Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for abnormality. Cervical disk disease. Signs and symptoms: Bilateral upper arm pain. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate mild degenerative disease and unremarkable otherwise.C3 -- C4 demonstrate mild disk and facet disease. No central spinal stenosis however mild bilateral neural foraminal compromise is noted. C4 -- C5 demonstrate mild degenerative changes resulting in moderate right and mild left neural foraminal compromise and no central spinal stenosis.C5 -- C6 demonstrate moderate disk disease and loss of disk height and mild bilateral facet and ligamentum flavum degenerative changes. There is a small left paramedian shallow disk protrusion with resultant partial effacement of the ventral subarachnoid space and mild flattening deformity of the cord. There is a faint focus of T2 hyperintensity of the cord posteriorly at this level which is best appreciated on sagittal T2 series 4 image 8 which is focus of edema or myelomalacia secondary to degenerative disease. There is moderate bilateral (right greater than left) neural foraminal compromise and mild central spinal stenosis.C6 -- C7 demonstrate moderate disk disease and loss of disk height and T2 signal intensity, mild bilateral facet and ligamentum flavum degenerative changes. There is a prominent left lateral hypertrophic spur which significantly compromises the ventral subarachnoid space and mild flattening deformity of the ventral aspect of the cord without cord signal changes. Mild central spinal stenosis and mild left neural foraminal compromise is noted.There is also hypertrophic changes of the posterior longitudinal ligament extending from this level inferiorly through the entire uppermost visualized thoracic spine to T3 level.C7 -- T1 demonstrate moderate disk disease and loss of disk height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. There is a small right paramedian shallow disk protrusion resulting in slight flattening deformity of the cord. Moderate left neural foraminal compromise and mild central spinal stenosis is present at this level.C7 -- T1 demonstrate advanced disk disease and loss of disk height, mild facet disease and ligamentum flavum hypertrophy is present. There is a shallow low T2 signal intensity finding in the left paramedian epidural space (axial T2 series 6 image 39) which may represent a tiny chronic disk fragment. This finding by subtle mass effect on the thecal sac. No evidence of central spinal stenosis or neural foraminal compromise. There is however a focus of T2/T2 stir hyperintensity in the left paramedian cord anteriorly with suggestion of decreased cord caliber on the left concerning for a focus of myelomalacia. This finding extends from approximately mid T1 level inferiorly to mid T2 level. No prior exams for comparison.Nonenhanced lumbar MRI:The alignment of vertebral column is anatomical however there is mild straightening of lumbar lordosis.T12 -- L1 demonstrate degenerative changes however without spinal stenosis or neural foramina compromise.L1 -- L2 demonstrate a left paramedian and left lateral shallow broad base disk protrusion which results in mild mass effect on the thecal sac and mild left neural foramina compromise. There is also mild central spinal stenosis at this level.L2 -- L3 demonstrate moderate to advanced disk disease and loss of disk height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. No neural foraminal compromise. Although degenerative changes demonstrate no significant mass effect on the thecal sac there is mild central spinal stenosis present at this level also. Possibility of underlying congenitally small canal/short pedicles cannot be entirely excluded.L3 -- L4 demonstrate mild disk disease and loss of disk height and extensive postoperative changes of the posterior elements and soft tissues. Although there is no detectable mass effect on the thecal sac at this level the overall caliber of the spinal canal is small. Moderate bilateral neural foraminal compromise (left greater than right) is also noted. L4 -- L5 also demonstrate moderate disk disease and loss of disk height, shallow diffuse bulging is, mild to moderate bilateral (right greater than left) ligamentum flavum hypertrophic changes and mild facet disease is present. There is mild central spinal stenosis and moderate to significant bilateral neural foraminal compromise.L5 -- S1 and the straight mild degenerative and hypertrophy changes of posterior elements and mild disk disease without loss of disk height. No central spinal stenosis or neural foraminal compromise.

Output: 1.Nonenhanced MRI of the cervical spine demonstrate degenerative changes extending from C5 -- C6 inferiorly to upper thoracic spine as detailed. Left paracentral small disk protrusion at C5 -- C6 with resultant flattening deformity of the cord on the left and faint focus of cord T2 hyperintensity as detailed. Osteophyte laterally at C6 -- C7 with resultant flattening deformity of the cord and the subtle T2 cord hyperintensity and mild central spinal stenosis. Right paramedian small disk protrusion at C7 -- T1 with subtle flattening deformity of the cord and associated cord T2 hyperintensity. T2 hyperintensity of the cord extending on the left lateral aspect of the cord from approximately T6 inferiorly to T2 level and with decreased cord caliber/myelomalacia. Multilevel neural foraminal compromise as detailed portable.2.Nonenhanced MRI of lumbar spine demonstrate a left paramedian and left lateral shallow disk protrusion at the L1 -- L2 with resultant mild central spinal stenosis and left neural foraminal compromise. Mild to moderate degenerative disk disease and hypertrophy changes of posterior elements and extensive postop changes of prior surgery at L3 -- L4 are also noted. Although there is no significant mass effect on the thecal sac there is generalized uniform smaller than expected caliber of thecal sac in the lumbar spine and with resultant central spinal stenosis at multiple levels as detailed per level above. Neural foraminal compromise as dictated per level above.


Instruction: Generate impression based on findings.

Input: 74 year-old man with history of CVA two years ago with right-sided weakness. Now alert and oriented x 0 with increased right-sided weakness. There are multiple areas of periventricular, subcortical, and cortical hypodensity. The most prominent is a region of cortical hypodensity with encephalomalacia in the left occipital lobe. This was present on the prior study dated 5/8/2006. There is a smaller left parietal hypodensity which was also present on the prior study. The subcortical hypodensities in the left parietal region appear more pronounced on the current study. MRI could better determine whether or not this represents an acute event. There are no CT findings of intracranial hemorrhage.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Increased prominence of left parietal subcortical hypodensities. MRI is recommended to evaluate for acute stroke.2. Stable findings of periventricular, subcortical, and cortical hypodensities consistent with prior stroke and small vessel ischemic disease.2. No CT evidence of intracranial hemorrhage.


Instruction: Generate impression based on findings.

Input: T1N0 squamous cell carcinoma of the right oral tongue here for initial consultation. There may be minimal signal abnormality along the right lateral oral tongue related to tumor excision, but there is otherwise no discernible gross tumor in the oral tongue or other portions of the upper aerodigestive tract. The imaged cervical lymph nodes are not particularly enlarged. The major salivary glands and thyroid gland are unremarkable. There is an anterior disc-osteophyte complex at C5-6. The imaged portions of the orbits and intracranial structures are unremarkable.

Output: Findings attributable to right oral tongue tumor excision, but no evidence of gross residual or recurrent tumor. No evidence of significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 92 year-old female with hypertensive urgency. Rule out CVA. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. There is an old left basal ganglia lacunar infarct. If there is strong clinical concern for an acute stroke, an MRI may be considered for further evaluation.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No definite evidence of acute intracranial abnormality. Small vessel ischemic disease and old lacunar infarct.


Instruction: Generate impression based on findings.

Input: 65-year-old male patient with medial sided knee pain for six weeks. No trauma. Evaluate for injury to account for pain. MENISCI: There is complex tearing of the posterior horn of the medial meniscus with radial and vertical components. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is generalized thinning of the weightbearing articular cartilage of the lateral femoral condyle and lateral tibial plateau. There is marked thinning of the articular cartilage of the weightbearing portion of the medial femoral condyle. There is a partial-thickness defect within the lateral facet of the patellar articular cartilage.There is a crescentic region of low signal intensity on T1 and T2-weighted images within the weightbearing portion of the medial femoral condyle with significant surrounding increased T2 signal compatible with bone edema (image 17, series 1101 and image 17, series 1201). These findings are consistent with an osteochondral fracture. No intervening T2 signal intensity is identified to suggest instability. The underlying cartilage is intact though markedly thinned.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Osteochondral fracture of the medial femoral condyle without evidence of instability and surrounding bone edema.2. Complex tearing of the posterior horn of the medial meniscus.3. Chondromalacia.


Instruction: Generate impression based on findings.

Input: History of metastatic melanoma. MRI brain for RT treatment planning after ventriculostomy: headache. There is no significant interval change in the multiple intracranial metastases with associated vasogenic edema, including within the bilateral cerebellar hemispheres, left middle frontal gyrus, left superior frontal gyrus, and left hippocampal tail. There is confluent T2 hyperintensity surrounding the lesions. There is no evidence of intracranial hemorrhage or acute infarct. The ventricular system is unchanged. There is no midline shift or herniation. There is mild scattered subcortical and confluent periventricular white matter T2 hyperintensity without associated enhancement. The major cerebral flow voids are intact. The orbital contents are grossly unremarkable. However, there is a subcentimeter exophytic cystic lesion in the skin along the left lateral eyelid region, which may represent a hidrocystoma. There is an apical scalp lipoma that measures 7 mm in thickness. There are scattered paranasal sinus retention cysts.

Output: Multiple supratentorial and infratentorial metastases with vasogenic edema, but no midline shift or herniation.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with pancreatic cancer and new onset of difficulty speaking and spelling. A small resection cavity is evident within the left parietal operculum showing hemosiderin staining and mild intrinsic T1 hyperintensity. No concerning enhancement is seen within or adjacent to the cavity. Only minimal T2 hyperintense signal is evident surrounding the cavity. A 2 mm focus of enhancement within the left cerebellar hemisphere is new when compared to the prior examination. This lesion causes no detectable edema in the adjacent parenchyma.No other pathologic intracranial enhancement is suspected. A cavernoma with an associated developmental venous anomaly is again seen in the right parietal lobe showing no significant interval change. Scattered small foci of white matter T2 hyperintensity are seen perhaps representing chronic microvascular ischemic disease. No edema or mass effect is detected. No acute intracranial hemorrhage or any abnormal fluid collections are seen. The ventricles are normal in size and morphology.

Output: 1.Expected evolution of the left parietal opercular resection cavity with no suspicious signal abnormality or enhancement.2.A 2 mm focus of enhancement within the left cerebellar hemisphere is new and concerning for a focus of metastatic disease.3.Stable right parietal lobe cavernoma.


Instruction: Generate impression based on findings.

Input: Recent translabyrinthine resection of a left vestibular schwannoma. There are postoperative findings related to recent left translabyrinthine resection of a left vestibular schwannoma. There is fat graft in the mastoidectomy bowl and cerebellopontine angle with a small amount of fluid in the subgaleal space posterior to the flap. There is a small amount of intrinsically T1 hyperintense material along the medial aspect of the resection cavity in the left cerebellopontine angle cistern, which may represent blood products and hemostatic material. There is also a thin curvilinear enhancing tissue in the anterior portion of the left cerebellopontine angle cistern resection cavity, which measures up to 7 mm in length, adjacent to the left trigeminal nerve root entry zone. There is a small area of partially imaged edema in the inferior left temporal lobe. The right temporal bone and internal auditory canal are unremarkable.

Output: Postoperative findings related to recent left translabyrinthine resection of a left vestibular schwannoma. Thin curvilinear enhancing tissue in the anterior portion of the left cerebellopontine angle cistern resection cavity, which measures up to 7 mm in length may represent a small portion of residual tumor wall versus granulation tissue, for example.


Instruction: Generate impression based on findings.

Input: Reason: r/o CVA History: left sided weakness, numbness, tingling The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Small foci of encephalomalacia are present along the cerebellar hemispheres bilaterally. A small focus of encephalomalacia is present along the left inferior parietal lobule. A small focus of encephalomalacia is present along the right superior parietal lobule.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a low marrow signal present throughout which is a nonspecific finding. It can be seen with younger age.Incidental is partial empty sella.

Output: 1.There is no evidence for acute ischemic infarction.2.Small foci of encephalomalacia in the cerebellar hemispheres, left occipital lobe, left inferior parietal lobule and right superior parietal lobule are suspected to be vascular related.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They are most likely vascular related, and could be related to vasculitis. Other causes such as sarcoid and demyelination are less likely. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Clinical question: Pain in right hip and down the back of right thigh. Signs and symptoms: Sciatica. Nonenhanced lumbar MRI: The lower most visualized thoracic spine and thoracic cord is unremarkable from T10 inferiorly.T12-L1 demonstrate a right para median disc protrusion minimal mass effect on the thecal sac without spinal stenosis or neural foraminal compromise. Findings demonstrate interval decreased size since prior study.L1-L2 demonstrate minimal degenerative changes and unremarkable otherwise.L2-L3 demonstrate advanced disc disease with significant loss of disc height, mild bilateral ligamentum flavum hypertrophy and mild facet disease. There is broad-based bulging disc however with interval decreased size of a right para median disc region with inferior migration since prior study. There is residual extruded disc posterior to the vertebral body of L3 on the right and with resultant right lateral recess compromise however without evidence of spinal stenosis or neural foraminal compromise.L3-L4 demonstrate moderate to advanced disc disease, new mild grade 1 anterolisthesis without central spinal stenosis however significant right neural foraminal compromise with interval worsening is detected.L4-L5 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy however without spinal stenosis. No significant neural foraminal compromise.L5-S1 demonstrate moderate disc disease and loss of disc height of mild facet and ligamentum flavum degenerative disease and hypertrophy. No spinal stenosis however moderate right neural foraminal compromise detected.

Output: 1.At L2-L3 there is evidence of interval decreased size of a right lateral disc extrusion inferior migration posterior to L3 level. No central spinal stenosis however right lateral recess compromise is detected.2.L3-L4 demonstrate progression of degenerative disease with resultant new mild grade 1 anterolisthesis and new significant right neural foraminal compromise.3.Interval decreased size of a right para median disc protrusion at T12-L1 however without spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: MRI on 1/24/2008 with diagnosis of the C4/5 disk. Patient with neck pain with pain in right arm and hand/numbness tingling. Please note, CT examination is very the limited in the evaluation of disk herniation. Within this limitation, the following observations are made.The bony density and alignment of the cervical spine is normal. Degenerative disk disease affects the cervical spine, most severe at the C5/C6 and C6/C7 vertebral levels. Findings by specific intervertebral level are as follows:C2/C3: Unremarkable.C3/C4: Degenerative changes. No evidence of neural foraminal narrowing or central spinal canal stenosis.C4-C5: Degenerative bulge of disk material. The neural foramina are narrowed bilaterally, right greater than left, which appear similar to the prior examination.C5-C6: Advanced degenerative disk disease with near complete loss of disk height. A large epidural hypertrophic spur is seen on the right and there is questionable right neural foramina narrowing. I cannot evaluate for disk herniation on this noncontrast CT examination. In review of the prior MRI, no definite herniation of disk material is seen. Findings on prior MRI appear to represent calcific hypertrophic changes secondary to degenerative disease rather than disk herniation.C6/C7: Advanced degenerative disk disease and mild bilateral neural foraminal narrowing.C7/T1: Unremarkable.T1/T2: Unremarkable.

Output: Advanced degenerative disk disease, most severe at the lower cervical spine levels. Please note, I cannot evaluate for disk herniation on this noncontrast CT examination. However, in correlation with today's examination, no definite disk herniation is identified on the prior MRI examination dated 1/24/2008 and the previously seen findings are believed to be represent calcific hypertrophic changes of degenerative disease.


Instruction: Generate impression based on findings.

Input: 72-year-old female with left knee pain. Rule out meniscal injury. MENISCI: There is increased signal intensity within the inner third of the posterior horn of the medial meniscus indicating a radial tear with fluid signal intensity entering the undersurface of the posterior horn of the medial meniscus within the white zone indicating additional undersurface tearing. Overall the tears are seen on 4 consecutive sagittal images,. There is globular signal intensity which extends into the body of the medial meniscus indicating intrasubstance degeneration. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is increased signal intensity and mild thinning of the articular cartilage of the medial facet of the patella indicating mild degeneration, considering the patient's age. There is linear increased signal intensity within the deep fibers of the articular cartilage of the medial facet of the patella which may represent focal delamination. There is also mild degeneration of the articular cartilage of the medial femoral condyle above and anterior to the posterior horn of the medial meniscus. The lateral compartment articular cartilage appears normal for age. There are small patellar osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Medial meniscus tear involving the inner fibers as described above.2. Mild cartilage degeneration.3. Small lobulated collection of fluid along the posteromedial aspect of the knee that may reflect a small ganglion or fluid within the semimembranosus tibial collateral ligament bursa.


Instruction: Generate impression based on findings.

Input: 25-year-old female with bilateral knee pain and stiffness and swelling. MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: Minimal heterogeneous bone marrow signal abnormality consistent with residual islands of red marrow. No full-thickness or near full-thickness articular cartilage defects are identified. LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Nonspecific subcutaneous edema along the lateral and posterior aspect of the knee. Otherwise, no specific findings to account for the patient's knee pain and stiffness or swelling.


Instruction: Generate impression based on findings.

Input: Shoulder pain after fall off bike and hit by car 10 weeks ago. Evaluate for labral tear. ROTATOR CUFF: The supraspinatus, infraspinatus, subscapularis, and teres minor tendons are intact without evidence of partial or full-thickness tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral articular cartilage is unremarkable. No evidence of labral tear.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: No evidence of a labral tear or other findings to account for pain.


Instruction: Generate impression based on findings.

Input: Female, 59 years old, with back pain and new incontinence. Evaluate for cauda equina syndrome. Cord compression protocol:No evidence of acute cord compression is seen. Multilevel disc osteophyte formation is seen at C4-5 and C5-6 as well as L4-5 resulting in some degree of spinal canal narrowing. These findings are better assessed on dedicated imaging. No epidural abnormalities are suspected. No pathologic marrow replacement or edema is seen.Cervical spine:Image quality is limited by motion artifact. Sagittal alignment is grossly anatomic. Vertebral body heights are preserved. No pathologic marrow replacement or edema is seen. No definite areas of spinal cord signal abnormality are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: No spinal canal stenosis or neuroforaminal narrowing. C4-5: Posterior disc-osteophyte complex formation with mild to moderate spinal canal compromise and perhaps slight deformation of the spinal cord. Mild right foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with mild spinal canal compromise. Mild to moderate right foraminal narrowing. C6-7: Mild posterior disc-osteophyte complex formation. No significant spinal canal compromise. Moderate right and mild left foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. Lumbar spine:The lumbar lordosis is straightened. There is a grade 1 anterolisthesis of L4 relative to L5. Vertebral body heights are preserved. Scattered degenerative endplate irregularity and Schmorl's node deformities are seen. No pathologic marrow replacement or edema is detected. Degenerative endplate signal change is noted at L4-5.The visualized distal spinal cord and conus are within normal limits. No epidural abnormalities are suspected.Multiple foci of apparent metallic artifact are seen along the posterior elements on the left at L4 and L5 suggesting the possibility of prior surgery.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: No significant spinal canal stenosis or neuroforaminal narrowing. L3-4: Mild facet arthropathy. No significant spinal canal stenosis or neuroforaminal narrowing. L4-5: Facet arthropathy with deformity along the left facet in particular. Bulging disc with a left paracentral/foraminal protrusion. The left lateral recess is effaced. The spinal canal is in general mildly narrowed. Moderate bilateral foraminal narrowing is seen. L5-S1: Facet arthropathy again with deformity along the left facet in particular. Bulging disc asymmetric to the right. No significant spinal canal stenosis. Severe right and moderate left foraminal narrowing.

Output: 1.No evidence of acute cord compression as assessed on the cord compression protocol examination.2.Posterior disc-osteophyte complex formation in the cervical spine resulting in spinal canal narrowing at C4-5 and C5-6. Scattered mild to moderate foraminal narrowing is also seen in the cervical spine.3.Findings are seen in the lumbar spine along the left posterior elements of L4 and L5 suggesting prior surgery. Correlation with surgical history is recommended.4.Disc degeneration and posterior element hypertrophy at L4-5 result in a mild spinal canal stenosis as well as moderate bilateral foraminal narrowing. Disc degeneration and posterior element hypertrophy at L5-S1 contribute to a severe right and moderate left foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: ? meniscal injury History: Knee pain. MENISCI: Complex tear of the posterior horn of the medial meniscus. This consists of a large radial component involving the inner two thirds of the meniscus. Lateral to this the root of the posterior horn appears unusually large which likely represents displaced adherent meniscal tissue. Additional signal is noted more medially within the posterior horn. The anterior horn and body of the medial meniscus is relatively preserved. There is slight medial extrusion of the body. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the weight-bearing portion the medial femoral condyle with possible full-thickness degeneration along the medial tibial plateau. Mild subchondral edema type signal within the far medial aspect of the medial femoral condyle is likely degenerative in etiology. The articular cartilage of the lateral compartment is relatively preserved. There is a subcentimeter full-thickness defect of the articular cartilage of the medial facet of the femoral trochlea. A subcentimeter linear focus of intermediate signal intensity that appears to arise from the superior aspect of the trochlear cartilage may represent a displaced trochlear cartilage flap.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Complex tear of the posterior horn of the medial meniscus.2. Cartilage defect/degeneration as described above.3. Moderate size joint effusion and small Baker's cyst.


Instruction: Generate impression based on findings.

Input: History of MS, with brain and spinal cord lesions. Brain: There are numerous supratentorial and infratentorial T2 hyperintense lesions. Many of the lesions are also T1 hypointense, but small lesions in the left corona radiata and peritrigonal white matter demonstrate enhancement. There is no evidence of intracranial hemorrhage or mass. 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.Spine: There are numerous patchy T2 hyperintense lesions in the cervical spinal cord and perhaps in the conus medullaris region. The thoracic spinal cord otherwise appears to be relatively spared. There is no evidence of enhancing lesions in the spinal cord. There is no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: Numerous intracranial and spinal cord demyelinating lesions, with acutely inflamed lesions in the left corona radiata and peritrigonal white matter.


Instruction: Generate impression based on findings.

Input: There are 5 lumbar-type vertebral bodies presumed to be present. The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. There is redemonstration of a 12 mm T1 and T2 hyperintense lesion in the L2 vertebral body, likely a hemangioma, which is unchanged from the prior exam, but increased in size compared to prior MRI dated 7/5/2007. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is multilevel facet degenerative changes. Level by level degenerative changes are as follows:L1-L2, L2-L3, L3-L4 and L4-L5 intervertebral disc spaces show no evidence of disc bulge, significant neural foraminal stenosis or spinal canal stenosis.At L5-S1, there is mild narrowing of the disc as well as disc desiccation. There is an annular fissure and small central disc protrusion, unchanged when compared to the prior exam. The disc protrusion may be abutting the right S1 nerve root but without any mass effect or displacement.

Output: 1. Degenerative changes in the lumbar spine predominantly at the L5-S1, where there is a stable small central disc protrusion probably abutting the right S1 nerve root at the lateral recess.2. L2 vertebral body lesion most likely representing a hemangioma, without change from the immediate prior exam. 3. No evidence of significant neuroforaminal or spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: Increasing seizure activity with right temporal EEG abnormalities. The hippocampi appear to be grossly unremarkable. There is no evidence of cortical heterotopia or discernible cortical malformation. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few nonspecific areas of T2 hyperintensity in the cerebral white matter, particularly in the frontal lobes. There are prominent perivascular spaces in the bilateral parietal lobes. 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 and scalp soft tissues are unremarkable. There is mild plagiocephaly. There is a small retention cyst in the left maxillary sinus.

Output: Few nonspecific areas of T2 hyperintensity in the cerebral white matter, particularly in the frontal lobes. Otherwise, the hippocampi appear to be grossly unremarkable, without discernible potential seizure foci.


Instruction: Generate impression based on findings.

Input: Female 25 years old with history of ascending numbness There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter primarily within the frontal and parietal lobes. Additional lesions noted within the bilateral posterior limbs of the internal capsule, adjacent to the right temporal horn, and posterior fossa including the bilateral right greater than left cerebral peduncles. The right middle cerebral peduncle lesion is located near the trigeminal nerve root entry zone.Thinning of the periventricular white matter in the bilateral parietal regions as well as a diminutive posterior corpus callosum noted. There is mild to moderate dilatation of the lateral and third ventricles and relatively normal size of the fourth ventricle. Cerebral aqueduct is grossly patent.No midline shift or herniation. The calvarium and extracranial soft tissues are grossly unremarkable.

Output: 1. Multiple supratentorial and infratentorial T2/FLAIR hyperintense lesions in the brain with a distribution suspicious for chronic demyelinating disease. These lesions do not demonstrate enhancement to suggest active demyelination.2. Dilatation of the third and lateral ventricles with grossly patent cerebral aqueduct. There is significant thinning of the parietal-occipital white matter and the posterior corpus callosum. Overall findings are favored to represent chronic hydrocephalus (favored communicating hydrocephalus, less likely but possible low-grade obstruction at the cerebral aqueduct). The thinning of the white matter is favored to be related to the long-standing hydrocephalus although possibility of perinatal injury resulting in the white matter volume loss remains and can be correlated with history.


Instruction: Generate impression based on findings.

Input: 79-year-old female with history of pancreas divisum and a pancreatic IPMN. Previous MRI/MRCP in 2013. Surveillance. ABDOMEN:LIVER, BILIARY TRACT: 11 mm non-enhancing T1 hypointense lesion in the right hepatic lobe is unchanged, only evident on T1-weighted imaging, uncertain whether artifactual or a benign lesion such as a cyst, stable from prior MRI exam. This is not seen on T2 or diffusion weighted images, may be due to slice thickness. Punctate arterially enhancing focus in hepatic segment 7, most likely a perfusional defect. Otherwise, no focal hepatic lesions.No intrahepatic biliary ductal dilation. The extrahepatic bile duct measures 8 mm, unchanged. Cholelithiasis without choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas divisum is again noted, with normal pancreatic parenchymal signal. The mildly dilated main pancreatic duct measures 7 mm, unchanged, and drains via the minor papilla. The ovoid T2 hyperintense lesion in the uncinate process measures 9 x 9 mm on MRCP images, previously 8 x 7 mm, and again appears to communicate with the ventral pancreatic duct. Additional punctate T2 hyperintense foci are seen in the pancreas, likely representing sidebranch IPMNs. No solid pancreatic lesions are noted. No ampullary lesion identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral renal cysts are again noted, with a hemorrhagic cyst in the left kidney upper pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: 2.6 cm cystic lesion in the right hemipelvis appears similar to prior, though is incompletely characterized.

Output: 1. Pancreas divisum, with unchanged mildly dilated main pancreatic duct draining via the minor papilla.2. Minimally increased size of the subcentimeter pancreatic intraductal papillary mucinous neoplasm (IPMN).


Instruction: Generate impression based on findings.

Input: 60 year old with history of pulmonary sarcoidosis with irregular heart beat presenting for structural evaluationMEDICATIONS: albuterol inhaler First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 195 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 88 ml (normal range 47+/-19), the LV mass index is 37 g/m2, and the LV mass is 83 g. There are no regional wall motion abnormalities present. No intracardiac thrombus.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 93 ml/m2 (normal range 82+/-16), the RVEDV is 209 ml (normal range 142+/-31), the RV end systolic volume index is 48 ml/m2 (normal range 31+/-9), and the RVESV is 108 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThere is a high signal focus in the right posterior medial lung, recommend PA/LAT chest xray for further evaluation. No significant lymphadenopathy.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Normal LV size and systolic function (LVEF 55%).4. Normal RV size and systolic function (RVEF 48%).


Instruction: Generate impression based on findings.

Input: Intermittent paresthesias. Evaluate for demyelination. Brain:Brain parenchyma is essentially within normal limits for age. There are two tiny T2 hyperintense foci in the subcortical right frontal white matter which are nonspecific. There is no other parenchymal signal abnormality lesion. Corpus callosum is also preserved in volume and signal. There is no abnormal signal along the callosal septal interface. There is no brainstem or cerebellar lesion. The ventricles and other CSF containing spaces are normal in size. The major intracranial vessels are patent.The orbits are normal. Mastoid air cells and middle ear cavities are clear. The paranasal sinuses are grossly clear.Cervical Spine:The cervical spinal cord down and upper thoracic cord to the T4-T5 level shows normal morphology and signal. Spinal alignment is anatomic. Vertebral body heights are preserved. Bone marrow signal is benign. The disc heights are also preserved. There is no significant spinal canal or neural foraminal stenosis at any level.

Output: 1.Brain MRI is essentially unremarkable. There are two tiny right frontal white matter lesions which while nonspecific are not particularly suggestive of demyelinating disease.2.There is no cervical spinal cord abnormality to suggest demyelinating lesion. 3.No spinal canal or neural foraminal stenosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Metastatic carcinoma of the lung status post craniotomy, adjuvant SRS, and most recently carbo/taxol. There are postoperative findings related to right suboccipital craniotomy with persistent subcentimeter nodular and linear areas of enhancement along the margins of the resection cavity, which overall appear to have slightly diminished. There is no evidence of acute infarction. The ventricles are unchanged in size and configuration. There is a new nodular areas of enhancement in the right posterior upper neck paraspinal soft tissues that measure up to 19 mm. There is a left maxillary sinus retention cyst.

Output: 1. Postoperative findings related to right suboccipital craniotomy with persistent areas of enhancement along the margins of the right cerebellar hemisphere resection cavity that may represent treatment effects, although small amounts of residual tumor cannot be entirely excluded.2. New nodular areas of enhancement in the right posterior upper neck paraspinal soft tissues that measure up to 19 mm may represent tumor deposits versus treatment effects, such as organizing hematomas.


Instruction: Generate impression based on findings.

Input: Reason: hx of lung CA, eval mets,pls compare to previous History: none The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of signal loss on SWI present within the right cerebellar hemisphere measuring 12x4mmThere are small foci of encephalomalacia along the cerebellar hemispheres.Punctate T2 hyperintense lesions are identified on T2 but not FLAIR within the right pons, left thalamus and right caudate nucleus. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Incidental note is made of partial empty sella.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.There is no evidence for brain metastases. 2.Punctate T2 lesions within the cerebellar hemispheres, right pons, left thalamus and right caudate nucleus are likely vascular related. 3.Findings suggest old hemorrhage in the right cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracerebral hemorrhage in cerebellum [I61.4], Reason for Study: ^Reason: rule out intracranial mets given known endometrial ca History: pls see above Brain MRIThere are multifocal restricted diffusion lesions on bilateral hemispheres (right worse than left) as well as left caudate nucleus posterior body with some susceptibility artifacts on the right occipital lobe and right inferior parietal lobule lesion indicating focal hemorrhagic conversions.Previously seen right cerebellar hemispheric and vermian ICH with surrounding edema are re-demonstrated.On contrast enhanced scan, there are multiple nodular enhancements especially on the left frontal lobe just around the left pre central gyrus, bilateral occipital lobes and lateral aspect of the right cerebellar hematoma and left cerebellar hemisphere. These lesions could represent metastatic nodules. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D 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. No evidence of intracranial arterial aneurysm. No evidence of intracranial arterial luminal stenosis.

Output: 1. Multifocal acute ischemic infarctions with focal hemorrhagic conversions as described above.2. Multiple both supra and infra tentorial enhancing lesions suggest possible metastatic lesions as described above. 3. Unchanged right cerebellar and vermian hematoma with surrounding edema.4. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: 69 year old female with known left IDC and right DCIS for MR study. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.RIGHT BREAST:There is regional non-mass enhancement at 2:00 - 4:00 position, measuring 30 x 35 x 16 mm (AP x LR x CC), corresponding to the area of malignant calcifications. Medial and inferior to the non-mass enhancement, there is a 6 x 6 x 6 mm enhancing mass, likely corresponding to the focal asymmetry on mammogram. There is an additional linear non-mass enhancement measuring 9 mm in AP direction, located posteriorly from the small mass. Overall size of all these abnormal findings is 47 x 35 x 16 mm.LEFT BREAST:There is a rim-enhancing mass, measuring 17 x 14 x 16 mm, at 2:00 position, with a marker clip. This is a proven IDC.AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: 1. Non-mass enhancement with small mass in the right upper- lower inner aspect. Non mass enhancement corresponds to the area of DCIS, and the mass corresponds to the focal asymmetry on mammogram.2. Biopsy procen IDC at 2:00 position in the left breast.3. No abnormal lymph nodes in either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 70 year old male with amyloidosis, s/p autologous SCT 5/2016, severe coronary atherosclerosis, HTN. Cardiac MRI 4/2016 with evidence of early cardiac amyloidosis but atypical findings noted (asymmetric hypertrophy, atypical LGE pattern). Referred for cardiac MRI to reassess for amyloidosis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%, the LVEDV is 190 ml (normal range 142+/-34), the LV end diastolic volume index is 86 ml/m2 (normal range: 74+/-15), the LVESV is 82 ml (normal range 47+/-19), the LV end systolic volume index is 37 ml/m2 (normal range 25+/-9), the LV mass is 107 g (normal range 164+/-36), and the LV mass index is 48 g/m2 (normal range 85+/-15). There are no regional wall motion abnormalities present. No intracavitary thrombus noted.  There is mild asymmetric left ventricular basal septal hypertrophy (septal thickness 14 mm; posterior wall thickness 8 mm) similar to previous Cardiac MR study. There is persistent focal mid-wall late gadolinium enhancement involving the basal inferoseptal wall which is atypical for infarction, and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This is similar to the previous study.The native myocardial T1 relaxation times were not reliably obtained.Left AtriumThe left atrium is moderately dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 54%, the RVEDV is 181 ml (normal range 142+/-31), the RV end diastolic volume index is 81 ml/m2 (normal range 82+/-16), the RVESV is 83 ml (normal range 54+/-17), and the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9).Right AtriumThe right atrium is moderately dilated.Aortic ValveThe aortic valve is trileaflet and opens widely with no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. There is posterior mitral annular calcification. There is no systolic anterior motion of the mitral valve.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 57%), stable form prior.2. Persistent asymmetric basal septal hypertrophy with focal late gadolinium enhancement in a "mid-wall stripe pattern" involving the hypertrophied basal inferoseptal wall similar to previous Cardiac MR study. This finding is still considered indeterminate for cardiac amyloidosis and may be seen in other infiltrative or inflammatory entities. This pattern is atypical for an ischemic etiology. Native myocardial relaxation T1 time values were not reliable.3. The right ventricle is normal in size with normal systolic function (RVEF 54%).4. Biatrial dilation.


Instruction: Generate impression based on findings.

Input: 68 year old man with significant burden of ventricular ectopy, referred for cardiac MRI for evaluation of possible underlying myocardial scar prior to EP study/ablation. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%, the LV end diastolic volume index is 115 ml/m2 (normal range: 74+/-15), the LVEDV is 280 ml (normal range 142+/-34), the LV end systolic volume index is 63 ml/m2 (normal range 25+/-9), the LVESV is 153 ml (normal range 47+/-19), the LV mass index is 62 g/m2 (normal range 85+/-15), and the LV mass is 151 g (normal range 164+/-36). LV dysfunction is global. There are 2 distinct regions of late gadolinium enhancement in a pattern that is atypical for prior myocardial infarction suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is mid-wall late gadolinium enhancement and involves the basal inferolateral wall and the basal anteroseptum. This pattern has frequently been described in old myocarditis, but can represent other non-ischemic etiologies as well. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%, the RV end diastolic volume index is 109 ml/m2 (normal range 82+/-16), the RVEDV is 265 ml (normal range 142+/-31), the RV end systolic volume index is 58 ml/m2 (normal range 31+/-9), and the RVESV is 140 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 45%.2. There are 2 distinct regions of late gadolinium enhancement in a pattern that is atypical for prior myocardial infarction suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. The pattern is mid-wall and involves the basal inferolateral wall and the basal anteroseptum and has frequently been described in old myocarditis, but can represent other non-ischemic etiologies as well. 3. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 47%.4. Mild dilation of the main pulmonary artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 years Male (DOB:6/5/1947)Reason: evaluate for brain metastatic disease History: renal cell CAPROVIDER/ATTENDING NAME: JAMES X TAO JAMES X TAO The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The cerebellar tonsils are low lying.

Output: There is no evidence for brain metastases. Please note that contrast-enhanced exams or more sensitive for the detection of metastatic disease compared to noncontrast exams.


Instruction: Generate impression based on findings.

Input: Meningioma. There is an enhancing dural based mass along the left frontal convexity that measures up to 15 mm in width, which is not significantly changed since 2009. Likewise, there is an enhancing dural based mass along the right frontal convexity that measures up to 5 mm in width, which is not significantly changed since 2009. There is no associated edema in the underlying brain parenchyma. There is no evidence of acute intracranial hemorrhage or acute infarct. There are mild nonspecific T2 hyperintense foci in the cerebral white matter, which likely represent chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull appears unremarkable. There is an enhancing right occipital scalp nodule with areas of low T2 signal that measures up to 21 mm, previously 18 mm.

Output: 1. No significant change in the bilateral frontal convexity meningiomas, left larger than right.2. An enhancing right occipital scalp nodule continues to increase in size and may represent a fibrous tumor, for example.


Instruction: Generate impression based on findings.

Input: 51-year-old male patient with pain. Question of rotator cuff tear. ROTATOR CUFF:There is linear fluid signal intensity within the substance of the supraspinatus at its insertion on the greater tuberosity indicating a concealed tear. The tear measures approximately 1.5 cm in the AP dimension. We see no disruption of either surface of the tendon, although the tear does extend through the distal most fibers of the tendon to the surface of the greater tuberosity. Mild edema type signal more proximally along the myotendinous junction of the supraspinatus could represent a mild strain or edema due to impression by the overlying bones of the acromioclavicular joint. The infraspinatus tendon/muscle is intact. There is mild to moderate fatty atrophy of the teres minor muscle of uncertain etiology or clinical significance, but the deltoid muscle is normal. The subscapularis muscle/tendon is normal in appearance.SUPRASPINATUS OUTLET: Mild osteoarthritis affects the acromioclavicular joint with small osteophytes resulting in mild impression on the superior fibers of the supraspinatus. We see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. We see no effusion. Intermediate signal intensity within the superior labrum particularly posteriorly is suggestive of degeneration or degenerative tearing. Rounded low signal intensity along the anterior and inferior aspect of the labrum is of uncertain etiology but may represent redundant capsular structures as the patient's arm is held in internal rotation. Alternatively, this could represent degenerative tearing of the labrum if the patient complains of instability. Further evaluation with MR arthrography can obtained if clinically warranted. Small cysts are noted in the posterolateral humeral head.BICEPS TENDON: Given limitations of a nonarthrogram study, the tendon of the long head of the biceps appears normal.

Output: 1. Concealed tear of the insertional fibers of the supraspinatus with mild edema along the myotendinous junction which may represent a strain or edema due to impression of the overlying structures of the acromioclavicular joint.2. Mild to moderate atrophy of the teres minor muscle of uncertain etiology or significance. 3. Acromioclavicular joint osteoarthritis.4. Labral degeneration/degenerative tearing as described above. If further imaging is clinically warranted, MR arthrography can be obtained.


Instruction: Generate impression based on findings.

Input: Clinical question: Possible stroke. Signs and symptoms: Left upper and/or extremity weakness. Nonenhanced head CT:Examination demonstrates a large area of vasogenic edema in the right frontal lobe there there is an isodense mass measuring 14 times 17-mm in size within the area of vasogenic edema. There is resultant effacement of adjacent cortical sulci however no midline shift is present. There is no evidence of hemorrhage associated with this finding. A questionable area of low attenuation in the inferior aspect of the left cerebellum may represent an additional focus of edema and or an artifact. Recommend follow-up with an MRI exam.

Output: 1.Right frontal lobe tumor measuring 17 times 14-mm in size with surrounding vasogenic edema.2.Either artifact or an additional small foci of edema in the inferior left cerebellum.3.Recommend follow-up with an MRI.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (8/4/15, 8/6/15, 9/1/15), ultrasound images of left breast (8/4/15, 8/6/15, 9/1/15), images from ultrasound guided biopsy of left breast and postprocedural left mammographic images (9/1/2015), breast MRI (9/9/15) performed at Adventist Hinsdale Hospital. For comparison, digital mammographic images (4/9/14, 12/11/12), ultrasound images (4/9/14, 12/11/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (8/4/15, 8/6/15, 9/1/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker is placed at upper outer quadrant of left breast, denoting the area of palpable lump. There is a developing focal asymmetry with architectural distortions at the site of palpable lump, at the upper outer quadrant in the left breast, measuring approximately 4 cm.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. 'ULTRASOUND IMAGES OF LEFT BREAST (8/4/15, 8/6/15, 9/1/15):An irregularly shaped hypoechoic mass is visualized at 1:30 position in the left breast measuring 17 x 10 mm. The lesion is unchanged in one month follow-up.A normal appearing lymph node is visualized in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (9/1/2015):Ultrasound guided biopsy was performed for the mass at 1:30 position in the left breast, with an appropriate needle placement. A marker clip is placed at anterior-medial aspect of the focal asymmetry with distortion at upper outer quadrant. Per outside radiology report, the biopsy result was malignant; invasive lobular carcinoma.BREAST MRI (9/9/15):Imaging protocol is outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.In the left breast, there is a large irregularly shaped mass at upper outer quadrant measuring 47 x 43 x 44 mm (AP x LR x CC). This enhancing lesion corresponds to the proven carcinoma, but the size of the lesion appears larger in the MRI. No abnormal enhancing lesions in the right breast.No abnormal lymph nodes are identified in either axillary region.

Output: Biopsy proven invasive lobular carcinoma in the left breast. Size of the tumor is larger on the MRI than on the conventional imaging.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Cerebellar hemorrhage. Signs and symptoms: Cerebellar hemorrhage. Nonenhanced brain MRI:No evidence of restricted diffusion on diffusion weighted studies.Examination demonstrates a focus of susceptibility/hemorrhage in the left cerebellum with subtle surrounding vasogenic edema without into change since the prior CT examination from 4 -- 24 -- 2015. Hematoma measures 9.5 x 8-mm in transaxial dimensions and without interval change or appreciable mass effect. The fourth ventricle remains within normal and in midline.Unremarkable images through posterior fossa otherwise.Images through the supratentorial space demonstrate patchy periventricular and subcortical flair/T2 hyperintensity highly suggestive of small vessel ischemic strokes of mild degree without evidence of hemorrhagic changes.Unremarkable cerebral cortex and cortical sulci as well as ventricular system and CSF spaces otherwise. The signal voids of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. Paranasal sinuses are well pneumatized however a retention cyst in the left maxillary sinus is noted. Bilateral mastoid air cells and there cavities demonstrate normal pneumatization signal patterns.Nonenhanced brain MRA: Patent bilateral intracranial vertebral arteries, bilateral pedicle branches, plaster are free and its distal branches. Mild atherosclerotic disease of right vertebral artery without significant vascular lumen compromise is noted.Patent right internal carotid artery however but it is some mild atherosclerotic disease of the cavernous segment and unremarkable otherwise. Patent right anterior and middle cerebral arteries and their branches. Mild atherosclerotic irregularity of the M1 segment of right middle cerebral artery is noted.Patent left internal carotid artery across the skull base however with mild atherosclerotic irregularity of its cavernous portion. Unremarkable left supraclinoid internal carotid, the left anterior and middle cerebral arteries.

Output: 1.Left cerebellar acute hematoma measuring 9.5 x 8-mm with subtle surrounding vasogenic edema and no appreciable mass-effect. Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres. 2.Mild atherosclerotic disease of the bilateral cavernous carotids and right vertebral artery without significant vascular lumen compromise and unremarkable nonenhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Left leg weakness, increased severity. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is partial ankylosis involving the C6 and C7 vertebral bodies likely representing a developmental segmentation anomaly. There is mild reversal of cervical lordosis with apex at the C4-C5 level where there is a prominent disc osteophyte complex. Bone marrow signal is benign with marrow signal changes at the C4-C5 levels on a degenerative basis.There is flattening of the cord at the C4-C5 level as described below. Cervical cord is otherwise normal in signal characteristics and morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: There is a prominent disc osteophyte complex with moderate to severe spinal canal stenosis. There is mild flattening of the cervical cord, particularly on the left. No definite cord signal abnormality. There is mild to moderate left and mild right neural foraminal stenosis. C5-6: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Degenerative changes at C4-C5 level with moderate to severe spinal canal stenosis at this level. There is mild flattening of the cord, particularly on the left, without definite cord signal abnormality.2. Partial fusion involving the C6 and C7 vertebral bodies which likely represents a developmental segmentation anomaly.3. Additional details as above.


Instruction: Generate impression based on findings.

Input: 52-year-old female with recent episode of severe epigastric pain. She has had 2 courses of chemotherapy for Hodgkin's lymphoma in the past. Today colonoscopy and EGD were performed and did not explain her symptoms. ABDOMEN:LIVER, BILIARY TRACT: No discrete hepatic lesions. No intra or extrahepatic biliary ductal dilatation. Tiny hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is mildly prominent. A tiny cystic lesion of the pancreatic head (coronal series 4 image 25) is favored to represent a tiny sidebranch type IPMN.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Incidental note is made of an infrarenal left IVC. No lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No acute abnormality is identified.2.Tiny cystic lesion of the pancreatic head is likely a sidebranch type IPMN.


Instruction: Generate impression based on findings.

Input: Clinical question: Assess for spinal stenosis. Signs and symptoms: Myelopathy and unsteady gait. Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.The signal intensity of vertebral column demonstrate changes consistent with degenerative disease.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes and a small centrally located disc protrusion resulting in effacement of ventral subarachnoid space and mild flattening deformity of the cord without central spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes resulting in mild central spinal stenosis, moderate right and mild left neural foraminal compromise.C5-C6 demonstrates moderate disc disease and loss of disc height and mild facet disease. Mild bilateral (L>R) neural foraminal compromise and no central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild facet and ligamentum flavum degenerative changes. Constellation of findings results in moderate to severe left and mild right neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate moderate disc disease and loss of disc height, mild ligamentum flavum and facet hypertrophic changes. There is resultant moderate to severe bilateral neural foraminal compromise and no central spinal stenosis. Upper most visualized thoracic spine demonstrate no spinal stenosis.

Output: 1.Degenerative changes of cervical spine results in multilevel bilateral neural foraminal compromise (some severe) as detailed per level above.2.Tiny central disc protrusion at C3-C4 results in mild central spinal stenosis.3.Mild central spinal stenosis is also noted at C4-C5 secondary to degenerative disease.4.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are multiple areas of cortical encephalomalacia involving the right frontal and left parietal lobes. There is also encephalomalacia in the bilateral cerebellar hemispheres, right more than left. There is unchanged periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. There are a few unchanged scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a prominent flow void indicating asymmetric prominence of the left cavernous ICA. Please see the accompanying MRA for further characterization. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. MRA Brain: Again demonstrated is ectasia of the left cavernous ICA segment and a similar appearing left ophthalmic segment carotid artery aneurysm that measures up to 6 mm. The neck of the aneurysm is approximately 5 mm wide. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The distal right V4 segment is developmentally diminutive post-PICA. The vertebral arteries, basilar artery, and posterior cerebral arteries also otherwise patent without significant stenosis.

Output: 1.No evidence of acute intracranial hemorrhage, mass or acute infarct.2.Multiple areas of encephalomalacia and chronic small vessel ischemic disease without significant change.3.No appreciable change in the ectatic cavernous portion of the left ICA or left ophthalmic segment carotid artery aneurysm that measures up to 6 mm.


Instruction: Generate impression based on findings.

Input: 44 year old man with heart block and exercise intolerance referred to evaluate for infiltrative cardiomyopathy. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 54%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 214 ml (normal range 142+/-34), the LV end systolic volume index is 44 ml/m2 (normal range 25+/-9), the LVESV is 99 ml (normal range 47+/-19), the LV mass index is 67 g/m2 (normal range 85+/-15), and the LV mass is 152 g (normal range 164+/-36). There are no regional wall motion abnormalities present. The measured native myocardial T1 relaxation time is 1036 msec (within normal limits). There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 212ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 110 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsHilar and mediastinal lymphadenopathy is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal left ventricular size with normal systolic function (LVEF 54%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with mildly reduced systolic function (RVEF 47%).3. Mild biatrial dilation.4. See extra-cardiac findings. 5. When compared to 4/25/2016, no significant change is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dizziness. Abnormal VNG with upbeating nystagmus. 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: 43 year old female with history of breast cancer, LV dysfunction on prechemotherapy echo (mildly reduced LV systolic function noted on echo, but MRI 2 days later showed normal function). Referred for cardiac MRI to reassess LV function. Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. The LVEDV is 147 ml (normal range 109+/-23), LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), LVESV is 76 ml (normal range 31+/-10), and LV end systolic volume index is 40 ml/m2 (normal range 18+/-5). The LV mass is 72 g (normal range 114+/-24) and the LV mass index is 39 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. Persistent indeterminate small focus of late gadolinium enhancement at the inferior septal wall of the left ventricle, at the insertion site of the right ventricle. There are no findings to suggest the presence of a diffuse underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 982 ms in the lateral LV wall and 1017 ms in the septum. These values are not suggestive of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%, the RVEDV is 137 ml (normal range 110+/-24), the RV end diastolic volume index is 72 ml/m2 (normal range 69+/-14), the RVESV is 74 ml (normal range 35+/-13), and the RV end systolic volume index is 40 ml/m2 (normal range 22+/-8).Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 49%. 2.The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 46%3.There is no late gadolinium enhancement to suggest the presence of a diffuse underlying fibrosing, infiltrative, or inflammatory process.4.The native T1 myocardial relaxation times are within normal limits, suggesting the absence of an underlying fibrosing, infiltrative, or inflammatory process.


Instruction: Generate impression based on findings.

Input: HCV cirrhosis. HCC screening. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology with T2 weighted reticular hyperintensity compatible with fibrosis.Left hepatic dome segment II focus of arterial enhancement measuring less than 1 cm (series 14, image 22) demonstrates no definite washout on portal venous, equilibrium or delayed phase imaging.This lesion likely represents a transient perfusion difference.No associated T2 weighted signal abnormality or restricted diffusion. Cholelithiasis without cholecystitis.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.

Output: 1. Cirrhotic liver without any focal lesions.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 64-year-old female with bloody discharge from the left nipple. Examinations performed at an Christ hospital were submitted for interpretation. BILATERAL MAMMOGRAM (4/4/2016): 2 standard views of both breasts with repeat left MLO were submitted for review. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C). Note is made of multiple bilateral subcentimeter masses for which long term stability should be confirmed. There is a focal asymmetry in the upper outer quadrant of the right breast, at posterior depth, which should also be evaluated for stability and can be further evaluated on MRI if that is performed for her nipple discharge. Note is made of bilateral benign morphology calcifications, including arterial calcifications. The left nipple appears inverted. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. TARGETED BILATERAL BREAST ULTRASOUND EXAMINATION (4/4/2016):Right Breast:Targeted right breast ultrasound examination demonstrates no focal mass lesion or cyst at images labeled at 9:00 to 11:00.Left Breast:Targeted ultrasound examination demonstrates ectatic ducts in the retroareolar region of the left breast. No focal mass lesion or cyst is identified.

Output: 1. Ectatic ducts in the retroareolar region of the left breast. Otherwise no findings to account for the patient's left sided bloody nipple discharge. Surgical consultation and consideration of further imaging with MRI are recommended for further evaluation.2. Multiple bilateral subcentimeter masses for which long-term stability should be confirmed. While multiplicity suggests benignity, submission of prior examinations for comparison is recommended. 3. Focal asymmetry in the upper outer quadrant of the right breast with a negative ultrasound. Comparison study submission would be helpful for this area as well, and it can also be further evaluated on MRI if that is performed for her nipple discharge.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: There is a punctate focus of bright signal on diffusion-weighted imaging in the left pons (series 301, image 206), with questionable corresponding low signal on the ADC map. There is no associated hemorrhage or mass effect evident. No diffuse-weighted abnormality is seen otherwise.There are mild periventricular and pontine T2 hyperintensities, which are non-specific though likely represent mild small vessel ischemic disease. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Punctate focus of bright signal in the left pons on diffusion-weighted imaging with questionable corresponding low signal on the ADC map. This may represent artifact versus a true focus of diffusion restriction secondary to small vessel ischemia. 2. Mild chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of prostate cancer. On active surveillance. Pathology dated 4/3/2015 shows a left mid gland prostate cancer with a Gleason grade of 3+3 PELVIS:PROSTATE:Prostate Size: 3.4 x 5.5 x 5.8 cmPeripheral Zone: 6 x 5 mm focus in the left mid gland (series 4 and 3/304) with restricted diffusion and corresponding subtle T2 hypointensity.Central Gland: No focal suspicious lesion.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 6 x 5 mm left mid gland lesion is compatible with the patient's known pancreatic cancer.No additional suspicious lesions.


Instruction: Generate impression based on findings.

Input: New left hand weakness. Rule out stroke. MRI: There is a small areas of cortical and subcortical diffusion restriction and T2 hyperintensity involving the postcentral gyrus, with minimal gyriform susceptibility effect. An additional punctate focus of susceptibility effect is present in the left thalamus without associated edema, which may represent focus of prior microhemorrhage. There are multiple foci of T2 hyperintensity involving the cerebral white-matter and punctate foci of encephalomalacia in the deep gray nuclei in addition to periventricular white-matter confluent T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.MRA: There is no evidence of significant steno-occlusive lesions. There appears to be mild narrowing of the anterior genu of the left cavernous internal carotid arteries and the mid left V4 segment. There is no evidence of saccular aneurysms.

Output: 1.Small acute right middle cerebral artery infarct, involving the precentral gyrus, with minimal susceptibility effect, which may represent prominent collateral blood flow or microhemorrhage, for example.2.Moderate chronic microvascular ischemia and multiple lacunar infarcts.3.No significant steno-occlusive lesions involving the large cerebral arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 86-year-old woman with history of medullary thyroid cancer and hypermetabolic pelvic mass seen on PET/CT from 10/26/2015. PELVIS:UTERUS, ADNEXA: There is a large mass arising from the left adnexa (series 7, image 28) which measures up to 88 x 62 mm in maximal axial dimension. This lesion previously measured 57 x 35 mm on the PET/CT from 9/21/2009. This lesion is predominantly solid (small cystic elements versus necrosis noted) and markedly T2 hypointense. This lesion mildly enhances in a heterogeneous pattern. The lesion crosses the midline and abuts the right ovary. Asymmetrically prominent left-sided pelvic varices are noted.BLADDER: The bladder is unremarkable.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. Of note, no ascites or peritoneal nodularity identified.

Output: Large left adnexal mass which has enlarged compared to PET/CT from 2009 and has signal characteristics suggestive of fibrous tumor given the markedly T2 hypointense signal demonstrated. The lesion shows interval growth since 2009 cross-sectional imaging. The differential for a lesion such as this one in a postmenopausal woman includes the following: An ovarian cystadenofibroma (particularly given the solid composition with small cystic elements and the minimal intralesional enhancement) or a fibroma/fibrothecoma (this however typically contains a small to no cystic portion) or a Brenner tumor (considered less likely given that this entity usually shows marked enhancement). Tissue sampling for confirmation recommended. Metastatic disease remains a consideration but medullary thyroid carcinoma has been seen to involve the ovary in only very rare instances. And if the T2 hypointense signal does in fact indicate a predominately fibrous composition, metastatic disease is highly unlikely. Also of note, no additional findings to suggest a primary ovarian malignancy, such as peritoneal nodularity or ascites, is seen. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The last well formed disk space is referred to as L5-S1. There is mild straightening of the lumbar lordosis. There is 2-mm retrolisthesis of L4 and L5. There is desiccation of the L4-5 and L5-S1 disks with moderate to severe loss of disk heights with type II degenerative endplate changes at L5-S1. The conus terminates at L1-2 and is within normal limits of size and signal intensity.T12-L1: No disk herniation or spinal stenosis. L1-2: No disk herniation or spinal stenosis. L2-3: No disk herniation. Ligamenta flava thickening and mild facet arthrosis with no significant spinal stenosis.L3-4: Mild disk bulge, ligament flava thickening and moderate facet arthrosis causing mild bilateral foraminal narrowing without significant spinal canal stenosis.L4-5: Diffuse disk bulge and osteophytic ridging of the endplates, and moderate facet arthrosis with ligamenta flava thickening causing moderate to severe spinal canal stenosis, and moderate bilateral subarticular and neural foraminal stenosis.L5-S1: Diffuse disk bulge and moderate facet arthrosis causing mild bilateral neural foraminal stenosis and no significant spinal canal stenosis.

Output: Multilevel lumbar spondylosis as described above, worst at L4-5 where there is moderate to severe spinal canal, and moderate bilateral subarticular and neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Clinical question: Ischemia. Signs and symptoms: Right-sided weakness. Nonenhanced brain MRI:Diffusion weighted images are negative for an acute ischemic stroke.There are tiny foci of periventricular and subcortical FLAIR hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Findings demonstrate tiny foci of internal susceptibility suggestive of microhemorrhages. Constellation of findings are believed to represent chronic small vessel ischemic strokes of mild degree. There is normal anatomical morphology and signal intensity of brain parenchyma otherwise on all MRI sequences area unremarkable cerebral cortex, cortical sulci, ventricular system otherwise and with maintained midline.The signal void of major intracranial arterial branches are identified.Images through the orbits demonstrate a prostheses on the right and unremarkable otherwise.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate a right paramedian disc protrusion with resultant flattening deformity and posterior displacement of the cord on the right and mild central spinal stenosis. No neural foraminal compromise and no detectable cord signal abnormality. (Finding is best appreciated on axial T2 series 1/7/2001 image 14 and sagittal T2/T2 STIR image 11).C6-C7 demonstrate a small shallow left-sided disc protrusion which results in subtle effacement of ventral subarachnoid space however without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord is unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate no acute ischemic process, chronic minimally hemorrhagic small vessel ischemic strokes of mild degree only in the subcortical and periventricular white matter, unremarkable intracranial contents otherwise, right eye prosthesis.2.Nonenhanced MRI of cervical spine demonstrate a focal disc protrusion on the right at C5-C6 with resultant mild central spinal stenosis and no neural foraminal compromise. Shallow left lateral disc protrusion at C6-C7 without spinal stenosis or neural foraminal compromise. Unremarkable images at other levels.


Instruction: Generate impression based on findings.

Input: Female 14 years old History: young woman with NF1 and plexiform tumor of left arm including a very superficial componentEXAMINATION: MRI of the left humerus and forearm without IV contrast. 3/20/2016 at 1607 There is a large STIR hyperintense nodular mass in the supraclavicular region which is not significantly changed compared to the prior exam, however is better evaluated on recent brachioplexus MRI. Multiple lobulated and rounded STIR hyperintense lesions are again seen throughout the left arm along the neurovascular bundles compatible with plexiform neurofibromas. These neurofibromas follow the neurovascular bundles of the axillary, radial, median, and ulnar nerves. Along the mid to proximal humerus these plexiform neurofibromas are not significantly changed compared to the prior exam. Previously measured conglomerate of neurofibromas anterolateral to the biceps at the level of the distal humerus measures 2.9 x 0.9 cm (series 1101, image 71), previously measuring 3.0 x 1.2 cm. Neurofibromas in the forearm along the radial and median nerves are unchanged compared to the prior exam.

Output: No significant change in innumerable plexiform neurofibromas in the left arm as detailed above.


Instruction: Generate impression based on findings.

Input: History of nasopharyngeal cancer and chemotherapy/radiation therapy, compare to previous measurements. No areas of diffusion restriction are seen to suggest acute infarction. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Punctate T2/FLAIR hyperintense foci are nonspecific, however likely related to minimal small vessel seen disease. No mass lesions are seen within the brain parenchyma. No areas of abnormal enhancement are identified. Intracerebral flow voids are intact. No midline shift or herniation. Posttreatment changes are seen throughout the nasopharynx with diffuse mucosal edema, however no nasopharyngeal mass lesion is identified.Heterogeneous marrow signal and enhancement within the central skull base is unchanged and may be due to prior therapy. Soft tissue component along the clivus has decreased from the prior study dated 9/28/2014. No suprasellar cistern or optic canal mass is identified. There is no mass effect on the optic chiasm.Severe mucosal thickening and near complete opacification of the maxillary sinuses is noted. Partial opacification of the ethmoid air cells is present. There is complete opacification of the mastoid air cells.

Output: 1.Nasopharyngeal post-treatment changes without measurable tumor in this area.2.No change in central skull base enhancement and heterogenous marrow signal favored to be secondary to prior therapy.3.Persistent paranasal sinus and mastoid air cell opacification.


Instruction: Generate impression based on findings.

Input: Clinical question: History of cervical degenerative disease and metastatic sarcoma. Rule out cord compression. Signs and symptoms: Right upper extremity weakness. Pre and post enhanced cervical MRI:Examination demonstrates a tiny focus of T2 hyperintensity within the center of the cord at C1-C2 level without abnormal enhancement. Clinical significance of this finding is not clear.Foramen magnum is unremarkable.C2-C3 demonstrate degenerative changes with resultant severe right and moderate left neural foraminal compromise similar to prior exam.C3-C4 redemonstrate postoperative changes of an anterior fusion and placement of metallic plate and fixating screws anteriorly. Hypertrophic changes of posterior elements similar to prior exam are again noted. There is resultant circumferential mass effect on the cord with resultant flattening deformity and central spinal stenosis as well as bilateral neural foraminal compromise.. There is intrinsic cord T2/T2 STIR hyperintensity primarily on the right suggestive of myelitis. Compared to prior exams both on sagittal T2 and sagittal T2 STIR there is suggestion of slight interval decrease in the extent of this finding. This observation although could be technique related possibility of interval decreased edema of the cord since prior exam cannot be entirely excluded. Post enhanced images demonstrate patchy enhancement of the cord at this site which is best appreciated on axial series 1/1/2001 image 27 and sagittal post enhanced series 1001 image 9. This finding is consistent with myelitis.C4-C5 demonstrate stable degenerative changes of disc and the posterior elements and resultant mild central spinal stenosis and severe left and moderate right neural foraminal compromise similar to prior exam.C5-C6 demonstrate degenerative changes of disc and posterior elements resulting in mild central spinal stenosis and severe bilateral neural foraminal compromise similar to prior exam.C6-C7 redemonstrate stable degenerative changes without spinal stenosis.C7-T1 demonstrate stable mild degenerative changes without central spinal stenosis.Post enhanced images demonstrate no findings to suggest metastatic disease.

Output: 1.Tiny nonspecific central cord T2 hyperintensity stable since prior exam and without enhancement.2.Extensive degenerative changes and postoperative fusion at C3-C4 with central spinal stenosis demonstrate no change since prior study. Focus of intrinsic T2 hyperintensity on the right aspect of the cord at this level demonstrate patchy internal foci of enhancement and is believed to represent myelitis. There is apparent decreased extent of hyperintensity of the cord at this level compared to prior exam which could be technique related, however possibility of interval decreased cord edema cannot be entirely excluded. Please correlate with neurological status.3.Extensive degenerative changes of cervical spine remains stable since prior exam from April 2015.4.Examination demonstrates no evidence of malignancy/metastatic disease.


Instruction: Generate impression based on findings.

Input: Male, 53 years old, with history of metastatic renal cell carcinoma, status post radiation to two right frontal lobe lesions, one right cerebellar lesion and one left cerebellar lesion in 10-2015. Evaluate new left-sided lesion. Again seen is evidence of right frontal craniotomy and cranioplasty. Sequelae of prior tumor resection and treatment are redemonstrated within the right frontal lobe showing no significant interval change. There is no pathologic enhancement in the treatment bed and the degree of encephalomalacia and parenchymal T2 hyperintensity is unchanged.A punctate focus of enhancement within the right parietal subcortical white matter (image 127 series 13) is unchanged from prior. A punctate focus of enhancement within the left cerebellum (image 54 series 13) is also unchanged from prior. No other parenchymal enhancing lesions are seen. Two foci of susceptibility, one in the right cerebellum and one in the left, are unchanged and likely represent a treatment related effect. A few scattered additional foci of nonspecific parenchymal T2 hyperintensity are unchanged. The ventricles are stable in size and morphology including ex vacuo dilatation of the right frontal horn.A 12 mm enhancing lesion within the left posterior parietal bone is unchanged when compared to the immediate prior examination but has increased in size when compared to older studies.

Output: 1.Stable postoperative and treatment related findings in the right frontal lobe.2.Stable punctate foci of susceptibility in the cerebellar hemispheres likely related to treated lesions.3.Punctate foci of enhancement within the right parietal lobe and in the left cerebellum are unchanged and nonspecific.4.A 12 mm enhancing lesion in the left posterior parietal bone is stable when compared to the immediate prior study but has increased in size relative to older exams compatible with a metastatic focus.