Instruction: Generate impression based on findings.

Input: There are post-treatment findings in the posterior fossa with cerebellar volume loss and distortion, confluent T2 hyperintensity in the cerebellar treatment zone and smaller areas of T2 hyperintensity in the brainstem that may include olivary degeneration, and persistent susceptibility effects and intrinsic T1 hyperintensity in the surgical cavity. However, there is an area of nodular enhancement that has developed in the left aspect of the cerebellar resection cavity, measuring up to 15 mm. There are unchanged punctate foci of susceptibility effect in the right basal ganglia and left precentral gyrus, which may represent chronic microhemorrhages or cavernous malformations. There is no evidence of acute cerebral infarct. There is a posterior left ventricular catheter that terminates in the right lateral ventricle with persistent confluent high T2 signal in the brain parenchyma along the catheter path. There is unchanged T2 hyperintensity along the previous right ventriculostomy tract in the right frontal lobe. The third and lateral ventricles remain collapsed.

Output: 1. Post-treatment findings in the posterior fossa with developing nodular enhancement, which may represent tumor progression.2. Unchanged appearance of the stunted ventricular system.


Instruction: Generate impression based on findings.

Input: Right hemianopsia. No evidence of acute ischemic or hemorrhagic lesion.Multifocal scattered high signal intensities on FLAIR imaging indicate minimal small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of significant luminal stenosis. Vertebrobasilar system shows subtle luminal irregularities without evidence of significant luminal stenosis. Brain MRA shows some motion related artifacts but interpretable.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature is not interpretable due to motion artifacts. Therefore, this exam should be repeated.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Minimal non specific small vessel disease.3. Subtle irregularities of intracranial arterial system without evidence of significant arterial luminal stenosis. 4. Neck MRA is not interpretable due to significant motion artifacts.


Instruction: Generate impression based on findings.

Input: Female, 78 years old, with gait imbalance. Evaluate for mass or stroke. No restricted diffusion is seen. Scattered foci of T2 hyperintensity are seen within the periventricular white matter. No edema or mass effect is observed. No acute intracranial hemorrhage or any abnormal extra-axial fluid collections are seen. The ventricles are normal in size and morphology. Incidentally noted on sagittal images is a significant degree of cervical spinal canal narrowing due to degenerative disease.

Output: 1.No acute intracranial abnormality.2.Findings are seen compatible with chronic microvascular ischemia.3.Stenosis of the cervical spinal canal is partially visualized. This abnormality can be better assessed with dedicated cervical spine imaging if clinically warranted.


Instruction: Generate impression based on findings.

Input: Headache and history of pseudotumor cerebri. MRI: The images are partially degraded by dental brace artifact. There is no definite evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears grossly unremarkable. The pituitary gland appears unchanged, with a partially-empty sella configuration. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. MRA: The images are partially degraded by dental brace artifact. There is an unchanged 2 mm outpouching in the region of the right ACOM complex at the origin of the orbitofrontal artery. There is no discernible evidence of significant steno-occlusive lesions.

Output: 1. No definite evidence of acute intracranial hemorrhage, mass, or acute infarct, although the images are partially degraded by dental brace artifact. 2. Unchanged partially-empty sella suggestive of pseudotumor cerebri.3. Unchanged 2 mm outpouching in the region of the right ACOM complex, which may represent a prominent infundibulum or small aneurysm.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:4/3/1959)Reason: Evaluate for stenosis, spondylolisthesis, scoliosis History: Pain, deformityPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a dextrocurvature to the thoracic spine. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine: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. There is a compensatory levocurvature to the lumbar spine. There is a T1 hyperintense lesion present within the T12 vertebral body measuring 10 mm in size. Most likely this represents a vertebral body hemangioma. A similar lesion is present at T11.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level. There is mild ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present 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.

Output: 1.There are mild degenerative changes present lumbar spine without significant outlet spinal canal or neural foramina.2.There is a sigmoid curvature present to the thoracolumbar spine without significant compromise to the spinal canal or exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Previously demonstrated left cerebellar lesion and signs of ventriculitis. Status post IV antibiotics for 6 days. Leukemia. Again seen is ependymal enhancement along the right frontal horn, and right greater than left occipital horns of the bilateral ventricles with associated diffusion restriction, most favored to represent ventriculitis with debris/pus in the right ventricle and not significantly changed since 6/3/2015. There is particular T2/FLAIR hyperintensity associated with the enhancement surrounding the right occipital horn similar to prior. Again seen is a peripheral nodular enhancing lesion in the left cerebellar hemisphere which demonstrates mild decrease in size, previously measuring 12 x 10 mm, now 10 x 8 mm. There is decrease in the previously seen associated restricted diffusion. Mild associated edema is similar to 6/3/2015. Again seen is leptomeningeal enhancement involving the surface of the bilateral left greater than right cerebellar hemispheres which is not significantly changed. There are scattered punctate foci of susceptibility artifact, likely representing hemosiderin deposition from chronic microhemorrhages and unchanged; these may be related to patient's history of DIC.No new focus of intraparenchymal edema or new fluid collection to suggest abscess or empyema. No new mass effect. No hydrocephalus. There is minimal mucosal thickening in the paranasal sinuses. Paranasal sinuses and mastoid air cells are otherwise clear.

Output: Compared to 6/3/2015, there appears to be mild decrease in size of peripherally enhancing lesion in the left cerebellar hemisphere and decrease in associated restricted diffusion. These findings are compatible with mild decrease in size of abscess. Mild associated edema is not significant changed. Prominent enhancement involving the lateral ventricular walls with debris/pus suggestive of ventriculitis is not significantly changed. Leptomeningeal enhancement involving the cerebellar surfaces is also not significantly changed. Given history, some of these findings may be related to leukemia although the overall constellation of findings favors infection. Recommend continued follow-up. No new focus of edema, new abscess, or new empyema.


Instruction: Generate impression based on findings.

Input: Evaluate for osteomyelitis. Sacral decubitus ulcer Examination of the images reveal abnormal T1 signal, T2 signal and enhancement within the right ischial tuberosity extending into the right inferior pubic ramus compatible with osteomyelitis. There is an approximately 2.1 cm open wound along the posterior right thigh with a sinus tract extending to the bone. There is significant surrounding edema and inflammatory changes.

Output: Osteomyelitis of the ischial tuberosity


Instruction: Generate impression based on findings.

Input: Left-sided numbness. Evaluate for acute ischemia. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: No evidence of acute intracranial hemorrhage, mass effect, or acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left sided stroke: Right hemiparesis. Brain MRI: There are areas of gyriform restricted diffusion and high T2 signal in the left parietal lobe adjacent to an underlying area of encephalomalacia, with associated cortical laminar necrosis and probable chronic microhemorrhages. There are also punctate foci of cortical and subcortical restricted diffusion and high T2 signal in the left frontal lobe. There is a background of mild scattered cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The is lack of flow-related enhancement of the imaged portions of the left internal carotid artery. There is reconstitution of flow in the left middle and anterior cerebral arteries at the circle of WIllis. The right vertebral artery appears to terminate as the PICA. There is a fetal right PCOM. The other cerebral arteries are unremarkable and there is no evidence of saccular aneurysms. Neck MRA: There is lack of enhancement through the left internal carotid artery. There is mild narrowing of the origin of the right internal carotid artery. The right vertebral artery is diminutive. The other portions of the major cervical arteries are intact.

Output: 1. Acute areas of infarction involving the left parietal and frontal lobes, mainly in a watershed distribution superimposed upon a chronic left parietal lobe infarct. 2. Significant steno-occlusive disease at the origin of the left internal carotid artery.


Instruction: Generate impression based on findings.

Input: Female, 34 years old, with Hashimoto's encephalopathy, assess for structural damage. Scattered foci of cortical restricted diffusion are seen involving both cerebral hemispheres. Since the prior examination, some previous lesions have diminished or resolved while other lesions are new. T2/FLAIR hyperintensity is evident correlating to these areas of restricted diffusion and as with the diffusion findings, many of these areas are new from prior. Of note, progressive T2 FLAIR signal abnormality is seen within the cerebral peduncles.Encephalomalacia affecting a majority of the right parietal, occipital and temporal lobes, as well as a portion of the left occipital and left parietal lobes is unchanged from prior. These findings result in ex vacuo dilatation of the ventricular atria.Minimal gyriform enhancement in the right temporal lobe is unchanged. No new parenchymal or extra-axial pathologic enhancement is seen.No evidence of any significant intracranial hemorrhage or abnormal extra-axial fluid is demonstrated. Ventricular size and morphology are not significantly changed.

Output: 1.Interval fluctuation of the size and number of cortical diffusion restricting lesions with interval decrease or resolution of some previously seen lesions and interval development of new lesions.2.Large areas of encephalomalacia are redemonstrated showing no significant interval change and representing sites of prior diffusion restricting disease.


Instruction: Generate impression based on findings.

Input: New headache, prior MRI showing Chiari malformation Low-lying cerebellar tonsils measuring 4 to 5 mm below the foramen magnum with a pointed configuration are again seen. There is mild crowding at the foramen magnum although the posterior fossa is incompletely evaluated on this cervical spine MRI. There is a small syrinx in the cervical cord extending from the C1 to the C4 levels, and measuring up to 2 mm at the mid C2 level which is similar to prior. There is minimal prominence of the central canal in the cervical cord inferior to the C4 level.The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis with apex at the C3-C4 level, as before.. Bone marrow signal is benign. Multilevel degenerative changes are present as described below:Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex including a small subligamentous disc extrusion and uncovertebral hypertrophy particularly on the right. There is mild to moderate spinal canal stenosis, particularly the right aspect of the spinal canal which appears minimally worse in the interval. There is moderate right neural foraminal stenosis as before. Minimal left neural foraminal narrowing.C4-5: Small disc osteophyte complex and prominent left-sided uncovertebral hypertrophy. Mild to moderate spinal canal stenosis is similar to prior. There is moderate to severe left neural foraminal stenosis which is similar to prior. Right neural foramen is patent.C5-6: Small disc osteophyte complex with very mild spinal canal narrowing. Mild left neural foraminal stenosis. Right neural foramen is patent.C6-7: No significant compromise to the spinal canal or right neural foramen. Moderate left-sided facet arthropathy with mild left neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Right-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. Findings compatible with a mild Chiari I malformation with a small cervical syrinx, not significantly changed since 3/25/2011. Note the posterior fossa is incompletely evaluated on this cervical spine study.2. Multilevel degenerative changes in the cervical spine which are stable to minimally worse since 2011. There is mild to moderate spinal canal stenosis at the C3-C4 level and to a milder degree at the C4-C5 and C5-C6 levels.3. Neural foraminal stenosis is worst at the right C3-C4 level and left C4-C5 levels similar to prior. Additional details as above.


Instruction: Generate impression based on findings.

Input: Hodgins Lymphoma s/p ABVD x 1cycle - persistent dysphagia / nausea / vomiting - vocal cord paralysis/ right facial weakness. Furthermore, there is apparent increase in size of portions of the right skull base tumor with enlargement of the portions in the right cerebellomedullary angle cistern, and new extension of tumor into the right Meckel cave. Otherwise, the soft tissue components in the right prevertebral and paravertebral spaces, with extension in the right middle ear, jugular foramen, hypoglossal canal, and foramen lacerum, and portions of the facial nerve path, including the greater superficial petrosal nerve and in the region of the stylomastoid foramen, have not significantly changed. There is persistent fluid within the right middle ear and mastoid air cells with extensive mucosal thickening. There is persistent diffuse enhancement of the bone marrow in the right lateral and central skull base, with mild overlying dural enhancement diffusely, including within the right internal auditory canal.

Output: Apparent increase in size of portions of the right skull base tumor with enlargement of the portions in the right cerebellomedullary angle cistern, and new extension of tumor into the right Meckel cave. Otherwise, the soft tissue components in the right prevertebral and paravertebral spaces, with extension in the right jugular foramen, hypoglossal canal, and foramen lacerum, and portions of the facial nerve segments, have not significantly changed. Persistent right tympanomastoid opacification, which may be related to Eustachian tube obstruction and/or otomastoiditis.


Instruction: Generate impression based on findings.

Input: Low back pain, chronic. There is a slight disc bulge and bilateral facet and ligamentum flavum thickening at L5-S1, with mild right and mild to moderate left neural foraminal stenosis, but no significant spinal canal stenosis. There is no significant spinal canal or neural foraminal stenosis at T12 to L5. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: Slight disc bulge and bilateral facet and ligamentum flavum thickening at L5-S1, with mild right and mild to moderate left neural foraminal stenosis, but no significant spinal canal stenosis. Otherwise, no significant spinal canal or neural foraminal stenosis at T12 to L5.


Instruction: Generate impression based on findings.

Input: Central precocious puberty; child with history of VP shunt. Brain: There is a right transfrontal ventricular shunt catheter that terminates in the right lateral ventricles. The entire ventricular system remains markedly dilated diffusely. There is also diffuse paucity of periventricular white matter, particularly in the frontal lobes. The brainstem is distorted by the enlarged fourth ventricle and may also be atrophic. There is no evidence of intracranial hemorrhage or acute infarct, although assessment is partly limited due to artifact from the shunt reservoir. 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. There are persistently prominent upper cervical and retropharyngeal lymph nodes. There are small nasopharyngeal retention cysts.Pituitary: There is a tiny pars intermedia cyst. The posterior pituitary bright spot is intact. The pituitary infundibulum appears to be relatively thin and anteriorly deviated.

Output: 1. Persistent ventriculomegaly with ventricular shunt catheter in position and associated deficiency of periventricular white matter.2. The pituitary infundibulum appears to be relatively thin and anteriorly deviated, perhaps due to pressure from the adjacent dilated third ventricle.


Instruction: Generate impression based on findings.

Input: A 42 year old female with history of repaired coarctation of Aorta and peripartum cardiomyopathy with left ventricular function that has returned to low normal. A previous cardiac MRI in 2011 showed coarctation with mild flow acceleration. A recent echocardiography showed accelerated flow at the level of the coarctation. Referred to cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 51%, the LV end diastolic volume index is 77 ml/m2 (normal range: 65+/-11), the LVEDV is 131 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 64 ml (normal range 31+/-10), the LV mass index is 42 g/m2 (normal range 67+/-11), and the LV mass is 72 g (normal range 114+/-24). There is hypokinesis of the basal inferoseptum segment only, which was described in previous echocardiography. There is a false chord in the LV apex. The left ventricle is somewhat hyper-trabeculated.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 52%, the RV end diastolic volume index is 57 ml/m2 (normal range 69+/-14), the RVEDV is 98 ml (normal range 110+/-24), the RV end systolic volume index is 27 ml/m2 (normal range 22+/-8), and the RVESV is 47 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. The coronary sinus is dilatedAortic ValveThe aortic valve is trileaflet, opens widely and there is mild aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is trace 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. There is aortic coarctation originates just distal to the left subclavian artery. The aorta measures 1.3 cm at this site. There is mild-moderate flow acceleration across the coarctation. There is post-coarctation dilation of the aorta with a maximum diameter of 2.3cm. No focal aneurysms or pseudoaneurysms are noted near the coarctation site.The remaining aortic measurements are as follows:Ascending aorta: 2.6 cmAortic arch just proximal to coarctation: 1.9 cmCoarctation Site: 1.3cmDescending aorta just distal to coarctation: 2.3 cmPulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThere is evidence of a persistent left SVC draining into a dilated coronary sinus. The right SVC is normal in size and drain normally into the right atrium. The IVC is dilated and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. A trivial pericardial effusion is noted. Extracardiac FindingsSternal wires were noted. A large gallstone is noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function, the LVEF is 51%. There is hypokinesis of the basal inferoseptum segment only, which was described in previous echocardiography and also seen on the prior cardiac MRI. The left ventricle is also somewhat hypertrabeculated but does not meet diagnostic criteria for left ventricular non-compaction.2. The right ventricle is normal in size and systolic function, the RVEF is 52%. 3. There is evidence of a persistent left SVC draining into the coronary sinus, which is dilated.4. There is aortic coarctation originating just distal to the left subclavian artery. The aorta measures 1.3 cm at this site. There is mild to moderate flow acceleration across the coarctation. There is post-coarctation dilation of the aorta with a maximum diameter of 2.3cm. There is not aneurysm or pseudoaneurysm in the vicinity of the coarctation. Compared to the previous cardiac MRI of 2011, no significant difference was noted despite no contrast in the study performed today. 5. There is mild aortic regurgitation. The aortic valve is trileaflet.6. A gallstone is noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Jaundice, hepatomegaly, evaluate for obstruction Suboptimal study secondary to patient motion artifact. ABDOMEN:LIVER, BILIARY TRACT: Marked T2 hypointensity of the spleen and liver and diffuse signal dropout in liver suggested on inphase imaging when compared to opposed phase imaging, findings may be seen in setting of iron deposition disease. Liver measures 19 cm in craniocaudal dimension. No intrahepatic or extrahepatic biliary duct dilatation. Increasing moderate abdominopelvic ascites. Small fluid and fat stranding seen extending into region of Morison's pouch and around the gallbladder. Gallbladder mildly prominent, measuring up to 3 cm in transaxial plane. No intraluminal signal void seen to suggest underlying cholelithiasis. Mild asymmetric gallbladder wall prominence, measuring up to 3 mm, may be reactive in presence of ascites. Otherwise, no secondary signs of acute cholecystitis. SPLEEN: Splenomegaly, spleen measures 14.5 cm. Marked T2 hypointensity of the spleen and liver, may be seen in setting of hemosiderosis/iron deposition disease. PANCREAS: Mildly decreased intrinsic T1 signal of pancreas in portions of pancreatic head with possible minimal restricted diffusion, mild mesenteric fat haziness. Findings may be seen in setting of mild acute pancreatitis. Previously visualized sidebranch intraductal papillary mucinous neoplasms not as well seen on current study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly thickened small bowel, particularly jejunum, most likely reactive in setting of ascites.BONES, SOFT TISSUES, OTHER: Bilateral increasing moderate sized pleural effusions with underlying atelectasis. Diastases of rectus muscles and small fat containing umbilical hernia. Upper abdominal artifact, likely secondary to enteric tube

Output: 1. Suboptimal exam secondary to patient motion artifact and absence of IV contrast. 2. Hepatosplenomegaly. Marked T2 hypointensity of the spleen and liver, suggestive of iron deposition disease. Correlation with patient's clinical history advised.3. Mildly decreased intrinsic T1 signal of pancreas in portions of pancreatic head with possible minimal restricted diffusion, mild mesenteric fat haziness. Findings may be seen in setting of mild acute pancreatitis, correlation with patient's clinical history/laboratory values recommended. 4. Increasing moderate abdominopelvic ascites and pleural effusions.


Instruction: Generate impression based on findings.

Input: Male, 19 years old, with history of DNET status post resection, follow-up examination. Evidence of left parietal craniotomy is again seen. A small resection cavity within the left precentral gyrus has decreased in size compared to the prior examination. The rim of the cavity demonstrates very mild T2/FLAIR hyperintensity. No pathologic enhancement is evident within or around the resection cavity.Brain parenchymal morphology is otherwise within normal limits. No other areas of pathologic signal or abnormal enhancement are detected. No significant intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. Ventricular size and morphology are within normal limits. A normal variant cavum septum pellucidum et vergae is noted.

Output: Expected postoperative findings status post tumor resection from the left precentral gyrus with no evidence of residual or recurrent tumor.


Instruction: Generate impression based on findings.

Input: Reason: s/p SRS for resected lesion History: None. There are postoperative changes of left parietal tumor resection with foci of susceptibility within the cavity suggesting old hemorrhage. Enhancement within the cavity is significantly increased measuring 3.0 x 2.2 cm (1 201/119, previously 2.4 x 1.0 cm. In addition, there is increased surrounding edema with T2 signal extending along the splenium of the corpus callosum, posterior limb of the left internal capsule, and into the left temporal lobe. There is an enhancing dural based lesion along the left temporal lobe which is significantly increased in size measuring 3.1 x 2.3 cm (1201/70), previously 0.7 x 0.6 cm. The lesion exhibits mass effect with effacement of the frontal horn of the left lateral ventricle and mild 3 mm left to right midline shift. Two smaller dural based enhancing lesions along the left occipital lobe inferior to the resection cavity are new from the prior exam.Left frontal and parietal subdural collections seen on the prior exam have resolved. Subependymal nodules at the foramina of Monro are unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The major cerebral flow voids are intact. The orbits and paranasal sinuses are grossly unremarkable. There is a disconjugate gaze.

Output: 1.Significantly increased enhancement within the resection cavity. Given the timing of prior radiation, differential diagnosis includes radiation necrosis or recurrent tumor.2.There is a large dural based left temporal lesion which has significantly increased in size, likely progressive metastatic disease. In retrospect, this was present on the prior exam, although much smaller. There are additional smaller dural based lesions inferior to the resection cavity which are new, also likely metastases.3.Subependymal nodules are unchanged and likely related to patient's known tuberous sclerosis.


Instruction: Generate impression based on findings.

Input: Male, 40 years old, lumbar pain and radiculopathy. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or edema is seen.The visualized distal spinal cord and conus are within normal limits. The nerve roots of the cauda equina disperse evenly through the thecal sac. No epidural abnormalities are suspected.Mild loss of disc height and disc bulging are seen in the lower thoracic spine as visualized on sagittal images. Additional level specific findings are as follows:L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet arthropathy. Small right foraminal disc protrusion which contacts the exiting right L3 nerve root. No significant spinal canal stenosis is seen. The right neural foramen is mildly narrowed. L4-5: Mild facet arthropathy, left more than right. No significant spinal canal stenosis. Mild left foraminal narrowing. L5-S1: Moderate facet arthropathy. Mild bulging disc with a superimposed left foraminal annular fissure/protrusion. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing.

Output: 1.A small foraminal disc protrusion on the right at L3-4 contacts the exiting L3 nerve root but causes only mild generalized narrowing of the foramen.2.A left foraminal protrusion at L5-S1, along with facet arthropathy, causes moderate narrowing of the neural foramen.3.No areas of significant spinal canal stenosis are seen


Instruction: Generate impression based on findings.

Input: Clinical question: Preoperative planning. Signs and symptoms: Seizure. Pre and post enhanced fusion brain MRI:Examination performed as a surgical guidance and is not a true diagnostic test.There are bilateral deep brain electrodes placed via bilateral occipital approach. The electrodes bilaterally extending along the medial aspect of bilateral temporal lobes and terminate along the medial aspect of bilateral temporal tips. These increased T2 signal intensity along the entire course of left electrode and only posteriorly along the course of the right electrode in the right posterior temporal-occipital region. Ventricular system are within normal size and with maintained midline.

Output: Pre and postcontrast enhanced fusion brain MRI as detailed above.


Instruction: Generate impression based on findings.

Input: Facial abscess. Acute renal failure. A limited examination was performed with only sagittal T1 and coronal STIR sequences as the patient could not tolerate being in the scanner for an extended time. It is also limited by lack of contrast administration.There is a severe, extensive edema and increased T2/STIR signal involving the soft tissues on the left side of the face, centered at the muscles of mastication with inferior extension into the left submandibular region, medially into the left parapharyngeal space as well as laterally into the subcutaneous fat and skin. This process extends superiorly to involve the temporal and infratemporal region. A well-defined component of the abnormality which shows more homogeneous T2-hyperintensity is present just lateral to the left mandibular ramus, deep to the left masseter muscle, and measures in the coronal plane 4.5 cm x 1.6 cm, probably representing an abscess. Associated abnormal left mandibular marrow signal is also seen without gross cortical erosion, which can be reactive or reflective of osteomyelitis. A larger but more heterogeneous fluid collection with gas and signs of loculation is present at the superior extension of the abnormality along the temporalis muscle. This measures coronally 8.2 cm x 2.1 cm. Anteroposteriorly, the abnormality measures at least 4.5 cm. There is no gross underlying skull erosion or definite marrow signal abnormality. A third large and more discrete abnormality is present in the left submandibular region and measures in the coronal plane 4.7 cm x 4.1 cm but is less T2-hyperintense and may reflect phlegmon. Smaller foci of fluid loculation are present within the left lateral and medial pterygoid muscles. The left posterior gland is enlarged and more T2-hyperintense, compared to the right which is probably reactive. Focal T2-hyperintensity that measures 1.5 cm in diameter abuts the inferior aspect of the proximal gland on image #15 of series #801.The deep left parapharyngeal extension is associated with mild-to-moderate narrowing of the pharynx.There is abnormal T2-hyperintensity surrounding the root of the last left maxillary molar which might be the source of the infection. Mucosal thickening and retention cysts are present in the left maxillary sinus. There is also mucosal thickening in the ethmoid and sphenoid sinuses, more on the left. Minimal right maxillary mucosal thickening is associated with focal T2-hypointensity, which may reflect inspissated secretions.While the major cervical carotid flow voids are preserved, the left internal jugular vein patency cannot be assessed.While there is no gross intracranial extension, this study is not designed to assess for that. There is no involvement of the left orbital or preorbital soft tissues. There is a right globe prosthesis. Included brain shows no gross abnormality.

Output: 1.This is a limited, noncontrast enhanced examination as described above.2.A severe infiltrative left facial abnormality is most compatible with an infection, with multiple abscesses including the left temporalis/masseter muscles as well as the left lateral and medial pterygoid muscles. The larger fluid locules are in the left temporal region and lateral to the left mandibular ramus deep to the left masseter muscle as described above. Large focal abnormality in the left submandibular region may represent phlegmon rather than a well-formed abscess. More accurate abscess assessment requires intravenous contrast administration but the patient is in acute renal failure.3.The component adjacent to the mandibular ramus is associated with abnormal marrow signal but no cortical erosion. This may reflect a reactive process but may also reflect early osteomyelitis.4.The deep left parapharyngeal extension is associated with mild-to-moderate narrowing of the pharynx.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Glenda Montague over the phone on on December 15, 2015 at 0851 hours.


Instruction: Generate impression based on findings.

Input: cT4bN2c left tonsil squamous cell carcinoma. There is an infiltrative mass centered in the left palatine tonsil, with extension into the soft palate and inferior nasopharynx, which overall measures up to at least 4 cm. There is a cystic component of the tumor that measures up to 12 mm and indents the adjacent left medial pterygoid muscle. There are partially cystic or necrotic bilateral level 2 cervical lymph nodes with ill-defined margins. For example, a left level 2A lymph node measures 16 x 21 mm in axial cross-section and a right level 2A lymph node measures 15 x 22 mm. There is also a heterogeneous left level 3 lymph node that measures 9 x 16 mm. In addition, there is an ill-defined mass centered in the left retropharyngeal space that measures up to 17 x 21 mm in axial cross-section, which infiltrates the lateral aspect of the left longus coli muscle, extends to the jugular foramen, and appears to encase the left internal carotid artery, as well as compress the internal jugular vein. There are associated denervation changes involving the left vocal cord. The thyroid and salivary glands appear unremarkable. The osseous structures are intact, aside from a small posterior disc-osteophyte complex at C5-6. The imaged intracranial structures and orbits are unremarkable.

Output: A left oropharyngeal mass with nasopharyngeal extension measuring up to at least 4 cm and associated bilateral lymphadenopathy, including a left retropharyngeal mass with signs of extracapsular extension is compatible with squamous cell carcinoma and metastatic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 46 year old man. Evaluate for bleed. Headache. There is no evidence of intracranial hemorrhage, mass or edema. Cerebellar volume loss is once again noted and is unchanged from the prior CT. The asymmetry of the cerebellar peduncles noted on the prior MRI is not clearly visible on this study.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Scattered mucosal thickening and opacification is present throughout the ethmoid air cells -- this finding was also seen on the patient's prior CT.

Output: No CT evidence of acute intracranial process.


Instruction: Generate impression based on findings.

Input: Reason: s/p tumor resection History: s/p tumor resection Prelim pathology suggestive of metastatic carcinoma. There has been interval left temporal parietal craniotomy for resection of previously seen underlying mass. Prominent susceptibility along the anterior aspect of the frontal lobes with mild mass effect as well as a few scattered foci near the convexity likely relate to pneumocephalus. There is now prominent susceptibility underlying the craniotomy flap in the surgical bed likely representing postoperative blood products as well as air. There is no significant diffusion abnormality in the area of the resection. Two punctate foci of apparent hyperintensity are seen along the cerebellar vermis (302/104) on diffusion-weighted images only, hand without correlative FLAIR abnormality or susceptibility. These may be artifactual.A tiny vessel medial to the posterior medial margin of the mass has seen on preoperative exam remains delineated. Apparent enhancement along the upper margin of the resection cavity is likely artifactual when evaluating precontrast imaging.Extent of surrounding abnormal T2/FLAIR hyperintensity extending into the adjacent left parietal lobe appears overall similar, with continued mild localized mass effect on the adjacent left ventricular atrium. There is a stable small oval area of T2/FLAIR hyperintensity in the left frontal subcortical white matter, which remains nonspecific.

Output: Interval expected postoperative changes following gross total resection of previously seen left posterior parietal/superior temporal region mass, with residual vasogenic edema and mild localized mass effect upon the left lateral ventricle. No definite residual enhancement to suggest residual tumor, although continued follow-up is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Workup for vertebral body masses. Signs and symptoms: Vertebral body masses thoracic and lumbar vertebrae. Nonenhanced lumbar MRI:Examination demonstrate diffuse marrow signal replacement involving vertebral bodies of L1 and L2. The signal changes are T1 hyperintense, T2 hyperintense and T2 stir hyperintense pattern suggestive of extensive fatty of the vertebral body. Axial images demonstrate course bony trabeculation. The findings are likely to represent either radiation or fatty deposit within the vertebral bodies or possibly hemangiomas. There is no evidence of fracture or malalignment at this level and no detectable epidural or paraspinal associated soft tissue abnormalities.Examination also demonstrate a large focus of marrow signal replacement involving extensively the vertebral body of L4. The signal changes consist of T1 hypointense and T2 iso to hyperintense and T2 stir hyperintensity. This vertebrae also demonstrate coarse trabeculation through the lesion and highly suggestive of a hemangioma as well. No fracture or malalignment. No evidence of perispinal or epidural associated soft tissue abnormality. Tiny additional foci of similar signal changes is noted in the superior aspect of body of T12 and the spinous process of L2 as well suggestive of hemangioma.The alignment the vertebral column is anatomical.T12 -- L1 is unremarkable.L1 -- L2 demonstrate advanced disk disease with significant loss of disk height and mild facet and ligamentum flavum hypertrophy. No spinal stenosis or neural foraminal compromise.L2 -- L3 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.L3 -- L4 demonstrate mild disk disease and loss of disk height and mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate left and mild right ligamentum flavum and facet hypertrophy. In addition there is a central and rightward broad based disk protrusion. Constellation of above findings results in moderate central spinal stenosis and moderate right neural foraminal compromise.At L5 -- S1 demonstrate moderate disk disease and loss of disk height, moderate left facet and bilateral ligamentum flavum hypertrophy and mild right facet disease. No spinal stenosis. Moderate to severe left neural foraminal compromise is however present.Normal signal intensity and morphology of conus and the cauda equina.There is no detectable perispinal soft tissue abnormalities. Psoas muscles are symmetrical and appear normal in size and morphology for stated age of 79. Bilateral kidneys are unremarkable.

Output: 1.Multiple foci of marrow signal replacement involving the vertebral bodies and posterior elements which are all suggestive of hemangioma as detailed above. There is no evidence of fracture or malalignment or any associated soft tissue abnormality with the above findings.2.Degenerative changes at L4 -- L5 and including a central and right-sided disk protrusion results in moderate central spinal stenosis and right neural foraminal compromise.3.Degenerative changes at other levels of varying degrees however without central spinal stenosis as detailed per level above.4.Asymmetric left-sided facet hypertrophic changes at L5 -- S1 results in moderate to severe left neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: There are no areas of abnormal signal or pathological enhancement. There are scattered punctate foci and confluent areas of T2 hyperintensity within the periventricular and subcortical white matter. There is also a punctate focus of T2 hyperintense signal within the right basal ganglia, which may represent a chronic lacunar infarct or prominent perivascular space in addition to other bilateral basal ganglia enlarged perivascular spaces. There is no midline shift or mass effect. The ventricles and cortical sulci are prominent consistent with moderate volume loss. There is susceptibility effects related to a dural based calcified lesion measuring up to 1.1 cm along the right lateral frontal convexity. There are bilateral mastoid effusions.

Output: 1. No evidence of intracranial metastases.2. Nonspecific cerebral white matter signal abnormality may represent treatment effects, perhaps superimposed upon chronic small vessel ischemic disease. 3. A small calcified dural based lesion along the right frontal convexity may represent a meningioma or perhaps an osteoma.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: disc herniation, spinal stenosis explaining neck/arm pain History: neck/arm pain, subjective weakness The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is straightening of the normal focal curvature present.At C2-3 there is no significant compromise to the spinal canal. There is left-sided facet hypertrophy present at this level resulting in narrowing of the left neural foramen and encroachment exiting nerve rootsAt C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level.At C4-5 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level associated with this material and encroachment of the exiting nerve roots bilaterally.At C5-6 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level associated with this material and encroachment of the exiting nerve roots bilaterally right worse than left.At C6-7 there is no significant compromise to the spinal canal. There are uncovertebral osteophytes present at this level associated with this material and encroachment of the exiting nerve roots bilaterally.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine which result in the neural foramen encroachment on the left side at C2-3, the right side at C5-6 and bilaterally at C4-5 and C6-7.


Instruction: Generate impression based on findings.

Input: Abnormal gait and reflexes Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild straightening and minimal retrolisthesis of C3 on C4. Bone marrow signal is within normal limits. There is T2 signal abnormality involving the bilateral cervical cord at the C3-C4 level with volume loss, most consistent with myelomalacia.Moderate degenerative changes are seen throughout the cervical spine as described below:C2-3: Small disc osteophyte complex with bilateral uncovertebral hypertrophy. No significant compromise to the spinal canal. There is mild to moderate left and mild right neural foraminal narrowing.C3-4: Disc osteophyte complex with uncovertebral hypertrophy. There is mild to moderate degree of spinal canal stenosis with cord myelomalacia as mentioned above. There is moderate to severe left and moderate right neural foraminal stenosis. C4-5: Disc osteophyte complex with uncovertebral hypertrophy. There is severe left neural foraminal stenosis and moderate right neural foraminal stenosis. There is mild to moderate degree of spinal canal stenosis.C5-6: Disc osteophyte complex which is predominantly left paracentral and ligamentum flavum thickening. There is moderate degree of spinal canal stenosis, particularly involving the left aspect of the spinal canal. There is also severe left neural foraminal stenosis and mild to moderate right neural foraminal stenosis.C6-7: Small disc osteophyte complex with small right paracentral protrusion. There is no significant spinal canal or right neural foraminal stenosis. There is mild to moderate left greater than right neural foraminal stenosis.C7-T1: Small disc osteophyte complex and uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate bilateral, left greater than right, neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: 1. There is abnormal cord signal and volume loss at the bilateral C3-C4 level consistent with myelomalacia. There is mild to moderate degree of spinal canal stenosis at this level, and as such this signal abnormality may be related to prior higher degree of spinal canal stenosis, superimposed trauma, or less likely prior ischemic or other injury.2. Moderate degenerative changes throughout the cervical spine. Spinal canal stenosis is worst at the C5-C6 level and moderate in degree. There is also significant multilevel neural foraminal stenoses, worst at the left C3-C4, C4-C5, and C5-C6 levels. Additional details as above.


Instruction: Generate impression based on findings.

Input: There is normal alignment of the thoracic spine. The osseous marrow signal is benign. Vertebral body heights are preserved. The disks are within normal limits. The thoracic cord shows normal caliber and signal characteristics. There is anterior displacement of the thoracic cord which is most likely related to normal thoracic kyphotic curvature. No focal indentation. There are small multiple bilateral perineural cysts. There is no significant thoracic disk herniation, spinal canal or neural foraminal stenosis. There is a focus of fat versus hemangioma in the superior endplate of T11 posteriorly. There are small bilateral pleural effusions.

Output: 1.No significant disk disease, spinal canal or neural foramina stenosis in the thoracic spine. No abnormal cord signal. No compression fractures.2.Small bilateral pleural effusions.3.Small multiple bilateral perineural cysts, which are a normal variant. There is apparent anterior displacement of the thoracic cord which is most likely related to the normal thoracic kyphosis. There is a remote possibility of an arachnoid cyst posteriorly; if there is high suspicion of thoracic myelopathy, a high resolution 3D T2 FIESTA MRI sequence or myelogram could be obtained for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Dizziness and dysarthria. Evaluate for ischemia. MRI:Patient motion limits exam and the exam was terminated early due to to patient inability to continue. No restricted diffusion to indicate acute ischemia. Minimal patchy periventricular white matter FLAIR hyperintensity compatible with chronic small vessel ischemic changes. Chronic left frontal lobe infarct with associated gliosis. No mass or edema is evident. The ventricles and basal cisterns are normal in size and configuration.MRA:Mild atherosclerotic irregularity of the cavernous segments of the internal carotid arteries. There is a broad-based 3 x 4 mm aneurysm arising inferomedially from the horizontal cavernous segment of the right internal carotid. There is a complete circle of Willis. The left A1 segment is hypoplastic. The right P-comm is hypoplastic. Partial fetal morphology left PCA. No high-grade stenoses.

Output: 1. Minimal small vessel ischemic changes and chronic left frontal lobe infarct. No acute ischemia.2. No high-grade steno-occlusive disease in the head. There is mild atherosclerotic irregularity of the cavernous segments of the internal carotid arteries.3. 3-4 mm broad-based saccular aneurysm arising from the horizontal right internal carotid artery cavernous segment.


Instruction: Generate impression based on findings.

Input: 78 years Female (DOB:5/18/1938)Reason: eval for large vessel occlusion History: R face/ arm/leg weakness, numbness, word findingPROVIDER/ATTENDING NAME: GREGG M HELLAND GREGG M HELLAND MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate susceptibility weighted imaging hypointense lesion in the left periventricular white matter which was also present on the prior exam and most likely represents an old microhemorrhage.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are patchy T2 and FLAIR hyperintense foci in the brainstem and basal ganglia.There is a millimeter-sized focus of susceptibility effect present in the left periventricular white matter adjacent to the trigone of the left lateral ventricle. In isolation this is of unknown clinical significance.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There is an 8 x 5 mm axial dimension aneurysm present which originates from the medial wall of the clinoidal segment of the right internal carotid artery and extends medially bulging and towards the sella. It is stable and compared to the previous exam.There is 60% stenosis at the right p3 segment of the posterior cerebral artery. This is unchanged since prior exam.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.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are similar in size.

Output: 1.There is an 8 mm aneurysm at the medial wall of the clinoidal segment of the right internal carotid artery which is stable.2.There is a 60% stenosis of the the right posterior cerebral artery at the p3 segment. This is stable.3.Periventricular and subcortical white matter lesions as well as brainstem lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Chiari malformation decompression, one month post op decompression. Brain: There are postoperative findings related to Chiari decompression surgery without residual fluid collection in the subcutaneous tissues. There has been interval evolution of the left posterior medulla hematoma with a small area of encephalomalacia and resolution of the edema. The rest of the brain parenchyma is unremarkable. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is a subcentimeter low signal lesion along the inner table of the skull overlying the left frontal lobe, which may represent an osteoma, meningioma, or calcifying pseudotumor. There is no midline shift or herniation. The major cerebral flow voids are intact. Cervical Spine: There is a trace syrinx that extends from C6 to T1. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There are a few small posterior disc-osteophyte complexes, but no significant spinal canal or neural foraminal stenosis.

Output: 1. Postoperative findings related to Chiari decompression surgery with interval evolution of the left posterior medulla hematoma with a small area of encephalomalacia and resolution of the edema. 2. Residual trace syrinx that extends from C6 to T1.


Instruction: Generate impression based on findings.

Input: Pain in pelvic region, Right leg pain. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is grade 1 spondylolisthesis of L4 on L5 with moderate to severe spinal stenosis.In addition, there is about 8mm sized synovial cyst arising from the right L45 facet joint which narrows right lateral recess of the L45 level.There is normal lumbar lordosis. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1-L2 level. Degenerative changes are specified by the intervertebral level as follows: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: no neuroforaminal narrowing or spinal stenosis. L3-L4: Disc desiccation, no neuroforaminal narrowing or spinal stenosis. L4-L5: Disc desiccation, grade 1 spondylolisthesis of L4 on L5 with bilateral ligamentum flavum thickening with moderate to severe spinal canal stenosis. In addition, there is about 8 millimeter sized synovial cyst arising from the right L4-5 facet joint which narrows right lateral recess of this level. No neuroforaminal narrowing or spinal stenosis. L5-S1: Disc desiccation. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Spondylolisthesis of L4 on L5 with moderate to severe spinal canal stenosis.2. Right L45 facet joint synovial cyst causes right lateral recess stenosis.3. Multi-level Disc degenerations as discussed above.


Instruction: Generate impression based on findings.

Input: Female, 15 years old. Left hip labral tear s/p prior hip scope. ACETABULAR LABRUM: There is a small cleft adjacent to the anterior superior labrum (radial sequence series 11, image 14) and susceptibility artifact likely due to prior surgery. The remainder of the labrum appears normal without additional tear identified.ARTICULAR CARTILAGE AND BONE: Bone marrow signal is normal. Articular cartilage is intact.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Postoperative changes involving the anterior superior labrum. Normal appearance of the remainder of the labrum without additional tear identified.


Instruction: Generate impression based on findings.

Input: Female 66 years old Reason: evaluate knee for cysts/ligament damage History: knee pain and fullness MENISCI: There is mild intrasubstance signal in the medial meniscus but we see no tear. We see no tear of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is focal increased signal within the articular cartilage of the medial facet of the patella indicating degeneration with small foci of increased signal intensity in the lateral facet. There is mild subjective thinning of articular cartilage in the medial and lateral tibial femoral compartments but no fluid-filled defect. Bone marrow signal is normal.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: Extensor mechanism is intact.ADDITIONAL

Output: Mild cartilage degeneration not atypical considering patient's age. We see no ligament damage or other findings to account for patient's pain.


Instruction: Generate impression based on findings.

Input: Pain. Question of ACL tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is near full thickness loss of articular cartilage of the superior aspect of the lateral facet of the patella with underlying subchondral edema. Additionally, there is heterogeneity of cartilage more inferiorly suggesting degeneration along with superficial delamination of cartilage along the medial facet. There is loss of articular cartilage of the posterior and inner aspect of the medial tibial plateau adjacent to the fracture as described below.There is a minimally displaced longitudinal fracture through the medial aspect of the medial femoral condyle. Additionally, there is another non-displaced, non-depressed fracture through the middle medial femoral condyle with intra-articular extension (image 24, series 301 and image 25, series 601). The underlying cartilage, however, is intact.There is comminuted, oblique fracture through the posterior tibial plateau that includes the tibial spine. The posterior cruciate ligament and posterior root of the lateral meniscus attach normally to the fracture fragment which is distracted approximately 4 mm. A transverse fracture through the proximal fibular diaphysis is partially imaged. There is bone marrow edema throughout the distal femur and proximal tibia. LIGAMENTS: The anterior and posterior cruciate ligaments are intact. The medial collateral ligament appears discontinuous at its attachment on the medial femoral condyle. The lateral collateral ligament is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. Multiple fractures through the medial femoral condyle, posterior tibial plateau, and proximal fibula as described above.2. Questionable MCL tear.3. Intact menisci and cruciate ligaments. 4. Chondromalacia as described above.


Instruction: Generate impression based on findings.

Input: Relapsed neuroblastoma. The lobulated heterogeneous mass along the floor of the left middle cranial fossa and infratemporal fossa with perineural extension into the left cavernous sinus through foramen ovale and rotundum is not significantly changed, measuring up to approximately 4 cm. However, tumor along the left lateral extraconal space appears to have slightly increase in size, measuring up to 7 mm in thickness, previously 6 mm, with mass effect upon the left lateral rectus muscle and narrowing of the optic canal and apex. However, the left optic nerve signal characteristics are preserved. Likewise, an extradural enhancing nodule adjacent to the inferior left frontal lobe laterally has not significantly changed in size. There is interval decrease in size of the tumors along the bilateral mandibular condyles. There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. There is scattered paranasal sinus mucosal thickening and secretions. There is obstructed fluid within the left mastoid air cells.

Output: 1. Perhaps slight interval increase in size of tumor along the left lateral wall of the orbit.2. No significant interval change in the mass along the floor of the left middle cranial fossa and infratemporal fossa with apparent perineural extension into the left cavernous sinus through foramen ovale and rotundum, as well as associated left Eustachian tube obstruction.3. A subcentimeter extradural lesion adjacent to the inferior left frontal lobe laterally has not significantly changed in size.4. Interval decrease in size of the tumors along the bilateral mandibular condyles.


Instruction: Generate impression based on findings.

Input: Female, 5 months old, with new diagnosis of infantile spasms. Evaluate for signs of tuberous sclerosis or other intracranial abnormalities. Gyral simplification and marked cortical thickening is seen bilaterally and symmetrically involving the posterior frontal and parietal lobes, particularly in the perisylvian regions. The anterior frontal lobes and the occipital and temporal lobes are affected to a much lesser degree if at all.As result, the brain demonstrates a slightly dysmorphic configuration. The pituitary region is unremarkable. The corpus callosum appears to be fully formed and intact. The cerebellum likewise appears to be normally formed. The tectum may be slightly thicker than what is typically seen, but the brainstem is otherwise unremarkable.The pattern of white matter myelination is otherwise appropriate for age. The ventricles are mildly dysmorphic and prominent but this is likely secondary to the parenchymal abnormalities. No evidence of any intracranial hemorrhage or abnormal extra-axial fluid collection is seen.

Output: Pachygyria is seen affecting the posterior frontal and parietal lobes bilaterally and symmetrically. Apart from this, no other focal or acute abnormalities are identified.


Instruction: Generate impression based on findings.

Input: intracranial abscess [324.0], Reason for Study: ^Reason: hx intracranial abscess. Evaluate change/ resolution History: surveillance Redemonstration of the right thalamic lesion with susceptibility artifacts with focal tissue loss. The lesion shows ill defined punctate subtle enhancement on gadolinium infusion, there is possibility of associated enlarged parenchymal venous structure on the right lateral ventricle. Above described findings constitute possible diagnosis of cavernous malformation associated with developmental venous anomaly.These findings do not show any interval change since prior study imaging scan. Right frontal burr hole, no significant interval change.No evidence of acute ischemic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right thalamic lesion with susceptibility artifacts suggest cavernous malformation with associated DVA, no interval change since prior scan.2. No acute ischemic lesion.3. Otherwise no remarkable finding since prior scan.


Instruction: Generate impression based on findings.

Input: Acute onset weakness left-sided and slurred speech. Extensive areas of hypoattenuation are seen in the periventricular and subcortical white matter consistent with small vessel ischemic disease, age indeterminant. No definite acute cortical stroke is present. However, further evaluation with MRI is recommended if clinical concern acute ischemia is present. Circumscribed low density lesions are seen in the bilateral basal ganglia and right peri-atrial white matter consistent with lacunar infarcts. No intracranial hemorrhage is seen. Subarachnoid space is prominent suggestive of parenchymal volume loss. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Extensive small vessel ischemic disease, age indeterminant. 2. No evidence of acute cortical stroke. MRI is more sensitive for detection of acute ischemia.


Instruction: Generate impression based on findings.

Input: 62-year-old male. Evaluate extent of prostate cancer. Pathology dated 8/26/2016 revealed adenocarcinoma of the left apex (Gleason 3+3), left mid gland (Gleason 3+3), right base (Gleason 3+4), right lateral base (Gleason 3+3), right lateral mid (Gleason 3+3), right lateral apex (Gleason 3+3). PELVIS:PROSTATE:Prostate Size: The prostate measures 4.5 cm in transverse, 3.8 cm in AP, and 4.5 cm in critical diameter.Peripheral Zone: Bilateral linear and wedge-shaped foci of T2 and ADC hypointense foci scattered throughout the peripheral zone, nonspecific. In the right mid gland, there is a 4.5 x 3.6 mm nodular T2 and ADC hypointense focus concerning for a suspicious lesion (axial series 801 image 19). An additional suspicious nodular T2 and ADC hypointense focus is identified in the midline apex (axial series 801 image 13) measuring 5 x 5 mm.Central Gland: Heterogenous appearance.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.Suspicious nodular foci in the midline apex and right mid gland as described above. No extracapsular extension or pelvic lymphadenopathy.2.Scattered linear and wedge-shaped T2 hypointense foci of the peripheral zone are nonspecific.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain Evaluation of the shoulder is significantly limited by patient motion artifact.ROTATOR CUFF: There is a full-thickness tear of the supraspinatus tendon with at least 1 cm of retraction. The full thickness component of the tear measures approximately 1 cm in its AP dimension. There is perhaps a thin strand of fibers representing the posterior supraspinatus tendon that extends to the greater tuberosity. There is mild fatty atrophy of the supraspinatus muscle. Evaluation of the infraspinatus tendon is difficult due to patient motion artifact. Although the deep and posterior fibers of the tendon appear to extend to the greater tuberosity, we suspect that there is delamination of the tendon resulting in retraction of the more anterior and superficial fibers of the tendon with additional interstitial tearing along the myotendinous junction. There is moderate fatty atrophy of the infraspinatus muscle. The teres minor muscle and tendon are intact. There is thickening of the subscapularis tendon consistent with tendinosis with a tiny insertional interstitial tear. There is minimal fatty atrophy of the superior portion of the subscapularis muscle.SUPRASPINATUS OUTLET: Mild osteoarthritis of the AC joint. There is a small amount of fluid in the subacromial and subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Mild osteoarthritis affects the acromioclavicular and glenohumeral joints. Evaluation of the glenoid labrum is limited due to patient motion artifact; however we see no large fluid-filled tear. There is a small glenohumeral joint effusion. Foci of intermediate signal intensity in the subscapular recess may represent synovitis or debris.BICEPS TENDON: Intermediate signal intensity within the extra-articular portion of the tendon of the long head of the biceps just distal to its transition to the rotator interval may reflect degeneration and/or degenerative tearing. The intra-articular portion of the tendon is not well seen likely due to motion artifact. ADDITIONAL

Output: 1. Limited study due to patient motion artifact.2. Full-thickness and partial-thickness rotator cuff tears as described above.3. Osteoarthritis of the acromioclavicular and glenohumeral joints and other findings as described above.


Instruction: Generate impression based on findings.

Input: 79 years, Female, Reason: evaluate for metastatic gallbladder cancer History: ERCP today with mass seen in gallbladder. ABDOMEN:LUNG BASES: No specific abnormality notedLIVER, BILIARY TRACT: There is a lesion within the gallbladder that measures 2.1 x 4.3 cm (501/14) which likely corresponds to finding on recent endoscopic ultrasound. This lesion demonstrates diffusion restriction, intermediate T2 signal with only a subtle focus of enhancement along the medial aspect. There are enhancing liver lesions immediately adjacent to and appearing to be in contiguity with this region.There are multiple enhancing hepatic lesions throughout the liver with the reference lesion in the right hepatic lobe measuring 2.6 x 2.9 cm (1201/307). Appearance consistent with metastases.There is thrombosis of the left portal vein. The visualized right portal vein and main portal vein are patent.Multiple large stones are noted throughout the gallbladder. There is a simple cyst in the hepatic dome with additional smaller cysts which are too small to characterize.Common bile duct is dilated to 1.3 cm to the level of the ampulla. No choledocholithiasis. There is also minimal intrahepatic biliary ductal dilatation. No obstructing mass is evident in this region.SPLEEN: No significant abnormality noted.PANCREAS: Main pancreatic duct is dilated up to 1 cm and is tortuous with dilated sidebranches. No stones or obstructing lesion evident. There is low T1 signal and atrophy of the parenchyma, e.g., of the tail.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal simple cyst.RETROPERITONEUM, LYMPH NODES: IVC filter.BOWEL, MESENTERY: Ventral diastasis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.There are multiple lesions throughout the liver, consistent with metastatic disease. 2.A mass within the gallbladder is suspicious for a primary gallbladder malignancy, with associated hepatic metastatic disease, but could also represent hepatic metastatic disease secondarily involving the gallbladder.3.Left portal vein thrombosis.4.Dilated main pancreatic duct up to 1 cm with multiple dilated side branches and parenchymal atrophy. Chronic pancreatitis is favored with a main duct IPMN considered less likely.


Instruction: Generate impression based on findings.

Input: 13 years Female (DOB:5/26/2002)Reason: Female, 13 years old, with seizures and mesial temporal abnormalities on prior imaging. re-evaluate temporal lobe History: encephalopathy w/ temporal lobe abnormalitiesPROVIDER/ATTENDING NAME: CHARLES J. MARCUCCILLI CHARLES J. MARCUCCILLI The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of generalized brain atrophy present and a marked degree of atrophy of the right temporal lobe. There is atrophy of the right hippocampus.. It is stable compared to the prior examNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: The examination is stable. There is redemonstration of brain atrophy predominantly involving the right temporal lobe and especially the right hippocampus.


Instruction: Generate impression based on findings.

Input: Clinical question: Chronic back pain, history of multiple lumbar surgeries, meningitis. Evaluate for abnormality, infectious process, scarring. Signs and symptoms: Chronic LBP and left leg pain. Pre-and post-enhanced lumbar MRI:There is normal anatomical alignment the vertebral column.There is unremarkable signal intensity of vertebral common.T12 -- L1 is unremarkable.L1 -- L2 is unremarkable.L2 -- L3 demonstrate mild disk desiccation and unremarkable otherwise.L3 -- L4 demonstrate minimal ligamentum flavum hypertrophy and unremarkable otherwise.L4 -- L5 demonstrate a mild to moderate disk disease and loss of disk height. There is evidence of prior surgery however without evidence of spinal stenosis. Mild left neural foraminal compromise and patent right. There is a thin linear T2 hyperintensity in the midline and to the left suggestive of an annular fissure with expected enhancement.L5 -- S1 demonstrate moderate disk disease and loss of disk height, broad-based central and left port disk protrusion with resultant compromise of the left lateral recess. No central spinal stenosis. Mild left neural foraminal compromise. There is evidence of left sided surgery/laminotomy with epidural thickening and enhancement on the left lateral aspect of thecal sac which is inseparable from the left S1 nerve root consistent with epidural scarring.There is thickening and abnormal angulation of cauda equina at L4 and L4 -- L5 disk level suggestive of arachnoiditis.

Output: 1.At L4 -- L5 there is evidence of prior surgery with resultant expansion of thecal sac and no evidence of central spinal stenosis. Mild left neural foraminal compromise is detected. Annular fissure with expected enhancement on the left is noted. 2.At L5 -- S1 there is evidence of surgery on the left with epidural thickening/scarring and enhancement which is inseparable from the left S1 nerve root as detailed. No spinal stenosis however mild left neural foraminal compromise is present. Broad-based disk protrusion in the midline and to the left with resultant left lateral recess compromise.3.There is partial clumping of cauda equina with abnormal angulation at L4 and L5 levels highly suggestive of arachnoiditis.


Instruction: Generate impression based on findings.

Input: 24-year-old female with primary sclerosing cholangitis, evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.Intrahepatic biliary ductal dilatation has increased from the prior exam. There areas of intrahepatic beading and narrowing, which have progressed since prior exam. No dominant stricture is evident. The common bile duct measures 9 mm to the level of the ampulla, previously 7 mm.No suspicious hepatic lesions. Mildly prominent portacaval lymph nodes.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: A thick walled pouch is present within the pelvis.BONES, SOFT TISSUES: Mild rightward curvature of the spine.OTHER: Small amount of free fluid in the pelvis and small follicles are likely physiologic.

Output: 1.Intrahepatic biliary ductal dilatation and intrahepatic strictures likely related to primary sclerosing cholangitis have increased since the prior exam.2.Increased dilatation of the common bile duct to the level of the ampulla, which is likely stenosed.3.No suspicious hepatic lesions to suggest cholangiocarcinoma.


Instruction: Generate impression based on findings.

Input: 23-year-old male. Perianal Crohn's disease with Seton in place. Evaluate for perianal abscess. PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left perianal transsphincteric fistula originating at the 3 o'clock position of the anus and extending inferiorly to bifurcate into two tracts within the subcutaneous tissues of the left inner buttock with drainage at the skin surface. Setons are noted in the fistula tracts. No abscess collection is identified.OTHER: No significant abnormality noted.

Output: Left perianal fistula originating at the 3 o'clock position without evidence of an abscess.


Instruction: Generate impression based on findings.

Input: 50-year-old female with shoulder pain. Evaluate cough. Suboptimal evaluation secondary to motion artifact and patient positioning.ROTATOR CUFF: There is intermediate signal intensity along the supraspinatus tendon near its insertion consistent with mild tendinosis. The tendon itself appears intact with no evidence of tearing. The supraspinatus muscle appears normal. The remaining rotator cuff tendons and muscles appear normal.SUPRASPINATUS OUTLET: There is an os acromiale with associated osteoarthritic changes affecting the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a small amount of fluid within the glenohumeral joint communicating with the long head of the biceps tendon in the intertubercular groove. There is also small small amount of fluid within the subacromial subdeltoid bursa. Osteoarthritic changes affect the glenohumeral joint with associated osteophyte formation. There is a tear along the anterior inferior labrum with an adjacent para labral cyst (series 3, image 15). There is absence of the anterosuperior labrum with a thickened middle glenohumeral ligament compatible with a Buford complex, normal variant. BICEPS TENDON: The long head of the biceps tendon is normally positioned in the intertubercular groove and demonstrates normal signal intensity. There is small amount of surrounding fluid within the tendon sheath communicating with the glenohumeral joint.ADDITIONAL

Output: 1. Anterior inferior labral tear with adjacent para labral cyst.2. Mild tendinosis affecting the supraspinatus tendon near its insertion.3. Os acromiale with associated degenerative changes at the acromioclavicular joint. Osteoarthritic changes also affect the glenohumeral joint.4. Cystic lesion within the posterior subcutaneous soft tissues, clinical correlation recommended.


Instruction: Generate impression based on findings.

Input: Disc protrusion, foraminal stenosis. Right leg numbness, pain shooting down laterally, anteriorly. Five lumbar type vertebral bodies are present. Vertebral body heights are within normal limits. There is mild loss of lumbar lordosis as well as grade 1 anterolisthesis of L4 on L5 and minimal L5 on S1 retrolisthesis. Bone marrow signal is benign with T1 hyperintense focus involving the L2 vertebral body consistent with hemangioma and multilevel endplate fatty signal changes on a degenerative basis. The conus medullaris is normal in position.Degenerative changes are seen throughout the lumbar spine including multilevel vacuum disc phenomena, better appreciated on recent CT, and disc space narrowing, worst at the L5-S1 levels. Individual levels as below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: Mild disc bulge and prominence of the epidural fat resulting in mild spinal canal narrowing. There is mild right and minimal left neural foraminal stenosis.L4-L5: Grade 1 anterolisthesis. There is edema involving the posterior aspect of the disc, most likely on a degenerative basis. Vacuum phenomena better seen on recent CT. There is bilateral facet arthropathy, worse on the left. There is also mild disc bulge eccentric to the right. There is resulting mild to moderate stenosis involving the proximal aspect of the right neural foramen. There is minimal left neural foraminal narrowing. No significant central canal narrowing.L5-S1: Minimal retrolisthesis. Severe loss of disc height. There is facet arthropathy, worse on the left than the right. No significant spinal canal narrowing. There is mild bilateral neural foraminal narrowing, relatively worse on the left. There is a prominent left lateral vertebral osteophyte.Evidence of left nephrectomy. Paraspinous soft tissues are within normal limits.

Output: Multilevel degenerative changes in the lumbar spine including mild spinal canal stenosis at the L3-L4 level. There is also also mild to moderate right neural foraminal narrowing at the L4-L5 level where there is possible impingement of the right L4 nerve root. Additional levels as above.


Instruction: Generate impression based on findings.

Input: Reason: Right knee pain and swelling, history of ACL reconstruction 2008, microfracture and meniscectomy, evaluate for meniscus tear, healing of microfracture, new chondral injury History: Right knee pain MENISCI: There is deformity and abnormal signal intensity of the posterior horn and body of the medial meniscus that appears similar to that seen on the prior studies when accounting for technical differences which likely represents a combination of postoperative changes, degeneration, and chronic tearing. The anterior horn appears relatively preserved. There is increased signal intensity within the lateral meniscus indicating intrasubstance degeneration as well as a possible tiny horizontal tear along the undersurface of the posterior horn near its free edge.ARTICULAR CARTILAGE AND BONE: There is delamination of the articular cartilage of the lateral facet of the patella immediately lateral to the median eminence. There is additional thinning and degeneration of the articular cartilage of the patella; the articular cartilage along the medial facet is perhaps slightly thicker than on the prior examination, which may reflect the sequela of prior microfracture, but this is equivocal. There is progression of cartilage degeneration of the medial compartment with a large area along the posterior aspect of the weightbearing surfaces devoid of articular cartilage. There is mild edema within the underlying subchondral bone. There has also been progression of full-thickness degeneration of the articular cartilage of the lateral compartment, particularly adjacent to the posterior horn of the meniscus. There has been progression of tricompartmental osteophytes.LIGAMENTS: The intra-articular portion of the ACL graft seen on the prior study is no longer evident likely representing a tear. The PCL appears thickened likely representing mucoid degeneration. The MCL and LCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Progression of osteoarthritis as described above.2. Nonvisualization of the intra-articular portion of the ACL graft presumably representing rupture.3. Deformity and signal abnormality of the medial meniscus likely represents a combination of prior surgery, degeneration, and chronic tearing.4. Degeneration and perhaps a small horizontal tear of the lateral meniscus.5. Joint effusion, Baker's cyst, and other findings as described above.


Instruction: Generate impression based on findings.

Input: Clinical question: Postop evaluation. Signs and symptoms: Status post craniotomy, tumor resection. Pre- and post enhanced brain MRI:Examination is a status post left posterior parietal craniotomy for removal of tumor. Expected postoperative changes and including small amount of epidural serosanguineous/air collection under the craniotomy flap measuring maximum of 6 mm in thickness with subtle mass effect is noted. A mixed signal intensity surgical cavity containing a small amount of air at the surgical site measures approximately 21 x 18 mm in transaxial dimensions. The expected blood product within the surgical cavity precludes precise assessment for presence of abnormal enhancement on this initial postoperative exam. Further follow-up is needed to assess for residual or recurrence of tumor.Residual vasogenic edema in the surgical site and its associated mass effect on the trigone of left lateral ventricle demonstrate no significant change since prior study. Ventricular system remains within normal and with maintained midline.

Output: 1.Expected postoperative changes of a left superior parietal craniotomy for removal of tumor as detailed.2.Surgical cavity measuring at 21 x 18 mm and with expected internal T1 hyperintensity/blood products preclude assessment for enhancement on this initial study. No convincing evidence of residual tumor/enhancement, however follow-up is needed.3.Residual vasogenic edema and associated mass effect demonstrate no significant change since prior exam.


Instruction: Generate impression based on findings.

Input: 49-year-old woman with history of left mastectomy in 2010 for IDC, status post hormonal therapy. Additional history of benign right breast biopsy for PASH in 2010 and benign left chest wall lymph node in 2011. Family history of breast cancer in her mother. The patient is status post left mastectomy, with bilateral retropectoral silicone implants. There is heterogeneous amount of fibroglandular tissue in the right breast. Moderate parenchymal enhancement is noted in the right breast. The silicone implants are not significantly changed in contour and position.No abnormal enhancement is seen in either breast. Right simple breast cysts are noted. The previously-seen enhancing masses at the 7:00 and 3:00 positions of the left breast are slightly decreased in size. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Left parapharyngeal mass, include skull base images to clavicle History: left parapharyngeal mass, include skull base images to clavicle. There is a T2 hyperintense nodule in the left parapharyngeal space at the left of the nasopharynx, which measures up to 12 mm. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is a dominant left thyroid nodule that measures up to 48 mm. The major salivary glands are unremarkable. There is a retropharyngeal left internal carotid artery. There is prominent torus palatinus. The airways are patent. The imaged intracranial structures are unremarkable.

Output: 1. A nodule in the left parapharyngeal space, which measures up to 12 mm, may represent a neoplasm.2. A dominant left thyroid nodule that measures up to 48 mm corresponds to the known colloid nodule with cystic degeneration. 3. Retropharyngeal left internal carotid artery.


Instruction: Generate impression based on findings.

Input: Diagnosis: Headache Hydrocephalus, unspecified Presence of cerebrospinal fluid drainage deviceClinical question: new weakness, h/o spina bifida s/p VP shuntsSigns and Symptoms: new weakness The patient is status post ventriculostomy tubes one coursing through the right temporal lobe into the trigone of the right lateral ventricle other one coursing through the left occipital lobe into the body of the left lateral ventricle with tip anteriorly adjacent to the frontal horn. There is a linear signal change present within the right frontal lobe which is a compatible with prior ventriculostomy tract is unchanged since the prior exam. There is a port adjacent to the left occipital catheter associated with tubing.There are periventricular T2 and FLAIR signal hyperintensities present as well as signal hyperintensities in the corpus callosum on T2 and FLAIR MRI which are stable compared to the previous exam.On susceptibility imaging imaging there is a punctate signal hyperintensity in the left centrum semiovale. Translation and is of little clinical significance. Some foci of signal hypointensity are also present along the right frontal lobe ventriculostomy tube tract.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrates mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact.

Output: 1.The MRI of the brain is stable compared to the 10/23/2014 MRI brain exam. There is redemonstration of status post ventriculostomy tube placement as well as signal changes brain parenchyma which are most likely related to ventriculostomy tube tracts.


Instruction: Generate impression based on findings.

Input: Post resection of GBM with Ziopharm trial. Evaluate changes in tumor. Postoperative changes are redemonstrated within the left temporal lobe, with hemosiderin deposition in the resection bed. There is abnormal enhancing tissue along the operative margin, which is decreased in size compared to prior, measuring 2.9 x 1.4 cm, previously 4.1 x 1.8 cm. There is also decreased ependymal enhancement along the atrium of the left lateral ventricle. The ventricles are unchanged in size. T2 hyperintensity involving the left temporal, parietal and occipital lobes is decreased from prior. No new enhancing lesions are identified. There are scattered foci of FLAIR T2 hyperintensity within the subcortical and periventricular white matter, which are nonspecific and not significantly changed. Evidence of endoscopic paranasal surgery is redemonstrated, with persistent ethmoid and frontal mucosal thickening.

Output: Decreased size of enhancing tissue along the left temporal operative margin, and decreased associated T2 FLAIR hyperintensity. Ependymal enhancement involving the atrium of the left lateral ventricle is also decreased. No new lesion is identified.


Instruction: Generate impression based on findings.

Input: Herniated lumbar disc, is disc still there? Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Previously seen left paracentral disc protrusion has essentially resolved. There is moderate facet arthropathy at this level with an approximately 9 x 11 mm T2 hyperintense structure adjacent to the left facet joint which is favored to represent a synovial cyst. There appears to be associated mass effect on the left descending L5 nerve root in the lateral recess. There is mild left neural foraminal narrowing. No significant central canal or right neural foraminal narrowing. L5-S1: Central disc protrusion is again seen. No significant spinal canal stenosis. There is minimal narrowing of the neural foramina bilaterally.Paraspinous soft tissues are within normal limits.

Output: 1. Compared to 7/7/2015, there has been significant interval decrease in size of the previously seen left paracentral disc protrusion at the L4-L5 level.2. Approximately 1 cm T2 hyperintense structure at the L4-L5 level is favored to represent a synovial cyst (less likely disc material) and is associated with mass effect on the descending left L5 nerve root in the lateral recess.3. No significant central canal stenosis at any level. Minimal neural foraminal narrowing as described above.


Instruction: Generate impression based on findings.

Input: Male; 48 years old. Reason: Active surveillance History: prostate cancer PELVIS:PROSTATE:Prostate Size: 3.9 x 5.4 x 5.8 cm.Peripheral Zone: Small low T2 signal focus with restricted diffusion and increased enhancement measuring up to 6 x 4 mm (series 604/244) in the left mid gland, compatible with prostate cancer. Small focus of T1 hyperintense hemorrhage is seen in the left base.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of invasion.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Small right and moderate left fat-containing inguinal hernias, partially visualized.OTHER: No significant abnormality noted.

Output: Small focus of prostate cancer in the left mid gland peripheral zone without extracapsular extension.


Instruction: Generate impression based on findings.

Input: Encephalopathy: confusion, encephalopathy. Many of the sequences are degraded by patient motion. There is an area of encephalomalacia in the right thalamocapsular junction region with extension into the corona radiata and left frontal lobe white matter, as well as punctate foci of encephalomalacia in the bilateral frontal lobe subcortical white matter and left thalamus, superimposed upon a background of patchy cerebral white matter T2 hyperintensity. However, there is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Scattered chronic infarcts and probable chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Re-evaluate suspected ischemic changes in occipital area: migraine. The subcentimeter non-enhancing T2 hyperintense cortical and subcortical lesion in the right superior parietal lobule appears slightly smaller. There is no evidence of intracranial hemorrhage, mass-effect, or acute infarct. The occipital lobes appear to be intact. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: The tiny cortical and subcortical lesion in the right superior parietal lobule has slightly decreased in size and may once again represent a prior ischemic event, but is otherwise nonspecific. The occipital lobes appear to be intact.


Instruction: Generate impression based on findings.

Input: Mild aphasia and cognitive decline, assess for atrophy/cerebrovascular disease. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal scattered bilateral cerebral white matter T2 hyperintensity, which are unchanged and nonspecific. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is opacification in the right maxillary sinus, which appears to be atelectatic. The orbits, skull, and scalp soft tissues are unchanged. There is multilevel degenerative cervical spondylosis, with mild anterolisthesis of C3 on C4.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Unchanged mild probable chronic small vessel ischemic cerebral white matter disease.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 38 years old Reason: check for progession in size of nodules History: none RIGHT LOBE MEASUREMENTS: 7.3 x 1.8 x 2.4 cmLEFT LOBE MEASUREMENTS: 7 x 1.8 x 2 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again noted heterogeneous echotexture and increased parenchymal vascularity. Largest nodule with some spongiform appearance measures 2.3 x 1.7 cm, slightly increased compared to previous study. Other smaller nodules are stable.LEFT LOBE: Again noted heterogeneous echotexture and increased parenchymal vascularity. Largest solid nodule measures 1.9 x 0.9 x 1.6 cm, slightly increased in size compared to previous study. Other nodules are also stable to minimally increased in size compared to previous study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral thyroid nodules which are minimally increased in size compared to previous study. Heterogeneous echotexture of the thyroid.