Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:12/26/1946)Reason: complete lung CA staging History: see abovePROVIDER/ATTENDING NAME: TODD STERN TODD STERN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR signal hyperintense lesions are present brainstem. On susceptibility weighted imaging there is a signal loss present in the medial aspect of the left thalamus. It is associated with some subtle T1 signal hyperintensity. Punctate foci of signal loss and susceptibility imaging present in the right frontal periventricular white matter as well as right centrum semiovale.A small focus of encephalomalacia is present in the right lingual gyrusNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The right eye lens is thin

Output: 1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 2.There are several microhemorrhages present in the periventricular white matter as well as the left thalamus. These are nonspecific.3.There is no evidence for brain metastases.4.A small focus of encephalomalacia in the right lingual gyrus is likely a result of prior injury such as infarction


Instruction: Generate impression based on findings.

Input: Male 53 years old. Evaluate for ACL re-rupture in a patent with left knee pain, positive Lachman and instability. MENISCI: There is attenuation of the anterior horn of the medial meniscus that may reflect prior partial meniscectomy. This appears similar to the prior study and we see no discrete meniscal tear.ARTICULAR CARTILAGE AND BONE: There is bone marrow edema within the lateral tibial plateau posteriorly and within the lateral femoral condyle above the anterior horn of the lateral meniscus representing bone contusions. Linear low signal intensity seen within the lateral femoral condyle edema on the T1 coronal sequence may represent a nondisplaced subchondral fracture but this is equivocal. There is also edema within the medial tibial plateau posteriorly with a nondisplaced fracture extending obliquely through the posterior lip of the medial tibial plateau.There is full-thickness degeneration of the articular cartilage of the femoral trochlea centrally. Mild heterogeneity of the articular cartilage of the patella as well as the lateral tibial plateau represents relatively mild cartilage degeneration.LIGAMENTS: Again seen are surgical changes of prior ACL reconstruction; however the graft has ruptured. The PCL, MCL and lateral collateral ligament complex are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Rupture of ACL graft.2.Bone contusions as described above as well as a nondisplaced fracture through the posterior lip of the medial tibial plateau.3.Other findings as above.


Instruction: Generate impression based on findings.

Input: 91-year-old male with acute acalculus cholecystitis ABDOMEN:LIVER, BILIARY TRACT: The common bile duct is dilated measuring up to 8 mm with abrupt transition and convex contour of the filling defect at the distal common bile duct just proximal to the ampulla. There is mild intrahepatic biliary ductal dilatation. No gallstones are present within the gallbladder. There is fluid signal surrounding the gallbladder without significant gallbladder wall thickening. Trace perihepatic ascites.SPLEEN: No significant abnormality noted. Trace perisplenic ascites.PANCREAS: The pancreas demonstrates restricted diffusion and surrounding fat stranding. The main pancreatic duct is dilated measuring 7 mm with abrupt cut off at the pancreatic head near the ampulla. There is a 12 mm T2 hyperintense cystic lesion in the uncinate process that may represent a sidebranch IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple T2 hyperintense simple cysts are noted bilaterally. No hydronephrosis or perinephric inflammation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis. BONES, SOFT TISSUES: Survey images demonstrate compression deformity of the L2 vertebral body and grade 1 anterolisthesis of L4 on L5, similar to the prior CT.Status post median sternotomy.OTHER: Multiple bilateral bladder diverticula are present. Small right pleural effusion.

Output: 1.Nonopacification of the CBD with relatively abrupt transition at the distal CBD with upstream new biliary dilation compatible with a small CBD stone.2.Findings compatible with mild pancreatitis. 3.Additional findings as above.


Instruction: Generate impression based on findings.

Input: NAT/TBI with bilateral subdural shunts. There are bilateral subdural shunt catheters with associated hardware that create substantial artifacts that obscure portions of the brain. Within this limitation, there are bifrontal subdural fluid collections, measuring up to 15 mm in thickness on the left and 9 mm on the right, with a few septations. There is flattening of the underlying brain parenchyma. There also appears to be areas of volume loss and high T2 signal in the bilateral anterior frontal lobes. The ventricles appear somewhat prominent, perhaps due to artifacts. There is marked thickening of the frontal calvarium. The orbits are unremarkable.

Output: Bilateral subdural shunt catheter hardware create substantial artifacts that obscure portions of the brain. Within this limitation, there are bifrontal subdural fluid collections, measuring up to 15 mm in thickness on the left and 9 mm on the right, with a few septations and associated flattening of the underlying brain parenchyma, as well as apparent areas of volume loss and high T2 signal in the bilateral anterior frontal lobes, which may be post-traumatic in nature.


Instruction: Generate impression based on findings.

Input: Clinical question: h/o atypical meningioma and craniotomy. Findings and symptoms: Surveillance. Pre and post enhanced brain MRI:Negative diffusion-weighted images.Chronic expected postoperative changes of a left anterior frontal craniotomy is noted.There is underlying small focus of encephalomalacia of the left frontal lobe at the site of surgery which remains identical to prior exam from 2014.Post enhanced images demonstrate expected minimal epidural thickening and enhancement at the surgical site however without evidence of residual or recurrence of tumor is a similar observation as prior exam.Additionally examination demonstrate extensive periventricular and subcortical and to a lesser degree bilateral basal ganglia and minimally of right paramedian pontine foci of FLAIR hyperintensity. Findings are nonspecific and remain stable since prior study. Although nonspecific in this age group this appearance could represent chronic small vessel ischemic strokes.Also as was noted on prior exam there is extensive chronic pansinusitis with interval progression of disease since prior study.

Output: 1.No acute intracranial process.2.Stable postoperative changes of left frontal craniotomy for removal of meningioma without residual or recurrence.3.Findings suggestive of chronic small vessel ischemic strokes of moderate degree without significant change.4.Extensive chronic pansinusitis with interval progression of disease since prior exam.


Instruction: Generate impression based on findings.

Input: 6-year-old male with tuberous sclerosis and seizure. Increasing frequency of seizures status post fall. Multiple densely calcified lesions in the subependymal bilateral ventricular system is noted. Additional similar findings within the parenchyma is also present. Multiple less calcific lesion and some with low density there is 30 are also believed to represent hamartomas of tuberous sclerosis. Further evaluation with a dedicated postinfusion MRI exam is recommended. No evidence of hemorrhage is identified and no evidence of any mass effect or midline shift. The cortical sulci and ventricular system remain within normal range. Calvarium is unremarkable.

Output: Extensive findings of tuberous sclerosis however no evidence of hydrocephalus or hemorrhage. Further evaluation with an infused MRI of brain is recommended.


Instruction: Generate impression based on findings.

Input: Hereditary hemorrhagic telangiectasia patient, access for brain AVM. There is a small focal enhancement on the right central sulcus. The lesion shows small vascular tangles indicating possible nidus is more likely located on the posterior central gyrus side with a tortuous enhancing vascular structure across the brain parenchyma and reaching to the right lateral ventricle ependymal surface. This lesion is most likely small brain AVM located on the central sulcus. Focal high signal intensity around the duct vascular tentacle on the right side posterior central gyrus with associated signal voids on gradient echo images indicate possible prior hemorrhage.There is also 18.5 mm x 26.4 mm sized extra-axial L enhancing mass on the left side paracentral lobule indicates meningioma.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Again right central sulcus vascular lesion is demonstrated.

Output: 1. Vascular lesion on the right central sulcus with nidus located on the anterior aspect of right postcentral gyrus indicating brain AVM. Possibility of prior hemorrhage is suggested.2. About 3 cm sized left paracentral local meningioma as described above.


Instruction: Generate impression based on findings.

Input: History of clear cell renal cell carcinoma status post left nephrectomy. Follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: The liver has normal morphology. There is diffuse parenchymal signal loss in the out of phase images compatible with hepatic steatosis. No biliary ductal dilatation.SPLEEN: Scattered T2 bright foci within the spleen which previously demonstrated delayed fill-in on postcontrast images compatible with hemangiomas.PANCREAS: There is a 13 x 8 mm simple cystic focus in the uncinate process, likely side branch IPMN. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. There are numerous cystic foci within the right kidney of varying signal characteristics. Evaluation for malignancy is markedly limited by the lack of intravenous contrast.There is a mixed solid and cystic mass within the renal hilum which measures 3.9 x 3.3 cm in maximum dimension (series 1601 image 19), previously 4.0 x 3.1 cm. The solid components demonstrate restricted diffusion. Overall this is not significantly changed from prior.An interpolar cyst with low T2, high T1 signal and no significant restricted diffusion is described in size and now measures 2.5 x 2.5 cm (series 501 image 13), previously 2.0 x 1.7 cm. There is an exophytic nodule arising from the inferior pole that has heterogeneous but intermediate T1 and T2 signal and no significant restricted diffusion which now measures 18 x 14 mm (series 501 image 6), previously 15 x 14 mm.RETROPERITONEUM, LYMPH NODES: Stable enlarged peripancreatic lymph node which measures 2.6 x 1.8 cm (series 501 image 23), previously 2.8 x 1.6 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple incompletely evaluated solid and cystic lesions within the right kidney compatible the patient's known renal cell carcinomas. There has been slight interval enlargement of some of these lesions as described above.2.Status post left nephrectomy. Stable enlarged peripancreatic lymph node. No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 51 years Female (DOB:12/6/1964)Reason: Bilateral arm numbness History: AbovePROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is a millimeter diameter and 1 cm length T2 hyperintense focus along the posterior aspect of the spinal cord at the C2 and C3 vertebral body levels.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level associated with small uncovertebral osteophytes and small endplate osteophytes. There is narrowing of the neural foraminaAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level associated with small uncovertebral osteophytes and small endplate osteophytes.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level associated with small uncovertebral osteophytes and small endplate osteophytes. There is mild narrowing of the neural foramina bilaterally at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disc space height, disc desiccation and a disc bulge at this level associated with small uncovertebral osteophytes and small endplate osteophytes.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are multilevel degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots.2.No abnormal mass lesions are appreciated within the spinal cord3.There is a linear signal hyperintense lesion along the posterior aspect of the spinal cord along the midline measuring a millimeter in diameter and a centimeter in length. Its significance is unknown it could represent old focus of injury though could also represent an old focus of demyelination. Its location corresponds to the posterior median fissure of the spinal cord which is adjacent to the fasciculus gracilis. This would therefore not readily explain the patient's symptoms of upper extremity numbness.


Instruction: Generate impression based on findings.

Input: Diagnosis: Injury, unspecifiedClinical question: s/p traumatic fall onto anterior neck, hematoma with tracheal shift and thyroid gland disruption on CT angio. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.The left thyroid lobe is disrupted and heterogeneous measuring 20x23mm axial dimensions and 30x40mm sagittal dimensions. The airway is displaced to the right. There is associated susceptibility effect.There is retropharyngeal space fluid present measuring up to 7 mm in thickness. This is contiguous with the visceral space hematoma.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.Findings suggest a large left sided visceral space hematoma involving the left thyroid lobe. This may be extending into the superior mediastinum.2.There is retropharyngeal space fluid present which may be an extension of the left visceral space hematoma3.No cervical spinal cord compromise is appreciated.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal for age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes, predominantly clustered within the basal ganglia. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal scattered paranasal sinus mucosal thickening. The mastoid air cells are clear.

Output: 1.No acute abnormality or abnormal enhancement. No specific findings to account for memory deficit.2.Mild-moderate chronic small vessel ischemic changes, with more confluent lacunar ischemic disease concentrated within the basal ganglia.


Instruction: Generate impression based on findings.

Input: 34-year-old female with melanoma, status post liver wedge resection and intraoperative laparoscopic ultrasound guided microwave ablation of tumor. Please do MRI liver protocol to evaluate for abnormalities. ABDOMEN:LIVER, BILIARY TRACT: Interval development of a wedge-shaped segment 7 ablation cavity. The circumferential T1 precontrast increased signal intensity likely represents hemorrhage or coagulation necrosis (axial series 1001 image 26). On the postcontrast subtraction series, thin peripheral enhancement is noted without focal nodularity at this level (axial series 10011 image 128). No new lesions identified. The portal and hepatic veins are patent. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: The known small right cardiophrenic lymph node is partially visualized (coronal series 4 image 13).BOWEL, MESENTERY: Trace free fluid in the pelvis could be physiologic in a premenopausal woman.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Wedge-shaped hepatic segment 7 ablation cavity. Apparent thin peripheral enhancement is favored to represent the adjacent liver capsule. No definite nodularity seen to suggest residual tumor.


Instruction: Generate impression based on findings.

Input: There is a patchy area of diffusion restriction in the right corona radiata measuring approximately 2 x 1 cm. Additionally, there are smaller areas of subcortical white matter diffusion restriction in the right occipital and medial temporal lobes. There is no significant mass effect or midline shift. There is no susceptibility artifact to indicate hemorrhage. There is moderate scattered T2 hyperintensity in the cerebral white matter and the pons suggesting chronic small vessel ischemic disease. The ventricles and sulci are within normal limits. The basal cisterns remain patent. The cerebral flow voids appear to be grossly intact. The lenses are replaced bilaterally.

Output: Recent infarcts of the right corona radiata and subcortical white matter of the right occipital and medial temporal lobes, perhaps in cerebral artery watershed territory distributions, superimposed upon a background chronic white matter small vessel ischemic disease, without midline shift, or hemorrhage. Dedicated head and neck vascular imaging may be useful if clinically warranted.


Instruction: Generate impression based on findings.

Input: Headaches No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns as well as gray/white matter differentiation remains within normal.Limited real paranasal sinuses, mastoid air cells and middle ear cavities are unremarkable.Calvarium is intact. Small densely calcified lesion along the inner table of the skull in the right pterion with extension inferiorly along the greater wing of sphenoid on the right is noted there is a lucent line separating this lesion from the inner table of the skull which may represent the dura. The finding may not present heavily calcified dural (dural plaque) however possibility of heavily calcified meningioma cannot be ruled out. This lesion can be further evaluated with a dedicated MRI examination of brain with contrast. I detect no soft tissue component with this finding which is best appreciated on bone density images 5 through 12.

Output: 1.Negative CT of brain parenchyma.2.Thin densely calcified extra-axial dural based lesion at the level of right pterion may represent a dural plaque or a heavy calcified meningioma. Please see above comments. Follow-up with a dedicated MRI is recommended.


Instruction: Generate impression based on findings.

Input: 48 year old female patient with pain after 9 foot fall off ladder Evaluate for rotator cuff tear and biceps tear. There is a mildly displaced avulsion type fracture of the greater tuberosity with the fracture fragment measuring approximately 1.3 x 0.5 cm. The fragment is uplifted slightly by 7 mm by the supraspinatus tendon, separated by underlying bone with heterogeneous signal intensity which presumably represents fluid and blood products. There is edema within the underlying humeral head. We see no additional fracture.ROTATOR CUFF: The supraspinatus tendon can be followed to its insertion on the mildly displaced greater tuberosity fracture fragment. It appears thickened which is likely due to slight retraction and edema but we see no discrete full-thickness tear. The supraspinatus muscle is within normal limits. There is longitudinally oriented increased signal intensity along the undersurface fibers of the infraspinatus tendon near the posterior margin of the fracture fragment, which perhaps represents a shallow posttraumatic undersurface tear, but we see no full-thickness tear of the tendon. Thickening and increased signal intensity of the subscapularis tendon likely represents a combination of tendinosis and internal rotation of the humerus. The subscapularis muscle is within normal limits. The teres minor muscle and tendon are intact.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint. There is a small amount of fluid within the subacromial/subdeltoid bursa, which may be due to the aforementioned greater tuberosity fracture.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small glenohumeral joint effusion. Mild osteoarthritis affects the glenohumeral joint. There is also increased signal intensity within the superior and anterior labrum which likely represents degeneration/degenerative tearing. BICEPS TENDON: Thickening and intermediate signal intensity in the biceps tendon within the intra-articular portion and transition to the intertubercular groove indicates moderate tendinosis, but we see no discrete tear. Small amount of fluid in the biceps tendon sheath may reflect extension of fluid from the glenohumeral joint.ADDITIONAL

Output: 1. Avulsion type fracture of the greater tuberosity as described above.2. Rotator cuff tendinosis and possible shallow undersurface tear of the infraspinatus, but no full-thickness rotator cuff tear.3. Tendinosis of the proximal tendon of the long head of the biceps without evidence of tear. The most distal portion of the biceps tendon is not included in the field-of-view; if there is concern for insertional injury, the patient may return for additional imaging.4. Mild osteoarthritis of the shoulder and degenerative labral tearing.


Instruction: Generate impression based on findings.

Input: Possible seizure activity. Abnormal EEG. ALTE. 5 week ex full term infant. There are multiple sequences which are motion degraded despite multiple attempts and limit evaluation for subtle abnormalities. There is however no evidence of intracranial mass or mass effect. No obvious cortical abnormality. No evidence of infarct or large hemorrhage. Ventricles and sulci appear within normal limits for age. Myelination also appears age-appropriate. Calvarium and extracranial soft tissues are unremarkable.

Output: No intracranial mass, mass effect, hemorrhage, or infarct is appreciated. No obvious cortical abnormalities to suggest seizure focus are appreciated. Please note examination is motion degraded and if there are continued seizures, repeat MRI may be considered to assess for subtle lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: Cerebral edema. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no evidence of acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. No evidence of any new findings since prior study. Considering provided clinical date of bone these last two CT examinations and negative CTs of the brain follow with an MRI is recommended.Calvarium, visualized paranasal sinuses, orbits and mastoid air cells are unremarkable.

Output: Negative nonenhanced CT of brain and calvarium.


Instruction: Generate impression based on findings.

Input: 69-year-old woman with history of medullary thyroid carcinoma and rising calcitonin. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder are normal. There is no intrahepatic biliary duct dilatation. The common bile duct is nondilated.SPLEEN: The spleen is normal.PANCREAS: The pancreas is normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: There are bilateral renal cysts, the kidneys are otherwise unremarkable.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: No evidence of metastatic disease.


Instruction: Generate impression based on findings.

Input: Progressive ataxia. Per EPIC, patient with gait difficulty and falls which started a few years following a motor vehicle accident in 1979. At the time of the accident there was a severe head injury with impaired consciousness for a couple of weeks. He was hospitalized for one month at that time (details unclear) and did not need any surgical intervention. He was told there was damage to his cerebellum due to the injury. MRI brain: There is diffusely severe volume loss of the cerebellum. There is no evidence of associated susceptibility or focal encephalomalacia. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is mild asymmetric increased T2 signal of the left medial temporal lobe with mild hippocampal volume loss suggested.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The right internal carotid artery flow void is mildly asymmetrically smaller, which may relate to an absent A1 segment. There is mild asymmetric prominence of the right superior ophthalmic vein.MR cervical spine: There is anterior cervical discectomy and fusion at C6-C7. There is minimal retrolisthesis of C4 on C5. The vertebral body heights are preserved. There is moderate loss of disc height at C5-6 with increased T1 signal, which may represent mineralization. The vertebral bone marrow signal is mildly heterogeneous. The spinal canal is congenitally narrowed, without significant superimposed spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.C2-C3: Mild posterior disc osteophyte complex and bilateral uncinate hypertrophy, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis.C3-C4: Mild posterior disc osteophyte complex and bilateral uncinate hypertrophy, contributing to mild bilateral foraminal stenosis. No significant spinal canal stenosis.C4-C5: Mild posterior disc osteophyte complex, left paracentral annular fissure and bilateral uncinate hypertrophy, contributing to mild bilateral foraminal stenosis with minimal flattening of the ventral cord. No significant spinal canal stenosis.C5-C6: There is partial fusion of the anterior C5-C6 vertebra, which is developmental. There is a small central convexity, which may represent a mineralized disc. No significant spinal canal or foraminal stenosis.C6-C7: Bilateral uncinate hypertrophy, contributing to moderate left foraminal stenosis. No significant spinal canal or right foraminal stenosis. C7-T1: Bilateral uncinate hypertrophy, contributing to mild to moderate left foraminal stenosis. No significant spinal canal or right foraminal stenosis.

Output: 1.Diffusely severe cerebellar atrophy, concerning for etiologies such as chronic alcoholism and neurodegenerative disease and much less likely trauma. 2.Subtle asymmetric FLAIR hyperintensity suggested associated with the mesial left temporal lobe hippocampal volume loss. Findings are nonspecific but can be seen in medial temporal sclerosis in the appropriate clinical setting. Please correlate clinically.3.Minimal chronic small vessel ischemic changes. No evidence of acute intracranial hemorrhage, mass, or acute infarct.4.Degenerative cervical spondylosis, contributing to mild multilevel foraminal stenosis. Congenitally narrowed spinal canal, but no significant superimposed spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Brain cyst, shunt, headaches, worsening symptoms. Evidence of right-sided hemispherectomy is again seen as well as fragmentation involving the right calvarium related to multiple prior craniotomies. There has been evolution and minimal decrease in size of extra-axial/extra-dural fluid collection along the right cerebral convexity. Unchanged position of catheter is in place spanning from this fluid collection to the left, across the residual left cerebral hemisphere, terminating within the left temporal lobe.A cyst within the anteromedial left temporal lobe measuring approximately 20 x 24 x 12 mm similar to prior previously 21 x 23 x 12 mm. Cysts posterior to the catheter appear similar to prior. A more posterior medial cyst which demonstrates an air-fluid level on 3/9/2016 and demonstrated decrease in size in 3/23/2016 appears to have resolved. Extensive chronic cerebral dysmorphism is unchanged. The white matter surrounding the residual left sided ventricular system remains T2 hyperintense. No new cysts or new mass effect is appreciated.

Output: 1.Grossly unchanged catheter traversing the right sided extra-dural fluid collection across to the left temporal lobe. The right-sided extradural fluid collection demonstrates evolution and minimal decrease in size.2.Cysts just anterior and posterior to the lateral aspect of the catheter persist but not clearly changed in size allowing for slight differences in measurement technique. There is a cyst more posteromedially which demonstrated an air-fluid level on 3/9/2016 and some decrease in size on 3/23/2016 which now appears to have resolved.3.Chronic dysmorphism of the brain and sequelae of right hemispherectomy are again seen.


Instruction: Generate impression based on findings.

Input: BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are no areas of abnormal parenchymal signal. 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. There is mild mucosal thickening and secretions within the paranasal sinuses. There is fluid within the left mastoid air cells. The skull and scalp soft tissues are unremarkable. SPINE: There are unchanged postoperative findings related to suboccipital craniectomy and C1 laminectomy. There is unchanged crowding at the foramen magnum and a congenitally narrow spinal canal. There is unchanged mild reversal of the normal cervical lordosis and vertebral bodies that are congenitally narrowed in the AP direction. There is lumbar vertebral body scalloping and Gibbus deformity of L2 resulting in a focal lumbar kyphosis. These findings in combination with the congenitally narrow spinal canal result in mild spinal canal stenosis at L1-L2 and L5-S, moderate spinal canal stenosis at L2-L3, and severe spinal canal stenosis at L3-L4 and L4-L5. There is also severe neural foraminal stenosis at all lumbar levels. In addition, at L1-L2 there is disc desiccation and mild loss of disc height. The vertebral bone marrow signal is unremarkable. There is trace prominence of the central spinal canal in the mid thoracic spine. The spinal cord otherwise displays normal signal and morphology with the conus terminating at L1. The paravertebral soft tissues are unremarkable.

Output: 1.Stigmata of a achondroplasia including a congenitally narrow spinal canal, and Gibbus deformity of L2 resulting in lumbar kyphosis and multi-level lumbar spinal canal and neural foramen stenosis. 2.Unchanged post-operative findings related to prior sub-occipital craniectomy and C1 laminectomy.3.Unremarkable brain MRI.4.Paranasal sinus inflammatory changes, for which clinical correlation is recommended.


Instruction: Generate impression based on findings.

Input: 16-year-old female patient with hematochezia and concern for IBD.EXAMINATION: MR enterography without and with IV contrast 11/03/2015 ABDOMEN:LIVER, BILIARY TRACT: Layering sludge is noted in the gallbladder. No evidence of cholecystitis. No intra or extra hepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is a 2.5 x 1.9 cm left adnexal cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a small amount of fluid in the pelvis, which may be physiologic.

Output: Left adnexal cyst and small amount of free fluid in the pelvis may both be physiologic. Otherwise, no findings to suggest inflammatory bowel disease.


Instruction: Generate impression based on findings.

Input: Patient with 4 weeks of worsening left great toe pain. Obvious dry gangrene. Question is extent of underlying infection to decide on level of amputation and debridement. There is extensive low T1/high T2 signal of the distal phalanx of the great toe with cortical disruption compatible with osteomyelitis. Signal changes also involve the distal aspect of the proximal phalanx of the great toe, also demonstrating cortical destruction. The remainder of the bones are spared. There is enhancement of the first metatarsophalangeal joint, compatible with synovitis.Soft tissue gas extends proximally to the level of the metatarsal bases on the dorsum of the foot. There is no evidence of abscess.

Output: 1.Signal changes and cortical destruction of the distal phalanx of the great toe, extending in to the distal aspect of the proximal phalanx, compatible with osteomyelitis.2.Enhancement of the first metatarsophalangeal joint, compatible with synovitis.


Instruction: Generate impression based on findings.

Input: Male, 64 years old, lumbar spinal pain. Trace retrolisthesis of L5 relative to S1 is seen. Spinal alignment is otherwise unremarkable.Vertebral body height and morphology are within normal limits accounting for scattered Schmorl's node deformities. Mild endplate edema is seen at L5-S1 without significant interval change.The distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are suspected.L1-2: Unremarkable. L2-3: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc height and mild disc bulging. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes. L3-4: Mild facet hypertrophy and ligamentum flavum thickening. Disc desiccation and mild disc bulging. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L4-5: Advanced facet arthropathy and ligamentum flavum thickening. Mild disc bulging. In combination with prominence of the dorsal epidural fat, this causes a mild narrowing of the thecal sac. Moderate bilateral foraminal narrowing. No interval changes. L5-S1: Mild facet hypertrophy and ligamentum flavum thickening. Loss of disc height and disc desiccation. Mild bulging disc. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes.

Output: No significant interval change in the severity of disc and posterior element degeneration is seen. No high-grade spinal canal stenosis is detected. Scattered mild to moderate foraminal narrowing is also unchanged as discussed above.


Instruction: Generate impression based on findings.

Input: 27-year-old male with Crohn's disease. Evaluate extent of ileal disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is moderate increased thickness and wall enhancement of the distal and terminal ileum over a segment measuring approximately 30 cm, most compatible with active inflammatory bowel disease. No evidence of bowel obstruction. No evidence of fistula or abscess.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Findings most compatible with active inflammatory bowel disease of the distal and terminal ileum as detailed above. No evidence of fistula or abscess.


Instruction: Generate impression based on findings.

Input: Dysphagia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The cerebellar tonsils are minimally low-lying, but retain a rounded morphology. The brain parenchyma and brainstem appear unremarkable. There is flattening of the pituitary gland. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small right maxillary sinus rentention cyst.

Output: Flattening of the pituitary gland is nonspecific, but may represent pseudotumor cerebri. In addition, the cerebellar tonsils are minimally low-lying. Otherwise, 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: Female 58 years old Reason: follow up IPMNs History: none ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. T2 hyperintense enhancing lesions in segment 2 and segment 6 of the liver unchanged and has imaging features compatible with small hemangiomas. Hepatic and portal veins are patent. No intrahepatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Small cystic focus in the pancreatic body measures 11 mm and connecting with the main pancreatic duct is compatible a small branch type IPMN. No internal enhancement is seen. There are smaller cystic foci in the pancreatic head and tail.Pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No significant change in the small cystic focus in the pancreatic body with imaging features suggestive of small IPMN's.


Instruction: Generate impression based on findings.

Input: Examination is limited by lack of intravenous contrast. Redemonstrated is diffuse destruction and replacement of the L1-2 disc space with T2 hyperintense signal with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. There is slight interval decrease in the extent of abnormal STIR hyperintensity. The degree of moderate retropulsion appears similar at the L1 level with unchanged moderate spinal canal stenosis and bilateral foraminal stenosis. No other worrisome marrow signal is appreciated. There is persistent diffuse edema, with poor definition of the bilateral psoas muscles, the right greater than left iliacus muscles, as well as the paravertebral muscles, which may represent a component of atrophy superimposed upon edema. There is slight interval decrease in size of the previously seen loculated collections within the psoas muscles.The lumbar spine is otherwise in stable alignment. The vertebral body and disc heights are otherwise unchanged. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. The previously described degenerative changes appear similar. Small amount of focal epidural fat is again incidentally noted along the right lateral aspect of the thecal sac at the L3-4 level. Partially imaged are bilateral renal atrophy with innumerable microcysts.

Output: 1. Lack of contrast again limits evaluation. Compared to 4/1/2015, there is continued gradual evolution of L1-L2 discitis-osteomyelitis with slightly decreased associated marrow edema. Stable extent of collapse of the L1 greater than L2 vertebral bodies with retropulsion with persistent moderate spinal canal and bilateral neural foraminal stenosis.2. Minimal decrease in size of small residual fluid collections within the psoas muscles, with persistent edema and possible superimposed atrophy of the psoas muscles, iliacus muscles and dorsal paraspinal muscles.3. No new or enlarging fluid collections or worsening signal abnormality in the disc spaces to suggest progression of infection.


Instruction: Generate impression based on findings.

Input: 68-year-old male with pain since 2008, occasional trigger. Evaluate for tenosynovitis or mass of the left thumb There is a multilobulated collection of near fluid signal intensity at the level of the base of the first and second metacarpals, deep to the first dorsal interosseous muscle, either within or along the dorsal surface of the adductor pollicis, adjacent to the dorsal carpal branch of the radial artery, measuring 8 x 5 mm in the transverse dimension and 14 mm in the craniocaudal dimension. We suspect that this represents a ganglion. Proximally, the mass abuts the base of the first metacarpal and tapers distally. The signal intensity of the bone itself is normal. The tendons, including that of the flexor pollicis longus appear normal. We see no findings to suggest a pulley tear.

Output: Small multilobulated mass adjacent to the radial aspect of the base of the second metacarpal likely representing a ganglion. The tendons appear normal.


Instruction: Generate impression based on findings.

Input: Ms. Denise Johnson is a 61 year old female with a personal history of a newly diagnosed cancer in her right breast, 10:00 position, 8 cm from the nipple. She presents today for ultrasound and possible ultrasound-guided biopsy of the additional enhancement demonstrated on the recent breast MRI. A targeted right ultrasound was performed for the area of concern on the MRI. In the right breast, 10:00 position, 8 cm from the nipple, there is an 1.3 x 1.7 cm hypoechoic mass with irregular margin and a biopsy clip, compatible with the biopsy proven malignancy. There is no suspicious finding anterior to this index mass in the upper outer right breast to correlate with the additional enhancement demonstrated on the MRI breast dated 5/13/2016. Therefore, ultrasound-guided biopsy is not performed today.

Output: No sonographic correlate for the additional enhancement anterior to the index cancer demonstrated on the MRI breast. Patient will be scheduled for MRI guided biopsy of the additional enhancement demonstrated only on the MRI. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Thoracic spine: There are multiple osseous lesions compatible with metastatic disease with associated epidural extension. There is enhancing soft tissue epidural extension at T1, T4, and T6. There is greater than 50% loss of vertebral body height with retropulsion of approximately 4 mm at T4, which abuts the spinal cord, but there is no actual spinal cord compression. There is exaggerated kyphosis centered at the T4 level. The disc heights are well maintained. The spinal cord is of normal signal. Numerous lesions are also present in several ribs bilaterally, which are compatible with metastatic disease. There is a partially imaged left pleural effusion.Lumbar spine: There are numerous foci of abnormal bone marrow signal and enhancement throughout the lumbar spine compatible with metastatic disease. There has been further height loss of the L4 vertebral body to approximately 75% loss, which also demonstrates abnormal bone marrow signal. There is worsening of retropulsion/soft tissue extension. Combined with degenerative ligamentum flavum thickening, there is resultant severe spinal canal stenosis at this level. Vertebroplasty changes are present in the L1 vertebra. The distal spinal cord and conus medullaris are within normal limits. There is diffuse disc desiccation signal and loss of intervertebral disc height throughout the lumbar spine. There are disc bulges at T12-L1, L2-L3, L3-L4, L4-5, and multilevel bilateral ligamentum flavum thickening causing multilevel spinal canal stenosis up to a moderate degree at L4-L5. Multiple lesions are present in the sacrum and bilateral iliac bones, which are also compatible with metastatic disease.

Output: 1. Diffuse metastases to the axial skeleton, including a pathologic T4 compression fracture without spinal cord compression and interval progression of a pathologic L4 compression fracture with persistent severe spinal canal stenosis at this level. 2. Multilevel degenerative spondylosis in the lumbar spine.3. Partially imaged left pleural effusion.


Instruction: Generate impression based on findings.

Input: Reason: pt has h/o pancreatic neck/body cyst - eval for changes History: pancreatic cyst ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter T2 hyperintensity is too small to characterize but likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: A 1.4 x 1.1 cystic lesion in the pancreatic neck is unchanged in size (8/17). This lesion contains a enhancing septations without nodular components, similar to the prior exam, and appears to communicate with the main pancreatic duct. Additional cystic lesions which also appear to communicate with the main pancreatic duct are unchanged. No pancreatic ductal dilatation.ADRENAL GLANDS: Nodular left adrenal, unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cystic lesion in the pancreatic neck with enhancing septations is stable and suggestive of a side branch IPMN.2.Additional subcentimeter lesions also likely represent side branch IPMNs and are stable.


Instruction: Generate impression based on findings.

Input: Reason: GBM. s/p short course RT. Now on TMZ (7 day on/7 day off). MGMT promoter methylated. Diplopia since craniotomy. Brain: Per technologist note, patient had difficulty tolerating the study and was combative. Examination is very motion degraded.Again seen are postsurgical changes of suboccipital craniotomy for resection of posterior fossa tumor. Compared to 4/14/2016 and 2/19/2016, there is further mild increase in FLAIR hyperintensity surrounding the resection cavity including the cerebellar vermis and right greater than left cerebellar hemispheres. There is also slight increase in heterogeneously enhancing tissue surrounding the resection cavity. Partial effacement of the fourth ventricle is again seen. Ventricles remain not significantly changed in size with mild prominence, likely related to volume loss, also not significantly changed. No new lesions are seen elsewhere in the brain. A nonspecific focus of T2 hyperintensity within the white matter adjacent to the left frontal horn is unchanged. No evidence of significant intracranial mass effect, midline shift, or herniation. Orbits: Bilateral lens implants. No abnormal mass or definite abnormal enhancement is seen in the orbits. There is minimal asymmetric enhancement surrounding the left optic nerve sheath which is of uncertain significance. The optic nerves themselves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable. Mild scattered paranasal sinus opacification.

Output: 1. Examination is significantly motion degraded. Compared to 4/14/2016 and prior, there is slight further increase in FLAIR hyperintensity and enhancement surrounding the cerebellar resection cavity. Given the recent time period since treatment and MGMT promotor methylation status, post-treatment change still remains a reasonable possibility. Recommend continued close follow up.2. Orbit MRI is essentially unremarkable. There is mildly increased enhancement/vascularity surrounding the left optic nerve sheath which is of uncertain significance.


Instruction: Generate impression based on findings.

Input: Left side ptosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

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


Instruction: Generate impression based on findings.

Input: Status post MVC with neck pain, evaluate for ligamentous injury Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No evidence of edema or disruption involving the ligamentous structures is demonstrated. No evidence of epidural hematoma. No cord signal abnormality to suggest edema or hemorrhage.There is no significant spinal canal or neural foraminal stenosis at any level in the cervical spine.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There is opacification of the bilateral mastoid air cells.

Output: No findings to suggest ligamentous injury in the cervical spine spine. No appreciable bone marrow edema or soft tissue edema is demonstrated to suggest associated cervical spine fracture; please note however MRI is not sensitive for small fractures and CT can be considered as clinically indicated.


Instruction: Generate impression based on findings.

Input: Clinical question: Past pituitary adenoma. Evaluate for or regrowth of adenoma. Signs and symptoms: Worsening memory for a year. Pre-and post-enhanced pituitary MRI:Examination demonstrate stable post surgical changes of prior removal of pituitary adenoma. There is no convincing evidence of residual tumor which is a similar observation as prior study. There is revisualization of pituitary stalk with rightward course and termination to residual pituitary gland on the right similar to prior exam. Heart remarkable bilateral cavernous sinuses and similar to prior study. Unremarkable suprasellar visual complex.Pre-and post-enhanced brain MRI:Negative diffusion weighted images.T2 flair images demonstrate minimal punctate foci of hyperintensity in the periventricular white matter of cerebral hemispheres which are nonspecific however often represent microvascular ischemic changes. There are no prior dedicated brain MRI in particular of flair sequence which makes precise comparison difficult. However comparison with prior axial T2 weighted images demonstrate no convincing evidence of progression of findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination are brain otherwise. Post-enhanced images fail to demonstrate any abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.

Output: 1.Stable post surgical changes of pituitary adenoma resection since prior exam and without evidence of residual tumor.2.Negative diffusion weighted images.3.Minute periventricular flair hyperintensity although nonspecific it could represent chronic microvascular ischemic changes of minimal degree.4.No detectable abnormal enhancement and unremarkable brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Diagnosis: WeaknessClinical question: r/o strokeSigns and Symptoms: ?new vs. chronic vs. none. L sided facial droop The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is present along the left superior frontal gyrus. There is associated focal enlargement of the left lateral ventricle.Multiple punctate foci of susceptibility effect are identified in the basal ganglia and brainstem. Additionally some punctate foci of susceptibility effect are present in the left medial temporal lobe.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are present in the brainstem.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no evidence for acute cerebral infarction.2.A focus of encephalomalacia is present along the left superior frontal gyrus which can also be identified on the prior CT from 2012. Most likely this is vascular related.3.Microhemorrhages are present within the deep gray nuclei, medial temporal lobes and brainstem. This pattern of distribution is most consistent with hypertensive pattern of microhemorrhages.4.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 5.Punctate lesions in the brainstem are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: hx met brain lesion. Preop planning for tumor resectionSigns and Symptoms: preop planning The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a 31 x 24 mm axial dimension heterogeneously enhancing mass centered in the left precuneus which has not changed since the prior exam. There is redemonstration of a 5 mm enhancing lesion within the left basal ganglia.There is a 3 mm extra-axial nodule present adjacent and anterior to the right frontal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There are mass lesions present in the left parietal lobe , left basal ganglia and adjacent to the right frontal lobe suspicious for metastatic disease . Please note that this examination is limited and was performed for the purposes of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Female 60 years old Reason: evaluate for choledocholithiasis History: RUQ pain, dilated CBD ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. Hepatic and portal veins are patent. There is mild to moderate intrahepatic biliary ductal dilatation. The common bile duct is dilated measuring up to 3 cm. It tapers at the head of the pancreas. While there are gallstones, the gallbladder is not distended. No definite evidence of choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Suboptimal evaluation of the pancreatic head due to motion artifact. The pancreatic duct is dilated up to 9 mm in the head of the pancreas. The ducts taper at the level of the ampulla with a small adjacent cystic lesion measuring 16 mm. No choledocholithiasis evident.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course. There is some edema surrounding these left upper abdominal small bowel loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without choledocholithiasis.2.Dilated common bile duct and pancreatic duct with a small cystic lesion near the head of the pancreas. Further evaluation is suggested to exclude a small underlying mass.3.Nonspecific edema surrounding the small bowel in the left upper abdomen.


Instruction: Generate impression based on findings.

Input: 61-year-old female with pain. Previous rotator cuff repair. The study is markedly suboptimal in quality due to metallic susceptibility artifact from the patient's suture anchors within the humeral head as well as patient motion artifact. Furthermore, the patient refused further imaging. ROTATOR CUFF: Anteriorly, the supraspinatus appears thinned which likely reflects partial thickness chronic attritional tearing or a full thickness tear, although we see no tendon retraction. More posteriorly, the supraspinatus tendon is of relatively normal thickness, although its insertion on the greater tuberosity cannot be assessed due to the aforementioned metallic susceptibility artifact. The bulk of the supraspinatus muscle appears decreased, although there is relatively little fatty infiltration. The visualized portions of the infraspinatus muscle and tendon appear normal, although its insertion cannot be assessed due to metallic susceptibility artifact. The teres minor muscle and tendon appear grossly intact. There is increased signal intensity within the superior fibers of the subscapularis suggesting partial thickness tearing, but we see no full-thickness tear. SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There perhaps a trace amount of fluid within the subacromial subdeltoid bursa. GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no large effusion is evident. Given the aforementioned limitations, we see no labral tear. Mild osteoarthritis affects the glenohumeral joint. BICEPS TENDON: The extra-articular portion of the tendon of the long head of the biceps appears appropriately situated within the bicipital groove. The intra-articular portion is not well seen due to the aforementioned limitations.

Output: Extremely limited evaluation of the right shoulder as described above which shows thinning of the anterior aspect of the supraspinatus tendon, but we cannot confirm or exclude a full-thickness tear. However, we see no frankly retracted tendon fibers. Other findings as described above. If further imaging evaluation is clinically warranted, CT arthrography may be considered.


Instruction: Generate impression based on findings.

Input: There is an unchanged lesion centered in the right petrous apex with high T2 and low T1 signal and thinning of the overlying cortex. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged T2 hyperintense foci compatible with chronic small vessel ischemic disease. There is also left medial temporal lobe encephalomalacia with hemosiderin staining. There is a partially-empty, expanded sella. The ventricles and basal cisterns are symmetric in size and configuration, and unchanged over several examinations. There is no midline shift or herniation. The orbits paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA

Output: 1. Unchanged lesion centered within the right petrous apex for which the differential diagnosis includes an effusion/early mucocele, cephalocele or prominent arachnoid granulation, and less likely neoplasm, such as low grade chordoid matrix tumor.2. Unchanged subcentimeter left MCA bifurcation and right PCOM aneurysms.3. Unchanged probable microangiopathic white matter disease and hypertensive microhemorrhages, as well as left medial temporal lobe encephalomalacia with prior hemorrhage.4. Partially-empty, expanded sella, which can be a manifestation of pseudotumor cerebri. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Brain metastases. Signs and symptoms: Breast cancer. Pre-and post enhanced CT of brain:100 cc of Omnipaque 350 was administered.Examination demonstrates diffuse subcortical and periventricular areas of low-attenuation which considering patient's age are suspected for advanced small vessel disease of indeterminate age. There is subtle ex vacuo dilatation of the lateral ventricles. There is no evidence of intracranial hemorrhage, edema or mass effect, midline shift or hydrocephalus.There is no evidence of any abnormal enhancement of renal parenchyma or the leptomeninges on post infused images to suggest for metastatic lesions.The calvarium is intact.Limited views of the orbits are unremarkable.Visualized portions of paranasal sinuses and mastoid air cells are unremarkable.Enhanced CT of cervical spine:Examination of the lower cervical spine is severely limited due to excessive artifact from patient's shoulders.Examination demonstrates extensive destructive changes involving vertebral body and the posterior elements of C7 vertebrae as was noted on prior MRI examination. Sagittal reformatted images demonstrate more than 50% compression deformity of C7 vertebrae and antral listhesis of C6 on C1. The destructive bony lesion involves the bodies, pedicles, right facets and lamina and the spinous processes of C7. Assessment for spinal canal stenosis cannot be made due to excessive artifact. Compared to prior MRI examination or were no gross interval change in the degree of subluxation is seen.Osteolytic changes of vertebral body of C6 is also suspected.Due to suboptimal quality of images possibility of additional metastatic lesions cannot be ruled out.Please refer to MRI examination of cervical spine from 12 -- 29 -- 2010 for further information. Follow up with a repeat MRI exam is recommended if surgical intervention is contemplated.Extensive degenerative changes of the cervical spine with resultant multilevel significant neural foramina compromise at C3 -- C4, C4 -- C5 and C5 -- C6 level are noted.

Output: 1.Pre-and post enhanced head CT demonstrates no evidence of metastatic disease. Advanced small vessel disease of indeterminate age is noted.2.Suboptimal enhanced CT of cervical spine due to extensive streak artifact from patient's shoulders. Three visualization of the destructive metastatic lesion involving the body and the posterior elements of C7 and body of C6 vertebrae as described above. Recommend further follow-up with an MRI examination for assessment of any interval change since prior MRI examination of 12 -- 29 -- 10.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35] / Other specified forms of tremor [G25.2], Reason for Study: ^Reason: MS, f/u progression History: ataxia Multifocal patchy FLAIR high signal intensity lesions on bihemispheric periventricular white matter and centrum semiovale as well as bilateral thalami, midbrain, pons, bilateral middle cerebellar peduncles and cerebellar hemispheres indicating demyelinating disease, unchanged since prior scan.Diffuse mild brain volume loss is again seen, unchanged.There is no evidence of abnormal enhancement on this scan.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Extensive supra and infratentorial white matter lesions consistent with demyelinating disease, unchanged since prior scan.No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 48-year-old female with anaplastic thyroid cancer: evaluate for metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a punctate focus of faint enhancement and susceptibility effect in the right paramedian pons. There is also a small developmental venous anomaly in the left superior frontal gyrus. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: Punctate probable capillary telangiectasia in the right pons and a small developmental venous anomaly in the left superior frontal gyrus. Otherwise, no evidence of intracranial metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There does appear to be enhancing material extending into the left CP angle at the level of the left porus acusticus which would be consistent with residual acoustic neuroma. However, due to the technique utilized for head CT acquisition, this study is relatively insensitive for thorough evaluation of the internal auditory canals. If dedicated imaging of this suspected residual acoustic neuroma would be clinically beneficial, MRI with contrast would be recommended. Left occipital calvarial changes would be consistent with a left-sided approach for prior acoustic neuroma surgery.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Mucosal thickening is present throughout the bilateral ethmoid air cells. Otherwise the visualized portions of the paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There does appear to be enhancing material extending into the left CP angle at the level of the left porus acusticus which would be consistent with residual acoustic neuroma. However, due to the technique utilized for head CT acquisition, this study is relatively insensitive for thorough evaluation of the internal auditory canals. If dedicated imaging of this suspected residual acoustic neuroma would be clinically beneficial, MRI with contrast would be recommended. 2.Mucosal thickening is present throughout the bilateral ethmoid air cells. 3.No CT evidence of intracranial metastatic disease.


Instruction: Generate impression based on findings.

Input: 72 years Male (DOB:6/28/1943)Reason: CNS lymphoma History: compare with previous MRI; s/p treatmentPROVIDER/ATTENDING NAME: CHADI NABHAN CHADI NABHAN The patient is status post left frontal lobe biopsy. A tract is identified coursing through the left frontal bone into the left frontal lobe and into the lesion There are punctate foci of microhemorrhage in the left frontal lobe. There is a heterogeneous lesion on FLAIR imaging along the left orbital gyrus without contrast enhancement present at this time. There is surrounding signal hyperintensity on FLAIR imaging centered in the left inferior frontal lobe which is a stable.A 3mm hemorrhagic focus is identified in the right frontal lobe which is stable. The FLAIR signal hyperintensity currently measures 18 x 10 mm. It has no significant contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.The patient is status-post left frontal lobe biopsy2.There is a left frontal lobe lesion centered in the left orbital gyrus which is stable since the prior exam from February. Most likely this represents posttreatment change.3.A smaller lesion in the right frontal lobe is also stable.


Instruction: Generate impression based on findings.

Input: There are multiple supratentorial and infratentorial lesions with variable enhancement, many showing susceptibility effect consistent with hemorrhagic products, which are compatible with metastases. Aside from the calcified right hippocampus lesion, a peripherally enhancing left superior frontal gyrus lesion, and the dominant peripherally enhancing lesion in the inferior right parietal lobe, which are not significantly changed, the other lesions have decreased in size and display less prominent enhancement. For example, a left cerebellar hemisphere lesion measures up to 4 mm, previously6 mm, a left medial temporal lobe lesion measures up to 6 mm, previously 9 mm, a left temporal lobe lesion measures up to 7 mm, previously 12 mm, and a right cuneus lesion measures up to 3 mm, previously 14 mm. In addition, there has been interval decrease in the degree of associated vasogenic edema overall. There is consequent decreased mass effect on the posterior horn and atrium of the lateral ventricles, right greater than left and there is no significant midline shift. There is a background of punctate T2 hyperintense signal abnormality scattered in the supratentorial periventricular and subcortical white matter, which is nonspecific. There is no evidence of acute infarct. The orbits, skull, and scalp soft tissues appear unremarkable.

Output: Stable to decreased size of the intracranial metastases and overall reduced associated vasogenic edema.


Instruction: Generate impression based on findings.

Input: Chiari malformation, decompressed, new headaches and neck pain. Brain: There are postoperative findings related to Chiari decompression. There is mild tenting of the posterior portions of the inferior cerebellar hemispheres towards the overlying dura. Otherwise, there is persistent prominence of the retrocerebellar cerebrospinal fluid space. There is intact cerebrospinal fluid flow across the anterior aspect of the foramen magnum, but apparently blunted flow posteriorly. There are multiple cerebral white matter T2 hyperintense lesions, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is mucosal thickening in the maxillary sinuses.Cervical Spine: There are numerous patchy areas of T2 hyperintensity in the cervical and imaged portions of the upper thoracic spinal cord. 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 unchanged multilevel degenerative cervical spondylosis, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Postoperative findings related to Chiari decompression with mild tenting of the posterior portions of the inferior cerebellar hemispheres towards the overlying dura, which is suggestive of adhesion formation. Otherwise, prominence of the retrocerebellar cerebrospinal fluid space persists. 2. Numerous intracranial and upper spinal cord white matter lesions likely represent multiple sclerosis.


Instruction: Generate impression based on findings.

Input: History of liver lesions on CT. No reported malignancy. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and enhancement. The previously described periportal hypoattenuation on CT corresponds to focal fatty deposition. Additional punctate lesions also lose signal on out of phase imaging suggestive of fatty deposition. No suspicious liver lesion, biliary ductal dilatation or vascular abnormality. The patient is status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical 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: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: Postsurgical changes of the ventral abdominal wall with laxity and rectus abdominis muscle diastases. Small fat-containing ventral hernia.OTHER: No significant abnormality noted.

Output: The previously described hepatic hypodensities on CT, correspond to periportal and punctate nodular focal fat deposition. No suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: Right shoulder pain and weakness ROTATOR CUFF: Although we see no fluid-filled full-thickness rotator cuff tear, there is intermediate signal intensity focally separating the distal fibers of the supraspinatus tendon from its insertion on the greater tuberosity. There is extension of these changes across the full-thickness of the tendon and this could reflect focal insertional tendinosis or perhaps a rim-rent type tear that has filled with granulation tissue; however, lack of fluid in the adjacent subdeltoid bursa argues against a tear. There is additional undersurface fraying of the supraspinatus tendon. More posteriorly within the anterior fibers of the infraspinatus tendon is a 3 mm focus of fluid signal intensity at its insertion representing a small concealed insertional tear. Additional intermediate signal intensity of the infraspinatus represents tendinosis. A small cyst is present within the underlying humeral head. There is mild fatty infiltration along the myotendinous junction of the infraspinatus muscle but the remaining infraspinatus and supraspinatus muscles are intact. The teres minor tendon and muscle are normal. There is increased signal intensity and thickening of the distal fibers of the subscapularis indicating tendinosis with small foci of fluid signal intensity within the superior fibers of the tendon representing small insertional tears. The subscapularis muscle is normal.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is deformity and abnormal signal intensity of the anterior labrum indicating tearing. There is also linear signal intensity partially separating the posterior superior labrum from the glenoid compatible with a SLAP tear. A small amount of fluid is present within the glenohumeral joint, particularly in the subscapular recess, but there is no large joint effusion.BICEPS TENDON: There is increased signal intensity and thickening of the long head of the biceps tendon as it courses through the rotator interval and into the intertubercular groove representing moderate tendinosis and perhaps longitudinal tearing. ADDITIONAL

Output: 1. Moderate tendinosis and perhaps longitudinal tearing of the long head of the biceps tendon.2. Labral tearing as above.3. Rotator cuff tendinosis and tearing as described above. There is no fluid-filled full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: 55-year-old male with a left knee wound with CT scan showing questionable osteomyelitis. Rule out osteomyelitis. Suboptimal examination secondary to motion artifact.MENISCI: There is linear branching increased signal abnormality within the posterior horn of the medial meniscus which extends to the femoral and tibial articular surface consistent with a complex degenerative tearing which also extends to involve the body of the medial meniscus.ARTICULAR CARTILAGE AND BONE: There is articular cartilage degeneration along the medial and lateral tibiofemoral compartment. Note is made of a focal full-thickness articular cartilage defect along the lateral femoral condyle.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: There is complete disruption of the patellar tendon. Patella baja.ADDITIONAL

Output: 1. Findings consistent with osteomyelitis of the left tibia and other findings, as described above, which may represent the sequela of chronic osteomyelitis.2. Complete disruption of the patellar tendon and other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Sollmann is a 34 year old female with a recent diagnosis of DCIS of the left breast. She presents today for MR imaging evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate to marked background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.In the left upper outer breast, far posterior depth, there is an irregular enhancing mass identified measuring 1.1 x 1.5 x 1.3 cm (AP x ML x SI). Susceptibility artifact from biopsy marker clip is seen just postero-lateral to this enhancement, compatible with biopsy-proven malignancy of the left breast. Although this mass is close to the pectoralis muscle, there is a discrete fat plane present between the mass and muscle. The pectoralis muscle is also of normal contour and enhancement pattern.In the left upper outer breast, there is heterogeneous masslike enhancement seen measuring approximately 4.3 x 3.1 x 3.6 cm. This corresponds to the mammographically detected global asymmetry. Susceptibility artifact from biopsy marker clip is seen at the inferolateral aspect of this mass, which is biopsy-proven to be a lactating adenoma. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Unifocal malignancy of the left upper outer breast. If breast conservation therapy is desired, the biopsy clip can be used for preoperative surgical guidance. Of note, the biopsy clip is located just postero-lateral to the MR-detected area of enhancement. (2) 4.3 cm enhancing mass in the left upper outer breast, which presumably represents the biopsy proven lactating adenoma (based on proximity of the biopsy marker clip). If patient has had prior mammograms, they can be submitted for confirmation of stability of mammographic findings. Alternatively, an US-guided biopsy can be performed. (3) No MRI evidence for malignancy of the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Status post SEGCA. (tuberosclerosis) with complaints of severe headache and pain. Evaluate hydrocephalus. There is no evidence of intracranial hemorrhage. Multiple subependymal tubers are again seen consistent with history of tuberous sclerosis. Subependymal mass in the right frontal horn appears stable again measuring 2.2 x 2.9 cm (image 13), suspicious for a subependymal giant cell astrocytoma. Additional lower density mass in the frontal horn and body of the left lateral ventricle also appears stable and may represent a cystic component of the presumed giant cell astrocytoma versus an arachnoid cyst. An additional subependymal mass in the body of the left ventricle is also concerning for an astrocytoma. MRI is recommended for further evaluation. The ventricles are enlarged although unchanged compared with prior examination. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No interval change in bilateral subependymal masses and subependymal calcifications consistent with history of tuberous sclerosis with presumed giant cell astrocytomas. Stable ventricular volumes. MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Lower back pain with numbness and weakness of left leg The vertebral bodies are appropriate in the overall height. There is grade 1 retrolisthesis of L5 on S1. There is straightening of the cervical and lumbar curvature. Again seen is diffuse T1 hypointense marrow signal which is nonspecific and can be seen in entities such as chronic anemias. No obvious cord signal abnormality. No evidence of cord compression. Spinal canal and neural foramina at the L1-L2, L2-L3, and L3-L4 are grossly preserved. At L4-L5, there is a left foraminal/extraforaminal protrusion with mass effect on the exiting left L4 nerve root similar to prior. At L5-S1 again seen is a large right paracentral disc extrusion with effacement of the lateral recesses, right worse than left, with mass effect on the S1 nerve roots.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified.Additional axial sequences of the lumbar spine again demonstrate an L5-S1 disc extrusion with effacement of the lateral recesses, right greater than left, similar to prior. Left-sided disc protrusion at the L4-L5 level with suspected impingement of the left L4 nerve root is also grossly similar to prior. Complete follow-up lumbar spine MRI can be considered for further evaluation as clinically indicated.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: hx of HTN, HLD, CAD, CVA now with weakness History: dysphagia, left sided facial weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.There are multifocal lacunar infarcts involving pons, bilateral thalami, bilateral basal ganglia, bilateral periventricular white matter and the left caudate head. On FLAIR imaging, patch confluent bihemispheric high signal intensity especially around periventricular white matter indicating nonspecific small vessel ischemic disease.On gradient echo, there are multifocal bihemispheric susceptibility lesions indicating prior chronic hemorrhagic foci or calcification. Considering no associated surrounding edema or mass effect, those lesions are assumed to be chronic.There is about 9.5mm x 6.6mm x 9mm sized T1 low signal, T2 slightly high or intermediate signal intensity well marginated lesion in the 4th ventricle without showing any evidence of ventricular enlargement. The lesion is likely represent subependymoma.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Left maxillary sinus fluid collection.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate luminal ectasia with the prominent basilar artery with tortuosity indicating atherosclerotic changes (dolichoectasia). Bilateral distal ICA, MCA and ACAs appear to be normal. Anterior communicating artery is patent, right posterior communicating artery seen but the left posterior communicating artery is not visualized. There is no evidence of intracranial arterial aneurysm. There is no significant luminal stenosis.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate, although tortuous normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. 9.5mm x 6.6mm x 9mm sized lesion likely represent subependymoma in the 4th ventricle without evidence of hydrocephalus.3. Multifocal chronic ischemic infarction related tissue losses as described above with chronic hemorrhagic foci.4. Moderate to severe non specific small vessel ischemic disease.5. Atherosclerotic changes of both intracranial and extracranial arterial system without evidence of significant luminal stenosis. No intracranial arterial aneurysm was seen.


Instruction: Generate impression based on findings.

Input: Male 72 years old Reason: r/o fracture History: pain TENDONS: There is minimal thickening of and increased signal intensity within the Achilles' tendon suggesting minimal Achilles' tendinosis which may not be of any clinical significance. There is a complete longitudinal tear of the tibialis posterior tendon as it courses behind and beneath the medial malleolus. Additional increased signal intensity within the tendon at its insertion likely represents insertional tendinosis. Fluid signal intensity within the tendon sheath, above the medial malleolus, suggests mild tenosynovitis. The peroneal tendons appear intact. Anterior tendons are normal.LIGAMENTS: The anterior talofibular and posterior talofibular ligaments appear intact. The calcaneofibular ligament appears slightly thickened, which may reflect old injury. The ligaments of the distal tibiofibular syndesmotic complex are intact. Loss of the normal striations of the deep fibers of the deltoid ligament may represent old injury, but we see no acute ligamentous disruption.ARTICULAR SURFACES AND BONE: We see no fracture. Mild osteoarthritis affects the tibiotalar joint. There are small foci of low signal intensity within the anterior recess of the tibiotalar joint which may represent cartilaginous loose bodies. ADDITIONAL

Output: 1.No fracture evident.2.Longitudinal tear of the tibialis posterior tendon as described above.3.Mild osteoarthritis of the tibiotalar joint with possible small cartilaginous loose bodies in the anterior aspect of the joint.4.Other findings as above.


Instruction: Generate impression based on findings.

Input: 52 year old female with history of metastatic breast cancer and HIV status post seizure; evaluate. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are mildly increased in volume; unchanged. Patchy areas of hypoattenuation are seen in the subcortical white matter (image 22 of 36, series #6747). Increased soft tissue density seen just posterior to the right globe and within the intraconal space; see recent brain MRI for further discussion. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Patchy areas of hypoattenuation in subcortical white matter may represent progressive multifocal leukoencephalopathy versus primary HIV infection.  2. Increased soft tissue density noted just posterior to the right globe and within the intraconal space. Please see brain MRI report from 11/16/2008 for further evaluation.


Instruction: Generate impression based on findings.

Input: T4N2c floor of mouth and tongue cancer Examination is limited by artifact. Enhancing anterior oral tongue mass, which crosses the midline and extends to the floor of mouth and tongue base posteriorly has not significantly changed in size measuring up to 35 mm (series 16, image 34), previously 35 mm, although there appears to be slight decrease in fullness. Slight interval decrease in reference cervical lymphadenopathy. Reference level left 1B lymph node measures 21 x 11 mm (series 11, image 108), previously 21 x 16 mm. Reference level right 2B lymph node measures 13 x 10 mm (series 16, image 41), previously 16 x 13 mm. Reference right level 3 measures 15 x 7 mm (series 16, image 47), previously 25 x 16 mm. Additionally a right level 1A lymph node measures 10 x 7 mm (series 16, image 44), previously 12 x 8 mm. There are additional subcentimeter lymph nodes, for example in left level 3 and right level 1B, which are nonspecific but were not definitively seen on the prior exam. The major salivary and thyroid glands are unremarkable. A right internal jugular catheter is noted. Disc osteophyte complex at C5-6 impinges upon the cord, unchanged. No suspicious focal osseous lesions.

Output: 1. No significant change in size or extent of tongue mass.2. Mild overall decrease in cervical lymphadenopathy. Please see details above.


Instruction: Generate impression based on findings.

Input: Reason: preop planning for tumor resection. Left side Vestibular schwannoma History: hearing loss, gait difficulty, balance The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 38 x 43 mm axial dimension mass in the left cerebellopontine angle cistern which is multi-cystic and enhances partially. It extends into the left internal auditory canal and does not appear to have changed compared to the prior exam. There is associated mass effect with compression of brainstem. The brainstem is shifted towards the right side Temporal horns of the lateral ventricles are mildly dilated. The mass distorts the adjacent seventh and eighth nerves as well as the fifth nerve. 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: 1.Left cerebellopontine angle cistern cystic mass. 2.Examination was performed for stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: Pain in left shoulder after fall going up stairs. Evaluate for torn ligament, tendon or other shoulder injury. ROTATOR CUFF: There is a full-thickness supraspinatus tear at its insertion, without significant retraction. The infraspinatus tendon appears intact. There is high signal within the subscapularis, consistent with tendinopathy. The subscapularis and teres minor appear intact. There is no fatty infiltration of the rotator cuff musculature.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: A small joint effusion is present within the subacromial/subdeltoid bursa. The labrum appears normal.BICEPS TENDON: There is nonvisualization of the proximal aspect of the biceps tendon, consistent with a tear. The distal aspect of the biceps tendon is visualized, but we do not see the proximal aspect within the bicipital groove.ADDITIONAL

Output: 1. Full-thickness supraspinatus tear at its insertion, with no significant retraction.2. Nonvisualization of the proximal aspect of the biceps tendon, consistent with tear.


Instruction: Generate impression based on findings.

Input: Ms. Ostroff is a 45-year-old female with a strong family history of breast cancer including mother, maternal aunt, maternal cousin, and paternal grandmother. Personal history of benign right breast biopsy in 2014 for adenosis and bilateral breast reduction. She has no current breast related complaints. There is scattered fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, which limits the sensitivity of this examination.Multiple circumscribed, homogeneously enhancing foci are identified in both breasts, but these lesions are stable over several prior studies and do not demonstrate suspicious morphology or kinetics. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Stable subcentimeter left hepatic cyst.

Output: Multiple stable benign enhancing foci in both breasts. No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Female 76 years old with metastatic rectal adenocarcinoma s/p diverting ileostomy and neo-adjuvant FOLFOX who was found to have extensive peritoneal disease. Evaluate for peritoneal disease burden. ABDOMEN:LIVER, BILIARY TRACT: Progressive intrahepatic biliary ductal dilatation. The pancreatic duct and common duct are dilated to the level of the ampulla. This may be due to stricture however obstructing stone or layering sludge is not excluded as this is not an MRCP. The gallbladder is decompressed.There is no suspicious hepatic lesion. The hepatic vasculature is patent.SPLEEN: Splenomegaly.PANCREAS: The pancreas enhances homogeneously. The pancreatic duct is dilated to the level of the ampulla as discussed above.ADRENAL GLANDS: Nodular thickening of the left adrenal gland with loss of signal on out of phase imaging indicating benign adenoma.KIDNEYS, URETERS: Multiple bilateral renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There are scattered small retroperitoneal and mesenteric lymph nodes. Stable infrarenal abdominal aortic aneurysm.BOWEL, MESENTERY: Status post partial colectomy with left lower quadrant ostomy and mucous fistula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is minimal perihepatic and splenic ascites.Linear restricted diffusion along the left anterior abdominal wall at the level of the splenic and mid anterior abdominal wall at the level of the lower pole of the kidneys (series 12, image 66 and 97 is present has no correlate on T2 or postcontrast images however this is suspicious for peritoneal disease.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is thickening and enhancement of the rectum with restricted diffusion perhaps related to prior radiation therapy. No discrete rectal mass is identified. There are foci of nodular, enhancing soft tissue anterior to the rectum, abutting the cervix, along the left pelvic wall and with extensive involvement of the omentum anteriorly.Status post partial colectomy with left lower quadrant ostomy and mucous fistula. There is diffuse thickening rectosigmoid colon wall over a distance of approximately 12 cm perhaps related to prior radiation therapy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Extensive pelvic peritoneal and mesenteric metastatic disease.2.Restricted diffusion along the left anterior upper abdominal wall and anteriorly along the mid abdominal is suspicious for additional peritoneal disease.3.Progressive intrahepatic ductal dilatation and dilatation of the pancreatic and common duct to the level of the ampulla. This may be due to stricture however an impacted stone layering sludge is not excluded without MRCP.