Instruction: Generate impression based on findings.

Input: Reason: chronic lateral patellar dislocation History: lateral patellar dislocation. Due to patient's body habitus, the high-resolution coil could not be used. An alternative coil was used resulting in slightly suboptimal images. MENISCI: Small foci of increased signal intensity within the root of the posterior horn of the medial meniscus of questionable clinical significance, but we see no definite tear.Intrasubstance abnormal signal in the posterior horn of the lateral meniscus indicating degeneration, but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: Chronic lateral dislocation of the patella. Although evaluation of the articular cartilage is limited, there appears to be full-thickness loss of cartilage along the medial facet of the patella and near full-thickness cartilage loss more focally along the lateral facet of the patella. Femoral trochlea is shallow compatible with dysplasia. Trochlear cartilage appears relatively intact. There are small patellofemoral osteophytes.The tibial tuberosity-trochlear groove distance is 2 cm.Osteophyte formation with overlying full-thickness cartilage loss along the anterior aspect of the lateral femoral condyle. Also moderate degeneration is apparent along the weightbearing surface of the lateral femoral condyle and perhaps the anterior aspect of the lateral tibial plateau.Articular cartilage of the medial compartment is intact.LIGAMENTS: The ACL is intact. The PCL is intact. The MCL is intact. The LCL complex is intact.EXTENSOR MECHANISM: The quadriceps and patellar tendons are intact.ADDITIONAL

Output: Chronic lateral patellar dislocation with osteoarthritic changes and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out stroke. Signs and symptoms: Patient with hemoglobin SC, severe headache. Nonenhanced head CT:No detectable acute intracranial findings. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.If concern for stroke is high recommend follow up with an MRI examination.Calvarium and soft tissues of the scalp are unremarkable.Limited images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.Prominence of adenoids is noted.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Clinical question: Memory issues. Signs and symptoms: Memory issues. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrate small foci of flair hyperintensity in the periventricular and to a lesser degree subcortical white matter of bilateral cerebral hemispheres, bilateral basal ganglia and thalami and pons which are nonspecific, nonhemorrhagic and nonenhancing. However considering patient's stated age of 76 this appearance most likely representing microvascular chronic ischemic changes of mild degree.There is a slight prominence of cortical sulci and supratentorial ventricular system which may be still within upper range of normal for age.Post-enhanced images are negative for any abnormal enhancement the brain parenchyma, leptomeninges, peritoneum or the retro-orbital spaces.There is normal signal intensity intracranial venous sinuses and with normal pattern of enhancement.Images through the orbits demonstrate a small chronic right lamina papyracea blowout fracture.Paranasal sinuses demonstrate minimal chronic left maxillary sinusitis. Mastoid air cells demonstrate patchy opacification bilaterally.

Output: 1.No diffusion weighted abnormalities and no acute ischemic stroke. 2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.No detectable abnormal enhancement.4.Small right orbital lamina papyracea chronic blowout fracture.


Instruction: Generate impression based on findings.

Input: Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: ^Reason: pre op to use for navigation History: planning left suboccipital craniotomy for resection of cerebellar tumor The purpose of this imaging scan is preoperative localization using STEALTH protocol.Multiple fiducial markers attached on the scalp.There is a large [51.5 mm(RL) x 39.4 mm(AP) x 33 mm(CC)] posterior fossa likely extra axial mass with mass effect toward the left cerebellar hemisphere. The fourth ventricle appears to be deformed due to mass effect, with a slightly prominent ventricular system.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 51.5 mm(RL) x 39.4 mm(AP) x 33 mm(CC) sized left side posterior fossa likely extra axial mass with mass effects.


Instruction: Generate impression based on findings.

Input: Brain MRI:Lobular abnormality is noted centered within the clivus extending into the adjacent sphenoid sinuses (right greater than left). There are also several foci of signal abnormality throughout the calvarium.There are a few scattered foci of T2 hyperintensity within the white matter without restricted diffusion or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within left maxillary sinus. Fluid is also present within bilateral mastoid air cells.Limited cord compression spine MRI:Widespread abnormality can be found throughout the spine with vertebral body compression deformities at several levels. Multilevel stenoses are present throughout the cervical spine as well as at the T4-T6 levels secondary to a combination of degenerative changes as well as osseous expansion. There is also narrowing of the central canal from L3 through L4, also secondary to osseous expansion. There also appear to be foci of epidural extension at the T4/5 as well as L2/3 levels. There appears to be moderate central stenoses within the cervical spine, however severe at the T4-T6 levels, with more moderate stenoses involving the lumbar spine.

Output: 1.Minimal chronic small vessel ischemic disease. No acute ischemia.2.There is widespread myeloma involvement throughout the spine with vertebral body compression deformities at multiple levels throughout each segment, including possible epidural extension at the T4/5 as well as L2/3 levels.There appears to be moderate central stenoses within the cervical spine, however severe at the T4-T6 levels by definition resulting in cord compression, with more moderate stenoses involving the lumbar spine. Given the widespread skeletal pathology without comparison, it is uncertain the chronicity of the cord compression and stenoses.


Instruction: Generate impression based on findings.

Input: 22 years, Female, hx of MS here w leg weakness, blurred vision, R hand tremor, eval for PMS vs MS vs acute process Again seen are multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter throughout the bilateral cerebral hemispheres with morphology and distribution consistent with known demyelinating disease. There has been increase in size of multiple foci of enhancement (greater than 20) and T2/FLAIR hyperintensity associated with the lesions seen on recent MRI from 11/9/2016. A dominant tumefactive lesion in the left centrum semiovale again demonstrates small focus of enhancement as before but otherwise unchanged.Several posterior fossa lesions including the left middle cerebellar peduncle along the right lateral aspect of the fourth ventricle as well as left cerebellar hemisphere are similar to prior and do not demonstrate enhancement. There is a relatively mild burden of T1 hypointense lesions. Brain parenchymal volume is preserved.No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. There is also abnormal signal involving the partially imaged cervical cord with multiple foci of enhancement including the C2 and C4-C5 levels which are more conspicuous than on prior from 11/9/2016 although can be better assessed with dedicated cervical spine MRI.

Output: 1.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for hydrocephalus. Signs and symptoms: Gait instability. Non-enhanced CT of brain:Examination demonstrate a highly suspected loculated mass in the left cerebellum with extensive surrounding vasogenic edema. There is significant mass-effect on the fourth ventricle with near complete collapse of the ventricle. There is crowding of the cerebellar tonsils at the level of foramina magnum and effacement of prepontine and cerebellopontine angle cisterns as well as effacement and deformity of the quadrigeminal plate. Consistent with significant mass effect in the posterior fossa and upward transtentorial herniation.Images through supratentorial space demonstrates significant enlargement of the supratentorial ventricular system consistent with hydrocephalus. There are a few small foci of periventricular and subcortical low attenuation that although may represent small vessel disease considering patient's tumor but in the posterior fossa these areas of low attenuation may represent edema and metastatic lesions. A dedicated MRI with enhancement is recommended. There is no evidence of hemorrhage or midline shift.

Output: 1.Mass with extensive surrounding vasogenic edema in the left cerebellum with significant associated mass effect and upward transtentorial herniation.2.Supratentorial hydrocephalus.3.Dedicated MRI examination with enhancement is recommended.4.The above findings were relayed to Dr.Thomas Kelley from neurosurgery department at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Increasing forearm mass Note that a marker was placed along the volar aspect of the midforearm in the region of the patient's mass. Again seen is an irregularly-marginated mass within the underlying subcutaneous fat of the volar forearm that contacts the underlying deep peripheral fascia of the anterior compartment musculature. This mass extends to the skin with the overlying skin surface appearing thickened. It now measures approximately measures approximately 3.1 x 1.4 cm in the transverse dimensions and 6.1 cm in the longitudinal dimension as compared to 3 x 1 x 5 cm previously. The mass demonstrates irregular and spiculated margins and is slightly hyperintense to muscle on T1, hyperintense to muscle on T2, and shows diffuse enhancement following gadolinium administration. There is subcutaneous edema extending along the fascia both proximal and distal from the mass over the majority of the length of the forearm appearing similar to the prior exam. The mass again does not infiltrate the underlying musculature. The muscles of the forearm are normal in caliber and signal and the marrow signal of the radius and ulna is also normal. There is mild edema and enhancement of the subcutaneous fat posterior to the olecranon which may reflect mild inflammation.

Output: Increasing size of left forearm mass.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of acute intracranial hemorrhage, mass-effect, or shift. No abnormal extra-axial fluid collections are identified. The ventricles and cortical sulci are within normal limits. There is an abnormal soft tissue lesion identified intraconally with the left orbit measuring approximately 1.5 cm. This examination was not tailored for evaluation of the orbits. If further imaging is warranted dedicated orbital CT or MRI may be helpful.

Output: No evidence of acute hemorrhage or shift. Intraconal mass lesion involving left orbit. This was also identified on prior MR imaging from March 16, 2009.


Instruction: Generate impression based on findings.

Input: 67-year-old male with history of fall. MENISCI: There is a 12-mm ossicle within the posterior horn of the medial meniscus near its root ("meniscal ossicle") which likely reflects the sequela of an old meniscal root tear, as the root attachment itself is not visualized. There is also globular signal abnormality within the remainder of the posterior horn extending into the body indicating intrasubstance degeneration.Intrasubstance signal within the lateral meniscus also reflects degeneration, but we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: Severe osteoarthritis affects the knee, particularly at the patellofemoral joint, with portions of the lateral patellofemoral articulation essentially devoid of articular cartilage. There are multiple foci of degenerative signal abnormality within the underlying bone. There is moderate thinning of the articular cartilage along the medial femoral condyle just above the posterior horn of the medial meniscus. There are small subchondral cysts within the anterior aspect of the medial tibial plateau. There is relatively mild articular cartilage degeneration within the lateral compartment. There are tricompartmental osteophytes. LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.No evidence of ligamentous tear.2.Meniscal degeneration with no evidence of acute meniscal tear; however there is a large ossicle present within the posterior horn of the medial meniscus likely representing a chronic avulsion/root tear.3.Osteoarthritis most severely affecting the patellofemoral joint.4.Moderate-sized joint effusion.5.Mild soft tissue edema as described above including edema within the popliteus muscle perhaps representing a mild strain.


Instruction: Generate impression based on findings.

Input: 69-year-old female for follow-up of thyroid nodules. Prior right thyroid lobectomy and parathyroidectomy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: 4.2 x 1.9 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No massesLEFT LOBE: 2 masses are again noted in the left lobe of the thyroid. A lower pole mass that is solid with cystic components measures 0.7 x 0.8 x 1.4 cm. This was not measured in the prior study and is unchanged in size. A second, heterogeneous mass in the inferior left lobe involving the left isthmus measures 0.9 x 1.2 x 2.3 cm. When retrospectively remeasuring the prior exam, this is unchanged. In addition, this contains multiple areas of comet tail artifact consistent with colloid.ISTHMUS: See abovePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No mass in the right thyroid bed.No significant change in size of left thyroid masses, one of which clearly contains comet tail artifact.


Instruction: Generate impression based on findings.

Input: Reason: RIGHT HIP PAIN, PLEASE EVALUATE FOR LABRAL TEAR, PLEASE INJECT WITH KENALOG 40MG AT TIME OF MRI ARTHROGRAM History: right hip pain ACETABULAR LABRUM: There is a tear extending through the anterior superior labrum extending from the 1 to 2 o'clock position. Heterogeneity of signal of the posterior labrum suggests degeneration and degenerative tearing.ARTICULAR CARTILAGE AND BONE: We see no full-thickness cartilage defects. The bone marrow signal intensity of the right hip is within normal limits. Mild degenerative disc disease affects the level of L5/S1. Although this examination was not protocoled for detailed evaluation of the lumbar spine, there is also edema within the upper medial right sacral wing that we suspect may be degenerative in etiology.SOFT TISSUES: There is mild peritrochanteric edema bilaterally which is not necessarily of any clinical significance. There is mild edema seen on the coronal fat saturated T2-weighted images situated between the lesser trochanter and ischium, bilaterally, that could reflect ischiofemoral impingement. The hamstring origins appear intact. ADDITIONAL

Output: 1. Tear of the anterior superior labrum with additional degeneration/degenerative tearing of the posterior labrum.2. Mild edema between the lesser trochanter and ischium, bilaterally, may reflect ischiofemoral impingement, but the clinical significance of this is uncertain.3. Mild peritrochanteric edema of questionable significance.4. Degenerative arthritic changes of the lumbosacral spine which could be better evaluated with a dedicated lumbar spine MRI examination.


Instruction: Generate impression based on findings.

Input: Brain MRI:There are a few scattered punctate foci of T2 hyperintensity within bifrontal subcortical white matter, without restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size; incidental note is made of a cavum septum pellucid et vergae. 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 inferior aspect of bilateral maxillary sinuses. The remaining paranasal sinuses and mastoid air cells are clear. Incidental note is made of a a few postinflammatory cysts within the nasopharynx. There is no abnormal enhancement within the brain. Cervical spine MRI:There is straightening of the cervical spine which is likely positional. The marrow signal is benign. The cervical and upper thoracic cord is normal in signal without abnormal enhancement. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. There is no significant degenerative disease or stenoses. There are no abnormal enhancing foci.

Output: 1.There are a few scattered punctate foci of T2 hyperintensity within bifrontal subcortical white matter, without restricted diffusion, susceptibility abnormality, or enhancement. These are nonspecific in appearance, and the differential diagnosis would most likely include small vessel disease, migraine sequelae, or residua from previous head trauma. Given lesional morphologies and locations, demyelination is to be unlikely.2.Negative contrast enhanced cervical spine MRI.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with one episode of right lower extremity numbness, and now with right T6-T10 numbness, urinary incontinence, and new headaches. Brain:A 6 mm enhancing lesion is evident along the roof of the right lateral ventricular body without significant mass effect. No additional enhancing lesions are seen. However, at least 10 scattered foci of T2/FLAIR hyperintensity are seen within the bilateral periventricular white matter, particularly clustered in the parietal regions, with additional focal lesions in the right pons and left brachium pontis. None of these lesions shows significant enhancement, but rather, several demonstrate conspicuous T1 hypointensity.No evidence of any significant parenchymal edema or mass effect is seen. Brain parenchymal volume is preserved. No intracranial hemorrhage or abnormal extra-axial fluid is detected. The ventricular system is normal in size and morphology.Thoracic spine:There may be a slight scoliotic curvature of the thoracic spine, but this could also be positional. Sagittal alignment is unremarkable.Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement, enhancement or edema are seen.A suggestion of T2 signal abnormality is noted within the left lateral cord at the C6-7 level, though this is evident on the first slice of the sequence only and may therefore be artifactual. More convincing T2 hyperintensity is seen within the right lateral cord at the T5 level, extending in the CC dimension for approximately one vertebral body length. No convincing pathologic spinal cord enhancement is observed.The intervertebral discs are preserved. No significant bulge or herniation is seen. The spinal canal and neural foramina are patent.

Output: Multiple white matter lesions are identified in the brain involving the periventricular regions bilaterally and the pons. One lesion, along the roof of the right lateral ventricle, demonstrates enhancement, while the remainder do not.Also noted is a nonenhancing T2 hyperintense lesion within the right lateral spinal cord which spans approximately one vertebral body in length. There may be an additional lesion in the left lateral cord at C6-7 but this is suboptimally evaluated.The above findings are most likely to represent demyelinating disease. The possibility of some other inflammatory or autoimmune process would be less likely.


Instruction: Generate impression based on findings.

Input: 57-year-old female with right shoulder pain. ROTATOR CUFF: There is mild heterogeneity of the supraspinatus suggesting mild tendinosis, but we see no fluid-filled tear. 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: Mild osteoarthritis affects the acromioclavicular joint. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is no evidence of joint effusion. There is intermediate signal intensity within the superior labrum suggesting degenerative tearing. The anterior superior labrum is attenuated which may represent additional degenerative tearing. The inferior labrum appears intact. BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps which is of questionable significance.

Output: 1. Mild tendinosis of the supraspinatus tendon without evidence of a rotator cuff tear.2. Mild osteoarthritis of the acromioclavicular joint.3. Degenerative tearing of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: Brain:Again seen are extensive postsurgical changes involving the calvarium including left and posterior calvarial cranioplasty as well as a suboccipital craniectomy and cranioplasty, better seen on prior CT. Again seen is a right posterior approach shunt catheter which courses within the right lateral ventricle and terminates near the callosal body. A stent is again seen extending between the cerebral aqueduct and dorsal subarachnoid space at the foramen magnum. The right lateral and third ventricles remain slitlike, unchanged. The left lateral ventricle is relatively larger but not particularly dilated and unchanged since 2/3/2014. The fourth ventricle remains enlarged, unchanged in extent, partially on an ex-vacuo basis secondary to encephalomalacia involving the inferior cerebellar hemispheres (right greater than left) and vermis. The degree of T2 and flair signal alteration involving the cerebellar hemispheres and vermis is stable. No areas of diffusion restriction is seen to suggest an acute ischemic event. There is high T2/FLAIR signal involving the bilateral cavernous sinuses extending into the bilateral tentorium favored to represent dural thickening/venous engorgement related to chronic shunting, and more pronounced when compared to more remote studies dating back to 2009. There is FLAIR hyperintensity along the surface of the left temporal lobe, which is new since 2/3/2014 MRI and may represent gliosis related to prior left-sided craniotomy and/or adjacent extra-axial collection seen on CT from March 20, 2014.CSF flow study redemonstrates biphasic flow anteriorly at the foramen magnum with no discernible CSF pulsation posteriorly, similar to the prior examination. As before, no definite evidence of CSF flow pulsation through the cerebral aqueduct, within the fourth ventricle, or through the stent. High-resolution 3-D T2 sequence also demonstrates focally diminished CSF space dorsally at the foramen magnum.Cervical spine: Motion degradation on the current and prior studies limit assessment, but there appears to be slight increase in size of the cervical syrinx at the C2 and C3 levels. The more inferior aspect of the syrinx extending from C4 to C7 is not appreciably changed and measuring approximately 10 x 9 mm at the C5-C6 level.A central disk protrusion asymmetric to left is present at C6-C7 with ligamentum flavum thickening similar to prior. Right paracentral disc protrusion at C7/T1 is also similar in appearance to the prior examination. There remains mild spinal canal stenosis from C5-C6 to the C7-T1 levels as before.

Output: 1. Compared to MRI brain dated 2/3/2014 there is no significant change in appearance of the posterior fossa with evidence of prior Chiari decompression, fourth ventricular stent, as well as effaced CSF spaces and diminished flow dorsally at the foramen magnum.2. No significant change in size of the ventricular system without evidence of hydrocephalus. Unchanged slitlike right lateral ventricle and relatively larger left lateral ventricle. 3. Again seen is a cervical syrinx. Compared to 2/3/2014, there appears to be mild increase in size of the syrinx component at the C2 and C3 levels. The more inferior aspect of the syrinx which is larger extending from C4 to C7 is not significantly changed.4. Please see additional details above.


Instruction: Generate impression based on findings.

Input: 25 year-old woman with history of knee pain status post motor vehicle accident. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is a small focus of bone marrow edema affecting the lateral condyle of the femur, however there is no acute fracture. The articular cartilage of the knee is intact.LIGAMENTS: The ACL, PCL, MCL, and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Bone contusion of the left lateral condyle.


Instruction: Generate impression based on findings.

Input: History of abdominal pain and biliary dilatation on recent CT. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again is intrahepatic and extrahepatic biliary ductal dilatation with the common bile duct measuring up to 1.4 cm. This is similar to the recent 1/5/2015 CT of the abdomen and 10/9/2015 CT of the chest. It appears to taper smoothly at the level of the ampulla without a filling defect or discrete mass lesion. The intrahepatic ducts are mildly tortuous near the confluence of the left and right hepatic ducts. There is no abnormal duct wall enhancement.No focal liver lesion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Minimal calyectasis of the right renal inferior pole collecting system versus renal sinus cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Small right-sided Tarlov cyst is noted.OTHER: Susceptibility artifact from an ASD Amplatz closure device.

Output: Intrahepatic and extrahepatic biliary ductal dilatation to the level of the ampulla without associated pancreatic ductal dilatation, similar to CT from 10/09/2015. No filling defect, mass lesion or evidence of stricture. This may represent progressive changes from postcholecystectomy state.


Instruction: Generate impression based on findings.

Input: Reason: hx atypical meningioma. Eval for growth History: none- surveillance Postoperative changes are again seen from previous right parietal craniotomy with paramedian craniectomy with subsequent cranioplasty.There is a small focus of diffusion restriction and intrinsic T1 hyperintensity anterior to the left paramedian parietal resection cavity with peripheral susceptibility, likely representing a small hematoma. There are other areas of other curvilinear susceptibility along the parietal lobes bilaterally, greater on the left side, consistent with chronic hemosiderin deposition. There is a similar configuration of extra-axial fluid subjacent to the craniectomy.There is redemonstration of an irregular heterogeneously enhancing nodule along the left parietal lobe at the upper margin of the resection cavity. Overall the pattern of enhancement appears slightly less confluent than on the prior exam, with a more lacelike appearance despite similar order of postcontrast imaging. This area of nodular enhancement measures up to 2.4 cm on the current exam on 1201/122, compared to previous comparable 2.8 cm. However, the rind of enhancement along the anterior aspect of the resection cavity measures 8 mm in greatest thickness on the current exam, previously 5 mm. In addition, there is a small area of new nodular enhancement anteromedial to the resection cavity as seen on 1201/128 which measures 6 x 5 mm in greatest axial dimensions. More inferiorly, this area of nodularity is again confluent with the prominent nodular enhancement located along the inferior aspect of the resection cavity extending to the right of midline which appears similar in overall size.The degree of T2/FLAIR hyperintensity within the surrounding parietal lobes in a vasogenic pattern appears similar. Areas of cystic degeneration are again seen along the right parietal lobe appears stable in size. Other scattered foci of nonspecific T2/FLAIR hyperintensity are seen within the periventricular and subcortical white matter. Ventricular caliber appears similar consistent with global volume loss.There is persistent left frontal sinus opacification. Scattered ethmoidal air cell opacification is also noted.

Output: 1.Findings concerning for slight progression of tumor at the site of prior tumor resection in the high parietal regions, although slight decreased size and confluence of enhancement of the more superior posterior heterogeneous nodule.2.Stable pattern of edema the parietal lobes with evidence of cystic encephalomalacia in the right parietal lobe.3.Small focus of likely interval blood product anterior to the resection cavity.


Instruction: Generate impression based on findings.

Input: Known osteochondral defect MENISCI: The medial meniscus is unremarkable. The lateral meniscus however demonstrates fraying of the inner edge with more discrete loss involving the apical aspect involving the posterior horn. Specifically extension is observed to the inferior articular surface. Both menisci are well anchored posteriorlyARTICULAR CARTILAGE AND BONE: The large medial femoral condyle osteochondral defect is again observed measuring 2 cm in both AP dimension and medial laterally. Depth approximately 6 mm in the defect extends up to and just touching the intercondylar notch. No evidence of underlying loosening or abnormal fluid.Marrow signal is otherwise unremarkable. The remaining cartilage is otherwise also unremarkable without focal defectsLIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Large medial femoral condylar osteochondral defect and minimal apical lateral meniscal tear extending into the posterior horn.


Instruction: Generate impression based on findings.

Input: No findings to suggest a seizure focus are appreciated. No evidence of cortical dysplasia, heterotopic gray matter, or loss of gray-white differentiation. There is no evidence of mass or acute infarct. There are no areas of abnormal parenchymal signal. The hippocampal formations are symmetric; normal in size and signal intensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Borderline low-lying cerebellar tonsils are again seen measuring up to 3-4 mm below the foramina magnum on the right. The midline structures and craniocervical junction are otherwise normal. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is paranasal sinus mucosal thickening most prominent in the maxillary sinuses where there is also a retention cyst.

Output: 1. No evidence for mass or structural abnormality to suggest seizure focus.2. Borderline low-lying cerebellar tonsils without clear evidence of Chiari 1. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 63-year-old male with GBM. Off all treatments. Previously was on Avastin. Signs and symptoms: GBM. Pre and postcontrast enhanced brain MRI:Diffusion weighted images demonstrate a punctate focus of restricted diffusion in the subcortical white matter of the right superior temporal gyrus posteriorly (diffusion-weighted series 5 image 18).Examination demonstrate a large focus of FLAIR hyperintensity in the pattern of vasogenic edema however without mass effect in the right hemisphere extending from high convexity right posterior frontal to right parietal and extensively in the right posterior temporal region consistent with gliosis and with ex vacuo dilatation of right trigone of lateral ventricle. Minimal hemorrhagic changes in the right posterior temporal at the site of prior surgical intervention is again noted. No appreciable change since prior exam.Post enhanced images demonstrate no evidence of residual or recurrence of tumor. A very thin linear enhancement traversing the posterior edge of surgical cavity is identical to prior exam.Small focus of periventricular FLAIR hyperintensity in the left hemisphere similar to prior exam and highly suggestive of treatment changes.Subtle FLAIR hyperintensity in the pons similar to prior study and could represent posttreatment change or chronic small vessel ischemic stroke. Tiny small focus of FLAIR hyperintensity in the right cerebellum without enhancement or interval change since prior exam is also noted.Slight prominence of lateral ventricles with maintained midline is similar to prior exam.

Output: 1.Punctate focus of restricted diffusion in the right superior temporal sinus posteriorly.2.Stable post operative and treatment changes of right posterior temporal lobe tumor without evidence of tumor recurrence as detailed.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: new right frontal mass History: LLE weakness There are irregular margin heterogeneously enhancing intra-axial masses one on the right middle frontal gyrus with the surrounding edema and another lesion on the right post central gyrus extended toward right superior parietal lobule. Both lesions show mixed signal intensities with enhancement. The right post central gyrus lesion shows restricted diffusion with subtle increase in CBV on perfusion imaging indicating high cellularity mass lesion instead of ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable except subtle mass effect toward right lateral ventricle. There are multiple small signal voids within the right middle frontal gyrus lesion indicating intra-tumoral hemorrhages.The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multifocal irregular margined mixed enhancing masses with surrounding edema, differential diagnosis include multifocal primary intraaxial high grade glial tumor. Metastatic tumors are also one of differential diagnosis.


Instruction: Generate impression based on findings.

Input: Bladder CA status post radical cystectomy. Evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Cholelithiasis without cholecystitis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. No suspicious renal lesion. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Postoperative changes of a cystectomy and neobladder creation, without evidence of complication. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal non-specific pelvic free fluid.

Output: No evidence of recurrent or metastatic disease.


Instruction: Generate impression based on findings.

Input: 64-year-old male with left knee pain. Evaluate medial meniscus. MENISCI: The lateral meniscus appears intact. There is increased signal abnormality and deformity of the posterior horn of the medial meniscus consistent with degenerative tearing. ARTICULAR CARTILAGE AND BONE: There is thinning of the articular cartilage most pronounced along the medial tibiofemoral compartment with foci of full-thickness and near full-thickness articular cartilage defects. There are foci of underlying bone marrow signal abnormality which are likely degenerative in etiology. No sign of tricompartmental degenerative changes including osteophyte formation and joint space narrowing.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Degenerative arthritic changes most pronounced along the medial tibiofemoral compartment with associated degenerative tearing of the posterior horn of the medial meniscus and articular cartilage degeneration, as described above.


Instruction: Generate impression based on findings.

Input: History of peak 53 mutation. Presents for cancer screening. SOFT TISSUES OF THE NECK: No significant abnormality noted.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 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:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedFEMURS: Within the distal diaphysis of the right femur there are several distinct adjacent very well-defined lobular medullary lesions which are mildly hyperintense on T1-weighted imaging relative to skeletal muscle and is homogenously hyperintense on T2-weighted imaging. There is mild expansion of the mid/distal femoral diaphysis. There is suggestion of peripheral sclerosis of the lesions. The extent of abnormality measures 10.2 cm in length (series 1001/13). There is no associated restricted diffusion or cortical breakthrough evident. There appears to be thin peripheral enhancement of the lesion, however this was not a dedicated post-contrast study.

Output: Incompletely characterized lesions involving the distal right femoral diaphysis likely representing a benign etiology such as non-ossifying fibroma. Further evaluation with radiographs and dedicated imaging is recommended to exclude a less likely diagnosis of sarcoma. These findings and recommendations were discussed with the referring physician Dr. Onel.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness 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.There is a mild 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 demonstrates a mucosal thickening in left sphenoid sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate medial deviation of the medial wall of the right orbit probably related to old right medial blowout fracture

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


Instruction: Generate impression based on findings.

Input: Right shoulder pain not responsive to physical therapy. ROTATOR CUFF: The rotator cuff muscles and tendons are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal in appearance. No fluid is noted within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. The articular cartilage is intact.The labrum is grossly within normal limits on this non-augmented evaluation.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

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


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are bilateral digital mammographic images (7/17/14), right digital mammographic images (7/24/14), left digital mammographic images (5/22/15), ultrasound images of right breast (7/24/14), ultrasound images of left breast (5/22/15), breast MRI (6/19/15) performed at Edward Hospital. For comparison, digital mammographic images (1/12/13, 12/4/10) are available. BILATERAL DIGITAL MAMMOGRAPHIC IMAGES (7/17/14):The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. RIGHT DIGITAL MAMMOGRAPHIC IMAGES (7/24/14):No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast.LEFT DIGITAL MAMMOGRAPHIC IMAGES (5/22/15):No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast.ULTRASOUND IMAGES OF RIGHT BREAST (7/24/14): There are no abnormal findings in the submitted images.ULTRASOUND IMAGES OF LEFT BREAST (5/22/15):There are no abnormal findings in the submitted images.BREAST MRI (6/19/15):MRI was performed with a protocol outlined in the outside radiology report.Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No mammographic, sonographic or MRI evidence of malignancy.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 92 year-old female. Follow-up ICH. Intraparenchymal hemorrhage is present in the right frontal pole. Edema is present throughout the right cerebral hemisphere with effacement of the cortical sulci which is most pronounced in the frontal pole. Accounting for differences in technique, these findings appear grossly unchanged when compared to the MRI dated 4/21/2009.The hemorrhage associated edema exerts mass effect upon the right lateral ventricle. Approximately 6 mm of midline shift and subfalcine herniation is present at the level of the genu of the corpus callosum. The basal cisterns appear preserved.In addition to the parenchymal hemorrhage, subarachnoid blood is noted along the right frontotemporal region and in the left frontal convexity.Mucosal thickening and an air-fluid level (likely blood) are present in the left maxillary sinus. Scattered mucosal thickening is present in the ethmoid air cells. Scattered opacification is present in the mastoid air cells bilaterally.Fracture is present in the left posterolateral aspect of the maxilla (series 3 image 3). Bruising is noted in the soft tissues of the left facial region.

Output: 1. Right frontal lobe parenchymal hemorrhage with associated cerebral edema, mass effect, and midline shift. Accounting for differences in technique, these findings appears grossly unchanged from the MRI dated 4/21/2009.2. Maxillary fracture as detailed above. If this injury has not been previously evaluated, consider maxillofacial CT.3. Additional abnormalities as detailed above.


Instruction: Generate impression based on findings.

Input: 60 year old with metastatic breast cancer. Now with new stroke seen on MRI. Signs and symptoms: new stroke stroke seen on brain MRI. CTA of intracranial circulation:65 cc of omni-350 is administered for this study.3-D reformatted images of this study were obtained utilizing a independent workstation. These images were utilized for interpretation on this exam. Additional 2-D reformatted images as well as MIP images were also utilized.CTA of intracranial circulation:Examination demonstrates patent and normal appearing bilateral internal carotid arteries across to skull base and in their supraclinoid portions. There are normal appearing patent bilateral posterior communicating arteries.Bilateral ophthalmic arteries are also visualized and unremarkable.Bilateral anterior and middle cerebral arteries with no evidence of pathology. Anterior communicating artery is unremarkable.There is a small left vertebral artery (hypoplastic nondominant). The left pica is visualized and unremarkable. The distal portion of left vertebral artery is extremely small and hypoplastic. This is a normal anatomical variation.The patent dominant right vertebral artery is also very small in size in a uniform fashion. The right pica is visualized and unremarkable. The basilar artery is small in it's caliber in a uniform fashion however remains patent throughout its course.The small size of the vertebral -- basilar system is believed to be secondary to prominent bilateral posterior communicating arteries.None infuse head CT:Examination again demonstrates a large area of vasogenic edema surrounding a mass in the right lateral aspect of the cerebellum measuring approximately 34 x 25-mm in size as was noted on prior MRI exam. There is significant mass effect on the fourth ventricle and anterior displacement and partial collapse of the fourth ventricle. This results in early onset of hydrocephalus of supratentorial ventricular system. Mass-effect in the posterior fossa and results in minimal effacement of the quadrigeminal plate cistern as well.Images through supratentorial space again demonstrate a focus of attenuation in the left periventricular white consistent with patient's known acute stroke described on prior MRI. There is no evidence of hemorrhagic transformation. There is no evidence of any new finding since prior exam.

Output: 1.CTA of intracranial circulation demonstrates no detectable abnormality of bilateral internal carotid arteries, middle and anterior cerebral arteries and their branches. There are prominent bilateral posterior communicating arteries. There is small caliber of bilateral vertebral arteries and basilar artery in a uniform fashion which is believed to be due presence of large bilateral posterior communicating arteries. There is however no evidence of any definitive vascular lumen compromise of the vertebral -- basilar system infectious carotid disease and or dissection.2.None infuse head CT demonstrates right cerebellar tumor with surrounding vasogenic edema and mass effect on the fourth ventricle. Resultant mild hydrocephalus and supratentorial ventricles. These findings remain stable since prior MRI exam. Stable left periventricular white matter stroke with no interval change.


Instruction: Generate impression based on findings.

Input: History of hepatitis C cirrhosis presents for HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic fibrotic liver morphology. No focal suspicious lesion, biliary ductal dilatation or vascular abnormality.Normally distended gallbladder.SPLEEN: Splenomegaly measuring 19.9 cm in the craniocaudal dimension.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: Gastroesophageal varices.BONES, SOFT TISSUES: Susceptibility artifact from lower lumbar spinal fusion hardware.OTHER: No significant abnormality noted.

Output: Cirrhosis without a suspicious lesion. Gastroesophageal varices and splenomegaly.


Instruction: Generate impression based on findings.

Input: Ms. Discipio is a 67-year-old female with known left breast cancer. Recent MRI demonstrated an indeterminate enhancing mass in the right upper inner breast. She presents today for MR directed ultrasound of this finding. A targeted right ultrasound was performed for the MRI/mammographic area of concern. In the right breast 2:00 location, approximately 2 cm from the nipple, two adjacent anechoic lesions are identified, measuring up to 8 x 2 x 4 mm. These are compatible with simple cysts. Additional similar appearing cysts are seen in the vicinity. These correspond to the MRI area of concern.

Output: Multiple small cysts in the right upper inner breast, corresponding to the MRI area of concern. No sonographic evidence of malignancy. No additional imaging workup is necessary for the right breast. All results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation.


Instruction: Generate impression based on findings.

Input: Syrinx of cervical and thoracic spine with adhesions. LP shunt. Worsening symptoms. Evaluate for changes. Examination is motion degraded. Again seen are are extensive postsurgical changes of suboccipital craniectomy and multiple cervical and thoracic laminectomies. Again seen is kyphotic attenuation of the cervical spine. Vertebral body heights are maintained. There are small disc protrusions at the C3-C4 to C5-C6 levels as well as a disc bulge at the C6-C7 level which are similar to prior and not associated with significant spinal canal stenosis. There is moderate to severe stenosis involving the right C3-C4 neural foramen and mild to moderate right and mild left neural foraminal stenosis at the C4-C5 level.Compared to 6/12/2014 there are areas of slight decrease in size of the cervical syrinx, which extends from the obex to the upper C6 level. For example at the mid C2 level syrinx measures 10 mm in the AP dimension previously 13 mm. At the right C4-C5 level, syrinx measures 3 to 4 mm in the AP dimension, previously 5 mm. There is significant volume loss involving the cervical and partially imaged thoracic cord as seen before with particular thinning at the lower cervical and thoracic level. The cord is posteriorly positioned along the posterior dural margin particularly at the cervicothoracic junction suspected to be related to adhesions. Position of the catheter within the syrinx from the C2-C4 level is similar to prior. A separate thoracic catheter is partially imaged. Thoracic syrinx which extends below the T2 level is seen only on the sagittal sequences.Diffuse calvarial thickening is partially imaged.

Output: 1. Note patient could not tolerate the full requested studies and only cervical spine MRI could be obtained. There is mild decrease in size of the cervical syrinx compared to 6/12/2014. Thoracic syrinx is partially imaged and not adequately assessed.2. Significant volume loss involving the cervical and thoracic cord as seen previously with particular flattening and posterior position of the upper thoracic cord which may be related to adhesions.


Instruction: Generate impression based on findings.

Input: Reason: Concern for AVN on recent Xray History: Has been on steroids for radiation pneumonitis Bone marrow signal intensity of the imaged proximal right femur is within normal limits. Similarly, bone marrow signal intensity of the imaged left proximal femur is within normal limits. Bone marrow of the bony pelvis is also normal in appearance. Mild osteoarthritis affects both hips. The musculature of the lower abdomen, hips and proximal legs is unremarkable.

Output: No evidence of avascular necrosis.


Instruction: Generate impression based on findings.

Input: 32 year old woman with coarctation of the aorta s/p bypass graft referred for repeat cardiac MRI for evaluation of her aorta. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 69%, the LV end diastolic volume index is 75 ml/m2 (normal range: 65+/-11), the LVEDV is 154 ml (normal range 109+/-23), the LV end systolic volume index is 23 ml/m2 (normal range 18+/-5), the LVESV is 48 ml (normal range 31+/-10), the LV mass index is 52 g/m2 (normal range 67+/-11), and the LV mass is 106 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No intracardiac thrombus.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 76 ml/m2 (normal range 69+/-14), the RVEDV is 157 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 89 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Aortic valve is trileaflet.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. There is no thoracic aortic aneurysm or thoracic aortic dissection. There is evidence of a severe aortic coarctation with nearly complete occlusion of the descending aorta just distal to the left subclavian artery. The coarctation is bypassed by a graft originating at the level immediately distal to the left subclavian artery origin. The graft is widely patent. The mean gradient across the bypass graft is negligible (1.4mmHg).Sinus of Valsalva: 29 x 30mmSinotubular Junction: 27mmAscending Aorta: 28 x 26mmDescending Aorta: 18 x 18mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is evidence of a severe aortic coarctation with nearly complete occlusion of the descending aorta just distal to the left subclavian artery. The coarctation is bypassed by a graft originating at the level immediately distal to the left subclavian artery origin. The graft is widely patent.2. Normal LV size and systolic function (LVEF 69%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.3. Normal RV size and systolic function (RVEF 57%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of DM, HTN, and ESRD admitted for kidney transplant yesterday. The patient had an episode of lost of consciousness, hypoxia, hypotension, and no urine output for about 15 minutes and has central sleep apnea. MRI: There is band-like high T2 signal in the pons and bilateral middle cerebellar peduncles. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the right mastoid air cells. There appears to be swelling and T2 hyperintensity of the right upper lip, which may be post-traumatic.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms.

Output: 1. Band-like signal abnormality in the pons and bilateral middle cerebellar peduncles along the expected course of the pontocerebellar fibers may represent an atypical form of posterior reversible encephalopathy syndrome, an unusual form of osmotic demyelination, drug-induced effects, or other toxic metabolic effect.2. No evidence of significant cerebrovascular steno-occlusive lesions.Discussed with Dr. Bodzin at 4:30 PM on 12/31/15.


Instruction: Generate impression based on findings.

Input: right side face and arm weakness, worse overnight. known pancreatic cancer. There are multifocal bihemispheric as well as bilateral cerebellar hemispheric restricted diffusion lesions indicating acute ischemic infarction. The most prominent restricted diffusion lesions are on the left side fronto-parietal white matter which correspond to the patient's clinical symptom.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. Ventricle size remains within normal limits. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate sudden cut off of the left MCA M2 segment indicate embolic occlusion. However, a frontal branch of the left MCA and left angular artery appear to be patent. Acom artery is patent.Left PCA is fetal origin and the right Pcom artery is patent. There is no evidence of intracranial arterial aneurysm.

Output: 1. Bihemispheric and cerebellar hemispheric multifocal scattered acute ischemic infarctions without evidence of hemorrhagic conversion as described above.2. Occlusion of the left MCA proximal M2 segment with frontal branch and left angular artery patency.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: headache h/o MS History: headache h/o MS Brain MRIMultifocal FLAIR/T2 high signal intensity lesions on bihemispheric white matter consistent with demyelinating disease.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. Multifocal bihemispheric white matter lesions consistent with demyelinating disease.2. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with weakness. Evaluate for cord compression. Cervical spine MRI:A longitudinal collection of T2 hyperintense, mildly T1 hyperintense material with rim susceptibility is seen intradurally occupying the right ventral and lateral thecal sac beginning at C1 and continuing down to C4-5. This material, which shows signal characteristics compatible with hemorrhage, appears to contact the spinal cord and causes a posterior and lateral displacement of the cord.The above findings are compounded by the presence of large posterior disc osteophytes in the left paracentral zone at C3-4 and in the right paracentral/foraminal zone at C4-5. The spinal cord is moderately impinged in these areas and seems to demonstrate subtle parenchymal T2 hyperintensity.Straightening of cervical lordosis is seen. Vertebral body heights are grossly preserved allowing for degenerative endplate irregularity. Vertebral body marrow signal characteristics are mildly heterogeneous, but no concerning areas of edema or marrow replacement are demonstrated.C2-3: Thickening of the posterior longitudinal ligament. Right ventral intradural hemorrhage causing displacement of the cord. Otherwise, no significant spinal canal or foraminal stenosis.C3-4: The combination of intradural blood and left paracentral disc osteophyte formation cause a moderate to severe spinal canal stenosis with impingement of the left ventral cord. No significant foraminal narrowing.C4-5: Large right paracentral/foraminal disc osteophyte causing severe narrowing of the right aspect of the spinal cord and flattening of the cord parenchyma. Mild right foraminal narrowing. C5-6: Moderate posterior disc-osteophyte complex formation with mild generalized spinal canal stenosis and moderate to severe bilateral foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation without significant spinal canal or foraminal stenosis. C7-T1: No significant spinal canal or foraminal stenosis. The enlarged multinodular thyroid gland is redemonstrated.Cord compression MRI:Evidence of intradural hemorrhage in the cervical region is better described above. Elsewhere, no acute cord compression is seen. The thoracic spine is free of significant stenosis. Multilevel disc degeneration is evident in the lumbar spine with resultant bulging at L2-3 through L4-5. The spinal canal and neural foramina are likely chronically narrowed at these levels.

Output: 1.An intradural hematoma is evident in the cervical region occupying the right ventral aspect of the thecal sac beginning at C1 and continuing down to the C4-5 level. This collection exerts some mass effect upon the spinal cord. While this hematoma is clearly intradural, it may be either subdural or subarachnoid in location.2.Superimposed on the hematoma is severe disc osteophyte disease causing further spinal canal stenosis and cord impingement at C3-4 and C4-5. The spinal cord in this area demonstrates possible subtle abnormal signal which could indicate edema or myelomalacia.3.No additional areas of acute cord compression are seen. Advanced degenerative findings are noted in the lumbar region which do likely narrow the spinal canal and neural foramina, but these findings are probably chronic.


Instruction: Generate impression based on findings.

Input: 24 years Female (DOB:12/23/1991)Reason: hx hydrocephalus. VPS removed. Eval for vent sizes History: headachesPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM There is asymmetry in the size of the lateral ventricles with the left being slightly larger than the right but unchanged compared to prior exam. The septum pellucidum is bowed towards the right side. There is redemonstration of T2 and FLAIR signal hyperintense tracts along the right parietal lobe and left frontal lobe.The patient is status post burr hole placement adjacent to the left coronal suture. The patient is status post burr hole along the right parietal bone. A ventriculostomy tube is not currently identified.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 vein of Galen appears small as does the straight sinus. There is obtained of the venous structures at the region of the vena Galen. The middle cerebral artery vasculature also appears tortuous at the sylvian fissures.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The cerebellar tonsils extend approximate 5 mm below the level of the foramen magnum.

Output: 1.The patient is status post previous ventriculostomy tube placement. There is no ventriculomegaly at this time.2.Low-lying cerebellar tonsils.3.Tortuous intracranial vasculature is a nonspecific finding.


Instruction: Generate impression based on findings.

Input: 41-year-old man with history of hepatitis B and lesion noted in the right hepatic lobe on outside imaging. ABDOMEN:LIVER, BILIARY TRACT: There is an 11 x 8 mm T2 hyperintense focus in segment IVb (series 1001, image 23), a 10 x 9 mm the 2 hyperintense focus in segment 5 (series 1101, image 20), and an 11 x 6 mm T2 hyperintense focus in segment 6 (series 1101, image 16). All of these foci demonstrate nodular enhancement in the arterial phase, gradually fill in, and are hyperenhancing relative to the liver on the delayed phase of imaging. Otherwise, the liver is normal in signal and morphology. The gallbladder is normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Simple renal cysts are seen bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The visualized portions of small bowel and colon appear normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple small liver hemangiomata.


Instruction: Generate impression based on findings.

Input: Ms. Robbins is a 27-year-old female who presents for initial screening MRI. Family history of breast cancer (mother 36, maternal aunt 50s, paternal grandmother 70s). No current breast complaints. There is extreme amount of fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.There are four oval circumscribed enhancing masses identified bilaterally (two - left breast, two - right breast). The largest of these masses is located in the left upper inner breast (approximately 10:00 position), measuring approximately 12 x 9 x 12 mm. The three additional circumscribed masses, located in the lower outer left breast (approximately 5:00 position), right retroareolar region, and lower inner right breast (approximately 6-7:00 position), have similar imaging features. MR findings are suggestive of bilateral benign fibroadenomas. No abnormal lymph nodes are identified in either axillary region.

Output: High probability benign fibroadenomas in both breasts as described above. A short term 6 month follow-up MRI is recommended to document stability of these findings.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 65 year old man who is s/p heart transplant and referred for evaluation of transplant arteriopathy. First Pass PerfusionDuring hyperemia, there is a non-transmural perfusion defect which involves the mid and apical septum, apical inferior, and apical lateral wall. The overall ischemia score is 4 out of 32 and 12% of the myocardium is ischemic. The ischemia is most likely in the the distal LAD territory. Viability/ Myocardial ScarThere was no of prior myocardial infarction. The entire myocardium is viable. However, there is a small, focal area of late gadolinium enhancement involving the basal inferior wall. The pattern is atypical for prior myocardial infarction and may be due to a prior episode of rejection. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 57%, the LV end diastolic volume index is 73 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 32 ml/m2 (normal range 25+/-9), the LVESV is 60 ml (normal range 47+/-19), the LV mass index is 48 g/m2, and the LV mass is 90 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is dilated consistent with transplant history. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 80 ml/m2 (normal range 82+/-16), the RVEDV is 151 ml (normal range 142+/-31), the RV end systolic volume index is 39 ml/m2 (normal range 31+/-9), and the RVESV is 75 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsSternal wires are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is mild ischemia in the usual distribution of the distal left anterior descending artery territory.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 57%). There is a very small amount of atypical late gadolinium enhancement in the basal inferior wall which represents underlying myocardial fibrosis, inflammation, and infiltration which is most likely due to an old episode of rejection. The pattern is atypical for prior myocardial infarction.4. Normal RV size and systolic function (RVEF 51%).


Instruction: Generate impression based on findings.

Input: 74 years Male (DOB:1/21/1942)Reason: Dr. Christoforidis acute stroke protocol to evaluate if candidate for IR intervention with MR perfusion History: rt sided weaknessPROVIDER/ATTENDING NAME: DAVID A HARTER DAVID G. BEISER MRI of the brainThere are multiple foci of diffusion restriction present. One in the right cerebellar hemisphere measures 33 x 28 mm axial dimensions. There are several smaller 1's scattered in both cerebellar hemispheres. There is a focus of diffusion restriction involving the left lingual and fusiform gyri as well as the left hippocampus measuring approximately 75 x 22 mm axial dimensions. Another focus of diffusion restriction is present in the left thalamus which measures 11 x 9 mm axial dimensions. Another one present in the left cuneus measures 5 mm in size. Many of these are associated with FLAIR signal hyperintensity with the exception of the left thalamic lesion.Perfusion imaging is suboptimal due to early triggering.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 mucous retention cysts. 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 right posterior cerebral arteries.There is occlusion of the left posterior cerebral artery at the proximal P2 segment. There is focal narrowing of the mid basilar artery with approximately 50% stenosis.The right vertebral artery is larger than the left vertebral artery. The left posterior inferior cerebellar artery is not readily identified though the right posterior inferior cerebellar artery is relatively larger.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The right A1 segment is hypoplastic. The posterior communicating arteries are small to medium sized.

Output: 1.There are multiple foci of cerebral infarction manifested there is diffusion restriction in the posterior circulation involving left medial temporal lobe, left occipital lobe and the cerebellar hemispheres.2.There is occlusion of left posterior cerebral artery at the proximal P2 segment.3.50% focal stenosis at the mid basilar artery.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.Perfusion imaging is suboptimal due to early triggering.Findings were reported to Dr ALSHAIKH, JUMANA TARIQ


Instruction: Generate impression based on findings.

Input: Reason: Meniscus tear History: Catching and locking. MENISCI: Globular intrasubstance signal within the lateral meniscus compatible with degeneration.Undersurface fraying and degenerative tearing of the anterior horn of the medial meniscus. The posterior horn of the medial meniscus is small with medial extrusion compatible with degeneration. ARTICULAR CARTILAGE AND BONE: Diffusely thinned and degenerated lateral tibiofemoral compartment articular cartilage. Diffusely thinned and degenerated medial tibiofemoral compartment articular cartilage. Full-thickness loss of the patellofemoral compartment with subchondral cyst formation within the lateral facet of the patella and lateral trochlea.Tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: Female, 21 years old, with brainstem lesion. Patchy but symmetric FLAIR hyperintensity is redemonstrated affecting the central pons in the vicinity of the transverse pontine fibers. Just posterior to this, there are thin linear foci of hyperintensity bilaterally which may correspond to the medial lemnisci. No significant interval change is seen when compared to recent prior examinations. On review of multiple prior examinations, abnormal signal in the pons is noted to have first become apparent on the 12/31/13 scan and has progressed over the intervening time. No other areas of focal signal abnormality are seen, and in particular, the other deep gray nuclei are unaffected.The region of abnormal signal in the pons was interrogated with single voxel spectroscopy (TE 35 ms). As a comparison, the nearest normal-appearing tissue was also interrogated more inferiorly in the pons. The lesional spectrum demonstrates reduction in the major metabolic peaks relative to normal appearing tissue. No evidence of lipid or lactate is seen. No atypical peaks are detected.

Output: Signal abnormality in the pons is redemonstrated showing no significant change from the recent prior examinations. This abnormality first became detectable in late 2013 and has progressed from that point.Spectroscopic assessment of the lesional tissue demonstrates a pattern consistent with chronic tissue injury. No lactate is seen to suggest active failure of aerobic metabolism. No lipid is detected to indicate ongoing membrane degradation. Although the differential remains broad for this abnormality, the pattern and morphology of the lesion are suggestive of prior osmotic demyelination. An inborn error of metabolism is not excluded, though patient age and imaging features make this less likely. Active inflammation and neoplasia are considered unlikely.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for change in mass. Signs and symptoms: Near syncope. Nonenhanced head CT:In comparison with prior examination there is further interval increase in the size of the right temporal horn and trigone of right lateral ventricle.There is interval improvement of postoperative changes and including complete absorption of air from surgical site. Diffuse area of low attenuation of white matter in the right posterior temporal and parietal lobe is grossly similar to prior exam. There is also overall less mass-effect and decrease in the midline shift. The midline shift at the level of the septum pellucidum on the current exam measures 6.4-mm wide on the prior exam measured 11.2. Recommend further follow-up with an MRI for better evaluation of residual tumor. There is a small linear increased density in the right parafalcine location adjacent to the surgical cavity which may represent small amount of blood. Possibly tumor calcification at the surgical site cannot be entirely ruled out. The only available exam is from 12 -- 23 -- 10 and there are no more recent exams for comparison.

Output: 1.Interval increase in the size of right temporal horn believed to represent entrapped right temporal horn.2.Interval improvement in postop changes.3.Overall there is less mass-effect on the current exam than prior study however 6.4-mm midline shift to the left at the level of septum pellucidum is still present.4.Diffuse area of low attenuation in the right posterior temporal, occipital and parietal likely represent patient's known tumor. This finding is associated with effacement of cortical sulci.5.recommend MRI examination for better evaluation.


Instruction: Generate impression based on findings.

Input: Left knee pain and mechanical change Note that the exam is slightly limited by the presence of metallic artifact relating to prior ACL repair.MENISCI: Medial meniscus: There is diffuse attenuation of the medial meniscus likely relating to a combination of changes from prior partial meniscectomy and chronic attritional tearing. There is marked attenuation of the body and posterior horn with a large gap within the body of the meniscus representing a radial tear (axial image 20/38 of series 4). Increased signal within the posterior horn likely represents additional degeneration.Lateral meniscus: There is blunting of the free edge of the posterior horn which may reflect changes from prior partial meniscectomy or free edge tearing. There is signal abnormality extending to the femoral articular surface representing a tear of the posterior horn. The root of the posterior horn is not well seen, likely representing additional tearing. There is blunting of the free edge of the body of the lateral meniscus with horizontally-oriented tearing. The anterior horn demonstrates attenuation likely relating to changes of prior meniscectomy and/or chronic tearing.ARTICULAR CARTILAGE AND BONE: There is severe tricompartmental osteoarthritis with multiple large osteophytes noted.Medial compartment: The weight bearing portions of the medial femoral condyle and medial tibial plateau are devoid of cartilage and there is underlying degenerative signal within the subchondral marrow.Lateral compartment: Moderate osteoarthritis is also noted with areas of partial and full-thickness degeneration. Edema within the lateral tibial spine is likely degenerative in nature.Patellofemoral compartment: There are moderate osteoarthritic changes with cartilage defects particularly along the lateral patellar facet. Additionally, there is partial thickness tearing of the articular cartilage of the medial facet of the femoral trochlea.LIGAMENTS:There is evidence of prior ACL repair however the ACL graft is ruptured. The PCL is intact but demonstrates increased intrasubstance signal perhaps representing degenerative change. The medial collateral and lateral collateral ligaments are intact.EXTENSOR MECHANISM: There is thickening of the patellar tendon with vertically oriented splitting likely relating to prior ACL graft harvest. The quadriceps tendon is normal.ADDITIONAL

Output: 1. Severe osteoarthritis with multiple loose bodies as described above. There is a defect of the posterior capsule of the knee that contains a cyst like collection of fluid measuring approximately 1.5 cm. Additionally, an elongated structure situated between the proximal tibia and the popliteus muscle likely represents a large ossicle.2. Bilateral meniscal pathology likely representing a combination of tearing and surgical change.3. Ruptured ACL graft.4. Moderate to large joint effusion with additional findings described above.


Instruction: Generate impression based on findings.

Input: 53 years Female (DOB:12/20/1963)Reason: questioning back pain History: back pain PROVIDER/ATTENDING NAME: SHARON MANGUM SERVICES ANCILLARY The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots.There is a Schmorl's node at T9-T10. There is multilevel disc desiccation present.

Output: There are some mild degenerative changes present in the thoracic spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:7/29/1942)Reason: Pt w/ CLL \T\ AML reporting 1-2 weeks of LE weakness :: Desire to r/o Cord / Nerve / Spinal pathology History: Hip weakness b/lPROVIDER/ATTENDING NAME: MICHAEL R BISHOP MICHAEL R BISHOP 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 a mild dextrocurvature at the lower lumbar spine.There is an extradural infiltrative type mass present along the ventral aspect of the spinal canal behind the L5 vertebral body and the sacrum which appears to encroach on the thecal sac and exiting nerve roots at L5-S1 and within the sacral spinal canal. It is not adequately visualized on this exam due to artifact and lack of contrast enhancing study.The images are degraded due to combination of motion artifact and other artifact. There is a mottled appearance to the osseous structures patchy foci of marrow replacement suspected.At L5-S1 there is narrowing of the spinal canal due to a ventrally located extra-axial mass extending from the sacral spinal canal which is associated with compression of the thecal sac and spinal stenosis. There appears to infiltrate into the neural foramina and encroachment of exiting nerve roots. Additionally there is mild facet hypertrophy at this level.At L4-5 there is loss of disc space height and T2 signal hyperintensity within the disc associated with a disc bulge and some mild facet hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation, loss of disc space height and disc bulge at this level.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.It appears that the bladder is distended but not entirely included on this exam to assess any further.

Output: 1.There appears to be a mass present within the lumbar spinal canal and sacral spinal canal extending from L5 down to S2-3. It appears infiltrate into the neural foramina and encroachment on the nerve roots within the spinal canal and neural foramina. It is not well imaged on this exam. Perhaps a contrast-enhanced MRI exam would be helpful to further delineate this and possibly identify an amenable site for percutaneous biopsy if clinically appropriate.2.There are multiple patchy foci of marrow replacement throughout the visualized sacral and lumbar spine which may be related the patient's leukemia.3.There are degenerative changes present in the lower lumbar spine associated with a dextrocurvature to the lower lumbar spine4.The urinary bladder appears to be markedly distended. No obstructing lesion cannot be excluded5.Examination is degraded due to patient motion which will obscure more subtle abnormalities.6.Findings were discussed with Dr. Bishop at the time of this interpretation.


Instruction: Generate impression based on findings.

Input: History of left breast cancer, status post surgery and radiation. Complains of headaches. Rule out metastases. CT of brain without and with infusion:A well demarcated low-density in the left basal ganglia remains stable since prior study. Prior MRI examination from 10 -- 3 -- 2006 is also reviewed which demonstrates the same finding which is believed to represent a lacunar infarct.No evidence of any additional foci of abnormal density of brain parenchyma is detected. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Post infusion images demonstrate no evidence of any abnormal enhancement the brain parenchyma or the leptomeninges and in particular no evidence of metastatic lesion is detected.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are also within normal limits.120 cc of Omnipaque 350 was utilized for the above study.

Output: Normal pre-and post infusion CT examination of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 58 years, Male, dysarthria, left frontal tumor. History of bladder cancer. There is a 3.4 x 3.7 x 3.6 cm enhancing mass in the left frontal lobe which demonstrates central necrosis. Minimal foci of susceptibility effect are also noted compatible with minimal associated blood products within the lesion. There is extensive surrounding T2 hyperintensity consistent with vasogenic edema with associated mass effect including sulcal effacement, effacement of the left lateral ventricle, and rightward subfalcine herniation. There is 5 mm rightward midline shift measured at the level of the foramen of Monro. There is also downward mass effect without uncal herniation. These lesions appear new compared to postcontrast CT from 12/10/2014.There is a 11 x 11 x 9 mm enhancing focus involving the left superior and middle temporal gyri consistent with a second lesion. There is mild associated edema.There is a 7 mm, punctate focus of restricted diffusion involving the left posterior temporal lobe, axial image 120 series 606 without corresponding T2 hyperintensity or enhancement, possibly artifactual. No definite evidence of restricted diffusion to suggest acute infarct. Major flow-voids are preserved.Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. No hydrocephalus. No extra-axial collections. No abnormal leptomeningeal or dural enhancement. Minimal paranasal sinus mucosal thickening involving the ethmoid air cells. Bone marrow signal and extracranial soft tissue structures are unremarkable.

Output: 1. Enhancing left frontal lobe mass as well as a smaller left temporal lesion are most consistent with metastatic disease.2. Vasogenic edema and mass effect, particularly associated with the left frontal lesion, results in rightward subfalcine herniation. There is also downward mass effect without uncal herniation.3. Apparent punctate focus of restricted diffusion in the left posterior temporal lobe without corresponding T2 hyperintensity favored to be artifactual.


Instruction: Generate impression based on findings.

Input: Epilepsy, depth electrode planning. There is possible focal volume loss and T2 hyperintensity in the medial right temporal lobe. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable, including a prominent right occipital arachnoid granulation. There is mucosal thickening in the right anterior ethmoid and frontal sinuses.

Output: Preoperative planning MRI demonstrates probable right medial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. No loss of vertebral body height. The osseous structures are unremarkable. The marrow signal is benign. The cervical cord signal is normal. The imaged paraspinal contents are unremarkable without evidence of soft tissue injury. No evidence of neuroforamina or central canal stenosis.

Output: No evidence of osseous or soft tissue injury.


Instruction: Generate impression based on findings.

Input: Male 35 years old Reason: staging evaluation for high rectal cancer. History: hematochezia Overall image quality: ExcellentPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: Two prominent lymph nodes are seen within the mesorectal fascia superior to the mass. For future reference, a left perirectal lymph node measures 9 x 6 mm (series 601/41).Lymph nodes outside the mesorectal fascia: Multiple prominent to mildly enlarged bilateral high common iliac lymph nodes are seen. For future reference, a left common iliac lymph node measures 9 x 8 mm (series 601/44).BOWEL, MESENTERY: Rectal Tumor:Size: 3.5 x 4.5 x 5.9 cm (series 501/21 and series 601/34).Tumor appearance on T2-weighted images: Predominantly solid lesion with intermediate signal intensityTumor location: Upper-third(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): Not applicable.Distance of the lower edge of the tumor to the pelvic floor (relationship of the tumor to the anal sphincter complex): Not applicable.Circumference of the rectum involved: 100%.Relationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): Tumor abuts and exerts mass effect on the posterior dome of the bladder and the seminal vesicles without definite invasion.MRI T-stage: T3a - Tumor invades < 0.5cm into perirectal fat or extramuralTumor Distance to Mesorectal Fascia: 0 to 1 mm (series 601/34).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: High rectal tumor as detailed above with pelvic lymphadenopathy. Please note that the field of view does not include the aortic bifurcation.


Instruction: Generate impression based on findings.

Input: Female, 50 years old, with history of multiple sclerosis on Rebif. Follow-up examination. Brain:Multiple scattered T2 hyperintense lesions are demonstrated within the periventricular and subcortical white matter, the corpus callosum, and minimally in the cerebellum. The number and size of these lesions have not significantly changed from the prior examination. No convincing lesional enhancement is seen. Most, however, are associated with moderate to marked T1 hypointensity. There is no evidence of significant parenchymal edema or mass effect. Overall brain volume is relatively preserved. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. C-spine:Slight reversal of the cervical lordosis is unchanged. Vertebral body heights are preserved. No worrisome marrow signal replacement or edema is detected. No pathologic marrow enhancement is seen. Signal characteristics compatible with benign hemangiomas are seen within the C5 and T1 vertebral bodies.A focus of T2 hyperintensity is seen within the right posterolateral cord at C5, unchanged from prior. There may be a few additional scattered foci of cord T2 hyperintensity, but imaging artifact prevents definitive visualization. No pathologic cord enhancement is seen.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Mild posterior disc-osteophyte complex formation and right uncovertebral hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. No interval changes. C5-6: Posterior disc-osteophyte complex formation with a right paracentral extrusion extending predominantly below the disc space, progressed from prior. There is effacement of the right ventral sac and perhaps very slight impingement of the right ventral cord. No significant foraminal narrowing. C6-7: Unremarkable. C7-T1: Unremarkable.

Output: 1.White matter lesions are identified in the brain compatible with multiple sclerosis. The size and number of these lesions have not significantly changed.2.At least one, but possibly several small lesions are seen within the visualized spinal cord. No significant interval change is suspected.3.A right paracentral disc extrusion at C5-6 has increased in size since the prior examination with resultant progressive effacement of the thecal sac.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 12 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 23 seconds.

Output: Successful fluoroscopic guided left hip arthrogram.


Instruction: Generate impression based on findings.

Input: Alignment is normal. The marrow signal is benign. Redemonstrated is an elongated peglike configuration of cerebellar tonsils with abnormal craniocaudal extent of about 2.5 cm below the level of the foramen magnum to the C2/3 intervertebral level. CSF flow analysis demonstrates diminished, yet persistent flow posteriorly at the level of the cervical tonsils. Additionally, there is diminished CSF flow anteriorly due to mass effect from the combined cord and descended tonsils.Just inferior to the level of the tonsillar ectopia, T2 signal is noted within the cord parenchyma from C3 through the C5 levels which is ill-defined and nonenhancing. The cord and conus are otherwise normal in signal. The conus terminates at the L1/2 level and is normal in morphology. There are no findings of fatty filum.There are no osseous dysplasias or stenoses.

Output: 1.Redemonstrated is an elongated peglike configuration of cerebellar tonsils with abnormal craniocaudal extent of about 2.5 cm below the level of the foramen magnum to the C2/3 intervertebral level consistent with Chiari I information.2.Just inferior to the level of the tonsillar ectopia, T2 signal is noted within the cord parenchyma from C3 through the C5 levels which is ill-defined and nonenhancing. This most likely represents a pre-syrinx state.