Instruction: Generate impression based on findings.

Input: Female, 83 years old, with right mandibular mass, follow-up after sclerotherapy x2 to the right mandibular mass. A heterogeneously T2 hyperintense, T1 hypointense, mildly expansile lesion is redemonstrated involving a majority of the right mandible. The overall size of the lesion is unchanged from the prior study, though that portion of the lesion which broke through the anterior gingival cortex of the mandible seems to be smaller. The lesion continues to enhance in a manner similar to prior.No new deep spaces mucosal lesions are seen. No pathologic adenopathy is detected. Multiple small thyroid nodules are redemonstrated on the right. Multilevel cervical spondylosis is seen without pathologic marrow replacement. Incidental note is made of patchy white matter and brainstem T2 hyperintensity compatible with microvascular ischemic disease. A focus of susceptibility is also seen in the right inferior frontal lobe suggesting a remote hemorrhagic injury.

Output: 1.No significant overall change is seen in the size of the right mandibular hemangioma.2.Signal characteristics and pattern of enhancement are similar to prior as well.3.No new lesions are detected.


Instruction: Generate impression based on findings.

Input: The brain parenchyma appears normal in signal intensity. There are no masses, mass effect or midline shift. The midline structures appear normal in morphology. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. The ventricles and sulci are symmetric and normal in size. Bilateral hippocampi appear within normal limits. 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.

Output: Negative MRI of the brain.


Instruction: Generate impression based on findings.

Input: 92 year-old male with altered mental status, found down. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal regions of patchy hypoattenuation are present in a subcortical and periventricular deep white matter distribution, nonspecific; however, most likely represent small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are mildly enlarged secondary to diffuse volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. No acute intracranial abnormalities.2. Multifocal regions of patchy hypoattenuation compatible with small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered.


Instruction: Generate impression based on findings.

Input: New suprasellar mass with visual loss, try to identify where mass is originating from for possible neurosurgical intervention. There is a homogeneously enhancing, dural-based mass along the posterior planum sphenoidale with extension into the sella and underlying hyperostosis, which measures approximately 29 mm anteroposteriorly, 25 mm transversely, and 18 mm craniocaudally. The mass mildly indents the superior surface of the pituitary gland and the anterior surface of the infundibulum. There is no evidence of intrinsic pituitary lesions. In addition, the mass displaces the prechiasmatic optic nerves laterally and abuts the optic chiasm and bilateral paraclinoid internal carotid arteries. There is a small patchy area of subcortical T2 hyperintensity in the posterior right gyrus rectus. There is mild diffuse periventricular white matter T2 hyperintensity, which is nonspecific, but may represent chronic small vessel ischemia. There are also small areas of encephalomalacia in the bilateral posterior occipital lobes, which may be the results of prior ischemia or trauma. There is no evidence of acute infarction. There is no midline shift or herniation. There is mild diffuse cerebral volume loss. Aside from hyperostosis along the sphenoid roofs, the paranasal sinuses are unremarkable. There is mild deviation of the anterior nasal septum to the left. There is prominence of the bilateral superior ophthalmic veins, which is nonspecific. There appears to be left frontal scalp scarring.

Output: A dural-based planum sphenoidal mass with extension into the sella above the pituitary gland that measures up to 29 mm likely represents a meningioma. The mass mildly indents the superior surface of the pituitary gland and the anterior surface of the infundibulum, displaces the prechiasmatic optic nerves laterally and abuts the optic chiasm, and is associated with mild vasogenic edema in the posterior right gyrus rectus.


Instruction: Generate impression based on findings.

Input: MS versus NMO. Right lower extremity weakness and swollen blurred vision. Brain: There are greater than 15 T2/flair hyperintense lesions involving the periventricular and subcortical white matter, many of which demonstrate an ovoid pericallosal morphology and distribution consistent with known demyelinating disease. Few juxtacortical lesions are seen. There is clear evidence of progression with most of these lesions being new compared to remote MRI brain from 7/19/2007. Few of these lesions have associated T1 hypointensity. There is no significant parenchymal volume loss. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Brain parenchyma is otherwise unremarkable for age. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical Spine: There is a T2 hyperintense lesion involving the right dorsal cord at the C3 level which appears to be present on prior 2007 status study, although not well imaged on that motion degraded study. Otherwise, no new lesions within the cervical cord are appreciated. There is trace prominence of the central canal in the cervical cord.Vertebral body heights are maintained. There is some loss of normal cervical lordosis. There is no significant disk disease, spinal canal, or neural foraminal stenosis.Thoracic Spine:No T2 hyperintense lesions to suggest demyelinating disease are definitively appreciated in the thoracic cord. There is a tiny syrinx extending from the T2-T3 to the T9-T10 levels and measuring up to 2 mm at the T5 and T6 levels. There is otherwise normal caliber of the thoracic cord.Minimal degenerative changes are seen in the thoracic spine. No significant disk herniation, spinal canal or neural foramina stenosis is appreciated. Vertebral body heights are normal. There is mild straightening of the thoracic spine; alignment is otherwise maintained. Focus of T1 hyperintensity involving the T5 vertebral body is compatible with a hemangioma. No suspicious osseous lesions are seen.

Output: 1. Multiple, greater than 15, T2/flair hyperintense lesions in the supratentorial white matter with morphology and distribution consistent with demyelinating disease. There is evidence of progression compared to 2007 with most of the lesions appearing new since the remote study. As clinically questioned, appearance and distribution of these lesions is more typical of multiple sclerosis than those associated with NMO.2. Single T2 hyperintense lesion involving the right dorsal C3 cervical cord, which appears to be present on prior study from 2007, although less well imaged at that time. No new lesions in the cervical or thoracic cord are definitively appreciated.3. Small syrinx in the thoracic cord extending from T2-T3 to the T9-T10 levels and measuring up to 2 mm in the axial plane.


Instruction: Generate impression based on findings.

Input: Female, 74 years old, with a rotatory hemorrhagic telangiectasia, screening evaluation for AVMs. Image quality is reduced by motion artifact. Within this limitation, no direct evidence of any intracranial vascular malformation is seen. However, the left middle meningeal artery is more prominent than the right which could be an indirect indication of a vascular malformation. Foci of susceptibility are seen within the left temporal lobe as noted on prior MRI. However, no abnormal vasculature is demonstrated in this immediate vicinity. The visualized proximal intracranial vessels demonstrate normal morphology and flow related signal. No significant vascular compromise is detected. However, please note that reduced image quality lowers the sensitivity for small and more distal lesions.

Output: 1.Please note that motion artifact on this examination reduces sensitivity for small or more distal lesions.2.No direct evidence of any intracranial vascular malformation is seen.3.However, the left middle meningeal artery is more prominent than the right which could potentially indicate the presence of a small vascular malformation. Conventional cerebral angiography can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: 43 years Female (DOB:12/14/1972)Reason: please do dr Javed MS protocol and compare to prior History: numbness, headachesPROVIDER/ATTENDING NAME: JACQUELINE T. BERNARD JACQUELINE T. BERNARD There is a 39 x 50 mm axial dimension cyst in the right middle cranial fossa associated with expansion of the right middle cranial fossa. It follows the signal characteristics of spinal fluid on all pulse sequencesThere is a punctate T2 and FLAIR hyperintense lesion present in the left periventricular white matter. In isolation this is of unknown clinical significance. This does not appear to have changed since the prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.No convincing evidence for foci of demyelination are identified in the brain. There is a punctate T2 and FLAIR hyperintense lesion present in the left periventricular white matter. In isolation this is of unknown clinical significance. This does not appear to have changed since the prior exam.2.Right middle cranial fossa arachnoid cyst.


Instruction: Generate impression based on findings.

Input: 26 years, Female, new posterior fossa mass. There is an enhancing mass centered on the inferior aspect of the fourth ventricle measuring 2.5 x 2.4 x 4.0 cm in the AP, transverse, and craniocaudal dimensions. The mass is almost entirely solid with small foci of cystic change within the lesion. There appears to be infiltration of the posterior aspect of the medulla. There is mild to moderate degree of enhancement, primarily in its posterior and superior aspects. Mass extends inferiorly through the foramen of Magendie. There is mild prominence of the lateral and third ventricles as well as the cerebral aqueduct suggesting mild ventricular outflow obstruction. There is also anterior displacement of the medulla with effacement of the ventral CSF space at the foramen magnum. There is mild restricted diffusion associated with the mass indicating tumor cellularity. There are also small foci of susceptibility which may represent minimal hemorrhage or mineralization.Remainder of the brain demonstrates no parenchymal signal abnormality. No additional foci of parenchymal or meningeal enhancement. No extra-axial collections. Major flow-voids are preserved. There is mild mucosal thickening involving the right greater than left frontal sinuses and anterior ethmoid air cells. There is diffuse opacification of the bilateral mastoid air cells.

Output: 1. Enhancing mass centered on the inferior aspect of the fourth ventricle measuring 2.5 x 2.4 x 4.0 cm. There appears to be infiltration and expansion of the posterior inferior aspect of the medulla suggesting possibility that this mass arises from the posterior medulla with exophytic extension into the fourth ventricle. Differentials include brainstem glioma as well as medulloblastoma and ependymoma.2. Mild enlargement of the more proximal ventricular system related to outflow obstruction.


Instruction: Generate impression based on findings.

Input: 17 years old, Female, History: knee injury MENISCI: The medial meniscus is intact. Increased signal intensity within the anterior horn of the lateral meniscus indicates undersurface tearing.ARTICULAR CARTILAGE AND BONE: There is significant bone marrow edema of the anterior lateral femoral condyle as well as the posterior lateral tibial condyle. This pattern of injury suggests a pivot shift mechanism of injury. The articular cartilage is intact.LIGAMENTS: Increased signal intensity and irregularity of the anterior cruciate ligament indicates a tear. Retraction of ligamentous fibers indicates a complete tear. No bone fragment is identified to suggest an avulsion of the ACL. The PCL, LCL complex, and MCL are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Complete ACL tear.2.Undersurface tearing of the anterior horn of the lateral meniscus.3.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: 63 years Male (DOB:5/20/1953)Reason: Evaluate for steno-occlusive disease History: fluctuating L sided weakness, history of R carotid stenosis s/p stentPROVIDER/ATTENDING NAME: IRA J BLUMEN IRA J BLUMEN MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia associated with ex vacuo effect on the right lateral ventricle and T2/FLAIR signal hyperintensity involving the right superior and middle frontal gyri and the adjacent precentral gyrus. Smaller foci of T2/FLAIR signal hyperintensity with widening of adjacent sulci are present in the right parietal lobe adjacent to the interparietal sulcus. T2/FLAIR signal hyperintensity extends to the right centrum semiovale.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal left 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 mucosal thickening in the left more than the right maxillary sinus as well as opacities elsewhere. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is occlusion of the right internal carotid artery. There is circle of willis reconstitution of the right middle and anterior cerebral arteries.There appears to be a high grade stenosis ar the left carotid siphon.The right vertebral artery has a high grade stenosis distally as it pierces the dura.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified and is small. The right posterior communicating artery is relatively small but can be identified. The left posterior communicating artery is tiny. The LVA is larger than the RVA.MRA neck:There is opacification of the aortic arch as well as the innominate artery and left subclavian artery from the aortic arch. The Left common carotid artery does not opacify There is no stenosis identified of the origins of the innominate artery and left subclavian artery from the aortic arch. The right common carotid artery and right internal carotid artery are occluded. On the basis of NASCET criteria there is no significant stenosis at the left carotid bifurcation. There is 33% narrowing of the origin of the left internal carotid artery origin. There is no significant stenosis along the course of the left vertebral artery. The right vertebral artery has a high grade stenosis proximally at its origin and distally as it pierces the dura.

Output: 1.Right CCA and ICA occlusion with poor COW collaterals2.Findings suggest a stenosis at the distal left internal carotid artery which may in part be artifactual due to flow phenomenon. A CTA of the brain may help further asses this.3.Right vertebral artery high grade tandem stenoses proximally and distally.4.No evidence for acute ischemic cerebral infarction.5.Encephalomalacia is present in the right hemisphere predominantly involving the right frontal lobe but also patchy areas of the right parietal lobe in a mixed watershed and embolic distribution as detailed above.6.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: 60 year old man with known coronary artery disease referred to evaluate viability. Left VentricleThe left ventricle is normal in size and systolic function. There is akinesis of the mid to apical anterior wall and dyskinesis of the apical cap. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 88 ml/m2 (normal range: 74+/-15), the LVEDV is 201 ml (normal range 142+/-34), the LV end systolic volume index is 40 ml/m2 (normal range 25+/-9), the LVESV is 90 ml (normal range 47+/-19), the LV mass index is 80 g/m2 (normal range 85+/-15), and the LV mass is 182 g (normal range 164+/-36). There are two distinct regions of late gadolinium enhancement. The larger is a transmural myocardial infarction involving the mid to apical anterior wall and the apical septum. These segments are not likely to be viable. There is an atypical pattern or late gadolinium enhancement (non-myocardial infarction pattern) involving the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction and suggests the presence of a secondary underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 73%, the RV end diastolic volume index is 82 ml/m2 (normal range 82+/-16), the RVEDV is 187 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 51 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with normal systolic function (LVEF 55%). There is akinesis of the mid to apical anterior wall and dyskinesis of the apical cap. 2. There are two distinct regions of late gadolinium enhancement. The larger is a transmural myocardial infarction involving the mid to apical anterior wall and the apical septum. These segments are not likely to be viable. There is an atypical pattern or late gadolinium enhancement (non-myocardial infarction pattern) involving the basal inferolateral and anterolateral walls. The pattern is not consistent with prior myocardial infarction and suggests the presence of a secondary underlying fibrosing, infiltrative, or inflammatory process. The remainder of the myocardium is free of late gadolinium enhancement and is viable. 3. Normal RV size and systolic function (RVEF 73%).


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:7/10/1954)Reason: diplopia r/o brain stem lesion History: as abovePROVIDER/ATTENDING NAME: SCOTT STERN SCOTT STERN The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an air-fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No mass lesions are appreciated intracranially to account for the patient's diplopia


Instruction: Generate impression based on findings.

Input: 61-year-old female with history of aneurysm presents with left-sided tingling. There is no evidence of intracranial hemorrhage, mass or edema. Small punctate focus of hyperdensity in posterior parietal cortex with a convexity consistent with cavernoma seen on previous MRI.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: Normal brain CT.


Instruction: Generate impression based on findings.

Input: History of elevated PSA. PELVIS:PROSTATE:Prostate Size: 3.8 x 6.0 x 3.9 cmPeripheral Zone: There is mild heterogeneous linear T2 signal throughout the peripheral zone. More focal area of linearity seen in left midgland peripheral zone, likely sequela of prior inflammation/scarring. There are no focal confluent areas of prominently decreased T2 signal, and there are no focal areas of restricted diffusion or early arterial enhancement.Central Gland: Moderate nodular changes of benign static hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No suspicious lesion seen, as above.


Instruction: Generate impression based on findings.

Input: Clinical question: Lung cancer with bony metastases, status post chemo, evaluate disease a status. Signs and symptoms: Lung cancer. Nonenhanced head CT:Patient refused injection of contrast after partial externalization of contrast from the first trial.There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Periventricular and subcortical low attenuation of bihemispheric white matter is suspected for mild small vessel ischemic disease of indeterminate age. No evidence of the mass on these non-infused study.Recommend either repeat CT exam with intravenous contrast or an enhanced MRI to exclude possibility of small metastatic disease.Calvarium is intact. Limited view of orbits are unremarkable.Lasted vessels limited cavities are pneumatized are unremarkable.Extensive chronic sinus disease of right maxillary sinus, minimally left maxillary sinus and minimally of bilateral ethmoid sinuses and the frontal signs.

Output: 1.No evidence of metastatic disease to the brain or the calvarium on these non-infused study.2.Minimal small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Examination is mildly motion degraded; axial oblique sequence was not obtained. There is grade 1 anterolisthesis of L4 on L5. Otherwise, alignment is within normal limits. There is degenerative disk disease affecting L3-4 and L4-5 with some loss of height. Vertebral body heights and disk spaces are otherwise within normal limits. The distal cord and nerve roots are unremarkable in morphology and signal. The paraspinal soft tissues are unremarkable. Additional level specific findings are as follows:T12-L1: No significant degenerative disk disease, central canal, or neural foraminal stenosis.L1-L2: No significant degenerative disk disease, central canal, or neural foraminal stenosis.L2-L3: No significant degenerative disk disease, central canal, or neural foraminal stenosis.L3-L4: Degenerative disk disease with mild disk bulge and facet degenerative changes without significant central stenosis. Mild to moderate left neuroforaminal stenosis.L4-L5: Degenerative disk disease, ligamentum flavum thickening, and facet degenerative changes results in mild central canal stenosis. Disk protrusion into the left lateral recess results in moderate-severe left neural foraminal stenosis. There is mild-moderate right neuroforaminal stenosis.L5-S1: Degenerative disk disease with mild disk bulge and facet degenerative changes without significant central stenosis. Mild left neuroforaminal stenosis.

Output: Degenerative lumbar spondylosis most severely affecting L4-L5 as described above with grade 1 anterolisthesis. There is mild spinal canal stenosis, moderate-severe left neuroforaminal, and mild to moderate right neuroforaminal stenosis at L4-5. There is also mild to moderate left L3-4 neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: 6 years Female (DOB:4/7/2010)Reason: 5yo patient, STEALTH MRI prior to surgery (surgery will be in CCD with peds anesthesia). Please page neurosurgery resident to place fiducials. History: Pre-op STEALTH MRI prior to craniotomy for cavernous malformation resection in CCDPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD 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 cerebral cavernous malformation centered in the posterior pons and exophytic into the fourth ventricle measuring 12 x 13 mm axial dimensions There is an associated developmental venous anomaly in the left cerebellar hemisphere. It is stable compared to the prior exam.The visualized portions of the paranasal sinuses are partially opacified. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is a cerebral cavernous malformation involving the posterior pons ventricle is associated with a developmental venous anomaly. Please note that this exam was performed for the purpose of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: 28-year-old female with chronic elbow pain and intermittent fevers. Rule out osteomyelitis. Somewhat suboptimal examination secondary to the inability to use a dedicated HD coil and inability to optimally position the patient.LIGAMENTS: Although this examination was not protocoled for evaluation of the ligamentous structures, the radial collateral, ulnar collateral, and lateral ulnar collateral ligaments are unremarkable.TENDONS: The common flexor and extensor tendons appear intact. The biceps brachii and brachialis tendons appear intact.ARTICULAR SURFACES AND BONE: The bone marrow signal intensity is within normal limits without evidence to suggest osteomyelitis.SURROUNDING STRUCTURES: The imaged musculature is normal in appearance.ADDITIONAL

Output: No evidence of osteomyelitis or other findings to account for the patient's elbow pain.


Instruction: Generate impression based on findings.

Input: 75 year-old female with altered mental status and lethargy. Evaluate for ICH or mass. There is no evidence of intracranial hemorrhage, mass or edema. Multifocal areas of patchy hypoattenuation in the subcortical and deep white matter distribution, nonspecific, however most likely related to small vessel ischemic disease, age indeterminate. No evidence of acute cortical stroke is noted. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns appear enlarged secondary to volume loss.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Multifocal white matter hypoattenuation most likely representing small vessel ischemic disease, age indeterminate. 2. No evidence of acute cortical stroke. If there is clinical concern for acute ischemia, MRI may be considered.3. No evidence of mass or intracranial hemorrhage as clinically questioned.


Instruction: Generate impression based on findings.

Input: Chronic headaches and family history of Chiari malformation. There cerebellar tonsils are not low-lying. There is intact CSF flow across the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of Chiari malformation.


Instruction: Generate impression based on findings.

Input: Direct comparison to the previous MRIs difficult given technical limitations on that study. Multiple periventricular white matter lesions appear more conspicuous and confluent than on the prior study, which may be due to technique and/or progression. For example, a posterior left frontal lobe lesion was not definitely apparent on the prior study and may represent a new lesion. Additionally, there are several punctate lesions in the bilateral cerebral hemispheres, which were not apparent previously and which may indicate new lesions. Furthermore, the T2 signal surrounding the right occipital horn of the lateral ventricle appears more pronounced than on the prior study. Many of these lesions demonstrate T1 hypointensity indicating chronicity. In particular, a right pons/midbrain lesion appears to have developed T1 hypointensity along with decreased T2 hyperintensity. The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect.

Output: Numerous supratentorial and infratentorial demyelinating lesions. Comparison with the prior exam is limited due to differences in technique, although some lesions may have slightly progressed and some now exhibit more chronic features.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: LBP, right anterior thigh and calf pain History: LBP, right sided radicular symptoms 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 loss of disk space height, disk desiccation and diffuse disk bulge associated with mild ligamentum flavum hypertrophy. There is partial effacement of the fat of the lateral recesses bilaterally at this level and effacement of the fat within the neural foramina at this level left worse than right there is encroachment of the left-sided exiting nerve roots within the neural foramina. There is mild encroachment of the nerve roots of the lateral recesses bilaterally left more than right at this level.At L4-5 there is loss of disk space height, disk desiccation and diffuse disk bulge associated with mild ligamentum flavum hypertrophy. Facet hypertrophy is more on the left versus the right side at this level. There is effacement of the fat of the left lateral recess and encroachment of intervertebral left lateral recess at this level. There is mild encroachment of the nerve roots of the right lateral recess at this level. There is mild narrowing of the neural foramina this levelAt L3-4 there is loss of disk space height and desiccation, diffuse disk bulge and moderate bilateral ligamentum flavum and facet hypertrophy resulting in effacement of the fat of the lateral recess ease and effacement of the spinal fluid surrounding the cauda equina. Overall there is a moderate degree of spinal stenosis at this level. There is mild narrowing of the neural foramina bilaterally at this level.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.There is some endplate reactive changes associated with the disk bulge at T11-T12 associated with a mild degree of spinal stenosis.

Output: 1.There is a moderate degree of spinal stenosis at L3-4 related to degenerative changes.2.There is encroachment of the nerve roots at the left lateral recess at L4-5 related to facet disease and a disk bulge.3.There is mild to moderate encroachment of the exiting nerve roots on the left-sided L5-S1 were there is also some mild to moderate encroachment of the nerve roots of the lateral recesses bilaterally - left more than right.


Instruction: Generate impression based on findings.

Input: New onset abnormal eye movements, not present at birth. Needs evaluation for CNS lesion versus inflammation. Brain: There is an appropriate degree of myelination. There is no acute infarct or intraparenchymal hemorrhage. There is no definite structural abnormality. There is no mass or mass-effect and no abnormal intracranial contrast enhancement. The ventricles and sulci are normal in size. The major intracranial vascular flow voids are preserved. The pituitary gland is normal and there is no destructive skull lesion.Orbits: There is no evidence of abnormal signal or enhancement of the intraorbital optic nerves. The bilateral globes, lacrimal glands, extraocular muscles, and orbital fat appear unremarkable. There is no evidence of intraorbital mass lesions.

Output: 1. No evidence of acute infarction, intracranial hemorrhage, or intracranial tumor.2. No evidence of intraorbital lesions.


Instruction: Generate impression based on findings.

Input: Clinical question: History of LBP and radiating leg pain. Unresolved pain medication. Signs and symptoms: Elevated BP, buttocks and leg pain. Nonenhanced lumbar MRI:There is normal anatomical alignment of vertebral column.The signal intensity of the vertebral column is unremarkable.Lower most visualized thoracic spine and thoracic cord is unremarkable. T12-L1 is unremarkable.There is generalized uniform smaller than expected size of the spinal canal which is believed to represent a congenital anatomical variation.L1-L2 is unremarkable.L2-3 is unremarkable.L3-L4 demonstrate mild disc desiccation and a mild ligamentum flavum and facet degenerative changes. There is a small shallow central and left paramedian disc protrusion at this level (axial T2 series 5 image 14) results in subtle flattening and posterior displacement of the thecal sac which in combination with congenitally small canal results in mild central spinal stenosis however without neural foraminal compromise.L4-L5 is unremarkable.L5-S1 demonstrate moderate disc desiccation and loss of disc height, there is a shallow broad-based disc protrusion in the midline and to the right at this level. Finding results in significant mass effect and effacement of right lateral recess and mass effect on the right S1 nerve root. No central spinal stenosis or neural foraminal compromise (finding has best appreciated on axial T2 series 5 image 24 and sagittal T2 series 3 image 8).There is no detectable abnormality of the perispinal soft tissues.

Output: 1.There is a uniformly smaller size of spinal canal representing congenital anatomical variation of short pedicle.2.Large right side disc protrusion at L5-S1 with significant mass effect on the right lateral recess and right S1 nerve root as detailed. No neural foraminal or central spinal stenosis.3.Tiny central and rightward shallow disc protrusion at L3-L4 with subtle mass effect on the thecal sac which in combination with congenitally small canal results in mild central spinal stenosis.4.Unremarkable images at other levels and lower most visualized thoracic spine and thoracic cord.


Instruction: Generate impression based on findings.

Input: Bilateral shoulder pain, rule out cord compression Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is loss of normal cervical lordosis. Alignment is otherwise maintained. Bone marrow signal is slightly heterogeneous which is nonspecific. However no discrete suspicious osseous lesions are demonstrated in the cervical spine. There is T1 shortening involving the anterior aspect of the cervical vertebral bodies as well as the skull base which may represent sequela of prior radiation.The cervical spinal cord has normal signal characteristics and overall morphology. Sagittal postcontrast sequences are limited due to lack of fat saturation, and could not be repeated due to patient intolerance. No abnormal enhancement however is appreciated.Degenerative changes are seen throughout the cervical spine including multilevel disc height loss, which is relatively worse at the C4-5, C5-C6, and C6-C7 levels. There is ossification of the posterior longitudinal ligament extending from the C4 to the C6 levels.Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina. Mild right-sided facet arthropathy.C3-4: Disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neural foraminal narrowing.C4-5: Central osteophyte contributes to to mild spinal canal stenosis. There is no significant neural foraminal stenosis.C5-6: Central osteophyte contributes to effacement of the ventral thecal sac and minimal overall spinal canal narrowing. There is no significant neural foraminal stenosis. C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: Small disc osteophyte complex eccentric to the right with right-sided uncovertebral hypertrophy. There is mild right-sided neural foraminal narrowing. No significant compromise to the spinal canal or left neural foraminal narrowing. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There is prominent volume loss involving the cerebellar vermis which is again seen.

Output: 1. Multilevel degenerative changes throughout the cervical spine without high-grade spinal canal or high-grade neural foraminal stenosis at any level. Degenerative changes are relatively worse at the C3-C4 level where there is up to mild-to-moderate right neural foraminal stenosis.2. No cord signal abnormality.3. No suspicious osseous lesions or evidence of tumor within the spinal canal.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 9 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 21

Output: Successful fluoroscopic guided right hip arthrogram for MRI.


Instruction: Generate impression based on findings.

Input: 64-year-old male with HCV and cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology, and perihepatic ascites. There is a mass in the right hepatic lobe measuring 2.6 x 2.6 cm with increased T2 signal, enhancement, and washout, consistent with HCC. The portal vein is small caliber but 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: Moderate ascites.

Output: 1.2.6-cm right hepatic mass consistent with HCC. The portal vein is small in caliber but appears patent.2.Cirrhotic liver morphology and ascites.


Instruction: Generate impression based on findings.

Input: Male, 79 years old, with low back pain. A grade 1 anterolisthesis of L4 relative to L5 is seen, likely secondary to pronounced facet hypertrophy at L4-5. Spinal alignment is otherwise unremarkable. Vertebral body morphology is within normal limits. No concerning marrow signal abnormality is detected.The visualized spinal cord conus are unremarkable.The disks show diffuse loss of T2 signal. Loss of disk height is evident at L5-S1. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L3-4: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. L4-5: Marked facet hypertrophy with effusion on the right. There may also be a synovial cyst projecting posteriorly from the facet joint on the right. The ligamentum flavum is thickening. Mild disk bulging/disk uncovering. Mild generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. L5-S1: Moderate facet hypertrophy. Mild bulging disk. No significant generalized spinal canal stenosis. Mild bilateral neuroforaminal narrowing. Bilateral renal cystic lesions are seen incidentally.

Output: Marked facet degeneration is seen at L4-5. This likely contributes to a grade 1 anterolisthesis of L4 relative to L5. Disk uncovering and posterior element hypertrophy at this level cause a mild spinal canal stenosis with a moderate narrowing of the right neural foramen.


Instruction: Generate impression based on findings.

Input: 75-year-old man with history of prostate cancer. PELVIS:PROSTATE:Prostate Size: 56 x 30 mm.Peripheral Zone: There is a very small area of decreased T2 signal in the peripheral left mid gland (701/19, 1201/16). ADC signal is normal at this site. The remainder of the peripheral gland appears normal.Central Gland: Within the transitional zone of the left anterior prostate (1201/19), there is an area of decreased T2 signal, decreased ADC signal, and mildly increased diffusion signal. There is no early enhancement corresponding to this focus.Seminal Vesicles: The seminal vessels appear normal.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Focus of abnormal signal in the left mid gland anterior transitional zone which could represent adenocarcinoma and is suggested as a target for biopsy.


Instruction: Generate impression based on findings.

Input: There are postoperative findings related to right parietal and temporal craniotomy for metastasectomy. There is hyperintense T2 signal abnormality in the treatment bed, which appears similar to prior. There are no areas of abnormal enhancement to suggest recurrence. There is encephalomalacia in the left parietal and occipital lobes, left basal ganglia and corona radiata, and right cerebellar hemisphere. There is ex vacuo dilatation of the left lateral ventricle. There are scattered foci of hyperintense T2 signal abnormality within the periventricular and subcortical white matter, which likely represent chronic small vessel ischemic disease. A punctate focus of susceptibility artifact in the left cerebellar hemisphere is compatible with a microhemorrhage. There is no acute infarct. There is mild fluid signal intensity within the right mastoid air cells. There are bilateral lens implants.

Output: 1. Post-treatment findings without evidence of recurrent or new intracranial metastases.2. Chronic infarcts in the left parietal and occipital lobes and left basal ganglia and corona radiata.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: assess for outcome of right shoulder rotator cuff surgery History: delayed recovery ROTATOR CUFF: There is marked atrophy of the supraspinatus, infraspinatus and subscapularis. There is no muscle retraction. There is fluid within the subacromial/subdeltoid bursa, although no distinct rotator cuff tear is appreciated.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum and glenohumeral articulation appear normal. BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No discrete rotator cuff tear. There is marked muscular atrophy without retraction.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. Again seen are postoperative findings from previous Chiari decompression and fourth ventricular stenting. The stent appears in stable position, with the cranial tip extending through to the upper cerebral aqueduct. Ample CSF space is seen at the distal end. The cerebellum is unchanged in appearance, with a patent neo-foramen magnum. CSF flow imaging demonstrates prominent ventral flow along the brainstem and upper cervical cord. There is redemonstration of biphasic flow along the dorsal aspect of the neo-foramen magnum and upper cervical spinal canal, although the anterior superior extent is not as well delineated as on prior exam, although this is possibly artifactual.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is redemonstration of a stable 5 mm nodule along the superior aspect of the pituitary gland. The remainder of the midline structures and craniocervical junction are within normal limits. Postoperative changes are seen from anterior cervical discectomy and fusion a C6-C7. Instrumentation is suboptimally evaluated on MRI. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are stable. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.Mild spondylosis at the C5-C6 and C6-C7 levels is unchanged, with minimal effacement of the ventral CSF space at the C5-C6 level related to minimal disc bulge and trace ligamentum flavum thickening.

Output: 1. Stable exam, with redemonstration of postoperative changes from previous Chiari decompression and fourth ventricular stenting. Patent neoforamen magnum without significant interval change in CSF flow appearance.2. Stable small rounded nodule along the superior aspect of the pituitary gland.


Instruction: Generate impression based on findings.

Input: 21-year-old male with history of Crohn's disease and abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The terminal ileum appears normal. There is no evidence of bowel obstruction. No abnormal enhancement after contrast administration.BONES, SOFT TISSUES: Mild scoliosis.OTHER: No significant abnormality noted.

Output: Limited exam due to lack of oral contrast. No evidence of active or chronic disease.


Instruction: Generate impression based on findings.

Input: Male, 46 years old, with inhalation injury, found down. Assess for ligamentous injury. Mild reversal of the normal cervical lordosis is again seen. T1/T2 hyperintense signal within the C4 and C6 vertebral bodies is seen compatible with focal fat or hemangiomas. No evidence of significant marrow edema or concerning marrow replacement.There may be minimal residual STIR hyperintensity within the soft tissues between and around the spinous processes, but it is reduced from the prior examination. No epidural fluid collections are detected. Mild prominence of the dorsal epidural fat is seen at C4 and C5, and again in the thoracic region. Similar to the prior examination, the anterior spinal cord shows patchy increased T2 signal from C3 through C6. The cord remains impinged at these levels by posterior disc osteophyte complexes which are discussed by level as follows.C2-3: Mild facet hypertrophy. Thickening of the posterior longitudinal ligament but no significant disc osteophyte formation. No significant spinal canal or foraminal stenosis. No interval changes.C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation with a large central protruding component which impinges upon the spinal cord. Mild left foraminal narrowing. No interval changes.C4-5: Left facet hypertrophy. Posterior disc-osteophyte complex formation with a moderately sized central protruding component which impinges the spinal cord. No significant foraminal narrowing. No interval changes.C5-6: Left facet hypertrophy. Mild posterior disc-osteophyte complex formation. Small central protruding component which minimally impinges upon the spinal cord. Mild left foraminal narrowing. No interval changes. C6-7: Facet hypertrophy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. No interval changes.C7-T1: Unremarkable.

Output: 1.Edema within the posterior paraspinal soft tissues seems to have decreased from the prior examination which may reflect healing soft tissue or ligamentous injury. No fluid collections are detected. No frankly disrupted ligaments are seen.2.The spinal cord remains impinged by disc osteophyte complexes at C3-4, C4-5 and C5-6. The spinal cord shows increased T2 signal at these levels, similar to prior, which may reflect myelomalacia and/or edema. The acuity of these disc protrusions is not entirely certain, though they may very well be chronic.


Instruction: Generate impression based on findings.

Input: A 13 year old female with a history of valve-sparing repair of Tetralogy of Fallot and closure of VSD. Operative notes from repair aged 10 months obtained, showing bovine monocuspid valve was positioned in the pulmonic position and a second patch to the entire main pulmonary artery, extended across the area of the annulus into the infundibulum. A small PFO was left intact. A Congenital Cardiac MRI performed on 7/8/2013 showed normal LV size and systolic function, severely dilated RV with normal systolic function, at least mild-moderate pulmonic regurgitation. Findings consistent with status post Tetralogy of Fallot repair.  Normal cardiac situs.  Normal Qp:Qs (1.27 according).Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 55%, the LV end diastolic volume index is 86 ml/m2 (normal range: 65+/-11), the LVEDV is 114 ml (normal range 109+/-23), the LV end systolic volume index is 39 ml/m2 (normal range 18+/-5), the LVESV is 51 ml (normal range 31+/-10). There is diastolic septal flattening. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. No interventricular septal defect was seen.No intracavitary thrombus was seen.Right VentricleThe right ventricle is severely dilated with normal systolic function. The overall RV ejection fraction is 54%, the RV end diastolic volume index is 130 ml/m2 (normal range 69+/-14), the RVEDV is 171 ml (normal range 110+/-24), the RV end systolic volume index is 60 ml/m2 (normal range 22+/-8), and the RVESV is 79 ml (normal range 35+/-13). AtriaThe left atrium is normal in size. The right atrium is severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is at least moderate pulmonic regurgitation (regurgitant fraction 37%). No pulmonic stenosis. The subpulmonic cuff measures 13 mm diameter on dedicated 3D reconstruction views. Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root, ascending aorta, aortic arch and descending aorta are normal in size. No coarctation was seen.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryOn dedicated 3D reconstruction views, the main pulmonary artery is mildly small in calibre measuring 16 mm compared to 12 mm in the sagittal plane on previous study; differences in measurement technique likely explain the differences in quantitative size. There are postsurgical changes in the pulmonic trunk, a patch is positioned in the pulmonic position and a second patch to the entire main pulmonary artery, extended across the area of the annulus into the infundibulum.The right pulmonary artery has a diameter of 15mm. The left pulmonary artery has a diameter of 13mm.Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsIncidental note made of aberrant right subclavian artery. 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: Compared to previous cardiac MRI from 2013, no significant changes were noted:1. Changes consistent with status post repair of Tetralogy of Fallot. 2. LV size and systolic function are normal, LVEF 55%. Previously, quantitative LVEF was calculated at 67%. Qualitatively, there is no difference in left ventricular ejection fraction implying that quantitative differences are due to different measurement technique.3. RV is severely dilated with normal systolic function, RVEF 54%. 4. There is at least moderate pulmonic regurgitation, with 37% regurgitation fraction.5. Aberrant right subclavian artery, a known aortic branch variant.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 80 years old, with primary CNS lymphoma. A right frontal burr hole is again seen. Mild ill-defined periventricular T2 hyperintensity is a stable finding over multiple prior exams. No pathologic parenchymal or extra-axial enhancement is detected.No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricular system is stable and within normal limits for size.Findings are seen compatible with prior transsphenoidal pituitary surgery. Irregular enhancing tissue within the sella and perhaps also the right cavernous sinus appears similar to prior exams.An oval nodule is again seen within the right parotid gland without change. The extracranial tissues are otherwise unremarkable.

Output: 1.No evidence to suggest recurrent primary CNS lymphoma.2.Stable appearance of the postoperative sella.3.Stable nonspecific right parotid nodule.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with right neck and shoulder pain with positive Spurling's test. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No areas of pathologic marrow replacement, edema or enhancement are seen.The spinal cord demonstrates normal signal intensity and morphology throughout. No pathologic cord enhancement is observed.Minimal disc osteophyte formation and/or thickening of the PLL is seen at C3-4, C5-6 and C6-7. At no level is there any significant spinal canal or foraminal stenosis.

Output: Minimal degenerative findings are seen without significant spinal canal or foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Disturbances of sensation of smell and taste 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. No mass lesion is appreciated in the expected location of the olfactory bulbsNormal 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 left vertebral artery appears to be hypoplastic distallyA punctate signal hyperintensity on T2 and FLAIR imaging located in the left centrum semiovale is probably of little clinical significance.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. No abnormal mass lesions are appreciated intracranially. No explanation for the patient's anosmia can be identified on the basis of this exam.


Instruction: Generate impression based on findings.

Input: Left renal mass and left flank pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology signal intensity and enhancement. No focal liver lesion. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: Spleen is normal in size measuring 12.5 cm in length without a focal lesion.PANCREAS: The pancreas is normal in morphology and enhancement without evidence of a focal lesion to suggest metastatic disease. It is displaced anteriorly by the left renal mass.ADRENAL GLANDS: The adrenal glands are normal in morphology, signal intensity and enhancement.KIDNEYS, URETERS: There is a large multilobulated mass infiltrating and expanding the left kidney measuring up to 10.4 x 10.5 x 12.7 cm (series 801/23 and series 701/21). The lesion at least abuts the adjacent perinephric fat. It demonstrates low T2-weighted signal intensity and heterogeneous postcontrast enhancement less intense than the renal cortex with regions of nonenhancement/necrosis. There are enlarged perirenal vessels. The mass has extensive involvement of the collecting system with obstructed dilatation of the superior and inferior collecting system.The left renal vein does not appear to be involved with tumor thrombus. It is displaced anteriorly by the extensive necrotic retroperitoneal lymphadenopathy.RETROPERITONEUM, LYMPH NODES: Extensive necrotic retroperitoneal lymphadenopathy. Retrocrural lymphadenopathy. Left supraclavicular and mediastinal lymphadenopathy noted on outside hospital CT. The lymphadenopathy elevates the abdominal aorta and displaces the pancreas anteriorly as well as the left renal vein. Lymphadenopathy encases the left renal artery which is opacified. For future reference the anterior left periaortic lymph node measures 3.9 x 3.4 cm (series 1 304/164).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions.

Output: Very large partially necrotic left renal mass expanding and infiltrating the left kidney with extensive associated retroperitoneal and retrocrural lymphadenopathy. Left supraclavicular and mediastinal lymphadenopathy noted on outside CT. The imaging characteristics of the lesion are not that of a conventional clear cell carcinoma. An atypical lesion specifically a collecting duct carcinoma or other neoplasm of the renal medulla is suspected.


Instruction: Generate impression based on findings.

Input: 64 years, Female, Reason: h/o cystic lesions in tail and body noted on CT scan History: abnormal CT imaging of pancreas. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Common bile duct is normal. Prominent pancreatic duct. There are few punctate subcentimeter cystic foci within the pancreas without clear communication to the pancreatic duct (6/85).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: A few punctate cystic foci within the pancreas without definite communication with the pancreatic duct are of unknown etiology or significance.


Instruction: Generate impression based on findings.

Input: 61-year-old woman with supratherapeutic INR now with acute mental status change. Parenchymal hemorrhage with layering blood products is present at the left posterior temporoparietal junction. The hemorrhage measures 3.4 x 3.0 cm in the axial plane (series 2 image 12). A rim of edema surrounds the hemorrhage. There is no underlying lesion evident by CT. There is mild mass effect upon the left lateral ventricle but no appreciable midline shift. The 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. Extensive soft tissue abnormality is present in the occipital region. This may represent sequela of prior soft tissue hemorrhage as seen on the MRI dated 1/17/2007.

Output: Left temporoparietal junction parenchymal hemorrhage as detailed above. No underlying lesion is evident by CT -- MRI is recommended for further evaluation if clinically appropriate.


Instruction: Generate impression based on findings.

Input: Reason: tumor recurrence, ischemia, abscess History: somnolence The patient is status-post right-sided craniotomy for right temporal lobe surgery and right frontal lobe surgery. There is a right-sided subdural collection present measuring 10 mm in thickness.There is a contrast enhancing lesion present along the posterior aspect of the right temporal lobe measuring approximately 24 by 21 mm in axial dimensions and 31 x 19 mm coronal dimensions. It is adjacent to the trigone of the right lateral ventricle. It is associated with a ependymal enhancement. There is associated enhancement along the temporal lobe at the sylvian fissure extending to the posterior aspect of the insula. There is associated susceptibility effect within the focus of enhancement. There is abnormal T2 and flair signal present within the white matter of the right temporal lobe in the gray and white matter of the insular cortex as well as right basal ganglia and internal capsule and external capsule. This temporal lobe enhancing lesion is not clearly associated with elevated cerebral blood volume. Part of the enhancing lesion has elevated CBV, however, this may represent adjacent choroid (The perfusion study is degraded by patient motion).There is a contrast enhancing lesion present along the anterior/inferior aspect of the right frontal lobe associated with adjacent T2 and flair signal hyperintensity. This frontal lobe enhancing lesion is associated with what appears to be elevated cerebral blood volumeThere is a focus of diffusion restriction present along the posterior limb of the right internal capsule extending to the right cerebral peduncle which is associate with contrast enhancement and loss of signal on SWI. CBV evaluation is not clear.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.There is midline shift with 8mm shift of the septum pellucidum to the left.

Output: 1.Status with right-sided craniotomy for tumor surgery. The right-sided subdural effusion present which is somewhat larger on the current versus the prior exam . It is associated with midline shift2.There is an enhancing lesion present along the right temporal lobe and insular cortex. Differential considerations include radiation necrosis, infection and recurrent tumor.3.Right internal capsule and cerebral peduncle lesion is new. Differential considerations include radiation necrosis, infection and recurrent tumor.4.Right frontal lobe lesion is new. Differential considerations include radiation necrosis, infection and recurrent tumor.5.Exam is somewhat compromised due to patient motion which confounds interpretation.


Instruction: Generate impression based on findings.

Input: There is stable 5-6-mm grade 1 anterolisthesis of L3 on L4, retrolisthesis of L4 on L5 as well as minimal grade 1 retrolisthesis of L5 on S1. The spine is otherwise in normal alignment. There is diffusely abnormal marrow signal, with numerous areas of abnormal T1 hypointensity and STIR hyperintensity consistent with known osseous metastatic disease. Since the prior MRI, there has been interval mild-moderate compression deformity of the T2 vertebral body along the superior endplate as well as mild compression deformity of T7. Better delineated on the prior CT, there is diffuse osseous metastatic disease at L4 with a pathologic fracture along its inferior endplate resulting in mild compression deformity and dorsal convexity of the posterior vertebral body margin. This in combination with prominence of dorsal epidural fat results in likely moderate-severe if not severe central spinal canal stenosis. There is also mild to moderate right and severe left foraminal narrowing at L4-L5 along with moderate right foraminal narrowing L5-S1.The vertebral body heights are otherwise well-maintained, with multilevel disk narrowing scattered throughout the spine, most severe at L4-L5. The distal spinal cord and conus are grossly within normal limits with the conus terminating at the approximate L1-L2 level. There is developmental narrowing of the lumbar central spinal canal due to short pedicles and proliferation of epidural fat.There are multilevel cervical spondylotic changes, most conspicuous from C4-C5 to C6-C7 where there is likely moderate central spinal stenosis. These appear grossly similar to the prior outside images.Incidental note is made of slight crowding at the level the foramen magnum, with the cerebellar tonsils extending approximately 5 mm below the level of the foramen magnum, although retaining a rounded morphology. There is a partially visualized right sided pleural effusion. A few T2 hyperintense lesions are suggested within the right cerebellum which are nonspecific.

Output: 1. Diffuse osseous metastatic disease with redemonstration of pathologic inferior endplate fracture of L4 with dorsally convex posterior vertebral body margin secondary to tumor/retropulsion, resulting in moderate-severe if not severe central spinal canal stenosis as well as severe left foraminal narrowing at L4-L5, especially when superimposed upon spondylotic changes and prominence of dorsal epidural fat. Stable grade 1 retrolisthesis of L4 on L5.2. Since prior outside MRI, mild-moderate compression deformity of T2 and mild compression deformity of T7.3. Partially visualized T2 hyperintense lesions within the right cerebellum. These are nonspecific although concerning for metastatic disease, and MRI of the brain with and without contrast is recommended for further evaluation.4. Partially visualized right sided pleural effusion.


Instruction: Generate impression based on findings.

Input: The lumbar lordosis is preserved. Minimal anterolisthesis of L3 over L4 and L4 on L5 appear similar to prior examination. The vertebral body heights are maintained. The non-contrast bone marrow signal characteristics are within normal limits. Lumbar spinal cord signal intensity and morphology are normal throughout. The conus terminates at L1 level showing normal morphology and signal characteristics. There is congenital narrowing of the lumbar spinal canal secondary to short bilateral pedicles and posterior epidural lipomatosis. There is redundancy and thickening of the cauda equina nerve roots. There is slight loss of disk height and disk desiccation at L3-4, L4-5 and L5-S1 with vacuum disc phenomena now at L4-5 and L5-1. Additional level specific findings are as follows.T10-T11: Unremarkable. T11-T12: Unremarkable. T12-L1: Unremarkable. L1-2: Unremarkable. L2-3: There is mild central spinal stenosis on the basis of developmental spinal canal narrowing without neuroforaminal stenosis. Bilateral facet and ligamentous hypertrophic degenerative changes are seen. L3-4: There is a diffuse disc bulge with facet and ligamentous hypertrophic degenerative changes with bilateral degenerative facet joint effusions resulting in mild to moderate right and moderate left neuroforaminal stenosis. A small dorsal left facet joint synovial cyst is visualized. L4-5: There is minimal uncovering of the disc with superimposed mild disc bulge is rightward predominant. There is significant bilateral facet arthropathy and ligamentum flavum thickening, greater on the left side. This results in moderate-severe left foraminal narrowing. There is moderate central spinal canal stenosis. L5-S1: There is a diffuse disc bulge eccentric to the left with a a superimposed left paracentral disc extrusion migrating cranially indenting the left thecal sac and impinging upon the descending left S1 nerve root. There are severe left and moderate right facet/ligamentous degenerative changes resulting in moderate-severe right and moderate left neuroforaminal stenosis.

Output: 1. Developmental narrowing of the mid to distal lumbar spinal canal. 2. Multilevel degenerative changes of the lumbar spine as described above, most pronounced at L5-S1 level where there is moderate severe right and severe left foraminal narrowing, as well as at L4-L5 where there is high-grade left foraminal narrowing.


Instruction: Generate impression based on findings.

Input: 69 year old male with history of CVA in 2004. Now presents with left-sided weakness and diffuse headaches. Images through posterior fossa are unremarkable with the exception of minimal calcification of the vertebral arteries.Images through supratentorial brain parenchyma demonstrate no evidence of hemorrhage, edema, mass effect among midline shift or hydrocephalus. No evidence of cortical stroke is detected. Ventricular system, cortical sulci and all CSF cisterns remain within normal limits.If clinical concern for stroke persist an MRI is recommended.

Output: Negative CT of brain.


Instruction: Generate impression based on findings.

Input: Progressive multiple sclerosis. There is no significant interval change in the size and number of cerebral white matter T2 hyperintense lesions. Many of the lesions are also T1 hypointense. There is also unchanged faint patchy enhancement associated with a right anterior cingulate gyrus lesion. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable interval change in the numerous demyelinating lesions in the brain.


Instruction: Generate impression based on findings.

Input: 65-year-old female with pain in the pelvic region and thigh. Concern for malignancy. Evaluate for mass. LEFT HIP:ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality may represent residual islands of red marrow. Mild degenerative changes affect the left hip including joint space narrowing and osteophyte formation.SOFT TISSUES: No significant abnormality noted. RIGHT HIP:ACETABULAR LABRUM: Although this examination was not protocoled for evaluation of the acetabular labrum, there is increased linear signal abnormality traversing the anterior acetabular labrum consistent with a labral tear.ARTICULAR CARTILAGE AND BONE: Heterogeneous bone marrow signal abnormality may represent residual islands of red marrow. Mild degenerative changes affect the right hip including joint space narrowing and osteophyte formation. There is a subcentimeter focus of increased signal abnormality right posterior ilium with associated enhancement on postcontrast sequences (series 5; image 3). SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1. Degenerative tearing of the anterior right acetabular labrum. No evidence of acute fracture or malalignment. 2. Nonspecific subcentimeter enhancing focus within the right posterior ilium is better characterized on the patient's recent lumbar spine MRI examination and may represent a hemangioma. Otherwise no evidence of metastatic disease or focal mass lesions.


Instruction: Generate impression based on findings.

Input: 53-year-old female with left eye visual loss and orbital pain. Rule out acute infarct or structural lesion. MRI brain: There is no restricted diffusion to indicate acute infarction. There is no intracranial hemorrhage or mass effect. The ventricles and sulci are normal in size and configuration. There is a punctate nonspecific focus of T2 hyperintensity in the right frontal lobe subcortical white matter. There are numerous punctate foci of increased susceptibility in a cortical and subcortical bilateral distribution in both cerebral hemispheres as well as the cerebellum. There is also extensive susceptibility caused by the patient's dental hardware. There is no evidence of pathologic enhancement on postcontrast images.MRI orbits: Evaluation of some sequences is limited by patient motion artifact. The extraconal and intraconal spaces, globes, extraocular muscles, and optic nerves appear symmetric and within normal limits. There is no evidence of pathologic enhancement on postcontrast images.MRA brain: There is redemonstration of a 2 mm aneurysm along the medial wall of the left cavernous internal carotid artery as seen on recent prior CT angiography. No additional aneurysms are identified. Both ophthalmic arteries are opacified. There is patent anterior and posterior circulation without evidence of significant stenosis. Incidentally seen is fenestration of the lower basilar artery.MRA neck: There is classic configuration of the aortic arch and patent bilateral carotid arteries without evidence of aneurysm or significant stenosis. Both vertebral arteries are patent and normal in caliber.

Output: 1. No evidence of acute infarct as clinically questioned. No intracranial mass. No intraorbital mass. Motion artifact makes evaluation difficult; however no abnormal signal or enhancement is seen involving the optic nerves.2. Scattered punctate foci of supratentorial and infratentorial susceptibility are consistent with multiple chronic microhemorrhages.3. Redemonstration of a 2 mm cavernous left internal carotid artery aneurysm. No additional aneurysms or stenoses are identified in the intracranial or neck vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Right upper quadrant pain suggesting biliary colic and minimal LFT abnormality. Negative right upper quadrant ultrasound. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, size, signal intensity and enhancement without a focal lesion, biliary ductal dilatation or vascular abnormality. Normally distended gallbladder without evidence of gallbladder inflammation or gallstones. No choledocholithiasis.SPLEEN: No significant abnormality noted.PANCREAS: The pancreas is normal in morphology, signal intensity and enhancement without pancreatic ductal dilatation or focal lesion.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: Unremarkable MRCP.


Instruction: Generate impression based on findings.

Input: Pain MENISCI: Similar minimal increased signal and fraying along the tibial surface of the body and posterior horn of the lateral meniscus is again observed. The menisci are otherwise preserved throughout, specifically no additional findings to suggest interval tearing. The above mentioned finding again most likely represents postsurgical changes from a previously described partial meniscectomy.ARTICULAR CARTILAGE AND BONE: Again previously observed heterogeneity of the articular cartilage most pronounced in the lateral compartment and along the weightbearing portions of the condyle are again observed. Specifically no progression and mild improvement is suggested, likely representing interval continued improvement from a prior surgical microfracture. Again no specific full-thickness articular cartilage abnormality is observed throughout, other than the thinning and heterogeneous signal in the lateral patellar facet.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Similar mild patella alta, unchanged.ADDITIONAL

Output: Scattered postsurgical changes and degenerative findings, however no new interval significant new abnormalities. See details provided


Instruction: Generate impression based on findings.

Input: Diagnosis: Disorientation, unspecifiedClinical question: strokeSigns and Symptoms: ams MRI of the brainNo diffusion weighted abnormalities are appreciated.The ventricles are large. There is cavum septum pellucidum and cavum vergae.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are tiny. The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.3.Ventriculomegaly could be a result of atrophy, though NPH/communicating hydrocephalus is associated with ventriculomegaly in the appropriate clinical context.4.No evidence for intracranial cerebrovascular occlusive disease.5.No evidence for extracranial cerebrovascular occlusive disease.


Instruction: Generate impression based on findings.

Input: History of BRCA2 mutation and 2 first degree relatives with history of pancreatic cancer. Evaluate for tumor. ABDOMEN:Extensive respiratory motion artifact limits evaluation, particularly of the postcontrast images.LIVER, BILIARY TRACT: The liver is normal in morphology and the background parenchyma has normal signal characteristics. There are multiple T2 bright cystic lesions without definite enhancement. One cyst in the subcapsular right lobe of has intrinsic high T1 signal ingesting hemorrhage or proteinaceous material.There are multiple round hepatic lesions with mildly increased T2 signal and restricted diffusion measuring up to 6 mm in diameter (series 3 image 13, 17, 21). It is unclear if these lesions enhance due to their small size and extensive motion artifact on the postcontrast images, however given the clinical history and appearance, these are highly suspicious for metastases.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass is evident within the limits of the exam. There is minimal diffuse fatty atrophy of the gland. The main pancreatic duct is nondilated.ADRENAL GLANDS: Slight nodularity of the left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No upper abdominal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous foci of increased T2 signal throughout the visualized thoracolumbar spine compatible with metastases.OTHER: Partially visualized large left pleural effusion with associated left lung atelectasis. There are numerous pulmonary nodules in the right lower lobe which are not significantly changed from prior accounting for differences in technique and compatible with metastases. There is associated pleural thickening.

Output: 1.Multiple round subcentimeter lesions within the liver as described. Evaluation is somewhat limited due to the small size and extensive respiratory motion artifact, but the appearance is highly suspicious for metastases.2.No evidence of a primary pancreatic mass within the limits of this severely motion degraded exam. 3.Partially visualized large left pleural effusion and multiple right lung metastatic lesions better evaluated on recent CT scan. Additionally there are numerous foci of signal abnormality in the thoracolumbar spine compatible with metastases.


Instruction: Generate impression based on findings.

Input: Left shoulder pain. ROTATOR CUFF: Intermediate signal within the supraspinatus tendon at its insertion is compatible with mild tendinosis. No discrete tears of the supraspinatus tendon are identified. The supraspinatus muscle is unremarkable. The remaining tendons and muscles of the rotator cuff are unremarkable.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No abnormal fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: The cartilage of the glenohumeral joint is grossly intact. The labrum appears intact.BICEPS TENDON: The tendon of the long head of the biceps is intact. ADDITIONAL

Output: Mild supraspinatus tendinosis without discrete rotator cuff tears.


Instruction: Generate impression based on findings.

Input: 57-year-old male with concern for osteomyelitis of the right third (middle) finger. There are postsurgical changes related to amputation of the third (middle finger) digit to the level of the middle phalanx. There is abnormal bone marrow signal intensity of the middle and proximal phalanx of the third digit with low T1 signal of the remaining middle phalanx and head of the proximal phalanx and corresponding high T2 signal. There may be associated mild enhancement of the bone marrow signal after intravenous contrast administration. There appear to be distal amputation of the second digit (index finger) however this is incompletely evaluated. The tendons and ligaments of the third digit appear normal. Bone marrow signal intensity of the remaining digits is unremarkable.

Output: Postsurgical changes related to amputation of the third digit (middle finger) to the level of the middle phalanx with findings suspicious for osteomyelitis of the head of the proximal phalanx and remaining middle phalanx extending to the amputation margin.


Instruction: Generate impression based on findings.

Input: Chronic daily headache. There is a fat signal intensity lesion in the right lateral ventricular choroid plexus glomus, which measures up to 5 mm. The lateral ventricles are slightly asymmetric, left larger than right, but there is no evidence of ventriculomegaly. There is no evidence of intracranial hemorrhage or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Subcentimeter right lateral ventricular lipoma. 2. The lateral ventricles are slightly asymmetric, which often represents a developmental variant.


Instruction: Generate impression based on findings.

Input: Bilateral trigeminal and hypoglossal nerves sensory complaints. Evaluate for brainstem pathology. Image quality is degraded by motion artifact.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No mass or abnormal enhancement is seen involving the cisternal segment of the trigeminal nerves, Meckel's cave, or cavernous sinus. The skull and extracranial soft tissues are unremarkable. No obvious mass involving the skull base is appreciated.Cervical spine: Examination is somewhat technically degraded. The vertebral body heights are preserved. There is minimal C3 on C4 and C4 on C5 retrolisthesis as well as mild C7 on T1 anterolisthesis similar to prior. There is moderate disc space narrowing throughout the cervical spine. There is fusion of the C5-C6 vertebral bodies. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.Ill-defined T2 hyperintensity in the cervical cord on the sagittal sequences is favored to be artifactual and not seen on the axial T2 sequence. No convincing cord signal abnormality is appreciated. No abnormal enhancement.C2-C3: Unchanged posterior disc osteophyte complex and bilateral facet degeneration. No significant spinal canal or right foraminal stenosis. Mild left neural foraminal narrowing.C3-C4: Posterior disc osteophyte complex, bilateral uncinate spurs and bilateral facet degeneration, contributing to mild bilateral foraminal narrowing. Mild spinal canal narrowing.C4-C5: Posterior disc-osteophyte complex, thickening of the ligamentum flavum, bilateral uncinate spurs and bilateral facet degeneration, contributing to moderate spinal canal stenosis particularly at the right lateral aspect of the spinal canal. There is moderate to severe right and mild left neural foraminal narrowing.C5-C6: There is fusion of C5 and C6 vertebral levels. There is mild right foraminal stenosis. No significant spinal canal or left neural foraminal narrowing.C6-C7: Posterior disc-osteophyte complex, bilateral uncinate spurs and facet degeneration, contributing to mild left greater than right foraminal stenosis and mild spinal canal narrowing. C7-T1: Disc bulge, ligamentum flavum thickening and bilateral facet degeneration, contributing to mild bilateral neural foraminal narrowing.

Output: 1. No intracranial mass or mass effect. Specifically, no lesion within the brainstem is appreciated. Dedicated cranial nerve high-resolution sequences were not obtained however no obvious mass or abnormal enhancement is seen involving the visualized course of the trigeminal nerves or at the hypoglossal canals. There is evidence of mild chronic small vessel ischemic disease.2. No significant interval change in multilevel degenerative changes of the cervical spine. There is up to moderate spinal canal stenosis at the C4-C5 level and to a mild degree at C3-C4 and C6-C7. There is moderate to severe right C4-C5 neural foraminal stenosis. Ill-defined T2 signal on the sagittal T2/STIR sequences in the cervical cord is not corroborated on the axial sequence and likely artifactual. No definite cord signal abnormality or enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female 56 years old with acute lateral right knee pain and swelling. Evaluate right knee for recurrent lateral meniscus tear vs. DJD. MENISCI: There is degeneration and fragmentation of the posterior horn and body of the lateral meniscus indicating complex tearing. Tearing also extends into the anterior horn with intermediate signal intensity tissue adjacent to the root of the anterior horn that may represent a displaced meniscal fragment. Globular and linear intrasubstance degeneration of the medial meniscus appears similar to the prior exam and there is perhaps mild fraying of the posterior horn but we see no discrete tear.ARTICULAR CARTILAGE AND BONE: There has been marked progression of osteoarthritis in the lateral compartment with much of the weightbearing surface of the lateral femoral condyle and tibial plateau devoid of cartilage with adjacent degenerative subchondral signal abnormality. There has also been progression of osteoarthritis affecting the medial compartment with osteophytes and chondral loss along the medial femoral condyle. Cartilage loss of the patella has also progressed with full-thickness cartilage loss along the lateral patellar facet.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Progression of osteoarthritis particularly involving the lateral compartment with extensive tearing of the lateral meniscus and other findings as above.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, status post re-resection of a cerebellar ganglioglioma, with swelling and drainage at the incision site. Again seen are findings related to right occipital craniotomy for tumor resection. A small epidural fluid collection beneath the craniotomy site is similar to or at most slightly increased from the prior examination. However, an extracranial fluid collection which appears to follow CSF signal has developed within the soft tissues of the neck overlying the craniotomy and extending inferiorly in the neck fascial planes to the C3 level. The collection measures up to 78 mm in craniocaudal extent, and measures 62 x 25 mm in maximal transaxial dimension.Lack of contrast limits assessment for residual tumor. However, the degree of T2 hyperintensity and restricted diffusion surrounding the cerebellar resection site has improved. The right cerebellum remains smaller than the left likely reflecting the effects of prior surgery and/or treatment. The quantity of postoperative intracranial air and intraventricular blood have also decreased. No new parenchymal lesions are seen. Again noted is prominence of the CSF space involving the right aspect of the pineal cistern. The supratentorial ventricular system is normal and similar in caliber to the prior exam.

Output: 1.Demonstration of postoperative findings compatible with recent re-resection of a cerebellar ganglioglioma. Lack of contrast prevents accurate assessment for residual tumor.2.Since the prior examination, an extracranial fluid collection has developed at the operative site compatible with a pseudomeningocele.


Instruction: Generate impression based on findings.

Input: History of abdominal discomfort. History of Crohn's disease 5/13/2013 biopsy with ileocecectomy. 11/10/2015 colonoscopy biopsies were negative ABDOMEN:LIVER, BILIARY TRACT: The liver dome was not included on multiple imaging sequences. The liver is normal in size morphology and signal intensity and enhancement. Several bilateral simple and lobulated cysts are noted. No suspicious liver lesion. No intra or extrahepatic biliary ductal dilatation.Cholelithiasis without evidence of acute cholecystitis within a normally distended gallbladder.SPLEEN: The spleen is normal in morphology size and signal intensity without a focal lesion.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: The small bowel is adequately distended with oral contrast. Contrast has reached the sigmoid colon.The small bowel fold pattern is unremarkable.There are surgical changes from an ileocecectomy and right hemicolectomy.The enterocolonic anastomosis is patent.Accounting for the distention attributable to the oral contrast and given the absence of a caliber differential the small bowel is not dilated. There is no abnormal wall signal intensity, thickening, restricted diffusion, or postcontrast enhancement.No perienteric inflammatory changes such as fibrofatty proliferation, vascular engorgement or mesenteric lymphadenopathy to suggest active inflammation.No fixed luminal narrowing or associated prestenotic/upstream dilatation to suggest a flow-limiting stricture.No evidence of sinus tract or fistula formation.No free fluid or loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See discussion above.BONES, SOFT TISSUES: Best seen on the coronal T2 images is a thick-walled 8 mm fluid-filled track extending from the left lateral rectum at the 3 o'clock position through the left levator ani musculature and ischiorectal fossa terminating in the left gluteal fold, measuring up to 6 cm in craniocaudal dimension. Adjacent to the left aspect of the rectum is a 2.0 x 1.5 cm fluid collection associated with the fistula. Communication with the left fornix of the vagina may also be present from a posterior aspect.OTHER: No significant abnormality noted.

Output: 1.No evidence of active small bowel inflammation or flow-limiting fibrostenotic disease.2.Suprasphincteric fistula extending from the left lateral rectum to the left gluteal fold with possible sinus tract communicating with the left fornix of the vagina. Associated 2.0 cm left peri-rectal peripherally enhancing fluid collection. These findings are similar to the 2013 study. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Minimal posterior osteophyte disc complex without stenosis.C3/4: Posterior osteophyte disc complex effaces the anterior CSF and causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C4/5: Posterior osteophyte disc complex effaces the anterior CSF and causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C5/6: Posterior osteophyte disc complex effaces the anterior CSF and causes slight anterior cord flattening without intrinsic cord signal abnormality. There are no significant stenoses.C6/7: Mild posterior osteophyte disc complex with a small right paracentral disc extrusion that extends slightly above the disc level, causing mild proximal and focal right neural foraminal stenosis, abutting adjacent traversing nerve roots.C7/T1: Unremarkable

Output: 1.C6/7: Mild posterior osteophyte disc complex with a small right paracentral disc extrusion that extends slightly above the disc level, causing mild proximal and focal right neural foraminal stenosis, abutting adjacent traversing nerve roots.2.Cervical spondylytic changes elsewhere as described in detail above without significant associated stenoses.