Instruction: Generate impression based on findings.

Input: Male, 10 years old, history of glioblastoma status post biopsy and radiation therapy and chemotherapy. Sequelae of right frontal approach biopsy are again seen including minimal gliosis along the biopsy tract through the right centrum semiovale, and the presence of a biopsy marker along the right aspect of the midbrain just below the thalamus.Patchy infiltrative T2 hyperintensity involving the midbrain and to a less degree the pons is unchanged in geographic extent and signal quality. Minimal enhancement within the pons, which may be vascular in nature, is unchanged. No new enhancing lesions are detected.Elsewhere brain morphology and signal characteristics are unremarkable. Diffusion weighted images are normal. No evidence of significant intracranial hemorrhage or any abnormal extra-axial fluid is seen.

Output: Stable examination with no evidence of new or progressive disease.


Instruction: Generate impression based on findings.

Input: 74-year-old female with right hemiparesis. Brain: There is no evidence of intracranial hemorrhage, mass or edema. There is a punctate focus of restricted diffusion in the left paramedian ventral pons, which likely represents an area of acute ischemia. Scattered periventricular and subcortical hypertense FLAIR signal abnormalities are compatible with chronic small vessel ischemic disease. Two subcentimeter foci of CSF signal intensity are seen in the right periventricular white matter, which likely represent old lacunar infarcts or prominent perivascular spaces. There is a wedge-shaped area of encephalomalacia in the right medulla, compatible with evolution of the prior infarction identified on the MRI dated 1/20/15. The ventricles and sulci appear prominent, compatible with parenchymal volume loss. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. There is partial opacification of the left mastoid sinus. There is a left lens replacement. The orbits are otherwise unremarkable. There is a non-specific right parotid gland nodule as seen on the recent CTA. Cervical Spine: The cervical spine demonstrates a normal alignment without evidence of subluxation or fracture. No significant marrow abnormalities are suspected. There is a focal, central disc protrusion at C2-C3 with mild narrowing of the central spinal canal. There is a focal, central disc protrusion at C3-4 with mild narrowing of central spinal canal and mild narrowing of the left neuroforamina. There is eccentric disc protrusion C4-5 with mild narrowing of the central spinal canal. At C5-6, there is mild disc bulge with mild narrowing of the right neuroforamina but no significant central spinal canal stenosis. At C6-7, there is mild disc bulge and mild bilateral neuroforaminal stenosis, left slightly greater than right, but no significant central spinal canal stenosis. There is no cord signal abnormality. There is an exophytic soft tissue nodule noted within the left neck, which is of uncertain clinical significance.

Output: 1.Punctate focus of restricted diffusion in the left paramedian ventral pons is compatible with acute ischemia. 2.Chronic infarct of the right medulla is seen.3.Cervical spondylosis is seen but no acute spinal abnormalities are detected.These findings were discussed with Dr. Kamson at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Pain and swelling. Cyst on dorsum of wrist with lunate cyst. A combination of fluid and intermediate signal intensity surrounds the tendons of the fourth extensor compartment as they course dorsal to the distal radius, indicating tenosynovitis. Multiple separate tendon slips are noted, which may either reflect anatomic variation or chronic longitudinal tearing. At the level of the radiocarpal joint, the fluid surrounding the tendons disappears, but there is thickening of the supratendinous extensor retinaculum. Distal to the retinaculum, fluid is noted within the fourth extensor compartment extending to the level of the metatarsal bases, indicating additional tenosynovitis. One of the slips of the extensor indicis tendon is markedly enlarged with foci of high signal intensity that likely reflects a combination of severe tendinosis and partial-thickness tearing. A relatively small amount of fluid is noted adjacent to the tendons of the first, second, and third extensor compartments, perhaps representing relatively mild tenosynovitis, but not necessarily of any current clinical significance. There is enlargement of the extensor carpi ulnaris tendon as it courses along the ulnar styloid with linear intrasubstance signal that extends to the surface of the tendon suggesting a partial thickness tear; there is only trace fluid within the extensor carpi ulnaris tendon sheath, however. The flexor tendons are unremarkable.There is a lobulated and branching mass of fluid signal intensity along the volar lip of the distal radius measuring just over 1 cm in mediolateral dimension, approximately 1 cm in craniocaudal dimension, and approximately 6 mm in AP dimension, likely representing a ganglion, perhaps arising from the attachment of the long radiolunate ligament. There is also a small lobulated collection of near-fluid signal intensity along the ulnar neurovascular bundle at the level of the proximal diaphysis of the fourth metatarsal which may represent a small ganglion or varix.There is a slight negative ulnar variance. There is mild increased signal intensity within the medial fibers of the articular disc of the triangular fibrocartilage complex suggestive of degenerative tearing at its ulnar styloid attachment. There is heterogeneous abnormal signal intensity within the lunate bone concentrated along its periphery, particularly medially, which is of low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. This may represent a cluster of degenerative cysts or intraosseous ganglia, although the possibility of an unusual pattern of osteonecrosis is also considered. Centrally, the marrow signal of the lunate is relatively preserved. A couple of small foci of signal abnormality within the scaphoid and capitate are of doubtful clinical significance. Moderate osteoarthritis affects the basilar joint, with thickening of its capsular ligaments.Evaluation of the intrinsic ligaments of the wrist is limited due to lack of intra-articular contrast, but I see no specific findings of disruption.

Output: Fourth extensor compartment tenosynovitis and other findings as described above.


Instruction: Generate impression based on findings.

Input: 72 years Female (DOB:11/18/1943)Reason: low back pain, radiating down right leg History: right leg painPROVIDER/ATTENDING NAME: KIMBERLY MARTIN SVETLANA BIELECKI Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Incidental note is made of a perineural cyst within the sacral spinal canal on the left sideAt L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild facet hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are degenerative changes present in the lower lumbar spine without significant compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Ankle pain with history of microfracture and 2009 for tibial osteochondral defect. TENDONS: The peroneal, flexor, extensor, and Achilles tendons are intact.LIGAMENTS: The lateral ligaments are intact. The visualized components of the medial ligament complex are intact. The tibiofibular syndesmotic complex is intact.ARTICULAR SURFACES AND BONE: No fractures are identified. Tiny osteophytes are noted along the tibial plafond. No signal abnormalities are seen at the site of the prior tibial osteochondral defect and microfracture. The articular surfaces are within normal limits.ADDITIONAL

Output: No significant abnormality.


Instruction: Generate impression based on findings.

Input: 72Yrs male with history of ulcerative colitis s/p colectomy and ileostomy (1970), cholecystectomy (1970), splenectomy (1974), PSC s/p liver transplant (1989), HCV s/p Harvoni (2015), CKD, chronic pancreatitis, presents for evaluation of pancreatitis. Evaluation limited by lack of intravenous contrast.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes related to liver transplant. Susceptibility artifact at the hepatic hilum mildly limits evaluation of surrounding structures. No significant biliary ductal dilatation. The hepatic parenchyma demonstrates normal signal intensity without focal lesions. No significant biliary ductal dilatation. Trace perihepatic ascites.SPLEEN: Status post splenectomy.PANCREAS: There is irregular dilation of the pancreatic duct in the body and tail measuring up to 13 mm, increased from the 12/6/2013 examination. The pancreatic duct abruptly narrows in the proximal body and is nondilated in the neck and head. Filling defects are noted within the dilated portions of the pancreatic duct compatible with pancreatic duct stones. The pancreas is atrophic. There are subcentimeter cystic structures in the uncinate process which could represent side branch IPMNs. Postsecretin imaging demonstrates that the aforementioned pancreatic duct stenosis remains fixed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left greater than right renal parenchymal atrophy. Numerous simple and complex cysts are again noted in the kidneys. Several cystic lesions are new or more prominent than on the 12/6/2013 examination, demonstrate intrinsically increased T1 signal, and may reflect proteinaceous and/or hemorrhagic cysts but are incompletely characterized without intravenous contrast.RETROPERITONEUM, LYMPH NODES: Mild lymphadenopathy is again noted with a reference aorto-caval node measuring 1.2 cm in short axis, not significantly changed.BOWEL, MESENTERY: Postsurgical changes related to colectomy and ileostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Examination limited by lack of intravenous contrast.2.Findings compatible with chronic pancreatitis. 3.Pancreatic duct stenosis with increased pancreatic ductal dilation in the body. Associated pancreatolithiasis. Further evaluation with ERCP may be considered as clinically warranted.4.Numerous renal cystic lesions, some of which are more prominent than on the prior examination. Though these may simply represent proteinaceous/hemorrhagic cysts, they are incompletely characterized without intravenous contrast.


Instruction: Generate impression based on findings.

Input: Male, 14 years old, with brainstem lesions, yearly follow-up examination. Three nonenhancing T2 hyperintense foci are redemonstrated within the dorsal and left lateral medulla showing no significant interval change in size or morphology. No new lesions are detected. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No pathologic enhancement is seen. No abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology. Mucosal thickening is evident within the left maxillary and bilateral sphenoid sinuses.

Output: No significant interval change in the size or morphology of nonenhancing lesions within the medulla.


Instruction: Generate impression based on findings.

Input: 77-year-old female with metastatic breast cancer and worsening hip pain. There is heterogeneous signal abnormality within the right ischium that corresponds to a treated metastasis seen on prior PET/CT and CT examinations dating back to 2011. The lesion is of heterogeneously high signal intensity on T2-weighted imaging and is predominantly fat signal intensity on T1-weighted imaging with relatively small areas of nonadipose signal on T1-weighted imaging. There is mild enhancement of the lesion following administration of gadolinium. The cortex surrounding the lesion is intact, representing healing when compared to the prior study from 2011. There is very mild poorly-defined edema-type signal abnormality within the head, neck, and intertrochanteric region of the right femur seen on T2-weighted imaging that shows minimal enhancement on postcontrast images. On the T1-weighted images, however, the marrow signal intensity of the femur is of fat signal intensity, more so than that on the contralateral side, suggesting that this is a site of a prior radiation port; therefore, these likely represent postradiation changes.. There is a trace amount of fluid within the right hip joint. There is mild synovial enhancement suggesting a very mild synovitis, but we see no erosions. The remainder of the visualized bone marrow is within normal limits. Degenerative disc disease affects the lower lumbar spine. We see no tendon tearing or gross asymmetry of the musculature of the pelvis. There are small right-sided obturator lymph nodes. Mild degenerative arthritis affects the pubic symphysis. Lobulated fat within the buttocks likely represents injection granulomas.

Output: 1. Findings compatible with the patient's history of a treated ischial metastasis. We see no additional lesions to suggest metastatic disease to bone.2. Minimal right hip synovitis which may reflect prior radiation therapy.3. Degenerative disc disease of the lower lumbar spine and other findings as described above.


Instruction: Generate impression based on findings.

Input: There are post-therapy findings in the posterior fossa with cerebellar volume loss and distortion, confluent T2 hyperintensity in the cerebellar treatment zone and smaller areas of T2 hyperintensity in the brainstem that may include olivary degeneration, and persistent susceptibility effects and intrinsic T1 hyperintensity in the surgical cavity, but no evidence of residual nodular enhancement. There are also unchanged punctate foci of susceptibility effect in the right basal ganglia and left precentral gyrus, which may represent chronic microhemorrhages or cavernous malformations. There is no evidence of acute cerebral infarct. There is a posterior left ventricular catheter that terminates in the right lateral ventricle with persistent confluent high T2 signal in the brain parenchyma along the catheter track. There is unchanged T2 hyperintensity along the previous right ventriculostomy tract in the right frontal lobe. The lateral ventricles are perhaps slightly less collapsed.

Output: Interval evolution of post-therapy findings in the posterior fossa without evidence of recurrent tumor.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pain in right shoulderClinical question: Mid back pain with radiation around trunk, rule out thoracic spine disc herniation The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are is some hypertrophy of the ligamentum flavum at T10-T11 without any compromise to spinal canal or exiting nerve roots.On the scout images there appear to be some degenerative changes in the cervical spine worse at C4-5 where there is narrowing the spinal canal and neural foramina.The right lobe of the thyroid appears heterogeneous in signal and enlarged.

Output: 1.There are mild degenerative changes present in the thoracic spine without significant compromise to spinal canal or exiting nerve roots.2.There are degenerative changes present in the cervical spine which are incompletely evaluated on this exam.3.The right lobe of the thyroid appears large and heterogeneous. Please correlate with patient's clinical symptoms and history. This is an incidental finding.


Instruction: Generate impression based on findings.

Input: 14 year old female patient with recurrent severe localized right upper quadrant pain and nausea. Question of any anatomic abnormality in the liver, gallbladder, biliary tract, and pancreatic duct. Motion limits evaluation. LIVER, BILIARY TRACT: No focal hepatic lesion is identified. No gallstones are identified. No intra- or extrahepatic biliary ductal dilatation. No filling defect is identified within the common bile duct.SPLEEN: The spleen is normal in appearance.PANCREAS: The pancrease is normal in appearance. The pancreatic duct is non-dilated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are normal in appearance. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Internal Auditory Canals: The right semicircular canals are dysplastic in association with a markedly diminutive semicircular bone island. In addition, the cochlear nerve is markedly deficient. The left inner ear structures and cranial nerve 7 and 8 complex are intact. There is no evidence of mass lesions in the temporal bones.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are scattered inflammatory changes in the paranasal sinuses.

Output: Dysplastic right semicircular canals and right cochlear nerve deficiency.


Instruction: Generate impression based on findings.

Input: 68 year old female with right knee pain and effusion. MENISCI: There is globular and linear intrasubstance signal throughout the lateral meniscus indicating degeneration with formation of a intrameniscal/parameniscal cysts within/along the meniscus. Within the anterior horn the signal abnormality appears to extend to the femoral articular surface and within the posterior horn to the tibial articular surface in a horizontal fashion compatible with degenerative tearing. There is mild intrasubstance degeneration of the medial meniscus but no discrete tear is evident.ARTICULAR CARTILAGE AND BONE: There is moderate degeneration of the articular cartilage of the undersurface of the patella with degenerative signal abnormality within the underlying subchondral bone. There is delamination of the articular cartilage along the weightbearing portion of the medial femoral condyle resulting in a full thickness defect measuring approximately 1.5 cm in AP dimension and 1.0 cm in the transverse dimension. There is mild thinning of the articular cartilage of the anterior aspect of the medial tibial plateau. There is focal near-full-thickness to full-thickness degeneration of the articular cartilage of the lateral tibial plateau between the meniscal horns. There is also degeneration of the articular cartilage of the lateral femoral condyle posteriorly.LIGAMENTS: The cruciate and collateral ligaments appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Intrasubstance degeneration and degenerative tearing of the lateral meniscus with formation of small intrameniscal/parameniscal cysts.2. Articular cartilage degeneration most notably affecting the patellofemoral and medial tibiofemoral compartments.


Instruction: Generate impression based on findings.

Input: Right knee pain. MENISCI: Menisci are intact.ARTICULAR CARTILAGE AND BONE: There appears to be a cortical defect of the medial tibial plateau without that fills with fibrous tissue without surrounding inflammatory changes which is of unknown clinical significance. The trochlear groove is shallow and hypoplastic. An enchondroma is incidentally noted in the distal femur. Remaining cartilage and bone are unremarkable.LIGAMENTS: Cruciate and collateral ligament are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: 1.Hypoplastic and shallow trochlear groove. 2.Cortical defect in the tibial plateau filling with fibrous tissue


Instruction: Generate impression based on findings.

Input: Clinical question: Status post tumor resection. Signs and symptoms: Headache. Pre and postcontrast enhanced brain MRI:There is a thin right hemispheric subdural measuring maximum of 4.2 mm in right anterior temporal and approximately 2.5 mm in the right occipital. There is no appreciable mass effect with this finding.As was noted on prior head CT examinations there is a hematoma in the right anterior frontal lobe and hemorrhage within the surgical cavity with extensive surrounding vasogenic edema. Hematoma measures approximately at 25 x 33 mm in transaxial dimensions. Constellation of findings results in subtle mass effect on the right frontal horn of lateral ventricle and trace the radiation of midline without significant change since prior head CT examination on 5-21-30. On post enhanced images there is no detectable abnormal enhancement at this site to suggest residual meningioma. There is a surgical drain in place at the surgical site in the right frontal. There is also a small extra-axial hemorrhage in the left anterior frontal measuring maximum of 8 mm in thickness without appreciable mass effect on the parenchyma. Minimal postsurgical air is present.Ventricular system remain within normal size and unchanged since prior exam.A previously known heavily calcified right high convexity posterior parietal meningioma is again identified without change. Other smaller meningiomas however are not as well-visualized on post enhanced imaging however are detected on nonenhanced series..

Output: 1.A thin right hemispheric subdural measuring maximum of 4.2 mm in anterior temporal and 2.5 mm in right occipital without appreciable mass effect.2.Parenchymal hemorrhage and hemorrhage within the right frontal surgical cavity, surrounding vasogenic edema and associated mass effect/trace midline shift to the left remains similar to preoperative study.


Instruction: Generate impression based on findings.

Input: Radicular pain down the right leg. There are 6 nonrib-bearing lumbar-type vertebrae. As on the prior examination, the last disc space is labeled L6-S1. The vertebral column alignment is within normal limits. Mild degenerative endplate signal change is present at L4-5, L5-6 and L6-S1. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis from L1-2 through L3-4. The imaged portion of the distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. Disc desiccation and mild loss of intervertebral disc height is unchanged at L4-5 through L6-S1. There are multilevel facet degenerative changes throughout the lumbar spine. At L4-5, there worsening of a now moderately-sized left paracentral disc protrusion and osteophyte complex, which is compromising the lateral recess and appears to contact the traversing left nerve root. At L5-6, there has been interval worsening of the moderately sized right paracentral to foraminal disc protrusion which compromises the lateral recess and appears to contact the traversing right nerve root at this level.

Output: There are 6 lumbar type vertebrae. Moderately sized paracentral disc protrusions, which are new at the L4-5 level and worsened at the L5-6 level. These appear to contact the traversing nerve roots in the lateral recesses on the left at L4-5 and right at L5-6.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.7 x 2.1 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple nodules on the right with the largest measuring 1.5 x 1.1 x 1.3 cm at the equator. Nodules are heterogeneous and mostly iso to hypoechoic. LEFT LOBE: Multiple nodules on the left with the largest measuring 1.6 x 1.5 x 1.3 cm located at the upper pole. Similar to the nodules on the right these are mostly heterogeneous and isoechoic to hypoechoic with respect to the remainder the gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral small level 3 lymph nodes measuring up to 1.3 cmOTHER: Attention was directed to the and left parotid tail nodule described on recent MRI for possible biopsy. This nodule represents a benign-appearing lymph node with a fatty hilum measuring 0.8 x 0.3 x 0.4 cm. Given small size and benign appearance, biopsy was deferred. The rationale for this was discussed at length with the patient at the time of the exam who agreed with the plan.

Output: Multiple thyroid nodules bilaterally. The nodule described on recent MR appears to be a benign-appearing subcentimeter lymph node; given appearance and small size, biopsy was deferred. This was discussed with both the patient as well as the clinical service (pager 6467) at the time of the exam.


Instruction: Generate impression based on findings.

Input: 18 year-old female. Chronic anterior knee pain. Evaluate for internal derangement. MENISCI: Medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Bone marrow signal intensity is within normal limits. Tibiofemoral and patellofemoral compartment cartilage is normal in thickness and signal intensity.LIGAMENTS: ACL, PCL, MCL, and lateral ligament complex are intact.EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Findings suggestive of Hoffa's fat pad impingement syndrome. Ligaments and menisci are normal.


Instruction: Generate impression based on findings.

Input: Brain parenchymal morphology is within normal limits. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. No edema is detected. No definite diffusion-weighted abnormality. Geographic area of mild diffusion hyperintensity within the left frontal lobe white matter without corresponding abnormal ADC signal is favored to reflect T2 shine through artifact. There is no evidence to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection. There is no pathological intracranial enhancement. The ventricles are prominent compatible with age-related volume loss.

Output: 1. No evidence of acute ischemia. No specific findings to account for the patient's visual changes.2. Moderate chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Ms. Ybarra is a 62 year old female with a personal history of bilateral mastopexy in 1991 and benign right breast excisional biopsy in 2000 for cyst. Family history of breast cancer in paternal grandmother and two paternal aunts. There is scattered fibroglandular tissuein both breasts.Minimal parenchymal enhancement is noted bilaterally. Architectural distortion compatible with bilateral mastopexy is present.No abnormal enhancement is seen in either breast. No abnormal axillary 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: Assess for progression of posterior fossa lesion. Signs and symptoms: Spasticity. Pre- and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates multiple patchy foci of T2 hyperintensity in bilateral basal ganglia with interval progression since prior exam from 2012. Multiple tiny foci of FLAIR hyperintensity is also noted in the subcortical and periventricular white matter without convincing evidence of change.Tiny foci of T2 hyperintensity in bilateral thalami (left greater than right are better visualized on T2-weighted images) without significant change.Images through posterior fossa demonstrates extensive bilateral peroneal and pontine foci of FLAIR and T2 hyperintensity without convincing evidence of progression since prior exam. There are no detectable signal abnormality of cerebral cortex or cerebellum/vermis which is a similar observation as prior exam.Cortical sulci as well as ventricular system remain within normal size for patient of stated age and with maintained midline.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement and none of the above described foci of T2/FLAIR hyperintensity demonstrate enhancement. The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal and the normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series. Unremarkable images through the paranasal sinuses and mastoid air cells.

Output: 1.Negative diffusion-weighted images.2.Extensive bilateral basal ganglia and to a lesser degree bilateral thalami and pons and minimally in the subcortical and periventricular white matter foci of FLAIR hyperintensity without evidence of enhancement are again noted. There is progression of disease in bilateral basal ganglia since prior study. There is no convincing evidence of lesions in the corpus callosum or the cerebellar peduncles. Findings are more suggestive of chronic small vessel ischemic strokes.3.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: CNS nocardia, now with numbness and tingling in fingers and visual change. There is an unchanged avidly enhancing mass with susceptibility effect in the splenium of the corpus callosum, which measures up to approximately 25 mm. There is unchanged associated extensive vasogenic edema that extends into the bilateral posterior cerebral hemispheres. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral and cerebellar hemispheres. There is also an unchanged branching area of susceptibility effect in the right pons with associated patchy enhancement and corresponding calcifications depicted on CT. There are unchanged scattered foci of T2 hyperintensity in the cerebral white matter, which may represent chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is a partially empty sella. 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: No significant interval change in the lesion within the splenium of the corpus callosum with associated extensive surrounding vasogenic edema and other stigmata of alleged central nervous system nocardiosis.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate for osteomyelitis in L foot. History: L foot ulceration There is ulceration of the plantar soft tissues beneath the first MTP joint. The ulceration extends to the flexor hallucis longus tendon and there is trace fluid and enhancement surrounding the tendon as it courses beneath the first metatarsal head. There is also edema and enhancement of the adjacent soft tissues extending into the great toe consistent with cellulitis. There is mild enhancement of the skin of the dorsum of the foot and edema in the underlying subcutaneous fat which may reflect additional relatively mild cellulitis. There is also edema within the plantar musculature of the foot but we see no focal fluid collection to suggest abscess. There is abnormal signal intensity within the medial sesamoid bone beneath the first metatarsal head (low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging) compatible with osteomyelitis. There is similar but slightly less pronounced signal abnormality noted within the lateral sesamoid bone, which is also concerning for osteomyelitis. There is enhancement of the first MTP joint indicating synovitis which is nonspecific and could be degenerative or inflammatory/infectious in etiology. There is minimal fluid within the first MTP joint. On the fluid sensitive sequences, there is patchy subchondral increased signal intensity within the head of the first metatarsal and base of the proximal phalanx which enhances following gadolinium administration. On the T1-weighted images, there is low signal intensity involving the first metatarsal head concerning for early osteomyelitis. Marrow signal intensity in the proximal phalanx is relatively preserved on the T1-weighted images, suggesting that the abnormal signal intensity on the fluid sensitive sequences in this area may reflect reactive osteitis rather than osteomyelitis. The marrow of the distal phalanx of the great toes is normal. The remaining bone marrow signal intensity is within normal limits.

Output: Plantar soft tissue ulcer with osteomyelitis of the sesamoid bones and possibly the first metatarsal head as well.Findings discussed with Dr. Harter at the time of dictation.


Instruction: Generate impression based on findings.

Input: 38-year-old female with abdominal pain, fullness, gas, nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent right lower quadrant mesenteric lymph nodes are present.BOWEL, MESENTERY: Postsurgical changes of a ileocecectomy with end to end anastomosis in the right mid-lower quadrant.Redemonstrated is circumferential wall thickening and luminal narrowing of a segment of neoterminal ileum measuring 5.8 cm. There is mild upstream dilation of bowel measuring 3.2 cm in diameter. There is corresponding diffusion involving this segment of bowel. A short segment of small bowel wall thickening and luminal narrowing several centimeters upstream (series 10020, image 250) may be due to underdistention although this may be another focus of disease. There are discontinuous areas of the rectum and descending colonic wall thickening and abnormal enhancement without significant upstream dilatation, similar to the prior examination.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: T-shaped IUD device is again noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Active on chronic inflammation involving a 5.8 cm narrowed segment of the neoterminal ileum as described above. There is mild upstream dilation of small bowel measuring 3.2 cm in diameter reflecting mild flow-limiting stenosis.2.Additional short segment skip lesions of active inflammation involving the descending colon and rectum as described above. 3.No fluid collection or abscess is evident.


Instruction: Generate impression based on findings.

Input: Male, 47 years old, with history of L3-4 diskitis osteomyelitis with MRSA bacteremia. The L3-4 intervertebral disk demonstrates abnormal increased T2 signal with irregularity and patchy T2 hyperintensity of the adjacent end plates. Moderate ill-defined T2 hyperintensity is seen within the adjacent paraspinal soft tissues, including the psoas musculature. No discrete epidural or paraspinal fluid collections are seen. A few scattered mildly prominent para-aortic and aortocaval lymph nodes are seen.Mild T2 hyperintensity is seen within the T11-12 disk space. There are small Schmorl's nodes along the adjacent end plates as well as increased T2 signal along the T12 superior endplate. Please note that this level is assessed only on sagittal images.A scoliotic curvature of the lumbar spine is demonstrated. Vertebral bodies are otherwise well aligned. Aside from endplate irregularity at L3-4, vertebral body heights and morphology are maintained.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable except as discussed below.T12-L1: No significant spinal canal stenosis or neuroforaminal narrowing.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild facet hypertrophy. Loss of disk height and T2 signal with disk bulging asymmetric to the right. Moderate generalized spinal canal stenosis with particular effacement of the right lateral recess. Moderate to severe right and mild left foraminal narrowing. L3-4: Moderate facet hypertrophy with a small facet effusion on the left and peri-facet edema. Bulging disk resulting in a moderate generalized spinal canal stenosis. Severe bilateral foraminal narrowing. L4-5: Moderate facet hypertrophy with a small facet fusion on the right and peri-facet edema. No significant spinal canal stenosis. Severe left and moderate right foraminal narrowing.L5-S1: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.

Output: Constellation of findings at L3-4 including abnormal disk signal intensity, irregularity and abnormal signal intensity of the adjacent endplates, and edema/inflammation of the adjacent paraspinal soft tissues, compatible with diskitis osteomyelitis. No definite discrete or drainable epidural or paraspinal collections are seen, though sensitivity for this is somewhat reduced without IV contrast. Peri-facet edema at L3-4, and to a lesser extent at L4-5, may be degenerative in nature, but the possibility exists that the posterior elements are also involved with infection.Mild abnormal signal of the T11-12 disk with some evidence of endplate edema at T12 could be degenerative, but the possibility of osteomyelitis diskitis must be considered at this level as well.Degenerative disk disease and posterior element hypertrophy result in a moderate generalized spinal canal stenosis and significant right neuroforaminal narrowing at L2-3. Abnormalities of the disk and posterior elements at L3-4 contribute to a moderate generalized spinal canal stenosis and significant neuroforaminal narrowing.


Instruction: Generate impression based on findings.

Input: 36-year-old male with history of metastatic renal cell cancer with back pain.EXAM: CT of the thoracic and lumbar spine was performed without IV contrast. Thoracic spine: Alignment of thoracic spine is normal. Mild degenerative changes are seen throughout the thoracic spine. No lesions suspicious for metastases are identified. Nodular opacities at the right lung base are likely due to previously identified consolidation.Lumbar spine:3.3 x 2.9 cm lucent lesion in the L3 vertebral body, with a sclerotic rim, is not significantly changed compared to CT pelvis study from 2/18/08. There is a suggestion of posterior extension of this lesion into the central canal, however, this is equivocal. Additionally, another lucent lesion measuring 1.5 x 0.8 cm in the L1 vertebral body with sclerotic borders is identified. Although these lesions have a benign appearance the etiology of these lesions is unknown, and further evaluation by infused MRI is recommended.

Output: Two lucent lesions in the lumbar vertebral bodies as described above. Extension of the L3 lesion posteriorly into the central canal cannot be excluded. Although they have a benign appearance, the etiology of these lesions is unknown. Further evaluation by contrast-enhanced MRI is recommended.


Instruction: Generate impression based on findings.

Input: planning for SRS, history of NSCLC and brain mets. Multiple enhancing lesions indicating brain metastasis were again demonstrated.In particular, three supratentorial lesions including bilateral paracentral lobule lesions and left occipital lobe lesions, and bilateral cerebellar hemispheric lesions do not show any interval change since prior exam.There is no evidence of acute intracranial hemorrhage or acute ischemic infarct. There is no midline shift or herniation. The ventricles and basal cisterns are unchanged in size and configuration. The skull, orbits, and scalp soft tissues are unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: 1. No change of multiple enhancing metastatic lesions supra and infratentorially as described above since prior exam.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Worsening low back pain with possible compression fracture at T12. Five lumbar type vertebral bodies are presumed to be present. Bone marrow demonstrates diffuse low T1 signal with heterogeneity and multiple round lesions throughout the lumbar spine and visualized pelvis, findings highly suspicious for metastatic disease. Relatively larger lesion is seen involving the L2 vertebral body. Lesions involving the posterior elements are also noted. There is approximately 30% loss of height involving the T12 vertebral body suspected to represent a pathologic fracture. Vertebral body heights in the lumbar spine are otherwise normal. There is minimal retrolisthesis of L3 on L4. Alignment is grossly maintained.There is soft tissue dorsal to the T12 and L2 vertebral bodies suspected to represent epidural tumor in the ventral spinal canal. Relatively thicker ventrolateral epidural tumor at the left L2 level measures up to 7 mm in thickness. There is however no significant associated central canal stenosis.There are multilevel degenerative changes are seen, as described below:L1-L2: No spinal canal or neural foraminal stenosis.L2-L3: There is mild narrowing of the neural foramen on the left partially related to epidural tumor, which is mostly superior to the level of the neural foramen at the mid L2 level. There is no significant central canal stenosis or right neural foraminal narrowing.L3-L4: There is minimal retrolisthesis and disc bulge, which is eccentric to the left. There is mild narrowing of the left neural foramen. There is contact of the extraforaminal left L3 nerve root related to far lateral component of the disc bulge. No significant central canal or right neural foraminal stenosis.L4-L5: There is mild spinal canal stenosis related to combination of disc bulge, ligamentum flavum thickening and facet arthropathy. There is moderate right and minimal left neural foraminal narrowing.L5-S1: There is severe loss of disc height and mild bulge. There is no significant central canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.Multiple enlarged retroperitoneal lymph nodes are evident.

Output: 1. Multiple osseous lesions throughout the lumbar spine and pelvis highly suspicious for osseous metastatic disease. Mild epidural tumor is suspected at the T12 and L2 levels which can be better assessed with postcontrast sequences. There is however no significant associated spinal canal stenosis. Mild pathologic compression fracture at T12 is also noted.2. Extensive retroperitoneal lymphadenopathy also compatible with metastatic disease. Consider dedicated CT chest, abdomen, and pelvis study.3. Multilevel degenerative changes, relatively worse at the L4-L5 level, where there is mild central canal stenosis and moderate right neural foraminal stenosisDr. Ali discussed findings with Dr. Schwartz at 1150 hrs on 12/21/2015


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 right 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, 12 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. Subsequently, a mixture of 1 cc of Kenalog and 2 cc's of 1% lidocaine were injected into the joint. 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: 18 seconds.

Output: Successful fluoroscopic guided right hip arthrogram and corticosteroid injection.


Instruction: Generate impression based on findings.

Input: Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: Gait disturbance hyper reflexia History: above 85 years Male (DOB:9/6/1931)Reason: Gait disturbance hyper reflexia History: abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered FLAIR/T2 high signal intensity lesions are seen on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.There are scattered lacunar infarcts involving bilateral basal ganglia, bilateral caudate heads and the left cerebellar hemisphere. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the major intracranial arterial system.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.Bilateral lenses are not seen indicating postoperative status.Cervical MRIThere is normal cervical lordosis. The cranial-cervical junction is normal. Spinal cord signal intensity is normal.Degenerative changes are as follows; C23: Within normal limits.C34: Diffuse bulging of osteophyte disc complex with bilateral ligamentum flavum thickening results mild spinal canal and bilateral neuroforaminal stenosis.C45: Minimal focal bulging of disc, otherwise unremarkable.C56: Central to right osteophyte disc complex bulging which abuts thecal sac with bilateral ligamentum flavum thickening results mild to moderate spinal canal stenosis. Minimal to mild right lateral recess stenosis at this level is also seen. C67: Minimal bulging of disc, otherwise unremarkable.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease.3. Multiple lacunar infarcts in bilateral basal ganglia, caudate heads and left cerebellar hemisphere. 4. Degenerative spondylosis of cervical spine with C34 and C56 spinal canal stenosis. 5. Normal cervical spina cord signal intensity.


Instruction: Generate impression based on findings.

Input: History of hemochromatosis and pancreatic abnormality on outside MRI. ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring 22 cm in craniocaudal dimension. It is mildly decreased in signal intensity on in phase imaging compared to out of phase imaging compatible with iron deposition and provided history of hemachromatosis. No significant intrahepatic biliary ductal dilatation. The common bile duct measures 6 mm and tapers smoothly to the level of the ampulla. 11 mm simple hepatic cyst and a few additional punctate probable hepatic cysts.No focal suspicious lesion. No vascular abnormality.SPLEEN: The spleen is normal in size measuring 9.3 cm in length. No focal lesion.PANCREAS: The pancreas is normal in morphology. It is mildly decreased in T1-weighted signal intensity diffusely. There is diffuse mild prominence of the pancreatic duct which measures up to 3 mm in caliber which is at the upper limits of normal. No parenchymal atrophy is evident. The duct tapers smoothly to the level of the ampulla. No filling defect to suggest a gallstone or mass lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal interpolar 1.2 cm lesion with macroscopic fat, compatible with an angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Upper limits of normal pancreatic ductal dilatation without a focal mass lesion or pancreatic atrophy.2. Hepatomegaly and findings of iron deposition without a focal suspicious lesion.


Instruction: Generate impression based on findings.

Input: Laser ablation for seizures. There are postoperative findings related to recent laser ablation of posterior left lateral ventricle subependymal heterotopia, with peripheral enhancement at the ablation zones. Portions of the heterotopia remain adjacent to the ablations zones and there is a dysmorphic appearance of the regional left cingulate gyrus. There are also postoperative findings related to remove of left temporal deep brain electrodes. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Postoperative findings related to recent laser ablation of posterior left lateral ventricle subependymal heterotopia.


Instruction: Generate impression based on findings.

Input: Clinical question: 16 year old with history of mediastinal lymphoma and extradural soft tissue mass at T5-T6. 11 month of therapy. Signs and symptoms: Evaluate disease status. Pre- and post enhanced complete spine MRI:Evaluation of cervical spine demonstrate normal signal intensity and alignment of vertebral column without detectable abnormal enhancement.There is normal signal intensity and caliber the cervical cord and without detectable abnormal enhancement.No evidence of spinal stenosis or neural foraminal compromise.Evaluation of the thoracic spine demonstrate normal signal intensity and alignment of vertebral column without enhancement.Normal signal intensity and caliber of the thoracic cord without abnormal enhancement.No spinal stenosis or neural foraminal compromise is detected.Examination of the lumbosacral spine demonstrate normal signal intensity and alignment of vertebral column without abnormal enhancement.Unremarkable signal intensity of the lower most visualized thoracic cord, conus and cauda equina without abnormal enhancement.No spinal stenosis or neural foraminal compromise is detected.

Output: Unremarkable pre and post enhanced MRI of total spine without evidence of recurrence or residual epidural mass.


Instruction: Generate impression based on findings.

Input: Further assess pituitary lesion seen on brain MRI: dizziness. There is a mildly T1 hyperintense lesion between the adenohypophysis and neurohypophysis that measures up to approximately 5 mm. The cavernous sinuses and optic apparatus are intact. The cerebellar tonsils are mildly low-lying. There are multiple nasopharyngeal retention cysts. There is also a right maxillary sinus retention cyst.

Output: Tiny probable pars intermedia cyst.


Instruction: Generate impression based on findings.

Input: Dizziness and giddiness [R42], Reason for Study: ^Reason: rule out lesions History: constant dizziness, pain in the head There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of neurofibromatosis type I Chest: Again seen is a large T2 bright, mildly enhancing mass involving the left chest wall, which measures 8.4 x 4.4 cm and previously measured 8.6 x 5.0 cm. Osseous components of the adjacent rib are noted extending anterior to the mass. An additional small dumbbell-shaped lesion involving the right chest wall is again visualized, unchanged from the prior exam. Numerous additional small enhancing lesions involving the skin and left breast are visualized likely representing additional neurofibromas There is nonspecific skin thickening along the right posterior chest wallPelvis: Again seen is a large enhancing mass along the right gluteus medius which measures 2.7 x 5.2 cm and previously measured 2.6 x 5.3 cm. Numerous additional enhancing lesions involving the body wall, likely represent additional neurofibromas. The uterus is atrophic or absent. An enhancing mass is present within the pelvis abutting the sigmoid and rectum which measures 9.8 x 7.0 cm, not significantly change from the prior exam.

Output: Numerous neurofibromas as described above, overall appearing similar to the prior exam.


Instruction: Generate impression based on findings.

Input: 49-year-old male with left arm numbness and tingling Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.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: Minimal disk osteophyte complex. No significant compromise to the spinal canal or neural foramina.C4-5: Moderate central disk protrusion with indentation of the ventral cord. No significant neuroforaminal narrowing.C5-6: Small central disk protrusion, mildly indenting the ventral cord. No significant compromise to the neural foramina.C6-7: Mild central disk protrusion. No significant compromise to the spinal canal or neural foramina.C7-T1: Mild disk bulge. No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Degenerative changes in the cervical spine, worst at the C4-C5 level, where a central disk protrusion results in indentation of the ventral cord. There is no cord signal abnormality. There is no significant neuroforaminal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Left hip pain; Lupus with history of corticosteroid use BONE MARROW: No significant abnormality noted. Specifically, there is no evidence of avascular necrosis.SOFT TISSUES: No significant abnormality noted. JOINTS: Minimal osteoarthritic changes are noted of the left hip. Evaluation of the labrum is limited by lack of intra-articular contrast however there is no evidence of a full-thickness labral tear.ADDITIONAL

Output: Minimal osteoarthritis of the hip. Otherwise unremarkable MRI.


Instruction: Generate impression based on findings.

Input: Spina bifida with hydrocephalus, unspecified region [741.00], Reason for Study: ^Reason: eval for pathology s/p Chiari decompression History: LUE weakness and paresthesias Post suboccipital craniectomy status for the decompression of Chiari malformation. There is focal hemorrhage on the left posterior aspect of the lower medulla which extends to cervical medullary junction caudally and to the level of left inferior cerebellar peduncle cranial with surrounding edema.There is MR evidence of sub-occipital area dural irregularity and susceptibility artifacts indicating post surgical status.Multiple round susceptibility artifacts on anterior aspects of bilateral frontal lobes indicate postoperative pneumocephalus.There is no evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Post decompressive suboccipital craniectomy status.2. Acute hemorrhage on the left posterior aspect of the lower medulla as described above with surrounding edema.3. No acute ischemic lesion.


Instruction: Generate impression based on findings.

Input: There are unchanged postoperative findings related to right occipital craniotomy and occipital mass resection with residual susceptibility effect in the section cavity. There is a focus of enhancement along the superior margin of the postoperative bed measuring 7 x 2.5 mm on series 1201 image 50, decreased from 8 x 3 mm previously. There is unchanged moderate nonspecific confluent subcortical and periventricular white matter T2 signal abnormality. There is no acute infarct, mass effect or midline shift. There is unchanged right transfrontal ventricular catheter terminating in the third ventricle/level of the foramen of Monro. There is mild diffuse volume loss with stable ventricles. There is mild bilateral maxillary and scattered ethmoid sinus mucosal thickening.

Output: 1.Small focus of enhancement along the superior margin of the resection cavity in the right occipital lobe which is slightly smaller from most recent exam. This is favored to represent posttreatment findings although residual/recurrent tumor is not entirely excluded. Continued follow-up is suggested as clinically indicated.2.Essentially stable exam otherwise.


Instruction: Generate impression based on findings.

Input: Low back pain/facet, (unclear wording). Nonenhanced CT of the lumber spine:Axial 3 mm CT images of the entire lumbosacral spine with zero degree angulation of the gantry were attained. Sagittal and coronal 2-D reformatted images were also obtained.A bony density of vertebral column and its alignment is within normal limits. There is no evidence of bony central canal stenosis is detected. Note should be made that CT examination is insensitive for evaluation of intra-canalicular soft tissues of disk and the cord ligamentum flavum. Precise assessment for central spinal stenosis is not possible on CT of lumber spine.Minimal degenerative disk disease in the lower lumbar spine is noted. There is minimal degenerative changes of posterior elements in the lower lumbar spine is identified. There is no significant hypertrophic changes of facets and no evidence for widening of the facet spaces are detected. Although not sensitive on this examination there is no detectable neural foramina compromise. Mild bulge of disk material at L3 -- L4 and L4 -- L5 levels are noted. Perispinal soft tissues are unremarkable.Examination at the level of sacrum demonstrate degenerative changes of SI joints bilaterally with vacuum phenomenon.MRI examination is significantly more sensitive for detection of degenerative changes.

Output: 1.Minimal degenerative changes of disk and posterior elements in the lower lumbar spine. There is however no evidence of any significant degenerative changes of disk or posterior elements. No significant hypertrophic changes of the facets or widening of the spaces is detected.2.No evidence of central spinal stenosis or neural foramina compromise at any level. This exam is insensitive for precise evaluation.3.Degenerative changes of the SI joints bilaterally with vacuum phenomenon. No bony sclerotic changes.4.MRI is significantly more sensitive for detection of subtle findings.


Instruction: Generate impression based on findings.

Input: History of breast cancer: headaches x 1 month. Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered cerebral white matter T2 hyperintensity, which is nonspecific. There is also a punctate focus of high T2 signal in the basal ganglia, which likely represents chronic lacunar infarcts or prominent perivascular spaces. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Syncope and collapse [R55], Reason for Study: ^Reason: syncope History: syncope No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 74-year-old female with stage III colon cancer and AAA. Evaluate for interval development of hepatic disease and change in AAA. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Cholelithiasis. Focal fat deposition of hepatic segment 4B is unchanged (series 902 image 63, series 1000 image 67). The portal and hepatic veins are patent.SPLEEN: Multiple calcified splenic granulomas with associated blooming artifact.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable simple cyst of the right upper renal pole. Bilateral subcentimeter T2 hyperintensities are too small to characterize, favor cystic. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Interval enlargement of the known infrarenal aortic aneurysm (series 10 image 30) measuring 4.5 x 4.6 cm (prior 4 x 4.2 cm).BOWEL, MESENTERY: No bowel obstruction or ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval enlargement of the known infrarenal abdominal aortic aneurysm measuring 4.5 x 4.6 cm (prior 4 x 4.2 cm).2.No suspicious hepatic lesions.


Instruction: Generate impression based on findings.

Input: Reason: eval for medial meniscus tear History: mjl pain, + mcmurray MENISCI: There is linear increased signal abnormality which extends to the tibial articular surface consistent with a complex tear of the posterior horn including a large oblique component as well as a smaller longitudinal component. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is partial thickness articular cartilage degeneration along the medial femoral condyle above the posterior horn of the meniscus. There is a focal full-thickness articular cartilage defect along the weightbearing surface of the medial femoral condyle as seen on image 11 of series 8. There is decreased curvilinear signal abnormality within the medial aspect of the weightbearing surface of the medial femoral condyle which is surrounded by bone marrow signal abnormality which may represent a insufficiency fracture/subchondral fracture (image 10; series 8). There are small tricompartmental osteophytes.There is a full-thickness articular cartilage defect along the median eminence of the patella with delamination that extends along the medial and lateral facet of the patella. There is underlying subchondral signal abnormality within the patella.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial meniscus as described above.2. Bone contusion and probable subchondral fracture/insufficiency fracture of the medial femoral condyle.3. Osteoarthritis of the knee with a full-thickness articular cartilage defect and articular cartilage delamination affecting the patellofemoral and medial compartments.4. Large joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Lumbar stenosis. Signs and symptoms: Low back pain, leg pain, difficulty ambulating because of severe pain. Nonenhanced lumbar MRI:T12/L1 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.L1-L2 demonstrate moderate disc disease and loss of disc height, shallow broad-based bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Constellation of findings results in moderate central spinal stenosis and mild bilateral neural foraminal compromise. No significant change since prior exam.L2-L3 demonstrate mild disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophy. Constellation of changes results in moderate to severe central spinal stenosis without significant change since prior exam. Mild bilateral (right greater than left) neural foraminal compromise is also noted.L3-L4 demonstrate moderate disc disease, loss of disc height, moderate to severe bilateral ligamentum flavum hypertrophy and mild bilateral facet hypertrophic changes. Constellation of changes results in significant central spinal stenosis and moderate to severe right neural foraminal and moderate left neural foraminal compromise. No significant change since prior exam.L4-L5 demonstrate moderate disc disease and loss of disc height, broad-based bulging disc, mild grade 1 anterolisthesis, significant bilateral ligamentum flavum hypertrophy and mild bilateral facet disease and hypertrophy. There is resultant significant central spinal stenosis with mild interval progression secondary to progression of ligamentum flavum hypertrophy since prior exam. Significant right and moderate left neural foraminal compromise is also noted.L5-S1 demonstrate advanced disc disease with loss of disc height, shallow broad-based bulging disc, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. No central spinal stenosis however moderate left and moderate to severe right neural foraminal compromise and lateral recess compromise bilaterally. No significant change since prior exam.

Output: 1.Extensive degenerative disc disease and hypertrophic changes of posterior elements of the lumbar spine results in multilevel central spinal stenosis of mild degree at L1-L2 and moderate stenosis at L2-L3 and moderate to severe at L3-L4 and L4-L5 levels (interval progression at the L4-L5 since prior exam) as detailed above.2.Multilevel bilateral neural foraminal compromise without significant change since prior exam as detailed per level above.


Instruction: Generate impression based on findings.

Input: 60-year-old male with ventricular ependymoma. Yearly follow-up. There is no restricted diffusion on DWI sequences.Again seen is a nonenhancing T2/FLAIR hyperintense oval lesion along the lateral wall of the left lateral ventricular body which measures 8 mm x 11 mm x 4 mm (series 8, image 26 and series 6, image 15) unchanged when remeasured in a similar manner. An additional 4 mm nonenhancing lesion with similar T2/FLAIR hyperintensity located more posteriorly is unchanged (series 8, image 21). The third previously noted lesion located more anteriorly within the left lateral ventricle is not well visualized on current images (series 1001, image 72). Previously referenced 6 mm x 11 mm T2 and FLAIR signal hyperintense lesion in the right centrum semiovale is stable compared to prior exam. No new intraparenchymal lesions are identified. Scattered periventricular and subcortical punctate hyperintense white matter lesions on the FLAIR and T2 images are also unchanged.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 show a small mucus retention cyst in the left maxillary sinus.

Output: 1. No significant interval change in nonenhancing left lateral ventricle subependymal lesions, with one of the previously noted lesions not well visualized on the current study. 2. Unchanged small right centrum semiovale lesion. 3. Scattered periventricular and subcortical white matter changes are again seen, nonspecific.


Instruction: Generate impression based on findings.

Input: 13-year-old female with pain. History of SCFE status post pinning. Metallic susceptibility artifact from the patient's orthopedic hardware limits evaluation of the femoral head and neck on multiple sequences.ACETABULAR LABRUM: Note is made of linear increased signal abnormality traversing the anterior superior acetabular labrum, extending from the 2 o'clock position to the 3 o'clock position, indicating a tear (image 3: series 1301).ARTICULAR CARTILAGE AND BONE: No full-thickness articular cartilage defects are identified within the aforementioned limitations of this examination. No definitive bone marrow signal abnormality is identified. Metallic susceptibility artifact limits our ability to evaluate for a CAM deformity.SOFT TISSUES: The imaged musculature of the right hip is normal in appearance. ADDITIONAL

Output: Anterior superior acetabular labral tear as described above.


Instruction: Generate impression based on findings.

Input: There are several punctate foci of T2 hyperintensity primarily involving the subcortical white matter located within the frontal lobes. These are not associated with mass effect, restricted diffusion, susceptibility abnormality, or enhancement. There are no similar appearing lesions within the posterior fossa structures.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Incidental note is made of a small left occipital developmental venous anomaly without MRI evidence of associated cavernous malformation. Otherwise flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Incidental note is made of two, 1 cm-sized, foci within the subcutaneous scalp tissues overlying the right paramedian parietal bone as well as left parietal bone, with MRI features consistent with sebaceous cyst.

Output: There are nonspecific punctate foci of T2 hyperintensity primarily involving the subcortical white matter located within the frontal lobes which are not associated with mass effect, restricted diffusion, susceptibility abnormality, or enhancement. For a patient of stated age 53 years, this is most likely secondary to chronic small vessel disease. The differential diagnosis would also include changes from migraine headaches or sequelae of remote head injury. Given lesional appearance and locations, demyelination is felt to be unlikely.


Instruction: Generate impression based on findings.

Input: 68-year-old female with severe left pain, evaluate for fracture/abscess/labral tear. Please note that per the technologist's notes the patient was combative and unable to hold still. The service was paged and medications were given prior to the MRI and during the exam by the RN. Evaluation of the left hip is limited due to suboptimal quality.ACETABULAR LABRUM: The labrum cannot be adequately visualized in this suboptimal study, however, no gross labral abnormalities are identified.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted. No acute fracture is identified.SOFT TISSUES: No significant abnormality noted. No evidence of infection/abscess. ADDITIONAL

Output: Given the limitations of this examination no significant hip pathology is identified. Perhaps a steroid/lidocaine injection might be helpful to determine if the patient's pain is definitely originating in the hip and not the lower lumbar spine.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appear unremarkable. There is no abnormal intracranial enhancement. There is mild flattening of the pituitary. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of acute intracranial hemorrhage or mass. 2. Mild flattening of the pituitary is nonspecific, but could represent pituitary atrophy or pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: 76 year old woman with history of ischemic cardiomyopathy with previous MI and multiple PCI, carotid stenosis, hypertension and hyperlipidemia referred for stress cardiac MRI to evaluate ischemic burden and scar. MEDICATIONS: aspirin, bisoprolol, CoQ10, simvastatin First Pass PerfusionDuring hyperemia, there was a moderate intensity perfusion defect in the basal inferior, inferoseptal, and inferolateral walls, which corresponds to the below described myocardial infarction.Viability/ Myocardial ScarThere is transmural late gadolinium enhancement noted in the basal to mid inferior, inferoseptal, and inferolateral walls; and the apical inferior wall. These territories are not likely to be viable. The remainder of the myocardium is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is moderate-severely dilated with mildly reduced systolic function. The overall LV ejection fraction is 44%, the LV end diastolic volume index is 106 ml/m2 (normal range: 65+/-11), the LVEDV is 196 ml (normal range 109+/-23), the LV end systolic volume index is 59 ml/m2 (normal range 18+/-5), the LVESV is 109 ml (normal range 31+/-10), the LV mass index is 36 g/m2, and the LV mass is 67 g. There is akinesis of the basal to mid inferior wall, which was seen on the previous study. There is no LV thrombus.Left AtriumThe left atrium is moderately to severely dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 121 ml (normal range 110+/-24), the RV end systolic volume index is 24 ml/m2 (normal range 22+/-8), and the RVESV is 44 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern. There is an extremely torturous bend in the descending aorta with mild atherosclerosis.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 FindingsHigh mediastinal lymph nodes and mild thyromegaly are noted. 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. There is a large transmural myocardial infarction in the usual territory of the RCA which is associated with a perfusion defect. The territory is not likely to be viable. 2. There is no obvious myocardial infarction or ischemia in the usual territory of the LAD and LCx.3. Moderate-severely dilated LV size with mildly reduced systolic function (LVEF 44%). 4. Normal RV size and systolic function (RVEF 63%).5. See extra-cardiac findings. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: 11 year old female with chronic abdominal pain and nausea. May 23, 2015, abdominal ultrasound findings: subtle contour deformity and questionable 9mm nodule along the anterior pancreatic body. History: abdominal pain, nauseaEXAMINATION: Pancreas MRI and MRCP without and with IV contrast 06/15/15 at 13:19 ABDOMEN:LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesions. No intra or extrahepatic biliary dilatation. The gallbladder is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas enhances homogeneously without focal lesions. No pancreatic ductal dilatation is identified. No surrounding inflammatory changes to suggest pancreatitis. A normal variant accessory pancreatic duct is noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral extrarenal pelvis sees are noted. No focal lesions or hydronephrosis. Mild prominence of the bilateral ureters, which is likely of no clinical significance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal examination.


Instruction: Generate impression based on findings.

Input: Chiari malformation, evaluate for syrinx or tethered cord. Torticollis, headaches. There are 7 cervical, 12 thoracic, and 5 lumbar type vertebral bodies.Thoracic:Examination is slightly motion degraded. Thoracic cord appears normal in signal and contour. No evidence of syrinx. Thoracic vertebral body heights are maintained. Alignment is maintained. No significant spinal canal or neural foraminal stenosis is seen. Bone marrow signal is appropriate for age with no suspicious lesions. Lumbar:Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is appropriate for age. The conus medullaris is normal in position at the mid L1 level.No evidence of filar lipoma or other masses in the spinal canal along the filum or cauda equina. There is appropriate anterior motion of the conus in the prone sequence.Paraspinous soft tissues are within normal limits. Distended urinary bladder and mild prominence of the ureters and renal pelvis, which can be better assessed with post voiding ultrasound as clinically indicated.

Output: 1. No evidence of tethered cord. Conus is in normal position with no lipoma or other masses within the spinal canal. Unremarkable thoracic cord without evidence of syrinx.2. Distended urinary bladder and mild prominence of the ureters and renal pelvis, which may be related to the distended bladder. Finding can be better assessed with post voiding ultrasound as clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: 67 year old male with RA, COPD and hypertension. Admitted with cavitary pulmonary lesion with confusion. Signs and symptoms: Confusion. Non-enhanced CT of brain:Examination demonstrates no evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns remain within normal. There is only a suspect a single focus of low-attenuation in the subcortical white matter of the right frontal lobe (image 21 of 32). Considering clinical history of hypertension this may represent a small subcortical stroke of indeterminate age. Follow-up with an MRI is recommended.Calvarium is intact. Mastoid air cells are well pneumatized. Extensive sinus disease of visualized paranasal sinuses

Output: 1.With the exception of a very small foci of low-attenuation in subcortical white matter of right frontal lobe this is study is within normal limits. This finding may represent small vessels stroke of indeterminate age.2.Extensive sinusitis all visualized paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Ms. Katzman is a 52 year old female with a prior stereotactic biopsy of left breast calcifications in 2015 with pathology of single focus of ADH. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.There is no abnormal enhancement seen in either breast. Specifically, there continues to be no abnormal enhancement at site of left breast biopsy for focus of ADH. A few scattered foci of enhancement are stable in size and appearance in both breasts when compared to prior exam. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months (Sept 2016) to confirm stability of these findings. BIRADS: 1 - Negative.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).


Instruction: Generate impression based on findings.

Input: 17-year-old female patient with a grand mal seizure. Evaluate for an intracranial process. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable, including the bilateral hippocampi. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Back pain. Evaluate for potential kyphoplasty. There is compression fracture of T10, with no significant retropulsion. The fracture involves primarily the anterior column. Posterior wall of the vertebral body and pedicles appear intact. Mild degenerative changes are seen in the rest of the thoracic spine. No additional fracture is seen. Please also refer to recent MRI of thoracic spine for additional findings suggesting multiple myeloma lesions.There is a left upper lobe mass, with central calcification, probably representing a calcified granuloma and measures 14 mm. Small pleural effusion is seen bilaterally.There is a large hiatal hernia. There is thickening of esophageal wall, of uncertain significance. This is prominent soft tissue density seen at the right lateral aspect of the esophagus, at T5 -- T6 level, of uncertain significance; this may represent a vascular structure, but an underlying mass cannot be excluded.

Output: 1. T10 compression fracture, with intact posterior wall of the vertebral body and pedicles.2. Please refer to recent MRI of thoracic spine for additional multiple myeloma lesions.3. Large hiatal hernia.4. Thickening of esophageal wall and prominent soft tissue density at the right lateral aspect of the esophagus, at T5 -- T6 level, of uncertain significance. Suggest correlation with contrast enhanced CT.5. Left upper lobe calcified granuloma.


Instruction: Generate impression based on findings.

Input: History of metastatic colon cancer to the pancreas status post Whipple. Fatty liver. Elevated CEA. PET CT reported suspicious liver lesions without MR correlate. ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis. Status post cholecystectomy. Normal liver morphology without a focal lesion or biliary ductal dilatation. The portal vein is chronically thrombosed with reconstitution by multiple small collateral vessels in the porta hepatis.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from Whipple procedure. The residual pancreatic tail duct is dilated up to 4 mm without significant parenchymal atrophy. There are small cystic foci which may represent side branch ectasia or small IPMNs measuring less than 1 cm. It demonstrates decreased intrinsic T1-weighted signal intensity with normal enhancement and no evidence of acute inflammation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple prominent mesenteric lymph nodes are not significantly changed compared to the 2/23/2016 CT.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Severe hepatic steatosis without a discrete suspicious lesion evident. The abnormality on PET/CT could have been related to differential tracer deposition given the patient's chronic portal vein thrombosis, however continued surveillance imaging is recommended. 2.Multiple prominent mesenteric lymph nodes are not significantly changed compared to the 2/23/2016 CT.3.Chronic portal vein thrombosis with cavernous transformation.4.Postsurgical changes from Whipple procedure with stable prominence of the distal pancreatic duct.


Instruction: Generate impression based on findings.

Input: Choking, voice change, coughing spells, and right side facial numbness. Brain: 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 are grossly unremarkable. There is a small right maxillary sinus retention cyst. There is plagiocephaly.Internal Auditory Canals: The bilateral cranial trigeminal nerves are intact. The bilateral Meckel caves and cavernous sinuses are unremarkable. There is no evidence of mass lesions.

Output: No evidence of intracranial or skull base mass and no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: There are no foci of restricted diffusion to suggest the presence of acute ischemia. Redemonstrated are multiple scattered punctate foci of susceptibility bilaterally, most prominent in the left temporal and occipital regions, including gyriform susceptibility artifact within the left frontal lobe with intrinsic T1 signal consistent with laminar necrosis in the area of prior infarct. Additional foci of prior infarcts now demonstrate expected encephalomalacia. Confluent areas of T2/FLAIR hyperintensity within the subcortical and periventricular white matter is again noted, consistent with advanced chronic small vessel ischemic disease. Previously demonstrated FLAIR hyperintensity along a left posterior temporal lobe sulcus has resolved and there are no new sulcal foci of FLAIR hyperintensity. There is no mass effect. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Fluid is again noted within the right mastoid air cells with new fluid within a few left mastoid air cells.

Output: 1.There is no restricted diffusion to suggest the presence of acute ischemia.2.Previously demonstrated FLAIR hyperintensity along a left posterior temporal lobe sulcus has resolved and there are no new sulcal foci of FLAIR hyperintensity. 3.Expected evolution of prior infarcts, including cortical laminar necrosis and encephalomalacia within the left frontal lobe.4.Multiple scattered foci of susceptibility bilaterally appearing similar in appearance to prior exam, overall peripheral in distribution and possibly relating to amyloid angiopathy.5.Fluid is again noted within the right mastoid air cells with new fluid within a few left mastoid air cells.


Instruction: Generate impression based on findings.

Input: New left optic neuritis, concern for spinal cord demyelinating lesions. Cervical Spine: The spinal cord displays normal signal and morphology. There is no abnormal enhancement within the spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues and imaged intracranial structures are unremarkable.Thoracic Spine: The spinal cord displays normal signal and morphology. There is no abnormal enhancement within the spine. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is a hemangioma in the left T8 vertebral body, pedicle, transverse process, and lamina. The vertebral bone marrow signal is otherwise unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: No evidence of spinal cord lesions.


Instruction: Generate impression based on findings.

Input: 27-year-old female with knee pain. Evaluate for knee avascular necrosis. MENISCI: The medial and lateral menisci appear intact.ARTICULAR CARTILAGE AND BONE: There is poorly defined intermediate to low signal intensity within the subchondral marrow of the distal femoral epiphysis, likely corresponding to the subchondral sclerosis seen on recent radiographs, although we do not see a pathognomonic double line sign. We see no associated edema, subchondral fracture or articular surface collapse. There is patchy intermediate signal intensity within the distal femoral metadiaphysis and proximal tibial metadiaphysis which may reflect the sequela of end-stage renal disease. We see no focal articular cartilage defects. Chronic periosteal reaction along the distal femur and proximal tibia is again noted, which may reflect renal osteodystrophy, but we cannot exclude hypertrophic osteoarthropathy.LIGAMENTS: There is increased signal intensity and thickening of the lateral collateral ligament proper, suggesting degeneration. The MCL appears intact. The cruciate ligaments appear intact. EXTENSOR MECHANISM: There is diffuse thickening of the patellar tendon compatible with tendinosis, without a discrete tear. There is also thickening of the quadriceps tendon compatible with tendinosis. There is more focal signal abnormality within the lateral fibers of the quadriceps tendon at its insertion, which may represent focal tendinosis or perhaps a small insertional tear.ADDITIONAL

Output: 1. Poorly defined subchondral low signal intensity within the distal femur may reflect avascular necrosis, although we do not see a double line sign. There is no associated edema, subchondral fracture, or articular surface collapse.2. Patellar and quadriceps tendon tendinosis.


Instruction: Generate impression based on findings.

Input: Parkinson's diease with increasingly severe pseudobulbar affect evaluate frontal structures. There appears to be slight relatively high cortical T2 signal in the bilateral medial portions of the anterior frontal lobes bilaterally and trace periventricular white matter T2 hyperintensity. The cerebellar tonsils extend up to 10 mm inferior to the foramen magnum and the posterior fossa appears to be small. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, calvarium, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Apparent slight relatively high cortical T2 signal in the bilateral medial portions of the anterior frontal lobes bilaterally, which ma be technical or related to a neurodegenerative process, as well as nonspecific trace periventricular white matter T2 hyperintensity. 2. Findings suggestive of Chiari type 1 malformation.


Instruction: Generate impression based on findings.

Input: Patient with anterocollis and possible dystonia. Please evaluate C1 -- C2 (non-legible wording) non-infused head CT, history of subdural hematoma weighted (non-legible wording). Non-infused head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is generalized slight prominence of cortical sulci of left hemisphere compared to the right. There is however no evidence of any density abnormality of the left cerebral hemisphere. Considering provided clinical history of subdural hematoma which is no longer identified on this exam, the findings of the left hemisphere may be result of posttraumatic volume loss. This can be further evaluated with a dedicated MRI of brain.Visualized paranasal sinuses and mastoid air cells are unremarkable.Calvarium is intact.CT of the cervical spine:There is reversal of cervical lordosis to a kyphotic deformity. On sagittal 2-D reformatted images there is grade 1 retrolisthesis of C3 in respect to C4. There is apparent mild anterior displacement of the entire C1, C2 and C3. This finding is best appreciated on sagittal reformatted images. This results in more anterior projection of the posterior arch of C1 compared to the posterior lip of foramen magnum. There is however maintained alignment of C1 and C2 and C3. There is no definitive evidence of any fracture. On coronal reformatted images there is evidence of a slight widening of the articulating space between the right occipital condyles and right lateral mass of C1 compared to the left. The clinical significance of this finding is not clear however this finding may be result of an old injury or due kyphotic deformity of cervical spine. On reformatted images the subarachnoid space at the level of foramen magnum and C2 -- C3 levels are identified both posteriorly and anteriorly. There is however effacement of the subarachnoid space at the level of grade 1 anterolisthesis of C3 -C4 with suggestion of central spinal stenosis.At C4 -- C5 level mild degenerative disk disease and bulge of disk material is noted. Subarachnoid space anterior and dorsal to the cord on reformatted images is identified.At C5 -- C6 and C6 and C7 levels there is moderate degree of degenerative disk disease and sclerotic changes of the adjacent endplates are noted. These changes are primarily along the anterior aspect of intervertebral disk space likely result of kyphotic deformity. Shallow ventral hypertrophic spur at these levels is also present.

Output: 1.Non-infused head CT demonstrates no evidence of an acute intracranial findings. There is no evidence of residual subdural as clinically is mentioned. There is generalized prominence of cortical sulci in the left hemisphere compared to the right which may indicate underlying parenchymal volume loss. If further evaluation is desired an MRI examination can add additional information of the cause of this finding. Calvarium is intact. Paranasal sinuses and mastoid air cells are unremarkable.2.Non-infused CT of cervical spine demonstrate grade 1 anterolistheses of C3 in respect to C4 with effacement of the subarachnoid space at this level and possible central spinal stenosis. There appears that the entire C1, C2 and C3 has shifted forward in respect to C4 and posterior lip of foramen magnum. There is however normal articulation of the occipital condyles and C1. Mild to moderate degenerative disk disease primarily at C5 -- C6 and C6 and C7 levels as described above.


Instruction: Generate impression based on findings.

Input: Brain MRI: The cerebellar tonsils extend up to 8 mm inferior to the foramen magnum and have pointed morphologies. There is narrowing of the cerebrospinal fluid flow across the anterior craniocervical junction and blunted flow of cerebrospinal fluid posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a left cerebellar hemisphere developmental venous anomaly. The brain parenchyma otherwise appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Spine MRI: There is a septated syrinx that extends from the C3 to T6 level, measuring up to 15 mm in width. The conus medullaris terminates at L1 vertebral body level. The spinal cord is freely mobile on prone imaging. There is mild convex right thoracic and convex left lumbar scoliosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal or neural foraminal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Chiari I malformation with associated large cervicothoracic syrinx. 2. Mild thoracolumbar scoliosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.