Instruction: Generate impression based on findings.

Input: Female, 69 years old, with complaint of imbalance for three weeks. History of hypertension, CSF leak, seizure disorder. Presumed sequelae of sphenoethmoidal encephalocele repair are again seen. This includes encephalomalacia of the left gyrus rectus which has become more prominent when compared to the prior examination. While this examination is not tailored for a fine assessment of the skull base, no evidence of any significant or large encephalocele recurrence is seen.Scattered small foci of T2 hyperintensity are seen in the cerebral white matter and within the pons which also contains a more linear focal defect, all of which shows no significant interval change.Mild prominence of the CSF space along the anterior left temporal lobe is unchanged. No new or concerning extra-axial collections are seen. No evidence of significant intracranial hemorrhage is detected. The ventricular system is stable and normal in size.

Output: 1.Redemonstration of presumed sequelae of sphenoethmoidal encephalocele repair. Since the prior examination, encephalomalacia of the left gyrus rectus has become more prominent. Otherwise, no significant changes are seen.2.Scattered white matter and pontine lesions are redemonstrated, similar to the prior examination, likely representing chronic small vessel and lacunar ischemic disease.3.No new intracranial findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Pain and weakness after a fall. Question of rotator cuff tear. ROTATOR CUFF: There is a full thickness insertional tear involving the supraspinatus tendon with minimal retraction. We estimate the tear to measure just under 2 cm in the AP dimension. Increased signal intensity within the distal supraspinatus suggests mild tendinosis and fraying. The supraspinatus muscle appears normal. Small cysts in the lateral aspect of the humeral head is likely related to overlying rotator cuff pathology. There is also a small linear tear of the infraspinous tendon that appears to predominantly involve the undersurface fibers although it may extend to the bursal surface fibers as well without any retraction. The infraspinatus muscle appears normal. Thickening of the subscapularis tendon with intrasubstance signal distally likely represents tendinosis or perhaps interstitial tearing. The subscapularis muscle appears normal. The teres minor muscle/tendon appears normal.SUPRASPINATUS OUTLET: There is an os acromiale with mild osteoarthritis of the acromioclavicular joint. A small amount of fluid in the subacromial/subdeltoid bursa contains small foci of intermediate signal intensity presumably reflecting debris.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. Evaluation of the glenoid labrum is limited due to lack of intra-articular contrast; however, intermediate signal intensity throughout much of the labrum suggests degenerative tearing. There appears to be a small paralabral cyst along the posteroinferior aspect of the labrum.BICEPS TENDON: The tendon of the long head of the biceps appears intact.

Output: 1. Rotator cuff tears as described above.2. Os acromiale and acromioclavicular joint osteoarthritis.3. Degenerative tearing of the labrum.


Instruction: Generate impression based on findings.

Input: 42 years Male (DOB:5/26/1973)Reason: please do dr Javed MS protocol compare to prior History: weakness, blurring of visionPROVIDER/ATTENDING NAME: JACQUELINE T BERNARD JACQUELINE T BERNARD There is redemonstration of periventricular white matter lesions perpendicularly oriented to the lateral ventricles as well as a lesion in the right cerebral peduncle and some subcortical white matter lesions. These appear stable and compared to the previous exam. No abnormal foci of contrast enhancement are appreciated within the brain parenchyma. Another FLAIR hyperintense lesions present in the left half of the cervical medullary junction.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 mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is redemonstration of periventricular and subcortical white matter lesions as well as a lesion the right cerebral peduncle and left anterolateral aspect of the cervicomedullary junction which are stable since the prior exam and support the patient's clinical diagnosis of demyelinating disorder.


Instruction: Generate impression based on findings.

Input: Lower back pain. Hx of pelvic pain and spastic pelvic floor syndrome Five lumbar type vertebral bodies are presumed to be present. There is evidence of mild scoliosis which can be better assessed with standing radiographs. There is also mild retrolisthesis of L1 on L2. Alignment is otherwise grossly maintained. Bone marrow signal is benign. The conus medullaris is normal in position. Moderate degenerative changes are present in the lumbar spine including loss of disc height at all levels and evidence of multilevel vacuum phenomena, which is worst at the L2-L3 level. There is associated edematous marrow signal change involving the superior endplate of L3. Vertebral body heights are grossly maintained.Individual levels as below:L1-L2: Mild retrolisthesis, disc bulge, and moderate bilateral facet arthropathy. There is no significant central canal stenosis. There is mild left neural foraminal stenosis. No significant right neural foraminal narrowing.L2-L3: Mild disc bulge, moderate bilateral facet arthropathy, and ligamentum flavum thickening. Minimal central canal narrowing. There is mild to moderate bilateral, left greater than right neural foraminal stenosis. L3-L4: There is a disc bulge, bilateral facet arthropathy, ligamentum flavum thickening, and prominence of the epidural fat. There is resulting mild to moderate central canal stenosis. There is mild to moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.L4-L5: There is a disc bulge eccentric to the right as well as a small central protrusion. There is also ligamentum flavum thickening, bilateral facet arthropathy, and prominence of the epidural fat contributing to mild central canal stenosis. There is moderate right-sided neural foraminal stenosis. There is mild left neural foraminal stenosis.L5-S1: There is mild disc bulge, advanced bilateral facet arthropathy, as well as ligamentum flavum thickening. There is effacement of the lateral recesses, left worse than right. There is also mild central canal stenosis. There is moderate to severe left and mild to moderate right neural foraminal stenosis.

Output: Moderate degenerative changes throughout the lumbar spine. There is mild to moderate central canal stenosis at the L3-L4 level and to a slightly lesser degree at additional levels as detailed above. There is also multilevel neural foraminal narrowing which is worst at the right L4-L5 and left L5-S1 levels. There is also advanced bilateral facet arthropathy throughout the lumbar spine which may be contributing to patient's back pain.


Instruction: Generate impression based on findings.

Input: Epilepsy, unspecified, not intractable, without status epilepticus [G40.909], Reason for Study: ^Reason: Seizures-evaluate for structural cause History: seizures 22 years Female (DOB:8/28/1994)Reason: Seizures-evaluate for structural cause History: seizuresPROVIDER/ATTENDING NAME: SANDRA L ROSE SANDRA L ROSE There is a focal susceptibility lesion at the mid Pons which is connected with a linear signal void. Subtle T2/FLAIR high signal intensity are seen around the susceptibility lesion. There is no associated diffusion restriction. There is no evidence of T1 high signal intensity.Constellation of above findings indicate possible focal cavernous malformation associated with developmental venous anomaly. Differential diagnosis include petechial chronic pontine hemorrhage, mineralization or capillary telangiectasia. Possibility of brain AVM is remote.Gadolinium enhanced brain MRI can be considered for further imaging evaluation if clinically indicated.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in major intracranial arterial system.Complete opacification of the right maxillary sinus and a couple of retention cysts on the left maxillary sinus are seen.The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1. Focal susceptibility lesion associated linear signal void at mid pons without evidence of surrounding edema or mass effects. Differential diagnosis include cavernous malformation with DVA, capillary telangiectasia, chronic petechial hemorrhage or mineralization.2. No acute ischemic lesion.MRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Ms. Nichols is a 60 year old female with a strong family history of breast cancer in mother, sister, and paternal grandmother. Personal history of bilateral benign breast biopsies including left breast biopsy in 2007 for fibroadenoma. Patient is BRCA1 positive. There is heterogeneous amount of fibroglandular tissue in both breasts. Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.Subcentimeter left hepatic cyst is stable.

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


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: r/o stroke History: AMS, ?left sided weakness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There are multifocal lacunar infarcts involving mid Pons especially on the right side, left thalamus and the left frontal lobe.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter are seen, these are nonspecific but may indicate small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal.The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multiple various degreed intracranial arterial luminal stenosis and irregularity are seen indicating atherosclerotic changes. In particular, left internal carotid artery cavernous sinus segment shows significant signal loss suggesting about 50% of luminal stenosis. Vertebrobasilar system hypoplastic left distal vertebral artery otherwise vertebrobasilar system appears to be normal.No intracranial arterial aneurysm is seen.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal lacunar infarcts involving mid Pons left side, left thalamus, and left frontal lobe.3. Minimal nonspecific small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: NF1: hands lock at times and can't grasp things. Cervical Spine: There is apparent mild thickening of multiple cervical nerve roots traversing the neural foramina. There is otherwise not mass effect upon the spinal cord or abnormal spinal cord signal. There are multiple subcentimeter T2 hyperintense nodules in the skin and subcutaneous tissues of the neck. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. There are partially imaged T2 hyperintense lesion in the cerebellum.Lumbar Spine: There is an unchanged fusiform lesion within the right L3-4 neural foramen with a targetoid appearance that measures up to 10 mm in width. There is also an unchanged fusiform lesion in the T12-L2 neural foramen that measures up to 8 mm in width. In addition, there appears to be enlargement of multiple sacral neural foramina. There are numerous T2 hyperintense nodules in the thoracic and lumbar paraspinous muscles, psoas muscles and subcutaneous fat. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is mild facet hypertrophy in the lower lumbar spine, but no significant spinal canal stenosis. The spinal cord displays normal signal and morphology.

Output: 1. Apparent mild thickening of multiple cervical nerve roots traversing the neural foramina, as well as mild enlargement of multiple sacral nerve roots, are compatible with stigmata of NF1. 2. Unchanged neurofibroma in the right L3-L4 and left T12-L1 neural foramina. 3. Numerous neurofibromas in the cervical and lumbar paraspinous muscles, subcutaneous tissues, and skin. 4. Partially imaged T2 hyperintense lesion in the cerebellum are compatible with stigmata of NF1, but are better depicted on the prior brain MRI.


Instruction: Generate impression based on findings.

Input: Male, 59 years old, with acute onset of truncal ataxia, right gaze weakness, hyperreflexia, high suspicion for Miller Fisher variant of GBS. Brain:A 3 mm focus of hyperintensity is seen within the subcortical white matter of the right precentral gyrus. No other areas of significant parenchymal signal abnormality are seen. No restricted diffusion is detected. There is no edema or mass effect. No pathologic parenchymal or extra-axial enhancement is seen. No findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid is detected. The ventricles are within normal limits.Cervical spine:Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body morphology is unremarkable. No concerning marrow replacement or pathologic marrow enhancement is seen. A Schmorl's node deformity is seen at T3-4.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intramedullary or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Disc osteophyte formation with a central disc extrusion which contacts and minimally deforms the cord. No significant generalized canal stenosis seen. No significant foraminal narrowing is evident. C4-5: Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate left foraminal narrowing. C6-7: Posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No specific lesions are seen in the brain or cervical spine to correlate with the suspected Miller Fisher syndrome.2.Disc degeneration is seen in the cervical spine, most notably affecting the C3-4 level where there is a disc extrusion which mildly impinges on the cord.


Instruction: Generate impression based on findings.

Input: Diplopia resolved, evaluate for new lesions compared to 12/2014. Again seen are greater than 20 foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter. No new lesions compared to 12/5/2014 are appreciated. No intracranial mass or mass effect. No evidence of acute ischemia or hemorrhage. No hydrocephalus. No extra-axial collections. Brain parenchymal volume is preserved. Mucous retention cysts in the maxillary sinuses, right larger than left, again seen and unchanged. Major flow-voids are preserved. Bone marrow signal is within normal limits.

Output: Multiple T2/FLAIR hyperintense lesions in the periventricular and subcortical white matter are compatible with known demyelinating disease. No new lesions compared to 12/5/2014 are appreciated.


Instruction: Generate impression based on findings.

Input: 26-year-old female with dropping hemoglobin and recent history of groin catheter placement. Evaluate for left retroperitoneal hematoma ABDOMEN:LUNG BASES: Bilateral large pleural effusions and dependent atelectasis, new from previous study.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Pancreas demonstrates fatty atrophy. The pancreatic duct in the tail is significantly dilated, measuring up to 12-mm. In the mid body SPECT its normal size. This finding is new from previous study. There is inflammation of the pancreatic tail. These findings may be secondary to pancreatitis. A solid lesion causing pancreatic ductal stricture cannot be excluded. No evidence of calcification. The pancreas. Further evaluation of this finding with MRI is recommended.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic bilateral kidneys.RETROPERITONEUM, LYMPH NODES: Left-sided common femoral venous catheter extends into the super renal IVC. No evidence of retroperitoneal hematoma.BOWEL, MESENTERY: Generalized ascites.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Generalized anasarca.OTHER: Generalized ascites.

Output: Interval dilatation of the pancreatic duct in the tail and associated peripancreatic minimal inflammatory findings. M.R.C.P. is recommended for further evaluation of the pancreatic duct. Fatty replacement of the pancreas.Bilateral pleural effusions, ascites, and generalized anasarca.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial mass or neuronal migrational abnormalities. Aside from terminal zones of myelination, the brain parenchyma appears to be unremarkable. There are prominent subarachnoid spaces along the anterior temporal poles, right larger than left, which may represent arachnoid cyst formation. There is no midline shift. The ventricles are normal in size and configuration. There is no evidence of acute infarction of intracranial hemorrhage. There is an ovoid lesion in the midline of the junctional zone of the tongue that measures up to 12 mm.

Output: 1. No potential seizure foci are identified.2. Prominent subarachnoid spaces along the anterior temporal poles, right larger than left, may represent arachnoid cyst formation.3. Probable thyroglossal duct cyst in the junctional zone of the tongue, which is otherwise incompletely characterized. An ultrasound of this region may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: left ulnar styloid fracture now with pain, eval for TFCC tear History: left ulnar styloid fracture now with pain, eval for TFCC tear LIGAMENTS: No intra-articular gadolinium is identified traversing the scapholunate or lunotriquetral ligament to suggest a tear. No intra-articular gadolinium is identified within the midcarpal joint or distal radioulnar joint.TRIANGULAR FIBROCARTILAGE COMPLEX: The trigonal fibrocartilage complex appears intact. There is slight heterogeneity of the triangular fibrocartilage complex which may reflect mild degeneration.TENDONS: There is circumferential fluid within the tendon sheath of the extensor carpi radialis which is likely iatrogenic, but may reflect a mild tenosynovitis. The flexor and extensor tendons appear intact BONES: Note is made of a minimally displaced fracture of the ulnar styloid. Lack of surrounding bone marrow edema suggests this is chronic in etiology. No additional bone marrow signal abnormality is identified.ADDITIONAL

Output: No findings to suggest disruption of the triangular fibrocartilage complex. Chronic appearing ulnar styloid fracture. Other findings as described above.


Instruction: Generate impression based on findings.

Input: 63 year old woman with history of PMR, recent admission with fevers, mild troponin elevation, referred for cardiac MRI for further evaluation of underlying ischemia or myocarditis.MEDICATIONS: ASA, Lipitor, metformin, Victoza, prednisone First Pass PerfusionDuring hyperemia, no perfusion defects were present.Viability/ Myocardial ScarThere is no late gadolinium enhancement to suggest prior myocardial infarction or underlying myocardial fibrosis, inflammation, or infiltration. The entire myocardium is viable. Additionally, there is no evidence of increased myocardial T2-signal or early gadolinium enhancement to suggest acute myocarditis. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 68%, the LV end diastolic volume index is 69 ml/m2 (normal range: 65+/-11), the LVEDV is 135 ml (normal range 109+/-23), the LV end systolic volume index is 22 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 34 g/m2, and the LV mass is 66 g. There are no regional wall motion abnormalities present. Left AtriumThe left atrium is normal in size. There is lipomatous hypertrophy of the interatrial septum.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 85 ml/m2 (normal range 69+/-14), the RVEDV is 168 ml (normal range 110+/-24), the RV end systolic volume index is 33 ml/m2 (normal range 22+/-8), and the RVESV is 64 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a "bovine arch" branching pattern (common origin of innominate and left common carotid artery).Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease. Normal pericardial thickness without evidence of acute pericarditis. 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. No perfusion defects/ "ischemia" present during hyperemia.2. No prior myocardial infarction. The entire myocardium is viable.3. There no evidence of myocardial infarction or underlying myocardial fibrosis, inflammation, or infiltration. No evidence of acute myocarditis. 4. Normal LV size and systolic function (LVEF 68%).5. Normal RV size and systolic function (RVEF 62%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 13 years Male (DOB:8/9/2003)Reason: 13 yo male with intractable epilepsy, static encephalopathy, and marked atrophy in previous imaging. Please evaluate for progression of atrophy. History: 13 yo male with intractable epilepsy and static encephalopathyPROVIDER/ATTENDING NAME: AUDREY OETOMO CHARLES J. MARCUCCILLI There is ventriculomegaly present in generalized brain atrophy. No abnormal mass lesions are appreciated intracranially.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 minor opacities.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Generalized brain atrophy and ventriculomegaly..


Instruction: Generate impression based on findings.

Input: Clinical question: Rule out aneurysm, intracranial hemorrhage. Signs and symptoms: Headaches. CTA of intracranial circulation:140 cc of Omnipaque 350 was administered for this exam.3-D reformatted images were obtained utilizing an independent workstation.Vertebral/basilar system.Normal appearing bilateral intracranial vertebral arteries, bilateral pica branches, basilar artery, superior cerebellar arteries and posterior cerebral. No vascular abnormality in particular no aneurysm is identified as clinically is questioned. There is anatomical variation of proximal basilar artery fenestration.Right internal carotid.The distal cervical portion of right internal carotid artery, internal carotid artery across the skull base and the supraclinoid portion of right internal carotid artery remain within normal limits. There is no posterior communicating artery visible. There is anatomical variation of hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable.Left internal carotid.There is patent normal appearing left internal carotid artery in its distal cervical portion and across the skull base. Normal-appearing supraclinoid left internal carotid artery. Nonvisualization of a left posterior communicating artery is an anatomical variation.There is a dominant left A1 supplying both A2 segments of the anterior cerebral arteries. There is no evidence of any aneurysm all anterior cerebral arteries, left middle cerebral artery or the supraclinoid left internal carotid artery. Incidental note is made of a slightly enlarged (compare to the right) left superior ophthalmic vein. There is high density of the left superior ophthalmic vein posteriorly in the retro-orbital space. The more anterior portion of the left superior ophthalmic vein demonstrate low density compared to its more posterior portion.. The exact etiology of this discrepancy in density is not clear. The hypodensity of the left superior ophthalmic vein posteriorly in the left retro-orbital space may present thrombus or contrast within a vessel. Please correlate with physical exam and patient symptomatology. This lesion can be further evaluated with an MRI exam if clinically is warranted.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, cisterns cisterns and gray -- white matter differentiation remains within normal.An extra-axial dural based densely calcified lesion in high convexity right frontal lobe may represent a dural plaque or a very small heavily calcified meningioma. This finding was present on prior exam and is unchanged.Calvarium is intact. Visualized mastoid air cells and middle ear cavities are unremarkable. Limited real paranasal sinuses demonstrate extensive opacification of right maxillary sinus.

Output: 1.No CTA of intracranial circulation for aneurysm as clinically is questioned. Fenestration of proximal basilar artery is noted.2.Slightly prominent left superior ophthalmic vein. Higher density of this vein in its more posterior portion in the retro-orbital space may represent clot or contrast. Please correlate with clinical findings, symptomatology and physical exam. If there is a concern and patient is symptomatic recommend an MRI examination.3.Stable unremarkable non-infused head CT. Stable small high convexity right frontal calcified dural based lesion measuring 8 times 6-mm in size since prior study. Right maxillary sinusitis.


Instruction: Generate impression based on findings.

Input: 39 year old with BRCA mutation. History of breast cancer in sister diagnosed at age 33 and paternal grandmother diagnosed at age 45. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally, right greater than left. The background enhancement pattern is more similar to several of the older prior studies than the most recent comparison. No suspicious 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: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: 57 year-old female with known DCIS in the left breast. Outside MRI demonstrated an indeterminate enhancing mass posterior to the proven DCIS. MRI guided biopsy for the indeterminate enhancing mass is performed. On subtraction images, a linear non-mass enhancement (15 mm in AP dimension) is demonstrated posteriorly extending from the known DCIS lesion. The enhancing mass seen on the outside MRI likely corresponds to the posterior portion of this non-mass enhancement. Therefore, it is determined to biopsy the most posterior portion of this non-mass enhancement. PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 10 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed to the target.Per a recommendation at the breast conference, a Hydromark clip was placed to the most posterior margin of the main enhancing lesion, in case this biopsy results are benign and a bracketed needle localization for main DCIS has to be planned.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral digital mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at posterior upper outer quadrant, with no evidence of any complications due to the procedure. The marker clip for the biopsy site is located 20 mm posterior from a clip of the known DCIS, and 8 mm posterior to the Hydromark clip for the posterior margin of the DCIS. Distance between the clip for known DCIS placed outside institution and the clip for the posterior margin of the DCIS is 15 mm. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Abe.

Output: Successful MR guided core needle biopsy of the left breast, posterior non mass enhancement from the main DCIS. Successful clip placement for the biopsy site and the posterior margin of the main DCIS lesion. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Lung cancer and brain metastasis treated via SRS. There is an unchanged punctate focus of susceptibility effect in the left cerebellar hemisphere, which corresponds to the treated metastatic lesions. Punctate foci of susceptibility in the right thalamus and right putamen are also unchanged and may represent chronic microhemorrhage. There is unchanged moderate periventricular and subcortical white matter punctate T2 hyperintense foci, compatible with chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage, new mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unchanged. There is a punctate right maxillary sinus retention cyst.

Output: A punctate treated lesion in the left cerebellar hemisphere and nonspecific scattered cerebral white matter disease are unchanged. Assessment for metastatic disease is otherwise limited due to the lack of intravenous contrast.


Instruction: Generate impression based on findings.

Input: 59-year-old man with history of nasopharyngeal cancer status post CRT, with new hypoattenuating lesions on CT. ABDOMEN:LIVER, BILIARY TRACT: The left lobe of the liver, there are two mildly T2 hyperintense lesions, the first measuring 20 x 19 mm (series 5, image 9) and the second measuring 16 x 14 mm (series 5, image 16). These lesions demonstrate diffusion restriction and mild peripheral enhancement. There is an additional, questionable lesion near the hepatic hilum (series 5, image 15). Scattered subcentimeter hepatic cysts are noted.The liver is otherwise normal in signal and morphology. The common bile duct is mildly prominent at 8 mm.SPLEEN: Spleen appears normal.PANCREAS: A 6 mm cystic focus is seen in the pancreatic head (series 5, image 21) and a 6 mm cystic focus is noted in the pancreatic tail (series 5, image 16). These lesions do not enhance.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: The visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Left lobe hepatic lesions highly suspicious for metastases.2.Subcentimeter probable sidebranch IPMNs.


Instruction: Generate impression based on findings.

Input: Back pain and numbness groin area, evaluation for disc herniation. For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing. The conus medullaris terminates at the L1-L2 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.

Output: Normal lumbar spine MRI.


Instruction: Generate impression based on findings.

Input: 40-year-old female with history of left rectus desmoid tumor status post resection. Evaluate for recurrence. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Unchanged small retroperitoneal lymph nodes.BOWEL, MESENTERY: Status post colectomy and take down.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Postoperative changes in the left hemi-abdominal wall. No suspicious masses or evidence of recurrence. PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus. Partially septated uterus.There is a large cystic lesion in the left adnexa with enhancing internal septations measuring 7.1 x 5.8 cm (image 12 of series 15). This lesion has significantly increased in size compared to the prior CT.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic nodes measuring up to 8mm.BOWEL, MESENTERY: Status post colectomy and take down.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Minimal ascites.

Output: 1.No evidence of desmoid recurrence in the anterior abdominal wall.2.Large left adnexal complex cystic lesion has significantly increased in size compared to the prior study and is suspicious. Followup with OB/GYN highly recommended.


Instruction: Generate impression based on findings.

Input: There is a redemonstration of the diffusion restriction along the lateral aspect of the posterior right dorsal medulla with associated T2 hyperintensity. There is no evidence of intracranial hemorrhage. The ventricles and sulci are unchanged in size and configuration. The basal cisterns remain patent. There is no midline shift or mass effect. The distal right vertebral artery flow-void appears to be markedly narrowed. There is mild mucosal thickening in the right maxillary sinus with suggestion of chronic inflammatory changes.

Output: Right dorsolateral medulla recent infarct without evidence of hemorrhagic transformation associated with steno-occlusive disease of the distal right vertebral artery, which is better depicted on the recent CTA. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Pain/numbness in hand/shoulder. There are prominent posterior disc-osteophyte complexes at C5-6 and C6-7, which along with prominence of the ligamentum flavum at these levels, result in severe bilateral neural foraminal and spinal canal stenosis with indentation upon the spinal cord. There is no abnormal spinal cord signal, however. There are degenerative bone marrow signal alterations involving C5 and C6. There is no significant spinal canal or neural foraminal stenosis at the other cervical spine levels. There is no significant spondylolisthesis. There is a left mastoid effusion. The paraspinal soft tissues are unremarkable.

Output: Degenerative spondylosis results in severe bilateral neural foraminal and spinal canal stenosis at C5-6 and C6-7 with indentation upon the spinal cord.


Instruction: Generate impression based on findings.

Input: Male 31 years old Reason: multiple cystic lesion to thighs bilaterally and varicosities to lower legs History: mass In the subcutaneous soft tissues at the site of a palpable marker there is a encapsulated ovoid structure which follows fat signal on all sequences, consistent with subcutaneous lipoma, which measures 2.9 x 2.1 cm (image 12 series 5). Additionally there is a similar appearing subcutaneous lipoma on the contralateral side only seen on coronal images (series 4 image 23).Bone marrow signal is within normal limits. The visualized muscles and tendons are within normal limits.

Output: Subcutaneous lipomas as described above.


Instruction: Generate impression based on findings.

Input: Central nervous system lymphoma status post chemotherapy and radiation. There are chronic findings related to right transfrontal biopsy. There is no evidence of abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged punctate foci of encephalomalacia in the right cerebellar hemisphere, which likely represent chronic infarcts. There are unchanged nonspecific patchy areas of T2 hyperintensity in the cerebral hemisphere white matter. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are left maxillary sinus retention cysts. There is also persistent minimal fluid and mucosal enhancement in the bilateral mastoid air cells.

Output: Stable post-treatment findings without evidence of intracranial central nervous system lymphoma recurrence.


Instruction: Generate impression based on findings.

Input: Re-evaluate disease status following adjuvant therapy: Stage III melanoma. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is unchanged minimal nonspecific cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a probable hemangioma in the left parietal calvarium. There are partially imaged findings related to partial left parotidectomy.

Output: No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: Redemonstrated is a heterogeneous T2/FLAIR hyperintense lesion within the cerebellar vermis, with areas of intrinsic T1 shortening and several foci of susceptibility artifact corresponding to previously noted calcifications as well as minimal patchy enhancement. Mild mass effect on the posterior wall of the fourth ventricle is again noted, without associated hydrocephalus. The mass is best delineated on the T2-weighted FLAIR images. It again measures 2.4 cm transverse x 3.0 cm AP dimension. These findings are unchanged.Low-lying cerebellar tonsils again extend 7 mm below the foramen magnum with associated crowding, unchanged in appearance. CSF flow analysis is nondiagnostic secondary to technical factors.No evidence of diffusion restriction or midline shift. No new pathological enhancement is identified. There is no extra-axial fluid collection. Normal flow voids are identified in the major intracranial vessels. There is mild mucosal thickening in the maxillary sinuses, unchanged, with an increase in ethmoid and frontal sinus mucosal thickening. There are no air-fluid levels. Mastoid air cells are clear.

Output: 1.No significant interval change in heterogeneous midline cerebellar vermian lesion with foci of calcification and enhancement.2.Stable low lying cerebellar tonsils, possibly relating to the mass effect from the cerebellar vermian lesion.


Instruction: Generate impression based on findings.

Input: 67-year-old male. Low risk prostate cancer. Please evaluate. PELVIS:PROSTATE:Prostate Size: 3.8 x 3.7 x 5 cm.Peripheral Zone: Subcentimeter T2 hypointense lesion in the left peripheral base that diffusion restricts (series 604, image 364), suspicious for prostate cancer.Central Gland: 1.4 x 0.9 cm T2 hypointense lesion in the TZ from the apex to the base with diffusion restriction and early enhancement consistent with prostate cancer (series 801, images 16; series 604 images 304 to 384).Seminal Vesicles: None.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multifocal prostate cancer with dominant lesion in the TZ from the apex to the prostate; this is amenable to MRI guided biopsy.


Instruction: Generate impression based on findings.

Input: Female 51 years old Reason: r/o meniscus tear History: injured left knee while hiking in Colorado. Problem with flex at the knee MENISCI: There is blunting of the inner margin of the posterior horn and body of the medial meniscus consistent with tearing. The lateral meniscus is intact. The lateral meniscus is partially extruded.ARTICULAR CARTILAGE AND BONE: There is a full-thickness focal articular cartilage defect in the midline trochlear groove with underlying T2 hyperintensity indicating marrow edema and subchondral cyst formation (series 701, image 12; series 501 image 17). Fraying of the patellar articular cartilage along the lateral facet and apex without focal defect. LIGAMENTS: Ligaments are intact. Degenerative change and cystic formation at the insertion of the ACL on the tibia and to a lesser extent the tibial insertion of the PCL.EXTENSOR MECHANISM: Extensor mechanism is intact. ADDITIONAL

Output: 1.Tear of the posterior horn and body of the medial meniscus as detailed above.2.Full-thickness focal articular cartilage defect in the midline trochlear groove with underlying marrow edema and cystic change.3.Other degenerative changes as detailed above.4.Moderate size Baker's cyst.


Instruction: Generate impression based on findings.

Input: Female, 61 years old, with a right-sided low-grade glioma. Surveillance imaging. An oval T2 hyperintense lesion is again seen within the right centrum semiovale, just above the body of the right lateral ventricle. This lesion continues to measure approximately 21 x 13 mm in the axial plane and shows no significant change from multiple prior exams. As before, the lesion shows evidence of prior biopsy. No associated pathologic enhancement is seen, and the lesion correlates to low rCBV.Elsewhere no new or significant areas of signal abnormality are seen. A few additional scattered foci of white matter T2 hyperintensity are unchanged and nonspecific. No evidence of parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is seen. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid are evident. The ventricles are normal in size and shape. Partially empty sella is noted incidentally.A subcentimeter nonspecific enhancing focus within the left frontal bone is unchanged. Marrow signal characteristics are otherwise unremarkable.

Output: No significant interval change in the size or appearance of a non-enhancing lesion in the right centrum semiovale.


Instruction: Generate impression based on findings.

Input: Reason: investigate meniscal injury vs. MCL, medial tenderness? History: same MENISCI: The medial and lateral meniscus appear intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness articular cartilage degeneration along the weightbearing surface of the lateral femoral condyle, anteriorly, with areas devoid of articular cartilage. There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle above the body of the meniscus. There is full-thickness articular cartilage degeneration along the median eminence of the patella and medial facet with a focal area devoid of articular cartilage. There is associated subchondral signal abnormality which is likely degenerative in etiology. There are tiny tricompartmental osteophytes.LIGAMENTS: There is increased signal abnormality within the anterior fibers of the superficial band of the MCL and the meniscofemoral component of the deep fibers of the MCL, indicating a sprain. Fibers can be trace from their origin to their insertion. The LCL appears intact. The ACL and PCL appear intact.EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Findings indicating a sprain/partial tear of the MCL.2. Osteoarthritis of the knee including tricompartmental articular cartilage degeneration.3. Multiple loose bodies within the joint.


Instruction: Generate impression based on findings.

Input: 90-year-old female with history of headache. Corpus callosum lesion identified on prior MRI. 1 year follow-up. Again seen there is T2 hyperintensity affecting the inferior portion of the splenium as well as the undersurface of the posterior body of the corpus callosum and posterior fornices. This is not associated with any mass effect or enhancement. There is no associated restricted diffusion. There is no significant interval change dating back to 9/13/2013. Perfusion imaging demonstrates no evidence of increased relative cerebral blood volume.Additional scattered foci of T2 hyperintensity in the periventricular and subcortical white matter compatible with chronic small vessel ischemic changes are not significant change from prior. No evidence of intracranial hemorrhage, mass, or abnormal enhancement. The ventricles remain within normal limits for size and shape. The visualized paranasal sinuses are clear. There is partial opacification of the mastoid air cells bilaterally.

Output: Stable appearance of the increased T2 signal centered within the splenium of the corpus callosum. Again there is no mass effect or abnormal enhancement to suggest a neoplastic process. The differential remains chronic sequela of vascular, metabolic, or toxic processes in addition to demyelinating disease or post infectious/inflammatory etiologies.


Instruction: Generate impression based on findings.

Input: Male 24 years old Reason: 24y/o aam with pmh transverse myelitis chronic UTI with SPT presenting with tachycardia, leukocytosis, and right groin, back pain. Evaluate for abscess/acute infectious process History: Right groin/pain, +SIRS Patient's deformities and artifacts from metallic spine prosthesis limit optimal evaluation of the abdomen and pelvis.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney. Punctate stone in the lower pole of the left kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CALCIFICATIONS IN ABDOMINAL AORTA AND ITS BRANCHES: BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Hypodense area in the prostate measuring 2.2 x 2.2 cm image #111, series #3, suspicious for an abscess. MRI may be helpful for further evaluation. BLADDER: Suprapubic catheter within the bladder. Bladder wall is diffusely thickened. Calcifications in the region of the prosthetic urethra may represent stones in the urethra. Low-density within the prostate is unchanged. An abscess in that location cannot be excluded. Bladder stone is again noted. It measures 9 mm.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Fat stranding and skin thickening in the posterior subcutaneous tissues of the pelvic wall. These likely represent decubitus ulcers.OTHER: No significant abnormality noted

Output: Limited study due to patient's deformities and artifacts from the metallic spine hardware.Left nephrolithiasis. Stone in the bladder.Possible stones in the prostatic urethra and large hypodensity within the prostate suspicious for an abscess. These findings were discussed with Trsiha Sheth at the time of dictation.


Instruction: Generate impression based on findings.

Input: Headaches, frontal sinus obliteration. There are postoperative findings related to endoscopic sinus surgery and frontal sinus obliteration via osteoplastic flap. There is diffuse mucosal thickening in the bilateral maxillary sinuses and ethmoid cavities, as well as in the operative frontal sinuses. There is a more focal 10 mm diameter rounded area of high T2 signal without enhancement in the right maxillary sinus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There appears to be a small outer table right frontal bone osteoma. The orbits are grossly unremarkable. There is fluid in the right mastoid air cells.

Output: 1. Postoperative findings related to endoscopic sinus surgery and frontal sinus obliteration via osteoplastic flap with diffuse paranasal sinus mucosal inflammation, including within the operative frontal sinus bed and what may represent a ciliated cyst or mucocele in the right maxillary sinus.2. No evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: 84 year old female with loss of consciousness. Persistent headaches Examination demonstrates extensive findings consistent with advanced small vessel disease of indeterminate age. In comparison to prior exam no gross interval change is detected.New since prior exam are 2 small foci of increased signal intensity one been interval left basal ganglia measuring approximately 5 mm in AP axis and 4-mm in transverse axis (axial image 13 which is suspected of a small area of hemorrhage. The second lesion is within the cortex of right parietal lobe and measures approximately 4 mm x 4 mm and is best the patient on axial image 18. This lesion is also suspected of a small hemorrhage. Further evaluation with an MRI is recommended to exclude possibility of hemorrhagic metastatic lesions. Neither one of these demonstrates any surrounding edema.The findings were reported to measure number 9239 at the time of interpretation.

Output: 1.Advanced small vessel disease of indeterminate age.2.Two very small foci of increased signal intensity new since prior study as detailed.3.Further evaluation with an MRI is highly recommended to exclude hemorrhagic metastatic lesions.


Instruction: Generate impression based on findings.

Input: 84-year-old female with history of hypertension, history of craniotomy with vascular clipping. Presents with aphasia. Rule out acute stroke. Large vessel intracranial vascular calcification is noted. Extensive metallic artifact limiting from the aneurysm clip on the left is again identified which obscures large area of the study. There is a new large area of low-density within the right thalamus and possibly in the right periventricular frontal which are suspected for acute stroke. Further evaluation with an MRI is recommended.No hemorrhage, mass-effect, hydrocephalus or midline shift is present. The above findings were relayed to pager number 3648 at the time of interpretation.

Output: Suspect nonhemorrhagic acute right thalamic and right frontal periventricular white matter infarcts.


Instruction: Generate impression based on findings.

Input: Reason: pain History: pain Five lumbar type vertebral bodies are presumed to be present. There is grade 1 anterolisthesis of L4 on L5. There is slight straightening of the normal lumbar lordosis. The vertebral body heights are well-maintained. There is multilevel loss of intervertebral disc space with endplate degeneration particularly at L2-3 and L5-S1. The conus medullaris on sagittal imaging is intact.There is a combination of disc disease and facet hypertrophy resulting in narrowing of the bilateral neuroforamina at T10-11 and T11-12.T12-L1: There is mild facet hypertrophy. No significant compromise to spinal canal or neural foramina.L1-L2: There is mild facet hypertrophy. No significant compromise to spinal canal or neural foramina.L2-L3: There is diffuse annular disc bulge with facet and ligamentum flavum hypertrophy resulting in moderate narrowing of the spinal canal, mild narrowing of the left neuroforamen and mild to moderate narrowing of the right neuroforamen. There is also mild bilateral lateral recess stenosis.L3-L4: There is diffuse annular disc bulge with facet and ligamentum flavum hypertrophy resulting in moderate narrowing of the spinal canal and moderate narrowing of the both neuroforamina, right greater than left. There is also moderate bilateral lateral recess stenosis.L4-5: There is diffuse annular disc bulge with facet and ligamentum flavum hypertrophy resulting in severe narrowing of the spinal canal, moderate narrowing of the right neuroforamen and moderate to severe narrowing of the left neuroforamen. There is also severe bilateral lateral recess stenosis.L5-S1: There is asymmetric left annular disc bulge with bilateral lateral osteophytes in addition to facet and ligamentum flavum hypertrophy resulting in mild narrowing of the spinal canal and moderate narrowing of both neuroforamina. Additionally, the bilateral S1 nerve root origins are flattened and compressed.

Output: 1.Multilevel spondylotic changes affect the lumbar spine, most pronounced at L3-4, L4-5 and L5-S1 where there is central stenosis, lateral recess stenosis, and neural foraminal stenosis, as detailed above.2.There is a combination of disc disease and facet hypertrophy resulting in narrowing of the bilateral neuroforamina at T10-11 and T11-12. If the patient has symptoms localized to thoracic spine, a dedicated MRI of the thoracic spine may be of benefit.


Instruction: Generate impression based on findings.

Input: Ependymoma: 3 month post surgical evaluation. There are expected postoperative findings related to posterior fossa tumor resection. There is no abnormal intracranial enhancement. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are punctate foci of susceptibility effect in the right parietal lobe along the path of a recently removed ventricular catheter. There is a small amount of pneumoventricle, but the ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No evidence of recurrent posterior fossa tumor.


Instruction: Generate impression based on findings.

Input: Male 67 years old Reason: evaluate sclerotic foci seen on Xray, concern for metastatic disease. History: HCC, prostate cancer, new worsening of R hip pain. BONE MARROW: Hardware components of a total right hip arthroplasty device cause degradation of image quality and limit evaluation in particular of the right hip and right hemipelvis. Two well-circumscribed T1 hypointense/stir hypointense signal lesions are identified, one within the superior aspect of the L5 vertebral body and a second within the right superior pubic ramus. The L5 lesion measures 2.1 x 1.8 cm (series 5, image 33), remeasured on prior study at 2.0 x 2.0 cm, and the right superior pubic ramus lesion measures 1.0 x 0.9 cm (series 5, image 13), remeasured on prior study at 1.2 x 0.9 cm. Both lesions are stable in size allowing for differences in imaging technique. The overlying cortex is intact and there is no surrounding bone marrow edema. There are no new lesions identified.SOFT TISSUES: No significant abnormality noted. JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1. Two indeterminate bone lesions are stable compared to prior studies dating back to 03/11/14. Given the interval stability, the absence of new lesions and the findings on prior nuclear medicine bone study, favor benign etiology however given the patient's history of prostate cancer, ongoing surveillance is recommended.


Instruction: Generate impression based on findings.

Input: Male, 18 years old. Posterior Shoulder Pain ROTATOR CUFF: There is mild supraspinatus tendinopathy near its insertion. Otherwise, the rotator cuff tendons and muscles are unremarkable, without tear identified.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is fragmentation of the posterior labrum (series 1001, image 14), compatible with tearing. There is a subchondral cyst within the posterior aspect of the humeral head (series 1401, image 15). Articular cartilage is otherwise grossly intact.BICEPS TENDON: The tendon of the long head of the biceps is normal in location and morphology. ADDITIONAL

Output: 1.Fragmentation of the posterior labrum and subchondral cyst formation in the posterior humeral head. These two findings are most compatible with posterior-superior glenoid impingement.2.Mild supraspinatus tendinopathy as above.


Instruction: Generate impression based on findings.

Input: Chronic headaches and complex partial seizures. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are small areas of high T2 and low T1 signal in the white matter surrounding the bilateral frontal horns. The brain parenchyma otherwise appears unremarkable. 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, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is minimal mucosal thickening in a right anterior ethmoid air cell.

Output: Nonspecific small areas of high T2 and low T1 signal in the white matter surrounding the bilateral frontal horns. Otherwise, no evidence of intracranial hemorrhage, mass, or other potential seizure foci.


Instruction: Generate impression based on findings.

Input: 39-year-old male with a right frontal lesion that was resected in 2010 (grade II oligodendroglioma positive for 1p/19q co-deletions with increased proliferative activity (MIB-1 of 8.2%). Developed progression on chemotherapy and repeat biopsy in January 2014 showed histologic progression to grade 3. There are changes related to previous right frontal craniotomy. Just deep to the surgical cavity in the anterior aspect of the right cranial fossa, there is remarkable progression of T2 hyperintensity which now involves most of the right frontal lobe white matter (reaching up to the precentral sulcus posteriorly and inferiorly to involve the right subinsular white matter). This is associated with mass effect resulting in mild anterior midline shaft as well as compression of the right lateral ventricle and right frontal sulci. There is abnormal T2 signal is associated with heterogeneous, nodular contrast enhancement that is most pronounced in the anterior-medial aspect of the new abnormality. The contrast-enhancing tissue is relatively T2 hypointense and mildly diffusion restricted. There are foci of susceptibility effect within the infiltrative signal abnormality which probably represent foci of intratumoral hemorrhage. On dynamic susceptibility contrast imaging, the abnormal tissue shows a heterogeneous elevation in relative cerebral blood volume (corrected for leakage) which is most pronounced also in the anterior-medial aspect of the abnormality where contrast enhancement is most pronounced. 2-D multivoxel MR spectroscopy with an intermediate echo time (144 ms) shows a generalized elevation of the choline peak as well as depression of N-acetylaspartate peak compared to the contralateral normal-appearing white matter. In some areas of the lesion, choline is markedly elevated reaching 2 to 2.5 times that seen in normal contralateral tissue. Some areas are also associated with the presence of lactate and lipid.Mild, confluent T2 hyperintensity in the left frontal periventricular white matter is separate from the tumor and has not changed since the previous examination and therefore may reflect effects of previous treatment. The remainder of the brain is normal. Besides the above described mass effect caused by the right frontal mass, the CSF-containing spaces are normal in size.

Output: Compared to the July 2015 examination, there has been remarkable progression of infiltrative, heterogeneously contrast enhancing tissue in the right frontal lobe. This tissue is associated with significantly elevated choline on spectroscopy, as well as elevated rCBV. Findings are highly suspicious for progressive disease.


Instruction: Generate impression based on findings.

Input: Moderate findings of multiple sclerosis are again seen with periventricular and subcortical white matter FLAIR signal abnormality. Compared to the prior examination, there is a new focus of FLAIR signal abnormality in the subcortical white matter of the left inferior frontal gyrus measuring approximately 9 x 5 mm (series 601, image 34). The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures.

Output: Findings of multiple sclerosis with mild interval worsening, particularly in the subcortical left inferior frontal gyrus.


Instruction: Generate impression based on findings.

Input: Female, 56 years old, history of rate 3 meningioma, assess for growth versus radiation changes (biopsy proven radiation changes previously). Evidence of prior wide left pterional craniotomy is again seen. Patchy, largely gyriform enhancement with scattered susceptibility along the peripheral brain parenchyma subjacent to the craniotomy is redemonstrated showing no convincing or significant interval change. Enhancement involves the superior and middle frontal gyri as well as the operculum and insula. T2 hyperintensity in the surrounding parenchyma has also not significantly changed.Ill-defined enhancement conforming to the ependymal surface of the left frontal horn has progressed from the prior examination. In addition, one small linear focus of gyriform enhancement within the left temporal operculum (see image 94 series 21) is new. Scattered smaller enhancing areas within the left posterior and superior temporal lobe are unchanged.Within the left middle cranial fossa, a region of dural thickening seen on the prior examination has expanded into a more masslike lesion measuring up to 20 x 14 mm in the axial plane. This lesion extends both extracranially into the temporalis musculature and intracranially where it abuts and displaces the anterior temporal parenchyma. There is new edematous T2 signal within this compressed parenchyma. New from the prior examination is the development of heterogeneously enhancing masslike tissue centered within the left orbital apex measuring up to 28 x 17 mm in the axial plane and up to 14 mm in thickness in the coronal plane. This lesion extends both into the orbit where it effaces the orbital apex and likely compresses the optic nerve. It also seems to extend above the orbital roof with mild elevation of the left inferior frontal lobe but no definite parenchymal invasion or parenchymal edema. This abnormal tissue extends posteriorly to encase the anterior clinoid process and likely invades the left cavernous sinus to a mild degree. The ICA flow void remains visible throughout.

Output: 1.Redemonstration of postoperative findings compatible with prior meningioma resection from the left calvarium.2.Patchy gyriform enhancement and associated parenchymal T2 signal abnormality subjacent to the craniotomy, previously biopsied and found to represent radiation effect, shows no significant interval change.3.Enhancement along the ependymal surface of the left frontal horn has increased from the prior examination. As this enhancement is still rather ill-defined and is found in a radiation sensitive area, this likely represents progressive radiation effect as well. A new small linear area of gyriform enhancement within the superior left temporal lobe is also probably radiation related.4.Interval growth of a masslike intracranial and extracranial process centered along the left lateral middle cranial fossa is seen. This process abuts and displaces the adjacent anterior temporal parenchyma with evidence of parenchymal edema. These findings are concerning for recurrent tumor, with or without radiation effect.5.New growth of masslike soft tissue centered on the left orbital apex is also concerning for recurrent tumor. This lesion effaces the orbital apex with likely compression of the left optic nerve. It also extends posteriorly to encase the anterior clinoid process and likely invades the left cavernous sinus to a mild degree.


Instruction: Generate impression based on findings.

Input: 56 years Female (DOB:9/22/1959)Reason: please evaluate known aneurysm and microhemorrhages, compare to prior images History: short-term aneurysm and microhemorrhage surveillance; altered mental statusPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. A punctate foci of signal loss and susceptibility weighted imaging along the subcortical white matter of the temporal lobes as well as along the periventricular white matter and along the left internal capsule as well as the left medial temporal lobe in the corpus callosum.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate an opacity in the left sphenoid sinus. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:There is a left posterior communicating artery aneurysm present measuring 7 x 5 mm axial dimensions and stable compared to the prior exam. The aneurysm is directed inferiorly and posteriorly and has a relatively wider neck.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 evidence for cerebrovascular occlusive disease.2.Stable 7mm left posterior communicating artery aneurysm3.There are multiple microhemorrhages present intracranially this pattern is most compatible with hypertension but nonspecific.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate underlying structural lesion like tumor underneath hemorrhage. Signs and symptoms: Hemorrhage Pre-and post-enhanced brain MRI:Examination demonstrates a focus of acute parenchymal hemorrhage in the left postcentral gyrus measuring approximately at 8 x 13-mm in size. There is minimal surrounding cortical restricted diffusion. Findings is believed to represent a small focus of hemorrhagic stroke. Post-enhanced images demonstrate expected minimal rim enhancement of hematoma and negative otherwise.Examination in addition demonstrate mild to moderate degree of chronic small vessel ischemic strokes primarily in the periventricular and to a lesser degree in subcortical white matter of cerebral hemispheres. Minimal similar finding in the right basal ganglia and few similar foci in the pons are also noted. Findings are highly suggestive of chronic small vessel ischemic strokes. There is normal thickness of susceptibility signal changes with the above described chronic small vessel ischemic strokes however there are multiple foci of susceptibility in bilateral cerebral hemispheres and left thalamus suggestive of prior microhemorrhages and suspected of amyloid angiopathy.The cortical sulci and ventricular system is within normal size and morphology for patient's stated age. The signal voids of major intracranial arterial branches are identified.The signal void of intracranial venous sinuses are within normal and the normal pattern of enhancement.

Output: 1.Examination demonstrate a small hemorrhagic stroke in of the left postcentral gyrus and without evidence of underlying tumor or vascular pathology.2.Mild chronic small vessel ischemic strokes primarily in the subcortical/periventricular white matter and minimally in the right basal ganglia and multiple chronic strokes in the pons. There are multiple small varying size foci of susceptibility throughout bilateral cerebral hemispheres consistent with chronic micro-hemorrhages which considering patient's stated age of 88 likely representing amyloid angiopathy.


Instruction: Generate impression based on findings.

Input: 60-year-old male with elevated PSA. PELVIS:PROSTATE:Prostate Size: 4.5 x 6.3 x 6 cm.Peripheral Zone: Single 5 mm round focus of low T2 signal with restricted diffusion and enhancement in the right lateral mid gland (series 901/14), suspicious for small focus of prostate cancer. The lesion is located adjacent to the central gland.Central Gland: Heterogeneous.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: No evidence of extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Single 5 mm focus in the right lateral mid gland suspicious for prostate cancer. No evidence of extracapsular extension.


Instruction: Generate impression based on findings.

Input: Clinical question: History of tentorial meningioma. Signs and symptoms: Surveillance scan. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination again demonstrates a tiny pleural-based extra-axial uniformly enhancing mass consistent with a meningioma along the inferior posterior aspect of right tentorial leaf. It measures approximately 7.1 x 9.5 mm in size just nearly identical to prior exam. This finding results in very subtle indentation along the superior aspect of right cerebellum without detected edema and stable since prior study.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination for stated age and without detectable abnormal enhancement.Extensive chronic sinusitis more prominent in the maxillary sinuses is noted which is a new finding since prior exam.Unremarkable images through the orbits including axial fat sat post enhanced series.

Output: 1.No acute intracranial process.2.Stable tiny meningioma along the inferior-posterior aspect of the right tentorial leaf measuring at 9.5 x 7.1 mm.3.Unremarkable pre and post enhanced brain MRI otherwise.4.Chronic pansinusitis which is a new finding since prior exam.


Instruction: Generate impression based on findings.

Input: 45 years Male (DOB:2/16/1971)Reason: GBM post crani History: GBM post craniPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Since the prior exam the patient has undergone right-sided craniotomy. There is a catheter entering the craniotomy site with tip in the larger and more laterally oriented cystic cavity of the mass lesion. Since the prior exam this tumoral cystic cavity has decreased in axial dimensions from 48 x 33 mm axial dimensions 2 38 x 12 mm axial dimensions. There is associated scalp soft tissue swelling. The left lateral ventricle is mildly dilated. There is mild subfalcine herniation present.There is no change in the appearance of the other cystic cavities within the tumor bed. One in the region of the left centrum semiovale measures 19 x 16 mm and previously measured the same. Another cystic cavity in the right thalamus measures 12 x 17 mm and has also not changed. One at the right cerebral peduncle and right internal capsule measures 14 x 12 mm and is also unchanged. The patient's right deep gray nuclei mass remains and is associated vasogenic edema which was also present on the prior exam. There are multiple punctate foci of signal hypointensity within the mass.The third ventricle is shifted towards the left by 9mm. This has decreased from 11mm.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: Since prior exam the patient has undergone placement of a drainage catheter into a left-sided tumoral cystic cavity. The particular cystic cavity has decreased in size and there is now slightly less mass effect. There is some mild subfalcine herniation present. The rest of the tumor mass and associated vasogenic edema remain stable.


Instruction: Generate impression based on findings.

Input: Female 65 years old Reason: Evaluate for disease progression. Patient with recurrent endometrial cancer on chemotherapy. Please compare to 4/20/2016 History: endometrial cancer ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small upper abdominal lymph node measuring 1.0 x 0.7 cm adjacent to the left renal vein on image 28/ 8.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and oophorectomy. Previously seen soft tissue thickening of the vagina has nearly resolved. No measurable soft tissue mass.Cystic area in the left pelvis possibly representing a lymphocele is unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Few scattered pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Near complete resolution of the soft tissue thickening of the vagina.2.Few scattered upper abdominal and pelvic lymph nodes.


Instruction: Generate impression based on findings.

Input: 25 year old with history of peripartum cardiomyopathy presenting for cardiac evaluation after abnormal echocardiogram. Left VentricleThe left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%, the LV end diastolic volume index is 89 ml/m2 (normal range: 65+/-11), the LVEDV is 163 ml (normal range 109+/-23), the LV end systolic volume index is 46 ml/m2 (normal range 18+/-5), the LVESV is 85 ml (normal range 31+/-10), the LV mass index is 37 g/m2 (normal range 67+/-11), and the LV mass is 68 g (normal range 114+/-24). The LV dysfunction is global. There a nontransmural, mid-myocardial stripe of late gadolinium enhancement in the basal to mid septal wall in the non coronary pattern and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process. This may represent a previous myocarditis episode or other cause of non-ischemic cardiomyopathy.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%, the RV end diastolic volume index is 71 ml/m2 (normal range 69+/-14), the RVEDV is 129 ml (normal range 110+/-24), the RV end systolic volume index is 26 ml/m2 (normal range 22+/-8), and the RVESV is 48 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 "pseudobovine" brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is mildly dilated with mildly reduced systolic function. The overall LV ejection fraction is 48%. The LV dysfunction is global. There nontransmural, mid-myocardial stripe of late gadolinium enhancement in the basal to mid septal wall in the non coronary pattern to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. This may represent previous myocarditis episode or another cause of non-ischemic cardiomyopathy. Additionally the native myocardial T1 relaxation time is mild to moderately increased and suggests the presence of diffuse myocardial interstitial fibrosis.2. The right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 63%.


Instruction: Generate impression based on findings.

Input: History of compression fracture. Thoracic spine: Again seen is a vertebra plana of the T12 vertebral body comparable to that seen on prior MRI in July, 2014. Mild multilevel degenerative disc disease affects the thoracic spine. There is approximately 55 degrees kyphosis as measured from the superior endplate of T1 to the inferior endplate of T11. Degenerative arthritis also affects the visualized cervical spine.Lumbar spine: The bones appear demineralized suggesting osteopenia. Severe degenerative disc disease affects the L5-L1 vertebral level and moderate to severe degenerative disc disease affects L4-L5. Facet joint osteoarthritis particularly affects the lower lumbar spine. There is mild dextroscoliosis of the thoracolumbar spine. A lumbar lordosis of approximately 60 degrees as measured from the superior endplate of L1 to the inferior endplate of L5 is seen. The degenerative disc disease and facet joint osteoarthritis appears similar to that seen on prior study.

Output: Severe T12 compression fracture with degenerative arthritic changes of the thoracolumbar spine as above.


Instruction: Generate impression based on findings.

Input: Reason: Evaluation for stress fracture History: Right hip and groin pain x 5 months in runner ACETABULAR LABRUM: A small focus of increased signal intensity along the undersurface of the anterior labrum, between the 3 and 4 o'clock positions, is suspected to represent cartilaginous undercutting, or perhaps a small normal variant recess, rather than a tear. The remainder of the labrum is unremarkable.ARTICULAR CARTILAGE AND BONE: Note is made of a supraacetabular fossa, a normal variant. Otherwise, the articular cartilage appears normal. The bone marrow signal intensity is within normal limits. We see no stress fracture or CAM deformity.SOFT TISSUES: There is minimal peri-trochanteric edema on the right, which appears slightly more prominent than the left, but this is of questionable clinical significance. The remainder of the soft tissues are unremarkable. ADDITIONAL

Output: Minimal right peri-trochanteric edema of questionable clinical significance. We see no stress fracture or other specific findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: Reason: h/o HNC and CRT, s/p RT to brain History: post RT imaging Prior recent brain MR studies have been motion degraded which limit comparison. There are multiple subcentimeter enhancing lesions consistent with metastatic disease. For example there is a 4 x 5 mm left parietal lesion, a 6 x 6 mm right temporal lesion abutting the right temporal horn and a 5 x 4 mm right cerebellar lesion. The left parietal and right temporal lesions are minimally larger since 8/15/2016. There is mild associated edema, which appears slightly increased in the interval associated with the right temporal lesion. Left occipital lesion seen on prior MRI from 8/15/2016 has decreased in size measuring 2 to 3 mm, previously 7 mm in the sagittal plane. A punctate right temporal enhancing lesion seen slightly inferior lateral to a larger lesion on 8/15/2016 is no longer evident.There is a larger heterogeneously enhancing mass involving the occipital scalp which measures approximately 20 x 43 mm in the AP and transverse dimensions previously approximately 14 x 41 mm. There is also greater central nonenhancement suggesting necrosis. There is also an 11 x 12 mm enhancing lesion involving the paraspinous musculature posterior to the right C3 lamina, not seen previously.Previous seen masslike lesion surrounding and possibly invading the posterior aspect of the superior sagittal sinus is markedly decreased in size. Occlusion of the posterior aspect of the superior sagittal sinus remains but appears improved. Asymmetric increased enhancement involving the right cavernous sinus is similar to prior and nonspecific. There is no new lesion to definitively suggest progression of metastatic disease.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No midline shift or herniation. No hydrocephalus. Significant volume loss involving the cerebellar vermis and to lesser degree cerebellar hemispheres again seen.

Output: 1. Intracranial metastatic disease demonstrates no clear evidence of interval progression. Enhancing mass involving the distal aspect of the superior sagittal sinus is markedly decreased since 8/15/2016 although there remains short segment occlusion involving the distal superior sagittal sinus. Previously seen adjacent left occipital parenchymal lesion has also significantly decreased in size. A punctate right temporal lesion is no longer perceptible.2. Subcentimeter left parietal and right temporal lesions are minimally larger since 8/15/2016 with also mild increase in edema associated with the right temporal lesion. These findings may represent posttreatment change but suggest continued close follow-up. Right cerebellar enhancing lesion is not significantly changed.3. Large occipital scalp metastases is mildly larger with increased central heterogeneous enhancement suggesting necrosis. There is also a new paraspinous soft tissue metastasis posterior to the right C3 lamina.4. Atrophy involving the cerebellum vermis and to a lesser extent cerebellar hemispheres again evident.


Instruction: Generate impression based on findings.

Input: 50-year-old male with history of prostate cancer. Left apex 3+4. PELVIS:PROSTATE:Prostate Size: 4.5 x 3.0 cmPeripheral Zone: There is a round T2 hypointense lesion with associated restricted diffusion and early enhancement located at the left lateral apex/mid gland measuring 8 x 6 mm (image 14 of series 801). T2 hypointense signal abnormality superficial to this lesion likely represents scarring.There is an additional T2 hypointense focus with associated restricted diffusion in the left anterior apex measuring 9 x 7 mm (image 15 of series 801).Ill-defined T2 hypointense area in the right lateral mid gland measuring 12 x 8 mm with mild restricted diffusion is moderately suspicious.There is linear T2 signal hypointensity located diffusely throughout the peripheral gland likely related to prostatitis or scarring.Central Gland: BPHSeminal Vesicles: No significant abnormality notedExtracapsular Extension: No distinct extracapsular extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1. Left lateral apical lesion compatible with patient's known biopsy-proven adenocarcinoma. No evidence of extracapsular extension.2. Additional highly suspicious focus in left anterior apex.3. Right lateral midgland lesion is moderately suspicious. Multiple areas of scarring noted involving bilateral peripheral zones.


Instruction: Generate impression based on findings.

Input: Encounter for other preprocedural examination [Z01.818] / Benign neoplasm of cranial nerves [D33.3], Reason for Study: ^Reason: PRE-OP please do at 6:00am in CCD. Please page neurosurgery resident to place fiducials. Cerebellar angle tumor. Multiple fiducial markers attached on scalp for the preparation of surgical planning.There is 30.3mm x 42.9mm sized right CP angle extra axial mass which shows mainly low signal intensity on T2 with central high signal intensity cystic portion and enhancement on Gad. The mass generates mass effects toward brainstem.The mass appears to be extended into the right internal auditory canal with mild enlargement of the IAC. Constellation of above findings suggest possible diagnosis of Neurogenic tumor with the differential diagnosis of meningioma.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no evidence of acute ischemic or hemorrhagic lesion.Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Right cerebellopontine angle mass with mass effects. Differential diagnosis include neurogenic tumor and meningioma.2. No evidence of acute ischemic or hemorrhagic lesion.


Instruction: Generate impression based on findings.

Input: Fecal incontinence and foot numbness. Known L4/L5 osteomyelitis and discitis. Assess for worsening. The contrast-enhancing edema involving the L4 and L5 vertebral bodies remain unchanged. Contrast enhancement within the anterior central part of the intervening L4-L5 disc has slightly increased. The associated anterior epidural contrast enhancement at L4 and L5 levels as well as S1 is not significantly changed. The mild dorsal contrast-enhancing thickening and minimal infiltration of the overlying fat is minimally increased, now extends from mid L3 level to L5-S1 level. There continues to be no definite, drainable fluid collection in the epidural space. However, the dural/epidural involvement is associated with severe spinal canal stenosis at L4 and the upper L5 levels, which is unchanged. There is also persistent abnormal contrast enhancement bilaterally in the L3-L4, L4-L5 and L5-S1 neural foramina. The paraspinal extension of the infectious process into the medial aspect of the psoas muscles and the paraspinal fat remains unchanged. The small reactive internal iliac lymph nodes are slightly larger. There continues to be no discrete paraspinal fluid collection. Otherwise, there has not been significant change since the previous examination regarding the alignment or the multilevel degenerative change. The 4 mm focus of contrast enhancement involving the right posterior lateral aspect of the conus at T12-L1 is unchanged. The other very small focus of enhancement in the thecal sac at the S1-2 level is also unchanged.

Output: 1.The findings related to L4/L5 discitis and osteomyelitis are not significantly changed. Epidural phlegmonous involvement also is not significantly changed but again noted to cause severe spinal canal stenosis at L4 and upper L5 levels. Also, the involvement of the paraspinal soft tissues remains unchanged. No drainable paraspinal fluid collection/abscess. 2.The tiny foci of contrast enhancement in relation to the conus medullaris at T12-L1 and one of the nerve roots on the left side at S1-S2 level are favored to represent incidental findings, for example small schwannomas, and appear to be present dating back to 12/29/2013.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Limited examination done for preoperative planning. Motion degraded postcontrast images.There is an enhancing mass in the right posterior frontal lobe measuring 2.0 x 2.2 cm (series 301, image 148). There is minimal localized mass effect. An additional smaller enhancing lesion in the left precentral gyrus measures 0.6 x 0.6 cm (series 301, image 132). There is surrounding high T2 signal compatible with vasogenic edema in the right frontoparietal lobes and left frontal lobe.The ventricles and sulci are mildly prominent compatible with age-related volume loss, aside from the areas of sulcal effacement in the areas of the masses. The cisterns remain patent. There is no midline shift or mass effect. 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. A left maxillary retention cyst is noted, previously noted to be T1 hyperintense on outside imaging.

Output: Enhancing lesions in the bilateral posterior frontal lobes with surrounding vasogenic edema are most consistent with metastatic disease.


Instruction: Generate impression based on findings.

Input: CERVICAL SPINE: There is a patchy focus of T2 hyperintensity in the cervical cord on the right at the upper C5 level and bilaterally at C5-C6 level. No evidence of cord edema or abnormal enhancement.There is straightening of the normal cervical lordosis. There are mild degenerative changes with multilevel small central disc osteophyte complexes with partial effacement of the ventral thecal sac. No significant spinal canal or neural foramina stenosis. The disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.THORACIC SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. Minimal multilevel disk bulges. There is no significant spinal canal stenosis.The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology with the conus terminating at the inferior L1 endplate. The paravertebral soft tissues are unremarkable.

Output: 1.Prior study is not available for comparison. Patchy T2 hyperintensity within the cervical cord at the C4 to C6 levels may represent residual edema or gliosis from prior demyelination/transverse myelitis. No lesions with enhancement to suggest active demyelination. 2.Minimal cervical and thoracic spine degenerative changes. 3.No lesions within the thoracic cord.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Mother with history of brain aneurysm. Patient with history of headaches. MRI BRAIN: The cerebellar tonsils extend approximately 19 mm below the level of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: 1. Cerebellar tonsils extend 19 mm below the level of the foramen magnum, consistent with Chiari 1 malformation. There is no evidence for ventriculomegaly on this exam.2. No evidence of intracranial hemorrhage, mass, or acute infarct.3. No evidence of intracranial stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: Left parotid lipoma. The left parotid gland is asymmetrically prominent without evidence of a discrete mass or abnormal enhancement. There is marked fatty atrophy of the right parotid gland. The left submandibular gland is slightly larger than the right submandibular gland. The thyroid gland is unremarkable. There is no evidence of significant cervical lymphadenopathy. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is a small mucous retention cyst in the right maxillary sinus.

Output: 1. Diffuse mild enlargement of the left parotid gland without evidence of a discrete mass, which may represent compensatory hypertrophy in response to marked fatty atrophy of the right parotid gland. 2. No significant cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Female, 68 years old, with non-small cell lung cancer undergoing treatment, now with lumbar back pain, left lower extremity radiation, weakness, and urinary retention symptoms. A dextroscoliosis of the thoracic spine is seen which does mildly affect the lumbar spine as well. A grade 1/2 anterolisthesis of L4 relative to L5 is demonstrated.Severe disc degeneration is seen at L4-5. There is mild degenerative irregularity of the inferior L4 endplate but severe irregularity of the superior L5 endplate. The L5 vertebral body is mildly wedged anteriorly but without evidence of edema.The remaining vertebral bodies demonstrate normal morphology and signal characteristics. No areas of suspicious marrow replacement or marrow edema are observed.The visualized distal spinal cord, conus and cauda equina are unremarkable except as discussed below.T12-L1: Small left paracentral disc extrusion. No significant spinal canal stenosis. No significant foraminal narrowing.L1-2: Unremarkable. L2-3: Unremarkable. L3-4: Mild facet hypertrophy. Mild ligamentum flavum thickening. Minimal laterally bulging disc. No significant spinal canal stenosis. No significant foraminal narrowing. L4-5: Advanced facet hypertrophy and ligamentum flavum thickening. Spondylolisthesis with disc uncovering. Moderately severe generalized spinal canal stenosis with crowding of the nerve roots of the cauda equina. Severe right worse than left foraminal narrowing with possible nerve root impingement. L5-S1: Facet hypertrophy. Ligamentum flavum thickening. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. Incidental note is made of bilateral renal cystic lesions.

Output: 1.Multilevel degenerative findings, with the most severe disease at L4-5. There is a grade 1/2 spondylolisthesis at this level which, along with posterior element hypertrophy, contributes to a moderately severe generalized spinal canal stenosis with crowding of the cauda equina. There is also severe bilateral foraminal narrowing, right worse than left, with possible nerve root impingement.2.No suspicious marrow edema or marrow replacement is seen to suggest presence of metastatic disease.


Instruction: Generate impression based on findings.

Input: 93 year-old female with left-sided facial droop and left-sided weakness. Evaluate for CVA. There is no acute intracranial hemorrhage, mass effect or basal cistern effacement. There is no CT evidence of acute territorial ischemia. However, there are multiple ill-defined areas of hypoattenuation in the periventricular and deep white matter bilaterally. In a patient of this age, these findings may represent chronic small vessel ischemic disease, however, an acute infarct cannot be completely excluded. MRI can definitively exclude ischemic insult if there is high clinical suspicion for infarct.The ventricles and basal cisterns are normal in size and configuration. . There is no extra-axial fluid collection. Expected moderate volume loss for age.The calvaria and skull base are radiographically normal. There is mild mucosal thickening of the left sphenoid sinus. There are mild atherosclerotic changes of the intradural vertebral arteries. Incidental note is made of bilateral lens prosthesis.

Output: No CT evidence of acute territorial ischemia or acute intracranial hemorrhage.Mild ill-defined periventricular and deep white matter hypoattenuation. In a patient of this age, these findings may represent chronic small vessel ischemic disease. MRI can more definitively exclude acute or small infarcts.