Instruction: Generate impression based on findings.

Input: 71 year old female with known left breast cancer with metastatic left axillary lymph node presents for staging MRI. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Port-A-Cath is present in the upper inner right chest wall.LEFT BREAST:In the left breast at anterior 11 o'clock position, there is an irregularly shaped enhancing mass, which is proven carcinoma, with non-mass enhancement extending anteriorly and posteriorly. The mass measures 29 x 33 x 27 mm (AP x LR x CC), and overall measurement is 50 x 38 x 33 mm with non-mass enhancement. A marker clip is identified at anterior aspect within the mass.Diffuse skin thickening, predominantly at medial aspect is noted. Mild edema is seen around the cancer. LEFT AXILLA:There is an enlarged lymph node, measuring 33 x 24 x 28 mm) with marker clip at the level 1 region of left axilla. This is a proven metastatic lymph node. In addition, there is another enlarged lymph node, measuring 28 x 13 x 20 mm, at the level 2 region of the left axilla.RIGHT BREAST:No abnormal enhancement is seen in right breast. RIGHT AXILLA:No abnormal axillary lymph nodes are identified in right axillary region.

Output: 1. Biopsy proven cancer in the left breast at 11 o'clock position.2. Two abnormal lymph nodes in the left axilla; one of which is proven metastatic.3. No MR evidence of malignancy on the right breast or right axilla. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical disease? Fibrosis. Signs and symptoms: Lower extremity hyperreflexia. Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and minimally of the pons. Findings are nonspecific however often represent microvascular ischemic changes. Unremarkable CT renal cortex, cortical sulci, ventricular system and CSF spaces for age.No detectable abnormal parenchymal or leptomeningeal enhancement is detected.Unremarkable calvarium and images through the orbits including axial fat sat post enhanced series.Small left paramedian occipital scalp lipoma measuring at 9 x 26 mm in transaxial dimensions is identified of no clinical significance.Signal void of major intracranial arterial branches are identified.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal signal intensity.Pre- and post enhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column.The signal intensity of vertebral column is within normal other than subtle changes related to degenerative disease. There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.Post enhanced images demonstrate no detectable abnormal enhancement of the cord or the meninges.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative disc disease, moderate left and mild right ligamentum flavum hypertrophy and mild facet disease. Changes results in significant left and moderate right neural foraminal compromise and mild central spinal stenosis.C4-C5 demonstrate moderate disc disease and loss of disc height, asymmetric (right greater than left) uncovertebral hypertrophic changes and mild facet and ligamentum flavum degenerative changes. Constellation of changes results in significant right moderate to significant left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate moderate to advanced disc disease and loss of disc height, asymmetric right greater than left facet hypertrophic changes and mild bilateral ligamentum flavum hypertrophy. There is resultant significant right and moderate to significant left neural foraminal compromise and no central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild bilateral facet disease and no significant ligamentum flavum hypertrophy. Constellation of changes results in significant left and moderate right neural foraminal compromise and no central spinal stenosisC7-T1 demonstrate mild degenerative changes without central spinal stenosis. Mild bilateral neural foraminal compromise is suspected.Visualized paraspinal soft tissues are unremarkable.

Output: 1.Pre- and post enhanced brain MRI demonstrate no acute intracranial process. Findings suggestive of mild to moderate chronic small vessel ischemic strokes only in the subcortical and periventricular white matter and minimally of the pons. Small left paramedian occipital scalp lipoma measuring 19 x 26 mm. Unremarkable pre and post enhanced brain MRI otherwise.2.Pre- and post enhanced MRI of cervical spine demonstrate mild to moderate degenerative disc and hypertrophic changes of posterior elements. There is mild central spinal stenosis at C3-C4 level. There are multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. Normal signal intensity and caliber of the cord. No detectable significant abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 56 year old male with history of CAD s/p LAD stent, htn, hpl now with chest pain for who presents for stress cardiac MRI to evaluate for ischemiaMEDICATIONS: lipitor, xarelto, bystolic, lisinopril, methotrexate, colchicine First Pass PerfusionDuring hyperemia, there is possible mild perfusion defect present in the apical inferior wall.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 131 ml (normal range 109+/-23), the LV end systolic volume index is 21 ml/m2 (normal range 18+/-5), the LVESV is 44 ml (normal range 31+/-10), the LV mass index is 66 g/m2, and the LV mass is 132 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 84 ml/m2 (normal range 69+/-14), the RVEDV is 176 ml (normal range 110+/-24), the RV end systolic volume index is 39 ml/m2 (normal range 22+/-8), and the RVESV is 81 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is 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 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 a mild perfusion defect noted in the apical inferior wall which appears unchanged from the study performed in 9/6/20112. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 66%).4. Normal RV size and systolic function (RVEF 54%).


Instruction: Generate impression based on findings.

Input: Cervical spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Mucosal thickening is present within the left maxillary and left sphenoid sinuses. Otherwise the visualized paraspinal contents are unremarkable.C2/3 to C5/6: UnremarkableC6/7: Bilateral uncinate hypertrophy causes moderate left and mild right neural foraminal stenosis.C7/T1: Left facet hypertrophy cause mild left neural foraminal stenosis.Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no significant degenerative changes, disc pathologies, or stenoses.

Output: 1.C6/7: Moderate left and mild right neural foraminal stenosis.2.C7/T1: Mild left neural foraminal stenosis.3.Negative noncontrast number spine MRI.


Instruction: Generate impression based on findings.

Input: Headache. Acute onset. Hypertensive. Rule out subarachnoid hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The lateral sinuses have higher than normal density which raises the question of sinus thrombosis. MRI/MRV is recommended for further evaluation.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.These findings were discussed with Dr. Adrianne Haggins at the time of interpretation.

Output: 1. No evidence of subarachnoid hemorrhage or edema.2. Increased density in the lateral sinuses raises question of sinus thrombosis. MRI/MRV is recommended for further evaluation


Instruction: Generate impression based on findings.

Input: 43-year-old female patient with left ankle pain with dorsiflexion. Evaluate for synovitis, mechanical injury, or anatomic abnormality. The tibiotalar and subtalar joints appear normal.There is poorly defined enhancement of the sinus tarsus extending laterally along the head of the talus. There is additional poorly defined enhancement along the medial aspect of the head/neck of the talus as well as surrounding the distal posterior tibialis tendon indicating synovitis. The tendons of the ankle otherwise appear normal. The ligaments of the ankle appear grossly intact.Small talonavicular joint osteophytes indicate mild osteoarthritis. There is mild edema within the subcutaneous fat along the medial malleolus which is nonspecific.

Output: Mild synovitis adjacent to the talus and other findings as described above.


Instruction: Generate impression based on findings.

Input: 67-year-old female presents with increased right hip pain. ACETABULAR LABRUM: The acetabular labrum is thickened with heterogeneous signal intensity compatible with a tear.ARTICULAR CARTILAGE AND BONE: Moderate bone marrow edema in the subcortical region of the femoral head and acetabulum. Moderate osteoarthritis affects the right hip.SOFT TISSUES: There is perhaps a mild strain of the right adductor muscles. ADDITIONAL

Output: 1. Moderate right hip osteoarthritis and marrow edema in the femoral head and acetabulum. Findings are favored to reflect osteoarthritis with reactive marrow changes, however, direct contusion injury may have a similar imaging appearance. Correlation with history of fall is recommended. No specific findings to suggest a stress fracture.2. Labral tear of the right hip.


Instruction: Generate impression based on findings.

Input: Alignment of the entire spinal column appears anatomic. Vertebral body heights and disc spaces are preserved. There is diffuse involvement of the spinal cord with mass lesions consistent with metastatic involvement from the patient's known primary malignancy, and multilevel severe spinal cord compression.

Output: There is diffusely abnormal appearance of the spinal cord with mass lesions appreciated throughout the entirety of the cervical, thoracic and lumbar spine. Please refer to the subsequent complete spine MRI for further details.


Instruction: Generate impression based on findings.

Input: Clinical question: Head and neck cancer. Signs and symptoms: Headache cancer. Enhanced CT of soft tissues of the neck:70 cc of Omnipaque 350 is administered for the exam. Images through the skull base including cavernous sinuses, bilateral petrous bones are unremarkable.Images through the neck again demonstrate postoperative changes of partial mandibulectomy in the midline anteriorly with a bony graft. There is interval change with a new bony graft compared to prior study. There is no definitive evidence of fusion of bony graft and the native bone. There are bilateral sonolucencies of the marrow space immediately at the level of mandibulectomy and without appreciable change since prior examination.Subtle soft tissue thickening surrounding the mandibulectomy size and the bony graft are within expected range for postop changes. There is however more soft tissue density anterior to the mandible on the right since prior exam which may be present at it postop changes. No definitive evidence of tumor. Recommend MRI for follow it on physical exam there is suspected tumor recurrence at this site.Extensive postoperative changes of bilateral neck is noted. No detectable cervical adenopathy.Multiple small varying sized cysts within an enlarged right lobe of thyroid and the isthmus of thyroid appears similar to prior exam. Limited images of the apices of the lungs demonstrate emphysematous changes however without metastatic lesions. However these reviewed dedicated reports of CT of chest performed on this date.Enhanced head CT:There is no evidence of metastatic disease to the brain, leptomeninges or the calvarium.The cortical sulci, ventricular system, CSF cistern and the gray -- white matter differentiation remains within normal.Calvarium is intact. Minimal chronic pansinusitis.

Output: 1.Evidence of interval further surgery at the site of anterior mandibulectomy in the midline with a new bony graft and increased soft tissue density anterior to the mandible on the right. No definitive recurrence of tumor at this site. There is no fusion of bone graft with the mandible. There is no evidence of recurrence of tumor or lymphadenopathy in the neck. Please see above comments there2.negative enhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: Male 57 years old Reason: rectal cancer staging History: none 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: There are multiple small lymph nodes measuring up to 6 mm in short axis.Lymph nodes outside the mesorectal fascia: There is a single enlarged left obturator internus lymph node which measures 9 x 10 mm. This is located 6 mm from the mesorectal fascia.BOWEL, MESENTERY: Rectal Tumor:Size: 3.7 x 1.7 x 2.6 cm (image 30/series 701)Tumor appearance on T2-weighted images: Hyperintense to the bowelTumor location: Inferior rectum(For lower rectal tumors):Distance of the lower edge of the tumor to the anal verge (lower edge of the anal canal): 3.3 cmCircumference of the rectum involved: 270 degreesRelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): 4 mm from the prostateTumor Distance to Mesorectal Fascia: 1.9 cm (image 41/series 501).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: The posterior and lateral aspects of the tumor margin are indistinct suggesting invasion of the mesorectal fat (image 40 series 501)

Output: 1.Tumor involving the lower rectum with measurements and position as described. There are scattered small nodes within the mesorectal fascia is well as a single enlarged left obturator internus lymph node external to the mesorectal fascia concerning for metastatic disease.


Instruction: Generate impression based on findings.

Input: Reason: 59M with Gleason 6 PrCA in right apex, MRI fusion biospy to confirm diagnosis for active surveillance History: as above PELVIS:PROSTATE:Prostate Size: 4.7 x 6.6 x 5.9 cmPeripheral Zone: In the right posterior apical and mid peripheral zone, there is T2 hypointense ill-defined signal with restricted diffusion suspicious for tumor (series 901 image 11). More focal area measures approximately 6 x 7 mm (series 901 image 15).In the left posterior mid peripheral zone, there is focal T2 hypointense signal with restricted diffusion also suspicious for tumor, measuring 5 x 5 mm (series 901 image 16).There is large apical T2 transitional zone hypointense ill-defined signal with restricted diffusion also suspicious for tumor, measuring 17 x 14 mm (series 901 image 7).Central Gland: Multiple probable hyperplastic nodules. Seminal Vesicles: No significant abnormality noted. No evidence of invasion.Extracapsular Extension: There is bulging of the capsule and the right posterior mid prostate secondary to tumor (series 901 image 11), without evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted. No osseous lesions are identified.OTHER: No significant abnormality noted.

Output: Multifocal bilateral suspicious lesions involving the peripheral and transitional zones as described above.


Instruction: Generate impression based on findings.

Input: Several sequences are limited by patient motion. There is redemonstration of asymmetric severe right and moderate left cerebellar atrophy associated extensive susceptibility along the residual right cerebellar parenchyma extending into the right pons and medulla which also demonstrate asymmetric volume loss. There is no significant associated FLAIR abnormality. Minimal areas of linear and somewhat ill-defined enhancement along the right cerebellar tissue without a masslike configuration. There is ex vacuo dilatation of the fourth ventricle, more prominent on the right side. There is no significant FLAIR abnormality. A focus of susceptibility is identified in the right lateral thalamus, corresponding to previously noted CT. Other punctate foci of calcifications seen along the right deep gray nuclei are not well appreciated on this MRI.The lateral and third ventricles are within normal limits. The cerebral sulci are mildly prominent, suggestive of mild global volume loss slightly greater than expected for the patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are few scattered punctate foci of T2/FLAIR hyperintensity in subcortical white matter within the frontal lobes which are nonspecific. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The structures and craniocervical junction are within normal limits. There is mild mucosal thickening in all the paranasal sinuses bilaterally. Aerated secretions are seen in the right sphenoid sinus.

Output: 1.Redemonstration of severe right and moderate left cerebellar atrophy with associated right pontine and medullary atrophy. Corresponding coarse calcifications on the right in the posterior fossa and along the brainstem, with minimal scant enhancement felt to relate to areas of scarring. Findings are suggestive of a chronic process with dystrophic calcifications, perhaps relating to sequela of previous infectious/inflammatory process such as cerebellitis or previous vascular insult. Neurodegenerative disorder remains within the differential and can be associated with autoimmune, para neoplastic, and toxic/metabolic abnormalities.2.No significant supratentorial abnormality aside from mild global volume loss, with a few scattered nonspecific punctate foci of T2/FLAIR hyperintensity no MR evidence of demyelinating disease as clinically questioned.3.Aerated secretions in the right sphenoid sinus. Please correlate clinically for acute sinusitis.


Instruction: Generate impression based on findings.

Input: CNS recurrence of DLBCL status post 2 cycles of MTR chemotherapy, in need of restaging. There has been interval decrease in size of the infiltrative enhancing mass involving the bilateral basal ganglia, hypothalami, columns of the fornices, and perhaps the anterior commissure, now measuring up to approximately 22 mm, previously 32 mm. There are right transfrontal post-biopsy findings with associated areas of susceptibility effect. There is no evidence of acute infarction. There is decreased effacement of the anterior third ventricle. The lateral ventricles are not significantly changed. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: Interval decrease in size of the CNS lymphoma, indicating treatment response.


Instruction: Generate impression based on findings.

Input: here is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are minimal punctate nonspecific foci of T2 signal hyperintensity in the deep white matter. The cerebral flow-voids appear to be intact. There is a mucus retention cyst in the right maxillary sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: 26-year-old female with dropping hemoglobin and recent history of groin catheter placement. Evaluate for left retroperitoneal hematoma ABDOMEN:LUNG BASES: Bilateral large pleural effusions and dependent atelectasis, new from previous study.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Pancreas demonstrates fatty atrophy. The pancreatic duct in the tail is significantly dilated, measuring up to 12-mm. In the mid body SPECT its normal size. This finding is new from previous study. There is inflammation of the pancreatic tail. These findings may be secondary to pancreatitis. A solid lesion causing pancreatic ductal stricture cannot be excluded. No evidence of calcification. The pancreas. Further evaluation of this finding with MRI is recommended.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic bilateral kidneys.RETROPERITONEUM, LYMPH NODES: Left-sided common femoral venous catheter extends into the super renal IVC. No evidence of retroperitoneal hematoma.BOWEL, MESENTERY: Generalized ascites.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Generalized anasarca.OTHER: Generalized ascites.

Output: Interval dilatation of the pancreatic duct in the tail and associated peripancreatic minimal inflammatory findings. M.R.C.P. is recommended for further evaluation of the pancreatic duct. Fatty replacement of the pancreas.Bilateral pleural effusions, ascites, and generalized anasarca.


Instruction: Generate impression based on findings.

Input: Female 65 years old; Reason: Hx of metastatic solitary fibrous tumor, please evaluate for other sites of disease History: above Degenerative changes affects the cervical spine. No cervical lymphadenopathy is evident on this noncontrast MRI.Postsurgical changes in the left lung. No pleural effusion. No mediastinal lymphadenopathy is evident.Postsurgical changes in the right lobe of the liver. There is compensatory hypertrophy of the left hepatic lobe. No definite intrahepatic lesions.Cystic lesion within the pancreas the pancreatic head measures 2.6 cm previously, 2.3 cm. No significant pancreatic ductal dilatation.No upper abdominal lymphadenopathy is evident.Postsurgical changes are noted in the right abdominal wall.Within the left thigh soft tissues, there is a soft tissue mass measuring 5.7 x 3.6 cm. Although the study is performed as a noncontrast exam, the lesion is suspicious for a soft tissue tumor.Uterus is absent or atrophic. Urinary bladder is unremarkable.No evident lymphadenopathy in the pelvis.

Output: 1.Soft tissue mass in the left lateral thigh soft tissue appearing nearly similar to prior exam.2.Postsurgical changes in the lung.3.Cystic pancreatic lesion not significantly changed from the prior CT.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal cancer. Head CT:There is no evidence of intracranial mass, hemorrhage or infarction. No enhancing abnormality is seen intracranially.Neck CT:There is a nasopharyngeal mass at the fossa of Rosenmueller on the left, measuring approximately 3.0 x 1.6-cm. extends to the left infratemporal fossa, at the region of the left foramen lacerum, causing erosion of the floor of the left carotid canal (image #19 of series 5). The soft tissue lesion is suspected to be partially encasing the left internal carotid canal, which can be better defined with MRI of the neck. There is no definite intracranial extension. There is adenopathy involving the left lateral retropharyngeal lymph nodes, and level 2 on the left.

Output: Left nasopharyngeal mass with extension to the left infratemporal fossa and skull base destruction. It is likely partially encasing the left internal carotid canal. Adenopathy involving left lateral retropharyngeal node and left level 2. No definite intracranial extension.


Instruction: Generate impression based on findings.

Input: Reason: right knee pain History: pain There is medial joint space narrowing and small tricompartmental osteophytes indicating mild osteoarthritis. Calcification at the MCL origin (Pellegrini-Stieda) is compatible with prior MCL injury as seen on prior MRI. No acute fracture or malalignment is evident.

Output: Mild osteoarthritis and findings of chronic MCL injury.


Instruction: Generate impression based on findings.

Input: Clinical question: Hematoma, subdural, abscess, or any other compression. Signs and symptoms: 28 year old female with headache, neck and back pain, tingling in face and hands. Nonenhanced complete spine MRI:The examination is degraded due to motion artifact.The signal intensity and the alignment of the vertebral column is unremarkable. There is no evidence of the spinal canal compromise or stenosis at any level. There is no evidence of neural foraminal compromise at any level. Foramen magnum is unremarkable.The signal intensity and caliber of the cord remains reading normal and without detectable mass effect.No evidence of perispinal soft tissue abnormalities.

Output: No evidence of cord compression.


Instruction: Generate impression based on findings.

Input: Atypical parkinsonism: dysfluency, tremors. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There may be a punctate left hippocampal fissure remnant cyst. There is minimal nonspecific cerebral white matter T2 hyperintensity. There is a right parietal lobe developmental venous anomaly. The substantia nigra and the rest of the brainstem appears unremarkable. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for ischemia, gait instability to L History: Gait instability to L, disorientation, suspected NPH The lateral ventricles and third ventricle and to lesser degree fourth ventricle are large. This was also the case in December. Biventricular diameter on the current exam is 55 mm and was the same in a comparable location on the prior exam. Third vebtricular diameter is currently 16 mm and previously was the same. Temporal horns remian enlarged.Although there is a punctate hyperintense lesion on the diffusion weighted images in the right centrum semiovale there is no associated diffusion restriction on ADC map. Rather there is T2 shine through.On susceptibility imaging there is a punctate focus of signal hypointensity identified in the left frontal lobe appeared in isolation is probably of little clinical significance. It is unchanged when compared to the previous examThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The ventricles are large. This is nonspecific finding. One possibility is that this represents normal pressure hydrocephalus. Please correlate with patient's clinical symptoms.2.There are periventricular white matter lesions present many which are perpendicularly oriented to the lateral ventricle. These are nonspecific. Differential considerations include vascular related lesions as well as demyelination and vasculitis.3.There are periventricular white matter lesions present many which are perpendicularly oriented to the lateral ventricle. These are nonspecific. Differential considerations include vascular related lesions as well as demyelination and vasculitis.


Instruction: Generate impression based on findings.

Input: 48-year-old female with history of Crohn's disease. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Appropriate small bowel distention. Above average stool burden of the ascending and transverse colon. No focal wall enhancement or wall thickening. Normal appearance of the terminal ileum. No fistulization or drainable fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Focal soft tissue edema in thea left lateral gluteal region (axial series 26 image 21).OTHER: No significant abnormality noted.

Output: 1.No evidence for active Crohn's flare.


Instruction: Generate impression based on findings.

Input: 49-year-old female with history of right mastectomy and reconstruction for breast cancer. Status post right mastectomy with implant placement.There is extreme amount of fibroglandular tissue in the left breast.Moderate parenchymal enhancement is noted in the left breast. There are multiple cysts in the left breast few of which are complex and few with peripheral enhancement. Bilateral retropectoral saline implants. Clip artifact is noted in the left medial breast from prior stereotactic biopsy.No abnormal enhancement is seen in left breast or right chest wall. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Is there evidence of a stroke Small area of a left frontal periventricular lucency is new since prior exam and it may represent a small periventricular white matter stroke. Age of this stroke cannot be determined. No initial hemorrhage, edema, mass effect, midline shift or cortical stroke is detected. Further evaluation with an MRI is recommended.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Elevated PSA.PER EPIC: T1c with a single low volume core of Gleason 7 prostate cancer at the right mid and a single core of Gleason 6 low volume at the left apex. PELVIS:PROSTATE:Prostate Size: 4.5 x 6.7 x 5.8 cmPeripheral Zone: Patchy T2-weighted hyperintensity in the right and the left lateral apex of the peripheral zone.In the right mid-gland there is a 4 x 4 x 6 mm lesion with restricted diffusion (series 1204/184) with associated decreased T2 weighted signal intensity (series 1101/12).Wedge-shaped T2 weighted signal abnormality with associated restricted diffusion measuring 8 x 7 x 10 mm in the left peripheral apex is (series 1 101/10 and series 1204/1 44). The morphology suggest predominantly scarring.Central Gland: Changes of benign prostatic hyperplasia with some nodules extending into the peripheral zone.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension. The left apical lesion demonstrates broad based abutment with the prostatic margin without frank extension. BLADDER: No significant abnormality noted.LYMPH NODES: Moderately prominent left external iliac lymph nodes measuring less than 5 mm in short axis, nonspecific.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No greater than 1 cm dominant lesion is apparent. 6 mm right mid-gland and 1.0 cm left apical lesions are amenable to TRUS/MRI Fusion biopsy.


Instruction: Generate impression based on findings.

Input: Evaluation of the MRI study is slightly limited by mild motion artifact, especially on the coronal sequences.The ventricles and sulci are prominent consistent with volume loss greater than expected for age. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is nonspecific FLAIR hyperintensity in the periventricular distribution which is nearly confluent, especially posteriorly along the occipital horns which may be minimally ex vacuo dilated. FLAIR hyperintensity is also noted within the splenium of the corpus callosum. Thin intrinsic gyriform T1 hyperintensity is noted within the bilateral occipital lobes, parietal lobes near the perirolandic areas, posterior temporal lobes, left greater than right side. There is also involvement of the insular cortex. There is no significant associated volume loss, susceptibility, or FLAIR hyperintensity in these locations. There may be some areas of superimposed subtle enhancement in this distribution as well. There is intrinsic T1 signal hyperintensity and minimal T2 signal hyperintensity in the dorsal thalami.There is no diffusion abnormality. There is no midline shift or herniation. No extra-axial fluid collection is identified.There is fluid noted within the mastoid air cells bilaterally, right greater than left. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. There is no evidence of acute intracranial abnormality. FLAIR hyperintensity within the splenium of corpus callosum may relate to recent seizure activity. 2 Thin gyriform intrinsic T1 hyperintensity within predominantly the posterior cerebrum bilaterally may represent laminar necrosis from prior cortical injury of unknown etiology, possibly from a prior vascular insult, prolonged seizures, PRES, or less likely ictal hypoxia.3. T1/T2 hyperintensity in the pulvinar bilaterally, which is nonspecific but can be seen relating to degeneration following prolonged seizure activity, as well as metabolic derangements.4. Confluent FLAIR hyperintensity along the lateral ventricular margins, especially posteriorly with possible mild ex vacuo dilatation of the occipital horns. This is nonspecific but may represent areas of gliosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Back pain, radiculopathy? Stenosis or disc herniation? Signs and symptoms: Back pain, leg, thigh pain, unsteady standing-new onset. Nonenhanced lumbar MRI:The signal intensity of vertebral column is unremarkable and maintained normal anatomical alignment.Lower most visualized thoracic spine and thoracic cord is unremarkable.T12-L1 is unremarkable.L1-L2 is unremarkable.L2-L3 is unremarkable.L3-L4 demonstrate mild disc desiccation, mild bilateral ligamentum flavum hypertrophy without spinal stenosis or neural foraminal compromise.L4-L5 demonstrate mild ligamentum flavum hypertrophy and unremarkable otherwise without spinal stenosis or neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.No detectable paraspinal soft tissue abnormalities.Limited view of the SI joints demonstrate no abnormality.Normal signal intensity and caliber of the lower thoracic cord, conus and the cauda equina.

Output: Unremarkable nonenhanced MRI of the lumbar spine other than minimal degenerative changes as detailed above.


Instruction: Generate impression based on findings.

Input: Pancreatic cancer with fever, altered mental status, hallucinations. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal cerebral white matter T2 hyperintensity and a punctate focus of high T2 signal in the left thalamus. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, orbits, and scalp soft tissues are unremarkable. There is a retention cyst in the left maxillary sinus.

Output: 1. No evidence of intracranial metastases.2. Minimal cerebral white matter T2 hyperintensity and a punctate focus of high T2 signal in the left thalamus may represent chronic small vessel ischemic disease and lacunar infarct, respectively, without evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: 14 years Female (DOB:12/17/2001)Reason: 14 yo F with hx cerebral AVM, s/p coil embolization and craniotomy, eval vasculature History: worsening HA and vomitingPROVIDER/ATTENDING NAME: SANGHYUN MARGARET PAIK STEPHEN THOMAS MRI of the brainThere is redemonstration of encephalomalacia involving the majority of the right frontal lobe. There is associated ex vacuo effect on the right lateral ventricle. There are some foci of susceptibility effect present within the right frontal lobe. Smaller focus of encephalomalacia is present along the medial aspect of the left frontal lobe anteriorly. This appears to have extended since the 6/27/2015 exam but not significantly changed since the 1/6/2016 CT of the head..The patient is status post right frontal craniotomy and embolization of a right frontal lobe vascular lesion.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.

Output: 1.Encephalomalacia involving large portion of the right frontal lobe and a small portion of the left frontal lobe. 2.No evidence for intracranial arteriovenous malformation.


Instruction: Generate impression based on findings.

Input: Preoperative planning for a patient with a brainstem lesion and partial Parinaud syndrome. There are postoperative findings related to prior right transfrontal biopsy. There is redemonstration of a mildly expansile, infiltrative, T2 hyperintense lesion involving the left posterior limb of the internal capsule and midbrain, although the degree of associated enhancement appears to have diminished. There is mild residual right basal ganglia, cerebral peduncle, and pons T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Preoperative planning MRI redemonstrates a lesion involving the left internal capsule and midbrain lesion with apparent decrease in the associated enhancement, which may be related to the natural course of the disease, treatment effects, and/or differences in MRI technique.


Instruction: Generate impression based on findings.

Input: PLEASE INCLUDE FAT SATURATION WITH THIS MRAReason: eval for dissection and any other vascular abnormalities in neck with fat sats. . Please compare to the CTA in PACS History: syncope11/21/196154 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sellaMRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Signal from the left middle cerebral artery vasculature is lower than that of the right middle cerebral artery vasculature suggesting less flow. There is mild asymmetry in the cortical veins signal intensity with left being somewhat lower than right.There is a 6 x 8 mm aneurysm present at the distal right internal carotid artery at the communicating segment. It is directed laterally inferiorly and posteriorly. It has a small neck.The anterior communicating artery is identified and is medium size. The right A1 segment is larger than the left A1 segment. The right posterior communicating artery is tiny. The left posterior communicating artery is fairly large.The left internal carotid artery is diminutive at the cervical segment and above. The left internal carotid artery beginning at the cavernous segment is very small and enlarges the communicating segment. There is no associated mural thrombus appreciated.The vertebral arteries are mildly asymmetric with the right being larger than the left.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries. The left internal carotid artery abruptly measures 1.5 to 2 mm diameter beginning approximately 12 mm above the bifurcation where there is a high-grade stenosis present.

Output: 1.No evidence for acute ischemic cerebral infarction.2.There is a high-grade stenosis present approximately 1.5 cm above the level of the left internal carotid artery origin associated with a diminutive left internal carotid artery. The intracranial anterior circulation is predominantly supplied from the left posterior communicating artery. The left A1 segment is hypoplastic. There is indirect evidence that there is relatively lower flow in the left middle cerebral artery territory compared to the right middle cerebral artery territory based on the MRA and the susceptibility weighted imaging.3.There is an 8 mm right ICA communicating segment aneurysm present.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.


Instruction: Generate impression based on findings.

Input: Evaluate left breast cancer response to treatment. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.At the site of the biopsy proven cancer near the left 11:00 position, artifact from the biopsy clip is seen. However, there is no significant residual enhancement near the clip, or elsewhere in the left breast. Please note that the enhancing mass was previously located just posterior/medial to the biopsy clip. No abnormal enhancement is seen in the right breast. A stable probable intramammary lymph node measuring a few millimeters is present in the posterior depth of the right central breast.No abnormal lymph nodes are identified in either axillary region. Port-A-Cath is present in the right upper chest wall.

Output: No residual enhancing mass near the left breast biopsy clip or other suspicious finding elsewhere in either breast.For surgical planning purposes, please note the the enhancing mass was located just posterior to the biopsy clip on the prior MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Six month follow up for brain tumors. Pituitary: There are postoperative findings related to transsphenoidal surgery. There is no significant interval change in the pituitary mass with suprasellar and bilateral cavernous sinus extension, as well as invasion into the clivus. Indeed, there is unchanged encasement of the left juxtasellar internal carotid artery and mass effect upon the optic apparatus, which displays volume loss. Brain: There are postoperative findings related to right frontal craniotomy with right frontal lobe encephalomalacia. There is no significant interval change in the multiple dural-based enhancing mass lesions, including along the tentorium with mass effect and edema in right occipital lobe, in the left anterior sylvian region, right frontal convexity and along the left anterior falx cerebri. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, paranasal sinuses, skull, and scalp soft tissues appear unchanged.

Output: 1. No significant interval change in the invasive pituitary macroadenoma with massa effect upon the optic apparatus and encasement of the left internal carotid artery.2. No significant interval change in the multiple intracranial meningiomas, including the dominant left tentorial lesion with associated right occipital lobe edema.


Instruction: Generate impression based on findings.

Input: The brain parenchyma appears within normal limits. No findings to suggest seizure focus are appreciated. Specifically, there is no evidence of gray matter heterotopia or cortical dysplasia. Bilateral hippocampi are symmetric in size, signal characteristics, and with preserved internal architecture. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: No findings to suggest seizure focus are appreciated.


Instruction: Generate impression based on findings.

Input: No known prostate cancer. Negative biopsy in 2008. PELVIS:PROSTATE:Prostate Size: 5.3 x 6.4 x 7.3 cmPeripheral Zone: The peripheral zone demonstrates homogeneously T2 weighted hyperintensity. Central Gland: In the right apex there is a well-defined 1.2 x 0.9 cm nodule predominantly in the transition zone demonstrating T2 weighted hypointensity (series 401/73) with associated decreased ADC signal most likely a benign nodule. Several additional similar nodules are noted in the transition zone. It has similar enhancement characteristics to other regions in the transition zone.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular tumor extension.BLADDER: No significant abnormality noted.LYMPH NODES: Small nonspecific pelvic lymph nodes are not pathologically enlarged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Significant BPH without a discrete suspicious lesion.


Instruction: Generate impression based on findings.

Input: 55 years, Female, Reason: evaluate for malignancy versus cyst, please perform delayed imaging. History: RUQ pain x 1 month. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is an enhancing lesion in segment 7 measuring 3.4 x 3.7 cm (11/19), previously 3.4 x 2 .5 cm, with peripheral nodular arterial phase enhancement which is homogenously enhancing on delayed phase images and is hyperintense on T2-weighted images, likely a hemangioma. No intralesional fat is identified. Adjacent subcentimeter enhancing lesions also likely represent hemangiomas. There is arterial phase shunting within the adjacent hepatic parenchyma.Segment two lesion with peripheral nodular enhancement measuring 1.3 cm (7/14) is decreased in size since exam from 2005 where a measured 1.7 cm, likely representing a sclerosed hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Segment 8 lesion seen on recent ultrasound and remote CT represents a hemangioma.2.Smaller segment two lesion is decreased in size since 2005 and likely represents a sclerosed hemangioma.


Instruction: Generate impression based on findings.

Input: 66 year old male with history of rheumatic heart disease, diabetes, hypertension who presents for cardiac MRI to further evaluate aortic valve regurgitation, aortic valve stenosis, and ascending aorta. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 92 ml/m2 (normal range: 74+/-15), the LVEDV is 192 ml (normal range 142+/-34), the LV end systolic volume index is 39 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 63 g/m2 (normal range 85+/-15), and the LV mass is 131 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is late gadolinium enhancement in the basal inferolateral wall which spares the endocardium and is in a pattern atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process, such as old myocarditis/ vasculitis/ etc.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVEDV is 159 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 64 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly increased.Aortic ValveThere is a bioprosthetic valve is the aortic position. There is mild aortic regurgitation. There is thickening and likely calcification of the aortic valve; however, aortic valve morphology is limited by artifact caused by the prosthetic valve. There is evidence of flow acceleration through the aortic valve and aliasing at a velocity of 3m/s. These findings suggest that there is at least moderate aortic valve stenosis, with a peak velocity >3m/s.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size; however, the ascending aorta is mildly dilated (43mm) measured approximately 5cm from the aortic valve plane.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. Normal LV size and systolic function (LVEF 58%) with evidence of late gadolinium enhancement involving the basal inferolateral wall. The pattern is atypical for prior myocardial infarction and suggests the presence of underlying myocardial fibrosis, inflammation, or infiltration. The finding most likely represents prior myocarditis.2. Normal RV size and systolic function (RVEF 60%).3. Severe left atrial dilation.4. There is a bioprosthetic valve is the aortic position. There is thickening of the aortic valve with at least moderate aortic valve stenosis and mild aortic regurgitation.5. Mild dilation of the ascending aorta.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with low back pain. Evaluate for facet arthropathy. Image quality is degraded by motion artifact.Spinal alignment is anatomic. Mild wedging and superior endplate concavity of T12 is seen without edema. Mild anterior wedging of L1 is seen without edema.Severe disc degeneration is evident at L2-3 with endplate irregularity, loss of disc height and marrow edema.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.Incidental note is made of a right adrenal nodule.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Moderate disc bulging. Mild to moderate generalized spinal canal narrowing with some crowding of the cauda equina. Moderate bilateral foraminal narrowing. L3-4: Facet arthropathy. Ligamentum flavum thickening. No significant spinal canal or foraminal stenosis. L4-5: Facet arthropathy. Ligamentum flavum thickening. Minimal bulging disc. No significant spinal canal or foraminal stenosis. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.

Output: 1.Advanced disc degeneration at L2-3 with severe endplate irregularity, marrow edema and a diffusely bulging disc. The spinal canal is moderately narrowed at this location with some degree of cauda equina crowding.2.No other areas of high-grade spinal canal stenosis are seen. Facet arthropathy is evident at lower lumbar levels as above.3.Incidental note is made of a right adrenal nodule. These are statistically most likely benign but the lesion is only partially evaluated on this examination.


Instruction: Generate impression based on findings.

Input: Diagnosis: Epilepsy, unspecified, not intractable, without status epilepticusClinical question: is there a focal abnormality, especially in left fronto-temporal area?Signs and Symptoms: seizures 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. There is fetal origin of the posterior cerebral arteries.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.

Output: MRI of the brain is within normal limits. There is no evidence for a seizure focus in the left frontal or temporal lobes.


Instruction: Generate impression based on findings.

Input: Recent history of subarachnoid hemorrhage. Evaluate for etiology of the subarachnoid hemorrhage. MRI Brain:The previously described subarachnoid hemorrhage is not readily seen on today's exam. Note is made of a right frontal approach ventriculostomy drain which terminates in the right foramen of Monroe. The ventricles are mildly enlarged but unchanged compared to the previous head CT. Incidental note is made of a punctate focus of diffusion restriction in the right parieto-occipital white matter corresponds with a T2/FLAIR signal abnormality and is a nonspecific finding. No other parenchymal abnormalities are noted. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI C-Spine: Limited study of the cervical spine which includes only sagittal T1 and T2 images.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No significant compromise to the spinal canal or neural foramina. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.

Output: 1.Limited study with early termination per patient request who reported claustrophobia as described in detail above in the technique section. No post contrast imaging was performed and no axial imaging of the cervical spine was performed. This limits evaluation.2.There is not evidence for AVM, intracranial mass or other potential source for hemorrhage.3.An acute microinfarct is present in the right parietal lobe white matter.4.The previous SAH is not readily appreciated on today's exam.5.Right frontal approach ventriculostomy drain and stable mild enlargement of the ventricles.6.Normal appearing cervical spine MRI, although only sagittal T1 and T2 images were available for review.


Instruction: Generate impression based on findings.

Input: Male 60 years old; Reason: History C4-5 anterior cervical fusion, follow-up evaluation of the fusion and hardware. Screws are seen in the bodies of C4 and C5 with an anterior sideplate. Bone graft material seen within the disc space. We see no hardware complications. There are degenerative changes of the cervical spine with large osteophytes seen at C6/7.

Output: Anterior cervical fusion of C4 and C5 without hardware complication.


Instruction: Generate impression based on findings.

Input: 17 year-old female status post fall with double vision and headache, loss of consciousness and blood from left ear canal. There is no evidence of intracranial mass or edema. A small focus of high density presumably represents an extra-axial fluid collection adjacent to the frontoparietal cortex, (images 12 and 13). Focus of soft tissue density overlying the left parietal occiput likely represents a hematoma without underlying fracture.These focal findings suspicious for a small subdural hematoma would be better evaluated with an MRI.Low-density focal widening of the right lateral sylvian fissure may represent an arachnoid cyst (image 7).The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Small focus of hyperdensity, as described above, may represent a subdural hematoma which would be better evaluated with MRI.2. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 81-year-old female with history of renal cell cancer, status post left radical nephrectomy. Abdominal pain, vomiting and diarrhea. Rule out obstruction. This examination is limited by the absence of intravenous contrast.ABDOMEN:LUNG BASES: Mild bibasilar atelectatic changes. Small pericardial effusion.LIVER, BILIARY TRACT: The gallstone seen on the prior MRI examination is no longer present in the gallbladder. The gallbladder contains a small amount of air seen on coronal image 73/118 and axial image 41/153 of series 3. A minimal amount of perihepatic free fluid is present. There is a punctate calcification in the left lateral hepatic segment, probably due to old granulomatous disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left radical nephrectomy. Large simple cyst at the right inferior pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is moderately dilated with fluid and retained food. There is partial small bowel obstruction. A 2.7-cm diameter gallstone with peripheral calcifications is present in the distal jejunum at axial image 102/153 of series 3. This is the apparent source of obstruction. The small bowel proximal to the gallstone obstruction is mildly dilated and the wall is thickened, probably due to edema.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic or absent. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine and pelvis.OTHER: No significant abnormality noted

Output: Gallstone ileus.


Instruction: Generate impression based on findings.

Input: 74-year-old male with history of metastatic lung cancer, right hip pain and unsteady gait. Note is made of multiple foci of abnormal marrow signal and enhancement within the right ischium, right and left iliac wings, sacrum, left lesser trochanter, and right proximal femoral diaphysis. For reference purposes, a lesion within the posterior/medial right ilium measures 3 cm in greatest dimension. We see no fracture.Mild osteoarthritis affects the right hip. There is increased signal intensity traversing the superior labrum compatible with tear with adjacent lobulated fluid signal intensity lesion likely representing a para-labral cyst. Increased signal intensity within the anterior labrum likely represents a combination of degeneration and tearing. There is a 1 cm ossicle anterior to the superior aspect of the femoral head, perhaps representing an old fractured osteophyte. There is minimal enhancement of the hip joint suggesting mild synovitis, although we see no frank joint effusion.Mild osteoarthritis affects the left hip with adjacent para-labral cysts suggesting an underlying labral tear. Moderate multilevel degenerative disk disease affects the lower lumbar spine. There is mild muscular atrophy of the gluteus minimus bilaterally.

Output: 1.Multiple metastatic lesions as described above.2.Osteoarthritis of the right hip with superior labral tear.3.Other degenerative changes as above.


Instruction: Generate impression based on findings.

Input: Female, 47 years old, with multiple sclerosis and paresthesias. Evaluate for progression. Brain:Redemonstrated are numerous T2 hyperintense lesions involving the corpus callosum, periventricular and juxtacortical white matter, and to a lesser extent the brainstem and cerebellum. Lesion number and size have not significantly changed. As before, most lesions demonstrate moderate T1 hypointensity with a few showing marked T1 hypointensity, unchanged from prior.No evidence of edema or mass effect is seen. No abnormal extra-axial collections are detected. Mild thinning of the corpus callosum and periventricular volume loss are unchanged.C-spine:A segment of T2 hyperintensity is seen involving the right dorsal spinal cord spanning the C2 and C3 vertebral body levels. When compared to the prior cervical MRI from 2009, this lesion has increased in size. However, it is also visualized on sagittal views of the brain MRI from 05/17/16, on comparison to which, it does not appear to have changed significantly.Straightening of the cervical lordosis is seen. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is demonstrated.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Left greater than right facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Moderate left foraminal narrowing. No changes. C5-6: Left facet arthropathy. No significant spinal canal or foraminal stenosis. No changes. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing, slightly progressed. C7-T1: Facet arthropathy. Very small left paracentral protrusion. No spinal canal or foraminal stenosis. No interval changes.

Output: 1.Stable size and number of demyelinating lesions in the brain.2.A spinal cord lesion spanning the C2 and C3 levels is unchanged relative to the prior examination from 2016, but has progressed relative to the older examination from 2009.3.Additional smaller spinal cord lesions have decreased in conspicuity relative to the 2009 examination.4.Mild degenerative changes of the cervical spine as above.


Instruction: Generate impression based on findings.

Input: 33 year old man with history of complex congenital disease with multiple previous surgeries, admitted for hypoxia and atrial fibrillation with suspected RA clot on CT, who is now referred for cardiac MRI to evaluate morphology and function.Surgical history is as follow:At birth: formation of PDA and atrial septal defectAt 6 months: Blalock-Taussig shunt At 4 years: RVOT patch At 6 years: Closure of BT shunt and ASD; Glenn shunt performed Overall AnatomyThere is pulmonary atresia with the right main pulmonary artery not well visualized, atretic or absent. Right pulmonary arteries are visualized at the right hilum at lobar level which branch to small segmental and subsegmental arteries. A Glenn shunt is present with the superior vena cava providing flow to the origin of the right pulmonary artery at the lobar level. The inferior vena cava maintains conventional anatomy and connects to the floor of the right atrium which is severely dilated.The right ventricle is normal in size and a tricuspid valve is present. The left ventricle is normal in size and is the systemic ventricle.Systemic Venous ReturnA Glenn shunt connects the SVC to the right pulmonary artery. The IVC empties in the right atrium. There are no obstructions or stenoses in either the SVC or IVC.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 42%, the RV end diastolic volume index is 58 ml/m2 (normal range 82+/-16), the RVEDV is 127 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 74 ml (normal range 54+/-17).Pulmonary Venous ReturnThere are four pulmonary veins which drain into the left atrium. There are no obvious obstructions of the pulmonary veins.Left VentricleThe left ventricle is normal size. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 51 ml/m2 (normal range: 74+/-15), the LVEDV is 111 ml (normal range 142+/-34), the LV end systolic volume index is 22 ml/m2 (normal range 25+/-9), the LVESV is 49 ml (normal range 47+/-19), the LV mass index is 39 g/m2 (normal range 85+/-15), and the LV mass is 85 g (normal range 164+/-36). There is interventricular septal flattening throughout the entire cardiac cycle.There is high signal on the delayed viability sequences at the basal interventricular septum which corresponds to expected membranous VSD patch. On the four-chamber cine images, this area demonstrates slight increased mobility than the muscular VSD. There is no associated jet on either side of this patch.Left Atrium: Normal size. There are 4 pulmonary veins on the right and 2 on the left that drain into the left atrium.Right Atrium: The right atrium is severely enlarged. There is a low signal nodular structure in the right atrium which appears to be adherent to the superior interatrial septum measuring 2.6 x 4.6cm. It approaches the ostium of the right atrial appendage and occupies the atrial chamber, not prolapsing into the tricuspid valve. It does not perfuse on first pass imaging or enhance, consistent with thrombus. The coronary sinus is dilated. No gross defect of the interatrial septum is visualized on cine views.Contrast injection was performed via antecubital fossa with initial opacification of the left chambers due to the Glen shunt. Therefore, possible resting shunt from right to left was not excluded. Aortic ValveThe aortic valve opens widely and there is trivial aortic regurgitation. Regurgitant fraction is 6%.Mitral ValveThe mitral valve appears normal in structure with trivial mitral regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. The septal leaflet is faintly visualized and appears to be displaced apically by 10 mm relative to the anterior leaflet of the mitral valve.AortaThe ascending thoracic aorta is located posterior to the pulmonary trunk. The ascending aorta is dilated (41mm x 41mm at the level of the main PA). There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is post ductal diffuse narrowing of the aorta without obvious coarctation. The descending thoracic aorta measures 1.3 x 1.7cm at the level of the coronary sinus. There is no thoracic aortic dissection. Pulmonary Artery: There is a patch in the RVOT consistent with previous surgery. The main pulmonary artery is small and atretic. The proximal right PA is not visualized. The left pulmonary artery diameter is 26mm.PericardiumThere is no pericardial effusion.Extracardiac FindingsSternotomy wires are present. The liver appears nodular with dilated suprahepatic IVC and intrahepatic veins, consistent with clinical history of cirrhosis.

Output: 1. Anatomy consistent with pulmonary atresia, with absent or atretic right main pulmonary artery. 2. The right ventricle is normal in size with moderately reduced function (EF 42%). There is a tricuspid valve present. 3. The left ventricle is the systemic ventricle, normal in size with normal systolic function (EF 57%).4. A Glenn shunt is seen connecting the SVC to a lobar branch of the right pulmonary artery. The IVC empties into the right atrium, which is severely enlarged.5. Due to contrast injection, unable to visualize the right sided chambers therefore cannot exclude a right to left shunt on this study.6. There is a large thrombus occupying the right atrium which measures 2.6 x 4.6cm. 7. Dilated ascending aorta (41 x 41mm) at the level of the main PA. There is post ductal narrowing without coarctation.8. Liver appearance consistent with cirrhosis, possibly related to reflux hepatopathy. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 24 years Male (DOB:4/11/1992)Reason: cspine dz History: neck painPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small left paramedian disc protrusion present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild broad-based central disc protrusion at this level which partially effaces spinal fluid ventral and posterior the spinal cord. Overall there is a mild to moderate degree of spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion at this level which partially effaces spinal fluid ventral and posterior the spinal cord. Overall there is a mild to moderate degree of spinal stenosis at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are small multilevel disc protrusions present which create to mild to moderate degrees of spinal stenosis at C4-5 and C5-6.


Instruction: Generate impression based on findings.

Input: History of myelofibrosis. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again are several benign hepatic cysts. Relative atrophy of the right hepatic lobe. No biliary ductal dilatation. Status post cholecystectomy.Demonstrated again are findings compatible with cavernous transformation of a chronically thrombosed portal vein.SPLEEN: Marked splenomegaly measuring 25 cm in the craniocaudal dimension, compared to 29 cm previously. At the level of the celiac artery origin the spleen measures 17.4 x 11.2 cm in cross-section, compared to 19 x 12.7 cm previously. Stable peripheral nonenhancing abnormality with parenchymal loss suspicious for prior small infarct. Numerous perisplenic collateral vessels are again noted. The largest varix measures 1.9 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several punctate renal cysts, including a proteinaceous/hemorrhagic cyst within the right inferior pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Heterogeneous bone marrow signal intensity, consistent with patient's history of myelofibrosis.BONES, SOFT TISSUES: Broad-based peri-umbilical abdominal wall laxity containing small bowel loops.OTHER: No significant abnormality noted.

Output: 1.Mild interval decrease in splenomegaly as detailed above. 2.Chronic portal vein thrombosis with cavernous transformation.


Instruction: Generate impression based on findings.

Input: Status of thyroid nodule? RIGHT LOBE MEASUREMENTS: 3.1 x 0.8 x 1.1 cmLEFT LOBE MEASUREMENTS: 3.5 x 1.0 x 0.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted. Thyroid is atrophic and scarred in appearanceLEFT LOBE: No significant abnormality noted. Thyroid is atrophic and scarred in appearanceISTHMUS: No significant abnormality noted. Thyroid is atrophic and scarred in appearancePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes bilaterallyOTHER: No significant abnormality noted.

Output: Small scarred thyroid with no focal nodules identified.


Instruction: Generate impression based on findings.

Input: Dystonia and parkinsonism. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is minimal nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are multiple polypoid sinonasal lesions.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of sinonasal polyposis.


Instruction: Generate impression based on findings.

Input: Craniocervical junction is unremarkable. There is minimal anterolisthesis of C3 on C4. Alignment is otherwise unremarkable. The osseous marrow signal is benign. There is mild disk desiccation at all levels in the cervical spine. The vertebral body heights are preserved. The cord signal is within normal limits.C2-3: No significant disk/endplate degeneration or spinal stenosis.C3-4: Small central disk osteophyte complex. No spinal canal or neural foraminal stenosis.C4-5: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C5-6: Small central disk osteophyte complex with no spinal canal or neural foraminal stenosis.C6-7: No disk/endplate degeneration or spinal stenosis.C7-T1: No disk/endplate degeneration or spinal stenosis.The upper imaged thoracic spine shows no significant disk herniation or spinal canal/neural foraminal stenosis.

Output: Minimal degenerative changes without significant spinal canal or neural foraminal stenosis at any level. No cord signal abnormality.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: GBM, on Avastin Again seen are postsurgical changes of right temporoparietal craniotomy for partial tumor resection involving the right temporal lobe. Nodular enhancement surrounding the right temporal resection cavity and right periatrial region is not significantly changed. Separate focus of enhancement involving the right temporal lobe cortex more anterolaterally is also not significantly changed. No new area of enhancement. There is also no significant change in extent of T2/FLAIR hyperintensity surrounding the resection cavity, the more superior right greater than left cerebral white matter, as well as along the occipital horns. Area of restricted diffusion related to treated tumor is not significantly changed. There is no significant change in size of the ventricular system which remains prominent. No evidence of acute infarct or acute hemorrhage. No new mass effect, midline shift, or herniation.

Output: Compared to 3/24/2016, there is no evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: 27-year-old male with Crohn's and abnormal LFTs ABDOMEN:LIVER, BILIARY TRACT: No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. There is no focal stricturing or mass involving the biliary ductal system.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No specific findings to suggest primary sclerosing cholangitis.


Instruction: Generate impression based on findings.

Input: Cervical spine:There has been prior suboccipital craniotomy for Chiari decompression, reconstituting a posterior CSF space. There is cerebellar ectopia, with the right cerebellar tonsil demonstrating a more pointed morphology.There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The visualized paraspinal contents are unremarkable. There is no MRI evidence of ligamentous injury.There are no significant degenerative changes or stenoses.Thoracic spine:Horizontal fractures are noted through the T12 vertebra involving anterior, middle, and posterior columns consistent with the history of Chance fracture. This is associated with significant superior endplate compression deformity, with approximately 50% loss of vertebral body height anteriorly. There is mild retropulsion of approximately 3-4 mm encroaching the anterior CSF space. Adjacent to this, there is a small focus of T2 hyperintensity within the conus. There is also splaying of the T11 and T12 spinous processes with significant interspinous and supraspinous ligamentous injury. There is also overlying soft tissue injury.There are no other fractures. Remaining vertebral body heights are maintained. Other than the conus, and the thoracic cord is normal in signal. There are no significant degenerative changes or stenoses.Lumbar spine:Note is made of sacralization of L5 with a rudimentary L5/S1 disc.Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable. There are no significant degenerative changes or stenoses.

Output: 1.There has been prior suboccipital craniotomy for Chiari decompression, reconstituting a posterior CSF space. There is cerebellar ectopia, with the right cerebellar tonsil demonstrating a more pointed morphology.2.Horizontal fractures are noted through the T12 vertebra involving anterior, middle, and posterior columns consistent with the history of Chance fracture. This is associated with significant superior endplate compression deformity, with approximately 50% loss of vertebral body height anteriorly. There is mild retropulsion of approximately 3-4 mm encroaching the anterior CSF space. Adjacent to this, there is a small focus of T2 hyperintensity within the conus. There is also splaying of the T11 and T12 spinous processes with significant interspinous and supraspinous ligamentous injury. There is also overlying soft tissue injury.3.No MRI evident ligamentous injury of the cervical or lumbar spine.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis, type 2 [Q85.02] / Benign neoplasm of cranial nerves [D33.3] There are postoperative findings seen in the right mastoid temporal bone. There are enhancing lesions within the bilateral internal auditory canals. The left lesion measures 6.6 x 9.5 cm, which is similar to the prior examination, while the right lesion appears to have enlarged compared to prior examination, now measuring 8.3 x 5.7 mm, previously 6.1 x 6 x 1 mm. There is a plaque-like enhancing mass along the right parietal convexity that measures up to 9 mm in thickness with minimal mass effect upon the brain. There is redemonstration of an expansile, heterogeneously enhancing lesion involving the medulla. In addition, punctate areas of gradient susceptibility involving the lesion likely relating to microhemorrhage appears slightly increased since prior examination. The lesion appears to have slightly increased in size, now measuring 2.3 x 1.8 x 2.7 cm, previously 2.2 x 1.7 x 2.4 cm. Additional small upper cervical spinal cord lesions are incompletely characterized. There is no evidence for hydrocephalus. There is no evidence of acute ischemia. There is no midline shift. There is no significant interval change in the lobulated, enhancing mass at the left C1-2 level with mild intraspinal and paraspinal extension, but no mass effect upon the spinal cord. There may also be an additional punctate enhancing nodule in the right aspect of the thecal sac at the C4 level.

Output: 1. Interval increase in size of right vestibular schwannoma, but stable left vestibular schwannoma.2. The medullary ependymoma has increased in size. Small upper cervical spinal cord lesions are incompletely characterized. 3. Stable appearance of schwannoma at left C1-2 level with paraspinal extension and possible additional punctate schwannoma at the right C4 level. Dedicated cervical spine imaging may be useful for further evaluation.4. Small right parietal convexity meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate for rotator cuff tear ROTATOR CUFF: No evidence is seen of a rotator cuff tear. There is some intermediate signal within the supraspinatus tendon that likely represents tendinopathy.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. Additional findings: There are vessels seen in the spinoglenoid notch but no evidence is seen of the sequela of suprascapular nerve entrapment

Output: Supraspinatus tendinopathy. No evidence of rotator cuff tear


Instruction: Generate impression based on findings.

Input: Clinical question: 25 years old male with fevers, vomiting, headaches, mental status change. Rule out intracranial increase pressure, mass, bleed. Signs and symptoms: Altered mental status, vomiting, fever and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is evidence of a prior in the right posterior temporal -- occipital junction with the extensor and inferior to the suboccipital region. There is underlying parenchymal encephalomalacia of right cerebellum and right occipital lobe. Please correlate with history regarding the reason for surgery. Follow-up with an MRI is recommended if there was a recurrence of tumor at this site. No acute finding on the current exam.Images through posterior fossa also demonstrate bilateral patchy and linear calcification that may be result of prior treatment. There is also ex vacuo dilatation of the fourth ventricle. Patchy calcification within the pons is also noted. This finding may be also result of prior treatment or a cavernoma. This finding and may also further evaluated with an MRI examination.Other than above described craniotomy calvarium is intact.Visualized mastoid air cells and middle ear cavities are unremarkable.There is limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Focal encephalomalacia right occipital and right cerebellum under a right-sided posterior temporal, occipital, suboccipital craniotomy site. Please correlate with past medical history.3.Patchy calcification of bilateral cerebellum may be result of prior treatment.4.Patchy calcification of the pons could result of prior treatment and or a cavernoma.5.If clinical concern persist recommend follow-up with an MRI exam.


Instruction: Generate impression based on findings.

Input: Severe pain ROTATOR CUFF: Focus of high T2 signal at the undersurface of the distal supraspinatus tendon likely represents partial tearing. The supraspinatus muscle is normal in appearance. The remainder of the rotator cuff appears unremarkable.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis of the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. The labrum is grossly intact.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial tearing of the undersurface fibers of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: Left knee pain and casting. Evaluate for lateral meniscus tear. MENISCI: There is inner edge fraying of the medial meniscus. The body of the anterior horn is largely degenerated and extruded. The posterior horn attachment is essentially intact towards its root.ARTICULAR CARTILAGE AND BONE: There is marked narrowing of the lateral tibiofemoral compartment with marked thinning and near complete focal full-thickness loss of cartilage along the posterior femoral condyle. There is bone marrow edema about the tibial plateau.LIGAMENTS: There is mild internal signal within the anterior cruciate ligament, but the fibers appear intact. The posterior cruciate ligament, medial collateral ligament and fibular collateral ligament are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Marked underlying meniscal degenerative changes, see details.


Instruction: Generate impression based on findings.

Input: Clinical question: Subacute loss of memory. Signs and symptoms: Subacute loss of memory. Pre and postcontrast enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates mild generalized prominence of cortical sulci which could be within the normal range for age. There is no significant change of this finding when compared with prior exam from 2003.Unremarkable anatomical morphology and signal intensity of brain parenchyma otherwise on all MRI sequences. Unremarkable cerebral cortex, ventricular system, CSF spaces and gray-white matter differentiation.The signal voids of major intracranial arterial branches are identified.Post enhanced images demonstrate no abnormal enhancement of brain parenchyma, leptomeninges, calvarium, soft tissues of the scalp or the orbits.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.

Output: Unremarkable pre and post enhanced brain MRI. Please see above comments.


Instruction: Generate impression based on findings.

Input: 52-year-old female with severe left shoulder pain. Rule out rotator cuff tear. ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. There is a full-thickness insertional tear of the infraspinatus tendon without retraction measuring approximately 7 mm in the AP dimension. There is mild edema within the adjacent tendinous fibers, but the muscle appears intact. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal for age. There is a trace amount of fluid within the subacromial/subdeltoid bursa likely related to the aforementioned focal rotator cuff tear.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is no glenohumeral joint effusion. However, there is a lobulated and septated collection of fluid signal intensity within the spinoglenoid notch extending into the suprascapular notch. There appears to be chronic pressure erosion of the underlying posterior glenoid. We suspect that this represents a paralabral cyst as there appears to be a tear of the posterior superior glenoid labrum as well. We see no frank atrophy of the infraspinatus at this time.BICEPS TENDON: The tendon long head of the biceps appears intact

Output: 1. Focal full-thickness insertional tear of the infraspinatus without retraction.2. Paralabral cyst within the spinoglenoid notch associated with a tear of the posterior superior glenoid labrum.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes centered at the L1-L2 level related to cord untethering. There is mild clumping of the left-sided cauda equina nerve roots at the L1-L2 level on the left which is not evident on prior study. No fluid collections in the posterior paraspinous soft tissues. There is no appreciable change in the appearance of the lower thoracic cord which is anteriorly positioned with mild concavity of the posterior cord contour at the T11 level. The conus more inferiorly is posteriorly positioned at the L1 level. There is no cord signal abnormality. No focal lesions involving the lumbar spinal canal. Prone images demonstrate appropriate ventral motion of the cauda equina nerve roots. However the conus remains posteriorly positioned in the spinal canal.Vertebral body heights and disc spaces in the thoracic and lumbar spine are unremarkable. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1. Interval postsurgical changes related to cord untethering. There is unchanged appearance of the distal thoracic cord which remains anteriorly positioned in the thoracic spinal canal. Of note recent myelogram identified no filling defect to suggest an arachnoid cyst. Differential remains unchanged including anterior displacement of the cord related to adhesion or potentially cord herniation, or less likely early filling of an arachnoid cyst which was not evident on the myelogram.2. Prone images demonstrate appropriate ventral motion of the cauda equina nerve roots. The conus however remains posteriorly positioned, perhaps related to adhesion.3. Subtle clumping of the left-sided cauda equina nerve roots at the L1-L2 level compatible with postsurgical change/mild arachnoiditis.


Instruction: Generate impression based on findings.

Input: Unspecified convulsions [R56.9], Reason for Study: ^Reason: assess for seizure focus History: complex partial seizures with secondary generalization No evidence of acute ischemic or hemorrhagic lesion.Scattered multifocal T2/FLAIR high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged.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, 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: Nonspecific small vessel ischemic disease, unchanged.No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Right hip pain, sickle cell disease There is a small focus of edema within the femoral head anteriorly that is suspected to represent avascular necrosis. There is a very small hip joint effusion with mild edema within and along the adjacent musculature suggesting mild inflammation.There is perhaps a slight CAM deformity of the femoral head-neck junction anteriorly with a small synovial herniation pit. These findings can be associated with femoral acetabular impingement in the appropriate clinical context. There is mildly increased signal of the anterior labrum suggesting degeneration or perhaps focal fraying.There is diffusely abnormal marrow signal consistent with the stated history of sickle cell disease but we otherwise see no additional focal marrow abnormalities. There is a small amount of free fluid in the pelvis. A 4 cm collection of near fluid signal intensity within the right adnexa likely represents a functional cyst.

Output: Signal abnormality of the anterior femoral head with very small joint effusion and mild surrounding soft tissue inflammation. We favor avascular necrosis as the etiology of these findings but if there is strong clinical concern for infection, aspiration can be considered.


Instruction: Generate impression based on findings.

Input: Increasing leg weakness. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild facet joint hypertrophy at L4-5 with mild bilateral neural foraminal stenosis, but no significant lumbar spinal canal or stenosis. There is mild sacral epidural lipomatosis. The lower spinal cord displays normal signal and morphology and the cauda equina appears to be grossly intact. The paravertebral soft tissues are unremarkable. There are partially-imaged bilateral renal cysts.

Output: Mild facet joint hypertrophy at L4-5 with mild bilateral neural foraminal stenosis, but no significant lumbar spinal canal or stenosis.