Instruction: Generate impression based on findings.

Input: Somnolence [R40.0], Reason for Study: ^Reason: evaluate for possible etiology for seizure, AMS History: Weakness, lower extremity loss of sensation No evidence of acute ischemic or hemorrhagic lesion.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: Normal brain MRI


Instruction: Generate impression based on findings.

Input: 69-year-old male status post transphenoidal hypophysectomy. Again seen are postsurgical changes related to transsphenoidal hypophysectomy with unchanged heterogeneous hyperdense material within the surgical bed in the suprasellar region measuring 2.0 cm x 1.7 cm x 2.4 cm (series 207, image 17; series 203, image 38). As before, the optic chiasm is not well delineated due to the adjacent heterogeneous collection. Bony defect along the posterior wall of the sphenoid sinus with low density likely representing additional postoperative material, also unchanged. Heterogeneous collection is also noted within the sphenoid sinuses presumably representing Merogel. Unchanged heterogeneous secretions within the nasal cavity, maxillary sinus and ethmoidal air cells with associated air-fluid levels within the maxillary sinuses, left greater than right.Gray-white matter differentiation is maintained. No acute intraparenchymal hemorrhage, mass effect or edema. The ventricles and sulci appropriate for patient's age with no midline shift. The mastoid air cells are clear. The imaged orbits are unremarkable.

Output: 1. No interval change in postsurgical findings related to transsphenoidal hypophysectomy with presumed blood products associated with postoperative material (Surgicel and gel-foam soaked in thrombin, Merogel) within the suprasellar region and sphenoid sinus. Postoperative bony defect along the posterior wall of the sphenoid sinus.2. Unchanged opacification of the nasal cavities, maxillary sinuses and ethmoidal air cells likely representing blood products.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of cirrhosis and HCC status post TACE RFA. Evaluate post procedural changes. ABDOMEN:LIVER, BILIARY TRACT: Nodular contour of the liver compatible with cirrhosis. Posttreatment changes from segment 5 radiofrequency ablation without residual arterial nodular enhancement or washout. There is rim enhancement of the ablation cavity consistent with hyperemia, not significantly changed. Interval decrease in the previously noted T1 hyperintensity within the ablation cavity consistent with evolution of blood products. Additionally, there is capsular retraction with small amount of perihepatic fluid overlying the ablation cavity, unchanged. Unchanged segment 6 hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: Unchanged T2 hyperintense lesion within the uncinate process of the pancreas, likely representing sidebranch type IPMN and measuring 9 x 8 mm. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post procedural changes of ablation of segment 5 suspected hepatocellular carcinoma without measurable arterial enhancement or washout to suggest recurrent or residual tumor.2.Cirrhotic liver morphology.


Instruction: Generate impression based on findings.

Input: 7 years Female (DOB:2/9/2009)Reason: 7yo female with history of cord transplant, now intubated; f/u progression of brain lesions History: 7yo female with history of cord transplant, now intubated; f/u progression of brain lesionsPROVIDER/ATTENDING NAME: CATHERINE A. HUMIKOWSKI RACHEL K. WOLFSON The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of periventricular confluent T2 and FLAIR signal hyperintensity which was present on the prior exams.There is redemonstration of a punctate enhancing focus in the left cerebellar hemisphere which remains unchanged compared to prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are partially opacified. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.

Output: 1.Periventricular white matter lesions are present which are nonspecific but most likely related to prior treatment2.A punctate-sized lesion in the left cerebellar hemisphere remains stable dating back to August 30..


Instruction: Generate impression based on findings.

Input: Patient is a 59 year old female with a personal history of right breast lumpectomy in 2/2001 for invasive mammary carcinoma. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Stable postsurgical changes in the upper outer right breast. No abnormal enhancement is seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Eval GBM. Pt on TMZ. History: GBM. Considering the difference in scan angle, the size, enhancing characteristics and the extent of surrounding edema of the right hemispheric GBM do not show any significant interval changes since prior scan.However, there are new ill defined several enhancing foci on the right basal ganglia mesial aspect of the main tumor mass which suggest progression of tumor. The degree of midline shift toward left side appears to be slightly lessen than prior exam (8.3mm, prior 9.2mm at the level of foramen of Monroe on coronal plane) but could also be related to scan direction.Although not quantitative, gradient echo images show more susceptibility lesions within the enhancing tumor especially on the anterior and lateral aspect indicating hemorrhagic foci. The ventricles, sulci and cisterns are unchanged. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval development of several new ill defined enhancing foci mesial aspect of the main tumor indicating possible tumor progression.2. Interval increase number of susceptibility lesions on the anterior and lateral aspect of the tumor indicating possible newly developed hemorrhagic foci.3. Overall right hemispheric GBM size, mass effects, surrounding edema and MR enhancement patterns do not show any significant interval change since prior scan.


Instruction: Generate impression based on findings.

Input: 31-year-old female with right lower quadrant pain. Evaluate for TOA and appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: The spleen is enlarged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructing right renal calculi are evident.RETROPERITONEUM, LYMPH NODES: Numerous small mesenteric lymph nodes are evident as well as a few prominent retroperitoneal nodes.BOWEL, MESENTERY: Trace peritoneal fluid. The appendix is normal. The omentum and peritoneum are infiltrated and the small bowel, particularly in the left lower quadrant, appears matted. Along with the presence of numerous mesenteric and retroperitoneal lymph nodes as described above, these findings most likely represent a diffuse inflammatory process such as gastroenteritis or mesenteric adenitis. Neoplastic disease is considered less likely.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral adnexal cystic lesions are inadequately evaluated on CT. If further imaging evaluation is clinically warranted, gynecologic ultrasound or MRI may be considered.BLADDER: No significant abnormality notedLYMPH NODES: Multiple prominent iliac, obturator, and inguinal lymph nodes are seen. See discussion above.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: Omental and mesenteric infiltration along with matted bowel and numerous mesenteric, retroperitoneal and pelvic lymph nodes suggests a diffuse inflammatory process such as gastroenteritis or mesenteric adenitis. Neoplastic disease is considered less likely. Cystic adnexal lesions may be further evaluated on ultrasound or MRI if clinically indicated.


Instruction: Generate impression based on findings.

Input: 50 year old female patient with chronic calcific pancreatitis likely secondary to alcohol abuse. Status post distal pancreatectomy, incarcerated ventral hernia status post repair with mesh complicated by seroma now resolved. Patient continues to have abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesion is identified. There is scattered focal fat deposition. No intra- or extrahepatic biliary ductal dilatation. The gallbladder is absent.SPLEEN: No significant abnormality noted.PANCREAS: Post-surgical changes of the pancreas with a small residual head/uncinate process. No evidence of acute inflammation. 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: Post-surgical changes of the ventral abdominal wall hernia repair. There is a 3.2 x 4.9 cm (transverse x craniocaudal) T2 hyperintense collection within the lower anterior abdominal wall soft tissues, in the region of prior drain, which is only visualized on the coronal T2 images (image 33, series 3) and not included within the field of view on axial imaging.OTHER: No significant abnormality noted.

Output: 1.Anterior abdominal wall T2 hyperintense collection in the region of a prior drain; this may represent a seroma, but is only visualized on coronal images and incompletely evaluated as it is not included in the field of view on contrast enhanced axial sequences.2.Post-surgical changes of the pancreas without acute intraabdominal abnormality.


Instruction: Generate impression based on findings.

Input: 59 years, Female, status post tumor resection. There are postsurgical changes of craniotomy for resection of large right parietal meningioma. Blood products are seen involving the resection bed. There is evidence of near total resection with residual enhancing tissue noted surrounding the superior sagittal sinus. There is rim of restricted diffusion surrounding the resection cavity much of which is related to blood products with small amount of cytotoxic edema. There is mild enhancement involving the right parietal lobe along the anterior-inferior aspect of the resection cavity with restricted diffusion and compatible with cytotoxic edema/postsurgical change. There is also vasogenic edema involving the right parietal lobe which is mildly increased. There is mild downward mass effect at the level of the resection cavity and minimal leftward midline shift.There is small filling defect involving the superior sagittal sinus which was not present on prior MRI with corresponding hyperdensity seen on recent CT likely representing a small thrombus. Superior sagittal sinus posterior to the level of the residual meningioma is widely patent.No hydrocephalus. Major arterial flow-voids are preserved. Paranasal sinuses and mastoid air cells are clear. Prominent mineralization of the basal ganglia is again noted.

Output: 1. Postsurgical changes of large right parietal meningioma resection. There is near total resection with minimal residual tumor surrounding the superior sagittal sinus.2. Faint enhancement in the right parietal lobe anterior inferior to the resection cavity with restricted diffusion is consistent with small amount of cytotoxic edema/postsurgical change.3. Small filling defect involving the superior sagittal sinus which was not present on preoperative MRI from 7/20/2015 and with corresponding hyperdensity on recent CT is consistent with a small thrombus. Superior sagittal sinus posterior to the level of the residual meningioma and the remainder of the major dural venous sinuses are patent.


Instruction: Generate impression based on findings.

Input: Female, 71 years old, with history of lung cancer, metastases to the brain, evaluate and compare to prior. No evidence of parenchymal edema, mass effect or pathologic enhancement is seen. Minimal scattered foci of white matter T2 hyperintensity are redemonstrated, nonspecific and unchanged. A developmental venous anomaly is noted incidentally in the left occipital lobe. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collection are observed. The ventricles are normal in size and morphology.

Output: No evidence of active intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 62 years old, status post third ventriculocisternostomy. History of ventriculomegaly and cortical stenosis. Sagittal fiesta best demonstrates a small anatomic defect consistent with the provided history of third ventriculocisternostomy. Sagittally acquired CSF flow analysis demonstrates a tuft of CSF flow through the region of this defect.Stable, marked ventriculomegaly is redemonstrated involving the lateral, third and fourth ventricles, not significantly changed from the prior examination. There are stable scattered foci of T2 hyperintensity within the cerebral white matter which are nonspecific. The cerebellar vermis is hypoplastic inferiorly, unchanged. Note is made of a presumed ventriculostomy catheter tract to the frontal lobe.

Output: Sagittal fiesta best demonstrates a small anatomic defect consistent with the provided history of third ventriculocisternostomy. Sagittally acquired CSF flow analysis demonstrates a tuft of CSF flow through the region of this defect.


Instruction: Generate impression based on findings.

Input: 66 year old female for evaluation prior to atrial fibrillation ablation. Left VentricleThe left ventricle is mildly dilated with reduced ejection fraction. The overall LV ejection fraction is 47%. The LVEDV is 185 ml (normal range 109+/-23), LV end diastolic volume index is 93 ml/m2 (normal range: 65+/-11), LVESV is 98 ml (normal range 31+/-10), and LV end systolic volume index is 49 ml/m2 (normal range 18+/-5). The LV mass is 119 g (normal range 114+/-24) and the LV mass index is 60 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumLeft Atrium: The left atrium is severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 36 ml/m2 (normal range 22+/-8), and the RVESV is 72 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsLinear defect within the spleen may represent sequela of previous trauma or infarct and can be better evaluated on same day CT abdomen. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Left ventricle is mildly dilated with reduced ejection fraction of 47%2. Normal right ventricular size with low normal ejection fraction at 47%3. Severely dilated left atrium. Four pulmonary veins are present. There in no left atrial appendage clot noted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Chiari, status post decompression, syrinx, worsening head and neck pain. Brain: There are postoperative findings related to Chiari decompression surgery and fourth ventricular stenting. There is kinking of the cervicomedullary junction posteriorly towards the overlying dura, which appears similar as on the prior exam. There is flow of cerebrospinal fluid across the neo-foramen magnum anteriorly, but not posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. There is a partially empty sella. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.Spine: There are 13 thoracic vertebrae. There is residual trace prominence of the thoracic spinal cord central canal. The conus medullaris is positioned at the lower L1 level. There are postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with residual punctate T1 hyperintensity at the L1-2 level and linear T1 hyperintensity extending from the L3-L4 level to the distal end of the thecal sac. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild degenerative spondylosis involving the lower lumbar spine, but no significant spinal canal stenosis.

Output: 1. Postoperative findings related to Chiari decompression with kinking of the cervicomedullary junction posteriorly towards the overlying dura, which may secondary to adhesion formation.2. Trace residual thoracic syrinx. 3. Postoperative findings related to tethered cord release and partial resection of filar fibrolipoma, with the conus medullaris positioned at the lower L1 level. 4. Nonspecific partially empty sella.


Instruction: Generate impression based on findings.

Input: 78-year-old male with history of prostate cancer and elevated PSA. Pathology 11/4/2015: right lateral apex- Prostatic adenocarcinoma, Gleason grade 3+4=7right apex- Prostatic adenocarcinoma, Gleason grade 3+3=6right base prostate- Prostatic adenocarcinoma, Gleason grade 3+3=6left lateral mid- Prostatic adenocarcinoma, Gleason grade 3+3=6, see comment.left lateral apex- Prostatic adenocarcinoma, Gleason grade 3+3=6, see comment.left apex- Prostatic adenocarcinoma, Gleason grade 3+3=6, see comment. PELVIS:PROSTATE:Prostate Size: 5.5 x 3.7 x 4.4 cmPeripheral Zone: Lesion in the right mid gland demonstrating T2 hypointensity with corresponding low ADC signal (series 901, image 17) measuring approximately 4 x 4 millimeters.Lesion in the right apex demonstrating T2 hypointensity with corresponding low ADC signal (series 901, image 13) measuring 8 x 3 mm.The right base is difficult to evaluate given artifact.Lesion in the left mid gland/apex demonstrating T2 hypointensity with corresponding low ADC signal (series 901, image 16) measuring approximately 10 x 5 mm.Central Gland: Heterogeneous and nodular central gland compatible with benign prostatic hypertrophy.Seminal Vesicles: No evidence of extension to seminal vesicles.Extracapsular Extension: No extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly enlarged external iliac chain lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a small left inguinal fat-containing hernia.

Output: 1.Multiple suspicious prostatic lesions as detailed.2.Nonspecific mildly enlarged external iliac chain lymph nodes.


Instruction: Generate impression based on findings.

Input: 18 year old male with a small mass for 9 months also seen on recent ultrasound examination. A marker was placed along the volar and medial aspect of the mid to distal forearm at the site of the palpable abnormality. We suspect that there is a small subcutaneous fatty mass deep to the marker that measures no more than 8 mm in the greatest transverse dimension and approximately 1.5 cm in the longitudinal dimension, however, accurate measurement is difficult to obtain due to lack of inherent contrast with the surrounding subcutaneous fat. There is no enhancement of this mass or the surrounding area. We see no additional masses. The signal intensity of the musculature of the forearm is normal. The bone marrow signal intensity is normal.

Output: Small subcutaneous lipoma of the left forearm.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the vertebral bodies. The vertebral body height is maintained. There is no fluid collection. There is no evidence of cord abnormality. There is no STIR abnormality in the ligaments.C7 and T1 are normal with no ligamentous injury. Questioned abnormalities on previous x-ray are artifactual.There are trace disc bulges at C4-C5 and C5-C6 with no spinal canal stenosis and no neural foraminal compromise.

Output: No ligamentous injury, without abnormality at C7-T1. Questioned abnormalities on previous x-ray are artifactual.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with back pain and fever, known vertebral body lesions. Patient is status post biopsy of the T10 and L4 vertebral bodies which did not, however, provide a definitive diagnosis. Thoracic:Heterogeneous marrow signal likely representing a combination of edema and sclerosis is seen involving the T4-T8 vertebral bodies, and the T4-5 intervertebral disc. These structures also demonstrate patchy heterogeneous enhancement.There may be mild loss of vertebral body height at T7-T8, but elsewhere heights are preserved. The T7-8 intervertebral disc is reduced in height and also demonstrates enhancement. The other involved disc spaces seem relatively preserved.Note is made of thickened enhancing tissue in the right anterior paraspinal space beginning at T4 and continuing down to T8. Minimal ventral epidural thickening is also seen at T7 and T8. No rim-enhancing collections are demonstrated.At T9 and T10, marrow signal is seen most compatible with sclerosis. Significant edema and enhancement are absent.There are technical differences between the present examination and the prior examination, but accounting for this, the overall pattern and distribution of these findings is similar to prior.A dextroscoliosis of the thoracic spine is redemonstrated. Sagittal alignment is unremarkable. Spinal cord signal characteristics are unremarkable. No large disc herniations are seen. No significant compromise of the spinal canal or neural foramina is suspected.Lumbar:Edema within the L3 and L4 vertebral bodies and the intervening disc space has progressed when compared to the prior examination. These structures also demonstrate diffuse heterogeneous enhancement. Furthermore, the anterior and lateral paraspinal soft tissues are thickened and enhancing, but no discrete fluid collections are seen. Edema and enhancement are noted within the posterior elements of L5, new from prior. The soft tissues surrounding the spinous process at this level are also thickened and enhancing.Vertebral body heights are preserved. No other definite marrow edema or pathologic marrow enhancement is seen. Spinal alignment is anatomic.Image quality is degraded by motion artifact, but within this limitation, the distal spinal cord and cauda equina are unremarkable, except as discussed by level below.L1-2: Loss of disc height, mild endplate irregularity, and disc bulging. No significant spinal canal stenosis. Mild right foraminal narrowing. L2-3: Disc bulging, asymmetric to the right foraminal and far lateral zones. No significant spinal canal stenosis. Mild right foraminal narrowing. L3-4: Mild facet hypertrophy. Disc bulging. Mild spinal canal narrowing without cauda equina impingement. No significant foraminal narrowing. L4-5: Facet hypertrophy. Disc bulging with a right paracentral disc protrusion. Moderate generalized spinal canal narrowing with particular effacement of the right ventral thecal sac and the right lateral recess. Mild bilateral foraminal narrowing. L5-S1: Facet hypertrophy. Mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing.

Output: Multiple vertebral bodies in the thoracic and lumbar spine demonstrate characteristics compatible with mixed edema and sclerosis. Edema and enhancement is also seen in scattered disc spaces as above. These findings appear relatively unchanged in the thoracic spine, but they have progressed at L3 and L4 in the lumbar spine.In both the thoracic and lumbar spine, the anterior and lateral paraspinal soft tissues adjacent to the affected vertebral bodies demonstrate thickening and enhancement compatible with inflammation. Edema and enhancement is also seen within and adjacent to the posterior elements of L5.The differential diagnosis for these findings would include a chronic smoldering osteomyelitis, or less likely an inflammatory arthritis. A neoplastic etiology is not entirely excluded, though this is also felt to be less likely.


Instruction: Generate impression based on findings.

Input: History of pancreatic lesion. Evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 9 mm, likely related to age and cholecystectomy. Stable mild intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The multilobulated pancreatic tail cystic lesion measures up to 1.3 cm (series 7/19), unchanged. The lesion appears to communicate with the main pancreatic duct which is normal caliber compatible with a sidebranch IPMN. No suspicious mural nodularity or postcontrast enhancement.Stable subcentimeter pancreatic head/uncinate process cystic lesion (series 9/26).ADRENAL GLANDS: Stable mild left adrenal gland thickening.KIDNEYS, URETERS: Bilateral punctate renal 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: Stable multilobulated pancreatic tail cystic lesion which appears to communicate with a normal caliber main pancreatic duct compatible with a side branch IPMN.


Instruction: Generate impression based on findings.

Input: 80-year-old man with history of persistent hypoglycemia, evaluate for pancreatic tumors. Please note that this examination is slightly limited by motion.ABDOMEN:LIVER, BILIARY TRACT: Multiple T2 hyperintense lesions are seen in the liver which are compatible with cysts. The gallbladder is normal. There is no intrahepatic biliary ductal dictation. The common bile duct is prominent, normal for the patient's age.SPLEEN: Spleen is normal.PANCREAS: Questionable foci of arterial enhancement seen in the body and tail of the pancreas (series 1501, image 104) are seen but appear tubular in appearance on the venous phase images. The remaining pancreatic parenchyma and pancreatic duct are normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Questionable foci of arterial enhancement seen in the body and tail of the pancreas thought to be vascular in etiology given appearance on venous phase.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Evaluate for rotator cuff Limited studyROTATOR CUFF: No gross abnormality seenSUPRASPINATUS OUTLET: Cannot be well evaluated.GLENOHUMERAL JOINT AND GLENOID LABRUM: Normal labrumBICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Limited study with only axial views. No gross abnormalities seen


Instruction: Generate impression based on findings.

Input: 59 years, Female, headaches, visual hallucinations. Evaluate for evidence of CADASIL. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are multiple scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific. There is mild global parenchymal volume loss. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses are clear. There is mild left and minimal right mastoid air cell opacification. Bone marrow signal and extracranial soft tissues are otherwise within normal limits.

Output: 1. No evidence of acute infarct, intracranial hemorrhage, mass, or mass effect. 2. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific and may reflect mild chronic small vessel ischemic disease, prior inflammation, or less likely demyelination. These foci can also be seen with migraines. Distribution of these lesions is not particularly suggestive of CADASIL as questioned.


Instruction: Generate impression based on findings.

Input: Reason: left knee pain, swelling since injury 2 weeks ago while running History: as above MENISCI: There is linear increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral and tibial articular surfaces indicating a horizontal tear which extends to involve the body of the meniscus. The anterior horn appears intact. There is focal fluid signal intensity within the anterior horn of the lateral meniscus, near its root, likely representing a meniscal cyst, indicating a tear. There is linear increased signal abnormality within the anterior horn that extends through the peripheral fibers of the body of the meniscus indicating a horizontal tear. The posterior horn appears intact.ARTICULAR CARTILAGE AND BONE: There is focal partial-thickness articular cartilage degeneration along the weightbearing portion of the lateral femoral condyle above the anterior horn of the meniscus. The medial compartment articular cartilage appears relatively spared. There is linear decreased signal abnormality within the articular cartilage of the lateral facet of the patella likely representing a full-thickness articular cartilage fissure with underlying subchondral signal abnormality. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Tearing of the medial and lateral menisci as described above. 2. Osteoarthritis of the knee with articular cartilage degeneration as well as a full-thickness articular cartilage fissure along the patellofemoral articulation. 3. Small amount of fluid along the medial aspect of the proximal tibia may represent a very mild pes anserine bursitis.


Instruction: Generate impression based on findings.

Input: Female, 53 years old, with hyperreflexia. Evaluate for cord compression. Trace retrolisthesis of C5 relative to C6 is seen. Spinal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or marrow edema is detected.The visualized spinal cord demonstrates normal signal intensity and morphology. No epidural abnormalities are suspected.C2-3: Unremarkable. C3-4: Unremarkable. C4-5: Unremarkable. C5-6: Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing C6-7: Unremarkable. C7-T1: Unremarkable.

Output: Minimal disc degeneration is seen at C5-6 without significant spinal canal stenosis or high-grade foraminal narrowing.No other specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of upper tract urothelial cancer status post surgery and chemotherapy PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy with a right lower quadrant ileal conduit. There is a horseshoe shaped enhancing mass in the cystectomy bed, surrounding the posterior left aspect of the urethra, measuring 2.6 x 2.3 x 3.4 cm (series 1001, image 46; series 401, image 35).LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral pars defects with grade 1 anterolisthesis of L5 on S1. Nonspecific enhancing, T1 and T2 hypointense foci in the posterior left iliac wing and anterior right iliac wing. Peripherally enhancing, T1 bright lesion in the left femoral diaphysis. OTHER: No significant abnormality noted.

Output: 1.Enhancing mass in the cystectomy bed as described above is consistent with local recurrence.2.Nonspecific osseous lesions in the posterior left iliac wing, anterior right iliac wing, and left femoral diaphysis raises the question of metastasis. A bone scan, or ideally a PET scan, is suggested for further evaluation.


Instruction: Generate impression based on findings.

Input: Other intervertebral disc displacement, thoracic region [M51.24] / Radiculopathy, lumbar region [M54.16], Reason for Study: Thoracic spineThere is normal thoracic kyphosis.The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. Minimal bulging of discs at the level of T8-T9, T9-T10, and T10-T11.L Spine:Scoliotic posture of lumbar spine was seen.Spinal cord signal is normal and the conus medullaris terminates at the level of T12-L1Degenerative changes are specified by the intervertebral level as follows: L1-L2: minimal bulging of disc with bilateral ligamentum flavum thickening. No neuroforaminal narrowing or spinal stenosis. L2-L3: disc dessication, diffuse bulging of disc with focal disc bulging toward left side neural foramen associated with left side ligamentum flavum thickening results left side neuroforaminal narrowing. L3-L4: disc dessication, Diffuse bulging of disc with broad based disc bulging toward the left side neural foramen results mild neuroforaminal stenosis. Bilateral ligamentum flavum were thickened. No evidence of spinal stenosis. L4-L5: disc dessication, diffuse bulging of disc, bilateral ligamentum flavum thickening with facet hypertrophy result bilateral mild neuroforaminal narrowing. No spinal stenosis. L5-S1: disc dessication, no neuroforaminal narrowing or spinal stenosis.

Output: 1. Spinal cord signal intensity is normal.2. Mild bulging of disc on multiple thoracic levels without evidence of spinal canal stenosis.3. Degenerative changes of lumbar spine with scoliotic changes.4. Multilevel lumbar level intervertebral disc degeneration with various degree neural foraminal stenosis especially on the left side as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain tumor, surgical planning pre-and post enhanced MRI. Signs and symptoms: Brain tumor. Pre-and post enhanced stealth brain MRI:Examination is performed utilizing surgical planning protocol and is not a true diagnostic exam.Examination demonstrates a single large necrotic mass in the left superior temporal gyrus measuring at 50 x 35-mm in transaxial dimensions and 32-mm in craniocephalad axis.The lesion demonstrates extensive surrounding vasogenic edema and with resultant effacement of adjacent cortical sulci, subtle mass effect on the left lateral ventricle and trace midline shift to the right. No evidence of ventriculomegaly.No additional detectable abnormal parenchymal or leptomeningeal enhancement.

Output: A single large necrotic and partially enhancing mass (50 x 35 x 32-mm) in the left superior temporal gyrus as detailed above. No prior exams for comparison.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of prostate cancer who presents for MRI evaluation.Pathology report 9/10/2014Prostate, right apex medial; needle biopsy:- High grade prostatic intraepithelial neoplasia PELVIS:PROSTATE:Prostate Size: 4.2 x 5.6 x 5.2 cmPeripheral Zone: Punctate 4 mm focus of restricted diffusion in the left apex (series 603/284), with associated decreased T2 weighted signal intensity.Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable 4 mm focus in the left apex may represent prostatic adenocarcinoma. No extraprostatic extension or pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 48-year-old male with metastatic carcinoid ABDOMEN:LIVER, BILIARY TRACT: Numerous T2 hyperintense lesions are noted in the liver, demonstrating interval increase in size since prior exam. Interval increase in size of reference segment seven lesion.Layering cholelithiasis is present. The common bile duct is dilated with tapering to the level of the ampulla without obstructing stone or lesion. There is a stone in the cystic duct (series 4, image 21).SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum anatomy is again noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense cysts are noted bilaterally, some of which are too small to further characterize. There is no hydronephrosis or perinephric inflammation.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.INDEX LESION MEASUREMENTS (Current exam date/time: 11/15/2016 10:56:11)SEGMENT 7 LESION: 2.2 x 2.7 cm (Image 15, Series 6); 2.5 x 2.0 cm on prior (8/16/2016) (Image 20, Series 4).

Output: 1.Increased size of numerous enhancing liver lesions with reference measurements as detailed above.2.Cholelithiasis with stones in the cystic duct without evidence of inflammation.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate thoracic syrinx-preoperative planning for tube insertion. Signs and symptoms: Chest and back pain. Nonenhanced thoracic MRI:Examination is degraded due to motion artifact which makes precise assessment of subtle findings not possible however studies remains diagnostic.There is revisualization of an expansile syrinx of thoracic cord extending from approximately T3 level inferiorly to T12 no without change in its extent and without convincing evidence of any appreciable change in its size/diameter. Similar to prior exam a thin linear T2 hyperintensity representing a drain is noted entering the spinal canal posteriorly from T9 -- T10 disk level and terminating superiorly at lower T8 level. The drain does not appear to remain in a straight axis and suspected of having kink or tortuosity within the cord similar to prior study.Small previously noted epidural collection at the site of surgery/site of insertion of drain demonstrate complete interval resolution. Minimal postoperative fluid collection in the musculature of mid back is also no longer detected and presumed resolved.

Output: 1.No evidence of appreciable interval change in the extent or laminar of syrinx of thoracic cord since prior exam.2.Revisualization of a drain entering the spinal canal at T9 -- T10 disk level and with the tip within the cord.3.Irregular coarse of the drain within the cord remains similar to prior exam.4.Interval resolution of postoperative small epidural at T9 -- T10 as well as resolution of post operative fluid collection within the musculature of mid back.


Instruction: Generate impression based on findings.

Input: Reason: new onset left sided rigidity, concern for ischemic event verus MSA versus atypical parkinson's disease: left sided weakness and bradykinesia, looking for hummingbird sign in brainstem. There is punctate susceptibility effect in the right globus pallidus, but the rest of the basal ganglia are unremarkable. The brainstem is intact, without evidence of the hummingbird or Mickey mouse sign. The brain parenchyma and cerebellum also appear unremarkable, aside from minimal nonspecific cerebral white matter T2 hyperintensity. There is no evidence of intracranial mass or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Nonspecific punctate susceptibility effect in the right globus pallidus, which may represent incipient mineralization. Otherwise, no specific imaging findings for progressive supranuclear palsy or multiple system atrophy. Perhaps a nuclear medicine scan may be useful for further evaluation.2. No evidence of intracranial mass or acute infarct.


Instruction: Generate impression based on findings.

Input: Left-sided headache for 3 months, wakes up from sleep. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, and appear mildly increased in the interval. Compared to 3/5/2013, there is minimal interval increase in ovoid focus of flair hyperintensity involving the left periatrial white matter measuring approximately 16 x 16 mm. There is also a new T2/FLAIR hyperintense focus involving the left frontal corona radiata. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial mass effect, hemorrhage, or acute ischemia. 2. Scattered foci of T2/flair hyperintensity in the periventricular and subcortical white matter are nonspecific. There is a new focus in the left frontal corona radiata. There is also an ovoid T2/FLAIR hyperintense lesion involving the left periatrial white matter which appears minimally larger compared to 3/5/2013. Overall findings are favored to be vascular related (atypical pattern of small vessel ischemic disease) with mild progression. Inflammatory vasculopathy or demyelinating disease (less likely in this age group) can also be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Right capsular stroke. Signs and symptoms: Left hemiparesis. Nonenhanced brain MRI:A small acute right basal ganglia lacunar infarct measuring at least at 6 x 13 mm in transaxial dimensions is again identified. This finding demonstrates a punctate focus of susceptibility (series 401 image 130) suspected of hemorrhage.Additionally exam demonstrate moderate chronic nonhemorrhagic small vessel ischemic strokes in the periventricular and subcortical white matter as well as bilateral basal ganglia and left thalamus.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.The signal void of all major intracranial arterial branches are identified and unremarkable.Images through the orbits demonstrate a chronic right lamina papyracea blowout fracture similar to prior CT examination and unremarkable orbits otherwise.Mild chronic right maxillary sinus disease and unremarkable other paranasal sinuses and mastoid air cells.

Output: 1.Acute right basal ganglia lacunar infarct (at least at 6 x 13 mm) with a punctate focus of susceptibility.2.Chronic nonhemorrhagic small vessel ischemic strokes of subcortical, periventricular white matter as well as bilateral basal ganglia.3.Chronic right lamina papyracea blowout fracture.4.Mild chronic right maxillary sinus disease and unremarkable sinuses otherwise.


Instruction: Generate impression based on findings.

Input: Whiplash injury. Evaluate for fracture. There are foci of air at the right C1-C2 level which may be related to distraction of the joint at this level. There is however no evidence of fracture or traumatic subluxation in the cervical spine. Atlantodental interval is maintained. No prevertebral edema.Vertebral body heights are normal. There is mild retrolisthesis of C3 on C4 which is favored to be degenerative in etiology as well as loss of cervical lordosis. Alignment is otherwise maintained. Multilevel degenerative changes are seen without high-grade bony spinal canal stenosis at any level. There is mild to moderate bilateral C3-C4 neural foraminal narrowing and moderate right C4-C5 neural foraminal stenosis. There is multilevel facet arthropathy, relatively worse at the left C2-C3 and right C4-C5 levels.

Output: 1. No evidence of acute fracture or traumatic subluxation in the cervical spine.2. There are foci of air at the right C1-C2 level which may be related to distraction of the joint. There is however no evidence of fracture or subluxation at this level. Atlantodental interval is maintained. No appreciable prevertebral edema. If there remains suspicion for ligamentous injury, consider MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Known left breast mass presents for research MRI as part of the Alan Penn study. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.In the left breast 9:00 anterior depth there is an oval enhancing mass measuring 10 x 7 x 10 mm, correlating to the sonographic finding. In the right central breast near the 6:00 position, there is an enhancing oval mass with high T2 internal signal measuring 9 x 5 x 6 mm. Differential considerations include a fibroadenoma and mucinous carcinoma. Elsewhere in each breast, there are scattered enhancing foci, none of which reach threshold for kinetic analysis. This includes in the left breast area of calcifications that will have stereotactic biopsy today. Some of the foci scattered in each breast may represent peripherally enhancing cysts. No abnormal lymph nodes are identified in either axillary region.A partially visualized high T2 signal right hepatic lobe lesion is probably benign such as a cyst or hemangioma.

Output: 1. Left retroareolar enhancing mass correlates with the sonographic finding. This will be biopsied after MRI today. No additional suspicious left breast enhancement on MRI. 2. Right breast mass for which MRI directed ultrasound is recommended. Differential considerations include fibroadenoma and mucinous carcinoma. If no correlate is seen, then MRI biopsy would be recommended. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 69-year-old female with history of small bowel obstruction 10 years prior, now with pain in the midabdomen and weight loss. Evaluate for small bowel narrowing or inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. No focal liver lesions identified. No biliary ductal dilation.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. No lymphadenopathy noted.BOWEL, MESENTERY: Normal appearing loops of bowel without abnormal enhancement, wall thickening, stricturing, fistulization, or associated fluid collections. No fibrofatty proliferation of the mesentery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of rectal stool noted. Otherwise normal appearing loops of bowel without abnormal enhancement, wall thickening, stricturing, fistulization, or associated fluid collections. No fibrofatty proliferation of the mesentery.BONES, SOFT TISSUES: Susceptibility artifact noted, likely secondary to spinal hardware.

Output: Large amount of rectal stool noted. Otherwise normal appearing loops of bowel without abnormal enhancement, wall thickening, stricturing, fistulization, or associated fluid collections.


Instruction: Generate impression based on findings.

Input: Check for meniscal injury, pain MENISCI: No significant abnormality noted. Specifically menisci are well positioned and anchored posteriorly. No abnormal internal signalARTICULAR CARTILAGE AND BONE: Moderate thinning of the cartilage in all compartments with associated focal scattered more focal changes involving the medial and lateral anterior condylar surfaces and medially. No distinct full thickness defects. The patellar surface also demonstrates a linear fluid signal underlying the inferior patellar cartilage without a clear cleft to the surface. Partial delamination cannot be excluded. Moderate osteoarthritic changes are again observed and in alignment with correlating plain films.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Moderate to more pronounced cartilaginous abnormalities as described with degenerative osteoarthritic disease. No distinct meniscal or ligamentous injuries are otherwise observed.


Instruction: Generate impression based on findings.

Input: Reason: 53F with large left renal mass. please specifically examine left renal mass and liver mass History: renal mass, concerning for metastatic rcc ABDOMEN:LIVER, BILIARY TRACT: The liver is enlarged measuring 22.9 cm in craniocaudal dimension. Multiple T2 hyperintense, T1 hypointense, nonenhancing lesions compatible with benign hepatic cysts. In segment II/III there is a heterogeneous T2 slightly hyperintense T1 hypointense mass with peripheral and heterogeneous central enhancement and restricted diffusion, measuring 2.8 x 3.1 x 3.4 cm (series 903 image 74, series 3 image 32). No intrahepatic or extrahepatic biliary ductal dilatation. Portal and hepatic vasculature are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: In the left mid pole, there is a large heterogeneous well-defined mass with restricted diffusion and heterogeneous enhancement measuring approximately 10 x 7 x 7.9 cm (series 904 image 66, series 12 image 21). Previously seen intrinsic T1 signal likely blood products has decreased compared to prior. The renal vein is patent. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple Tarlov cysts.OTHER: No significant abnormality noted.

Output: 1.Large 10 cm left hemorrhagic renal mass highly suspicious for a primary renal malignancy.2.Left 3 cm hepatic lobe mass highly suspicious for a metastasis.


Instruction: Generate impression based on findings.

Input: Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.Lumbar Spine: There is diffuse thickening of most of the cauda equina nerve roots, generally to a mild degree. Otherwise, the imaged spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. At L3-4, there is mild facet hypertrophy and ligamentum flavum thickening, without no significant spinal canal stenosis, but mild bilateral neural foramen narrowing. At L4-5, there is a disc bulge with mild bilateral neural foramen narrowing, but no significant spinal canal. At L5-S1, there is disc desiccation and small central disc protrusion with no significant neural foramen or spinal canal stenosis. There paraspinal soft tissues are unremarkable.

Output: 1. No evidence of acute cerebral infarction, intracranial mass, or intracranial hemorrhage.2. Diffuse thickening of the cauda equina nerve roots. Differential include an inflammatory or neoplastic process, or perhaps a hereditary motor sensory neuropathy. Further evaluation via MRI with contrast and DRIVE/FIESTA sequence may be useful. 3. Mild degenerative spondylosis of the lumbar spine with small central disc protrusion at the L5-S1 level, but no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Concern for PHACES syndrome: vascular lesions on the right side of the face affecting the lower lip, medial aspect of right upper lip, right side of the oral cavity, right lateral face, right inferior eyelid, and right ear. MRI: There is an enhancing lesion along the right posterolateral aspect of the spinal cord at the C2 level, which measures up to 8 mm. There appear to be superficial enhancing areas in the right lips and the right auricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is aplasia of the right common carotid artery and deficiency of the right external and internal cervical carotid arteries. The superior portions of the right internal carotid artery are supplied by retrograde flow via the circle of Willis via a hypoplastic intracranial internal carotid artery and there is a communication with the cervical internal carotid artery with the hypoplastic extracranial vertebral artery via a proatlantal type artery. In addition, there appears to be communication between the right superior cervical artery and right vertebral artery. The right vertebral artery otherwise terminates as the PICA. The left carotid and vertebral arteries, on the other hand, are diffusely enlarged and there are bilateral posterior communicating arteries. The bilateral anterior, middle, and posterior cerebral arteries are patent. There is no evidence of cerebral aneurysms.

Output: 1. A subcentimeter enhancing lesion along the right posterolateral aspect of the spinal cord at the C2 level may represent a hemangioma. Furthermore, enhancing areas in the right lips the right auricle likely correspond to the known cutaneous hemangiomas. Otherwise, no evidence of intracranial hemangiomas.2. Aplasia of the right common carotid artery and deficiency of the right external and internal cervical carotid arteries. The superior portions of the right internal carotid artery are supplied by retrograde flow via the circle of Willis via a hypoplastic intracranial internal carotid artery and there is a communication with the cervical internal carotid artery with the hypoplastic extracranial vertebral artery via a proatlantal type artery. In addition, there appears to be communication between the right superior cervical artery and right vertebral artery. 3. Compensatory enlargement of the left carotid and vertebral arteries.


Instruction: Generate impression based on findings.

Input: 64-year-old female with history of recurrent ovarian high-grade serous carcinoma status post debulking surgery in 2006. Evaluate right upper quadrant cystic lesion's relationship to liver, porta hepatis, and bowel. ABDOMEN:LIVER, BILIARY TRACT: 10 mm intermediate to high signal T2 lesion in segment 4a (series 601/32) with a continuous thin rim of peripheral arterial enhancement, appearing new since prior CT on 12/30/2014 and suspicious for metastasis. An additional 13 mm intermediate to high signal T2, enhancing lesion is seen in the inferior right hepatic lobe (series 601/21), also suspicious for metastasis.4 mm high signal T2 lesion in segment 2 (series 601/37), stable since prior exams and most likely a cyst . No biliary ductal dilation. Portal and hepatic veins are patent.SPLEEN: Multiple subcentimeter T2 hyperintense lesions are likely due to benign cysts.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right upper quadrant cystic lesion without significant enhancement measures up to 6.2 x 6 x 8.2 cm (AP by transverse by craniocaudal, series 1204/29 and 701/14). The lesion is inseparable from a small bowel loop in the right upper quadrant, exerts mild mass effect with scalloping of the inferior right hepatic lobe, and abuts the gallbladder fundus. The lesion is stable in size since prior CT on 6/5/2015. Heterogeneous low T2 signal debris is noted within the lesion. This lesion is nonspecific and may be a metastatic implant, particularly given the provided clinical history and that it is reportedly a new finding since prior CT at outside institution in August 2014, and the suspicious hepatic lesions detailed above. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Two small hepatic lesions suspicious for metastases, as detailed above.2. Right upper quadrant cystic lesion is stable in size since prior CT on 6/5/2015, as detailed above. The lesion is nonspecific, and may be a metastatic implant, also as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: r/o infection, look for signs of increased icp History: fevers, confusion in liver transplant patient There is no evidence of intracranial hemorrhage, mass or edema. Patchy periventricular and subcortical white matter hypoattenuation is consistent with small vessel ischemic disease of indeterminate age.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age. Otherwise, no acute intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Pain after injury MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is moderate thinning of the articular cartilage of the medial femoral condyle anteriorly with associated degenerative marrow signal. Otherwise articular cartilage of the knee is preserved.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Moderate cartilage loss of the medial femoral condyle.2. Mild prepatellar bursitis.


Instruction: Generate impression based on findings.

Input: Intractable headache (occipital). There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is patchy and scattered cerebral white matter T2 hyperintensity, which is most pronounced in the bilateral posterior periventricular regions. There is no abnormal intracranial enhancement. There are bilateral small lateral ventricular choroid plexus glomus xanthogranulomas. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is an apparent small right parotid lesion that is only depicted on the coronal T2-weighted sequence. There is a subcentimeter incisive duct cyst.

Output: 1. Probable chronic small vessel ischemia, but no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Incompletely imaged apparent small right parotid lesion. An ultrasound of this region may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 79 year old woman with history of hypertension, CVA transferred from outside hospital status post fall now with right facial droop and question of right hemineglect. There is a hypoattenuating region in the left parietal lobe. This is consistent with late subacute versus chronic infarct in the left MCA distribution. Recommend MRI to better define acuity of infarct. No CT findings of intracranial hemorrhage, mass effect, or midline shift.There are periventricular hypoattenuating regions consistent with age-indeterminate, small vessel ischemic disease.The ventricles and basal cisterns are normal in size and configuration. Cavum septum pellucidum, a nonpathologic finding, noted.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Late subacute versus chronic infarct in left MCA distribution. Recommend MRI to better define acuity of infarct. These findings were communicated with the ordering physician at the time of interpretation.


Instruction: Generate impression based on findings.

Input: Diagnosis: Sensorineural hearing loss, asymmetricalClinical question: Asymmetrical SNHL, L>RSigns and Symptoms: hearing loss IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.There are subdural effusions in the posterior fossa present which are probably related to atrophy.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.There are some opacities present in the left mastoid air cells.

Output: 1.There is mild cerebellar atrophy present. 2.There is no evidence for internal auditory canal or inner ear mass to account for the patient's hearing loss.3.Please note that this exam was specific for evaluation of posterior fossa, internal auditory canals and inner ear structures.


Instruction: Generate impression based on findings.

Input: Reason: pelvic mass behind the uterus History: pelvic pain PELVIS:UTERUS, ADNEXA: The uterus is normal in appearance. No focal mass is identified. Both ovaries are identified and appear normal with small physiologic follicles. There is no significant free fluid.BLADDER: The gallbladder is partially collapsed but appears normal.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Benign perineural cysts are noted dorsal to the sacrum. There is a femoroacetabular impingement cyst at the right femoral head neck junction.OTHER: There is a large, complex presacral mass which demonstrates heterogeneous T1 and T2 signal intensity, with a T2 hypointense rim, measuring 7.0 x 7.7 x 8.4 cm. The mass appears to the tethered to the anterior coccyx, possibly representing sacral nerve roots. There is heterogeneous enhancement with a large nodular enhancing portion in the superior portion of the mass, which measures approximately 2.5 x 2.2 cm.

Output: Complex presacral mass with heterogeneous signal intensity and enhancement, for which the differential diagnosis includes tumors of neural origin including giant schwannoma and paraganglioma.


Instruction: Generate impression based on findings.

Input: 34-year-old male with intracranial hemorrhage. Evaluate for interval change in the hematoma. History of hemangioblastoma resection from posterior fossa and status post EVD placement.EMR: 12/14: POD1 s/p posterior fossa craniotomy for recurrent hemangioblastoma resection complicated by intraoperative hemorrhage. There is extensive heterogeneous evolving intracranial hemorrhage involving the now large resection cavity in the fourth ventricle with severe crowding of the posterior fossa, near complete effacement of the fourth ventricle and other CSF spaces, including compression/anterior displacement of the the brainstem. There is interval development of new FLAIR hyperintensity involving the right brachium pontis. There is a thin rim of restricted diffusion and FLAIR hyperintensity along the margins of the resection cavity, especially on the right and extending into the superior vermis which may be in part from post-operative ischemia, and possibly also from compressive ischemia from the swelling. This was likely present on the most recent prior head CT exam but is better delineated by today's MRI.There is prominent intraventricular hemorrhage with slightly higher level of dependent hemorrhage in the occipital horn of the left lateral ventricle but this may be due to redistribution, especially since the size of the ventricles have improved. The right frontal approach ventriculostomy tube is unchanged in position. There is a tiny amount of air and/or blood product around the catheter. A second tract is seen in the brain right frontal parenchyma next to the catheter. There is a small air fluid level in the left maxillary sinus and fluid in the nasal cavity and oropharynx, which may be secondary to intubation status.

Output: 1.Evolving hemorrhage within the posterior fossa resection cavity with post-operative ischemic changes involving the cerebellum, including extending into the vermis. Resultant significant crowding of the posterior fossa structures, with now fourth ventricular near complete effacement and compression on/anterior displacement of the the brainstem. 2.Stable likely redistributed intraventricular hemorrhage and Interval improvement in the size of the lateral ventricles.


Instruction: Generate impression based on findings.

Input: Reason: s/p crani for tumor resection History: s/p crani for tumor resection Patient is status post recent right parietal craniotomy. There are is associated scalp soft tissue swelling, surgical staples along the skin surface, intracranial air adjacent to the right hemisphere as well as an epidural collection underneath the craniectomy site which is made up of predominantly air associated with some lead products.There is a midline hypodense focus present adjacent to the falx and the corpus callosum measuring 19 x 16 mm sagittal dimensions and 18 x 11 mm axial dimensions.The patient is status post remote left-sided craniotomy. There is encephalomalacia present along the left superior frontal gyrus.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. The patient is status post recent right-sided craniotomy for removal of a a midline the mass. There are attendant post operative changes as detailed above. The possibility of a residual lesion cannot be excluded on the basis of a CT exam.


Instruction: Generate impression based on findings.

Input: Metastatic base of tongue cancer, with known epidural tumor at T1-T5, presenting with increasing back pain and new 4/5 weakness in right quadricep. No urinary symptoms, normal rectal tone. Had kyphoplasty at T3 on 12/2. Evaluate for cord compression. There is multifocal narrowing of the spinal canal, most pronounced at the level of C3-4, in addition to indentation of the cord at T3-4 without evidence of acute cord compression. There are numerous osseous metastases throughout the spine, similar in extent as on the prior exam. There has been interval kyphoplasty of the T3 pathologic compression fracture, with persistent approximately 50% loss of height and apparent increased retropulsion inferiorly along the disc material, which mildly indents the spinal cord. No new pathologic fractures are identified. There are multiple epidural metastases, which do not appear significantly changed from the prior exam. Specifically, epidural tumor extends from T1 through T5 and is present at T10 and L2 with extension into the right neural foramina at these levels, as well as at S1 to S3. There is an intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina, which appears similar to the prior exam. There is multilevel degenerative spondylosis in the lower lumbar spine with associated minimal spinal canal and neural foraminal narrowing. There is edema within the upper thoracic and lower lumbar paraspinal muscles, perhaps related to denervation effects. There is partly imaged mediastinal and left axillary adenopathy.

Output: 1. Numerous metastases to the axial skeleton with epidural extension, particularly at in the upper thoracic region, with possible mild spinal cord compression and at T10 and L2 with associated neural foraminal narrowing, as well as at S1 to S3. However, the lack of contrast and axial images limit the assessment.2. Interval kyphoplasty of the T3 pathologic compression fracture with apparent increased retropulsion and indentation of the spinal cord.3. Intrathecal metastatic lesion at the level of L3-4 measuring up to approximately 30 mm, with compression of the cauda equina.4. Partly imaged mediastinal and left axillary adenopathy related to metastatic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Status post L1 -- L3 spinal fusion and tumor resection. There is mild thickening at the posterior aspect of the trachea at the T3 level. At T10 - T11 right neural foramen, there is prominent soft tissue density of uncertain etiology. This may represent prominent nerve root sleeve or perineural cyst and can be better assessed with MRI study.Postsurgical changes of tumor resection at L2 vertebral level, and spinal fusion from L1 to L3 are again noted. Hardware is intact without evidence of acute fracture. Fusion cage at L2 level is again seen positioned posteriorly laterally, and is causing effacement of the left neural foramina at L2 -- L3, with possible nerve impingement. Multi-level degenerative disease of the lumbar spine is again noted with spinal canal and neuroforaminal narrowing as described previously. No significant interval change is noted.

Output: 1. Postsurgical changes and degenerative disease of the lumbar spine as described above. No evidence of interval change.2. Mild thickening at the posterior aspect of the trachea at the T3 level of uncertain significance. This can represent secretion. Please correlate or follow-up as clinically indicated.3. At T10 - T11 right neural foramen, there is prominent soft tissue density of uncertain etiology. This may represent prominent nerve root sleeve or perineural cyst and can be better assessed with MRI study.


Instruction: Generate impression based on findings.

Input: History of headaches consistent with migraines, rule out structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: extrahepatic biliary dilation seen on ultrasound, longstanding elevation of alk phos History: as above ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No significant intrahepatic biliary ductal dilatation. The common bile duct is nondilated without an obstructing lesion evident. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter left renal T2 hyperintensity, likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post cholecystectomy without evidence of intrahepatic or extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for progression of metastatic lesions. Signs and symptoms: History of metastatic melanoma with prior brain metastases. No new periods of intermittent confusion, concerning for progression of disease. Limited nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Images through posterior fossa demonstrate mildly prominent fourth ventricle and unremarkable otherwise and without interval change.There is a hemorrhagic metastatic lesion in the right occipital lobe without significant surrounding edema measuring 16 x 17 mm in size compared to prior study measurement of 8.4 x 7 mm.A right posterior parietal occipital hemorrhagic metastatic lesion is again noted without significant surrounding edema or mass effect and measuring at 12.3 x 13.4 mm without significant change since prior exam.Metastatic hemorrhagic lesion in the left posterior parietal with extensive surrounding vasogenic edema demonstrates interval increased size and increased surrounding edema and associated regional mass effect. The tumor measures approximately 15 x 16 mm intravenous axial dimensions compared to prior study measurement of 12 x 14.Focus of FLAIR hyperintensity in the right anterior frontal with evidence of hemorrhagic changes demonstrate no significant change since prior study. There is evidence of prior surgical intervention at this site and findings could represent post surgical change.Metastatic lesion in the high convexity right anterior parietal and is surrounding edema demonstrate no significant change. A well demarcated CSF signal intensity cystic-like lesion likely representing postsurgical change in high convexity left paramedian posterior frontal measures up to 24 x 23 without significant change since prior study.Mildly dilated supratentorial ventricular system with maintained midline demonstrate no appreciable interval change. The CSF cisterns and cortical sulci remain patent.

Output: 1.Incomplete and nonenhanced MRI of brain is performed due to patient's inability to continue.2.There is no acute intracranial process and negative diffusion-weighted images.3.Interval increased size and surrounding vasogenic edema of the metastatic lesions as detailed/measured above.4.Stable mildly dilated supratentorial ventricular system however with maintained midline.5.Stable postoperative changes as detailed.


Instruction: Generate impression based on findings.

Input: Postoperative pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Compared to 8/26/2015, interval postsurgical changes of decompressive laminectomy via left-sided approach at L2-L3 is seen. Expected postsurgical changes include small fluid collection in the laminectomy bed. There is persistent effacement of the thecal sac at this level with small central protrusion at the L2-L3 level again noted. There is no significant epidural or paraspinous hematoma.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Decompressive laminectomy, small disc protrusion, small postoperative fluid collection in the surgical bed, and persistent effacement of the thecal sac as above. There is mild bilateral neural foraminal stenosis. Facet arthropathy.L3-L4: Disc bulge and facet arthropathy. There is mild effacement of the left lateral aspect of the thecal sac. There is mild right and mild-to-moderate left neural foraminal narrowing.L4-L5: Facet arthropathy and ligamentum flavum thickening as well as minimal disc bulge resulting in mild spinal canal stenosis. There is minimal neural foraminal narrowing.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.

Output: Postsurgical changes of decompressive laminectomy at L2-L3. There is a small fluid collection in the laminectomy bed dorsal to the thecal sac which may represent residual seroma or pseudomeningocele. There is effacement of the thecal sac at the L2-L3 level in part related to this small fluid collection. Otherwise no significant epidural or paraspinous hematoma.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, known pituitary adenoma, follow-up exam. The size and morphology of the pituitary gland are stable and within normal limits. The gland measures no more than 7 mm in height. Signal characteristics and pattern of enhancement are slightly heterogeneous. However, no definite focal lesions are detected. At most, there may be a 3-mm focus of slightly increased T2 signal within the midline inferior gland (see image 8 of series 501). This finding is not appreciated on the prior examination, and there is no clear correlation of this finding on post contrast images. The pituitary stalk enters gland at midline and enhances normally. The suprasellar cistern is free of lesions. The visualized optic apparatus is unremarkable.

Output: Stable examination with no definite focal pituitary lesion seen. A small focus of slightly increased T2 signal within the midline inferior gland is of uncertain significance and may be artifactual given that no correlation for this finding is seen on other sequences or on the prior study.


Instruction: Generate impression based on findings.

Input: Metastatic brain lesions. Evaluate for changes. Again seen is evidence of right frontal craniotomy and cranioplasty. Sequelae of prior tumor resection and treatment are redemonstrated within the right frontal lobe showing no significant interval change. There is no new pathologic enhancement in the treatment bed and the degree of encephalomalacia and parenchymal T2 hyperintensity is unchanged.Previously described punctate focus of enhancement within the right parietal subcortical white matter (image 66 series 14) is slightly less conspicuous. A punctate focus of enhancement within the left cerebellum (image 154 series 14) is not significantly unchanged from prior. There is a 3 mm focus of enhancement in the right frontal lobe, image 99 series 14, which also appears minimally more prominent and associated with susceptibility effect. 3 mm nodular focus of enhancement along the left inferior cerebellar surface, coronal series 1401 image 169, is slightly more prominent. Two foci of susceptibility, one in the right cerebellum and one in the left, are unchanged and likely represent a treatment related effect. A few scattered additional foci of nonspecific parenchymal T2 hyperintensity are unchanged. The ventricles are stable in size and morphology including ex vacuo dilatation of the right frontal horn.A 12 mm enhancing lesion within the left posterior parietal bone is unchanged when compared to the immediate prior examination but has increased in size when compared to older studies.

Output: 1.Punctate foci of enhancement within the right frontal lobe, right parietal lobe, and in the left cerebellum are again seen with slight differences in in appearance which may be related to technique differences (current study at 3T, prior on 1.5T). In particular, 3 mm nodular lesions along the inferior cerebellar surface and in the right frontal lobe appear more prominent in the interval and would suggest close follow-up due to possibility of enlarging metastases.2.Stable postoperative and treatment related findings in the right frontal lobe.3.Stable punctate foci of susceptibility in the cerebellar hemispheres likely related to treated lesions.4.A 12 mm enhancing lesion in the left posterior parietal bone is stable when compared to the immediate prior study but has increased in size relative to older exams and compatible with a metastatic focus.


Instruction: Generate impression based on findings.

Input: Brain lesion and cyst, abnormal MRI in the past, 3 month post surgical follow up. There has been interval evolution of postoperative findings related to left frontal convexity cyst fenestration, with a small amount of high T1 and low T2 signal extra-axial blood products along the anteromedial left frontal convexity and collapse of the cyst cavity. There is minimal residual T2 hyperintensity in the underwing brain parenchyma and no significant mass effect upon the underlying brain parenchyma. There is no evidence of acute territorial cerebral infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is bilateral otomastoid fluid.

Output: Interval evolution of postoperative findings related to left frontal convexity cyst fenestration, with a small amount of late subacute extra-axial blood products along the anteromedial left frontal convexity and collapse of the cyst cavity.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for cord compression - 62 yo with recent C spine laminectomy complicated by fluid collection and MRSA bacteremia now with AMS, new LE weakness and supratherapeutic PTT c/f cord compression per neurosurgery History: AMS, dec LE strength, fever, supratherapeutic PTT Vertebral body heights in the cervical, thoracic, and lumbar spine are normal. Alignment is grossly maintained. There are postsurgical changes of cervical laminoplasty from C3 to C7. Degenerative changes are again seen in the cervical spine including T2 hyperintensity within the C3-C4 disc space with small disc extrusion as seen on recent MRI. There is mild spinal canal stenosis at this level without cord compression. Thoracic and lumbar spinal canal are also patent. There are postsurgical changes of spinal canal decompression and fusion at L4-L5. There is edema involving the T12 vertebral body with minimal irregularity and Schmorl's node involving the superior endplate, questionably worse since 12/6/2010. No significant loss of height. There is focus of T2 hyperintensity involving the dorsal spinal canal at the epidural space at L1-L2 which is not well evaluated on these limited sequences and may represent fluid; finding is nonspecific and may be from a degenerative, traumatic, or infectious basis.

Output: 1. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.2. Postoperative changes of cervical laminoplasty for spinal canal decompression. Cervical spine is better assessed on recent MRI from 12/14/2015.3. Edema involving the T12 vertebral body, possibly related to minimal irregularity of the T12 superior endplate or trauma. No significant loss of height or osseous retropulsion. Small focus of T2 hyperintensity in the dorsal epidural space at the L1-L2 level which may be on a degenerative basis although other etiologies such as infection or blood products may also be considered in the appropriate clinical setting. There is no associated cord compression. Please note this is a limited study to exclude cord compression. Although there is no cord compression, if there is high suspicion for infection including epidural abscess, would recommend a dedicated MRI spine study with gadolinium.


Instruction: Generate impression based on findings.

Input: Male, 73 years old, history of metastatic lung cancer, evaluate for brain metastases. No evidence of parenchymal edema or mass effect is seen. No diffusion restricting lesions are identified. There is no evidence of pathologic parenchymal or extra-axial enhancement. A small area of encephalomalacia is redemonstrated in the right inferior frontal gyrus without significant interval change. No new parenchymal defects are seen. A few scattered small foci of FLAIR hyperintensity are nonspecific. The ventricular system is within normal limits.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis complex. There are multiple predominantly subcortical foci of T2 hyperintensity in the cerebral hemispheres. There are multiple subependymal nodules, the largest of which measures up to 8 mm in the region of the right foramen of Monro. There is extensive encephalomalacia in the right temporal lobe and left cerebellar hemisphere volume loss. There is also an area of low T2 signal that may represent prior hemorrhage associated with encephalomalacia in the right thalamus. There is no evidence of acute infarct. The ventricles are unchanged in size and configuration. The major cerebral flow voids are intact. There are postoperative findings in the right skull. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Extensive stigmata of tuberous sclerosis complex including multiple areas of cerebral dyplasia and subependymal nodules, but no evidence of obstructive hydrocephalus.2. Areas of encephalomalacia in the right temporal lobe and thalamus with crossed cerebellar diaschisis, but no evidence of acute infarction.


Instruction: Generate impression based on findings.

Input: H/o brain tumor. S/p biopsy. Examination demonstrates postsurgical change including a Burr hole in the right frontal bone. Again, a hypoattenuating mass is seen in the right frontal lobe with extension into the genu of corpus callosum and left anterior frontal lobe and mass effect on the right frontal horn. Please refer to the previous MRI for the measurements. No evidence of intracranial hemorrhage is identified. The ventricular size has been stable.

Output: Frontal tumor. Interval postsurgical change with no intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: Leg weakness, multiple sclerosis, evaluate for progression. There are numerous T2 hyperintense lesions in the periventricular white matter, cerebellum, and brainstem. Several of these lesions demonstrate corresponding low T1 signal. Overall, these lesions appear grossly similar to prior examination. There is mild prominence of the cortical sulci in proportion to the cerebral ventricles consistent with mild diffuse global volume loss. There is no evidence of acute infarction. There is no midline shift or mass effect appreciated. There is redemonstration of a 1.8 cm diameter T2 hyperintense nodule in the left cheek, which may represent a sebaceous or epidermal inclusion cyst.

Output: Numerous supratentorial and infratentorial demyelinating lesions related to multiple sclerosis, which do not appear to have significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 12 years Male (DOB:4/5/2004)Reason: seizures, ADHD, FAS History: seizuresPROVIDER/ATTENDING NAME: SERVICES ANCILLARY SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for intracranial mass lesion or other anatomic explanation for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Clinical question: History of high-grade glioma status post multiple treatments, normal status post re-chemo/RT. Signs and symptoms: apraxia. Pre-and post-enhanced brain MRI:Examination demonstrates significant interval decreased size of the enhancing component of the large tumor in the left temporal lobe since prior study. The largest remaining focus of tumor enhancement measures at 24 x 43 mm in transaxial dimensions compared to prior study measurement of approximately 31 x 55-mm. This enhancement is immediately posterior to the surgical cavity in the left temporal lobe. The remaining tumor reaches the left lateral ventricle and with resultant slight bulge of tumor toward the intraventricular space. A very thin however irregular enhancement extends from posterior surgical cavity wall anteriorly. This pattern of enhancement also demonstrate interval improvement/decrease. There is also noticeable decreased in surrounding flair hyperintensity consistent with vasogenic edema since prior exam. Similar to prior study the surgical cavity is contiguous with the subarachnoid space and demonstrate an associated CSF signal intensity subdural space widening. The signal intensity of this collection follows CSF signal pattern. There is subtle interval decrease in extent of this collection since prior exam. There is however slight increased caliber of remaining extra-axial collection measuring approximately 15.6 mm compared to prior study measurement of 13. This collection lies subtle mass effect on the adjacent brain parenchyma is also noticeable interval increased size of left lateral ventricle likely secondary to underlying decreased tumor volume. Midline however is maintained.

Output: 1.Interval decreased size of enhancing component of tumor measuring at 24 x 43-mm compared to prior study measurement of 31 x 55-mm, interval decreased surrounding vasogenic edema and overall mass effect.2.Interval increased size of left lateral ventricle with maintained midline and likely secondary to decreased tumor volume and edema.


Instruction: Generate impression based on findings.

Input: 68 year old male status post tumor resection. Redemonstrated are postoperative changes of a right parietal craniotomy for resection of a mass from the right parieto-occipital region. There is mild ill-defined enhancement along the deep margin of the resection cavity. There is mild diffusion restriction along the resection cavity margins, which likely represents expected post-operative ischemia. There is expected susceptibility within the surgical bed and areas of intrinsic T1 hyperintensity, compatible with postoperative blood products.The overall vasogenic pattern of T2/FLAIR hyperintensity within much of the right cerebral white matter, especially posteriorly, is not significantly changed. The right lateral ventricle is better seen compared to the pre-operative MRI and similar to the more recent post-operative head CT. The 5 mm leftward shift is again seen at the level of the foramen of Monro and not significantly changed. The left lateral ventricle and fourth ventricle are stable and within normal limits.A thin extra axial collection is again seen underlying the craniotomy flap. Other patchy areas of stable mild periventricular and subcortical white matter T2/FLAIR hyperintensity is most consistent with chronic small vessel ischemic disease. There is mild scattered mucosal thickening within right-sided paranasal sinuses.

Output: 1.Postoperative changes of a right parieto-occipital craniotomy and resection of underlying mass. There is mild ill-defined enhancement along the deep margin of the resection cavity of which close follow-up is recommended as this may represent residual tumor. 2.There is mild diffusion restriction along the resection cavity relating to post-operative ischemia and central blood products.3.No significant change in the extensive right parieto-occipital vasogenic edema, although with improved mass effect compared to preoperative status. Stable 5-6 mm of leftward midline shift.


Instruction: Generate impression based on findings.

Input: 30-year-old male with gunshot wound to abdomen/pelvis in 10/2016. Status post small bowel resection at outside hospital. Here with abdominal pain, elevated LFTs with dilated biliary ducts on CT. Needs MRCP. Patient with abdominal pain, nausea and vomiting. ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter right hepatic lobe T2 hyperintensities are too small to characterize, favor cystic. There is a 3.5 mm stone in the distal common bile duct (coronal series 3 image 15) with mild to moderate intra and extrahepatic biliary ductal dilatation. The distal common bile duct caliber change is noted at this level as seen on the MRCP sequence (coronal series 9 image 19). Cholelithiasis better appreciated on the prior CT exam.SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 signal intensity of the pancreatic parenchyma is relatively low, which may reflect sequelae of prior pancreatitis.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Midline susceptibility artifact from prior surgery/known trauma. Post-traumatic surgical changes better described on the prior CT exam.BONES, SOFT TISSUES: The previously described right thigh soft tissue hematoma is not included on the current study.OTHER: No significant abnormality noted.

Output: 1.Choledocholithiasis with mild to moderate intra and extrahepatic biliary ductal dilatation.2.Additional findings as above.


Instruction: Generate impression based on findings.

Input: Reason: persistent instability following ACL reconstruction r/o rerupture History: instability and pain MENISCI: There is mild fraying of the inner edge of the medial meniscus. The body of the meniscus appears normal. There is mild lateral extrusion of the lateral meniscus. ARTICULAR CARTILAGE AND BONE: Screws within the lateral femoral condyle and medial aspect of the tibia as well as an additional empty screw tract within the proximal tibia reflecting prior ACL repair. There is no bone marrow edema.LIGAMENTS: There is increased signal within the anterior cruciate ligament, indicating tendinopathy, but the ACL appears intact. The posterior cruciate ligament appears intact. The medial collateral ligament and lateral collateral ligament complex appear intact. EXTENSOR MECHANISM: The quadriceps tendon and patellar tendon appear intact.ADDITIONAL

Output: Sequelae of prior ACL repair. Tendinopathy of the ACL, but no tear is evident. No acute abnormalities.


Instruction: Generate impression based on findings.

Input: 61-year-old female with medial sided left knee pain. MENISCI: Mild intrasubstance degeneration of the posterior horn of the medial meniscus. No evidence of meniscal tear.ARTICULAR CARTILAGE AND BONE: There is mild thinning of the cartilage along the anterior femoral head. There is no full-thickness tear. There is fissuring along the medial ridge of the patella. Full-thickness loss is present along the medial facet of the patella.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: Synovitis with a moderate joint effusion and debris within the joint. This could represent synovial chondromatosis or less likely pigmented villonodular synovitis.


Instruction: Generate impression based on findings.

Input: Dementia: Altered mental status, hallucinations. Many of the images are degraded by patient motion. There are bilateral cerebral convexity subdural cerebrospinal fluid signal collections, which measure up to 10 mm in thickness on each side. There is sulcal T2 hyperintensity in the posterior cerebral hemisphere, which corresponds to the subarachnoid hemorrhage demonstrated on the prior CT. There are also small right frontal lobe paramedial intraparenchymal hemorrhages. There are also several small areas of apparent restricted diffusion, including in the body of the corpus callosum, bilateral cingulate gyri, and left inferior frontal lobe deep white matter, at least some of which appear to be distinct from the areas of hemorrhage. Otherwise, there is mild scattered cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no midline shift. The skull and orbits appear to be unremarkable.

Output: 1. Bilateral cerebral convexity subdural cerebrospinal fluid signal collections, which measure up to 10 mm in thickness on each side. 2. Sulcal T2 hyperintensity in the posterior cerebral hemisphere corresponds to the subarachnoid hemorrhage demonstrated on the prior CT. 3. Small right frontal lobe paramedial intraparenchymal hemorrhages.4. Several small areas of apparent restricted diffusion, including in the body of the corpus callosum, bilateral cingulate gyri, and left inferior frontal lobe deep white matter, at least some of which appear to be distinct from the areas of hemorrhage, may represent acute infarcts in the anterior cerebral artery distribution. However, precise assessment is limited by patient motion.