Instruction: Generate impression based on findings.

Input: Alcoholic cirrhosis. ABDOMEN: The study is slightly motion limited.LIVER, BILIARY TRACT: Cirrhotic liver morphology with mild fibrosis.No focal suspicious arterially enhancing lesion or biliary ductal dilatation.The portal vein is attenuated and not well seen at the hilum. Its branch vessels are not well seen. The hepatic veins are poorly seen.Normally distended gallbladder.SPLEEN: Mild splenomegaly measuring 16 cm in length without a focal lesion. Perisplenic collateral vessels.PANCREAS: Peripancreatic collateral vessel formation. No focal lesion or may pancreatic ductal dilatation.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: Dependent body wall edema.OTHER: No significant abnormality noted.

Output: Cirrhosis with mild fibrotic changes. No suspicious lesions.Stigmata of portal hypertension.The portal vein is attenuated and suboptimally opacified. If there is clinical concern an ultrasound may better evaluate portal vein patency.


Instruction: Generate impression based on findings.

Input: Evaluate for goiter. Hoarseness. RIGHT LOBE MEASUREMENTS: 5.9 x 1.9 x 1.0 cmLEFT LOBE MEASUREMENTS: 4.8 x 2.0 x 1.0 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. Benign-appearing lymph nodes bilaterallyOTHER: No significant abnormality noted.

Output: No evidence of thyroid nodules.


Instruction: Generate impression based on findings.

Input: The patient is a 13-year-old female with history of neurofibromatosis. Cerebellar tumor resection in June 2005. Tinnitus, vertigo, ear pain and decreased hearing. Again seen is hypodensity in the left cerebellar hemisphere partially surrounded by calcified rim which appears unchanged from the prior study. Midline posterior craniectomy defect and postoperative changes in posterior fossa appear similar to the prior study.Ventricular shunt catheter tubing enters the a right frontal approach with tip terminating near midline, also unchanged from the comparison study.There is no evidence of intracranial hemorrhage, mass or edema. The internal auditory canals are normal in caliber and symmetric. However, for evaluation of tumor at this site, MRI is recommended. The cerebral hemispheres, brainstem and remainder of the cerebellum are normal in morphology and attenuation.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. Normal caliber internal auditory canals. For evaluation for possible tumor at this location, we recommend MRI.2. Stable postoperative findings.


Instruction: Generate impression based on findings.

Input: Craniopharyngioma treated with surgery and radiation: surveillance There are stable findings related to craniopharyngioma treatment. There is no definite evidence of recurrent tumor. The remaining pituitary gland appears unchanged. The infundibulum is not discernible and may be interrupted. There is unchanged thinning of the optic chiasm, but no mass effect upon the optic apparatus. The cavernous sinuses are intact.

Output: Post-treatment findings without evidence of recurrent craniopharyngioma.


Instruction: Generate impression based on findings.

Input: 66 year old female with DM, HTN, breast cancer s/p lumpectomy and chemotherapy, cardiomyopathy for 2 years (NICM) LVEF 30% in TTE and 40% on cardiac catheterization. Referred for MRI to accurately assess LVEF. Left VentricleThe left ventricle is mildly dilated with moderately depressed systolic function. The overall LV ejection fraction is 32%. The LVEDV is 169 ml (normal range 109+/-23), LV end diastolic volume index is 91 ml/m2 (normal range: 65+/-11), LVESV is 115 ml (normal range 31+/-10), and LV end systolic volume index is 62 ml/m2 (normal range 18+/-5). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. Abnormal septal motion noted.The native T1 myocardial relaxation time is <1050 ms and is not suggestive of underlying diffuse fibrosis or infiltration.There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is mildly dilated.Right VentricleThe right ventricle is normal in size with mildly depressed systolic function. The overall RV ejection fraction is 47%, the RVEDV is 72 ml (normal range 110+/-24), the RV end diastolic volume index is 39 ml/m2 (normal range 69+/-14), the RVESV is 39 ml (normal range 35+/-13), and the RV end systolic volume index is 21 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 at least mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is at least mild eccentric 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 mildly dilated with moderately depressed systolic function. LVEF 32%. There are no regional wall motion abnormalities present. Abnormal septal motion noted.2.The right ventricle is normal in size with mildly depressed systolic function. RVEF 47%3.No late gadolinium enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 49-year-old female with right neck mass. Per prior requisition, history of craniopharyngioma status post resection. Head CT: Stable postoperative changes are noted status post resection of craniopharyngioma with surgical clips in the sellar region. If clinical suspicion for the recurrence of craniopharyngioma is high, MRI may be considered. There is a well corticated focal bony deformity located along the inner table of the right parietal convexity. Similar findings were noted on the MRI from 2003 and have not changed since then. These findings likely represent an atypical arachnoid granulation with cortical vasculature extending through it. Recommend routine MRI with SPGR sequence for evaluation of this lesion if clinically indicated.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.Neck CT: There is diffuse contrast enhancing lymphadenopathy in the neck bilaterally, right greater than left. The largest lymph node measures approximately 2.3 x 2.1 cm and located at the level 2 of the right jugulodigastric chain. No evidence of airway obstruction or midline shift. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. Mild degenerative changes are noted in the vertebral bodies of the cervical spine. Otherwise, the osseous structures are unremarkable.

Output: Extensive bilateral, right greater than left, neck lymphadenopathy without a discrete primary lesion. Although an inflammatory process with reactive lymphadenopathy is possible, a neoplastic lesion cannot be excluded.


Instruction: Generate impression based on findings.

Input: Evaluate for medial meniscus tear. Left knee pain. MENISCI: The medial meniscus appears normal. There is mild deformity of the anterior horn of the lateral meniscus that may reflect interval partial meniscectomy. There is increased signal intensity in the anterior horn, more suggestive of intrasubstance degeneration than a tear. There is horizontally oriented linear increased signal intensity within the body of the lateral meniscus, extending to the femoral articular surface that may represent a horizontal tear, but was present on the prior study. There is a small fluid collection lateral to the body of the lateral meniscus, likely a parameniscal cyst, new from prior. The posterior horn of the lateral meniscus is unremarkable.ARTICULAR CARTILAGE AND BONE: We see no fluid-filled articular cartilage defects. Sclerotic foci in the distal femur likely represent bone islands. Bone marrow is otherwise normal.LIGAMENTS: Cruciate and collateral ligaments are intact. There is a small collection of fluid between the posterior oblique ligament and undersurface of the medial femoral condyle, which may represent a small bursa or ganglion, present on prior study. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. No evidence of medial meniscus tear.2. Small collection of fluid signal intensity deep to the posterior oblique ligament may represent bursa or ganglion, present on prior study and of questionable significance.3. Signal intensity changes of the lateral meniscus suggestive of a horizontal tear of the body of the lateral meniscus, as described above, with a new small parameniscal cyst.


Instruction: Generate impression based on findings.

Input: Female 78 years old Reason: Evaluate for cause of knee pain History: knee pain MENISCI: There is marked loss of the posterior horn of the medial meniscus. The anterior and posterior horns of the lateral meniscus are grossly intact.ARTICULAR CARTILAGE AND BONE: There is marked loss of cartilage in the medial and lateral compartments with areas of full-thickness cartilage loss on the posterior lateral femoral condyle. Marked thickness cartilage loss is seen along the medial patellar facet and medium patellar eminence. The cartilage in the femoral trochlea is thinned and irregular with a full-thickness defect along the lateral aspect of the femoral trochlea.There is reactive bone marrow edema in the medial and lateral compartments and there are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Degeneration and tearing of the posterior horn of the medial meniscus.2.Marked loss of cartilage and osteoarthritic changes in all 3 compartments.


Instruction: Generate impression based on findings.

Input: Brain MRI:No restricted diffusion to indicate an acute ischemic infarct. No susceptibility abnormalities to indicate hemorrhage. No mass, mass effect, midline shift of herniation. There is minimal periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and sulci are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts in the sphenoid sinuses. The skull and scalp soft tissues are unremarkable. There is a partially-imaged cystic lesion in the right maxillary alveolus which is unchanged.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified within the brain. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:The right vertebral artery is hypoplastic and there is a focal 8 mm region of luminal narrowing in the V3 segment which suggests a possible dissection. The carotid and left vertebral arteries are of normal caliber without evidence of dissection or aneurysm.

Output: 1.No evidence of acute intracranial hemorrhage or mass.2.No evidence of steno-occlusive disease or aneurysm in the arteries of the brain3.The right vertebral artery is hypoplastic and there is a focal 8 mm region of luminal narrowing in the V3 segment which suggests a possible dissection. A CTA of the neck would provide further information if clinically warranted. 4.Findings discussed with Dr. Eric Toone (# 4305) of the PICU service by phone by Dr. Michael Veronesi of the Radiology service at the time of this final entry.


Instruction: Generate impression based on findings.

Input: Lower extremity weakness and low back pain. Epidural and paraspinal abscesses. On antibiotics. Assess for change. The anterior sacral epidural space now shows symmetric contrast enhancement with resolution of the fluid pockets/abscesses. It has not changed significantly in overall thickness. The contrast enhancement with small fluid pocket anterior to the sacrum remain unchanged. The abscesses in the posterior paraspinal muscles, most pronounced at S2 level, are significantly smaller. On the right, the largest measures 0.8 cm x 0.5 cm, compared to 2.1 cm x 1.6 cm previously. The largest on the left measures 0.8 cm x 0.4 cm, compared to 1.8 cm x 1.3 cm previously. There continues to be abnormal contrast enhancement bilaterally in the sacral foramina and also involving the inferior aspect of the right L5-S1 neural foramen. There continues to be no osseous erosion or abnormal disc or marrow enhancement. The vertebral bodies are preserved in height. Mild multilevel degenerative disease has not changed. There is no abnormal contrast enhancement along the cauda equina. A 1.5 cm cyst in the upper pole of the left kidney is unchanged.

Output: 1.Epidural infectious process is now more phlegmon-like, with resolution of the previously seen epidural fluid collections. 2.The posterior paraspinal abscesses are significantly smaller. 3.Presacral fluid collections and abnormal contrast enhancement remain. These are better assessed on CT scan of the pelvis.


Instruction: Generate impression based on findings.

Input: Girl with NF1 and markedly accelerated growth. Brain: There is unchanged enlargement of the bilateral optic nerve cisternal segments with sparing of the optic chiasm. There is persistent patchy T2 hyperintensity in the supratentorial and infratentorial deep grey matter. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a newly apparent punctate focus of enhancement in the right temporal scalp, just posterior to the orbital rim.Orbits: There is unchanged diffuse expansion, T2 hyperintensity, and enhancement of the bilateral intraorbital optic nerve segments, measuring up to 6 mm in diameter on the left and 5 mm in diameter on the right. There is also unchanged expansion of the and canalicular optic nerve segments.

Output: 1. Unchanged optic nerve gliomas and intracranial stigmata of neurofibromatosis type 2.2. A newly apparent punctate focus of enhancement in the right temporal scalp, just posterior to the orbital rim, may represent a peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Memory impairment; new onset dizziness; spelling difficulty. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of intracranial hemorrhage, mass, or acute infarct. Mild scattered cerebral white matter T2 hyperintensity is nonspecific, but may represent chronic small vessel ischemia.


Instruction: Generate impression based on findings.

Input: Unspecified nystagmus [H55.00] / Unsteadiness on feet [R26.81], Reason for Study: ^Reason: Evaluate for brainstem lesion History: Horizontal and vertical nystagmus, episodes of gait instability Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are, however, multifocal high signal intensity lesions on bilateral periventricular white matter, centrum semiovale, bilateral trigone area (right worse than left) and right midbrain. These lesions appear to be a bit perpendicular to the axis of ventricular system suggesting possible demyelinating disease such as multiple sclerosis.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous major arch vessels without evidence of luminal stenosis. In particular, the right extracranial ICA is located medially and likely to be retropharyngeal course. Bilateral carotid bifurcation appear to be normal without evidence of luminal stenosis.Vertebrobasilar system appears to be normal without showing any evidence of luminal stenosis.

Output: 1. Multifocal scattered high signal intensity lesions on white matter on FLAIR images. Diagnostic possibility includes demyelinating disease such as multiple sclerosis. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Normal brain MRA.3. Tortuous course of craniocervical arterial system without evidence of luminal stenosis or irregularity.


Instruction: Generate impression based on findings.

Input: Uterine fibroids, menorrhagia, dysmenorrhea PELVIS:UTERUS, ADNEXA: The uterus is enlarged. There are two intramural and one submucosal fibroid. The submucosal fibroid is anterior in location and measures 4.5 x 2.8 x 3.5 cm (series 601, image 22). The fibroids demonstrate cystic foci and regions of poor enhancement compatible with necrosis. There is a fat containing ovarian lesion most consistent with a dermoid.Cystic lesion in the upper vagina.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Intramural and submucosal uterine fibroids as described above.2.Left ovarian dermoid.


Instruction: Generate impression based on findings.

Input: 27 years Female (DOB:4/15/1989)Reason: r/o structural lesion History: seizuresPROVIDER/ATTENDING NAME: SHASHA WU SHASHA WU MRI of the brainThe 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. The hippocampi appear symmetric and without an intrinsic lesion.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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: No abnormal mass lesions are appreciated within the brain parenchyma to explain the patient's epilepsy.There is no evidence for dural venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: Acute myeloid leukemia, without mention of having achieved remission [205.00], Reason for Study: ^Reason: rule out press History: visual, auditory hallucination, weird eye movements No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Slightly prominent pituitary gland with convex upper margin considering the age and gender of the patient. There is no focal enhancement or evidence of mass effect, however, if indicated, dedicated pituitary gland MR can be considered for further imaging evaluation.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. Bilateral mastoid air cells are opacified.There are mucosal thickening on bilateral maxillary sinuses and a retention cyst on the right maxillary sinus and sphenoid sinus.

Output: No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.Slightly prominent ventricular indices described above, if indicated, dedicated pituitary MR imaging can be considered for further imaging evaluation.


Instruction: Generate impression based on findings.

Input: 37 year old female with history of brain tumor. Evidence of a bifrontal high convexity frontal craniotomy which extends across the midline. Some soft tissue density with central enhancement appears to be along the inner table of the craniotomy flap. This finding could represent epidural thickening as result of surgery. Due to high positioning of the craniotomy it is not possible to determine with certainty whether there is residual tumor in this location. The brain parenchyma immediately inferior to the flap however appears normal and demonstrates no evidence of any edema, encephalomalacia or any abnormal enhancement. Although this exam does not demonstrate any definitive evidence of tumor, further evaluation with MRI would be more definitive. The findings in this exam are believed to be entirety post operative change. Multiple thick dural based calcification in the area of surgery is noted which are believed to represent dural calcific plaques.

Output: No definitive evidence of recurrence of tumor. Follow up exam and MRI is recommended.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:12/29/1959)Reason: eval for lumbar radiculopathy History: L leg sciaticaPROVIDER/ATTENDING NAME: DIANE L. ALTKORN DIANE L. ALTKORN Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: No compromise to lumbar spinal canal or neural foramina.


Instruction: Generate impression based on findings.

Input: Male, 73 years old. Reason: ro cord compression metastatic esophageal cancer. Back pain, le weakness There are no acute compression fractures.Again seen is fusion of the C3-C6 vertebral bodies with associated bony projection into the spinal canal at C3-4 and C5-6 with mild indentation of the cord at the C3-4 level. Again seen is mild cord volume loss at the C5 level with associated focal high T2 signal in the gray matter. These findings are unchanged from and better evaluated on the dedicated cervical spine MR from one day prior.The thoracic spinal canal and neural foramina are grossly preserved.There are mild degenerative changes involving the lumbar spine with mild to moderate neuroforaminal narrowing at L3-4 and endplate edema involving the L5-S1 disc space which may be on a degenerative basis but is incompletely evaluated on nondedicated imaging. There is no significant compromise of the spinal cord at the lumbar level or of the cauda equina.

Output: 1.Again seen is fusion of the C3-C6 vertebral bodies with associated moderate spinal canal stenosis at C3-4 and myelomalacia at C5, which are better evaluated on the recent dedicated MR cervical spine exam dated 09/30/2015.2.No evidence of acute cord compression or high-grade stenosis in the cervical, thoracic, or lumbar spine.3.Degenerative changes of the lumbar spine including edema involving the L5-S1 disc which may be on a degenerative basis (versus early infection in the appropriate clinical setting) but is incompletely evaluated. Also noted is bilateral neural foraminal narrowing at L3-L4. Further evaluation with dedicated lumbar spine MR can be considered as clinically indicated.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 5-year-old female status post VP shunt and subdural shunts. No evidence of acute intracranial abnormality, including no hemorrhage or midline shift.Interval removal of right frontal subdural catheter. Remaining bilateral subdural catheters and ventriculostomy catheter appear unchanged. Bilateral subdural collections are unchanged in size, with decrease in amount of gas in the left subdural collection.Mild interval decrease in size of common lateral ventricular chamber, which now measures approximately 6.7 cm in transverse dimension, previously measured 7.5 cm. Abnormal morphology of ventricles is unchanged.Stable displacement of cerebellar tonsils below foramen magnum by 9 mm, previously this measured 9 mm.Persistent abnormal morphology of brain parenchyma consistent with severe periventricular leukomalacia and areas of porencephaly in superior frontal and right occipital lobes, as described on recent MRI. Persistent abnormal morphology of the calvarium and burr holes noted. The visualized paranasal sinuses and mastoid air cells unremarkable.

Output: 1.No acute intracranial abnormality.2.Mild interval decrease in ventricular size.3.Interval removal of right subdural catheter, without significant change in bilateral subdural collections size.4.Stable Chiari I malformation.5.Stable abnormal morphology of brain parenchyma and calvarium.


Instruction: Generate impression based on findings.

Input: MRI brain:The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Isolated punctate low signal in the susceptibility sequence with associated diffusion restriction is seen in the subcortical white matter adjacent to the post central gyrus. This may imply diffuse axonal injury.Normal vascular flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the paranasal sinuses and the maxillary sinuses.Subgaleal hematoma is seen adjacent to the right parietal bone.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. The visualized portion of the lungs demonstrates right apical pleural effusion.

Output: 1. Findings are compatible with several foci of right parietal lobe diffuse axonal injury associated with a microhemorrhage.2. Subgaleal hematoma adjacent to the right parietal bone. 3. No evidence of cervical spine injury.4. Findings suggest right pleural effusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 34 year old man with history of type 2 diabetes, hypertension and known LV dysfunction, as well as coronary angiography with RCA and LAD disease, who presents for cardiac MRI with vasodilator stress testing and contrast to evaluate for ischemic burden and viability. First Pass PerfusionDuring hyperemia, perfusion defects involved the entire ventricle except the basal to mid lateral wall. Viability/ Myocardial ScarThere was a small transmural myocardial infarction involving the apical inferior and septal walls. These territories are not viable. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable. Left VentricleThe left ventricle is severely dilated with moderately reduced systolic function. The overall LV ejection fraction is 33%, the LV end diastolic volume index is 153 ml/m2 (normal range: 74+/-15), the LVEDV is 380 ml (normal range 142+/-34), the LV end systolic volume index is 103 ml/m2 (normal range 25+/-9), the LVESV is 255 ml (normal range 47+/-19), the LV mass index is 92 g/m2, and the LV mass is 228 g. There is global hypokinesis with regional variationLeft AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 55%, the RV end diastolic volume index is 90 ml/m2 (normal range 82+/-16), the RVEDV is 225 ml (normal range 142+/-31), the RV end systolic volume index is 41 ml/m2 (normal range 31+/-9), and the RVESV is 102 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 mild 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 are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease. A trivial pericardial effusion is present.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. Extensive ischemia involving nearly the entire left ventricle except the basal to mid lateral wall.2. There was a small transmural myocardial infarction involving the apical inferior and septal walls. These territories are not viable. The remainder of the myocardium is free of myocardial infarction and is highly likely to be viable. 3. Severe LV dilation with moderately reduced systolic function (LVEF 33%).4. Normal RV size and systolic function (RVEF 55%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 33-year-old female with Gitelman's Syndrome, hypomagnesemia, sinus tachycardia, palpitations, and PVC's s/p ablation 4/2014 (RVOT focus). MRI for further evaluation of possible RV dilation on TTE. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%. The LVEDV is 111 ml (normal range 109+/-23), LV end diastolic volume index is 56 ml/m2 (normal range: 65+/-11), LVESV is 46 ml (normal range 31+/-10), and LV end systolic volume index is 23 ml/m2 (normal range 18+/-5). The LV mass is 88 g (normal range 114+/-24) and the LV mass index is 44 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 50%, the RVEDV is 148 ml (normal range 110+/-24), the RV end diastolic volume index is 74 ml/m2 (normal range 69+/-14), the RVESV is 74 ml (normal range 35+/-13), and the RV end systolic volume index is 37 ml/m2 (normal range 22+/-8). No focal right ventricular wall motion abnormalities or aneurysms. No evidence of fatty or fibrous infiltration into the RV.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 mild 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. Normal-sized left ventricle with normal systolic function (LVEF 58%).2. Normal-sized right ventricle with normal systolic function (RVEF 50%) without any cardiac MRI features of arrhythmogenic right ventricular dysplasia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left shoulder pain ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is mild degeneration of the anterior labrum which is expected in a patient of this age. No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Normal MRI of the shoulder for the patient's age. There is no evidence of full-thickness rotator cuff tear.


Instruction: Generate impression based on findings.

Input: History of hepatocellular carcinoma status post TACE/RFA. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic nodular liver morphology.Segment VI ablation cavity measures approximately 4.9 x 4.2 cm (series 9/255). Along the posteromedial aspect of the resection margin there is a vague asymmetric nodular region of late arterial phase enhancement (series 9/64), measuring 1.4 x 1.1 cm. The enhancement appears more peripheral on the more delayed phase imaging with questionable wash-out.Multiple additional punctate arterial enhancing foci without definitive washout.The vessels are patent. 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: Segment 6 ablation cavity with a subtle peripheral posteromedial nodular region of enhancement with questionable washout raises suspicion for residual tumor. The focus is in a similar location to the pre-ablation lesion but is somewhat smaller in size.


Instruction: Generate impression based on findings.

Input: Ms. Schacht is a 62 year old female with a strong family history of breast cancer, including her mother, sister, maternal aunt, and maternal cousin. She is a BRCA1 mutation carrier. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Scattered foci of enhancement are seen symmetrically in both breasts, all of which appear stable when compared to multiple prior exams. There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.Stable cysts of the left hepatic lobe.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Images are somewhat limited by patient motion. The cervical spine is in normal alignment, with a normal cervical lordosis. There is minimal disc narrowing at C5-C6. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement.There is abnormal T2 hyperintensity within the cord in an ill-defined manner from C5-C6 and C6-C7, with significant deformity of the cord due to degenerative changes as detailed below.At C2-C3, there is no significant disk pathology or stenosis. There is mild uncovertebral hypertrophy.At C3-C4, there is a mild posterior osteophyte disk complex with minimal left uncovertebral hypertrophy. There is minimal left foraminal narrowing and mild central spinal canal stenosis.At C4-C5, there is a mild posterior osteophyte disk complex. There is mild left facet arthropathy with overall moderate left foraminal narrowing with mild-moderate central spinal canal stenosis.At C5-C6, there is a diffuse posterior osteophyte disk complex with superimposed central/right paracentral disc protrusion which deforms the right ventral cord. There is right greater than left uncovertebral hypertrophy protruding to overall moderate central spinal canal stenosis as well as moderate-severe right and moderate left foraminal narrowing. There is also bilateral ligamentum flavum thickening.At C6-C7, there is a diffuse posterior osteophyte disk complex with significant bilateral facet arthropathy and ligamentum flavum thickening. There is moderate-severe right and moderate left foraminal narrowing with significant deformity of the cord and overall moderate-severe central spinal canal stenosis.At C7-T1, there is no significant disk pathology or stenosis.Sagittal images suggest minimal left paracentral/foraminal disc protrusion at T2-T3 and a small left paracentral protrusion at T3-T4.There is prominent retropharyngeal effusion spanning C1-C2 level down to at least the lower T2 level. This measures up to 10 mm in greatest thickness.

Output: 1.Prominent retropharyngeal effusion of uncertain etiology spanning C1-C2 to at least lower T2, not present on prior comparison CT. Please correlate clinically.2.Moderate cervical spondylotic changes worst at C5-C6 and C6-C7, where there is up to moderate as well as moderate-severe central spinal canal stenosis as well as abnormal cord signal with deformity likely relating to chronic compression and myelomalacia. Also moderate-severe right foraminal narrowing at these levels.


Instruction: Generate impression based on findings.

Input: Metastatic breast cancer with new diagnosis of Bell's palsy. Evaluate for leptomeningeal disease. There is asymmetrically diffuse, mild, smooth enhancement along much of the left facial nerve. There is no evidence of intraparenchymal hemorrhage, mass, or acute infarct. There a numerous scattered, non-enhancing, punctate foci of T2 hyperintensity in the cerebral white matter. 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, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The bone marrow of skull and upper cervical spine is heterogeneous with diffuse areas of T1 and T2 hypointensity, but the cortical margins appear to be intact.

Output: 1. The appearance of enhancement along the left facial nerve is compatible with an inflammatory neuritis, such as Bell's palsy, rather than metastatic disease. Nevertheless, follow up to resolution of this abnormality is recommended.2. No evidence of intraparenchymal hemorrhage, mass, or acute infarct. 3. Mild probable chronic white matter small vessel ischemic disease.4. The appearance of the imaged bone marrow is suggestive of an infiltrative process such as metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Traumatic brain injury. Signs and symptoms: Increased tone. None CT of brain:Examination demonstrates significant ventriculomegaly of the lateral and third ventricle. There is a ventricular catheter entering from right posterior frontal, traversing the right parietal lobe and enters into the right lateral ventricle. The tip of the catheter traverses the midline and is at the level of the left foramina of Monro. There are no old films available for comparison of the ventricular size. There is a shallow CSF dense CT extra axial collection surrounding the bilateral cerebral hemispheres and is consistent with chronic subdurals. On the right side the thickest portion of the subdural measures 7.5-mm (axial image 17) and on the left subdural measures approximately 6.5 mm on axial image 15 in the frontal region). There is no areas of acute blood product within the subdural space.There is no evidence of parenchymal hemorrhage.No attenuation of brain parenchyma in the left temporal lobe extends from left anterior temporal posteriorly to involve the entire length of the left temporal lobe. This is believed to represent an area of old encephalomalacia. Possibility of an ischemic stroke cannot be however entire without. Please review outside studies or follow-up with an MRI exam. The cortical sulci are still preserved and are prominent and overall appearance of brain is suggestive of diffuse right lung volume loss.

Output: 1.No detectable acute posttraumatic findings.2.Low density extra-axial subdural collection encircles the entire brain parenchyma bilaterally as detailed.3.Significant ventriculomegaly and supratentorial space with a shunt in place. There are no old studies for comparison.4.Large area of low-attenuation involves the left temporal lobe which may represent encephalomalacia however less likely possibility of an ischemic stroke of more recent onset cannot be entirely ruled out.5.There is no evidence of skull fracture.6.Extensive exaggerated pneumatization of visualized paranasal sinuses.


Instruction: Generate impression based on findings.

Input: Left eye blurry vision and proptosis concern for Graves disease. Orbits: There appears to be mild left proptosis and there is mild contour deformity of the left globe. Otherwise, the left extraocular muscles, orbital fat, and optic nerve are unremarkable. The right globe, extraocular muscles, orbital fat, and optic nerve are also unremarkable. There is no evidence of orbital mass lesions.  Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Mild left proptosis and there is mild contour deformity of the left globe, suggestive of staphyloma, but no findings to suggest dysthyroid orbitopathy.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 63-year-old male patient with HCC status post TACE/RFA. Assess liver lesion. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver with interstitial T2 hyperintensity compatible with fibrosis.There is a segment 3 ablation cavity measuring approximately 2.5 x 1.7 cm (image 273, series 10). There is increasing marginal enhancement about the left aspect of the ablation cavity with a more nodular enhancing focus anteriorly (image 49, series 10). Scattered peripheral arterially enhancing foci without washout may be perfusional in etiology.Stable hepatic cysts in the right hepatic lobe. Cholelithiasis within a contracted gallbladder. Trace perihepatic fluid. SPLEEN: Splenomegaly with the spleen measuring 22 cm in the craniocaudal dimension. Recanalized periumbilical vein.PANCREAS: There are numerous cystic pancreatic foci which appear to communicate with the main pancreatic duct, appearing similar to the prior study. A reference proximal pancreatic tail cystic lesion measures 1.2 x 1.0 cm (image 34, series 7), previously 1.2 x 0.9 cm. There are no suspicious enhancing features. The main pancreatic duct is mildly prominent in the distal body and tail, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate hyperintensities in both kidneys are too small to characterize, unchanged and likely benign cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastroesophageal and retroperitoneal varices. BONES, SOFT TISSUES: Mild bilateral gynecomastia. OTHER: A subpleural nodule within the right lower lobe is better characterized on prior CT chest.

Output: 1.Increasing marginal enhancement about the segment 3 ablation cavity. Residual/recurrent disease is not excluded; correlate with liver markers. 2.Cirrhotic morphology of the liver with fibrosis and stigmata of portal hypertension.3.Stable appearance of multiple cystic pancreatic lesions likely representing sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Diagnosis: Secondary malignant neoplasm of brain and spinal cord(198.3)Malignant neoplasm of bronchus and lung, unspecified siteClinical question: Hx of metastatic lung cancer s/p craniotomy and SRS, surveillance MRI The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left-sided craniotomy. There is T2 and FLAIR signal hyperintensity centered in the left middle temporal gyrus anteriorly which is associated with some susceptibility effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to the previous exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient is status post left-sided craniotomy for left temporal lobe surgery. 2.There is no evidence for intracranial metastases at this time.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: There is a subcentimeter focus of high T2 signal in the midline of the splenium of the corpus callosum. The rest of the brain parenchyma appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: A subcentimeter focus of high T2 signal in the midline of the splenium of the corpus callosum may represent a transient splenial lesion, which can be a manifestation of viral encephalitis, epilepsy, and drug reaction, for example. Otherwise, no evidence of acute intracranial hemorrhage, mass, or acute infarct. Nevertheless, a follow up brain MRI may be useful.


Instruction: Generate impression based on findings.

Input: History of cervical meningioma status post resection. Neck and upper extremity pain. Evaluate for change in size/recurrence. Cervical Spine: There are post-surgical findings related to meningioma resection at the C2 level. There is no evidence of intraspinal mass or pathologic enhancement to suggest tumor recurrence. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to spinal canal or neural foramina. At C3-4 there is no significant compromise to spinal canal or neural foramina. At C4-5 there is new mild disc bulge and uncovertebral osteophytes causing minimal effacement of the ventral thecal sac, but no significant neural foramen compromise. At C5-6 there is mild disc bulge and posterior uncovertebral osteophytes without significant spinal canal or neural foramen stenosis. At C6-7 mild posterior uncovertebral osteophytes causes mild to moderate neuroforamen stenosis bilaterally. At C7-T1 there is no significant compromise to spinal canal or neural foramina. The vertebral artery flow voids appear to be intact.Thoracic Spine: There is severe dextroscoliosis of the thoracic spine. The thoracic vertebral bodies are appropriate in height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar Spine: There is severe levoscoliosis of the lumbar spine. There is also 14 mm of right lateral listhesis of L1 upon L2. The conus medullaris on sagittal imaging is grossly intact. At L1-2 there is mild bilateral facet hypertrophy superimposed upon the effect of right lateral listhesis result in mild spinal canal and right neural foramen stenosis. At L2-3 there is mild facet hypertrophy, mild ligamentum flavum thickening, and severe diffuse right sided disc bulge, with mild neural foramen narrowing and probable contact with the right nerve root. At L3-4 there is a disc bulge, mild ligamentum flavum thickening, and extensive bilateral facet hypertrophy causing mild central canal stenosis as well as moderate to severe right and mild left neural foramen narrowing. At L4-5 there is mild diffuse disc bulge and moderate bilateral facet hypertrophy, without significant central canal stenosis, but minimal to mild left neural foramen stenosis. At L5-S1 there is a disc bulge and moderate bilateral facet hypertrophy, without significant central canal stenosis, but mild left neural foramen stenosis.

Output: 1.No evidence of meningioma recurrence in the upper cervical spinal canal.2.Severe thoracolumbar scoliosis and right lateral listhesis of L1 on L2.3.Multilevel degenerative spondylosis of the cervical and lumbar spine, as described in the findings section.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Persistent hyperprolactinemia. Rule out prolactinoma: Galactorrhea. There is an apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm. The pituitary gland is otherwise neither enlarged or atrophic. The pituitary infundibulum and posterior bright spot are intact. There is no compromise of the cavernous sinuses or optic apparatus.

Output: An apparent hypoenhancing or nonenhancing focus along the posterior aspect of the adenohypophysis that measures up to 3 mm may represent a pars intermedia cyst or microadenoma.


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out cord compression. Signs and symptoms: Urinary/bowel incontinence. Nonenhanced lumbar MRI:Examination demonstrates a large destructive enhancing mass involving vertebral bodies of S1-S3 and their posterior elements. There is extraosseous spread of tumor into the spinal canal at these levels which is completely occupied by the mass. There is significant extension of mass into bilateral neural foraminal There is significant extraosseous spread of mass into the left pelvis and left presacral space, extensive extension into the sacral canal which is nearly completely occupied by tumor as well as bilateral neural foraminal of the sacral region.Additionally exam demonstrates fairly extensive lymphadenopathy on the left anterior to the spine.The left presacral mass measures at least at 52 x 55 mm in transaxial dimensions. The largest transaxial dimensions of partially visualized nodes measures at 50 x 36 mm in transaxial dimensions. This cluster of nodes measures approximately at 140 mm in cranial cephalad access and extending from T12-L1 inferiorly to the pelvis.There is significant expansion of the bladder.Nonenhanced total spine MRI:Examination is performed utilizing cord compression protocol without axial series.Examination demonstrates extensive tiny foci of marrow signal replacement with hypointense T1 and hyperintense T2 and T2 STIR signal pattern highly suspicious for metastatic disease. The findings are present throughout the cervical and thoracolumbar spine. On sagittal post enhanced images of the dedicated lumbar MRI the lesions demonstrate enhancement and all highly suspected of diffuse metastatic lesions.

Output: 1.Nonenhanced total spine (cord compression protocol) MRI exam demonstrate numerous tiny foci of marrow signal replacement involving extensively the vertebral column highly suggestive of metastatic lesions.2.Dedicated pre and postcontrast enhanced lumbar MRI demonstrate a large destructive enhancing mass involving S1, S2 and S3 vertebral bodies, extensively occupying the sacral canal at these levels, large extraosseous component in the left pelvis and extensively of the sacral neural foraminal as detailed. There is extensive loculated lymph nodes within the abdomen on the left paraspinal tissues extending from T12-L1 to the pelvis as detailed/measured above.3.Significant expansion of the bladder.


Instruction: Generate impression based on findings.

Input: 52-year-old male with newly diagnosed prostate carcinoma. Staging examination. PELVIS:PROSTATE:Prostate Size: 5.1 x 2.6 x 3.3 cm (TR x AP x CC)Peripheral Zone: Note is made of multiple foci of increased T1 signal abnormality in the peripheral zone of the prostate gland, consistent with postbiopsy hemorrhage.There are multiple bilateral foci of decreased T2 signal abnormality with associated restricted diffusion which is suspicious for multifocal prostate adenocarcinoma. The largest focus of signal abnormality is located in the left apex anteriorly, measuring 11 x 5 mm (image 6; series 1001). There is no definite extracapsular extension or neurovascular bundle involvement.Seminal Vesicles: No convincing evidence of seminal vesicle involvement.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of decreased signal abnormality are identified within the peripheral zone of the prostate gland, bilaterally, which are suspicious for prostate carcinoma. There is no convincing evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: 60-year-old woman with history of abdominal pain and gas pain. ABDOMEN:LIVER, BILIARY TRACT: There is a 34 mm simple cyst in segment 4a (9/15) with additional, scattered subcentimeter cysts. The liver is otherwise normal in signal and morphology. Gallbladder is normal. There is no intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct normal in caliber. No focal parenchymal lesions identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is no hydronephrosis. No focal renal lesions identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Specifically, no bowel wall thickening, evidence of obstruction, or focal mass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus without additional significant abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large stool burden. No additional abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace fluid in the pelvis is nonspecific.

Output: Large stool burden suggestive of constipation, otherwise no significant small bowel or colonic pathology.


Instruction: Generate impression based on findings.

Input: There is a heterogeneously T2 hyperintense, nonenhancing, ovoid lesion in the right frontal white matter measuring 2.1 cm x 1.4 cm in axial dimension and 1.2 cm in coronal craniocaudal height. This is associated with slight heterogeneous T1 hypointensity, however it does not contain foci of susceptibility abnormality, and there is no associated mass effect or edema.There are also small foci of T2 hyperintensity within the right frontal lobe located immediately posteroinferior to the lesion, along the anterior aspect of the internal capsule anterior limb, as well as along the medial aspect of the globus pallidus. These are also nonenhancing and do not contain foci of susceptibility abnormality with no associated mass effect or edema.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within the right maxillary sinus which also demonstrates thickened walls suggesting a history of a chronic inflammatory state. Otherwise the remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.There is a heterogeneously T2 hyperintense, nonenhancing, ovoid lesion in the right frontal white matter associated with slight heterogeneous T1 hypointensity, however it does not contain foci of susceptibility abnormality, and there is no associated mass effect or edema.2.There are also small foci of T2 hyperintensity within the right frontal lobe located immediately posteroinferior to the lesion, along the anterior aspect of the internal capsule anterior limb, as well as along the medial aspect of the globus pallidus. These are also nonenhancing and do not contain foci of susceptibility abnormality with no associated mass effect or edema.3.The right frontal lobe lesion may represent a low-grade neoplasm. However, given patient age, in the setting of the other described foci of T2 hyperintensity, the differential diagnosis would also include an inflammatory etiology for all lesions.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, history of non-Hodgkin's lymphoma with PET avid T11 lesion. Marrow signal intensity is diffusely heterogeneous on T1 and T2 weighted sequences but without significant STIR hyperintensity, unchanged from prior. Superimposed upon this background is a more localized region of abnormal low T1 and T2 signal within the anterior/superior T11 vertebral body, corresponding to the area of abnormal FDG uptake. This lesion shows no significant STIR hyperintensity. Relative to the prior examination, there has been no significant interval change.On postcontrast images, no convincing evidence of pathologic enhancement is seen to correspond with either the diffuse marrow heterogeneity, or the more localized signal abnormality within the T11 vertebral body. No pathologic epidural or intrathecal enhancement is seen.Spinal alignment is anatomic. Vertebral body height is preserved throughout. No evidence of significant degenerative disk disease, spinal canal or neuroforaminal stenosis is detected.The right adrenal gland remains mildly thickened. The left kidney contains a cystic lesion with a blood fluid level.

Output: 1. Diffuse heterogeneity of the marrow signal is redemonstrated, similar to the prior examination. This finding could reflect the presence of osseous lymphomatous disease. Lack of STIR signal abnormality or pathologic enhancement suggests, however, that the disease may be quiescent or treated. The possibility that these diffuse findings represent a treatment related marrow reconversion is felt to be less likely given the pattern of the abnormality.2. A more localized region of abnormal low T1/T2 signal within the T11 vertebral body is stable in size relative to the prior exam. Again, there is no corresponding STIR signal abnormality or pathologic enhancement. Nevertheless, given the CT findings, this remains concerning for localized tumor. 3. No epidural or intrathecal abnormalities are suspected. The spinal cord is normal.


Instruction: Generate impression based on findings.

Input: Status post acute CVA for 2 month followup. Episode of left sided weakness and dysarthria. MRI HEAD: There is global parenchymal volume loss. There is redemonstration of T2 hyperintense lesions in theright hemispheric watershed territory as well as small foci of hyperintensity in the basal ganglia, cerebellum and brain stem. There are new T2 hyperintense lesions in the right parietal lobe and right posterior temporal lobe adjacent to the craniotomy site. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered foci of susceptibility artifact, consistent with chronic microhemorrhages. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is moderate mucosal thickening of the bilateral maxillary sinuses and scattered mucosal thickening of the bilateral ethmoid sinuses. The right ICA flow void is again absent. MRA HEAD: Exam is degraded my motion artifact. There is evidence of right STA-MCA bypass in the interval. There is redemonstration of occlusion of the right internal carotid artery along the cavernous and opthalmic segments but reconstituted along the communicating segment via the PCOM, unchanged from prior exams. Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is no evidence for intracranial aneurysm. The anterior communicating artery is identified. The left posterior communicating artery not definitively visualized. The vertebral arteries are similar in size.

Output: 1. No evidence of acute infarct or intracranial mass effect.2. Unchanged occlusion of the right internal carotid artery at the ophthalmic segment with flow-related enhancement of the right anterior and middle cerebral arteries via collaterals and right STA-MCA bypass.3. Multiple foci of chronic watershed infarcts in right cerebral hemisphere again seen as well as lacunar infarcts in the basal ganglia, cerebellum and brain stem. Compared to 1/11/2015, new areas of T2/FLAIR hyperintensity in the right parietal lobe and right posterior temporal lobe are compatible with evolution of previously seen acute infarcts on MRI 1/11/2015 as well as some adjacent to the interval craniotomy which are compatible with postsurgical change. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 3-year-old with lower back and bilateral thigh pain, evaluate for tethered cord Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position at the upper L1 level. Prone images demonstrate appropriate ventral motion of the conus and cauda equina nerve roots. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine. No evidence of lipoma or other masses involving the filum terminale or cauda equina nerve roots. Paraspinous soft tissues are unremarkable. Distended urinary bladder noted.

Output: 1. MRI of the lumbar spine is within normal limits. No evidence of tethered cord.2. Distended urinary bladder is noted, which is nonspecific, and can be correlated with post voiding ultrasound if there is clinical suspicion for urinary retention.


Instruction: Generate impression based on findings.

Input: Diagnosis: Subarachnoid hemorrhageClinical question: Evaluate for aneurysmSigns and Symptoms: Diffuse SAH, no clear etiology seen on CTAOPERATORS: Greg Christoforidis, Sophia ShakurFLUOROSCOPY TIME: 24.3 minutesFrontal: 1105.19 mGyLateral: 644.54 mGyPROCEDURES: 1) cerebral angiogram 2) Intracranial cerebral aneurysm coil embolization with balloon assistance. 3) 3-D reconstructions of intracranial right internal carotid artery Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There was transient opacification of the ACOMA which was intact. The ACOMA was moderate size. Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There is no evidence for aneurysm, AVM or AV fistula.Left vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There is extracranial origin of the left posterior inferior cerebellar artery. There is double origin of the left posterior inferior cerebellar artery from the V3 and V2 segments. There is no evidence for aneurysm, AVM or AV fistula.Right vertebral artery: No evidence for aneurysm AVM or arteriovenous fistula. There is opacification of the basilar artery and both posterior cerebral arteries. There is extracranial origin of the right posterior inferior cerebellar artery. The posterior falx artery originates from the right vertebral artery. There is supply to the anterior spinal artery.Intraprocedural angiograms:Serial arteriograms performed during aneurysm coiling demonstrate serial occlusion of the aneurysm. The balloon remained across the neck of the aneurysm throughout the procedure.Final RICA arteriogram :At the end of the procedure there is no opacification of the aneurysm dome with a small residual base which contains a coil loop. There was preservation of the PCOMA and anterior choroidal artery and no thromboembolic events.Right common iliac artery: No contraindications to closure device.

Output: 1.2mm right communicating segment aneurysm2.Embolic coil occlusion of 2mm right communicating segment aneurysm using MRI compatible embolic occlusion coils.3.Findings were discussed with Dr Awad after the procedure.


Instruction: Generate impression based on findings.

Input: There are stable treatment related findings in the left precentral and post central gyri with confluent high T2 signal surrounding the resection cavity. Curvilinear enhancement is along the surgical cavity in the medial aspect is unchanged and may represent a vascular structure. There is no acute infarct or hemorrhage. There is a medial right cerebellar developmental venous anomaly. The ventricles and sulci are unchanged. There is no midline shift or mass effect. The scull and extracranial soft tissues are unchanged.

Output: Stable posttreatment changes in the left precentral and postcentral gyri without evidence of tumor progression.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 65 years old. Further evaluation of 2.5 cm right adrenal gland nodule which does not meet imaging criteria for a benign adenoma, indeterminate for malignancy. ABDOMEN:LIVER, BILIARY TRACT: No biliary ductal dilation, or ascites. There is a well-circumscribed 5 mm T2 hyperintense, nonenhancing lesion in the right lobe of the liver consistent with a simple cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Enhancing 2.5 x 2.2 cm right adrenal mass demonstrates loss of signal on out of phase imaging consistent with benign adenoma. The left adrenal gland is unremarkable.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate hiatal hernia.BONES, SOFT TISSUES: The lesion within the right posterior aspect of the T12 vertebral body as well as T1, intermediate on T2 weighted images and enhances. This may represent an atypical hemangioma.OTHER: 5.3 x 4.1 cm cystic left ovarian lesion is only seen on coronal T2 weighted images. It has the appearance of a simple cyst but is incompletely evaluated on this exam (series 3, image 18). Fibroid uterus.

Output: 1.Right adrenal adenoma.2.5.3 x 4.1 cm cystic left ovarian lesion is incompletely imaged. Further evaluation with pelvic ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: Female, 81 years old, history of atypical meningioma and left leg dysfunction. Assess for etiology of leg dysfunction. Evidence of a right parietal craniotomy is seen. No definite residual or recurrent masslike lesion is seen subjacent to the craniotomy. Only mild nonspecific extra-axial thickening is noted.An extra-axial homogeneously enhancing mass is evident along the planum sphenoidale measuring 12 x 12 x 6 mm. This lesion induces minimal local mass effect but there is no evidence of significant parenchymal edema.No additional enhancing or masslike lesions are seen intracranially. In particular, the lower extremity motor areas of the precentral gyri are morphologically normal and free of any impinging or compressing lesions.Scattered small areas of T2 hyperintensity are seen within the cerebral white matter, somewhat more so on the right than on the left. No evidence of parenchymal edema or significant generalized mass effect is seen. No abnormal extra-axial fluid collections or acute intracranial hemorrhage is identified. A few scattered small foci of susceptibility are noted in the brain which likely reflect chronic microhemorrhage. The ventricular system is within normal limits for size and morphology.

Output: 1.Findings compatible with prior right parietal craniotomy. No evidence of any residual or recurrent masslike lesion is seen subjacent to the craniotomy. Only mild extra-axial thickening and enhancement is seen at this location which likely represents granulation or chronic dural thickening.2.A small presumed meningioma is evident along the planum sphenoidale causing no significant mass effect or parenchymal edema.3.No additional findings are seen to account for the patient's left leg dysfunction. In particular, the lower extremity motor areas are free of significant signal abnormality, and there are no adjacent compressing or impinging lesions.


Instruction: Generate impression based on findings.

Input: 3 month follow-up of brain lesion Peripherally enhancing left occipital lesion has increased in size and now measures 1.0 x 1.2 x 1.5 cm (image 36, series 1201; image 172, series 1202), previously 0.6 x 0.8 x 1.0 cm. The surrounding T2/FLAIR hyperintensity has increased, likely representing a combination of edema and gliosis. No new intraparenchymal mass lesion or new abnormal areas of enhancement are identified.Status post right frontal craniectomy. The underlying confluent increased T2 signal is seen throughout the right frontal lobe is unchanged. Periventricular increased T2/FLAIR signal is also unchanged and may be treatment related small vessel ischemic disease.No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. No abnormal areas of enhancement are seen. The CSF spaces are appropriate for the patient's stated age with no midline shift. Normal vascular flow voids are present in the major intracranial vasculature.Enhancing right temporal bone lesion is unchanged from the prior study.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.Increase in size of peripherally enhancing left occipital lesion with increase in surrounding edema/gliosis.2.No change in right temporal osseous metastasis.3.Right frontal lobe postsurgical changes.


Instruction: Generate impression based on findings.

Input: Multiple myeloma.. The marrow is diffusely heterogeneous in signal which can be reflective of involvement by multiple myeloma and/or reactive red marrow. There is no pathologic compression fracture. Mild posterior height loss at L5 is probably degenerative in nature given the associated endplate/matter typeII. Degenerative signal.There is a posterior epidural T2-hyperintense, mildly T1-hyperintense (relative to muscle) which anterior displaces and mildly compresses the spinal cord. This extends from C6-C7 level to the mid T5 level (craniocaudal length of 12.5 cm) and has a maximum anteroposterior diameter of 1.0 cm. The compressed spinal cord signal shows a subtle increase in STIR signal but this can also be artifactual. There is no significant compression of the thecal sac otherwise. While this may represent epidural hemorrhage, it is more likely to represent epidural involvement by multiple myeloma especially given the below-described paraspinal mass, which has similar signal characteristics. Partially imaged is a left sided paraspinal mass at T3 level with superior extension to T2 level with extension towards the left T2-T3 and T3-T4 neural foramina. This is probably related to extraosseous involvement by multiple myeloma. These were not present on the previous examination from December 2014.

Output: 1.Cervicothoracic (C6-C7 through mid T5) posterior epidural soft tissue with compression of the thecal sac/spinal cord is most probably related to involvement by the known multiple myeloma. There is suggestion of subtle increase in cord STIR-signal. However, the study was limited to T1 and STIR sequences in the sagittal plane and therefore cannot accurately assess for cord edema.2.Thoracic left paraspinal soft tissue mass has similar signal characteristics and is also most compatible with extraosseous involvement by multiple myeloma.Contrast-enhanced thoracic spine MRI would more definitively assess the above described epidural component and the mass effect it causes on the spinal cord.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Anubha Ganjoo over the phone on Oct 31, 2015 at 1044 hours.


Instruction: Generate impression based on findings.

Input: 16 year-old male with knee injury MENISCI: Complex tear of the posterior horn of the medial meniscus with horizontal and vertical components. Vertical signal abnormality within the posterior horn of lateral meniscus extending from the attachment of the meniscofemoral ligament laterally consistent with a vertical longitudinal tear of the posterior horn. ARTICULAR CARTILAGE AND BONE: There are small contusions within the posterolateral tibial condyle and anterolateral femoral condyle. The articular cartilage is intact.LIGAMENTS: The ACL is torn. The PCL is intact. The MCL appears normal. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: Intact.ADDITIONAL

Output: 1. ACL tear with kissing contusions in the posterolateral tibial and anterolateral femoral condyles.2. Complex tear of the posterior horn of the medial meniscus and vertical longitudinal tear of the posterior horn of lateral meniscus ("Wrisberg rip"). 3. Large joint effusion.


Instruction: Generate impression based on findings.

Input: 68-year-old woman with history of lumbago, sciatica, and right leg pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is minimal retrolisthesis of L5 on S1, otherwise alignment is within normal limits. Probable hemangiomata in L1 and L2 vertebral bodies. Bone marrow signal is benign. The L4/L5 and L5/S1 discs have decreased T2 signal suggesting desiccation. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: There is a mild disc bulge. There is moderate bilateral facet arthropathy with ligamentum flavum thickening. Bilateral neural foramina and the spinal canal are mildly narrowed.L4-L5: There is a mild disc bulge. There is moderate to severe bilateral facet arthropathy with ligamentum flavum thickening. Bilateral neural foramina and the spinal canal are also mildly narrowed.L5-S1: There is a mild disc bulge, slightly eccentric to the left. There is moderate bilateral facet arthropathy. The left lateral recess is slightly narrowed, similar to the prior examination. There is mild narrowing of the left neural foramen. The right neural foramen and central spinal canal are without significant stenosisParaspinous soft tissues are within normal limits.

Output: 1. No significant change in mild multilevel degenerative changes in the lumbar spine. No high-grade spinal canal or high-grade neural foraminal stenosis. Additional details as above.2. There is multilevel facet arthropathy in the lower lumbar spine, relatively worse at the L4-5 level, which may be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: Right knee pain MENISCI: There is truncation of the anterior horn of the lateral meniscus which likely relates to prior partial meniscectomy. Otherwise the lateral meniscus is intact. There is abnormal signal within the posterior horn of the medial meniscus with extension to the superior articular surface concerning for tear. The anterior horn and body appear intact.ARTICULAR CARTILAGE AND BONE: There is diffuse thinning of the articular cartilage of the lateral compartment without discrete full-thickness defect. Similar but more severe areas of thinning are also noted in the medial compartment with scattered areas of partial-thickness defects noted in the medial femoral condyle posteriorly and near the intercondylar notch. Degenerative cystic changes are noted in the tibial plateau posteriorly at the level of the posterior horn of the meniscus. Moderate diffuse cartilage thinning of the patellofemoral compartment is also noted with areas of near full-thickness to full-thickness defects in the lateral patellar facet and femoral trochlea centrally.LIGAMENTS: There is evidence of prior ACL reconstruction, although the ACL graft is torn. The PCL is intact. The MCL and LCL are intact.EXTENSOR MECHANISM: Enthesopathic changes are noted in the distal quadriceps tendon which is otherwise intact. The patellar tendon is intact.ADDITIONAL

Output: 1. Ruptured ACL graft.2. Abnormal signal within the posterior horn of the medial meniscus concerning for tear.3. Diffuse tricompartmental thinning of the articular cartilage with areas of partial-thickness to near full-thickness defects of the medial and patellofemoral compartments.4. Large joint effusion.


Instruction: Generate impression based on findings.

Input: Clinical question: Follow-up MRI guided laser ablation for intractable epilepsy. Signs and symptoms: Left temporal epilepsy. Nonenhanced brain MRI:Negative diffusion weighted images.Small well-demarcated focus of minimally hemorrhagic encephalomalacia in the left hippocampal head is detected and representing site of prior laser ablation. The finding measures approximately 20 x 7.7 mm in transaxial dimensions on sagittal T2-weighted series and 9 x 8 mm on coronal T2-weighted series 5 image 16.A thin hemosiderin laden linear signal abnormality extends from the site of laser ablation posteriorly to the left posterior temporal burr hole consistent with track of laser ablation device.Tiny focus of gliosis at the site of the left posterior temporal burr hole and left paramedian frontal burr hole is noted. There is prominence of cerebral cortical sulci and of cerebellar-vermian folia for patient's stated age of 42 consistent with parenchymal volume loss and do not significant change since prior studies.Ventricular system remain within normal size and maintained midline.

Output: 1.Focus of minimally hemorrhagic encephalomalacia in the left hippocampal head measuring at 20 x 7.7 mm on axial T2 and 9 x 8 mm on coronal T2-weighted images representing sites of prior laser ablation.2.Prominence of cortical sulci, cerebellar and vermian folia for stated age of 42 without change since multiple prior exams.3.Other expected findings of prior electrode placement as well as laser ablation device as detailed.4.No acute intracranial process and unremarkable exam otherwise. Please see above comments.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes of suboccipital decompression including resection of the posterior arch of C1. There is much improvement in CSF spaces at the foramen magnum with robust biphasic flow now present ventrally and slightly diminished, but interval improved, flow dorsally. There is small fluid collection at the level of the suboccipital craniectomy measuring approximately 9 mm in thickness compatible with a pseudomeningocele. There is prominent enhancement involving the paraspinous soft tissues likely related to granulation tissue, although infection is not excluded and can be considered in the appropriate setting. Enhancement is also noted along the pial surface of the cerebellar tonsils.There is interval decrease in size of previously seen syrinx. Prior exam demonstrated a syrinx extending from the lower medulla into the cervical and thoracic cord with inferior limit at the T11-T12 level based on prior sagittal lumbar MRI images. Note a dedicated prior thoracic spine MRI is not available for comparison. Current study demonstrates significant decrease in extent and caliber of the syrinx which now extends to the mid T11 level. Residual signal abnormality involving the medulla is again evident best seen on the 3-D T2 sequence. There is marked decrease in the caliber of the syrinx; for example at the C6-C7 level, syrinx previously measuring 6.7 mm now measures 2.4 mm in the AP dimension. Previously seen associated cord expansion has now resolved with thinning/volume loss of the cord parenchyma much more apparent.There is mild reversal of normal cervical lordosis. There is also mild thoracic dextroscoliosis. Vertebral body heights are maintained. Disc desiccation at multiple levels are also seen with minimal bulge. Upper cervical spinal canal appears small on a congenital basis. There is also mild C3-C4 and C4-C5 neural foraminal narrowing. Otherwise no high-grade spinal canal or neural foraminal stenosis. There is calvarial thickening including the partially imaged clivus and also evident on outside brain MRI. Finding nonspecific and may be related to dysplasia or endocrinologic abnormality, for example. Dysplastic appearance of the thoracic ribs are also noted which appear slightly widened.

Output: 1. Compared to outside MRI, interval postsurgical changes of suboccipital decompression for Chiari I malformation are seen with much improvement in CSF spaces and biphasic flow at the foramen magnum. There is also marked improvement in size and extent of syrinx which extends from the medulla to the lower thoracic cord, as detailed above. There is associated resolution of previously seen cord expansion with volume loss/parenchymal thinning in the cord now more evident.2. Small suboccipital fluid collection likely represents a pseudomeningocele. There is also T2 hyperintensity involving the cerebellar tonsils as well as enhancement along the surface of the cerebellar tonsils which may represent expected postsurgical change. There is also prominent enhancement involving the suboccipital soft tissues which while may also represent postsurgical change/granulation tissue, but raises possibility of infection in the appropriate clinical setting. 3. Thickening of the clivus/partially imaged calvarium as well as mildly dysplastic appearance of the thoracic ribs which are broadened. These findings are nonspecific and may be related to dysplasia or endocrinologic abnormalities for example.


Instruction: Generate impression based on findings.

Input: New diagnosis of multiple myeloma: saddle anesthesia, right hip and buttock pain, and acute renal failure. There is degenerative spondylosis in the cervical spine, particularly at C3-4 and C4-5, with mild indentation of the spinal cord. Patchy high T2 signal projecting over the spinal cord in this region may be artifactual or may represent myelomalacia. There is a T2 hyperintense mass within the posterior aspect of the T12 vertebral body with epidural extension associated with compression of the spinal cord. There is also mild deformity of the superior endplate of T12. There may be trace edema in the spinal cord at this level versus artifact. There is focal fat in the inferior T7 vertebral body. There appears to be a predominantly T2 hyperintense lesion in the superior portion of the L2 vertebral body with mild irregularity of the superior endplate. The vertebral column alignment is grossly intact. There is a partially-imaged mass arising from the right sacrum and iliac bone. The cerebellar tonsils are mildly low-lying.

Output: 1. Degenerative spondylosis in the cervical spine worse at C3-4 and C4-5 with mild indentation of the spinal cord. 2. A myelomatous deposit in the T12 vertebra with pathological fracture and epidural extension results in spinal cord compression.3. A lesion in the superior portion of the L2 vertebral body with mild irregularity of the superior endplate may represent an additional myelomatous deposit versus an intravertebral disc herniation, although characterization is limited without intravenous contrast. 4. Partially-imaged mass arising from the right sacrum and iliac bone. Please refer to the separate pelvis MRI report for additional details.5. Diffuse enlargement of the bilateral kidneys likely represents myelomatous infiltration.6. The cerebellar tonsils are mildly low-lying.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 68 years Male (DOB:9/11/1947)Reason: Hx of lung CA, please compare to previous and measure History: New lesions per PET on 7/20PROVIDER/ATTENDING NAME: BRITTANY L BEACH BAKHTIAR L YAMINI The patient status post left-sided frontal craniotomy and left-sided temporal craniotomy. There is adjacent dural thickening and enhancement at the craniotomy sites.There is encephalomalacia present along the left frontal lobe anteriorly which was also present on the prior exam and associated with some loss of volume and ex vacuo effect on the left lateral ventricle. There is a smaller focus of encephalomalacia in the left temporal lobe along the inferior temporal gyrus. There is thickening of the dura and surface of the encephalomalacic brain at the left frontal lobe which was also present on the prior exam but has regressed.There is a 3 mm punctate focus of enhancement redemonstrated in the left temporal lobe at the surgical site. This was not present on exams from 2014, 2013 and 2012 but was present on the 2011 exam.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 right maxillary sinus is smaller than the left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Status post left frontal and temporal lobes surgeries for tumor removal. 2.A punctate focus of enhancement in the left temporal lobe is stable compared to the prior exams. The possibility this represents neoplasia cannot be excluded. It is too small to characterize further.3.There is interval regression of a focus of enhancement involving the dura and surface of the left frontal lobe at the prior frontal craniotomy site. It is suspected is mostly represents scar.


Instruction: Generate impression based on findings.

Input: Asymptomatic human immunodeficiency virus (hiv) infection status [Z21] / Polyneuropathy in diseases classified elsewhere [G63], Reason for Study: ^Reason: rule out intracranial structural abnormalities History: headache in HIV patient No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement.Subtle patchy ill defined fairly symmetric bilateral periventricular white matter high signal intensity lesions are seen on T2/FLAIR images. These are non specific findings. There is no associated cortical atrophy. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Patchy subtle ill defined symmetric T2/FLAIR high signal intensity lesions on bilateral periventricular white matter are seen which are non specific. Differential diagnosis include minimal representation of HIV encephalitis which needs clinical correlation and non specific small vessel ischemic disease.2. No evidence of acute ischemic or hemorrhagic lesion.3. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Reason: Labral tear History: pain ROTATOR CUFF: The supraspinatus muscle and tendon appear intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: No fluid or intra-articular gadolinium extends into the subacromial subdeltoid bursa. Mild degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is increased signal abnormality within the anterior superior labrum at the 2 o'clock position likely a normal variant sublabral foramen. There is heterogeneity of the posterior labrum which may represent very mild degeneration/superficial fraying. No fluid-filled labral tear is evident. No full-thickness articular cartilage defects are identified.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Very mild degeneration/superficial fraying of the posterior labrum without evidence of a fluid filled tear. Mild osteoarthritis of the acromioclavicular joint.


Instruction: Generate impression based on findings.

Input: Brachytherapy planning, cervical malignancy PELVIS:UTERUS, ADNEXA: Intrauterine linear structure related to brachytherapy. Poorly-enhancing and ill-defined cervical tumor is difficult to delineate but appears to be relatively hypoenhancing and measures approximately up to 2.8 x 1.6 cm in the same location seen on prior MRIs and PET scan (series 103/36). This is not significantly changed in size since most recent MRI.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left pelvic sidewall lymph node 8 x 6 mm (series 4/23), unchanged. BOWEL, MESENTERY: Mild circumferential rectosigmoid colon wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Ill-defined cervical tumor appears grossly unchanged.2. Unchanged reference left pelvic sidewall lymph node.3. No new sites of disease.


Instruction: Generate impression based on findings.

Input: 41 year-old female with right-sided weakness for 12 hours. Clinical question to be answered: Stroke No definitive evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and all CSF cisterns are unremarkable. Reevaluation with an MRI is recommended. Calvarium, paranasal sinuses and mastoid air vessels are also unremarkable.

Output: Negative CT of the brain.


Instruction: Generate impression based on findings.

Input: Paresthesias, multiple sclerosis. Follow-up progression. Javed MS protocol. Brain: There are approximately 20 foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter with distribution and morphology compatible with known demyelinating disease. Several of these foci are associated with T1 hypointensity. Infratentorial lesions including the left aspect of the midbrain and left cerebellar hemisphere also noted. Compared to 3/19/2015, there is no new lesion to suggest disease progression. Brain parenchymal volume is preserved. No evidence of intracranial mass or mass effect. No hydrocephalus or extra-axial collections. Calvarium and extracranial soft tissues are unremarkable.Cervical Spine: There are T2 hyperintense lesions in the cord compatible with known demyelinating disease including the ventral C4 level in the midline and the dorsal T1-T2 level. These lesions were present on prior study. No new lesions to suggest disease progression. There is mild loss of of cervical lordosis. Vertebral body heights and alignment are otherwise maintained. Minimal disc protrusions are present such as at the right paracentral C3-C4 and left paracentral C5-C6 levels. There is no significant spinal canal or neural foraminal stenosis at any level. Bone marrow signal is unremarkable.

Output: Multiple T2/FLAIR hyperintense lesions in the brain, cervical, and partially imaged upper thoracic cord as described above are consistent with known chronic demyelinating disease. Compared to 3/19/2015, no new lesions are seen to suggest disease progression.


Instruction: Generate impression based on findings.

Input: 37-year-old with history of recent gallstone pancreatitis status post cholecystectomy. Also status post ERCP benign-appearing biliary and pancreatic duct stricture treated with stents. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified. The gallbladder has been surgically removed. Susceptibility artifact is present surrounding the common bile duct corresponding to the common bile duct stent seen on 10/21/2015 ERCP radiographic images. The common bile duct remains mildly dilated measuring up to approximately 8 mm.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic head is prominent and demonstrates heterogeneous signal intensity suggestive of pancreatitis. There is a 6 mm cystic focus within the posterior pancreatic head (series 5, image 26) which may be a sidebranch IPMN. The remaining pancreas is normal in morphology and signal intensity. No peripancreatic fluid collections are identified. The pancreatic stent seen on radiographic images from 10/21/2015 ERCP is not well-visualized on this examination. The pancreatic duct is mildly irregular in contour and measures up to 4 mm in diameter at the level of the pancreatic neck, decreased from 8 mm on prior ultrasound. The previously seen distal pancreatic duct stone is no longer visualized. Post-secretin images demonstrate minimally decreased compliance but satisfactory excretion function.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening and increased enhancement involving the second and third portions of the duodenum compatible with mild duodenitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post cholecystectomy and placement of common bile duct stent. Pancreatic duct stent seen on prior imaging not well visualized.2.Findings suggestive of pancreatitis of the pancreatic head with associated reactive duodenitis. No peripancreatic fluid collection.3.Interval removal of pancreatic duct stone and decrease in caliber of pancreatic duct. Pancreatic duct is mildly irregular and demonstrates mildly decreased compliance on post-secretin imaging.4.A 6 mm cystic focus in the posterior pancreatic head may be a sidebranch IPMN.