Instruction: Generate impression based on findings.

Input: Male, 47 years old, with multiple myeloma, pre-proton therapy evaluation. Brain:Findings are seen compatible with right frontal approach endoscopic third ventriculocisternostomy. A small defect is evident in the corpus callosum at the point where the endoscope penetrated the ventricular system. There is susceptibility artifact and diffusion restriction at this site which may represent a combination of blood product and cytotoxic edema. The ventricular caliber has returned to normal when compared to the planning MRI dated 4/26/2016.The solid enhancing left posterior frontal tumor has clearly increased in size compared to the examination of 3/29/2016, but is stable to only minimally increased in size when compared to the most recent planning MRI. As before, enhancement extends from this lesion into the adjacent precentral sulcus. Surrounding parenchymal edema is similar in geographic extent. Patchy leptomeningeal enhancement more anteriorly in the left frontal lobe and minimally along the right frontal lobe appears to have slightly increased as well. The solidly enhancing pineal mass shows no convincing interval change in size. A 4 mm enhancing nodule along the undersurface of the vermis at the level of the foramen of Magendie is stable when compared to the immediate prior examination, but increased when compared to the older exam. No entirely new intracranial lesions are seen.Cervical spine:A subcentimeter focus of nonenhancing T2 hyperintensity is seen within the C4 vertebral body which is nonspecific. No definite myelomatous lesions are seen in the marrow space. Vertebral body height and morphology are within normal limits. Alignment is anatomic.The spinal cord demonstrates normal signal intensity and morphology. No focal cord lesions are seen. No pathologic intramedullary or leptomeningeal enhancement is detected.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is seen.Thoracic spine:A subcentimeter T2 hyperintense and mildly enhancing lesion is evident within the T9 vertebral body, nonspecific. No additional marrow space lesions are seen. Mild anterior wedging of the T11 and T12 vertebral bodies is seen without evidence of marrow edema. Vertebral body heights are otherwise preserved. Spinal alignment is anatomic.The visualized spinal cord demonstrates normal signal intensity and morphology throughout. No focal lesions are seen. No pathologic intramedullary enhancement is seen. There may be minimal dorsal leptomeningeal enhancement at the T9-10 level versus vascular structures.Scattered small disc protrusions are seen but there are no areas of significant spinal canal or foraminal stenosis.Incidental findings include basilar atelectasis and multiple renal cysts.Lumbar spine:Alignment is anatomic. Vertebral body heights are preserved. A small hypointense focus is seen along the inferior T12 endplate which may represent a Schmorl's node. No concerning marrow replacement, edema or pathologic marrow enhancement is observed.Somewhat diffuse enhancement of the nerve roots of the cauda equina is seen. In addition, there are five or six frank enhancing nodules within the thecal sac and extending into several neural foramina.L1-2: Mild disc bulge. No significant spinal canal stenosis. Mild left foraminal narrowing. L2-3: Small left foraminal disc protrusion. No significant spinal canal stenosis. No significant foraminal narrowing. L3-4: Mild facet arthropathy. No significant spinal canal stenosis. Mild foraminal narrowing. L4-5: Facet arthropathy. Loss of disc height and disc bulging with a right paracentral annular fissure. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. L5-S1: Facet arthropathy. Loss of disc height and disc bulging asymmetric to the left. No significant spinal canal stenosis. Severe bilateral foraminal narrowing.

Output: 1.The left frontal lobe enhancing parenchymal lesion is stable to slightly increased in size.2.Scattered leptomeningeal enhancement in the left frontal lobe, and to a much lesser degree in the right frontal lobe, also appears more prominent.3.No significant change in the size of a pineal region enhancing lesion.4.A small enhancing nodule along the undersurface of the cerebellar vermis has increased in size also likely representing tumor.5.Sequelae of endoscopic third ventriculocisternostomy are seen with return of ventricular caliber to normal size.6.No definite myelomatous disease is seen in the marrow space of the spine.7.However, diffuse leptomeningeal disease is seen along the nerve roots of the cauda equina with numerous superimposed intradural and foraminal nodules.


Instruction: Generate impression based on findings.

Input: 68-year-old male with prostate cancer (Gleason 4+4 in the right mid gland). Evaluate extent of disease. PELVIS:PROSTATE:Prostate Size: 3.9 x 3.2 x 2.5 cmPeripheral Zone: There is hazy T2 hypointensity in the right peripheral zone without a focal diffusion restricting, enhancing lesion.Central Gland: No significant abnormality identified.Seminal Vesicles: No significant abnormality.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: There is hazy T2 hypointensity in the right peripheral zone without a focal diffusion restricting, enhancing lesion.


Instruction: Generate impression based on findings.

Input: Female, 76 years old, with headaches. Brain:Postcontrast imaging only was acquired as a supplement to the recent prior noncontrast brain MRI. No pathologic parenchymal or extra-axial enhancement is observed.Cervical spine:The typical cervical lordosis is straightened which is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow enhancement is seen.Ill-defined T2 hyperintensity is noted within the spinal cord at the C4-5 level. There is no associated pathologic enhancement and the cord in this region is not particularly expanded. The spinal canal is congenitally slender. No discrete epidural abnormalities are suspected.C2-3: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. No significant foraminal narrowing.C3-4: Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing. C4-5: Left facet arthropathy. Posterior disc-osteophyte complex formation. Mild to moderate generalized spinal canal narrowing. Severe left and moderate right foraminal narrowing.C5-6: Left facet arthropathy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal narrowing. Severe left and mild right foraminal narrowing. C6-7: Bilateral facet arthropathy. Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. C7-T1: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.

Output: 1.No enhancing lesions are demonstrated on the postcontrast evaluation of the brain.2.Ill-defined signal abnormality is seen within the spinal cord at the C4-5 level. There is no associated enhancement or evidence of cord expansion. As such, chronic myelomalacia is favored over edema. The etiology for this finding is uncertain, though given that the C4-5 level shows a mild to moderate spinal canal stenosis, this could represent sequelae of chronic degenerative impingement or prior trauma.3.Relatively mild degenerative disc findings are seen. However, as these are superimposed on a congenitally slender canal, canal stenosis ranging from mild to moderate is seen at multiple levels. Variable foraminal narrowing is also noted as above.


Instruction: Generate impression based on findings.

Input: Female 58 years old; Reason: Evaluate right hip for posterior labral tear, iliopsoas tendinitis, greater trochanteric bursitis, and piriformis tendinitis, patient has pain in the posterolateral right hip and groin with snapping. ACETABULAR LABRUM: There is a linear increased signal intensity traversing the anterior labrum at the 2:00 to 3:00 position consistent with a labral tear. There is also deformity and increased signal intensity involving the superior labrum at the 12:00 position, indicating an additional tear. We see no tear of the posterior labrum.ARTICULAR CARTILAGE AND BONE: There is mild heterogeneous signal intensity in the articular cartilage adjacent to the superior labral tear suggesting focal degeneration and tearing. There are also tiny osteophytes. There is a slight prominence of the femoral head and neck junction anteriorly indicating a CAM deformity with an alpha angle of approximately 60 degrees. There is an underlying synovial herniation pit. Bone marrow signal is otherwise normal in intensity.SOFT TISSUES: There is minimal edema along the right greater trochanter, which is often seen in asymptomatic individuals and is not necessarily of any clinical significance. Musculature appears normal including the iliopsoas and piriformis muscles. ADDITIONAL

Output: Right acetabular labral tears and other findings as above.


Instruction: Generate impression based on findings.

Input: 49 year old male with atrial fibrillation and hypertension referred for cardiac MRI prior to consideration of ablation. Left VentricleThe left ventricle is normal in size, mildly reduced systolic function. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 234 ml (normal range 142+/-34), the LV end systolic volume index is 48 ml/m2 (normal range 25+/-9), the LVESV is 129 ml (normal range 47+/-19), the LV mass index is 20 g/m2 (normal range 85+/-15), and the LV mass is 54 g (normal range 164+/-36). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Native pre-contrast myocardial T1 relaxation times (~950 ms) are within normal limits. Left AtriumThe left atrium is moderate-severely dilated. Right VentricleThe right ventricle is mildly dilated with moderately reduced systolic function. The overall RV ejection fraction is 40%, the RV end diastolic volume index is 128 ml/m2 (normal range 82+/-16), the RVEDV is 346 ml (normal range 142+/-31), the RV end systolic volume index is 78 ml/m2 (normal range 31+/-9), and the RVESV is 209 ml (normal range 54+/-17).Right AtriumThe right atrium is severely dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. Trace tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsThere are 2 left-sided pulmonary veins in standard locations. The right inferior pulmonary vein demonstrates early branching; there is a small accessory pulmonary vein just inferior and posterior to the takeoff of the right superior pulmonary vein. No pulmonary vein stenosis.Pulmonary ArteryThe main pulmonary artery is mildly dilated (32mm).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. The left ventricle is normal in size, mildly reduced systolic function (LVEF 49%). No evidence of late gadolinium enhancement. 2. The right ventricle is mildly dilated with moderately reduced systolic function (RVEF 40%). 3. Biatrial dilation. 4. Mild anomalous pulmonary venous drainage: There are 2 left-sided pulmonary veins in standard locations. The right inferior pulmonary vein demonstrates early branching; there is a small accessory pulmonary vein just inferior and posterior to the takeoff of the right superior pulmonary vein.3. The main pulmonary artery is mildly dilated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Diplopia and history of thyroid cancer. Brain: There is no evidence of intracranial mass lesions or acute cerebral infarct. There is a right frontal developmental venous anomaly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered mild paranasal sinus mucosal thickening.Orbits: There is no evidence of intraorbital mass lesions or abnormal enhancement. The bilateral globes, ocular adnexa, and optic nerves appear to be intact.

Output: 1. No evidence of intracranial metastases or acute cerebral infarction.2. No evidence of intraorbital lesions.


Instruction: Generate impression based on findings.

Input: Oscillopsia, eye pain, and headaches. Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a persistent left trigeminal artery. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of orbital lesions.2. No evidence of demyelinating lesions, acute intracranial hemorrhage, mass, or cerebral infarction.


Instruction: Generate impression based on findings.

Input: 50-year-old female with left foot drop and acute onset left-sided pain with decreased pin and light touch sensation; rule out stroke or other lesion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of T2/FLAIR hyperintensities in the supratentorial subcortical white matter which are nonspecific. The brain parenchyma appears otherwise unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Scattered foci of T2/FLAIR hyperintensities in the supratentorial subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. Examination is otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 55-year-old female with ulcer along foot, evaluate for osteomyelitis Extensive soft tissue swelling about the ankle and midfoot. TENDONS: The extensor and flexor tendons are grossly intact with extensive edema in the surrounding soft tissues.LIGAMENTS: The ATFL is grossly intact.ARTICULAR SURFACES AND BONE: There is marked edema within the anterior aspect of the talus and dorsal displacement of the navicular relative to the talus with abnormal T1 hypointense and T2 bright bone marrow signal in the navicular and cuneiform bones. Multifocal bone marrow edema is noted throughout the mid foot without discrete fracture line or erosion.ADDITIONAL

Output: Extensive soft tissue swelling, multifocal bone marrow edema and talonavicular dislocation as described above more likely representing neuropathic joint, although infection cannot be excluded.


Instruction: Generate impression based on findings.

Input: 72-year-old female with lower extremity weakness. Evaluate for cord compression. History of lung malignancy. The vertebral bodies are appropriate in the overall alignment and height. There are patchy areas of marrow replacement particularly focally involving the C4 and T7 vertebral bodies which are not entirely evaluated and could be benign. However given the history of lung malignancy, the possibility of metastatic disease should be considered. The spinal cord has normal signal characteristics and overall morphology. There is no definite spinal cord compression. There are multiple small disc osteophyte complexes involving the lower cervical spine as well as mild disc bulges involving the lower lumbar spine. The most prominent disease level is in the lower lumbar spine at the L2-3 level where there is disc height loss and degenerative endplate bone marrow changes. The disc bulge here causes at least a mild central canal stenosis and some degree of neural foraminal narrowing. Incidentally noted is a cavitary process in the right lung apex which is better described on a prior chest CT from 11/11/2015. There is also a large left-sided pleural effusion that has developed in the interim.

Output: 1.This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. 2.Degenerative changes and mild multilevel disc disease in the cervical and lumbar spine are as described above which causes at most mild central spinal canal stenosis at the L2-3 level.3.A right apical lung cavitary process is partially visualized and better characterized on the recent previous chest CT. Interval development of a right-sided pleural effusion.


Instruction: Generate impression based on findings.

Input: 84-year-old male with history of left renal mass. Evaluate for invasion into left renal vein. ABDOMEN:LIVER, BILIARY TRACT: Small gallstone in the dependent lower gallbladder body. No intra or extra hepatic biliary ductal dilatation. No suspicious parenchymal lesion. Susceptibility artifact related to the known calcified granulomas of the right hepatic lobe (axial series 11 images 100, 142).SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small T1 hyperintense cysts and simple T2 hyperintense cysts of the right kidney. There is mild wall thickening of the lateral aspect of a subcentimeter cyst of the right lower renal pole (series 10012 image 325). No hydronephrosis.Large predominately peripherally enhancing and centrally necrotic lesion of the anterior left mid/lower renal pole measuring 7.7 x 5 cm (series 12 image 112) with expansion and invasion of the lateral-most aspect of the left renal vein (series 12 image 169).Stable large simple cyst of the left lower renal pole. Additional small T1 hyperintense cysts of the left kidney are also seen.RETROPERITONEUM, LYMPH NODES: No enlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large enhancing mass of the anterior left mid/lower renal pole with expansion and invasion of the lateral most aspect of the left renal vein.2.There is mild wall thickening of the lateral aspect of a subcentimeter cyst of the right lower renal pole. Attention on follow-up imaging is recommended.


Instruction: Generate impression based on findings.

Input: 52-year-old female with SLE, twitching/jerking movement around her mouth for a few days with speech. Evaluate for intracranial abnormalities. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal punctate scattered T2 periventricular and subcortical white matter hyperintensities which not significantly changed compared to previous exam. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Minimal nonspecific white matter signal abnormality again seen and not significantly changed from previous exam.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for left cervical radiculopathy. Signs and symptoms: Radicular pain in LUE. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with resultant significant left and moderate right neural foraminal compromise and no central spinal stenosis. Interval progression since prior exam.C4-C5 demonstrate moderate disc disease and loss of disc height and mild bilateral facet and ligamentum flavum hypertrophy. No spinal stenosis however moderate bilateral neural foraminal compromise is present without significant change since prior exam.C5-C6 demonstrate moderate to advanced disc disease and loss of disc height and mild to moderate ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate left and mild right neural foraminal compromise is present without significant change since prior exam.C6-C7 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No spinal stenosis however moderate right and mild to moderate left neural foraminal compromise is present. No significant change since prior exam.C7-T1 demonstrate mild disc disease and hypertrophic changes of posterior elements without spinal stenosis or neural foraminal compromise and is stable since prior study. Signal intensity and caliber of cervical and upper most visualized thoracic cord to T3 level is within normal

Output: 1.Degenerative changes of cervical spine with resultant multilevel neural foraminal compromise without significant change since prior exam. Please review detailed report per level above.2.No evidence of central spinal stenosis at any level.3.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, history lung cancer, with brain tumor, preoperative evaluation. A very heterogeneous, lobular mass is evident centered on the left temporal lobe which spans the temporal stem to involve the thalamus and basal ganglia. The core of the lesion is composed of predominantly nonenhancing, cystic components with areas of smudgy low T2 signal likely representing either blood product or mineralization. Rim enhancement of the cystic components is seen with heterogeneous but relatively more solid enhancement along the inferior margin. Curvilinear internal enhancement is suggestive of vascularity. On some slices, the lesion appears to be contiguous with the choroid plexus. There may be subependymal enhancement along the left lateral ventricle.Extensive T2 hyperintensity surrounds the lesion extending into the adjacent white matter tracts. Substantial generalized mass effect is observed with a midline shift to the right of up to 12 mm, uncal herniation, shift of the brainstem to the right, effacement of and herniation into the left ambient cistern and prepontine cistern, and effacement of the left lateral ventricle. The left occipital horn is likely entrapped. The left cisternal trigeminal nerve appears stretched.The right lateral ventricle is not dilated. The third and fourth ventricles are within normal limits. No remote enhancing lesions are seen. A left cerebral subdural fluid collection is seen which follows CSF signal intensity on both T1 and T2-weighted images measuring up to 15 mm in thickness. Single and multi voxel spectroscopy was performed within and around the large left temporal lesion. The core of the lesion demonstrates prominent peaks related to both lipid and lactate indicating necrosis. The enhancing margin of the lesion shows variably reduced NAA and increased choline, though the choline increase is modest relative to levels obtained from normal-appearing parenchyma. The immediate perilesional tissues show no significant choline increase.

Output: A very large heterogeneously enhancing tumor is present centered on the left temporal lobe with substantial associated mass effect as described above. The core of the lesion is largely cystic and necrotic with enhancing tissue seen predominantly along the periphery and the inferior margin. The lesion appears to be quite vascular. The differential diagnosis would include a high-grade primary brain tumor as well as a metastatic lesion. The appearance of the lesion on conventional images would favor a primary brain tumor. However, on spectroscopic assessment, lack of choline elevation in the lesion periphery is a feature often attributed to noninfiltrative lesions such as metastases.


Instruction: Generate impression based on findings.

Input: 14 year old female patient with right knee pain/injury. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is increased T2 signal in the lateral aspect of the lateral femoral condyle and medial aspect of the patella compatible with edema and suggestive of a transient patellar dislocation. Mild edema is also noted in the lateral tibial plateau. The articular cartilage of all three compartments is intact.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Bone contusions in a pattern consistent with transient lateral patellar dislocation.


Instruction: Generate impression based on findings.

Input: Re-evaluate tethered release: numbness and weakness lower extremities. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Spine: There are postoperative findings related to tethered cord release. The conus medullaris remains positioned at T12 -L1. Motion of the spinal cord cannot be assessed since the prone images are degraded by artifact. There is an unchanged punctate focus of T1 hyperintensity that looses signal with fat suppression along the filum terminale at the L1 level. There is no abnormal enhancement within the spinal canal. There are unchanged mild T12 and L3 superior endplate defects that may represent Schmorl's node formation. The vertebral body heights are otherwise preserved. The vertebral column alignment is within normal limits. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. Postoperative findings related to tethered cord release with unchanged appearance and position of the conus medullaris and a punctate filum terminale fibrolipoma.


Instruction: Generate impression based on findings.

Input: This is a 5-year-old male with a history of Dandy-Walker malformation with P. with a VP shunt who presents with behavioral changes. Please evaluate ventricles and for shunt malformation. Changes consistent with Dandy-Walker malformation with large posterior fossa cyst which is continuous with the fourth ventricle. The VP shunt catheter is located in the posterior fossa within the fourth ventricle. When compared to the prior MRI in 2007 there are no changes in the size of the posterior fossa cyst. There is no significant ventricular prominence. There is an interval slight decrease in the frontal horns of the lateral ventricles.There is no evidence of intracranial hemorrhage, mass or edema.

Output: 1. Dandy-Walker malformation with VP shunt catheter located in the posterior fossa cyst.2. There are no changes in the size of the posterior fossa cyst. 3. No significant ventricular prominence.


Instruction: Generate impression based on findings.

Input: Reason: ich History: right side weakness Nonenhanced CT of the brain:Examination demonstrates no evidence of acute intracranial hemorrhage. Diffuse white matter low attenuation of right hemisphere and to a lesser degree of the left hemisphere is similar to what was noted on prior MRI examination and is believed to represent post therapy changes for patient's known tumor. The ventricular system remain within normal range of size and morphology and also with no interval change since prior MRI exam.There is no definite evidence of any cortical abnormality. Small areas of small vessel ischemic changes can be completely obscured by post therapy changes. If clinical concern for stroke persist an MRI is recommended.

Output: Extensive intracranial findings consistent with post therapy changes of patient's known tumor which appears similar to prior MRI examination from 10 -- 19 -- 10. No evidence of hemorrhage, hydrocephalus or midline shift. If concern for stroke persist follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Male, 82 years old, with multiple brain lesions presented with weakness, preoperative planning examination for biopsy. Nodular masslike lesions are redemonstrated including a solidly enhancing lesion centered on the left cingulate gyrus, and a minimally enhancing lesion centered on the right posterior limb of the internal capsule. Diffuse thickening of the splenium corpus callosum is also redemonstrated without significant associated enhancement.Scattered nonspecific foci of parenchymal T2 hyperintensity are seen. The ventricles and sulci are proportionately prominent compatible with underlying parenchymal volume loss. A cyst of the cavum vergae or vellum interpositum is seen. Atrophy or encephalomalacia of the left anterior temporal lobe is suspected.

Output: Redemonstration of multiple brain lesions for surgical planning purposes.


Instruction: Generate impression based on findings.

Input: Pancreatic body and tail cystic lesion. Pt with documented pancreatic body tail mass that measured 3.2 X 2.9 cm on 8/14/15 MRCP. Had EUS 8/19/15,, lesion c/w serous cyst adenoma, CEA 7.8 and Amylase 95. Needs repeat imaging in 12-18 months if necessary. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis within a normally distended gallbladder. Focal mild cystic thickening of the gallbladder fundus and the neck is unchanged dating back to 2012, likely focal adenomyomatosis.No choledocholithiasis or biliary ductal dilatation.The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion.The vessels are patent.SPLEEN: The spleen is borderline enlarged measuring 15 cm in craniocaudal dimension.PANCREAS: In the distal pancreatic body/tail junction there is a 3.1 x 2.5 x 3.1 cm cystic lesion with a lobular contour and multiple internal cystic components in a cluster of grapes appearance. It previously measured 3.2 x 2.9 cm. There is no definite communication with the adjacent normal caliber main pancreatic duct. Postcontrast images demonstrate thin rim septal enhancement internally but no suspicious mural nodularity or soft tissue enhancement.Several punctate cystic foci with the largest measuring 8 mm in the pancreatic head, unchanged.Normal variant pancreaticobiliary ductal anatomy. Normal intrinsic T1-weighted signal intensity and postcontrast enhancement of the pancreas.ADRENAL GLANDS: Stable subcentimeter left adrenal lipid rich adenoma.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable pancreatic distal body/tail cystic lesion with morphology most suggestive of a serous cystadenoma.2.Additional punctate cystic pancreatic foci without suspicious imaging characteristics may represent small sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: DCM Left VentricleThe left ventricle is normal sized with moderately reduced performance. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 59 ml/m2 (normal range: 74+/-15), the LVEDV is 153 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 245 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is dilated. Right VentricleThe right ventricle is normal sized with mild reduced performance. The overall RV ejection fraction is 45%, the RV end diastolic volume index is 62 ml/m2 (normal range 82+/-16), the RVEDV is 162 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 88 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant 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.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Moderate cardiomyopathy without evidence of delayed enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and weakness ROTATOR CUFF: Rotator cuff muscles are intact. No muscle atrophy.SUPRASPINATUS OUTLET: There is mild capsule hypertrophy and edema at the AC joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No focal cartilage defects allowing for non arthrographic exam. Glenoid labrum appears intact for technique.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Mild capsular edema surrounding the acromioclavicular joint with a small amount of associated subacromial subdeltoid bursitis. Otherwise no internal derangement of the shoulder.


Instruction: Generate impression based on findings.

Input: Female 26 years old with new onset upper and lower extremity weakness. Is there any evidence of myositis anywhere? Additional history from the medical record indicates a skeletal muscle biopsy with features suggestive of dermatomyositis. Evaluation is slightly limited due to motion artifact.There is diffusely increased T2 signal within and surrounding all muscles in the flexor, extensor, abductor and gluteal musculature bilaterally. In addition, there is diffuse subcutaneous edema most pronounced along the medial and lateral aspects of the thigh.Bone marrow signal intensity is within normal limits.

Output: Bilateral symmetric increased T2 signal within and surrounding the musculature of the lower pelvis and femur consistent with an inflammatory myopathy.


Instruction: Generate impression based on findings.

Input: Research scan for AMARANTH Alzheimer's disease trial: Memory decline. There is mild cerebral volume loss that is most pronounced in the bilateral medial temporal lobes. There is extensive cerebral and pontine white matter T2 hyperintensity bilaterally. There is no midline shift or evidence of intracranial mass lesions. There are bilateral lens implants.

Output: 1. Mild cerebral volume loss that is most pronounced in the bilateral medial temporal lobes may represent Alzheimer's disease.2. Extensive cerebral and pontine white matter T2 hyperintensity bilaterally is nonspecific, but may represent chronic small vessel ischemia.


Instruction: Generate impression based on findings.

Input: Obtunded, unexplained. Evaluate for infection or inflammation causing severely altered mental status. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There is unchanged encephalomalacia involving most of the the right parietal lobe with adjacent FLAIR hyperintensity/gliosis extending into the right frontal and occipital lobes. Global parenchymal volume loss is again seen with prominence of the ventricles and sulci commensurate with patient's advanced age. There is no edema or mass effect. There is no midline shift. The basal cisterns are patent. There are patchy areas of T2/Flair signal abnormalities in the subcortical and the periventricular white matter, which are nonspecific, but most consistent with chronic small vessel ischemic changes. No abnormal parenchymal or meningeal enhancement.Mucosal thickening involving the left maxillary sinus and to a lesser degree right posterior ethmoid and left frontal sinuses is unchanged. Opacification of the left greater than right mastoid air cells is also unchanged. Bone marrow signal and remainder of the extracranial soft tissues are unremarkable.

Output: 1.No evidence of acute infarct, hemorrhage, intracranial mass, or mass effect. No abnormal enhancement. No MRI findings to suggest intracranial infection or inflammation; if there is high suspicion for meningitis, consider lumbar puncture for further evaluation.2.Extensive encephalomalacia involving the right parietal lobe, as seen previously, and likely related to prior infarct.


Instruction: Generate impression based on findings.

Input: Thumb pain Note that the axial sequences are limited by motion artifact.LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: No significant abnormality noted.TENDONS: No significant abnormality noted. BONES: No significant abnormality noted.ADDITIONAL

Output: Within the limits of this motion degraded exam, MRI of the thumb is unremarkable.


Instruction: Generate impression based on findings.

Input: 64 old female with witnessed partial seizure (new onset). Evaluate for bleed. Hypodense region in the left posterior parietal and left occipital lobes with no significant mass effect or volume loss concerning for a subacute infarct. MRI is recommended for further evaluation. Subcortical and periventricular white matter diffuse hypodensities consistent with small vessel ischemic disease of indeterminate age.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1- Left posterior parietal and occipital lobes hyperdense the concerning for subacute infarct. MRI is recommended for further evaluation.2- Small vessel ischemic disease of indeterminate age.These findings were communicated to Dr. Christopher Chapman via phone at 10:50am.


Instruction: Generate impression based on findings.

Input: Ms. Bailey is a 42 year old female with a recent stereotactic biopsy of the right breast with pathology revealing ADH/FEA. Given this high-risk pathology, an MRI was obtained for further evaluation. There is extreme amount of fibroglandular tissuein both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Susceptibility artifact from biopsy marker clip is identified in the right lower inner breast at site of prior biopsy. There is subtle linear enhancement seen associated with this clip, likely related to postbiopsy changes. There is no additional abnormal enhancement seen in the right breast or in the left breast. Scattered benign simple cysts are seen bilaterally. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Minimal associated enhancement seen at site of biopsy proven ADH/FEA in the right breast. If surgical excision is performed, the biopsy marker clip can be mammographically targeted for preoperative needle localization placement.(2) No MRI evidence of malignancy in the left breast. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right arm pain and radicular pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. There is evidence of anterior cervical fusion extending from C3 to C5; hardware can be better assessed on radiographs or CT. There is diffuse mild to moderate degree of spinal canal stenosis in the cervical spine with partial effacement of the ventral and dorsal thecal sacs.The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild disc bulge and uncovertebral hypertrophy on the right. There is mild to moderate spinal canal stenosis. No significant neural foraminal stenosis.C4-5: Small left paracentral disc osteophyte complex. There is mild to moderate spinal canal stenosis. No significant neural foraminal stenosis.C5-6: Left paracentral disc osteophyte complex with mild to moderate degree of spinal canal stenosis. No significant neural foraminal stenosis.C6-7: Small disc osteophyte complex and uncovertebral hypertrophy with no significant spinal canal stenosis. There is mild bilateral, right greater than left neural foraminal stenosis.C7-T1: Small disc protrusion on the right with uncovertebral hypertrophy with mild right neural foraminal stenosis. No significant spinal canal or left neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Postsurgical changes of anterior cervical fusion from C4 to C6. Hardware appears grossly unremarkable but can be better assessed with radiographs or CT.2. Degenerative changes with mild right-sided neural foraminal stenosis at the C6-C7 and C7-T1 levels related to uncovertebral hypertrophy and small disc protrusion. Additional levels as above.


Instruction: Generate impression based on findings.

Input: History of grade 2 oligodendroglioma on PCV therapy. There are post-treatment findings in the left frontal lobe with unchanged patchy enhancement, susceptibility effect, and confluent high T2 signal surrounding the resection cavity. A few scattered punctate foci of increased T2 signal within the subcortical and periventricular white matter are also unchanged. There is no evidence of acute infarct. There is no midline shift or herniation. The ventricles are unchanged in size and configuration. The major cerebral flow voids are intact. The extracranial structures are unchanged.

Output: Stable post-treatment findings in the left frontal lobe without evidence of tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of metastatic lung cancer s/p craniotomy and post-op SRS History: surveillance MRI Redemonstration of the left temporal lobe anterior aspect post resection gliotic changes without evidence of abnormal enhancement.There is no evidence of acute ischemic or hemorrhagic lesion.There no abnormal enhancement.Scattered high signal intensity lesions on periventricular white matter are non specific but likely represent small vessel ischemic disease, no change since prior scan.Right basal ganglia shows localized high signal intensity adjacent to prominent CSF space is also non specific but may represent a focal lacunar infarction, 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: No change of left temporal resection site with gliotic changes since prior scan.No evidence of abnormal enhancement or signal intensity indicate recurrence or residual mass.No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for etiology of pain in triceps (?torn muscle, ?mass lesion) History: Pain in L triceps muscle The alignment of the glenohumeral joint is anatomic. The bone marrow signal of the visualized osseous structures are within normal limits. No abnormal nonenhancing structure or fluid collection is identified. The triceps muscle appear within normal limits. Although this study is not optimal for evaluation of shoulder, there appears to be rotator cuff pathology.

Output: No specific abnormality of the triceps muscle to account for patient's pain. Likely rotator cuff pathology on this limited evaluation of the shoulder. If there is clinical concern, dedicated shoulder MRI may be obtained.


Instruction: Generate impression based on findings.

Input: 27 year old woman with LV dysfunction. She is referred to evaluate etiology. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 37%, the LV end diastolic volume index is 132 ml/m2 (normal range: 65+/-11), the LVEDV is 268 ml (normal range 109+/-23), the LV end systolic volume index is 84 ml/m2 (normal range 18+/-5), the LVESV is 170 ml (normal range 31+/-10), the LV mass index is 88 g/m2 (normal range 67+/-11), and the LV mass is 179 g (normal range 114+/-24). There is global hypokinesis. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. T2-ratio and global relative enhancement are within normal limits. Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 103 ml/m2 (normal range 69+/-14), the RVEDV is 209 ml (normal range 110+/-24), the RV end systolic volume index is 48 ml/m2 (normal range 22+/-8), and the RVESV is 97 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 moderate to severe mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is 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. Severe left ventricular dilation with moderately reduced systolic function (LVEF 37%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Mild right ventricular dilation with normal systolic function (RVEF 54%).3. Severe left atrial dilation.4. Moderate to severe mitral regurgitation.5. Mild dilation of main pulmonary artery.


Instruction: Generate impression based on findings.

Input: Left sided weakness. Brain: There appears to a small, faintly enhancing lesion with susceptibility effect in the right amygdala. There is concavity of the superior aspect of the pituitary gland. There is approximately 5 mm of inferior cerebellar tonsillar ectopia. There is an ossified extra-axial nodule along the right superior frontal gyrus that measures 5 mm in diameter, which is better depicted on the prior head CT. There is no evidence of acute infarct. The cerebellum and brainstem appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: 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 a slight posterior disc-osteophyte complex at C5-6, but no significant spinal canal or neural foramen stenosis throughout the cervical spine. The spinal cord displays normal signal and morphology. There is no evidence of enhancing tumors in the cervical spine. The paravertebral soft tissues are unremarkable.

Output: 1. An apparent small, faintly enhancing lesion with susceptibility effect in the right amygdala is nonspecific, but may represent a neoplasm, sequela of prior infection or inflammation, such as a granuloma, or vascular malformation, such as a telangiectasia. 2. No evidence of acute cerebral infarction. 3. Mild inferior cerebellar tonsillar ectopia.4. Nonspecific flattening of the pituitary gland, which can represent atrophy of pseudotumor cerebri.5. An ossified extra-axial nodule along the right superior frontal gyrus that measures 5 mm in diameter may represent a meningioma or dural ossification, for example, but is better delineated on the prior head CT. 6. No significant spinal canal or neural foramen stenosis throughout the cervical spine.


Instruction: Generate impression based on findings.

Input: 4 month old with achondroplasia. There is malformation of the skull base with associated frontal bossing in keeping with achondroplasia. In particular, there is narrowing of the foramen magnum and perhaps the jugular foramina. There is an enlarged suprasellar cistern, effacement of the cisterna magna, and a relatively vertical orientation of the straight sinus. The third and lateral ventricles are enlarged, while the fourth ventricle is not enlarged. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma otherwise appears unremarkable, with a normal degree of myelination. There is prominence of the cerebrospinal fluid spaces overlying the cerebral convexities. There is no midline shift or herniation. There is nonspecific fluid signal within the bilateral mastoid air cells and middle ears.

Output: Malformation of the skull base with associated frontal bossing in keeping with achondroplasia with associated narrowing of the foramen magnum and perhaps the jugular foramina, which may be associated with communicating hydrocephalus.


Instruction: Generate impression based on findings.

Input: Lumbar spinal stenosis. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is straightening of the spinal curvature as seen before. There is minimal anterolisthesis of L2 on L3 which was not seen in 2012 but present on outside MRI from 12/3/2014. Bone marrow signal is benign. The conus medullaris is normal in position.There is vacuum phenomena involving the discs at the L4-5 and L5-S1 levels as seen diffusely. There is developmental narrowing of the lumbar spinal canal as seen before with superimposed degenerative changes as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc bulge and bilateral facet arthropathy which appear slightly worse in the interval. Minimal anterolisthesis not seen previously. There is no significant spinal canal stenosis. There is mild left worse than right neural foraminal stenosis. L3-L4: Disc bulge and bilateral facet arthropathy as well as mild prominence of the dorsal epidural fat. There is mild central spinal canal stenosis. There is mild right neural foraminal narrowing. Left neural foramen is patent.L4-L5: Disc bulge eccentric to the left and bilateral facet arthropathy. There is effacement of the left lateral lateral recess and moderate to severe left neural foraminal stenosis similar to prior. There is mild central spinal canal stenosis. Right neural foramen is patent.L5-S1: Disc bulge, eccentric to the left, and bilateral facet arthropathy. There is no significant central spinal canal stenosis. There is moderate to severe left neural foraminal stenosis and partial effacement of the left lateral recess similar to prior. There is mild right neural foraminal stenosis. Paraspinous soft tissues are within normal limits.

Output: 1. There is mild central spinal canal stenosis at the L3-L4 and L4-L5 levels related to combination of developmental narrowing and superimposed degenerative changes similar to prior from 2012. 2. There is moderate to severe left neural foraminal stenosis as well as partial effacement of the left lateral recesses at the left L4-L5 and L5-S1 levels similar to prior. There may be impingement of the left L4 and left L5 nerve roots in the neural foramina and possibly the left S1 nerve root in the lateral recess at the L5-S1 level.3. Overall degenerative findings are stable to minimally worse (such as at the L2-3 level) since prior MRI from 2/22/2012. Please see additional details above.


Instruction: Generate impression based on findings.

Input: 47-year-old female with history of enough, enlarging mass at left inguinal regions with increasing SUV uptake on PET scan, evaluate for MPNST. Again seen are postsurgical changes of a left lower extremity amputation with hip disarticulation. Associated fatty muscle atrophy of the left musculature.Again seen are innumerable cutaneous lesions the multiple masses within the pelvis compatible with neurofibromas. Previous reference right inguinal lesion currently measures 4.6 x 3.7 x 7.3 cm (series 7 image 20, series 5 image knee), previously measuring 3.9 x 3.0 x 5.8 cm. This lesion continues to demonstrate peripheral enhancement suggestive of internal necrosis. Previous reference left psoas muscle lesion measures 4.2 x 4.0 cm (series 7 image 9), previously 4.1 by 4.2 cm.Previous reference left posterior pelvic lesion measures 3.9 cm (series 7 image 24), previously 4.2 cm, although grossly appears unchanged.Neurofibroma within the left psoas muscle is not significantly changed measuring 4.1 x 4.2 cm (series 501 Image 38), previously 4.3 x 4.1 cm. Neurofibroma within the posterior left pelvis exerting mass effect on the uterus has not significantly changed measuring 4.2 cm (series 501 image 21), previously 4.3 cm.Soft tissue mass in the fundus of the uterus has slowly been enlarging and demonstrates avid enhancement post gadolinium. For reference, this lesion measures 7.6 x 5.8 cm (series 1 image 20). Additional heterogeneous and nodular myometrium compatible with leiomyomas again noted.Sacral dural ectasia and scalloping of the posterior aspect of the vertebral bodies appear similar to prior.

Output: 1.Continued interval increase in right inguinal neurofibroma with internal necrosis, which was markedly hypermetabolic on recent PET, suspicious for malignant peripheral nerve sheath tumor. Additional neurofibromas appear stable.2.Soft tissue mass at the fundus of the uterus has slowly been growing and demonstrates avid enhancement. Differential diagnosis includes leiomyoma/sarcoma or plexiform neurofibroma.


Instruction: Generate impression based on findings.

Input: There are unchanged mildly low-lying cerebellar tonsils. There are stable postoperative findings related to suboccipital craniectomy and posterior fossa shunting. There is no acute infarct, mass effect, or acute hemorrhage. There are minimal bilateral cerebral convexity subdural effusions. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged. There is hardware related susceptibility effect from anterior fusion of C5-6.

Output: Minimal bilateral cerebral convexity subdural effusions may indicate low intracranial pressure. Otherwise stable postoperative findings related to Chiari decompression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Snuffbox tenderness. Evaluate for scaphoid fracture. LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact. TRIANGULAR FIBROCARTILAGE COMPLEX: Mildly increased signal intensity within the triangular fibrocartilage tissue likely reflects mild degeneration. No fluid-filled tear is seen.TENDONS: Note is made of multiple slips of the tendon of the flexor pollicis longus, a normal variant. The extensor carpi ulnaris tendon appears medially subluxed from the ulnar groove, however the tendon appears normal without fluid within the sheath.BONES: Bandlike focus of abnormal signal traverses the waist/proximal pole of the scaphoid, consistent with a nondisplaced fracture. There is minimal adjacent edema, suggestive of a subacute healing fracture. Also seen is curvilinear abnormal signal in the proximal end of the scaphoid suggestive of avascular necrosis with adjacent edema. No abnormal contour or fragmentation of the scaphoid is seen. The remaining bones appear normal.ADDITIONAL

Output: Findings consistent with a subacute healing fracture of the scaphoid with mild avascular necrosis of the proximal pole. Other findings as described above.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to biopsy of a right basal ganglia lesion with T2 hyperintensity and susceptibility effect along the biopsy tract. There is unchanged ill-defined mild T2 hyperintensity within the left basal ganglia, with only faint nodular enhancement along its medial aspect suggested only on delayed postcontrast images (15/91). There is also unchanged gliosis and cystic encephalomalacia within the anterior right superior frontal gyrus. There is minimal unchanged nonspecific periventricular T2 hyperintensity.There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal paranasal sinus mucosal thickening and mild fluid within the bilateral mastoid air cells.

Output: Stable bilateral basal ganglia lesions, with stable residual nodular focus of enhancement along medial aspect of the left basal ganglia lesion.


Instruction: Generate impression based on findings.

Input: This exam is extremely limited as the patient canceled the exam prior to completion. No dedicated internal auditory canal or postcontrast sequences are available. There are postoperative findings related to left occipital craniotomy for presumed resection of a CP angle or internal auditory canal mass. There is a 22 x 9 mm rounded and loculated focus of low signal intensity on T1 and T2-weighted imaging within the left cerebellopontine angle. In addition, there is a 3 x 4 mm low intensity structure along the anterior wall of the left internal auditory canal which has a deformed postoperative appearance. There is volume loss along the lateral aspect of left cerebellar hemisphere and T2 hyperintensity compatible with gliosis - findings suggesting a chronic AICA infarct. Within the limitations as discussed above as well as lack of comparison exams, no definitive statement can the made regarding the presence or absence of tumor in this location. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There are bilateral maxillary sinus retention cyst, left greater than right.

Output: 1.Within the marked limitations as discussed above and the lack of comparison exams, no definitive statement can be made regarding the presence or absence of tumor in the left cerebellopontine angle/internal auditory canal. Tissue in this region may represent residual tumor or granulation tissue / blood products. A repeat contrast-enhanced exam of the internal auditory canals is suggested.2.Findings compatible with chronic left cerebellar AICA distribution infarct.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with history of recurrent urinary tract infections, please evaluate for urethral diverticula. PELVIS:UTERUS, ADNEXA: Retroverted, retroflexed uterus. The junctional zone is thickened measuring up to 18 mm. Small nabothian cysts noted (601/60).BLADDER: No significant abnormality noted. Specifically, there is no evidence of urethral diverticulum.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. Punctate foci of susceptibility artifact in the anterior lower abdominal soft tissues likely from prior surgery.OTHER: No significant abnormality noted.

Output: 1.No urethral diverticulum or finding to explain the patient's symptoms.2.Thickened uterine junctional zone which can be seen in adenomyosis.


Instruction: Generate impression based on findings.

Input: 60 years Male (DOB: 6/20/1956)Reason: rule out C-spine lesion History: RUE weaknessPROVIDER NAME: THOMAS J. KELLY MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate T2 and FLAIR hyperintense foci present in the subcortical white matter of the superior frontal gyri bilaterally.Is a punctate focus of signal loss present in the subcortical white matter of the left frontal lobe on susceptibility weighted imaging most likely is represents a microhemorrhage which in isolation is most likely of little significance.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 a mucous retention cyst in the left maxillary sinus and some 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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal lesions are identified in the cervical spine. There is reversal of normal cervical curvature present which is centered at C5-6. There is some multilevel disc desiccation present.. There is a T1 hyperintense lesion present within the T3 vertebral body most likely representing a vertebral body hemangioma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a disc bulge present associated with uncovertebral osteophytes and narrowing of the neural foramina bilaterally. This partial effacement of spinal fluid ventral and posterior spinal cord at this level resulting in a mild to moderate degree of spinal stenosis. There is encroachment of left-sided exiting nerve roots within the neural foramen at this level due to disc material. There is some mild encroachment of right-sided exiting nerve rootsAt C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is loss of disc space height, disc desiccation and a diffuse disc bulge associated with bilateral uncovertebral osteophytes and encroachment of the exiting nerve roots within the neural foramina bilaterally.At C6-7 there is disc desiccation as well as endplate uncovertebral osteophytes associated with a disc bulge and narrowing of the neural foramina bilaterally with encroachment of the left-sided exiting nerve roots and to a lesser degree right-sided exiting nerve roots.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are few subcortical white matter lesions present in the frontal lobes which are nonspecific but most likely vascular related at this age.2.There are multilevel degenerative changes present in the cervical spine with findings suggestive of spinal stenosis at C3-4 and neural foraminal encroachment of exiting nerve roots worse on the left side at C3-4, right side at C6-7 and bilaterally at C5-6 but also present on the left-side at C6-7 and on the right side at C3-4.


Instruction: Generate impression based on findings.

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

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

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

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


Instruction: Generate impression based on findings.

Input: 55-year-old female with left-sided neck pain with radicular pain down the left upper extremity. There are scattered patchy non-expansile T2/STIR spinal cord signal abnormalities located at the upper C2 level, centrally at the lower C2 level, posteriorly at the upper C3 level, along the right lateral aspect of the spinal cord at the C3-4 level and within the right lateral aspect of the spinal cord at C5 level.Similarly, there are at least two small focal T2/STIR lesions in the deep white matter of the left cerebellum and a single focus of signal abnormality in the left medial dorsal lower medulla.The cervical spine alignment is maintained. The cervical vertebral bodies are appropriate in height. There is mild loss of disc height at the C4-5 and C5-6 levels. The bone marrow signal is within normal limits. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant disc disease or compromise to the spinal canal or neural foramina.C3-4: Trace diffuse disc osteophyte complex with mild uncovertebral hypertrophy which causes mild bilateral neuroforaminal narrowing. No spinal canal stenosis.C4-5: Small diffuse disc osteophyte complex with mild uncovertebral hypertrophy which causes moderate bilateral neuroforaminal narrowing. There is minimal spinal canal stenosis. C5-6: Trace disc osteophyte complex and mild bilateral neuroforaminal narrowing. No spinal canal stenosis.C6-7: Small disc osteophyte complex with mild to moderate bilateral neuroforaminal stenosis and minimal spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.At the T1-T2 and T2-T3 levels, there is minimal disc disease but no significant neuroforaminal or spinal canal stenosis.The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits. There is partially visualized mucosal thickening involving the left maxillary sinus and an air-fluid level within the right maxillary sinus which could indicate sinusitis.

Output: 1.Scattered patchy areas of T2/STIR signal abnormality in the posterior fossa and cervical spinal cord which are suspicious for a demyelinating process. MRI Brain with and without contrast is recommended for further evaluation.2.Mild spondylotic changes of the cervical spine with at most moderate bilateral neuroforaminal narrowing and minimal spinal canal stenosis at the C4-5 level.3.Maxillary sinus mucosal thickening with a air-fluid level within the right maxillary sinus which could indicate sinusitis. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of glioblastoma status post resection with adjuvant chemotherapy and radiation therapy completed 10/20/2016. Postoperative findings are seen at the junction of the left parietal and temporal lobes. The previous hemorrhage-containing surgical cavity has evolved into a larger cystic space with homogeneous T2 hyperintense, T1 hypointense fluid which does not suppress on FLAIR imaging suggesting proteinaceous contents. In largest cross-sectional dimension (6/20), this measures 48 x 31 mm. Surrounding this cystic space is a rim of new, continuous enhancement. While this rim of enhancement is prominently smooth and thin, there is thicker and in some areas nodular enhancement along its superior margin. No additional suspicious foci of enhancement are seen.T2/FLAIR signal hyperintensity in the surrounding white matter extending to the atrium of the left lateral ventricle, and into the splenium of the corpus callosum, has progressed. Scattered small foci of signal hyperintensity in the right superior frontal gyrus and the right inferior frontal gyrus are unchanged and nonspecific. Very small foci of diffusion restriction surrounding the surgical cavity have decreased from the prior exam. Slight susceptibility artifact surrounding the surgical cavity is suggestive of trace residual blood products, but there is no significant intracranial hemorrhage. Mass effect upon the left lateral ventricular atrium has slightly increased. Otherwise, the ventricles are normal in size and morphology.

Output: A fluid-filled, rim-enhancing lesion has developed at the junction of the left parietal and temporal lobes, at the site of the prior resection cavity. The enhancing rim of this lesion is predominantly thin and smooth, though there is thick and nodular enhancement along its superior margin. Given the recent timing of treatment, these findings could at least in part represent treatment effect, but there is suspicion for viable tumor as well.


Instruction: Generate impression based on findings.

Input: Acute mental status changes. Nonverbal. Question bleed. There is no evidence of intracranial hemorrhage, mass or or midline shift. Extensive areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI may be considered for further evaluation. A lacunar infarct is noted in the left basal ganglia. Prominence of the sulci and ventricles is consistent with corticomedullary volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate. No evidence of acute infarction by CT. However, an MRI may be considered if there is concern for acute stroke.


Instruction: Generate impression based on findings.

Input: Male, 58 years old, with MRSA endocarditis and back pain, concern for epidural abscess. Cannot receive gadolinium due to GFR of 8. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement or marrow edema is observed.Within the limitations of a noncontrast examination, no epidural inflammation or fluid is seen. Diffusion-weighted images show no evidence of restricted diffusion within or around the spine. The visualized distal spinal cord, conus and cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Right lateral disc protrusion resulting in mild effacement of the right lateral recess and mild narrowing of the right neural foramen, unchanged. L4-5: Moderate facet hypertrophy and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal narrowing and mild bilateral foraminal narrowing, unchanged. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. No significant spinal canal or neuroforaminal stenosis.

Output: 1.No evidence of epidural abscess or any other active inflammatory process in the spine.2.Mild degenerative disease as above, unchanged from the recent prior MRI.


Instruction: Generate impression based on findings.

Input: Left pulsatile tinnitus, history of sinus surgery. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is an enlarged partially-empty sella. The partially0imaged left maxillary sinus is small and there are postoperative findings related to uncinectomy.

Output: 1. No evidence of retrocochlear or inner ear lesions.2. An enlarged partially-empty sella is nonspecific, but can be a manifestation of pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Metastatic pancreatic cancer. Acute pulmonary embolism. Right-sided weakness. Rule out brain infarct or hemorrhage. The study is mildly to moderately limited by patient motion.There is no gross intracranial hemorrhage but subsequent SWI imaging was not obtained because of patient's intolerance to the length of the examination. There is no evidence of mass, or acute infarct. There are multiple punctate and confluent areas of T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. Also, there is apparent T2-hyperintense signal in the right posterolateral aspect of the medulla without correlating FLAIR abnormality or diffusion restriction.The ventricles and basal cisterns are normal in size and configuration accounting for mild-to-moderate brain volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The marrow is diffusely less fatty than expected which may reflect red marrow reconversion.

Output: 1.No evidence of mass, or acute infarct. No gross intracranial hemorrhage but the hemorrhage-sensitive sequence was not obtained because of patient intolerance.2.Nonspecific white matter lesions, greater than expected for patient's stated age. Differential diagnosis includes infectious/inflammatory etiologies, demyelinating disease, and chronic small vessel ischemic changes with a few chronic lacunar infarcts.3.Focal T2-hyperintense signal in the right posterolateral medulla without correlating FLAIR abnormality, which might be artifactual.


Instruction: Generate impression based on findings.

Input: Back mass A series of vitamin E markers were placed along the region of interest along the upper right back of the patient. Along the markers is prominence of the subcutaneous fat without definite encapsulation. There is a mild amount of increase signal intensity on T2-weighted sequences which may reflect some underlying edema. This is best appreciated on series 701, images 17-33. Following contrast administration, there are no enhancing nodules or thick septa. There is otherwise no abnormal enhancement detected elsewhere. Note that the examination was not tailored for the evaluation of the shoulder, chest, or abdomen.

Output: Prominence of the subcutaneous fat of the right upper back without underlying enhancement or other aggressive features. These findings most likely represent a benign lipoma, however given the stated history of an enlarging mass, consultation with orthopedics is recommended.


Instruction: Generate impression based on findings.

Input: Evaluate for cortical tubers, some ependymal giant cell astrocytoma. Compared to MRI for -- 13 -- 07. 2-year-old male with tuberous sclerosis. Pre-and post infusion CT of brain:Small area of calcific density at the level of left foramina of Monro several enhancement is noted. This lesion measures approximately 4.5-mm times 4 1/2 mm in transaxial dimension. This finding cannot be properly compared with prior MRI due to technique difference and pattern of enhancement as well as a slice thickness. The lesion however appears grossly stable.A heavily calcified lesion in the subependymal lining of the left lateral ventricle at the level of the trigone is consistent with a calcified tuber with no appreciable enhancement due to is heavy calcification. This lesion appeared as an area of low signal intensity on T2-weighted images of MRI of brain and measured approximately 8 mm times 6-mm in transaxial dimension. On the current CT examination this lesion measures 7.6 mm x 8 0.1-mm. multiple additional small punctate calcific lesions of the subependymal lining of the lateral ventricles are also present with no enhancing component. The A. minimally cortical based calcific tumor in the right frontal lobe is also present. This lesion demonstrates no definitive enhancement the overall appearance of this lesion is similar to what was noted on prior MRI examination. 20 cc of Omnipaque was utilized for the above study.

Output: Although comparison to the prior MRI is not accurate due to difference in technique, the overall appearance of patient's calcific tubers in the left ventricle as well as the cortex of the right frontal lobe remain essentially stable.


Instruction: Generate impression based on findings.

Input: Prostate cancer status post prostatectomy PELVIS:PROSTATE: Status post prostatectomy. Nodular focus seen near the vesicourethral anastomosis measuring approximately 14 x 9 mm on image 13 series 901 with low ADC signal and T2 soft tissue signal intensity, see image 244 series 704. Corresponding postcontrast enhancement also seen.BLADDER: Underdistended.LYMPH NODES: Small inguinal/external iliac lymph nodes.BONES, SOFT TISSUES: Please refer to same day nuclear medicine bone scan for additional findings.

Output: 1. Nodular focus seen near vesicoureteral anastomosis as above, highly suspicious for recurrent/residual tumor.


Instruction: Generate impression based on findings.

Input: Male; 55 years old. Reason: HCC? History: Rising AFP, cirrhosis. ABDOMEN:LIVER, BILIARY TRACT: Nodular hepatic contour is compatible with cirrhosis. Paraumbilical and esophageal varices indicate portal hypertension and are unchanged. New arterially enhancing lesion in segment 8 abuts the middle hepatic vein and demonstrates washout on delayed phase images, measuring 11 x 10 mm (series 11, image 29). Patent hepatic vasculature. No biliary ductal dilatation. Cholelithiasis. Enhancing polypoid nodule in gallbladder fundus of unclear etiology (series 12, image 72). SPLEEN: Mild splenomegaly.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.Cirrhotic liver morphology with new arterially enhancing segment 8 lesion that meets criteria for HCC. 2.Enhancing polypoid nodule in gallbladder fundus of unclear etiology. 3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma with recent progression. There is an enhancing left sellar mass that extends into the left cavernous sinus with encasement of the left internal carotid artery. The mass also extends into the left sphenoid sinus. Overall, the mass measures up to approximately 2 cm. There is no mass effect upon the optic apparatus. The pituitary infundibulum is intact.

Output: No significant interval change in the pituitary macroadenoma with extension into the left cavernous sinus, where there is encasement of the left internal carotid artery, and extension into the left sphenoid sinus.


Instruction: Generate impression based on findings.

Input: Reason: temporal lobe lesion History: temporal lobe lesion. GBM Please note the postcontrast images are moderately limited due to patient motion.There are postsurgical findings of right temporal craniotomy for resection of a right temporal lobe GBM. The resection cavity has decreased in size measuring 2.5 x 1.8 cm, previously 3.6 x 3.3 cm, with evolution of blood products seen on the prior exam. Susceptibility surrounding the resection cavity is likely due to prior blood products. There is significant surrounding T2/FLAIR hyperintense signal, which is increased in extent in all directions and is more confluent. Mild right to left midline shift is unchanged measuring 7 mm. There is a significantly increased thickened rind of irregular enhancement surrounding the resection cavity and extending into the adjacent parenchyma. Mild restricted diffusion is present along the margins of the resection cavity, which has become more diffuse since the prior exam. Perfusion imaging in this region shows increased rCBV in the enhancing regions, which is decreased in the surrounding areas of white matter abnormality.An enhancing satellite lesion in the right temporal lobe has increased in size with increased posterior extension measuring 2.1 x 0.8 cm, previously 1.2 x 0.7 cm, now extending to directly abut the enhancing portion of the resection cavity. There may be minimal hyperperfusion in this region.There is mass effect on the right lateral ventricle. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is opacification of the right mastoid air cells and inner ear.

Output: 1.Enhancement, diffusion restriction and hyperperfusion surrounding the resection cavity is suspicious for recurrent/residual tumor.2.Enhancing more inferior right temporal lobe satellite lesion has increased in size and is now contiguous with the enhancing portions of the resection cavity.3.White matter abnormality has increased in extent since the prior exam.4.Opacification of the right mastoid air cells and inner ear, nonspecific.


Instruction: Generate impression based on findings.

Input: Pituitary tumor surveillance. There has been interval increase in size of the pituitary tumor, which now measures 19 AP x 19 RL x 17 SI mm, previously 18 AP x 19 RL x 13 SI mm. The tumor protrudes into the left cavernous sinus and now abuts the right optic nerve. The pituitary infundibulum is intact, but slightly deviated to the right. There is mucosal thickening within the sphenoid sinuses. There is a cavum septum pellucidum. There are nonspecific scattered foci of cerebral white matter T2 hyperintensity in the partially-imaged brain.

Output: Interval increase in size of the pituitary macroadenoma.


Instruction: Generate impression based on findings.

Input: Right shoulder pain Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Mild degenerative changes are seen in the cervical spine as described below:C2-3: There is right sided uncovertebral hypertrophy and disc component with minimal right neural foraminal narrowing. Otherwise no significant compromise to the spinal canal or neural foramina. C3-4: There is mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy. No significant compromise to the spinal canal or left neural foramen.C4-5: Small right paracentral disc osteophyte complex and uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. There is partial effacement of the right ventral thecal sac without significant compromise to the spinal canal overall. C5-6: Minimal disc osteophyte complex without significant spinal canal stenosis. Mild narrowing of the bilateral neural foramina.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild degenerative changes in the cervical spine. There is no significant spinal canal stenosis at any level. There is relatively worse neural foraminal stenosis at the right C3-C4 and right C4-C5 levels.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: MS; f/u progression History: weakness; paresthesias Brain MRIThere are multifocal bihemispheric supra and infratentorial FLAIR high signal intensity lesions.Comparing to prior scan, there are more FLAIR high signal intensity lesions on current scan. In particular, the right superior parietal lobule and right periventricular white matter especially along the right lateral ventricle occipital horn.Signal intensity level of each lesion appears to be more prominent on current scan, but this could be related to imaging technique, thus the significance of this finding is hard to determine.On Gad enhanced scan, there are multiple various sized enhancing nodules at bilateral centrum semiovale, periventricular white matter, frontal deep white matter and left cerebellar hemisphere indicating active inflammatory lesions.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical Spine MRIThere are multifocal T2 high signal intensity lesions on cervical spinal cord. In particular, at the level of C4 and C5. The C4 level lesion shows cord swelling as well. These findings are consistent with spinal cord involvement by demyelinating disease such as multiple sclerosis. On Gad enhanced scan, the lesions show enhancement indicating active inflammation.There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance.The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal stenosis, cord compression or myelopathy.

Output: 1. Interval progression of multiple sclerosis lesions with evidence of active inflammation as described above.2. Cervical spinal cord involvement of multiple sclerosis especially at the level of C4 and C5 with evidence of active inflammation.


Instruction: Generate impression based on findings.

Input: 42 years Female (DOB:7/7/1973)Reason: MS; F/U progression History: paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There is redemonstration of multiple periventricular and subcortical white matter lesions within the brain parenchyma many of which are perpendicularly oriented to the lateral ventricles. In general there is not appear to be a substantial change in the number or size of these lesions. There are several punctate cerebellar white matter lesions and brainstem lesions which are also stable. Additional lesions in the corpus callosum were also stable. One brainstem lesion is present in the left posterior lateral aspect of the medulla whereas others are present in the left half of the pons.A previously noted lesion in the left inferior parietal lobule is not seen on the current examNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since prior exam there is no significant change. There is a lesion left inferior parietal lobule which is not identified on the current exam and was present on the previous exam. There are multiple periventricular and subcortical white matter lesions as well as a few lesions in the cerebellum and brainstem which are compatible with the patient's diagnosis of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Right shoulder pain ROTATOR CUFF: There is a full-thickness tear of the distal insertional fibers of the supraspinatus with retraction of the tendon by approximately 1.1 cm. The tear measures approximately 6 mm in the AP dimension and this is superimposed upon tendinopathy of the supraspinatus. There is mild tendinopathy of the infraspinatus tendon but no evidence of a full-thickness tear. There is a small focus of increased signal intensity within the insertional fibers of the subscapularis which may reflect a small interstitial tear. The teres minor tendon is normal. The rotator cuff musculature is preserved.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Alignment of the glenohumeral joint is normal. There is abnormal signal intensity and morphology of the anterior labrum likely reflective of degeneration and degenerative tearing. There is a small amount of fluid in the glenohumeral joint but no sizable effusion.BICEPS TENDON: The biceps tendon is intact. A trace amount of fluid surrounds the biceps tendon and the intertubercular groove which may reflect extension from the glenohumeral joint.ADDITIONAL

Output: 1. Full-thickness rotator cuff tear of the distal insertional fibers of the supraspinatus tendon with approximately 1 cm of retraction. There is tendinopathy of the supraspinatus and infraspinatus tendons as well.2. Degeneration and degenerative tearing of the anterior labrum which is likely age-related.3. Normal appearance of the biceps tendon.4. Soft tissue mass anterior to the acromioclavicular joint likely reflects a small lipoma.


Instruction: Generate impression based on findings.

Input: Reason: eval for post-op hematoma History: bilateral lower extremity pain Postsurgical changes of L4-L5 bilateral laminectomy with placement of bone graft material and an interspinous clamp. There is minimal anterolisthesis at L4-L5, otherwise alignment is anatomic. Vertebral body heights are intact. Multilevel disc desiccation with degenerative disc disease, most severe at L4-L5. Endplate degenerative changes at L4-L5. Normal signal within the distal cord and conus which ends at L1-L2. Clumping of the cauda equina below L2-L3 likely reflects arachnoiditis.There is a heterogeneous T2 hyperintense lesion within the spinal canal which extends from the L4-L5 level to the mid S1 level in the midline and along the right aspect of the thecal sac. There is moderate narrowing of the spinal canal. Finding is suspected to represent an epidural hematoma and measures approximately 1 cm in thickness and 4.3 cm in the craniocaudal dimension (best seen on sagittal T2 image 12/23). More superiorly, there are minimal extra-axial (possibly subdural) fluid/blood products are seen extending more superiorly along the right lateral aspect the thecal sac to the L2-L3 level without mass effect.T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. Mild ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.L3-L4: Diffuse disc bulge. Mild facet arthropathy and ligamentum flavum thickening. Mild bilateral neural foraminal stenosis. No significant spinal canal stenosis.L4-L5: Laminectomy and medial facetectomies are noted at this level. Extrathecal fluid is noted at the level of the facetectomies. There is moderate to severe right-sided neural foraminal stenosis within the impingement of the right L4 nerve root. There is also mild left neural foraminal narrowing. There is a fluid collection which extends from the L4-L5 level inferiorly in the right aspect of the thecal sac extending to the L5-S1 level with moderate thecal sac narrowing.L5-S1: Mild disc bulge and facet arthropathy. Heterogeneous T2 hyperintense collection is seen in the right lateral aspect of the thecal sac with mild to moderate stenosis. There is no significant right neural foraminal narrowing. There is minimal left neural foraminal narrowingNumerous bilateral renal cysts.

Output: 1. Postsurgical changes of L4-L5 laminectomy and interspinous fusion. There is a heterogeneous T2 hyperintense lesion within the spinal canal which extends from the L4-L5 level to the mid S1 level along the right dorsal aspect of the thecal sac. There is moderate narrowing of the spinal canal. Finding is suspected to represent an epidural hematoma and measures approximately 1 cm in thickness and 4.3 cm in the craniocaudal dimension (best seen on sagittal T2 image 12/23).2. Clumping of the cauda equina nerve roots below L2-L3 compatible with arachnoiditis.3. Moderate to severe narrowing of the right L4-L5 neural foramen which may be impinging the right L4 nerve root.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.