Instruction: Generate impression based on findings.

Input: 28-year-old female, unresponsive, encephalopathy, weakness. Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, 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. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Fluid is layering within the pharynx and larynx, secondary to intubation.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. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Cervical spine MRI:Straightening of the spine is likely positional. The cervical vertebral bodies are appropriate in height. Bone marrow signal is within normal limits. Paraspinal contents are unremarkable.The cervical spinal cord has normal signal characteristics and overall morphology.C2-3: No significant compromise to the spinal canal or neural foramina, unchanged.C3-4: No significant compromise to the spinal canal or neural foramina, unchanged.C4-5: No significant compromise to the spinal canal or neural foramina, unchanged.C5-6: No significant compromise to the spinal canal or neural foramina, unchanged.C6-7: Minimal dorsal annular fissure and small central protrusion. No significant compromise to the spinal canal or neural foramina. These findings are unchanged.C7-T1: No significant compromise to the spinal canal or neural foramina, unchanged.

Output: 1.Negative noncontrast brain MRI.2.Negative noncontrast brain MRA.3.C6-7: Minimal dorsal annular fissure and small central protrusion. No significant compromise to the spinal canal or neural foramina. These findings are unchanged.


Instruction: Generate impression based on findings.

Input: Neck pain. Radiculopathy on the right side. 52-year-old male 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. There is disc desiccation present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is disc desiccation present at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a minor disc bulge, disc desiccation and mild posterior ligamentous hypertrophy at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level. There is some disc desiccation and a disc bulge at this level.At C6-7 there is no significant compromise to the spinal canal. There are bilateral uncovertebral osteophytes present at this level associated with narrowing of the neural foramina bilaterally and mild encroachment of the exiting nerve roots within the neural foramina -right worse than left. The exiting nerve roots within the neural foramina are surrounded by fat. There are endplate reactive changes present adjacent to the right sided exiting nerve roots at this level with high signal on T2 and lower signal on T1. This is best visualized on the T2 STIR images sequence #4 images # 2- 8At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: There are degenerative changes present in the cervical spine without significant compromise to the spinal canal or exiting nerve roots. However, there are inflammatory changes present involving the endplates adjacent to the right lateral recess at C6-7 which affects the right-sided exiting nerve roots within the neural foramen at this level where there is also mild encroachment of the right-sided exiting nerve roots.


Instruction: Generate impression based on findings.

Input: 59 year old male with cellulitis of the foot. There is nonenhancing reticulation of the subcutaneous fat of the ankle, particularly anterolaterally, indicating edema. Additional nonenhancing edema is noted within the dorsal subcutaneous fat of the midfoot extending into the forefoot off the field of view of this study. We see no fluid collection in the soft tissue to suggest an abscess.Bone marrow signal is normal without evidence of osteomyelitis. We see no gross tendon or ligament abnormality. There is a small amount of fluid in the tibiotalar joint but no large effusion. Mild osteoarthritis affects the talonavicular joint.

Output: Nonspecific ankle and foot edema without evidence of abscess or osteomyelitis.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:3/20/1960)Reason: MS eval for lesion load History: ataxiaPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED There are multiple periventricular and subcortical white matter lesions present many which are perpendicularly oriented to the lateral ventricles. Lesions are also present at the colossal cingulate junction. There are several T2 and FLAIR hyperintense lesions in the cerebellar hemispheres one located in the left dentate nucleus. 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 demonstrate partial opacification of right mastoid air cells and middle year. Some minor opacities are present in the left mastoid The visualized portions of the orbits are intact.

Output: There are multiple periventricular subcortical white matter lesions present. There is general appearance are consistent with demyelinating disorder. In particular there is one lesion located in the region of the left dentate nuclei left cerebellar hemisphere which may account for the patient's ataxia.


Instruction: Generate impression based on findings.

Input: Female 46 years old Reason: R medial foot pain near peak of arch. Type I DM for years. Assess for Charcot changes, rule out stress fracture History: Foot pain There is mild osteoarthritic changes with subchondral cysts at the tibiotalar joint. Along the dorsal aspect of the talonavicular articulation there is osseous debris; multiple small ossific fragments dorsally (series 7, image 15), better seen on radiographs 6/10/2016. Abnormal low T1 signal on the anterior aspect of the navicular bone where it articulates with the cuneiforms. This abnormal signal is on both sides of the joint. There is abnormal low T1 signal and high T2 signal throughout the middle cuneiform. Subchondral cyst and abnormal T2 hyperintensity is present in the lateral cuboid where articulates with the fourth and fifth metatarsal tarsals. At the junction of the base and diaphysis of the fifth and third metatarsal there is abnormal high T2 and low T1 signal which marrow edema, possibly secondary to stress reaction. No fracture lines are identified. No large joint effusion.The tendons are normal in appearance.

Output: Multiple areas of abnormal marrow signal as well as osseous debris suggestive of early Charcot foot as detailed above.


Instruction: Generate impression based on findings.

Input: Altered mental status and reported CVA at outside hospital 2 weeks ago No restricted diffusion to indicate acute ischemia.There is extensive periventricular and subcortical white matter increased T2 signal which becomes confluent superiorly and posteriorly. Statistically this most likely represents extensive chronic small vessel ischemic changes. There are multiple small areas of susceptibility in the left parietal lobe likely microhemorrhages. The small focus of increased density on prior CT in the right caudothalamic groove also has susceptibility artifact and punctate increased T1 and T2 signal suggestive of a subacute microhemorrhage.No abnormal enhancement within the limits of a motion degraded exam. There is no evidence of intracranial hemorrhage, mass or edema. Generalized cerebral volume loss with prominence of the ventricles and sulci. The expected intracranial vascular flow voids are present.Mild left maxillary sinus mucosal thickening. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: 1. No acute ischemic infarct.2. Extensive subcortical and periventricular white matter T2 signal abnormality compatible with extensive chronic small vessel ischemic disease.3. Possible subacute microhemorrhage in the right caudothalamic groove with additional chronic microhemorrhages in the left parietal lobe.


Instruction: Generate impression based on findings.

Input: H/o breast cancer. S/p Ommaya removal. Examination demonstrates diffuse right frontoparietal edema which was detected on the prior MRI exam. The fluid collection within the area of the edema appears smaller. The catheter has been removed. There is no intracranial hemorrhage, extraaxial fluid collection or midline shift. The ventricles are normal in volume. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Stable head CT exam with decrease in size of the right frontal fluid collection. No intracranial hemorrhage, extraaxial fluid collection or midline shift.


Instruction: Generate impression based on findings.

Input: Other visual disturbances [H53.8], Reason for Study: ^Reason: vasculitis of internal carotid History: concern for vasculitis Motion artifacts significantly degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion.The left distal ICA lumen appears to be significantly (more than 50%) narrowed in long segment especially from the opthalmic segment to the ICA bifurcation.Vascular wall imaging, even with significant motion artifacts so precise evaluation is not possible, shows thickening of left ICA distal petrous segment with diffuse wall enhancement (series 1601, image 1-4, series 2301, image 1-4 and series 2001, image 1-4). Wall thickening and enhancement of the left ICA's cavernous sinus segment is not possible due to diffuse cavernous sinus enhancement. The supraclinoid segment of the left ICA does not show any evidence of wall thickening or wall enhancement.In general, active vasculitis can show multi layer wall thickening indicating active inflammation and wall edema. Therefore, diffuse homogeneous type of wall enhancement which is shown on the left ICA is likely representing fibrosis of arterial wall. In addition, there is no evidence of intra dural arterial wall enhancement which may indicate active intracranial arteritis.There is again left basal ganglia and external capsule encephalomalacia, unchanged.No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no intracranial abnormal brain parenchymal enhancement.Inclusion cyst on the left temporal scalp is again seen, unchanged.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.

Output: 1. No evidence of active intracranial arteritis. Diffuse wall thickening of enhancement seen on extra dural segment of the left ICA more likely represent fibrotic changes of arterial wall.2. Unchanged left basal ganglia and external capsule encephalomalacia.3. Unchanged left temporal scalp inclusion cyst.4. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with locally advanced lung adenocarcinoma. No evidence of edema, mass effect or pathologic intracranial enhancement is seen. A few scattered foci of FLAIR hyperintensity are seen within the cerebral white matter, a nonspecific finding. No diffusion restricting lesions are seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Syncope and collapse. History of metastatic gastric adenocarcinoma. Possible seizure. Evaluate for metastasis. There is diffuse prominence of the cortical sulci in proportion to the cerebral ventricles consistent with moderate global volume loss. There is encephalomalacia involving the right MCA territory with gliosis. Patchy T2/FLAIR hyperintensity in the periventricular white matter is demonstrated. No intracranial hemorrhage is identified. No midline shift or mass effect is appreciated. There is no diffusion restriction to suggest ischemia. No abnormal enhancing lesions are identified. Opacification of the left sphenoid sinus is again seen.

Output: 1. There is diffuse global volume loss, right MCA territory encephalomalacia from chronic infarction, and white matter changes likely related to chronic microvascular ischemic change.2. There is no evidence for acute ischemia.3. There is no evidence for intracranial metastasis.4. Left sphenoid sinus opacification.


Instruction: Generate impression based on findings.

Input: 20-year-old female with a history of a pelvic desmoid tumor, currently being treated with tamoxifen. PELVIS: Again seen is an ill-defined infiltrating mass in the left hemipelvis which has increased in size compared to the prior examination. The mass measures 9.6 x 7.3 cm (series 14, image 81), previously 9.5 x 6.6 cm. It continues to encase the left external iliac artery. The mass invades and occludes the left external iliac vein with collaterals again identified. Anteriorly, the mass invades largest left rectus muscle and adductor brevis. Laterally, the mass invades the left pelvic sidewall, iliacus muscle, psoas muscle, and abuts the left acetabular cortex. Posteriorly, the mass extends into the obturator internus muscle. Medially, the mass abuts the left lateral bladder wall and multiple loops of bowel. There is increased extension into the perirectal area and probable increased extension/invasion into the left psoas muscle. UTERUS, ADNEXA: No significant abnormality noted. BLADDER: The urinary bladder is displaced to the right. LYMPH NODES: No significant abnormality noted. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted.

Output: Increase in size and extent of the left pelvic desmoid tumor.


Instruction: Generate impression based on findings.

Input: The patient has been placed left side down. A catheter is present entering via the right posterior calvarium with its tip residing in the anteromedial right temporal lobe.

Output: A catheter is present entering via the right posterior calvarium with its tip residing in the anteromedial right temporal lobe.


Instruction: Generate impression based on findings.

Input: 39 year-old female with multiple sclerosis diagnosed in 2005. MRI BRAIN: There is a new left pontine lesion with low T1 signal and a newly apparent patchy T2 hyperintense lesion in the right middle cerebellar hemisphere. Otherwise, there has been no significant interval change of the T2 hyperintense cerebral white matter and small medial left cerebellar hemisphere lesions, which are predominantly distributed in the periventricular regions. Many of the lesions demonstrate T1 hypointensity, but there is no evidence of associated enhancement. The ventricles are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. There is mild persistent scattered paranasal sinus mucosal thickening. The skull and extracranial soft tissues are unchanged. MRI CERVICAL SPINE: There is redemonstration of scattered high T2 signal lesions in multiple portions of the cervical and thoracic spinal cord. No enhancing lesions are identified. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. There is mild disc desiccation signal throughout the cervical spine and mild disc height loss at C5-6. The vertebral bone marrow is unremarkable. A posterior disc osteophyte complex with central disc protrusion is demonstrated at C5-C6 with mild flattening of the ventral spinal cord. There is no significant neural foraminal stenosis is evident.

Output: 1. Newly apparent infratentorial demyelinating lesions. The supratentorial demyelinating lesions otherwise appear to be similar as on the prior exam, accounting for differences in technique. 2. The demyelinating lesions in the cervical and thoracic spinal cord do not appear significantly changed, given differences in technique.3. Interval central disc protrusion at C5-C6 that mildly indents the spinal cord.


Instruction: Generate impression based on findings.

Input: The study is degraded by motion artifact. Myelination is normal for correlated age. No migrational abnormalities. There are no structural abnormalities.Ventricular size is normal. No midline shift. Basal cisterns are patent. There is a nonspecific focus of susceptibility along the right lateral ventricular body margin, which may represent old blood products versus mineralization. There is prominence of the anterior subarachnoid spaces and the ventricles. Myelination appears appropriate for corrected age.There is fluid in the right greater than left mastoid air cells. There is patchy opacification of the paranasal sinuses..

Output: 1. No structural abnormalities. 2. Nonspecific focus of susceptibility along the right lateral ventricular margin, which may represent chronic blood product versus mineralization.3. Prominence of the lateral ventricles and anterior subarachnoid spaces, likely relating to benign enlargement of subarachnoid spaces of infancy which should resolve by 2 years of age. Follow-up imaging may be obtained as clinically indicated.4. Nonspecific right greater than left mastoid air cell fluid opacification with patchy paranasal sinus fluid. Please correlate clinically.


Instruction: Generate impression based on findings.

Input: bell's palsy, right sided numbness, hyperreflexia, gait imbalance MRI brain: No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The CSF space just above right precentral sulcus appears slightly prominent and may represent an arachnoid cyst. Otherwise the ventricles, sulci, and cisterns are normal in size without evidence of ventriculomegaly. There is nonspecific focus of left periventricular white matter FLAIR hyperintensity. The tympanic and mastoid portions of the right facial nerve appear slightly more enhancing than the left facial nerve. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. MRI cervical spine: Exam is limited by motion artifact. Alignment is anatomic without subluxation. The marrow signal is benign. Vertebral body heights are maintained. Mild multilevel degenerative changes of the cervical spine. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. Spinal cord has a smooth contour and is without gross abnormality. The image paraspinal contents are unremarkable. Major cervical vasculatures with normal flow voids.C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis or foraminal narrowing. C3/4: Disc osteophyte complex without significant spinal stenosis. Mild uncovertebral arthropathy with moderate right foraminal narrowing and no significant left foraminal narrowing. C4/5: Disc osteophyte complex without significant spinal stenosis. Mild to moderate uncovertebral arthropathy with moderate to severe right foraminal narrowing and mild left foraminal narrowing. C5/6: Disc osteophyte complex without significant spinal stenosis. Mild uncovertebral arthropathy with moderate right foraminal narrowing and no significant left foraminal narrowing. C6/7: Disc osteophyte complex without significant spinal stenosis. Mild uncovertebral arthropathy with mild bilateral foraminal narrowing. Mild left foraminal narrowing.C7/T1: No significant spinal canal stenosis or foraminal narrowing.

Output: 1.Limited evaluation of the right tympanic and mastoid portions of the facial nerve shows slight asymmetric enhancement. Such a finding would be compatible with Bell's palsy.2.Nonspecific focus of white matter FLAIR hyperintensity of the left periventricular white matter. 3.Mild degenerative changes of the cervical spine, most severe at C4-5 level with moderate to severe right foraminal narrowing and mild left foraminal narrowing. There is no significant spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: 23 years Female (DOB:12/12/1992)Reason: high opening pressure on LP, ID recommends MRI History: fever, meningitisPROVIDER/ATTENDING NAME: ELIZABETH A SONNTAG The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Female 53 years old Reason: Scapular Dyskenesia with pain distal to the scapular, please include distally of the back, past scapula to evaluate soft tissue around the serratus anterior History: pain There is abnormal increased T2 signal within the inferior angle of the left scapula. There is also a 1.8 x 0.7 cm oval, masslike focus of abnormal T2 hyperintensity near the insertion of the latissimus dorsi on the inferior angle of the left scapula. This focus is isointense to muscle on T1 imaging. Mild atrophy of the left serratus anterior compared to the contralateral side.The remaining muscles and osseous structures are within normal limits. Structures in the chest are grossly normal. Partially visualized upper abdomen is also grossly unremarkable. A nonspecific nodule present within the left thyroid lobe.

Output: The findings are nonspecific but because of the location adjacent to the inferior tip of the left scapula,Elastofibroma is a likely diagnosis.


Instruction: Generate impression based on findings.

Input: History of neuroblastoma. In remission. Rule out relapse. There is no acute infarct or intracranial hemorrhage. There is no space-occupying brain lesion, midline shift or herniation. Tiny focus of T2/FLAIR hyperintensity in the deep left posterior left temporal white-matter is unchanged. The ventricles and other CSF-containing spaces are normal in size. Following contrast administration, there is no abnormal brain or leptomeningeal contrast enhancement. Major intracranial vascular flow voids are preserved. The pituitary gland is unremarkable. There is moderate left maxillary mucosal thickening.. There is mild ethmoid and maxillary sinus mucosal thickening. These findings are nonspecific. The mastoid air cells are clear. The palatine tonsils are prominent, right more than left. This is a fairly common finding in this age group and is usually reactive. There is asymmetric increased contrast enhancement in the left hemiglossus and the included left parotid gland. There is also asymmetric fatty signal in the marrow in the left side of C1 and C2 vertebrae. These findings are probably related to previous radiation treatment. There is no destructive osseous lesion.

Output: 1.There is no intracranial mass or abnormal enhancement to suggest metastasis.2.Posttreatment changes in the face are partially included. Please refer to the report of the CT scan of the neck from the same day for details.


Instruction: Generate impression based on findings.

Input: Meningioma resection: surveillance. There has been interval evolution of postoperative findings related to resection of a right middle cranial fossa meningioma. There is a small amount of plaque-like enhancement along the floor of the middle cranial fossa in the operative bed, measuring up to 3 mm in thickness. Otherwise, there is interval resolution of vasogenic edema in the right anterior temporal lobe, with a small area of encephalomalacia in the surgical bed region. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a small, branching developmental venous anomaly within the left paramedian pons. The major cerebral artery flow voids are intact. The orbits are grossly unremarkable.

Output: 1. Postoperative findings related to resection of a right middle cranial fossa meningioma. There is a small amount of nonspecific plaque-like enhancement along the floor of the middle cranial fossa in the operative bed. Otherwise, interval resolution of vasogenic edema in the right anterior temporal lobe, with a small area of encephalomalacia in the surgical bed region.2. Small developmental venous anomaly within the left paramedian pons.


Instruction: Generate impression based on findings.

Input: Reason: eval for lateral foot pain (? Peroneal tendon injury) History: pain in the area of os peroneum / calcaneocuboid joint The flexor and extensor tendons appear intact. There is increased signal abnormality within the distal right radius brevis tendon at the level of its insertion on the tuberosity of the fifth metatarsal indicating moderate tendinopathy (image 23; series 701). There is subcutaneous soft tissue edema in the surrounding area. Peroneal tendons appear intact. The Achilles tendon is normal in appearance. There is a lobulated focus of fluid signal intensity along the medial aspect of the flexor digitorum longus at the level of the medial malleolus which may represent ganglion formation. The lateral collateral ligament complex appears intact the distal tibiofibular syndesmotic complex appears intact. The components of the deltoid ligament appear intact. There is subcutaneous edema along the dorsal aspect of the foot which is nonspecific. There is a small amount of fluid within the retrocalcaneal bursa which may reflect a mild bursitis. There is minimal increased signal abnormality within the posterior aspect of the calcaneus at the level of the insertion of the Achilles tendon which may reflect tiny cyst formation.

Output: Findings indicating tendinosis of the peroneus brevis tendon with subcutaneous and soft tissue edema in the surrounding area which may be reactive in etiology. There is also nonspecific subcutaneous edema along the dorsal aspect of the foot. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Ms. Warmack is a 61-year-old woman with hypertension, alcoholic cirrhosis, bipolar disorder, chronic mastoiditis, and history of presumed heart failure presenting for cardiac evaluation Left VentricleThe left ventricle is mildly to moderately dilated with severely reduced systolic function. The overall LV ejection fraction is 30%, the LV end diastolic volume index is 95 ml/m2 (normal range: 65+/-11), the LVEDV is 169 ml (normal range 109+/-23), the LV end systolic volume index is 67 ml/m2 (normal range 18+/-5), the LVESV is 119 ml (normal range 31+/-10), the LV mass index is 46 g/m2 (normal range 67+/-11), and the LV mass is 81 g (normal range 114+/-24). The systolic dysfunction is global. There is significant motion artifact throughout the study. However, no abnormal enhancement is present.No intracardiac thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with severely reduced systolic . The overall RV ejection fraction is 36%, the RV end diastolic volume index is 80 ml/m2 (normal range 69+/-14), the RVEDV is 142 ml (normal range 110+/-24), the RV end systolic volume index is 51 ml/m2 (normal range 22+/-8), and the RVESV is 91 ml (normal range 35+/-13). 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 visibly mild mitral regurgitation. Dedicated imaging was not performed.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 common origin of the right innominate and left common carotid artery. 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 pericardial effusion.Extracardiac FindingsThere are multiple T2 hyperintense lesions in the liver, the largest is 4.0 x 5.5 cm. These are incompletely characterized and can be further evaluated with hepatic MRI. Considerations include cysts and hemangiomas.

Output: 1. LV ejection fraction is 30%. No abnormal enhancement.2. RV ejection fraction is 36%.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Possible seizure, also with question of HSV encephalitis: AMS, headache prior to admission. There appear to be punctate foci of restricted diffusion in the bilateral superior frontal gyri. There is mild periventricular white matter T2 hyperintensity, but the temporal lobes are spared. There is also numerous scattered foci of susceptibility effect in the right basal ganglia, left periventricular white matter, and more peripherally in the left cerebral hemisphere, which correspond to the calcifications demonstrated on CT. There is mild diffuse cerebral volume loss. 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. However, there is fluid within the bilateral mastoid air cells.

Output: 1. Apparent punctate foci of restricted diffusion in the bilateral superior frontal gyri.2. Mild periventricular white matter T2 hyperintensity may represent chronic small vessel disease, but there are no findings specific for herpes encephalitis, although assessment is limited without contrast.3. Numerous scattered calcifications in the bilateral cerebral hemispheres may be related to a prior infection or granulomatous disease.4. Fluid within the bilateral mastoid air cells may represent mastoiditis.


Instruction: Generate impression based on findings.

Input: 57 years, Male, history of Pott straight cancer status post prostatectomy. Rising PSA. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy.Peripheral Zone: Status post prostatectomy. No measurable disease present.Central Gland: Status post prostatectomy.Seminal Vesicles: No abnormalities noted.Extracapsular Extension: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post prostatectomy without measurable disease or lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 34 year old with strong family history of breast cancer. Personal history of benign right breast biopsy in 2010. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Artifact from the right central breast biopsy clip is again noted. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: History of right liver lobe mass. s/p large VHR repair without mesh now with wound dehiscence, please eval for fascial integrity History: 52 yo M s/p emergent colectomy with primary anastomosis for perforated contained diverticulitis in 2009, c/b anastomotic leak, requiring several repeat operations including a diverting ileostomy now s/p VHR by Dr. Gottlieb on 5/12/2015 ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology and size. Demonstrated again is a large mass in the right hepatic lobe with lobular margins measuring up to 8.3 x 7.4 cm (series 901/385) compared to 8.1 x 7.4 cm previously, not significantly changed accounting for technical differences. The lesion is intrinsically peripherally hyperintense on T2-weighted imaging with central hypointensity. It demonstrates peripheral thick and internal thick enhancement. Centrally there is no obvious enhancement. No wash-out is evident. There is associated thrombosis of a right portal vein branch. No associated biliary ductal dilatation.SPLEEN: Splenomegaly measuring 15 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: As seen on the prior CT there are large para-esophageal and gastrohepatic and right cardiophrenic lymph nodes. For future reference a right cardiophrenic lymph node measures 1.7 x 1.0 cm (series 5 on 1/29).BOWEL, MESENTERY: No significant abnormality noted. Right lower quadrant colostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The right hepatic lobe mass is more suspicious for neoplasm as opposed to an abscess. Differential considerations include cholangiocarcinoma or metastases. Tissue sampling is recommended.Enlarged paraesophageal, gastrohepatic and right cardiophrenic lymph nodes.


Instruction: Generate impression based on findings.

Input: Male, 26 years old, with seizures, right lower extremity weakness, and brain lesions status post biopsy. An irregularly marginated, enhancing lesion is redemonstrated centered on the left cingulate gyrus. The lesion is predominately solidly enhancing with a somewhat feathery appearance along its inferior margin which encroaches into the corpus callosum. The lesion is similar in size when compared to the immediate prior Stealth MRI, but has increased relative to the examination of 05/26/16. Associated surrounding edema has also increased.A smaller but similar-appearing, solidly enhancing lesion is again seen within the left parietal lobe. This lesion is also unchanged relative to the immediate prior examination, but increased in size when compared to the older study. Adjacent postbiopsy changes are seen including a burr hole in the left parietal bone and a small biopsy cavity immediately anterior to the enhancing lesion.No other pathologic intracranial enhancement is observed. However, there are scattered small foci of white matter T2 hyperintensity within the right cerebral hemisphere which are not significantly changed. No areas of significant intracranial hemorrhage or any abnormal extra-axial fluid are seen.

Output: 1.Findings are seen compatible with left parietal lobe biopsy. A biopsy cavity is evident just anterior to the enhancing nodule within the left parietal lobe.2.Solidly enhancing lesions within the left parietal lobe and in the left cingulate gyrus are redemonstrated. When compared to the immediate prior Stealth MRI, these lesions and their associated edema have not changed, but when compared to the older MRI, they have increased in size.


Instruction: Generate impression based on findings.

Input: 62 years, Male, brain metastases. Also concern for spinal metastases. Brain: Limited sequences per SRS treatment protocol.There are multiple enhancing lesions throughout the brain consistent with metastatic disease and similar to recent prior. There is a 11 x 11 mm lesion in the right frontal lobe, series 30, axial image 126. There is a 2 to 3 mm lesion in the right frontal lobe more posteriorly, axial image 121. There are 2 punctate posterior left frontal lobe lesions, axial images 134 and 120. There is a 6 x 7 mm lesion involving the posterior aspect of the left superior temporal gyrus, axial image 89. There is a 9 x 6 mm lesion involving the right occipital lobe, axial image 65. There is susceptibility compatible with hemorrhage associated with the right frontal and left temporal lesions.There is edema surrounding the relatively larger right frontal, left temporal, and right occipital lesions, which is better assessed on prior T2/FLAIR sequences. There appears to be mild improvement in the edema, but again not well assessed on the available sequences. There is slight increase in size of the left lateral ventricle. No evidence of hydrocephalus. No midline shift or uncal herniation. Multiple foci of enhancement are seen in the calvarium consistent with osseous metastatic disease, relatively more prominent in the right occipital region where there is adjacent mild thickening and enhancement of the adjacent dura, which may be reactive. No definite evidence of dural invasion or leptomeningeal disease. Evidence of small vessel ischemic disease with lacunar infarcts involving the left caudate nucleus, left midbrain, and bilateral cerebellar hemispheres noted.Total spine: CERVICAL SPINE

Output: 1. Examination of the brain per SRS treatment planning protocol. There are 6 enhancing lesions in the brain consistent with intracranial metastatic disease as detailed above and similar to outside prior study. There is small amount of hemorrhage associated with the relatively larger right frontal and left temporal lesions.2. Evidence of calvarial metastases which can be correlated with prior bone scan if available. A relatively larger right occipital bone metastasis is associated with mild adjacent dural thickening and enhancement, which may be reactive.3. Chronic small vessel ischemic disease and evidence of multiple supratentorial and infratentorial lacunar infarcts.4. Examination of the spine demonstrate multiple osseous metastatic lesions involving the cervical, thoracic, and lumbar spine as detailed above. No evidence of epidural tumor in the spinal canal. There is mild endplate depressions involving the L2 vertebral body which may represent a pathologic fracture. Vertebral body heights and alignment in the spine are otherwise maintained. There is also a relatively large lesion involving the right sacrum and iliac bone. Please see additional details above.


Instruction: Generate impression based on findings.

Input: Low back pain Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L2 on L3, L3 on L4, and L4 on L5 with some loss of lordosis similar to prior. Multilevel degenerative changes are seen with disc desiccation and height loss at L2-L3, L3-L4, L4-L5 which have mildly progressed since 2007. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge, ligamentum flavum thickening, and facet arthropathy resulting in mild spinal canal stenosis, which is progressed in the interval. No significant neural foraminal narrowing.L2-L3: Loss of disc height, disc bulge, disc bulge, moderate bilateral facet arthropathy, ligamentum flavum thickening and prominence of the dorsal epidural fat. There is moderate to severe spinal canal stenosis which has progressed in the interval. There is moderate left and mild to moderate right neural foraminal stenosis.L3-L4: Loss of disc height, disc bulge, moderate bilateral facet arthropathy, ligamentum flavum thickening and prominence of the dorsal epidural fat. There is moderate to severe spinal canal stenosis which has slightly progressed in the interval. There is moderate to severe left and mild right neural foraminal stenosis. There is a left foraminal and extraforaminal disc protrusion which contacts the exiting left L3 nerve root.L4-L5: Loss of disc height, disc bulge, advanced bilateral facet arthropathy, and ligamentum flavum thickening. There is moderate to severe spinal canal stenosis which has slightly progressed in the interval. There is severe right and moderate to severe left neural foraminal stenosis which may be impinging on the exiting L4 nerve roots, particularly on the right.L5-S1: No significant disc disease. Mild right neural foraminal narrowing. No spinal canal or left neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Degenerative changes throughout the lumbar spine which have mildly progressed since 6/25/2007.2. There is moderate to severe spinal canal stenosis at L2-L3, L3-L4, L4-L5 which has progressed in the interval. 3. Neural foraminal stenosis at multiple levels as detailed above, severe at the right L4-L5 level where there may be impingement of the right L4 nerve root. 4.Facet arthropathy is also seen throughout the lumbar spine, worst at L4-L5, which may be also be contributing to patient's low back pain.


Instruction: Generate impression based on findings.

Input: 56 year old female with hepatic encephalopathy. Still with poor mental status. New since prior examination is a focal area of well demarcated low attenuation in the left thalamus. Finding is non-specific and could possibly represent an area of stroke. A follow-up with an MRI is recommended if clinically considered warranted. This examination is otherwise stable. No initial hemorrhage, midline shift or hydrocephalus is detected.

Output: Focal area of low-attenuation in the left thalamus as detailed.


Instruction: Generate impression based on findings.

Input: Male, 80 years old, with vertigo, nausea and vomiting. History of right acoustic neuroma and TIA. No definite restricted diffusion is seen. A punctate focus of bright diffusion signal along the left precentral sulcus shows no ADC correlate and may therefore be artifactual.Fairly extensive patchy T2 hyperintensity is seen within the cerebral white matter, predominantly in the periventricular regions. Most of this is unchanged relative to the prior examination. However, there is a new focus of FLAIR hyperintensity along the right precentral gyrus without mass effect or edema. Some of these areas of T2 signal abnormality are associated with mild susceptibility.A small focus of encephalomalacia within the left cerebellum is unchanged. No significant parenchymal edema or mass effect is detected. No abnormal extra-axial collections or acute intracranial hemorrhage is noted. The ventricles are stable in size and slightly prominent likely representing parenchymal volume loss.A 7 x 5 mm homogeneously enhancing nodule within the right internal auditory canal has not significantly changed in size or morphology. Both cranial nerves VII and VIII appear to pass through or along this lesion. The lesion is almost entirely contained within the internal auditory canal with no significant extension into the CP angle cistern. The inner ear and IAC structures are otherwise unremarkable.Elsewhere in the brain, no pathologic parenchymal or extra-axial enhancement is seen.A mucous retention cyst in the right maxillary sinus is unchanged.

Output: 1.Stable right IAC nodule likely representing a schwannoma. No new inner ear or IAC abnormalities are appreciated.2.Sequelae of fairly extensive chronic small vessel ischemic disease with perhaps some superimposed chronic cortical ischemia. Although no definite acute lesions are appreciated, one small lesion along the right precentral gyrus is new when compared to the prior examination.


Instruction: Generate impression based on findings.

Input: Primary CNS lymphoma status post treatment. There are postoperative findings related to left transfrontal biopsy. There is unchanged patchy T2 hyperintensity in the left corona radiata, basal ganglia, and insula, with minimal faint enhancement in this region. There is also unchanged patchy intrinsic T1 hyperintensity and susceptibility effect in the left basal ganglia enhancement at the biopsy site. There is unchanged patchy high T2 signal in the left cerebral peduncle without associated enhancement. There is no residual midline shift or herniation. There is diffuse cerebral volume loss with superimposed ex vacuo dilatation of the left lateral ventricle and Wallerian degeneration of the left brainstem. There is no acute infarct. There is an unchanged nonspecific enhancing lesion in the left parietal skull.

Output: 1. Treated CNS lymphoma centered in the left basal ganglia and left cerebral peduncle without evidence of tumor recurrence.2. Unchanged nonspecific enhancing lesion in the left parietal skull.


Instruction: Generate impression based on findings.

Input: Diplopia [H53.2], Reason for Study: ^Reason: TM eval History: numbness below T6 There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the T12-L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Normal thoracic spine MRI


Instruction: Generate impression based on findings.

Input: 52-year-old female with history of acute liver inflammation with concern for autoimmune hepatitis. ABDOMEN:Motion artifact limits evaluation on multiple sequences. Within this limitation, the following observations are made.LIVER, BILIARY TRACT: Cirrhotic liver morphology with nodular contour and hypertrophy of the caudate lobe. 1.6 x 1.4 cm segment 7 lesion with suggestion of peripheral nodular enhancement and fill-in on delayed phase images, most likely a hemangioma.No biliary ductal dilation. Gallbladder is underdistended and demonstrates mild wall thickening with enhancement and mild pericholecystic free fluid, which is nonspecific in the setting of chronic liver disease.Hepatic and portal veins are patent.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: Mild upper abdominal ascites.

Output: 1.Cirrhotic liver morphology.2.Probable segment 7 hemangioma. Short interval follow-up can be obtained to confirm this finding, particularly given motion artifact on the current exam.3.Gallbladder wall thickening and enhancement with pericholecystic fluid, nonspecific in the setting of chronic liver disease.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with low back pain radiating to the feet. History of MVA. Spinal alignment is anatomic. Vertebral body morphology is within normal limits. Edematous endplate signal alteration is demonstrated at L4-5 the right. Otherwise, marrow signal characteristics are within normal limits.The visualized spinal cord, conus and nerve roots of cauda equina are unremarkable.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Facet hypertrophy and ligamentum flavum thickening. Prominence of the dorsal epidural fat. Mild generalized narrowing of the thecal sac. Mild left foraminal narrowing. L4-5: Facet hypertrophy with effusion on the right and ligamentum flavum thickening. Prominence of the dorsal epidural fat. Bulging disc with annular fissuring in the right foraminal zone. Mild generalized spinal canal stenosis with effacement of the lateral recesses. Moderate bilateral foraminal narrowing. L5-S1: Facet hypertrophy and ligamentum flavum thickening. Minimal bulging disc with a small annular fissure at the left foraminal zone. Mild bilateral foraminal narrowing.

Output: Relatively mild degenerative disc disease is seen. Mild generalized spinal canal narrowing is seen at L3-4 and L4-5. Moderate neuroforaminal narrowing is evident bilaterally at L4-5.


Instruction: Generate impression based on findings.

Input: Right vestibular schwannoma treated to 12.5 Gy using SRS: dizziness. There is has been slight interval increase in size of the right vestibular schwannoma that is extends from fundus of the internal auditory canal to the cerebellopontine angle cistern, now measuring up to 21 AP x 24 RL x 18 SI mm, previously 20 AP x 21 RL x 16 SI. There is associated increased mass effect upon the right middle cerebellar peduncle and right cerebellar hemisphere, where there appears to be mild edema. There is persistent slightly diminished fluid signal within the right labyrinthine structures. There are unchanged mild scattered foci of cerebral white matter T2 hyperintensity, which likely represent microangiopathy.

Output: Slight interval increase in size of the right vestibular schwannoma.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:5/31/1954)Reason: Early onset AD with progressive cognitive and visual loss and apraxia History: visual inattention, optic apraxia, apraxiaPROVIDER/ATTENDING NAME: JAMES A MASTRIANNI JAMES A MASTRIANNI The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There 5-10 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These were also present on the prior exam and have not changed 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: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: ? cardiac amyloid Left VentricleThe left ventricle is mildly hypertrophied at 12 mm. Hypertrophy is concentric with sigmoid septum. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 69 ml/m2 (normal range: 74+/-15), the LVEDV is 157 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 57 ml (normal range 47+/-19). There are no regional wall motion abnormalities present. There appears to be mild diffuse late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. The native T1 times is 3 separate areas of myocardium are 1050-1100 msec.Left AtriumThe left atrium is enlarged. Right VentricleThe right ventricle is normal. The overall RV ejection fraction is 68%, the RV end diastolic volume index is 78 ml/m2 (normal range 82+/-16), the RVEDV is 152 ml (normal range 142+/-31), the RV end systolic volume index is 23 ml/m2 (normal range 31+/-9), and the RVESV is 47 ml (normal range 54+/-17).Right AtriumThe right atrium is normal.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation, but the severity of aortic regurgitation can be underestimated by the MRI pulse sequence used in this study.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation, but the severity of pulmonic regurgitation can be underestimated by the MRI pulse sequence used in this study.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumMinimal pericardial effusion.Extracardiac Findings . This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV systolic function with mild concentric hypertrophy.2. Normal RV3. There appears to be mild diffuse delayed enhancement and the native T1 times are upper normal which suggests but is not sufficiently abnormal to be definitive of cardiac amyloid involvement.


Instruction: Generate impression based on findings.

Input: Ms. Cooney is a 55 year old female with a personal history of basal cell carcinoma at age 40 years and a strong family history of breast and other cancers. Her mother had breast cancer at the age of 48 years. Her father had colon cancer at the age of 72 years, prostate cancer at 74 years and melanoma at 82 years. Her maternal aunt had breast cancer at 70 years. Her maternal grandmother had breast and ovarian cancer. Her maternal and paternal grandfathers had leukemia. The patient has a history of bilateral breast reduction in 2011. Mild parenchymal enhancement is noted bilaterally. Scattered fibroglandular tissue is present.RIGHT BREAST - Within the superolateral right breast, there is a tortuous ectatically dilated duct identified with increased T1 signal, consistent with proteinaceous fluid. At the terminal end of this duct, within the right nipple, is an irregular enhancing mass measuring 0.9 x 0.8 x 0.7 cm. These findings are highly suspicious for an intraductal mass with associated intraductal dilatation. LEFT BREAST - There is no abnormal enhancement identified within the left breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: (1) Suspected intraductal mass with associated dilatation in the right superior breast. An MR-directed US is recommended for further evaluation of these findings. If a suspicious sonographic correlate is identified, an US-guided biopsy may be recommended at that time.(2) No MR evidence of malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required.


Instruction: Generate impression based on findings.

Input: Diagnosis: Pilonidal cyst without mention of abscessClinical question: Sacral dimple, evaluate for communication with the spinal canalSigns and Symptoms: Sacral dimple, pain with clear drainage Within the subcutaneous tissues to the right of the coccyx and the posterior to it. It is bright on T2 and dark on T1 It is associated with contrast enhancement. There is infiltration of the fat planes surrounding it. The fluid like portion measures approximately 11 mm x 6 mm axial dimensions. There is a small amount of enhancement of the adjacent bony marrow at the tip of the coccyx, as well as the adjacent periosteum and tissues immediately adjacent to the coccygeal bone. The spinal canal is approximately 3 bone segments above the level of the inflamed marrow.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.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.

Output: There is a small fluid collection associated with inflammatory changes presumably representing a small abscess located in the subcutaneous tissues adjacent to the coccygeal bone. There is some associated involvement of the distal tip of the coccyx compatible with osteomyelitis. There is no involvement of the spinal canal appreciated.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, status post recent lumbar untethering of the cord with syrinx, assess for residual abscess. Findings compatible with surgery for tethered cord release are again seen. The lower lumbar and sacral spinal canal is ectatic and in addition has been surgically widened with laminectomy at L5 and perhaps in the sacrum as well. Posterior paraspinal collections which were previously seen in the lower lumbar and sacral regions have almost completely resolved. Only a 1 to 2 mm sliver of fluid persists along the left L4 lamina. No new paraspinal or epidural fluid collections are seen.The distal spinal cord syrinx shows no significant interval change from the prior examination, it begins at approximately the T12 level and continues to the L4 level with a maximum caliber of approximately 3 x 2 mm. As on the prior examination, the distal spinal cord is closely opposed and may be adherent to the posterior thecal sac. The cord terminus is difficult to ascertain but it appears that the cord ultimately tapers and blends with strands of soft tissue which traverse the lower thecal sac. No significant change in cord positioning is seen on prone imaging.The lumbar lordosis is straightened. Vertebral body height, morphology and signal characteristics are otherwise unremarkable. No evidence of marrow edema or pathologic marrow enhancement is seen. No significant compromise of the spinal canal or neural foramina is detected.

Output: 1. Redemonstration of findings compatible with spinal cord tethering. The paraspinal fluid collections seen in the operative region on prior examinations have almost completely resolved. Only a thin sliver of fluid persists along the left L4 lamina. No new or worrisome paraspinal or epidural fluid collections are detected.2. The distal spinal cord syrinx is stable in caliber and craniocaudal extent. The appearance of the distal spinal cord is also unchanged.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with history of cervical schwannoma status post resection. Yearly evaluation for tumor recurrence. Findings are redemonstrated compatible with laminectomy at C1 and partial laminectomy at C2 on the right. A 9 x 7 mm focus of enhancement in the operative bed along the right C2 nerve root is unchanged. No new enhancing lesions are seen.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology.C2-3: No significant spinal canal or foraminal stenosis. C3-4: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis. Moderate left and mild right foraminal narrowing. No changes. C4-5: Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis and mild bilateral foraminal narrowing. No changes.C5-6: Minimal posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild spinal canal stenosis. No significant foraminal narrowing. No changes.C6-7: Posterior disc-osteophyte complex formation with a left paracentral fusion. Ligamentum flavum thickening. Moderate spinal canal stenosis with slight flattening of the left ventral cord. Moderate left and mild right foraminal narrowing. No changes. C7-T1: No spinal canal or foraminal stenosis.

Output: Postoperative findings are redemonstrated compatible with schwannoma resection at the right C1-2 neural foramen. Nonspecific enhancing tissue in the operative bed is unchanged. No new or growing lesions are detected.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few punctate foci of T2 hypertensity within the supratentorial white matter. 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.

Output: A few punctate foci of T2 hypertensity within the supratentorial white matter are nonspecific. Otherwise unremarkable MRI.


Instruction: Generate impression based on findings.

Input: 62-year-old female with history of hypodense segment 5 lesion seen on previous CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology including hypertrophy of the left hepatic and caudate lobes as well as fissural prominence. In segment 5, there is a lesion corresponding to the prior CT findings measuring 12 x 10 mm demonstrating high T2/low T1 signal abnormality which avidly enhances on arterial phase imaging and demonstrates rapid washout. There is signal dropout on out of phase series suggesting microscopic fat. Additionally, there is signal dropout on fat suppression imaging indicating macroscopic fat. No associated diffusion abnormalities. No discrete capsule.Right hepatic dome granuloma.Status post cholecystectomy.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: Cirrhotic liver morphology. Segment 5 lesion with rapid enhancement and washout, which in presence of cirrhosis and hepatitis C, is most compatible with a fat-containing HCC.Findings discussed with Dr. Reddy at 1500 on 2/16/16.


Instruction: Generate impression based on findings.

Input: Absent reflexes in the bilateral patellae and ankles. Pain in right leg. Right leg gives out. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is diffusely heterogeneous. No discrete marrow infiltrating or destructive lesion is evident. Scattered foci of T1 hyperintensity are consistent with foci of fat or small hemangiomas. There are small foci of T2/STIR hyperintensity in the bone marrow without clear T1 shortening such as the involving the L1 vertebral body in its lateral aspects measuring up to 15 x 12 mm as well as a smaller one involving the left L4 vertebral body; these lesions may possibly represent atypical hemangioma but are nonspecific and would suggest comparison with prior MRI if available. Expansile lesions involving the spinal canal at the S2 level are consistent with perineural cysts and abut the S1 and S2 nerve roots. There is an 11 mm lesion posterior to the facet joint at the left L5 level likely representing a synovial cyst. The conus medullaris is normal in position. Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge without significant spinal canal or neural foraminal stenosis. Mild facet arthropathy.L2-L3: Mild disc bulge and facet arthropathy. No significant spinal canal stenosis. No significant neural foraminal stenosis.L3-L4: Mild disc bulge and mild bilateral facet arthropathy no significant spinal canal or left neural foraminal stenosis. Mild right neural foraminal narrowing.L4-L5: There is a disc bulge with a small left foraminal protrusion as well as facet arthropathy bilaterally. There is partial effacement of the lateral recesses. There is no significant central spinal canal or right neural foraminal stenosis. There is moderate left foraminal stenosis and possible impingement of the left exiting L4 nerve root.L5-S1: Small left posterior annular fissure. Otherwise no significant disc disease or spinal canal or neural foraminal stenosis. There is bilateral facet arthropathy.Paraspinous soft tissues are within normal limits.

Output: 1. Overall mild multilevel degenerative changes in the lumbar spine. There is no significant central spinal canal stenosis at any level. There is mild right L3-L4 and more significant left L4-L5 neural foraminal stenosis where there may be impingement of the exiting left L4 nerve root. Additional levels as above.2. Prominent perineural cysts at the S2 level which are a relatively common incidental finding. These lesions however appear to have mild local mass effect on the S1 and S2 nerve roots which is of uncertain clinical significance.3. Small nonspecific lesions involving the L1 and L4 vertebral bodies as above. These may represent benign entity such as atypical hemangioma but would suggest comparison with prior MRI if available or follow-up to ensure stability. No discrete marrow infiltrating or destructive lesion is evident.


Instruction: Generate impression based on findings.

Input: Reason: R shoulder soft tissue sarcoma, x/p chemo/xrt, evaluate for treatment effect prior to surgery History: above Note is made of a large heterogeneous mass abutting the posterior margin of the trapezius and superior margin of the supraspinatus, posterior to the scapular spine, measuring 8.0 x 6.1 x 5.4 cm, previously 6.3 x 4.8 x 4.8 cm, consistent with stated history of a soft tissue sarcoma. There are foci of internal increased signal abnormality on T1-weighted images likely representing blood products/internal hemorrhage. There are also fluid fluid levels identified internally. There is mass effect on the supraspinatus and trapezius musculature. There is also increased signal abnormality and fluid sensitive sequences within the medial aspect of the trapezius which demonstrates patchy enhancement on postcontrast sequences which is nonspecific but may reflect intramuscular extension of tumor, appearing similar to the prior study. No bone marrow signal abnormality is identified in the surrounding area. Note is made of heterogeneous bone marrow signal within the proximal humerus which may represent residual islands of red marrow. Although this examination was not protocoled for detailed evaluation of the rotator cuff musculature, there appears to be a partial-thickness bursal surface tear of the supraspinatus approximately 2.5 cm from the level of its insertion on the greater tuberosity. There is thickening and intermediate signal intensity within the supraspinatus indicating tendinosis. No evidence of lymphadenopathy.

Output: Interval increase in size of the enhancing soft tissue lesion consistent with the stated history of soft tissue sarcoma with reference measurements and other findings as provided above.


Instruction: Generate impression based on findings.

Input: There is a multinodular goiter with enlargement of the bilateral thyroid lobes and isthmus. For example left thyroid lobe measures up to 5.1 cm in the AP dimension and isthmus measures 2.2 cm in the AP dimension. There is inferior extension into the superior mediastinum bilaterally. No significant airway narrowing. No significant mass effect on the brachial plexus is appreciated, which is lateral to the goiter. There is no signal abnormality involving the brachial plexus nerve roots, trunks, or cords. Degenerative changes involving the cervical spine at C5-C6, C6-C7, and C7-T1 are again seen. Slightly prominent submental lymph nodes in the midline are again noted.

Output: 1. Significantly enlarged, multinodular thyroid gland with mild extension into the superior mediastinum. 2. No abnormal signal involving the brachial plexus or mass effect on the brachial plexus related to the goiter is seen.3. Degenerative changes involving the lower cervical spine including significant right C5-C6 and C7-T1 neural foraminal stenosis better assessed on dedicated cervical spine MRI study.


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of unspecified part of unspecified bronchus or lungClinical question: eval for pre-op brain biopsySigns and Symptoms: brain lesion There is T2 hyperintensity associated with sulcal enhancement and some contrast enhancement along the white matter of the right fusiform inferior temporal gyri. It is associated with mass effect and some compression of the trigone of the right lateral ventricle which was also present on the MRI from 12/2/2015.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a lesion involving the right fusiform gyrus and inferior temporal gyrus which was defined on the recent MRI of the brain. Differential considerations could include the an infiltrative lesion such as lymphoma, leptomeningeal disease (including carcinomatosis) or granulomatous disease.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: assess for HCC recurrence History: + HCC s/p TACE/RFA ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology with widened fissures. Hepatic parenchyma has findings suggestive of fibrosis. The segment 6 ablation cavity measures 3.5 x 3.6 cm on image 180/series 10 previously, 4.9 x 4.2 cm. There is some ill-defined enhancement along the periphery but no definite lesion identified that shows enhancement and washout in the ablation cavity.There are other foci of arterial enhancement along the periphery without definite washout.Hepatic and portal veins are patent.Gallbladder contains multiple calculi. No biliary ductal dilatation. SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Stable ablation cavity in the right hepatic lobe without definite evidence of residual disease.2.No new lesions are evident.3.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 85-year-old female with expressive aphasia and left sided lean. Rule-out CVA. There is no evidence of intracranial hemorrhage, mass or edema. Right frontoparietal hypodensity consistent with old stroke involving the lenticular striate arteries. Right basal ganglia lacunae. No acute cortical ischemia. If there is clinical concern for acute ischemia, an MRI is recommended.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: Right frontoparietal hypodensity consistent with previous ischemia. If there is clinical concern for acute ischemia an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Moderate bilateral focal subcortical T2/FLAIR signal abnormality, which is nonspecific. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. Right maxillary mucous retention cyst; otherwise, paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: For the purposes of numbering, there are 5 lumbar-type vertebral bodies. There is a grade I anterolistheses of L3 on L4 and L4 on L5, similar to the prior exam. Vertebral bodies heights are maintained. Fatty marrow changes are noted in the L4-L5 vertebral bodies. There has been slight interval worsening of degenerative spondylosis, notably at L4-5 where there is now complete loss of disc height. There is ex vacuo phenomenon at the intervertebral disc spaces of L3/4, L4/5, and L5/S1. The conus is normal in signal and morphology and terminates at T12-L1. There is a mild disc bulge at T9/10 with mild spinal canal stenosis as seen on the sagittal images.T10/11: Mild disc bulge and ligamentum flavum thickening with mild spinal canal stenosis, moderate right neural foraminal narrowing, and mild left neural foraminal narrowing.T11/12: Mild disc bulge, facet arthropathy, ligamentum flavum thickening with mild left neural foraminal narrowing. No significant spinal canal stenosis or right neural foraminal narrowing.T12/L1: Worsening broad-based disc bulge, facet arthropathy, and ligamentum flavum thickening with mild to moderate spinal canal stenosis and mild to moderate bilateral neural foraminal narrowing. L1/2: Worsening broad-based disc bulge, facet arthropathy, ligamentum flavum thickening with mild spinal canal stenosis, mild to moderate right neural foraminal narrowing and no left neural foraminal narrowing.L2/3: Worsening broad-based disc bulge, facet arthropathy, ligamentum flavum thickening and mild spinal canal stenosis with minimal bilateral neural foraminal narrowing.L3/4: Worsening broad-based disc bulge, facet and ligamentum flavum thickening with moderate spinal canal stenosis and moderate bilateral neural foraminal narrowing.L4/5: Pseudobulge, facet arthropathy, and ligamentum flavum thickening with moderate spinal canal stenosis, moderate right and moderate to severe left neural foraminal narrowing.L5/S1:Disc bulge without significant spinal stenosis. Moderate right and mild to moderate left neural foraminal narrowing.

Output: 1. Advanced degenerative changes of the lumbar spine, slightly worse since prior, with moderate spinal canal stenosis at L3/4 and L4/5. 2. Multilevel neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Pain with weightbearing and hip flexion. Evaluate for labral tear or hip flexor injury. ACETABULAR LABRUM: Best seen on sagittal image 21 of series 701 and oblique sagittal image 14 of series 801 is a thin band of intermediate signal intensity traversing the anterior superior labrum at approximately the 2:00 position, indicating a tear. The posterior labrum appears intact.ARTICULAR CARTILAGE AND BONE: I see no fluid-filled articular cartilage defects. There is slight subjective prominence of the anterosuperior aspect of the femoral head-neck junction, with a borderline alpha angle of 55 degrees. There is a small, mild focus of edema along the medial aspect of the femoral neck that could represent a small focal stress reaction, but I see no fracture line or signal abnormality in the adjacent cortex. There appears to be transitional lumbosacral morphology, with a slightly hyperkyphotic lumbosacral junction. Small foci of fluid signal intensity arising from the facet joints of the lower lumbar spine suggest synovial cysts and osteoarthritis. These findings are not adequately optimally assessed on this hip MRI study, and would be better evaluated with lumbar spine radiographs and perhaps lumbar spine MRI. There is a small focus of edema-type signal within the inferior aspect of the right sacral wing adjacent to the sacroiliac joint which I suspect is degenerative in etiology. The remaining visualized bone marrow is unremarkable.SOFT TISSUES: There is edema-type signal within the anterior soft tissues of the hip left hip that I suspect is iatrogenic related to the injection portion of the procedure. The ligamentum teres appears intact. I see no muscle or tendon tear/disruption. Thin bandlike low signal intensity traversing the lateral subcutaneous fat of the left hip likely reflects prior surgery.

Output: 1.Tear of the left anterior superior labrum at the 2:00 position.2.Small focus of mild edema within the medial aspect of the base of the left femoral neck which could conceivably represent a mild stress reaction, but I see no discrete fracture line or signal abnormality in the cortex.3.Transitional lumbosacral morphology with facet joint osteoarthritis and possible synovial cysts. These findings would be better assessed with lumbosacral spine radiography and/or lumbar spine MRI, if clinically warranted.4.Other findings as above.


Instruction: Generate impression based on findings.

Input: Female, 38 years old, with pain in the C7 distribution, mild slowing on EMG. Straightening of the cervical lordosis may be positional. Sagittal alignment is otherwise unremarkable.Vertebral body height and morphology are normal. No concerning marrow replacement or evidence of marrow edema is seen.Visualized spinal cord shows normal signal intensity and morphology throughout.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Mild right foraminal narrowing secondary to slight uncovertebral and facet hypertrophy. No spinal canal stenosis. C4-5: No spinal canal stenosis or neuroforaminal narrowing. C5-6: Posterior disc-osteophyte complex with a focal component in the right foraminal zone resulting in a severe right foraminal stenosis. The disc osteophyte slightly flattens the ventral cord, but no significant spinal canal stenosis is seen. C6-7: Uncovertebral hypertrophy resulting in mild to moderate bilateral foraminal stenosis. No spinal canal stenosis. C7-T1: Mild to moderate foraminal narrowing is seen largely due to facet hypertrophy. No significant spinal canal stenosis. A large and very heterogeneous lesion is evident within the left thyroid lobe. The right thyroid lobe contains smaller heterogeneous lesions as well. Corresponding lesions were noted on a prior ultrasound, though at least the left-sided lesion seems to have increased in size.

Output: 1.Focal disc and osteophyte disease is seen within the right C5-6 foraminal zone result in a severe stenosis of the right C5-6 neural foramen.2.Scattered additional areas of mild to moderate foraminal narrowing are seen as detailed above.3.No areas of high-grade spinal canal stenosis are detected.4.Bilateral thyroid lesions are noted incidentally with some questionable increase in size on the left when compared to a thyroid ultrasound from 2005.


Instruction: Generate impression based on findings.

Input: 37-year-old male with severe pain in the upper edge of the right posterior iliac bone and around to the anterior side. Palpable cystic mass is noted to site. Evaluate for malignancy versus fibrocystic mass. Exam is slightly limited by motion artifact.2 skin markers were placed adjacent to the right hemipelvis anteriorly corresponding to the site of palpable mass. No focal solid or cystic mass lesion is present in the pelvis. No abnormal enhancement is noted.There is mild subcutaneous soft tissue edema in the lateral anterior pelvis. Adjacent to the right anterior inferior iliac spine there is intermediate signal intensity along the course of the right rectus femoris tendon compatible with tendinosis and partial-thickness tearing of the tendon. There is mild adjacent bone marrow edema. The rectus femoris muscle appears normal. The remaining pelvic musculature and tendons are unremarkable.Mildly prominent inguinal lymph nodes are present bilaterally, nonspecific.The imaged bowel loops in the lower abdomen and pelvis are unremarkable. The prostate and bladder are unremarkable. No pelvic free fluid.

Output: 1. No evidence of a solid or cystic mass in the pelvis as clinically questioned.2. Tendinosis and partial-thickness tearing of the right rectus femoris tendon with adjacent bone marrow and soft tissue edema.


Instruction: Generate impression based on findings.

Input: History of prostate cancer with new urinary incontinence. Artifact from aortoiliac stent graft limits evaluation of the lower lumbar spine.There are numerous areas of marrow signal abnormality throughout the spine and visualized pelvis consistent with metastatic disease. The vertebral body heights are grossly maintained. There is ankylosis involving the C5 and C6 vertebral bodies. There is complete loss of intervertebral disc space at C5-C6.Multifocal areas of spinal stenosis are demonstrated primarily on the basis of degenerative change. There is at least moderate degree of spinal stenosis at multiple levels, most prominent at C3-C4, C4-C5 and C6-C7 levels. Additional area of relatively higher grade spinal stenosis is demonstrated at the T11-T12 level. No findings to suggest acute cord compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Diffuse osseous metastatic disease is demonstrated throughout the spine and visualized pelvis without evidence for acute cord compression. There are multiple areas of at least moderate spinal canal stenosis primarily on the basis of degenerative disease in the cervical and lower thoracic spine. MRI of the complete spine with contrast may be considered for further evaluation if there remains clinical suspicion of cord compression.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for tethered cord. Signs and symptoms: 11-year-old man with back pain, patient had x-rayed that stated concern for spina bifida occulta at L5. Nonenhanced lumbar MRI:There is normal signal intensity and alignment of vertebral column.A thin apparent bony defect suggestive of spina bifida occulta seen on prior lumbar spine images appear as a thick band of T2 hypointensity which likely representing fibrotic tissue and without convincing evidence of a true bony defect on this exam. No evidence of Schmorl's nodes.There is normal signal intensity and caliber of the lower most visualized thoracic cord (T10), conus and the cauda equina. No evidence of fatty filum is detected.There is distinct anterior movement of the conus and the proximal cauda equina on prone sagittal T2-weighted images.There is no evidence of spinal canal or neural foraminal compromise at any level.Unremarkable perispinal soft tissues.

Output: Unremarkable nonenhanced MRI of the lumbar spine.


Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: multiple cerebral aneurysms, r/o SAHSigns and Symptoms: sudden onset headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There are flow voids present where the patient's known right posterior communicating artery bilobed aneurysm is present. It appears to be at least in part embedded in the medial aspect of the right temporal lobeThe visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No abnormal mass lesions are appreciated intracranially. Please refer to CT angiogram of the same date for further comments regarding the patient's aneurysm.2.No stigmata of subarachnoid hemorrhage are appreciated on this exam.


Instruction: Generate impression based on findings.

Input: There is some progression of myelination compared to the prior MRI study, but myelination remains immature compared to what is expected for age. Single voxel spectroscopy was performed separately in regions of predominantly gray matter and predominantly white matter, including the white matter that is visually abnormal on FLAIR sequence. Spectra from both tissue types show nonspecific reduced choline and questionable decreased NAA peaks.There is evidence of diffuse white matter loss especially in the periventricular region. The corpus callosum remains thin. There is a small cyst at left caudothalamic groove, which is stable from prior study and may represent a congenital anomaly or remote injury. The lateral ventricles and third ventricle remain prominent especially involving atria and occipital horns (right greater the left). Note is made of a cavum septum pellucidum and cavum vergae. These findings are without significant change from prior study.No diffusion-weighted abnormalities are identified. There is no evidence for intracranial hemorrhage. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.

Output: 1.Myelination has progressed compared to prior exam, but remains immature compared to what is expected for age.2.Stable prominent lateral ventricles and third ventricle, especially involving atria and occipital horns (right greater the left). 3.Spectroscopy data shows a nonspecific pattern of decreased choline and questionable decreased NAA, which may reflect sequelae of tissue injury or or abnormal development.


Instruction: Generate impression based on findings.

Input: Male, 50 years old. Right shoulder pain with no improvement from Subacromial injection ROTATOR CUFF: There is an undersurface tear of the supraspinatus tendon at its insertion on the greater tuberosity that appears to involve the anterior fibers of the infraspinatus tendon as well. Along the posterior margin of the tear, only a thin strand of bursal surface fibers remains. It is difficult to compare the tear on the current study to that seen on the prior study due to differences in positioning. The tear is approximately 1.5 cm in AP dimension. There is also mild interstitial tearing along the myotendinous junction of the supraspinatus more proximally that has progressed slightly from the prior study. The supraspinatus muscle appears normal. There is also mild tendinosis of the infraspinatus tendon with cyst formation in the underlying humeral head that has progressed from the prior study. The infraspinatus muscle appears normal. The teres minor tendon and muscle appear normal. The subscapularis tendon is intact, and the muscle appears normal. SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis affects the acromioclavicular joint. We see no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is normal. There is no joint effusion. The gap between the anterior portion of the superior labrum and the underlying glenoid appears wider on the current study than on the prior study. This may be due to differences in patient positioning resulting in exaggeration of a normal variant sublabral sulcus. The inferior labrum appears intact.BICEPS TENDON: Mild increased signal within the intra-articular portion of the tendon of the long head of the biceps suggests tendinosis.

Output: 1.Undersurface tearing of the distal supraspinatus tendon as described above.2.Acromioclavicular osteoarthritis appearing similar to the prior study.3.Other findings as described above.


Instruction: Generate impression based on findings.

Input: Reason: r/o radiculopathy History: vibration sensation in buttock and legs 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.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: 19-year-old male with shoulder pain for 3 months and positive Speeds test. ROTATOR CUFF: No evidence of atrophy within the muscles of the rotator cuff. Mild increased T2 signal near the musculotendinous junction of the supraspinatus is compatible with tendinopathy. No gadolinium in the subacromial/subdeltoid bursa to indicate a rotator cuff tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No evidence of joint dislocation. The articular cartilage is unremarkable. There appears to be increased T2 signal underneath the anterior-superior labrum (2:00 position), most likely representing a normal sublabral foramen.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Findings compatible with tendinopathy at the supraspinatus musculotendinous junction without evidence of rotator cuff tear.


Instruction: Generate impression based on findings.

Input: Migraine but persistent right V2 hypesthesias and increasing weakness voice, now some difficulty handling secretions. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. In particular, the paths of the trigeminal nerves appear unremarkable, including the cavernous sinuses and Meckel caves. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable.Neck: The trigeminal fat pads are preserved. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy, including a cluster of small left supraclavicular lymph nodes. There are multiple subcentimeter T2 hyperintense thyroid nodules that appear to enhance. The salivary glands and upper aerodigestive tract appear unremarkable. The major cervical flow voids are intact. There is multilevel degenerative spondylosis with indentation of the spinal cord at C4-5 and C5-6 secondary to disc-osteophyte complexes. There is a subcentimeter retention cyst in the right ethmoid sinus.

Output: 1. The trigeminal nerves appear unremarkable and there is no evidence of intracranial hemorrhage, mass, or acute infarct. 2. Multiple subcentimeter T2 hyperintense thyroid nodules. Further evaluation via ultrasound may be useful.3. Multilevel degenerative spondylosis with indentation of the spinal cord at C4-5 and C5-6.


Instruction: Generate impression based on findings.

Input: 9-year-old girl with chromosomal abnormality. Presented with facial droop. To Rule out transient ischemic attack or stroke. The exam was done without sedation and is limited by patient motion.Brain MRI:The brain demonstrates no diffusion restriction or susceptibility effect. A very subtle questioned tiny linear focus of increased signal in the right side of the pons on the diffusion weighted imaging with subtle ADC hypointensity is probably artifactual unless the patient has symptoms/signs directly correlating to this. Also, there are multiple foci of similar appearing low signal on ADC elsewhere in the pons, as well as right lateral to the questioned focus with similar configuration, which also increases the likelihood of the findings being artifactual. Gray-white differentiation is preserved. A very tiny focus of T2 hyperintensity in the right parietal periventricular white matter is nonspecific. There is no focal brain lesion, otherwise. There is no mass effect or midline shift. The ventricles and the other CSF-containing spaces remain unremarkable.There is mild to moderate mucosal thickening in the maxillary and anterior ethmoid sinuses. The orbits are unremarkable. There is no destructive skull lesion.Head MRA:The MR angiography is markedly limited by patient motion. While vessel caliber and morphology cannot be accurately assessed, there is no high-grade major vessel narrowing or occlusion. The basilar artery shows a long segment fenestration. There is also one or a dominant pericallosal artery arising from the right side. There is no left posterior communicating artery visualized. These are congenital variations.

Output: 1.Study is limited by patient motion as described above.2.There is no definite brain infarct or hemorrhage. The subtle tiny apparent diffusion weighted imaging finding in the right side of the pons is likely artifactual, unless can be directly correlated to patient's symptoms and signs as described above.3.There is no major vessel occlusion or flow-limiting narrowing. The MR angiography is otherwise of limited value given motion.


Instruction: Generate impression based on findings.

Input: Vertigo, gait ataxia, evaluate for acute ischemia No diffusion restriction is seen to suggest acute ischemia. No susceptibility weighted artifact is seen to suggest intracranial hemorrhage. Encephalomalacia seen along the right posterior operculum with adjacent volume loss. No midline shift or focal mass lesion. Incidental note is made of a cavum septum pellucidum and cavum vergae, normal variants.Normal vascular flow voids are present in the major intracranial vasculature.The imaged portions of the paranasal sinuses are clear. The imaged portions of the mastoid air cells are clear. The imaged portions of the orbits are intact. Diffuse marrow replacement is nonspecific and may be secondary to red marrow reconversion. A dermal lesion over the right occipital calvarium likely represents a sebaceous cyst.

Output: No evidence of acute ischemia.


Instruction: Generate impression based on findings.

Input: Occipital headaches. Chiari malformation. Assess for syrinx or cord tethering. The odontoid process is retroflexed. There is cervical spinal sagittal straightening. Please refer to the previous cervical spine MRI report for other details.Thoracic alignment is anatomic. The vertebral bodies are preserved in height. There is no suspicious focal marrow lesion. There is disc desiccation at T7-T8 and T8-T9 with mild height loss. The other discs are relatively preserved in height. The spinal canal is notable for mild narrowing at T10-T11 caused by facet arthropathy and right greater than left ligamenta flavum thickening which minimally indents the right posterolateral aspect of the thecal sac and abuts the spinal cord. There is also narrowing of the left T10-T11 neural foramen by facet arthropathy and a cyst, which may represent a perineural cyst or less likely a synovial cyst related to the facet. The cyst measures axially 0.7 cm x 0.4 cm. Cervical spinal cord is notable for diffuse mild dilatation of the central canal (from T4 level through lower T12 level but most pronounced at mid T7 level measuring axially 3 mm x 3 mm). The conus medullaris has normal shape and its tip is located at the L1-L2 level.Right ventrolateral to spine at the level of T5-T6 disc, there is a 10 mm x 6 mm well-circumscribed, homogeneously T2-hyperintense, T1-hypointense structure which probably reflects focal dilatation of the thoracic duct. Alternatively but less likely, this may represent a small focal foregut duplication cyst or even lymphatic malformation.

Output: 1.Mild thoracic syrinx, measuring up to 3 mm at mid T7 level.2.Mild spinal canal stenosis at T10-T11 cause by facet arthropathy and ligamenta flava thickening. A small left T10-T11 neural foramen cyst may represent either a perineural or less likely synovial cyst.3.Small right ventral paraspinal cyst at T5-T6 level may represent focal dilatation of the thoracic duct, a small focal foregut duplication cyst or lymphatic malformation.4.Normal position of the conus medullaris tip.5.Please refer to the report of the brain MRI from the same day for more details regarding the Chiari malformation.