Instruction: Generate impression based on findings.

Input: 20 year old with history of suspicion for median arcuate ligament syndrome and syncope presenting for cardiac evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 79 ml/m2 (normal range: 65+/-11), the LVEDV is 114 ml (normal range 109+/-23), the LV end systolic volume index is 29 ml/m2 (normal range 18+/-5), the LVESV is 42 ml (normal range 31+/-10), the LV mass index is 33 g/m2 (normal range 67+/-11), and the LV mass is 48 g (normal range 114+/-24). There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 115 ml (normal range 110+/-24), the RV end systolic volume index is 32 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). No regional wall motion abnormalities or aneurysms in the RV free wall.Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%. 2. The right ventricle is normal in size and systolic function. The overall RV ejection fraction is 58%. No regional wall motion abnormalities or aneurysms in the RV free wall. No cardiac MRI evidence for right ventricular arrhythmogenic cardiomyopathy.3. The presence of myocardial fibrosis can not be determined on this scan because patient refused contrast administration.


Instruction: Generate impression based on findings.

Input: 24 years, Male, Reason: eval crohn's activity and phlegmon History: rlq pain, crohn's disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Dilated left upper pole calix is unchangedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enhancement and bowel wall thickening involving the terminal ileum and a short segment of the ascending colon has decreased since the prior exam. There is persistent stricturing of the descending colon as well as narrowing at the terminal ileum. Prestenotic dilatation of the distal ileum and cecum is unchanged.Phlegmon adjacent to the ileocecal valve seen on the prior study has resolved. There are a few luminal nodular enhancing foci at the ileocecal valve which may represent inflammatory polyps. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Acute on chronic inflammatory changes involving the terminal ileum and ascending colon has decreased slightly since the prior exam. There is persistent stricturing of the ascending colon and narrowing at the terminal ileum.2.Resolution of phlegmon seen on the prior exam.


Instruction: Generate impression based on findings.

Input: C7 lesion seen on CT and history of hepatocellular carcinoma. There is diffuse low T1 and T2 signal in the C6 and C7 adjacent to the disc space, with associated mild patchy enhancement related to underlying degenerative spondylosis. In particular, at C6-7, there is a disc-osteophyte complex that results in moderate spinal canal stenosis and bilateral neural foraminal stenosis. In addition, at C7-T1, there is 5 mm of anterolisthesis and a disc-osteophyte complex, as well as ligamentum flavum thickening that results in severe spinal canal and bilateral neural foraminal stenosis. There is also rather significant bilateral neural foraminal stenosis and mild spinal canal narrowing at C3-4. The degenerative spondylosis at other levels is otherwise less pronounced. The vertebral body heights are preserved. The spinal cord displays normal signal characteristics. There is no evidence of mass lesions within the cervical spine. The paraspinal soft tissues and imaged intracranial contents are unremarkable. There appear to be small retention cysts in the bilateral maxillary sinuses.

Output: 1. Sclerotic degenerative endplate alterations at C6-7 and an associated disc-osteophyte complex that results in moderate spinal canal stenosis and bilateral neural foraminal stenosis, but no findings specific for metastatic disease.2. At C7-T1, 5 mm of anterolisthesis and a disc-osteophyte complex, as well as ligamentum flavum thickening result in severe spinal canal and bilateral neural foraminal stenosis.3. Rather significant bilateral neural foraminal stenosis and mild spinal canal narrowing at C3-4.


Instruction: Generate impression based on findings.

Input: 70 years, Male, Reason: H/o IVC sarcoma resected early this year. F/U CT Scan here on yesterday, new soft tissue lesion near IVC and hepatic lesion. Needs MRI for better charcterizattion History: none. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Left hepatic lesion which is hyperintense on T2 with peripheral nodular centripetal progressive enhancement likely represents a hemangioma it is unchanged in size measuring 1 cm (701/26). There is a punctate enhancing focus in segment 8 measuring 6 mm (1002/307) which is bright on T2 and nonspecific. A segment 5 T2 hyperintensity is new from the prior exam but does not demonstrate significant enhancement and may be postsurgical.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: There is been interval resection of IVC sarcoma. There is a small amount of enhancement along the left diaphragmatic crus measuring 1.9 x 1.2 cm (1004/199) with a focus of diffusion restriction in within a portion of the lesion (601/238), likely representing recurrent tumor.Low-density focus seen on prior CT is nonenhancing and is T2 hyperintense, likely a small fluid collection which measures 2.5 x 1.5 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes along the anterior abdominal wall.OTHER: No significant abnormality noted.

Output: 1.Postsurgical changes of IVC sarcoma resection. A small amount of enhancing tissue along the right diaphragmatic crus likely represents recurrent tumor.2.Hypodense collection identified in prior CT is nonenhancing and likely represents a small amount of postoperative edema.3.Segment 5 T2 hyperintensity does not demonstrate significant enhancement and likely postoperative.


Instruction: Generate impression based on findings.

Input: Acute mental status changes. History of end-stage renal disease. Now with decreased blood pressure. There is no evidence of intracranial hemorrhage, mass or midline shift. An area of low attenuation in the right parieto-occipital region appears slightly larger than on the prior study and is somewhat well defined. This likely represents an infarct of the indeterminate age. An MRI is suggested for further evaluation. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No evidence of intracranial hemorrhage. Low attenuation lesion in the right parieto-occipital region is slightly larger than on the prior study. An MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 68-year-old male with rising PSA and history of negative TRUS guided biopsies. Assess for prostate cancer. PELVIS:PROSTATE:Prostate Size: 4.4 x 5.9 x 5.8 cm.Peripheral Zone: Low T2 signal with restricted diffusion and increased enhancement extending posteriorly from the left base to the inferior mid gland, compatible with prostate cancer. The lesion measures up to 2.3 x 1.2 cm in greatest axial dimension (series 503/404).Central Gland: Heterogeneous.Seminal Vesicles: Left-sided prostate cancer demonstrates invasion into the inferior left seminal vesicle.Extracapsular Extension: Thinning of the posterior capsule on the left with mild focal extracapsular extension of the above-mentioned prostate cancer.BLADDER: No significant abnormality noted.LYMPH NODES: A nonspecific 10 x 10 mm left external iliac lymph node is seen (series 1802/121).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Left-sided prostate cancer with left seminal vesicle invasion and focal extracapsular extension.


Instruction: Generate impression based on findings.

Input: History of large left-sided disc herniation with low back pain and neurogenic claudication. Evaluate for resolution of herniation and nerve compression. There is redemonstration of moderate dextroscoliosis of the lumbar spine. There is unchanged mild anterolisthesis of L4 relative to L5.Marked degenerative endplate irregularity and signal alteration is demonstrated from L3-4 through L5-S1. No additional concerning marrow signal alteration is seen. Except for degenerative endplate deformation, the vertebral bodies show normal morphology. L1-2: Bilateral facet hypertrophy. Ligamentum flavum thickening. Mild bulging disk. No spinal canal stenosis. Moderate left and mild right foraminal narrowing. L2-3: Left greater than right facet hypertrophy. Ligamentum flavum thickening. Bulging disk with resolution of previously identified superimposed left subarticular zone extrusion. Mild generalized spinal canal stenosis. Severe left foraminal and moderate right foraminal narrowing.L3-4: Marked bilateral facet hypertrophy somewhat worse on the left. Ligamentum flavum thickening. Bulging disk and osseous spurring. Moderate generalized spinal canal stenosis. Severe left and moderate to severe right foraminal narrowing. Findings are unchanged. L4-5: Marked bilateral facet hypertrophy. Disk bulging and osseous spurring. Severe generalized spinal stenosis with crowding of the nerve roots. Severe right and moderate to severe left foraminal narrowing. Findings are unchanged. L5-S1: Marked facet hypertrophy. Mild bulging disk. No significant generalized canal stenosis though there is some effacement of the right lateral recess. Severe right and moderate to severe left foraminal narrowing. Findings are unchanged. There are small bilateral renal cysts. The left psoas muscle and some of the left posterior paraspinal muscles are partially atrophic.

Output: 1. Interval resolution of left L2-3 disk extrusion. There remains mild generalized spinal canal stenosis at this level, with severe left foraminal and moderate right foraminal narrowing.2. Moderate generalized canal stenosis at L3-4 with severe left and moderate to severe right foraminal narrowing, which are unchanged.3. Severe generalized spinal canal stenosis at L4-5 with severe right and moderate to severe left foraminal narrowing, which are unchanged. 4. Severe right and moderate to severe left foraminal narrowing at L5-S1, which are unchanged.


Instruction: Generate impression based on findings.

Input: 75 years, Female, headache, falls. Stroke? Subdural?. Patient also has neck pain, question myelopathy. Brain: There are extensive patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and to a lesser degree periventricular white matter, which are nonspecific, but may be related to advanced chronic small vessel ischemic disease. Small chronic lacunar infarcts are also evident including the right caudate nucleus, left thalamus, left pons, and left cerebellar hemisphere. There is also mild to moderate degree of global parenchymal volume loss. There are multiple foci of susceptibility effect in the bilateral cerebral hemispheres which are predominantly in a peripheral lobar distribution. Multiple foci more centrally are also evident including the thalami. Major flow-voids are preserved. There is a punctate focus of hyperintensity in the left parietal lobe on the diffusion-weighted sequence with a relatively larger area of FLAIR hyperintensity and elevated ADC surrounding this region. No restricted diffusion to suggest acute ischemia in the remainder of the brain. No intracranial mass or mass-effect. No extra-axial collections. The ventricles are within normal limits in size and configuration. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction alignment is maintained. There is retroodontoid soft tissue without associated spinal canal stenosis. There is mild edema involving the dens as well as right lateral mass of C1. There is also fluid at the left C1-C2 articulation. These findings may be on a degenerative or chronic inflammatory basis but if there is suspicion for recent trauma, CT may better assess for bony disruption in this region.The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained with only minimal C6 on 7 retrolisthesis and minimal C7 on T1 anterolisthesis. No suspicious osseous lesions.There is no definite cord signal abnormality with motion degradation limiting evaluation.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis. C4-5: Disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild spinal canal stenosis. There is moderate left and mild to moderate right neural foraminal stenosis.C5-6: Disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis including ventral indentation of the cord. No definite cord signal abnormality. There is moderate to severe bilateral neural foraminal stenosis.C6-7: Small disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal. There is mild bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Extensive T2/FLAIR hyperintensity in the subcortical and periventricular white matter which is nonspecific but may be related to moderate to severe chronic small vessel ischemic disease. Multiple small chronic lacunar infarcts are also evident.2. Punctate focus of diffusion hyperintensity in the left parietal lobe as described above suspected to represent a tiny recent infarct adjacent to an area of chronic ischemia.3. Numerous foci of chronic microhemorrhage, which are nonspecific but given the predominant peripheral distribution, suggest amyloid angiopathy as an etiology. Additional foci such as in the thalami may be related to chronic hypertension.4. Moderate degree of multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis from the C3-C4 to C6-C7 levels. There are also multilevel neural foraminal stenoses. Additional details of individual levels as above. No definite cord signal abnormality.5. Bone marrow edema involving the C1 and C2 level which may be on a degenerative or chronic inflammatory basis. There is no significant prevertebral edema, however, sequela of prior trauma is not entirely excluded and CT can better assess for possibly underlying fracture if clinically indicated. Ligamentous structures are intact.


Instruction: Generate impression based on findings.

Input: Status post right knee arthroscopy microfracture of the medial compartment and patellofemoral joint. Evaluate for healing. MENISCI: There is blunting of the body of the medial meniscus likely reflecting post-surgical changes. Within this remnant, there is new horizontal signal abnormality which may represent a superimposed tear. The lateral meniscus is intact. ARTICULAR CARTILAGE AND BONE: There is redemonstration of delamination of the articular cartilage of the weight-bearing portion of the medial femoral condyle. Within this area of delamination, there is a new full thickness cartilage defect measuring approximately 1 cm in the AP dimension. There is chondral softening of lateral femoral condyle articular cartilage without full thickness defect. There is mild focal degeneration of the articular cartilage of the lateral tibial plateau along the lateral aspect of the tibial spine. There is significant thinning of the articular cartilage of the medial patellar facet, as well as focal near full-thickness degeneration of the articular cartilage of the lateral patellar facet. There is also full-thickness degeneration of the articular cartilage of the femoral trochlear centrally, with near full-thickness degeneration along the medial and lateral facets.There is interval decrease in bone marrow edema within the medial femoral condyle. LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. New full thickness chondral defect within a region of delamination of the medial femoral condyle articular cartilage. 2. New superimposed horizontal tear of the remnant of the body of the medial meniscus.3. Improved medial femoral condyle bone edema.


Instruction: Generate impression based on findings.

Input: Neck pain and radiation. Shoulder pain and weakness. Rule out rotator cuff tear. ROTATOR CUFF: There is perhaps mild focal undersurface fraying of the subscapularis tendon best seen on the axial series, but this is equivocal and the rotator cuff otherwise appears normal without a discrete tear. Rotator cuff musculature is normal.SUPRASPINATUS OUTLET: The acromioclavicular joint appears normal. I see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. I see no joint effusion. Apparent separation of the anterior superior labrum from the underlying glenoid probably represents a normal variant sublabral foramen. There is mild intermediate signal intensity within the superior labrum that suggests degeneration, but I see no discrete fluid-filled tear.BICEPS TENDON: The tendon of the long head of the biceps appears normal. ADDITIONAL

Output: Equivocal mild focal undersurface fraying of the subscapularis tendon, but otherwise normal-appearing rotator cuff. Other findings as above, with no specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: History of possible IBD with bloating and fullness. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, and enhancement. Steatosis. No focal suspicious liver lesion. No biliary ductal dilatation. Normally distended gallbladder. Cholelithiasis without cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 6.3 cm right renal superior pole simple cyst. 1 cm left renal interpolar cyst. No hydronephrosis or suspicious lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small and large bowel are normal in caliber wall thickness and signal intensity. No abnormal postcontrast enhancement. No fibrofatty perforation. No discrete fluid collection.Sigmoid diverticulosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild left peritrochanteric soft tissue enhancement.OTHER: No significant abnormality noted.

Output: No specific findings of inflammatory bowel disease. Diffuse fatty infiltration of the liver. Mild left peritrochanteric soft tissue enhancement may reflect bursitis.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke. Signs and symptoms: Stroke. Unenhanced CT of brain:Examination demonstrate findings consistent with a small vessel disease of indeterminate age. No definitive interval change is detected. Focal area of low-attenuation in the left paramedian pons is believed to represent a lacunar infarct of indeterminate age. This finding may have been present on the prior exam. Please correlate with clinical history and follow-up with an MRI.There is no evidence of hemorrhage or acute cortical stroke. Cortical sulci, ventricular system and all CSF cisterns remain within normal for patient stated age.

Output: 1.No evidence of hemorrhage, mass effect or midline shift.2.No definitive acute intracranial stroke.3.Findings consistent with small vessel disease of indeterminate age..


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with history of adenocystic carcinoma of the left lacrimal gland, diagnosed in 2014 at an outside hospital, status post resection and flap reconstruction. Subsequent complications included flap failure and infection. Left maxillary and orbital resection is seen with evidence of soft tissue and bony flap repair. Although this is not a dedicated examination for the facial soft tissues, and without the benefit of a prior examination for comparison, no definite suspicious soft tissue is seen within the operative bed.Multiple areas of periventricular T2 hyperintensity are seen, some of which demonstrate a relatively linear morphology with respect to the ventricular surface. No evidence of restricted diffusion or parenchymal edema is seen. No mass effect is identified. No pathologic intracranial enhancement is observed. The ventricles are of normal size and morphology. No evidence of acute intracranial hemorrhage or any other abnormal extra-axial fluid collection is seen.

Output: 1.White matter lesions are identified in the brain with a distribution and morphology compatible with demyelinating disease.2.No evidence of any acute parenchymal edema, mass effect or pathologic enhancement is seen to suggest intracranial metastatic disease.3.Extensive postsurgical findings are demonstrated compatible with left maxillary and orbital resection with soft tissue and bony flap reconstruction.


Instruction: Generate impression based on findings.

Input: Per provided information, the patient is status post ultrasound guided biopsy of a suspicious mass in the right breast. Clip was also placed. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. There are a few cysts in the right breast.There is extensive abnormal enhancement centered in the right lower inner quadrant. This includes two masses in the posterior depth that measure 8 x 10 x 10 mm and 9 x 10 x 8 mm. Each mass has central artifact suggesting a biopsy clip has been placed in each. The more posterior mass abuts the pectoralis, but the muscle itself enhances normally. Predominately medial to the two masses, there is non-mass enhancement measuring about 4 cm AP. The lateral/posterior extent of the non-mass enhancement also approaches the pectoralis, and the anterior extent approaches the skin. Inclusive of all the suspicious enhancement the extent is 4.4 x 3.1 x 3.8 cm. No abnormal enhancement is seen in the left breast. A few scattered foci are present but no suspicious mass, non-mass enhancement or any area that reaches threshold for kinetic analysis is seen.No abnormal lymph nodes are identified in either axillary region.

Output: Extensive abnormal enhancement in the right breast measuring up to 4.4 cm in total. Correlation with all prior breast imaging and breast pathology is recommended. Presuming that a malignant result has already been obtained, surgical consultation is also recommended. The need for any additional biopsy and method of imaging guidance for any additional biopsy would best be determined after surgical consultation and review of all breast imaging. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 18-year-old male status post trauma assess for thumb MCP ulnar collateral ligament injury. Pain and swelling. The ulnar collateral ligament of the metacarpophalangeal joint is abnormally thickened and detached from the base of the proximal phalanx indicating a tear. The ulnar margin of the base of the proximal phalanx appears disrupted with edema in the underlying bone likely representing a fracture. There is a 2 mm focus of fat signal intensity within the soft tissues adjacent to the suspected fracture which may represent a mildly displaced avulsion fracture fragment. We see no specific findings to suggest a Stener lesion. The accessory ulnar collateral ligament, although thickened, may be intact. The radial collateral ligament is intact. The interphalangeal joint and basilar joint of the thumb are unremarkable. The flexor and extensor tendons are intact.

Output: Tear of the ulnar collateral ligament with findings suggestive of a small avulsion fracture off the base of the proximal phalanx.


Instruction: Generate impression based on findings.

Input: Brain metastases. Presurgical planning stealth enhanced CT of brain. Enhanced MRI of brain:50 cc of Omnipaque is administered for this exam.Stealth post infused CT of brain for surgical planning is performed.Examination identifies a left inferior frontal lobe ring enhancing tumor likely a metastatic lesion measuring 7.7 x 7.6-mm in size on axial image 101 surrounding vasogenic edema is again identified. This lesion measures minimally smaller than MRI exam and this is believed to be secondary to difference in technique between the two studies. A second enhancing lesion overlapping the interhemispheric cortex of left frontal lobe with no necrosis however with subtle surrounding vasogenic edema. This lesion measures approximately 8.5 times 5-mm in size. Not significantly different from prior exam.This is study also demonstrate a third lesion in the right posterior temporal -- occipital junction measuring 7.4 times 8-mm in size on axial image 77.

Output: 1.Examination demonstrates previously noted two metastatic foci in the left frontal lobe similar to what was noted on prior exam.2.A third metastatic focus in the right posterior temporal -- occipital junction measuring 7.4 times 8-mm in size on axial image 77. 3.The new third metastatic lesion was not identified on prior post infused MRI images.


Instruction: Generate impression based on findings.

Input: Reason: eval MPFL, trochlear dysplasia, loose bodies, assess TT-TG History: Left patellar instability MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartment articular cartilage appears intact. There is superficial fraying of the articular cartilage along the lateral facet of the femoral trochlea. There is partial-thickness articular cartilage degeneration along the lateral facet of the patella. No full-thickness articular cartilage defects are identified. There is increased signal abnormality within the lateral femoral condyle and medial aspect of the patella likely representing contusions from prior transient patellar dislocation. The femoral trochlea is shallow, superiorly, indicating a mild femoral trochlear dysplasia.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is increased signal abnormality and subcutaneous edema about the mid substance fibers of the MPFL. The mid substance fibers of the MPFL are indistinct indicating a tear.EXTENSOR MECHANISM: The extensor mechanism appears intact. There is a small amount of fluid within the deep infrapatellar bursa.ADDITIONAL

Output: 1. Findings consistent with prior transient patellar dislocation including bone contusions and disruption of the medial patellofemoral ligament.2. Patella alta, mild femoral trochlear dysplasia, and borderline tibial tubercle to trochlear groove distance.3. Articular cartilage degeneration affecting the patellofemoral compartment as described above without evidence of a full-thickness articular cartilage defect.


Instruction: Generate impression based on findings.

Input: 46 year old with biopsy proven DCIS in left breast presents for staging MRI. There is heterogeneous amount of fibroglandular tissue in both breasts.Multiple cysts are present in both breasts, left greater than right.Moderate parenchymal enhancement is noted bilaterally.There is an irregularly shaped, spiculated enhancing mass at posterior 5 o'clock position in the left breast, measuring 14 x 17 x 21 mm (AP x LR x CC). This enhancing mass is located within the area of multiple clustered cysts. Focal non mass enhancement is present from this mass toward superior lateral direction, and overall measurement including mass and non mass is 22 x 26 x 26 mm. A marker clip is located within the non mass portion of this enhancement.No abnormal enhancement is seen in right breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Irregularly shaped mass with non mass enhancement at posterior 5 o'clock position in the left breast. As a marker clip is present at the non mass enhancement of this lesion, this portion likely corresponds to proven DCIS. The mass portion might be an invasive component. If clinically indicated, repeat ultrasound study and biopsy can be performed.2. No MR evidence for malignancy in right breast or either axillary region. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 42 year old man with history of idiopathic VF arrest in July 2016 s/p ICD placement, referred for cardiac MRI to evaluate scar burden. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 99 ml/m2 (normal range: 74+/-15), the LVEDV is 201 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 83 ml (normal range 47+/-19). There are no gross regional wall motion abnormalities present. With standard late gadolinium imaging there was significant artifact associated with the ICD, overlying the basal to mid segments of the anterior wall. This was improved with wideband imaging with a frequency shift of +1500Hz, which demonstrated no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is grossly normal in size. Right VentricleThe right ventricle is grossly An ICD lead terminates in the apex of the right ventricle.Right AtriumThe right atrium is grossly normal in size. There is a transvenous lead traversing the right atrium.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve is not well seen.Tricuspid ValveThe tricuspid valve opens widely. There is no obvious tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. Pulmonary VeinsThere are four pulmonary veins which drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is not well visualized.Venous AnatomyThe SVC and IVC drain normally into the right atrium. Transvenous leads are seen in the SVC.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%.2. With standard late gadolinium imaging there was significant artifact associated with the ICD, overlying the basal to mid segments of the anterior wall. This was improved with wideband imaging with a frequency shift of +1500Hz, which demonstrated no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.3. The right ventricle appears visually normal in size with normal systolic function.4. A single lead ICD is present.


Instruction: Generate impression based on findings.

Input: 66-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 6.7 x 4.4 x 6.4 cm.Peripheral Zone: T2 hypointense lesion with mild corresponding ADC signal in the left apical peripheral zone measuring approximately 1.3 x 1.2 cm. No corresponding early enhancement.Central Gland: Moderate to marked degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Focal enhancement in the right L5 endplate consistent with degenerative change. OTHER: No significant abnormality noted.

Output: 1.Indeterminate lesion in the left apical peripheral zone may represent a prostate malignancy.


Instruction: Generate impression based on findings.

Input: 55 year old man with new bi-ventricular heart failure, referred for further evaluation of heart failure etiology. MEDICATIONS: ASA, Lipitor, Coreg, Lasix, Lisinopril, insulin, Xarelto, Aldactone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no evidence of myocardial infarction; however, there is a prominent mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern is not consistent with prior myocardial infarction and is a well described finding secondary to myocardial fibrosis in patients with dilated cardiomyopathy. Left VentricleThe left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 19%, the LV end diastolic volume index is 113 ml/m2 (normal range: 74+/-15), the LVEDV is 252 ml (normal range 142+/-34), the LV end systolic volume index is 92 ml/m2 (normal range 25+/-9), the LVESV is 205 ml (normal range 47+/-19), the LV mass index is 57 g/m2, and the LV mass is 127 g. LV dysfunction is global with regional variation.Left AtriumThe left atrium is moderately dilatedRight VentricleThe right ventricle is mildly dilated with severely reduced systolic function. The overall RV ejection fraction is 27%, the RV end diastolic volume index is 119 ml/m2 (normal range 82+/-16), the RVEDV is 267 ml (normal range 142+/-31), the RV end systolic volume index is 86 ml/m2 (normal range 31+/-9), and the RVESV is 192 ml (normal range 54+/-17).Right AtriumThe right atrium is moderately dilatedAortic ValveThe aortic valve opening is restricted with evidence of flow acceleration suggestive of aortic stenosis. Correlate with echocardiography to determine the severity. There is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least moderate tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a psuedo-bovine brachiocephalic branching pattern (normal variant).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is a trace pericardial effusion.Extracardiac FindingsSmall bilateral pleural effusions. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. There is a prominent mid-wall stripe of late gadolinium enhancement involving the basal to mid septum. This pattern is not consistent with prior myocardial infarction and is a well described finding secondary to myocardial fibrosis in patients with dilated cardiomyopathy. 3. The left ventricle is mildly dilated with severely reduced systolic function. The overall LV ejection fraction is 19%.4. The right ventricle is mildly dilated with moderate to severely reduced systolic function. The overall RV ejection fraction is 27%.5. At least moderate tricuspid regurgitation.6. See extracardiac findings above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old male with AML and neutropenic fever. Status post SCT. Now with recent seizure and fevers Suboptimal exam secondary to extensive motion artifact.No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected. Further follow-up with an MRI recommended.The paranasal sinuses are unremarkable and no pneumatized.Mastoid air cells demonstrates opacification bilaterally which was present on the prior exam.

Output: Poor quality exam and no definitive evidence of an acute findings.


Instruction: Generate impression based on findings.

Input: 69 years Female (DOB:1/11/1947)Reason: assess for strokes History: slurred speech, left arm numbnessPROVIDER/ATTENDING NAME: JAMES J WALTER MA THERESA G ABARING MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. There is fetal origin of the PCA bilaterally with small p1 segments. The RVA is larger than the LVA. There is extra cranial right PICA origin.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: No evidence for acute cerebral infarction.No evidence for intracranial or extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: 32-year-old male patient with pain and swelling of mass of right medial proximal forearm. No discrete mass is identified in the region of the proximal medial forearm underlying a marker placed to denote the site of abnormality.Signal within the visualized bone and musculature is within normal limits. The visualized tendinous and ligamentous structures are intact. No abnormal enhancement is seen on postcontrast imaging.

Output: Normal examination without mass identified underlying the region of interest within the proximal medial forearm.


Instruction: Generate impression based on findings.

Input: Clinical question: Cord compression. Signs and symptoms: Right upper and lower extremity weakness. Unenhanced cervical MRI:Examination demonstrates degenerative changes of cervical spine, post operative changes of an anterior fusion of C3, C4 and C5 levels similar to prior exam.Foramen magnum is unremarkable.C2 -- C3 a broad-based disk protrusion (more prominent on the right) which is new since prior exam. This finding in combination with significant hypertrophic changes of ligamentum flavum posteriorly results in complete effacement of subarachnoid space, flattening deformity of the cord and moderate to severe central spinal stenosis. There is no convincing evidence of cord signal abnormality/edema at this level. There is significant left and mild right neural foraminal compromise.C3 -- C4 demonstrate expected postoperative changes of anterior fusion and posterior laminectomy without significant change since prior exam. There is flattening deformity of the cervical cord secondary to ventral hypertrophic changes, significant bilateral (right greater than left) neural foramina are compromised which all remain stable since prior exam. There is diffuse cord signal abnormality and decreased caliber extending from approximately C3 inferiorly to C5 -- C6 disk level similar to prior exam and consistent with cord myomalacia.C4 -- C5 demonstrate expected post op changes of prior anterior fusion, posterior laminectomy, expansion of thecal sac, significant right and moderate left neural foraminal compromise. There is no evidence of interval change since prior study.C5 -- C6 demonstrate slight forward angulation of the cervical spine similar to prior exam. Mild central spinal stenosis, significant bilateral neural foraminal compromise remain all similar to prior study.C6 -- C7 demonstrate mild-to-moderate degenerative changes without convincing evidence of central spinal stenosis. Moderate to significant bilateral neural foraminal compromise without change since prior study.C7 -- T1 demonstrate moderate disk disease and loss of disk height prominent bilateral ligamentum flavum hypertrophy, mild central spinal stenosis, significant left and moderate right neural foraminal compromise. There is no significant interval change in the extent of the findings since prior study.

Output: 1.At C2 -- C3 a central and rightward broad-based disk protrusion in combination with significant ligamentum flavum hypertrophy results in moderate to severe central spinal stenosis which is new since prior exam. There is no distinct cord signal abnormality at this level.2.Diffuse myomalacia of cervical cord extending from C3 to C5 -- C6 disk level similar to prior exam.3.Stable post operative changes of anterior fusion of C3, C4 and C5 and posterior laminectomy without central spinal stenosis.4.Multilevel degenerative changes of cervical spine results in multilevel bilateral neural foraminal compromise (some significantly) as detailed. There is no significant change since prior study.


Instruction: Generate impression based on findings.

Input: Evaluate for cause of diplopia and dizziness. History of craniotomy, meningioma. Nonenhanced head CT:Examination again demonstrate encephalomalacia in the left posterior parietal lobe as was noted on prior MRI exam. Slightly high density mass at the level of the superior sagittal sinus and right parafalcine region in the parietal region is consistent with patient's known residual meningioma which extends slightly to the left. This finding is also similar to prior exam. Subtle periventricular low attenuation of brain parenchyma in the parietal region is also similar to prior exam and may represent post therapy changes. Minimal small vessel disease of indeterminate age is also present.There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Calvarium is intact and only reveals evidence of a wide biparietal craniotomy. Visualized paranasal sinuses are well pneumatized and unremarkable. Partial opacification of right mastoid air cells and minimally of the right middle ear cavity. This finding was observed on prior MRI examination of brain.

Output: 1.No evidence of acute intracranial findings.2.Postoperative changes of biparietal craniotomy for removal of patient's known meningioma is noted.3.Residual encephalomalacia and small residual right parafalcine parietal meningioma similar to prior MRI from 2 -- 17 -- 11.


Instruction: Generate impression based on findings.

Input: 36-year-old with sarcoidosis and headaches. Evaluate for progression of abnormalities. The subtle cortical FLAIR abnormality questioned on the exam from 7/24/2013 is not identifiable on the current exam and was also not seen on the most recent previous study.There are one or 2 punctate foci of T2 hyperintensity within the inferior frontal lobes as on the previous exam and a new punctate T2 hyperintensity within the right parietal lobe. There is no associated mass effect, susceptibility artifact or enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal parenchymal or extra-axial enhancement. Although this is a nondedicated exam, the optic nerves appear unremarkable.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Several punctate subcortical white matter lesions are nonspecific, one new focus is seen in the right parietal lobe. 2.The subtle cortical FLAIR abnormality questioned on the exam from 7/2013 is again not identifiable on today's exam. The abnormality may have resolved or the finding may have been related to imaging artifact.


Instruction: Generate impression based on findings.

Input: Assess for metastasis: Newly diagnosed lung cancer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and mastoid air cells are grossly unremarkable. There appears to be diffuse enhancement along the left temporalis tendon.

Output: 1. No evidence of intracranial metastases. 2. Apparent diffuse enhancement along the left temporalis tendon may be inflammatory rather than neoplastic in nature. However, imaging follow up may be useful.


Instruction: Generate impression based on findings.

Input: 71-year-old male with left knee pain, not improving with physical therapy. Evaluate for lateral meniscal tear. MENISCI: Horizontally oriented high signal within the anterior horn of the lateral meniscus extending into the body and contacting the femoral articular surface on multiple sequences is consistent with a meniscal tear. There is also blunting of the free edge of the posterior horn of the lateral meniscus indicating a radial tear. There is a collection of intermediate and high signal intensity lateral to the body of the lateral meniscus likely representing a parameniscal cyst and perhaps synovitis. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a full-thickness articular cartilage defect along the lateral tibial plateau underlying the posterior horn of the lateral meniscus measuring approximately 1 cm in greatest diameter. There is also a full-thickness cleft along the cartilage of the lateral femoral condyle just above the torn free edge of the lateral meniscus with underlying degenerative subchondral signal intensity. Additional thinning of the cartilage of the lateral compartment is also present. There is superficial fraying of the cartilage of the weightbearing portion of the medial femoral condyle. There is focal intermediate signal intensity extending through the medial patellar facet, likely representing focal full thickness degeneration, with an underlying subchondral cyst. Subchondral cysts are also present within the inferior central aspect of the femoral trochlea with partial-thickness degeneration of overlying cartilage, and smaller subchondral cysts are seen more superiorly in the femoral trochlea and near the superior margin of the articular cartilage.LIGAMENTS: There are intrasubstance ganglia within the proximal anterior cruciate ligament but otherwise the ligament fibers appear intact. There is an elongated thin fluid collection tracking superficial to the lateral collateral ligament proper, which may arise from the underlying parameniscal cyst, however the ligament itself appears intact. The posterior cruciate ligament and medial collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Lateral meniscal tears as described above with findings suggestive of adjacent parameniscal cysts and edema/inflammation in the lateral soft tissues. The lateral ligamentous structures however appear intact.2. Cartilage defects and degeneration as described above.3. Intrasubstance ganglia within the anterior cruciate ligament.


Instruction: Generate impression based on findings.

Input: B-cell lymphoma The exam is markedly limited by motion artifact and the patient's body habitus.There is a diffusely heterogeneous appearance of the marrow signal of the pelvis and proximal femora likely the result of leukemia and posttreatment effects. There is diffuse subcutaneous edema, muscle edema, and muscle atrophy of the pelvis.As described on the corresponding MRI of the lumbar spine, there is fullness of the epidural space which is best appreciated at the level of L5-S1 on this exam (series 8 images 38 and 39 of 44 and series 9 image 41 of 44) although this is unclear. There is no evidence of an enhancing soft tissue mass within the pelvis.

Output: 1. Severely limited examination.2. The epidural fullness described on corresponding lumbar MRI is not well seen although there may be some mass effect at the level L5-S1.3. Abnormal marrow appearance of the pelvis likely reflects a combination of leukemia and posttreatment change.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 15 seconds.

Output: Successful left hip arthrogram.


Instruction: Generate impression based on findings.

Input: Prostate cancer PELVIS:PROSTATE:Prostate Size: 5.3 x 5.0 x 4.8 cm.Peripheral Zone: There is abnormal T2 signal in the left mid peripheral zone in a wedge shaped configuration, which demonstrates early enhancement most suggestive of prostatitis rather than neoplasm. No suspicious foci of abnormal signal or enhancement are seen otherwise.Central Gland: The central gland is enlarged with regenerative nodules, compatible with BPH.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Abnormal T2 signal and enhancement in the left mid peripheral zone most suggestive of prostatitis rather than neoplasm. No suspicious foci of abnormal signal or enhancement are seen otherwise.


Instruction: Generate impression based on findings.

Input: Focal motor seizure with secondary generalization. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable, including the hippocampi. 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 unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Acquired deformity of head.IMAGE ACQUISITIONS: 1 mm contiguous axial CT sections of brain and skull base. Postoperative status post suboccipital craniectomy and cranioplasty for Chiari decompression are again noted. There has also been left parietal craniotomy. There is a very small amount of nonspecific extra axial fluid deep to the inferior aspect of the right suboccipital cranioplasty flap. As on previous scans, cerebellar tonsils extend through the foramen magnum. Brain parenchymal attenuation is normal. There is no hydrocephalus.Postoperative change is again noticed that status post multilevel cervical laminectomy. There is a linear hyperdense structure within the spinal canal at the C5 level. This appears to be within the substance of the spinal cord. Comparison with a previous MRI of the cervical spine dated 01/31/2008 suggests possible subtle low signal intensity in this region on gradient echo axial images. It would be helpful to follow-up with a repeat MRI of the cervical spine to determine whether this calcified or ossified structure is new since there are no prior CTs of the cervical spine.

Output: 1.Normal postoperative changes status post suboccipital cranioplasty and left parietal craniotomy.2.It would be helpful to compare with the previous CT scan of the cervical spine if there is a prior outside exam. Otherwise, a follow-up MRI of the cervical spine would be helpful to discern determine whether there is new signal change in the substance of the cervical spinal cord at C5, corresponding with calcified or ossified structure within the substance of the cord at the C5 level.


Instruction: Generate impression based on findings.

Input: Clinical question: Change in C6-C7 herniation? Signs and symptoms: LUE radiculopathy. No unenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate asymmetric left-sided uncovertebral hypertrophy with resultant mild left neural foraminal compromise and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes with mild asymmetric left-sided uncovertebral hypertrophy with resultant moderate to severe left neural foraminal compromise.C4-C5 demonstrate mild degenerative changes, mild asymmetric left-sided uncovertebral and facet hypertrophy and mild bilateral ligamentum flavum hypertrophy. There is no spinal stenosis however severe left and mild to moderate right neural foraminal compromise is detected.C5-C6 demonstrates moderate disease and loss of disc height, moderate right and mild left uncovertebral hypertrophy and mild symmetrical bilateral ligamentum flavum hypertrophy. No spinal stenosis. However significant bilateral neural foraminal compromise is present at this level.C6-C7 demonstrate mild disc disease and loss of disc height, mild bilateral facet and ligamentum flavum hypertrophy. There is a large broad-based central and rightward disc protrusion is again noted and without significant change since prior exam. Similar to prior study there is evidence of mass effect and posterior displacement of the cord (R>L) with resultant moderate central spinal stenosis and moderate bilateral neural foraminal compromise. There is subtle T2 STIR increased signal intensity of the cord centered at this level and highly suspected of myelopathy. Retrospectively this finding cannot be identified with certainty on prior study however note should be made that excessive motion artifact on prior exam could obscure subtle finding.C7-T1 demonstrate mild bilateral ligamentum flavum hypertrophy and unremarkable otherwise.Degenerative changes of cervical spine results in mild reversal of cervical lordosis which remains similar to prior exam.Images at T1-T2 and T2-T3 levels are unremarkable

Output: 1.Degenerative changes of cervical spine with resultant multilevel neural foraminal compromise as detailed per level above and without significant change since prior study. Please see detailed report.2.Degenerative changes at C6-C7 and including a broad-based disc protrusion resulting in mass effect and posterior displacement of the cord, central spinal stenosis and bilateral neural foramina without definitive interval change. Subtle T2 STIR hyperintense signal changes of the cord at this level cannot be identified with certainty on prior exam due to motion artifact on T2 STIR series. This finding is concerning for myelopathy secondary to findings at this level


Instruction: Generate impression based on findings.

Input: Evaluate for stroke with history of gait instability. There are small areas of T2 hyperintensity and restricted diffusion within the posterior and inferior left cerebellar hemisphere and posterior medulla. There is no associated hemorrhage. However, there is a small area of susceptibility effect in the right middle cerebellar peduncle. There are a few scattered areas of subcortical and periventricular T2 hyperintensity without restricted diffusion. There is a punctate T1 hyperintense lesion posterior in the pituitary gland, which may represent a Rathke cleft cyst. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive left maxillary sinus mucosal thickening. There appear to be retained secretions within the pneumatized left petrous apex.

Output: 1. Small areas of acute infarction within the left cerebellar hemisphere and medulla, mainly in the left PICA distribution, without evidence of acute hemorrhage.2. A few mild subcortical periventricular white matter may represent chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Squamous cell carcinoma of the face, status post prior treatment. There are postoperative findings related to partial resection of the right nasal ala. There is an infiltrative mass along the medial right cheek and remaining portions of the right nasal ala, which measures up to approximately 5 cm. There is perineural extension of tumor along the infraorbital nerve, with widespread infiltration of the posterior orbit, and into the pterygopalatine fossa and superior orbital fissure, from which it attains the right cavernous sinus and Meckel cave. The contiguous portion of the right trigeminal nerve trunk is also involved by tumor, with associated denervation changes in the right masticator muscles. There is no significant cervical lymphadenopathy. The thyroid and salivary glands are unremarkable. There is no evidence of acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid within the bilateral mastoid air cells. There are bilateral lens implants.

Output: 1. An infiltrative mass along the medial right cheek and remaining portions of the right nasal ala, which measures up to approximately 5 cm is compatible with recurrent tumor, perhaps with superimposed cellulitis. 2. Extensive perineural extension of tumor along the infraorbital nerve, with widespread infiltration of the posterior orbit, and into the pterygopalatine fossa and superior orbital fissure, from which it attains the right cavernous sinus and Meckel cave. The contiguous portion of the right trigeminal nerve trunk is also involved by tumor, with associated denervation changes in the right masticator muscles.3. No evidence of cervical lymph node or brain parenchymal metastases.


Instruction: Generate impression based on findings.

Input: Female 56 years old Reason: rule out thyroid nodules History: none RIGHT LOBE MEASUREMENTS: 5.3 x 1.7 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.9 x 2.3 x 2.6 cmISTHMUS MEASUREMENTS: 5-mmRIGHT LOBE: Multiple complex appearing predominantly cystic nodules in the right lobe largest measuring 8mm in diameter in the mid right lobe.LEFT LOBE: Multiple complex appearing, predominantly cystic nodules in the left lobe largest measuring 2.3 by 2-cm in the mid left lobe.ISTHMUS: Subcentimeter cystic nodule in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes in the neck.OTHER: No significant abnormality noted.

Output: Multinodular goiter with bilateral multiple complex cystic nodules.


Instruction: Generate impression based on findings.

Input: Possible seizure, also with question of HSV encephalitis: AMS, headache prior to admission. There appear to be punctate foci of restricted diffusion in the bilateral superior frontal gyri. There is mild periventricular white matter T2 hyperintensity, but the temporal lobes are spared. There is also numerous scattered foci of susceptibility effect in the right basal ganglia, left perivesicular white matter, and more peripherally in the left cerebral hemisphere, which correspond to the calcifications demonstrated on CT. There is mild diffuse cerebral volume loss. 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. However, there is fluid within the bilateral mastoid air cells.

Output: 1. Apparent punctate foci of restricted diffusion in the bilateral superior frontal gyri.2. Mild periventricular white matter T2 hyperintensity may represent chronic small vessel disease, but there are no findings specific for herpes encephalitis, although assessment is limited without contrast.3. Numerous calcifications in the right basal ganglia, left perivesicular white matter, and more peripherally in the left cerebral hemisphere may be related to a prior infection or granulomatous disease.4. Fluid within the bilateral mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: 45-year-old female with bilateral leg paresthesias and weakness Alignment is anatomic. Vertebral body heights are intact. There is a well defined T1/T2 hypointense likely sclerotic lesion in the posterior T11 vertebral body which is unchanged from prior exam. Otherwise no abnormal marrow signal. Signal within the cord and cauda equina is grossly normal. There is no evidence of cord compression. Multi-level disk desiccation with mild disk space loss at T10-T11 and T11-T12. There is a posterior disk osteophyte complex at C4-C5 which is slightly less prominent with minimal effacement of ventral thecal sac. A diffuse disk bulge at C6-C7 is also unchanged. There is ligamentum flavum thickening at C5-C6 and C6-C7 which is unchanged.Mild diffuse disk bulge at T1-T2 slightly worse than the prior exam. Facet arthropathy and ligamentum flavum thickening at T10-T11 is unchanged.Diffuse disk bulge at T11-T12 appears slightly worse than the prior exam.There is a large lobulated soft tissue structure in the pelvis which was present on prior exams but appears slightly enlarged, however this is incompletely visualized. This extends cranially up to the L3 level, previously to the L4 level. There is partially exophytic rounded component anteriorly along the mass measuring at least 7.8 cm. There is additional less well-defined soft tissue extending into the lower pelvis. Multiple thyroid nodules and cysts are present.

Output: 1.No evidence of cord compression.2.Multilevel spondylolyses which is slightly worse T1-T2 and T11-T12 and less prominent at C4-C53.Large pelvic soft tissue structure may represent uterine fibroids, but appears larger than the prior exam and is incompletely visualized. Pelvic ultrasound may be considered for further evaluation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of upper lobe, right bronchus or lungClinical question: vertigo; also history of lung cancer with non-specific vascular abnormality in brainstem on staging brain MRI from an outside institution; please evaluate for etiology of vertigoSigns and Symptoms: vertigo The CSF spaces are appropriate for the patient's stated age with no midline shift. A small ill-defined focus of enhancement is present along the right paramedian pons which is associated with loss of signal on the susceptibility weighted imaging. It is associated with minimal T2 and FLAIR signal hyperintensity and no evidence for diffusion restriction.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 some minor opacities. The visualized portions of the orbits are intact.Incidental note is made of a a Thornwaldt cyst in the posterior nasopharyngeal mucosal space of the nasopharynx.

Output: 1.A small lesion in the pons is suspected to represent capillary telangiectasia rather than metastatic disease. If clinically appropriate, given the patient's clinical history for possible metastases, follow-up exams would help confirm this.


Instruction: Generate impression based on findings.

Input: Transphenoidal for pituitary tumor resection. Evaluate for residual/recurrent tumor. There are postoperative findings related to prior transphenoidal surgery. There has been gradual increase in size of the enhancing right sellar mass with extension into the right cavernous sinus, which now measures 19 AP x 17 RL x 13 SI mm. The mass encases the right cavernous portion of the internal carotid artery. However, there is no mass effect upon the optic apparatus. The infundibulum intact and midline. There are partially imaged prominent arachnoid granulations in the bilateral greater sphenoid wings.

Output: Gradual increase in size of the pituitary macroadenoma over the course of several years.


Instruction: Generate impression based on findings.

Input: 30 year-old female. Status post left ACL injury, gait abnormality. Pain. MENISCI: Medial and lateral menisci are normal in signal intensity and morphology without evidence of a tear.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits without evidence of contusion or fracture. Diffuse mild thinning of the patellofemoral compartment cartilage without a full thickness defect. LIGAMENTS: Abnormal intermediate signal intensity and marked thinning of the superior half of the ACL consistent with a chronic tear. Perhaps a few fibers remain intact. MCL, LCL, and PCL are intact.EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Findings consistent with a chronic tear of the ACL near its femoral insertion.


Instruction: Generate impression based on findings.

Input: 40 years, Male, positive Lhermitte's sign. Evaluate for cervical lesion, MS or myelopathy. Brain:MRI of the brain is within normal limits for age. Specifically, no lesions to suggest demyelinating disease are appreciated. No abnormal signal in the midbrain or pons is seen. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine:There is no abnormal signal in the cervical cord. Cord caliber and contour is within normal limits. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. There is a small central disc protrusion at the C5-C6 level which contacts the ventral aspect of the cord. There is no significant spinal canal stenosis at this level. Remainder of the spinal canal and cervical neural foramina are patent. Paraspinous soft tissues are unremarkable.

Output: 1. Brain MRI appears within normal limits. Specifically, no findings to suggest demyelinating disease are appreciated.2. Cervical cord demonstrates no lesions to suggest demyelinating disease. There is a small disc protrusion at the C5-C6 level which contacts the ventral cord without significant mass effect or cord signal abnormality. Spinal canal is otherwise patent.


Instruction: Generate impression based on findings.

Input: THORACIC SPINE: There is diffuse marrow heterogeneity of the thoracic spine with diffuse infiltration of the T1 through T4 vertebral bodies. Multiple scattered enhancing foci are noted throughout the thoracic vertebrae. There is involvement of the posterior elements at multiple levels, most prominent at the left greater than right T1-T2 level and right T5-T6 level. There is curvilinear enhancement of the epidural space at the ventral aspect of T1-T2 and T2-T3, ventral lateral and left posterior aspect of T3-T4, ventral and right lateral aspect of T4-T5, and right lateral aspect of T5-T6, representing epidural spread of tumor. The vertebral column alignment is within normal limits. The vertebral body heights are grossly maintained. There is no significant spinal canal stenosis. There is mild left T1-T2, left T2-T3 and right T5-T6 foraminal narrowing. There is minimal deformity of the posterior aspect of the thoracic cord at the level of T6-T7, which may be related to an arachnoid cyst. The spinal cord otherwise displays normal signal. Incidentally noted is a 14 mm adrenal nodule extending off the medial limb of the right adrenal gland. LUMBAR SPINE: The vertebral column alignment is within normal limits. There is diffuse marrow heterogeneity with multiple scattered foci of enhancement throughout the lumbar vertebrae, sacrum and iliac bones. There is diffuse marrow infiltration of the L1 and L3 vertebral bodies. There is minimal compression of the L1 and L3 vertebral bodies, suspected to be pathologic. There are Schmorl's nodes at the superior and inferior endplates of L3. There is mild left foraminal narrowing at L3-L4, related to small disc protrusion. There is advanced facet arthropathy of the lower lumbar spine. The distal spinal cord and conus are within normal limits with the conus terminating at the L2-L3 level. There is no abnormal leptomeningeal enhancement. Partially imaged is an enlarged uterus with presumed calcified leiomyomas as correlated with CT abdomen and pelvis of 1/27/2015.

Output: 1. Diffuse osseous metastases of the axial skeleton with epidural tumor involvement at upper to mid thoracic spine as described. No significant spinal canal stenosis or cord compression.2. Minimal pathologic compression deformities of the L1 and L3 vertebral bodies. No associated osseous retropulsion into the spinal canal.


Instruction: Generate impression based on findings.

Input: Male 81 years old. CT demonstrated possible liver hemangiomas. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size and morphology.The segment 4B lesion demonstrates loss of signal on out of phase imaging consistent focal fat (series 901, image 274). The subcapsular segment 2 lesions are progressively enhancing, T2 hyperintense, T1 hypointense lesions compatible with hemangioma. An enhancing focus within segment 8 has no T2 correlate and is consistent with perfusional abnormality. There is a subcentimeter cyst in segment 4A. Additional hepatic lesions are too small to accurately characterize.No suspicious hepatic lesion.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is not dilated. The pancreas enhances homogeneously.ADRENAL GLANDS: A small left adrenal nodule demonstrates loss of signal on out of phase imaging indicating benign adrenal adenoma.KIDNEYS, URETERS: There are a few bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is eccentric thickening of the gastric fundus measuring 4.0 x 3.3 cm (series 1005, image 284). Moderate hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious hepatic lesion.2.Eccentric thickening of the gastric fundus may represent the sequela of chronic gastric ulceration versus neoplasia. This can be further evaluated with endoscopy as clinically warranted.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is slight irregularity and increased signal intensity of the posterior horn of the medial meniscus best appreciated on series 501 image 17. This may be due to volume averaging although the presence of a small tear is not excluded, particularly if this correlates to the area of the patient's pain. There is a mild amount of degenerative marrow signal intensity within the lateral tibial plateau posteriorly (series 501 image 18). The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Subjectively, there is mild thinning of the articular cartilage of the lateral and medial compartments although no discrete full-thickness defect is identified. There is degenerative signal heterogeneity of the patellofemoral articular cartilage but again, no discrete full-thickness defect is seen.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Slight irregularity and increased signal the posterior horn of the medial meniscus may represent a small tear particularly if this correlates to the region of the patient's pain. There is otherwise no evidence of internal derangement of the knee.


Instruction: Generate impression based on findings.

Input: Shoulder pain, multiple prior cuff repairs Multiple suture tracks are seen within the humeral head/greater tuberosity and there are multiple foci of metallic susceptibility artifact overlying the shoulder which relate to prior surgical intervention.ROTATOR CUFF: There is heterogeneity of signal in the distal supraspinatus tendon likely reflecting a combination of tendinosis and scar tissue. We see no fluid-filled gap to suggest a full-thickness tear. Small surface defects likely represent chronic partial-thickness tears. Also, subcentimeter foci of abnormal signal intensity within the tendon demonstrate signal characteristics of bone marrow and represent small ossicles. The above-mentioned signal heterogeneity extends posteriorly to involve the anterior fibers of the infraspinatus tendon with perhaps small cysts within the distal infraspinatus tendon near a suture anchor tract. There is no full-thickness tear of infraspinatus tendon. There is moderate fatty atrophy along the myotendinous junction of the supraspinatus tendon but more proximally the muscle belly is relatively normal. There is mild fatty atrophy of the infraspinatus muscle distally as well. The teres minor tendon and muscle are intact. There is mild tendinosis of the subscapularis tendon but no discrete tear is identified. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: There is widening of the acromioclavicular joint, presumably postsurgical in nature. There is no fluid within the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the joint but no joint effusion. The superior labrum is attenuated with increased signal likely reflecting degenerative tearing. The inferior labrum is intact.BICEPS TENDON: The extra-articular portion of the biceps tendon is visualized within the bicipital groove; however the tendon is not well-visualized in the rotator interval and may be torn.

Output: 1. Findings of prior rotator cuff repair. There is heterogeneous signal intensity of the supraspinatus and anterior infraspinatus tendons that we suspect represents a combination of scarring, tendinosis, and perhaps focal partial-thickness tearing along the surface; however we see no fluid-filled gap to indicate full-thickness tear.2. Other findings detailed above.


Instruction: Generate impression based on findings.

Input: 55 years Female (DOB:5/23/1961)Reason: MS folow up History: nonePROVIDER/ATTENDING NAME: HALINA BRUKNER HALINA BRUKNER 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. These are stable compared to the prior exam from 8/4/2015. Some of the lesions are perpendicularly oriented to the lateral ventricles and extends to the colosso-cingulate junctionNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of multiple periventricular subcortical white matter lesions as well as cerebellar lesions which are stable compared with previous exam. Although these lesions are nonspecific they do support the clinical diagnosis of multiple sclerosis.


Instruction: Generate impression based on findings.

Input: Tumor resection follow up. There are postoperative findings related to right frontal lobe tumor resection. There is fluid, air, and hemostatic material within the surgical cavity. There is mild linear enhancement along portions of the surgical margins. The ventricles are unchanged in size and configuration. There is unchanged slight midline shift to the left. The extracranial structures are grossly unchanged.

Output: Limited exam at reduced charge shows expected postoperative findings related to right frontal lobe. please refer to the brain MRI report from 3/3/15 for additional details.


Instruction: Generate impression based on findings.

Input: Grade II astrocytoma treated with RT/TMZ+TMZ. Off all treatment currently. There are unchanged post-treatment findings in the posterior fossa and unchanged patchy T2 hyperintensity in the pontomedullary region. There is an unchanged punctate focus of susceptibility effect in the right posterior medulla, which may represent a microhemorrhage or cavernous malformation. There is unchanged confluent T2 hyperintensity in the right cuneus and mild scattered nonspecific foci of susceptibility effect in the cerebral white matter. There is no evidence of acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: Male; 67 years old. Reason: research History: prostate cancer PELVIS:PROSTATE:Prostate Size: 2.8 x 4.2 x 3.5 cm.Peripheral Zone: Mild scattered high T1 signal in the peripheral zone bilaterally, due to hemorrhage. Large lesion with low T2 signal and restricted diffusion in the right peripheral zone extending from the base to the mid gland with invasion into the central zone, extracapsular extension, and mild invasion into the right seminal vesicle, compatible with prostate cancer and measuring up to 1.2 x 2.9 cm (series 903/324).A smaller suspected focus of prostate cancer is seen at the left apex without extracapsular extension (series 3/284).Central Gland: Large right prostate cancer invasion into the central zone.Seminal Vesicles: Mild invasion into the right seminal vesicle by large right prostate cancer.Extracapsular Extension: Extracapsular extension is seen of the right prostate cancer laterally.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered subcentimeter in short axis pelvic sidewall lymph nodes are nonspecific. For future reference, a left pelvic sidewall lymph node measures 7 x 3 mm (series 2901/148), and a right pelvic sidewall lymph node measures 8 x 4 mm (series 2901/140).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large right prostate cancer with extracapsular extension and invasion into the right seminal vesicle.2.Smaller suspected focus of prostate cancer at the left apex without extracapsular extension.3.Nonspecific small pelvic sidewall lymph nodes.


Instruction: Generate impression based on findings.

Input: BRAIN: A right parietal approach ventriculostomy catheter is again demonstrated with its tip in the medial aspect of the right lateral ventricle. There is no evidence of hydrocephalus with decreased size of the ventricular and adjacent CSF spaces. Findings are consistent with a small posterior fossa and at least Chiari I malformation. Partial agenesis of the corpus callosum is again noted with deficient rostrum, posterior body and splenium. A right paramedian ventricular cyst extending to the vertex via a small communication in the midline is again noted. Bilateral hemispheres are asymmetric, right greater than left which can be seen in the setting of hemimegalencephaly, and bilateral cortical dysplasias.There has been interval posterior fossa decompression, including suboccipital craniectomy and partial resection of the posterior arch of C1. Postsurgical changes related to craniosynostosis are also again noted. Biphasic CSF flow is present posteriorly at the foramen magnum and level of the cerebellar tonsillar tips.CERVICAL SPINE:Suboccipital craniectomy and partial resection of the posterior arch of C1 is noted. The cervical vertebral bodies are appropriate in height. Sagittal alignments are maintained. Bone marrow signal is within normal limits. Mild levoconvex curvature of the cervical spine of is noted.The cervical spinal cord has normal signal characteristics and overall morphology.There is no significant degenerative change, spinal canal stenosis, or neural foraminal narrowing in the cervical spine.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1.Right parietal approach ventriculostomy catheter terminating in the right lateral ventricle. No current evidence of hydrocephalus with decreased size of the ventricular and adjacent CSF spaces.2.Complex congenital malformations in the supratentorial and infratentorial brain.3.Postsurgical changes related to posterior fossa decompression. Biphasic CSF flow is present posteriorly at the foramen magnum and level of the cerebellar tonsillar tips.4.Redemonstrated postsurgical changes of the calvarium related to prior craniosynostosis repair. 5.No syrinx or other significant abnormality in the cervical spine.


Instruction: Generate impression based on findings.

Input: Benign neoplasm of pituitary gland [D35.2], Reason for Study: ^Reason: evaluate for pituitary abnormalities History: s/p transphenoidal surgery. Pituitary MRIComparing to preoperative scan, central portion of intrahepatic atrium nonenhancing lesion has been resection with minimal linear remained non-enhancing portion. On the other hand, bilateral lateral aspect of the lesion appear to be persistent [right side: 5mm (CC) x 4.2mm (RL); left side:3.6mm(CC) x 4.2mm (RL)]. Pituitary stalk is in the midline and shows normal enhancement and size. No other abnormal enhancement is seen.The suprasellar cistern, optic chiasm, hypothalamus, and cavernous sinuses are unremarkable. The orbits and contents are unremarkable. Brain MRI No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Redemonstration of a small focus of gray matter heterotopia along the right frontal horn is unchanged. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection, hemorrhage, restricted diffusion/acute ischemia or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV2-D TOF MRV brain and 3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate hypoplastic left transverse sinus. However, normal flow enhancements were seen in the superior sagittal sinus, right transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.There is no evidence of venous occlusive disease.

Output: 1. Central portion of previously seen intra pituitary non enhancing lesion has been near totally resected. However, bilateral lateral aspects of the lesion appear to be remained. There is no evidence of abnormal enhancement. And sphenoid sinus does not show any postoperative unusual finding.2. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.3. Unchanged small right frontal horn area gray matter heterotopia since prior scan.4. Normal MR venogram without evidence of major venous sinus occlusion.


Instruction: Generate impression based on findings.

Input: The examination is slightly limited by motion artifact. There is pronounced volume loss involving the temporal lobe, including the hippocampus, where there appears to be mild T2 hyperintensity. There is a background of diffuse cerebral volume loss as well. There is no midline shift or mass effect. There is no abnormal intracranial enhancement. There is no diffusion abnormality. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a 10 mm periapical cyst involving tooth number 9. There is minimal paranasal sinus mucosal thickening.

Output: The pronounced atrophy of the right temporal lobe appears grossly similar to prior examination and may represent the sequela of a prior encephalitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 11 year old female with history of Chiari malformation status post decompression 12/2012, with headaches and back pain Again seen are postsurgical changes of suboccipital craniectomy and C1 laminectomy for Chiari decompression. CSF spaces at the level of the foramen magnum are patent ventrally and dorsally. The cerebellum abuts the dura dorsally. No tonsillar herniation is evident. CSF flow analysis shows good biphasic anterior and posterior flow. Visualized intracranial structures show no hydronephrosis or other abnormality.Alignment of the spine is anatomic with intact vertebral body heights and disk spaces. Signal within the cord and conus is normal, which terminates normally at L2-L3. No significant central canal or neuroforaminal narrowing. No syrinx is evident.

Output: Status post Chiari decompression with preservation of the CSF spaces ventrally and dorsally at the foramen magnum. No syrinx.


Instruction: Generate impression based on findings.

Input: 61-year-old female with a prior history of benign left breast biopsy. She has a strong family history of breast cancer in her mother, four maternal aunts, and paternal aunt. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.An intramammary lymph node is again seen in the upper outer quadrant of the right breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: History of MS and metastatic renal cancer, status post SRS to cerebellar metastases. Assess for progression. Signs and symptoms: None Pre and post enhanced brain MRI:Examination redemonstrate an irregular hemosiderin laden focus of enhancement in the right posterior parietal lobe without appreciable change in its size (20 x 22 x 22 mm), morphology or extent since prior exam. The enhancement however appears less intense and with suggestion of increased internal necrosis. This finding is associated with subtle mass effect on the trigone and posterior body of right lateral ventricle similar to prior study.Examination also redemonstrate an enhancing mass in the superior (median vermis with interval increase internal necrosis and increased size. Increased size could represent pseudo progression secondary to necrosis. Follow-up exams however are recommended. This lesion measures approximately 16 x 10 x 13 mm compared to prior study measurements of 15 x 8 x 9 mm. Associated surrounding FLAIR hyperintensity consistent with edema remains fairly similar to prior exam.There are no detectable new foci of parenchymal or leptomeningeal enhancement.Fairly extensive FLAIR hyperintensity of bilateral hemispheric white matter consistent with posttreatment changes are again noted.Calvarium is unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.

Output: 1.Treated metastatic lesion in the right posterior parietal demonstrate no significant change in size however there is mild further increase in internal necrosis as detailed.2.Vermian metastatic lesion demonstrates subtle interval increased size and internal necrosis as detailed/measured above. Increased size may represent pseudo progression secondary to internal necrosis.3.Stable diffuse FLAIR hyperintensity of bilateral hemispheric white matter, ex vacuo dilatation of the supratentorial ventricular system however with maintained midline.


Instruction: Generate impression based on findings.

Input: 84 year-old woman with history of sacral decubitus ulcers, evaluate for osteomyelitis. SOFT TISSUES: There is soft tissue loss posteriorly compatible with the stated history of sacral decubitus ulcer. We see no abscess.There is edema within the subcutaneous fat of the left buttock. Increased signal intensity on T2 sequences within the gluteal muscles and adductor muscles on the left is nonspecific. Increased signal intensity along the left gluteal medius tendon could represent a myotendinous tear but the tendon itself extends to insert on the greater tuberosity.There is edema within the subcutaneous fat of the right flank. Also, there is increased signal intensity on the T2 sequences in the anterior aspect of the gluteus medius, gluteus minimus, and adductor muscles of the hips perhaps representing additional edema. Also, there is mild edema amidst the anterior musculature of the upper right thigh.Increased signal intensity on both T1 and T2 sequences in the paraspinal muscles likely represents atrophy. BONE MARROW: Adjacent to the sacral decubitus ulcer, there is signal abnormality on both T1 and T2 sequences in the lower half of S5 as well as the upper coccyx consistent with osteomyelitis. Additionally, increased signal intensity is noted on the fat saturated T2 sequence in the lower coccyx and the remainder of S5 with relatively normal signal on T1 sequences suggesting reactive edema. The remaining bone marrow signal intensity is within normal limits without evidence of osteomyelitis.JOINTS: Mild degenerative arthritic changes affect the lower lumbar spine.ADDITIONAL

Output: 1.Sacral decubitus ulcer with abnormal signal intensity in the lower sacrum and upper coccyx compatible with osteomyelitis.2.Additional soft tissue inflammation as described above.


Instruction: Generate impression based on findings.

Input: 8-week-old female status post ECMO found to have subdural hemorrhage on MRI. Please evaluate interval change. Again seen are subdural fluid collections overlying the right frontal, temporal, and occipital regions and interhemispheric fissure as seen on recent MRI, grossly unchanged. No high density material is seen to suggest acute hemorrhage. The underlying cerebral and cerebellar hemispheres are unchanged in appearance. The ventricles are midline, with normal morphology and volume.Extensive soft tissue edema is seen about the skull. There is opacification of several ethmoid air cells. No definite skull fracture is evident.

Output: Stable subdural hematomas and extensive soft tissue edema, with no evidence of acute hemorrhage.


Instruction: Generate impression based on findings.

Input: 46-year-old female with question of left shoulder nerve entrapment. ROTATOR CUFF: The rotator cuff appears intact without significant tearing or tendinopathy. The bellies of the visualized musculature appears intact without significant fatty atrophy. The subscapular notch and spinoglenoid notch appear without significant abnormality.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted. No significant tearing of the glenohumeral joint and glenoid labrum is seen.BICEPS TENDON: The biceps tendon appears well seated without significant abnormality. ADDITIONAL

Output: No findings to suggest nerve entrapment as clinically queried.