Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: stroke?Signs and Symptoms: left sided weakness MRI of the brainThere is a small (9x7mm) focus of restricted diffusion with associated increased T2 and FLAIR signal within the right pons likely representing a small acute to subacute ischemic infarction. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Subcentimeter foci of T2/FLAIR signal hyperintensity are also present in the basal ganglia and right thalamus. The lesions in the basal ganglia are associated with susceptibility effect. The right basal ganglia lesion is also associated with 3mm size T1 hyperintensity. 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 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.Exam is mildly degraded by patient motion.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are medium size. The right vertebral artery is larger than the left vertebral artery.There is 70% stenosis at the proximal right p2 segment by WASID criteria.There is 80% stenosis at the distal left m1 segment by WASID criteria.There is 70% stenosis at the left vertebral artery intracranially distal to the PICA origin. The left PICA has extracranial originMRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The LCCA originates from the innominate artery. There is 70% stenosis at the left vertebral artery intracranially distal to the PICA origin. The left PICA has extracranial origin

Output: 1.Right pontine acute infarction2.Older lacunar infarcts in the basal ganglia and thalami with mineralization along the right basal ganglia.3.There is 70% stenosis at the proximal right p2 segment.4.There is 80% stenosis at the distal left m1 segment.5.There is 70% stenosis at the left vertebral artery intracranially distal to the PICA origin. 6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68-year-old male with history HNC and CRT, compare to previous measurements. History of RT to the left orbit. There is susceptibility artifact related to patient dental hardware which somewhat limits examination. Posttreatment findings are again seen in the left supraciliary region. There is persistent enhancement along the left superolateral orbital wall and extraconal space extending superiorly through the frontal bone coursing medially adjacent to the left frontal sinus, not appreciably changed when compared to 1/5/2016 and 10/7/2015. Enhancing tissue also extends to the left frontal dura margin as before. No new mass lesions or areas of abnormal enhancement are noted to suggest tumor progression. Lytic osseous defect is better seen on recent CT. The right orbit is unremarkable. There is partial opacification of the bilateral ethmoid sinuses as well as a mucus retention cyst in the left maxillary sinus.

Output: Posttreatment changes in the left supraciliary region with unchanged nonspecific enhancing tissue at the site of the treated squamous cell carcinoma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of bone and bone marrowClinical question: hx C5 tumor resection and fusion, eval for tumor recurrenceSigns and Symptoms: some mid back pain Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. The patient is status post C5 corpectomy and C4-C6 anterior fusion with plate and screws.Since the prior exam from June a mass centered in the right half of the C5 corpectomy site has enlarged from 10x15mm to 31x18mm axial dimensions and now encroaches on the right C5-6 exiting nerve roots and had epidural extension at the right lateral recess. There is redemonstration of associated marrow replacement along the right sided posterior elements of C5. The lesions extends towards the left side of the corpectomy site and left epidural space and mildly narrows the left neural foramen. The mass partially surrounds the right vertebral artery and displaces the right common carotid artery and right jugular vein. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.There are small heterogenous lesions present in the thyroid gland.MRI thoracic spine:There is a T5 compression fracture present with 50% loss of vertebral body height. The compression was not present on the prior exam. The mass has significantly enlarged. There is a marrow replacing mass involving all of C5 which protrudes from the vertebral body and right pedicle into the spinal canal and compresses the spinal cord. It predominantly involves the right hemicanal but extends across the ventral midline. It also obliterates the right T5-6 neural foramen. It has enlarged from 21x19mm to 29x23mm axial dimensions. The mass also bulges against the pleura.There is a marrow replacing lesion at T8 which is located at the right anterior aspect of the T8 vertebra currently measuring 21x28mm axial dimensions and previously measuring 19x16 mm axial dimensions. There is enhancement of the majority of the T8 vertebral body.The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There appears to be interstitial thickening in the visualized lung which could be better evaluated on CT chest.

Output: 1.Since the prior exam a right sided exophytic mass at C5 has significantly enlarged and now encroaches on the right exiting nerve roots at C5-6, partially encases the right vertebral artery and extends into the ventral aspect of the spinal canal and now involves the majority of the corpectomy site and mildly narrows the left neural foramen.2.Progression of T5 mass where there is now a compression fracture associated with cord compression and compression of the right T5-6 exiting nerve roots.3.Interval enlargement of T8 vertebral body mass.4.Please refer to CT chest for further comments.5.An email was sent to Dr Ramos with the above findings.6.Status post C4-5 spinal surgery.


Instruction: Generate impression based on findings.

Input: Reason: eval chordoma, eval for pathology History: weakness.. Brain MRIThere is multifocal patchy periventricular white matter hyperintensity on FLAIR images, which likely represents small vessel ischemic disease of indeterminate age and is unchanged compared to prior MRI. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.C SpineThe high signal prevertebral mass that was previously seen anterior to the C3 vertebral body and extending along the anterior longitudinal ligament demonstrate interval decrease in size. There is again demonstration of high signal intensity of the C3, C4, and C5 vertebral bodies, not significantly changed compared to prior MRI. The vertebral bodies of C3, C4, and C5 are again seen to enhance with contrast. The cervical and thoracic spinal cord demonstrates diffuse high intensity on T2 weighted images compared to prior exam, which is consistent with post-radiation spinal cord edema. There is new enhancement of the spinal cord at the C4-C5-C6 level, which is favored to represent postradiation myelopathy, with metastasis less likely. Thoracic SpineThere is no evidence of compression of the thoracic spine. There is diffuse high signal intensity on T2-weighted images of the thoracic spinal cord extending to the T5 level. Lumbar SpineThere is mild foraminal narrowing bilaterally at the L1-L2, L2-L3, and L3-L4 levels with mild foraminal stenosis bilaterally. There is diffuse intervertebral disc bulge at the L3-L4 level. There is diffuse intervertebral disc bulge also at level L5-S1. There is spondylolisthesis at the L4-L5 level and severe central canal stenosis at the L4-L5 level. The conus medullaris is normal at the L1-L2 level, with normal signal intensity. There is evidence of diffuse disc desiccation.The bladder is distended with fluid. The paraspinal soft tissues are unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. Nonspecific chronic small vessel ischemic disease of indeterminate age.2. Interval decrease in size of the previously identified extracorporeal mass anterior to vertebral body C3. However, no significant change in MR characteristics of the vertebral bodies compared to prior exam.3. There is new spinal cord enhancement at the C4-C5-C6 level, which favors radiation-induced myelopathy, cannot exclude metastatic lesion.4. Diffuse increased signal of the cervical and thoracic spinal cord extending from C1 to T5 on T2-weighted and STIR images, which is suggestive of postradiation spinal cord edema.5. Severe central canal stenosis at the L4-L5 level secondary to vertebral spondylolisthesis.


Instruction: Generate impression based on findings.

Input: 58-year-old male with elevated PSA, evaluation of pelvic lymph nodes PELVIS:PROSTATE:Prostate Size: 6.3 x 5.7 x 5.3 cm.Peripheral Zone: Focus of T2 hypointensity in the right paracentral apex of the peripheral zone measuring 7 x 6 mm (series 901, image 9) with corresponding restricted diffusion. Previously seen focus of left mid gland medial lesion is no longer well appreciated.Central Gland: Severe degree benign prostatic hypertrophy. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: The tumor abuts the prostate capsule without evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Unchanged scattered external iliac lymph nodes are noted bilaterally. BONES, SOFT TISSUES: Right hamstring and left gluteus medius/minimus tendinopathy.OTHER: No significant abnormality noted.

Output: 1.Right paracentral apex peripheral zone lesion suspicious for malignancy.2.Unchanged bilateral prominent external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: Re-evaluate for progression of prior abnormalities, and assess for new insult of the right centroparietal on the basis of EEG change in this area: CJD remains at top of differential. There are more conspicuous areas of high DWI signal in the right caudate, posterior right cingulate gyrus, right medial parietal lobe cortex, and left thalamus and posterior cingulate gyrus. There is no associated abnormal enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged mild scattered periventricular and subcortical white matter T2 hyperintense lesions, which are nonspecific. There is cavum septum pellucidum and vergae. 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. There is mucosal thickening and secretions in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

Output: Mild nonspecific cerebral white matter lesions may represent chronic small vessel ischemic disease, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. More conspicuous areas of asymmetric signal abnormality in the right caudate, posterior right cingulate gyrus, right medial parietal lobe cortex, and left thalamus and posterior cingulate gyrus may once again represent a form of Creutzfeld Jacob disease.


Instruction: Generate impression based on findings.

Input: Right shoulder pain. Concern for rotator cuff tear. ROTATOR CUFF: There is full thickness tearing of the insertional fibers of the supraspinatus tendon measuring approximately 12 mm in the AP dimension. There is no significant tendon retraction or supraspinatus muscle atrophy. Thickening and increased signal intensity within the distal fibers of the supraspinatus tendon is compatible with tendinosis. The infraspinatus and teres minor muscles/tendons appear intact. There is full thickness insertional tearing of the subscapularis muscle measuring approximately 12 mm without significant tendon retraction or subscapularis muscle atrophy. SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The labrum is grossly intact.BICEPS TENDON: The biceps tendon is intact. ADDITIONAL

Output: Supraspinatus and subscapularis rotator cuff tears as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified disorder of vestibular function, unspecified earClinical question: enhancing lesions in the brainSigns and Symptoms: severe vertigo and unusual looking 2 spots in the brain. History of autoimmune disease MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are asymmetric towards the right hemisphere versus the left. Compared to the prior exam these have not changed.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.Cervical Spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. The exam is mildly degraded by patient motion which may obscure more subtle abnormalities.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation and a minor disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are several periventricular and subcortical white matter lesions present which are stable since the prior exam. These are nonspecific.2.The cervical spine exam is mildly degraded by patient motion which may obscure more subtle abnormalities. No cervical spinal cord lesions are appreciated.3.There are minimal degenerative changes present in the cervical spine.


Instruction: Generate impression based on findings.

Input: 36-year-old female with right shoulder pain. History of labral repair. Evaluate for new labral tear. An ABER view was not able to be obtained due to patient discomfort, decreasing sensitivity for labral tears.ROTATOR CUFF: The supraspinatus and infraspinatus muscles and tendons appear intact. There is intermediate signal intensity within the supraspinatus tendon indicating mild tendinosis. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: Mild degenerative changes affect the acromioclavicular joint. There is a trace amount of gadolinium identified within the subacromial subdeltoid bursa which is presumably related to injection as no full-thickness rotator cuff tear is evident.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear branching signal abnormality within the superior glenoid labrum, which fills with intra-articular gadolinium, consistent with a re-tear of the glenoid labrum. There is extension of this linear signal abnormality, which fills with intra-articular contrast, into the biceps anchor. There is also heterogeneity and increased signal abnormality within the anterior superior glenoid labrum which may represent postsurgical changes or prior tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Findings consistent with a re-tear of the superior glenoid labrum with extension into the biceps anchor as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Bifrontal GBM. Evaluate for tumor grows. Patient on TMZ. Signs and symptoms: GBM. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate a focus of flair/T2 hyperintensity involving the cortex and subcortical white matter and left anterior frontal lobe and reaching the left lateral ventricle without significant change in its extent. There is however noticeable interval decrease size of enhancing tumor at this site and post-infused series. In largest transaxial dimensions of enhancing mass in current exam are asked 13 x 7-mm compared to 16.6 x 14-mm size on prior post-enhanced images. There is also revisualization of a small focus of enhancement along the medial aspect of the left anterior temporal lobe measuring at 7.2-mm compared to prior age as study measurement of approximately 7.8 mm. There is complete resolution of surrounding flair hyperintensity vasogenic edema of this lesion since prior exam.No convincing evidence of any additional foci of enhancement.

Output: 1.There is interval decreased size of enhancing tumor in the left frontal lobe which measures 13 x 7 compared to prior study measurements of approximately 16.6 x 14-mm. Surrounding flair hyperintensity signal demonstrate no significant change since prior exam.2.Small enhancing tumor in the right superior frontal gyrus demonstrates minimal interval decreased size to approximately 7.2 mm compared to prior study remeasurement of 7.8-mm and with interval complete resolution of its surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: 69-year-old male with history of liposarcoma status post nephrectomy. Evaluate for recurrence or metastases. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Cholelithiasis. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Normal intrinsic T1 hyperintensity without evidence of pancreatic ductal dilatation or pancreatic masses.ADRENAL GLANDS: The adrenal glands are normal in size and morphology bilaterally.KIDNEYS, URETERS: Postoperative changes of right nephrectomy. The left kidney enhances normally without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty subcentimeter retroperitoneal lymph nodes are not enlarged by CT size criteria and not changed compared to the prior CT examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No definite evidence of metastatic disease.2.Nonspecific shotty subcentimeter retroperitoneal lymph nodes are nonenlarged by CT size criteria and not significantly changed compared to the previous CT examination.


Instruction: Generate impression based on findings.

Input: Surveillance of brain metastases from melanoma. There is redemonstration of small, nonenhancing foci of gliosis in the left pons and right genu of the corpus callosum appearing similar to the prior study. There were enhancing lesions in these locations on remote prior studies. There is an additional small focus of gliosis involving the callosal splenium on the left which is unchanged and may be related to prior metastasis, ischemia or other injury. There is no evidence of abnormal intracranial enhancement on the current study to suggest active metastatic disease. There is no mass effect, midline shift or herniation. The ventricles and cisterns are normal in size and configuration. The major cerebral flow voids are intact. There are small mucous retention cysts in the maxillary sinuses. There is diffuse T1 hypointensity of the bone marrow without discrete destructive osseous lesions, which may represent marrow reconversion. The orbits are unremarkable.

Output: No evidence of active intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: r/o calcaneal stress fractures vs. Plantar fascia rupture History: pain TENDONS: Medial, peroneal and extensor tendons are intact. Achilles tendon is intact.LIGAMENTS: Medial and lateral ligaments are intact.ARTICULAR SURFACES AND BONE: No abnormal marrow edema ADDITIONAL

Output: Normal MRI ankle, specifically no evidence of calcaneal stress fracture or plantar fascia rupture.


Instruction: Generate impression based on findings.

Input: 29-year-old female with cerebral cavernous malformations and a tiny falx meningioma experiencing headaches. Redemonstrated are numerous supratentorial and infratentorial cavernous malformations, which are not significantly changed. None demonstrate perilesional edema. There is an unchanged 4 mm transverse dimension enhancing lesion along the right falx cerebri which is unchanged in appearance. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are stable in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is a right maxillary sinus retention cyst, unchanged.

Output: 1.Numerous supratentorial and infratentorial cavernous malformations are not significantly changed, none demonstrating perilesional edema. No evidence of acute intracranial hemorrhage or acute infarct.2.An unchanged 4 mm wide enhancing lesion along the right falx cerebri likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: 53-year-old female with multiple sclerosis and generalized weakness. MRI Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few unchanged scattered areas of white matter T2 signal abnormality predominately in the periventricular distribution and prominent perivascular spaces in the left basal ganglia. There is no evident abnormal 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. There is a left maxillary sinus mucous retention cyst or polyp and mild right greater than left mastoid air cell fluid. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRI Cervical Spine: The spinal cord appears unremarkable. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. There are mild multilevel degenerative spondylosis, particularly at C3-4, and C4-5, but no significant compromise of the spinal canal or neural foramina. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Mild scattered white matter lesions are nonspecific and unchanged.3.Mild degenerative spondylosis, but no abnormality in the cervical spinal cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pancreas mass. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size, measuring 15.7 cm in craniocaudal dimension. No focal suspicious lesion. No biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: Punctate cyst in the inferior aspect of the spleen. Normal splenic size measuring 10.8 cm in length.PANCREAS: In the pancreatic body tail junction demonstrated again is a 2.2 x 1.8 x 2.3 cm cystic lesion (series 8/17 and series 7/21). The lesion demonstrates a lobular contour and internal thin septations. Previously the lesion measured 2.2 x 1.8 cm in transverse dimension. Internal hypointense foci without enhancement likely represent debris. There is suspected subtle mild enhancement of an anterior mural nodule (series 11/56), likely present on prior MR and definitely seen on CT from 09/26/15. There is no main pancreatic ductal dilatation or distal pancreatic parenchymal atrophy. No new lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable size of the cystic pancreatic body lesion with suspected internal debris and a mildly enhancing mural nodule in the anterior aspect of the lesion, unchanged from the priors.


Instruction: Generate impression based on findings.

Input: Male, 45 years old, history of GBM status post RT/TMZ + TMZ, also status post interval drainage of cystic fluid. Redemonstrated is an irregular, multicystic rim-enhancing lesion centered on the right thalamus, cerebral peduncle, basal ganglia and temporal stem. As before, a catheter traverses the dominant cystic component of this lesion from a right temporal approach.Since the prior examination, some of the cystic components of the lesion have slightly increased in size with progressive thickening of the enhancing rim, particularly along the lesion's posterior superior margin. In addition, small foci of enhancement seen on the prior examination extending cranially into the right superior parietal lobule have coalesced and increased in size. The enhancing components of this lesion demonstrate variable elevated rCBV.Extensive T2 hyperintensity surrounding the above-mentioned lesions is again seen involving the temporal lobe, insula, thalamus, basal ganglia, posterior right frontal and parietal lobes. This signal abnormality and associated mass effect have progressed in the right paracentral lobule and parietal lobe. There is partial effacement of the right lateral ventricle appearing similar to prior, as well as a midline shift to the left of approximately 10 mm, slightly progressed. The left lateral ventricle is mildly prominent suggesting a degree of entrapment, also slightly progressed. There may be minimal ependymal enhancement along the right ventricular atrium, but this is equivocal.

Output: A large, multicystic rim-enhancing lesion is redemonstrated within the right cerebral hemisphere showing slight interval change in size and progressive thickening of the enhancing tissue. In addition, areas of enhancing tissue have also increased in size more cranially within the right parietal lobe. These findings are most compatible with progressive disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Arachnoid cyst, reason for seizures. Signs and symptoms: Headaches, seizures. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a CSF signal intensity extra-axial cyst (arachnoid cyst) in left high convexity posterior frontal region along the inner table of skull. The finding measures maximum 29 x 24 and transaxial dimensions and 41 x 19 on coronal T2-weighted series. There is resultant mass effect and buckling of the adjacent cortex without detectable T2 or FLAIR signal abnormality of parenchymal. The overlying calvarium is unremarkable. The ventricular system remains within normal size and with maintained midline.The anatomical morphology of the brain is otherwise within normal limits and normal signal intensity on all MRI sequences. Cortical sulci, ventricular system and CSF spaces are within normal for patient's stated age. Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits.Unremarkable calvarium and soft tissues of the scalp.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process and negative diffusion weighted series.2.Left posterior frontal high convexity arachnoid cyst measuring 29 x 14 mm (transaxial) and 41 x 19 mm (coronal T2) with regional mass effect and no detectable signal abnormality of adjacent parenchyma.3.Unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: There is large enhancing infiltrative mass centered within the mucosal space of the nasopharynx. It is difficult to measure accurately due to its infiltrative nature, however, it measures approximately 70 mm in transverse dimension. There is enhancement of the bilateral torus tubari extending into the eustachian tubes, right greater than left, with extension into the bilateral masticator space, again right greater than left, including the bilateral medial pterygoid and right lateral pterygoid muscles. There is extension into the right post maxillary fat, right sphenopalatine foramen and pterygopalatine fossa, through the right foramen rotundum and foramen ovale with extension into the right cavernous sinus, and the floor of the right anterior middle cranial fossa where there is dural thickening. There is asymmetrically prominent enhancement of the mastoid segment of the right facial nerve. There is questionable infiltration and enhancement of the clivus as well. There is partially imaged bilateral cervical lymphadenopathy, including a left intraparotid node.The internal auditory canals are symmetrical and normal in size. The inner ears are normal. There is no mass. There is fluid within the right mastoid air cells and middle ear cavity that is likely secondary to eustachian tube obstruction. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1.Large infiltrative bilaterl nasopharyngeal masses ( R>L). There is perineural tumor spread through the right foramen rotundum and foramen ovale as well as possibly along the right facial nerve. The findings are most compatible with lymphoma, among other neoplastic etiologies. 2.Partially imaged cervical lymphadenopathy .3.Further evaluation with a dedicated CT neck soft tissues with contrast is suggested.These findings were discussed with Dr. Gluth at 1 p.m. on 3/25/2015.


Instruction: Generate impression based on findings.

Input: History of intraductal pancreatic mucinous neoplasms. ABDOMEN:LIVER, BILIARY TRACT: Steatosis. No focal lesion or biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas parenchyma demonstrates normal intrinsic T1-weighted signal intensity.Multiple T2 hyperintense punctate foci are noted within the pancreas. The largest is in the tail measuring 7 x 6 mm, not significantly changed from the prior and likely represent small IPMNs and dilated sidebranches. There is no main pancreatic ductal dilatation.ADRENAL GLANDS: Mild right adrenal nodularity is unchanged.KIDNEYS, URETERS: Multiple T2 hyperintense lesions are unchanged with the largest in the midpole of the left kidney measuring 3.5 cm, compatible with benign renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable appearance of multiple punctate probable IPMNs.Hepatic steatosis.


Instruction: Generate impression based on findings.

Input: 73 year man with coronary artery disease, ischemic cardiomyopathy, paroxysmal atrial fibrillation, DM, CK, pulmonary sarcoidosis, and ventricular tachycardia. Resting SPECT perfusion defects noted in the mid to apical inferior wall, the apical septum and anterior walls, and in the apical cap. LVEF (visual) on TTE was 35%. Referred for cardiac MRI to delineate scar tissue for possible ablation. Left VentricleThe left ventricle is moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 27%. Evaluation of systolic function is slightly limited by imaging artifact from the AICD. The LVEDV is 285 ml (normal range 142+/-34), the LV end diastolic volume index is 142 ml/m2 (normal range: 74+/-15), the LVESV is 77 ml (normal range 47+/-19) and the LV end systolic volume index is 104 ml/m2 (normal range 25+/-9). The LV mass is 132 g (normal range 164+/-36) and the LV mass index is 65 g/m2 (normal range 85+/-15). There is akinesis and severe thinning of the apical cap and apical septum extending into the apical anterior and inferior walls. There is hypokinesis and moderate thinning of the mid septum as well as basal lateral LV wall. There is question mild septal dyskinesis suggestive of intra-ventricular conduction delay. There are multiple areas of full thickness and near full-thickness (75%) late gadolinium enhancement in the mid and apical septum, in the apical anterior and inferior walls and apical cap. There is also full thickness late gadolinium enhancement in the entire basal septum.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 38%. The RVEDV is 149 ml (normal range 142+/-31), RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVESV is 92 ml (normal range 54+/-17), and the RV end systolic volume index is 46 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation which may be related to ICD lead. ICD lead is noted in the right ventricle.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMutiple enlarged lymph nodes in the mediastinum and bilateral hila compatible with patient's history of sarcoidosis. Right upper lung irregular opacity likely scarring, but incompletely evaluated on this study.This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is moderately dilated with severely reduced systolic function. LVEF 27%. Evaluation of systolic function is slightly limited by imaging artifact from the AICD.2.The right ventricle is normal in size with moderately reduced systolic function. RVEF 38%.3.Three vessel coronary artery disease with nonviable myocardium involving predominantly the mid and apical septum and basal lateral wall as detailed above.4.Stigmata of sarcoidosis with likely bandlike scarring in the right upper lobe.


Instruction: Generate impression based on findings.

Input: History of cervical cancer and worsening gait and pain. Presumably treated with radiation therapy. PELVIS:UTERUS, ADNEXA: Anteverted anteflexed uterus.The uterus measures approximately 7.3 x 4.1 cm in the sagittal plane. There are numerous very low T2-weighted signal intensity well-defined masses compatible with numerous poorly enhancing fibroids with the largest measuring 4.2 x 3.1 cm in the dorsal body. The fibroids distort the endometrial canal which is normal in thickness. The visualized endometrium/junctional zone is unremarkable.There is a post treatment/radiation changes of the cervix without any solid enhancing or restricting components. There is a mild delayed enhancement of the scar tissue involving the left aspect of the cervix (series 805/270).This abuts the anterior rectal wall without frank invasion.BLADDER: No significant abnormality noted.LYMPH NODES: Partially imaged right pericaval lymph node (series 605/480). No enlarged pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Post treatment/radiation changes of the cervix without a solid enhancing mass with residual scar tissue demonstrating expected delayed enhancement. Right pericaval adenopathy is incompletely visualized. Follow up is recommended as this area may be outside the radiation treatment zone.Leiomyomatous uterus.


Instruction: Generate impression based on findings.

Input: 79-year-old male with questionable brain metastases with improved creatinine. Evaluate for brain metastasis in the presence of contrast enhanced exam. MRI brain:Redemonstrated is a mildly contrast-enhancing, slightly intrinsically T1 bright lesion in the left medial temporal lobe which measures 7 x 6 mm and remains suspicious for a metastasis. The lesion is associated with strong susceptibility effect. Within the limitations of some motion degradation, and absence of the 3-D T1 postcontrast images, no additional intracranial enhancing lesions are seen. There is unchanged nonspecific mild scattered cerebral white matter T2/FLAIR hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the bilateral ethmoid sinuses. MRI C-spine:The C4 vertebral body is expanded and enhancing secondary to tumor involvement. There is prominent extension of tumor into the anterior epidural space which causes moderate spinal canal stenosis at the C4-5 level. Enhancing tumor is also seen within the neural foramina at the C4-5 level bilaterally including surrounding the foramina transversaria as well as extending into the prevertebral soft tissues anterolaterally. Additional paraspinal tumor is suspected only partially visualized on the right at T1 and corresponds with abnormal FDG avid activity on a prior PET/CT from 7/15/2016.The craniovertebral junction appears within normal limits. There is slight reversal of the cervical lordotic curvature There are multilevel degenerative changes of the cervical spine most prominently involving the C5-6 level where there is disc height loss, minimal retrolisthesis of C5 on C6, a small disc osteophyte complex, left foraminal disc protrusion, and facet arthropathy, which contribute to the spinal canal stenosis and moderate left neuroforaminal narrowing at this level. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact.

Output: Redemonstration of a subcentimeter lesion in the left hippocampus which enhances and is suspicious for metastasis, possibly containing blood product.Expansile enhancing C4 vertebral body metastatic lesion extending into the anterior epidural space, contributing to moderate spinal canal stenosis at this level, along with the degenerative changes. Tumor involves the C4-5 neuroforamina, encases the foramina transversaria and extends into the lateral anterior paraspinal soft tissues. An additional paraspinal tumor is suspected but only partially visualized on the right at T1 and corresponds with abnormal FDG avid activity on a prior PET/CT from 7/15/2016.


Instruction: Generate impression based on findings.

Input: Female 61 years old with choledochal cyst. ABDOMEN:LIVER, BILIARY TRACT: The liver measures up to 21 cm in length and has a normal contour. There is a small hypervascular focus in the left hepatic lobe which is nonspecific (series 1203, image 292). No suspicious liver lesion is identified. The hepatic vasculature appears patent.There is fusiform dilation of the mid common duct up to 10 mm in diameter. The distal common bile duct is normal in appearance. There is no intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are a few bilateral simple renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Type I choledochal cyst.2.Hepatomegaly.


Instruction: Generate impression based on findings.

Input: Evaluate shunt/hydrocephalus. History of VA shunt, hydrocephalus, slit ventricular syndrome. Developmental delay, seizure. Nonenhanced head CT:There is no areas of parenchymal hemorrhage, edema or mass effect.There redemonstration of agenesis of corpus callosum and interdigitation of interhemispheric fissure.There is mild dilatation of the supratentorial ventricular system which appears identical to the study from 11 -- 23 -- 2008. There is no evidence of slit like ventricular system.A right-sided ventricular catheter enters from a right posterior parietal, traverses the brain parenchyma and with the tip in the midline at the expected level of the third ventricle.No evidence of hemorrhage or edema in the brain parenchyma. Subtle low-attenuation of periventricular white matter is again identified and may represent periventricular leukomalacia. This findings are noted on prior head CT and MRI studies. There is no evidence of midline shift. Images through posterior fossa are unremarkable.

Output: 1.Mildly dilated and shunted supratentorial ventricular system. This findings are identical to prior examination from 2008.2.Agenesis of corpus callosum.3.No evidence of acute intracranial finding.


Instruction: Generate impression based on findings.

Input: Elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.2 x 5.7 x 5.1 cm.Peripheral Zone: Uniformly high signal T2-weighted signal intensity without focal suspicious lesion.Central Gland: No suspicious foci.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No suspicious lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No focal suspicious lesions for prostate cancer.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 76 year old man with prior PCI to LCx and RCA, referred for evaluation of chest tightness.MEDICATIONS: ASA, Lipitor First Pass PerfusionDuring hyperemia, no perfusion defects were present. There is a prominent dark rim artifact noted.Viability/ Myocardial ScarThere is a small area of late gadolinium enhancement in the basal inferolateral wall. It is mid myocardial and not consistent with prior myocardial infarction. It may be due to a prior fibrotic, inflammatory, or infiltrative process. It appears similar to prior cardiac MRI on 7/8/14. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 74+/-15), the LVEDV is 121 ml (normal range 142+/-34), the LV end systolic volume index is 24 ml/m2 (normal range 25+/-9), the LVESV is 45 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. The interatrial septum is aneurysmal. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 63 ml/m2 (normal range 82+/-16), the RVEDV is 120 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 63%).4. Normal RV size and systolic function (RVEF 51%).5. There is a small area of late gadolinium enhancement in the basal inferolateral wall. It is not consistent with prior myocardial infarction and may be due to a prior fibrotic, inflammatory, or infiltrative process. 6. Compared to prior MRI on 7/8/14, there is no significant change.


Instruction: Generate impression based on findings.

Input: 53 year old man with history of premature CAD s/p CABG in 2008 and re-do in 2009 for RIMA to OM, as well as subsequent PCI to RIMA and left main coronary, with refractory angina. He is referred for cardiac MRI with vasodilator stress testing to evaluate for ischemia.MEDICATIONS: Regadeneson 0.4mg with aminophylline 75mg First Pass PerfusionDuring hyperemia, perfusion defects are noted in the basal inferior and anterior walls; the mid anterior, anteroseptal, inferoseptal, inferior, and inferolateral walls; and the apical septal and lateral walls. Viability/ Myocardial ScarThere is a small non-transmural myocardial infarction involving the basal inferolateral wall which suggests prior myocardial infarction. This segment has an intermediate probability of viability; the remainder of the myocardium is viable. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 88ml/m2 (normal range: 74+/-15), the LVEDV is 209l (normal range 142+/-34), the LV end systolic volume index is 39ml/m2 (normal range 25+/-9), the LVESV is 94ml (normal range 47+/-19), the LV mass index is 74g/m2, and the LV mass is 177g There is basal inferolateral hypokinesis. There is abnormal septal motion consistent with history of previous cardiac surgeries. Left AtriumThe left atrium is mild to moderately dilatedRight VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 79 ml/m2 (normal range 82+/-16), the RVEDV is 189 ml (normal range 142+/-31), the RV end systolic volume index is 31 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trace tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere are sternotomy wires present with associated artefact. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is a large burden of ischemia as described above.2. Small non-transmural myocardial infarction involving the inferolateral wall. This segment has an intermediate probability of viability. The remainder of the entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%) with mild hypokinesis of the basal inferolateral wall.4. Normal RV size and systolic function (RVEF 61%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 60-year-old male with history of prostate cancer status post prostatectomy. Evaluate for local recurrence or lymphadenopathy. PELVIS:PROSTATE:Prostate: Status post prostatectomy. No evidence of residual or recurrent disease.Seminal Vesicles: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Stable prominent lymph node just outside the mesorectal fascia along the internal iliac chain measuring up to 6 mm (series 1101/40), previous 6 mm. No lymphadenopathy by size criteria.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1. Status post prostatectomy without evidence of residual or recurrent disease.2. No pelvic lymphadenopathy by size criteria.


Instruction: Generate impression based on findings.

Input: Female, 77 years old, with left-sided facial droop. No restricted diffusion is seen to indicate acute ischemia. T2 hyperintensity is seen within the right basal ganglia corresponding to hypoattenuation noted on prior CT. A few additional scattered foci of T2 hyperintensity are present within the cerebral hemispheres which are nonspecific.No evidence of significant parenchymal edema or mass effect is seen. No abnormal extra-axial fluid is detected. No acute intracranial hemorrhage is seen. The ventricles are normal in size and morphology.The facial nerves are not specifically assessed on this examination. However, no significant abnormalities are detected at the CP angles or at the level of the IACs.

Output: 1.No definite evidence of acute ischemia is seen. A lesion in the right basal ganglia could represent a chronic or late subacute lacunar infarct.2.A few additional scattered foci of T2 hyperintensity are nonspecific but potentially related to chronic microvascular ischemic disease.3.The facial nerves are not specifically assessed on this examination, though no significant abnormality is suspected at the CP angles or within the IACs.


Instruction: Generate impression based on findings.

Input: 29 year old with stiff person syndrome. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is an enhancing mass at anterior 12:00 position in the right breast. measuring 10 x 8 x 7 mm (AP x LR x CC), likely fibroadenoma.No other abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MR evidence of malignancy. Fibroadenoma in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Evaluate lesion seen on recent CT imaging, Budd-Chiari and regenerative nodules, status post TIPS ABDOMEN:LIVER, BILIARY TRACT: A significant portion of the liver primarily the right lobe is not able to be evaluated due to extensive susceptibility and blooming artifact from intrahepatic vascular stent placement. Multiple arterially enhancing bilobar hepatic lesions seen with washout suggested (refer to key images and see images 26 and 58 series 103), suspicious for multifocal hepatocellular carcinoma. Submitted for reference is hepatic segment 2 lesion measuring 1.2 x 1.1 cm on image 25 series 11, and a right hepatic lesion measuring 1.1 x 1 cm on image 58 series 11. Unable to definitively identify corresponding restricted diffusion. Accounting for differences in technique and modality, lesions are probably unchanged in size from prior exam. Heterogeneous liver parenchymal signal particularly in postcontrast venous phase.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Evaluation of multiple arterially enhancing liver lesions was better achieved on prior CT imaging as much of the liver parenchyma is unable to be evaluated on the current MRI exam secondary to extensive susceptibility and blooming artifact from vascular stent placement. Bilobar arterially enhancing lesions seen with washout suggested on subsequent more delayed phase imaging, suspicious for multifocal HCC, see discussion above.


Instruction: Generate impression based on findings.

Input: 65-year-old female patient with history of liver adenomas, hepatectomy. ABDOMEN:LIVER, BILIARY TRACT: Post-surgical changes of a left hepatectomy and segmentectomy. Multiple hepatic lesions demonstrating intralesional fat with minimal enhancement appear similar in size and number to the prior study. The largest within segment 6/7 measures approximately 3.5 x 2.5 cm, unchanged. No new hepatic lesion is identified.No intra or extra hepatic biliary ductal dilatation. The patient's gallbladder is absent.SPLEEN: No significant abnormality noted.PANCREAS: There are multiple subcentimeter cystic lesions in the pancreas, appearing similar in size to the prior study, which likely represent IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts are unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post-surgical changes of the liver with multiple hepatic lesions, compatible with patient's diagnosis of hepatic adenomatosis, appearing similar in size and number to the prior study.2.Multiple subcentimeter cystic pancreatic lesions likely represent IPMNs, stable.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified fall. Muscle weakness (generalized). Dizziness and giddinessClinical question: Please eval for stroke, posterior circulationSigns and Symptoms: 63 yo M with HTN, Hyperthyroidism uncontrolled, presents with left sided weakness and overall dysequilibrium, several fallsComments: Has tolerated Gadolinium on prior MRI in 2014 here. | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the prior exam .No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.No foci of signal loss on susceptibility imaging are appreciated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam 2.There is no evidence for intracranial mass lesion and no evidence for acute ischemic cerebral infarction.


Instruction: Generate impression based on findings.

Input: Increasing shoulder pain for 6 weeks. ROTATOR CUFF: Mild thickening with associated increased T2 weighted signal of the supraspinatus tendon is compatible with moderate tendinosis. No discrete tears of the supraspinatus tendon. The supraspinatus muscle is within normal limits. The infraspinatus, teres minor, and subscapularis muscles and tendons are within normal limits. SUPRASPINATUS OUTLET: Mild osteophytic changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral cartilage is grossly intact. The labrum is grossly intact within the limitations of a non-arthrogram study.BICEPS TENDON: The tendon of the long head of biceps is intact. ADDITIONAL

Output: Moderate supraspinatus tendinosis without discrete rotator cuff tears.


Instruction: Generate impression based on findings.

Input: Lower leg mass Note that markers were placed in the region of palpable mass. Within this region there is an abundance of fat which is difficult to separate from the normal underlying subcutaneous fat. There is slight prominence between the markers although this is superficial in nature and these findings likely represent an underlying lipoma. There are no aggressive or malignant features identified and following contrast administration, there is no nodular enhancement. The underlying marrow signal of the tibia and fibula is normal. No additional masses are identified. There is a mild amount of subcutaneous edema below the designated area as well as tracking more medially.

Output: Prominence of fat in the region of interest likely reflecting the presence of a lipoma. There are no aggressive or malignant features identified. Mild amount of subcutaneous edema is also noted.


Instruction: Generate impression based on findings.

Input: 14-year-old male with history of syncope and new right-sided limp. The cerebellar tonsils extend down to the level of the foramen magnum, raising the question of tonsillar herniation. This could be better evaluated on MRI.There is no evidence of intracranial hemorrhage, mass or edema. 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: Question of low lying cerebellar tonsils which could be better evaluated on MRI. Otherwise, unremarkable examination.


Instruction: Generate impression based on findings.

Input: 55 year old male with history of DVT /PE, HTN, DM, hemachromatosis (heterozygous), and family history of premature CAD who presents for evaluation of possible cardiac involvement of sarcoidosis given history of palpitations/PVCs. Left VentricleThe left ventricle is normal in size with low normal systolic function (LVEF 54%). The overall LV ejection fraction is 54%, the LV end diastolic volume index is 52 ml/m2 (normal range: 74+/-15), the LVEDV is 132 ml (normal range 142+/-34), the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 45 g/m2 (normal range 85+/-15), and the LV mass is 116 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the basal inferolateral wall and possibly a small patch in the apical inferolateral wall, both of which were previously present. Native myocardial T1 and T2 times are within normal limits, suggesting no active myocardial inflammation. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild tricuspid regurgitation. AortaThere is a left sided aortic arch with a common origin of the innominate and left common carotid artery. The aortic root is mildly dilated (SoV 45 mm).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function (LVEF 54%). There is a small patch of late gadolinium enhancement in the basal inferolateral wall and apical inferolateral wall suggesting of an underlying fibrotic process consistent with prior episode of cardiac sarcoid. Based on normal myocardial T1 and T2 times, there is no evidence of active myocardial inflammation. 2. The right ventricle is normal in size and systolic function (RVEF 58%)3. Mild dilatation of the Sinus of Valsalva. 4. When compared to cardiac MRI from 9/14/2015, no significant change. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71-year-old female with persistent pain and swelling after minor trauma. MENISCI: There is linear increased signal abnormality which extends to the tibial articular surface of a blunted posterior horn of the lateral meniscus. There is increased signal abnormality and deformity of the body of the lateral meniscus. These findings are consistent with complex degenerative tearing of the lateral meniscus. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a linear focus of decreased T1 signal abnormality with associated increased T2 signal abnormality in the inferomedial patella consistent with an acute fracture. There is associated extensive bone marrow edema type signal abnormality affecting the patella in the surrounding area. There is grade 2 chondromalacia affecting the articular cartilage of the lateral facet of the patella. There are no full-thickness or near full-thickness articular cartilage defects. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Nondisplaced fracture of the patella as well as complex degenerative tearing of the lateral meniscus, as described above.


Instruction: Generate impression based on findings.

Input: Female, 46 years old, with history of right parietal lobe cavernoma, motor mapping requested for preoperative planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Cortical activation related to hand movement maps superior to the right parietal lesion, and cortical activation related to face and tongue movement maps anterior and lateral to the lesion.

Output: Successful functional MRI for sensorimotor cortical mapping.


Instruction: Generate impression based on findings.

Input: Reason: Pt has mild cognitive impairment, evaluate for vascula disease and atrophy History: Mild cognitive impairment, MOCA = 19/30 The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Subdural effusion the posterior fossa is most often related to atrophy.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. There is a right maxilla are old healed or lesion which protrudes into the floor of the right maxillary sinus and is relatively dark on T2 The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The AP dimension of the left eye is significantly increased. The right eyeball lens is thin.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Left-sided buphthalmos.3.No evidence for acute ischemic cerebral infarction or microhemorrhage.4.Alveolar maxillary bone lesions are present which are incompletely evaluated. One possibility is that they are odontogenic. Please correlate with prior dental history. Further evaluation with plain film or CT exam may be helpful to further evaluate this.


Instruction: Generate impression based on findings.

Input: 48-year-old male with bilateral L5 radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Since prior MR, posterior fusion has been extended to include the L4-S1 levels with iliac screws. Details are better appreciated on most recent CT on 12/13/2016. Interbody fusion device at the L5-S1 level and laminectomy at the L5 level are again noted. There are endplate changes involving the L5-S1 level, likely related to postoperative and degenerative changes. Vertebral body heights are otherwise well-maintained. There is 10 mm of anterior spondylolisthesis of L5 on S1, without significant interval change. Alignment is otherwise within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.There are fluid collections in the superficial and deep posterior soft tissues. In the deep posterior soft tissues, an irregular fluid collection extends from the L3-L4 level to the L5-S1 level and measures up to 6 cm in the craniocaudal dimension and 2.5 cm in thickness with enhancement of the surrounding soft tissues. More superficially, there is a larger fluid collection measuring up to 12 cm in the craniocaudal dimension and 2.5 cm in thickness. No epidural collection is identified.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Again seen is a mild disc bulge with small central protrusion. Mild neural foraminal stenosis, without significant interval change. No significant spinal canal stenosis. L5-S1: Grade 2 anterolisthesis of L5 on S1, without significant interval change. There are endplate changes, likely related to surgery and degeneration. Again seen is diffuse disc bulge and mild facet arthropathy causing mild spinal canal stenosis. Neural foraminal stenosis is suspected bilaterally but not well seen due to surrounding artifact.

Output: 1. Evidence of interval extension of posterior fusion, which now extends from the L4-S1 level and iliac bones.2. New fluid collections in the superficial and deep posterior operative soft tissues, which may be within normal limits given patient's recent surgery. Correlation with clinical and laboratory parameters is advised to assess for possibility of infection.3. Disc degeneration and facet arthropathy of the L5-S1 level causing mild spinal canal stenosis, similar to prior. Neural foraminal stenoses is suspected but not well seen due to artifact.


Instruction: Generate impression based on findings.

Input: Follow-up of supraclinoid internal carotid artery aneurysm and occlusion of the right middle cerebral artery with collaterals (moyamoya phenomenon) on outside imaging. Brain MRI:The brain is notable for few T2/T2 FLAIR hyperintense foci in the left frontal white matter that are nonspecific. The were present on the previous examination. There is no mass effect or midline shift. There is no intracranial hemorrhage. There are slightly conspicuous lenticulostriate vessels in the lentiform nuclei, as best seen on SWI, as post-contrast images are not available. There is no abnormal brain diffusion restriction. The dural venous sinuses are patent.There is minimal mucosal thickening in the frontal and anterior ethmoid sinuses without fluid.Cranial MR Angiography:There is fusiform dilatation and tortuosity of the supraclinoid/intradural segment (just distal to the takeoff of the ophthalmic artery) of the right internal carotid artery, with a maximum diameter of 8 mm. The fusiform dilatation extends to more mildly involve the right A1 segment. There is no visualized right M1 segment. There is an apparent small, triangular outpouching arising anteriorly from the most inferior loop of the aneurysmal segment from which a tiny vessel appears to arise. This may represent an enlarged infundibulum. The tortuous fusiform aneurysm results in mild mass effect on the right hippocampus. Attenuation of the flow-related signal in this aneurysmal right ICA/A1 segment may in part relate to tortuosity. An anterior communicating artery is present and flow in the downstream right anterior cerebral artery is preserved.As discussed above, there is no visualization of the right M1 segment. There is severe attenuation of caliber and flow-related signal involving the more downstream right middle cerebral artery and its branches. This minimal, residual flow might be coming from enlarged, tortuous right lenticulostriate and thalamostriate arteries.Compared to the previous examination of 2013, there has not been significant change regarding the diffuse fusiform aneurysm and nonvisualization of the right M1 segment. However, previously there was more flow-related signal in the more downstream right middle cerebral artery and branches. The left internal carotid artery is preserved in caliber and flow-related signal. The left anterior and middle cerebral arteries are preserved as well. The basilar artery is codominantly supplied by the vertebral arteries. There is a large right posterior communicating artery which connects to the dilated right internal carotid artery. The caliber and the flow in the posterior cerebral arteries are preserved and symmetric.

Output: 1.Fusiform, aneurysmal dilatation of the intradural segment of the right internal carotid artery with extension into the right A1 segment. This has not changed since the previous examination. Small outpouching from the inferior aspect of the aneurysmal segment is again noted, and may represent an enlarged infundibulum which was less conspicuous on the previous examination although may relate to technique.2.There is nonvisualization of the right M1 segment with severe downstream attenuation of flow-related signal in the right middle cerebral artery and its branches with mildly prominent lenticulostriates. The appearance would be compatible with moyamoya phenomenon. Findings are slightly progressed since the previous examination but there are no signs of ischemia in the right cerebral MCA territory on this resting examination.3.Few small left frontal white matter lesions are nonspecific.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 37-year-old female with known left breast cancer and metastatic left axillary lymphadenopathy, status post neoadjuvant chemotherapy. I-SPY MR #4. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.LEFT BREAST: Susceptibility artifact from biopsy marker clip is seen at at the site of known cancer, but abnormal enhancement is no longer present. No other abnormal enhancement identified elsewhere in the left breast.The reference node in the right left axilla with clip now measures approximately 1.1 cm, previously 1.2 cm, and originally 3.6 cm. RIGHT BREAST: No abnormal enhancement is seen in the right breast.No abnormal axillary lymph nodes are identified in the right axillary region.

Output: Complete imaging response of the left breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with bilateral upper extremity neuropathy. Spinal alignment is anatomic. Vertebral height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. A focus of T2 hyperintensity within the C7 vertebral body is nonspecific but likely benign. The visualized spinal cord shows normal signal intensity and morphology allowing for motion artifact. No epidural lesions are suspected. Minimal if any disc degeneration is seen at lower cervical levels. No significant spinal canal compromise is seen. Mild foraminal narrowing is seen on the left at C5-6 largely due to facet arthropathy. The thyroid gland is enlarged and nodular, particularly the left lobe.

Output: Mild degenerative changes without significant spinal canal stenosis or specific cord abnormalities. Foraminal narrowing is evident on the left at C5-6. Incidental note is made of an enlarged and nodular thyroid gland.


Instruction: Generate impression based on findings.

Input: 51-year-old with fatigue and numbness. MS protocol. Brain: There is a nonspecific focus of T2/FLAIR hyperintensity in the right inferior frontal lobe involving the subcortical white matter which appears to be present on prior MRI from 5/23/2007 but less well appreciated due to differences in technique. No new lesions are demonstrated. No lesions with enhancement to suggest active demyelination. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. Incidentally noted is a cavum septum pellucidum and cavum vergae. No hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is straightening of the cervical spine; alignment is otherwise maintained. Bone marrow signal is benign. Incidentally seen is a T1 hyperintense lesion involving the left aspect of the T2 vertebral body which may represent hemangioma or focal fat.Moderate degenerative changes are seen with disc desiccation and height loss at C4-C5, C5-C6, and to a lesser degree at C6-C7. No abnormal cord signal is seen in the cervical spine. No abnormal enhancement.Degenerative changes in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is a central and right paracentral disc osteophyte complex including disc extrusion. There is moderate spinal canal stenosis with mild flattening of the ventral cord in the midline and on the right. Mild left neural foraminal narrowing. No significant right foraminal narrowing.C5-6: Small disc osteophyte complex with minimal narrowing of the spinal canal at this level. Minimal bilateral neural foraminal narrowing.C6-7: Disc osteophyte complex including disc extrusion and mild to moderate spinal canal stenosis. There is mild impression on the ventral aspect of the cord bilaterally. There is no significant neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Nonspecific focus of T2/FLAIR hyperintensity in the right inferior frontal lobe which appears to be present since 2007. No new lesions or clear stigmata of chronic demyelinating disease in the brain.2. There are moderate degenerative changes in the cervical spine with moderate spinal canal stenosis at C4-C5 and to a slightly lesser degree at C6-C7. There is associated cord flattening, relatively worse at C4-C5 and C5-C6. No associated cord signal abnormality. 3. No findings to suggest demyelinating lesions in the cervical cord.


Instruction: Generate impression based on findings.

Input: 50 year old man with heart/kidney transplant on 10/22/15, referred for screening of cardiac allograft rejection. Left VentricleThe left ventricle is normal in size with normal systolic function. There is borderline left ventricular hypertrophy (wall thickness10mm). The overall LV ejection fraction is 66%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 155 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 52 ml (normal range 47+/-19), the LV mass index is 40 g/m2 (normal range 85+/-15), and the LV mass is 96 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Qualitatively, the myocardial to skeletal T2-enhancement ratio is 1.6, which is in the normal range. The global relative enhancement is 1.68, which is in the normal range. The native myocardial T1 time in the interventricular septum is 1200 ms, which is significantly elevated and can represent edema or interstitial fibrosis. The extra-cellular volume fraction (ECV) is 37%, which is elevated. Left AtriumThe left atrium is consistent with transplant.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 149 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 59 ml (normal range 54+/-17).Right AtriumThe right atrium is consistent with transplant.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion.Extracardiac FindingsSternal wires are present. There is significant iron overload of the liver and spleen. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%.2. The myocardial to skeletal T2 ratio and global relative enhancement are normal. There is no late gadolinium enhancement. These findings all speak against acute rejection. The native myocardial T1 time and the extracellular volume fraction are both elevated which could suggest rejection; however, these values would also be expected to be elevated early after heart transplantation. The earliest reported native T1 time for post-transplant myocardium was measured at 6-7 weeks and was 1100ms with a steady decline over the subsequent months. 3. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%.4. Significant iron overload of the spleen and liver.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, with prostate cancer and lower extremity weakness with low back pain. Evaluate for compression. Evidence of kyphoplasty is again seen at the L1 and L2 vertebral bodies. The L1 vertebral body is significantly wedged, particularly anteriorly where there is about 60% loss of vertebral body height. Significant central compression of the L2 vertebral body is also seen. These findings are relatively similar to those noted on prior CTs, but are new or progressed when compared to the older MRI exam.Findings at T12 are discussed on the recent thoracic spine MRI. Areas of marrow replacement are demonstrated within L1 and L2, surrounding the kyphoplasty cement, as well as within the left pedicle of L3, the vertebral bodies of L4 and L5, and numerous spinous processes. The sacrum is also extensively involved with metastatic disease. A bulky tumor deposit at the S3 level on the right projects into the presacral space anteriorly and infiltrates the right S1 and S2 neural foramina. Furthermore, the right sacral ala is extremely irregular with areas of sclerosis and potentially fragmentation or pathologic fracturing.Beginning at the L3 level and continuing down into the sacrum, there is a loculated, heterogeneous epidural collection which is predominantly dorsal but also wraps to the ventral aspect in some places. This collection is of low signal intensity on T1-weighted images but is heterogeneous on T2 and shows thin peripheral enhancement. The collection contributes to a severe long segment spinal canal stenosis from L3 through the sacrum with likely compression of the cauda equina nerve roots.T12-L1: Retropulsed vertebral body material and focal kyphosis results in a moderate generalized spinal canal stenosis. The neural foramina are moderately narrowed as well.L1-2: Facet hypertrophy and ligamentum flavum thickening. Bulging disc preferentially towards the neural foramina. No significant spinal canal stenosis, though there does appear to be some clumping of the nerve roots in this area. Mild bilateral foraminal narrowing. L2-3: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Epidural collection, predominantly ventrally. Severe spinal canal narrowing with compression of the cauda equina. Severe right and moderate left foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Bulging disc. Epidural collection, predominantly dorsally. Severe spinal canal narrowing with compression of the cauda equina. Severe left and moderate right foraminal narrowing. L4-5: Facet hypertrophy and ligamentum flavum thickening. Bulging disc with a small central protrusion. Epidural collection predominantly dorsally. Severe spinal canal narrowing with compression of the cauda equina. Severe right and moderate left foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Epidural collection predominantly dorsally. Effacement of the spinal canal with perhaps some nerve root compression. Moderate bilateral foraminal narrowing.

Output: Findings are seen compatible with progression of osseous metastatic disease when comparison is made to the prior MRI examination.Sequelae of prior kyphoplasty are seen at L1 and L2. Compression deformities of the T12-L2 vertebral bodies are also seen, progressed from prior MRI exams but similar to that noted on more recent CTs.Severe metastatic involvement of the right aspect of the sacrum is seen with a large exophytic tumor deposit projecting into the right presacral space with infiltration of the right S1 and S2 neural foramina. The right sacral ala is extremely irregular and likely fragmented or pathologically fractured.A long segment, loculated and heterogeneous epidural collection is seen beginning at approximately L3 and continuing down into the sacrum. This results in severe spinal canal narrowing with compression of the nerve roots of cauda equina. This is new when compared to the prior MRI examination. The etiology of the collection is uncertain but it does appear to resemble fluid rather than epidural tumor. As such, this may represent an evolving epidural hematoma, loculated effusion or abscess in the appropriate clinical context.Findings were discussed with Dr. Jacobs at 4:30 PM on 12/1/15.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with C5 radiculopathy. Trace retrolisthesis of C3 relative to C4 is noted. Alignment is otherwise unremarkable. Vertebral body height and morphology are normal. No concerning marrow replacement or marrow edema is seen. C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Posterior disc-osteophyte complex formation asymmetric to the left. Moderate generalized spinal canal stenosis with deformation of the spinal cord, most severely affecting the left, but no definite cord signal abnormality. Severe left foraminal narrowing. No significant interval changes. C4-5: Ligamentum flavum thickening. Posterior disc-osteophyte complex formation slightly asymmetric to the left. Moderate to severe spinal canal stenosis with deformation of the cord but no definite cord signal abnormality. Severe left foraminal narrowing. No significant interval changes. C5-6: Ligamentum flavum thickening. Posterior disc-osteophyte complex formation with a superimposed central disc extrusion which has increased in size. Worsened generalized spinal canal stenosis along with cord impingement and perhaps minimal questionable cord T2 hyperintensity. Mild right foraminal narrowing. C6-7: Ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.A progressive disc extrusion at C5-6 results in worsening moderate to severe spinal canal stenosis and cord impingement. There is perhaps some minimal questionable cord signal abnormality at this level.2.Stable disc disease and associated spinal canal stenosis at C3-4 and C4-5, both levels showing significant canal stenosis and cord deformation. Severe left-sided foraminal narrowing is also seen at these levels.


Instruction: Generate impression based on findings.

Input: 54-year-old female patient with right shoulder pain and concern for supraspinatus tendon tear. ROTATOR CUFF: There is mild increased signal intensity in the supraspinatus tendon, indicating mild tendinosis, but we see no fluid-filled tear and the muscle is intact. There is mild increased signal intensity in the anterior fibers of the infraspinatus tendon suggesting tendinosis, but we see no fluid-filled tear and the muscle is intact. The subscapularis and teres minor tendons and muscles are within normal limits.SUPRASPINATUS OUTLET: There is an os acromiale with a small subchondral cyst, likely degenerative. There is also a lobulated lesion with near fluid signal in the distal clavicle that measures 18 mm in greatest dimension with a small component also noted dorsal to the clavicle, which may represent a degenerative cyst or an intraosseous ganglion. There is minimal impression upon the superior muscle fibers of the supraspinatus by the distal clavicle. There is no free fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no joint effusion. Glenohumeral alignment is within normal limits. There is blunting and mild abnormal increased signal intensity in the anterior labrum, which may represent degenerative changes and perhaps mild degenerative tearing, but we see no fluid-filled tear. Given the limitations of this non-arthrographic study, the remaining labrum appears normal.BICEPS TENDON: The tendon of the long head of the biceps is within normal limits.

Output: 1.Mild rotator cuff tendinosis without fluid-filled tear.2.Os acromiale with osteoarthritic changes as described above and additional cystic lesion in the distal clavicle, which is likely degenerative in etiology or perhaps represents an intraosseous ganglion.3.Blunting and heterogeneity of the anterior glenoid labrum likely represents degenerative changes.


Instruction: Generate impression based on findings.

Input: 88-year-old female with a sacral decubitus ulcer. Evaluate for osteomyelitis. Metallic susceptibility artifact from the patient's right total hip arthroplasty device limits evaluation of the right hip. Note is made of soft tissue irregularity along the posterior aspect of the sacrum and coccyx consistent with the known history of ulceration. There is an enhancing sinus tract which extends anteriorly from the aforementioned ulceration to the level of the coccyx. There are multiple foci of signal void in the surrounding area consistent with foci of gas. There is increased signal abnormality on fluid sensitive sequences within the surrounding subcutaneous tissues. There is increased signal abnormality on fluid sensitive sequences within the coccyx with associated decreased signal abnormality on T1-weighted sequences consistent with osteomyelitis. There is associated enhancement on postcontrast sequences. There is enhancing signal abnormality in the presacral space suggestive of phlegmon formation. No focal fluid collection is identified to suggest abscess formation.There is nonspecific subcutaneous edema along the lateral aspect of the thighs and peritrochanteric region, bilaterally. There is increased signal abnormality within the gluteal musculature and abductor musculature on the left which is nonspecific. There is nonspecific increased signal abnormality within the left iliacus muscle on fluid sensitive sequences. There is enhancement of the left gluteus maximus muscle belly and postcontrast sequences. Foley catheter in place.

Output: 1. Findings consistent with sacral decubitus ulcer with osteomyelitis of the coccyx as described above. Enhancing signal abnormality in the presacral space suggestive of phlegmon formation. No focal fluid collection is identified to suggest a drainable abscess.2. Nonspecific subcutaneous edema about the lateral aspect of the hips as well as nonspecific increased signal abnormality within the left iliacus, gluteal and abductor musculature. Superimposed infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: There is a 6-7 mm cystic-appearing focus within the expected location of the pineal gland demonstrating nonnodular, peripheral enhancement. 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. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.6-7 mm simple pineal cyst.2.No significant T2 residua from previous ADEM.3.No abnormal enhancing foci, masses, or mass effect.


Instruction: Generate impression based on findings.

Input: There is a nodular focus measuring up to 17 mm in maximal dimension along the lateral aspect of the left lateral ventricle atrium, which is isointense to gray matter on all sequences without enhancement.There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter without mass effect, restricted diffusion, susceptibility and rounded, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. Mucosal thickening within specific secretions is noted within posterior ethmoid air cells. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Coronal images of the temporal lobes demonstrate the temporal horns, hippocampal formations and parahippocampal gyri to be normal in morphology bilaterally without signal abnormalities, masses, or abnormal enhancement identified within the medial temporal lobes on either side. There is no evidence of mesial temporal sclerosis.

Output: 1.There is a focus of nodular gray matter heterotopia along the lateral aspect of the left lateral ventricle atrium.2.Nonspecific scattered foci of T2 hyperintensity are present within the periventricular and subcortical white matter. The differential diagnosis would most likely include small vessel disease, migraine sequelae, or less likely demyelinating disease.


Instruction: Generate impression based on findings.

Input: 17-year-old male with right knee pain. Rule out meniscus and/or ligament injury MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: No full-thickness or near full-thickness articular cartilage defects are identified. Heterogeneous bone marrow signal abnormality likely represents residual islands of red marrow. There is increased signal abnormality within the anterior aspect of the medial tibial plateau which may represent a direct bone contusion.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. No evidence of meniscal or ligamentous injury as clinically questioned. 2. Probable direct bone contusion within the medial tibial plateau. 3. Subcentimeter lobulated foci of fluid signal abnormality along the posterior aspect of the distal fibers of the PCL may represent ganglion formation as described above.


Instruction: Generate impression based on findings.

Input: Ulnar sided wrist pain. Direct tenderness over hamate. Evaluate right wrist for hamate fracture and TFCC/wrist ligament injury. There is contrast within the radiocarpal joint and its recesses, as expected. Although there is a small amount of fluid within the distal radioulnar joint, I see no gadolinium within the distal radioulnar joint nor do I see a tear of the articular disk of the triangular fibrocartilage complex. Gadolinium is present, however, within the soft tissues along the medial and volar aspects of the distal ulna, and there is also a small amount of contrast within the extensor carpi ulnaris tendon sheath. Furthermore, the ulnar sided capsular structures, including the meniscal homolog, are indistinct. These findings suggest a "peripheral" tear of the triangular fibrocartilage complex with an intact articular disk. Furthermore, the extensor carpi ulnaris tendon is subluxed medially from its groove suggesting a subsheath injury. The ulnar sided attachment of the subsheath is not well visualized and I suspect is torn. The tendon is subluxed on both pronation and supination. The remaining tendons appear normal. No contrast is seen extending into the midcarpal joint to suggest a tear of the scapholunate or lunotriquetral ligament. Bone marrow signal intensity is within normal limits; specifically, the hamate appears normal. See no abnormalities of the ulnar and median nerves.

Output: "Peripheral" tear of the triangular fibrocartilage complex with an intact articular disk, as well as an extensor carpi ulnaris subsheath injury with tendon subluxation, as described above. I see no fracture.