Instruction: Generate impression based on findings.

Input: Female, 50 years old, with adenoid cystic carcinoma of the tongue, presenting with slurred speech and right facial droop. Assess for cranial nerve involvement of known metastatic cancer. Motion artifact degrades some imaging sequences. Within this limitation, the following observations are made.No pathologic parenchymal or leptomeningeal enhancement is appreciated. The cranial nerves as visualized show normal morphology and are free of pathologic enhancement. Incidental note is made of a developmental venous anomaly in the left middle frontal gyrus.Diffusion-weighted images are within normal limits. No parenchymal edema or mass effect is detected. No intracranial hemorrhage or abnormal extra-axial fluid collections are seen. The ventricular system is normal in size and morphology.

Output: 1.No acute intracranial abnormality to account for the patient's symptoms.2.No evidence of parenchymal or leptomeningeal metastatic disease.3.No evidence of perineural spread of tumor.


Instruction: Generate impression based on findings.

Input: Congenital lymphangioma status post sclerotherapy. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.Face: There is a large multicystic trans-spatial right face mass with a hemorrhage level in a right parapharyngeal cystic compartment that measures up to 17 mm, increase in size of a dominant right oral cavity cystic component that measures up to 35 mm, but decrease in size of the nasopharyngeal cystic components, measuring up to 25 mm. The submental region cystic component are similar in size and there is an unchanged heterogeneously fatty component in the left nasal and oral cavity that measures up to approximately 25 mm. There is associated deformity of the mandible and a cleft palate. There is persistent effacement of the upper pharyngeal airway, which is otherwise intubated.Neck: There is no significant cervical lymphadenopathy. The salivary glands are unchanged. The thyroid gland is unremarkable. The cervical spine appears to be intact.

Output: 1. Multicystic trans-spatial right face mass with recent hemorrhage in a right parapharyngeal cystic compartment, increase in size of a dominant right oral cavity cystic component, but decrease in size of the nasopharyngeal cystic components. The lack of vascular elements on the prior biopsy and the presence of a fatty component associated with the mass raises the possibility of a teratoma, perhaps in conjunction with a lymphatic malformation.2. Cleft palate, which is better depicted on the prior CT.3. No evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 52-year-old with history of T8 with Patchy areas of periventricular hypodensity are present in the subcortical white matter, right side greater than left. Findings are consistent with small vessel ischemic disease These are present on the prior study and do not appear significantly changed.If there is clinical concern for acute ischemic changes MRI with diffusion weighted imaging would allow more sensitive evaluation.

Output: Small vessel ischemic disease without significant change from prior.


Instruction: Generate impression based on findings.

Input: Unspecified sensorineural hearing lossClinical question: assess for hearing lossSigns and Symptoms: hearing loss No abnormal mass lesions are identified in the cerebellopontine angle cisternsImages of both right and left internal auditory canals images normal neural bundles with at least 4 neural bundle seen on the sagittal oblique views. There is normal appearance of the membranous labyrinth with no evidence of enlargement of the endolymphatic ducts at the level of the vestibular aqueduct bilaterally. There is no evidence of abnormal enhancement.Incidental note is made of mucous retention cysts in the left maxillary sinus.Incidental note is made of several cystic lesions in the parotid glands which are not entirely included on this exam. The ones included on post gadolinium imaging demonstrate no contrast enhancement.

Output: 1.There is no evidence for internal auditory canal or cerebellopontine angle cistern mass or abnormality appreciated.2.There are cystic lesions present in the parotid glands bilaterally. These are only partially imaged on this exam.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for MS flare up. Signs and symptoms: Increased number of falls. Pre and post enhanced brain MRI:There are no prior MRI exams for comparison with this study.No diffusion-weighted abnormalities.Examination demonstrate diffuse periventricular and corpus callosum, subcortical, cortical, right cerebral peduncle, left middle cerebellar peduncle and right paramedian medulla foci of FLAIR hyperintensity consistent with patient's known demyelinating disease. There is detectable enhancement of multiple demyelinating plaques in the right posterior frontal cortex, right anterior frontal white matter, right periventricular white matter and right posterior temporal white matter suggestive of demyelinating plaques. No prior exams for comparison.There is a slight uniform prominence of cortical sulci, lateral ventricles and cerebellum-millimeter folia for patient's stated age.The signal void in the major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series.With the exception of a small retention cyst in the right maxillary sinus are paranasal sinuses and bilateral mastoid air cells, middle ear cavities demonstrate normal pneumatization signal patterns.

Output: 1.Finding consistent with chronic and acute demyelinating disease as detailed above. There are no prior MRI exams for accurate assessment of progression.2.Subtle prominence of cortical sulci, lateral ventricles, cerebellum and vermian folia for age.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: There is redemonstration of postsurgical findings related to right frontal lobe tumor resection. Compared to prior examination, there is increased ill-defined scattered enhancement along the margins of the treated tumor sites in the bilateral anterior frontal lobes. There is also diffuse diffusion restriction and edema involving the bilateral anterior frontal lobes. However, relative cerebral blood volume in the region of the soft tissue is not significantly elevated. Otherwise, there is redemonstration of mild volume loss in the right temporal lobe. Ex vacuo dilatation of the anterior and of the right lateral ventricle is again demonstrated. The third ventricle remains dilated.

Output: Persistent scattered areas of enhancement along the margins of the treated tumor involving the bilateral frontal lobes, where there is also confluent restricted diffusion and edema. The findings are suggestive of Bevacizumab-induced diffusion-restricted lesions associated with the treated glioma versus less likely tumor progression.


Instruction: Generate impression based on findings.

Input: Reason: known plamacytoma in S1, r/o progression compared to Jan 2015 MRI History: known plamacytoma in S1, r/o progression compared to Jan 2015 MRI MRI thoracic spine:There is diffuse patchy marrow replacement throughout the visualized thoracic spine there is mild super endplate compression at T10.The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment. The conus medullaris on sagittal imaging is grossly intact. There are multiple patchy foci of marrow replacement throughout the lumbar spine associated with a superior endplate compression at the L1, L2 and L3 vertebral bodies where there is mild loss perch or body height.There is patchy marrow replacement also present in the sacrum and iliac bones. There is extra osseous extension of neoplasm from the sacrum into the left S1 neural foramen where there is encroachment of the nerve root.There is multilevel disk desiccation present.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Diffuse patchy marrow replacement throughout the visualized lumbar and thoracic spine is compatible the patient's diagnosis of multiple myeloma.2.There is extra osseous extension of neoplasm from the sacrum into the left S1 neural foramen where there is encroachment of the nerve root.3.There are mild compression fractures present at T10, L1, L2 and L3


Instruction: Generate impression based on findings.

Input: Lumbago with sciatica, right side [M54.41], Reason for Study: ^Reason: cause of low back pain with radicular distribution History: low back pain radiating down legs. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. The bone marrow of whole lumbar spine as well as bilateral iliac bone show low T1 signal intensity with patchy high signal intensity areas. This finding likely to be artifactual due to signal inhomogeneity, however, possibility of diffuse bone marrow infiltrative lesions cannot be completely excluded. Clinical correlation is recommended.In addition, there is subtle T2/STIR signal intensity with irregular enhancement of Bilateral S1 ala and S2 body. There is no evidence of associated soft tissue lesion on this scan. This may represent compression/stress fracture, bone infarctions or other bone marrow infiltrative lesions. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level.The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: no neuroforaminal narrowing or spinal stenosis. L4-L5: minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. L5-S1: minimal diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Diffuse patchy low T1 signal intensity of lumbar and sacral vertebral bodies as well as bilateral iliac bones. Differential diagnosis include artifacts and diffuse bone marrow infiltrative lesions.2. Inhomogeneous enhancement with subtle T2/STIR high signal intensity lesions at S1 and S2 suggest possibility of compression/stress fracture, bone infarcts or bone marrow infiltrative lesion.3. Diffuse bulging of discs at the level of L45 and L5S1. Comment: Bony Pelvic CT can be considered for further imaging evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: Reason: ICH noted on head CT History: history of head trauma MRI of the brainThere is T1 signal hyperintensity present within the left geniculated nucleus measuring approximate 7 mm in size. A similar lesion which is T1 hyperintense is present in the right superior colliculus measuring 4 mm. The margins of these two lesions are rather ill-defined. On the T2, FLAIR, SWI and DWI imaging these are not conspicuous. No diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are of uncertain significance in isolation.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate arch opacification of the maxillary sinus is associated with blood products. 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. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. There is extracranial origin of the left posterior inferior cerebellar artery. There is no convincing evidence for arteriovenous malformation on this exam.

Output: 1.Small lesions identified in the left geniculated nucleus and the right superior colliculus are present. It is suspected that this represents calcified lesions. Although the MR angiogram did not demonstrate that these are vascular lesions, the possibility cannot be excluded on the basis of this exam.2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: Brain MRI: Exam limited by motion.No restricted diffusion to indicate infarct. No susceptibility weighted abnormalities to indicate hemorrhage. No mass, mass effect or midline shift. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The mastoid air cells are clear. Small amount of mucosal thickening in the posterior sphenoid sinus.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:Normal variant origin of the left common carotid artery off of the brachiocephalic trunk. No evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.Negative MRI of the brain.2.Negative MRA of the brain.3.Negative MRA of the neck.4.Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 28-year-old male with a history of cavernous malformation here for yearly surveillance. No specific symptomatology is provided. There is redemonstration of a focus of susceptibility effect associated with a centrally higher T1 signal and a popcorn-like appearance located within the left parietal lobe. This has not changed in size when compared to the prior exam. It measures 11 x 11 mm in axial dimensions.Normal vascular flow voids are present in the distal internal carotid arteries, distal left vertebral artery and the proximal anterior middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Findings suggest a hypoplastic right vertebral artery.The visualized paranasal sinuses demonstrate mucosal thickening. The visualized mastoid air cells are clear. There is some medial protrusion of orbital contents into the left ethmoid air cells suggesting old medial blowout fracture in the left orbit. This finding was also present on the prior exam and is unchanged.

Output: 1.The patient's cavernous malformation located in the left parietal lobe is stable compared to the prior exam.


Instruction: Generate impression based on findings.

Input: Left sided asymmetric sensorineural hearing loss. There appears to be deficient bone overlying the superior semicircular canal. Otherwise, the inner ear structures, including the cochlea, vestibule, endolymphatic duct appear unremarkable. There is a somewhat prominent venous flow void in the cerebellopontine angle cistern, but the cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The mastoid air cells and middle ears also appear unremarkable.Right: The 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 mastoid air cells and middle ears also appear unremarkable.

Output: Apparent deficient bone overlying the superior semicircular canal, which may represent dehiscence, but no evidence of retrocochlear or inner ear lesions. A temporal bone CT may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:9/22/1943)Reason: evaluate for lumbar spine pathology History: low back and LLE painPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is a scoliotic curvature to the lumbar spine. With a levocurvature to the upper lumbar spine. There is left lateral translation of L3 on L4 and a rotatory component.At L5-S1 there is no significant compromise to the neural foramina. There is bilateral facet hypertrophy at this level. There is a left lateral recess disc protrusion at this level associated with endplate osteophytes which encroaches on the nerve roots at the left lateral recess. There is loss of disc space height at this level as well as left-sided endplate reactive change. The endplate reactive changes bright on T1.At L4-5 there is loss of disc space height, disc desiccation and a left lateral broad-based disc extrusion. Disc material extends behind the left lateral superior aspect of the L4 vertebral body and also extends into the left neural foramen. It is associated with encroachment of the nerve roots at the left lateral recess and the left neural foramen at this level. There is moderate bilateral facet hypertrophy at this level. The facet hypertrophy appears to be worse on the left compared to the right side.At L3-4 there is left lateral translation of L3 on L4 with mild rotation of L3 on L4. There is moderate bilateral facet hypertrophy at this level. There is some narrowing of the spinal canal at this level. There is mild encroachment of the left-sided exiting nerve roots.At L2-3 there is a moderate disc bulge at this level associated with moderate bilateral facet and ligamentum flavum hypertrophy. This results in narrowing of the thecal sac with effacement of spinal fluid surrounding the nerve roots within the thecal sac. Overall there is moderate spinal stenosis at this level. Within the neural foramina the exiting nerve roots are surrounded by fat.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a large left parapelvic cyst present measuring 26 x 13 mm axial dimensions.

Output: 1.There are multilevel degenerative changes present in the lumbar spine with the left lateral translation of L3 and L4 associated with the rotatory scoliosis and a levocurvature to the upper lumbar spine.2.There is moderate spinal stenosis present at L2-3.3.There is encroachment of the left-sided exiting nerve roots within the neural foramen at L4-5 associated with encroachment of the nerve roots at the left lateral recess at this level.


Instruction: Generate impression based on findings.

Input: Ms. Segev is a 59-year-old female with personal history of right breast lumpectomy with re-excision in 2008 for ILC status post chemotherapy, radiation therapy and hormonal therapy. Personal history of benign left breast biopsies. Family history of breast cancer in sister, diagnosed at the age of 49. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Postsurgical changes are reidentified in the right lower inner breast along with a 1.5 cm seroma cavity, compatible with provided history of right breast lumpectomy. There are scattered foci of enhancement seen in the left breast, appearing similar when compared to the prior examination from 2013. In addition, a lobulated enhancing mass in the left medial breast remains stable in appearance. There is no new abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Stable postsurgical changes of the right breast. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Left parapharyngeal mass. There is a well-defined mildly bosselated T2 hyperintense and enhancing lesion in the left prestyloid parapharyngeal space, which measures up to 12 mm. There is no significant cervical lymphadenopathy. There is a heterogeneous left thyroid nodule. The major salivary glands are unremarkable. The osseus structures are grossly intact. There imaged intracranial structures and orbits are grossly unremarkable.

Output: 1. A small lesion in the left prestyloid parapharyngeal space may represent an ectopic salivary neoplasm, such as a benign mixed tumor.2. A heterogeneous left thyroid nodule corresponds to the recently biopsied colloid nodule with cystic degeneration.3. The patient was recalled for repeat imaging at no additional charge.


Instruction: Generate impression based on findings.

Input: Chiari malformation with syrinx, yearly follow up and history of craniosynostosis repair. Brain: The cerebellar tonsils are peg-shaped and extend approximately up to 4 mm inferior to the foramen magnum. There is a dysmorphic and hypoplastic clivus with mild platybasia and small posterior fossa. There is intact cerebrospinal fluid flow is present across the anterior and posterior portions of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchymal signal appears unremarkable. There is unchanged prominence of the bilateral Meckel's caves. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There is scattered paranasal sinus mucosal thickening. There are postoperative findings related to craniofacial reconstruction for bicoronal synostosis.Cervical Spine: There is no significant interval change in size of the syringohydromyelia at C5 through T1, which measures up to 4 mm in width. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Dysmorphic craniocervical junction associated with Chiari 1 malformation.2. No significant interval change in size of the cervicothoracic syrinx.3. Postoperative findings related to craniofacial reconstruction for bicoronal synostosis.


Instruction: Generate impression based on findings.

Input: Characterized paraesophageal cystic lesion. Patient with encephalitis. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: In the high right posterior mediastinum there is a 1.4 x 1.1 x 2.3 cm T2 hyperintense well-defined lesion, unchanged, adjacent to the vertebral body which is normal in morphology. Postcontrast characteristics cannot be evaluated as contrast was not administered. No communication with the neuroforamen. CHEST WALL: No significant abnormality noted.

Output: 1.4 x 1.1 x 2.3 cm high right posterior mediastinal T2 hyperintense well-defined lesion, likely a simple cystic lesion (although contrast was not administered) such as an duplication or neuroenteric cyst.


Instruction: Generate impression based on findings.

Input: 21 years Male (DOB:2/27/1995)Reason: 3T Scanner, QSM/Permeability, CCM Protocol, please evaluate cavernomas History: Known cavernomas, hx of radiation, headachesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple small foci of signal loss on susceptibility weighted imaging scattered throughout the brain parenchyma above and below the tentorium. These are mainly subcortical in location.There is more confluent signal loss and susceptibility weighted imaging and on T2 and FLAIR imaging within the subcortical white matter along the left precuneus.. There is no associated contrast enhancement. A prior hematoma in this location has evolved.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Multiple punctate hemorrhagic lesions scattered throughout the subcortical white matter of the brain. In general this appears stable.2.Continued evolution of hemorrhagic focus in the left precuneus.


Instruction: Generate impression based on findings.

Input: New onset migraines. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a nonspecific punctate cystic focus in the right frontal lobe periventricular white matter, anterior to the right caudate head. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Nonspecific punctate cystic focus in the right frontal lobe periventricular white matter, anterior to the right caudate head, which may represent sequela of prior injury or a prominent perivascular space. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 62 year old male with recurrent PVC despite lifestyle modification and medication use. Left VentricleThe left ventricle is normal in size and function. The overall LV ejection fraction is 56%. The LVEDV is 194 ml (normal range 142+/-34), the LV end diastolic volume index is 97 ml/m2 (normal range: 74+/-15), the LVESV is 86 ml (normal range 47+/-19) and the LV end systolic volume index is 43 ml/m2 (normal range 25+/-9). The LV mass is 102 g (normal range 164+/-36) and the LV mass index is 50 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. . There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and function. The overall RV ejection fraction is 61%. The RVEDV is 181 ml (normal range 142+/-31), RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVESV is 71 ml (normal range 54+/-17), and the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIndeterminate 1 cm T2 hypointense lesion along the anterior aspect of the pericardium at the level of the inferior cavoatrial junction. Probable small left renal cyst. 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 left ventricular structure and function with EF at 56%.2. Normal right ventricular structure and function3. Indeterminate 1 cm T2 hypointense lesion along the anterior aspect of the pericardium at the level of the inferior cavoatrial junction. Chest CT follow-up in 6 months is suggested to reassess this lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The cerebellar tonsils extend up to approximately 2 cm inferior to the foramen magnum. The craniocervical junction and cervical spine are otherwise incompletely characterized. There is a long segment thoracic syrinx that is most prominent between T5 and T8, where is measures up to 6 mm in width. The width of the syrinx is approximately 6 mm. The vertebral bone marrow signal is within the normal limits. The alignment of the vertebral bodies is normal. There is normal alignment of the lumbar vertebral bodies. The vertebral bone marrow signal appears normal. The conus medullaris is seen at the level of L1. The filum terminale appears normal. There is no evidence of spinal canal or neural foraminal stenosis. The paraspinal soft tissues are unremarkable.

Output: 1. The cerebellar tonsils extend up to approximately 2 cm inferior to the foramen magnum compatible with Chiari malformation. The craniocervical junction and cervical spine are otherwise incompletely characterized.2. Long segment thoracic syrinx.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 relapsed AML status post transplant with back pain. Thoracic Spine: There is diffuse vertebral bone marrow T1 and T2 hypointensity. There is degenerative disc disease in the cervical spine seen on sagittal view without evidence of cord compression. There is no intrathecal hematoma, abscess, or tumor deposit. However, there is posterior epidural lipomatosis at multiple levels, measuring up to 10 mm in thickness and resulting in anterior displacement of the spinal cord and marked effacement of the intrathecal cerebrospinal fluid. Nevertheless, there is not convincing spinal cord deformity or signal abnormality. The vertebral column alignment is anatomic. The vertebral body heights are preserved. There is diffuse subcutaneous edema.Lumbar Spine: There are partially-imaged geographic heterogeneous areas in the bone marrow of the bilateral sacral ala and iliac bones. Otherwise, there is a background of diffuse T1 and T2 vertebral bone signal hypointensity. The conus is normal in morphology and terminates at L1 level. There is a posterior disc-osteophyte complex at the L4-5 level without significant spinal canal or neural foraminal stenosis. There is lack of the usual lordosis, but no spondylolisthesis. The vertebral body heights are preserved. There are bilateral renal cysts. There is diffuse subcutaneous edema.

Output: 1. Diffuse bone marrow signal abnormality related to leukemia. Partially-imaged heterogeneous bone marrow of the bilateral sacral ala and iliac bones may also be related to leukemia and/or treatment effects, although osteonecrosis is a potential consideration. Please refer to the separate pelvis MRI report for additional details.2. Epidural lipomatosis in the thoracic spine associated with multilevel spinal canal narrowing.3. Mild degenerative disc disease at the L4-5 level without significant spinal canal or neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Ms. Noone is a 58 year old female with a personal history of right right breast lumpectomy in 2005 for DCIS treated with radiation and hormonal therapy. Personal history of benign left breast MR guided biopsy in 2012 for intraductal hyperplasia. BRCA mutation carrier. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.In the left lower outer breast, posterior depth, there is a developing enhancing mass identified measuring approximately 0.8 x 0.7 x 0.8 cm (AP x ML x SI). Multiple additional enhancing foci in the left breast are stable when compared to multiple prior MRI examinations.Stable postsurgical changes of the right breast from prior lumpectomy. There is no abnormal enhancement seen in the right breast.No abnormal lymph nodes are identified in either axillary or internal mammary region.Incidental note is made of small hiatal hernia.

Output: (1) 0.8 cm developing enhancing mass in the left lower outer breast. An MRI-guided biopsy with clip placement is recommended for further evaluation.(2) No MRI evidence for malignancy in the right breast. All results and recommendations were discussed with Dr. Romero on 12/15/2016.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.


Instruction: Generate impression based on findings.

Input: Nontraumatic subarachnoid hemorrhage, unspecified [I60.9], Reason for Study: ^Reason: evaluate structure, any infectious concerns? History: Infant with subarachnoid bleed. Brain MRIMultifocal symmetric bilateral posterior temporal, parietal and occipital lobe as well as splenium of bilateral corpus callosum restricted diffusion lesions without evidence of hemorrhagic conversion indicating acute ischemic infarction.There are, however, focal susceptibility artifacts on bilateral lateral ventricles occipital horns indicating intraventricular hemorrhages which is unchanged since prior head CT scan.The ventricles, sulci and cisterns are symmetric.There is no evidence of abnormal enhancement.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. Bilateral symmetric acute ischemic infarctions involving parietal, posterior temporal, and occipital lobes as well as splenium of bilateral corpus callosum indicating acute ischemic infarctions without evidence of hemorrhagic conversion.2. Intraventricular hemorrhage.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Ms. Cesarz is a 49 year old female with recently diagnosed DCIS of the left breast. She presents for staging MRI for further imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Bilateral retropectoral silicone implants are identified. Susceptibility artifact from biopsy marker clip is identified in the left lower outer breast, at site of biopsy-proven malignancy. There is faint to little enhancement seen around this biopsy marker clip.There is no additional abnormal enhancement seen in the remainder of the left breast or in the right breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

Output: (1) Unifocal malignancy of the left breast. If breast conservation therapy is desired, wire localization can be performed under mammographic guidance targeting the biopsy marker clip and residual calcifications (if any) in the left lower-outer breast. (2) No MRI evidence for malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58 year old woman s/p OHT, referred for evaluation of allograft rejection. Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 73%, the LV end diastolic volume index is 52 ml/m2 (normal range: 65+/-11), the LVEDV is 94 ml (normal range 109+/-23), the LV end systolic volume index is 14 ml/m2 (normal range 18+/-5), the LVESV is 25 ml (normal range 31+/-10). There is mild concentric LVH. There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Pre and post contrast T1 ratio is normal. Native T1 mapping was technically limited.Left AtriumThe left atrium is consistent with transplant. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 65%, the RV end diastolic volume index is 45 ml/m2 (normal range 69+/-14), the RVEDV is 82 ml (normal range 110+/-24), the RV end systolic volume index is 16 ml/m2 (normal range 22+/-8), and the RVESV is 29 ml (normal range 35+/-13). Right AtriumThe right atrium is consistent with transplant. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac Findings . 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 biventricular systolic function.2. No delayed enhancement or other features to suggest significant myocardial rejection.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 58-year-old female with increasing left shoulder pain for several months, worse with movement. History breast cancer, never recurrent. Evaluate for metastases, tears. ROTATOR CUFF: There is mild increased signal intensity within the supraspinatus and infraspinatus tendons, with perhaps mild undersurface fraying but no discrete tear. The supraspinatus and infraspinatus muscles appear normal. A small cyst is seen in the underlying posterior aspect of the humeral head, likely degenerative in etiology. The teres minor and subscapularis muscles and tendons appear normal.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. No fluid is seen in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the glenohumeral joint, with delamination of the articular cartilage along the superior aspect of the humeral head. There is a small glenohumeral joint effusion with extension to the subscapular recess. Blunting and increased signal intensity of the superior labrum likely represents degenerative tearing. The inferior labrum appears normal.BICEPS TENDON: Mild thickening and increased signal intensity of the intra-articular aspect of the long head of the biceps tendon is present, suggesting tendinosis. Fluid surrounding the extra-articular portion of the long bead of the biceps tendon may represent tenosynovitis or simply extension of fluid from the glenohumeral joint. ADDITIONAL

Output: 1.No evidence of metastatic disease. 2.Rotator cuff tendinosis and possible mild undersurface fraying without a discrete tear. 3.Osteoarthritis of the glenohumeral joint and other findings as described above.


Instruction: Generate impression based on findings.

Input: Sacral decubitus ulcer. Evaluate for osteomyelitis There is diffuse subcutaneous gas seen in the soft tissue overlying the proximal right femur, with partial loss of the greater trochanter and lucencies within the proximal femur, consistent with osteomyelitis, unchanged from the MRI of the same day. No evidence of acute fracture or malalignment.

Output: Osteomyelitis of the right femur, with diffuse subcutaneous gas, better seen on the MRI from the same day.


Instruction: Generate impression based on findings.

Input: Right wrist pain The exam is limited by motion artifact.LIGAMENTS: No significant abnormality noted.TRIANGULAR FIBROCARTILAGE COMPLEX: The TFCC complex is intact.TENDONS: No focal tendinosis or tenosynovitis. BONES: No focal bone marrow abnormality.ADDITIONAL

Output: Etiology for the patient's right wrist pain is not evident.


Instruction: Generate impression based on findings.

Input: A 80 year old male with personal history of hypertension, diastolic dysfunction, hyperlipidemia, stroke, diabetes, obstructive sleep apnea, chronic renal disease and morbid obesity. Recently diagnosed with MGUS. Echocardiography showed normal left and right ventricular function and left ventricular hypertrophy. Referred to cardiac MRI for further evaluation Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 89 ml/m2 (normal range: 74+/-15), the LVEDV is 191 ml (normal range 142+/-34), the LV end systolic volume index is 33 ml/m2 (normal range 25+/-9), the LVESV is 71 ml (normal range 47+/-19). There is basal septum mild asymmetric hypertrophy (up to 13mm). There are no regional wall motion abnormalities present, the deformation images (tagging) are normal. The native T1 myocardial times are mildly increased, this is of unclear significance. The delayed enhancement images are suboptimal, but do not suggest significant delayed enhancement. The ECV is 24% in the basal septum.No intracavitary thrombus was seen.Left AtriumThe left atrium is mildly dilated (102ml). Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 59%, the RV end diastolic volume index is 113 ml/m2 (normal range 82+/-16), the RVEDV is 244 ml (normal range 142+/-31), the RV end systolic volume index is 51 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. In the right PA just after the bifurcation, a signal defect was noted in multiple views concerning for thrombus.Venous AnatomyThe SVC and IVC and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsModerate left pleural effusion. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function, the LVEF is 63%. There is basal septum mild asymmetric hypertrophy (up to 13mm). Normal LV wall motion.2. The native T1 myocardial times are mildly increased, this is of unclear significance. The delayed enhancement images are suboptimal, but do not suggest significant delayed enhancement. The ECV is 24% in the basal septum.3. Mild left atrium dilation. 4. The right ventricle is normal in size and systolic function, the RVEF is 59%. 5. In the right PA just after the bifurcation, a signal defect was noted in multiple views concerning for thrombus. Dr A. Patel notified.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: WHO grade 2 ependymoma status post GTR: nystagmus. There are postoperative findings related to posterior fossa tumor resection with minimal residual nonspecific linear enhancement along the posterior aspect of the medulla and medial aspect of the left cerebellar hemisphere, which may be vascular in nature or represent granulation tissue. Otherwise, there is no evidence of gross residual tumor. The edema involving the pons, cerebellum, frontoparietal periventricular white matter, and the basal ganglia appears bilaterally to have subsided, although the sequences are not optimized for evaluating this. There is a left cerebellar developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Postoperative findings related to posterior fossa tumor resection without evidence of gross tumor.2. The edema involving the pons, cerebellum, frontoparietal periventricular white matter, and the basal ganglia bilaterally appears to have subsided, although the sequences are not optimized for evaluating this.


Instruction: Generate impression based on findings.

Input: Metastatic lesion, back pain. History of renal cell cancer. Again seen are postsurgical changes of spinal canal decompression and posterior spinal fusion with hardware extending from the L1 to L5 levels. There are paraspinous rods with interconnecting devices as well as bilateral pedicle screws at L1-L2, on the right at L3, on the right at L4, and bilaterally at L5. Compared to 2/1/2015, there has been interval development of a large mass involving the lumbar spine and paraspinous musculature which extends from the L2-L3 to the L5 levels. Susceptibility artifact makes evaluation difficult, however, there is infiltration of the L3 and L4 vertebral bodies left greater than right with extension into the posterior elements. There is associated marked spinal canal stenosis at the mid L4 level. There is also severe effacement of the right L3-L4 and left L3-L4 and L4-5 neural foramina. Mass measures at least 9 x 14 cm in the AP and transverse dimensions with craniocaudal extent as above. There is mild loss of height involving the L3 and L4 vertebral bodies on the left. Vertebral body heights and alignment are otherwise maintained.There is a thin peripherally enhancing fluid collection dorsal to the thecal sac measuring approximately 1 cm in thickness and extending from the L2 to the L4-L5 levels. Large left retroperitoneal/renal mass again seen.

Output: 1. Compared to MRI lumbar spine dated 2/1/2015, there has been interval development of a large mass involving the lumbar spinal canal and paraspinal musculature extending from the L2-L3 to the L5 levels most compatible with tumor recurrence/progression. There is associated severe spinal canal stenosis at mid L4 level. There is also severe effacement of the right L3-L4 and left L3-L4 and L4-L5 neural foramina. Infiltration involving the L3 and L4 vertebral bodies and posterior elements and mild loss of height on the left are compatible with pathologic fractures.Given the susceptibility artifact related to the hardware, CT may be helpful for further delineation of the tumor and hardware.2. Thin peripherally enhancing fluid collection in the surgical bed measuring approximately 1 cm in thickness and extending craniocaudally from the L2 to the L4-L5 levels dorsal to the thecal sac. Possibility that this fluid collection represents an abscess cannot be excluded and sampling can be considered as clinically warranted.3. Large left retroperitoneal/renal mass is again seen.Dr. Ali discussed findings Dr. Deshmukh at 1437 hrs.


Instruction: Generate impression based on findings.

Input: 59 year old woman with history of acute aortic dissection s/p ascending aortic graft repair. Patient with recent syncopal episode and atypical chest pain referred to evaluate aorta and rule out ischemia.MEDICATIONS: aspirin, atorvastatin, carvedilol, and bumex First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is severely dilated with normal systolic function. The overall LV ejection fraction is 66%, the LV end diastolic volume index is 111 ml/m2 (normal range: 65+/-11), the LVEDV is 196 ml (normal range 109+/-23), the LV end systolic volume index is 37 ml/m2 (normal range 18+/-5), the LVESV is 66 ml (normal range 31+/-10), the LV mass index is 111 g/m2, and the LV mass is 193 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 89 ml/m2 (normal range 69+/-14), the RVEDV is 157 ml (normal range 110+/-24), the RV end systolic volume index is 44 ml/m2 (normal range 22+/-8), and the RVESV is 77 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is mild to moderate aortic regurgitation. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is dilated. There is a graft in the ascending aorta. The proximal portion of the aortic arch is dilated. No thoracic aortic dissection noted. Sinus of Valsalva: 47 x 48 mmSinotubular junction: 35 x 35 mmArch (proximal): 43 x 38 mmArch (mid): 35 x 36 mmDescending aorta: 31 x 30 mmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is dilated (proximally 40mm, distally 46mm). The LPA and RPA proximally were within normal limits. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Severe LV dilation with normal systolic function (LVEF 66%).4. Normal RV size and systolic function (RVEF 51%).5. The aortic root is dilated (measurements as above). Ascending aorta repair/ graft noted without focal aneurysm or obvious complication at the anastomoses sites. 6. Mild to moderate aortic regurgitation7. There is significant dilation of the main pulmonary artery.


Instruction: Generate impression based on findings.

Input: There is a 3.6 cm AP x 3.1 cm transverse lesion centered in the left parietal lobe. It demonstrates peripheral, irregular enhancement with adjacent asymmetric edema mildly flattening the left occipital horn, as well as central necrosis. There are no other abnormal enhancing foci. Basilar cisterns are maintained. Expected vascular flow voids are demonstrated. The sinuses and mastoid air cells are clear.

Output: There is a 3.6 cm AP x 3.1 cm transverse enhancing, centrally necrotic lesion centered in the left parietal lobe.


Instruction: Generate impression based on findings.

Input: 59-year-old male with prostate cancer PELVIS:PROSTATE:Prostate Size: 6.0 x 3.5 x 5.0 cm.Peripheral Zone: There is a 6 x 4 mm T2 hypointense lesion in the right mid gland peripheral zone with corresponding restricted diffusion (series 401, image 79). Linear triangular-shaped T2 hypointense in the peripheral zone bilaterally are not suspicious. Central Gland: Severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality.Extracapsular Extension: The aforementioned hypointense lesion in the right mid gland peripheral zone abuts the capsule without convincing evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered inguinal and external iliac lymph nodes without significant lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Hypointense lesion in the right midgland peripheral zone suspicious for malignancy.2.Severe degree benign prostatic hypertrophy.


Instruction: Generate impression based on findings.

Input: The study is partially motion degraded and repeated sequences were performed when possible. Given this caveat:There are scattered punctate to small foci of T2 hyperintensity within the subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar findings involving the posterior fossa structures.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. A small retention cyst versus polyp is noted in the left maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.The study is partially motion degraded and repeated sequences were performed when possible.2.There are scattered punctate to small foci of T2 hyperintensity within the subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar findings involving the posterior fossa structures. These findings are nonspecific and the differential diagnosis would most likely include small vessel ischemic disease, migraine sequelae, although given lesional location and morphology demyelination is felt to be less likely.


Instruction: Generate impression based on findings.

Input: Meningitis/abscess and pseudomeningocele. Also, history of fourth ventricle mass resection (cerebellar ganglioglioma) and posterior fossa decompression. Evaluate for changes. There are changes of previous suboccipital craniectomy and tumor resection. The overlying CSF intensity fluid collection is more distended, now measures 3 cm in depth compared to 2 cm previously. The collection is slightly more well circumscribed with better defined T2-hyperintense wall. The posterior wall at midline is inseparable from the skin but there is also susceptibility artifact in the region. There is suggestion of the area of direct communication of the CSF space with the pseudomeningocele to the right of midline on 701/4, with flow artifact.The surgical cavity in the inferior aspect of the fourth ventricle is slightly smaller. The contrast enhancement along the surgical margins has decreased since the prior examination. Ex vacuo enlargement and distortion of the fourth ventricle are unchanged as well as the chronic postoperative changes in the right cerebellar hemisphere, cerebellar vermis and the right-sided cerebellar peduncles. There is no acute infarct. Scattered foci of susceptibility effect are present in the resection bed as well as in the ventricular system. Tiny focus of T2-hyperintensity in the body of the left caudate nucleus is unchanged, likely chronic sequela of prior injury. Otherwise, the supratentorial brain is unremarkable.The incidental, eccentric to the right, CSF intensity pineal cyst, which measures up to 2 cm, is unchanged nor the associated mass effect on the tectum. The sylvian aqueduct remains patent and there is no lateral/third ventricular dilatation. Flow artifact continues to be more exaggerated in the region of the left foramen of Monro.The small cyst in the superior anterior aspect of the left maxillary sinus is unchanged. Mild mucosal thickening is present in the right ethmoid sinuses. The orbits are grossly unremarkable.

Output: 1.The suboccipital pseudomeningocele is larger with more convex margins than on the previous MRI from January 2016. It shows no definite signs of associated inflammation.2.Chronic and evolving postoperative findings are present in the posterior fossa without sign of definite tumor recurrence. However, flow-related artifact partially obscures the treatment bed, especially on postcontrast imaging.


Instruction: Generate impression based on findings.

Input: History of testicular germ cell tumor. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left-sided extrarenal pelvis. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Again seen is a small left periaortic lymph node which measures 8 x 6 mm, previously 9 x 6 mm. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable normally sized retroperitoneal lymph nodes. No evidence of metastatic disease in the abdomen and pelvis.


Instruction: Generate impression based on findings.

Input: 29-year-old pregnant female with history of 2 C-sections and now has placenta previa. Evaluate for placenta accreta. Please note that this study was not protocoled to evaluate the fetus.PELVIS:UTERUS, ADNEXA: A single male fetus is identified within the uterine cavity in breach presentation. Normal 3 vessel cord. The placenta is mainly right lower anterior with a smaller component extending posteriorly covering the endocervical canal compatible with placenta previa. There is a low signal scar in the anterior uterine wall from prior C section. The uterine-placental line is not well seen anteriorly with many vascular flow voids coursing near the serosal surface compatible with placenta increta. No signs of placenta percreta.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: 1. Placenta previa and increta with no gross evidence of placenta percreta.2. Male fetus in breach presentation.


Instruction: Generate impression based on findings.

Input: Clinical question: 87-year-old female with right buttock pain. Evaluate for spinal stenosis versus degenerative disease and neural foraminal compromise. Signs and symptoms: As above. Nonenhanced lumbar MRI:Examination demonstrates mild dextroscoliosis centered at L3-L4 level which is best appreciated on coronal T2-weighted series 301. There is normal anatomical alignment of vertebral column.The lower most visualized thoracic spine from T10 inferiorly is negative for spinal stenosis however advanced degenerative disc disease at T10-T11 in particular is noted.T12-L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophic changes and mild facet disease. Constellation of changes results in mild central spinal stenosis and with mild bilateral neural foraminal compromise.L2-L3 demonstrate mild disc disease with shallow diffuse bulging disc, significant bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of changes results in moderate central spinal stenosis and moderate left neural foraminal compromise.L3-L4 demonstrate advanced disc disease and loss of disc height, diffuse asymmetric bulging disc in the midline and to the left and significant bilateral ligamentum flavum hypertrophy with mild facet disease. Constellation of changes results in moderate to significant central spinal stenosis and significant left lateral recess compromise (due to asymmetric bulging disc). Moderate right neural foraminal compromise and mild on the right.L4-L5 demonstrate advanced degenerative disc disease with near complete loss of disc height, shallow broad-based bulging disc and hypertrophic spur is present. Severe bilateral ligamentum flavum hypertrophy and mild degenerative facet disease is noted. Constellation of changes results in significant central spinal stenosis, significant right lateral recess compromise and moderate bilateral neural foraminal compromise.L5-S1 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however moderate lateral recess compromise bilaterally is noted. There is also severe asymmetric right-sided neural foraminal compromise.

Output: 1.Degenerative changes of the lumbar spine with resultant significant central spinal stenosis at L3-L4 and L4-L5 levels and to a lesser degree at L2-L3 as detailed.2.Multilevel bilateral neural foraminal and lateral recess compromise as detailed per level above.


Instruction: Generate impression based on findings.

Input: There is diffuse volume loss without a specific lobar predominant atrophy pattern. There are no masses, mass effect, or midline shift. Expected vascular flow-voids are demonstrated, and there is an intact circle of Willis. Scattered foci of mucosal thickening can be found within the paranasal sinuses without superimposed fluid levels. Mastoid air cells are clear. There are no abnormal enhancing foci..

Output: Diffuse volume loss without a specific lobar predominant atrophy pattern.


Instruction: Generate impression based on findings.

Input: 14-year-old male with history of fibrillary astrocytoma status post chemotherapy. Evaluation off chemotherapy. MRI BRAIN: Redemonstration of a T2/FLAIR hyperintense intra-axial lesion within the medulla and cervicomedullary junction, which when measured carefully at multiple levels, appears to have mildly increased in size by a few millimeters. For example, the lesion now measures 20 mm x 17 mm (series 1501, image 33), previously 19 mm x 15 mm. This slight increase in size is more conspicuous when comparison is made to older exams. The lesion continues to demonstrate no enhancement. No new areas of abnormal signal or enhancement are identified. No acute intracranial hemorrhage. The ventricles and sulci are appropriate for patient age with no midline shift. The paranasal sinuses and mastoids are clear. The imaged orbits are unremarkable.MRI CERVICAL SPINE: There is reversal of the normal cervical lordosis, otherwise vertebral body heights and disc spaces are maintained. No abnormal marrow signal is identified. Spinal cord signal is normal except at the level of the cervical medullary junction. No abnormal enhancement is seen.

Output: 1. Very mild interval increase in caliber of the brainstem lesion is suspected without evidence of any new lesion or pathologic enhancement. The clinical significance of this finding is uncertain.2. Except as above, the cervical spine is within normal limits.


Instruction: Generate impression based on findings.

Input: Female, 62 years old, with back pain and history of multiple myeloma. Compression fracture on recent prior CT imaging. Assess for acuity. A compression deformity of the T5 vertebral body is new when compared to the prior MRI with approximately 40% loss of vertebral body height. There is very mild associated STIR signal abnormality within the vertebral body.A compression deformity of the T8 vertebral body with 50% loss of height is unchanged from the prior MRI. Mild compression of the T11 and T12 vertebral bodies, and significant compression of the L1 vertebral body with at least 60% loss of height are unchanged. Findings compatible with interval vertebroplasty are seen at T12 and L1.At the L1 level, there is very minimal retropulsion of the superior aspect of the vertebral body which effaces the ventral thecal sac but does not impinge the conus or cauda equina. No other areas of significant spinal canal stenosis are seen. The neural foramina also appear to be patent throughout.Expansile marrow replacement involving the right T9 transverse process is unchanged. Small foci of marrow signal abnormality within the T1 and T7 vertebral bodies are new and nonspecific. The marrow signal of the thoracic spine is overall heterogeneous.The thoracic kyphosis is exaggerated at T5 but sagittal alignment is otherwise unremarkable.

Output: 1.A compression deformity of the T5 vertebral body is new when compared to the prior MRI. However lack of significant marrow edema would suggest that this lesion is at least subacute if not chronic.2.Compression deformities involving T8, T11, T12 and L1 are unchanged allowing for evidence of interval kyphoplasty at T12 and L1.3.No areas of significant spinal canal or neuroforaminal compromise are seen.4.New small areas of focal marrow signal abnormality within T1 and T7 are nonspecific, on a background of diffuse marrow heterogeneity.


Instruction: Generate impression based on findings.

Input: There is smooth osseous expansion involving the right aspect of the sella as seen on recent CT study. There is a peripherally enhancing lesion measuring up to 26 x 26 x 28 mm in the AP, transverse, and craniocaudal dimensions which involves the sella, suprasellar cistern, and right cavernous sinus. Superiorly mass abuts the optic chiasm although not well seen due to the motion degradation. There is questionable abnormal signal involving the optic chiasm which can be better assessed with a dedicated orbit study. Normal enhancing pituitary tissue is not definitively identified.There is a punctate focus of restricted diffusion in the right frontal lobe associated with T2/FLAIR hyperintensity consistent with acute infarct. No other foci of infarct are evident. There is also a punctate focus of diffusion hyperintensity involving the left occipital horn which was present on outside MRI which may represent pus or blood products. There is normal ventricular size. No brain parenchymal mass or abnormal meningeal enhancement. No findings to suggest parenchymal edema. There is no midline shift or herniation. There are nonspecific scattered foci of hyperintensities in the subcortical and the periventricular white matter, most consistent with chronic small vessel ischemic disease. There are scattered foci of susceptibility compatible with chronic hemorrhage including the right caudate head, right cerebellar hemisphere, as well as a slightly larger area in the right temporal lobe. Mucous retention cysts are seen in both maxillary sinuses.

Output: 1. Peripherally enhancing mass involving the sella, right cavernous sinus, and suprasellar cistern as described above. There is smooth osseous remodeling of the sella and clivus suggesting a chronic underlying lesion (such as macroadenoma for example). The peripheral enhancement pattern however is most worrisome for infection/abscess, possibly superimposed on a chronic underlying lesion. Necrotic macroadenoma or other necrotic tumor may also have this appearance. 2. There is a punctate focus of restricted diffusion consistent with acute infarct in the right frontal lobe. No obvious narrowing of the right internal carotid artery is demonstrated. However as mentioned above, the enhancing lesion encases the right cavernous internal carotid artery. 3. Punctate focus of diffusion hyperintensity layering within the left occipital horn which may represent pus or other debris. This finding was present on prior prior from 12/16/2015. If there is possibility of intracranial infection, consider CSF sampling. There is however no abnormal parenchymal or meningeal enhancement in the brain parenchyma or findings to suggest cerebritis.4. Chronic small vessel ischemic disease and evidence of chronic microhemorrhages. Slightly larger focus of chronic hemorrhage is seen with the right temporal lobe.5. Mass extends to the level of the optic chiasm. There is also questionable signal abnormality involving the optic chiasm. Given motion degradation on the current study and brain MRI technique, MRI orbit/sella may be helpful for more detailed visualization.Dr. Ali discussed findings with Dr. Platt at 1610 hours on 12/20/2015.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: rule out METs. Signs and symptoms: Right eye pain and vision loss. Examination demonstrates a large destructive bony metastasis of the right frontal bone involving the floor of the right anterior cranial fossa and with a significant extracranial component which measures 80-mm in AP axis and 40-mm in transverse axis (axial image 6 of 50). Although not as well-visualized on this exam as it was noted on MRI of brain dated 10 -- 10 -- 2009 there is a large intracranial extension of tumor into the right anterior and middle cranial fossas. Extensive destructive changes of the frontal bone along the floor of the right anterior cranial fossa, lateral orbital ridge and greater wing of the sphenoid on the right is noted. There is a large extraconal retro-orbital spread of tumor which does not extend to the apex of the orbit. This component of the mass measures 53-mm times 26-mm in transaxial dimensions (axial image 50). There is significant mass effect on the retro-orbital content, including lateral rectus, superior rectus, right optic nerve and globe which is significantly deformed. There is also suggestion of extension of tumor into the right frontal sinus. This component of tumor within the right frontal sinus may be a second smaller metastatic lesion. There is no apparent involvement of the cavernous sinus. No extension of tumor into the apex of the orbit, no involvement of the lamina papyracea. The extracranial component of the tumor appears to extend inferiorly into the right infratemporal fossa. The paranasal sinuses are well pneumatized and demonstrate only minimal opacification of right anterior ethmoid air cells. Mastoid air cells and middle ear cavities are unremarkable.

Output: 1.Large destructive mass involving the right frontal bone along the floor of right anterior cranial fossa with extension into the right orbit, right frontal sinus, right anterior and middle cranial fossas, right frontal temporal extracranial region and right infratemporal fossa. Please see above detailed report.2.Paranasal sinuses are well pneumatized. Please see above comments.


Instruction: Generate impression based on findings.

Input: Reason: Violinist with persistent right shoulder pain and limited ROM History: pain and limited ROM ROTATOR CUFF: There is thickening and intermediate signal intensity within the supraspinatus indicating mild to moderate tendinosis. There is partial thickness tearing of the articular surface fibers of the supraspinatus just proximal to the level of its insertion on the greater tuberosity and involving less than 50% of the tendon width. No full-thickness tear or retraction is identified. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. There is a tiny interstitial tear of the subscapularis tendon at the level of the myotendinous junction. The subscapularis and teres minor muscles and tendons otherwise appear intact. SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid recess. Mild osteoarthritis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal intensity within the superior and anterior glenoid labrum likely representing a combination of degeneration and degenerative tearing.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small amount of circumferential fluid within the tendon sheath of the long head of the biceps which likely represents fluid extension from the joint. ADDITIONAL

Output: Rotator cuff tendinosis and partial thickness tearing of the supraspinatus without evidence of a full-thickness rotator cuff tear or retraction.


Instruction: Generate impression based on findings.

Input: 7 year old male patient with possible seizure focus on left. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is extensive maxillary sinus mucosal thickening, right greater than left, and partial mucosal thickening and secretions in the ethmoid air cells. There is slight prominence of the bilateral optic nerve sheath cerebrospinal fluid, but is no bulging of the optic discs or optic nerve atrophy. The skull and scalp soft tissues are grossly unremarkable.

Output: 1. No potential seizure foci are identified.2. Slight prominence of the bilateral optic nerve sheath cerebrospinal fluid is a non-specific finding, but can be a manifestation of elevated intracranial pressure. 3. Findings suggestive of sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI ORBITS: Some of the sequences are motion degraded. No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. No evidence of acute intracranial abnormality.2. Unremarkable MRI of the orbits.


Instruction: Generate impression based on findings.

Input: MRI Brain:There are multiple areas of restricted diffusion bilaterally within the cerebral hemispheres including involving the bilateral frontal and bilateral parietal lobes. There is an additional punctate focus of restricted diffusion involving the left cerebellar hemisphere which is also suspicious for an acute infarct. There is a small amount of FLAIR signal abnormality involving a subset of the areas of infarct bilaterally but there is no significant mass effect, midline shift or herniation. There are tiny foci of susceptibility abnormality within the regions of infarct within the bilateral frontal lobes which could indicate chronic microinfarcts. However focal small amount of hemorrhagic conversion cannot be excluded. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: Exam is limited by motion artifact. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The left vertebral artery is asymmetrically smaller compared to the dominant right vertebral artery and appears to terminate in the left PICA. The basilar artery and posterior cerebral arteries also are patent with no significant stenosis. There are prominent posterior communicating arteries bilaterally, a small left P1 segment and absent right P1 segments which are normal variants. No evidence of aneurysms or vascular malformations. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. The right vertebral artery origin is patent. Artifact limits evaluation of the origin of the left vertebral artery.

Output: 1.Multifocal acute infarcts involving the bilateral cerebral hemispheres as well as a punctate infarct involving the left cerebellar hemisphere. No significant mass effect, midline shift or herniation.2.Tiny foci of susceptibility abnormality within the regions of infarct within the bilateral frontal lobes could indicate chronic microinfarcts. However focal small amount of hemorrhagic conversion cannot be excluded. 3.No evidence of significant arterial luminal stenosis or irregularity on both intracranial and extracranial arterial system.4.The left vertebral artery is hypoplastic which ends with left PICA. No intracranial aneurysm is seen.


Instruction: Generate impression based on findings.

Input: Sudden right idiopathic hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The right inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is suggestion of dehiscence of the posterior portions of the left superior and posterior semicircular canals. The bilateral mastoid air cells and middle ears also appear unremarkable. There are left maxillary sinus retention cysts. The bilateral are diffusely prominent bilaterally.

Output: 1. No evidence of right retrocochlear or inner ear lesions.2. Suggestion of dehiscence of the posterior portions of the left superior and posterior semicircular canals. A temporal bone CT may be useful for further delineation.3. The bilateral are diffusely prominent bilaterally, which may be a normal variant or represent sialosis.


Instruction: Generate impression based on findings.

Input: Stiff-man syndrome [333.91] / Muscle weakness (generalized) [728.87], Reason for Study: ^Reason: stenosis, inflammation? History: severe neck pain and hyperreflexia C-SpineThere is mild diffuse bulging of disc at the level of C34 which abuts thecal sac with mild kyphotic angulation, no significant interval change since prior scan.There are bilateral multifidus muscle patchy enhancement at the level of C45. This finding could suggest possible inflammatory changes or atrophic changes of multifidus muscle. Since there is no STIR abnormality on those lesions, the possibility of atrophic change is low.No evidence of abnormal signal intensity of spinal cord.The cranial-cervical junction is normal. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. T-SpineThere is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1-L2 level.

Output: 1. Patchy enhancement of C45 level multifidus muscles indicating possible inflammatory changes or atrophic changes.2. No change of mild disc bulging of disc at the level of C45.3. No abnormal spinal cord signal intensity. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, mask and cap. The patient was prepped and draped in the usual aseptic fashion. Local anesthesia over the target area was obtained by 1% lidocaine. Targeted ultrasound examination demonstrates an heterogeneous but predominantly hypoechoic collection with numerous foci of internal echogenicity along the volar aspect of the first metacarpal, surrounding the flexor pollicis longus tendon, corresponding to the findings seen on recent MRI examination. There was no internal vascularity on Doppler interrogation. A 17-gauge needle was advanced into the collection under ultrasound guidance. Approximately 15 cc's of blood-tinged purulent fluid was aspirated from the collection. Specimens were placed in a sterile cup, black top anaerobic tube and green top tube. The specimens were hand delivered to the clinical service.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were communicated to the patient.ESTIMATED BLOOD LOSS: Less than 5cc. An adhesive bandage was placed on the patient’s skin.

Output: Ultrasound guided aspiration of known fluid collection surrounding the flexor pollicis longus tendon of the right hand as described above.


Instruction: Generate impression based on findings.

Input: 61-year-old female with altered mental status and elevated filling pressures on tap. Evaluate for metastasis, edema, or hydrocephalus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild periventricular and subcortical white matter T2 hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Limited exam secondary to motion from patient discomfort and early termination of the study. Within these limitations, there is no evidence of acute intracranial hemorrhage, mass, acute infarct or hydrocephalus. Mild chronic likely small vessel ischemic disease is seen.


Instruction: Generate impression based on findings.

Input: 14-year-old female with history of hemivertebrae.VIEWS: Thoracolumbar spine PA (1 views) 5/7/2015 at 1328 There is approximately 53 degrees of dextroscoliosis with apex at the T11 vertebral body. There is approximately 71 degrees of levoscoliosis with apex at the L2 vertebral body. Note is made of T12 hemivertebral abnormality. 11 left-sided ribs are seen. Postoperative findings of left acetabular osteotomy are seen.

Output: Scoliosis and other findings as above.


Instruction: Generate impression based on findings.

Input: Reason: F/u MRI brain after dentures removed History: complex partial seizures with secondary generalization with no known structural lesions The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.In the temporal horn of the right lateral ventricle is larger than the temporal horn of the left lateral ventricle. There is no signal hyperintensity appreciated within the hippocampi. The size of the hippocampi are symmetric.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No convincing evidence for mesial temporal sclerosis on the basis of this exam


Instruction: Generate impression based on findings.

Input: Male, 67 years old, with history of metastatic thyroid cancer with metastases to the bone, presenting with new right lower extremity paralysis and thoracic spinal tenderness. Evaluate for cord compression. Metastatic infiltration of the C2 and C3 vertebral bodies has progressed when compared to the two prior examinations. In particular, infiltration of the C2 vertebral body with osseous expansion is significantly progressed when compared to 9/15/2015 and perhaps mildly progressed when compared to 11/5/2015. This osseous expansion results in a significant degree of spinal canal narrowing with spinal cord impingement at the C2 level.Metastatic infiltration has also progressed at C7, T1, T2 and T3. The T1 and T2 vertebral bodies are newly compressed with a mild degree of retropulsion. The spinal canal canal is narrowed in this region and there is very likely some degree of cord impingement.Extensive surgical findings status post partial corpectomy of T6 and T7 are again seen with posterior instrumented fixation extending from T4 through T11. Artifact from the surgical instrumentation obscures visualization of the bones and spinal cord through this region. However there does appear to be a substantial quantity of infiltrative tumor within the left aspect of the residual vertebral bodies at T6 and T7 which appears larger than on prior exams.Heterogeneous marrow signal is seen within T12 and L1. The marrow is relatively more fatty replaced from L2 down. No significant expansile tumor is evident in the lumbar region. Degenerative endplate changes are seen most notably at L2-3 and at L4-5. However, no significant or high-grade spinal canal narrowing is suspected in the lumbar region due to either tumor or degenerative disease.A retropharyngeal effusion is seen similar to the prior examination. Prominent T2 hyperintensity is demonstrated within the pons which appears to have progressed from prior exams but this may be technical.

Output: 1.Progressive metastatic disease in the upper cervical spine, particularly affecting C2 which is expanded and which consequently causes a severe spinal canal narrowing and cord impingement at this level.2.Progressive metastatic disease in the upper thoracic spine with new compression deformities of T1 and T2, osseous retropulsion, and spinal canal narrowing with cord impingement.3.Although the mid thoracic region is obscured by metallic artifact, growing tumor is suspected adjacent to the corpectomy levels.4.No significant tumor related spinal canal stenosis is seen in the lumbar region.


Instruction: Generate impression based on findings.

Input: History of medulloblastoma resected in 1994, with recent seizures, for which workup detected a right parietal meningioma. There is an avidly enhancing right superior parietal convexity extra-axial mass that measures up to 22 mm, which is unchanged. There is associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema. There are postoperative findings related to left suboccipital craniotomy with encephalomalacia in the left cerebellar hemisphere, but no evidence of a mass in the posterior fossa. There is diffuse dural thickening related to calcifications. There is encephalomalacia in the right lateral temporal lobe. There are scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a left transparietal ventricular catheter in unchanged position. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is an enhancing mass in the right frontal scalp that measures up to 16 mm. There are bilateral posterior maxillary cystic lesions.

Output: 1. Unchanged right parietal convexity meningioma with associated mass effect upon the underlying brain parenchyma, but no evidence of regional vasogenic edema2. Postoperative findings related to left suboccipital craniotomy related to medulloblastoma resection with encephalomalacia in the left cerebellar hemisphere, but no evidence recurrent tumor in the posterior fossa. 3. Diffuse dural calcification may be a manifestation of Gorlin syndrome.4. Bilateral posterior maxillary cystic lesions may represent keratocystic odontogenic tumors, which may also be a manifestation of Gorlin syndrome. Dedicated maxillofacial imaging may provide further insights, nevertheless.5. A persistent right frontal scalp lesion may represent a basal cell nevus or carcinoma or other neoplasm.6. Scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres may represent cavernous malformations or chronic microhemorrhage related to prior radiation. 7. Unchanged appearance of the shunted ventricular system.


Instruction: Generate impression based on findings.

Input: known tibial spine avulsion injury. Evaluate meniscal/cartilage injury. MENISCI: Increased signal seen in the posterior horn of the medial meniscus does not definitively extend to the articular cartilage, however a partial tear cannot be excluded. Increased signal seen in the anterior and posterior horns of the lateral meniscus, anterior greater than posterior, extending to the articular cartilage and are compatible with a tear.ARTICULAR CARTILAGE AND BONE: An avulsion fracture of the tibial spine is located in the intracondylar notch. Increased signal abnormalities in the lateral femoral condyle, medial tibial plateau and posterior lateral tibial plateau are compatible with bone contusions.LIGAMENTS: The anterior cruciate ligament is thickened and demonstrates increased laxity with signal changes, a partial tear cannot be excluded. The posterior cruciate ligament, lateral collateral and medial collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Tibial spine avulsion fracture.2.Thickened and lax anterior cruciate ligament with signal abnormalities may reflect a partial ACL tear.3.Lateral meniscal tear as described above. Increased signal abnormality in the posterior horn of the medial meniscal may represent a partial medial meniscal tear.


Instruction: Generate impression based on findings.

Input: Clinical question: evaluate for intracranial process, metastases. Signs and symptoms: Altered mental status, metastatic disease or joint cancer. Non-enhanced CT of brain:Examination demonstrates no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. There is revisualization of nonspecific periventricular and subcortical white matter patchy area of low-attenuation that are believed to represent small vessel disease. These findings were present on prior exam and demonstrate no gross interval change. No evidence of metastatic lesion to the brain on this non-infusion study. Lack of intravenous contrast enhancement significantly reduces the sensitivity of this exam for detection of small metastatic lesions. Follow up with an enhanced study or an MRI is recommended.Calvarium is intact. Limited images of orbits are unremarkable. Mastoid air cells and limited real paranasal sinuses are unremarkable.

Output: 1.Findings consistent with small vessel disease of indeterminate age and with no gross interval change since prior exam.2.Enhanced examination will significantly increase the sensitivity of the test for detection of metastatic lesions. This non-infused study demonstrate no large metastatic lesions.3.Calvarium, paranasal sinuses and mastoid air cells are unremarkable.


Instruction: Generate impression based on findings.

Input: 49 years Female (DOB:4/11/1967)Reason: r/o growth of adenoma History: h/o microadenoma of the pituitaryPROVIDER/ATTENDING NAME: RONALD N COHEN RONALD N COHEN MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. The cavernous sinuses are intact bilaterally.There is millimeter-sized cystic lesion in the middle of the pituitary adjacent infundibulum represent a small pituitary cyst.

Output: 1.Millimeter sized pituitary cystic lesion along the midline of the pituitary at the level of the infundibulum. This is stable.2.No convincing evidence for pituitary microadenoma. Asymmetry in the signal intensity in the pituitary gland can be accounted for on the basis of minimal asymmetric size right and left pituitary and some asymmetry in the adjacent bony structures. Please correlate with clinical evaluation.


Instruction: Generate impression based on findings.

Input: cT1N2bM0 L BOT SCC, s/p CT please evaluate in comparison to previous MRI and need measurements. Multiple sequences are motion degraded. Mild residual enhancement at the left tongue base is not significantly changed since 9/12/2016 and compatible with treatment change. No new or enlarging lesion is appreciated. There is also no significant cervical lymphadenopathy.Airway is patent. There is fluid opacifying the vallecula. The thyroid and salivary glands are unremarkable. There is a disc-osteophyte complex at C5-6, which mildly indents the spinal cord. There is minimal scattered paranasal sinus opacification including a small fluid level in the right maxillary sinus. The orbits and imaged intracranial structures are unremarkable.

Output: 1. No significant change in mild residual enhancement at the left base of tongue without residual measurable mass.2. No significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 9-year-old male status post trauma. In the right cerebellopontine angle, there is a low density lesion approximating CSF attenuation consistent with an arachnoid cyst or epidermoid cyst. This lesion causes surrounding bony remodeling, however there is no evidence of bony destruction. There is mild mass effect upon the cerebellum, however no edema is noted in the adjacent brain parenchyma. A follow-up MRI is recommended for further evaluation. The remainder of the cerebral and cerebellar hemispheres and brainstem are normal in morphology and attenuation. No intracranial hemorrhage or edema is noted. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right cerebellopontine angle arachnoid cyst or epidermoid cyst. An MR is recommended for further evaluation. These findings were discussed with Dr. Amanda Johnson at 11:25 a.m. on 8/26/08.