Instruction: Generate impression based on findings.

Input: 66 years, Female, history of TIA with worsening left facial droop. No restricted diffusion to suggest acute ischemia. No findings to suggest acute intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Again seen are scattered foci of susceptibility effect throughout the brain. Unchanged relatively large focus of susceptibility in the left cingulate gyrus. Again seen is linear susceptibility effect along the anterior and the posterior interhemispheric fissures as well as the falx, suggestive of remote subarachnoid and subdural hemorrhage and residual siderosis. Foci of susceptibility artifacts are also seen in the cerebellum. These all are unchanged since 10/15/2015.Major flow-voids are preserved. There is diffuse heterogeneous of the bone marrow signal which may be related to known leukemia.

Output: 1. No evidence of acute infarct.2. Multiple scattered chronic microhemorrhages in the brain parenchyma as well as siderosis related to likely prior subarachnoid and subdural hemorrhages as seen previously on 10/15/2015.3. Diffuse heterogeneous bone marrow which may be related to known leukemia.


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: sacral cyst seen on non infused MRI study Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is bilateral facet hypertrophy present at this level which is worse on the right side compared to the left. There is thickening of the right ligamentum flavum associated with synovial cyst which encroaches on the right lateral recess and mildly displaces the nerve roots of the right lateral recess. Compared to the prior exam the synovial cyst has regressed.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is bilateral ligamentum flavum hypertrophy present which is worse on the right compared to left side associated with triangulation of the thecal sac. This is stable compared to the previous examAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level. There is mild triangulation of the thecal sac at this level. There is mild ligamentum flavum hypertrophy at this level. There is right worse than left partial effacement of the fat at the lateral recess at this level associated with mild encroachment of nerve roots at the right lateral recess at this level. The encroachment of the nerve root of the right lateral recess is somewhat worse on the current exam compared to the prior exam from June 2013.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.At T12-L1 there is loss of disc space height as well as endplate reactive changes which are heterogeneous on T2 inversion recovery and hypointense on T1. There is associated contrast enhancement. There is a disc bulge present at this level. Compared to the prior exam from 6/21/1913 loss of disc space height and endplate reactive change has progressed.A cystic lesion is present along the anterior aspect of the right kidney which is stable compared to the prior exam.

Output: 1.Since the prior exam a synovial cyst at the right lateral recess at L5-S1 has regressed. There is now only mild displacement of the nerve roots of the right lateral recess at L5-S1.2.There is mild encroachment of the nerve roots at the right lateral recess at L3-4 due to degenerative changes which has mildly progressed since the prior exam.3.Mild spinal stenosis at L4-5 is stable.4.Degenerative changes at T12-L1 without compromise to the spinal canal or exiting nerve roots have mildly progressed since the June 2013 exam.


Instruction: Generate impression based on findings.

Input: Clinical question: History of recent head and neck cancer, post surgery, pre-chemotherapy/RT. Signs and symptoms: Baseline chemo/RT CT of soft tissues of neck with contrast:70 cc of Omnipaque 350 was utilized for the above study.Images through the skull base, cavernous sinuses, paranasal sinuses and mastoid air cells are unremarkable. There is evidence of thrombosed right internal jugular vein that appears to extend into the right jugular bulb. This is a new finding since prior study. There is expansion of thrombosed right internal jugular from the skull base to approximately the level of the right carotid bifurcation.Examination demonstrates extensive postoperative changes of right neck with a large flap which extends from the right submandibular level inferiorly to the level of the right thyroid cartilage. There is evidence of partial right mandibulectomy. There is fixating screws and rod extending from anterior aspect of remaining right body of mandible posteriorly to the ramus of mandible.Postoperative changes in the including multiple surgical clips near right submandibular region are noted. This is also believed to be related to surgical changes of the lack placement.There is no definite differential mass or pathologic adenopathy by CT size criteria is identified. There is a small cyst within the right lobe of thyroid measuring approximately 10.5 mm times 7-mm on coronal reformatted image 39.Limited images of the apices of the lungs and mediastinum are negative. Please review dedicated report of CT of chest which visualizes both of these regions would better advantage.The osseous structures of the area of exam other than what was noted in the mandible are unremarkable. No evidence of cartilaginous erosion. The carotid system is intact.CT of brain with contrast:Examination demonstrates an enhancing mass measuring approximately 8 mm times 5 mm in transaxial dimension in the body of the left lateral ventricle. The mass is well demarcated and demonstrates uniform intense enhancement. No definitive calcification is detected. There is no associated edema of the adjacent brain parenchyma. Considering patient's history of malignancy metastatic lesion should be considered. Other differentials for this mass includes intraventricular meningioma, great plexus papilloma, ependymoma and other lesions. Follow up with a dedicated MRI may help in differentiating the etiology of this finding.There is no evidence of any additional area of abnormal enhancement. No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Gray/white matter differentiation is well preserved.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells are unremarkable.There is redemonstration of thrombosed and expanded right jugular vein in upper cervical with apparent extension into the right jugular bulb.

Output: 1.Extensive postoperative changes of the neck on the right with no detectable tumor or pathologic adenopathy.2.Well demarcated a small mass within the body of left lateral ventricle (5-mm times 8mm) as detailed. Differential includes metastatic lesion, meningioma, ependymoma and choroid plexus papilloma. Considering the history of malignancy metastatic disease should be considered and follow-up with an MRI is recommended.3.CT examination of brain and calvarium is otherwise unremarkable for malignancy.4.Thrombosed right jugular vein in upper cervical region and with apparent extension into the right jugular bulb.


Instruction: Generate impression based on findings.

Input: Female 44 years old Reason: R sided thyroid enlargement in pt s/p radioactive iodine 20 yrs ago. On replacement hormone w normal TSH History: as above RIGHT LOBE MEASUREMENTS: 3.5 x 1.2 x 1 cmLEFT LOBE MEASUREMENTS: 3.5 x 0.9 x 0.3 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: 1.3 x 0.7 x 0.6 cm isoechoic solid nodule within the right thyroid lobe.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing bilateral lymph nodes in the neck.OTHER: No significant abnormality noted.

Output: Solitary solid nodule in the right thyroid lobe, amenable to percutaneous biopsy.


Instruction: Generate impression based on findings.

Input: Status post resection of skull based meningioma on 4/8/14: 6 month follow up residual tumor. There has been interval evolution of postoperative findings related to right pterional craniotomy for resection of a planum sphenoidal tumor. There is persistent mild residual dural enhancement in the right paraclinoid region. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation.

Output: Postoperative findings with small amounts of residual tumor in the right paraclinoid region.


Instruction: Generate impression based on findings.

Input: There are multiple nonspecific T2/FLAIR hyperintensities in subcortical and periventricular white matter without associated mass effect or susceptibility abnormality. There is no evidence of structural lesion, mass effect, or hemorrhage. There is no restricted diffusion. There are no susceptibility abnormalities. There is mucosal thickening in the maxillary sinuses bilaterally, right more than the left, in the right ethmoid sinus, and in the left frontal sinus. The mastoid air cells are clear.

Output: 1.No evidence for acute intracranial hemorrhage, mass effect, or edema. There are no structural lesions.2.Mild chronic small vessel ischemic changes in the subcortical and periventricular white matter. 3.There is mucosal thickening in the maxillary sinuses bilaterally, right more than the left, in the right ethmoid sinus, and in the left frontal sinus.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. Interested in focal ablation. Patient reports 3+3 disease on random ultrasound-guided biopsy. PELVIS:PROSTATE:Prostate Size: 6.6 x 4.7 x 7.7 cmPeripheral Zone: Mild thinning and scarring of the peripheral zone without a discrete suspicious lesion.Note is made of small foci of post-biopsy hemorrhage.Central Gland: In the right central zone region there is a distinct asymmetric 1.0 x 1.0 cm lesion (series 901/26) which is T2 hypointense and demonstrates restricted diffusion and arterial enhancement which may represent a site of prostatic carcinoma.There are several T2 weighted hypointense lesions in the transition zone, one of which in the left anterior mid gland appears to demonstrate more significant restricted diffusion measuring 1.0 x 0.9 cm (series 603/264).Significant benign prostatic hyperplasia. Median lobe hypertrophy.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Several nonspecific small subcentimeter pelvic lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.1.0 cm right central zone asymmetric lesion may represent a site of prostatic carcinoma.2.1.0 left anterior mid gland transitional zone lesion may represent benign prostatic hyperplasia but has relatively increased restricted diffusion and is amenable to fusion biopsy.3. Prostatomegaly with marked benign prostatic hyperplasia.


Instruction: Generate impression based on findings.

Input: Right nasopharyngeal carcinoma, treated with and radiation and chemotherapy. Neck: There are post-treatment findings in the right nasopharynx with mild right asymmetric pharyngeal mucosal space thickening without measurable residual mass, although assessment is limited by the lack of intravenous contrast. There is also diffuse mucosal enhancement that is suggestive of mucositis. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unchanged. There is unchanged enhancement within the right mandibular ramus. There is mild anterolisthesis of C3 on C4 and C4 on C5, as well as cervical spondylosis with at least moderate spinal canal stenosis at C5 and C6 and retrolisthesis of C6 on C7. There are several cervical neural foramina subcentimeter perineural cysts. There are degenerative changes in the right temporomandibular joint with an associated trace effusion.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is persistent fluid signal within the bilateral mastoid air cells. There are maxillary sinus retention cysts and scattered paranasal sinus mucosal thickening. There is radiation-associated fatty marrow signal in the skull base and upper cervical spine.

Output: 1. Post-treatment findings in the right nasopharynx without measurable residual mass.2. No evidence of intracranial tumor.3. Degenerative spondylosis of the cervical spine with spinal canal stenosis at C5 and C6.4. Unchanged nonspecific enhancement within the right mandibular ramus.


Instruction: Generate impression based on findings.

Input: Clinical question: History of enhancing abnormality in cervical spine. Signs and symptoms: Right arm/hand paresthesias; surveillance scan. Pre and post enhanced cervical MRI:Examination demonstrate an intramedullary right hemicord foci of T2 hyperintensity with evidence of subtle decreased cord caliber. There is questionable faint enhancement of this lesion. This finding is associated with subtle decreased cord caliber on this study which is new since prior exam and likely representing evolution of lesion into a more chronic state. Finding is highly suggestive of a inflammatory/demyelinating disease. Other possibilities of an infectious process or tumor is exceedingly unlikely. There is no convincing evidence of any additional foci of cord signal abnormality or abnormal enhancement.There is generalized smaller than expected caliber of the spinal canal is believed to be a congenital anatomical variation. Additionally diffuse posterior longitudinal ligament hypertrophy further contributes to decreased caliber of the spinal canal and spinal stenosis at C3-C4, C4-C5 and C5-C6 levels and to a lesser degree at C6-C7 level. This appearance has not significantly changed since prior study from 2-25-15.Degenerative disc disease at C3-C4 including a tiny central and right para median disc protrusion with enhancement is again noted. This finding also contributes to spinal stenosis at this level.Degenerative changes at C6-7 and a shallow left paramedian disc protrusion with enhancement also remains fairly similar to prior exam and with resultant subtle mass effect on the cord and contributing to central spinal stenosis.

Output: 1.Intramedullary right hemicord signal abnormality at C3-C4 disc level demonstrates interval subtle decrease cord caliber and with questionable faint enhancement. This finding most likely representing a focus of inflammatory/demyelinating process. Other differentials of primary cord tumor/lymphoma or an infectious process is considered extremely less likely. Further follow-up however is recommended. 2.Congenitally small size of cervical canal as well as diffuse posterior longitudinal ligament hypertrophy results in multilevel central spinal stenosis without significant change since prior exam.3.Degenerative disc disease at C3-C4 and a central and rightward small disc protrusion with enhancement demonstrated no significant change since prior exam and contributes to central spinal stenosis at this level.4.Degenerative changes at C6-C7 and including a shallow left paramedian faintly enhancing disc protrusion demonstrate no significant change.


Instruction: Generate impression based on findings.

Input: History of neurofibromatosis and optic glioma, off therapy. There is no significant interval change in the expanded cisternal and prechiasmatic portions of the right optic nerve and optic chiasm, measuring up to 15 mm in width. There is also no significant interval change in the diffusely expanded left optic nerve, measuring up to 7 mm in width. There is are persistent scattered T2 hyperintensities within the basal ganglia, medial right thalamus, periaqueductal grey matter, right splenium of the corpus callosum, bilateral hippocampi, and right cerebellum. There is no evidence of intracranial hemorrhage or acute infarct. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No significant interval change in the bilateral optic gliomas, right larger than left, and other intracranial stigmata of neurofibromatosis type 1.


Instruction: Generate impression based on findings.

Input: Clinical question: Grade 2 oligodendroglioma, status post RT and L4 cycles of PCV. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination demonstrate stable post treatment changes of the left frontal lobe since prior exam and without abnormal enhancement.Changes in the left frontal lobe includes a large focus of cystic encephalomalacia and gliosis containing a hemosiderin laden surgical cavity similar to prior exam under a left frontal craniotomy.Bony thickening and enhancement consistent with fibrous dysplasia along the roof of the right orbit also remains stable since prior exam.Stable ventricles and with maintain midline similar to prior.

Output: 1.No acute of new intracranial finding since prior exam.2.Stable post treatment/surgical changes of left frontal lobe tumor without abnormal enhancement.3.Stable small fibrous dysplasia along the right orbital roof.


Instruction: Generate impression based on findings.

Input: 67 years, Female, Reason: 67F s/p whipple for intraampullary IPMN c/w pancreatic anastomotic leak History: pancreatic anastomotic leak. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Postsurgical changes of Whipple procedure. Mild intrahepatic biliary ductal dilatation. Small fluid collection along the inferior margin of liver measuring 2.4 x 2.0 cm decreased from the prior CT where it measured 6.6 x 3.1 cm. Subtle intermediate T2 signal surrounding the collection suggests inflammation and delayed enhancement may indicate some degree of fibrosis. This collection appears to communicate with the main pancreatic duct at the pancreatic jejunum anastomosis. An anterior abdominal drain enters this collection. SPLEEN: No significant abnormality noted.PANCREAS:Postsurgical changes of Whipple procedure.Prominent pancreatic duct with short segment of stricturing immediately proximal to the anastomosisDiffuse restriction and low T1 signal throughout the pancreas suggests some degree of active inflammation/pancreatitis, however enhancement is normal. Normal response to secretin administration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple appearing renal cysts. Additional renal T2 hyperintensities are too small to characterize but likely represent cysts.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.Suggestion of anastomotic leak with decreased size of subhepatic collection.2.Prominent pancreatic duct with short segment of stricturing immediately proximal to the anastomosis.3.Diffuse restriction and low T1 signal throughout the pancreas suggests some degree of active inflammation/pancreatitis.


Instruction: Generate impression based on findings.

Input: Male, 6 years old, with GTC seizure activity, history of Dandy-Walker, developmental delay, autism, epilepsy. The left cerebellar hemisphere is hypoplastic and the fourth ventricle communicates with a large posterior fossa CSF space. The left aspect of the posterior fossa is relatively larger than the right. No torcular-lambdoid inversion is seen.Supratentorially, no significant structural abnormalities are detected. No areas of signal abnormality or edema are seen. The ventricles demonstrate normal size and morphology. No findings are seen to suggest intracranial hemorrhage. The mesial temporal lobe structures are symmetric and unremarkable.

Output: Findings are seen in the posterior fossa which may represent a Dandy-Walker spectrum anomaly, though they do not fulfill criteria for a classic Dandy-Walker malformation. Supratentorially, the evaluation is unremarkable with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Female 42 years old Reason: hx of 9.5 and 3 cm liver lesions ? hemangiomas History: liver lesions ABDOMEN:LIVER, BILIARY TRACT: There are two T2 hyperintense, lobulated lesions within the liver. One is within segment 4 A, the second is within segments 7/8. The largest measures 8.4 x 9.3 cm (series 7, image 14). The smaller measures 1.6 x 1.8 cm (series 7, image 17). Both lesions demonstrate incomplete peripheral nodular enhancement with progressive fill in on delayed images. These are consistent with hemangiomas.A subcentimeter T2 hyperintense lesion at the hepatic dome is too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Two liver hemangiomas as detailed above. The largest measures 9.3 cm.2.A subcentimeter lesion at the hepatic dome is too small to characterize.


Instruction: Generate impression based on findings.

Input: Female 27 years old Reason: 27 yo with complex right ovarian cyst History: abdominal pain PELVIS:UTERUS, ADNEXA: Left ovary located in the left lower pelvis is normal in morphology with physiologic follicles and a dominant follicle.There is a large cystic midline lesion that likely arises from the right adnexa that is in midline measuring 10 x 10 x 13 cm. The wall is thin. The lesion has a few thin but enhancing septations. No nodular enhancing components are evident.Uterus is normal in morphology. Endometrial thickness is normal.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free fluid.

Output: 1.13 cm midline cystic mass likely arising from the right adnexa. It has thin enhancing septations but no nodular components. Differential considerations include a serous cystadenoma.2.The right ovary is not clearly defined.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 8 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 55 seconds

Output: Successful fluoroscopic left hip arthrogram injection.


Instruction: Generate impression based on findings.

Input: Male 72 years old Reason: 72-year-old male with PSC patient currently for HCC or cholangio, strictures, etc History: Ulcerative colitis with PSC ABDOMEN:LIVER, BILIARY TRACT: Stable to slight improvement in the biliary ductal dilatation. A percutaneous right hepatic biliary drain terminates within the jejunum. Status post hepaticojejunostomy. The common hepatic duct is not visualized. No suspicious hepatic lesion. The contrast bolus is suboptimal as portion of it was extravasated.SPLEEN: No significant abnormality noted.PANCREAS: Small T2 hyperintense focus in the uncinate process of the pancreas likely represent small side branch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Possible small cysts in both kidneys. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Multiple perihepatic and peripancreatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable to slight decrease in intrahepatic biliary ductal dilatation.2.No suspicious hepatic lesions.Contrast extravasation description:Supervising radiologist: Stephanie McCannMinor or major extravasation: MinorContrast type:20 cc of MultiHance were administered. 20ccAmount extravasated: approximately 20 ccLocation of extravasation: Right antecubital fossaSigns and symptoms: Swelling and pain, peripheral pulses were intact as well as tract. No paresthesias.Treatment given: Warm packDischarge instructions given: Yes


Instruction: Generate impression based on findings.

Input: 22-year-old male. Evaluate for meniscus tear. MENISCI: Again seen is branching signal abnormality in the posterior horn and body of the lateral meniscus that contacts the femoral and tibial surfaces as well as blunting of the free edge and body of the posterior horn, consistent with a complex tear. The medial meniscus is intact without evidence of a tear.ARTICULAR CARTILAGE AND BONE: There is increased marked thinning of the articular cartilage of the lateral femoral condyle just above the posterior horn of the lateral meniscus, with areas of near full-thickness cartilage loss. The patellofemoral compartment articular cartilage shows high signal abnormality and surface fraying with areas of partial thickness cartilage loss.Bone marrow signal intensity is within normal limits. There has been interval development of tricompartmental osteophytes.LIGAMENTS: The ACL graft is completely disrupted consistent with a full thickness tear. PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Findings consistent with an ACL graft full thickness tear.2. 11 mm loose body just above the tibial intercondylar eminence.3. Interval progression of chondromalacia of the lateral femoral condyle with areas of near full thickness cartilage loss and new chondromalacia of the patellofemoral compartment.4. Complex tear of the lateral meniscus, not significantly changed.


Instruction: Generate impression based on findings.

Input: Sensorineural hearing loss and tinnitus of the right ear. The bilateral cranial nerve 7 and 8 complexes are grossly intact. There is no evidence of mass lesions, although the postcontrast sequences are degraded by patient motion. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. The bilateral mastoid air cells and middle ears also appear unremarkable. There is encephalomalacia in the right lateral temporal lobe. There is also scattered patchy cerebral and pontine white matter T2 hyperintensity. There is a right maxillary sinus retention cyst.

Output: 1. No evidence of retrocochlear or inner ear lesions, although the postcontrast sequences are degraded by patient motion.2. RIght lateral temporal lobe chronic infarction and scattered probable chronic small vessel ischemic white matter disease.


Instruction: Generate impression based on findings.

Input: Pain. History of sarcoma resection Again seen is a large mass situated within the posterolateral aspect of the left mid thigh. It is approximately 5 x 5.3 cm in greatest transverse dimension, and approximately 16 cm in craniocaudal dimension. The mass lies just lateral to the semitendinosus muscle and sciatic nerve. It is slightly hyperintense to skeletal muscle on T1-weighted images. It is heterogeneous on T2-weighted images with foci that are hyperintense and isointense to skeletal muscle, as well as a rim of low signal intensity. There is a slightly irregular, thin, incomplete rind of enhancement following gadolinium administration, but overall the mass does not enhance. The superior margin of the mass lies just below the inferior fibers of the gluteus maximus muscle, which show mild edema and enhancement but no discrete intramuscular mass. There is a surgical scar superficial to the mass traversing the subcutaneous fat. There is mild edema within the musculature of the thigh, particularly distally, that may reflect prior treatment. Mild edema is also noted between the peripheral deep fascia and the underlying vastus lateralis muscle. There is a small knee joint effusion with peripheral enhancement suggesting a mild synovitis. Bone marrow signal intensity of the femur is within normal limits.

Output: Findings compatible with postoperative hematoma as described above.


Instruction: Generate impression based on findings.

Input: Reason: Prostate cancer-Biopsy of lumbar vertebral body lesion from metastatic prostate for research requirement History: none Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion.

Output: L1 vertebral bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o mets/cord compression History: RLE weakness 79 years Male (DOB:7/12/1937)Reason: r/o mets/cord compression History: RLE weaknessPROVIDER/ATTENDING NAME: OMAR JILANI Thoracic spine MRIMultilevel vertebral body metastatic lesions are seen especially at the level of T6,T7,T9,T10 and T11 vertebral bodies.Especially at the level of T7, there are large paraspinal soft tissues as well as epidural extension of soft tissue mass which compresses spinal cord at this level with abnormal signal intensity of spinal cord indicating spinal compressive myelopathy.At the level of T11, the metastatic lesion is involving vertebral body as well as posterior column on the right side with involvement of right side T 1112 neural foramen.L-spine MRIFor the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There are multiple osseous and extraosseous masses are seen which show inhomogeneous signal intensity on T1 and T2 weighted images indicating possible metastatic metastatic lesions.In particular, vertebral body metastasis are seen at the level of T12, L2, L3, L4, L5 and sacral bones. In addition, bilateral highly also show metastatic bony lesions.Extraosseous mass lesions are seen at the level of L2-3, anterior aspect of the right psoas muscle and bilateral gluteal muscles.The vertebral body height is preserved. The conus medullaris terminates at the L1 level.Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis. L4-L5: Disc degeneration. Diffuse bulging of disc with bilateral ligamentum flavum thickening results mild spinal stenosis at this level. No neuroforaminal narrowing or spinal stenosis. L5-S1: Diffuse bulging of disc. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Multiple vertebral body metastatic lesions including thoracic and lumbar spines as well as sacrum and bilateral ilium.2. Spinal cord compression with the subtle cord signal abnormality at the level of T7 vertebral body due to epidural soft tissue.3. Multifocal extra osseous metastatic lesions including left T7 pleura, right psoas muscle and bilateral gluteus muscles.


Instruction: Generate impression based on findings.

Input: There are post-treatment findings in the neck with no grossly measurable tongue mass. There is decreased swelling the aryepiglottic folds. There is no evidence of significant lymphadenopathy in the neck based on size criteria. The thyroid is unremarkable. The left submandibular gland is atrophic. There is multilevel degenerative cervical spondylosis, with disc-osteophyte complexes that abut the spinal cord at C5-6 and C6-7, but no evidence of osseous metastases. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with no evidence of gross residual or recurrent measurable tumor in the neck.


Instruction: Generate impression based on findings.

Input: 18-year-old male with right shoulder pain. ROTATOR CUFF: The rotator cuff musculature and ligaments are unremarkable.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum is grossly intact.BICEPS TENDON: The biceps tendon is normally positioned within the bicipital groove. ADDITIONAL

Output: Acromioclavicular injury with probable long-standing avulsion fracture of the trapezial insertion as detailed above.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Four views of the right shoulder reveal no acute fracture or dislocation. There is interval widening of the acromioclavicular joint with resorption of the distal end of the clavicle.

Output: Widening of the AC joint and resorption of the distal clavicle compatible with osteolysis, similar in appearance to a recent MRI.


Instruction: Generate impression based on findings.

Input: Major depressive disorder, single episode, unspecified [F32.9], Reason for Study: ^Reason: h/o hormone-sensitive breast CA in 2011 with worsening/different migraines, eval for cranial metastases History: vision changes, positional headache No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Previously described alternating T2 low signal intensity lesions from the brainstem to the upper cervical cord are not seen on today's scan thus confirming the nature of prior findings were artifacts.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. Normal brain MRI.2. No evidence of metastatic lesion on the scan.


Instruction: Generate impression based on findings.

Input: Marginal zone lymphoma: headache. There is no recurrent orbital tumor or abnormal enhancement. There are post-surgical findings in the left cranium and scalp without residual abnormal dural enhancement or edema in the temporal lobe. There is no acute infarct. There is an unchanged expanded partially empty sella. There is a persistent ovoid cerebrospinal fluid signal intensity collection that measures up to 25 mm in length within the left frontal sinus with mild surrounding enhancement and an apparent defect in the overlying skull base, with distortion and signal abnormality of the subjacent brain parenchyma. There is mild diffuse mucosal inflammation within the bilateral mastoid air cells.

Output: 1. No recurrent orbital tumor or abnormal enhancement. 2. Post-surgical findings in the left hemisphere, without evidence of tumors in this region.3. Expanded, partially empty sella, which can be a manifestation of pseudotumor cerebri.4. Persistent left frontal sinus cephalocele.5. Mild diffuse mucosal inflammation within the bilateral mastoid air cells.


Instruction: Generate impression based on findings.

Input: 60 year old female with personal history of breast cancer, need MRI to evaluate scattered foci of enhancement. There is scattered fibroglandular tissue in the right breast Patient is status post left mastectomy with reconstruction.Mild parenchymal enhancement is noted in the right breast and left reconstructed breast. Multiple pockets of fat necrosis and post surgical changes identified in the left breast. The previously mentioned enhancing scattered foci in right breast are less conspicuous on today's imaging and appear to be benign. No abnormal enhancement is seen in right breast or left reconstructed breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Male, 17 years old, with history of locoregional synovial sarcoma of the spine with cardiac extension, surveillance imaging. Brain:A 5-mm non-enhancing focus of T2 hyperintensity in the right middle frontal gyrus has not significantly changed. Two or three punctate foci of susceptibility scattered through the brain are also unchanged. No other significant parenchymal signal abnormality is seen. No enhancing lesions are detected. There is no evidence of acute hemorrhage or any other abnormal fluid collections. The ventricles are normal in size and morphology.C-spine:Sequalae of C2-T2 laminoplasty and tumor debulking are again seen. Confluent enhancing left spinal and paraspinal tumor is redemonstrated spanning these levels with invasion of each neural foramen and minimal extension into the intraspinal epidural space. The overall bulkiness of this extensive lesion, and the degree to which it infiltrates the foramina, are stable compared to the immediate prior exam, and improved relative to older studies. Infiltrative tumor in the deep neck soft tissues adjacent to the spine has also decreased in size mildly. A collection seen previously in the left neck has resolved. Patchy heterogeneous marrow replacement throughout the cervical spine is unchanged. A progressive kyphotic curvature has developed at the cervico-thoracic junction. Vertebral body heights are preserved. The bony spinal canal is narrowed from C3-C7 which may in part be positional and in part due to scarring. There is mild cord flattening though this region without convincing cord signal abnormality. No cord or leptomeningeal enhancement is seen. The posterior paraspinal tissues are extensively scarred. T-spine:Patchy marrow replacement continues into the thoracic spine with involvement of the T1-T3 vertebral bodies. A focus in the T3 vertebral body is slightly larger than on prior exams, but these marrow abnormalities are otherwise unchanged. No other areas of concerning marrow signal are seen. Vertebral body heights are preserved. Spinal alingnment is anatomic. Below the laminoplasty levels, the spinal canal is widely patent. No additional paraspinal, foraminal or intraspinal tumor is seen. The spinal cord is normal in morphology and signal. Two nodules are present in the partially visualized right lung, the largest measuring up to 18 mm.

Output: 1.Redemonstrated are finding related to prior left spinal and paraspinal tumor debulking and C2-T2 laminoplasty. 2.The size and distribution of residual paraspinal and foraminal tumor is unchaged when compared to the immediate prior exam. Tumor is smaller when compared to older exams. 3.Heterogeneous marrow replacement of the cervical and upper thoracic vertebral bodies is seen compatible with treated tumor. A small focus of marrow replacement in the T3 vertebral body is slightly larger, but the remaining marrow lesions are not changed. 4.Right lung nodules are better assessed on chest CT.5.No convincing evidence of intracranial metastases. A focus of T2 hyperintensity in the right middle frontal gyrus, and scattered punctate foci of susceptibility, are non-specific and may be related to therapy.


Instruction: Generate impression based on findings.

Input: AML. Evaluate for infection Ventilation images reveals normal bone marrow throughout the tibia and fibula. There is some mild stranding in the lateral subcutaneous fat. No evidence of an abscess in the soft tissues. No evidence of a uterine soft tissues.

Output: Mild stranding of the subcutaneous fat along the lateral aspect of the leg representing mild inflammation.


Instruction: Generate impression based on findings.

Input: Orbits: The right lacrimal gland is enlarged diffusely, with hyperenhancement. There is increased fluid signal adjacent to the right lacrimal gland, likely related to increased lacrimation. There is mild right posterolateral uveoscleral thickening and enhancement. In addition, there is inferotemporal low T2 and intermediate T1 signal material that appears to be subretinal and measures up to 5 mm in thickness. There is mild mucosal thickening and fluid signal in the anterior ethmoids and nasal cavity. The right extraocular muscles and optic nerve are unremarkable. There is no involvement retro-orbital fat. The left orbit is unremarkable. Brain: There are few scattered foci of subcortical and periventricular white matter, as well as pontine high T2 signal. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The pituitary gland and stalk appear to be 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 skull and scalp soft tissues are grossly unremarkable.

Output: 1.Right lacrimal gland enlargement, mild preseptal inflammation, right uveoscleral thickening, and what may represent an associated right subretinal collection. Differential considerations include IgG4-associated orbital and ocular inflammation, perhaps related to rheumatoid arthritis, sarcoidosis, or other granulomatous or autoimmune disorders and less likely neoplasm or atypical infection.2.Scattered mild nonspecific cerebral white matter signal abnormality may represent chronic small vessel disease. Otherwise, no evidence of intracranial meningeal disease or tumors.


Instruction: Generate impression based on findings.

Input: Knee lateral joint line pain, flexion contracture. MENISCI: The lateral meniscus is abnormally thickened, representing a discoid meniscus. There is diffuse abnormal signal throughout the anterior and posterior horns of the lateral meniscus, with suggestion of a tear at the superior aspect of the meniscus. The medial meniscus is normal.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Discoid lateral meniscus with diffuse abnormal signal and suggestion of a tear. The medial meniscus is normal.


Instruction: Generate impression based on findings.

Input: Lesion of the distal radius A well-circumscribed expansile lesion is noted within the distal metaphysis of the radius approaching but not involving the epiphysis. The mass measures 4.4 x 2.9 x 3.1 cm in the greatest craniocaudal, AP, and transverse dimensions. There is thinning of the posterior medial cortex with irregularity likely relating to prior fracture. On T2 sequences, the lesion demonstrates numerous fluid-fluid levels and there is a small amount of reactive muscle edema and enhancement. Following contrast administration, there is diffuse thinning septal enhancement with areas of slightly thicker enhancement (series 13, images 22 and 24 of 34).

Output: Expansile mass within the distal radius demonstrates imaging characteristics most compatible with aneurysmal bone cyst.


Instruction: Generate impression based on findings.

Input: 42 year-old female with breast cancer. Syncope with loss of consciousness. Hit head. There is no evidence of intracranial hemorrhage, edema or midline shift. No definite evidence of metastatic involvement. However, an MRI would better evaluate for metastases.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal without evidence of fracture. There is a small air-fluid level in the sphenoid sinus. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Minimal inflammatory sinus disease, otherwise unremarkable brain CT. MRI would better evaluate for metastatic involvement.


Instruction: Generate impression based on findings.

Input: Reason: any internal plexiform neurofibromas? History: man with NF1 who has severe daily pain, some of which seems superficial; he also has recurrent vomiting Limited study secondary to motion artifact.There is normal appearance of the liver, spleen, pancreas, adrenal glands, and kidneys. No focal masses are identified within the organs. There is no hydronephrosis or nephrolithiasis. No evidence of bowel obstruction. The bladder appears normal. No significant lymphadenopathy.Multiple small cutaneous neurofibromas are seen within the superficial soft tissues of the abdomen and pelvis. The largest in the right hemiabdomen measures 2 x 1 cm, and demonstrates expected T2 hyperintensity.Additionally, multiple neurofibromas are seen along the lower lumbar nerve roots, best appreciated on coronal image is 18-20 (these are better assessed on previous lumbar spine MR of 10/11/16).No large intraperitoneal/retroperitoneal mass is identified.

Output: 1.Multiple neurofibroma are noted along the exiting lower lumbar spinal nerve roots.2.Several small cutaneous neurofibromas are identified.3.No large intra-abdominal mass is identified.


Instruction: Generate impression based on findings.

Input: Female 85 years old Reason: evaluate urethral diverticulum, possible stone History: urethral diverticulum with reportedly palpable hardened area PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticular disease of the sigmoid and descending colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a 2.0 x 3.4 cm nonenhancing, cystic lesion between the urethra and vagina with a fluid-fluid level (series 16, image 21). This has a somewhat horseshoe-type configuration partially encasing the urethra which it is intimately related to. There is no solid enhancing component. Given the intimate relationship to the urethra this is most compatible with a urethral diverticulum. A Gartner's duct cyst could have a similar appearance however this is felt less likely. Superimposed infection cannot be excluded on the basis of this appearance.

Output: 1.3.4 cm cystic lesion between the urethra and vagina containing layering fluid or debris. Given the intimate relationship to the urethra, appearance is compatible with a urethral diverticulum. A Gartner's duct cyst could have similar appearance however this is felt less likely. Superimposed infection cannot be excluded on the basis of the MRI appearance.


Instruction: Generate impression based on findings.

Input: 44-year-old male with left lower calf pain and prior ultrasound showing "mass in left groin/calf."IMAGE ACQUISITIONS: Helical scanning through the left lower extremity performed after IV administration of 120 cc of Omnipaque 380 at a rate of 4 cc/sec. Although no discrete mass is seen, there is a poorly defined, tubular structure within the soleus musculature that is difficult to delineate as it is nearly isodense to muscle. On the transverse images (series 7, image 479/699), it is 1.5 cm in diameter and extends for a length of 7 cm as seen on the coronal images (series 80420, image 54/68). It does not have the typical appearance of a soft tissue tumor and may represent either an isolated bundle of muscle or perhaps a venous varix as it does appear to be slightly hyperintense to musculature on coronal images. The possibility of a deep venous thrombus cannot be excluded. Please correlate with ultrasound examination; MRI may be considered for further evaluation if clinically warranted.There is also a 2 cm x 1 cm collection of low density seen between the left femoral vein and the lateral aspect of the pubic bone (series 7, image 70/699), which based on location and density likely either represents a para-labral cyst or fluid within the iliopsoas bursa. No additional mass is evident.

Output: 1.Poorly defined, tubular structure in the calf as described above that may either represent a separate muscle bundle or possibly a venous varix. The possibility of a deep venous thrombus cannot be excluded. Correlation with ultrasound examination is recommended; MRI evaluation may be considered if clinically warranted.2.Left hip para-labral cyst versus fluid in the iliopsoas bursa as described above. Findings discussed with Dr. Druelinger of the emergency department at the time of dictation.


Instruction: Generate impression based on findings.

Input: 57 year old male with low ejection fraction, normal coronary angiogram, evaluate etiology of cardiomyopathy Left VentricleThe left ventricle is severely dilated with severely decreased function. The overall LV ejection fraction is 20%. The LVEDV is 357 ml (normal range 142+/-34), the LV end diastolic volume index is 204 ml/m2 (normal range: 74+/-15), the LVESV is 287 ml (normal range 47+/-19) and the LV end systolic volume index is 164 ml/m2 (normal range 25+/-9). The LV mass is 207 g (normal range 164+/-36) and the LV mass index is 118 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. There is a mid-wall pattern of late gadolinium enhancement involving the basal to mid septum which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The pattern is classically thought to be fibrosis associated with dilated cardiomyopathy. The native T1 myocardial relaxation time is [1090]ms, which is borderline increased and consistent with the presence of underlying myocardial fibrosis. No evidence of left ventricular thrombus.No evidence of myocardial iron overload. Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is moderate to severely dilated with moderately decreased function. The overall RV ejection fraction is 31%. The RVEDV is 253 ml (normal range 142+/-31), RV end diastolic volume index is 145 ml/m2 (normal range 82+/-16), the RVESV is 176 ml (normal range 54+/-17), and the RV end systolic volume index is 100 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severely dilated left ventricle with severely reduced ejection fraction of 20%.2. Moderate to severely dilated right ventricle with moderately reduced ejection fraction of 31%.3. There is a mid-wall stripe pattern of late gadolinium enhancement involving the basal to mid septum which suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is atypical for prior myocardial infarction. The pattern is classically thought to be fibrosis associated with dilated cardiomyopathy. 4. Moderate left atrial dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: History of colon cancer, vision changes, headaches, dizziness with ambulation, loss of balance recently. Signs and symptoms: As above. Pre- and post enhanced brain MRI: Negative diffusion weighted series.Examination demonstrates few punctate foci of FLAIR hyperintensity in the periventricular and subcortical white matter which considering patient's stated age of 65 likely representing chronic changes of microvascular ischemic disease.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray-white matter differentiation otherwise.There is no detectable abnormal parenchymal, meningeal or calvarial enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are within normal and a normal pattern of enhancement.

Output: 1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.No detectable abnormal parenchymal, meningeal or calvarial enhancement.4.Extensive chronic sinusitis is noted.


Instruction: Generate impression based on findings.

Input: Visual loss. Rule out optic neuritis. There is no definite T2 hyperintensity or enhancement involving the bilateral optic nerves. There is questionable subtle increased T2 hyperintensity involving the posterior aspect of the intraorbital nerves, left relatively greater than right. No abnormal enhancement. Remainder of the bilateral orbital structures are unremarkable.The included parts of the brain are unremarkable as well. The sella turcica is expanded and near completely CSF filled with only thin rim of pituitary tissue along the floor of the sella. A 3 mm apparent triangular-shaped cystlike lesion at the junction between the infundibulum and the compressed pituitary may represent a benign entity such as a tiny pars intermedia cyst or Rathke's cleft cyst. There is deviation of the pituitary infundibulum to the right though without discrete intrasellar mass, otherwise. There is mild, scattered mucosal thickening in the paranasal sinuses.

Output: 1.There is no definite MRI evidence of optic neuritis. There is questionable subtle T2 hyperintensity involving the posterior intraorbital optic nerves, left relatively greater than right, which is of uncertain significance and possibly artifactual.2.Partially empty sella with rightward deviation of the infundibulum. This finding can be normal variant or associated with pseudotumor cerebri in the appropriate clinical setting. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Intermittent twitching, gait instability, and lightheadedness. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is extensive diffuse patchy and scattered cerebral white matter T2 hyperintensity without corresponding restricted diffusion. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a defect in the left lamina papyracea, which may represent a chronic blow-out fracture. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there is fluid signal within the right mastoid air cells.MRA: There is no evidence of significant steno-occlusive lesions. There is a prominent right superior hypophyseal artery infundibulum, but no evidence of aneurysm.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Extensive cerebral white matter T2 hyperintensity likely represents chronic small vessel ischemic disease. 3. Right mastoid fluid may represent mastoiditis.4. No evidence of significant steno-occlusive lesions.


Instruction: Generate impression based on findings.

Input: Male, 88 years old, with vertigo, history of basilar occlusion. Due to patient agitation and discomfort, a very limited examination was obtained consisting of sagittal T1, axial diffusion and axial susceptibility images only. No restricted diffusion is seen. No evidence of significant generalized edema or mass effect is seen. On the basis of T1-weighted imaging, no abnormal collections are detected. There are no findings on the susceptibility weighted images to suggest significant intracranial hemorrhage.

Output: Very limited examination which nevertheless shows no evidence of acute ischemia, mass effect or significant intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Male, 68 years old, history of renal cell carcinoma with solitary brain metastasis status post resection and postoperative radiation, surveillance scan. Findings are seen compatible with prior left frontal craniotomy, tumor resection and hematoma evacuation. An extra-axial fluid collection seen previously subjacent to the craniotomy has resolved. T2 hyperintensity within the left frontal lobe, surrounding the resection cavity, has improved when compared to the immediate postoperative examination. The cavity itself is hemosiderin stained and demonstrates gyriform intrinsic T1 hyperintensity compatible with laminar necrosis.Within the superior aspect of the cavity, an enhancing, hemosiderin stained nodule is identified measuring 11 x 7 mm (image 49 series 11). This lesion seems to correlate with a T1 hyperintense oval structure on the prior radiation planning examination which at that time measured 17 x 15 mm. It is unclear if this lesion enhanced on that prior exam as no precontrast images were obtained. The lesion also correlates with an area of blood product and mild adjacent enhancement seen on the immediate postoperative examination.No new intracranial lesions are seen. No new or significant parenchymal mass effect is detected. The left frontal horn has reexpanded with improvement in surrounding parenchymal edema, and the ventricular system is otherwise unremarkable.

Output: 1.Demonstration of findings compatible with left frontal tumor resection and hematoma evacuation. Acute postoperative findings have resolved, and the degree of diffuse abnormal signal surrounding the resection cavity has improved.2.Within the resection cavity, however, an enhancing, hemosiderin stained nodule is identified. This lesion seems to correlate with an oval T1-bright structure on the prior RT planning exam, and with a small collection of blood product and mild adjacent enhancement on the immediate postoperative MRI. The differential for this finding would therefore include an organized hematoma with fibrovascular or granulation tissue accounting for the enhancement, as well as a nodule of treated residual tumor.


Instruction: Generate impression based on findings.

Input: Reason: H/O poorly differentiated adenocarcinoma, initially diagnosed 5/19/2010, later staged as stage IIB (T1bN1M0) on 9/16/2010. Patient had a solitary brain met resected on 7/20/2011. There are post-treatment findings in the left frontal lobe region. There is unchanged patchy T2 hyperintensity surrounding the treatment bed and elsewhere in the cerebral white matter without associated abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles 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 unchanged.

Output: Stable post-treatment findings without evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for headaches. Signs and symptoms: Headaches. Pre-and post-enhanced brain MRI:Unremarkable diffusion weighted images.There is normal anatomical morphology and with normal signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Anatomical variation of a small cavum septum pellucidum is noted. There is no detectable abnormal parenchymal, leptomeningeal or calvarial enhancement on post enhanced series.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses is within normal and with normal pattern of enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle cavities demonstrate normal pneumatization signal patterns.

Output: Unremarkable pre-and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Advanced HIV/AIDS (CD4 <20), nonadherent to medications; experiencing "regression" as per her report. Difficulty with gross motor skills, coordination. Concern for PML versus space-occupying lesion or other infectious process. There is marked diffuse cerebellar volume loss, without signal abnormalities. Otherwise, the brainstem, cerebral hemispheres, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The third and lateral ventricles 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 moderate diffuse paranasal sinus mucosal thickening.

Output: 1. Extensive diffuse cerebellar volume loss may represent a primary cerebellar degeneration associated with HIV, for which JC virus variant has been implicated.2. No evidence of progressive multifocal leukoencephalopathy, abscess, or acute infarct. REFERENCES:1. Elsheikh BH, Maher WE, Kissel JT. Cerebellar atrophy associated with human immunodeficiency virus infection. Arch Neurol. 2010 May;67(5):634-5. 2. Roux D, Bouldouyre MA, Mercier-Delarue S, Seilhean D, Zagdanski AM, Delaugerre C, Simon F, Molina JM, Legoff J. JC virus variant associated with cerebellar atrophy in a patient with AIDS. J Clin Microbiol. 2011 Jun;49(6):2196-9.


Instruction: Generate impression based on findings.

Input: Ms. Pierre is a 56-year-old female presenting with a screen detected mass in the right breast for which she will get an ultrasound-guided biopsy after MRI. She also has high probability benign calcifications of the left breast for which a six-month follow-up has been recommended. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.In the right lower outer breast, 8:00 location, there is an irregular enhancing mass identified measuring approximately 2.2 x 2.1 x 2.2 cm (AP times ML times SI). This corresponds to the mammographically detected mass in the right lower outer breast. There is no additional abnormal enhancement identified in the right breast.In the left lower outer breast, there is a 0.4 cm enhancing focus identified. This corresponds in location to the mammographically identified cluster of high probability benign calcifications, likely representing fibroadenomatous type calcifications. There is no additional enhancement seen in the left breast.No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) 2.2 cm irregular enhancing mass in the right lower outer breast, corresponding to the mammographically detected mass. Patient is scheduled for an ultrasound-guided biopsy immediately following this MRI.(2) 0.4 cm enhancing focus identified in the left lower outer breast, corresponding in location to the mammographically identified cluster of high probability benign calcifications. This likely represents fibroadenomatous type calcifications. A short-term 6 month mammographic follow-up is recommended in order to confirm benignity of these findings.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Neck pain Examination is motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained. Bone marrow signal is within normal limits. There is a disc extrusion at the C3-C4 level which effaces the ventral thecal sac and results in mild deformity of the left ventral cord. Dorsal thecal sac is patent at this level. Small disc bulges are also seen at the C5-C6 and C6-C7 levels with mild effacement of the ventral thecal sac. There is otherwise no significant spinal canal stenosis in the cervical spine. Up to moderate neural foraminal narrowing at the left C3-C4 level is questioned. Otherwise no high-grade neural foraminal stenosis is seen, within the limitations of the motion degradation. No definite cord signal abnormality is seen. Mild multilevel facet arthropathy.

Output: Moderately motion degraded exam, please see comment in the technique section. There is a disc extrusion at the C3-C4 level which mildly deforms the left ventral cord and results in moderate narrowing involving the left aspect of the spinal canal at this level. There is otherwise no significant spinal canal stenosis at additional levels. No definite cord signal abnormality.


Instruction: Generate impression based on findings.

Input: 63 years Female (DOB:1/26/1953)Reason: right arm pain History: right arm painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There are right-sided uncovertebral osteophytes present at this level and some ligamentum flavum hypertrophy. There is encroachment of the exiting nerve roots within the right neural foramen at this level as a result of osteophyte formationAt C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes at this level with narrowing of the neural foramina bilaterally but worse on the right side where there is encroachment of the right-sided exiting nerve roots within the neural foramen.At C6-7 there is no significant compromise to the spinal canal. There is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes at this level with some narrowing of the neural foramina bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The right vertebral artery appears very small and has very little intracranial contribution..

Output: There are multilevel degenerative changes present in the cervical spine with encroachment of exiting nerve roots predominantly in the right side at C4-5 and C5-6 as a result of a degenerative changes.


Instruction: Generate impression based on findings.

Input: 59-year-old female with chest pain with new hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.7 x 2.3 x 2.9 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.7 x 2.4 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Heterogeneous and hypervascular right thyroid lobe without distinct nodule.LEFT LOBE: Heterogeneous and hypervascular left thyroid lobe without distinct nodule.ISTHMUS: Enlarged and heterogeneous.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Small level three lymph node containing a fatty hilum measuring 1.5 x 0.3 x 0.6 cmOTHER: No significant abnormality noted.

Output: Enlarged heterogeneous and hypervascular thyroid gland without discrete measurable nodule. Findings may represent Grave's disease versus thyroiditis.


Instruction: Generate impression based on findings.

Input: Male, 72 years old, Muscle weakness (generalized) [M62.81], Reason for Study: ^Reason: r/o myelopathy, syrinx History: bilateral arm weakness Cervical spine alignment is within normal limits. Vertebral body heights are maintained. Cervical spinal cord signal intensity is normal throughout. C2-3: Within normal limits C3-4: Diffuse bulging of disc with bony spur result moderate to severe spinal canal stenosis. C4-5: Diffuse bulging of disc with bony spur formation result moderate to severe spinal canal stenosis. Bilateral lateral recess stenosis are also seen.C5-6: Diffuse bulging of disc with bony spur result in the moderate to severe spinal canal stenosis. Eccentric bulging of disc results left side lateral recess stenosis at this level.C6-7: Central focal bulging of disc indents anterior thecal sac, otherwise unremarkable. C7-T1: Within normal limits.

Output: 1. Degenerative spondylosis especially from C34 to C5-6 with moderate to severe spinal canal stenosis as well as various degree lateral recess stenosis.2. Spinal cord signal intensity is normal. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Diffusion weighted images are again compromised due to extensive ferromagnetic artifact from postoperative changes of left temporal craniotomy and aneurysm clip in the left paramedian sellar region. The artifact obscures the midbrain, left antrum, right basal ganglia and portions of bilateral anterior frontal lobes along the floor of anterior cranial fossa. Beyond the region of artifact there is no abnormal restricted diffusion. Extensive blooming artifact obscures full visualization on SWI images. Within these limitations there is no evidence of acute hemorrhage. No abnormal contrast enhancement is noted on postcontrast images.The previous well demarcated focus of increased signal intensity in the left basal ganglia is again seen and not significantly changed. The abnormal T2/flair signal representing encephalomalacia in the left anterior temporal lobe is also not significantly changed.Redemonstrated is small varying sized foci of flair and T2 increased signal intensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres and minimally in bilateral basal ganglia, which are believed to represent chronic small vessel ischemic strokes.Interval resolution of the mixed-signal intensity blood under the left sided craniotomy flap with expected postsurgical changes.

Output: 1.Postsurgical changes from a left temporal craniotomy and aneurysm clipping in the left paramedian sellar region.2.No significant change in the periventricular and subcortical white matter disease.3.A subdural hematoma has resolved.4.There is a small focus of left temporal lobe encephalomalacia present.


Instruction: Generate impression based on findings.

Input: 37-year-old female with history of stage IV T2N2bM0 squamous cell carcinoma of the left lateral tongue on protocol 12-1712 ended induction on 7/8. Evaluate for interval change. The previously described anterior left oral tongue tumor has decreased in size and become less well-defined. The lesion now measures up to 35 mm in the coronal plane (image 16 series 501), previously 40 mm. As before, the lesion probably involves the left submental space, but does not invade into deeper structures. No abnormality of the adjacent mandible is seen.The previously referenced necrotic left level II node or nodal aggregate is redemonstrated now measuring 47 x 43 mm (image 22 series 901), previously 35 x 30 mm. As before, abnormal infiltrative enhancement contiguous with this large necrotic aggregate does involve the adjacent carotid space. A previously referenced left level Ib lymph node measures 13 x 12 mm (image 17 series 901), previously 16 x 12 mm. The left lateral retropharyngeal lymph node measures 8 x 4 mm (image 30 series 901), previously 7 x 5 mm. The right level IIa reference node measures 10 x 7 mm (image 20 series 901), previously 10 x 7 mm.The remaining neck lymph nodes show no significant interval change. There is a cystic right thyroid nodule that measures up to 9 mm and is unchanged. There are small maxillary sinus retention cysts. There are also secretions in the left sphenoid sinus. The orbits and imaged intracranial structures are unremarkable. There is a small posterior disc-osteophyte complex at C5-C6 that mildly indents the spinal cord. Ill-defined enhancement within the C5 vertebral body is unchanged and nonspecific but may represent a hemangioma.

Output: 1.Interval decrease in the size of the left anterior oral tongue tumor.2.The dominant left level II necrotic nodal aggregate has increased in size. While some of this increase represents expansion of the necrotic/cystic core, there does also appear to be a thicker rind of enhancing tissue as well.3.Additional cervical lymph nodes are stable or reduced in size as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 19 years, Male, evaluate for abscess or meningitis. Examination is limited to post contrast sequences and demonstrates postoperative changes related to resection of recurrent tumor in the posterior fossa. There is minimal enhancement along the resection cavity margin include foci of nodularity, some of which appeared increased since prior postoperative MRI from 1/13/2016 particularly on the left lateral margin of the resection cavity. Restricted diffusion was evident within this region and therefore this is likely representative of evolution of postsurgical changes. There is a approximately 6 mm nodule with T1 hyperintensity and susceptibility indicative of blood products along the right dorsal margin of the fourth ventricle which was present on prior; there is questionable associated enhancement. There is no definite evidence of residual tumor on this current studyElsewhere in the brain there is no abnormal parenchymal or meningeal enhancement to suggest infection. No evidence of intracranial abscess or empyema. Air is an extra-axial fluid collection in the posterior fossa. There is also a larger fluid collection with surrounding enhancement in the suboccipital soft tissues which extends below the field-of-view at the C1 level, larger than prior study from 1/13/2016. Collection measures approximately 8 cm in the craniocaudal dimension. There is surrounding enhancement without restricted diffusion centrally and favored to be a pseudomeningocele. In the left frontotemporal scalp there is a focus of peripheral enhancement with restricted diffusion measuring approximately 3 cm in the AP dimension and 4 mm in thickness.

Output: 1. Examination limited to postcontrast sequences demonstrate no evidence of intracranial abscess or empyema. There is enhancement at the cerebellar resection cavity margins which may represent postsurgical change. No definite MR evidence of meningitis, although assessment is limited due to recent surgery. Suggest correlation with CSF sampling for meningitis. 2. Postoperative changes of resection of recurrent tumor in the posterior fossa without definitive evidence of residual tumor. There is mild residual enhancement in the surgical bed as described above and can be further assessed on follow-up studies.3. Suboccipital fluid collection is compatible with a pseudomeningocele and larger than prior MRI from 1/13/2016. Fluid collection is seen extending to the skin surface. There is surrounding enhancement which may be postsurgical. No associated restricted diffusion is seen to definitively suggest pus however superimposed infection cannot be excluded.4. Thin fluid collection involving the left frontal temporal scalp measuring up to 4 mm in thickness and 3 cm in the AP dimension, which is suspicious for a superficial abscess by imaging.5. Please refer to recent noncontrast MRI report from 1/27/2016 for additional findings.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of bronchus and lung, unspecified site [162.9], Reason for Study: ^Reason: rule out metastases History: ams, There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is a focal high signal intensity on the right post central gyrus (224, series 406) but it does not show restricted diffusion and shows high signal intensity on T2 and FLAIR indicate T2 shine through artifact. Several scattered high signal intensity foci on bilateral hemispheres on FLAIR images indicate non specific.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, 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: No evidence of acute ischemic or hemorrhagic lesion on the scan.Non specific white matter lesions on FLAIR images as described above.If metastatic lesion is suspicious, MR exam should be repeated with Gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: Male 68 years old Reason: local staging History: metastatic Rectal cancer, s/p liver resection, s/p chemoradiation therapy per chart. Overall image quality: GoodPELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted. LYMPH NODES: Lymph nodes in the perirectal space, within the mesorectal fascia: There are several non-specific subcentimeter lymph nodes within the mesorectal fascia.Lymph nodes outside the mesorectal fascia: Non-specific prominent left external iliac lymph node measuring 1.1 x 0.5 cm (series 5 image 20).BOWEL, MESENTERY: Rectal Tumor: There is irregularly-shaped soft tissue extending posterolaterally left greater than right from the rectum to the mesorectal fascia and abutting it. It is very low signal intensity on T2-weighted imaging sequences.Size: The signal abnormality is difficult to accurately measure but involves approximately 2.8 x 2.4 x 4.3 cm (series 5 image 44 and series 6 image 43).Tumor appearance on T2-weighted images: Very low signal intensity.Tumor location: Middle-thirdRelationship and proximity of the tumor to adjacent structures (prostate, seminal vesicles): The signal abnormality is posterolateral without involvement of the prostate or seminal vesicles.BONES, SOFT TISSUES: Prominent left greater than right inguinal lymph nodes. No suspicious discrete osseous abnormality.OTHER: No significant abnormality noted.

Output: 1.Irregular soft tissue extending posterolaterally left greater than right from the mid rectum to the mesorectal fascia and abutting it. Given the dark signal intensity of the lesion posttreatment related fibrosis is favored.2.Nonspecific prominent left external iliac lymph node and subcentimeter mesorectal lymph nodes.3.Nonspecific prominent left greater than right inguinal lymph nodes.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: eval (AD)renal mass History: eval (AD)renal mass ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Hepatic and portal veins are patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is a left adrenal mass which is heterogeneously T2 hyperintense measuring 4.2 x 3.7 cm that originates from the lateral limb of the left adrenal gland. The lesion has heterogeneous early contrast enhancement. There is slight infiltrative changes along the medial border of the lesion with the left renal vein and left crus of the diaphragm.KIDNEYS, URETERS: There are bilateral renal cysts. No hydronephrosis in either kidney. Left renal vein is collapsed limiting evaluation. No definite evidence of thrombus although the mass abuts the left renal vein and compresses it. Infiltration of tumor along into left renal vein wall is not excluded.RETROPERITONEUM, LYMPH NODES: There are multiple small left periaortic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes with lumbar hardware involving the lower lumbar spine.OTHER: No significant abnormality noted.

Output: 1.Findings of a 4.2 cm malignant-appearing left adrenal mass. Differential considerations include pheochromocytoma and possibly adrenocortical carcinoma.2.There is infiltration of the medial border of the mass as it abuts the left renal vein which is extrinsically compressed and early invasion is not entirely excluded. There is also loss of the fat plane between the adrenal mass and the left diaphragmatic crus.3.No specific evidence of metastatic disease in the upper abdomen although there are small left retroperitoneal lymph nodes in the region.


Instruction: Generate impression based on findings.

Input: The vertebral body heights are preserved. Mild L3-4 anterolisthesis. Alignment is otherwise maintained. There is severe loss of disc height with endplate degenerative changes at L5-S1 with vacuum phenomenon. There are scattered T1 hyperintense foci of the lumbar spine, which may represent focal fatty replacement or fat containing hemangiomas. No suspicious osseous lesions. There is no significant spinal canal stenosis. The distal spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.Individual levels as below:T11-T12: Mild disc bulge. No significant spinal canal or foraminal stenosis. These findings are unchanged.T12-L1: Bilateral facet arthropathy. No significant disc bulge, spinal canal or foraminal stenosis. These findings are unchanged.L1-L2: There is a new right paracentral disc extrusion that extends above the disc level causing marked right lateral recess stenosis. As before, there is bilateral facet arthropathy and mild disc bulge, moderate right foraminal stenosis, no significant spinal canal or left foraminal stenosis, unchanged.L2-L3: Mild disc bulge and bilateral facet arthropathy. Mild bilateral foraminal stenosis. No significant spinal canal foraminal stenosis. These findings are unchanged.L3-L4: Mild disc bulge with superimposed right foraminal protrusion and advanced bilateral facet arthropathy, contributing to mild right foraminal stenosis. There are also bilateral facet effusions. No significant spinal canal or left foraminal stenosis. These findings are unchanged.L4-L5: There is mild neural foraminal narrowing on the right related to advanced facet arthropathy. Otherwise no significant spinal canal or neural foraminal stenosis. These findings are unchanged.L5-S1: Disc bulge and bilateral facet arthropathy, contributing to moderate left foraminal stenosis with flattening of the left S1 nerve root sheath origin. No significant spinal canal stenosis. These findings are unchanged.SI joint: There are minimal marginal osteophytes.

Output: 1.L1-L2: There is a new right paracentral disc extrusion that extends above the disc level causing marked right lateral recess stenosis. As before, there is moderate right foraminal stenosis, unchanged.2.L2-L3: Mild bilateral foraminal stenosis, unchanged.3.L3-L4: Mild right foraminal stenosis, unchanged.4.L4-L5: Mild neural foraminal narrowing on the right, unchanged.5.L5-S1: Moderate left foraminal stenosis with flattening of the left S1 nerve root sheath origin, unchanged.


Instruction: Generate impression based on findings.

Input: Reason: Chiari malformation , has NOT had surgery. yearly follow up evaluate for changes History: yearly follow up , headaches. MRI brain:There is 1.1 cm descent of the right cerebellar consult and 0.5 cm descent of the left cerebellar tonsil which is similar to the prior exam. Effacement of the foramen magnum CSF space is similar to the prior exam. Biphasic CSF flow can be seen across the foramen magnum, similar to the prior exam.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. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. A small cyst in the pineal gland is unchanged.MRI cervical spine:Redemonstration of tonsillar descent consistent with a Chiari 1 malformation. Minimal prominence of the central canal at C5-C6 is unchanged, however no syrinx is seen in the cervical or upper thoracic cord. Straightening of cervical lordosis, otherwise alignment is anatomic. Normal marrow signal. No spinal or foraminal stenosis.

Output: 1.Chiari 1 malformation is stable without new intracranial abnormalities.2.Minimal central canal prominence at C5-C6 without evidence of syrinx.


Instruction: Generate impression based on findings.

Input: Diagnosis: Altered mental status, unspecified Cerebellar stroke syndromeClinical question: r/o acute infarcts or enhancementSigns and Symptoms: altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the posterior aspect of the right cerebellar hemisphere which was in the subacute phase and 2013. There is associated asymmetric dilation of the fourth ventricle. A smaller focus of encephalomalacia is present in the left temporal lobe anteriorly. Another small focus of encephalomalacia is present along the left cerebellar hemisphere.Redemonstration of a T2 and FLAIR hyperintense focus centered in the left thalamus.Periventricular and subcortical white matter T2 and FLAIR hyperintense punctate foci of a mild degree are present. The lateral ventricles are fairly large but unchanged compared to a recent head CT.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The pituitary gland measures 10 mm in height but is unchanged since prior exam 9/20/2013.MRA brain:Exam is somewhat degraded due to patient motion which would obscure more subtle abnormalities.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The A2 segment is azygos.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for acute cerebral infarction.4.There is redemonstration of moderate-sized focus of encephalomalacia involving the right cerebellar hemisphere and smaller foci of encephalomalacia in the left cerebellar hemisphere and anterior portion of the left temporal lobe which were present on the recent CT head exam from 11/30/15 and have not changed. These are likely vascular related.5.There is redemonstration of an old lacunar infarct in left thalamus.6.The lateral ventricles appear large. Although this could be a result of brain atrophy possibility of normal pressure hydrocephalus cannot be excluded. Please correlate with patient's clinical symptoms.7.Enlargement of the pituitary gland is relatively stable compared to prior exams. Possibility of a pituitary abnormality cannot be excluded. Please correlate with patient's clinical history, signs and laboratory tests8.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Obstructive sleep apnea (adult) (pediatric) [G47.33], Reason for Study: ^Reason: Patient with episodes of apnea requiring intubation History: Patient with episodes of apnea requiring intubation Brain MRINo evidence of acute ischemic or hemorrhagic lesion.A couple of T2/FLAIR high signal intensities are non specific. There are focal tissue losses on the bilateral thalami indicating chronic lacunar infarctions. Prominent sulci and ventricular system indicate mild brain atrophy which is age appropriate.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 are clear.Bilateral mastoid air cells are opacified.Brain MRAMotion artifacts degraded examination quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate irregularities of bilateral MCAs and focal luminal narrowing on the proximal basilar artery. However, these lesions could well be related to motion artifacts. Overall, there is no evidence of significant luminal narrowing. Bilateral PCAs are fetal origin and Acom artery appears to be patent.No aneurysm was found.However, if clinically indicated, brain MRA can be repeated without additional charge for more precise evaluation.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Motion artifacts degraded Brain MRA, so precise evaluation of intracranial arterial system is not possible. Grossly, there is no significant intracranial arterial luminal stenosis.


Instruction: Generate impression based on findings.

Input: 65-year-old male with a history of myeloma, sciatic pain, and a history of a L5 lesion with progression of disease. Evaluate for interval change of the myeloma, sciatica and L5 lesion. There is normal lordotic curvature of the lumbar spine. There is preservation of the vertebral body heights. There is mild multilevel disc desiccation and mild disc height loss involving the L3-4 and L4-5 levels. There is diffuse marrow T1 hypointensity and slight STIR hyperintensity which is unchanged compared to the previous exam and likely related to multiple myeloma.The right inferoposterior L5 vertebral body myelomatous lesion is again visualized and demonstrates eccentric protrusion toward the right L5-S1 lateral recess, also abutting the thecal sac. This has increased in the extent of protrusion compared to the previous exam and further narrows the right L5-S1 lateral recess and neuroforamen causing greater impingement/encroachment on both the exiting L5 nerve root and traversing S1 nerve root. Elsewhere in the lumbar spine from T12-L1 through L2-L3, there is no neuroforaminal narrowing or spinal stenosis. Minimal disc bulging at the L3-4 with a tiny left paracentral protrusion, and broad based disc bulging at the L4-5 level, are unchanged.

Output: 1. Interval increase in the protrusion of the myelomatous lesion along the right aspect of the inferoposterolateral L5 vertebral body which is causing increased narrowing of the right lateral recess and right L5-S1 neural foramen with evidence of increased mass effect on both the traversing S1 nerve root as well as the exiting L5 nerve root.2. The remainder of the spondylotic findings within the lower lumbar spine are unchanged.3. Diffuse replacement of normal fatty marrow is likely related to multiple myeloma.


Instruction: Generate impression based on findings.

Input: Mr. Kemph is a 56 yr old male with PSA 4.2 to 5.7 ng/ml with recent 20 core and lesion-guided biopsy without evidence of cancer. PELVIS:PROSTATE:Prostate Size: 4.6 x 5.7 x 3.9 cm.Peripheral Zone: Within the central left aspect of the mid gland (series 601, image 23), there is a focus of decreased T2 and ADC signal measuring 4 x 8 mm which is suspicious for neoplasm.Central Gland: The central zone is hypertrophic with numerous hyperplastic nodules compatible with BPH. Within the central zone, there are 2 discrete well-circumscribed nodules (series 601, images 19 and 17) which demonstrates low T2 and ADC signal which most likely represent benign nodules.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing bilateral inguinal hernias are noted.

Output: Central left mid peripheral zone focus of signal abnormality suspicious for neoplasm measuring 4 x 8 mm.


Instruction: Generate impression based on findings.

Input: 77 years Male (DOB:7/30/1938)Reason: yearly surveillance pituitary lesion- on 3T please History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The pituitary gland enhances heterogeneously and is predominantly hyperintense in signal. This raises the question of necrosis within the pituitary gland. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.The right eye lens is thin.

Output: The examination is not changed substantially since the 7/20/2015 exam. The pituitary gland although appropriate in size and morphology has abnormal signal and enhancement pattern. The differential diagnosis would most likely an involuting adenoma, prior pituitary apoplexy, or a resolving pituitary inflammatory process.


Instruction: Generate impression based on findings.

Input: Medial pain, check for meniscal tear MENISCI: Bilateral menisci appear intact without focal internal abnormality.ARTICULAR CARTILAGE AND BONE: The medial and lateral compartments are otherwise intact with normal-appearing cartilage and underlying osseous structures, however there is mildly thickened medial patellar plica with a large full thickness defect of the patellar cartilage involving the medial facet. The irregularity measuring approximately 1 cm in diameter.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Changes correlating with thickened medial patellar plica with an associated underlying cartilaginous defect of the medial patellar facet. Please see details


Instruction: Generate impression based on findings.

Input: 63-year-old male with a soft tissue mass/possible lipomas. Note is made of multiple vitamin E capsules along the lateral and posterior aspect of the distal left humerus presumably representing the patient's palpable area of concern. There is slight prominence of the subcutaneous fat in the surrounding area, however, no discrete mass lesion is identified. This may be related to lack of contrast with the adjacent subcutaneous fat, which can be seen in patient's with palpable lipomas. There is a subcentimeter focus of enhancement along the lateral aspect of the distal right humerus, which is nonspecific but may represent a sebaceous cyst or perhaps a lymph node. This finding does not correspond to any of the markers denoting the palpable areas of concern. Note is made of a 6.5 cm lobulated focus of fat signal intensity along the lateral aspect of the right 11th and 12th ribs likely representing a lipoma although this is incompletely imaged on this examination.

Output: Slight prominence of the subcutaneous fat adjacent to the skin markers which may represent lipoma formation, although no discrete mass is identified. Other findings as described above.