Instruction: Generate impression based on findings.

Input: 78 year-old female with history of basilar tip thrombus and multiple strokes. There is no evidence of intracranial hemorrhage, mass or edema. Mild, patchy areas of hypoattenuation in the periventricular and subcortical white matter may represent small vessel ischemic disease.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.Atherosclerotic calcifications noted in the intracranial vasculature.

Output: 1.No CT evidence of intracranial hemorrhage or other acute abnormality.2.Evidence of small vessel ischemic disease.3.The previously known small infarcts reported on prior MRI and basilar tip thrombosis are not well appreciated on this study.


Instruction: Generate impression based on findings.

Input: Female 37 years old; Reason: Evaluate right patellofemoral joint for recurrent damage History: Right knee pain s/p patellar chondroplasty 6 months ago MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There are two foci of near full-thickness cartilage defects at the posterior aspect of the lateral femoral condyle, without underlying bone marrow reactive changes. There is near total absence of cartilage at the lateral facet of the patella, with underlying bone marrow reactive changes and cyst formation. The cartilage of the medial facet of the patella is unremarkable. Otherwise, the cartilage is unremarkable. Two subcentimeter subchondral cysts are noted at the posterior lateral aspect of the medial tibial plateau.LIGAMENTS: The cruciate and collateral ligaments are intact and unremarkable.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Cartilage defects at the lateral femoral condyle and lateral facet of the patella, as described above.


Instruction: Generate impression based on findings.

Input: Female, 64 years old, with history of nasopharyngeal carcinoma, completed treatment. The mucosa of the pharynx, soft palate, base of tongue and supraglottic larynx is diffusely edematous and mildly enhancing. No discrete masslike lesion is seen in the nasopharynx or elsewhere along the aerodigestive tract. The salivary glands are unremarkable. The subcutaneous tissues of the anterior neck are reticulated likely related to therapy. No pathologic adenopathy is detected in that portion of the neck included within the field-of-view. The previously referenced right paratracheal lymph node is not included on this examination. Marrow signal changes are seen in the cervical spine compatible with prior radiotherapy. The mastoid air cells are opacified bilaterally, a finding which has progressed from prior.

Output: 1.Evidence of pharyngeal mucositis is seen likely related to therapy. No findings to suggest locally recurrent tumor are noted.2.No pathologic adenopathy is detected in the visualized neck. A previously referenced right paratracheal node is not included in the field-of-view of this examination.3.Progressive opacification of the mastoid air cells probably represents eustachian tube dysfunction.


Instruction: Generate impression based on findings.

Input: 57-year-old female with shoulder pain. Evaluate subscapularis/rotator cuff. ROTATOR CUFF: There is thickening and heterogeneity of the supraspinatus tendon and anterior fibers of the infraspinatus tendon indicating moderate tendinosis. There are small cysts along the bursal surface fibers of the supraspinatus and anterior infraspinatus tendon likely due to superficial bursal surface fraying/tearing but we see no full-thickness fluid-filled defect. There is also a small elongated collection along the myotendinous junction of the supraspinatus tendon likely representing interstitial tearing which perhaps extends to the bursal surface fibers. The supraspinatus and infraspinatus muscles appear intact. There is thickening and increased signal intensity of the subscapularis tendon indicating tendinosis. There is additional more focal increased signal intensity within the tendon at its insertion indicating a partial thickness tear with minimal retraction. The subscapularis muscle appears intact. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: Moderate osteoarthritis affects the acromioclavicular joint. There is trace fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Moderate osteoarthritis affects the glenohumeral joint. There is abnormal signal intensity throughout much of the labrum compatible with extensive degenerative tearing. There is a small amount of fluid within the glenohumeral joint with intermediate signal intensity which may reflect synovitis or debris.BICEPS TENDON: There is a small amount of fluid within the tendon sheath of the long head of the biceps. The tendon itself is unremarkable.

Output: 1. Osteoarthritis of the glenohumeral and acromioclavicular joints.2. Tendinosis and partial-thickness tearing of the rotator cuff, including the subscapularis tendon, as described above.


Instruction: Generate impression based on findings.

Input: Evaluate for subcortical or cerebellar abnormalities: wide based gait and bilateral lower extremity sensory symptoms, but no weakness. There is no evidence of intracranial hemorrhage, mass, encephalomalacia, or acute infarct. There is minimal nonspecific periventricular cerebral white matter T2 hyperintensity and scattered mildly prominent perivascular spaces. The cerebellum appears 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, and scalp soft tissues are grossly unremarkable. There is mild bilateral maxillary sinus mucosal thickening.

Output: No evidence of acute intracranial hemorrhage, mass, or infarct. The cerebellum appears unremarkable.


Instruction: Generate impression based on findings.

Input: 38 year ols with history of left skin/nipple sparing mastectomy in 05/2013 for ER/PR positive breast cancer. There is extreme amount of fibroglandular tissue in the right breast.Marked parenchymal enhancement is noted in the right breast.Status post left mastectomy.Bilateral retropectoral silicone implants appear intact.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Pituitary adenoma, syncopal episode, pacemaker/defibrillator, Cushing's disease. Evaluate change. Pre-and post-enhanced CT of pituitary:100 of Omnipaque 350 is administered for the post-infused portion of the exam.Contiguous axial 0.9-mm CT images of the entire brain before and after administration of contrast were obtained. Sagittal and coronal 2-D reformatted images were also rendered.This examination is tailored primarily for evaluation of pituitary gland.The nonfused exam demonstrates no evidence of any acute intracranial process. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is identified. Coronal and sagittal reformatted images demonstrate normal at hearing size of sella turcica and with primarily CSF density content. A very thin pituitary gland is identified. The pituitary stalk is also identified. There is no evidence of any abnormality in the basal cistern. The suprasellar visual complex is unremarkable.On post infused images there is no detectable abnormal enhancement the brain parenchyma or leptomeninges.Sagittal and coronal 0.9-mm 2-D reformatted images through the sella identifies very small thin pituitary gland with enhancement. Due to very small size of the gland precise measurement is not possible however but the best estimate the gland measures approximately 1.5 mm in cranial -- cephalad axis. On prior enhanced MRI of pituitary the heights of pituitary gland measured 3 mm.There is normal enhancement of midline pituitary stalk. There is subtle increase in the caliber of the pituitary far laterally on the left which measures approximately 3.9 x 4.9-mm in size. This may represent a pituitary microadenoma. There is no abnormality of basal cistern. The cavernous sinuses demonstrate no definitive abnormality. Sphenoid sinus is well pneumatized and unremarkable.Although not possible to precisely compare this CT exam with the prior pituitary MRI study the overall very small size of the pituitary gland is similar to prior exam. Prior MRI also demonstrates a focus of low attenuation on post infused images in the far left side of pituitary gland along its inferior aspect which measures 7.1 x 4.1-mm which is larger than current measurements of 3.9 times 4.9-mm..

Output: 1.Very small and thin (approximately 1.5 mm in thickness) and abnormal enhancement. The heights of pituitary on prior exam and measures approximately 3 mm in size. Pituitary stalk demonstrates normal enhancement and is in midline.2.Focal thickening of pituitary gland far laterally on the left measuring 4.9 x 3.9-mm in size compared to prior MRI measurements of 7.1 x 4.1-mm. This finding could represent a small pituitary microadenoma.3.Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: 49-year-old male with L5-S1 back and leg pain Vertebral body heights are maintained. Disk spaces are maintained however there is loss of disk T2 signal at L5-S1. No abnormal marrow signal. Normal signal within the distal cord and conus, which ends at L1-L2. No abnormal marrow signal.T12-L1 to L3-4: No central canal or neuroforaminal stenosis.L4-L5: Mild facet hypertrophy. No central canal stenosis. Minimal neuroforamina stenosis bilaterally.L5-S1: Small central protrusion with annular fissure. No central canal stenosis. Mild bilateral neural foraminal stenosis. Mild bilateral facet hypertrophy.

Output: Mild degenerative findings with a small central protrusion and mild bilateral neural foraminal stenosis at L5-S1.


Instruction: Generate impression based on findings.

Input: Cellulitis. Suspicious for osteomyelitis of left great toe based on x-ray. There is mild deformity of the proximal phalanx of the great toe, as seen on recent radiographs; I cannot tell if is due to prior trauma or perhaps the sequela of prior infection. There is replacement of the normal subcutaneous fat plantar to the base of the proximal phalanx with intermediate signal intensity which shows enhancement following contrast administration. There is also slight irregularity of the overlying skin surface. These findings may reflect ulceration with underlying granulation tissue, but I see no discrete sinus tract or fluid collection. There is additional diffuse enhancement of the soft tissues of the great toe compatible with the stated history of cellulitis, as well as mild diffuse edema of the forefoot, particularly along its dorsal aspect, extending along the medial aspect of the midfoot. There is also enhancement of the soft tissues immediately dorsal to the head of the fifth metatarsal, but the underlying marrow signal intensity appears normal.There is abnormal signal intensity within the base of the proximal phalanx (low signal intensity on T1-weighted images, high signal intensity on fat-suppressed T2-weighted images) that is nonspecific but could represent osteomyelitis in the correct clinical context. Additional bandlike low signal intensity extending longitudinally through the proximal phalanx may represent an old healed fracture. Although there is mild edema-type signal within the head of the proximal phalanx on the fat-suppressed T2-weighted images, the normal fatty marrow signal intensity is relatively preserved on the T1-weighted images, and therefore this more likely represents reactive osteitis than osteomyelitis. Similarly, there is relatively mild increased signal intensity within the distal phalanx of the great toe on the fat-suppressed T2-weighted images, with relative preservation of the normal fatty signal intensity on T1-weighted images, suggesting reactive osteitis rather than osteomyelitis. Deformity of the base of the distal phalanx of the great toe, as seen on radiographs, again may reflect old trauma or sequela of prior infection. I see no fluid signal intensity within the interphalangeal joint or first metatarsophalangeal joint to indicate septic arthritis. The signal intensity of the sesamoid bones is normal. Moderate osteoarthritis affects the first metatarsophalangeal joint. Additional osteoarthritis affects the visualized portions of the midfoot. A small amount of nonenhancing fluid between the first and second metatarsal heads may represent a bursitis.

Output: Soft tissue inflammatory changes as described above, particularly affecting the great toe. Deformity of the proximal phalanx of the great toe and the base of the distal phalanx of the great toe may reflect old trauma or sequela of prior infection. Abnormal signal intensity within the base of the proximal phalanx of the great toe is nonspecific and could represent osteomyelitis in the correct clinical context, although may simply reflect osteoarthritic changes.


Instruction: Generate impression based on findings.

Input: Diagnosis: Epilepsy, unspecified, not intractable, without status epilepticusClinical question: migraines and seizure disorder + auras (oscillopsia) she thinks = "pre-seizure," Semiology most consistent with complex-partial seizures, although give early age of onset cannot ru The CSF spaces are appropriate for the patient's stated age with no midline shift. A small focus of T2 and FLAIR signal hyperintensities present along the left external capsule. In isolation is probably of little clinical significance.The hippocampi are symmetric in size morphology and signal characteristics with no abnormal foci of enhancement and no abnormal signal characteristics.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: MRI of the brain is within normal limits. There is no evidence for intracranial mass lesion to explain patient's seizures.


Instruction: Generate impression based on findings.

Input: Female; 69 years old. Reason: R/o Osteo History: fever MRI right foot:There is soft tissue ulceration at the medial and posterior aspect of the heel with abnormal signal and enhancement extending from the ulcer to the underlying calcaneus. However, there is no signal abnormality within the calcaneus itself to indicate osteomyelitis. No fluid collections to suggest abscess. A rounded focus of increased signal in the navicular bone may represent a cyst, ganglion, or small enchondroma. Mild osteoarthritis affects the ankle and midfoot. The visualized tendons appear intact. The visualized ligaments appear grossly intact, although lack of striations of the deep fibers of the deltoid ligament may represent an old sprain. Fatty atrophy of the plantar musculature noted.MRI left foot:No evidence of osteomyelitis. Mild nonspecific edema seen in the pre-Achilles fat pad. No fluid collections or evidence of abscess. The visualized tendons appear intact. The visualized ligaments appear grossly intact, although lack of striations of the deep fibers of the deltoid ligament may represent an old sprain. No abnormal enhancement.

Output: Right heel soft tissue ulceration and inflammatory changes, but no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Essential tremor. There is no evidence of intracranial hemorrhage, or mass. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unremarkable MRI for the purposes of preoperative deep electrode stimulator surgery planning.


Instruction: Generate impression based on findings.

Input: Cerebral cavernous malformation. There is a lesion with extensive susceptibility effect in the right peritrigonal white matter, which measures up to approximately 10 mm. There is no surrounding vasogenic edema, but there appears to be a small associated developmental venous anomaly. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral artery flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Right peritrigonal white matter cavernous malformation measuring up to approximately 10 mm, with what appears to be a small associated developmental venous anomaly.


Instruction: Generate impression based on findings.

Input: Volar hand and wrist masses. There is a mass immediately volar to the radiocarpal joint arising from the median nerve measuring approximately 1.5 x 1.0 cm in the transverse dimension and just under 2 cm in the longitudinal dimension. The mass appears isointense to skeletal muscle on T1-weighted images, heterogeneously hyperintense on T2-weighted images, and demonstrates diffuse but heterogeneous enhancement following contrast administration. Although signal characteristics are not classical for nerve sheath tumor, this is the most likely diagnosis.There is a second mass with similar signal characteristics along the distal aspect of the thenar eminence measuring approximately 1.3 x 1.0 cm in the transverse dimension and 1.4 cm in the longitudinal dimension. A third mass with similar signal characteristics is situated within the subcutaneous fat volar to the sesamoid of the second metacarpal head and measures 0.8 x 0.6 cm in the transverse dimension and approximately 1.0 cm in the longitudinal dimension. We suspect that these masses also represent nerve sheath tumors presumably arising from a branch of the median nerve.We see no additional masses. The remaining soft tissues are unremarkable. Bone marrow signal is within normal limits. Mild osteoarthritis affects the basilar joint.

Output: Three soft tissue masses as described above likely representing nerve sheath tumors in the median nerve distribution.


Instruction: Generate impression based on findings.

Input: 17-year-old male with pain and instability. Evaluate for ACL tear. MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the femoral articular surface consistent with a horizontal tear. Additionally, there is a linear focus of increased signal abnormality along the free edge of the posterior horn of the lateral meniscus consistent with a radial tear. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is a tiny focus of partial-thickness articular cartilage degeneration along the posterior aspect of the weightbearing surface of the medial femoral condyle. The lateral tibiofemoral compartment appears relatively spared. Note is made of a lesion within the posterior aspect of the distal femoral metaphysis consistent with the findings of a nonossifying fibroma seen on recent radiographs.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the lateral meniscus as described above.2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 9 year-old female with rhabdomyosarcoma of the nasal cavity now with METs to brain to evaluate for further METs This is a suboptimal study for soft tissue lesion due to no contrast media is used.Limited view of the brain demonstrate right frontal lobe soft tissue mass with vasogenic edema, midline shift to the left and hydrocephalus. Please refer to the dedicated MRI examination for more details.Non-enhancing CT demonstrates a soft tissue mass in superior nasal cavity and ethmoid sinus with possible extension to the right orbital cavity. The ethmoid bone, fovea ethmoidalis, cribriform plates, right lamina papyracea and anterior clinoid process show erosion and loss of continuity. Mucosal thickening is seen in the right maxillary sinus, opacification of the left maxillary sinus, sphenoid sinuses and frontal sinuses are seen.Views of soft tissue neck shows numerous lymph nodes in bilateral posterior triangle, jugular chain, submandibular and submental regions. One in the left jugulodigastric lymph nodes measures 17.3-mm. it is hard to differentiate all those lymph nodes due to lack of contrast. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent.

Output: Soft tissue mass in superior nasal cavity and ethmoid sinuses with multiple bony destruction and occlusive paranasal sinuses inflammatory change as detailed above.Intracranial extension better seen on MR and CT. Neck lymphadenopathy as detailed above.


Instruction: Generate impression based on findings.

Input: Bilateral shoulder pain ROTATOR CUFF: There is a partial tear of the supraspinatus that is on the articular side. No evidence of retraction.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Partial articular sided tear of the supraspinatus


Instruction: Generate impression based on findings.

Input: Choroid plexus papilloma status post resection: surveillance. There are postoperative findings related to midline suboccipital craniotomy and resection of the posterior arch of C1. There is a persistent subcentimeter nodular focus of enhancement within the right cerebellomedullary angle. The lesion abuts the right vertebral artery. There is also subcentimeter patchy enhancement within the fourth ventricle. There is a right transparietal ventricular catheter which courses from the occipital horn of the lateral ventricle and terminates within the body of the lateral ventricle, indenting upon the cavum septum pellucidum. There is no significant change in size of the ventricular system. There is also interval resolution of bilateral subdural fluid collections and decreased diffuse smooth dural enhancement. There is no evidence of acute infarction. There is an unchanged mildly prominent and partially cystic pineal gland that measures up to 10 mm, which may be physiologic in nature. The major cerebral flows voids are grossly intact. There is fluid within the right mastoid air cells. The orbits are unremarkable.

Output: 1. Persistent subcentimeter foci of enhancement within the right cerebellomedullary angle and fourth ventricle, which may represent residual tumor and/or treatment effects. 2. Unchanged appearance of the shunted ventricular system, but resolution of the mild bilateral cerebral convexity subdural effusions.3. Fluid within the right mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: 50 years, Female, Reason: h/o right DBS; planning for left side DBS placement. Examination is obtained for operative planning. There is a right transfrontal DBS lead in place with the lead tip in the region of the subthalamic nucleus on the right. There is T2 hyperintensity involving the proximal aspect of the lead which is nonspecific and may represent gliosis or inflammatory response. No significant edema, intracranial mass, or mass effect. No masses or vascular abnormalities are evident along the expected trajectory of a planned left-sided DBS lead. No hydrocephalus. No extra-axial collections. Major arterial and venous structures are patent.

Output: Examination for operative planning. Right-sided DBS lead as above.


Instruction: Generate impression based on findings.

Input: There is now complete visualization of a prominently diffusion restricting infiltrative mass centered in the left parotid gland. The mass again demonstrates prominent T1 hypointensity and heterogeneous superimposed enhancement with overall T2 hyperintensity with respect to adjacent parotid tissue. The most confluent portion of the left parotid level mass measures 3.0 x 3.8 cm on 24/20, by approximately 4.6 cm CC on 13/20. Lobule of the mass extends deep to the anterior margin of the upper left sternocleidomastoid muscle, just caudal to the mastoid tip. The left retromandibular vein is not readily identified. There is asymmetric enhancement posterior to the left mandibular condyle although this could relate to venous engorgement. There is extension of enhancing soft tissue through the expanded left stylomandibular canal, along the course of the mastoid segment facial nerve. A thick cord of enhancement with associated diffusion restriction measuring up to 8 mm in greatest thickness extracranially extends intracranially via the course of the facial nerve.There is suggestion of asymmetric thickening and enhancement as well as mild T2 hyperintense signal along left V3 through the foramen ovale which appears slightly widened. Although this could represent associated asymmetric venous engorgement secondary to the infiltrative process, there is concern for further perineural spread via the left parapharyngeal and masticator spaces. Meckel's cave and trigeminal nerves appear symmetric and unremarkable.There is an adjacent left level 2A lymph node which measures 1.5 cm on 21/30. There is a small amount of fluid in the dependent pharynx presence of endotracheal tube. The visualized left sigmoid sinus demonstrates intrinsic T1 hyperintensity with corresponding lack of normal T2 hypointense flow-void concerning for slow flow or possible thrombosis. The left internal jugular vein extending from the skull base to just below the left neck mass is not well delineated. There is severe left mastoid air cell and middle ear opacification with fluid signal and intrinsic T1 hyperintensity. There is a lobulated homogeneously enhancing mass in the left internal auditory canal with probable extension into the cochlear fossette. The lobulated soft tissue extends to the porus acousticus and into the prepontine cistern, along the cisternal segments of the cranial nerves VII and VIII. Please refer to separately dictated report for recent MRI of the IACs for further details.There is slight asymmetric prominence of the right aspect of the pituitary gland with slight rightward deviation of the infundibulum, which appears minimally prominent in thickness, although grossly this appears similar to prior exams. Mild dolichoectasia of the visualized left internal carotid artery is again noted.There is exaggeration of the normal cervical lordosis, with focal posterior osteophyte disc complex at C5-C6.

Output: 1.Improved delineation of extent of infiltrative mass centered in the left parotid gland with extension to the widened left stylomandibular canal, and further intracranial extension along the significantly thickened and abnormal appearing left facial nerve.2.Additional concern for perineural spread of tumor via left V3 through the somewhat widened foramen ovale, although a component of this enhancement could be venous in origin.3.Redemonstration of known intracranial component of tumor in the left internal auditory canal and cisternal left seventh/eighth cranial nerves. Please see separately dictated report for MRI of the IACs the prior day for further details.4.Abnormal signal in the left sigmoid sinus concerning for thrombosis or at least slow flow, with additional nonvisualization of the upper left internal jugular vein due to adjacent mass effect.


Instruction: Generate impression based on findings.

Input: Assess for cause of altered mental status Motion artifact limits the study. Periventricular and subcortical white matter T2/FLAIR hyperintensity is likely secondary to mild small vessel ischemic disease. No focal mass lesion is seen. No extra-axial collection is noted. Moderate volume loss is noted.Mucosal polyps/retention cysts are seen in the maxillary sinuses. The orbits are intact.

Output: Limited suboptimal examination with probable mild small vessel ischemic disease. No focal mass lesion or extra-axial collection. Unable to exclude acute infarction as no diffusion-weighted images were obtained.


Instruction: Generate impression based on findings.

Input: Reason: Right ant lateral meniscal pain for 5 weeks after twisting History: as above MENISCI: There is linear increased signal abnormality within the posterior horn of the lateral meniscus which extends to the tibial articular surface indicating a horizontal tear which extends to involve the body of the meniscus. The anterior horn appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is superficial fraying of the articular cartilage along the lateral facet of the patella. There is near full-thickness chondromalacia along the lateral facet of the patella. The medial and lateral tibiofemoral articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Tear of the lateral meniscus. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 12 years Female (DOB:11/10/2003)Reason: 3T scanner, please assess for cerebral AVMs, hx of pulmonary AVMs (treated w coils and plugs in 2016) History: hx of nosebleeds \T\ pulmonary AVMs, may have HHTPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated. There is artifact emanating from the patient's teeth which obscures some of the pulse sequences such as susceptibility weighted imaging and diffusion-weighted imaging. It also creates distortion along the orbits on MR imaging.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium sized.. The posterior communicating arteries are medium-sized. The vertebral arteries are similar in size.The right posterior inferior cerebellar artery is the dominant vessel and has a prominent vermian branch.

Output: 1.No evidence for cerebrovascular occlusive disease.2.There is no convincing evidence for arteriovenous malformation. The vermian branch of the right posterior inferior cerebellar artery appears relatively prominent. This is a nonspecific finding, however, given the artifacts on this exam emanating from the patient's dental hardware perhaps a CT angiogram may help further assess this.3.No evidence for intracranial aneurysm.4.There is no evidence for intracranial mass lesion.5.The exam is somewhat degraded due to metal artifact from dental hardware which may obscure some abnormalities. The orbits and infratemporal fossa are obscured on almost all pulse sequences. Susceptibility imaging and diffusion-weighted imaging there are significant compromise to by the artifact.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for structural lesions contributing to possible seizures History: paroxysmal LOC \T\ weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a posterior fossa subdural effusion present which is most likely related to atrophyThere are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are mainly in the right hemisphereNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The basilar artery appears very small. There appears to be fetal origin of the posterior cerebral arteries bilaterally.The visualized portions of the paranasal sinuses demonstrate mucosal thickening and opacification of the right maxillary sinus, right anterior ethmoid air cells and right frontal sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

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


Instruction: Generate impression based on findings.

Input: Abnormal LFTs. Cholestatic picture. Please note that evaluation is limited by extensive motion artifact and lack of IV contrast.ABDOMEN:LUNG BASES: Moderate-sized right hydropneumothorax, slightly increased compared to the prior CT on 6/10/2015. Right lower lobe atelectasis. Small hiatal hernia noted.LIVER, BILIARY TRACT: Cirrhotic liver morphology. The liver is very slightly increased in signal on out of phase images, which may be in part artifactual or represent mild iron deposition. No large focal lesions noted, though evaluation is limited by lack of IV contrast. Cholelithiasis without specific evidence of cholecystitis. No biliary ductal dilation. Small amount of perihepatic ascites. SPLEEN: Splenomegaly.PANCREAS: The inherent T1 signal of the pancreas is not well visualized, which is likely predominantly due to motion artifact, though may also reflect a component of parenchymal dysfunction. Evaluation for focal lesions is limited by motion artifact and lack of IV contrast. There is no pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Limited examination due to lack of IV contrast and extensive motion artifact. 2.Cirrhotic liver morphology, without biliary ductal pathology evident. 3.Subtle increased signal of the liver parenchyma on out of phase images, which may represent mild iron deposition.4.Moderate-sized right hydropneumothorax, slightly increased compared to 6/10/2015.


Instruction: Generate impression based on findings.

Input: The last well formed disc space is referred to as L5-S1. The spinal cord and cauda equina appear unremarkable. There is disc desiccation at L4-5 and L5-S1 discs with mild loss of disc height at L4-5 and moderate loss of disc height at L5-S1 with endplate degenerative changes at the L5-S1 endplates and mild enhancement along the posterior aspect of the L5-S1 disc. There is mild bilateral neural foramen stenosis at L5-S1, but no significant spinal canal stenosis. There are subcentimeter sacral perineural cysts. There is normal alignment of the lumbar spine with preserved vertebral body heights. There is a dominant right renal exophytic cyst and a few subcentimeter left renal cysts.

Output: 1.Mild degenerative spondylosis in the lower lumbar spine with mild bilateral neural foramen stenosis at L5-S1, but no significant spinal canal stenosis.2.No evidence of mass lesions within the spine.3.Large right renal exophytic cyst and few subcentimeter left renal cysts. A dedicated ultrasound exam may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 82 -year-old woman with history of non-small cell lung cancer and lesion noted on recent CT. There is a rim-enhancing 12 x 11 mm lesion in the left inferior frontal lobe (series 1401, image 17) with an adjacent, 4 mm enhancing nodule immediately anterior. The left inferior frontal lobe lesion demonstrates increased central T2 signal, likely related to cystic degeneration or necrosis. There is vasogenic edema within the surrounding white matter of the left frontal lobe with increased T2 signal extending to the left frontal horn of the left lateral ventricle. There is minimal associated mass effect with effacement of the overlying left frontal sulci.There is no abnormal leptomeningeal enhancement, although 3D T1 postcontrast images are slightly limited by artifact. The major intracranial vessels appear patent.Extensive, bilateral scattered areas of increased T2 signal in the periventricular and subcortical white matter are nonspecific but most suggestive of chronic small vessel ischemic disease.No abnormality on diffusion-weighted images to suggest acute ischemia. No abnormality on susceptibility weighted images to suggest intracranial hemorrhage.

Output: 1.Rim-enhancing lesion in the inferior left frontal lobe with enhancing small satellite nodule. Associated vasogenic edema with mild sulcal effacement but no significant mass effect. Given the history, this is most compatible with metastasis.2.No additional enhancing lesions identified.


Instruction: Generate impression based on findings.

Input: Low back pain radiating to the leg. There is mild facet hypertrophy and ligamentum flavum thickening in the lower lumbar spine with apparent mild neural foraminal stenosis at multiple levels, particularly on the left side. However, there is no significant spinal canal stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a T2 hyperintense lesion in the right kidney, which may represent a cyst, but is incompletely characterized.

Output: Mild lower lumbar degenerative spondylosis with apparent mild neural foraminal stenosis at multiple levels, particularly on the left side, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 30-year-old male with history of L5-S1 herniation now with recurring back pain. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is loss of disc height at L5-S1. Alignment is within normal limits. A benign hemangioma or focal fat is present within the vertebral body of L1. There is degenerative signal abnormality at the inferior endplate of L5 and superior endplate of S1. The conus medullaris is normal in position terminating at the level of T12-L1. The paraspinous soft tissues are within normal limits.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: No significant disc disease. No spinal canal or neural foraminal stenosis.L5-S1: The previously seen large disc extrusion is no longer visualized. There is a residual disc bulge and a sequestered disc fragment measuring 1 cm craniocaudally within the ventral epidural space posterior to the mid L5 vertebral body. There is a shallow left paracentral protrusion which slightly narrows the nerve root sleeve of the descending left S1 nerve root. There is mild neuroforaminal narrowing, worse on the left. No significant spinal canal stenosis.

Output: Previous L5-S1 disc extrusion no long visualized, although there is a residual disc bulge and a sequestered disc fragment measuring 1 cm craniocaudally within the ventral epidural space posterior to the middle aspect of the vertebral body of L5. There is a slight left paracentral protrusion component which narrows the descending left S1 nerve root sleeve. Overall, the appearance has improved when compared to the prior MRI.


Instruction: Generate impression based on findings.

Input: Female 34 years old with history of wrist pain and instability, evaluate for midcarpal instability, SL ligament Successful contrast administration to the midcarpal joint. Please refer to the subsequent MRI report for further information.EXPOSURE TIME: 1 minutes 02 seconds

Output: Successful contrast administration to the right midcarpal joint with contrast traversing the scapholunate and triquetrolunate ligaments. Correlate with pending MR.


Instruction: Generate impression based on findings.

Input: 45-year-old female patient with locking/catching, knee gives out over several years. MENISCI: There is slight medial extrusion of the body of the medial meniscus but we see no discrete tear. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is degeneration of the articular cartilage of the lateral facet of the patella associated with a fluid-filled cleft and subchondral cysts, appearing similar to the prior study accounting for technical differences. There is also focal degeneration of the superior aspect of the femoral trochlear cartilage, which may be new compared to the prior study. Again seen is degeneration of the articular cartilage of the medial compartment that has progressed compared to the prior study with new full-thickness defects of the medial femoral condyle and medial tibial plateau with underlying edema. There is new edema type signal underlying the medial tibial plateau. Heterogeneity of the articular cartilage of the weightbearing portion of the lateral femoral condyle indicates degeneration with subchondral cysts, similar to that seen on the prior study. There are tricompartmental osteophytes.LIGAMENTS: The anterior cruciate and posterior cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: Mild increased signal intensity in the patellar tendon insertion suggests tendinosis. Mild edema is noted within the soft tissues anterior to the patellar tendon.ADDITIONAL

Output: 1. Tricompartmental osteoarthritis as described above which appears to have progressed compared to the prior study in the medial compartment.2. Possible loose bodies as described above.3. Mild extrusion of the body of the medial meniscus but no discrete tear.4. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Cluster headache. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a pineal gland cyst that measures up to 14 mm. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, herniation, orbital mass, or hydrocephalus. 2. A pineal gland cyst measures up to 14 mm.


Instruction: Generate impression based on findings.

Input: Reason: please compare size of mass to previous films History: boy with NF1 and plexiform of neck. Again seen is a trans-spatial plexiform mass centered in the left retropharynx that spans from the level of the nasopharynx into the upper mediastinum, with extension and left carotid space with associated partial encasement of the great vessels, and into the left visceral space with associated distortion of the thyroid gland. The mass measures up to 4.5 cm in the AP dimension, up to 4.5 cm in the transverse dimension, and up to approximately 14 cm in the craniocaudal dimension. Lesion was remeasured on the prior study from 3/23/2015 and measures identical on the current study.There is narrowing of the oropharyngeal airway. The cervical lymph nodes appear to be unchanged. There are T2 hyperintense lesions in the cerebellum, brainstem, and middle cerebellar peduncles which appear unchanged. T2 hyperintense lesions involving the left thalamus and globus pallidus are also noted and not imaged on the recent study. Cervical and upper thoracic spinal canal remains patent.

Output: 1. Compared to 3/23/2015, there is no appreciable change in size of the plexiform neurofibroma centered in the left retropharynx at the level of the nasopharynx with extension into the left visceral space, upper mediastinum, and left carotid space with associated partial encasement of the great vessels. 2. Partially-imaged intracranial stigmata of neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Back pain and sciatica, evaluate for herniated disc or spinal stenosis Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There is minimal fibrofatty infiltration of the filum terminale measuring less than 2 mm. The conus medullaris is normal in position. Limited evaluation of the lower thoracic spine demonstrates a disc bulge at the T11-T12 level without significant spinal canal or neural foraminal stenosis.Multilevel degenerative changes are seen in the lumbar spine, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a disc bulge with small right paracentral protrusion. There is also mild ligamentum flavum thickening, mild facet arthropathy, and prominence of the epidural fat which all contribute to mild to moderate spinal canal stenosis at this level. There is mild bilateral neural foraminal narrowing L4-L5: Minimal disc bulge. No spinal canal or neural foraminal stenosis.L5-S1: Evidence of remote left-sided laminotomy. Significant loss of disc height and degenerative fatty endplate marrow signal changes. There is a disc bulge with left foraminal disc protrusion. There is prominent facet arthropathy on the left. There is moderate narrowing of the left neural foramen related to a disc material, endplate osteophyte, and facet arthropathy. There is minimal narrowing of the right neural foramen. No significant central canal stenosis. Paraspinous soft tissues are within normal limits.

Output: Degenerative changes in the lumbar spine. There is mild to moderate spinal canal stenosis at the L3-L4 level. There is also moderate left L5-S1 neural foraminal stenosis with possible impingement of the left L5 nerve root. Please see details above.


Instruction: Generate impression based on findings.

Input: Reason: 84 F w 17mm lesion in liver. Please also perform MRCP, family history of pancreatic carcinoma ABDOMEN:LIVER, BILIARY TRACT: Large heterogenous enhancing T1 dark, T2 bright segment 7 lesion, measurement as below. There is also mildly T2 bright lesion in segment 6, suspicious for metastasis. Scattered T2 hyperintense lesions compatible with cysts. There is intrahepatic and extrahepatic biliary ductal dilatation with common bile duct measuring up to 12 mm with abrupt cut off at the pancreatic head mass.SPLEEN: No significant abnormality noted.PANCREAS: Large mass, presumably arising from the pancreatic head, measurement as below. There is small fluid collection adjacent to this mass and enlarged peripancreatic lymph nodes. SMV is not well seen and may be occluded from this mass. There is soft tissue infiltration around SMA, suspicious for cancer spread. Distal pancreas is not well seen, likely atrophied. Pancreatic duct is not well visualized. This is suspicious for adenocarcinoma but EUS may be more definitive if indicated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral T2 hyperintense lesions, compatible with cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large abdominal ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Significantly elevated left hemidiaphragm with abdominal contents having cardiomediastinal shift to the right. INDEX LESION MEASUREMENTS (Current exam date/time: 12/28/2016 12:55:29)SEGMENT 7 HEPATIC LESION: 4.2 x 4.0 cm (Image 24, Series 8).PANCREATIC MASS: 5.6 x 6.1 cm (Image 330, Series 12).

Output: 1.Large mass presumably arising from the head of the pancreas as described above with metastatic lesions in the liver. CT chest is recommended for complete staging. 2.Significantly elevated left hemidiaphragm with abdominal contents causing cardiomediastinal shift to the right. 3.Findings were text paged to Dr. Bianca Chang.


Instruction: Generate impression based on findings.

Input: Clinical question: 66-year-old male with NSCLC and two brain metastases. Treatment planning MRI for SRS. Patient has remote history of head trauma in 1989 and was hit with a pipe along right skull Signs and symptoms: None. Pre-and post enhanced treatment planning brain MRI:There is a tiny ring enhancing lesion in the superior aspect of the left cerebellar measuring at 5 x 5-mm stable since prior exam and suspected for a small metastatic lesion. There is no detectable blood product with this finding.Additionally a tiny superficially located focus of ring enhancement in the anterior right frontal lobe measuring also approximately a 5-mm in transaxial dimensions. There is hemosiderin deposition at this location within the brain parenchyma likely has result of prior trauma. This finding although highly suspected of an additional metastatic lesion, the less likely possibility of enhancement surrounding chronic hemorrhage at the site cannot be entirely excluded.Examination redemonstrates multiple foci of hemorrhagic encephalomalacia from patient's known prior injury to the head.

Output: 1.Approximately 5 mm ring enhancing metastatic lesion along the superior surface of left cerebellar.2.Approximately 5 mm enhancing metastatic lesion superficially in the right anterior frontal lobe.3.Chronic posttraumatic hemorrhagic changes of brain as was noted on prior dedicated brain MRI.


Instruction: Generate impression based on findings.

Input: 45 year old female with a history of ovarian cancer presents for screening breast MRI. Breast parenchyma is almost entirely fat in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.There is a port-A-cath in the right upper inner chest wall.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 75 years Female (DOB:3/24/1941)Reason: Alzheimer's vs Frontotemporal Dementia History: cognitive changesPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a punctate focus of susceptibility effect in the right middle frontal gyrus subcortical white matter. This is not present on the prior exam from 2012. In isolation this is of unknown clinical significance.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.Exam is mildly degraded due to patient motion.

Output: No intracranial mass lesions are appreciated. An isolated microhemorrhage in the right frontal lobe is of little clinical significance.


Instruction: Generate impression based on findings.

Input: The clinical question to be answered: Mental status changes. Signs and symptoms: Unresponsive. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal range for patient's stated age of 77. This examination demonstrates no interval change since prior study. Calvarium, paranasal sinuses and mastoid air cells are also unremarkable. Follow-up with an MRI examination is highly recommended considering patients provided clinical data.

Output: Stable CT examination.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for nerve root compression causing hyperreflexia. Signs and symptoms: Hypertension. Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with a straightening of cervical lordosis. There is some a large focus of marrow signal change involving extensively the left aspect of T1 vertebrae and extending into the left pedicle and articulating facet. This finding demonstrates increased T2 signal intensity both on T1 and T2 weighted images and the appearance is highly suggestive of a benign hemangioma. Unremarkable signal intensity of vertebral column otherwise.Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative changes with resultant moderate bilateral neural foraminal compromise.C3 -- C4 demonstrate degenerative changes with resultant significant bilateral neural foraminal compromise and no central spinal stenosis.C4 -- C5 demonstrate degenerative changes with resultant significant (left greater than right) neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate degenerative changes with resultant significant bilateral neural foraminal compromise and no central spinal stenosis.C6 -- C7 demonstrate degenerative changes with resultant significant left and moderate right neural foraminal compromise without central spinal stenosis.C7 -- T1 demonstrate moderate (left greater than right) neuroforaminal compromise and no central spinal stenosis.T1 -- T2 there was a degenerative changes resulting in mild central spinal stenosis and moderate bilateral neuroforaminal compromise (right greater than left).The signal intensity and caliber of cord remains within normal.

Output: 1.Degenerative changes of cervical spine results in bilateral significant neural foraminal compromise at all levels as detailed. There is however no evidence of spinal canal compromise or stenosis at any level. The signal intensity and caliber of cervical and uppermost visualized thoracic cord is normal.2.There is also evidence of neural foraminal compromise at T1 -- T2 level due to degenerative changes and mild central spinal stenosis.


Instruction: Generate impression based on findings.

Input: Congenital anomaly of the peripheral vascular system, unspecified site [747.60], Reason for Study: ^Reason: 5 yo with PHACE syndrome, possible internal carotid artery aneurysm, follow up study History: Visual disturbance 3D 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.The left distal ICA as well as the left ACA A1 segment appear to be slightly ectatic and the right ACA A1 segment is hypoplastic. Since the Acom artery is patent, the right ACA A2 segment is supplied by the left side. There is no evidence of intracranial arterial aneurysm.There is no evidence of arterial luminal stenosis.Bilateral Pcom arteries are patent.

Output: No evidence of intracranial arterial aneurysm.The left distal ICA and left ACA A1 segment appear to ectatic with hypoplastic right ACA A1 segment. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: 74 years, Male, with meningioma, evaluate for change in size. There is a homogeneously enhancing extra-axial mass in the left paraclinoid region extending into the middle cranial fossa measuring 3.5 x 3.3 x 3.5 cm consistent with meningioma. Medially mass extends into the cavernous sinus with partial encasement of the left cavernous internal carotid artery. Mass also noted to abut the left V2 and V3 divisions of the trigeminal nerve. No significant luminal narrowing of the internal carotid flow-void is appreciated. Superiorly mass abuts the left M1 segment. No parenchymal edema is appreciated associated with the meningioma. There is local mass effect on the adjacent left anterior and medial temporal lobe. Comparison with available outside MRI from 4/19/2010 demonstrates the enhancing mass to measure 2.9 x 2.9 x 3.1 cm indicating interval enlargement.There are subcentimeter foci of susceptibility including the left anterior frontal lobe, right parietal lobe, as well as in the left parietal lobe abutting the splenium, which are compatible with chronic microhemorrhages. There is apparent susceptibility along the right caudate head which may be related to mineralization. Remainder of the brain parenchyma demonstrates mild global parenchymal volume loss as well as mild scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with mild small vessel ischemic changes. No midline shift or herniation. No hydrocephalus. There is diffuse opacification of the right maxillary sinus. There is an 18 mm enhancing calvarial lesion in the right lateral parietal calvarium with apparent vascular continuity superiorly and inferiorly and favored to represent a venous lake. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: 1. Compared to outside MRI dated 4/19/2010, there is mild interval enlargement of meningioma in the left paraclinoid region and middle cranial fossa.2. Foci of susceptibility compatible with chronic microhemorrhages in the left frontal and bilateral parietal lobes, possibly related to amyloid angiopathy but nonspecific. These are not appreciated on the outside 2010 MRI study, which was performed with a less sensitive technique.


Instruction: Generate impression based on findings.

Input: Non suppressible leg shaking, change in sensation and subsequent numbness occurring at night several times a month. There is perhaps mild volume loss and T2 hyperintensity in the left hippocampus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: Possible left medial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: 66-year-old female with pancreatic mass last imaged on 9/8/2016 (endoscopic ultrasound). ABDOMEN:LIVER, BILIARY TRACT: Perihepatic ascites. The common bile duct is normal in caliber. No focal liver lesions.SPLEEN: Perisplenic ascites.PANCREAS: Mass like enlargement of the head of the pancreas is again noted although now decreased when compared to the prior exam dated 7/7/2016. There is decrease in surrounding T2 edema type signal. There is also decrease in duodenal wall thickening. The main pancreatic duct is normal in caliber. There is normal excretory response to secretin. There is decreased compliance of the main pancreatic duct with administration of secretin.ADRENAL GLANDS: Mild left adrenal gland thickening.KIDNEYS, URETERS: T2 hyperintense cysts are noted bilaterally. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: Unchanged T2 hyperintense elongated cystic focus in the left para-aortic region, may be lymphatic in origin. Scattered mildly prominent para-aortic lymph nodes are noted.BOWEL, MESENTERY: Small volume of abdominal and pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Partially imaged lobular pelvic lesion may represent a large uterine fibroid. Trace bilateral, right greater than left, pleural effusion. Left lower lobe consolidation may reflect infection.

Output: 1.Mass like enlargement of the pancreatic head is again noted with interval decrease in size, surrounding interstitial edema, and duodenal wall thickening when compared to prior examination. Differential diagnosis includes malignant or benign etiologies; consider granulomatous pancreatitis. Correlation with histopathology is recommend.2.Left lower lobe consolidation may represent infection.


Instruction: Generate impression based on findings.

Input: Pressure and pain. History of left occipital occipital scalp hemangioma resection. Rule out recurrence. There are unchanged postoperative changes in the left posterior scalp and underlying skull spanning the proximal, occipital and suboccipital regions. In addition, the multilobulated, T2-hyperintense, intensely contrast enhancing residual left suboccipital scalp mass is unchanged. In the axial plane, the largest, left suboccipital component of the lesion measures 5.9 cm x 1.2 cm (series #1301, image #13) compared to 6.0 cm x 1.2 cm previously. The smaller left parietal scalp lesion is minimally larger and now measures in the axial plane 1.2 cm x 0.7 cm (series #1301, image #24) compared to 1.1 cm x 0.5 cm in May 2012. A similar right parieto-occipital scalp lesion that measures in the axial plane 1.4 mm x 0.6 mm is new since May 2012 examination. The prominent left parietal cortical veins remain unchanged.Focal encephalomalacia involving the posterior left parietal lobe remain unchanged. The remainder of the brain is unremarkable without acute infarct or intracranial hemorrhage. The ventricles and other CSF-containing spaces are unchanged. There is no midline shift or brain herniation.There is no gross orbital abnormality. Mastoid air cells are clear.

Output: 1.Unchanged residual left suboccipital scalp hemangioma and associated postoperative change.2.The small left parietal scalp hemangioma is minimally larger than on the previous examination as above.3.A similar small lesion has developed in the right parieto-occipital scalp since the previous examinations. 4.Unchanged small left parietal encephalomalacia and other posttreatment findings.


Instruction: Generate impression based on findings.

Input: Lung cancer metastasis to the brain, status post SRS treatment. There are postoperative findings related to left pterional craniotomy with increased enhancement along the surgical margins and persistent high T2 signal surrounding the left temporal resection cavity. There is otherwise no evidence of intracranial mass lesions elsewhere. There appears to be a chronic lacunar infarct in the right corona radiata. There are a few other scattered nonspecific T2 hyperintense white matter lesions. There is no evidence of acute infarction or hemorrhage. There is no significant midline shift or herniation. The ventricles are unchanged in size. The skull, paranasal sinuses, and orbits appear to be unchanged.

Output: Postoperative findings in the left temporal lobe with increased enhancement along the surgical margins, which may represent tumor progression or treatment-effects. Otherwise, no evidence of intracranial metastases elsewhere.


Instruction: Generate impression based on findings.

Input: 66 year old M with HTN, history of syncope, inducible VT s/p Pacemaker, HFrEF, now with infection s/p pacemaker leads removal. Referred for MRI to assess for scar as likely etiology of VT. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. The LVEDV is 154 ml (normal range 142+/-34), the LV end diastolic volume index is 81 ml/m2 (normal range: 74+/-15), the LVESV is 79 ml (normal range 47+/-19) and the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9). There are no regional wall motion abnormalities present. There is an area of mid myocardial late gadolinium enhancement in the basal and mid anterior and septal left ventricle. This suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is within normal limits in the lateral wall and septum. It is abnormal in the area of late gadolinium enhancement (1174 ms) again suggestive of underlying diffuse fibrosis or infiltration in that region.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. The RVEDV is 145 ml (normal range 142+/-31), RV end diastolic volume index is 76 ml/m2 (normal range 82+/-16), the RVESV is 69 ml (normal range 54+/-17), and the RV end systolic volume index is 36 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal in size.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 mild 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. SVC thrombus.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.Mid myocardial late gadolinium enhancement noted in the basal and mid anteroseptal and septal left ventricle. This suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is not the pattern of prior myocardial infarction.2.Native T1 myocardial relaxation time is abnormal in the region of this late gadolinium enhancement (1174 ms) again suggestive of underlying diffuse fibrosis or infiltration in that region.3.The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%.4.The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%. 5.SVC thrombus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: r/o structural abnormality History: headache, worsening in the last year No evidence of acute ischemic or hemorrhagic lesion.There is about 1mm lower lying cerebellar tonsils through the foramen magnum, unchanged.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Interval clearance of left side sphenoid sinus opacification.

Output: No evidence of acute ischemic or hemorrhagic lesion. No mass.About 1mm low lying cerebellar tonsils through foramen magnum, unchanged.


Instruction: Generate impression based on findings.

Input: 55 year old male s/p lung transplant, on immunosuppressive medication who is found to have pericardial effusion and septal bounce on recent echo - MRI to evaluate for pericardial disease, specifically constrictive pericarditis. Left VentricleThe left ventricle is normal sized with normal function. The overall LV ejection fraction is 57%. The LVEDV is 113 ml (normal range 142+/-34), the LV end diastolic volume index is 53 ml/m2 (normal range: 74+/-15), the LVESV is 49 ml (normal range 47+/-19) and the LV end systolic volume index is 23 ml/m2 (normal range 25+/-9). The LV mass is 92 g (normal range 164+/-36) and the LV mass index is 43 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.There is septal bounce during diastole during breath-hold with leftward intraventricular septal straightening during inspiration consistent with interventricular dependence.Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal sized with mildly decreased ejection fraction. The overall RV ejection fraction is 53%. The RVEDV is 90 ml (normal range 142+/-31), RV end diastolic volume index is 42 ml/m2 (normal range 82+/-16), the RVESV is 48 ml (normal range 54+/-17), and the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is normal sized.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 a moderate sized pericardial effusion, likely loculated in the inferior aspect of the pericardium. There is likely pericardial enhancement with associated mild thickening. Probable adhesions are noted at least within the anterior and left lateral aspects of the pericardium.Extracardiac FindingsLarge bilateral pleural effusions. 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. Findings suggestive of pericardial constriction: Mild pericardial thickening and enhancement, likely loculated inferior pericardial effusion, intraventricular dependence, and probable pericardial adhesions. 2. Normal Left ventricle size and function at 57%. Normal RV size with low normal ejection fraction.3. Large bilateral pleural effusions. 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 Merkel cell cancer on right cheek, with metastasis to right orbit: protosis and restrictive eye movement on right. There is a low T2 signal, enhancing, somewhat infiltrative mass in the inferior right orbit that measures up to 16 mm in thickness and 35 mm in length. The mass is inseparable from the right inferior rectus muscle and appears to invade the right medial and lateral rectus muscles. The mass also abuts the optic nerve. The left orbit is unremarkable. There is a 5 mm diameter enhancing nodule in the left Meckel cave and a punctate enhancing nodule within the right Meckel cave. There is a partially imaged mass in the right cheek subcutaneous tissues, measuring up to 9 mm in thickness. There is mild mucosal thickening in the right maxillary sinus with a small amount of fluid. There is partly imaged diffuse periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemia.

Output: 1. An infiltrative massa in the inferior right orbit measures up to 35 mm likely represents metastatic Merkel cell carcinoma.2. Nodules in the bilateral Meckel caves, left larger than right, may also represent metastatic Merkel cell carcinoma versus schwannomas.3. The subcutaneous mass in the right cheek corresponds to the treated recurrent Merkel cell carcinoma.4. Findings suggestive of right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: Unsteadiness. Increased tone and hyperreflexia in the lower extremities. Assess for myelitis. Cervical Spine: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable apart from minimal type I degenerative signal subjacent to the C5-C6 endplates on the right, which also contrast enhances. There is multilevel disc desiccation and mild height loss. Disc-osteophyte complexes at C4-C5, C5-C6 and C6-C7 result in mild spinal canal stenosis. The cervical spinal cord displays normal signal and morphology. Uncovertebral and, to a lesser extent, facet arthropathy result in neural foraminal stenoses that is moderate to severe on the right and mild to moderate on the left at at C4-C5 and C5-C6, as well as the on the right at C3 C4. There is no abnormal intrathecal contrast enhancement. The paravertebral soft tissues are unremarkable. Thoracic Spine: The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The vertebral bone marrow signal is unremarkable. There is multilevel disc desiccation and height loss causing very shallow ventral indentations of the thecal sac but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are mild neuroforaminal stenoses on the right at T4-T5, T10-T11, T11-T12, and on the left at T7-T8, T10-T11, and T11-T12. There is no abnormal spinal cord contrast enhancement. There is prominent lower esophageal contrast enhancement and diffuse mural thickening.

Output: 1.No definite evidence of spinal cord lesions.2.Multilevel degenerative cervical and thoracic spondylosis results in neural foraminal stenoses, but no significant spinal canal stenosis.3.Prominent lower esophageal contrast enhancement and diffuse mural thickening is nonspecific but may represent esophagitis. Endoscopy may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:12/20/1943)Reason: History of chronic pain due to osteoarthritis now with acute worsening of lumbar pain with left radiculopathy. History: As aboveReferring Attending: MICHAEL T HUBER Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.Along the left perivertebral space of approximately L3-S1. There is a 7 mm fluid collection behind the left L45 facet joint.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.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.There is a 19 mm cystic lesion along the left kidney. This most likely represents a simple cyst.

Output: 1.There is a ring-enhancing lesion behind the left L4-5 facet joints associated with inflammatory change. Possibility this represents an abscess cannot be excluded. Please correlate with patient's clinical history and symptoms. Findings were reported to Kara Davey at the time of the exam.2.No compromise to lumbar spinal canal or neural foramina. There are mild degenerative changes present in the lumbar spine.


Instruction: Generate impression based on findings.

Input: Stroke: Nystagmus, N/V, hypertension. There is a punctate focus of restricted diffusion in the right middle frontal gyrus subcortical white matter, without associated susceptibility effect. There is otherwise moderate scattered cerebral white matter T2 hyperintensity bilaterally. There is a prominent perivascular space in the left pons. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is paucity of the right internal carotid artery flow void. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Punctate acute infarct in the right middle frontal gyrus subcortical white matter without evidence of hemorrhagic transformation. A background of moderate cerebral white matter signal abnormality likely represents chronic small vessel ischemic disease. Significant steno-occlusive disease involving the right internal carotid artery is better depicted on the recent CTA.


Instruction: Generate impression based on findings.

Input: Nausea and jaundice. Evaluate for CBD obstruction. History of bowel perforation end-stage renal disease and sepsis. ABDOMEN:LIVER, BILIARY TRACT: Markedly decreased liver parenchymal T2-weighted signal intensity and loss of signal on in phase imaging compatible with iron deposition. The liver measures 21 cm in length.No focal lesion.Contracted gallbladder containing intermediate attenuation sludge. No intra or extrahepatic biliary ductal dilatation. No filling defect to suggest choledocholithiasis.SPLEEN: The spleen measures 11 cm in length without a focal lesion. It is low on T2 weighted signal intensity compatible with iron deposition.PANCREAS: The pancreas is mildly atrophic. The main pancreatic duct is minimally prominent without a discrete lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: End-stage kidneys without hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Percutaneous gastrostomy tube retention balloon within the distal gastric body. Partially imaged left lower quadrant end ileostomy.BONES, SOFT TISSUES: Loculated right-sided pleural effusion with adjacent consolidation/atelectasis. Small left pleural effusion and basilar atelectasis.Scoliosis.Osseous stigmata suggestive of renal osteodystrophy.Partially imaged anterior pelvic wound.OTHER: No significant abnormality noted.

Output: 1.Sludge within a contracted gallbladder. No choledocholithiasis or biliary ductal dilatation.2.End-stage kidneys. Findings of hemosiderosis.3.Moderate size loculated appearing right-sided pleural effusion with adjacent consolidation/atelectasis.


Instruction: Generate impression based on findings.

Input: MRI brain: Artifact related to the shunt reservoir limits evaluation particularly in the susceptibility weighted and diffusion weighted images. Some of the images are also motion degraded.There are postsurgical findings related to Chiari decompression. The cerebellar tonsils are unchanged in position and morphology, and extend down to level of the upper margin of the odontoid process. Neo foramen magnum is widely patent.CINE phase contrast CSF flow sequence shows biphasic flow at the level of neo-foramen magnum. CSF flow is well visualized along the ventral aspect with diminished flow dorsally, caudal to the cerebellar tonsils, which is unchanged.There is right frontal ventriculostomy shunt catheter and reservoir with tip terminating in the region of left foramen of Monro, unchanged. The ventricular size and configuration is unchanged. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality or susceptibility within limitation of artifact related to the shunt reservoir. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. MRI spine: There is redemonstration of syringomyelia in the cervical cord which extends from C4-C5 disc space down to mid T1 level, measuring 3 x 5 mm in axial dimensions at mid C7 level, previously 3 x 5 mm, without significant interval change.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Stable very minimal degenerative changes are noted in the cervical spine predominantly at C6-C7.There is no significant neural foraminal or spinal stenosis at any levels. Paraspinal soft tissue structures are unremarkable.

Output: 1. Stable postoperative findings of posterior fossa decompression for Chiari malformation and right frontal ventriculostomy. Ventricular size and configuration is unchanged.2. No evidence of intracranial hemorrhage or mass.3. Cervical syringomyelia extends from C4-C5 disc space down to mid T1 level, without significant change in size and morphology.4. Mild degenerative changes in the cervical spine without significant neuroforaminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: There is mild loss of lumbar lordosis. Alignment is grossly within normal limits. Severe degenerative disk disease affects L5-S1, and moderate degenerative disk disease affects L4-5. The other vertebral disk spaces are relatively preserved. Vertebral body heights are preserved without fracture. There is a L2 vertebral body hemangioma, and probable small subcentimeter hemangiomas involving the superior endplate of L3 and the inferior endplate of L4. The conus medullaris terminates at the level of the T12 vertebral body. Image portions the distal cord and nerve roots appear normal in caliber and signal. The imaged paraspinal soft tissues are unremarkable. Additional level specific findings are as follows:T12-L1: No significant degenerative disk disease, central canal, or neural foraminal stenosis.L1-L2: No significant degenerative disk disease, central canal, or neural foraminal stenosis.L2-L3: No significant degenerative disk disease, central canal, or neural foraminal stenosis.L3-L4: Minimal disk bulge and mild facet degenerative changes. No significant neural foraminal or central stenosis.L4-L5: Degenerative disk disease with disk bulge, ligamentum flavum thickening, and advanced facet degenerative changes results in mild central stenosis. There is moderate-severe left and mild to moderate right neuroforaminal narrowing.L5-S1: Severe degenerative disk disease with loss of disc space. There is a disk bulge with central protrusion. There are facet degenerative changes. There is no significant central canal stenosis. Mild to moderate bilateral neuroforaminal narrowing.

Output: 1. Degenerative changes in the lumbar spine at the L4-L5 and L5-S1 levels as detailed above. There is mild spinal canal stenosis at L4-L5. Otherwise no significant spinal canal stenosis. There is bilateral neural foraminal narrowing at L4-L5 and L5-S1 as described above.2. Facet arthropathy, particularly at the L4-L5 level, which may be contributory patient's low back pain.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the left maxillary sinus. Otherwise the paranasal sinuses and mastoid air cells are clear. Cervical spine MRI:There is slight straightening of the cervical spine which is likely positional. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: UnremarkableC3/4: Mild disc bulge without significant associated mass effect or stenosis.C4/5: UnremarkableC5/6: There is a small left paracentral disc protrusion without significant associated mass effect or stenosis which abuts traversing nerve roots.C6/7: UnremarkableC7/T1: UnremarkableSagittal images demonstrate a T2/3 small bulge/protrusion which causes slight anterior cord flattening without intrinsic cord signal abnormality or resulting stenosis.

Output: 1.C5/6: There is a small left paracentral disc protrusion without significant associated mass effect or stenosis which abuts traversing nerve roots.2.Sagittal images demonstrate a T2/3 small bulge/protrusion which causes slight anterior cord flattening without intrinsic cord signal abnormality or resulting stenosis.3.No MRI evidence of syrinx as clinically questioned.


Instruction: Generate impression based on findings.

Input: Again seen are multiple T2 hyperintense lesions in the periventricular and subcortical supratentorial white matter as well as multiple lesions in the posterior fossa consistent with known demyelinating disease. Two previously seen lesions in the body and right posterior aspect of the corpus callosum are decreased in size compared to prior. Lesion in the left inferior cerebellar peduncle and T2 hyperintensity adjacent to the temporal horn of the right lateral ventricle are both less conspicuous. No new lesions are identified allowing for differences in technique. Several lesions with T1 hypointensity also noted. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect.

Output: Allowing for differences in technique, no new lesions are seen compared to 7/12/2014 to suggest progression of demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

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

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Reason: any change in the plexiform neurofibroma? History: girl with NF1 and plexiform neurofibroma which is getting larger and is associated with pain now. Left arm pain. There is no discrete mass evident involving the visualized left-sided cervical nerve roots or proximal left brachial plexus. Plexiform neurofibroma involving the posterior aspect of the left arm is better assessed on separate MRI humerus study. There is however extension medially to involve the distal brachial plexus/ branches at the level of the axilla which is similar to prior.Small neurofibromas along the upper bilateral intercostal nerves are present similar to prior. There also few scattered T2 hyperintense lesions involving the visualized subcutaneous soft tissues compatible with small neurofibromas.

Output: The large left arm neurofibroma is better imaged on the separate MRI humerus study, although there is medial extension into the brachial plexus branches at the level of the axilla as before. No discrete mass involving the visualized cervical nerve roots or proximal brachial plexus.


Instruction: Generate impression based on findings.

Input: Patient with history of right shoulder dislocation x15, most recent 3 weeks ago, evaluate for labral tear. ROTATOR CUFF: There is focal tearing of the undersurface of the supraspinatus tendon at approximately 1.5 cm proximal to its insertion site. A thin linear collection of gadolinium extends distally within the substance of the tendon from this tear, suggesting a component of focal delamination. Overall this tearing affects less than 50% of the width of the tendon and we see no full thickness tearing of the tendon. The supraspinatus muscle is intact. There is also a small focal undersurface tear of the infraspinatus tendon immediately proximal to its insertion site, best seen on the sagittal oblique series 6. The infraspinatus muscle is intact. The teres minor tendon and muscle appear intact. The subscapularis tendon and muscle appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal and there is no fluid in the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is normal. However, the majority of the anterior labrum is absent, including the anterior inferior labrum. The anterior inferior glenohumeral ligament is not visualized on the ABER sequences. Posterior labrum is intact. We suspect that there is tearing of the anterior superior labrum, but posteriorly the superior labrum appears intact. There is slight depression of the posterior aspect of the humeral head indicating a Hill-Sachs deformity.BICEPS TENDON: Tendon of the long head of the biceps appears normal.

Output: Nonvisualization of the anterior labrum and Hill-Sachs deformity, compatible with stated history of recurrent shoulder dislocations.


Instruction: Generate impression based on findings.

Input: Homonymous bilateral field defects, right side [H53.461] / Migraine with aura, not intractable, without status migrainosus [G43.109], Reason for Study: ^Reason: 74 year old female with old history of headaches, with acute onset of visual aura followed by No evidence of acute ischemic or hemorrhagic lesion.Few scattered FLAIR high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease. There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Lens replacement on the right side.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.3. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: right shoulder with possible rotator cuff tear of supraspinatus possible infra. History: pain and lack of range of motion ROTATOR CUFF: There are complete tears of the supraspinatus and infraspinatus tendons with up to 4 cm of retraction. The intervening gap is filled with intermediate signal intensity which presumably represents a combination of synovitis and debris. There is minimal fatty atrophy of the supraspinatus and infraspinatus along the myotendinous junction. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: The acromioclavicular joint is normal for age. There is a small amount of fluid within the subacromial/subdeltoid bursa with foci of low signal intensity anteriorly which may reflect debris or synovitis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is a small to moderate sized glenohumeral joint effusion. The glenoid labrum appears intact.BICEPS TENDON: There is fluid within the tendon sheath of the long head of the biceps tendon that likely represents fluid extension from the joint, however, the tendon itself appears normal. ADDITIONAL

Output: Complete retracted tears of the supraspinatus and infraspinatus tendons with other findings as described above.


Instruction: Generate impression based on findings.

Input: History of tectal glioma, evaluate for change. There are postoperative findings related to right transfrontal biopsy of a periaqueductal lesion with persistent susceptibility effect and T2 hyperintensity along the surgical tract related to prior hemorrhage. There is no significant interval change in the subcentimeter nonenhancing, T2 hyperintense lesion within the tectum. There are a few scattered punctate foci of increased T2/FLAIR signal within the periventricular white matter, not significantly changed. There is a new curvilinear focus of increased T2/FLAIR signal within the left cerebellar hemisphere with associated faint enhancement compatible with interval small lacunar infarct. There is no associated restricted diffusion to suggest acute ischemic infarction.The ventricles and basal cisterns are unchanged in size and configuration. 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.Minimal mucosal thickening is present within the paranasal sinuses. The orbits and skull are grossly unremarkable.

Output: 1.Postoperative findings related to biopsy of a periaqueductal lesion, which has not significantly changed in size.2.Stable foci of nonenhancing white matter signal abnormality, with likely new now subacute small lacunar infarct in the left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: 61-year-old male patient status post prostatectomy with detectable PSA. History of surgical complication and negative biopsy of prostate bed mass. PELVIS:PROSTATE: The patient is status post prostatectomy. Within the prostatectomy bed, there is a multicystic, lobulated mass measuring up to 4.4 x 3.5 cm in the axial dimension, which appears to correlate with an abnormality seen on prior CT and is similar in size. There are multiple fluid-fluid levels within the mass and intrinsic T1 hyperintensity suggesting blood products or proteinaceous material. There is no appreciable enhancement of this lesion. BLADDER: No significant abnormality noted.LYMPH NODES: No significant pelvic lymphadenopathy. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multicystic, lobulated mass within the prostatectomy bed of uncertain etiology; this would be unusual for prostate adenocarcinoma recurrence and is felt to be more likely benign in etiology, but not classic for lymphocele. Correlate with operative report for removal of seminal vesicles as their appearance would be similar.


Instruction: Generate impression based on findings.

Input: Left upper extremity numbness and weakness. There are postoperative findings related to right transfrontal biopsy of the medullary and upper cervical spinal cord lesion, which has decreased in size and demonstrated considerably less enhancement. There is high T2 signal and enhancement along the biopsy tract in the right frontal lobe, but no additional lesions within the brain, There is no evidence of acute infarct. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The paranasal sinuses and orbits are unremarkable. 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: Interval decrease in size and enhancement of the medulla and upper cervical spine cord lesion,


Instruction: Generate impression based on findings.

Input: 66-year-old man with history of orthotopic liver transplant, now with fever and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: Patient is status post orthotopic liver transplant. No focal hepatic lesion is identified. The liver is normal in signal and morphology.There is focal narrowing at the biliary enteric anastomosis with the extrahepatic bile duct measuring up to 8 mm in diameter (15/85). Questionable T2 hypointense material within the extrahepatic bile duct is suggestive of sludge. No obstructing stone or extrinsic obstructing lesion identified. Additionally, there is mild diffuse intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is atrophic, otherwise normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lateral ventral hernias again noted with postoperative changes in the anterior midabdomen.OTHER: No significant abnormality noted.

Output: 1.Mild narrowing at the biliary enteric anastomosis with mild intra and extra hepatic ductal dilatation.2.Possible sludge in the bile duct, but no stone or extrinsic compressing mass.3.Limited examination with field of view not including the liver on postcontrast imaging. Postcontrast images will be repeated at no cost to the patient and addendum to this report will be issued at that time.


Instruction: Generate impression based on findings.

Input: Male, 7 years old, with altered mental status, seizure like activity, and peripheral tingling of the digits. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The mesial temporal lobe structures are symmetric and normal.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. C-spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No abnormalities of the intervertebral disks are seen. The spinal canal and neural foramina are patent. The visualized spinal cord shows normal signal intensity and morphology.

Output: Unremarkable evaluation of the brain and cervical spine with no specific findings to account for the patient's symptoms.