Instruction: Generate impression based on findings.

Input: 21-year-old female with dyspareunia. Evaluate for urethral diverticulum. PELVIS:UTERUS, ADNEXA: The uterus is normal in appearance and size with the endometrial stripe measuring approximately 4 mm. No evidence of uterine fibroids. The adnexa are unremarkable.BLADDER: The bladder is normal in appearance. The urethra is normal in appearance without evidence of urethral wall thickening or a diverticulum.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: No evidence of urethral diverticulum as clinically questioned.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticusClinical question: h/o intractable epilepsy; preop planning for depth electrodes The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: MRI of the brain is within normal limits to the extent of visualization. Please note that this is a limited exam performed for guidance during treatment.


Instruction: Generate impression based on findings.

Input: Female, 15 years old, with cerebral cyst, yearly follow-up for changes. Redemonstrated is a cystic lesion located just cranial to the left lateral ventricular atrium which measures up to 10 mm in diameter, previously 10 mm. As on the prior examination, the lesion curves in conformity with the trajectory of adjacent perivascular spaces. FLAIR hyperintensity is redemonstrated along the lateral margin of the lesion which is unchanged.A punctate focus of mild FLAIR hyperintensity within the white matter of the left anterior centrum semiovale is unchanged and nonspecific. No new lesions are seen. Note is again made of generally prominent perivascular spaces.No evidence of significant edema or mass effect is detected. No acute intracranial hemorrhage is seen. Ventricular size and morphology are within normal limits.

Output: Stable small cerebral cyst which is favored to represent a benign etiology such as a dilated perivascular space or perhaps a postinflammatory cyst.


Instruction: Generate impression based on findings.

Input: Female 74 years old Reason: Knee pain Tiny, 4 mm ossicle in the soft tissues adjacent to the medial femoral condyle may represent a loose body. Small lucent defect in the proximal fibular diaphysis is again seen and likely of no clinical significance. Small joint effusion. Large soft tissue structure posterior to the knee represents large Baker's cyst, better evaluated on MRI 7/13/2016.

Output: Large Baker's cyst and other findings as above.


Instruction: Generate impression based on findings.

Input: NF1 and persistent headaches. There is an enhancing mass in the right spinal canal at the C3-4 level that measures 12 mm in diameter. There are numerous skin nodules. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific cerebral white matter T2 hyperintense foci. 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, and paranasal sinuses are grossly unremarkable. There appears to be a small Thornwaldt cyst.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. A mass in the right spinal canal at the C3-4 level that measures 12 mm in diameter likely represents a neurofibroma.3. Numerous skin nodules also likely represent neurofibromas.


Instruction: Generate impression based on findings.

Input: Clinical question: New neuro symptoms in pt with known MS off Tecfidera x 2 weeks and JC virus positive; PML vs. MS flare. Signs and Symptoms: paresthesias, headaches, vision changes. Pre and post enhanced brain MRI:There is technique difference between the current routine brain MRI (4 mm slices) and prior dedicated protocol with 2 mm slices.Within this limitation examination demonstrate no definitive change in the extent of the mild chronic nonenhancing supratentorial demyelinating disease since prior exam. A single tiny focus of FLAIR hyperintensity in the left hemispheric white matter without enhancement also remain similar to prior exam and likely representing additional benign lesion.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are within normal for stated age of 43. Negative post contrast images.Unremarkable images through the orbits including axial fat sat post enhanced series.Normal pneumatization signal patterns of all paranasal sinuses and bilateral mastoid air cells.

Output: Stable mild chronic nonenhancing demyelinating disease since prior exam as detailed. Please see above comments.


Instruction: Generate impression based on findings.

Input: Clinical question: CVA. Signs and symptoms: Blindness. CTA of intracranial circulation:65 cc of Omnipaque 350 is administered for this study.Source images as well as 2-D reformatted images and 3-D reformatted images were utilized for interpretation of this exam.Vertebral -- basilar system:Vertebrobasilar system demonstrate patent bilateral vertebral arteries, bilateral pica branches, basilar artery, bilateral superior cerebellar arteries and posterior cerebral arteries with no evidence of vascular abnormality.Left internal carotid:Patent normal-appearing left internal carotid artery across the skull base. Patent left cavernous carotid however with vascular calcification. The left anterior and middle cerebral arteries and their branches are unremarkable.Right internal carotid: There is patent right internal carotid artery across the skull base and in its supraclinoid portion. There is an infundibulum shaped vascular outpouching at the expected location of right posterior communicating artery. The reformatted images demonstrate no posterior communicating artery at this site. However on source images a very minute right posterior communicating artery is identified. Although this finding may represent an infundibulum possibility of an aneurysm cannot be entirely ruled out. This finding measures 3.5 -mm at its base and 3.5-mm in height. The right anterior and middle cerebral arteries and their branches are unremarkable.CTA of the neck:No additional contrast was given for this portion of the exam.There is normal appearing bilateral vertebral arteries and including their origins.Right common carotid artery and including its origin is within normal limits. Very minimal atherosclerotic irregularity at the origin of the right internal carotid artery is noted. No vascular lumen compromise. The left common carotid artery and left internal carotid arteries are widely patent. Very minimal atherosclerotic irregularity at the origin of left internal carotid artery is however noted.Non-infused head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. As noted on MRI there is fullness of the left cavernous sinus and left Meckel's cave and a small soft tissue density immediately medial to the left anterior clinoid as detailed on MRI report.

Output: 1.CTA of intracranial circulation demonstrates very minute atherosclerotic irregularity at the origin of bilateral internal carotid arteries and the otherwise negative CTA of vasculature of the neck.2.CTA of intracranial circulation demonstrates an infundibulum at the expected origin of the right posterior communicating artery. There is a very minute size posterior communicating artery on this side. Although this finding likely represent an infundibulum possibility of an aneurysm cannot be entirely ruled out considering the very small size of right posterior communicating artery. CTA of intracranial circulation is otherwise unremarkable. 3.Nonenhanced head CT is negative for any acute intracranial findings. Please review report of MRI examination regarding the mass at the level of left anterior clinoid and mass within the left cavernous sinus/Meckel's cave.


Instruction: Generate impression based on findings.

Input: 8 years Male (DOB:5/21/2008)Reason: pre-op planning History: preop planningPROVIDER/ATTENDING NAME: NEETHI P PINTO NEETHI P PINTO The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient status post recent depth electrode placement in the right temporal lobe. There is associated metal artifact. Patient's also status post right temporal lobe surgery.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The examination is performed for the purposes of stereotactic guidance and an surgery. There are depth electrodes present in the right temporal lobe which create artifact and may obscure more subtle lesions. The patient is status post right temporal lobe surgery.2.Please note this is a limited exam for the purposes of stereotactic guidance during surgery.


Instruction: Generate impression based on findings.

Input: 77 year old man with multivessel coronary artery disease referred to assess for myocardial viability. Left VentricleThe left ventricle is severely dilated with severely reduced systolic function (estimated LVEF 25%). There is no obvious late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is extensive myocardial viability in all three coronary artery territories.Left AtriumThe left atrium is severely dilated. Right VentricleThe right ventricle is mildly dilated with normal systolic function. Right AtriumThe right atrium is mildly dilated.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size. There is mild protruding atheroma in the descending thoracic aorta. Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is mildly dilated. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMultiple bilateral renal cysts, which are poorly characterized. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Severe left ventricular dilation with severely reduced systolic function (LVEF 25%). No evidence of underlying myocardial infarction. There is a significant amount of myocardial viability in all three coronary artery territories. 2. Mild right ventricular dilation with normal systolic function.3. Severe left atrial dilation.4. Mild protruding atheroma noted in descending thoracic aorta. 5. Mild dilation of the main pulmonary artery. 6. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: The right cerebellar tonsil lies 5 mm below the level of the foramen magnum and demonstrates a primarily rounded morphology. The left cerebellar tonsil is normal in position and morphology. These findings are more suggestive of right cerebellar tonsillar ectopia. Biphasic CSF flow is noted posteriorly around the cerebellar tonsils. There is mild retroflexion of the odontoid tip.Brain MRI:The ventricles and sulci are normal in size. 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. Cervical spine MRI:There is slight reversal of upper cervical curvature centered at C5/6. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable. Incidental note is made of subcentimeter T2 hyperintense foci within the thyroid lobes (left more than right).C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Mild disc bulge and right uncinate hypertrophy without stenosis.C6/7: Minimal disc bulge without stenosis.C7/T1: Unremarkable

Output: 1.The right cerebellar tonsil lies 5 mm below the level of the foramen magnum and demonstrates a primarily rounded morphology. The left cerebellar tonsil is normal in position and morphology. These findings are more suggestive of right cerebellar tonsillar ectopia.2.Minimal to mild degenerative changes at C5/6 and C6/7 without associated stenosis.3.Incidental note is made of subcentimeter T2 hyperintense foci within the thyroid lobes (left more than right). These are nonspecific in appearance, and most likely represent thyroid nodules. These could be further characterized with ultrasound.


Instruction: Generate impression based on findings.

Input: 57-year-old female with cervical cancer PELVIS:UTERUS, ADNEXA: Interval placement of tandem and ovoid implants within the vagina and uterus are noted, in acceptable position. The tip of the tandem is is seen approximately 2.3 cm from the uterine fundus. BLADDER: Foley catheter is present within the bladder. Small amount of air is likely related to instrumentation.LYMPH NODES: Enlarged right external iliac lymph nodes are again noted measuring up to 12 mm, slightly decreased when compared to the prior exam.BOWEL, MESENTERY: Rectal catheter is noted.BONES, SOFT TISSUES: Sclerotic focus in the right anterior iliac wing likely represents a benign bone island, unchanged. No significant change in pelvic soft tissue focus with stellate margins (501/67).OTHER: There is trace amount ascites.

Output: 1.Limited examination with only axial T2 images acquired. Interval placement of tandem and ovoid implants are noted within the vagina and uterus, as described above.2.Slight decrease in size of enlarged right external iliac lymph nodes.


Instruction: Generate impression based on findings.

Input: 45-year-old male with anosmia. History of stereotactic brain biopsy in frontal lobe. CT of brain with infusion:Dural based enhancing tumor is noted in bifrontal regions (right greater than left). The mass extends along the false bilaterally for approximately 24 mm from the inner table of the skull in the frontal region. Bifrontal dural based enhancing tissue extends to mid convexity of calvarium. There is also suggestion of extension of dural based mass along the floor of bilateral anterior cranial fossa which appears to extend along the greater wings of the sphenoid in bilateral middle cranial fossa. In comparison with the prior MRI examination of brain with infusion no definitive evidence of interval change can be appreciated. There is evidence of subtle mass effect on the brain parenchyma however no vasogenic edema is detected. The density of brain parenchyma, vertical sulci and ventricular system remains within normal. No definite osseous abnormality is noted. The immediate prior CT examination of the brain was performed without the infusion and cannot be compared with the current study. Comparison with any CT of brain dated 9 -- 20 -- 2008 demonstrate significant interval reduction in the size of dural based mass and also resolution of previously noted edema brain parenchyma.CT of paranasal sinuses with infusion:The paranasal sinuses are well pneumatized and with no evidence of acute or chronic sinus disease. The ostiomeatal units of maxillary sinuses are patent bilaterally. No evidence of any osseous abnormality is detected. Images at the level of the skull base including palnum sphenoidale, cribriform plate and fovea ethmoidalis demonstrate no abnormality. 80 cc of Omnipaque 350 was utilized for the above study.

Output: 1.Bilateral frontal dural based enhancing lesion likely represents patient's known sarcoidosis. In comparison with prior MRI from 6 -- 30 -- 2009 no definitive interval change is noted however in comparison with prior CT examination from 9 -- 3 -- 2008 there is significant reduction in size as described.2.Subtle mass effect on bifrontal lobes with no evidence of edema or enhancement of brain parenchymal or pia matter.3.Well pneumatized paranasal sinuses and with patent bilateral ostiomeatal units.


Instruction: Generate impression based on findings.

Input: Right hemiparesis, pseudobulbar palsy. Stroke history, declining mobility, right leg weakness. There is diffuse global parenchymal volume loss supratentorially as well as infratentorially including the brainstem and cerebellum, which is advanced for age. Diffuse thinning of the corpus callosum is also noted, likely related to Wallerian degeneration. Confluent areas as well as scattered of foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic disease. Multiple areas of cavitation are noted in the bilateral basal ganglia and to a lesser degree bilateral frontal corona radiata consistent with lacunar infarcts. Lacunar infarcts are also noted in the pons bilaterally. No restricted diffusion to suggest acute ischemia. Multiple foci of susceptibility are noted within the pons, left posterior frontal periventricular white matter, and at the thalamus midbrain junction compatible with chronic microhemorrhages. No intracranial mass or mass-effect. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is moderate mucosal thickening involving the left maxillary sinus and to a lesser degree right maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. Advanced chronic small vessel ischemic disease with multiple supratentorial and infratentorial lacunar infarcts. Some of these lacunar infarcts demonstrate hemosiderin staining compatible with prior hemorrhage. 2. Advanced supratentorial and infratentorial parenchymal volume loss. 3. No acute infarct or intracranial mass effect.


Instruction: Generate impression based on findings.

Input: Hyper-reflexia in the lower extremities. There is a combination of disc-osteophyte complex, ligamentum flavum thickening, and facet hypertrophy that result in severe stenosis of the spinal canal at T11-12, as well as moderate bilateral neural foraminal stenosis. There is associated focal compression and T2 hyperintensity of the spinal cord at this level. There are disc-osteophyte complexes and facet degenerative changes at T10-11, where there is mild spinal canal stenosis and moderate to severe bilateral neural foraminal stenosis, at T9-10, where there is mild bilateral neural foraminal stenosis, and at T7-8, where there is mild right spinal canal and neural foramen stenosis. There is mild straightening of the thoracic vertebral column alignment in the sagittal plane. The vertebral body and disc space heights are preserved. There is a hemangioma within the T7 vertebral body. The paravertebral soft tissues are unremarkable.

Output: 1. Significant spinal canal stenosis at T11-12 with associated myelomalacia.2. Degenerative spondylosis at other levels of the thoracic spine, including at T10-11, where there is mild spinal canal stenosis and moderate to severe bilateral neural foraminal stenosis, at T9-10, where there is mild bilateral neural foraminal stenosis, and at T7-8, where there is mild right spinal canal and neural foramen stenosis.


Instruction: Generate impression based on findings.

Input: 61 year old female with palpitations, history of atrial fibrillation/flutter. Referred to cardiac MRI prior to ablation to evaluate pulmonary venous anatomy. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 63 ml/m2 (normal range: 65+/-11), the LVEDV is 111 ml (normal range 109+/-23), the LV end systolic volume index is 24 ml/m2 (normal range 18+/-5), the LVESV is 41 ml (normal range 31+/-10), the LV mass index is 25 g/m2 (normal range 67+/-11), and the LV mass is 44 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 53 ml/m2 (normal range 69+/-14), the RVEDV is 93 ml (normal range 110+/-24), the RV end systolic volume index is 23 ml/m2 (normal range 22+/-8), and the RVESV is 40 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium. Each pulmonary vein has a distinct ostia. Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size and systolic function (LVEF 63%). No evidence of late gadolinium enhancement. 2. The right ventricle is normal in size and systolic function (RVEF 57%). 3. All four pulmonary veins drain normally into the left atrium. Each pulmonary vein has a distinct ostia. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 46 years Female (DOB:7/21/1969)Reason: Eval for demyelinating disease History: Tinnitus and paresthesiasPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are periventricular and subcortical white matter T2 and FLAIR hyperintense lesions present approximately 15 in each hemisphere. The largest 1's appear to be in the left temporal lobe periventricular and subcortical white matter.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a subtle left paramedian disc protrusion at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a small central disc protrusion at T7-8 and a right paramedian disc protrusion at T8-9.There is a mild superior endplate compression at T3.

Output: 1.Some periventricular white matter and subcortical white matter lesions are present which are nonspecific but given patient's clinical history could be related to demyelinating disease. Alternative considerations may include vascular related lesions including vasculitis as well as sarcoid and2.There are mild degenerative changes present in the cervical spine and thoracic spine without significant compromise to spinal canal or exiting nerve roots.3.No intrinsic lesions are appreciated within the thoracic spinal cord.4.No intrinsic lesions are appreciated in the cervical spinal cord.5.There is mild superior endplate compression at T3.


Instruction: Generate impression based on findings.

Input: Reason: medial meniscus tear History: Left knee pain MENISCI: The lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is near full-thickness to full-thickness cartilage degeneration along the medial femoral condyle above and just anterior to the posterior horn of the medial meniscus with delamination. There may also be mild cartilage loss along the medial femoral condyle above the anterior horn as well. The remainder of the articular cartilage is unremarkable.LIGAMENTS: The cruciate and collateral ligaments appear intact. There is mild edema along the superficial band of the medial collateral ligament which is nonspecific, but could represent a mild sprain in the correct clinical context.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Degeneration of the articular cartilage of the medial femoral condyle and other findings as described above. We see no meniscal tear.


Instruction: Generate impression based on findings.

Input: Lung cancer with brain metastases. There is an incompletely characterized lesion in the left parietal lobe that measures up to approximately 20 mm. There is no midline shift or herniation. The ventricles are within normal limits in size and configuration.

Output: Aborted examination demonstrates a left parietal lobe lesion, which may represent a metastases, although this is incompletely characterized.


Instruction: Generate impression based on findings.

Input: Follow-up evaluation of mass. Evaluate for ventricles history of normal pressure hydrocephalus and mass anterior to pons. Implanted defibrillator. Status post VPS placement Nonenhanced CT of brain:There is revisualization of a left sided extra axial mass in the left cerebellopontine angle with extension across the midline posterior to the clivus. The mass superiorly reaches the dorsum sella. There is subtle mass effect on the pons. There is no detectable in edema of brain parenchyma. On this non-infused study this lesion remains similar in size and density.Findings a brief to represent a meningioma. Fourth ventricle is normal in size and unchanged since prior exam.Images through supratentorial space demonstrated enlargement of supratentorial ventricles with a right sided ventricular catheter. The measurements of lateral ventricles demonstrate a very subtle interval decrease in their size. There is better visualization of subarachnoid space surrounding the knee to high complexity of brain parenchyma compared to prior exam. I suspect a small nonhemorrhagic subdural in these locations. This can be only definitively diagnosed with an MRI examination or a post infused CT of brain. The thickest portion of this collection measures approximately 5 mm.

Output: 1.Stable extra-axial left cerebellopontine and prepontine mass to represent a meningioma.2.Slight interval decrease in the size of the supratentorial ventricular system.3.Better visualization of extra-axial CSF in the midpole hypodensity bilateral frontal -- parietal regions which suspect the extra-axial subdural nonhemorrhagic collections.


Instruction: Generate impression based on findings.

Input: 54-year-old male with left shoulder pain, please evaluate for labral tear or recurrent rotator cuff tear. ROTATOR CUFF: No full-thickness rotator cuff tear. There is partial thickness undersurface tearing of the supraspinatus and infraspinatus in the setting of at least moderate tendinosis. On the anterior aspect of supraspinatus, there is approximately 50 percent or greater than 50 percent tearing with retraction of some of the fibers along the undersurface.SUPRASPINATUS OUTLET: Supraspinatus outlet appears intact. However, partial thickness undersurface tearing of the supraspinatus in the setting of at least moderate tendinosis is seen.GLENOHUMERAL JOINT AND GLENOID LABRUM: Global degenerative tearing of the labrum is visualized.BICEPS TENDON: The intra-articular portion of the biceps tendon is torn. ADDITIONAL

Output: 1. Partial-thickness undersurface tearing and moderate tendinosis of the supraspinatus and infraspinatus.2. Global degenerative tearing of the labrum.3. Moderate osteoarthritis affects the glenohumeral joint, acromioclavicular joint, and os acromiale.


Instruction: Generate impression based on findings.

Input: 56 year old female status post mastectomy for invasive lobular carcinoma in 2013, presents today for routine follow up. No current breast complaints. Family history of breast osteoma in her mother at age 73 internal and at age 62. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. 2 biopsy clips are again seen unchanged in location at the site of the prior benign breast biopsies. Several benign morphology masses in the right breast which have previously been characterized as cysts on prior MRI and ultrasound examinations are stable or have decreased in size since the previous exam. There is no dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla.

Output: Stable biopsy clips and stable to decreased size of benign cysts in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: [28-year-old male patient with hip pain, history of Ewing's sarcoma. Evaluate for cause.] [There is a large mass which appears to be arising off or involving the left superior pubic ramus. The mass demonstrates low T1 signal, heterogeneous high signal on T2-weighted images, and has heterogeneous enhancement on postcontrast imaging consistent with tumor. Furthermore, confluent with the mass is a centrally low signal intensity, peripherally enhancing component which may represent necrotic tumor. Overall, the solid and cystic components of the mass measure 8.0 x 6.8 x 8.3 cm (AP by transverse by craniocaudal). Signal abnormality extends into the anterior column of the left acetabulum. New abnormal T2 signal within the left ilium also likely represents tumor. Abnormal signal intensity within the right sacrum is not significantly changed from the prior study. Redemonstration of postsurgical changes of a resection of the right ilium with superior displacement of the femoral head, which is now flattened in contour and irregular. Tubular focus of signal abnormality within the femoral head likely represents surgical intervention. There is abnormal signal extending from the right lesser trochanter into the intertrochanteric region which is more apparent on this examination compared to priors and could represent tumor.There is edema type signal within the bilateral hip adductor musculature, right greater than left, and the right gluteus muscles. There is generalized atrophy of the muscle on the right.

Output: [Tumor progression with a large mass within the left hemipelvis and multiple sites of osseous involvement.


Instruction: Generate impression based on findings.

Input: Diplegia of upper limbs [344.2], Reason for Study: ^Reason: Bilateral upper extremity palsy most consistent with lower motor neuron injury, please evaluate for lesions that would explain such clinical presentation (eg. Anterior horn lesions) Brain MRINo evidence of acute ischemic or hemorrhagic lesion.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, or restricted diffusion/acute ischemia. 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.C-SpineHigh signal intensity lesion on T2 weighted and STIR images bilateral anterior horn cell from C34 to C67 spinal cord. Since there is no evidence of associated spinal cord edema, these findings could be related to prior incident. Gad enhancement may be helpful for evaluation of active inflammation.The 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 epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: 1. Anterior horn of cervical spinal cord high signal intensity lesions, differential diagnosis include infectious origin such as Poliomyelitis, prior inflammatory or demyelination, or prior infarct.2. Normal brain MRI.


Instruction: Generate impression based on findings.

Input: Reason: possible FAI History: possible femoral acetabular impingement ACETABULAR LABRUM: Degenerative tearing of the anterior and anterosuperior labrum. No chondrolabral detachment.ARTICULAR CARTILAGE AND BONE: No full-thickness cartilaginous defect is identified. There is no significant osteoarthritis. No acute fracture or malalignment.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Degenerative tearing of the anterior and anterosuperior labrum.


Instruction: Generate impression based on findings.

Input: Weakness, back pain, can't walk. Hemodialysis patient. There is slight straightening of the spinal curvature. The vertebral bodies are appropriate in the overall alignment and height. There is diffuse low T1 and T2 signal the bone marrow which is nonspecific however can be related to renal osteodystrophy. There is mild diffuse spinal canal stenosis predominantly on a developmental basis. No obvious cord signal abnormality or evidence of acute cord compression. Multilevel degenerative changes of the cervical spine are demonstrated, relatively worse at C6-C7 where there may be up to moderate spinal canal stenosis secondary to a disc osteophyte complex formation. There is no evidence for high-grade spinal canal stenosis.

Output: 1. 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. No cord compression is identified. There is developmental narrowing of the spinal canal with superimposed mild degenerative changes, relatively worse at the C6-7 level where there may be up to moderate stenosis and which can be better assessed with dedicated cervical spine image if clinically indicated.2. Due to the screening nature of this protocol details are not as evident on imaging as with dedicated protocols of the spine.


Instruction: Generate impression based on findings.

Input: 79-year-old female status post fall 3 days ago. Rule out bleed. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of diffuse hypodensity within the periventricular and subcortical white matter distribution consistent with small vessel disease, age indeterminate. If there is concern for acute stroke, an MRI may be considered. 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: small vessel disease, age indeterminate. If there is concern for acute stroke, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neuralgia and neuritis, unspecified Unspecified disturbances of skin sensationClinical question: assess for cervical radiculopathySigns and Symptoms: neck pain, often radicular Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild disc desiccation present at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. Straightening of the normal cervical curvature could be related to patient positioning or muscle spasm.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina. There are Schmorl's nodes at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present and a mild disc bulge at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There is no compromise to the spinal canal or exiting nerve roots. There are mild degenerative changes present in the cervical and lumbar spines


Instruction: Generate impression based on findings.

Input: Diagnosis: Radiculopathy, lumbar regionClinical question: Eval for stenosisSigns and Symptoms: right leg radicular painComments: Any MRI | Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal. There is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with mild facet hypertrophy. There is partial effacement of the fat surrounding the exiting nerve roots at this level with mild to moderate encroachment of exiting nerve roots. There is partial effacement of fat at the lateral recess bilaterally at this level. Overall there is mild spinal canal stenosis at this level.At L4-5 there is loss of disk space height, disk dessication and diffuse disk bulge at this level associated with moderate facet hypertrophy. There is 2mm anterior subluxation of L4 on L5. There is mild to moderate spinal stenosis at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and mild ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and mild ligamentum flavum hypertrophy at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: 1.There are mild degenerative changes in the lumbar spine as detailed above with mild to moderate spinal stenosis at L4-5 and bilateral encroachment of exiting nerve roots at L5-S1.2.Exam is limited. The patient refused to complete the exam.


Instruction: Generate impression based on findings.

Input: Thoracic spine compression fracture. There is mild thoracic scoliosis convex to the left. Compression deformities of various degrees are seen in thoracic spine, involving T4, T5, T6, T7, T8, T10, T11 and T12. The compression deformities are worst at T8 and T12 level. At T12 level, there are changes related to previous vertebroplasty. Small amount of vertebroplasty material is seen extravasated into the right paraspinal region, possibly involving a venous structure. At T11 - T12 there is disk bulging without significant compromise to spinal canal. Mild disk bulging is also seen throughtout the rest of the thoracic spine, without significant compromise of the spinal canal, although mild neuroforaminal narrowing is present.Abnormal opacity in the left upper lobe is partially visualized, suspicious for a neoplastic process as reported on prior CT chest of 9/15/2011. This is a lytic lesion involving the left pedicle L1, with no definite corresponding lesion seen on prior MRI study. Metastasis cannot be excluded.

Output: 1. Multi-level compression deformities in thoracic spine. Status post vertebroplasty at T12, with extravasated material in the right paraspinal region, probably through venous structure.2. Suspicious for left upper lobe neoplasm. Please correlate with CT chest.3. New lytic lesion at left L1 pedicle, suspicious for a lytic metastasis. Further correlation with MRI with contrast is recommended.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:3/14/1987)Reason: 3T scanner, please evaluate for cerebral AVMs and compare to last scan/ small brain anomaly History: surveillance for pregnancyPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD 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 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.There is a developmental venous anomaly present in the right parietal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.

Output: 1.No MR angiographic or MRI evidence for arteriovenous malformation.2.Developmental venous anomaly in the right parietal lobe.


Instruction: Generate impression based on findings.

Input: Dear male loss of consciousness and head laceration. A scalp laceration in the right frontal region is noted.A very small cortical based lucency in involves the cortex of high convexity right parietal lobe this is highly suspected of a very small cortical stroke. This is best demonstrated on axial image 22 and 23. Further follow-up with an MRI is recommended.No additional areas of hemorrhage, edema, mass effect, midline shift or hydrocephalus is detected.

Output: Very small area of vertical low-attenuation in the right high convexity parietal suspected a very small cortical stroke.


Instruction: Generate impression based on findings.

Input: 33-year-old female with a history of removal of 3 lesions along the medial aspect of the left extremity, suspect schwannoma. A vitamin E capsule overlies the medial soft tissues of the left upper extremity, presumably representing the patient's surgical scar. No focal mass lesions are identified. No abnormal enhancement is identified on postcontrast sequences. The imaged musculature of the left upper extremity is within normal limits. The glenohumeral joint alignment is anatomic. Although this examination was not protocoled for evaluation of glenoid labrum, there is heterogeneity and increased signal intensity within the posterior labrum which may reflect degeneration, but this is equivocal. There is minimal nonspecific subcutaneous edema along the posterior aspect of the elbow/olecranon.

Output: No focal mass lesions are identified. No evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Female, 47 years old. Reason: hyper reflexia of RLE, r/o cord compression History: above Redemonstrated are postsurgical findings of myelomeningocele repair with a low-lying cord, likely tethered, terminating in the sacral region, unchanged.The vertebral bodies are appropriate in overall alignment and height. The spinal cord has normal signal characteristics. There is no compromise of the spinal cord to suggest acute cord compression.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No cord compression is identified. Grossly unchanged postsurgical findings in the lumbosacral spine as described above.


Instruction: Generate impression based on findings.

Input: 47 year old woman with diffuse large B-cell lymphoma, family history of coronary disease, found to have reduced LV function on pre-chemotherapy echocardiography. She is being followed with serial MRIs while on chemotherapy. Left VentricleThe left ventricle is with normal in size with mildly reduced systolic function. The overall LV ejection fraction is 52%, the LVEDV is 138 ml (normal range 109+/-23), the LV end diastolic volume index is 68 ml/m2 (normal range: 65+/-11), the LVESV is 66 ml (normal range 31+/-10), the LV end systolic volume index is 33 ml/m2 (normal range 18+/-5). The LV mass is 86 g (normal range 114+/-24) and the LV mass index is 42 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. The mild left ventricular dysfunction is global. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Native T1 times are normal (1020 - 1040 ms).There is no myocardial iron overload. There is no LV thrombus. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 52%, the RVEDV is 109 ml (normal range 110+/-24), the RV end diastolic volume index is 54 ml/m2 (normal range 69+/-14), and the RVESV is 57 ml (normal range 35+/-13), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. There is a catheter in the SVC. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsPort present on right chest. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is with normal in size with mildly reduced systolic function. The overall LV ejection fraction is 52%. The left ventricular dysfunction is global.2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 52%. Overall the left and right ventricular function is mildly improved from the previous cardiac MRI on 5/5/2016.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: assess RTC and biceps History: assess RTC and biceps. Limited evaluation due to patient motion artifact and incomplete examination. Patient unable to complete the examination due to pain.ROTATOR CUFF: Severe supraspinatus tendinopathy with articular surface partial thickness tearing at the insertion. Severe infraspinatus tendinopathy without discrete tear. Mild supraspinatus tendinopathy without discrete tear. The teres minor is intact. No muscle atrophy or edema. SUPRASPINATUS OUTLET: Moderately AC joint osteoarthritis.GLENOHUMERAL JOINT AND GLENOID LABRUM: The anterior labrum is diminutive and ill-defined. The superior posterior labrum is diminutive and ill-defined. These findings are compatible with degenerative tearing.Low signal foci within the glenohumeral joint cartilage may represent chondrocalcinosis. BICEPS TENDON: Small amount of fluid within the biceps tendon sheath may be related to joint effusion. The biceps tendon is intact.ADDITIONAL

Output: 1.Severe supraspinatus and infraspinatus tendinopathy. Articular surface partial thickness tearing of the supraspinatus tendon.2.Degenerative tearing of the anterior labrum and superior posterior labrum. 3.Moderate joint effusion.4.Possible chondrocalcinosis within the glenohumeral joint, which can be seen in crystalline arthropathy.


Instruction: Generate impression based on findings.

Input: 38-year-old male with malignant neoplasm of the testis and left RPLND ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. Subcentimeter T2 hyperintense foci in the liver are not significantly changed and are likely benign. No suspicious liver lesions. The gallbladder is within normal limits. No intrahepatic or extrahepatic biliary ductal dilatation.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: Redemonstrated is a nonenhancing T2 hyperintense lesion on the left lateral margin of the aorta at the level of the bifurcation measuring 2.0 x 1.6 x 6.1 cm, stable to slightly smaller. Scattered subcentimeter mesenteric lymph nodes without pathologically lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Status post left orchiectomy and retroperitoneal lymph node dissection without evidence of metastatic disease to the abdomen or pelvis.2.T2 hyperintense lesion along the left lateral margin of the aorta at the level of the bifurcation is favored to represent a lymphocele or seroma.


Instruction: Generate impression based on findings.

Input: 80-year-old male with pain. Evaluate for rotator cuff tear. ROTATOR CUFF: There is a large full-thickness tear of the anterior fibers of the supraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 17 mm in AP dimension, with approximately 1.8 cm of retraction. There is increased signal abnormality within the supraspinatus muscle which may suggest an acute component. There is mild fatty infiltration of the supraspinatus muscle at the level of the myotendinous junction.The infraspinatus muscle appears intact. There is thickening and increased signal abnormality within the infraspinatus tendon indicating moderate tendinosis. There is full-thickness tearing of the anterior fibers of the infraspinatus tendon at the level of its insertion on the greater tuberosity measuring approximately 3 mm in AP dimension. There is near full-thickness undersurface tearing of the subscapularis tendon at the level of its insertion on the lesser tuberosity. There is associated medial subluxation of the long head of the biceps tendon. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a small amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is linear increased signal abnormality within the superior labrum indicating a tear, within the limitations of a non arthrogram study. The glenohumeral joint alignment is anatomic.BICEPS TENDON: Note is made of medial subluxation of the long head of the biceps tendon. There is thickening and intermediate signal abnormality within the long head of the biceps tendon indicating moderate tendinosis. There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the glenohumeral joint versus tenosynovitis.ADDITIONAL

Output: 1. Full-thickness rotator cuff tear with retraction and tendinosis as described.2. Medial subluxation of the long head of the biceps tendon with associated biceps tendinosis.3. Small glenohumeral joint effusion.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis [G35], Reason for Study: ^Reason: please do dr javed MS protocol, compare to prior History: progression MS Brain MRIThere are multifocal bihemispheric various size periventricular white matter and deep white matter FLAIR/T2 high signal intensity lesions consistent with demyelinating disease, unchanged since prior scan.There is no evidence of abnormal enhancement.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Cervical spine MRIThere are multifocal patch T12/STIR high signal intensity lesions at the level of C2, C4 and T2 level indicating involvement of demyelinating disease of cervical and thoracic spinal cord. Above described findings do not show any significant interval change since prior scan.Normal cervical lordosis is seen.The craniocervical junction is normal.Spine alignment is anatomic and the vertebral body height is appreciated.There is no evidence of spinal canal or neuroforaminal stenosis on the scan.There is no evidence of abnormal enhancement.

Output: 1. Unchanged bihemispheric various sized demyelinating disease since prior scan. No evidence of abnormal enhancement.2. Cervical spinal cord and thoracic spinal cord involvement of demyelinating disease unchanged since prior scan. No evidence of abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Extra-CNS DLBCL. There are postoperative findings related to left frontal craniotomy with a resection cavity in the middle frontal gyrus with surrounding susceptibility effect. There are unchanged areas of encephalomalacia and scattered cortical laminar necrosis in the bilateral occipital lobes, right parietal lobe, and left frontal lobe. There is also unchanged patchy high T2 signal in the left corona radiata and punctate foci of high T2 signal in the bilateral basal ganglia. There is no evidence of acute intracranial hemorrhage or acute infarct. There is no abnormal intracranial enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable. There is mucosal thickening in the maxillary sinuses.

Output: Unchanged postoperative findings in the left frontal lobe and multifocal areas of encephalomalacia.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for labral tear vs hernia History: progressive pain with ambulation and coughing Moderate to severe osteoarthritis affects the hip with full-thickness degeneration of the articular cartilage along the anterior superior aspect of the joint. There is associated osteophyte formation. There is mild enhancement of the hip joint following contrast administration indicating a mild synovitis. Subchondral foci of signal abnormality also show enhancement following contrast administration and could either represent enhancing degenerative "geodes" or erosions, however, we see no joint effusion. There is deformity and increased signal intensity within the acetabular labrum, particularly superiorly, likely representing a combination of mucoid degeneration and degenerative tearing. There is relatively mild osteoarthritis of the left hip. There is a small cyst adjacent to the left superior labrum that may reflect an underlying labral tear. Mild osteoarthritis affects the pubic symphysis. Mild osteoarthritis affects the sacroiliac joints. Severe degenerative disc disease affects the imaged lower lumbar spine.The skin appears unusually thickened and there is little subcutaneous fat between the skin and underlying gluteus maximus muscle and virtually no fat within many of the imaged muscles. The subcutaneous fat that is present posteriorly shows reticulation and enhancement suggesting mild inflammation extending along the lateral aspect of the hip. Review of the patient's medical records indicates a history of lower extremity sclerosing skin process with atypical fasciitis/lipodystrophy syndrome. There is a large uterine mass presumably representing a fibroid that was present on a prior CT examination from 2008. We see no hernia.

Output: 1. Moderate to severe osteoarthritis of the right hip with mild synovitis and enhancing subchondral foci that could represent degenerative geodes or small erosions. We see no joint effusion.2. Degeneration and tearing of the acetabular labrum.3. Other findings as described above including osteoarthritis, degenerative disc disease, a uterine fibroid, and findings compatible with the patient's history of a lower extremity sclerosing skin process with atypical fasciitis/lipodystrophy syndrome.


Instruction: Generate impression based on findings.

Input: 24-year-old female with right upper quadrant pain and elevated bilirubin. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No biliary ductal dilation. High T1 signal dependently within the gallbladder, most compatible with sludge. No cholelithiasis. No gallbladder wall thickening or enhancement.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Gallbladder sludge, but otherwise unremarkable examination.


Instruction: Generate impression based on findings.

Input: Left ankle swelling and pain. Evaluate for fracture, stress fracture, or achilles tendonitis. TENDONS: No significant abnormality noted. The tendons are intact and normal in appearance.LIGAMENTS: No significant abnormality noted. The ligaments are intact and normal in appearance.ARTICULAR SURFACES AND BONE: No significant abnormality noted. No fracture or osteochondral defect is seen ADDITIONAL

Output: No specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: The patient was placed in a prone position. A radiopaque grid was placed over the patient's mid back for needle localization. Using multidetector helical CT, axial 3 mm scans were obtained through the thoracic spine demonstrating osteolytic lesion in the T7-T8 vertebral body and disk space suspicious for osteomyelitis/diskitis as seen on the patient's recent MRI study.A trajectory was plotted into the T7-T8 intervertebral disk space using a left parapedicular approach. The patient's back was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of T7-T8 intervertebral disk. Aspiration through the coaxial13- gauge Bonopty needle yielded approximately 2 ml of viscous sero-sanguinous fluid. Next, a 22-gauge x 15-cm Chiba needle was utilized to perform fine needle aspiration which yielded another 1 ml of serosanguineous aspirate. Finally, the inner bone cutting needle was utilized to obtain a core tissue disk biopsy. The samples were placed into a vial and mixed with normal saline to facilitate microbiology analysis. The sample was sent directly to microbiology for infectious analysis (viral/bacterial/fungal, and mycobacterial cultures).The coaxial needle was removed and adequate hemostasis was achieved with manual compression for 5 minutes.The patient tolerated the procedure well with no immediate complications. The patient remained neurologically at baseline at the end of the procedure. The patient was transferred back to the inpatient unit in stable condition.

Output: Successful CT-guided fine-needle aspiration and core needle biopsy of the T7-T8 intervertebral disk.


Instruction: Generate impression based on findings.

Input: 50 year-old male with headache. Evaluate for postoperative hemorrhage. Postoperative changes status post left temporal craniotomy in the region of dural thickening seen on recent MRI, with small amount of pneumocephalus and overlying subgaleal edema and hematoma. Minimal high density is seen at the surgical cavity compatible with hemorrhage. There is mild effacement of the sylvian fissure on the left, with no additional evidence of mass effect.Encephalomalacia is again seen in the left basal ganglia/subcortical white matter, unchanged from the prior exam. The remainder of the cerebral and cerebellar hemispheres and brainstem demonstrate normal morphology and density. The ventricles are midline, with normal volume and morphology. There is no midline shift.Postoperative changes status post bitemporal craniotomies. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Expected postoperative changes status post left temporal craniotomy.


Instruction: Generate impression based on findings.

Input: Reason: Jay has mosaic neurofibromatosis and bilateral optic nerve gliomas s/p chemotherapy History: off therapy evaluation There is redemonstration of a oval T2/FLAIR hyperintense lesion along the right optic tract, extending inferiorly into the mesial right temporal lobe. This lesion measures 13 x 14 x 12 mm, compared to previous measurements of 12 x 12 x 13 mm, respectively. There is persistent enhancement, which is now increased in thickness peripherally. On the April 2015 exam, the lesion measured 9 x 12 x 7 mm, respectively.There is also a nonenhancing T2/FLAIR hyperintense and T1 hypointense lesion in the left optic chiasm/hypothalamus, measuring 11 x 12 mm in greatest axial dimensions, x 12 mm CC, compared to previous comparable measurements of 10 x 13 x 12 mm, respectively. This has not significantly changed since prior exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Smaller foci of T2/FLAIR hyperintensity along the more posterior portions of the bilateral optic tracts continue to appear similar.There is redemonstration of an oval peripherally enhancing right orbital segment optic nerve lesion with central cystic appearance, measuring up to 7 mm AP. Orbital structures are otherwise unremarkable. There is mild scattered mucosal thickening within the paranasal sinuses.

Output: 1. Slight increased thickness of rind of enhancement associated with right optic tract lesion extending into the mesial right temporal lobe, with slight increased size especially when compared to more remote exams. This is again concerning for progression of disease.2. Other presumed bilateral optic pathway gliomas are stable.


Instruction: Generate impression based on findings.

Input: Hypodense liver lesions seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is of normal morphology size and signal intensity. Best seen on the postcontrast images are several relatively hypointense lesions in the right hepatic lobe with the largest measuring 1.2 x 1.1 cm (series 1 203/43). This lesion is minimally hyperintense to liver parenchyma on precontrast T1-weighted imaging. There is no associated arterial enhancement restricted diffusion or T2 weighted signal abnormality.There are several punctate intrinsically T1 weighted hyperintense foci in the liver (series 1 201/34). None of these lesions demonstrate arterial enhancement. Many of the lesions noted on the recent prior CT are not discretely seen on today's study.Note is made of mild prominence of the portal vein and hepatic veins with a dilated IVC.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Not all of the lesions seen on the recent CT are evident on today's MRI suggesting that these lesions are isointense to the liver. The largest lesion measuring 1.2 cm in the posterior right hepatic segment is minimally hyperintense to liver parenchyma on T1-weighted imaging without associated arterial enhancement, restricted diffusion or T2 weighted signal abnormality. Overall these findings suggest that these lesions are hepatocellular in origin. In the absence of known chronic liver disease or cancer these are unlikely to be malignant. Rather, given the patient's cardiac history and findings suggestive of elevated right-sided heart pressure, congestive hepatopathy should be considered with associated development of large regenerative nodules, although the lack of arterial enhancement is somewhat atypical. Hepatologic follow-up and work-up for congestive hepatopathy should be considered.


Instruction: Generate impression based on findings.

Input: 85 year-old man with confusion and dysarthria. There is a left frontal area of encephalomalacia consistent with old ACA stroke. This finding was present on the prior study dated 2/15/2006. There are no CT findings of intracranial hemorrhage. There are no CT findings of acute stroke. However, if stroke is of clinical concern recommend MRI.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: 1. Left frontal encephalomalacia consistent with old ACA stroke.2. No CT findings of intracranial hemorrhage or acute stroke. However, if stroke is a clinical concern recommend MRI.These findings were reported to Dr. Corning at 3:30 p.m. 08/11/2008.


Instruction: Generate impression based on findings.

Input: There is no acute infarct, mass effect, or cerebral edema. There is a slightly larger right high parietal convexity dural based enhancing mass measuring up to 5 x 14 mm (series 12 image 11) compared to 3 x 12 mm previously, without significant surrounding vasogenic edema or mass-effect. There are minimal scattered punctate T2 signal abnormalities in the periventricular and subcortical white matter, nonspecific, likely representing chronic microvascular ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.

Output: Slightly larger right parietal convexity presumed meningioma without associated mass effect or vasogenic edema.


Instruction: Generate impression based on findings.

Input: Reason: Hx of AML with pancytopenia, with Rt shoulder pain History: shoulder pain ROTATOR CUFF: Mild thickening and slightly increased signal at the distal supraspinatus and infraspinatus tendon without evidence of tear. Subscapularis and teres minor tendons are intact. Mild teres minor atrophy.SUPRASPINATUS OUTLET: Mild to moderate osteoarthritis of the AC joint. No significant fluid in the subacromial subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is fluid signal through the anterior superior labrum, which may represent tear (series 10 image 11). There is also diffuse increased signal intensity and globus appearance of the anterior inferior labrum, which may represent degeneration (series 10 image 9).BICEPS TENDON: Tendon of the long head of the biceps is normal. ADDITIONAL

Output: 1. Small joint effusion with debris suggestive of synovitis.2. Findings suggestive of anterior labral tear and degeneration as above.


Instruction: Generate impression based on findings.

Input: Female 57 years old Reason: evaluate for torn cruciate ligaments History: falling, knee giving way MENISCI: There is marked truncation of the body of the lateral meniscus representing a large tear in the absence of prior meniscal surgery. There is also attenuation of the anterior horn of lateral meniscus, with increased signal that extends to the free edge and femoral articular surface, indicating additional tearing. There is also fraying/degenerative tearing along the undersurface and free edge of the posterior horn of the lateral meniscus. Medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is severe osteoarthritis of the lateral compartment with portions of the lateral femoral condyle and lateral tibial plateau devoid of articular cartilage. There is degenerative signal abnormality in the underlying subchondral bone. There is mild heterogeneity of the articular cartilage of the medial femoral condyle indicating mild degeneration. There is superficial fraying of the articular cartilage of the patella and focal thinning along the far medial aspect of the patella. There are small tricompartmental osteophytes.LIGAMENTS: Cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Severe osteoarthritis of the lateral tibiofemoral compartment with extensive tearing of the lateral meniscus, particularly its body. Other findings as described above; the cruciate ligaments are intact.


Instruction: Generate impression based on findings.

Input: Pain in left knee. Please assess lateral structures including biceps and LCL. Injury was in September. MENISCI: There is a complex tear of the lateral meniscus with branching signal abnormality in the posterior horn of the meniscus extending to the tibial articular surface, as well as a defect within the superior fibers of the posterior body of the meniscus and what we suspect is a displaced fragment between the posterior horn and popliteal tendon. This tear also extends horizontally to involve the body and anterior horn, with extension to the tibial articular surface. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: Mild bone marrow edema is present at the lateral aspect of the proximal fibula. We see no fluid-filled cartilage defect. An ossific density seen on the recent radiograph adjacent to the proximal fibular tip may either represent a subacute avulsion fracture fragment or posttraumatic heterotopic ossification, but is not clearly visualized on this MRI study. LIGAMENTS: There is thickening and increased signal intensity in the distal half of the anterior cruciate ligament, likely representing subacute full-thickness rupture. The posterior cruciate ligament and medial collateral ligament are intact. There is thickening of the distal biceps femoris tendon and intermediate signal intensity separating the distal fibers of the tendon and lateral collateral ligament proper from the fibular head. These findings are compatible with a partial thickness tear/full-thickness tear with interposed granulation tissue. The iliotibial band is intact.EXTENSOR MECHANISM: No significant abnormality noted.

Output: 1.No comparison studies have been submitted to Poiesis.2.Complete tear of the lateral meniscus, as described above.3.ACL tear.4.Findings suggest prior injury to the biceps femoris tendon and lateral collateral ligament ligament, either representing a partial-thickness tear, or more likely a healing full-thickness tear.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a single nonspecific punctate focus of T2/FLAIR hyperintensity left centrum semiovale There are no areas of pathological enhancement. There is no diffusion abnormality to suggest recent ischemia. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a moderate-sized air-fluid level in the right maxillary sinus mild circumferential mucosal thickening. The right maxillary sinus contents demonstrates mild diffusion restriction dependently. There is also mild mucosal thickening along the right anterior ethmoid air cells.CERVICAL SPINE

Output: 1.No acute intracranial abnormality. Punctate focus of nonenhancing nonspecific FLAIR hyperintensity in the left centrum semiovale.2.Moderate-sized air-fluid level in the right maxillary sinus with associated diffusion restriction concerning for acute sinusitis. Please correlate clinically for possibility of etiology of headache.3.Minimal mid cervical spondylotic changes as detailed above with no high-grade central spinal canal stenosis. Findings most conspicuous at C4-C5 where there is a small right paracentral disc extrusion abutting the right ventral cord. Mild to moderate right foraminal narrowing at C5-C6 and C6-C7.


Instruction: Generate impression based on findings.

Input: Please evaluate for malformations, hydrocephalus, or tumors: speech delay, macrocephaly, 5 cafe-au-lait spots one large (12x15cm). Brain: The lateral ventricles and third ventricle are diffusely prominent. The cerebral aqueduct and fourth ventricles are intact. There is a left medial middle cranial fossa arachnoid cyst that measures 15 mm in width. There is a mega cisternal magna. 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 is a normal degree of myelination. There is no abnormal intracranial enhancement. Orbits: The globes and ocular adnexa are intact. No intraorbital enhancement or mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. The optic nerves are grossly unremarkable.

Output: 1. Prominence of the triventricular system and a left middle cranial fossa arachnoid cyst. Otherwise, no stigmata of neurofibromatosis type 1, intracranial tumors, or hemorrhage. 2. Unremarkable orbits.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. The subarachnoid spaces are enlarged bilaterally along the anterior frontal and temporal lobes, along with prominence of the ventricles. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRI of the internal auditory canal shows no abnormal enhancement. Normal T2 signal is identified associated with inner ear structures. Cranial nerves 7 and 8 are intact bilaterally, however the distal left cochlear nerve is similar in size but slightly less T2 hypointense than the right. There is a small area of increased T2 signal within the left middle ear/mastoid.

Output: 1.The distal left cochlear nerve is similar in size but with apparent slightly less T2 hypointense signal than the right, and adjacent nerves within the IAC. No definite associated enhancement. This finding is of uncertain clinical significance and could possibly be technical, however correlation with clinical exam and hearing tests are recommended. Unremarkable MR appearance of the inner ear structures.2.Nonspecific small area of T2 signal within the left middle ear/mastoid. This could be further evaluated with CT temporal bone if clinically warranted.3.Enlarged subarachnoid spaces likely represents benign enlargement of the subarachnoid spaces in infancy, which usually resolves by the age of two. Follow-up is recommended.


Instruction: Generate impression based on findings.

Input: New left sided weakness, recent seizure. There is no evidence of acute infarct. There are multiple areas of encephalomalacia involving the bilateral cerebellar hemispheres, and right occipital and parietal lobes. There is no abnormal intracranial enhancement. There is moderate scattered patchy cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.

Output: Chronic infarcts in multiple vascular territories and chronic small vessel ischemic disease, but no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 48-year-old male with history of back pain. Evaluate for acute cord compression. There is no evidence of acute cord compression. There is linear STIR signal abnormality throughout the cord which is likely artifactual. Otherwise, spinal cord signal intensity is normal although the mid cervical cord appears decreased in the AP dimension. The bony spinal canal is developmentally narrowed along the cervical spine due to shortened pedicles. Vertebral body heights are maintained. Bone marrow signal is normal. There is prominent dorsal epidural fat in the lumbar spine which causes diffuse mild spinal canal narrowing. There is a mild disc bulge at C3-4 and a moderate disc bulge at C4-5 and C5-6.A dedicated cervical spine MRI will be dictated separately.

Output: 1. No evidence of acute cord compression.2. Developmentally narrowed spinal canal with mild degenerative changes as above.3. A dedicated cervical spine MRI will be dictated separately.


Instruction: Generate impression based on findings.

Input: 53-year-old male with newly diagnosed prostate cancer undergoing prostatectomy. Patient is on research protocol.Pathology: Prostatic adenocarcinoma, Gleason grade 3+4=7 in the left lateral base PELVIS:PROSTATE:Prostate Size: 4.5 x 2.2 cmPeripheral Zone: There is a T2 hypointense lesion in the left lateral mid gland and base with corresponding hypointensity on ADC and early contrast enhancement consistent with history of adenocarcinoma. This lesion measures 14 x 10 mm (series 701, image 16). This lesion may abut the left perineural fat; although discrete perineural invasion cannot be excluded (series 2/2/2001, image 984).Additionally, there are regions of T1 hyperintensity and T2 hypointensity in the peripheral zone, most likely secondary to hemorrhage from previous biopsy.Central Gland: There are benign appearing hyperplastic nodules in the central gland.Seminal Vesicles: Seminal vesicles are unremarkable.Extracapsular Extension: This lesion may abut the left perineural fat; although, perineural invasion cannot be excluded (series 2201, image 984).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a T2 hyperintense focus in the right internal obturator muscle without contrast enhancement (series 701, image 16) most consistent with a benign lesion.

Output: Left lateral mid gland and base lesion as above consistent with adenocarcinoma. The lesion may abut the left perineural fat; although, perineural invasion cannot be excluded.


Instruction: Generate impression based on findings.

Input: 67-year-old female with history of left breast IDC and DCIS, status post lumpectomy in 2005 followed by chemotherapy, radiation and hormonal therapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Moderate motion artifacts are seen.Stable lumpectomy changes are present in the left inferior breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Diagnosis: Malignant neoplasm of major salivary gland, unspecified Malignant neoplasm of parotid gland. Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasmClinical question: h/o salivary gland ca and CRT, compare to previous, measurements please. MRI brain:The patient is status post right parotidectomy. There is opacification of the right mastoid air cells.Enhancement along the tympanic portion, geniculate portion and descending portion of the right facial nerve remains stable compared to the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. Incidental note is made of fenestration of the basilar artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the orbits are intact.MRI Neck:The patient is status post right parotidectomy. The right mandibular gland is smaller than the left submandibular gland. The patient is status post right neck dissection.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears stable to the extent of visualization...The carotid and vertebral vasculature visualized on this exam appears intact.The upper cervical vertebral bodies in general are intact with no evidence for canal stenosis.

Output: 1.There is redemonstration of enhancement and thickening of the right facial nerve which is suspicious for perineural spread of disease. This is stable compared to the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Status post right parotidectomy and right neck dissection.4.Opacification of the right mastoid air cells continues to be present and has increased relative to the prior exam . It now also involves the petrous apex. This is nonspecific


Instruction: Generate impression based on findings.

Input: 69-year-old man with history of Lynch syndrome status post resection of small bowel adenocarcinoma in 8/2014. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder are normal.SPLEEN: The spleen is normal.PANCREAS: The pancreas appears normal.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: The kidneys are normal and enhance symmetrically.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Postsurgical changes are noted with subtotal colectomy. There is no enhancing mass to suggest tumor.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: PROSTATE GLAND: No significant abnormality noted.BLADDER: The bladder is normal.LYMPH NODES: No significant lymphadenopathy noted.BOWEL, MESENTERY: Postoperative findings are noted. There is mild dilation of the bowel at the anastomotic site without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Postoperative changes without evidence of recurrent disease.


Instruction: Generate impression based on findings.

Input: Altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is punctate SWI signal hypointensity along the right and left frontal subcortical white matter and medial left parietal subcortical white matter.There is patchy T2 and FLAIR signal hyperintensity along the pons and right thalamus.There are a couple right sided periventricular white matter lesions present which display T2 and FLAIR signal hyperintensity.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 brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 2.5 mm left communicating segment ICA aneurysm directed inferiorly and posteriorly. The proximal portion of the left anterior choroidal artery courses adjacent and medial to this aneurysmThere is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right PCOMA is large. The left PCOMA is small. The vertebral arteries are similar in size.There is fenestration of the left A1 segment.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.2.2.5mm left PCOMA aneurysm. Long term follow-up imaging is suggested.3.Several subcortical microhemorrhages are non-specific, however, it could represent early evidence for amyloid angiopathy.4.Lesions in the pons and right thalamus are suspected to be vascular related.5.No evidence for carotid or vertebral cervical cerebrovascular occlusive disease.6.Fast sequences were used due to patient instability. This may decrease sensitivity to smaller lesions.


Instruction: Generate impression based on findings.

Input: Back pain, r/o abscess History: Focal spinal tenderness, HIV+, urinary incontinence Vertebral body heights in the thoracic spine are normal. Alignment is normal. No abnormal signal is seen within the thoracic cord. No evidence of epidural or paraspinous fluid collections. No significant spinal canal or neural foraminal stenosis. Bone marrow is heterogeneous similar to prior which is nonspecific without focal suspicious lesions.Vertebral body heights in the lumbar spine are normal. Alignment is normal. Bone marrow is heterogeneous, which is nonspecific, without focal suspicious lesions. Conus is in normal position. No evidence of epidural or paraspinous fluid collections. No significant spinal canal or neural foraminal stenosis.

Output: Slightly limited evaluation for infection in the absence of intravenous gadolinium. There is however no appreciable edema or fluid collections in the thoracolumbar spine or paraspinous soft tissues to suggest infection or abscess. No spinal canal or neural foraminal stenosis in the thoracic or lumbar spine. No cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: please evaluate for stroke History: h/o meningioma sp resection, seizures, p/w acute onset aphasia given tPA Brain MRIThere are scattered restricted diffusion lesions involving left frontal operculum (frontal lobe) and insular cortex indicating acute ischemic stroke. Associated susceptibility lesions especially at subcortical white mater of anterior aspect of insular cortex suggest hemorrhagic transformation.There is focal tissue loss on the left frontal lobe which likely to be related to prior meningioma surgery.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal.The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus. Both eye lenses are not seen indicating postoperative changes.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) of luminal stenosis at the right MCA M1 segment.The left MCA and bilateral ACAs appear to be normal.Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate subtle luminal irregularities on bilateral carotid bulbs without evidence of luminal stenosis.Otherwise, there are normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. Acute ischemic infarction involving left MCA territory, specifically left frontal lobe and insular cortex with focal hemorrhagic conversion.2. Significant (more than 50%) luminal stenosis of the right MCA M1 segment. Otherwise unremarkable intracranial arterial system.3. Subtle irregularities of bilateral carotid bulbs without evidence of luminal narrowing. Otherwise unremarkable extracranial craniofacial arterial system.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with straightening of normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are postsurgical findings of laminectomy from L2-L5 levels and changes related to tethered cord release. The conus terminates at the L4-L5 level. Probable developmental dysraphism of the sacrum is again noted. There is redemonstration of a dilated central canal involving the distal spinal cord which is most pronounced at L3 level measuring 8 mm x 6 mm x 39 mm (AP by transverse x craniocaudal dimensions) previously 9 mm x 6 mm x 39 mm. Hyperintense T1 and T2 lesion is again seen eccentric along the distal thecal sac consistent with a lipoma. There is a plaque-like area of additional fat signal extending distally distal to the sac in the area of dysraphism, unchanged from piror examination. There is no significant ventral motion of the distal spinal cord and conus on prone imaging although there is motion involving the more proximal cord.There is a partially visualized syrinx involving the thoracic spinal cord at the T9 level measuring 4 x 4 mm. The syrinx was present on recent prior studies although not completely included in the field-of-view, limiting comparison. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.A small amount of pelvic free fluid is again demonstrated.

Output: 1.Postsurgical changes of laminectomy and tethered cord release with persistent low lying conus. The lumbar syrinx appears similar to prior examination. There is no significant ventral motion of the distal cord on prone imaging similar to prior examination. Again, this may relate to possible re-tethering in the appropriate clinical setting.2. There is a partially visualized small syrinx involving the thoracic cord which was present on recent prior examinations although not completely included in the field-of-view and therefore comparison is limited. If further evaluation is needed, dedicated imaging of the thoracic spine may be considered. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: Rathke's cleft cyst, evaluate for change. Signs and symptoms: Surveillance scan. Pre- and post enhanced pituitary MRI: Images are degraded due to motion artifact in particular on enhanced series.Within this limitation examination again demonstrate a mass with T1 hyperintense and T2 isointense signal intensity and with hypoenhancement on postinfusion series within the pituitary gland on the left and with mild extension across the midline to the right. The mass measures approximately 13 mm in transverse axis and an 7 mm in height which are measured on coronal post enhanced series. The overall appearance, signal intensity and size of this findings remains fairly similar to prior exam and without convincing evidence of change considering suboptimal post enhanced images.There is no evidence of extension of the lesion into the cavernous sinuses. The mass over slightly bulges into the basal cistern and is in contact with the suprasellar visual complex similar to prior exam. Pituitary stalk demonstrates normal size and enhancement similar to prior exam.Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrate normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.Stable pituitary lesion suggestive of a Rathke's cleft cyst without evidence of change since prior exam.2.Unremarkable pre and post enhanced brain MRI.


Instruction: Generate impression based on findings.

Input: Headache after transphenoidal surgery for intrasellar mass with hemorrhage. There are postoperative findings related to recent transsphenoidal surgery. There is a small amount of fluid signal along the inferior aspect of the pituitary, measuring up to 3 mm in thickness, which corresponds to the site of the decompressed cystic lesion. There is also heterogeneous material within the sphenoid sinuses, which may represent at least in part blood products. Otherwise, the remaining pituitary gland is not enlarged and the infundibulum is intact. There is no mass effect upon the cavernous sinuses or optic apparatus. There is a subcentimeter focus of heterotopic grey matter along the lateral aspect of the right lateral ventricle.

Output: 1. Postoperative findings related to recent transsphenoidal surgery, with interval decompression of a cystic pituitary lesion and hemorrhagic material within the sphenoid sinuses.2. Subcentimeter focus of heterotopic grey matter along the lateral aspect of the right lateral ventricle.