Instruction: Generate impression based on findings.

Input: Clinical question: Grade II astrocytoma of the cord. s/p RT 9w/ proton beam) + TMZ. Now receiving TMZ. Completed RT in ~5/2015. Signs and Symptoms: Grade II astrocytoma of spinal cord. Pre- and post enhanced cervical MRI:Examination redemonstrate an expansile lesion of the cervical cord extending from C2-C4 disc level to C7-T1 disc level. The expanded lesion occupies the entire spinal canal with effacement of subarachnoid space in particular at C5 level. The lesion is primarily on the right aspect of the cord however mildly extends across the midline to the left. It demonstrate T2/T2 STIR hyperintense and slightly hyperintense on T1-weighted images. The signal intensity, overall morphology and size of this mass remains identical to prior study.Mild-to-moderate degenerative changes of cervical spine most severely at C4-C5 through C6-C7 levels similar to prior exam and with evidence of mild reversal of cervical lordosis is again noted.Moderate to advanced degenerative changes of cervical spine in particular at C4-C5 through C6-C7 levels are present. There is resultant mild reversal of cervical lordosis. Signal changes of cervical vertebral column suggestive of prior radiation treatment.No detectable enhancement of the expansile cord lesion similar to prior exam.Pre and post enhanced thoracic MRI:Examination demonstrate a stable expansile lesion of the thoracic cord in signal intensity, morphology and extent since prior study. This mass extends from approximately mid T2 level inferiorly to mid T8 level similar to prior study. It measures approximately at 112 mm in craniocaudad axis. There is faint band of T2 STIR hyperintense extending from the inferior aspect of this mass to approximately the level of the conus with mild expansion of the cord similar to prior study. Finding is believed to represent peritumoral edema or possibly post radiation change.The signal intensity of vertebral column demonstrate changes consistent with prior radiation therapy. The alignment of vertebral, remains within normal.Mild to moderate degenerative disc disease and including a tiny disc protrusion at T7-T8 resulting tiny indentation of the ventral aspect of the cord.Post contrast images demonstrate no enhancement of the expansile cord lesion, which is a similar observation as prior exam.Pre- and post enhanced lumbar MRI.Signal intensity changes on vertebral column consistent with prior radiation in the upper lumbar spine is noted.There is normal anatomical alignment of vertebral column.There is moderate degenerative changes of the disc and facet hypertrophic changes and including bilateral facet effusion at L4-L5 with resultant moderate central spinal stenosis remain similar to prior exam.Post enhanced images demonstrate expected enhancement of the generative/hypertrophic changes of lower lumbar spine and without evidence of metastatic disease to the vertebral column or of the leptomeninges.

Output: 1.Stable expansile mass of the cervical cord in size, extent and overall morphology as detailed.2.Stable expansile lesion of the thoracic cord in size, extent and overall morphology as detailed.3.Unremarkable MRI of the lumbar spine other than moderate central spinal stenosis secondary to degenerative disease at L4-L5 level.


Instruction: Generate impression based on findings.

Input: Nine-year-old male with new onset of chest pain, shortness of breath, lower extremity clonus, upward gaze. Non-verbal. There is no evidence of intracranial hemorrhage. No mass or midline shift is present. Gray-white differentiation is normal and cortical sulci are preserved.The ventricles and basal cisterns are normal in size and configuration. Slight prominence of the temporal horn of the left lateral ventricle may represent normal anatomic asymmetry -- however, given the patient's symptoms, further evaluation with MRI should be considered.The calvaria and skull base are radiographically normal. Minimal mucosal thickening is present in the sphenoid sinus and ethmoid air cells. The mastoid air cells and middle ear cavities are normal in appearance.

Output: 1. No CT findings of acute intracranial process.2. Slight asymmetry of temporal horns of lateral ventricles -- given reported symptoms, consider further evaluation with MRI.


Instruction: Generate impression based on findings.

Input: Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: UnremarkableC4/5: There is a small central paramedian disc protrusion which abuts the anterior cord surface without intrinsic cord signal abnormality. There is also slight ligamentum flavum thickening. There are no stenoses.C5/6: There is a small right paracentral disc protrusion which abuts the anterior cord surface without intrinsic cord signal abnormality. There is also slight ligamentum flavum thickening. There are no stenoses.C6/7: Slight ligamentum flavum thickening. There are no stenoses.C7/T1: Facet hypertrophy causes mild bilateral neural foraminal stenosis.Lumbar spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. There is a 1 cm well-circumscribed T2 homogeneously hyperintense focus within the left kidney most consistent with a simple renal cyst. The remaining visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation with mild disc height loss is present from L2/3 through L5/S1.At L1/2 there is mild facet hypertrophy with no neural foraminal compromise or spinal stenosis, unchanged. At L2/3 there mild facet hypertrophy with no neural foraminal compromise or central spinal stenosis, unchanged. At L3/4 there is diffuse annular disc bulge, ligamentum flavum thickening, and moderate facet hypertrophy. There is new mild central, mild bilateral lateral recess, and mild bilateral neural foraminal stenosis.At L4/5 there is diffuse annular disc bulge containing a right posterolateral annular fissure, ligamentum flavum thickening, moderate left facet hypertrophy, and severe right facet hypertrophy. There is new mild bilateral lateral recess and mild bilateral neural foraminal stenosis. No central spinal stenosis. At L5/S1 there is diffuse annular disc bulge and mild bilateral facet hypertrophy. Mild left lateral recess stenosis and mild bilateral neural foraminal stenosis is unchanged. There is no central spinal stenosis.

Output: 1.C4/5: There is a small central paramedian disc protrusion which abuts the anterior cord surface without intrinsic cord signal abnormality. There are no stenoses.2.C5/6: There is a small right paracentral disc protrusion which abuts the anterior cord surface without intrinsic cord signal abnormality. There are no stenoses.3.C7/T1: Facet hypertrophy causes mild bilateral neural foraminal stenosis.4.L3/4: New mild central, mild bilateral lateral recess, and mild bilateral neural foraminal stenosis.5.L4/5: New mild bilateral lateral recess and mild bilateral neural foraminal stenosis. No central spinal stenosis. 6.L5/S1: Mild left lateral recess stenosis and mild bilateral neural foraminal stenosis is unchanged.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, with history of pachymeningitis, receives annual MRI of the brainstem, last MRI 5/15. Evidence of right temporal craniotomy is seen. There is a small resection cavity within the adjacent right middle temporal gyrus.A small focus of bright signal on the diffusion sequence within the right corona radiata does not show a correlating ADC abnormality and therefore probably represents T2 shine through artifact. Scattered additional small T2 hyperintense lesions are evident within the cerebral hemispheres which are nonspecific. No evidence of parenchymal edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid is seen. On postcontrast images, minimal generalized dural thickening is seen with no areas of focal nodularity. No abnormal enhancement is seen within the basal cisterns or along the cranial nerves. No pathologic parenchymal enhancement is detected. Note is made, however, of ill-defined enhancement within the intraconal space of the orbits. This is only visualized on the fat-suppressed axial images.Redemonstrated is evidence of pan-sinus mucosal thickening and secretions. Bone marrow signal characteristics are unremarkable.

Output: 1.Evidence of right temporal craniotomy and biopsy from the right middle temporal gyrus is seen.2.Scattered nonspecific T2 hyperintense lesions are evident within the cerebral hemispheres. These are most likely related to chronic microvascular ischemic disease.3.Mild diffuse dural thickening is seen which is nonspecific but may potentially be related to the patient's history of pachymeningitis.4.Note is made of ill-defined enhancement within the intraconal orbits. This may represent vascularity or vascular congestion, though if concern for orbital pathology exists, dedicated orbital imaging can be considered.


Instruction: Generate impression based on findings.

Input: 85 years Female (DOB:1/10/1931)Reason: word finding difficulty and paraphasic errors concerning for L thalamic and/or L frontal lobe involvement History: pls see abovePROVIDER/ATTENDING NAME: GREGG M HELLAND JACQUELINE T BERNARD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a punctate focus of signal loss centered in the medulla just to the left of midline and posteriorly which measures 3 mm on T2-weighted imaging and has a subtle T2 signal hyperintense component centrally. It cannot be identified on the other pulse sequencesOn susceptibility weighted imaging there is a punctate focus of signal hypointensity present in the left lower midbrain. Another punctate focus identified on susceptibility imaging is present in the posterior aspect of the left orbital gyrusOn susceptibility weighted imaging there is a somewhat ectatic appearing vessel located in the left postcentral gyrus lateral to the hand motor area. It is not included on the MRA exam of the brain.No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally associated with a hypoplastic right P1 segment and a small left P1 segment. There is a small submillimeter sized bump along the left P1 segment which appears to be an infundibulum.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery originates from the aortic arch. The left vertebral artery is smaller than the right vertebral artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is a 3mm hemorrhagic lesion present within the midbrain. Although this could represent a microhemorrhage but also represent a cavernoma.3.There is an incompletely imaged ectatic vessel in the left central sulcus. It is not included on the MRA exams. The possibility of an aneurysm can't be excluded. A CT angiogram of the brain may be of benefit in further evaluating this. Alternatively an MRA exam at 3 Tesla which includes the upper aspect of the brain may be of further benefit in evaluating this. The technologist was asked to recall this patient, specifically for this particular focus, however, because the patient has been discharged home which may present some difficulties in doing so.4.A couple microhemorrhages in isolation are probably of little clinical significance.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 54 year old male patient status post orthotopic liver transplant for HCC, incidental cholangiocarcinoma. Evaluate for lesions, assess hepatic vessel patency. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a liver transplant and cholecystectomy with a hepaticojejunostomy. Central curvilinear signal void may represent pneumobilia. No focal hepatic lesion is identified. The hepatic veins and portal veins are patent. Evaluation of the hepatic artery is inadequate secondary to susceptibility artifact related to the surgery.SPLEEN: Mild splenomegaly with the spleen measuring 15 cm in the craniocaudal dimension. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild focal dilatation of the distal celiac artery is unchanged.

Output: 1.Status post liver transplant without suspicious hepatic lesion.2.Patent hepatic and portal veins. Evaluation of the hepatic artery is inadequate secondary to susceptibility artifact related to the surgery; this can be evaluated with CTA if indicated in the future.3.Mild splenomegaly.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out subdural. Signs and symptoms: Status post left parietal fracture from fall. Non-enhanced CT of brain:There is no evidence of a right small hemorrhage or subarachnoid hemorrhage.The cortical sulci, ventricular system and CSF cisterns remain within normal for patient stated age of 10 weeks. There is prominence of subarachnoid space in bifrontal, temporal and parietal regions which extends into the cement fissures bilaterally. This could be within normal for patient stated age. There is some inhomogeneity of the prominent subarachnoid space which also may be secondary to motion artifact. There is no detectable mass effect on the parenchyma. The entirely exclude the possibility of isodense subdural follow-up with an MRI is recommended.Examination demonstrates a linear nondisplaced fracture of left parietal bone which is best appreciated on bone density images 23 through 27.

Output: 1.No definite abnormality of brain parenchyma or subarachnoid hemorrhage.2.Prominent subarachnoid space which could be within normal for patient's stated age however it cannot exclude possibility of isodense subdural. There is no detectable mass effect on the brain parenchyma.3.Nondisplaced fracture of left parietal bone.4.There are no old studies for comparison.5.Visualized mastoid air cells and middle ear cavities and limited view of paranasal sinuses are unremarkable.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: left arm weakness Brain MRI_Patient motion degraded exam quality.There is a focal restricted diffusion on the right internal capsule posterior limb without evidence of associated susceptibility artifacts indicating acute ischemic infarct without hemorrhagic transformation.Underlying brain shows minimal FLAIR/T2 high signal intensity on periventricular white matter indicating nonspecific small vessel ischemic disease. 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. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Mucosal thickening of the right maxillary sinus, sphenoid sinus and small retention cyst on the left maxillary sinus are seen.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate relatively smaller vertebrobasilar system. Bilateral PCAs are fetal origin. No evidence of intracranial arterial luminal stenosis or aneurysm on bilateral ICAs, MCAs and ACAs.

Output: 1. Acute ischemic infarction on the right internal capsule posterior limb without evidence of hemorrhagic conversion.2. No evidence of intracranial arterial luminal stenosis. Relatively small vertebrobasilar system which is normal variation associated with bilateral fetal PCAs.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right temporal craniotomy and cystic drainage catheter insertion. Overall, there does not appear to have been significant interval change in size of the mixed cystic and solid tumor centered in the suprasellar cistern with extension into the prepontine, cerebellopontine angle cistern, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. The ventricular system also appears to be unchanged.

Output: No significant interval change in the craniopharyngioma with superimposed treatment findings based on this limited MRI.


Instruction: Generate impression based on findings.

Input: There is no acute cord compression. Degenerative stenosis are noted involving the cervical spine with varying degrees of probable mild central stenosis. There are bilateral pleural effusions.

Output: No acute cord compression.


Instruction: Generate impression based on findings.

Input: Reason: eval OA History: pain Right wrist:Punctate ossific density along the radial aspect of the base of the proximal phalanx of the fifth digit may represents prior remote trauma. No acute fracture is evident. Note is made of a prominent physeal scar along the lateral aspect of the distal radius, but no fracture is evident. Mild degenerative changes affect the basilar joint. There is perhaps soft tissue swelling about the dorsal aspect of the wrist. If strong clinical concern for fracture, further evaluation with MRI could be considered.Right knee:There is sharpening of the tibial spines and osteophyte formation indicating mild osteoarthritis. No large effusion is seen. There is no fracture evident. Mild osteoarthritis affects the left knee is seen on the frontal view. There is calcification along the medial aspect of the left medial femoral condyle which may reflect prior injury to the MCL/Pellegrini Stieda process. Note is made of a bipartite patella.

Output: 1. Soft tissue swelling along the dorsal aspect of the wrist. If strong clinical concern for an occult fracture, further evaluation with MRI could be considered.2. Osteoarthritis of the right knee. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: 15 month old with cardiomyopathy. Evaluate for hemorrhage. Signs and symptoms: Prematurity, sepsis. Unenhanced CT of brain: Hypoplastic and or atrophic left cerebellum is again identified. Images through posterior fossa are otherwise unremarkable and in particular no evidence of hemorrhage is identified.Images through supratentorial space demonstrate no definitive evidence of abnormality and in particular no hemorrhage is identified as clinically questioned. There is prominence of subarachnoid space more in the bifrontal region which is similar to prior MRI examination.

Output: No evidence of acute intracranial findings and stable exam since prior MRI from 3 -- 10 -- 10.


Instruction: Generate impression based on findings.

Input: No intra-articular gadolinium is identified within the distal radioulnar joint to suggest disruption of the triangular fibrocartilage. No intra-articular gadolinium traverses the scapholunate or lunotriquetral interval to suggest ligamentous disruption. Please refer to the subsequent MRI report for further information.Exposure time: 2 minutes and 10 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the right wrist for subsequent MR arthrogram examination. Please see the MRI examination report for further details.


Instruction: Generate impression based on findings.

Input: Reason: hx brain lesions. Eval for growth/change History: surveillance imaging There are unchanged postoperative findings related to bifrontal and left temporal craniotomy as well as radiation therapy with extensive hemorrhagic encephalomalacia in the bilateral anterior frontal lobes. There is diffuse linear dural thickening and enhancement along the margins of the craniotomy, but no discrete nodular focus of enhancement to suggest local tumor recurrence.There is no significant interval change in size of the enhancing left parafalcine dural based mass, which measures up to 8 mm in width (1201/51). There is an unchanged dural-based enhancing lesion along the right dorsum sella/posterior clinoid, which measures up to 6 mm (1201/32). There is also an unchanged plaque-like enhancing lesion along the right posterior frontal convexity that measures up to 3 mm in thickness. The heterogeneously enhancing right frontal bone lesion appears stable when compared to the immediate prior. The ventricles are stable in size and configuration, including ex vacuo dilatation of the bilateral anterior lateral ventricles. Again seen are multiple unchanged punctate foci of susceptibility effect within the supratentorial and infratentorial brain, which likely represent a combination of cavernous malformations and chronic punctate microhemorrhages related to previous radiation. The major arterial cerebral flow voids appear to be grossly intact. There is unchanged absence of the anterior superior sagittal sinus, likely related to prior surgery. The extracranial structures are unchanged.

Output: 1.No significant interval change in size of the left parafalcine and right dorsum sella dural-based masses, likely representing meningiomas. 2.Unchanged plaque-like enhancing lesion along the right posterior frontal convexity, which likely represents scarring versus residual tumor. 3.Unchanged extensive post-treatment findings in the bilateral anterior frontal lobe regions, without definite local recurrence tumor.4.Multiple unchanged punctate foci of susceptibility effect within the supratentorial and infratentorial brain, which likely represent a combination of cavernous malformations and chronic punctate microhemorrhages related to previous radiation.


Instruction: Generate impression based on findings.

Input: 40 year-old male with history of anoxic encephalopathy. With change in neurological exam. Increased bilateral hypodensities in the area of the basal ganglia consistent with evolving profound ischemic changes. These findings correlate with signal abnormality seen on recent MRI.There is no evidence of intracranial hemorrhage.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Partial opacification of the sphenoid sinuses and the mastoid air cells.

Output: 1.Evolving bilateral basal ganglia ischemic changes.2.Sphenoid sinus and mastoid air cell opacification.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: Vertebral body heights in the cervical spine are normal. There is mild reversal of the normal cervical spine lordosis. Alignment is otherwise maintained. There is intrinsic T1 hyperintensity involving the cervical and upper thoracic vertebral bodies likely related to radiation. No suspicious osseous lesions or evidence of epidural tumor. The spinal cord is of normal caliber and signal. There is no pathological enhancement. Mild degenerative changes are seen with small disc osteophyte complexes at C4-C5 and C5-C6 with effacement of the ventral thecal sac and minimal spinal canal stenosis at these levels. There is mild left neural foraminal stenosis at the C2-C3 level. No high-grade spinal canal narrowing or neural foraminal stenosis at any level. THORACIC SPINE

Output: 1. No evidence of metastatic disease in the cervical or thoracic spine.2. Extensive ill-defined soft tissue thickening and enhancement in the partially visualized right lower neck soft tissues above the level of the right lung apex. There is significantly increased FDG uptake within this region on recent PET-CT favoring metastasis over post treatment change. Please note these changes are in the region of the right brachial plexus and dedicated MRI brachial plexus study can be considered for better visualization of this region if clinically indicated.


Instruction: Generate impression based on findings.

Input: 33 year old with history of left breast benign biopsy in March 2015, presents for follow up MRI. There is scattered fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.There are mildly dilated ducts in the left retroareolar region. A marker clip from prior biopsy is identified at left retroareolar region. Non-mass enhancement around those ducts seen on the prior study is no longer present.A small skin lesion is present at left 6:00 position.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. As long as patient is asymptomatic with no abnormal physical exam, screening mammogram is recommended at age 40.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Abdominal pain. 44-year-old male with decompensated cirrhosis. History of hepatic hydrothorax and gallstones. ABDOMEN:LUNG BASES: Large right pleural effusion, with right lower lobe segmental atelectasis.LIVER, BILIARY TRACT: Cirrhotic liver morphology with recanalized umbilical vein and extensive varices. Minimal upper abdominal ascites. No focal hepatic lesions are evident. The common hepatic duct and common bile duct are mildly prominent. No intrahepatic biliary ductal dilation. Collapsed gallbladder with wall thickening, likely related to the patient's cirrhosis.SPLEEN: Marked splenomegaly.PANCREAS: No significant abnormality noted in the pancreatic parenchyma. No pancreatic ductal dilation. Upper abdominal ascites is non-specific and may reflect cirrhosis and/or pancreatitis. No loculated peripancreatic fluid collections. 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.

Output: 1. Cirrhosis with a small amount of upper abdominal ascites and a large right pleural effusion.2. No focal pancreatic abnormality evident.


Instruction: Generate impression based on findings.

Input: Recurrent patellar dislocation MENISCI: There is a lobulated collection of fluid signal intensity which appears to arise from the peripheral fibers of the posterior horn of the medial meniscus and extends along the posterior margin of the MCL. Based on the proximity to the posterior horn, this could represent parameniscal cyst although we see no fluid-filled tear extending to either articular surface. Alternatively, it may represent a ganglion.The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. The femoral trochlea appears shallow suggesting dysplasia. There is no abnormal marrow signal.LIGAMENTS: The cruciate and collateral ligaments are intact. Portions of the MPFL are not well visualized which may reflect chronic tearing. There is nonspecific edema within the soft tissues surrounding the medial retinaculum.EXTENSOR MECHANISM: No significant abnormality noted. There is no patella alta and the TT to TG distance is 9 mm, which is within normal limits.ADDITIONAL

Output: 1. Imaging findings of femoral trochlea dysplasia with poor definition of portions of the MPFL consistent with known history of recurrent patellar dislocation. The TT to TG distance is normal.2. Lobulated cystic structure along the distal femur and medial meniscus which could represent a parameniscal cyst although no discrete meniscal tear is identified. Alternatively, this may represent a ganglion.


Instruction: Generate impression based on findings.

Input: Clinical question: Cervical spinal stenosis. Signs and symptoms: Neck symptoms. Nonenhanced MRI of cervical spine:Examination demonstrate advanced degenerative changes of cervical spine. Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild degenerative changes and unremarkable otherwise.C4 -- C5 demonstrate advanced disk disease with loss of disk height and partial disk fusion. Significant (left greater than right) neural foraminal compromise and no spinal stenosis.C5 -- C6 demonstrate advanced disk disease, significant loss of disk height and mild facet and ligamentum flavum hypertrophy. There is a moderate to severe left and mild to moderate right neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate advanced disk disease with significant loss of disk height, mild to moderate right and mild left hypertrophic changes of facets and ligamentum flavum. Findings results in significant bilateral neural foraminal compromise and mild central spinal stenosis.C7 -- T1 demonstrate advanced disk disease with significant loss of disk height, moderate left and mild to moderate right facet and ligamentum flavum hypertrophy. Constellation of changes results in significant bilateral (left greater than right) neural foraminal compromise and spinal stenosis. Degenerative changes also results in mild anterolisthesis at this level.T1 -- T2 demonstrate mild degenerative changes with resultant right neural foraminal compromise.There is suggestion of subtle increased T2 signal intensity of the cord at C7 without convincing evidence of change in cord caliber. Possibility of this observation representing an artifactual finding cannot be entirely excluded due to suboptimal images.The uppermost visualized thoracic spine to T4 level is unremarkable.

Output: 1.Extensive degenerative changes of cervical spine most significant at C4 -- C5 through C7 -- T1 levels.2.There is is some multi-level bilateral neural foraminal compromise (some significantly) as detailed parallel oblong. 3.Degenerative changes also results in mild central spinal stenosis at C6 -- C7 and C7 -- T1 levels.4.Suggestion of subtle increased cord T2 signal intensity without change in the caliber of the cord at C7 level which could also represent an artifactual finding due to suboptimal axial images.


Instruction: Generate impression based on findings.

Input: 81 years, Female, left-sided weakness. There is restricted diffusion involving the right posterior frontal periventricular white matter extending into the posterior putamen and subinsular region consistent with acute infarct. There is corresponding T2/FLAIR hyperintensity. There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate chronic small vessel ischemic changes. Chronic cortical infarcts also noted in the left posterior parietal and left lateral occipital lobes. Chronic infarct in the right lateral cerebellar hemisphere also noted. Global parenchymal volume loss is evident including of the bilateral hippocampi. There is gliosis and volume loss involving the right anterior temporal lobe which may also be related to prior injury. No hydrocephalus or extra-axial collections. Multiple sequences are motion degraded, especially the susceptibility sensitive sequences which limits evaluation for hemorrhage. However no large hemorrhage is evident. No intracranial mass or mass effect. No midline shift or herniation. There is diffuse opacification of the left maxillary sinus as well as patchy opacification elsewhere in the paranasal sinuses.

Output: 1. Acute infarct involving the right posterior frontal periventricular white matter extending into the subinsular region. Multiple supra- and infratentorial chronic infarcts as described above.2. Moderate chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: 11 year old male with history of Tuberous Sclerosis. Evaluate for renal angiomyolipoma. ABDOMEN:LUNG BASES: There is bibasilar dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous tiny (3 mm or less) low attenuation lesions are present in both kidneys, with the largest measuring up to 6 mm (series 3, image 57) located in the midportion of the right kidney. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fundoplication clips are noted. Otherwise no significant abnormality noted.BONES, SOFT TISSUES: The height of the vertebral bodies is diminished most likely due to lack of upright weight bearing. OTHER: Gastrostomy tube tip in the stomach.

Output: Numerous tiny bilateral renal low attenuation lesions with one small lesion located in the right kidney. These are likely a combination of cyst and angiomyolipoma.


Instruction: Generate impression based on findings.

Input: 68 year old man with recent diagnosis of multiple myeloma and fat pad biopsy positive for amyloidosis, with hypertrophy and systolic dysfunction of the left ventricle on echocardiogram, referred for cardiac MRI to evaluate ejection fraction and for native T1 mapping. Left VentricleThe left ventricle is normal in size with moderately-severely reduced systolic function. The overall LV ejection fraction is 36%, the LV end diastolic volume index is 65 ml/m2 (normal range: 74+/-15), the LVEDV is 104 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 115 g/m2 (normal range 85+/-15), and the LV mass is 185 g (normal range 164+/-36). There is global hypokinesis with severe concentric hypertrophy (septal and posterior wall thickness of 16mm). Native T1 mapping demonstrates a T1 relaxation time of 1274 ms in the septum, 1295 ms in the inferolateral wall and 1350 ms in the anterior wall. These values are highly suspicious for cardiac amyloidosis especially given the associated findings.Left AtriumThe left atrium is normal in size. The interatrial septum appears thickened.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The right ventricular wall appears thickened. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 47 ml/m2 (normal range 82+/-16), the RVEDV is 76 ml (normal range 142+/-31), the RV end systolic volume index is 25 ml/m2 (normal range 31+/-9), and the RVESV is 40 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is trace aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. The leaflets appear thickened.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation. The leaflets appear thickenedAortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Aortic sinus of valsalva 38.7 mm.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a small pericardial effusion mostly over the right atrium. Extracardiac FindingsThere are bilateral moderate pleural effusions (right greater than left). This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal sized LV with moderate-severely reduced systolic function (EF 36%). There is severe concentric hypertrophy. 2. Normal sized RV with mildly reduced systolic function (EF 47%). 3. Small pericardial effusion and bilateral pleural effusions. 4. Interatrial septal thickening. 5. Native T1 is abnormally elevated. Taken together with the associated findings cardiac amyloidosis is highly suspected. Endomyocardial biopsy could be considered for confirmatory diagnosis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Medial left knee pain MENISCI: Within the posterior horn of the medial meniscus, there is faint linear signal extending to the articular surface concerning for small meniscal tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is moderate diffuse thinning of the articular cartilage of the medial compartment, particularly the femoral condyle with scattered areas of near full-thickness loss. There is mild heterogeneous signal of the articular cartilage of the lateral compartment without discrete tear. The articular cartilage of the patellofemoral compartment is intact.LIGAMENTS: There is minimally increased signal surrounding the MCL which is otherwise intact. The remaining cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Small tear of the posterior horn of the medial meniscus.2. Grade 1 MCL sprain. 3. Moderate cartilage thinning of the medial compartment with scattered areas of near full-thickness loss anteromedially.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unspecified condition of brain Other convulsions Congenital anomaly of cerebrovascular systemClinical question: cerebral cavernous malformation, MRI presurgical for image guidance during surgerySigns and Symptoms: Surgery, STEALTH for presurgical planning for surgeryComments: The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 32 x 21 mm axial dimension lesion in the left temporal lobe which has low signal periphery and heterogeneous central portion on T2-weighted imaging which has not changed substantially when compared to the previous examsNormal 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: 1.Findings are compatible with a cavernoma located in the left temporal lobe.2.Please note that this examination was performed through purpose of stereotactic guidance for surgery and is therefore a limited exam.


Instruction: Generate impression based on findings.

Input: NF1 and epilepsy, as well as scoliosis, status post correction with rods with constant mid back pain. Brain: There is enlargement of multiple segments of the optic nerves bilaterally, left more than right, with dilatation of the optic nerve sheaths. There is no evidence of intracranial hemorrhage or acute infarct. There is diffuse patchy T1 hyperintensity in the bilateral basal ganglia and thalami. There are also several small foci of high T2 signal in the medial portions of the cerebellum. The lateral ventricles are asymmetric, but not enlarged. However, there is prominence of the subarachnoid space in the anterior left middle cranial fossa measuring up to 10 mm in width, with associated anterior bowing of the overlying lateral orbital wall. A similar finding is present on the contralateral side, but to a lesser degree. There is no midline shift or herniation. The major cerebral flow voids are intact. The scalp soft tissues are unremarkable, but there is a small enhancing nodule in the left cheek skin and subcutaneous tissues.Spine: There is focal kyphosis at C5-6 with mild anterior wedge deformity of the C5 and C6 vertebral bodies. There also appears to be mild narrowing of the spinal canal at this level, but no spinal cord compression. There is no evidence of tumors in the cervical spine, although assessment is limited based on only the localizer images of this region. There are postoperative findings related to multilevel thoracolumbar scoliosis surgery. Metal artifact obscures surrounding anatomy, including the spinal cord and most of the vertebral bodies. There is moderate apex right thoracic and apex left lumbar scoliosis. There is a cerebrospinal fluid signal collection in the left paraspinal region that spans the lower thoracic and upper lumbar spine levels, with what appears to be associated enlargement of the adjacent neural foramina. There are numerous scattered subcutaneous nodules. There is also a more infiltrative lesion that is partly imaged in the left lateral lower back subcutaneous tissues.

Output: 1. Bilateral optic nerve gliomas, mild sphenoid wing dysplasia, and other stigmata of neurofibromatosis type 1 in the brain.2. Multiple cutaneous nodular neurofibromas and what may represent a large left lateral lower back superficial neurofibroma, although this is incompletely imaged.3. Focal kyphosis at C5-6 with mild anterior wedge deformity of the C5 and C6 vertebral bodies. 4. Postoperative findings related to multilevel thoracolumbar scoliosis surgery with persistent scoliosis, whereby metal artifact obscures surrounding anatomy. Nevertheless, what likely represents a large left thoracolumbar pseudomeningocele is partly discernible.


Instruction: Generate impression based on findings.

Input: 62-year-old female with neck pain and pain in the left arm which radiates to the hand including all fingers. The patient has known cervical stenosis. Compare to previous MRI done 2/5/2015. Postoperative changes of Chiari decompression are again seen with preserved CSF spaces and biphasic flow at the foramen magnum. There is no discrete syrinx in the cervical spine, although there is trace prominence of the central canal as seen before. Postoperative changes are seen of multilevel laminectomies involving the lower cervical and upper thoracic spine which are unchanged. There is unchanged T2 signal abnormality along the dorsal aspect of the thoracic cord at the T1-T2 level. The cord at the T1-T2 level again abuts the dorsal dura suggesting possibility of tethering but is unchanged.There is minimal retrolisthesis of C3 on C4 and C4 on C5 which is unchanged. The vertebral body heights are maintained. There is some loss of disc height at the C3-4, C4-5 and mildly at the C5-6 levels. There are degenerative Schmorl's nodes in the C4 vertebral body which are unchanged. Otherwise there is no focal worrisome marrow signal abnormality. 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: Small disc osteophyte complex as well as mild uncovertebral hypertrophy which contributes to mild to moderate spinal canal and mild bilateral neuroforaminal stenosis. C4-5: Small disc osteophyte complex as well as mild uncovertebral and facet hypertrophy with mild ligamentum flavum thickening. There is mild to moderate spinal canal stenosis with mild to moderate left and mild right neuroforaminal stenosis.C5-6: Minimal right greater than left disc osteophyte complex, mild facet arthropathy and mild ligamentum flavum thickening without spinal canal or neuroforaminal stenosis.C6-7: Minimal disc osteophyte complex and mild ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Postoperative changes of Chiari decompression with preserved CSF spaces and flow across the foramen magnum.2.No discrete syrinx in the cervical spine. Unchanged trace prominence of the central canal in the upper cervical cord.3.Postoperative changes of lower cervical/upper thoracic laminectomies. Unchanged appearance of the upper thoracic cord which is dorsally positioned as before suggesting possibility of tethering. Stable T2 signal abnormality/myelomalacia along the dorsal aspect of the thoracic cord at the T1-2 level.4.Degenerative changes as described above with mild-to-moderate spinal canal stenosis at the C3-4 and C4-5 levels as well as up to mild to moderate left C4-5 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Young man with encephalopathy and hallucinations and history of seizures and history of brain abscess a long time ago. There is extensive encephalomalacia in the right anterior frontal lobe with marked ex vacuo dilatation of the right lateral ventricle and there is a small area of encephalomalacia in the right basal ganglia. There is also a 10 mm diameter area of cystic encephalomalacia in the left parietal lobe, which may communicate with the left lateral ventricle and is surrounded by mild T2 hyperintensity. There is no abnormal intracranial enhancement. There is diffuse cerebellar volume loss. The hippocampi are unremarkable. There is no significant midline shift or herniation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The major cerebral flow voids are intact. There appear to be postoperative findings in the right frontal bone. There is otherwise diffuse thickening of the calvarium. The orbits are grossly unremarkable.

Output: 1. Apparent remote postoperative findings in the right frontal region with extensive encephalomalacia in the right anterior frontal lobe with marked ex vacuo dilatation of the right lateral ventricle and a small chronic lacunar infarct in the right basal ganglia. 2. Probable porencephalic cyst measuring 10 mm in diameter in the left parietal lobe.3. Diffuse cerebellar volume loss and diffuse thickening of the calvarium are likely related to chronic seizure therapy.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The segment 8 ablation cavity measures approximately 2.8 x 15, cm, not significantly changed and without evidence of marginal residual or recurrent disease. No new suspicious arterial enhancing and washing out lesion. A peripheral, wedge-shaped area of increased enhancement on arterial phase in segment 8 which lacks washout is compatible with a transient hepatic intensity difference.Decreased parenchymal signal intensity on out of phase images is compatible with hepatic steatosis. The hepatic vasculature appears patent.No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Normal splenic size without a focal lesion.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: Heterogeneous bone marrow signal intensity with areas of increased T2 signal is nonspecific but appears similar to the 1/15/2016 examination. Degenerative changes affect the spine.OTHER: No significant abnormality noted.

Output: 1.Stable post treatment changes of segment 8 without evidence of residual or recurrent hepatic neoplasm. 2.Nonspecific heterogeneous bone marrow signal, not significantly changed.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered:Evaluate face and brain. Signs and symptoms: Term infant with facial dermal cyst versus meningocele. Technique:1 mm axial images of the entire craniofacial region without infusion of contrast material were obtained. 3-D reformatted images of the bony structures and soft tissues were obtained. Sagittal and coronal 2-D reformatted images were also obtained for evaluation. Examination demonstrates a small defect in the midline at the level of cribriform plate anteriorly. CSF density appears to extend across this defect and extends inferiorly posterior to the nasal bridge and eventually terminates into a low density collection in the midline in the subcutaneous tissues of the nose. The collection measures approximately 14 mm in cranial/cephalad axis and 7-mm in AP axis.This finding is consistent with a meningocele. This finding is best appreciated on the 2-D reformatted images in all 3 axial, sagittal and coronal planes. Further evaluation with an MRI examination may assess for detection of possible presence of neural tissue within the meningocele or along its tract. Cisternography is also a helpful study for disk evaluation.Both on sagittal and coronal 2-D reformatted images there is a suspected small amount of tissue within the tract and a meningocele.This examination is otherwise unremarkable.All appropriate 3-D reformatted measurements are submitted in patient's radiology 5.

Output: Midline anterior bony defect at the level of cribriform plate with an associated meningocele as described above.


Instruction: Generate impression based on findings.

Input: 48 years, Male, other malaise and fatigue [780.79] / Disturbance of skin sensation [782.0], Reason for Study: MS? History: Tingling, upgoing toes, eye symptoms Brain: There are approximately 20 T2/FLAIR hyperintense lesions in the supratentorial white matter, many of which are in the periventricular as well as juxtacortical distribution. Few lesions along the callosal surface also seen. No infratentorial lesions in the brain are appreciated. No T1 hypointense lesions/"black holes" are definitively appreciated. Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No evidence of infarct or hemorrhage. No abnormal parenchymal or meningeal enhancement. No extra-axial collections. Ventricles and sulci are within normal limits. Sella and orbits are grossly unremarkable. Calvarium and extracranial soft tissues are unremarkable.Cervical Spine: No abnormal signal seen within the cervical cord to suggest demyelinating disease. Vertebral body heights are normal. Bone marrow signal is benign. There is minimal retrolisthesis of C3 on C4. Alignment of the cervical spine is otherwise maintained. Multilevel degenerative changes are seen with disc osteophyte complexes at C3-C4, C5-C6 and C6-C7 with uncovertebral hypertrophy. There is mild spinal canal stenosis at the C5-C6 and C6-C7 levels. There is mild to moderate C3-C4 neural foraminal stenosis bilaterally related to prominent uncovertebral hypertrophy and disc protrusion. There is also mild to moderate bilateral C5-C6 and mild left C6-C7 neural foraminal stenosis. Thoracic Spine: Apparent punctate T2 hyperintensity seen in the right ventral cord at the T6-T7 level seen on single axial slice is favored to be artifactual. No definite thoracic cord signal abnormality is appreciated. No abnormal enhancement. The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. T1 hyperintense lesion involving the T8 vertebral body is compatible with a hemangioma. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Approximately 20 T2/FLAIR hyperintense lesions in the supratentorial white matter most of which are in a periventricular and juxtacortical distribution and suspicious for chronic demyelinating disease. No abnormal enhancement to suggest active demyelination. Brain parenchymal volume is preserved.2. No convincing cord signal abnormality is appreciated within the cervical or thoracic cord. No abnormal enhancement.3. Degenerative changes in the cervical spine at the C3-C4, C5-C6, and C6-C7 levels as above with mild to moderate neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 37-year-old female with concern for pancreatitis. Evaluate for biliary ductal dilatation and appearance of the liver. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter right hepatic lobe cyst. No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in signal and morphology. No evidence of edema or diffusion restriction to suggest pancreatic abscess. No peripancreatic fluid collections.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.No evidence of pancreatitis.2.No intra or extrahepatic biliary ductal dilatation. Liver is normal in signal and morphology.


Instruction: Generate impression based on findings.

Input: Multiple shoulder dislocations in need of MRA. ROTATOR CUFF: The rotator cuff tendons are intact. SUPRASPINATUS OUTLET: The acromioclavicular joint is normal in appearance. There is no gadolinium in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is irregularity of the posterolateral humeral head compatible with a Hill-Sachs deformity.There appears to be tearing of the anterior inferior labrum.BICEPS TENDON: The biceps tendon is intact.ADDITIONAL

Output: Anterior inferior labral tear.


Instruction: Generate impression based on findings.

Input: Back pain and leg weakness Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of normal lumbar lordosis. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: There is disk bulge with component of central disk protrusion which effaces the lateral recesses and contacts the bilateral traversing S1 nerve roots. No significant central canal stenosis. There is mild bilateral neural foramina stenosis.Paraspinous soft tissues are within normal limits.

Output: Mild degenerative changes in the lumbar spine with disk protrusion at the L5-S1 level. There is contact of the traversing S1 nerve roots in the lateral recesses as well as mild narrowing of the L5-S1 neural foramina involving the exiting L5 nerve roots.


Instruction: Generate impression based on findings.

Input: 93-year-old male with unstageable sacral draining decubital ulcer + UTI, presented with sepsis. BONE MARROW: Again seen is a right femoral neck fracture with superior and anterior displacement of the diaphyseal fracture fragment, subacute.Questionable faint T1 hypointense, T2/STIR hyperintense signal and disruption of the cortex underlying the sacral ulcer.SOFT TISSUES: Soft tissue edema and ulceration overlying the sacrococcygeal junction. No enhancing fluid collection to suggest abscess formation.Diffuse anasarca. Diffuse fatty muscle atrophy.JOINTS: Mild osteoarthritis affects both hips and the lower lumber spine.ADDITIONAL

Output: 1.Sacral ulcer with questionable underlying early osteomyelitis of the sacrococcygeal junction.2.Subacute right femoral neck fracture.


Instruction: Generate impression based on findings.

Input: Status post uterine fibroid embolization. Patient is clinically improving. PELVIS:UTERUS, ADNEXA: Nabothian cysts. The uterus measures 6.2 x 4.0 cm (7/24), previously 7.0 x 5.0 cm. The junctional zone is not well visualized on this exam. Multiple fibroids have decreased in size and enhancement since the prior exam. A reference intramural fibroid in the fundus measures 2.0 x 1.6 cm, previously 2.3 x 1.8 cm. Ovaries are not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple fibroids have decreased in size and enhancement status post uterine artery embolization.


Instruction: Generate impression based on findings.

Input: 55-year-old female with history of liver lesion seen on prior CT examination in July. Evaluate hepatic lesion. ABDOMEN:LIVER, BILIARY TRACT: Redemonstration of nodular contour of the liver with widened fissure consistent with history of cirrhosis. Previously noted segment 5 arterially enhancing lesion is again noted. This lesion is T2 hyperintense and T1 hypointense; it has increased in size compared to the previous examination currently measuring 21 x 15 mm (series 1501, image 39) previously measuring 6 x 8 mm. This lesion does not demonstrate washout. There is also a focus of fat within this lesion. These imaging criteria are not specific for HCC, but are suspicious, and differential includes early HCC, cholangiohepatoma, or even an atypical dysplastic nodule.Small amount of nonspecific pericholecystic fluid is present.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Redemonstration of occlusion the proximal celiac trunk with collateralization.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval increase in size of the arterially enhancing segment 5 hepatic lesion as above which does not meet AASLD criteria for HCC. However, given history of cirrhosis and interval increase in size, this lesion remains highly suspicious, with a suggested differential above.2.Redemonstration of chronic celiac trunk occlusion.


Instruction: Generate impression based on findings.

Input: Pain, swelling, and instability after fall. MENISCI: There is mildly increased signal within the posterior horn of the medial meniscus which does not definitively extend to the articular surface. No discrete meniscal tears are identified.ARTICULAR CARTILAGE AND BONE: Bone marrow edema is present within the anterior aspect of the lateral femoral condyle. There is an approximately 2 mm depression of the anterior aspect of the lateral femoral condyle with cortical irregularity and focal cartilage thinning compatible with an impaction fracture. Additional bone marrow edema is present within the posterior aspects of the bilateral tibial condyles. The cartilage of the tibiofemoral and patellofemoral compartments is otherwise intact.LIGAMENTS: A complete tear of the anterior cruciate ligament is present. The PCL is intact. A small amount of fluid is present surrounding the medial collateral ligament which remains intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Complete tear of the ACL with associated bone contusions, lateral femoral condyle impaction fracture, grade 1 sprain of the MCL, and moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Female, 26 years old, with benign intracranial hypertension, Chiari malformation, include cine flow. Brain:Postoperative findings are seen compatible with Chiari decompression including suboccipital craniectomy and resection of the posterior arch of C1. The CSF space at the level of the neo-foramen magnum is well expanded with no evidence of tonsillar or brainstem crowding. Robust biphasic CSF flow is seen both anteriorly and posteriorly through the neo-foramen magnum.Brain parenchymal morphology and signal characteristics are within normal limits. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.C-spine:Postoperative findings are seen related to Chiari decompression surgery as above. The osseous structures of the spine are otherwise intact. Straightening of the cervical lordosis is likely positional. Sagittal alignment is otherwise within normal limits. Vertebral body height and morphology are unremarkable. No evidence of marrow replacement or marrow edema is seen.The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.The intervertebral discs are preserved. No significant spinal canal or foraminal stenosis is seen.

Output: 1.Findings are seen compatible with Chiari decompression surgery. The CSF space at the level of the neo-foramen magnum is well decompressed with no evidence of brainstem or tonsillar crowding. Adequate CSF flow is seen both anteriorly and posteriorly.2.No specific intracranial abnormalities are identified.3.Apart from surgical changes, no significant abnormalities are seen in the cervical spine.


Instruction: Generate impression based on findings.

Input: Male 62 years old Reason: S/p Peustow procedure, cholecystectomy, with recurrent acute on chronic pancreatitis. Please evaluate and compare to previous. ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are identified within the liver. The largest is in the medial right hepatic lobe. Moderate intra and extrahepatic biliary ductal dilatation which appears progressed compared to prior study which abruptly terminates at the ampulla. There is a filling defect within the distal CBD (series 301, image 9) which may represent a small CBD stone.SPLEEN: The spleen is measured at upper limits of normal. There is occlusion of the splenic vein and region of the pancreatic tail with extensive collateral vessel formation.PANCREAS: There is a cystic lesion in the pancreatic head with central T2 hyperintense foci corresponding to calcifications on recent CT. A second smaller cystic abnormality is identified within the pancreatic tail. These communicate with the pancreatic duct. The pancreatic duct is patent however there is a stricture in the neck best seen on series 1001, image 1. There is a blunted response to secretin suggesting a degree of pancreatic dysfunction.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post bilateral nephrectomy.RETROPERITONEUM, LYMPH NODES: Prominent peripancreatic lymph nodes may be reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild peripancreatic fluid is unchanged in size compared to prior study. Abdominal ascites. Diffuse anasarca.

Output: 1. No significant change in the appearance of intrapancreatic cystic lesions suggestive of pseudocysts.2. Stricture in the pancreatic neck and blunted response to secretin suggesting a degree of pancreatic dysfunction.3. Filling defect in the distal common bile duct suggestive of a small stone with increasing intra and extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Neurofibromatosis 1 with right facial plexiform neurofibroma. There is redemonstration of a diffuse plexiform neurofibroma that infiltrates the entirety of the right temporalis muscle including into the infratemporal fossa and also involves the right frontotemporal scalp and right cheek. The size of this lesion appears similar to the prior studies with the temporalis muscle portion measuring up to 17 mm transverse and the cutaneous scalp/cheek neurofibroma measuring up to 7 mm thick. As before, there appears to be some remodeling of the right sphenoid bone. Anteriorly there is extension to the lateral-most aspect of the orbit without intraorbital involvement. Inferiorly, there is extension to the lateral aspect of the lateral pterygoid muscle within the masticator space, unchanged.Redemonstrated are ill-defined areas of FLAIR hyperintensity in the globus pallidus, thalami, medial temporal lobes, left cerebral peduncle, medial cerebellar hemispheres as well as pons. The lesions involving the globus pallidus, left cerebral peduncle, and pons have become less conspicuous. The remaining lesions appear stable. There is no abnormal parenchymal enhancement. Incidental tentorial deficiency.The ventricles and sulci retain normal size configuration. There is no abnormal fluid collection. There is no midline shift or basal cistern effacement. The paranasal sinuses and mastoid air cells are clear. Expected vascular flow voids are demonstrated.The optic nerves, chiasm, and tracts appear normal. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The globes appear normal with physiologic enhancement of the ciliary bodies and choroid. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion.

Output: 1.Stable size of diffuse plexiform neurofibroma involving right frontotemporal scalp and right cheek as well as the right temporalis muscle. 2.No orbital mass or evidence of abnormal orbital signal/enhancement.3.Redemonstrated are ill-defined areas of FLAIR hyperintensity in the globus pallidus, thalami, medial temporal lobes, left cerebral peduncle, medial cerebellar hemispheres as well as pons. The lesions involving the globus pallidus, left cerebral peduncle, and pons have become less conspicuous.


Instruction: Generate impression based on findings.

Input: History of rotator cuff tear now with shoulder pain, evaluate for recurrent tear. Foci of signal void within the soft tissues likely represent metallic susceptibility artifact from prior surgery. Similar foci within the humeral head presumably represent suture anchors.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at the 12:00 position with delamination of fibers such that bursal surface fibers are retracted by approximately 1.5 cm and the articular surface fibers are retracted by approximately 2.5-3 cm. The tear measures just over 1 cm in the AP dimension. The retracted portions of the tendon appear thickened consistent with tendinosis. The more anterior fibers of the supraspinatus tendon appear to extend to the greater tuberosity. Mild fatty infiltration affects the myotendinous junction of the supraspinatus. The supraspinatus muscle otherwise appears normal. The aforementioned supraspinatus tear appears to extend posteriorly to involve the anterior fibers of the infraspinatus tendon. There also appears to be mild interstitial tearing of the infraspinatus tendon more proximally near the myotendinous junction. Mild fatty infiltration is present along the myotendinous junction of the infraspinatus. The infraspinatus muscle otherwise appears normal. The teres minor muscle and tendon are intact. The subscapularis muscle and tendon are intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears widened consistent with prior surgery. Bone marrow edema within the distal end of the clavicle is of uncertain etiology or significance, but we see no pronounced inflammatory changes to suggest infection. A small amount of fluid is present in the subacromial bursa which extends into but not beyond the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. A small amount of fluid is present within the glenohumeral joint without large effusion. Blunting of the superior labrum may be postoperative in etiology. The inferior labrum appears intact.BICEPS TENDON: The long head of the biceps tendon is not seen at the level of the rotator interval or within the proximal intertubercular groove. What we presume to be the biceps tendon is seen more distally, and these findings may reflect biceps tenotomy.ADDITIONAL

Output: Recurrent rotator cuff tear and postoperative changes as other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: History of smoldering multiple myeloma, need MRI to evaluate for myelomatous lesions History: Most recent bone marrow with 30% plasma cells; two right iliac lucencies seen on CT. BONE MARROW: Bone marrow signal is slightly heterogeneous without discrete lesions. No abnormal enhancement.SOFT TISSUES: No significant abnormality noted. No abnormal enhancement. JOINTS: No significant abnormality noted.ADDITIONAL

Output: Heterogeneous bone marrow signal with no discrete myelomatous lesion.


Instruction: Generate impression based on findings.

Input: No focal abnormal signal or mass is present within the pituitary gland. The pituitary stalk is intact and lies in the midline. The posterior pituitary bright spot is intact. The suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological intracranial enhancement. There is no evidence of acute infarction or intracranial hemorrhage. Normal flow-voids are demonstrated in the major intracranial vascular structures. A retention cyst is present in the right maxillary sinus.

Output: No evidence of pituitary lesions or other intracranial abnormalities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 39 years old. Reason: assess bleed R ICH-- going straight to OR History: altered mental status There is an acute right temporal lobe hematoma measuring 4.6 x 3.5 cm with surrounding vasogenic edema and associated 10 mm of leftward midline shift. Small amount of subarachnoid hemorrhage is also present. There is no evidence of hydrocephalus.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Acute right temporal lobe hematoma with associated vasogenic edema and midline shift.


Instruction: Generate impression based on findings.

Input: The intracranial internal carotid arteries are normal in course and caliber. Along the proximal petrous right internal carotid artery, there is slight attenuation of flow-related enhancement, which is favored to relate to asymmetric bone along the petrous canal and focal tortuosity of the vessel at this level. The middle and anterior cerebral arteries are unremarkable. The PComm arteries are not visualized bilaterally. The vertebral arteries and basilar artery are normal in course and caliber. There is stable minimal irregularity involving the right P2 and P3 segments and left P2 segment. There is no evidence of flow-limiting stenosis or aneurysm.Encephalomalacia and ex vacuo dilatation of the occipital horn of the left lateral ventricle in the left parieto-occipital region is better assessed on the recent prior brain MRI.

Output: Stable minimal irregularity of the distal PCAs bilaterally without evidence of flow limiting stenosis.


Instruction: Generate impression based on findings.

Input: Vocal cord paralysis and dysphagia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, 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. There is a 5 mm diameter right paraophthalmic aneurysm. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.

Output: 1. No evidence of gross brainstem lesions or lesions along the proximal portions of the vagus nerves.2. A 5 mm diameter right paraophthalmic aneurysm is better depicted on the prior MRA.


Instruction: Generate impression based on findings.

Input: Elevated alkaline phosphatase. Concern for biliary stricture. History of AML. Status post transplant. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology. There is abnormal periportal signal diffusely without definite enhancement.The previously seen segment 4A/B lesion has increased in size, see measurements below. It demonstrates T2 weighted moderate hyperintensity, is isointense on T1-weighted imaging and demonstrates arterial enhancement but no washout. There is a more peripheral satellite lesion adjacent to the dominant lesion with similar imaging characteristics.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder without gallstones.SPLEEN: The spleen is normal morphology and size. Suspected iron deposition.PANCREAS: 1.3 cm pancreatic tail cystic lesion without suspicious enhancement. This does not clearly communicate with the pancreatic duct. There is also mild atrophy and pancreatic ductal dilatation distal to this lesion. Stable atrophy of the distal pancreatic body/proximal tail without a focal lesion.The remainder of the pancreatic parenchyma is unremarkable. 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. There is diffuse abnormal periportal signal intensity which does not definitively show dropout on out of phase imaging. Although this may still represent nodular fatty infiltration an infectious or infiltrative process cannot be excluded. There is no discrete associated enhancement.2. Nonspecific enhancing segment 4A/B lesion is increased in size from the prior with a new satellite lesion. It does not demonstrate washout or other specific imaging characteristics. Differential considerations include focal nodular hypertrophy or a regenerative nodule amongst other possibilities. A malignant etiology is considered less likely as the lesion does not wash-out.3. New cystic pancreatic tail lesion does not clearly communicate with the main pancreatic duct and may represent a mucinous neoplasm, a small intrapancreatic pseudocyst or cystic islet cell neoplasm.


Instruction: Generate impression based on findings.

Input: Reason: eval for disease progression History: hx of lymphoma with cns recurrence s/p autoSCt, now with left cervical radiculopathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive confluent cerebral white matter T2 hyperintensity. There is no abnormal brain parenchymal enhancement. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a small left maxillary sinus retention cyst.

Output: 1. No evidence of intracranial mass lesions.2. Extensive cerebral white matter abnormality is likely treatment-related.


Instruction: Generate impression based on findings.

Input: Reason: pelvic abscess progression History: pelvic abscess Again seen is increased signal intensity within the left sacroiliac joint on T2-weighted images with enhancement of the joint following contrast administration compatible with the suspected history of infection. There is edema and enhancement within the adjacent left ilium and left sacrum. There are small erosions along the iliac and sacral margins of the joint appearing similar to the prior study when accounting for technical differences. We see no frank fluid collection either anterior or posterior to the sacroiliac joint, and overall the degree of edema and enhancement in the adjacent gluteal and iliacus musculature has decreased when compared to the prior study. There is also a focus of signal abnormality within the left sacral wing likely representing a benign bone island. There is mild enhancement along the origin of the rectus femoris which may represent a mild enthesopathy which may be of no current clinical significance.

Output: Findings compatible with left sacroiliac joint inflammation, presumably infectious in etiology, without evidence of disease progression. Overall the degree of inflammation in the surrounding soft tissues has decreased and we see no soft tissue abscess.


Instruction: Generate impression based on findings.

Input: headache during sex No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.The left side sphenoid sinus shows opacification.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs and ACAs.Bilateral Pcom arteries were identified and patent. Acom artery is also patent.There is no evidence of intracranial arterial aneurysm, significant intracranial arterial luminal stenosis or occlusion.Smaller than 3mm sized intracranial arterial aneurysm cannot be identified on MR angiography. Therefore, if clinically indicated, diagnostic cerebral angiography can be considered for further evaluation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Left sphenoid sinus opacification.3. No evidence of intracranial aneurysm on MRA.Rec: If clinically indicated, diagnostic cerebral angiography can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: Reason: Metastatic prostate cancer needs re-evaluation and compare to prior scans. Per RECIST 1:1 bi-dimensional measurements where applicable. History: Metastatic prostate cancer needs re-evaluation and compare to prior scans. Per RECIST 1:1 bi-dimensional measurements where applicable. ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of a cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. Punctate T2 hyperintense nonenhancing lesions likely IPMNs. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged. Mild cortical atrophy, unchanged. Focal protrusion along the right superior pole is unchanged and may represent lobulation. Recommend special attention on follow up surveillance exams. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval decrease in size of fluid collection in the cystoprostatectomy surgical bed.2.No specific evidence of recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: 14-year-old with history of GBM, currently on maintenance chemotherapy with Temozolomide. Compared to 3/10/2015, there has been evolution of postsurgical changes related to left parietal craniotomy for tumor re-resection. There is no significant change in appearance of the left parietal resection cavity and cystic areas adjacent to the trigone of the left lateral ventricle. No significant change in surrounding T2/FLAIR hyperintensity. No significant change in the enhancement along the posterior medial margin of the resection cavity as well as a 7 mm nodular focus of enhancement abutting the trigone of the left lateral ventricle.There is a nodular focus of extra-axial enhancement along the lateral aspect of the left anterior temporal convexity which is more prominent than prior and may be be vascular in etiology, attention on follow-up suggested. Left anterior temporal arachnoid cyst incidentally noted and unchanged. Interval decrease in extra-axial collection along the left cerebral convexity with increased dural enhancement which is likely reactive. No evidence of infarct. No new mass effect. No midline shift or herniation. No hydrocephalus.

Output: 1. Compared to 3/10/2015, there is no evidence of tumor progression. No significant change in appearance of the left parietal resection cavity, cystic areas adjacent to the trigone of the left lateral ventricle, enhancement along the posterior medial margin of the resection cavity, as well as nodular focus of enhancement abutting the trigone of the left lateral ventricle.2. Nodular focus of extra-axial enhancement along the lateral aspect of the left anterior temporal convexity is more prominent than prior and may be be vascular in etiology, attention on follow-up suggested.


Instruction: Generate impression based on findings.

Input: Results indicate right unilateral vestibular weakness. 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.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Arm weakness and hyperreflexia. There is straightening of the cervical spine alignment in the sagittal plane. The vertebral bone marrow signal is unremarkable aside from degenerative endplate alterations at T1-2 where there is a T1-T2 disc-osteophyte complex that slightly indents the spinal cord. The spinal cord otherwise appears unremarkable. At C2-C3, there is no significant compromise to the spinal canal or neural foramina. At C3-4, C4-C5, and C5-C6, there is no significant compromise to the spinal canal. However, right uncovertebral proliferative change does mildly to moderately narrowed right neural foramen. At C6-C7, there is minimal left uncovertebral proliferative change causing minimal narrowing of the neural foramen. There is no central or right foraminal narrowing. At C7-T1, there is no significant compromise to the spinal canal or neural foramina. The vertebral artery flow voids appear to be intact. There is a well-circumscribed T1 isointense, T2 hyperintense left subcutaneous lesion that measures approximately up to 3 cm.

Output: 1. Multilevel degenerative spondylosis that is most pronounced at T1-2, where a dis-osteophyte complex slightly indents the spinal cord, without spinal cord signal abnormality.2. Posterior left neck inclusion cyst measuring up to approximately 3 cm.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of lung cancer status post chemoradiation therapy for followup. There is no intracranial mass or mass effect. There is no abnormal parenchymal or meningeal enhancement. Multiple foci of susceptibility artifact, including the left periatrial region, right pons, and right frontal operculum, are consistent with hemosiderin deposition from chronic microhemorrhages are unchanged. Previously described 2 mm lesion with susceptibility effect and possible enhancement does not demonstrate enhancement on the current study and may have been artifactual. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. Again seen is nonspecific left falcine calcification. There is a left frontal developmental venous anomaly. The skull and extracranial soft tissues are unremarkable.

Output: 1. No convincing evidence of intracranial metastatic disease on the current study. 2. There are unchanged punctate foci of susceptibility effect, including in the left periatrial region, right lateral pons, and right frontal operculum, which are consistent with chronic microhemorrhages and nonspecific in etiology. Enhancement questioned with one of the lesions on the prior study is no longer appreciated and may have been artifactual versus represent treatment response.3. Mild chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: History of PSC status post left hepatectomy now with right upper quadrant pain and elevated alkaline phosphatase. Evaluate for infection or obstruction. ABDOMEN:LIVER, BILIARY TRACT: Status post left hepatectomy. Susceptibility artifact near the surgical margin limits evaluation. The residual right hepatic lobe is normal morphology, size, signal intensity and enhancement. Unchanged mild intrahepatic biliary ductal dilatation, likely reflecting patent hepaticojejunostomy. The mild to moderate irregular dilatation is also similar in appearance to the prior exam and is compatible with PSC without a new dominant stricture or discrete lesion. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst formation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Left adnexal 3.2 cm cyst, only included on coronal T2 weighted imaging sequence, peripheral T2 hypointensity may reflect peripheral calcifications.

Output: 1. Stable postsurgical changes from left hepatectomy with stable right intrahepatic ductal dilatation without a discrete obstructive mass although evaluation centrally is limited by susceptibility artifact. Stenosis at the hepaticojejunostomy anastomosis should be considered given the clinical history. No specific evidence of cholangitis as clinically questioned.2. Left adnexal 3.2 cm cyst, only included on coronal T2 weighted imaging sequence, peripheral T2 hypointensity may reflect peripheral calcifications. Lesion is probably benign but if there is any clinical concern, further evaluation with pelvic sonography recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thyroid carcinoma, known metastatic disease. Shortness of breath with hemoptysis, query pulmonary embolism. PULMONARY ARTERY: This is a technically adequate examination for the evaluation of pulmonary embolism. No pulmonary embolism is noted to the subsegmental level.LUNGS AND PLEURA: Despite the short term interval, there is evidence of interval progression of metastatic disease. Some of the innumerable pulmonary nodules throughout both lungs have slightly enlarged. For example, on image 47/156, a pulmonary nodule measures 11 mm as compared to 10 mm one month ago. A second nodule in the right upper lobe (image 36/156) currently measures 8 mm as opposed to 6 mm.Progressive thickening of the major fissure with irregular nodularity is noted. There is progressive increased reticulonodular thickening of the interlobular septae raising a question of lymphangitic involvement. Persistent atelectasis at the superior segment of the left lower lobe.MEDIASTINUM AND HILA: The mediastinal and hilar lymphadenopathy has increased in size. The right low pretracheal lymph node now measures 22 x 26 mm, compared to 26 x 19 mm one month ago. The subcarinal lymph node is also enlarged, measuring 26 x 22 mm as compared to 22 x 22 mm.The left paraesophageal lymph node is stable, measuring 20 x 20 millimeters.CHEST WALL: A right breast nodule inferior at the nipple line on image 168/313 has slightly enlarged, measuring 10 x 10 mm, as opposed to 9 x 6 mm. A second nodule in the inferomedial left breast currently measures 8 mm AP dimension as opposed to 6 mm.UPPER ABDOMEN: The enhancing left adrenal nodule has increased in size, measuring 27 x 20 mm on image 290/313 as opposed to 18 x 24 mm. The right adrenal mass with central low density is not significantly changed in size. However, there is a new enhancing nodule anterior to the right adrenal gland measuring approximately 9 mm in its transverse dimension.Although this is not optimized for evaluation of the hepatic parenchyma, there are new foci of hyperdensity throughout the right hepatic lobe suspicious for hypervascular metastases. Further evaluation may be performed with either triphasic CT or dedicated hepatic MRI. Incidentally, there is a replaced right hepatic artery.A hiatal hernia is present. BONES: There are multiple osseous lesions in the mid and lower thoracic and upper lumbar vertebral bodies compatible with metastases.

Output: 1. No evidence of pulmonary embolism to the subsegmental level2. Progression of pulmonary metastases with enlarging pulmonary nodules and mediastinal lymphadenopathy.3. Interval appearance of hypervascular lesions throughout the right hepatic lobe suspicious for metastatic disease. Further investigation with a triphasic CT or dedicated hepatic MRI recommended.,


Instruction: Generate impression based on findings.

Input: 43-year-old female with history of bilateral benign breast biopsies. Family history of breast cancer diagnosed in mother at age 59. There is extreme amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally, significantly more than on the prior study. This is a limitation to the study.No abnormal enhancement is seen in either breast. A few right inner breast foci appear unchanged in size compared to the prior study. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Stable right breast foci. Any future breast MRI should be performed during the second week of the patient's menstrual cycle to minimize the effects of background parenchymal enhancement. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Right hepatic lobe lesion. The study is severely created by respiratory motion artifact.ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology size and contour.In segment 5/8 there is a very subtle T2 weighted mildly hyperintense focus measuring 1.4 x 1.2 cm (series 4/18). There may be very subtle restricted diffusion (series 9/18). The postcontrast images are severely motion degraded but there is suggestion of arterial enhancement and delayed phase washout in this region (series 17/153 and series 17/249). There is no retention of hepatobiliary contrast agent on the 3 hour delayed hepatobiliary phase images (series 5 image 68).No biliary ductal dilatation.The main portal vein appears patent.Status post cholecystectomy.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral renal cysts are present. Mild left-sided hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascites is noted.BONES, SOFT TISSUES: The lower lumbar spine fusion hardware is incompletely imaged.OTHER: No significant abnormality noted.

Output: Severely respiratory motion degraded study. A 1.4 cm right hepatic lobe segment 5/8 lesion likely corresponds to the incidental lesion seen on the recent ultrasound. Due to the poor image quality from respiratory motion it is difficult to confidently assess the characteristics of this lesion. Overall, the lesion does not have the appearance of a benign lesion such as a cyst or hemangioma. A small hepatocellular carcinoma cannot be excluded, especially if the patient has a history of chronic liver disease. A dedicated liver CT would be helpful in characterizing the lesion given the shorter scan time.


Instruction: Generate impression based on findings.

Input: 51-year-old male with pain and weakness. Rule out rotator cuff tear. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon at its insertion, with less than 1 cm of retraction, which measures approximately 1.5 to 2 cm in the AP dimension. The most posterior fibers of the supraspinatus tendon appear to be spared as are the fibers of the infraspinatus tendon. Mild tendinosis affects the remainder of the supraspinatus tendon. There is mild fatty atrophy along the myotendinous junction of the supraspinatus and infraspinatus muscles, but otherwise the muscles appear normal. The teres minor muscle and tendon appear intact. The subscapularis muscle and tendon appear intact.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is no large joint effusion. The glenoid labrum appears within normal limits for age.BICEPS TENDON: The tendon of the long head of the biceps appears within normal limits. ADDITIONAL

Output: Full-thickness tear of the supraspinatus tendon of the left shoulder and other findings as described above.


Instruction: Generate impression based on findings.

Input: Weakness, [728.87], right facial droop, slurred speech There is a focal restricted diffusion on the left basal ganglia (posterior aspect of. Putamen) indicate acute ischemic infarct. There is no evidence of hemorrhage transformation.Underlying brain shows multifocal encephalomalacia especially on the right external capsule anteriorly will internal capsule indicating chronic ischemic infarct.FLAIR imaging shows patch bihemispheric periventricular white matter high signal intensity indicate nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate a moderate (about 50-70%) stenosis on the mid basal artery. In addition, subtle irregularities of bilateral MCA M2 segments indicate intracranial arthrosclerotic changes. However, there is no evidence of intracranial arterial hemorrhage or occlusion.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. Bilateral vertebral artery origins appear to be narrowed about 50%. Although tortuous, there is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. No evidence of luminal stenosis.

Output: 1. Acute ischemic infarction, left posterior aspect of putamen without hemorrhagic transformation.2. Multifocal chronic ischemic infarctions as well as minimal non specific small vessel ischemic disease.3. Mild atherosclerotic changes of intracranial arterial system including moderate (50-70%) luminal narrowing of mid basilar artery.4. No significant (more than 70%) luminal stenosis on both extracranial and intracranial arterial system. No intracranial aneurysm. No occlusion of arterial system.


Instruction: Generate impression based on findings.

Input: Again seen is a ill-defined homogenously enhancing mass involving the right middle cranial fossa that extends into the right orbital apex, sella, suprasellar cistern, prepontine cistern, right Meckel's cave and cavernous sinus, and consistent with known meningioma. Mass measures approximately up to 45 mm in the AP and transverse dimensions and not significantly changed. Craniocaudal extension is also not significantly changed. There is right-sided proptosis similar to prior. Although the lesion encases the right ICA, the vessel remains patent. There appears to be some extension of the tumor into the left cavernous sinus, stable compared to prior examination. Tiny 8 x 3 mm focus of extra-axial enhancement adjacent to the left transverse sinus is also is unchanged and compatible with an additional meningioma.Again seen is evidence of right frontotemporal craniotomy with encephalomalacia involving the right anterior temporal and frontal lobes. Confluent and patchy T2/FLAIR hyperintensity compatible with moderate chronic small vessel ischemic disease and treatment changes is unchanged. No evidence of acute infarct or new mass or mass effect. Major flow-voids are preserved. Atrophic changes are again noted involving the right muscles of mastication which may be related to denervation.

Output: 1.No significant interval change of meningioma involving the right middle cranial fossa which extends into the right orbital apex, sella, suprasellar cistern, Meckel's cave, and right greater than left cavernous sinuses.2.Postsurgical and post-radiation changes appear unchanged.