Instruction: Generate impression based on findings.

Input: Diagnosis: Subdural hemorrhageClinical question: past history of SDH with subarachnoid blood - please assessSigns and Symptoms: stable The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated intracranially.A focus of encephalomalacia is present along the left frontal lobe orbital gyrus. This is associated with signal change on susceptibility weighted imaging. This was not present on the exam of 8/23/2013. There is an intraparenchymal hemorrhage in this location identified on the 10/18/2014 head CT.There are foci of T2 and FLAIR signal hyperintensity present in the right temporal lobe centered at the right superior temporal gyrus, right orbital gyrus extending to the right inferior frontal gyrus and the right some central lobule. There is evidence of prior subarachnoid hemorrhage, small intraparenchymal hemorrhage and subdural hemorrhage adjacent to these lesions on the 10/18/2014 CT of the head exam.There is pachymeningeal thickening present adjacent to the right parietal lobe.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are unchanged since the prior examNo 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.There is hypertrophy of the cruciate ligaments present which appears to mildly progressed since the prior exam..

Output: 1.Since the previous examination the patient has developed a focus of encephalomalacia in the left frontal lobe suspected to represent sequela of prior traumatic brain injury.2.There are multiple lesions involving gray and white matter at the right frontal lobe, right temporal lobe and right some central lobule. These could potentially the sequela of prior subarachnoid, intraparenchymal and subdural hemorrhage.3.Right sided pachymeningeal thickening adjacent to the right parietal lobe is nonspecific but can be related to sequela of prior subdural hematoma or infection . It is conceivable that similar thickening may be seen with granulomatous disorder and lymphoma depending on the clinical history.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: 15 years Female (DOB:9/2/2000)Reason: eval for spondylolysis History: lpb worth sports for months, volleyballPROVIDER/ATTENDING NAME: HOLLY JOAN BENJAMIN HOLLY JOAN BENJAMIN Five nonrib-bearing lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. It appears that L5 is sacralized and there is a formed disc at the lumbosacral junction. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disc desiccation at this level associated with loss of disc space height and a mild disc bulgeAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.Please note that based on the premise that all lumbar vertebrae are nonrib-bearing vertebrae, L5 is a transitional vertebra and is sacralized.2.Based on the above enumeration there is L4-5 disc bulge without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with left-sided weakness for three weeks and urinary incontinence. Brain:Numerous (greater than 20) T2 hyperintense lesions are identified within the juxtacortical and periventricular regions of both cerebral hemispheres, as well as within the brainstem and cerebellum. Many of these lesions are oriented radially with respect to the ventricles. Several of these lesions demonstrate corresponding enhancement. None is associated with significant local or regional mass effect. Brain parenchymal volume is relatively preserved. No significant generalized mass effect is seen. No evidence of acute or chronic intracranial hemorrhage is detected. The ventricles are normal in size and morphology.Spine:A T2 hyperintense lesion is evident occupying the left lateral and anterior aspects of the cervical spinal cord. This lesion spans from C1 to C2 and measures up to 25 mm in craniocaudal length. This lesion demonstrates minimal if any rim enhancement. A small T2 hyperintense lesion is evident within the anterior cord at the T8 level. An additional T2 hyperintense lesion is evident within the anterior spinal cord at the T11 level measuring up to 25 mm in length. This lesion demonstrates mild ill-defined enhancement. The nerve roots of cauda equina are within normal limits. No additional pathologic enhancement is seen. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow enhancement is seen. Scattered minimal disc protrusions are seen in the thoracic spine. No significant spinal canal or foraminal narrowing is evident at any spinal level.

Output: Numerous intracranial and spinal cord lesions are identified showing morphology and distribution compatible with demyelinating disease. Some of these lesions are enhancing which would indicate active inflammation/demyelination.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for spinal stenosis. Signs and symptoms: Weakness with walking. Nonenhanced lumbar MRI:There is unremarkable signal intensity of the vertebral column and with normal anatomical alignment.Examination at T12-L1 through L3-L4 levels demonstrate mild degenerative changes however without spinal stenosis or neural foraminal compromise. Incidental note is made of a well demarcated CSF signal intensity in the left neural foramina at T11-T12 without evidence of neural foraminal widening. Finding is highly suggestive of a small Tarlov or perineural cyst of no clinical significance.L4-L5 demonstrate mild disc disease and moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Mild bilateral facet space widening and effusion at this level is also noted. Constellation of changes results in significant central spinal stenosis as well as moderate to severe bilateral neural foraminal compromise.L5-S1 demonstrate mild disc desiccation and severe bilateral facet hypertrophy and including bilateral facet effusion and moderate ligamentum flavum hypertrophy. There is a right para median annular fissure. Mild central spinal stenosis and moderate bilateral (R>L) neural foraminal compromise is also detected.There are bilateral Tarlov cysts in the sacral spine.Unremarkable paraspinal soft tissues.

Output: 1.Degenerative changes at L4-L5 (more noticeably of the posterior elements) results in significant central spinal stenosis with bilateral neural foraminal compromise.2.Mild Central spinal stenosis at L5-S1 and with moderate bilateral neural foraminal compromise. There is a small right paramedian annular fissure at this level.3.Unremarkable images at all other


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB: 1/29/1961)Reason: Eval for demyelinating lesions History: neck pain and paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a mild disk bulge at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There are small perineural cysts at this level.The vertebral artery flow voids appear to be intact.

Output: 1.There a mild degenerative changes in the cervical spine without significant compromise to the spinal canal or neural foramina.2.There is no convincing evidence for demyelinating lesion in the cervical spinal cord..


Instruction: Generate impression based on findings.

Input: Again seen is left parietal intraparenchymal hematoma measuring 3.4 x 3.0 cm with adjacent edema similar to recent CT. There is FLAIR hyperintensity in the left frontal lobe involving the left middle frontal gyrus with suggestion of volume loss, which may be related to prior infarct. There is also additional scattered increased T2/FLAIR signal abnormality in the bilateral subcortical and periventricular white matter which are nonspecific but compatible with chronic small vessel ischemic disease. There are multiple abnormal areas of leptomeningeal enhancement within the left frontal lobe along the left middle frontal gyrus as well as inferiorly, left parietal lobe, left inferior temporal lobe, left posterior temporal and left occipital lobes. These findings are concerning for leptomeningeal metastatic disease. There is abnormal enhancement associated with the left parietal hematoma. There is linear areas of enhancement and susceptibility effect in the left superior parietal lobule and left temporo-occipital lobes likely representing leptomeningeal tumor with blood products. Major flow-voids are preserved. No midline shift or herniation. Calvarium is intact.

Output: 1.There are multiple abnormal areas of leptomeningeal enhancement within the left frontal lobe along the left middle frontal gyrus as well as surfaces of the inferior frontal lobe, left parietal lobe, left posterior temporal and left occipital lobes. There is susceptibility effect in some of these areas compatible with chronic blood products. Findings are suspicious for leptomeningeal metastatic disease. 2.Stable left parietal intraparenchymal hematoma with abnormal associated enhancement which is at least predominantly leptomeningeal. No additional foci of abnormal intraparenchymal enhancement are definitively appreciated. 3.Probable chronic infarct in the left frontal lobe.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness, numbness. Rule out infection/compression. Five lumbar type vertebral bodies are presumed to be present. Hypoplastic ribs are present at T12. There is transitional anatomy involving the L5 level with pseudoarticulation involving the right L5 transverse process with the sacrum, better seen on recent CT abdomen. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L1 on L2 and L3 on L4 and minimal anterolisthesis of L4 on L5. Bone marrow signal is benign. The conus medullaris is normal in position. No abnormal enhancement involving the cauda equina nerve roots. No edema or abnormal enhancement to suggest discitis-osteomyelitis or epidural abscess. No paraspinous fluid collections.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy. No spinal canal or neural foraminal stenosis.L3-L4: Disc bulge with small central protrusion, mild facet arthropathy, and ligamentum flavum thickening. There is no significant spinal canal stenosis. There is mild bilateral neural foraminal stenosis.L4-L5: Mild disc bulge, ligamentum flavum thickening, and advanced bilateral facet arthropathy. No significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.L5-S1: No significant disc disease. Mild to moderate facet arthropathy. Pseudoarticulation involving the right L5 transverse process and the sacrum noted. No significant spinal canal or neural foraminal stenosis.

Output: 1. No findings to suggest infection in the lumbar spine. Specifically, no discitis-osteomyelitis, epidural abscess, or paraspinous abscess.2. Multilevel degenerative changes as detailed above without high-grade spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 44-year-old male status with bilateral DBS insertion. Interval placement of bifrontal DBS electrodes entering the frontal bones bilaterally and terminating in the region of the cerebral peduncles bilaterally. Foci of pneumocephalus are consistent with the patient's history of recent DBS insertion. There is no evidence of postoperative hemorrhage or hematoma formation. There is no evidence of intracranial hemorrhage, extra-axial fluid collection, mass or edema. There is no mass effect or midline shift. There is preservation of the gray-white matter interface. There is no evidence of acute territorial ischemia. The ventricles and basal cisterns are normal in size and configuration. There is no effacement of the basal cisterns. Redemonstration of posterior fossa arachnoid cyst better demonstrated on recent MRI examination.Bilateral bifrontal bone burr holes. The calvaria and skull base are otherwise radiographically normal. The visualized mastoid air cells and paranasal sinuses are within normal limits.

Output: 1. Expected postoperative changes from interval placement of bilateral DBS electrodes without evidence of complication.2. Posterior fossa arachnoid cyst, unchanged.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:12/17/1957)Reason: etiology of L sided weakness History: LUE and LLE weaknessPROVIDER/ATTENDING NAME: KOUROSH L REZANIA KOUROSH L REZANIA There is redemonstration of ventriculomegaly and confluent periventricular white matter signal hyperintensities extending to the subcortical white matter. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently 42 mm and previously was 40 mm. Third ventricular diameter at the level of the massa intermedia is 8 mm on the current exam and was 8 mm on the prior exam. Fourth ventricle also appears similar. Corpus callosum is thin.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is diffuse cerebral atrophy present and loss of white matter which has very subtly progressed since the prior exam. There is no evidence for acute cerebral ischemic infarction. Underlying etiology is uncertain.


Instruction: Generate impression based on findings.

Input: Epilepsy There is irregularity and thickening of the cortex along the right sylvian fissure (mostly posteriorly) compatible with polymicrogyria. This involves the right frontotemporal and parietal opercula including the supramarginal gyrus.Remainder of the brain demonstrates no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No findings to suggest cortical dysplasia or heterotopic gray matter. Ventricles are within normal limits without evidence of hydrocephalus. No extra-axial collections. Major flow-voids are intact. Calvarium and extracranial structures unremarkable.

Output: Findings most consistent with polymicrogyria along the sylvian fissure involving the right frontal, temporal, and parietal lobes.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, the inferior most fully formed intervertebral disc space is considered to be the L5-S1 disc space. There is mild straightening of the lumbar lordosis which may be positional. There is minimal retrolisthesis of L2 over L3. The vertebral body heights and intervertebral disc spaces are maintained. The no worrisome focal marrow signal is demonstrated. The distal spinal cord and cauda equina demonstrate normal caliber and signal intensity. The conus terminates at L1-2.L1-2: No significant disc herniation, neuroforaminal stenosis or spinal canal stenosis is noted at this level.L2-3: There is a mild diffuse disc bulge with suggestion of an annular fissure and small left extraforaminal protrusion contacting the left L2 nerve root. There is mild facet arthropathy and tiny small synovial cyst posterior to the right facet joint better seen on sagittal STIR sequence.L3-4: No significant disc herniation, neuroforaminal stenosis, or spinal canal stenosis is noted at this level.L4-5: There is a mild diffuse disc bulge with central/right paracentral protrusion without significant central spinal canal or neural foraminal stenosis at this level.L5-S1: There is a minimal diffuse disc bulge without significant neuroforaminal or spinal canal stenosis at this level. Mild hypertrophic degenerative changes of the posterior facets are demonstrated.

Output: Mild degenerative changes of the lumbar spine, relatively worse at L2-3 where there is a mild diffuse disc bulge and suggestion of a small left extraforaminal protrusion which may be contacting the left L2 nerve root. There is no significant spinal canal stenosis at any level. There is also no high-grade neural foraminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: 56-year-old female patient with personal history of left mastectomy in 2011 for IDC and right lumpectomy for carcinoma 2003. Patient received chemotherapy and radiation. Family history of breast cancer in her maternal aunt and cousin. There is scattered fibroglandular tissuein the right breast.Mild parenchymal enhancement is noted in the right breast.No abnormal enhancement is seen in the right breast. There are stable postlumpectomy changes at the 12:00 position in the right breast. Status post left mastectomy and reconstruction. No abnormal enhancement is seen in the reconstructed left breast.No abnormal axillary 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: Clinical question: Hepatic encephalopathy, now with acute mental status change, only responsive to pain. Signs and symptoms: Altered mental status. Very minimal blood adjacent to right frontal pressure monitor is again identified with no interval change. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus since prior study. No definitive evidence of edema or parenchymal air is detected. Cortical sulci, ventricular system and all CSF cisterns are stable since prior study. Extensive opacification of all paranasal sinuses with interval worsening since prior exam. The above findings could be related to instrumentation.Further evaluation with an MRI is recommended.

Output: No definitive evidence of any new finding since prior exam. Please see above comments.


Instruction: Generate impression based on findings.

Input: Clinical question: History of pituitary adenoma status post resection and RT. Signs and symptoms: Surveillance. Pre- and post enhanced pituitary MRI:Examination redemonstrate and expanded sella without interval change. Patchy ill-defined and very irregular residual enhancing soft tissue within the sella is again demonstrated and could represent a combination of residual pituitary tumor and postop changes. This enhancing tissue measures maximum of 7 mm intracranial cephalad access in the midline compared to prior study measurement of 7.4 mm. Pituitary stalk is difficult to identify atelectasis secondary to atrophy and postop changes which is also similar to prior study. There is no convincing evidence of abnormality of the cavernous sinuses. There is evidence of inferior herniation of the suprasellar visual complex similar to prior exam and likely as a result of treatment.Signal void of internal carotid arteries through the cavernous sinuses and in supraclinoid segments are identified and unremarkable.

Output: 1.Fairly stable very irregular and ill-defined residual enhancing tissue within the expanded sella as detailed/measured above. 2.Inferior herniation of suprasellar visual complex similar to prior exam and likely as a result of treatment.


Instruction: Generate impression based on findings.

Input: Evaluate for evidence of recent stroke. Right leg weakness for about 8 weeks. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, including prominent scattered perivascular spaces. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implants. There are partially-imaged degenerative changes in the upper cervical spine.

Output: 1. No evidence of acute infarction, intracranial hemorrhage, or mass.2. Partially-imaged degenerative changes in the upper cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: meniscus tear, ligament injuries History: significant swellings of the knee and pain. Evaluation is limited due to patient motion artifact.MENISCI: Attenuation of the posterior horn of the medial meniscus likely reflects chronic attritional tearing. Signal abnormality within the posterior horn and body of the medial meniscus extending to the tibial articular surface likely reflects additional undersurface tearing. There is slight medial extrusion of the body of the medial meniscus. The anterior horn of the medial meniscus is relatively intact.The lateral meniscus appears normal for age.ARTICULAR CARTILAGE AND BONE: Moderate to severe degeneration of the articular cartilage of the medial tibiofemoral compartment with foci of full-thickness cartilage loss concentrated along the weightbearing portions. Edema-type signal within the anterior aspect of the medial tibial plateau and medial femoral condyle likely is degenerative in etiology, although could conceivably represent bone contusions.Much of the lateral facet of the patella is devoid of articular cartilage with relatively mild degeneration of the medial facet articular cartilage. Near full-thickness to full-thickness degeneration of the lateral facet of the femoral trochlea with underlying subchondral cyst formation and relatively mild degeneration of the articular cartilage of the medial facet of the femoral trochlea.Moderate degeneration of the articular cartilage of the lateral tibial plateau particularly along the tibial spine with underlying subchondral cyst formation.Tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Osteoarthritis as described above, most severely affecting the medial tibiofemoral and patellofemoral compartments with medial meniscal tearing as described above.2.The ligaments appear intact.


Instruction: Generate impression based on findings.

Input: Reevaluate extent of disease in patient with HCC. Ascites, abdominal pain. ABDOMEN: Limited study due to significant dielectric effect due to ascites.LIVER, BILIARY TRACT: Post changes of right partial hepatectomy. Cirrhotic morphology of the remaining liver.Bilobar numerous arterial enhancing masses with washout consistent with multifocal HCC, significantly increased in size from prior.Reference segment 4 lesion is 3.7 x 3.4 cm (series 1601, image 227), previously 2.7 x 2.6 cm. Additional nonreference lesion are also larger.Postsurgical findings of cholecystectomy. Intrahepatic right portal vein is blunted at its distal end and the left portal vein is not visualized, unchanged. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Edematous wall thickening of the right colon and diffuse small bowel wall thickening, likely related to portal hypertension.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of ascites.

Output: Significant interval progression of bilobar multifocal HCC. Limited study due to dielectric effect from large amount of ascites; for follow-up exams, consider doing a paracentesis prior to MRI for improved diagnostic quality.


Instruction: Generate impression based on findings.

Input: 9-year-old female with headaches and two episodes of loss of consciousness. There is no evidence of intracranial hemorrhage, mass, or acute infarct. No heterotopic gray matter is identified, and the sulcal/gyral patterning is unremarkable. The white matter is fully myelinated. 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: Normal examination, no findings seen to account for the patient's headaches and loss of consciousness.


Instruction: Generate impression based on findings.

Input: There is slight reversal of upper cervical curvature 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. There are no significant degenerative changes. There are no stenoses.

Output: Negative noncontrast cervical spine MRI. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: There is a nonenhancing focus of T2 and FLAIR abnormality in the subcortical white matter of the right temporal lobe measuring 8 mm, unchanged since the previous study. There is no evidence of hemorrhage, mass effect, or edema. Ventricular size is normal. No evidence of midline shift. No evidence of herniation. Basal cisterns are patent. A 13 x 16 mm of calvarial subcutaneous nodule with low T1 signal and heterogenous high T2 signal and homogenous enhancement is seen overlying the right superotemporal orbital rim, unchanged from the most recent as well as oldest MRI. There is a small osseous component of the lesion as seen on the previous CT of 11/17/2009.There is no restricted diffusion or susceptibility abnormality.There is a retention cyst in both maxillary sinuses.The flow voids of the visualized internal carotid arteries and the cerebral arteries are normal.

Output: 1. Hemangioma overlying the soft tissue of the right superior temporal orbital rim with a small osseous component, unchanged since 2009.2. The high T2 signal abnormality noted previously in the right temporal lobe is unchanged.


Instruction: Generate impression based on findings.

Input: View ventricular size and any loculated areas for pre-op planning: prior EVD placement for onset of hydrocephalus after GBS meningitis. Brain: There is persistent, albeit slightly decreased, marked enlargement of the ventricular system, with interval insertion of a right transfrontal ventricular catheter that terminates in the left lateral ventricle, with a small amount of pneumocephalus. There is a defect in part of the septum pellucidum. There are persistent areas of cystic encephalomalacia and/or porencephaly, mainly in the bilateral posterior and inferior portions of the cerebral hemispheres and left frontal lobe. In particular, a cystic component in the right parietal lobe measures up to approximately 25 mm. There is now diffuse prominence of the bilateral supratentorial subdural spaces, particularly overlying the collapsed anterior left temporal lobe, measuring up to approximately 25 mm in width. There is extensive diffuse cerebral and brainstem white matter volume loss, but no evidence of acute infarction. There is susceptibility effect along the choroid plexi and posterior margins of the lateral ventricles related to chronic blood products, but no evidence of acute intracranial hemorrhage. In addition, there are punctate foci of susceptibility effect along the left caudothalamic groove and posterior fourth ventricular margin, also consistent with chronic hemorrhage. There are punctate foci of T1 hyperintensity in the bilateral basal ganglia. There is no midline shift or herniation. There is no evidence of acute infarction or hemorrhage. The orbits are unremarkable.Pituitary: The pituitary gland is normal in size and signal characteristics, including a posterior pituitary bright spot. The infundibulum is intact.

Output: 1. Findings compatible with extensive diffuse chronic cerebral infarction related to neonatal group B streptococcal meningitis with persistent areas of cystic encephalomalacia and/or porencephaly, 2. New subdural fluid collections, likely commensurate to slightly diminished ventriculomegaly, status post interval right transfrontal shunt catheter insertion.2. The pituitary gland appears to be unremarkable.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with paranoid delusions, possible metastases to the brain, with non-small cell lung cancer. No evidence of parenchymal edema, mass effect or pathologic intracranial enhancement is seen. Diffusion-weighted images are within normal limits. Minimal scattered nonspecific white matter T2 hyperintense lesions are seen. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricular size and morphology are normal. Fluid signal is evident in the mastoid air cells.

Output: 1.No evidence of intracranial metastases.2.No other specific findings which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 23 years old. Reason: r/o fx. Fell 2.5 weeks ago, pain with weight bearing proximal to second toe History: pain x 2.5 weeks distal 2nd metatarsal We see no findings to suggest an etiology for the patient's distal second metatarsal pain. There is slight widening of the interval between the medial cuneiform and the base of the second metatarsal. Furthermore, there appears to be slight lateral translation of the second metatarsal relative to the middle cuneiform as seen on the oblique view. While these findings may not be of any current clinical significance, if there is concern for Lisfranc injury, MRI can be considered for further evaluation.

Output: 1.No findings to suggest an etiology for the patient's pain at the distal second metatarsal.2.Slight lateral translation of the second metatarsal with respect to the middle cuneiform is of questionable current clinical significance, but if there is concern for Lisfranc injury, MRI can be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: History of odontogenic abscesses, osteomyelitis: persistent facial swelling. The images are degraded by patient motion. There has been interval removal of packing material from the left upper neck wound. There is interval decrease in size of the masticator space fluid collections, with a residual collection that measures 12 x 16 x 50 mm within the anterior belly of the left temporalis muscle, surrounding the coronoid process. There is a background of residual extensive diffuse edema mainly in the lateral masticator space soft tissues. There is also signal abnormality in the left mandibular ramus. In addition, there are mild inflammatory changes in the anterior left parotid gland. There is left otomastoid fluid, likely due to Eustachian tube dysfunction. There is extensive mucosal thickening within the maxillary and ethmoid sinuses.

Output: Involution of the extensive left masticator space infectious process with decrease in size of the left temporal fossa fluid collection that likely represents an abscess involving the anterior belly of the temporalis muscle, and persistent myositis, cellulitis, and left mandibular osteomyelitis, as well as probable partial left parotitis. Assessment is otherwise limited by the lack of intravenous contrast and excessive patient motion. Furthermore, a CT may be useful to further assess the dentition.


Instruction: Generate impression based on findings.

Input: 47 years Male (DOB:4/21/1969)Reason: 3 t scaner s/p resection History: surveillancePROVIDER/ATTENDING NAME: PETER C. WARNKE PETER C. WARNKE The patient is status post left craniotomy and left temporal lobe surgery for removal of a left temporal lobe mass known to represent a glioblastoma. Since the prior exam postoperative effects on the left temporal lobe have regressed. There is adjacent dural enhancement. There is no clear evidence of residual enhancing neoplasm. There is a small nodular enhancement in the periphery inferiorly of the left temporal lobe which is suspected to represent meningeal reaction adherence to the pia matter. There is associated ex vacuo effect on the left lateral ventricle temporal horn.Incidental note is made of a developmental venous anomaly in the right frontal lobe.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 demonstrate opacification of the left mastoid air cells which are hypoplastic.. The visualized portions of the orbits are intact.

Output: Since the prior examination postoperative effects in the left temporal lobe have regressed. There is no convincing evidence for tumor. Curran's at this time. A punctate focus of nodular enhancement at the inferior aspect of the left temporal lobe is suspected to represent postoperative change, follow-up exam would help confirm this.


Instruction: Generate impression based on findings.

Input: Low thoracic pain, rule out disk herniation or nerve compression Thoracic vertebral body heights are maintained. There is mild thoracic dextrocurvature. Alignment is otherwise maintained. No significant spinal canal or neural foraminal stenosis is seen. Thoracic cord is normal in signal and contour. Bone marrow signal is benign with no suspicious lesions. Small perineural cysts are incidentally noted at the T1-2 level.Mild degenerative changes are seen. Minimal disk bulges are seen at T2-T3, T3-T4, and T5-T6 without significant spinal canal or neural foraminal stenosis. No significant disk disease in the lower thoracic spine is appreciated. There is facet arthropathy at the T11-T12 and T12-L1 levels. Disk osteophyte complex at the C6-C7 level is noted without significant spinal canal stenosis.

Output: 1. Mild degenerative changes in the thoracic spine without significant spinal canal or neural foraminal stenosis at any level.2. Facet arthropathy in the lower thoracic spine at the T11-T12 and T12-L1 levels which may be contributing to patient's lower thoracic pain.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with left temporal tumor. Preoperative planning exam. A large peripherally enhancing, centrally necrotic tumor is evident centered on the inferior aspect of the left anterior temporal lobe. In the axial plane, the enhancing component of the lesion measures up to 50 x 39 mm. Extensive T2 signal abnormality spreads from the lesion into the adjacent left temporal lobe, a portion of the left parietal lobe, the left thalamus and adjacent white matter capsules, and into the left cerebral peduncle. Significant regional mass effect is seen in the form of sulcal effacement, medialization of the left uncus, effacement of the left lateral ventricle, rightward displacement of the brainstem and a generalized midline shift to the right of approximately 6 mm.Subcentimeter foci of T2 hyperintensity within the orbital gyri of the bilateral inferior frontal lobes are nonspecific. A developmental venous anomaly is evident in the right corona radiata. Patchy opacification of the left mastoid air cells seen.

Output: Demonstration of a large peripherally enhancing and centrally necrotic tumor centered on the anterior left temporal lobe.


Instruction: Generate impression based on findings.

Input: Pain after injury MENISCI: There is mildly increased signal within the posterior horn of the medial meniscus suggesting degeneration although there is no discrete tear identified within either lateral or medial menisci.ARTICULAR CARTILAGE AND BONE: Scattered areas of partial and full-thickness articular cartilage loss are seen in the medial patellar facet. There is diffuse thinning of the articular cartilage of the lateral compartment without full-thickness defect. Moderate articular cartilage loss of the patellofemoral compartment is also noted particularly involving the lateral patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Varying degrees of articular cartilage loss which is worst in the medial compartment which contains small areas of full-thickness defects.2. Small joint effusion.


Instruction: Generate impression based on findings.

Input: 61-year-old female with lower extremity wounds, assess for osteomyelitis. Left foot: There is diffuse edema of the subcutaneous soft tissues without evidence of discrete fluid collection or sinus tract. Marrow signal of the forefoot and midfoot appears within normal limits, without evidence of osteomyelitis. There is no pathologic enhancement on postcontrast images.Right foot: There is diffuse edema of the subcutaneous soft tissues without evidence of discrete fluid collection or sinus tract. There is focal edema type signal signal along the dorsal aspect of the base of the first metatarsal adjacent to the tarsometatarsal joint with small cystic spaces, which is favored to be degenerative or post-traumatic in etiology. There is no pathologic enhancement on postcontrast images.

Output: Diffuse soft tissue swelling and degenerative changes without specific evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Syringomyelia w/ back pain, numbness and weakness of the legs. Rule out cord compression. The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. A small syrinx measuring approximately 2 mm in diameter is present at the T11-T12 level. However, there is no evidence of spinal cord compromise.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. The patient's known small syrinx measuring approximately 2 mm in diameter is present at the T11-T12 level. However, there is no evidence of spinal cord compression.


Instruction: Generate impression based on findings.

Input: 67-year-old woman with history of upper abdominal pressure, incidental spinal mass found on pelvic MRI. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is significant dextroscoliosis of the lumbar spine and mild levoscoliosis of the lower lumbar spine. Bone marrow signal is heterogeneous but benign. The conus medullaris is normal in position.At the right posterolateral T12 level (1202/40) there is a 13 x 13 x 12 cm homogenously enhancing, T1 and T2 isointense, round intradural, extra medullary lesion. This lesion displaces the conus to the left and has mass effect with flattening of the distal cord. There are subtle calcifications noted corresponding to this lesion on the CT from 2/2013. No additional abnormal enhancing foci are identified.Multilevel degenerative changes are seen, as described below:T12-L1: Disc osteophyte complex is present and there appears to be moderate narrowing of the left neural foramen. No right neural foraminal or spinal canal stenosis.L1-L2: Disc bulge is present and there is marked left facet joint arthropathy with thickening of the ligamentum flavum. There is moderate narrowing of the left neural foramen. No significant spinal canal or right neural foraminal stenosis.L2-L3: Disc bulge is present and there is bilateral facet joint arthropathy with ligamentum flavum hypertrophy. There is partial effacement of the left lateral recess, mild to moderate narrowing of the left neural foramen, and fairly mild narrowing of the right neural foramen. No spinal canal stenosis.L3-L4: There is bilateral facet joint arthropathy, right greater the left, with ligamentum flavum hypertrophy. There is partial effacement of the right lateral recess and mild narrowing of the bilateral neural foramina. There is mild central spinal canal stenosis.L4-L5: There is bilateral facet joint arthropathy, right greater the left, with ligamentum flavum hypertrophy. There is partial effacement of the right lateral recess and moderate narrowing of the right neural foramen. No significant left neural foraminal stenosis. There is mild central spinal canal stenosis.L5-S1: There is mild bilateral facet joint arthropathy and an eccentric right disc bulge with a small central protrusion. There is no significant neural foraminal or spinal canal stenosis, but there is contact of the disc with the extraforaminal right nerve root.Mildly complex renal cysts partially visualized bilaterally. Large fibroid uterus partially visualized.

Output: 1.Extramedullary-intradural enhancing mass in the posterolateral spinal canal at T12 with imaging features favored to represent meningioma. Nerve sheath tumor is an additional consideration. 2.T12 lesion causing moderate to severe spinal canal stenosis including mass effect on the conus.3.Scoliosis, moderate degenerative changes of the lumbar spine, and multifocal neural foraminal stenoses as described above without associated high-grade spinal stenosis.


Instruction: Generate impression based on findings.

Input: At the T2 level within the central compartment of the spinal cord is subtle abnormal T2 hyperintensity with a very subtle blush of enhancement. Evidence of enhancing lesions are also partially visualized in the posterior fossa on the recent outside hospital MRI with a dominant lesion in the right cerebellar hemisphere. The spinal lesion does not enhance to the extent of the intracranial lesions. The cervical spine is slightly straightened which is probably positional. The vertebral body and disk heights throughout the cervical, thoracic and lumbar spine are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical, thoracic or lumbar spine. The paraspinal soft tissues are unremarkable.Note is made of diffuse lymphadenopathy in the neck and mediastinum as well as pulmonary nodules bilaterally in the lungs. Status post splenectomy.

Output: 1.Abnormal T2 hyperintensity with a very subtle blush of enhancement at the T2 level of the spinal cord. Evidence of enhancing lesions are also partially visualized in the posterior fossa with a dominant lesion in the right cerebellar hemisphere. The spinal lesion does not enhance to the extent of the intracranial lesions but is likely of similar etiology. The differential diagnosis is broad and includes infection secondary to immunosuppression, a post infectious inflammatory phenomenon, direct reaction to medication, or a PTLD-like lymphoproliferative phenomenon.2.Diffuse lymphadenopathy in the neck and mediastinum as well as pulmonary nodules bilaterally in the lungs. The mediastinal lymphadenopathy and pulmonary nodules are better appreciated on the recent previous chest CT.


Instruction: Generate impression based on findings.

Input: 41-year-old male with right knee pain. MENISCI: Curvilinear signal abnormality in the posterior horn of the medial meniscus, extending to the tibial articular surface, on one or perhaps two images, is suspicious for a small undersurface tear. Signal abnormality extending into the body of the medial meniscus likely represents intrasubstance degeneration. The anterior horn of the medial meniscus appears normal. The body of the lateral meniscus appears slightly prominent, perhaps representing a mild discoid morphology. We see no lateral meniscal tear.ARTICULAR CARTILAGE AND BONE: There is edema within the posterior aspect of the medial tibial plateau. A small focus of curvilinear low signal intensity within the edema in the subchondral bone beneath the peripheral fibers of the posterior horn of the medial meniscus likely represents a small nondisplaced/nondepressed subchondral fracture. Heterogeneity of the articular cartilage of the inferior aspect of the medial femoral trochlea, with a focus of low signal intensity in the underlying subchondral bone, likely represents focal degeneration. The articular cartilage of the patella and lateral compartment are intact.LIGAMENTS: Although the distal fibers of the anterior collateral ligament appear taut, the proximal fibers are poorly defined. Furthermore, there is abnormal signal intensity along the lateral aspect of the ligament, that we suspect represents torn fibers. These findings suggest at least a full-thickness tear of the posterolateral bundle of the ACL, and probably a tear through the entirety of the ligament proximally. The posterior collateral ligament is within normal limits. There is mild edema superficial to the medial collateral ligament, which may represent a mild sprain, but the ligament itself appears normal. The lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Findings are compatible with a small nondisplaced/nondepressed subchondral fracture in the far posterior aspect of the medial tibial plateau, with a small undersurface tear of the overlying posterior horn of the medial meniscus.2. Findings suggestive of at least a full-thickness tear of the posterolateral bundle of the anterior collateral ligament, and probably a full-thickness tear through the entire ligament proximally.


Instruction: Generate impression based on findings.

Input: Female, 70 years old. Pain. ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon posteriorly near its junction with the infraspinous tendon, approximately 2 cm from the insertion. The tear extends for 2-3 mm in AP dimension, and there is no significant tendon fiber retraction. There is a background of moderate supraspinatus tendinopathy. There is mild to moderate subscapularis tendinopathy without discrete tear identified. The teres minor tendon and muscle are intact.SUPRASPINATUS OUTLET: There is fluid in the subacromial/subdeltoid bursa, compatible with a full-thickness rotator cuff tear. Mild mastoiditis affects the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact within the limits of nonarthrographic study.BICEPS TENDON: The tendon of the long head of the biceps is normal in morphology and position. ADDITIONAL

Output: Full-thickness tear of supraspinatus tendon on a background of rotator cuff tendinopathy as above.


Instruction: Generate impression based on findings.

Input: Female 29 years old Reason: r/o meniscus tear History: right knee pain MENISCI: Horizontal tear of the anterior horn of the lateral meniscus near its root with associated para meniscal cyst formation. These multilobulated parameniscal cysts are situated in the anterior joint space and measure approximately 8 x 1.6 cm (series 5, image 11).ARTICULAR CARTILAGE AND BONE: No abnormal bone marrow edema is present. Articular cartilage is intact.LIGAMENTS: ACL and PCL are intact. MCL and components of the lateral collateral complex are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Horizontal tear of the anterior horn of the lateral meniscus near its root with associated parameniscal cyst formation.


Instruction: Generate impression based on findings.

Input: Left arm numbness, right leg numbness, left face numbness, rule out transient ischemic attacks. There is no evidence of acute infarct, intracranial hemorrhage, mass. There is a punctate focus of T2 hyperintensity within the right frontal lobe, unchanged. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts in the maxillary sinuses. The orbits are grossly unremarkable. There is a 2 mm thick frontal outer table osteoma.

Output: 1. No evidence of acute infarct or intracranial hemorrhage.2. Unchanged nonspecific punctate focus of T2 hyperintensity in the right frontal lobe white matter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: 59 yo male with hx of retroperitoneal sarcoma; please evaluate for changes History: retroperitoneal sarcoma ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Status post cholecystectomy. No biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postsurgical changes related to prior ureteral resection with ureteric reimplantation onto the bladder. Mild right hydronephrosis, stable/mildly decreased compared to prior study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate, unchanged.BLADDER: The bladder has been displaced superiorly by the below described mass. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without MRI evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A large enhancing mass with central necrosis is again seen in the right iliac fossa. This measures 8.1 x 10.5 cm (series 19, image 52), previously 7.4 x 10.1 cm. This is consistent with provided history of retroperitoneal liposarcoma and is minimally increased compared to prior study. The mass invades the pelvic sidewall laterally, abuts the psoas muscle posteriorly and invades the right common iliac and external iliac vessels. It continues to exert mass effect on the bladder. On its medial aspect this is closely related to the sigmoid colon without invasion. Status post ligation of the right internal iliac artery and vein. No satellite lesions are identified.

Output: 1.Right iliac fossa mass compatible with provided history of liposarcoma. This demonstrates right pelvic sidewall and vascular invasion and displaces the bladder superiorly. It demonstrates slight interval increase in size compared to prior study.2.Mild right hydronephrosis, slightly decreased from prior study.


Instruction: Generate impression based on findings.

Input: Loss of consciousness. Evaluate for seizure focus. Susceptibility artifact from braces significantly limits evaluation. The bilateral hippocampi are symmetric. There is no evidence of large intracranial hemorrhage, mass effect, or acute infarct of the visualized brain parenchyma. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: 1. Evaluation is significantly limited by artifact from braces which may obscure some abnormalities especially in the anterior frontal and temporal lobes. To the extent of visualization there is no evidence of mesial temporal sclerosis. Consider repeat study when braces are removed.2. Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: There are interval post-operative changes related to suboccipital craniectomy with resection of posterior arch of C1 for Chiari decompression. The cerebellar tonsils are less peg-like and more rounded in configuration compared to the prior study. The inferior margin of the tonsils extend below the widely patent neo-foramen magnum and are at the level of the upper margin of the arch of the anterior C1.The cerebral hemispheres, cerebellar hemispheres and brainstem have otherwise normal morphology and signal characteristics. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Incidentally noted are several small pineal cysts. The skull and extracranial soft tissues are unremarkable. The CSF flow sequence reveals biphasic flow ventral to the cervicomedullary junction, but it is difficult to detect biphasic flow dorsally. CSF identified through the cerebral aqueduct and fourth ventricle.

Output: 1. Postoperative findings related to interval posterior fossa decompression for Chiari malformation with a more rounded configuration of the cerebellar tonsils, which now only extend to the upper margin of C2. 2. Adequate biphasic flow ventral to the cervicomedullary junction, but is difficult to detect dorsally. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: Male, 4 years old, with new onset episodic headache and emesis. A 6 x 5 x 5 mm slightly lobular, intraparenchymal T2 hyperintense lesion is evident just medial to the right occipital horn. The lesion is mildly T1 hypointense, but induces strong susceptibility artifact. No definite associated edema or mass effect is seen.No additional parenchymal lesions are seen. Brain morphology is within normal limits. No areas of edema or mass effect are detected. No diffusion restricting lesions are present. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra axial fluid collection. The ventricles are normal in size and morphology.The region of the pituitary is unremarkable. The brainstem, cerebellar vermis and cerebellar hemispheres are unremarkable. The corpus callosum is fully formed and intact. The pattern of myelination is mature.

Output: A subcentimeter, slightly lobular, intraparenchymal T2 hyperintense lesion is evident just medial to the right occipital horn. The lesion induces strong susceptibility effect which may represent hemosiderin deposition or mineralization.Lack of associated edema or mass effect is reassuring for a benign etiology, and this may in fact be an incidental finding unrelated to the patient's presenting symptoms. Likely differential considerations would include a cavernous malformation or small area of gliosis/hemosiderin staining from a prior insult. A follow-up examination with contrast can be considered in 6-12 months.


Instruction: Generate impression based on findings.

Input: There are postoperative changes at L4 and L5. There is disc desiccation at all levels. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. With the exception of endplate degenerative change, the vertebral bone marrow signal is unremarkable. The imaged spinal cord displays normal signal and morphology and the conus terminates at L1-L2. The paravertebral soft tissues are unremarkable.L1-L2: There is an unchanged minimal disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. There is no significant spinal canal or neural foramen stenosis.L2-L3: There is an unchanged mild disc bulge asymmetric to the left as well as bilateral facet arthropathy and ligamentum flavum thickening that is mildly progressed as well as ligamentum flavum thickening. These findings result in minimally worsened mild spinal canal stenosis and impingement upon the right subarticular zone.L3-L4: There is unchanged loss of disc height, modic type 2 endplate degenerative changes, and a slightly enlarged moderately sized disc bulge as well as bilateral facet arthropathy and ligamentum flavum thickening. Findings result in unchanged moderate spinal canal stenosis and unchanged severe right and moderate left neural foramen stenosis.L4-L5: There is unchanged loss of disc height, modic type 2 endplate degenerative changes and a moderately sized disc bulge as well as a small unchanged annular fissure. There is severe bilateral facet arthropathy that is mildly progressed as well as ligamentum flavum thickening. These findings result in mildly progressed severe spinal canal stenosis as well as severe right and moderate left neural foramen stenosis.L5-S1: There is an unchanged mild disc bulge as well as bilateral facet arthropathy. Findings result in unchanged severe left and moderate right neural foramen stenosis and no significant spinal canal stenosis.

Output: Slightly progressed multilevel severe degenerative changes including up to severe spinal canal stenosis at L4-L5, multilevel moderate and severe neural foramen stenosis, and severe multilevel facet arthropathy.


Instruction: Generate impression based on findings.

Input: Back pain, fever. Rule out abscess. Patient refused post contrast imaging which limits evaluation. There is severe loss of disc height at the L4-L5 level with mild residual edema. Bone marrow edema involving the L4 and L5 vertebral bodies is markedly improved. There is mild T2 hyperintensity involving the L5-S1 disc space which is grossly similar to prior and nonspecific. No discrete epidural or paraspinous fluid collection is appreciated, with lack of contrast limiting evaluation for small abscesses.There remains severe spinal canal stenosis at the L4-L5 level which is on a degenerative basis with disc osteophyte complex, ligamentum flavum thickening, and prominence of the epidural fat. There is also moderate to severe bilateral, left worse than right, neural foraminal stenoses. Spinal canal stenosis is to a moderate degree at the L3-L4 level with also mild bilateral neural foraminal stenosis at this levelVertebral body heights are maintained. Straightening of the lumbar spinal curvature is again seen. Paraspinous edema is again seen, which although overall improved is interval increased at the left posterior paraspinous left L1 to L3 levels.

Output: 1. Since 3/5/2016 there is an marked improvement in edema involving the L4 and L5 vertebral bodies and L4-L5 intervertebral disc space. Residual signal abnormality at the L4-L5 disc level may represent sequela of prior discitis-osteomyelitis, although residual infection cannot be entirely excluded. No new level of discitis-osteomyelitis is definitively appreciated. There is however interval increase in edema involving the posterior paraspinous musculature at the left L1 to L3 levels, which while nonspecific may be related to infection. No large paraspinous fluid collections are appreciated within the limits of noncontrast imaging.2. Severe spinal canal stenosis and moderate to severe neural foraminal stenosis are not significantly changed the L4-L5 level.


Instruction: Generate impression based on findings.

Input: Medial knee pain MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Negative left knee examination


Instruction: Generate impression based on findings.

Input: 49-year-old female with right knee pain, meniscus tear MENISCI: Degenerative tearing of the posterior horn of the medial meniscus with mild extrusion. The lateral meniscus is within normal limits.ARTICULAR CARTILAGE AND BONE: Grade 3-4 chondromalacia of the medial tibiofemoral compartment with subchondral sclerosis and edema type signal in the medial tibial plateau and medial femoral condyle. Grade 2-3 chondromalacia of the lateral tibiofemoral compartment. Grade 3-4 chondromalacia of the patellofemoral compartment, particularly along the inferior aspect of the medial facet where there is subchondral cyst formation.LIGAMENTS: The cruciate ligaments are intact. The collateral ligaments are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Severe osteoarthritis affects the right knee worst at the medial tibiofemoral compartment.2.Degenerative tearing of the posterior horn of the medial meniscus with mild extrusion.3.Large joint effusion and a Baker's cyst.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:11/15/1958)Reason: MLF lesion? History: Internuclear ophthalmoplegiaPROVIDER/ATTENDING NAME: PHILIP A VERHOEF Brain MRIRedemonstration of multifocal bihemispheric, supra and infratentorial diffusion restriction lesions including bilateral cerebellar hemispheres, left temporal lobe, and the right frontal lobe. In particular, there is a focal restricted diffusion on the left side inferior aspect of midbrain likely located at the left medial longitudinal fasciculus (series 502, image 96).On FLAIR/T2, corresponding restricted diffusion lesions show high signal intensity indicate these lesions are subacute ischemic infarcts.In addition, there are multiple bilateral lateral periventricular white matter as well as centrum semiovale FLAIR/T2 high signal intensity lesions which most likely represent nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Neck MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant tortuosity of extracranial bilateral carotid arterial system. However, there is no evidence of significant (more than 50%) luminal stenosis on both intracranial and extracranial arterial system. Vertebrobasilar system appears to be normal.

Output: 1. Multifocal ischemic infarctions involving bilateral cerebral hemispheres, cerebellum and midbrain. In particular, a focal ischemic infarction involving left medial longitudinal fasciculus. 2. Non specific small vessel ischemic disease.3. No evidence of significant luminal stenosis on both intracranial and extracranial arterial system.


Instruction: Generate impression based on findings.

Input: 15 year-old female with Li-Fraumeni syndrome and p53 mutation, genetic susceptibility malignant neoplasm of the breast. The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no structural abnormality, mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Negative contrast-enhanced brain MRI. Specifically, there are no MRI findings of a malignant neoplastic process.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3], Reason for Study: ^Reason: any atrophy? masses? History: memory, attention issues No evidence of acute ischemic or hemorrhagic lesion.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 paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 80 year old man with palpitations, NSVT, dyspnea referred for evaluation of underlying ischemia.MEDICATIONS: ASA, lisinopril, Toprol XL First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere is an area of late gadolinium enhancement noted in the basal inferolateral wall which spares the endocardium. It is in a pattern atypical for infarction and may suggest a fibrotic, inflammatory, or infiltrative process. The entire myocardium is otherwise viable.Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 70 ml/m2 (normal range: 74+/-15), the LVEDV is 148 ml (normal range 142+/-34), the LV end systolic volume index is 31 ml/m2 (normal range 25+/-9), the LVESV is 65 ml (normal range 47+/-19), the LV mass index is 42 g/m2, and the LV mass is 89 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 72 ml/m2 (normal range 82+/-16), the RVEDV is 153 ml (normal range 142+/-31), the RV end systolic volume index is 35 ml/m2 (normal range 31+/-9), and the RVESV is 73 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. No evidence of aortic valve mass.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%. There is an area of late gadolinium enhancement noted in the basal inferolateral wall in a pattern that is atypical for infarction and may suggest the presence of a localized fibrotic, inflammatory, or infiltrative process. 4. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%.5. Moderate tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:10/15/1969)Reason: 46y F with recent intracranial infection and edema seen surrounding VP shunt, please assess for interval changes History: headachesPROVIDER/ATTENDING NAME: MAI T PHO MAI T PHO MRI brain:The patient is status post suboccipital craniotomy as well as status post shunt with tubing coursing through the left occipital lobe and tip along the midline just above the corpus callosum. There is metal artifact present adjacent to the left parietal and occipital lobes related to the shunt system. Previously noted T2 and FLAIR signal hyperintensity adjacent to the shunt tubing within the brain parenchyma is not identified on the current exam.An old ventriculostomy tract course of the right frontal lobe into the right lateral ventricle.There is redemonstration of a developmental venous anomaly in the right cerebellar hemisphere.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact .Some subperiosteal fluid adjacent to the left orbital roof remains unchanged since the prior exam. There is some associated contrast enhancement which is also stable

Output: 1.The patient is status post suboccipital craniotomy. There is no evidence for ventriculomegaly.2.The patient status post placement of shunt tube which courses through the left parietal lobe and has its tip just above the level of the corpus callosum along the midline. Previously noted interstitial edema adjacent to the shunt tubing within the brain parenchyma is not identified on the current exam suggesting interval regression of any inflammatory process associated with the shunt tubing.3.Imaging along the calvarium and surface of the brain at the entry point of the shunt tubing into the brain is obscured by metal artifact. An underlying lesion in this location would not be visible on MRI.4.Some subperiosteal fluid and inflammatory reaction adjacent to the left orbital roof remains unchanged since the prior exam.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Presurgical evaluation. PELVIS:PROSTATE:Prostate Size: 4.8 x 3.8 x 2.7 cmPeripheral Zone: There is heterogeneous but diffuse low T2 signal throughout the left peripheral zone. This low signal becomes particularly confluent and prominent along the left lateral border of the prostate (series 701 image 16). These regions have mild restricted diffusion and early arterial enhancement compatible with diffuse tumor.There is an additional region of more confluent low T2 signal in the right mid gland extending into the right apex which measures 10 x 8 mm in axial dimension (series 901 image 21). This is associated with mild restricted diffusion and early arterial enhancement. Compatible with additional tumor.Central Gland: Nodular changes of benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality or tumor involvement is identified.Extracapsular Extension: There is extension of abnormal signal along the posterior border of the right peripheral zone on the ADC images (series 503 image 344). This however is not correlated with the findings on the T2 and contrast enhanced sequences. For this remains equivocal for minimal extracapsular extension. The abnormal signal does not extend to involve the neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic or inguinal lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Diffuse abnormal signal throughout both the left and right peripheral zones compatible with diffuse tumor, particularly in light of biopsy history.2.Equivocal findings for possible minimal extracapsular extension along the posterior aspect of the right peripheral zone as described.


Instruction: Generate impression based on findings.

Input: BRAIN: There are multiple foci of susceptibility effect within the midbrain and pons with an associated developmental venous anomaly. There are additional dominant foci of susceptibility effect within the right frontal and left occipital white matter and innumerable punctate foci of susceptibility effect throughout the brain. These are all unchanged compared with the prior exam without surrounding edema to suggest recent hemorrhage. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is mild mucosal thickening within the sphenoid sinuses.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. There is an unchanged 2 mm outpouching at the proximal A2 segment of the right anterior cerebral artery. The middle and anterior cerebral arteries are otherwise unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1.Innumerable unchanged cavernous malformations most prominent in the pons where there is an associated developmental venous anomaly. 2.Unchanged 2 mm outpouching at the A2 segment of the right anterior cerebral artery may represent an aneurysm or an infundibulum.


Instruction: Generate impression based on findings.

Input: 69 year old with known left invasive breast cancer presents for pre-treatment MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Segmental non mass enhancement is present at upper inner quadrant in the left breast, measuring 105 x 36 x 40 mm (AP x LR x CC), extending from near pectoralis muscle to the nipple, which is retracted. A marker clip is identified at posterior medial part of this non mass enhancement.An enhancing focus is seen at 2:00 position in the left breast, likely a normal intramammary lymph node.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Segmental non mass enhancement in the left upper inner quadrant, corresponding to the proven malignancy.2. No abnormal enhancement in right breast3. No abnormal lymph nodes in either axillary regionBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Pathology dated 1/15/2016 right mid medial 3+ 3 2-mm 15%, right mid lateral 3+3 less than 1 mm 5%, right Apex medial 3+ 3 7-mm 7%, right Apex lateral 3+4 10 mm 70%, left base medial 3+4 less than 1 mm 5%, left apex medial 3+ 3 1-mm. PELVIS:PROSTATE:Prostate Size: 4.0 x 5.8 x 5.6 cmPeripheral Zone: In the medial right apex there is a poorly marginated 1.4 x 1.1 cm T2-weighted hypointense lesion (series 501/7) with associated restricted diffusion (series 703/124). The lesion demonstrates avid early enhancement (series 1901/1214) and washout.Otherwise the peripheral zone is heterogeneous onT2-weighted imaging without an additional dominant lesion.Central Gland: Changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The right apical lesion appears to extend beyond the expected prostate boundary on diffusion weighted imaging and bulges the capsule on DCE imaging suspicious for extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly prominent right external iliac lymph node.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Dominant 1.3 cm right apical lesion is suspicious for prostatic adenocarcinoma with local extraprostatic extension.


Instruction: Generate impression based on findings.

Input: Female, 23 years old, with history of lipomyelomeningocele, Chiari and pseudotumor, evaluate for pathology. Brain:Metallic artifact along the right suboccipital region may represent the presence of a shunt system, new from the prior MRI. Trace T1 hyperintense material adherent along the ependymal surface of the right lateral ventricle, and to a lesser extent in the suprasellar cistern, has become less conspicuous than on prior exams. No evidence of parenchymal edema or mass effect is seen. Diffusion-weighted images are within normal limits. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are small in caliber but within normal limits.Cervical spine:Evidence of suboccipital craniectomy and resection of the posterior arch of C1 is demonstrated. Expansion of the CSF space at the foramen magnum is seen with no evidence of crowding of the cerebellar tonsils or the brainstem. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected. Assessment of the spinal cord is compromised by motion artifact but no significant abnormalities are suspected.Thoracic spine:A dextroscoliotic curvature of the thoracic spine is noted. In the sagittal plane, the vertebral bodies are well aligned. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is observed. Again, evaluation of the spinal cord is somewhat compromised by motion artifact, but no significant abnormalities are suspected.Lumbar spine:Compensatory scoliotic curvature of the lumbar spine is seen. In the sagittal plane, the vertebral bodies are well aligned. No evidence of marrow replacement or marrow edema is seen. Postoperative findings are redemonstrated compatible with laminectomy from L2 through the sacrum. The spinal cord remains low-lying with the conus continuing down to the L3 level. Below this point, the nerve roots of the cauda equina are closely opposed to the left lateral aspect of the thecal sac suggesting adhesions. Scattered fibrous strands are also noted within the ectatic lower thecal sac which may represent adhesions as well. No significant interval change is observed. On prone imaging, no clear anterior motion of the conus or cauda equina is demonstrated.

Output: 1.No acute findings or significant interval changes are noted intracranially.2.Findings are seen compatible with Chiari decompression. The CSF space is expanded at the foramen magnum with no evidence of brainstem or cerebellar tonsil crowding.3.Apart from scoliosis, evaluation of the thoracic spine is unremarkable.4.Redemonstration of postoperative findings in the lumbar spine. The spinal cord remains low-lying and is likely adhesed to the left lateral wall of the thecal sac. No significant interval change is noted.


Instruction: Generate impression based on findings.

Input: 30 years, Male, Reason: history of aneurysm rupture, hydrocephalus, third VC, syrinx. History: new headaches, neck pain Brain MRI: Again seen are postoperative findings related to right PICA aneurysm clipping as well as suboccipital craniotomy for Chiari decompression. There is artifact related to the aneurysm clip, which obscures the surrounding anatomy. Again seen is encephalomalacia and susceptibility effect in the right frontal periventricular region and caudate head likely related to prior hemorrhage. T2/FLAIR hyperintensity in the right frontal subcortical white matter has increased since 5/11/2016 although similar to the increased hypoattenuation noted on CT dated 9/15/2016 when compared to 7/24/2016. This finding may represent increased gliosis and/or edema. Ventricles have increased in size as prior MRI from 5/11/2016 although not significantly changed since more recent CT from 9/15/2016 allowing for differences in technique. There is mild increase in T2/FLAIR hyperintensity, compared to prior MRI, in the periventricular region which may represent transependymal flow of CSF.A left transparietal ventricular shunt catheter again seen. Prior additional ventriculostomy tracts are also evident. There is no evidence of acute infarction. Susceptibility artifact related to aneurysm clip limits assessment for CSF spaces and flow dorsally at the foramen magnum; there is however grossly preserved ventral CSF space at the foramen magnum with suggestion of preserved biphasic flow ventrally. The prepontine cistern appears minimally smaller than on prior MRI.Brain MRA:There is nonvisualization of the right distal vertebral artery to the level of right vertebrobasilar junction related to aneurysm clip artifact.Remainder of the intracranial circulation including the bilateral ICAs, MCAs, ACAs and vertebrobasilar arteries appear to be otherwise patent. No appreciable aneurysm.Cervical and Thoracic Spine:There is no significant change in overall size of the cervicothoracic syrinx. For example the syrinx at the C1-C2 level measures 2 x 5 mm in the AP and transverse dimensions, not significantly changed. In the lower cervical cord the syrinx occupies the right aspect of the cervical cord as before and measures up to 3 x 6 mm at the at the C7-T1 level which is also not significantly changed.Significant motion degradation limits assessment of the thin syrinx extending through the thoracic cord. There is however no gross evidence to suggest interval enlargement.Unchanged reversal of cervical lordosis. Moderate degree of thoracic scoliosis with apex at approximately the T8 level is again noted and better assessed with standing radiographs. There is no significant spinal canal stenosis at any level. Bone marrow signal is benign.

Output: 1. Compared to prior brain MRI from from 5/11/2016 there has been increase in dilatation of the ventricular system, although not significantly changed compared to more recent CT from 9/15/2016. There is also increase in T2/FLAIR hyperintensity in the right subcortical frontal lobe compared to prior MRI, which may reflect increased gliosis and/or edema; this finding was also noted on more recent CT from 9/15/2016.2. No significant change in findings of Chiari decompression. CSF spaces and flow ventrally at the foramen magnum is grossly preserved. Evaluation of the dorsal foramen magnum severely limited due to artifact from aneurysm clip.3. Postsurgical changes compatible with history of prior PICA aneurysm clipping. The right distal vertebral artery cannot be assessed due to artifact and CTA may be useful to assess for stenosis or aneurysm in this region. Remainder of the intracranial circulation is patent.4. No significant change in extent of cervicothoracic syrinx.


Instruction: Generate impression based on findings.

Input: The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. There is redemonstration of abnormal caudal extension of the cerebellar tonsils below the level the foramen magnum, measuring approximately 12 mm with significant pointing. There is severe crowding at this level.

Output: Redemonstration of Chiari I malformation. No MR evidence of syrinx.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer, status post craniotomy and SRS. There are post-treatment findings in the left parietal lobe with a small area of linear enhancement and susceptibility effect in the surgical bed and surrounding confluent high T2 signal, as well as volume loss with ex vacuo dilatation of the left lateral ventricle. There are punctate foci of DWI T2 shine-through in the right occipital lobe without corresponding enhancement. There are a few other nonspecific scattered foci of high T2 signal elsewhere in the cerebral white matter. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. Aside from postoperative alterations, the skull and scalp soft tissues are grossly unremarkable. The orbits and paranasal sinuses are also unremarkable.

Output: Post-treatment findings in the left parietal lobe with a small area of linear enhancement and susceptibility effect in the surgical bed, which is likely treatment-related, but otherwise no convincing evidence of active intracranial metastases. Punctate foci of DWI T2 shine-through in the right occipital lobe without corresponding enhancement may represent subacute infarcts.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:12/3/1964)Reason: h/o meningoencephalitis - evaluate History: confusionPROVIDER/ATTENDING NAME: JESSICA PENTZ RIDGWAY JESSICA PENTZ RIDGWAY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Since the prior exam leptomeningeal enhancement predominantly involving posterior fossa structures has regressed and is not visible. There are several subtle enhancing nodules present adjacent to the quadrigeminal plate which demonstrate enhancement. Another small nodule is present adjacent to the left trigeminal nerve root origin. To have a ring-enhancing appearance and measure 4 mm diameter and one is more solid in appearance and measures 4 mm in diameter. These were not present on the prior exam. There are some subtle leptomeningeal enhancement present surrounding the upper brainstem. FLAIR signal hyperintensity is present along the surface of the entire brainstem.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is some residual/persistent nodules present adjacent to the quadrigeminal plate and the left trigeminal nerve root origin which were not present on the prior exam representing some residual meningitis. The amount of the leptomeningeal enhancement in the posterior fossa has significantly regressed but not completely resolved.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for abnormal enhancement, possible infl CNS disorder History: Altered mental status, facial nerve palsy, suspected infl. CNS disorder The CSF spaces are appropriate for the patient's stated age with no midline shift. There is diffuse marrow replacement throughout the calvarial structuresNo 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 demonstrate minor opacities. The visualized portions of the orbits demonstrate small eyeballs with heterogeneous appearing fluid suggestive of blood products.Incidental is made of partial empty sella.

Output: 1.No abnormal lesions are appreciated intracranially to explain the patient's symptoms. However, examination is limited due to the fact that the patient was unable to adequately cooperate with exam. No post contrast imaging was performed. Many of the imaging sequences were repeated.2.Diffuse marrow replacement is a nonspecific finding which can be seen with chronic disease, anemia, lymphoproliferative or myeloproliferative disorders. Please correlate with clinical findings. (The patient's current hemoglobin level is 8.2 which may provide an explanation)3.Pthisis bulbi with intraocular hemorrhage and atrophy of the eyes. The patient is known to have prior history of uveitis and iridocyclitis.


Instruction: Generate impression based on findings.

Input: Postoperative assessment. Status post resection of left frontal tumor. Since the previous examination, there has been a new left frontal craniotomy with expected overlying scalp including swelling, fluid collection and foci of susceptibility. Also, there is expected underlying dural thickening. There is no perioperative infarct, significant mass-effect or significant hemorrhage.There has been resection of much of the previously described T2/FLAIR hyperintensity in the superior frontal gyrus surrounding the prior resection cavity and extending into the left frontal horn. There is focal contrast enhancement (up to 8 mm) along the anterior lateral resection margin which may represent the contrast enhancing nodule described on the previous MRI from February 2016 or may represent new postoperative contrast enhancement (coronal postgadolinium series 1203 image 78 on current study compared with coronal postgadolinium series 1102 image 86 on study from 2/18/2016). Evolution of this contrast enhancement on follow-up examinations may better characterize its significance. The deep extension of the T2 signal toward the anterior body/frontal horn of the left lateral ventricle has not changed, nor the associated ex vacuo enlargement. Otherwise, the ventricles are unchanged in size. The remainder of the brain remains unremarkable.

Output: 1.Expected postoperative changes of recent re-resection of the recurrent left frontal lobe tumor. There has been resection of much of the previously described, slowly progressive T2 signal surrounding the prior left superior frontal gyrus resection cavity extending to the left frontal horn margin.2.Focal contrast enhancement along the anterior lateral surgical margin may represent the contrast enhancing nodule described on the previous MRI from February 2016 or may represent new postoperative contrast enhancement. Evolution of this contrast enhancement on follow-up examinations may better characterize its significance. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 71 years, Male, urothelial cancer to brain, RT planning. Recent resection of brain metastasis. Examination is limited to sequences for treatment planning. Compared to postoperative MRI dated 4/23/2016, there has been slight evolution of postsurgical changes related to tumor resection in the right frontal lobe. Precontrast T1-weighted images were not obtained with question of minimal residual enhancement along the medial aspect of the resection cavity better assessed previously. There are blood products filling the right frontal resection cavity. Small right extra-axial fluid collection has decreased. Extensive vasogenic edema in the right frontal lobe is again seen and slightly decreased in the interval. Mass effect including partial effacement of the right frontal horn is again seen. There is minimal leftward midline shift. No uncal herniation. No lesions elsewhere in the brain are appreciated.

Output: 1. Slight evolution of postoperative changes of resection of right frontal mass. Sequences are limited for treatment planning; better assessed on prior study are findings of no definite evidence of residual tumor with question of minimal residual enhancement along the medial aspect of the resection cavity. No lesions elsewhere in the brain.2. Slight decrease in extensive vasogenic edema in the right frontal lobe.


Instruction: Generate impression based on findings.

Input: The image quality is somewhat degraded by motion artifact. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There are scattered nonspecific punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter and left cerebellar hemisphere, which may represent chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are extensive calvarial, skull base, and upper cervical spine lesions, consistent with treated metastases.

Output: 1. No definite evidence of intracranial metastases.2. Multiple osseous metastases, with involvement of the central skull base, which can account for cranial nerve deficits.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with metastatic melanoma, with brain mets, RT planning. Again seen is a hemorrhagic mass within the left cerebellum showing no significant interval change in overall size compared to the immediate prior examination. As before, this lesion induces edema in the surrounding parenchyma and causes mass effect upon the fourth ventricle. Hemosiderin stained encephalomalacia is redemonstrated within the left occipital lobe and in the right parietal lobe. A small hemosiderin stained lesion is also seen within the left superior frontal gyrus. None of these lesions demonstrates enhancement and they show no significant interval change when compared to the prior examination. However, they do not appear to have been present in 2013.

Output: 1.No interval change in the size of a large left cerebellar hemorrhagic mass.2.Chronic appearing hemorrhagic lesions of the left occipital lobe, right parietal lobe, and left superior frontal gyrus have not significantly changed from the immediate prior examination, though they were not present in 2013.


Instruction: Generate impression based on findings.

Input: Female 25 years old Reason: assess ACL graft History: laxity in ACL repaired right knee. MENISCI: There is deformity of the undersurface of the posterior aspect of the body of the medial meniscus extending into the posterior horn, with clefts of fluid signal intensity disrupting the undersurface of the meniscus. We do not have a previous MRI study for comparison, but these findings are strongly suggestive of a persistent unhealed tear, a retear, or a new tear of the medial meniscus. There also appears to be small parameniscal cyst posterior to the posterior horn. The anterior horn of the medial meniscus appears intact.The body of the lateral meniscus appear slightly blunted along its free edge. While it is conceivable that this could represent mild tearing or fraying along the free edge, this may simply reflect prior partial meniscectomy.ARTICULAR CARTILAGE AND BONE: There is a small full-thickness cleft through the articular cartilage of the lateral tibial plateau, beneath the posterior horn of the lateral meniscus (see image 10 of series 5). The remainder of the articular cartilage is unremarkable. The bone marrow signal is within normal limits.LIGAMENTS: Patient is status post anterior cruciate ligament reconstruction; the graft appears intact. A subcentimeter focus of low signal intensity between the anterior aspect of the graft and intracondylar notch could conceivably represent a small focus of arthrofibrosis, but this is equivocal and may not be of any clinical significance.Posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Postoperative changes of anterior cruciate ligament reconstruction; the graft appears intact. 2.Medial meniscal abnormality as described above is suggestive of a tear. As we do not have previous MR imaging, we cannot determine if this is a new tear, a retear, or an old tear that has not healed.3.Small full-thickness cleft of the articular cartilage of the lateral tibial plateau.


Instruction: Generate impression based on findings.

Input: 67-year-old female ESRD on HD, found down at home, bacteremia, sepsis, in atrial arrhythmia. Overall weakness. Evaluate for cause of acute altered MS. Clinical differential diagnosis includes stroke (septic emboli or thromboembolic), meningoencephalitis. There are multiple patchy areas of restricted diffusion which are mostly concentrated within the watershed regions of the cerebral hemispheres bilaterally with additional scattered foci elsewhere including the cerebellum and right hippocampus. Many of these lesions are associated with susceptibility effect either within the parenchyma or adjacent sulci which suggests blood product. No significant edema or mass effect is noted. The ventricles are normal in size with no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Multiple patchy areas of restricted diffusion which likely represent small infarcts with many of these lesions located in the watershed regions and many associated with evidence of blood products. Differential includes bland embolic or watershed infarcts, however the presence of such extensive blood product would be unusual outside of a coagulopathy or anticoagulation. than patient is coagulopathic. Therefore, and given the history, septic emboli should also be considered. Findings were discussed with Dr. Krishnamoorthi by phone on 12/21/2015 at 4:15 PM.


Instruction: Generate impression based on findings.

Input: 42-year-old female with history of menorrhagia and infertility. PELVIS:UTERUS, ADNEXA: Abnormal uterine myometrium with a diffusely abnormal junctional zone, particular about the right aspect of the uterus. Large myometrial signal intensity lesion with indistinct borders within the right myometrium containing scattered small cysts compatible with an adenomyoma. There is adjacent mass effect on the endometrial canal.The ovaries appear unremarkable by MRI.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Large right myometrial adenomyoma as above.