Instruction: Generate impression based on findings.

Input: Male, 62 years old, with history of multiple myeloma, status post spinal fusion from L2 through L3, with severe DJD. Patient presenting with worsening of pain in the right thigh. Posterior fusion instruments are in place bilaterally at L2-3 along with an intervertebral fusion device. Laminectomy has also been performed at L3 and perhaps partially at L4.Trace retrolisthesis of L1 relative to L2 and L2 relative to L3 are seen. Elsewhere alignment is unremarkable. Vertebral body heights are preserved.Marrow signal characteristics are generally somewhat heterogeneous. Superimposed on this, however, are a 13 mm enhancing lesion within the S2 vertebral body and an 18 mm enhancing lesion within the left iliac bone.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected. No pathologic intrathecal enhancement is observed.L1-2: Mild left facet arthropathy. Loss of disc height with mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. L2-3: Left facet arthropathy. Minimal residual disc bulging or osteophytic ridging. No significant spinal canal stenosis though the right lateral recess is slightly narrowed. Mild bilateral foraminal narrowing. L3-4: Bilateral facet arthropathy. Disc bulging asymmetric to the right with a focal component encroaching on the right neural foramen. There is also a small right paracentral inferiorly directed extrusion. No significant generalized spinal canal stenosis but the right lateral recess is narrowed. Severe right foraminal narrowing with probable nerve root impingement. Mild left foraminal narrowing. L4-5: Bilateral facet arthropathy. Minimal disc bulging. No significant generalized spinal canal stenosis. Minimal bilateral foraminal narrowing. L5-S1: Facet arthropathy. Disc bulging with a small extrusion projecting towards the right neural foramen. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.Postoperative findings compatible with instrumented fusion of L3-4.2.Focal marrow space lesions within the S2 vertebral body and in the left iliac compatible with multiple myeloma. Diffuse mild heterogeneity of the marrow signal characteristics is nonspecific.3.Multilevel degenerative findings are demonstrated without any areas of high-grade spinal canal stenosis. However, at L3-4, the right neural foramen is severely narrowed with likely nerve root impingement secondary to a disc protrusion.


Instruction: Generate impression based on findings.

Input: lumbar radiculopathy (left) with persistent pain; any change from 2011 MIRSigns and Symptoms: lumbar radiculopathy (left) with persistent pain; any change from 20 Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disc desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a left paramedian broad-based disc protrusion present at this level. There is a a small T2 hyperintensity along the posterior aspect of the annulus on this exam which is unchanged since the prior examAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a cortical cyst present along the medial and superior aspect of the right kidney measuring 2.5 cm in diameterThe uterus appears somewhat heterogeneous in appearance but unchanged since the prior exam

Output: 1.There are multilevel degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina. Overall there is no significant change when compared to the prior exam.


Instruction: Generate impression based on findings.

Input: 78 year-old woman, with malignant neoplasm of thyroid gland and filling defect noted in CT, echo not conclusive, referred for MRI to assess LV thrombus. Left VentricleThe left ventricle is normal in size and low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), the LVEDV is 116 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 56 ml (normal range 31+/-10), the LV mass index is 40 g/m2 (normal range 67+/-11), and the LV mass is 79 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Septal dyssynergy of unclear significance. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is no thrombus in the LV.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 60%, the RV end diastolic volume index is 55 ml/m2 (normal range 69+/-14), the RVEDV is 109 ml (normal range 110+/-24), the RV end systolic volume index is 22 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. The ascending aorta is mildly dilated with dimensions 38 x 38. 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 mild to moderate pericardial effusion measuring 13 mm along the RV free wall and LV anterior wall. Extracardiac FindingsLeft lung apical density noted. This was characterized on recent CT (08/14). Also noted mediastinal adenopathy. 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 and low normal systolic function. The overall LV ejection fraction is 52%. No mass/thrombus appreciated in the left ventricle on this study.2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%3. The ascending aorta is mildly dilated with dimensions 38 x 38.4. There is mild to moderate pericardial effusion measuring 13 mm along the RV free wall and LV anterior wall.


Instruction: Generate impression based on findings.

Input: A punctate nonspecific T2/FLAIR signal is seen in the right mid inferior frontal lobe white matter, which is nonspecific. There are no diffusion or susceptibility abnormalities. No evidence of acute hemorrhage or acute infarct.Ventricular size is normal. There is no midline shift.The vascular flow voids are normal.Mucous retention cyst is seen in the left maxillary sinus and a small retention cyst in the right maxillary sinus.

Output: No evidence of acute infarct. Nonspecific single focus of T2 hyperintensity in the right frontal lobe white matter.


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with radicular pain. Assess for worsening disc disease. A grade 1 retrolisthesis of L5 relative to S1 has not significantly changed. Spinal alignment is otherwise anatomic.Vertebral body height and morphology are within normal limits allowing for degenerative endplate irregularity at L5-S1.Marrow signal characteristics are mildly heterogeneous with scattered T1/T2 hypointense foci, but no concerning marrow lesions are seen.The visualized spinal cord, conus and cauda equina are unremarkable. The spinal canal is slender at lower lumbar levels.Severe loss of disc height is again seen at L5-S1 without significant change. Additional level specific findings are as follows:L1-2: Mild facet hypertrophy with very small bilateral posterior synovial cysts, unchanged. No significant spinal canal or neuroforaminal stenosis. L2-3: Facet hypertrophy with a small effusion on the left, unchanged. Minimal bulging disc, unchanged. No significant spinal canal or foraminal stenosis. L3-4: Facet hypertrophy, unchanged. No significant spinal canal or foraminal stenosis. L4-5: Facet hypertrophy, unchanged. Stable mildly bulging disc with interval resolution of the previously seen left foraminal protrusion. There is only minimal annular fissuring evident at this location on the present study. No significant spinal canal stenosis. Mild right foraminal narrowing, unchanged. Mild left foraminal narrowing, improved from prior. L5-S1: Evidence of right-sided laminectomy with fatty material filling the operative bed. This fatty material encroaches upon the spinal canal more than on the prior study, resulting in a mild effacement of the right thecal sac. Facet hypertrophy, disc bulging with osteophytic ridging, and severe bilateral foraminal narrowing are all unchanged.

Output: 1.Interval resolution of the previously seen left foraminal disc protrusion at L4-5 with resultant relief of foraminal stenosis.2.Redemonstration of findings compatible with right-sided laminectomy at L5-S1. Fatty material within the operative bed encroaches upon the right posterior thecal sac to a greater degree than on the prior examination resulting in mild thecal sac effacement.3.Degenerative disc disease and severe bilateral foraminal narrowing at L5-S1 are not significantly changed.4.Mild degenerative findings at other levels without significant interval change.


Instruction: Generate impression based on findings.

Input: Reason: Eval for left rotator cuff injury History: left shoulder pain ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus indicating mild to moderate tendinosis. The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid identified within the subacromial subdeltoid bursa which may represent a mild bursitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. The glenoid labrum appears intact within the limitations of a non arthrogram studyBICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Mild to moderate tendinosis of the rotator cuff without evidence of a full-thickness rotator cuff tear or retraction.2. Small amount of fluid within the subacromial subdeltoid bursa may reflect a mild bursitis.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain. Evaluate liver cysts, as well as biliary tree. There is a discrete tear all of the sequences ABDOMEN:LIVER, BILIARY TRACT: There are multiple small scattered hepatic cysts. A cyst within segment 2 and a cyst within the caudate contain thin septations. No suspicious hepatic lesion is identified. The liver is normal in contour and morphology. No intra- or extra- hepatic biliary ductal dilatation is identified. The gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is mildly ectatic. The pancreas is normal in signal. No focal lesion is identified.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: Bilateral saline breast prostheses are partially imaged.

Output: Scattered hepatic cysts, as detailed above.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: History of diabetes, hypertension, JL w b/l knee pain; recent flare up of right knee s/p twist injury on Jan 5th 2016 r/o tear MENISCI: There is intrasubstance increased signal in both the medial and lateral meniscus, likely representing intrasubstance degeneration. No discrete tear is identified.ARTICULAR CARTILAGE AND BONE: Increased T2 edema type signal in the medial tibial patella. There is focal chondral thinning of the medial patellar facet. There is focal fissuring of the cartilage of the lateral patellar facet with underlying bone edema. There is loss of hyaline cartilage along the lateral tibial plateau.LIGAMENTS: Complete rupture of the ACL. PCL is intact. Collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Complete rupture of the ACL. 2.Intra-articular mass highly suspicious for focal nodule of PVNS.3.Large joint effusion and diffuse subcutaneous edema. 4.Contusion of the medial tibial plateau.


Instruction: Generate impression based on findings.

Input: Male, 13 years old, with epilepsy and focal cortical dysplasia. An area of cortical thickening and blurring of the gray-white junction is again seen in the left frontal lobe. There has been no significant interval change in these findings compared to the prior examination. The remainder of the brain is unremarkable. No evidence of edema, mass effect or diffusion restriction is seen. No intracranial hemorrhage or any abnormal extra axial fluid collections are observed. The mesial temporal structures are symmetric and free of pathologic signal abnormality. Ventricular size and morphology are within normal limits.

Output: Focal cortical dysplasia in the left temporal lobe is redemonstrated without significant interval change. The examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 24-year-old male with history of ulcerative colitis and presumed primary sclerosing cholangitis based on outside hospital imaging. ABDOMEN:LIVER, BILIARY TRACT: Left greater than right intrahepatic biliary ductal dilation and beading. There is mild stricturing of the proximal left bile duct. There is associated enhancement of the biliary duct walls. Prominent porta hepatis lymph nodes. 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: Featureless transverse and descending colon compatible with history of ulcerative colitis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left greater than right intrahepatic biliary ductal dilation and enhancement and beading with mild stricturing of the left bile duct compatible with suspected primary sclerosing cholangitis. 2.Chronic changes of ulcerative colitis throughout the visualized transverse and descending colon.


Instruction: Generate impression based on findings.

Input: Status post tumor resection, headache. Examination is motion degraded and limited to non-contrast sequences. Interval postsurgical changes of right frontal craniotomy for tumor resection are seen. There has been resection of the tumor involving the right superior frontal gyrus and cingulate gyrus as well as removal of the previously seen cystic component posterolaterally. Air and blood products are seen in the surgical cavity. There is a FLAIR hyperintensity surrounding the surgical bed. There is restricted diffusion along the margin of the resection cavity, particularly inferiorly compatible with cytotoxic edema. Some component of the restricted diffusion corresponds to blood products. Again seen is effacement of the right frontal horn, which is improved in the interval. There is mild leftward subfalcine herniation. Again seen is mild asymmetric enlargement of the left lateral ventricle. No uncal herniation. No hydrocephalus. Major flow-voids are preserved.

Output: 1. Expected postsurgical changes of right frontal craniotomy for resection of previously seen nonenhancing infiltrative and partially cystic neoplasm. There appears to be gross total tumor resection. There are areas of FLAIR hyperintensity surrounding the resection cavity which may represent postoperative edema with small component of residual tumor not excluded. 2. There is small areas of restricted diffusion compatible with cytotoxic edema inferior and to a lesser degree lateral and superior aspects of the resection cavity which may transiently enhance on follow-up studies.


Instruction: Generate impression based on findings.

Input: Complete staging for T2N0 nasal vestibule SCC and T1aNII stage 3 adenocarcinoma of the lung, status post resection of left nasal vestibule and left neck dissection. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there are postoperative findings related to left nasal ala tumor resection.

Output: 1. No evidence of intracranial metastases. 2. Postoperative findings related to left nasal ala tumor resection.


Instruction: Generate impression based on findings.

Input: There is a large right intraparenchymal temporoparietal hematoma is not significantly changed along with areas of low and high T2 signal and predominantly low T2 signal and surrounding vasogenic edema. There is no discernible underlying nodule enhancement. There is persistent partial effacement of the right lateral ventricle, right uncal medialization, as well as approximately 5 mm of midline shift to the left. There is minimal right parietal subarachnoid hemorrhage and intraventricular hemorrhage. There are no new areas of intracranial hemorrhage or hydrocephalus. There are periventricular and subcortical T2 hyperintensities, which are nonspecific, but most compatible with chronic microvascular ischemic disease. However, there is no acute territorial infarct. There is mildly prominent leptomeningeal enhancement diffuse in the right cerebral hemisphere diffusely, which may be due to altered hemodynamics. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD

Output: 1.Redemonstration of large right intraparenchymal temporoparietal hematoma, with adjacent vasogenic edema and effacement of the right lateral ventricle. There is no midline shift or herniation.2.Unchanged minimal right parietal subarachnoid and intraventricular hemorrhage.3.No evidence of vascular malformation, aneurysm or significant steno-occlusive lesions within the limits of MRA.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 10 year old with persistent RUE and LLE pain, tingling, and weakness. Please assess for focal defect. History: RUE and LLE tingling, pain, weakness. Thoracic spine:Alignment is anatomic. Vertebral body heights and discs are intact. Benign marrow signal. No abnormal signal within the visualized cord. No abnormal enhancement. No significant spinal or neural foraminal narrowing.Lumbar spine:Alignment is anatomic. Vertebral body heights and discs are intact. No abnormal signal within the cord or conus which ends at L1-L2. No abnormal enhancement. Benign marrow signal. No significant spinal canal or neural foraminal stenosis at any level.Distended bladder.

Output: No abnormal signal within the cord. No significant spinal canal or neural foraminal narrowing at any level.


Instruction: Generate impression based on findings.

Input: 39 year-old female with right knee pain There is mild sharpening of the tibial spines and small osteophytes indicating mild osteoarthritis.

Output: Mild osteoarthritis.


Instruction: Generate impression based on findings.

Input: 60-year-old female with abdominal pain and polycystic liver disease. Please evaluate. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly is again noted likely related to presence of innumerable cystic structures. Large hepatic dome cysts are again noted.The largest is a septated lesion in the mid liver measuring 12.7 x 10.7 x 11.5 cm (series 7 image 18) and has decreased in size (prior 14.1 x 10.3 x 16.7 cm).An adjacent cyst in the posterior right hepatic lobe measuring 6.4 x 6 x 6.1 cm (series 7 image 10) has decreased in size (prior 10.5 x 7.2 cm).The previously described large left hepatic lobe lesion containing complex fluid has resolved in the interval.The cystic lesion in the periphery of segment 3 measuring 2.3 x 1.5 cm (series 7 image 37) has decreased in size (prior 4.2 x 4.0 cm).The remaining cystic lesions measure less than 2 cm.There are a few T1 hyperintense proteinaceous cysts in the right hepatic lobe (series 15 images 28, 32, 61), which show no enhancement on the postcontrast subtraction series.No internal or mural nodular postcontrast enhancement is identified in any of these cystic lesions. Minimal enhancement of a few septations are noted.No intra or extrahepatic biliary ductal dilatation.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: 1.Hepatomegaly with numerous bilobar cystic structures. The largest cysts have decreased in size in the interval. The previously described large left hepatic lobe lesion containing complex fluid has resolved in the interval.


Instruction: Generate impression based on findings.

Input: History of right lower quadrant pain and elevated CRP. History of fistula and abscess. History of regional enteritis. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.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: There is very low T2-weighted signal moderate wall thickening and narrowing involving the terminal ileum extending approximately 3.6 cm in length (series 7 image 17 through 21). This region demonstrates moderate postcontrast enhancement. 3 cm upstream there is a similar segment of very low T2-weighted signal mild wall thickening and stricture involving 2.5 cm of the ileum. No significant restricted diffusion. There is no upstream/prestenotic dilatation. The remainder of the small bowel is relatively well distended without evidence of wall thickening, dilatation or abnormal enhancement. There is minimal fibrofatty perforation of the right lower quadrant without evidence of acute mesenteric fluid, lymphadenopathy or discrete fluid collection.There is an abnormal mural contour of the cecum which appears narrowed compatible with fibrotic change from chronic inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Mild acute bowel inflammation superimposed on chronic fibrotic stricturing disease involving approximately 10 cm of the distal ileum without significant upstream dilatation. Chronic fibrotic changes affect the cecum. No loculated fluid collection.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Evaluate extent of disease. Biopsy: Left mid Gleason 3+3 5%; Right mid, Gleason 3+4 38% PELVIS:PROSTATE:Prostate Size: 2.5 x 4.5 x 3.9 cmPeripheral Zone: A dominant lesion is noted in the paramedian posterior right mid gland measuring 1.3 x 0.8 x 0.9 cm (series 801/10). A small suspicious focus is present in the left apex.Central Gland: No focal suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The dominant posterior right mid-gland lesion abuts and slightly bulges the posterior fibromuscular stroma, possibly reflecting extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant posterior right mid-gland lesion with possible extracapsular extension.


Instruction: Generate impression based on findings.

Input: There is no abnormal signal or enhancement. Ventricular size is normal. There is no midline shift. There is normal gray-white matter differentiation. The basal cisterns are patent. There is no bleed, mass effect, or edema. Vascular flow voids appear normal.

Output: Unremarkable MRI of the brain.


Instruction: Generate impression based on findings.

Input: Status post MVC with back pain and bladder incontinence. No evidence of acute cord compression. No acute osseous abnormalities are seen. Multilevel cervical spondylolysis is noted with some degree of central canal stenosis and possibly cord impingement but this is chronic and degenerative in nature. Elsewhere there is no evidence of spinal canal stenosis.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No evidence of acute cord compression. Multilevel chronic spinal canal stenosis is seen in the cervical region due to degenerative disease. If further imaging evaluation is warranted, nonemergent dedicated C-spine MRI can be considered.


Instruction: Generate impression based on findings.

Input: Female, 37 years old. Pain. Evaluate for Achilles tendon pathology. TENDONS: The tendons and ligaments of the ankle are intact. Specifically, the Achilles tendon appears normal.LIGAMENTS: The tendons and ligaments of the ankle are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal and joint spaces are normal. ADDITIONAL

Output: Normal appearance of the Achilles tendon without other acute abnormality to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Neoplasm related pain (acute) (chronic) [338.3] / Malignant neoplasm of anterior two-thirds of tongue, part unspecified [141.4], Reason for Study: ^Reason: is there metastatic cancer in the lower cervical spine History: pain and numbness in ulnar distribution. There are multiple bone marrow signal replacing lesions including C2 odontoid process, C2 body and T1 vertebral bodies with enhancement indicating metastatic lesion.In addition, there are soft tissue masses with diffuse enhancement on the right C12 neural foramen, right C7T1 and right T1-T2 neural foramen as well as adjacent C6, C7 transverse process indicating metastatic lesion.There is normal cervical lordosis. The cervical spine alignment is anatomic. The signal of the visualized cord is normal. There is no evidence of cord compression.Degenerative changes are specified by the intervertebral level as follows: C2-C3: diffuse enhancement of bilateral neural foramen with indistinct nerve root sleeves indicate possible metastatic infiltration. No spinal stenosis. C3-C4: no neuroforaminal narrowing or spinal stenosis. C4-C5: no neuroforaminal narrowing or spinal stenosis. C5-C6: ligamentum flavum thickening with minimal bulging of disc and disc dessication, however, no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: Soft tissue mass on the right neural foramen which obliterates neural foraminal fat indicating metastatic soft tissue lesion, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal normal bone marrow signal replacing lesions including C2, C6, C7 and T1 as described above.2. Soft tissue mass lesions on the neural foramen of C23 bilateral, C7TT1 right and T1T2 right neural foramen.3. Spinal cord signal intensity appears to be normal. No cord compression.


Instruction: Generate impression based on findings.

Input: Back and leg pain. Patient with pain over a year and sharp stabbing pain to the legs, failed medications, physical therapy, and steroid injections. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge, slightly eccentric to the left which contacts the left exiting L2 nerve root far laterally without impingement. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L3-L4: Minimal disc bulge and mild facet arthropathy contribute to mild bilateral neural foraminal stenosis. No significant spinal canal stenosis. L4-L5: Minimal disc bulge with no significant spinal canal stenosis. Mild bilateral neural foraminal narrowing. Mild facet arthropathyL5-S1: There is disc bulge with right dorsal annular fissure. There is also mild to moderate bilateral facet arthropathy. There is mild effacement of the right lateral recess without clear evidence of nerve root impingement. There is mild bilateral neural foraminal stenosis. No central canal stenosis. There is a bony defect involving the right iliac bone which may represent a bone graft site, recommend correlation with history.

Output: Mild multilevel degenerative changes in the lumbar spine with mild multilevel neural foraminal narrowing. No evidence of high-grade spinal canal or high-grade neural foraminal stenosis at any level. Please see details above.


Instruction: Generate impression based on findings.

Input: 38-year-old male. Man with NF1 who has a deep muscular neurofibroma on the right upper abdomen. Please define intramuscular neurofibroma in the upper lateral abdomen. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.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: Small and mildly enlarged retroperitoneal lymph nodes, nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Three subcentimeter round STIR hyperintense foci in the right erector spinae muscle, likely intramuscular neurofibromas. The largest measures 0.8 x 0.7 cm (series 11, image 21).OTHER: Numerous cutaneous nodules consistent with neurofibromas, the largest is approximately 1.3 x 0.6 cm in the central abdomen.

Output: 1.3 subcentimeter STIR hyperintense foci in the right erector spinae muscle, likely small intramuscular neurofibromas.2.Numerous cutaneous neurofibromas consistent with known NF1.


Instruction: Generate impression based on findings.

Input: 74-year-old female with soft tissue swelling of the bilateral medial tibia/fibula. Right tibia/fibula: Bone marrow appears within normal limits. The bony cortex is intact throughout the extent of examination. Soft tissues appear within normal limits. There is no specific evidence of soft tissue inflammatory change medially within the imaged lower extremity. There is minimal muscular atrophy, compatible with patient's stated age. There is severe osteoarthritis of the right knee, including bone-on-bone apposition of the medial compartment with associated subchondral sclerosis and cystic change. There is incompletely evaluated desiccation of the menisci and articular surfaces that may be better evaluated with dedicated knee imaging, if clinically warranted. Moderate osteoarthritis also affects the ankle joint.Left tibia/fibula: Bone marrow appears within normal limits. The bony cortex is intact throughout the extent of examination. Soft tissues appear within normal limits. There is no specific evidence of soft tissue inflammatory change medially within the imaged lower extremity. There is minimal muscular atrophy, compatible with patient's stated age. There is severe osteoarthritis of the left knee, though less prominent than the right, including bone-on-bone apposition of the medial compartment with associated subchondral sclerosis and cystic change. There is incompletely evaluated desiccation of the menisci and articular surfaces that may be better evaluated on dedicated knee imaging, if clinically warranted. Moderate osteoarthritis also affects the ankle joint.

Output: 1. Severe right greater than left osteoarthritis as outlined above.2. No specific findings of medial soft tissue swelling or underlying pathology.


Instruction: Generate impression based on findings.

Input: Signs and Symptoms: wax and wane altered mental status after trauma. Clinical question: axonal injury The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: 50-year-old female with ulnar-sided wrist pain A marker was placed along the ulnar aspect of the wrist. There is thickening and abnormal signal intensity of the extensor carpi ulnaris tendon as it courses along the distal ulna and ulnar aspect of the wrist indicating moderate to severe tendinosis. There is increased signal intensity within the tendon extending to the surface indicating partial thickness tearing. Enhancement of the tendon sheath indicates tenosynovitis. In addition, there is inflammation in the soft tissues surrounding the tendon sheath.Multiple slips of the abductor pollicis longus may reflect a normal variant. A small cleft is present within the extensor carpi radialis just proximal to its insertion which may represent partial thickness tearing, but this may not be of any current clinical significance. The visualized musculature is within normal limits. A lobulated small collection of fluid signal intensity with peripheral enhancement volar to the radioscaphoid articulation, along the distal margin of the radioscaphocapitate ligament, likely represents a ganglion or synovial cyst. The scapholunate and lunotriquetral ligaments are intact. There is mild increased signal intensity and enhancement along the medial fibers of the articular disc of the TFCC at the ulnar styloid; this may be due to mild inflammation or degenerative changes, but we see no discrete tear. Mild synovial enhancement is seen within the carpus suggesting a mild synovitis. A small lobulated focus of abnormal signal intensity within the capitate may represent a degenerative cyst, chronic erosion or ganglion.

Output: Tenosynovitis, tendinosis and partial tearing of the extensor carpi ulnaris with other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for strokeSigns and Symptoms: Right hemibody numbness and right extremity weakness. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate opacification of the right maxillary sinus and mucosal thickening .in the reset of the paranasal sinuses The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for intracranial mass or cerebral infarction.2.Opacification of paranasal sinuses is most likely inflammatory in nature.


Instruction: Generate impression based on findings.

Input: Pituitary MRI:Dedicated images through the sella demonstrate stable post-surgical changes of a prior transsphenoidal resection, with normal enhancing pituitary tissue along the margins of the sella. However, there is still an asymmetric focus of soft tissue occupying the inferior aspect of the right cavernous sinus which causes mild elevation of the cavernous ICA, although this does not appear significantly changed in size and configuration compared to the exam from 2015. There has been some interval lobulated appearance of the enhancing soft tissue, with mild increased T2 signal hyperintensity in this region indicating a more cystic character which may be related to previous radiation treatment in 2013.Brain MRI:There is nonspecific diffuse mild, thin, and smooth pachymeningeal thickening which is stable since the MRI from 2015 but was not present in 2013. There is no sagging of the brain. There is a homogeneously enhancing plaque-like extra-axial mass along the right aspect of the falx in the posterior frontal region measuring 1.0 x 1.4 cm (series 15, image 140). There is no significant mass effect on the brain parenchyma. However, the flow void through the superior superior sagittal sinus in the area of mass is not well seen, which may indicate invasion by the mass. Within the left inferior frontal lobe is a incidentally noted developmental venous anomaly. There is a subtle small rounded nonspecific T2/FLAIR hyperintense focus within the left cerebellar white matter.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation,

Output: 1.Stable post-surgical findings of a prior transsphenoidal pituitary procedure with normal enhancement of the visualized pituitary gland.2.Stable asymmetric enhancing tissue occupying the inferior aspect of the right cavernous sinus with mild elevation of the right cavernous ICA, without significant change in size or configuration compared to the exam from 2015. Mild increased T2 signal hyperintensity in this region indicates a more cystic character which may be related to previous radiation treatment.3.Small right parafalcine plaque-like mass, likely represents a meningioma, and appears similar in size compared to the prior exam.4.There is poor visualization of the flow void through the superior sagittal sinus in the region of the presumed meningioma, raising the question of possible invasion of the sinus by the mass vs. narrowing from mass effect. This could be further evaluated with a MRV head.5.Nonspecific mild diffuse pachymeningeal thickening stable since 2015 but new since 2013. Findings are of uncertain etiology, and clinical correlation is recommended, especially for any history of recent CSF access.


Instruction: Generate impression based on findings.

Input: 77-year-old male with left lower extremity weakness x 3 days. Rule out CVA. Examination demonstrates no evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The images through the supratentorial brain parenchyma are essentially within normal limits for patient of stated age of 77.Images through posterior fossa demonstrates normal morphology and density of the cerebellar hemispheres. Within the lower pons at the level of the pontomedullary junction a focal area of low-attenuation (axial image 6) in the right paramedian location is noted. This finding may represent a lacunar infarct however the possibility of volume averaging of CSF is considered and the cannot be entirely ruled out. Please correlate with clinical findings and if further evaluation is needed an MRI is recommended.

Output: 1.Unremarkable CT of brain in supratentorial brain parenchyma.2.Focal low density in the right aspect of the pons may present in a clean or an area of volume averaging with CSF as detailed.3.4.


Instruction: Generate impression based on findings.

Input: 87-year-old female with left lower facial droop. Fall. There is no evidence of intracranial hemorrhage, mass or edema. An area of hypodensity within the right basal ganglia is of uncertain. Acute MCA abnormality cannot be entirely excluded. MRI is recommended for further evaluation if clinically indicated. Scattered periventricular and subcortical white matter hypodensity is consistent with small vessel ischemic change, age indeterminate.The ventricles and basal cisterns are normal in size and configuration.Groundglass pattern of the left sphenoid bone is consistent with fibrous dysplasia. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right basal ganglia hypodensity is of uncertain chronicity. MRI can be obtained if concern remains for acute ischemia.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia [I78.0], Reason for Study: ^Reason: Please assess for cerebral AVMs History: HHT, at risk for cerebral AVMs Brain MRIThere are two enhancing lesions, one on the posterior body of the left side corpus callosum adjacent to the left callosal sulcus (about 5mm) and another is on the right side of upper pons (about 2mm).The right upper pons lesion extends craniocaudally about 6mm, so it could represent prominent venous structure. Considering the patient's clinical information about HHT, these two lesions especially left corpus callosum posterior body lesion could represent so called capillary vascular malformation. There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Two small enhancing lesions; one on the left corpus callosum posterior body and another on the right upper pons as described above. These lesions especially left corpus callosum lesion might represent the diagnosis of capillary vascular malformation. 2. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Ms. Mahler has a strong family history of breast cancer. She is an ATM mutation carrier. There is scattered fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Few non-enhancing cysts are seen bilaterally.No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: No MRI evidence for malignancy. Of note, no recent mammogram is available in our system. If patient has had a recent mammogram performed at outside institution, this should be submitted for future comparison purposes. Otherwise, patient is due for a screening mammogram. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 84-year-old male with right sided neglect x 2 to 3 days. On Coumadin. Evaluate for subdural. Findings consistent with mild small vessel disease of indeterminate age are noted. No definitive interval change since prior exam. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Vascular calcification. No evidence of extra axial hemorrhage. Calvarium remains intact. A clinical concern persists an MRI is recommended.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Ms. Green is a 43-year-old female with a history of newly diagnosed right breast DCIS with a family history of breast cancer in the patient's cousin at the age of 30. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild background parenchymal enhancement is noted bilaterally. RIGHT BREAST:In the right medial breast, anterior depth, there is faint nonmass enhancement identified measuring approximately 3.0 cm in the AP dimension. This corresponds in location and distribution to the mammographically detected calcifications that are biopsy proven to be DCIS. Susceptibility artifact from biopsy marker clip is seen immediately postero-lateral to this MR enhancement. There is also associated skin thickening/enhancement, which is likely related to post-biopsy changes.There is no additional abnormal enhancement seen in the right breast.LEFT BREAST: There are two enhancing foci/masses identified in the left retroareolar region. The more medial enhancing focus measures 0.5 cm and has internal fat signal intensity, compatible with a benign intramammary lymph node. The more lateral enhancing mass measures 0.8 x 1.2 cm and has a benign morphologic appearance. AXILLA:No abnormal lymph nodes are identified in either axillary region.

Output: (1) 3.0 cm linear nonmass enhancement in the right medial breast, corresponding in distribution and span to the mammographically detected calcifications that are biopsy proven to be DCIS. Of note, the clip is slightly postero-lateral to the area of non-mass enhancement. A bracketed wire localization can be performed mammographically for preoperative surgical guidance. (2) 1.2 cm enhancing mass in the left lateral retroareolar breast for which an MR-directed ultrasound is recommended for further evaluation. If no sonographic correlate is identified, then a short term 6 month MRI follow-up is recommended. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: Research MRI for AMARANTH Alzheimer's disease trial. IRB14-1133. History: Cognitive decline Multifocal T2/FLAIR high signal intensities on bilateral hemispheric subcortical white matter and deep white matter which are non specific. Comparing to prior scan, those high signal intensity lesions appear to be slightly increased in number, but otherwise unremarkable.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. The paranasal sinuses and mastoid air cells are clear.

Output: Non specific multifocal T2/FLAIR high signal intensity lesions, slightly increased number since prior scan, otherwise unremarkable scan.No mass, no edema, no large hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, with neck pain and left arm radicular symptoms. Trace retrolisthesis of C3 relative to C4, and C6 relative to C7 are demonstrated. Endplate irregularity and edema is seen at most levels compatible with degeneration. Otherwise, vertebral body morphology is unremarkable.Multiple small chronic strokes are seen within the cerebellum. Details of the cervical spinal cord will be discussed by level as follows:C2-3: Left facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing. No spinal cord abnormality.C3-4: Right worse than left facet hypertrophy. Significant posterior disk osteophyte formation, asymmetric to the right. Severe spinal canal stenosis with flattening and impingement of the spinal cord. Mild increased T2 signal within the cord at this level and slightly below along with cord thinning. Moderate left and severe right foraminal narrowing.C4-5: Mild facet hypertrophy. Mild posterior disk osteophyte formation. No significant spinal canal stenosis or cord abnormalities. Moderate bilateral foraminal narrowing. C5-6: Mild facet hypertrophy. Moderate posterior disk osteophyte formation with mild generalized spinal canal narrowing but no significant cord impingement. Severe left and moderate right foraminal narrowing. C6-7: Mild facet hypertrophy. Moderate posterior disk osteophyte formation causing mild/moderate generalized spinal canal stenosis and slight cord flattening. Moderate bilateral foraminal narrowing. C7-T1: Facet hypertrophy. Minimal central disk protrusion. No significant spinal canal stenosis. Moderate right and mild left foraminal narrowing.

Output: Multilevel cervical spondylosis, most severely affecting the C3-4 level where a disk osteophyte complex, in combination with posterior element hypertrophy, results in significant spinal canal stenosis with cord impingement. The cord is thinned and T2 hyperintense at this level which favors myelomalacia, though some component of superimposed edema cannot be excluded.Less significant spinal canal stenosis, and variable foraminal narrowing, are also seen as discussed above.


Instruction: Generate impression based on findings.

Input: 55-year-old female with left tender leg that his swollen, although symptoms have been present for 3 years There is mild edema within the subcutaneous tissues. The tibia and fibula are normal without abnormal marrow signal. No soft tissue lesions are evident. No abnormal enhancement.

Output: Mild subcutaneous edema without underlying osseous abnormalities or soft tissue lesions.


Instruction: Generate impression based on findings.

Input: There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. Prominent perivascular spaces are commonly seen in a patient of 82 years. There is mild diffuse volume loss without a specific lobar predominant atrophy pattern. There are no findings of hydrocephalus.. 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. Mucosal thickening is present within the left frontal, anterior left ethmoid, and left maxillary sinuses. A superimposed small air-fluid level is present in the left maxillary sinus. The remaining paranasal sinuses and the mastoid air cells are clear. There is no abnormal enhancement within the brain. Note is made of endosteal hyperostosis.Coronal images of the temporal lobes demonstrate the hippocampal formations and parahippocampal gyri to be unremarkable bilaterally without signal abnormalities, masses, or abnormal enhancement. There are no foci of heterotopic gray matter.

Output: 1.Chronic small vessel ischemic disease.2.Mild diffuse volume loss without a specific lobar predominant atrophy pattern.3.Mucosal thickening is present within the left frontal, anterior left ethmoid, and left maxillary sinuses. A superimposed small air-fluid level is present in the left maxillary sinus.


Instruction: Generate impression based on findings.

Input: Demyelinating disease of central nervous system, unspecified [G37.9], Reason for Study: ^Reason: Evaluate for demyelinating lesions History: urinary incontinence, history of ADEM Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature.No abnormal enhancing lesions are appreciated in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI thoracic spine: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. No abnormal enhancing lesions are appreciated in the thoracic spine.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disk space height and a mild disk bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild loss of disk space height and a mild disk bulge at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.No abnormal lesions are identified in the spinal cord or conus medullaris.2.No significant compromise to the cervical, thoracic or lumbar spinal canal or exiting nerve roots.3.There are minor disk bulges in the lumbar spine4.There is straightening of the normal cervical curvature.


Instruction: Generate impression based on findings.

Input: Clinical question: Preop planning for tumor resection. Signs and symptoms: Preop planning. Pre and post enhanced spelled brain MRI:Examination is performed utilizing a Stealth protocol and is not a true diagnostic study. Examination demonstrates a well-demarcated mildly enhancing mass in the left posterior frontal high convexity measuring approximately at 29 x 31 mm in transaxial dimensions. It demonstrates subtle surrounding vasogenic edema and with resultant regional mass effect.There is also evidence of a mass within the superior sagittal sinus at this site with resultant expansion of the sinus. This finding does not demonstrate any definitive continuity with the above detailed mass however this exam is not a complete diagnostic tests and does not include all MRI sequences. Both of these findings were present on prior exam and without significant change.Ventricular system remains within normal size and did maintain midline. There is no convincing evidence of any additional masses.There is evidence of a left sided parietal craniotomy which mildly extends across the midline to the right similar to prior exam.

Output: Mass within the high convexity left posterior frontal and superior sagittal sinus as detailed.


Instruction: Generate impression based on findings.

Input: 9 year old male with abdominal pain and history of Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 2/6/2015 ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is no evidence of hydronephrosis or hydroureter. There is no evidence of nephrolithiasis or ureterolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The distal ileum and terminal ileum again appears featureless with long segments of mild dilatation as well as narrowings consistent with sequelae of inflammation. Additionally, there is mild mucosal hyperenhancement suggesting an acute on chronic component. There is abnormal peristalsis of the terminal ileum as well as associated fibrofatty proliferation. Overall these findings and the extent of the affected bowel appear similar to the prior examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The distal ileum and terminal ileum again appears featureless with long segments of mild dilatation as well as narrowings consistent with sequelae of inflammation. Additionally, there is mild mucosal hyperenhancement suggesting an acute on chronic component. There is abnormal peristalsis of the terminal ileum as well as associated fibrofatty proliferation. Overall these findings and the extent of the affected bowel appear similar to the prior examination.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Acute on chronic inflammation of the distal and terminal ileum, with the length of affected bowel appearing similar to the previous examination.


Instruction: Generate impression based on findings.

Input: Male, 32 years old, with epilepsy, preoperative evaluation for depth electrode placement. Again seen is an undulating band of subcortical tissue which matches signal characteristics of gray matter involving the bilateral cerebral hemispheres. No definite evidence of parenchymal edema or mass effect is seen. No abnormal extra-axial collections are noted. No pathologic parenchymal or extra-axial enhancement is observed. Volume loss of the cerebellum is redemonstrated. Choroid plexus cysts are noted incidentally at the atria.

Output: Findings compatible with band heterotopia.


Instruction: Generate impression based on findings.

Input: 77 years Female (DOB:9/7/1938)Reason: r/o ischemic stroked History: hx of CVA, AMS, focal neurological deficitsPROVIDER/ATTENDING NAME: MARDI I GOMBERG-MAITLAND MARDI I GOMBERG-MAITLAND MRI of the brainThere are several foci of diffusion restriction present. One is located in the left centrum semiovale in the frontal lobe. One is located in the right postcentral gyrus subcortical white matter a few more scattered in the right centrum semiovale posteriorly, one in the right occipital lobe subcortical white matter in the couple in each of the temporal lobe as well as one in the right lower midbrain and a couple are located in the left half of the splenium of the corpus callosum.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple punctate foci of susceptibility effect in the thalami, periventricular white matter, subcortical white matter, cerebral peduncles and brainstem.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 demonstrate opacities left and to lesser degree right mastoid air cells. The visualized portions of the orbits are intact. The right eyeball lens is thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is fenestrated. The right posterior communicating artery is relatively small but can be identified. The left posterior communicating artery is medium-sized.. The right vertebral artery is larger than the left vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The thyroid gland is large and heterogeneous

Output: 1.There are multiple microinfarcts scattered throughout the brain in multiple vascular territories both anterior and posterior circulation.2.Periventricular and subcortical white matter lesions as well as lesions in the brainstem and cerebellar hemispheres of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.There are multiple microhemorrhages present which the large degree could be hypertensive in nature but are nonspecific.4.The thyroid gland is large and heterogeneous suggesting a goiter..


Instruction: Generate impression based on findings.

Input: 35-year-old female with left lower quadrant and abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is gallbladder sludge versus cholelithiasis. No definite evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: The uterus is enlarged and there is a central fundal mass which measures 5.6 x 6.4 cm, most likely due to a fibroid, at axial image 114/157. There is a larger anterior and superior central pelvic mass extending from the uterus which appears circumscribed with a thickened wall that measures 8.2 x 10 x 14.3 cm on axial image 91/157 of series 3 and coronal image 67/100. This mass contains fluid and central fat density. There are peripheral calcifications best seen at axial images 86 - 87/157 and coronal image 57/100. These findings suggest the presence of a mature cystic teratoma. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: A small amount of pelvic free fluid is present.

Output: Central pelvic mass(es) as probably consisting of a fibroadenoma and teratoma, as described above. Further evaluation with transvaginal ultrasound and/or MRI may be helpful, if indicated.Cholelithiasis without cholecystitis.


Instruction: Generate impression based on findings.

Input: Knee pain and swelling. MENISCI: There is marked degeneration and complex multidirectional tearing involving the posterior horn and extending into the body of the medial meniscus with partial extrusion of the medial meniscus. The anterior horn of the medial meniscus appears intact. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a focus of full-thickness cartilage loss in the weightbearing portion of the medial femoral condyle measuring approximately 8 mm in AP dimension (series 11, image 11) with subjacent reactive bone marrow edema. There is diffuse thinning of the cartilage of the medial tibiofemoral compartment. There is diffuse thinning of the articular cartilage of the lateral patellofemoral compartment with a focus of near full-thickness cartilage loss involving the weightbearing portion of the lateral tibial plateau with associated subjacent reactive bone marrow edema (series 9, image 23). There is also small focus of reactive bone marrow edema involving the anterior aspect of the medial tibial plateau. There is marked thinning of the articular cartilage of the patellofemoral compartment with extensive subchondral cysts particularly involving the lateral facet of the patella.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Marked degeneration and complex multidirectional tearing of the body and posterior horn of the medial meniscus.2.Severe degenerative changes as described above including a focus of full-thickness cartilage loss in the medial tibiofemoral compartment.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 67 year-old female with left arm tingling and numbness. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse areas of hypodensity in the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate but grossly overall unchanged from the previous examination. Focal area of hypodensity adjacent to the right thalamus and basal ganglia unchanged from the previous study. No new cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized mastoid air cells are normally pneumatized. Limited view of the paranasal sinuses are unremarkable.

Output: Chronic ischemic focus unchanged. Small vessel disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Patient with lung cancer presenting with altered mental status and hyponatremia. Evaluate for malignancy. There is no evidence of intracranial metastases. There is no evidence of intracranial hemorrhage, mass effect or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, stable to minimally increased in number compared to 2012. The ventricles and basal cisterns are normal in size and configuration. There is redemonstration of an enlarged CSF space in the posterior fossa, which may represent a mega cisterna magna or arachnoid cyst. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1.No evidence of intracranial metastatic disease.2.Chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 2 years old, with history of hydrocephalus and VP shunt presenting with new onset seizures. A right parietal approach ventricular shunt catheter is in place with its tip to the left of midline at the level of the lateral ventricular body with tenting of the septum pellucidum.Since the prior examinations, there has been a significant reduction in the caliber of the ventricular system. The transfrontal diameter in the coronal plane now measures 42 mm and previously measured 76 mm. The third and fourth ventricles are also substantially decreased in size. The lateral ventricular margins are wavy and distorted.FLAIR hyperintense and T1 isointense subdural fluid collections have developed along both cerebral hemispheres, particularly in the left frontal region, and to a lesser extent along the tentorium. There may also be some component of diffuse dural thickening. There is no susceptibility effect or T1 hyperintensity to be seen within these collections.The cerebral hemispheres are diffusely dysmorphic compatible with long-standing hydrocephalus. The genu of the corpus callosum and adjacent cingulate gyri are deformed and demonstrate abnormal T2 hyperintense signal. A focus of abnormal T2 hyperintense signal is also seen in the left periventricular white matter. No evidence of restricted diffusion is seen to suggest acute ischemia.The cerebral hemispheres demonstrate reduced volume and a generalized loss of white matter. Myelination has progressed compared to the prior exam. The corpus callosum is diffusely thinned. The pituitary region is unremarkable. The posterior fossa structures are within normal limits.

Output: 1.Significant interval decrease in caliber of the shunted ventricular system.2.Interval development of bilateral subdural collections which are favored to reflect nonhemorrhagic, proteinaceous effusions probably secondary to relief of hydrocephalus and subsequent brain retraction.3.Sequelae of long-standing hydrocephalus are seen including parenchymal deformity and loss of white matter volume. 4.Deformity and signal abnormality affecting the genu of the corpus callosum and the adjacent cingulate gyri may represent chronic injury related to traction or perhaps a remote ischemic insult.


Instruction: Generate impression based on findings.

Input: 32 years, Female, headache, left optic neuritis, history of mild Chiari, rheumatoid arthritis on immunosuppressants. Evaluate for inflammatory versus infectious etiology. Brain: There is no significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Cerebellar tonsils are borderline low without clear evidence of Chiari I malformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Orbits appear grossly unremarkable although note evaluation for optic nerve signal abnormality can be better performed with dedicated MRI orbit sequences. There is a partially empty sella. There is small left maxillary sinus mucus retention cyst. Paranasal sinuses are otherwise grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: No cord signal abnormality or abnormal enhancement in the cervical spine. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Mild degenerative changes are present throughout the cervical spine with multilevel disc desiccation and small disc bulges from C3-C4 to the C5-C6 levels, which along with ligamentum flavum thickening contribute to mild spinal canal and minimal left neural foraminal narrowing at the C5-C6 level. There is no high-grade spinal canal or neural foraminal stenosis at any level.

Output: 1. Brain MRI demonstrates no evidence of inflammation/infection or demyelinating disease.2. Note evaluation for optic nerve signal abnormality can be better performed with dedicated orbital sequences. There is however no orbital mass lesion.3. Partially empty sella which can be a normal variant or associated with intracranial hypertension in the appropriate clinical setting. 4. Cerebellar tonsils are borderline low without significant crowding at the foramen magnum or clear evidence of Chiari malformation.5. No cord signal abnormality in the cervical spine. There are mild multilevel degenerative changes, as described above, without high-grade spinal canal or neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Intracranial hemorrhage. 63-year-old female. There is a left parietal extra-axial mass present currently measuring 15 x 22 mm and previously measuring 13 x 19 mm on head CT. This has been followed on MRI exams.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of nonhemorrhagic CVA3.There is an extra-axial mass which is compatible with a meningioma with a little interval change. There may be slight enlargement of this mass since 2005 as described above.


Instruction: Generate impression based on findings.

Input: 52-year-old man with history of elevated PSA. Additional history as per chart: PSA of 6.6 in 2014, and PSA of 8.5 in June 2016. December 2014 biopsy showing atypical cells in the right apex, 2015 biopsy showing atypical cells in the right apex. PELVIS:PROSTATE:Prostate Size: 50 x 46 mmPeripheral Zone: No suspicious foci of T2 or diffusion signal to suggest tumor.Central Gland: BPH nodules noted.Seminal Vesicles: Seminal vesicles are normal.Extracapsular Extension: There is no extracapsular soft tissue abnormality.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 foci of signal abnormality to suggest adenocarcinoma.


Instruction: Generate impression based on findings.

Input: Intermittent back pain. History of bone metastasis is from lung cancer. There is bone marrow edema surrounding the focal T1-hypointense, T2-hyperintense, contrast-enhancing lesions involving the anterior superior L2 vertebral body, left posterolateral L2 vertebral body, and left L5 vertebral body/pedicle junction. There is also a metastatic lesion involving the left L3 transverse process associated with abnormal signal and contrast enhancement in the ipsilateral vertebral body and pedicle marrow as well as the adjacent paraspinal soft tissues. Smaller osseous lesions are present in the spinous processes of T10, L3 and L4. There is no displaced pathologic fracture or osseous expansion. Similar metastatic involvement is present in the partially imaged right iliac bone and right sacral ala. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild disc bulges and desiccation at L4-L5 and L5-S1. The disc bulges, combined with facet arthropathy and ligamenta flava thickening, result in mild-to-moderate left and mild right L5-S1 and mild bilateral L4-L5 neural foraminal narrowings. There is no significant spinal canal stenosis. The caudal spinal cord displays normal signal and morphology. The tip of the conus medullaris lies at upper L2 level. There is a small lower sacral perineural cyst. There are multiple, poorly contrast-enhancing right renal masses, which are not completely imaged, compatible with metastasis. The left kidney is absent. There are small, nonspecific para-aortic lymph nodes.

Output: 1.Multiple spine and pelvic osseous metastasis, but no displaced, pathologic fracture, or osseous expansion. However, these metastatic osseous lesions are associated with surrounding marrow edema. The lesion in the left L3 transverse process is associated with abnormal signal in the adjacent soft tissues as well.2.Mild lower lumbar spondylosis worst at the left L5-S1 neural foramen causing mild-to-moderate stenosis. No significant spinal canal stenosis.3.Multiple right renal masses are not completely imaged, but compatible with metastasis. Please refer to the report of the abdomen/pelvis CT scan from May 25, 2016 for additional details. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: right hip pain and difficulty walking after vaginal delivery 2/20 History: right hip pain and difficulty walking ACETABULAR LABRUM: Evaluation of the labrum is limited due to the lack of intra-articular contrast, however, there is a small focus of intermediate signal intensity within the acetabular labrum, anteriorly, between the 2 and 3 o'clock position, suggesting a small partial thickness undersurface tear. This is immediately beneath the crossing of the iliopsoas tendon raising the question of iliopsoas impingement.ARTICULAR CARTILAGE AND BONE: There is perhaps mild thinning of the articular cartilage along the posterior aspect of the acetabulum, but we see no focal fluid-filled articular cartilage defects. The bone marrow signal intensity of the proximal femur and acetabulum is normal. On the large field-of-view images, there is edema within the pubic symphysis and the bodies of the adjacent pubic bones which may represent trauma related to the patient's recent vaginal delivery. The symphyseal width is less than 5 mm, which is within normal limits. There is also a small 6 mm focus of fluid signal intensity beneath the body of the right pubic bone which may reflect a secondary cleft sign due to a small focal insertional adductor / pre-pubic aponeurotic complex tear, but the significance of this in the setting of recent childbirth is uncertain. This could be better evaluated with a pubalgia protocol MRI examination if clinically warranted. There is mild edema type signal within the medial aspect of the right ilium adjacent to the inferior portion of the right sacroiliac joint which may represent mild trauma following childbirth.SOFT TISSUES: There is low signal intensity debris within the endometrial cavity, presumably representing blood products.ADDITIONAL

Output: 1. Although the width of the pubic symphysis is within normal limits, there is a small amount of fluid within the symphysis extending into the prepubic aponeurotic complex suggesting aponeurotic injury although the clinical significance of this finding in the setting of recent vaginal delivery is uncertain.2. Small amount of edema within the right ilium adjacent to the right sacroiliac joint may also reflect mild trauma sustained with childbirth.3. Although the study is not optimal for evaluation of the acetabular labrum, there appears to be a small tear within the acetabular labrum beneath the iliopsoas tendon raising the possibility of iliopsoas impingement.


Instruction: Generate impression based on findings.

Input: Right There are multiple foci of metallic susceptibility at the level of the acromioclavicular joint relating to prior surgery.ROTATOR CUFF: There is a massive tear of the rotator cuff including complete tears of the supra and infraspinatus tendons with retraction to the level of the glenohumeral joint. There is severe fatty atrophy of the infraspinatus muscle with moderate to severe fatty atrophy of the supraspinatus muscle. There is complete or near complete full-thickness tearing of the subscapularis muscle with retraction of most of the fibers to the level of the inferior glenoid. There is severe fatty atrophy of the subscapularis muscle. There is profound fatty atrophy of the teres minor muscle although the tendon itself appears to extend to the greater tuberosity.SUPRASPINATUS OUTLET: There is deformity of the distal clavicle and acromion indicating prior surgery. There is fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The humeral head is high riding. There is moderate osteoarthritis of the glenohumeral articulation with loss of the articular cartilage along the superomedial aspect of the humeral head. There is a moderate effusion with thickening of the synovium and a numerous small foci of debris within the joint. There is degeneration and degenerative tearing of the labrum, particularly superiorly.BICEPS TENDON: The intra-articular long head portion of the biceps tendon is not visualized, likely secondary to tearing.

Output: Massive rotator cuff tear with profound associated muscle atrophy. Additional findings are described above.


Instruction: Generate impression based on findings.

Input: known left thalamic and basal ganglia ICH with mass effects. There is 47mm x 57mm sized left thalamic and basal ganglia ICH with surrounding edema and midline shift toward right side.As well, IVH and right hemispheric SAH were also seen.Comparing to prior CT scan, the approximate size of the ICH, the degree of midline shift toward right side, and the extent of the IVH do not show any significant interval change.There is no evidence of acute ischemic lesion on this scan.Brain edema was also seen on the left cerebral peduncle, midbrain and upper pons area.The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral distal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Acom artery is patent and bilateral Pcom arteries are also patent.There is no evidence of intracranial arterial aneurysm or significant luminal stenosis or occlusion.3D MRA neck non-gadolinium enhanced MRA with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in bilateral CCAs, extracranial ICAs and VAs.Aortic arch origins of major vessels cannot be precisely evaluated but appear to be within normal limits. Extracranial cranio-cervical arterial system appear to be normal without evidence of luminal irregularity or stenosis.

Output: 1. Re-demonstration of left thalamic and Basal ganglia ICH with mass effects as well as IVH and SAH.2. No evidence of acute ischemic lesion on this scan.3. No evidence of intracranial arterial aneurysm, significant luminal stenosis or occlusion.4. No evidence of extracranial cranio cervical arterial system's significant luminal stenosis or occlusion .


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:6/6/1983)Reason: MS, f/u progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate to marked degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Many of these are perpendicular to the lateral ventricles. Some extend to the corpus callosum. Additional lesions are present in the internal capsules and brain stem as well as the right cerebellar hemisphere. When compared to the prior exam there is not appear to be a significant interval change. The lesion along the posterior limb of the left internal capsule is less signal hyperintense on the current exam but otherwise unchanged. Other lesions in the midbrain are also less conspicuous. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Redemonstration of multiple white matter lesions scattered throughout the brain but predominantly the supratentorial brain are stable when compared to the prior exam. Some of the lesions that were more conspicuous on the prior exam are less conspicuous on the current exam.


Instruction: Generate impression based on findings.

Input: Characterize left retroperitoneal collection. ABDOMEN:Exam is limited by patient motion/shimming artifact.LUNG BASES: Cardiomegaly. Pleural effusions.LIVER, BILIARY TRACT: Mild hepatomegaly. The IVC and hepatic veins are distended, which may be seen in patients with right heart failure. Cholecystostomy tube again noted.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: There is a large multilobulated lesion demonstrating heterogeneous, high T2 and T1 signal intensity appearing to arise from the left psoas and iliacus muscles, compatible with retroperitoneal hematoma. The hematoma measures approximately 8.3 x 8.3 x 12.1 cm (AP by ML by CC). Superimposed infection cannot be excluded without a contrast-enhanced exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe anasarca. Large amount of ascites is redemonstrated.OTHER: No significant abnormality noted.

Output: 1.Large left iliopsoas retroperitoneal hematoma. Superimposed infection cannot be excluded due to limitation by lack of intravenous contrast.2.Signs of volume overload include cardiomegaly, pleural effusions, distended central veins, and severe anasarca.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary lesion. Evaluate for change. Signs and symptoms: None. Mild headaches. Surveillance imaging. Pre- and post enhanced pituitary MRI:Examination redemonstrate a round well-demarcated T1 hyperintense and T2 mixed signal, hypoenhancing lesion along the superior aspect of the pituitary gland measuring gas 7.7 x 8.4 mm on coronal T1-weighted series. The lesion bulges into the basal cistern however is not in contact and produces no mass effect on the suprasellar visual complex. The lesion measures identical to prior exam and is suggestive of a Rathke's cleft cyst. The rest of the pituitary gland demonstrate normal signal intensity and pattern of enhancement. Pituitary stalk demonstrate normal size and pattern of enhancement.Bilateral cavernous sinuses are well-visualized and unremarkable.

Output: 1.Stable well demarcated round hypoenhancing sellar mass suggestive of Rathke's cleft cyst.2.Unremarkable and stable pre and post enhanced MRI of the pituitary otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brainClinical question: hx met lesion, radiation necrosis- Baseline evaluation post opSigns and Symptoms: none- surveillance The patient is status post left-sided craniotomy. There is adjacent dural thickening present and blood products. A previously noted mass in the left inferior parietal lobule is not readily identified on the current exam. Instead there is a small amount of enhancement associated with the susceptibility effect indicative of postsurgical change.There is a 6 mm ring-enhancing lesion present along the left superior parietal lobule just behind the left postcentral gyrus. This measured 8 mm on 5/29/2015 and 6 mm on the 6/23/2015 exam.There is redemonstration of a 3 mm enhancing longitudinal along the lateral aspect of the right orbital gyrus. This area is obscured on susceptibility weighted imaging.A 2 mm minimal nodule is redemonstrated at the frontal horn of the right lateral ventricle. It is no longer visible on the current postcontrast exam and was more conspicuous on prior exams. It is associated with the susceptibility effect and is more conspicuous on the susceptibility weighted images on the current exam.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 scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is a small lesion present in the left parietal lobe which remains stable when compared to prior exams.2.The patient has undergone surgical removal of a left inferior parietal lobule mass.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with multiple vascular and risk factors with acute mental status changes and slurring of speech. There is no evidence of intracranial hemorrhage, mass, edema or midline shift. The ventricles and basal cisterns are normal in size and configuration. Subtle asymmetry to the sulci is likely related to patient positioning. However subtle abnormalities cannot be ruled out and an MRI may be considered if an acute infarct is suspected.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No acute abnormality noted. However, subtle findings cannot be ruled out and an MRI may be considered if acute infarct is suspected as clinically indicated.


Instruction: Generate impression based on findings.

Input: 52-year-old with history of right breast IDC/DCIS status post lumpectomy with pathology revealing tumor close to the surgical margins. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Postoperative changes in the right axillary region from prior lumpectomy are again noted. There is no suspicious nodular or masslike enhancement adjacent to the collapsed seroma.Both breasts contain a few foci of benign parenchymal enhancement, no area uniquely suspicious.No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Rule out metastasis. Headache. Known neoplastic process. There is a right frontoparietal extra axial hyperdense lesion again identified, measuring two x 5 0.1-cm [image 17]. It is adjacent to the right craniotomy defect, very similar in appearance when compared to prior MRI 5/13/2009. Large amount encephalomalacia involving the right frontal lobe is again seen with ex vacuo dilatation of the right lateral ventricle. There are calcifications seen within the displaced falx, as well as the periphery of this extra-axial lesion. There is no other evidence of intracranial hemorrhage. Left frontal encephalomalacia again seen. Left lateral ventricle is moderately dilated. The basal cisterns are patent. Mild vascular calcifications. Diffuse thickening , with lucent and sclerotic appearance of the right lower frontal temporal calvarium as well as the sphenoid bones and are identified, underlying metastasis cannot be excluded.

Output: No acute intracranial abnormalities. Again identified is a large right extra-axial frontal parietal hyperdense collection, similar in appearance when compared to prior MRI 5/13/2009.


Instruction: Generate impression based on findings.

Input: 28 year old male; evaluate for CVA. Subtle area of low attenuation within the brainstem likely represents artifact. A separate subtle area of low attenuation is noted in the right thalamus/posterior limb of the internal capsule; if acute infarct is suspected, recommend MRI or repeat examination to further evaluate.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: Subtle areas of low attenuation with the brainstem and right basal ganglia/posterior limb of internal capsule; recommend MRI or repeat CT if acute infarct is suspected.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: eval for stenosisSigns and Symptoms: stroke syndrome presenting with 2d h/o left sided weakness, and mildly slurred speech MRI of the brainThere is a focus of diffusion restriction present in the right posterior limb of the internal capsule. It is hyperintense on T2 and FLAIR MRIPunctate foci of T2 and FLAIR hyperintensity without diffusion restriction are present in the thalami, basal ganglia, left cerebellar hemisphere and left cerebral peduncle. A patchy focus of T2 and FLAIR signal hyperintensity is present in the left brainstem extending from the left cerebral peduncle to the left medulla.There is a low signal focus present in the right caudate nucleus on susceptibility weighted imaging.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The LCCA originates from the innominate artery.

Output: 1.There is a subacute lacunar infarct present in the right posterior limb of internal capsule.2.An old small hemorrhage is present in the right caudate nucleus where the is not encephalomalacia.3.Multiple old lacunar infarcts are present in the basal ganglia and brainstem. It is possible that a patchy lesion along the left brainstem represents wallerian degeneration.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease present.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient was transferred from an outside institution for respiratory failure. Found down at trauma on paralytics and sedated at outside hospital. Now lie attending sedation and off paralytic agents. Still minimally responsive. Non-enhanced CT of brain:There is lower than expected hypoattenuation of the white matter of bilateral cerebral hemispheres. There is however no evidence of effacement of cortical sulci, mass effect midline shift or hydrocephalus. The density of cortex and basal ganglia and thalami remain within normal limits. Considering provided clinical date of possibly two underlying diffuse cerebral edema cannot be entirely ruled out and follow-up with an MRI is recommended. It is also possible that this appearance may be technique related. Images through posterior fossa are essentially unremarkable.

Output: Suspected cerebral edema of bihemispheric white matter as detailed. Considering patient's provided clinical date of follow-up with an MRI is recommended. There is no evidence of hemorrhage, mass-effect, midline shift or hydrocephalus. Please see above comments.


Instruction: Generate impression based on findings.

Input: Left knee pain and swelling MENISCI: There is blunting and truncation of the inner free edge of the medial meniscus with abnormal morphology of the posterior horn consistent with the radial tearing which involves the posterior horn and body. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneity of the articular cartilage of the medial femoral condyle particularly anteriorly suggesting degeneration and possible partial thickness loss. There is no evidence of a full-thickness defect.The articular cartilage of the lateral compartment also appears thinned but otherwise intact.There is moderate to severe articular cartilage loss of the patellofemoral compartment with areas of near full-thickness to full-thickness loss particularly of the medial compartment.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Radial tearing of the medial meniscus involving the posterior horn and body.2. Moderate to severe articular cartilage loss of the patellofemoral compartment with mild degeneration of the medial and lateral compartments.


Instruction: Generate impression based on findings.

Input: Reason: RCT History: Pain, Weakness Suboptimal evaluation on multiple sequences secondary to patient motion artifact as well as inability to optimally position the patient for the ABER view.ROTATOR CUFF: There is a complete tear of the supraspinatus with approximately 1 cm of retraction of the proximal tendon fragment. Some of this tearing appears to extend posteriorly to involve the anterior fibers of the infraspinatus. There is thickening and intermediate signal intensity within the supraspinatus indicating tendinosis. There is fatty atrophy of the supraspinatus. There is thickening and intermediate signal intensity within the subscapularis indicating moderate tendinosis. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Intra-articular gadolinium extends into the subacromial subdeltoid bursa confirming a full-thickness tear. Note is made of postsurgical changes of prior acromioplasty affecting the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a full-thickness articular cartilage cleft along the anterior superior glenoid. There is partial-thickness articular cartilage degeneration along the glenoid. There is heterogeneity and intermediate signal intensity within the posterior and superior labrum indicating degeneration/degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: 1. Postsurgical changes of prior rotator cuff tear with findings indicating a complete retear of the supraspinatus with retraction as described above. Other findings as described above. 2. Degeneration/degenerative tearing of the glenoid labrum as well as articular cartilage degeneration along the glenoid.3. Low signal intensity debris within the glenohumeral joint may reflect a synovitis.