Instruction: Generate impression based on findings.

Input: There is mild prominence of the subarachnoid spaces anteriorly and along the anterior falx most consistent with benign enlargement of the subarachnoid spaces. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. Bilateral incomplete partitioning at the cochlear apex with coalescence of the apical and middle turns is better demonstrated on the separately acquired temporal bone CT. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. There are no vascular anomalies.

Output: 1.MRI findings most consistent with benign enlargement of the subarachnoid spaces, which typically resolves by 2 years of age.2.Bilateral incomplete partitioning at the cochlear apex with coalescence of the apical and middle turns is better demonstrated on the separately acquired temporal bone CT. 3.The seventh and eighth nerves are normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally.


Instruction: Generate impression based on findings.

Input: 67-year-old female with 1.6 cm pancreatic mass. Outside CT report filed to epic media tab. Last MRCP done U of C. ABDOMEN:LIVER, BILIARY TRACT: No parenchymal lesions. No intra or extrahepatic biliary ductal dilatation. Mild tortuosity of the common bile duct is again noted. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Stable cystic lesion of the pancreatic tail measuring 7 mm (coronal series 9 image 47) with a bilobed appearance (coronal series 9 images 47, coronal series 401 image 17). Stable cystic lesion of the mid pancreatic tail measuring 3 mm (coronal series 9 image 73, axial series 6 image 27). No abnormal parenchymal enhancement. No main pancreatic ductal dilatation. No solid parenchymal mass is identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. Stable appearing left lower pole parapelvic cyst measuring 3.6 x 3 cm (series 6 image 17).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable cystic focus arising from the upper sacrum (coronal series 4 image 10).OTHER: No significant abnormality noted.

Output: 1.Stable subcentimeter cystic lesions of the pancreatic tail, and sidebranch IPMNs are favored. No solid parenchymal mass is identified.2.Stable cystic lesion of the proximal sacrum, favor Tarlov cyst.


Instruction: Generate impression based on findings.

Input: History of persistent pelvic pain after vulvar surgery. PELVIS:UTERUS, ADNEXA: There are multiple ovarian follicles bilaterally which are peripherally distributed, unchanged from the prior. The right ovary measures 3.8 x 2.1 cm, the upper limits of normal. The left ovary measures 2.4 x 1.8 cm. These findings are likely physiologic for this patient but may be seen in the setting of polycystic ovarian syndrome or ovarian hyperstimulation syndrome.IUD is noted. The endometrial thickness is normal as is the junctional zone.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace pelvic free fluid is within physiologic limits.BONES, SOFT TISSUES: There are small Bartholin cysts bilaterally with the larger left-sided one measuring up to 6 mm.OTHER: No significant abnormality noted.

Output: No specific findings to account for the patient's persistent pelvic pain. See additional findings above.


Instruction: Generate impression based on findings.

Input: Patient with recent whiplash injury and strain of neck, numbness radiating down the left arm. Rule out fracture. I see no fracture. There is mild degenerative disc disease at C4/5, C5/6, and C6/7, with small posterior vertebral body osteophytes at these levels. There is perhaps a minimal retrolisthesis of C5 relative to C6, but otherwise alignment is within normal limits. Evaluation the neural foramina is limited due to under-rotation of the patient, but I suspect that there is mild narrowing of the neural foramina of the lower cervical spine. This would better evaluated with MRI, if clinically warranted.

Output: Degenerative disc disease and other findings as described above. I see no fracture.


Instruction: Generate impression based on findings.

Input: Diagnosis: Ataxia, unspecifiedClinical question: h/o cerebellar ataxiaSigns and Symptoms: preop planning for DBS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the T2 images. A high signal focus on T2 imaging is present in the ponsNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and left 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 right vertebral artery is very small and may be partially occluded.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: 1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.This is a limited exam for the purpose of DBS planning.3.Findings raise the question of stenosis at the right vertebral artery.4.A high signal focus on T2 imaging is present in the pons. This is nonspecific.


Instruction: Generate impression based on findings.

Input: Male, 55 years old, with worsening lower back pain, history of prostate cancer, assess for cord compression. No acute cord compression is seen. Vertebral body marrow is diffusely and heterogeneously replaced compatible with widespread metastatic disease. However, no evidence of vertebral body compression fracture or significant epidural tumor spread is seen. Alignment is anatomic. A disc osteophyte complex at the C3-4 level results in spinal canal stenosis with deformation of the spinal cord and associated cord T2 signal abnormality.

Output: 1.Widespread osseous metastatic disease without evidence of vertebral body compression or acute cord compression.2.A disc osteophyte complex at C3-4 results in spinal canal stenosis with cord impingement and evidence of cord signal abnormality which may reflect myelomalacia and/or edema.


Instruction: Generate impression based on findings.

Input: Right facial droop, recent TIA. Evaluate for stroke. Moderate prominence of the ventricles and the sulci likely due to age-related volume loss. There is periventricular and subcortical white matter FLAIR signal abnormality likely due to chronic small vessel ischemic disease, which has progressed mildly compared to prior exam. Chronic right cerebellar infarct is unchanged. The CSF space is asymmetrically enlarged about the cerebellum, right greater than left, similar to prior exam.There is no evidence of intracranial hemorrhage, mass or edema. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. Bilateral maxillary sinus mucous retention cysts.Normal flow-voids are demonstrated in the major intracranial vascular structures.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.

Output: Moderate small vessel ischemic disease, which has mildly progressed compared to the prior exam. No evidence of acute ischemic stroke.


Instruction: Generate impression based on findings.

Input: 23 year old female. Fibromatosis. Evaluate for progression. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infiltrative right retroperitoneal heterogeneous signal, predominantly T2 hypointense lesion anterior to the right psoas muscle measures 4.9 x 5.5 cm, previously 4.9 x 5.4 cm (series 18, image 7). The mass is again noted to abut the anterior aspect of the IVC and right lateral aspect of the SMV. Adjacent small and large bowel are tethered to this mass without obstruction. BOWEL, MESENTERY: Tethering of small and large bowel to the aforementioned retroperitoneal mass without obstruction. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small follicles in bilateral ovaries.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable size of right retroperitoneal mass consistent with stated history of fibromatosis. No new lesions.


Instruction: Generate impression based on findings.

Input: Male, 71 years old, with pain in the L5-S1 intervertebral distribution on the right. History of advanced non-small cell lung cancer with bone metastases. Since the prior examination, significant progression is seen in the size and number of numerous marrow replacing, enhancing lesions compatible with osseous metastatic disease. Small lesions are evident within every vertebral body level. In addition, there are large dominant lesions involving the L3 vertebral body, the S1 and S2 vertebral bodies, and the left iliac bone.Slight endplate concavity is evident at L3. However, no significant compression deformity is seen. Vertebral body heights are generally preserved.No evidence of significant epidural tumor extension is seen. The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No pathologic intrathecal enhancement is seen.L1-2: No significant spinal canal stenosis or neuroforaminal narrowing. L2-3: Mild disc bulging asymmetric to the left. The left lateral recess is mildly effaced. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. No interval changes. L3-4: Facet arthropathy. Bulging disc. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Bulging disc. Mild generalized spinal canal narrowing. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. No significant foraminal narrowing. No interval changes.

Output: 1.Progression of osseous metastatic disease is seen at all vertebral body levels including the sacrum and iliac bones.2.No compression deformities are seen. No significant epidural tumor involvement is detected.3.Multilevel degenerative findings show no significant change from the prior examination.


Instruction: Generate impression based on findings.

Input: 54-year-old with left breast cancer, IDC. Family history of 2 aunts with ovarian cancer There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.There is a heterogeneously enhancing irregular mass with clip artifact within it in the left breast 1:00 position. It measures 31 x 24 x 24 mm (AP x ML X CC). No abnormal enhancement is seen in right breast. A benign intramammary lymph node is identified in the right breast 8:00 position measuring 8 x 7 mm.No abnormal lymph nodes are identified in either axillary region.

Output: 3.1 cm unifocal malignancy in the left breast 1:00 position.No abnormality noted in the right breast or bilateral axillary regions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Syncope and collapse: evaluate right lower midbrain lesion, see CT reportSigns and Symptoms: syncope, dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the brainstem and thalami as well as the basal ganglia. In particular lesion in the right midbrain is a low signal on FLAIR and T1, high signal on T2 and not associated with diffusion restriction. This could represent a perivascular space or prior lacunar infarct.No foci of diffusion restriction are appreciated within the brain parenchyma.On susceptibility imaging there are 10-15 punctate foci of signal loss in the subcortical white matter located in the parietal lobes and temporal lobesNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus and mild mucosal thickening elsewhere. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is medial deviation of the right lamina papyracea. This could be related to a prior right orbital medial blowout fractureThere is a small subdural effusion present which is likely related to volume loss.

Output: 1.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 2.Punctate lesions in the brainstem, thalami and a subtle ganglia are also likely vascular related . In particular the lesion in the right lower midbrain most likely represents an old lacunar infarct.3.Subcortical microhemorrhages of a mild degree are present. Their distribution in the subcortical white matter would raise the question of amyloid angiopathy. They predominate in the temporal lobes and to a lesser degree parietal lobes.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered mucosal thickening can be found throughout the paranasal sinuses without superimposed air-fluid levels. Fluid is noted within a few bilateral mastoid air cells. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement.


Instruction: Generate impression based on findings.

Input: 43 years, Female, left-sided weakness. There are multiple areas of restricted diffusion predominantly in the right cerebral hemisphere including the right frontal, parietal, temporal, and occipital lobes. Diffusion predominantly involves the cortex but also includes the right frontoparietal corona radiata as well as caudate head and putamen on the right. Small foci of restricted diffusion are also noted in the left frontal lobe. There is corresponding FLAIR hyperintensity. Again seen is evidence of multiple chronic lacunar infarcts including the right centrum semiovale, right basal ganglia, and bilateral pons which were present on 11/15/2013. There is no intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Partially empty sella again incidentally noted. Diffuse low T1 marrow signal is noted which is nonspecific but can be seen in conditions such as chronic anemias.

Output: 1. Multiple acute infarcts throughout the right cerebral hemisphere with relatively greater involvement of the right frontal and right parietal cortex. Small acute infarcts involving the right basal ganglia as well as the contralateral left frontal lobe are also noted. 2. No intracranial mass effect. No evidence of hemorrhage on the available sequences (and on recent CT).3. Multiple chronic lacunar infarcts including the right basal ganglia, right centrum semiovale, and bilateral pons which were present on prior study from 11/15/2013.4. Please note patient did not tolerate the study well. Motion degradation is present on some sequences, and SWI as well as postcontrast sequences were not obtained.Dr. Ali discussed findings with Dr. Buerki at 1330 hrs on 7/22/2015.


Instruction: Generate impression based on findings.

Input: Optic nerve gliomas, now off therapy. Orbits: There is no significant interval change in the peripherally-enhancing right orbital segment optic nerve glioma with a central cystic component, which measures up to 7 mm in diameter. The other orbital contents are otherwise unremarkable. Brain: There is no significant interval change in the non-enhancing T2 hyperintense lesion centered within the left optic chiasm and hypothalamus that measures up to 10 mm. Additional nonenhancing T2 hyperintense foci that localize to the more posterior portions of the bilateral optic tracks are also unchanged. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The skull and scalp soft tissues are unremarkable. There is mild scattered paranasal sinus mucosal thickening.

Output: Unchanged bilateral optic pathway gliomas.


Instruction: Generate impression based on findings.

Input: Newly diagnosed tongue mass, eval extent of lesion. There is a heterogeneously enhancing mass in the right floor of mouth with possible involvement of the overlying right mylohyoid muscle and oral tongue. The tumor extends across the midline measures up to approximately 35 mm. In addition, there is surrounding ill-defined T2 hyperintensity and enhancement that extends towards the tongue base, which also appears diffusely enlarged. However, the overlying mandible appears to be intact. Although not particularly enlarged based on size criteria, right level 1B and 2B lymph nodes appear hyperenhancing. There is a heterogeneous right level 3 lymph node that measures 11 x 13 mm. There is also a prominent left level 1B lymph node that measures 12 x 15 mm in axial cross section. The thyroid and salivary glands appear to be intact. The larynx appears to be unremarkable. The orbits and intracranial structures are grossly unremarkable. There is multilevel degenerative spondylosis of the cervical spine, including a disc-osteophyte complex at C5-6 that mildly impinges upon the spinal cord.

Output: 1. A heterogeneously enhancing mass in the right floor of mouth and oral tongue with extension across the midline measures up to 35 mm likely represents a squamous cell carcinoma. Ill-defined enhancement that extends towards a prominent, likely hyperplastic lingual tonsil may represent peritumoral inflammation rather than tumor infiltration.2. Bilateral cervical lymphadenopathy likely, at least in part, represents metastatic disease.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient DLB and episodes of confusion. Signs and symptoms: Cognitive decline and parkinsonism there Nonenhanced brain MRI:Negative diffusion weighted images.Subtle periventricular and subcortical flair hyperintensity remains is stable since prior exam. Although the findings are nonspecific possibility of mild chronic small vessel ischemic strokes should be considered. Prominence of cortical sulci similar to prior exam. Mildly prominent ventricular system similar to prior exam. The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.

Output: 1.No evidence of an acute or new finding since prior exam.2.Mild periventricular and subcortical flair hyperintensities without change since prior exam.3.Mild prominence of cortical sulci and supratentorial ventricular system is stable since prior study.4.Unremarkable calvarium, orbits and paranasal sinuses/mastoid air cells


Instruction: Generate impression based on findings.

Input: Nonhealing ulcer There is mild diffuse edema of the subcutaneous tissues surrounding the ankle particularly overlying the anteromedial aspect of the distal tibia. Within this area is an irregular, rim-enhancing fluid collection which measures approximately 4 cm in total transverse dimension beginning just anterior to the flexor digitorum tendon and extending posteromedially. There is ulceration of the overlying skin in this area however there is no abnormal marrow signal intensity to suggest osteomyelitis. There is perhaps a trace amount of fluid surrounding the flexor digitorum tendon which is otherwise normal.Although not tailored for the examination of the ligamentous and tendinous structures of the ankle, these appear grossly intact.

Output: Ill-defined rim-enhancing fluid collection within the anteromedial soft tissues overlying the distal tibia concerning for small subcutaneous abscess. There is no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Female, 35 years old, with history of seizures and headache in the setting of eclampsia and PRES. The previously seen scattered areas of parenchymal signal abnormality in the bilateral frontal, parietal and occipital lobes have resolved. No residual edema or mass effect is seen. No restricted diffusion is demonstrated. Parenchymal volume is preserved with no areas of encephalomalacia.Susceptibility effect is redemonstrated within the right intraparietal sulcus, and in the right occipital lobe, similar to the prior examination. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles are normal in size and morphology. Incidental note is made of a partially sella which has increased in prominence relative to the prior exam.

Output: 1.Resolution of prior findings compatible with PRES. No residual parenchymal signal abnormality is seen. No areas of parenchymal tissue loss are demonstrated.2.Susceptibility effect within the right intraparietal sulcus and in the right occipital lobe are redemonstrated similar to the prior examination. This could reflect chronic hemosiderin deposition related to the patient's prior episode of PRES.3.A partially empty sella is noted, more conspicuous than on the prior examination. This finding can reflect normal variation, though it is also seen in conditions of elevated intracranial pressure such as idiopathic intracranial hypertension.


Instruction: Generate impression based on findings.

Input: History of right renal mass, evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Punctate T2 hyperintensities within the liver too small to characterize but likely represent small cysts. Mild signal dropout on out of phase images suggestive of fatty infiltration.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is redemonstration of a partially exophytic lesion arising from the lower pole of the right kidney (series 18, image 17) which measures 1.1 x 1.1 cm, unchanged. The lesion is solid, isointense on T1, hypointense on T2, and demonstrates enhancement less than cortex. Left renal lower pole simple cysts are unchanged. No new suspicious renal lesions are identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Right kidney 1.1 cm lesion compatible with renal cell carcinoma, unchanged. Given imaging characteristics, favor papillary subtype.


Instruction: Generate impression based on findings.

Input: Stroke. History of endocarditis. BRAIN MRI:The study is mildly to moderately limited by motion.In addition to the large right parieto-occipital and the smaller right thalamic/mesial temporal as well as the left posterior temporal infarcts, there are multiple smaller infarcts involving both cerebral and cerebellar hemispheres. The infarcts are associated with susceptibility effect, which probably reflects the presence of hemorrhage. The infarcts show peripheral contrast enhancement and surrounding edema and mass-effect. The larger infarcts show a gyriform pattern of contrast enhancement while the smaller infarcts show ring-like contrast enhancement with prominent central diffusion restriction, especially within the frontal lobes. These findings are suggestive of evolution of the infarcts and perhaps cerebritis towards the formation of abscesses. The right parieto-occipital and right thalamic/medial temporal infarcts are associated with abnormal contrast enhancement along the lining of the adjacent posterior right lateral ventricle, which may reflect additional early ventriculitis. Besides compression of the posterior right lateral ventricle by the adjacent infarcts, the ventricular system is normal in size. There is only very minimal midline shift at the level of the third ventricle. There is no herniation. There is fluid in the sphenoid sinuses and mild mucosal thickening in the paranasal sinuses. Right retinal detachment with subretinal hemorrhagic effusion are not grossly changed since the previous CT scan. Minimal vitreous hemorrhage is likely present as well.CRANIAL MRA:The study is at least moderately limited by patient motion. There is attenuation of the distal right posterior cerebral artery and its branches without abrupt cut off, which may relate to the right parieto-occipital infarct. The left A1 segment is also is attenuated, which can be congenital. The major intracranial vessels are otherwise grossly patent. There is no definite large aneurysm but small aneurysms cannot be ruled out given the study limitation by motion.NECK MRA:Accounting for the study limitations, there is no significant, flow-limiting stenosis or gross dilatation of the cervical carotid and vertebral arteries.

Output: 1.Mild-to-moderate study limitation caused by motion.2.Evolution of the embolic multifocal cerebral and cerebellar infarcts with evidence of hemorrhage. The possibility that these represent septic embolic infarcts should be considered as the pattern of enhancement of many of the infarcts is somewhat unusual for bland infarction but can be seen in the setting of developing abscess and cerebritis.3.Attenuation of the right distal posterior cerebral artery and its branches, without abrupt cutoff, probably relate to the large right parieto-occipital infarct and the mass-effect. Cranial and neck MRAs are limited by motion artifact but show no significant stenosis, otherwise.4.Right retinal detachment with subretinal hemorrhagic effusion are not grossly changed since the previous CT scan. Minimal vitreous hemorrhage is likely present as well.


Instruction: Generate impression based on findings.

Input: Stage IIC ovarian cancer s/p debulking (May 2013) and adjuvant chemotherapy (ended Oct 2013) with a recurrence s/p secondary debulking including a splenectomy, brain mass excision and lymph node dissection (November 2015) followed by radiation (December 2015). Per EPIC complex mass/collection seen on pelvic ultrasound 02/2016, confirmed on MRI and subsequently not present ~02/16/2016 without intervening treatment. Negative on today's clinical examination. PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy. The previously described heterogeneously enhancing lesion adjacent to the right vaginal cuff is not evident on today's study. There is fluid with internal septations and complexity partially surrounding the mid rectum. This is not associated with restricted diffusion or abnormal postcontrast enhancement.BLADDER: No significant abnormality noted.LYMPH NODES: Stable hyperenhancing left external iliac lymph node measuring 9 mm in short axis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: The previously described mass adjacent to the right superolateral and posterior aspect of the vaginal cuff is no longer evident. There is partially loculated perirectal mildly complex fluid with septations but no discrete enhancing components, unchanged.


Instruction: Generate impression based on findings.

Input: Hb-SS disease without crisis [282.61] / Unspecified disorder of eye movements [378.9], Reason for Study: ^Reason: cause of eye deviation History: hyperreflexia, eye deviation (Hb SS patient) No evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion on the scan.2. Normal brain MRA.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: weakness. There is no significant interval change in the extent of the supratentorial and infratentorial white matter lesions. Many of the lesions demonstrate T1 hypointensity, but no abnormal 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, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: No significant change in the intracranial demyelinating lesions.


Instruction: Generate impression based on findings.

Input: History of PSC and IPMN. Evaluate for cholangiocarcinoma. ABDOMEN:LIVER, BILIARY TRACT: Demonstrated again are findings of the patient's known primary sclerosing cholangitis appearing similar to the prior study with multifocal areas of irregular mild dilatation and stricturing of the intra and extrahepatic bile ducts. Stable stricture of the proximal hepatic duct including Klatskin's point measuring 1.5 cm in length (series 10 image 7), unchanged. Mild stricture of the distal common bile duct is also unchanged measuring 3.1 cm in length (series 10 image 6).No intraductal lesion is noted.Stable subcentimeter right liver cyst. No suspicious hepatic lesion or vascular abnormality.SPLEEN: No significant abnormality noted.PANCREAS: Stable punctate cystic lesions adjacent to the pancreatic duct which may represent side branch IPMNs. (Series 5 image 29). Findings suggestive of pancreas divisum.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable appearance of primary sclerosing cholangitis without an intraductal mass or suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: 75-year-old male with metastatic renal cell carcinoma.. There is redemonstration of a lesion centered in the right pedicle and lamina of the T6 vertebra, measuring up to 3.7 cm in greatest dimension. There is expansion of the lamina with effacement of the right posterior lateral epidural space and likely minimal adjacent epidural extension of the tumor at the T6 level. There is slight involvement of the posterior aspect of the T6 vertebral body, right sixth rib and right paraspinal soft tissues. The overall spinal canal is mildly narrowed without significant mass effect on the spinal cord. Mild right neural foraminal narrowing is also present at T6-T7. There are no additional enhancing lesions identified in the thoracic spine. Bone marrow signal abnormality from the endplates at T10-T11 are felt to reflect degenerative changes. The vertebral column alignment is within normal limits. The vertebral body and disc heights are preserved. The spinal cord displays normal signal and morphology. There are multiple enlarged hilar lymph nodes bilaterally and a few scattered pulmonary nodules nodules, which are better evaluated on prior CT of the chest. The left kidney is not visualized.

Output: 1. Expansile lesion in the right posterior elements of T6 with associated effacement of the right posterior lateral epidural space with violation of the cortex and likely minimal adjacent epidural extension. No significant mass effect on the spinal cord. No additional enhancing osseous lesion identified in the thoracic spine.2. Numerous enlarged intrathoracic lymph nodes and lung lesions, better evaluated on prior CT of the chest.


Instruction: Generate impression based on findings.

Input: Other musculoskeletal symptoms referable to limbs(729.89) [729.89], Reason for Study: ^Reason: ischemia History: aphasia and RLE weakness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is significant metallic artifact on the right ACA and distal right ICA surgical clipping area.There is a burr hole on the left frontal lobe with underlying inferior aspect of precentral gyrus as well as part of the postcentral gyrus encephalomalacia. No change of above findings since prior scan.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. The mastoid air cells are clear. Mucosal thickenings on bilateral ethmoid sinus and bilateral maxillary sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal left ICAs, and left MCAs. Distal right ICA, right MCA and Acom area cannot be evaluated due to artifacts. Vertebrobasilar system appears to be normal.C-SpineThe cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows:C23: within normal limitsC34: Diffuse minimal bulging of disc, otherwise unremarkable.C45: Diffuse bulging of disc which abuts thecal sac, otherwise unremarkable.C56: Diffuse minimal bulging of disc, otherwise unremarkable.C67: within normal limitsC7T1: within normal limits

Output: 1. Post surgical clipping status, no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Limited brain MRA due to metallic artifacts, no evidence of intracranial arterial lesion.3. Multifocal degenerative changes of cervical discs, otherwise no remarkable C-spine MRI


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. Abnormal cord signal intensity involves the dorsal aspect of the cervical cord at the C4/C5 level. Additionally, there is mild T2 hyperintensity extending inferiorly within the cervical cord to the approximate level of C6-C7. The cervicomedullary junction is normal. The visualized paraspinal contents are unremarkable.There are multilevel degenerative changes, individual levels as below:C2/3: No significant spinal canal stenosis or neuroforaminal narrowing. C3/4: There is minimal disc bulge and mild right sided uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is mild to moderate right and mild left neuroforaminal narrowing.C4/5: There is a posterior disc osteophyte complex with bilateral uncovertebral hypertrophy with moderate bilateral neuroforaminal narrowing and moderate spinal canal stenosis. Cervical cord signal abnormality is maximal at this level as described above.C5/6: There is a small posterior disc osteophyte complex and bilateral uncovertebral hypertrophy with mild to moderate left and mild right neuroforaminal narrowing. There is mild spinal canal stenosis.C6/7: There is minimal posterior disc bulge with mild spinal canal stenosis. The neuroforamina are patent.C7/T1: No significant spinal canal or neural foraminal narrowing.

Output: 1. Abnormal T2 hyperintense signal involving the dorsal cervical cord from C4/C5 to C6/C7, greatest at C4/5. Differentials include subacute combined degeneration, given the dorsal column distribution of the signal abnormality. Inflammatory myelopathy is also high in the differential. Given the relatively higher grade of spinal canal stenosis at this level, compressive myelopathy also remains a consideration. Postcontrast imaging and brain imaging may be considered if an inflammatory process seems likely based on clinical findings and symptoms are of recent onset. 2. Multilevel degenerative changes with spinal canal and neural foraminal narrowing as detailed above.


Instruction: Generate impression based on findings.

Input: Left hip abscess with open wound, evaluate extension of infection Evaluation of the femur is limited secondary to inability to optimally position the patient.Again seen is a large posterior decubitus ulceration of the left buttock/upper thigh appearing similar to the prior exam. The ulceration contains mottled signal abnormality presumably representing packing material. There is extension of a fluid-filled tract from the ulceration to the greater trochanter which contains abnormal signal intensity and enhancement indicating osteomyelitis. This collection also tracks inferiorly into the mid-distal thigh along the semitendinosus, and measures approximately 25 cm in length. A second smaller tract extending inferiorly is seen more laterally along the long head of the biceps. There is mild edema within the adjacent affected musculature.There is generalized atrophy of the hamstring musculature likely reflecting chronic tearing of the hamstring origin. There is edema of additional musculature of the hip and upper thigh with enlargement of the sciatic nerve reflecting inflammation. There is also mild edema affecting the quadriceps musculature, particularly the vastus lateralis.Again seen is a moderate sized left hip effusion with additional inflammatory and arthritic changes previously noted on the pelvis MRI. Multiple enlarged inguinal lymph nodes are present which are likely reactive in nature. Deformity of the left ischium likely reflects longstanding osteomyelitis.

Output: Large decubitus ulceration of the left gluteus and upper thigh with fluid tracking to the greater trochanter and inferior into the mid to distal thigh along the semitendinosus muscle. Abnormal signal intensity within the greater trochanter reflects osteomyelitis.


Instruction: Generate impression based on findings.

Input: Crohn's disease, concern for small bowel involvement, abdominal pain, diarrhea, nausea and vomiting and fevers LIVER, BILIARY TRACT: Mild intrahepatic and extrahepatic biliary duct dilatation. Diffuse hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Intrinsic T1 pancreatic parenchymal signal decreased. Pancreatic ductal dilatation increased from prior MR imaging, now measures 8 mm, previously measured 3 mm. Peripancreatic fluid collections visualized, largest seen in gastrohepatic location measuring approximate 5.5 x 3.4 cm, mildly complex, internal septations seen, restricted diffusion suggested suspicious for superimposed infection. Thrombosed splenic vein, left-sided varix formation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.BOWEL, MESENTERY: Focally dilated left-sided small bowel loop in left lower quadrant measuring up to 4.5 cm on image 15 series 1701 suspicious for skip area with a site of adjacent focal narrowing or skip lesion seen on 25 series 1201. Additional alternating mild small bowel prominence and narrowing seen, however to lesser degree. 4.3 cm segment of collapsed distal transverse colon appears to be persistently underdistended throughout exam and when compared to prior MRI and September 2015 CT imaging, this region was also underdistended, suspicious for narrowing secondary to chronic inflammation. Areas of submucosal fat deposition involving colon also seen.UTERUS, ADNEXA: Intrauterine susceptibility artifact presumably related to IUD.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Sternotomy sequela.OTHER: No significant abnormality noted.

Output: 1. Focally dilated left-sided small bowel loop in left lower quadrant measuring up to 4.5 cm with site of adjacent focal narrowing. Segmentally collapsed distal transverse colon appears to be persistently underdistended throughout exam and when compared to prior MRI and September 2015 CT imaging, this region was also underdistended, suspicious for narrowing secondary to chronic inflammation. Additional alternating mild small bowel prominence and narrowing seen, however to lesser degree.2. Seen on this nondedicated exam are findings consistent with chronic pancreatitis. Peripancreatic fluid collections described above suspicious for pseudocyst formation, superimposed infection a consideration. Increased from prior MRI pancreatic duct and extrahepatic biliary ductal dilatation. While majority Correlation with patient's clinical history and serum lipase and amylase levels also recommended. Please note that these findings would be better evaluated with dedicated contrast-enhanced CT or MRCP.3. Diffuse hepatic steatosis.


Instruction: Generate impression based on findings.

Input: Right inferior quadrantanopia. There is encephalomalacia in the left cuneus. There are also small areas of encephalomalacia in the right pons and right globus pallidus. There are otherwise mild scattered foci of high T2 signal in the bilateral cerebral hemisphere. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: Chronic left medial occipital lobe, right pons, and right basal ganglia infarcts and mild probable chronic small vessel white matter ischemic disease, but no evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: Seizure like activity. There is no evidence of heterotopia or mesial temporal sclerosis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is a mega cisterna magna. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is extensive diffuse paranasal sinus mucosal thickening. There is patchy fluid signal within the bilateral mastoid air cells.

Output: 1. No discernible seizure foci.2. FIndings suggestive of sinusitis and mastoiditis.


Instruction: Generate impression based on findings.

Input: Inability to walk, which is worsened since July. Motion artifact does degrade image quality on multiple sequences.There is mild reversal of the normal cervical spine lordosis without evidence of acute subluxation. Multilevel degenerative changes are present throughout the cervical spine, worst at C3-C4 with mild impression on the ventral aspect of the cervical spinal cord. There is no definite abnormal signal in the cervical spinal cord. Significant spinal canal narrowing with cord compression and mild cord signal abnormality at T10-T11 appears similar to the exam from 7/1/2016. There are again findings compatible with discitis/osteomyelitis with loss of anterior vertebral body height more so at T11 than T10. There is been interval improvement of the paraspinal abscess. The abnormal vertebral body signal at T10 is resolved. Abnormal signal remains at the T10-T11 disc and anterior superior aspect of the T11 vertebral body. There is again resultant Minimal grade 1 anterolisthesis of L4 on L5. No high-grade lumbar spinal canal stenosis.

Output: 1. The degree of spinal stenosis and cord compression at T10-11 related to discitis/osteomyelitis appears grossly similar to the examination from 7/1/2016 with similar cord signal abnormality. 2. Improved paraspinal abscess and vertebral body edema. Motion artifact does degrade image quality.3. Multilevel degenerative changes in the cervical spine with stenosis and mild mass effect on the cord, worst at C3-C4, is similar to the degree seen on localizer imaging from the thoracic spine MRI dated 7/1/2016. 4. No definite abnormal signal in the cervical spinal cord. This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.Preliminary findings were discussed with Dr. Krupa Andalkar (neurosurgery) at 0755 hours on 8/4/2016.


Instruction: Generate impression based on findings.

Input: 81-year-old female with nausea and vomiting. Evaluate for extra/intrahepatic ductal dilatation. ABDOMEN:LIVER, BILIARY TRACT: As seen on the prior exams, there is moderate degree of intra and extrahepatic biliary ductal dilatation. The common bile duct has a somewhat tortuous course, and there is concentric narrowing at the distalmost portion (coronal series 701 image 78). Common bile duct dilatation extends to the level of the ampulla where there is a round T2 hypointense focus (coronal series 201 image 17) with apparent corresponding postcontrast enhancement on image 130 series 1101. Please see key images.SPLEEN: No significant abnormality noted.PANCREAS: Parenchymal atrophy of the pancreas. Of note, no pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left-sided simple renal cysts. Incidental note is made of a circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Rectus diastases.OTHER: Cardiomegaly.

Output: Moderate degree intra and extrahepatic biliary ductal dilatation. Tortuous course of the common bile duct demonstrates concentric narrowing at the distalmost segment. A small T2 hypointense focus in bowel lumen at the level of the ampulla could represent a normal ampulla with a focal stricture of the distal common bile duct, however underlying neoplasm (particularly given apparent postcontrast enhancement) cannot be excluded. Correlation with the patient's clinical history recommended and further evaluation with ERCP/EUS should be be considered.


Instruction: Generate impression based on findings.

Input: Clinical question: Reason for left arm pain and finger numbness. Signs and symptoms: As above. Pre-and post-enhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 is unremarkable and stable since prior study.C3 -- C4 demonstrate minimal degenerative changes and unremarkable otherwise. No change since prior exam. C4 -- C5 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise or interval change.C5 -- C6 demonstrates mild to moderate disk disease and loss of disk height and mild facet degenerative changes with minimal interval progression. There is a shallow broad-based disk protrusion with subtle interval progression however without spinal stenosis or appreciable neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and loss of disk height moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is also hypertrophic changes of posterior longitudinal ligament at C5 through C7 levels with interval progression since prior exam. There is a broad-based disk protrusion with interval progression since prior exam. Findings resulting mild flattening deformity of the cord and central spinal stenosis. There is a small left lateral disk extrusion present at this level without significant change since prior exam. The finding results in mass effect on the thecal sac and the exiting left nerve roots on the left (axial T2 series 7 image 22 and sagittal T2 series 3 image 11). These no convincing area so any significant change of this finding since prior exam.There is mild reversal of cervical lordosis centered at C5 and C6 levels with subtle interval worsening since prior exam. This finding however could be positional. The signal intensity of the cervical cord remains within normal.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine the thoracic cord is unremarkable.

Output: 1.Mild progression of degenerative / hypertrophic changes at C5 -- C6 and C6 -- C7 levels.2.Mild interval increase size of broad-based disc protrusion at C6-- C7 level as detailed. Stable small left lateral disk extrusion at this level and associated mass effect on the thecal sac and exiting nerve roots on the left since prior exam. Central spinal stenosis is present at this level is identified.3.Normal signal intensity and caliber of the cervical and uppermost visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: 16-year-old male with left knee pain and instability MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Linear T1 hypointensity along the medial tibial plateau with associated vague T2 edema type signal. Subtle linear T1 hypointensity in the anterior medial femoral condyle with associated vague T2 edema type signal with mild notching of the femoral condyle.There is mild apparent grade 1-2 chondromalacia of the lateral femoral condyle articular cartilage along the central weightbearing surface.LIGAMENTS: There is mild edema type signal within the ACL and PCL although the fibers are grossly intact. The MCL is intact. The lateral collateral ligament complex is intact. EXTENSOR MECHANISM: The extensor mechanism is intact. ADDITIONAL

Output: 1.Linear T1 hypointensities and associated edema type signal in the medial tibial plateau and femoral condyle suggest impaction injury/fracture. Additional findings of a hyperextension mechanism injury as detailed above. 2.Mild edema type signal within the ACL and PCL although the fibers are intact.


Instruction: Generate impression based on findings.

Input: Reason: assess for meniscal vs cruciate injury, history of popping injury with minor trauma, no significant effusion, no focal tenderness, unable to fully extend. There are tricompartmental osteophytes and a small joint effusion.MENISCI: Hyperintense signal within the posterior horn of the lateral meniscus extends to the articular surface, representing a probable vertical tear of the posterior horn of the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There is thinning of the medial articular cartilage with a full-thickness defect posteriorly. There is generalized thinning of the articular cartilage laterally and marked loss of articular cartilage along the medial facet of the patella.LIGAMENTS: Sequela from prior ACL repair are noted without complication. The PCL, MCL, and LCL are intact. EXTENSOR MECHANISM: No additional significant abnormalities noted.ADDITIONAL

Output: 1. Probable vertical tear of the posterior horn of the lateral meniscus.2. Multiple rounded densities posteromedially may represent multiple intra-articular loose bodies. These could be confirmed with CT examination.3. Degenerative thinning and full-thickness defects of the articular cartilage.


Instruction: Generate impression based on findings.

Input: 47 year old female with pain. Evaluate for right third ulnar proximal nailbed glomus tumor. A marker was placed along the dorsal and ulnar aspect of the middle phalanx at the level of the DIP joint. Deep to the marker, is curvilinear enhancement along the lower margin of the DIP joint and head of the middle phalanx that measures approximately 5 mm in the AP dimension. This curvilinear focus of enhancement is of low to intermediate signal intensity on T1-weighted imaging and is of intermediate to slightly increased signal intensity on T2-weighted imaging. It lies deep to the ulnar collateral ligament. The ulnar collateral ligament itself appears slightly thickened and its attachment to the base of the distal phalanx is indistinct, which may represent a tear. There may also be slight scalloping of the underlying medial aspect of the head of the middle phalanx, but this is equivocal. The radial collateral ligament appears normal. The remaining bones appear normal. The PIP joint appears normal. The flexor and extensor tendon apparati appear normal.

Output: Although no discrete mass is seen, there is peculiar curvilinear enhancement along the medial aspect of the DIP joint and head of the middle phalanx of uncertain etiology or significance. It may represent a focal synovitis, but would be an unusual morphology for a glomus tumor. The overlying ulnar collateral ligament also appears slightly thickened and its attachment to the distal phalanx is indistinct on coronal images, suggesting the possibility of a tear.


Instruction: Generate impression based on findings.

Input: 11-year-old female with history of medulloblastoma. Status post craniotomy, radiotherapy and chemotherapy. Off treatment. Now has neck pain and altered mental status. Brain: This study is mildly limited by artifact related to dental hardware. Findings related to prior surgery and treatment within the posterior fossa are significantly changed. The tumor resection bed, and associated encephalomalacia of the cerebellar hemispheres, are stable in appearance. A small area of enhancement measuring 6 x 4 mm along the right margin of the fourth ventricle is unchanged. There is no new suspicious enhancement.Elsewhere in the brain, encephalomalacia affecting the right occipital lobe is unchanged and there are no new foci of pathologic enhancement. The numerous foci of susceptibility artifact within the brain parenchyma and along the ventricular margins are not significantly changed. Ventricles are minimally larger than they were on the previous examination. Spine: Spinal cord morphology and signal characteristics are within normal limits. There is no pathologic intrathecal contrast enhancement but the cervical spine is partially obscured by artifact on the postcontrast images.Fatty marrow replacement at some levels of the spine is compatible with prior radiation therapy. There is no suspicious marrow signal abnormality, otherwise.Spinal alignment is anatomic, coming for cervical and lumbar straightening which can be related to patient position. Vertebral body heights and morphology are within normal limits. There is no spinal canal or neuroforaminal stenosis.

Output: 1.The posttreatment findings in the posterior fossa remain unchanged without sign of local recurrence. Minimal contrast enhancement along the right lateral fourth ventricular wall is unchanged since May 2014.2.Other findings throughout the brain also remain unchanged without suspicion of recurrence.3.Spinal imaging is notable for radiation treatment findings in the marrow but no sign of metastasis is seen.


Instruction: Generate impression based on findings.

Input: Clinical question: History of multiple sclerosis, RLE weakness, evaluate for burden of disease and positive lesions. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:There are no prior extends for comparison. If such exams exist and are provided the radiology department an addendum to this report will be submitted after comparison.Negative diffusion weighted images.Examination demonstrates extensive periventricular and to a lesser degree subcortical foci of flair hyperintensity of bilateral cerebral hemispheres. Similar signal changes are also noted on flair sagittal series involving the corpus callosum. Findings are associated with moderate enlargement of lateral ventricles, slight prominence of cortical sulci and atrophic changes of corpus callosum. Post-enhanced images demonstrate no detectable abnormal enhancement the brain parenchyma or the meninges.Minimal similar signal changes are also detected at the level of quadrigeminal plate. Although the findings are nonspecific findings and are suggestive of chronic demyelinating disease and less likely chronic small vessel ischemic stroke. No detectable susceptibility signal changes of brain is detected.Signal void in the major intracranial arterial branches are identified.Calvarial and soft tissues of the scalp as well as paranasal sinuses and mastoid air cells remain unremarkable.Pre-and post-enhanced cervical MRI:There is diffuse T2 hyperintensity signal abnormality of the cervical cord extensively. There is however no detectable abnormal enhancement of the cord. There are small regional foci of decreased cord caliber suggestive of atrophy. Findings are highly suggestive of chronic advanced demyelinating disease. The alignment of vertebral column remains within normal. The signal intensity of vertebral column demonstrate changes secondary to degenerative disease and unremarkable otherwise. Degenerative changes results in mild to moderate central spinal stenosis at C4 -- C5 only. Mild neural foraminal compromise at multiple levels is also noted.Pre-and post-enhanced thoracic MRI:Thoracic cord demonstrate multiple foci of T2 hyperintensity with resultant decreased cord caliber/atrophy throughout its length. There is however no evidence of abnormal enhancement of the cord or the leptomeninges. These findings are also highly suggestive of chronic changes of demyelinating disease.Signal intensity and alignment the vertebral column is unremarkable. There is no evidence of spinal stenosis at any level and no convincing evidence of any significant neural foraminal compromise.

Output: 1.Brain MRI demonstrate extensive periventricular, subcortical and corpus callosum foci of flair hyperintensity without enhancement and suggestive of chronic demyelinating disease or less likely chronic small vessel ischemic strokes. The findings are associated with underlying parenchymal volume loss as detailed. No prior exams for comparison.2.Pre-and post contrast MRI of the cervical spine demonstrate extensive foci of T2 hyperintensity of the cervical cord without enhancement however with cord volume loss are suggestive of extensive chronic demyelinating disease. Mild degenerative changes of cervical spine results in mild central spinal stenosis at C4 -- C5 level.3.Pre-and post-enhanced MRI of thoracic spine demonstrate extensive patchy foci of cord T2 hyperintensity with underlying cord atrophy and without thickness of enhancement. Findings are highly suggestive of advanced chronic changes of demyelinating disease. No significant degenerative changes of thoracic spine, no central spinal stenosis or neural foraminal compromise.


Instruction: Generate impression based on findings.

Input: Seven month old female with a full and bulging anterior fontanelle There is no evidence of intracranial hemorrhage, mass or edema. There are prominent ventricles and subarachnoid spaces, unchanged since recent MRI dated 9/26/2008.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Prominent ventricles and subarachnoid spaces


Instruction: Generate impression based on findings.

Input: Syncope. There is no evidence of acute intracranial hemorrhage or acute infarct. There is a subcentimeter left pons focus of susceptibility effect that corresponds to calcification on CT. There is focal right pons and periventricular frontoparietal white matter T2 hyperintensity. The ventricles and sulci are dilated due to cerebral volume loss. There is a partially empty sella. There is no midline shift or herniation. There is a diminished flow void in the V4 segment of the left vertebral artery related to the proximal stenosis described on the recent CTA. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the ethmoid sinuses and left mastoid air cells. The retrodental pannus moderately narrows the upper cervical spinal canal. There is also a posterior disc-osteophyte complex at C3-4 that abuts the spinal cord.

Output: 1.No evidence of acute intracranial hemorrhage or acute infarct.2.A subcentimeter left pontine lesion may represent a chronic calcified hemorrhage or cavernous malformation.3.Moderate cerebral and pontine white matter chronic microvascular ischemia and moderate brain volume loss, with slight frontotemporal predominance.


Instruction: Generate impression based on findings.

Input: 19-year-old female with a history of NMO, SLE, on prednisone, presents with right eye blurry vision, decreased visual acuity for 2 days. Evaluate for new mass, lesion, or NMO flare. Brain: There are numerous areas of T2 hyperintensity within bilateral cerebral hemisphere, which have overall increased in extent compared to the prior exam, particularly in the right frontal and left parietal lobes. Additional unchanged lesions are present in the corpus callosum, the right cerebral peduncle, and right anterior medulla. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Orbits: There may be areas of high T2 signal in portions of the bilateral optic nerves versus artifacts. There is no evidence of orbital tumors. The globes and extraocular muscles are unremarkable bilaterally.

Output: 1.Interval progression of the intracranial demyelinating lesions.2.Possible demyelinating lesions in the optic nerves versus artifacts. 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, 52 years old, with worsening lower extremity numbness. Since the prior examination, the patient has undergone laminectomy at L4, L5 and S1 with expansion of the thecal sac through this region. The vertebral bodies are otherwise intact. No evidence of suspicious marrow replacement or marrow edema is seen. Spinal alignment is anatomic.Visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No epidural abnormalities are seen.L1-2: Mild facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. No interval changes. L2-3: Moderate facet hypertrophy and ligamentum flavum thickening, progressed from prior. No significant spinal canal or neuroforaminal stenosis. L3-4: Advanced facet hypertrophy and ligamentum flavum thickening, particularly on the left, progressed from prior. Minimal disc bulging with a trace right foraminal annular fissure, not significantly changed. Moderate generalized spinal canal stenosis, to which prominence of the dorsal epidural fat contributes, progressed from prior. Moderate right and mild left foraminal narrowing, progressed. L4-5: Advanced facet hypertrophy, particularly on the left, progressed. Surgical thinning of the ligamentum flavum. Minimal bulging disc with a small right foraminal and far lateral protrusion, not significantly changed. The spinal canal is decompressed. Moderate right and mild left foraminal narrowing, slightly progressed. L5-S1: Moderate facet hypertrophy, similar to prior. Surgical thinning of the left ligamentum flavum. Progressive loss of disc height with disc bulge and endplate osteophytic spurring. The previously seen large left paracentral protrusion is significantly smaller. Previous significant spinal canal stenosis is relieved with surgical decompression. Mild effacement of the left lateral recess persists. There may be mild residual impingement of the left transiting S1 nerve root. Moderate to severe bilateral foraminal narrowing, not significantly changed.

Output: 1. Evidence of interval laminectomy and spinal canal decompression spanning from L4 through S1.2. Although the L5-S1 disc shows progressive loss of height, the previously seen large disc herniation at this level, and associated severe spinal canal stenosis, are much improved. The neural foramina remain moderately to severely narrowed at this level, similar to prior.3. Progression of facet arthropathy and ligamenta flava thickening is seen at other levels as detailed above. Most notably, the L3-4 level demonstrates a moderate generalized spinal canal narrowing which is progressed from prior.


Instruction: Generate impression based on findings.

Input: Male 14 years old Reason: R knee cartilage injury vs. ligament tear History: R knee swelling MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: No articular cartilage defect. No abnormal signal within the bone. No evidence of osseous contusion. Apparent bone island is present within the medial femoral condyle near the physis.LIGAMENTS: The ACL, PCL, MCL, and lateral collateral complex are intact. No abnormal signal within the posterior lateral corner. EXTENSOR MECHANISM: Extensor mechanism is intact. No abnormal joint effusion.ADDITIONAL

Output: Medial fluid collection separate from the joint likely represents a small Morel Lavelle injury.


Instruction: Generate impression based on findings.

Input: 65-year-old male with elevated INR and mental status change. Evaluate for hemorrhage. There is no evidence of intracranial hemorrhage, mass or edema. Diffuse hypodense region within the subcortical and periventricular white matter consistent with small vessel disease, age indeterminate. Well defined hypodense region within the left MCA territory and left cerebellum consistent with previous strokes. No acute cortical stroke is seen, however, if there is clinical concern for acute ischemia, an MRI may be considered. Dense atherosclerotic calcifications noted throughout the large vessels.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. No interval change. 2. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 9-year-old female. Assess for dorsal ganglion cyst involvement of the scapholunate ligament and bone quality of lunate. The dorsal aspect of the capitolunate interval demonstrates a focal well-defined lobulated area of increased signal on T2 hyperintensity with associated decreased signal on T1 imaging. Marrow signal of the capitate and lunate bones is within normal limits. No acute fracture or malalignment is identified.

Output: Focal well defined lesion in the dorsal aspect of the capitolunate interval with increased T2 signal intensity and decreased T1 signal intensity is most likely a ganglion cyst. The capitate and lunate bones are normal.


Instruction: Generate impression based on findings.

Input: Clinical question: Compression. Signs and symptoms: Weakness. Nonenhanced complete spine MRI:Examination is performed utilizing cord compression protocol and without any axial imaging.Examination demonstrate normal signal intensity, morphology and alignment of vertebral column. There is normal signal intensity and caliber of the cord and unremarkable cauda equina. There is no detectable spinal canal or neural foraminal compromise or stenosis at any level. There is no evidence of fracture. There is no evidence of perispinal soft tissue abnormalities.

Output: Negative nonenhanced complete spine MRI for cord compression as detailed.


Instruction: Generate impression based on findings.

Input: Clinical question: Patient with multiple myeloma, status post calibers stem cell transplant with relapsed disease. Signs and symptoms: Nausea and vomiting, central process suspected. Pre-and post-enhanced CT of brain:There is prominence of the supratentorial ventricular system when more apparent in the lateral ventricles and the third ventricle. There is also a paucity of cortical sulci. There is however no detectable cerebral edema and gray -- white matter differentiation is well-preserved. There are no old studies available for comparison. There is however partial visualization of the supratentorial ventricular system on prior CT of soft tissues of neck from 4 to 27 next 2010 which demonstrate similar sized ventricular system.There is no evidence of intracranial hemorrhage, edema or midline shift.Post infusion images demonstrate enhancement of thickened pituitary stalk that measures 6 mm in transaxial dimension. This finding was present on prior CT of soft tissues of neck from 4 -- 27 -- 2010.Examination also demonstrate thickening and enhancement along the left petroclinoid ligament which appears to be continuous with the enhancement of the cavernous sinus. There is no definitive associated bony changes however the dorsum sella on the left side and including the left posterior clinoid appear thinner than the right which may indicate erosive bony changes. The constellation of above findings could represent a metastatic disease or an infectious/granulomatous process. It is highly recommended that this finding to be followed with an enhanced MRI of pituitary and brain which would visualizes all the above regions of abnormal finding.Bony density of calvarial demonstrate multiple well demarcated small lytic lesions within the diploic space. Considering patient's history of multiple myeloma this finding may represent multiple myeloma. MRI examination with further clarified this finding.Above findings were discussed with the referring clinical service Garcia Ima pager number 5251 at the time of interpretation.80 cc of Omnipaque 350 was administered for this study.

Output: 1.Abnormal enhancement of the left cavernous sinus with extension posteriorly along the petroclinoid ligament and left CP angle. Thickened pituitary stalk with enhancement and with possible some thinning of dorsum sella as described above. Follow-up exam with an MRI is recommended. The constellation of above findings can be secondary to a metastatic disease, infectious or a granulomatous process.2.No definitive evidence of parenchymal abnormality of brain.3.Prominent lateral ventricles with only minimal dietitian of temporal horns. This finding may be a normal variation which was also partially visualized on prior CT of soft tissues of neck from 4 -- 27 -- 2010. This finding is not associated with any periventricular edema and I believe this is a normal anatomical variation for patient's age. Follow-up MRI would further assess this finding.4.Multiple well demarcated lytic lesions of calvarial with the largest measuring only 6 mm times 5-mm in the right frontal bone. Findings may also represent multiple myeloma.5.Above findings were discussed with referring clinical service Garcia Ima pager number 5251.


Instruction: Generate impression based on findings.

Input: Patient with episodes of nonresponsiveness, weakness for past two days, rule out TIA. There is no evidence of intracranial hemorrhage, mass or midline shift. Patchy areas of subcortical and periventricular white matter hypodensity likely represent small vessel ischemic disease, age indeterminate by CT. These changes appear minimally more prominent than on the prior study. If there is concern for an acute stroke, an MRI is recommended for further evaluation.The ventricles appear unchanged compared to the prior examination. Small choroid plexus cysts appear stable since 2002.The calvaria and skull base are radiographically normal. The left sphenoid sinus demonstrates evidence of chronic inflammatory changes but now appears mostly aerated. The remaining visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease, age indeterminate by CT. If there is concern for an acute stroke, an MRI is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: 74-year-old female with history of left DCIS status post mastectomy in 2014, and right intramammary cysts. Family history is positive for breast cancer in maternal aunt and cousin. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is , unchanged in pattern and distribution. Redemonstrated right upper central anterior architectural distortion, unchanged dating back to 2013. Redemonstrated partially obscured masses in the right breast, proven intramammary cysts on MRI of 2014. Redemonstrated diffusely scattered benign microcalcifications of the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Considering patient's history of mammographically and sonographically occult left breast cancer and high breast density, adjunctive annual screening with bilateral breast MRI would be useful. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: Procedure: MRI BRAIN WODiagnosis: Other speech disturbancesClinical question: eval for ICH MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.No evidence for acute ischemic cerebral infarction.2.No evidence for cervical carotid or vertebral occlusive disease.3.MRI of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: There is reversal of cervical lordosis with partial effacement of the ventral thecal sac at C-4. Cervical spine is otherwise normal in alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. THORACIC SPINE

Output: No evidence of spinal cord contusion. No significant disc herniation or spinal canal or neural foraminal stenosis is seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Seizure characterized by abnormal jaw movement and generalized shaking. CT report from OSH showed small calcific density in posteriolateral aspect of right occipital lobe no evidence or mass or hemorrhage. MRI report from prior w only empty sella. There is subcentimeter area of gyriform susceptibility effect along the right occipital lobe convexity. There is no otherwise evidence of acute intracranial hemorrhage, mass, or acute infarct. The hippocampi are unremarkable. There is a mild partially empty sella appearance. 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: A subcentimeter area of gyriform susceptibility effect along the right occipital lobe convexity is compatible with the reported nonspecific calcification demonstrated on an outside CT. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 10-month-old female status post tumor biopsy. Evaluate for hemorrhage. Status post right frontotemporal craniotomy with expected postoperative pneumocephalus and subcutaneous gas. Small amount of extra-axial fluid is seen in the operative field. No evidence of intra-or parenchymal or subarachnoid hemorrhage. The mixed cystic and solid attenuation suprasellar mass, which extends superiorly to the level of the foramen of Monro and posteriorly to the interpeduncular fossa, appears not significantly changed from recent MRI. There is mild compression of the anterior aspect of third ventricle, unchanged. The lateral and fourth ventricles appear unchanged from prior exam. No significant midline shift or evidence of herniation. The visualized paranasal sinuses and mastoid air cells are normal for age.

Output: 1.Expected postoperative pneumocephalus, subcutaneous gas, and small amount of extra-axial blood in surgical field. No evidence of intraparenchymal or subarachnoid hemorrhage.2.Known suprasellar mass appears not significantly changed.


Instruction: Generate impression based on findings.

Input: Ms. Aden is a 40 year old female with a family history of breast cancer. She has a Tyrer-Cuzick lifetime risk of 31%. She has no current breast related complaints. There is heterogeneous amount of fibroglandular tissue in both breasts. Moderate background parenchymal enhancement is noted bilaterally, limiting the sensitivity of this examination.There is no abnormal enhancement seen in either breast. No abnormal axillary lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for acute or subacute subdural hematoma. Signs and symptoms: Altered mental status with unclear history. Nonenhanced head CT:Examination demonstrates very extensive subcortical and periventricular low-attenuation white matter which considering patient's age likely are presenting advanced small vessel ischemic strokes of indeterminate age.There is also a focus of low attenuation involving the cortex and subcortical white matter of the left posterior temporal -- and which has the appearance of a cortical stroke or with indeterminate age. Similar larger finding in the right posterior temporal -- occipital region is also present and is suspected of an acute to early subacute ischemic stroke.No evidence of acute intracranial hemorrhage, midline shift or hydrocephalus.Recommend follow-up with an MRI examination.

Output: 1.Advanced small vessel ischemic strokes of indeterminate age.2.Regions of cortical stroke in the bilateral posterior temporal -- occipital regions which are also indeterminate as of their age. Recommend follow up with MRI exam.3.No detectable acute intracranial hemorrhage, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: pre op planning - no fiducials needed History: ams The exam was performed with pre-operative stealth protocol.There are ill-defined low signal intensity lesions with significant surrounding edema on T2 images, one on the right parietal and the other is on the left parietal lobes (right side lesion is bigger than the left).The right lateral ventricle occipital horn shows effacement due to mass effect. However, there is no midline shift.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Multiple various size intra-axial masses with surrounding edema (right side lesion is bigger than that of the left). Differential diagnosis include brain abscess, metastatic lesions, or primary malignant brain tumor.


Instruction: Generate impression based on findings.

Input: 63 year old male with recent diagnosis of LV dysfunction of unknown etiology. Referred for vasodilator stress cardiac MRI to evaluate for ischemia or infiltrative disease. History of previously reported lymphoma.MEDICATIONS: Losartan, multivitamin. First Pass PerfusionDuring hyperemia, no perfusion defects were present. Viability/ Myocardial ScarThere was no late gadolinium enhancement noted suggesting that there is no prior myocardial infarction, fibrosis, inflammation, or infiltration. The entire myocardium is viable.Left VentricleThe left ventricle is mildly dilated, with moderately reduced systolic function with regional variability. The overall LV ejection fraction is 38%, the LV end diastolic volume index is 122 ml/m2 (normal range: 74+/-15), the LVEDV is 229 ml (normal range 142+/-34), the LV end systolic volume index is 75 ml/m2 (normal range 25+/-9), the LVESV is 142 ml (normal range 47+/-19), the LV mass index is 76 g/m2, and the LV mass is 143 g. No intracardiac thrombus. Left AtriumThe left atrium is normal. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 74 ml/m2 (normal range 82+/-16), the RVEDV is 139 ml (normal range 142+/-31), the RV end systolic volume index is 28 ml/m2 (normal range 31+/-9), and the RVESV is 53 ml (normal range 54+/-17).Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely. Mitral regurgitation is present. Dedicated imaging was not performed; however, by visual estimation it appears moderate in severity. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThe majority of the abdomen and pelvis are not included in the field of view. T2 hyperintense focus in the left hepatic lobe incompletely characterized. Previously described normal-sized lymph nodes on recent PET/CT are again noted. No axillary or mediastinal lymphadenopathy is detected.

Output: 1. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. Mildly dilated left ventricle, with moderately reduced systolic funciton (LVEF 37%).4. Normal RV size and systolic function (RVEF 62%).


Instruction: Generate impression based on findings.

Input: Clinical question: 70-year-old female is status post aortic valve replacement, here with recurrent syncopal episodes. Signs and symptoms: Hypoglycemia versus seizure. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrates scattered periventricular and subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres and minimally within the pons and bilateral cerebellar hemispheres. Findings are highly suggestive of chronic small vessel ischemic strokes of moderate degree. There is suggestion of mild interval progression of disease since prior exam from 2014.Slight prominence of cortical sulci and ventricular system demonstrate no significant change since prior exam.The signal void of major intracranial arterial branches are identified.There is no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium, scalp or the orbits.The signal intensity of intracranial venous sinuses are within normal and normal pattern of enhancement.

Output: 1.No acute intracranial process.2.Moderate chronic small vessel ischemic strokes in the bilateral subcortical and periventricular white matter as well as pons with slight interval progression since 2014 exam.3.Bilateral small (R>L) chronic cerebellar ischemic strokes.4.No detectable abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 27-year-old male patient with history of abdominal paraganglioma and SDHA germline mutation consistent with hereditary paraganglioma syndrome. Evaluate for new sites. Neck:No specific evidence of tumor or metastatic disease in the neck.Chest:No specific evidence of tumor or metastatic disease within the mediastinum.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The main pancreatic duct within the head and body is mildly dilated, which appears new from a prior CT. No definite obstructing lesion is identified, but this is incompletely evaluated. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No definite new sites of disease.2.Interval mild dilatation of the pancreatic duct which is new from a prior CT from 7/29/2015; dedicated MRCP with contrast is recommended for further evaluation. Findings discussed via telephone with Dr Churpek at 1123 hrs on 8/22/2016.


Instruction: Generate impression based on findings.

Input: Evaluate for brain lesions. Post fall. Evaluation is limited by motion artifact. There are punctate foci of restricted diffusion within the bilateral cerebellum associated T2/FLAIR hyperintensity and no definite enhancement, probably acute to subacute infarcts. There is a 5.2 x 5.1 x 6.1 cm large enhancing mass, which overall demonstrates mild restricted diffusion and areas of susceptibility representing microhemorrhage, that expands the sella turcica. The optic chiasm is presumably displaced superiorly and compressed not well delineated. Normal pituitary tissue is not identified. The mass encases and laterally displaces the anterior cerebral arteries, and also encircles the cavernous supraclinoid internal carotid arteries by greater than 50%, suggestive of cavernous sinus invasion. There is a mild rim of FLAIR hyperintense vasogenic edema, predominantly within anterior frontal lobes. There is slight truncation of the frontal horns of the lateral ventricles. The third ventricle is mildly prominent and foreshortened likely due to mass effect. The fourth ventricle is normal in size. There is superior displacement of the corpus callosum, with the rostrum not clearly delineated. The suprasellar cistern is obliterated. The remaining basal cisterns are intact.There is a left extra-axial uniformly enhancing mass with dural extension measuring 1.1 x 0.8 cm (series 1301, image 124), probable meningioma. An additional left frontal dural based enhancing mass measures 1.9 x 1.7 cm (series 1301, image 151), and extends within the left precentral sulcus. There is prominence of the right lateral frontal subarachnoid space, with normal traversing vessels visualized. This may relate to asymmetric mass effect from findings in the left hemicranium rather than right-sided volume loss. There is slight increased fluid distention of the distal right optic nerve sheath. Trace fluid is noted in the right mastoid air cells.

Output: 1.Large enhancing sellar/suprasellar multilobulated mass containing areas of restricted diffusion and microhemorrhage, expanding the sella turcica, encasing and displacing the anterior cerebral arteries, and invading the cavernous sinus. Significant localized mass effect. Differential diagnosis includes primarily pituitary macroadenoma, versus meningioma and less likely craniopharyngioma. 2.Punctate foci of restricted diffusion within the bilateral cerebellum, consistent with acute to subacute infarcts.3.Enhancing left frontal dural based mass, most compatible with meningiomas.


Instruction: Generate impression based on findings.

Input: Female, 51 years old, with paresthesias, assess for demyelinating disease. Cervical:The spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of any focal lesion is seen. No epidural abnormalities are suspected.The normal lordotic curvature of the cervical spine is straightened, but alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No concerning marrow signal change is seen.Mild disc osteophyte formation is evident at C5-6 and C6-7. The left neural foramina are mildly narrowed at these levels. No other significant spinal canal or foraminal narrowing is seen.Incidental note is made of a Thornwaldt cyst in the midline nasopharynx.Thoracic:The spinal cord demonstrates normal signal intensity and morphology throughout. No evidence of any focal lesion is seen. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal change is seen.No significant disc bulge or disc herniation is evident. There is no significant compromise of the spinal canal or neural foramina.Lumbar:The conus is normal and terminates at the L1-L2 level. The nerve roots of the cauda equina are distributed evenly through the thecal sac. No epidural abnormalities are observed.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal change is seen.At L4-5, there is mild loss of disc T2 signal but preservation of disc height. Minimal generalized disc bulging is seen with a left foraminal annular fissure. No significant spinal canal stenosis is evident, but the neural foramina are mildly narrowed.The remaining disc levels are free of significant bulge or herniation and no other spinal canal or foraminal stenosis is seen.

Output: 1.No evidence to suggest any active demyelinating process and the spinal cord.2.No other specific findings are seen to account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of kidney cancer status post radical nephrectomy, evaluate for metastatic disease ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. The hepatic vasculature is patent. No intra or extrahepatic biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. No evidence of tumor recurrence within the nephrectomy bed. Prominent left extrarenal pelvis and left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: Status post right nephrectomy without evidence of tumor recurrence or metastatic disease in the abdomen.


Instruction: Generate impression based on findings.

Input: 67-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: The prostate measures 5.2 cm in transverse, 3.7 cm in AP, and 4.8 cm in craniocaudal diameter.Peripheral Zone: In the right mid gland to apex, there is a small focus of T2 and ADC hypointensity (axial series 704 image 184). No focal contrast enhancement in this region is identified.Central Gland: Nodular hypertrophic appearance.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific enhancing focus in the right ilium (axial series 1401 image 136).OTHER: No significant abnormality noted.

Output: 1.Suspicious lesion in the right mid gland to apex.2.Nonspecific enhancing focus in the left iliac bone. A nuclear medicine bone scan is recommended for further evaluation.


Instruction: Generate impression based on findings.

Input: Female, 41 years old, with headaches and visual changes. Numerous scattered foci of periventricular and juxtacortical T2 hyperintensity are again seen. Some of these lesions are oriented relatively perpendicular to the ventricular surface. Accounting for significant differences in technique on the prior comparison examination, no definite change in the size or number of lesions is seen. However, new enhancement is seen corresponding to a lesion along the left ventricular atrium. Some of the above-mentioned lesions are associated with mild to moderate T1 hypointensity.No significant parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is suspected. Brain parenchymal volume is preserved. The ventricular system is normal in size and morphology.

Output: Numerous scattered white matter lesions are redemonstrated showing no significant interval change in size or number when compared to the prior examination. However, a lesion along the left ventricular atrium does appear to be newly enhancing. As before, these lesions would be compatible with a demyelinating process, with additional considerations including sequelae of migraine or vasculitis.


Instruction: Generate impression based on findings.

Input: Extensive stage SCLC, being considered for preventative cranial irradiation. There is a new ovoid area of restricted diffusion in the left middle frontal gyrus that measures approximately up to 15 mm, with surrounding vasogenic edema. The lesion contains a focus of restricted diffusion in the right middle frontal gyrus that measures up to approximately 5 mm, which may represent hemorrhage or calcification, for example. There is no midline shift or herniation. There is mild diffuse periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The skull and orbits are unremarkable. There is moderate mucosal thickening in the right maxillary sinus. There is an unchanged left parietal scalp lipoma.

Output: New lesions in the bilateral frontal lobes likely represent metastatic disease with associated vasogenic edema, but no midline shift. However, the assessment is somewhat limited by the lack of intravenous contrast.Discussed with Dr. Malik at 8:20 AM on 1/7/15.


Instruction: Generate impression based on findings.

Input: Female, 69 years old, with left-sided sciatica pain. Alignment is grossly anatomic. Vertebral body morphology is unremarkable. No concerning areas of marrow replacement or marrow edema are seen.The visualized spinal cord, conus and cauda equina are unremarkable. No epidural abnormalities are seen.The lumbar intervertebral discs demonstrate loss of T2 signal but with relative preservation of height. Additional level specific findings are as follows:T12-L1: Mild disc bulging. No significant spinal canal or foraminal stenosis.L1-2: Unremarkable. L2-3: Mild facet arthropathy and ligamentum flavum thickening. Disc bulging with a broad protrusion which spans the right paracentral and foraminal zones. Partial effacement of the right lateral recess. Moderate right foraminal narrowing. No significant left foraminal narrowing. L3-4: Moderate facet arthropathy and ligamentum flavum thickening. Mild bulging disc. Mild generalized spinal canal narrowing. Mild bilateral foraminal narrowing. L4-5: Advanced facet arthropathy and ligamentum flavum thickening. Bulging disc. Moderate generalized spinal canal narrowing without clear evidence of nerve root impingement. Moderate left and mild right foraminal narrowing. L5-S1: Advanced facet arthropathy. Minimal disc bulging. No significant spinal canal or foraminal stenosis.

Output: 1.A broad disc protrusion involving the right paracentral and foraminal zones at L2-3 causes partial effacement of the right lateral recess and moderate right foraminal narrowing.2.Disc degeneration in combination with advanced facet arthropathy at L4-5 cause a moderate generalized spinal canal narrowing and moderate left foraminal narrowing.