings are seen compatible with holoprosencephaly. Based on the specific imaging features, the severity appears to fall somewhere between the semilobar and alobar variants.


Instruction: Generate impression based on findings.

Input: Dysphagia for 1-2 weeks. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is a subcentimeter subcutaneous nodules in the right cheek, which may represent an inclusion cyst. There is a right lens implant.

Output: Mild probable chronic small vessel ischemic white matter disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: any change in glioma or any other tumors or abnormalities noted History: NF type 1, optic glioma. MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is no evidence of intracranial hemorrhage. No foci of diffusion restriction are appreciated.There are subtle T2 hyperintensities in the thalami bilaterally and pons. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. 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. Mild mucosal thickening of the ethmoid and maxillary sinuses is present.MRI orbits:The eyeballs are intact. There is redemonstration of enhancement and thickening of the orbital, canalicular and prechiasmatic left optic nerve. Distribution is similar to the prior exam. It measures up to 5 mm in thickness on the current exam. Given the differences in technique a direct comparison in size in thickness with the prior exam would be less accurate, however, there does not appear to be a substantial change in the thickness of the lesion. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The suprasellar cistern is intact .No lesions involving the right optic nerve are appreciated.

Output: 1.A lesion involving the left optic nerve suspicious for an optic glioma is likely unchanged from the prior exam. This lesion is better visualized on the current exam, which is likely due to dedicated orbit imaging, and subtle changes may not be appreciated. No new lesions are present.2.Areas of increased T2 signal in the basal ganglia and pons likely represent focal areas of signal intensity (FASI), commonly associated with NF1. These were also present on the prior exam.


Instruction: Generate impression based on findings.

Input: History of thoracic astrocytoma s/p chemotherapy History: off therapy evaluation. There are postoperative findings in the lower thoracic and upper lumbar spine. There unchanged diffuse expansion and T2 hyperintensity without corresponding abnormal enlacement. There is also persistent significant narrowing of the lower thoracic spinal canal with flattening of the lower thoracic spinal cord. There is unchanged considerable thoracolumbar levoscoliosis and exaggerated kyphosis in the lower thoracic region related to mild wedging of the T7 through T12 vertebral bodies.

Output: 1. Unchanged post-treatment findings and tumor involving the lower thoracic spinal cord.2. Severe stenosis of the lower thoracic spinal canal.3. Unchanged considerable thoracolumbar levoscoliosis.


Instruction: Generate impression based on findings.

Input: Parkinson's with dyskinesias: preoperative planning for DBS. There is no evidence of intracranial hemorrhage or mass. There are mild nonspecific cerebral white matter T2 hyperintense foci. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mucosal thickening and fluid in the left maxillary sinus.

Output: 1. Preoperative planning MRI shows no evidence of intracranial mass lesions or hemorrhage.2. Findings suggestive of acute sinusitis.


Instruction: Generate impression based on findings.

Input: History of primary biliary cirrhosis. Evaluate for hepatocellular carcinoma or suspicious lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver with nodular surface contour. There is a reticular pattern of increased T2 signal throughout the hepatic parenchyma indicating a component of fibrosis. There are a few scattered subcentimeter foci of early arterial enhancement, however these do not demonstrate washout on the delayed images. No focal suspicious enhancing lesion.The hepatic veins, hepatic arteries, and portal veins are patent.Cholelithiasis without evidence of cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of numerous prominent perihepatic lymph nodes likely related to the patient's chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: 1.Cirrhotic morphology of liver with dysplastic nodules, but no evidence of hepatocellular carcinoma.2.Stable mildly prominent perihepatic lymph nodes likely related to the patient's chronic liver disease.3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:3/12/1999)Reason: MRI Stealth brain with pituitary cuts and dynamic views for surgery planning today. Pituitary hemorrhage third time History: MRI for surgery planning and image guidance during surgery .PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM There is a small cystic appearing lesion present within the pituitary fossa. It has not changed since the prior exam. It measures 11 x 6 mm sagittal dimensions. It has a fluid fluid level.There is a focus of gray matter heterotopia adjacent to the frontal horn of the right lateral ventricle. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Cystic type lesion possibly with blood products located within the pituitary fossa. This remains stable since prior exam.2.Stable focus of gray matter heterotopia along the right frontal horn. Otherwise, unremarkable evaluation of the brain.


Instruction: Generate impression based on findings.

Input: 2-year-old male with a history of hydrocephalus and ventricular dilatation. Evaluate the ventricles. There are no prior exams available to assess for interval changes in the ventricular system. There is a right parietal approach ventricular catheter which terminates near the anterior horn of the right lateral ventricle. A second left frontal approach ventricular catheter terminates within the anterior horn of the right lateral ventricle. The lateral ventricles are relatively decompressed compared to the dilated temporal horns. The fourth ventricle is markedly dilated and the third ventricle is dilated to a lesser degree. The dilatation of the fourth ventricle is causing mass effect on the adjacent brain stem and cerebellum. The corpus callosum is diffusely thinned and deformed but fully formed. There is an asymmetrically smaller left hemisphere compared to the right and a plagiocephalic left cranial morphology. There is focus of cystic encephalomalacia of the right inferior parietal lobe. The supratentorial white matter is diminished. The myelination pattern is grossly normal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact.

Output: 1.No prior studies are available for comparison. Decompressed bodies of the lateral ventricles with significant dilatation of the temporal horns of the lateral ventricles and marked dilatation of the fourth ventricle, which is causing mass effect on the brainstem and cerebellum. The third ventricle is dilated to a lesser degree. Right parietal and left frontal approach ventricular catheters which terminate within or near the anterior horn of the right lateral ventricle.2.Diminished supratentorial white matter and thinning of the corpus callosum, which is also deformed. Focus of cystic encephalomalacia in the right inferior parietal lobe.


Instruction: Generate impression based on findings.

Input: Reason: 59yr old male with history of MM; pre-auto sct evaluation History: evaluate SKULL: Multiple small lytic lesions are seen throughout the skull, compatible with a history of multiple myeloma.CERVICAL SPINE: The lower cervical spine is partially obscured. Degenerative changes affect the cervical spine. No discrete myelomatous lesion is evident. THORACIC SPINE: Compression deformity is again seen involving the T5 vertebral body, with approximately 60% loss of vertebral body height and areas of lucency within the vertebral body, compatible with known history of myeloma, appearing similar to that seen on previous MRI. Mild anterior wedge deformity is also seen is T8 vertebral body, and appears chronic. Degenerative disc disease affects the remainder of the thoracic spine.LUMBAR SPINE: Mild degenerative disc disease and facet arthropathy affect the lumbar spine. No discrete myelomatous lesion is evident.RIBS: Subtle lucency along the posterior aspect of the left second rib may represent a myelomatous deposit, but this is equivocal. Mild deformity and sclerosis along the posterolateral aspect of the right ninth rib may represent healing/healed pathologic fracture, possibly related to myelomatous lesion.PELVIS: There is a 5-6 cm lytic lesion with sclerotic margins in the right ilium as seen on previous CT. A healed pathologic fracture is visualized in the left ischium. Degenerative changes affect the bilateral hips. Surgical clips project over the scrotum.UPPER EXTREMITY: Subtle lucencies in the bilateral proximal humeri may represent additional myelomatous deposits, but this is equivocal. Deformity of the mid left clavicle may represent a healed fracture. No myelomatous deposits are seen within the forearms. Degenerative changes affect the bilateral acromioclavicular joints. LOWER EXTREMITY: Poorly defined 1 cm lucency within the distal femoral diaphysis bilaterally, suggestive of myelomatous deposits. Punctate high density foci are seen in the medial subcutaneous fat of the left thigh, of unknown etiology. No discrete myelomatous lesions are seen within the lower legs. An ossicle in the posterior left knee joint may represent a loose body.

Output: Multiple myeloma and other findings as above.


Instruction: Generate impression based on findings.

Input: Headaches. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or ventriculomegaly.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or acute infarct. There is a focal dilatation of the left temporal horn with a possible associated intraventricular cyst only seen on the sagittal T1 sequence that measures approximately 7 x 18 mm. There is no associated enhancement. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. The midline structures and craniocervical junction are within normal limits.

Output: Focal dilatation of the left temporal horn, possibly due to an intraventricular cyst such as an arachnoid or choroid plexus cyst, of unlikely clinical significance. Otherwise unremarkable MRI.


Instruction: Generate impression based on findings.

Input: 52-year-old female with a history of metastatic breast cancer status post whole brain radiation. The enhancing medial right cerebellar lesion measures 3 x 3 mm (series 11, 46), previously 5 x 4 mm. There are two enhancing lesions in the left cerebellar hemisphere. The more superior lesion measures 2 x 2 mm (series 11, image 42), previously 4 x 4 mm and the more inferior lesion is no longer discretely measurable due to faint, indistinct enhancement (series 11, image 27). The enhancing lesion in the white matter adjacent to the lateral right thalamus measures 8 x 5 mm (series 11, image 7), which is unchanged in size, although the surrounding T2 signal abnormality has decreased. No new enhancing lesions are identified. There is patchy T1 hyperintensity in the bilateral globi pallidi. There is no evidence of intracranial hemorrhage or acute infarct. 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. There are no focal skull lesions. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Interval decrease in size of metastatic lesions in the left and right cerebellum.2.Unchanged size of a lesion in the deep white matter adjacent to the right thalamus, but with a decrease in surrounding edema.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Rule-out intracranial process. Signs and symptoms: Seizure. Prominence of cortical sulci and ventricular system for patient's stated age is again identified and the great normal change.A nonspecific small new area of low-attenuation in the subcortical white matter of left frontal lobe is noted. The finding may represent edema. There is however no detectable mass effect with this finding. The exact etiology of finding is not clear. Further evaluation with an infused MRI is recommended. This examination is otherwise unremarkable. Calvarium, paranasal sinuses and mastoid vessels are also unremarkable.

Output: 1.Prominence of cortical sulci and ventricular system for patient's stated age as was noted on prior examination from 2007.2.Nonspecific focal area of low-attenuation in the subcortical white matter of left frontal lobe which needs further evaluation with an infused MRI examination.3.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with history of metastatic melanoma and brain metastases. Again seen is evidence of a treated lesion within the right superior frontal gyrus. The lesion is mildly hemosiderin stained with an irregular area of internal enhancement measuring up to 9 mm in diameter, previously 10 mm. Internally, the lesion has become predominantly T2 bright and FLAIR suppressing compatible with cystic degeneration. Minimal surrounding FLAIR hyperintensity compatible with gliosis is unchanged.A 3-mm enhancing focus within the left occipital lobe is unchanged in size. This lesion causes no significant edema or mass effect.No new enhancing lesions are detected. A developmental venous anomaly is present in the right precentral gyrus. Scattered nonspecific T2 hyperintense white matter lesions are not significantly changed. Ventricular size and morphology are normal.

Output: 1.A treated lesion in the right superior frontal gyrus shows stable to slightly reduced internal enhancement and no other evidence to suggest lesion growth.2.A small enhancing focus in the left occipital lobe is also unchanged.3.No new intracranial lesions are seen.


Instruction: Generate impression based on findings.

Input: Recent gait instability/imbalance (since July 2015) and paresthesias in bilateral hands for approximately 1 year. Differential includes: paraneoplastic syndrome, prion disease, ALS, multisystem atrophy, vasculitis, hep C peripheral neuropathy and CNS disease. . Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter focus of T2 hyperintensity in the left middle frontal gyrus, which is nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in the left posterior ethmoid sinus.Cervical Spine: There is multilevel degenerative spondylosis of the cervical spine superimposed upon a congenitally narrow spinal canal and thickening of the posterior longitudinal ligament. In particular, there is compression of the spinal cord at C3-4, C4-5, and C6-7 and neural foraminal stenoses bilaterally. In addition, there is volume loss and high signal within the spinal cord at these levels. There is minimal anterolisthesis of C4 on C5 and minimal retrolisthesis of C3 on C4. The vertebral bone marrow displays degenerative endplate signal alterations at multiple levels, but is otherwise unremarkable. The vertebral body heights are preserved. No mass lesions are present in the cervical spine. The paravertebral soft tissues are unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2 .Multilevel degenerative spondylosis of the cervical spine superimposed upon a congenitally narrow spinal canal and thickening of the posterior longitudinal ligament.


Instruction: Generate impression based on findings.

Input: Evaluate for hypertrophic cardiomyopathy. Chest pain. Left VentricleThe left ventricle walls are thickened with special thickening of the interventricular septum and anterior wall. There are no regional wall motion abnormalities present. Mild to moderate LVOT obstruction noted. There is a possible late gadolinium enhancement of the anterior wall of the left ventricle (image 17 series 2/3/2001). The overall LV ejection fraction is 63%, the LV end diastolic volume index is 112.39 ml/m2 (normal range: 74+/-15), the LVEDV is 181.73 ml (normal range 142+/-34), the LV end systolic volume index is 41.59 ml/m2 (normal range 25+/-9), the LVESV is 67.24 ml (normal range 47+/-19), the LV mass index is 100 g/m2 (normal range 85+/-15), and the LV mass is 161 g (normal range 164+/-36). Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 45.66%, the RV end diastolic volume index is 89.93 ml/m2 (normal range 82+/-16), the RVEDV is 145.41 ml (normal range 142+/-31), the RV end systolic volume index is 48.88 ml/m2 (normal range 31+/-9), and the RVESV is 79.01 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is minimal dephasing inferior to the aortic valve suggesting mild aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. Anterior systolic motion of the anterior medial valve with consequent mild to moderate regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.Extracardiac FindingsPartial visualization of the solid organs and hollow viscus of the upper abdomen are normal.

Output: 1. Hypertrophic cardiomyopathy with mild LVOT obstruction.2. Possible leg gadolinium enhancement of the anterior wall of the left ventricle. Follow-up in 6 to 12 months is recommended3. Mild to moderate mitral and aortic valve regurgitation.


Instruction: Generate impression based on findings.

Input: Male, 50 years old, with abnormal brain MRI, status post two biopsies. Evaluate for changes over the past few MRIs. Evidence of right frontal approach and right temporal approach biopsies is again noted. A slitlike, hemosiderin stained cavity is also redemonstrated within the right basal ganglia compatible with a healed parenchymal hemorrhage.Ill-defined infiltrative T2 hyperintensity and thickening is again seen involving the right temporal lobe, insula, basal ganglia and thalamus, cerebral peduncle, splenium of the corpus callosum and centrum semiovale white matter. The overall geographic extent of this abnormality has not changed, though some of the involved gyri appear to be subjectively somewhat thicker than on the prior examination. As before, this lesion does not enhance.Generalized mass effect with a midline shift to the left of approximately 5 mm is unchanged. The right lateral ventricle is partially effaced. No brain herniation is seen. No pathologic parenchymal or extra-axial enhancement is detected. No new parenchymal lesions are seen.

Output: There has been no convincing or measurable change in the geographic extent of the large infiltrative T2 hyperintense process involving multiple lobes of the right cerebral hemisphere. Subjectively, some of the involved gyri appear slightly thicker, but this is potentially related to differences in technique. Continued follow-up is advised.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of uncertain behavior of brain, unspecifiedClinical question: Eval for growth of grade II astrocytoma.Signs and Symptoms: grade II astrocytoma s/p surgery and RT.Comments: R frontal grade II astrocytoma s/p surgery and RT. | The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The patient is status post right frontal craniotomy. There is a small focus of T2 and FLAIR signal hyperintensity along the medial aspect of the right superior frontal gyrus associated with volume loss and some distortion suggesting prior surgery.. The appearance is stable since prior exams dating back to 11/8/2012There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. They're more prevalent along the right hemisphere versus the left.There is a T2 and FLAIR hyperintense punctate lesion along the right posterior pons which is stable compared to previous exams.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The exam is stable compared to previous exams. There is redemonstration of a status post right frontal craniotomy for a right superior frontal gyrus lesion as well as periventricular white matter lesions which are presumably treatment related.


Instruction: Generate impression based on findings.

Input: Rule out mass or mass effect. History of histiocytosis X. Non-enhanced CT of brain: There is no evidence of intracranial hemorrhage, edema, mass effect, mass, midline shift or hydrocephalus. Cortical sulci, ventricular system, CSF cisterns and gray -- white matter remains within normal. If clinical concern persists follow-up with an MRI is recommended.Visualized paranasal sinuses and mastoid air cells on the left are unremarkable. There is almost no pneumatization of right mastoid air cells. The right middle ear cavity however is well pneumatized.Calvarium is intact.Limited images of orbits are unremarkable. No abnormality of soft tissues of the scalp is detected.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Ms. Adamczyk is a 35 year old female with a strong family history of breast cancer, including in her sister diagnosed in her 30s. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Few simple cysts are identified in both breasts. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 69 years, Female, Reason: L sided hemisensory deficit There is mild restricted diffusion involving the right thalamus without clear corresponding area of low signal on the ADC map. There is associated FLAIR hyperintensity. No other focus of restricted diffusion to suggest additional infarcts. There is a small extra-axial lesion measuring 9 x 11 mm along the left anterior frontal convexity which is incompletely evaluated without contrast but favored to represent a small meningioma. Otherwise no intracranial mass or mass effect. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.There is focus of low T1 and low T2 signal involving the right parietal calvarium measuring up to 2.3 cm in diameter without corresponding lytic changes on recent CT.

Output: 1. Mild restricted diffusion involving the right thalamus with corresponding FLAIR hyperintensity is consistent with an acute to subacute infarct.2. 9 x 11 mm extra-axial lesion along the left anterior frontal convexity is incompletely evaluated without contrast but favored to represent a small meningioma. No significant associated mass effect.3. Nonspecific 2.3 cm lesion involving the right inferior parietal calvarium without corresponding destructive changes on recent CT. Remainder of the calvarium is otherwise unremarkable.Dr. Ali discussed findings with Dr. Del Brutto at 12:50 PM on 7/30/2015


Instruction: Generate impression based on findings.

Input: Again seen are postoperative findings related to a right posterior parietal craniotomy. The resection cavity is unchanged with mild T2/FLAIR signal surrounding the CSF-filled cavity remaining unchanged across multiple prior studies. There are no areas of pathologic enhancement. Curvilinear susceptibility abnormality along the lateral aspect of the right frontal lobe and within the central sulcus/post central gyrus, likely reflects chronic blood products and is unchanged. Incidentally seen is a small arachnoid cyst without mass effect along the left frontotemporal operculum and also remains unchanged. There is a nonspecific focus of T2/FLAIR hyperintensity in the left parietal deep white matter which may be related to treatment and present previously. The ventricles are within normal limits and the basal cisterns remain patent. No areas of diffusion restriction are present to suggest an acute ischemic event. No extra-axial fluid collection is identified. The cerebellar tonsils are in normal position. Pituitary gland is unremarkable for age. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Small maxillary sinus mucous retention cyst again seen. The orbits are unremarkable.

Output: Posttreatment changes in the right parietal lobe. No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Female, 19 years old, with right leg weakness and right and left patchy sensory changes, elevated systemic inflammatory markers. Clinical question: Please evaluate for CNS inflammation. The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The lumbar puncture was performed under general anesthesia. The general anesthesia was induced due to planned subsequent MR examination. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously and into the deeper soft tissues. Using fluoroscopic guidance, a 22 gauge x 5 inch spinal needle was localized into the thecal sac at the L3-L4 level. There was no immediate return of cerebrospinal fluid. Hence under fluoroscopic guidance, the spinal needle was localized into the thecal sac at L2-3 level. With valsalva maneuver ,there was immediate return of clear cerebral spinal fluid, approximately 3 ml of which was collected and and provided to the clinical service. The stylette was replaced, the needle removed, and hemostasis achieved with manual compression. The patient was then transferred to the MRI suite for MRI knee and spine under general anesthesia.

Output: Successful fluoroscopy-guided lumbar puncture.Cumulative fluoroscopy time: 11.9 minutes.


Instruction: Generate impression based on findings.

Input: Other injury of unspecified body region [T14.8], Reason for Study: ^Reason: hx of stage 3 lung cancer, recently treated with chemo and radiation, had T9 compression fracture prior to diagnosis, pain around T9, rule out malignancy History: hx of stage 3. Due to patient's claustrophobia, the examination is very limited. The T9 vertebral body shows more than 80% of compression fracture with minimal bone marrow edema. Clinical correlation is recommended if the compression fracture is symptomatic or not.There is minimal retropulsion of the fractured vertebral body which indents anterior thecal sac, however, the degree of retropulsion does not result spinal stenosis.There is subtle T2 high signal intensity foci at this level spinal cord but could represent an artifacts. Otherwise spinal cord signal intensity appears to be normal.There is no evidence of associated soft tissue mass on this scan.Other vertebral bodies included in this scan do not show any abnormal marrow signal intensity.The bone marrow and end plates demonstrate a normal MR appearance. The conus medullaris terminates at the L1 level.

Output: 1. About 80% or higher compression fracture of T9 vertebral body with minimal bone marrow edema with minimal retropulsion. Clinical correlation is recommended if the compression fracture is symptomatic.2. No definitive evidence of spinal cord signal abnormality.3. No evidence of associated soft tissue lesion on this scan.4. No other vertebral body lesion is seen on this scan.


Instruction: Generate impression based on findings.

Input: Patient with continual lightheadedness, evaluate for left eye proptosis There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered periventricular and subcortical white matter T2/FLAIR hyperintense foci are seen which are nonspecific but likely represent mild chronic small vessel ischemic disease. The brain parenchyma appears otherwise unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild chronic small vessel ischemic disease. 2. No evidence of acute infarct, hemorrhage, or intracranial mass effect. 3. No evidence of proptosis by imaging criteria as questioned. No retrobulbar mass.


Instruction: Generate impression based on findings.

Input: Shoulder pain, persistent. Evaluate for impingement or rotator cuff pathology. ROTATOR CUFF: Mild increased signal intensity within the distal supraspinatus tendon suggests mild tendinosis and possibly the bursal surface fraying along the anterior aspect of the tendon, but I see no fluid-filled tear. The supraspinatus muscle appears normal. Mild increased signal intensity within the distal infraspinatus tendon at its insertion also suggests mild tendinosis but I see no tear, and the muscle appears normal. There is moderate fatty atrophy of the teres minor muscle, of unknown etiology. Focal increased signal intensity within the distal subscapularis tendon at its insertion suggests tendinosis but I see no fluid-filled tear. There is a small cyst in the underlying humeral head. The subscapularis muscle appears normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. I see no frank fluid within the subacromial/subdeltoid bursa. There is trace fluid within the subdeltoid bursa, of doubtful significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the glenohumeral joint, but no large effusion. There is mild deformity and increased signal intensity of the anteroinferior labrum that may reflect degeneration/degenerative tearing, but this is not necessarily of any current clinical significance. The posterior labrum appears intact.BICEPS TENDON: Given the limitations of a non-arthrogram study, the tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1.Mild rotator cuff tendinosis and possible bursal surface fraying as described above, but I see no fluid-filled tear. Fatty atrophy of the teres minor muscle is of unknown etiology.2.Mild osteoarthritis of the acromioclavicular joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: 55-year-old female with multiple myeloma. Evaluate for source of new jaw numbness. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The osseous structures including the calvarium, occipital condyles, and C1 and C2 vertebral bodies show innumerable permeative lytic lesions consistent with the patient's history of multiple myeloma. There is no discrete soft tissue mass to suggest a plasmacytoma. However, an MRI has already been ordered and should help in the evaluation for a plasmacytoma or other cause for the patient's symptoms. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Innumerable diffuse lytic lesions to the osseous structures are consistent with the patient's history of multiple myeloma. An MRI of the head and neck has been ordered and this will help in evaluation for a plasmacytoma or other cause for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 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. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are scattered sporadic foci of mucosal thickening within the paranasal sinuses without superimposed air fluid levels. The mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: There are scattered sporadic foci of mucosal thickening within the paranasal sinuses without superimposed air fluid levels. Otherwise negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Possible metastasis: cervical cancer, seizures, waxing/waning mental status. There is an enhancing lesion in the left cerebellar hemisphere that measures up to 19 mm, with mild surrounding vasogenic edema. There is also an enhancing lesion in the inferior right cerebellar hemisphere that measures up to 5 mm. There are a few scattered cerebral white matter T2 hypointense lesions without associated enhancement. There is no evidence of acute infarct or intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are mild scattered paranasal sinus secretions.

Output: A lesion in the left cerebellar hemisphere and a smaller lesion in the right cerebellar hemisphere likely represent metastatic disease, but no evidence of intracranial hemorrhage or acute infarct. A few scattered cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of medullary thyroid cancer, compare to previous. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and parenchymal signal intensity.Small area of of nodular arterial enhancement in segment 7 without washout or restricted diffusion compatible with a small hemangioma (series 11/212) or transient hepatic intensity difference not significantly changed since 1/17/2011. Additional subcentimeter segment IVb subcentimeter cysts also unchanged. No new suspicious focal hepatic lesions.Cholelithiasis without evidence of cholecystitis. No biliary ductal dilatation.SPLEEN: Splenic cyst. Additional subcentimeter areas of low T1 signal corresponding to calcified granulomas seen on CT.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable right adrenal lipid-rich adenoma. KIDNEYS, URETERS: Stable left superior pole minimally complex cyst with thin internal septations but no suspicious enhancement. Additional subcentimeter probable cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Hemangioma within L3 vertebral body.OTHER: No significant abnormality noted.

Output: Stable examination without specific evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Pain. TFCC tear? LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact. A subcentimeter lobulated focus of fluid signal intensity immediately dorsal to the scapholunate ligament likely represents a ganglion.TRIANGULAR FIBROCARTILAGE COMPLEX: There is intermediate signal intensity within the articular disc of the triangular fibrocartilage just radial to the lamina suggesting degeneration; I see no fluid signal intensity traversing the articular disc to indicate a tear.TENDONS: There is dislocation of the extensor carpi ulnaris tendon such that the tendon courses volar to the ulnar styloid; there is little if any edema in the adjacent soft tissue, so I suspect this is a chronic abnormality. The remaining tendons are unremarkable. BONES: Bone marrow signal intensity is within normal limits.ADDITIONAL

Output: 1.Dislocation of the extensor carpi ulnaris tendon volar to the ulnar styloid.2.Intrasubstance degeneration of the articular disc of the triangular fibrocartilage without discrete tear.3.Ganglion dorsal to the scapholunate ligament.


Instruction: Generate impression based on findings.

Input: Unexplained left sided weakness after seizure and trauma. Brain: There is a predominantly high T1 and low T2 signal intensity left holoconvexity subdural hematoma that measures up to 12 mm in thickness. There is associated mild mass effect upon the left cerebral hemisphere, 3 mm of midline shift to the right, and partial effacement of the left lateral ventricle, and mild prominence of the right alteral ventricle with diffuse mild periventricular white matter T2 hyperintensity. There is also a punctate focus of susceptibility effect in the right paracentral lobule with mild associated vasogenic edema, patchy T2 hyperintensity in the right cerebral peduncle, a small patchy area of T2 hyperintensity in the inferior portion of the anterior left putamen, punctate foci of high T2 signal in the posterior left insular subcortical white matter and posterior left hippocampal tail, as well as punctate foci of susceptibility in the left thalamus, right superior frontal gyrus, right lateral anterior temporal lobe, and left lateral medulla. Some of the areas with high T2 signal may display mildly restricted diffusion. There is a partially empty sella. The major cerebral flow voids are intact. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The skull bone marrow signal displays diffusely low T1 and T2 signal. There is a T2 hyperintense nodule in the superficial left parotid gland, which measures up to 9 mm.Cervical Spine: The vertebral body and disc space heights are preserved. The vertebral bone marrow signal displays diffusely low T1 and T2 signal. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There is no spondylolisthesis. The paravertebral soft tissues are unremarkable. However, there is diffuse reticulation of the subcutaneous fat. There are enteric and endotracheal tubes in position.

Output: 1. Subacute left holoconvexity subdural hematoma that measures up to 12 mm in thickness, with associated mild mass effect upon the left cerebral hemisphere, 3 mm of midline shift to the right, and partial effacement of the left lateral ventricle.2. A punctate focus of hemorrhage in the right paracentral lobule with mild associated vasogenic edema, patchy T2 hyperintensity in the right cerebral peduncle, a small patchy area of T2 hyperintensity in the inferior portion of the anterior left putamen may represent sequelae of trauma, including hemorrhagic contusions and shear injury, and Kernohan notch phenomenon, perhaps. Nevertheless, underlying microhemorrhages from other causes are a consideration and follow up brain MRI may be useful. 3. No evidence of spinal canal stenosis. 4. Diffuse low signal of the bone marrow may represent a marrow replacement disorder.5. Incidental subcentimeter left parotid tumor may represent a pleomorphic adenoma, for example. Follow up with dedicated imaging may be useful.Discussed with Dr. Kramer at 4:15 PM on 4/28/16.


Instruction: Generate impression based on findings.

Input: History of myelofibrosis. ABDOMEN:LIVER, BILIARY TRACT: A few hepatic cysts are noted. No focal suspicious lesion or biliary ductal dilatation.Status post cholecystectomy with postsurgical susceptibility artifact in the gallbladder fossa.Poor visualization of the portal vein with several small caliber collateral vessels in the porta hepatis suspicious for portal vein thrombosis. SPLEEN: Marked splenomegaly with the spleen measuring 29 cm in the craniocaudal dimension. At the level of the celiac artery origin the spleen measures 19 x 12.7 cm in cross-section. No focal splenic lesion. Numerous perisplenic collateral vessels are present the appearance of which is suspicious for splenorenal shunting. The largest varix measures up to 1.6 cm. Minimal perisplenic fluid. Small peripheral irregularly-shaped parenchymal signal abnormality likely reflects a prior small infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several right renal simple cysts. Subcentimeter right renal hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Heterogeneous bone marrow signal intensity.OTHER: No significant abnormality noted.

Output: 1.Marked splenomegaly with perisplenic collateral vessels and appearance suspicious for splenorenal shunting.2.Poor visualization of the portal vein which appears replaced with several porta hepatis small caliber vessels, suspicious for portal vein thrombosis. Color Doppler ultrasound may be considered to confirm patency as clinically warranted.


Instruction: Generate impression based on findings.

Input: 18-year-old woman with history of obesity and left lower extremity numbness. Five lumbar type vertebral bodies are presumed to be present. There is a small Schmorl's node at the anterior superior endplate of T12. Vertebral body heights are within normal limits. Alignment is within normal limits. There is apparent mild, diffuse T1 hypointensity of the bone marrow which may be artifactual. No discrete suspicious osseous lesions are evident. The conus medullaris is normal in position. There is no abnormal enhancement on postcontrast images.There is no significant disc disease, spinal canal, or neural foraminal stenosis. The paraspinous soft tissues are within normal limits.

Output: 1. No significant disc disease, spinal canal, or neural foraminal stenosis in the lumbar spine.2. Examination is mildly technically degraded due to patient's body habitus.


Instruction: Generate impression based on findings.

Input: Pain, instability. Evaluate labrum. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact. No partial or full thickness rotator cuff tear is present. No significant fluid is seen in the subacromial/subdeltoid bursa.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is contrast seen deep to a displaced labral fragment of the superior labrum, extending from approximately the 10:00 to 1:00 position, suggestive of SLAP lesion (best seen on image 14, series 401).BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Findings suggestive of SLAP lesion, as above.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with history of AVM status post treatment (SRS in January 2015). Evaluate for changes. The known arteriovenous malformation of the left superior frontal gyrus is redemonstrated as an area of ill-defined enhancement measuring 12 x 7 x 6 mm, previously 14 x 11 x 9 mm. As before, a mildly prominent draining vein extends to the adjacent dura. Of note, there is new mild FLAIR hyperintensity within the parenchyma surrounding the lesion. No significant local mass effect is seen.Elsewhere, numerous scattered foci of periventricular and subcortical white matter T2 hyperintensity are again seen without gross interval change. No evidence of significant parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. A 9 x 5 mm dural-based enhancing nodule is evident along the high left convexity, unchanged. No new enhancing lesions are seen. The ventricular system is stable and normal in size.The field-of-view of the MRA inadvertently excludes the left superior frontal gyrus lesion. Elsewhere, no new vascular lesion or significant stenosis is observed. A 1 mm outpouching from the left P1 segment is unchanged and favored to represent an infundibulum rather than an aneurysm.

Output: 1.Enhancement pertaining to the left superior frontal gyrus arteriovenous malformation has decreased. However, new mild FLAIR hyperintensity has developed surrounding the lesion. In the absence of detectable mass effect, this may reflect treatment related gliosis, but continued imaging follow-up will be required.2.MRA imaging inadvertently excludes the left superior frontal gyrus lesion. The patient will be brought back to repeat this imaging sequence at no additional charge. The MRA examination is otherwise unremarkable.3.Elsewhere in the brain, scattered white matter lesions are seen which may reflect chronic microvascular ischemia. No new or acute lesions are detected. A small dural based enhancing nodule along the high left convexity may represent a dilated venous structure or a meningioma.


Instruction: Generate impression based on findings.

Input: Evaluate for choledocholithiasis. Right upper quadrant pain. ABDOMEN:LIVER, BILIARY TRACT: Numerous small gallstones within a normally distended gallbladder. Some of the gallstones are at the level of the gallbladder neck. No gallbladder wall thickening, edema or pericholecystic inflammatory changes.No intra or extrahepatic biliary ductal dilatation. No filling defect to suggest a stone or mass in the common bile duct. The liver is normal morphology, size, signal intensity and enhancement without a focal lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in morphology. It demonstrates mild T2-weighted hyperintensity, compatible withe edema. There is mild peripancreatic inflammatory fluid. The main pancreatic duct is not well seen. No loculated fluid collection, evidence of pancreatic parenchymal necrosis, hemorrhage or vascular abnormality.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diastases of the lower anterior abdominal wall musculature.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis with numerous small gallstones without specific evidence of acute cholecystitis.2.No choledocholithiasis.3.Mild acute interstitial edematous pancreatitis with peripancreatic inflammatory changes but no fluid collection, necrosis, hemorrhage or vascular complication.


Instruction: Generate impression based on findings.

Input: Sepsis, unspecified organism [A41.9] / Other fatigue [R53.83] / Dysphagia, unspecified [R13.10], Reason for Study: ^Reason: rule out brain metastasis; weakness, tinnitus, and possible confusion and falls at home History: h/o lung mass and liver nodules There are multifocal restricted diffusion lesions involving right superior frontal gyrus, right middle frontal gyrus, left parietal lobe periventricular white matter, left occipital lobe, left cerebellar hemisphere and 2 suspicious lesions on the right cerebellar hemisphere indicating acute ischemic stroke. These lesions do not show susceptibility artifacts suggesting they are not associated with intra-lesional hemorrhages.On Gad enhanced images, there is no evidence of diffuse meningeal enhancement.However, there is focal enhancing nodular lesion on the left lateral ventricle periventricular white matter (series 1301, image 107). This could represent metastatic nodule.Underlying brain shows scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Multifocal restricted diffusion lesions on bilateral hemispheres and cerebellum indicating multifocal supra and infra tentorial ischemic strokes without evidence of hemorrhagic conversion.2. There is no evidence of diffuse meningeal enhancement.3. A small enhancing nodule on the periventricular white matter adjacent to the left lateral ventricle which possibly indicate single metastatic nodule.4. Underlying non specific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 41-year-old female with knee pain. Assess for meniscal injury. MENISCI: Medial lateral meniscus appear intact. There is small focal globular increased signal abnormality within the posterior horn of the medial meniscus consistent with mild mucoid degeneration.ARTICULAR CARTILAGE AND BONE: There is mild chondromalacia affecting the patellofemoral compartment. No bone marrow signal abnormality is identified.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Mild mucoid degeneration of the medial meniscus and chondromalacia without evidence of meniscal injury.


Instruction: Generate impression based on findings.

Input: Postoperative changes are again seen from Chiari decompression, with a widely patent neoforamen magnum, similar to the appearance on the most recent comparison MRI cervical spine. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and patchy areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures, although the flow-void associated with the right distal transverse and sigmoid sinuses appear slightly less conspicuous than on the contralateral side, with increased T2 signal at the level of the jugular bulb and caudally. On T1-weighted images, the sinus appears similar to prior exam, where previous postcontrast images demonstrated venous patency. There is no significant associated diffusion restriction or susceptibility along these venous structures, and therefore findings are felt to be artifactual related to flow. The midline structures and craniocervical junction are within normal limits. There is a persistent prominent mucosal retention cyst in the right maxillary sinus.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. No acute abnormality. Stable probable minimal chronic small vessel ischemic changes.2. Stable postoperative changes from prior Chiari decompression with patent neoforamen magnum.3. Unremarkable MRA of the head.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with diffuse numbness and weakness, blurred vision. History of stroke. Evaluate for MS or other etiology. No restricted diffusion, focal edema or mass effect is detected. A relatively small number (no more than five) of scattered punctate foci of T2 hyperintensity are seen mostly within the subcortical regions predominantly in the right frontal lobe. At least one of these lesions was present on the examination from 2002. No pathologic parenchymal or extra-axial enhancement is observed. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricles are normal in size and morphology.

Output: 1.No acute intracranial abnormality or any specific findings to account for the patient's symptoms.2.A few scattered punctate foci of signal abnormality are identified which are nonspecific.


Instruction: Generate impression based on findings.

Input: Other disturbances of skin sensation [R20.8], Reason for Study: ^Reason: eval for cord compression History: sent from urgent care, numbness/paresthesia that progressed to saddle anesthesia today There is no evidence of spinal cord compression on this scan.The conus medullaris terminates at the level of T12. On STIR images, there are suspicious scattered high signal intensity lesions on cervical cord at the level of C2, C3 and C4 level which may indicate possibility of demyelinating disease. At L5S1 level, there is disc bulge at the level of L5S1.There is about 25mm lesion within the uterus which may indicate fibroid.There is normal cervical lordosis. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. If clinically indicated, dedicated cervical spine MRI and lumbar spine MRI can be considered for further imaging evaluation.

Output: 1. No evidence of spinal cord compression.2. Disc bulge seen at the level of L5S1.3. Suspicious cervical spinal cord high signal intensity lesions which possibly indicate demyelinating lesion.Comment: If clinically indicated, dedicated cervical spine MRI can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Changes are present from previous C5/6 ACDF.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Mild posterior osteophyte disc complex and right uncinate hypertrophy without significant associated stenosis.C4/5: Mild posterior osteophyte disc complex and uncinate hypertrophy. There is mild to moderate bilateral neural foraminal stenosis.C5/6: Postoperative level without significant stenosis.C6/7: Minimal posterior osteophyte disc complex without significant associated stenosis.C7/T1: Unremarkable

Output: 1.Changes are present from previous C5/6 ACDF.2.C4/5: Mild to moderate bilateral neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Multiply recurrent atypical meningioma, now on Avastin. There are postoperative findings related to parieto-occipital craniotomy. There are multiple foci of extra-axial tumor along the posterior falx cerebri and tentorial leaflets, with invasion of the superior sagittal sinus, which are perhaps slightly larger than in October 2015. For example, the dominant parafalcine mass measures 46 AP x 27 RL x 45 SI mm, previously 44 AP x 25 RL x 37 SI mm. The associated extensive vasogenic edema in the adjacent brain parenchyma bilaterally appears to be similar in extent as before. However, there is now cystic encephalomalacia in the medial right occipital lobe with thin enhancement along the parenchymal margins and there has been evolution of the enhancement more laterally along the parenchymal margins of the left occipital lobe resection site with areas of apparently restricted diffusion and susceptibility effect. There is no large acute territorial infarct. There is ex vacuo dilatation of the right lateral ventricle and overall prominence of the left lateral and third ventricles. There is mild left sphenoid sinus mucosal thickening. The orbits are unremarkable. There are changes in the posterior scalp related to interval hardware removal.

Output: Post-treatment findings in the posterior cranium with overall slight increase in size of multiple foci of recurrent meningioma along the posterior falx cerebri and tentorial leaflets with associated extensive vasogenic edema in the adjacent bilateral cerebral hemispheres since October 2015. Evolution of enhancement along the medial margins of the bilateral occipital lobes associated with encephalomalacia and perhaps necrosis may be treatment-related.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: oligodendroglioma. History: glioma. 50 years Male (DOB:12/1/1966)Reason: oligodendroglioma. History: glioma.PROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS There is no evidence of acute ischemic or hemorrhagic lesion.Post resection cavity of left frontal lobe with streaky enhancing areas are again seen, unchanged since prior scan.High signal intensity lesions on T2/FLAIR surrounding the resection cavity and susceptibility lesions surrounding resection cavity are again seen, unchanged in extent.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. No evidence of acute progression.2. Post surgical resection changes of the left frontal lobe are again seen, unchanged since prior scan.


Instruction: Generate impression based on findings.

Input: 16-year-old male with history of hip pain. ACETABULAR LABRUM: There is linear intermediate signal abnormality which obliquely traverses the anterior labrum from the 2 to 3 o'clock positions indicating a labral tear. The posterior and superior portions of the labrum appear intact.ARTICULAR CARTILAGE AND BONE: There is slight bony prominence along the anterior aspect of the femoral head/neck junction compatible with a mild CAM deformity with an alpha angle of approximately 60 degrees. Bone marrow signal intensity of the right hip is normal. The articular cartilage is intact.SOFT TISSUES: The ligamentum teres is unremarkable. The visualized musculature is within normal limits. ADDITIONAL

Output: Anterior labral tear and mild CAM deformity as described above.


Instruction: Generate impression based on findings.

Input: 74 year old man with pAF, HTN, new inferior hypokinesis on echo, referred for ischemia evaluation. MEDICATIONS: Pindolol, Xarelto, Zetia First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is mid-wall/ epicardial myocardial late gadolinium enhancement noted in the basal inferolateral wall. The pattern is atypical for myocardial infarction and may suggest underlying fibrosis, inflammation, or infiltration. It was present on CMR in 2010 and is unchanged. The remainder of the myocardium is viable without evidence of any myocardial infarction.Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 53%, the LV end diastolic volume index is 100 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 47 ml/m2 (normal range 25+/-9), the LVESV is 108 ml (normal range 47+/-19), the LV mass index is 53 g/m2, and the LV mass is 121 g. There is no regional wall motion abnormality. The basal inferior and inferolateral walls show evidence of a "pseudo-wall motion abnormality," which is in fact, through plane of motion of the mitral anular plane and the left atrium and not a true wall motion abnormality. Sigmoid septum is noted. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 99 ml/m2 (normal range 82+/-16), the RVEDV is 227 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 83 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. There is bileaflet mitral valve prolapse. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is upper limits of normal.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. The left ventricle is normal in size with normal systolic function without evidence of regional wall motion abnormality. The overall LV ejection fraction is 53%. There is epicardial/ mid myocardial late gadolinium enhancement noted in the basal inferior/inferolateral wall. The pattern is atypical for myocardial infarction and may suggest underlying fibrosis, inflammation, or infiltration. It was present on CMR in 2010 and is unchanged. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%4. Mitral valve prolapse with mild to moderate mitral regurgitation noted. When compared to the prior cardiac MRI from 2010, the LVEF is slightly lower. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.