Instruction: Generate impression based on findings.

Input: Sarcoid with worsening pain, assess for progression. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There are multiple new T1 hypointense lesions throughout the lumbar spine compared to 6/5/2010, as well as the partially imaged lower thoracic spine and pelvis compatible with known history of osseous sarcoidosis. The relatively largest lesion is present at the L4 level measuring approximately 17 x 17 mm in the sagittal plane. Posterior element involvement is also seen at multiple levels. STIR hyperintensity and enhancement is associated with the lesions. T1 hyperintensity is seen associated with some of the lesions perhaps indicating chronicity/healing.In comparing the partially imaged pelvic lesions with the more recent pelvic MRI from 6/25/2015, some lesions demonstrate increase in T1 hyperintensity, perhaps reflecting healing.Vertebral body heights in the lumbar spine are normal. There is minimal superior endplate depression involving the T12 endplate with small Schmorl's node, which remains unchanged since 6/5/2010. Alignment is maintained. The conus medullaris is normal in position. No nodular leptomeningeal enhancement involving the conus or cauda equina is appreciated.Mild multilevel degenerative changes include disc height loss at the L4-L5 level. Additional details as below:L1-L2: Small left paracentral disc extrusion with mild craniocaudal migration is not significantly changed. No spinal canal or neural foraminal stenosis.L2-L3: There is a small right paracentral and foraminal disc protrusion. Mild facet arthropathy. There is mild narrowing of the right neural foramen. Spinal canal and left neural foramen are patent.L3-L4: Mild disc bulge and mild facet arthropathy. No spinal canal or neural foraminal stenosis.L4-L5: There is a disc bulge with a mild left foraminal protrusion component which is slightly larger. There is associated partial effacement of the left lateral recess. Central spinal canal remains patent. There is mild narrowing of the left neural foramen related to the disc and mild left-sided facet arthropathy. Right neural foramen is patent. L5-S1: Minimal disc bulge. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits.

Output: 1. Numerous osseous lesions in the lumbar spine, partially imaged thoracic spine, and pelvis consistent with known osseous sarcoidosis. No recent lumbar spine MRI is available for comparison but there has been significant progression since 8/5/2010 with multiple new lesions. Of note, however, recent pelvic MRI for which there are recent comparisons did not demonstrate progression. 2. Mild multilevel degenerative changes in the lumbar spine which have slightly progressed as detailed above. There is mild right L2-L3 and mild left L4-L5 neural foraminal stenosis. No high-grade neural foraminal or spinal canal stenosis at any level.


Instruction: Generate impression based on findings.

Input: Clinical question: Altered mental status for one week, blunt head trauma. Signs and symptoms: Same Unenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal. Limited view of the orbits are unremarkable. Calvarium and visualized paranasal sinuses and mastoid air cells as well as middle ear cavities are also unremarkable. There is no evidence of any soft tissue abnormality of scalp. If clinical concern persists recommend an MRI examination.

Output: Negative nonenhanced head CT.


Instruction: Generate impression based on findings.

Input: Female, 58 years old, with back pain and radiculopathy. Alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal abnormality is seen. The visualized spinal cord, conus and cauda equina are unremarkable.L1-2 to L3-4: Mild to moderate facet arthropathy. No significant disk degeneration, spinal canal or neuroforaminal stenosis. L4-5: Moderate facet hypertrophy. Advanced disk degeneration with loss of disk height and fatty endplate marrow change. Disk bulge with a central/right paracentral inferior extrusion which does not appear to directly impinge on any nerve roots. Mild generalized spinal canal narrowing. Moderate bilateral foraminal narrowing. L5-S1: Mild facet hypertrophy. Advanced disk degeneration with loss of disk height and fatty endplate marrow change. Bulging disk. No significant spinal canal narrowing. Severe left foraminal narrowing with probably nerve root impingement. Moderate to severe right foraminal narrowing with questionable nerve root impingement.

Output: 1.Advanced disk degeneration at L4-5 with a disk bulge and central/paracentral extrusion, mild generalized spinal canal narrowing, and moderate foraminal narrowing.2.Advanced disk degeration at L5-S1 with a disk bulge and severe bilateral foraminal narrowing. Nerve root impingement is highly suspected on the left, with questionable impingement on the right.


Instruction: Generate impression based on findings.

Input: 39-year-old male status post BKA for sarcoma, progressive pain in joint and stump MRI of the left tibia and fibula stump was performed with the field of view expanded to include the knee and distal femur. There is an approximately 1.1 cm focus of tissue within the anterior joint anterior to the anterior aspect of the lateral tibial plateau which enhances and contains dark signal on T2 weighted images, suspicious for PVNS. A small amount of fluid is present within the knee joint without frank effusion. The cruciate and collateral ligaments as well as the menisci appear grossly intact. The extensor mechanism is normal.Within the distal aspect of the stump there is increased T2 signal within the soft tissues and marrow with mild enhancement which may simply represent reactive changes although early tumor recurrence cannot be excluded purely on the basis of imaging. The remainder of the bone marrow signal is within normal limits.

Output: 1. Focus of enhancing tissue within the knee joint as described above with T2 dark signal suspicious for PVNS.2. Mild edema and enhancement within the marrow and soft tissues of the distal stump, which may simply be reactive in etiology although on the basis of imaging tumor recurrence cannot be entirely excluded.


Instruction: Generate impression based on findings.

Input: Epilepsy at childhood, then again age 21. There appears to be mild diffuse T2 hyperintensity in the right hippocampus with perhaps slight volume loss. The brain parenchyma otherwise appears unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a partially empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. Findings suggestive of right medial temporal sclerosis. Follow up via MRI with contrast may nevertheless be useful.2. A partially empty sella may indicate pseudotumor cerebri.


Instruction: Generate impression based on findings.

Input: Reason: evaluate for structural lesion in setting of seizrues and headaches History: seizures and headaches The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 20 x 10 mm axial dimensions extra-axial left parafalcine mass adjacent to the left frontal lobe which was also identified on the previous exam last July and is not appear to have changed dramatically. It is bright signal on T1 and low signal on T2 and dark on susceptibility imaging. There is no substantial contrast enhancement associated with this.The hippocampi are symmetric.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is no significant change compared to the previous exam. There is remonstration of a small left parafalcine lesion adjacent to the left frontal lobe which appears to be calcified.


Instruction: Generate impression based on findings.

Input: Clinical question: 62-year-old female with SLL, history of subdural bleed with midline shift, now with hypertension and bradycardia, concern for elevated intracranial pressure. Signs and symptoms: Bradycardia, hypertension Non-infused CT of brain:Redemonstration of periventricular low attenuation in bifrontal lobes. In comparison to the prior examination there is suggestion of interval increase of this finding.Also new since prior examination is large area of low attenuation involving the left occipital lobe surrounding the occipital horn of left lateral ventricle. Also note is made of interval increase in the size of the supratentorial ventricles. There is no evidence of hemorrhage. I believe the above findings may represent transependymal exudate secondary to gradually increasing hydrocephalus. Further evaluation with an MRI is recommended to exclude other possibilities. There is no evidence of residual subdural. Small calcified meningioma along the left petroclinoid ligament is again identified.Images through posterior fossa suggests interval increase in the size of fourth ventricle as well.

Output: 1.Increased in size of all ventricular system since prior exam. 2.Increased in periventricular low attenuation is concerning for hydrocephalus and periventricular exudate of CSF.3.correlate with clinical history and if concerned an MRI is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question: Subarachnoid hemorrhage. Signs and symptoms: Right-sided weakness. Unenhanced head CT:Examination demonstrates a large area of vasogenic edema in high convexity left frontal lobe with resultant effacement of adjacent cortical sulci.Within the region of vasogenic edema there is a superficially located mass measuring approximately 14.3 x 11.5-mm in transaxial dimensions on axial image 22. The prior measurements of this tumor on prior enhanced MRI on 6 -- 9 -- 11 there is 12.6 x 11 0.7-mm in size. This mass demonstrate mildly high-density which may represent minimal internal hemorrhage. There are no prior head CTs for comparison of the density of this mass. There in no evidence of parenchymal or subarachnoid hemorrhage or mass effect on the left lateral ventricle or midline shiftOther than the above described findings the study is unremarkable and in particular no additional similar abnormalities are identified.

Output: 1.Left precentral frontal lobe tumor with minimal internal high density measuring 14.3 x 11.5-mm with extensive surrounding vasogenic edema. The higher than brain parenchyma density of this tumor may represent minimal internal hemorrhage.2.Surrounding vasogenic edema and resultant effacement of the adjacent cortical sulci.3.No evidence of parenchymal or subarachnoid hemorrhage, midline shift or hydrocephalus.


Instruction: Generate impression based on findings.

Input: 42 year old male status post fall MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: There is curvilinear T1 hypointense signal within the lateral tibial plateau consistent with a nondisplaced tibial plateau fracture, with the fracture fragment measuring 2.9 x 1.9 cm. There is associated marrow edema.The overlying articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The patella and quadriceps tendons are intact.ADDITIONAL

Output: 1. Nondisplaced tibial plateau fracture as described above.2. Intact menisci, cruciate and collateral ligaments.


Instruction: Generate impression based on findings.

Input: Transient alteration of awareness [R40.4], Reason for Study: ^Reason: Concern for encephalitis/PRES/stroke/bleed History: altered mental status Brain MRIMotion artifacts degraded exam quality.There is no evidence of acute ischemic or hemorrhagic lesion.There is no evidence of abnormal FLAIR/T2 signal intensity that can suggest possible edema.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No evidence of abnormal enhancement. No evidence of brain edema.2. Normal brain MRV.


Instruction: Generate impression based on findings.

Input: Neuromyelitis optica. Arm and leg weakness and numbness. The cervical spine images are limited by patient motion.Brain:A tiny noncontrast-enhancing, T2 hyperintense focus in the right parietal white matter is unchanged and nonspecific. Otherwise, the brain continues to show no focal abnormality. No evidence of acute infarct, hemorrhage, intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. No hydrocephalus. No extra-axial collections. Bone marrow signal and extracranial soft tissues are unremarkable.Dedicated orbital MRI sequences were not obtained however no obvious signal abnormality is appreciated within the optic nerves on the brain MRI sequences. Mastoid air cells and paranasal sinuses are clear. Cervical Spine:Previously seen contrast-enhancing lesion in the right dorsal aspect of the cervical spinal cord at the C3 level no longer demonstrates contrast enhancement. Associated previously seen extensive T2 hyperintensity extending throughout the cervical cord has evolved with significant decrease in signal abnormality and cord swelling with development of mild volume loss. Sagittal images demonstrate patchy T2 signal abnormality involving the upper thoracic cord possibly worse in the interval but not well evaluated. No abnormal cord enhancement is appreciated. Cervical spine shows straightening but normal alignment otherwise. Vertebral morphology and marrow signal are normal. No significant spinal canal or neural foraminal stenosis. The left vertebral artery is small which is unchanged and may be related to hypoplasia.

Output: 1.Unchanged single focus of T2/FLAIR hyperintensity. No abnormal enhancement or findings to suggest NMO involvement of the brain. No evidence of acute infarct, mass, or mass effect. 2.Compared to 7/24/2012, there is been interval resolution of the previously seen enhancing lesion at the right C3 level as well as marked decrease in previously seen extensive cervical cord T2 hyperintensity and edema. Current study demonstrates residual T2 signal abnormality throughout the cervical cord, greater dorsally and on the right, with development of volume loss. Findings are consistent with sequela of prior myelitis. No abnormal enhancement is appreciated to suggest active disease.3.Patchy T2 signal abnormality is noted in the partially imaged thoracic cord on the sagittal T2 cervical cord sequences, possibly worse but not well-assessed. Dedicated thoracic spine MRI can be obtained as clinically appropriate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of right lung. The right frontal lobe lesion is no longer discernible and there is no evidence of new enhancing intracranial lesions. There are diffuse areas of white matter T2 hyperintensity bilaterally. There is no evidence of intracranial hemorrhage 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 unremarkable. There is mild right maxillary sinus mucosal thickening.

Output: The right frontal lobe metastasis is no longer discernible. Diffuse areas of white matter T2 hyperintensity bilaterally may represent treatment effects and/or chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is minimal disc narrowing at from T12-L1 through L2-L3. The vertebral body and disk heights are otherwise well-maintained, with mild scattered disc desiccation. No worrisome focal marrow signal abnormality is appreciated. Similar to the appearance on recent MRI of the cervical and thoracic spine, there is diffuse enhancement along the surface of the distal cord and conus with mild enhancement of especially the distal cauda equina nerve roots. The distal spinal cord and conus are otherwise within normal limits with the conus terminating at the mid L1 level.At T12-L1 and L1-L2, there are very minimal disc bulges without stenosis.At L4-L5 and L5-S1, there are tiny central annular fissures. There is also prominent facet arthropathy at these levels.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. .There is severe distention of the bladder. The liver appears significantly T2 hypointense which may indicate iron deposition

Output: 1. Leptomeningeal enhancement along the distal cord and conus as well as along the cauda equina nerve roots especially distally. Differential diagnosis again includes leptomeningeal infection/inflammation versus less likely neoplasm.2. Severe distention of the bladder.3. Very mild spondylotic changes without significant stenosis at any level.4. Prominent T2 hypointensity of the visualized liver which may relate to iron deposition.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, status post L5-S1 laminectomy and lumbar fusion with increasing pain in the bilateral lower extremities. Assess for hematoma. Findings are seen compatible with recent posterior instrumented fusion of L5 and S1. A right hemilaminectomy has been performed at L5-S1 as well as interbody fusion. Extensive paraspinal soft tissue enhancement is seen within the posterior operative soft tissues, within expected limits. The spinal canal is not well seen in the operative region on postcontrast images due to metallic artifact. Where evaluable, the dorsal dura is uniformly thickened, likely reactive to recent surgery. A fluid collection measuring up to 34 mm in diameter is evident within the posterior subcutaneous soft tissues.Beginning at the L3-4 level and continuing down to the sacrum, a sizable collection is evident predominantly within the left dorsal epidural space which is T2 hyperintense and predominantly T1 hypointense. This collection effaces the thecal sac through its length, causing its most significant stenosis at the L5 level where the cauda equina nerve roots are displaced and compressed into the right aspect of the spinal canal.A severe scoliotic curvature of the lumbar spine is seen with a slight right lateral translation of L3 relative to L4. In the sagittal plane, there is a grade 1 anterolisthesis of L5 relative to S1. Apart from scoliotic deformities and surgical change, vertebral body morphology is grossly unremarkable. No worrisome marrow replacement is seen. The distal spinal cord and conus are unremarkable.L1-2: Left facet hypertrophy. Loss of disc height and disc osteophyte formation, particularly towards the left. No significant generalized canal stenosis. Moderate left foraminal narrowing. L2-3: Minimal lateral disc bulging. Questionable right lateral epidural effacement but no significant generalized canal stenosis. Mild bilateral foraminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Left dorsal epidural collection as above. Mild disc bulging asymmetric to the left with annular fissuring centrally. Moderate generalized spinal canal stenosis. Moderate left and mild right foraminal narrowing. L4-5: Facet hypertrophy. Large epidural collection as above. Significant generalized spinal canal stenosis with the nerve roots of the cauda equina displaced and compressed into the right lateral spinal canal. Moderate right foraminal narrowing. L5-S1: Spondylolisthesis with disc uncovering and disc bulging. Large epidural collection as above causing significant effacement of the thecal sac. The neural foramen are not well assessed due to metallic artifact.

Output: 1.Postoperative findings compatible with posterior instrumented fusion, right hemilaminectomy/facetectomy, and interbody fusion at L5-S1.2.Beginning at the L3-4 level and continuing down into the sacrum, there is a large predominantly left dorsal epidural collection which causes significant effacement of the thecal sac, particularly at L5 where the nerve roots of the cauda equina are displaced to the right aspect of the spinal canal and likely compressed. This collection could represent a hematoma or perhaps less likely a pseudomeningocele. An infected collection is not entirely excluded though this would be unlikely given the short time course from surgery. Discussed with Dr. Creighton at 4:00 PM on 12/14/15.3.Severe scoliotic deformity and superimposed degenerative findings are also noted as detailed above.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/3/15), breast MRI (10/17/15), ultrasound images of right breast (10/28/15), images from ultrasound guided biopsy of right breast with postprocedural right mammographic images (10/28/2015), images from MRI guided biopsy of right breast and postprocedural right mammographic images (11/3/2015) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (9/20/2013, 9/4/2013, 7/10/2012, 4/13/2010), ultrasound images (9/20/2013)are available. DIGITAL MAMMOGRAPHIC IMAGES (4/3/15):The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Scattered benign calcifications are present in both breasts.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. BREAST MRI (10/17/15):The study was performed with a protocol outlined in the outside radiology report.There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is an irregularly shaped enhancing mass measuring 13 x 14 x 15 mm (AP x LR x CC) at anterior 12:30 position in the right breast. There are a few satellites immediately inferior to this mass, and linear non-mass enhancement immediately medial to the mass. Overall measurement of these lesions is 16 x 20 x 20 mm. There is a benign-appearing enhancing focus at the central aspect in the right breast.There are multiple enhancing foci in the left breast, likely parenchymal enhancement.No abnormal lymph nodes are identified in either axillary region.ULTRASOUND IMAGES OF RIGHT BREAST (10/28/15):An ill-defined, irregularly-shaped hypoechoic mass measuring 13 x 9 x 15 mm at 12:00 position, 3 cm from nipple, is detected, corresponding to the enhancing mass on the MRI. There is an echogenic rim around this mass, suggesting malignancy.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/28/2015):Ultrasound guided biopsy for the right breast mass at 12:00 position was performed with an appropriate needle placement. A coil clip is placed at anterior 12:00 position on the postprocedural mammogram. Per outside radiology report, pathology was malignant, invasive carcinoma with mixed ductal and lobular features grade 1.IMAGES FROM MRI GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (11/3/2015):MRI guided biopsy was performed for the enhancing focus at the central aspect in the right breast. Targeting appears appropriate. Post procedural mammographic images show a rod shaped clip at posterior upper outer quadrant in the right breast. Per outside radiology report, the pathology result was benign.

Output: 1. Biopsy proven invasive carcinoma in the right breast at 12:00 - 12:30 position. Breast MRI demonstrated mass with a few satellites and a linear non-mass enhancement. 2. Biopsy-proven benign lesion at the central aspect in the right breast.3. No MRI or mammographic evidence for malignancy in the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: 80-year-old female with a history of neurofibromatosis type I status post excision of right buttock lesion. Postsurgical changes of a resection of a malignant peripheral nerve sheath tumor in the right buttock. No residual lesion or abnormal enhancement is identified. The enhancing mass within the subcutaneous fat of the posterior left buttock has not significantly changed and measures approximately 3 cm in diameter. Accounting for differences in technique, positioning, and inter-user measurement the enhancing mass within the musculature anterior to the proximal left femur has not substantially changed. Multiple scattered cutaneous and intramuscular neurofibromas are noted bilaterally. Additional findings have not substantially changed.Hypointense mass within the uterus likely represents a fibroid. Heterogeneous appearance of the bone marrow likely reflects residual or retroverted red marrow. Osteoarthritic changes have not significantly changed. Degenerative disc disease affects the lumbar spine most severe at L5-S1.

Output: 1. Postsurgical changes of a resection of a malignant peripheral nerve sheath tumor in the right buttock without findings to suggest locoregional recurrence.2. No significant change in additional findings including multiple scattered cutaneous and intramuscular neurofibromas.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with history of multiple tonsil cancer recurrences, with a new recurrence in the nasopharynx, compare to previous exams. Redemonstrated are postoperative findings compatible with resection of the posterior right hemimandible with hardware fixation and flap reconstruction of the right-sided pharyngeal soft tissues. Sequelae of right neck dissection are also redemonstrated.The previously described infiltrative tumor centered on the right nasopharynx with involvement of the pterygoid plates and parapharyngeal space is less bulky and less well-defined than on the prior examination. The lesion is no longer accurately measurable as it cannot be definitively isolated from the normal nasopharyngeal structures.Architectural distortion of the tongue is seen which may reflect hemiatrophy or flap reconstruction of the right oral tongue. Since the prior examination, the right hemitongue region has become T2 hyperintense and enhances mildly, also appearing slightly more edematous than on the prior exam.Generalized hyperemia of the residual native pharyngeal and soft palate mucosa is seen with edema spreading into the left masticator space. Pooling secretions are seen within the piriform sinuses.The right parotid gland is enlarged relative to the left and slightly hyperemic but this is not significantly changed from prior. The salivary glands and the thyroid are otherwise unremarkable. Small scattered lymph nodes are seen within the neck but none of which is pathologically enlarged by size criteria. Patchy fluid is evident within the right mastoid air cells. Patchy mucosal thickening is also seen within the paranasal sinuses.

Output: 1.Since the prior examination, infiltrative tumor that had been centered on the right nasopharynx is significantly decreased in conspicuity and bulk and is now no longer discretely measurable.2.New edema and hyperenhancement is seen within the right hemitongue. This could represent a treatment related mucositis, or assuming that this tissue is not a flap construct, a denervation related effect. Tumor involvement is felt to be unlikely, though the area should be evaluated with direct inspection.3.Likewise, progressive edema is seen within the residual nasopharyngeal and soft palate mucosa. Findings are favored to reflect treatment related mucositis but these areas should be inspected directly to exclude tumor involvement.4.No pathologic adenopathy is detected in the neck.


Instruction: Generate impression based on findings.

Input: Male 58 years old Reason: assess right triceps mass History: present for 10 months Again noted with in the right arm, within the triceps muscle is a 3.8 x 4.6 x 5.0 cm soft tissue mass, stable/mildly increased from prior allowing for differences in imaging technique. Linear high signal and appearance suggestive of a dural tail extends from the superior and inferior aspects of the main body of the mass. This is homogeneously iso-/hypointense to muscle on T1 weighted images and somewhat inhomogeneously hyperintense to muscle on T2 weighted images. Postcontrast it demonstrates rim enhancement and inhomogeneous internal enhancement. It is well delineated without reactive edema in the surrounding musculature. The humerus is unremarkable.

Output: 5.0-cm soft tissue mass in the right triceps muscle. Although this may represent a benign peripheral nerve sheath tumor, due to the inhomogeneity, the appearance is somewhat worrisome for a malignant peripheral nerve sheath tumor.


Instruction: Generate impression based on findings.

Input: Relapsed multiple myeloma with new left mental numbness. Evaluate for cranial nerve involvement or lytic bone lesions. There is no evidence of marrow replacement corresponding to the lytic lesion of the left mandible as seen on prior maxillofacial CT. There is no evidence of acute intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci of abnormal T2 hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is evidence of right uncinectomy. There is marked mucosal thickening of the left maxillary sinus. There is mild mucosal thickening of the right maxillary and bilateral sphenoid sinuses. There is diffuse mucosal thickening of the bilateral ethmoid sinuses.

Output: 1. No evidence of marrow replacement corresponding to the area of the left mandibular lytic lesion as seen on prior maxillofacial CT, to suggest that the lytic lesion on CT would represent a myelomatous lesion. Please note that only part of the mandible was included on this exam.2. No evidence of intracranial hemorrhage, mass, or acute infarct.3. Diffuse paranasal sinus opacification.


Instruction: Generate impression based on findings.

Input: Female 41 years old Reason: s/p duodenal switch 2008; recent diagnosis of cholelithiasis; evaluate for ductal stone History: abdominal pain (RUQ) ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The hepatic and portal veins are patent.Gallbladder contains multiple tiny gallstones. There is mild gallbladder distention.There is no pericholecystic fluid. Common bile duct is normal in caliber. No choledocholithiasis is evident.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal morphology. No interstitial or peripancreatic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Cholelithiasis without definite evidence of cholecystitis or choledocholithiasis.2.Mild gallbladder distention.


Instruction: Generate impression based on findings.

Input: Altered mental status There is a focal restricted diffusion on the right deep parietal white matter indicating small ischemic infarct.There is no evidence of acute hemorrhage lesion.On FLAIR images, patch bilateral periventricular white matter high signal intensity lesions with a some scattered white matter high signal intensities indicate nonspecific small vessel ischemic disease.There is focal volume loss with surrounding patch high signal intensity on FLAIR on the left mesial aspect of cerebellar hemisphere indicate chronic ischemic infarct.Previously shown restricted diffusion lesions show focal increased signal intensity lesions on FLAIR imaging, however, do not show evidence of restricted diffusion anymore indicating chronic ischemic infarct.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. A new focal restricted diffusion on the right deep parietal lobe white matter indicating focal acute ischemic infarct without hemorrhagic transformation.2. Moderate degree nonspecific small vessel ischemic disease, no change since prior exam.


Instruction: Generate impression based on findings.

Input: Male, 31 years old, with radiating sciatic pain, right side more than left. Spinal alignment is anatomic. Vertebral body morphology is normal. No concerning marrow replacement is seen. Mild endplate edema is evident at L5-S1.The visualized spinal cord, conus and nerve roots of the cauda equina are unremarkable.Loss of disk height and T2 signal are seen at L5-S1. A large central and left paracentral disk protrusion is present at this level which causes a mild generalized canal narrowing. There may be some impingement of the left S1 and S2 nerve roots. Questionable mild impingement of the right S1 and S2 nerve roots is also seen. The neural foramina are at most mildly narrowed.Mild disk bulging is seen at L4-5 without significant spinal canal or neuroforaminal stenosis. The remaining levels are free of significant degenerative disk disease.

Output: Disk herniation at L5-S1 resulting in a mild generalized spinal canal stenosis with suspected impingement of the S1 and S2 nerve roots, left side more so than right.


Instruction: Generate impression based on findings.

Input: Altered mental status and history of leukemia. Surgical planning for biopsy of the intracranial lesions. There are numerous subcentimeter supratentorial and infratentorial lesions, some of which are perhaps minimally larger and have increased associated surrounding vasogenic edema. For example, a left superior frontal gyrus lesions measures up to 5 mm, previously 4 mm. Otherwise, the majority of the lesions have not appreciably changed in size. 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 unchanged.

Output: Preoperative MRI demonstrates numerous subcentimeter supratentorial and infratentorial lesions, some of which are perhaps minimally larger and have increased associated surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: Female 20 years old Reason: Right renal abscess or Right ovarian septic thrombophlebitis History: septic, recurrent fevers despite source control, Right- pyelonephritis, c/f abscess, also for pelvic septic thrombophlebitis ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged measuring 20 cm in craniocaudal dimension. No biliary ductal dilatation. Gallbladder is decompressed by a cholecystostomy tube.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys are heterogeneous and enlarged bilaterally with multiple striations with areas of restricted diffusion. There are small cortically-based T2 hyperintense foci, which are triangular in shape. Differential considerations for these small lesions include small complex cysts vs. small microabscesses their configuration and signal favors areas of microabscess formation. No drainable fluid collections or perinephric drainable fluid collections. There is inflammation surrounding both kidneys that extends into the retroperitoneum.RETROPERITONEUM, LYMPH NODES: No specific evidence of gonadal vein thrombosis. The left gonadal vein is normal in caliber. Right gonadal vein is partially obscured by the inflammation surrounding the right ureter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Body wall anasarcaOTHER: No significant abnormality noted.

Output: 1.Findings compatible with bilateral pyelonephritis with probable small cortical microabscesses. No drainable abscess or fluid collections.2.No hydronephrosis or obstruction.3.No specific evidence for thrombophlebitis of the gonadal veins as they are normal in caliber. The right gonadal vein is partially obscured by the inflammation in the retroperitoneum surrounding the right ureter.


Instruction: Generate impression based on findings.

Input: 62 years Female (DOB:2/12/1954)Reason: Evaluate for infarct History: Woke up with bilateral leg weaknessPROVIDER/ATTENDING NAME: JAMES J WALTER ADIL J JAVED MRI of the brainNo diffusion weighted abnormalities are appreciated.There is some encephalomalacia involving the right centrum semiovale where there is ex vacuo effect along the right lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense lesions are present in the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the 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 internal carotid artery flow voids are absent.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The internal carotid arteries are not identified in either side proximal to the communicating segment on the left and proximal to the communicating segment on the right. The ophthalmic arteries are not readily identified. The right posterior communicating artery is not readily identified.. There appears to be greater time of flight signal within the left middle cerebral artery versus the right middle cerebral artery. The left posterior communicating artery is fairly large.Is not clear whether the left anterior cerebral arteries occluded or the A2 segment is azygos. There is a tubular type of extrusion coming off of the right proximal A2 segments which could represent a blood vessel or an aneurysm. It measures approximately 4 mm in length and 1.5 mm in diameter. It is directed laterally and has a curved course. The anterior communicating artery is small to medium sized.Antegrade flow is present in the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right vertebral artery is larger than the left vertebral artery.

Output: 1.Findings suggest occlusion of the internal carotid arteries proximal to the communicating segments. Supply to the anterior circulation is predominantly via the left posterior communicating artery. It appears that the anterior communicating artery offers some resistance to flow in the right middle cerebral artery.2.It is not clear whether the left A2 segment is occluded or whether there is an azygos A2 segment. If clinically appropriate a CT angiogram be helpful to further investigate.3.There is a tubular extrusion of the right A2 segment near the anterior communicating artery junction with the right A2 segment which could either represent an aneurysm or a vessel. Perhaps a CT angiogram would help further evaluate this.4.There is encephalomalacia along the right centrum semiovale which is suspected to represent a watershed distribution infarction.5.Periventricular and subcortical white matter lesions as well as lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Syncope. Suspicion of seizure. There is a punctate focus of susceptibility effect in the subcortical right superior frontal talus is not associated with edema. Otherwise, there is moderate T2 signal involving the frontoparietal white-matter. There are also small linear foci of encephalomalacia in the cerebellar hemispheres. There is no intracranial mass or acute infarct. There is no abnormal intracranial enhancement. There is no midline shift or herniation. There is mild diffuse cerebral volume loss and a partially empty sella. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The eye lenses are replaced bilaterally. There is degenerative spondylosis in the upper cervical spine, with mild indentation of the spinal cord by a C4-5 disc-osteophyte complex.

Output: 1.No evidence of acute intracranial hemorrhage, mass, or acute infarct. 2.Non-specific diffuse patchy cerebral white matter may represent small vessel ischemic disease.3.Small chronic cerebellar infarcts.4.Chronic focus of microhemorrhage in the right frontal lobe.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 57-year-old male patient status post fall downstairs with pain and swelling. Evaluate for ligamentous or tendon injury. MENISCI: There is slight abnormal increased intrasubstance signal intensity in the body and posterior horn of the medial meniscus, compatible with degeneration. There is no discrete tear in the medial or the lateral meniscus.ARTICULAR CARTILAGE AND BONE: There are no fluid-filled cartilage defects. There are subchondral reactive marrow changes in the posterior aspect of the lateral femoral condyle and posterior lateral tibial plateau, compatible with contusions. Small tricompartmental osteophytes are noted.LIGAMENTS: There is tearing of the superior fibers of the medial collateral ligament. Additionally, there is rupture of the anterior cruciate ligament. The posterior cruciate ligament, lateral collateral ligament complex, and patellar retinacula are intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Rupture of the anterior cruciate ligament with associated bone contusions in the posterior lateral femoral condyle and lateral tibial plateau.2.Medial collateral ligament tear.3.Joint effusion and loose body, as above.4.Degeneration in the body and posterior horn of the medial meniscus without discrete meniscal tear.


Instruction: Generate impression based on findings.

Input: History of thyroid cancer with intracranial metastases. Follow-up exam. New punctate focus of restricted diffusion in the left cerebellar hemisphere without associated T2 abnormality compatible with an acute to subacute infarct.Again seen is a peripherally enhancing focus of susceptibility in the left paracentral lobule with associated surrounding increased T2 signal. There appears to be a mild decrease in the degree of peripheral enhancement, and the surrounding edema is not significantly changed.Again seen are multiple foci of enhancement in the frontal lobes bilaterally and anterior right temporal lobe. Most of these lesions appear slightly increased in size. For example, the most superior left frontal lobe lesion measures 4 mm (series 1/2/2001 image 120), previously 2 mm. In addition there are new punctate foci of enhancement in the right caudate head and left frontal orbital gyrus which were not clearly present on the prior exam. No significant associated mass effect, midline shift, or herniation.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. Unchanged bilateral partial mastoid air cell opacification. The orbits are unremarkable.

Output: 1. New punctate left cerebellar acute to subacute ischemic infarct.2. Mild interval increase in size and number of punctate enhancing foci in the bilateral frontal lobes, right basal ganglia, and right temporal lobe compatible with progression of metastatic disease.3. Mild interval decrease in peripheral enhancement associated with the left paracentral lobule cavitary lesion.Findings were discussed with Dr. Mark Belkin p1002 of the inpatient service at the time of dictation.


Instruction: Generate impression based on findings.

Input: Female, 13 years old, with right frontal hemorrhage and intraventricular hemorrhage. Concern for vascular abnormality. A large acute right frontal lobe hematoma is evident occupying a large portion of the right superior and middle frontal regions with involvement of the right basal ganglia.Hemorrhage has dissected into the ventricular system with casting of the lateral, third and fourth ventricles. A left frontal approach ventricular shunt catheter is in place with its tip at the level of the left foramen of Monro.Relatively modest parenchymal edema is seen surrounding the frontal lobe hematoma. There is resultant generalized mass effect with midline shift to the left of at least 10 mm, effacement of the right frontal horn, and subfalcine herniation. The suprasellar and quadrigeminal cisterns remain patent.The right lateral ventricle is mildly dilated. The remainder of the ventricular system demonstrates relatively normal morphology.FLAIR hyperintensity within some of the sulci of the cerebral vertices may represent either a small amount of subarachnoid blood product or slow vascular flow.Diffusion restriction surrounding the right frontal hematoma may reflect a combination of ischemic injury and hemorrhage related artifact. A small focus of restricted diffusion is seen within the high left superior frontal gyrus. Mild restricted diffusion versus artifact is seen along the high interhemispheric falx posteriorly. Linear restricted diffusion is evident within the right putamen.A 15 mm long curvilinear and lobular region of enhancement is demonstrated just lateral and below the epicenter of the right frontal hematoma. On T1 precontrast images, there is the suggestion of a tuft or tangle of small vessels in this location.Dedicated MRA imaging fails to demonstrate any definite pathologic vasculature in this area, though this could be artifactual and due to compromised flow from edema and mass effect. The major intracranial vessels as visualized are patent and demonstrate no significant stenosis or occlusion. No other aneurysm or vascular abnormality is suspected.

Output: 1.Large right frontal lobe hematoma with dissection into the ventricles. Associated mass effect results in midline shift to the left, subfalcine herniation and effacement of the right frontal horn. The right lateral ventricle is mildly dilated.2.Just below and lateral to the center of the hemorrhage, a curvilinear enhancing structure is identified. On T1 precontrast images, there is a suggestion of a tuft or tangle of small vessels. MRA imaging fails to confirm this finding, though this could be a technical artifact. Findings are concerning for the presence of a vascular malformation. Further evaluation with conventional angiography is recommended.3.Several areas of ischemic injury are suspected including within the high left superior frontal gyrus, and within the right basal ganglia. Some of the parenchyma surrounding the right frontal lobe hematoma may also have sustained ischemic injury.


Instruction: Generate impression based on findings.

Input: History of CNS lymphoma and pituitary adenoma status post resection/radiation therapy presents with syncope and confusion with concern for CNS lymphoma. There are postoperative changes related to remote transphenoidal hypophysectomy. This is not a dedicated pituitary study; however, there is a grossly stable appearance of enhancing soft tissue in the right sella and right cavernous sinus. Again noted is a heterogeneous appearance with cystic appearing components within the sphenoid bone. There is again a burr hole along the right frontal bone.The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. There is otherwise no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. A small focus of susceptibility effect is again noted in the right basal ganglia, consistent with hemosiderin deposition.Normal flow-voids are demonstrated in the major intracranial vascular structures. The remainder of the midline structures and craniocervical junction are within normal limits. There is a diminutive right maxillary sinus.There is redemonstration of a nodule in the right parotid gland.

Output: 1. No findings to suggest recurrent CNS lymphoma. No evidence of acute ischemia or intracranial mass effect.2. Heterogeneous appearance of the sphenoid bone and perisellar region status post transphenoidal hypophysectomy. Findings are compatible with post-treatment changes and residual adenoma. No interval enlargement to suggest disease progression.3. Right parotid gland nodule again noted which may represent low-grade salivary gland neoplasm or pathologic lymph node.


Instruction: Generate impression based on findings.

Input: 61 years Male (DOB:4/1/1955)Reason: pars defect History: pars defectPROVIDER/ATTENDING NAME: MICHAEL J LEE MICHAEL J LEE Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level.At L4-5 there is a right lateral recess disc protrusion which effaces the fat at the right lateral recess and compresses the nerve root at the right lateral recess. There is no endplate reactive changes appreciated. There is loss of disc space height and disc desiccation present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is disc desiccation present at this level

Output: There is a right lateral recess disc protrusion at L4-5 which compresses the nerve root at the right lateral recess at this level (probably the right L5 nerve root).


Instruction: Generate impression based on findings.

Input: 17 years Female (DOB:10/8/1998)Reason: low grade glioma, yearly follow up , eval for changes History: yearly follow upPROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM There is T2 and FLAIR signal hyperintensity present within the right parahippocampal gyrus and extending collateral sulcus and the adjacent fusiform gyrus. There is associated susceptibility effect within this lesion. This was also present on 1/6/2016 exam. It has a similar appearance. Compared to the 6/7/2012 exam it also appears relatively stable. The foci of susceptibility effect were not present at that time and likely related to a biopsyNormal 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 mucosal thickening on the right maxillary sinus more than the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.The patient's right parahippocampal centered mass also involving adjacent fusiform gyrus remains stable over time. It is known to represent Low-grade astrocytic proliferation based on a biopsy from September 2012.2.New mucosal thickening in the maxillary sinuses is likely inflammatory in nature. Please correlate with clinical history.


Instruction: Generate impression based on findings.

Input: 78 year old male with metastatic colon cancer in lung and liver. Staging. CHEST: LUNGS AND PLEURA: Scarlike opacities and postsurgical changes are seen in both lungs. In the left upper lobe, there is a 1.5 x 1.4 cm nodule consistent with metastatic disease. A smaller and more irregularly shaped nodule in the right lower lobe measures 1.1 x 1.4 cm, consistent with a metastasis. Small right pleural effusion has resolved. MEDIASTINUM AND HILA: Atherosclerotic calcifications in the thoracic aorta and coronary arteries. Normal heart size. No pericardial effusion. Borderline enlarged right hilar lymph node. Small mediastinal lymph nodes.CHEST WALL: Right chest wall Port-A-Cath with the tip in the superior vena cava. There is possibly partial collapse of the L1 vertebral body which is incompletely visualized on this study. Right-sided venous access device is in expected position.ABDOMEN:LIVER, BILIARY TRACT: Intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified.Large mass noted in the right lobe of the liver without enhancement. This mass has an exophytic component. It measures 4.7 x 7.7 cm (image 82, series #3). A second, smaller lesion with similar characteristics is noted inferior to the dominant mass that also is compatible with a metastasis. Additional, subcentimeter lesions are scattered throughout the liver with typical features of benign cysts on the MRI exam. Cholelithiasis noted.SPLEEN: No significant abnormality noted. Calcified splenic granulomata. PANCREAS: Prominent pancreatic duct.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression deformity at the superior endplate of L1.OTHER: IVC filter is in the expected position. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid diverticulosis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Benign calcifications in the left groin and left spermatic cord.

Output: 1. Minimal intra- and extra-hepatic biliary ductal dilatation to the level of the ampulla. No obstructing mass is identified; however, cannot rule out obstructing ampullary stricture.2. Hepatic metastases are stable since the prior MRI exam.


Instruction: Generate impression based on findings.

Input: Systemic lupus erythematosus, unspecified [M32.9], Reason for Study: ^Reason: SLE, cognitive difficulties History: SLE, cognitive difficulties Brain MRINo evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement on the scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. 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 normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Right ACA A1 segment is hypoplastic and the right Pcom artery is not seen. The left Pcom artery and Acom artery are patent. There is no intracranial arterial aneurysm. No intracranial arterial luminal irregularity or occlusion.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. Normal brain MRA and MRV.


Instruction: Generate impression based on findings.

Input: Brain MRI is within normal limits. There is no diffusion abnormality. No intracranial mass or mass effect. The ventricles and sulci are within normal limits for age. 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. No abnormal parenchymal or meningeal enhancement.MRA HEAD

Output: 1. Brain MRI appears within normal limits. No evidence of infarct, intracranial mass, or arteriovenous malformation.2. MRA of the head and neck are within normal limits. MR venogram is also within normal limits.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, status post tumor resection. Expected postoperative findings are seen compatible with recent T12-L1 laminectomy. A small amount of fluid is present within the laminectomy bed extending up to the level of the duraplasty which does appear to be intact.The previously seen intradural tumor at the L1 level has been resected with no evidence of any residual tumor. Prior mass effect upon the conus has been relieved.Spinal alignment is anatomic. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow signal abnormality is detected.Apart from some slight clumping of the cauda equina at the level of the resected tumor, the visualized intradural elements are unremarkable.Facet hypertrophy develops at lower lumbar levels becoming quite severe at L4-5.At L1-2 through L3-4, only minimal disc bulging is seen with no significant spinal canal or neuroforaminal stenosis.At L4-5, there is mild disc bulging but no significant spinal canal or neuroforaminal stenosis.At L5-S1, there is severe disc degeneration with complete loss of disc height and fatty endplate signal alteration. No significant spinal canal stenosis is seen. However, the left neural foramen is severely narrowed.

Output: Expected postoperative findings status post resection of an intradural tumor at the L1 level. No evidence of residual tumor is seen.


Instruction: Generate impression based on findings.

Input: 84-year-old male with right sided neglect x 2 to 3 days. On Coumadin. Evaluate for subdural. Findings consistent with mild small vessel disease of indeterminate age are noted. No definitive interval change since prior exam. No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Vascular calcification. No evidence of extra axial hemorrhage. Calvarium remains intact. A clinical concern persists an MRI is recommended.

Output: Small vessel disease of indeterminate age.


Instruction: Generate impression based on findings.

Input: Dementia. Many of the sequences are degraded by patient motion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There has been progression of diffuse areas of cerebral and pons white matter T2 hyperintensity. The ventricles and sulci are diffusely enlarged. There is a partially-empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. However, there is diffuse paranasal sinus mucosal thickening and fluid within the maxillary sinuses. There is fluid signal within the mastoid air cells as well. There are bilateral lens implants.

Output: 1. Diffuse cerebral volume loss without a pattern suggestive of a specific neurodegenerative syndrome.2. Interval progression of nonspecific diffuse areas of cerebral white matter T2 hyperintensity, which may be related to chronic small vessel ischemic disease. 3. Findings suggestive of acute sinusitis and right mastoiditis.


Instruction: Generate impression based on findings.

Input: History of hepatitis B and hepatocellular carcinoma status post TACE RFA most recently on 8/13/2015 ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology including hypertrophy of the left hepatic and caudate lobes. Status post cholecystectomy. The common bile duct measures up to 13 mm, however tapers smoothly to the level of the ampulla, unchanged. No filling defect suggesting mass or gallstone. Cystic duct remnant is noted.More centrally in the posterior segment is a new ablation cavity measuring 2.5 x 1.8 cm (series 9/235). No residual enhancing lesion. No new arterial enhancing lesion.Right hepatic lobe inferior ablation cavity measures 3.4 x 1.9 cm (series 9/235), compared to 3.3 x 1.9 cm previously.The slightly more superior right hepatic lobe peripheral ablation cavity measures 2.6 x 1.8 cm (series 9/232), unchanged.The left hepatic lobe ablation cavity measures 1.9 x 1.4 cm (series 9/235), unchanged.Stable hypervascular lesion in the left lateral segment of the liver, characterized as a portal to hepatic venous shunt.The portal vein is patent. The visualized hepatic artery is patent.No specific stigmata of portal hypertension.SPLEEN: The spleen is normal in size without a focal lesion.PANCREAS: The pancreas is normal in morphology. The main pancreatic duct is normal in caliber. There is a stable 4 mm pancreatic head side branch IPMN. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate renal cysts are noted bilaterally. No hydronephrosis or suspicious renal lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Nonspecific mild elevation of the left hemidiaphragm. Trace pleural fluid.

Output: Post ablation changes of the posterior segment hepatic lesion without residual arterially enhancing component. No new suspicious liver lesion. Otherwise stable ablation cavities in both the right and left hepatic lobe.


Instruction: Generate impression based on findings.

Input: Clinical question: The stenosis? Signs and symptoms: 61-year-old female with right hand numbness, previous fusion. Nonenhanced cervical MRI:Examination demonstrates extensive postoperative changes of anterior approach spinal fusion of C3, C4 and C5 levels. Fusion includes placement of an anterior metallic plate and fixating screws in the vertebral bodies of C3, C4 and C5. There is normal anatomical alignment of vertebral column. There is also fusion of vertebral bodies of C6 and C7 without evidence of surgical intervention.Foramen magnum is unremarkable.C2-C3 demonstrate mild disc disease, shallow disc-osteophyte complex, moderate left and mild right facet and moderate bilateral ligamentum flavum hypertrophic changes. Constellation of changes results in flattening and posterior displacement of the cord with complete effacement of subarachnoid space and moderate central spinal stenosis. There is also significant left and moderate right neural foraminal compromise. No detectable signal abnormality of the cord.C3-C4 demonstrate post operative changes with mild central spinal stenosis. There is moderate right and mild left neural foraminal compromise.C4-C5 demonstrate postoperative changes without central spinal stenosis. Moderate left and patent right neural foraminal.L5-C6 demonstrate no spinal stenosis however moderate left neural foraminal compromise and unremarkable left right neural foraminal.C6/C7 demonstrate no spinal stenosis or neural foraminal compromise.C7-T1 demonstrate mild degenerative changes and asymmetric mild left facet and ligamentum flavum hypertrophic changes resulting gain mild left neural foraminal compromise and no central spinal stenosis.There is no detectable signal abnormality of the cord.

Output: 1.Postoperative changes of anterior approach spinal fusion from C3 through C5 with only residual mild central spinal stenosis at C3-C4.2.Degenerative changes at C2-C3 with resultant moderate central spinal stenosis as detailed.3.No spinal stenosis at any other level.4.There are multilevel neural foraminal compromise of varying degrees as detailed per level above.5.No detectable myelopathy.6.Incidental note is made of a focus of T2 hyperintensity (sagittal T2 series) in the dorsal aspect of pons which is nonspecific however could represent a focus of lacunar infarct of indeterminate age.


Instruction: Generate impression based on findings.

Input: Reason: change in brain lesions, pituitary? History: daily headaches. History of right carotid body. Ganglia,. There is a 1.5 cm lesion in the right frontal lobe with extensive susceptibility compatible with a prior hemorrhagic infarct. Surrounding FLAIR signal in the right centrum semiovale is slightly increased posteriorly. No evidence of new hemorrhage.Areas of increased T2 signal with associated susceptibility and mildly increased T1 signal in the right occipital lobe are unchanged and suggestive of laminar necrosis secondary to prior ischemia.No new areas of abnormal signal. No evidence of restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Absence of flow void in the right internal carotid artery with dilatation of the left internal carotid artery appears similar to the prior exam. Prominent ventricles may reflect a mild degree of volume loss. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable. T1 hyperintense thickening along the pituitary stalk measuring 4 mm is unchanged.

Output: 1.Right frontal lobe hemorrhagic infarct with slightly increased surrounding T2 signal, within the expected progression of this lesion. 2.Right occipital laminar necrosis is unchanged.3.Absent flow-void in the right internal carotid artery is unchanged.4.Nonspecific pituitary stalk lesion is unchanged.


Instruction: Generate impression based on findings.

Input: History of pancreatitis and elevated LFTs. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology, signal intensity and size, measuring 20 cm in craniocaudal dimension. No intra or extrahepatic biliary ductal dilatation. Minimal perihepatic fluid.The gallbladder is normally distended with several gallstones. No gallbladder wall thickening. There is mild pericholecystic fluid. No choledocholithiasis.SPLEEN: The spleen is normal in size and morphology without a discrete lesion.PANCREAS: The pancreas is mildly decreased in intrinsic T1 signal intensity at the level of the pancreatic head and uncinate process. There is mild heterogeneous enhancement of the pancreatic head/uncinate process with the remainder the pancreas is enhancing homogeneously without evidence of pancreatic necrosis. There is moderate peripancreatic inflammatory fat stranding and fluid. No loculated fluid collection.No evidence of venous thrombus or arterial pseudoaneurysm formation.The main pancreatic duct is normal in caliber and inserts with the common bile duct at the major papilla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Subcentimeter retroperitoneal lymph nodes may be reactive. Enteric tube noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small right greater than left pleural effusion with adjacent consolidation/atelectasis.

Output: 1. Mild acute interstitial edematous pancreatitis without evidence of pancreatic necrosis, significant fluid collection, arterial or venous complication. 2. Cholelithiasis without evidence of acute cholecystitis or choledocholithiasis. The etiology of the pancreatitis is not apparent on this study but may be related to a passed gallstone.3. Small right greater than left pleural effusion with adjacent consolidation/atelectasis.


Instruction: Generate impression based on findings.

Input: History of metastatic breast cancer with syncope. There is no evidence of acute infarction. There are no enhancing lesions in the brain, brainstem, or cerebellum. However, there is patchy white matter T2 hyperintensity in the bilateral peritrigonal regions. The ventricles sulci are mildly prominent diffusely. There is also dilatation of the bilateral Meckel caves, left greater than right, and the pituitary gland is mildly flattened. There is a subcentimeter calcified mass along the left inferior frontal convexity. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1) No evidence of intracranial metastasis, hemorrhage, or acute infarct. 2) Nonspecific white matter abnormality in the bilateral peritrigonal regions may be related to prior therapy.3) Mild flattening of the pituitary gland and bilateral enlargement of the Meckel caves may indicate underlying increased intracranial pressure and can be associated with the uncommon Usher syndrome.4) A subcentimeter calcified mass along the left inferior frontal convexity may represent a meningioma or osteoma, for example.


Instruction: Generate impression based on findings.

Input: Female, 25 years old, with tethered cord, low back pain, scoliosis. Evaluate for changes. Posterior fusion instruments are in place extending from the T4 level down to the L4 level. Associated artifact obscures portions of the spine. Evidence of additional surgery is also seen in the lumbar region where the posterior elements are absent beginning at L2 and continuing down to L5. An S-shaped scoliotic curvature of the spine is seen which is predominantly levoscoliotic in the lumbar region with perhaps a mild dextroscoliosis in the thoracic region. Sagittal alignment is within normal limits. Vertebral body heights are preserved. No evidence to suggest marrow edema or pathologic marrow replacement is seen.Findings compatible with split cord malformation (diastematomyelia) are seen. Partial separation of the hemicords begins at the T7 level. The hemicords become completely separated at T12 and then re-unite at the L2 level. No definite evidence of an intervening osseous spur is seen. Image quality is not adequate to exclude the possibility of a thin fibrous septation.Below the L2 level, the re-united cord becomes closely apposed to the dorsal thecal sac. The spinal cord is low lying and reaches at least to the L3 level. On prone imaging, the distal spinal cord and cauda equina nerve roots remain closely apposed to the dorsal thecal sac.A thin T1 hyperintense cord-like structure is evident dorsally beginning at the L4 level compatible with a fatty filum terminale. At the L5 level, there is a gap of approximately 2 cm where no definite fatty filum is seen. However, the fatty filum reappears at the S1 level (see image 12 series 1301).

Output: 1.A scoliotic curvature of the spine is demonstrated. Long segment thoracolumbar instrumented fusion has been performed.2.Absent posterior elements in the lower lumbar spine likely represent additional postoperative change though this could also potentially represent congenital dysraphism.3.Findings are seen compatible with split cord malformation. The cord begins to separate into two halves at the T7 level with complete separation evident at T12. The hemicords re-unite at the L2 level. No definite evidence of an intervening osseous spur is seen, though image quality is not adequate to exclude the possibility of a fibrous septation.4.A T1 hyperintense cord like structure in the lower lumbar spine along the dorsal thecal sac likely represents fatty infiltration of the filum terminale. It appears that there is a 2 cm long disruption in this structure which could indicate prior surgical detethering. Alternately, the filum terminale may only be intermittently fatty infiltrated.5.Multiple findings are seen suggesting tethered cord including a low-lying spinal cord, the presence of fatty infiltration of the filum terminale, and lack of cord movement on prone imaging.


Instruction: Generate impression based on findings.

Input: Headache. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are minimal nonspecific foci of high T2 signal in the cerebral white matter. There is a partially-empty sella. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is staphylomatous deformity of the bilateral globes.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Nonspecific partially-empty sella.


Instruction: Generate impression based on findings.

Input: Newly diagnosed lung cancer, staging exam. There is a 6x6 mm peripherally enhancing lesion in the right frontal lobe anteriorly along the cortical surface (axial post gad series 12 image 71/184) and 8x5 mm peripherally enhancing lesion in the left superior cerebellar hemisphere. No significant associated edema. No evidence of mass effect, midline shift, or herniation.There is extensive encephalomalacia involving the left greater than right frontal lobes, and the left anterior temporal lobe, which may related to prior trauma. Additional focal areas of encephalomalacia also noted involving the right paracentral lobule and the left superior parietal lobule. There are foci of susceptibility consistent with hemosiderin deposition associated with many of these areas as well as along the right cortical surface in the right parieto-occipital region. There is severe volume loss involving the callosal genu consistent with Wallerian degeneration. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. No hydrocephalus. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There are mucous retention cysts in the maxillary sinuses.There is a 4 cm area of low T1 hyperintensity, restricted diffusion, and enhancement involving the right frontal calvarium. Additional area of abnormal enhancement is suspected in the left parietal calvarium (axial postgad sequence 10 image 5/29).

Output: 1. 6 mm right frontal lobe and 8 mm left cerebellar peripherally enhancing lesions are suspicious for metastatic disease. These are better seen on the postgadolinium 3D FSPGR sequence. No significant associated edema or mass effect.2. Extensive mutlifocal areas of encephalomalacia, particularly left greater than right frontal lobes and anterior left temporal lobes, with multiple areas of hemosiderin deposition. These are favored to be related to prior trauma.3. 4 cm right frontal area of enhancement in the calvarium. Unclear if this represents a large calvarial metastasis, related to possibly prior surgery, or other osseous lesion. CT would be helpful to better assess the osseous anatomy in this region. Additional subcentimeter enhancing lesion is seen in the left parietal calvarium. Recent PET-CT does not include these regions.


Instruction: Generate impression based on findings.

Input: Male, 78 years old, status post head injury, assess for cervical ligamentous injury. Reversal of the cervical lordosis is seen centered at C4-5. A grade 1 anterolisthesis of C4 relative to C5 also noted. Degenerative loss of vertebral body height is seen involving C4, C5 and C6 with corresponding degenerative endplate signal alteration.The spinal canal is narrowed due to degenerative disease beginning at C3-4 and continuing down to C5-6. The spinal cord is variably impinged through this region. There may be some vague increased cord T2 signal at C4-5 but this is equivocal.Mildly hyperintense STIR signal is evident within the interspinous spaces at C3-4 and C4-5. Elsewhere, the spinal ligaments and paraspinous soft tissues are unremarkable. Trace edema or fluid is seen along the prevertebral space at C3 and C4.C2-3: Facet arthropathy, left worse than right. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild left foraminal narrowing. C3-4: Facet arthropathy, left more than right. Posterior disc-osteophyte complex formation and ossification of the posterior longitudinal ligament, asymmetric to the left. Moderate spinal canal stenosis without significant cord deformation. Moderate left and mild right foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation and ossification of the posterior longitudinal ligament. Severe spinal canal stenosis with cord impingement and flattening. Moderate to severe bilateral foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis with slight cord deformation. Moderate to severe bilateral foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.

Output: 1.No definite evidence of traumatic osseous injury.2.Mild signal abnormality within the interspinous spaces at C3-4 and C4-5 could represent mild ligamentous injury or strain. Hyperintense STIR signal along the prevertebral space at C3 and C4 is nonspecific, but given the lack of adjacent soft tissue swelling, may simply be degenerative in nature.3.Multilevel degenerative findings are seen which contribute to significant spinal canal compromise from C3-4 through C5-6. The spinal cord is most severely impinged at C4-5 where there may be some mild abnormal cord signal indicating either edema or myelomalacia.


Instruction: Generate impression based on findings.

Input: 34-year-old male with recurrent dislocations with shoulder pain for years. Evaluate for labral tear. Several sequences are limited by patient motion artifact.ROTATOR CUFF: There is increased signal intensity along the undersurface of the distal supraspinatus tendon, just proximal to its insertion on the greater tuberosity, indicating focal tendinosis or undersurface tearing with a small erosion/cyst in the underlying humeral head. This involves less than 50% of the tendon width and measures approximately 5 mm in the longitudinal dimension. We see no full-thickness tear. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There may be minimal osteoarthritis of the acromioclavicular joint which otherwise appears normal. There is a trace amount of fluid within the subacromial-subdeltoid bursa, but no gadolinium.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a bucket-handle type tear of the superior labrum with additional full-thickness tearing that extends into the anterior labrum and partial-thickness detachment (Perthes-type lesion) of the anteroinferior labrum. There is full-thickness articular cartilage loss along the torn anterior labrum. The posterior labrum appears intact. The glenohumeral joint alignment is within normal limits.BICEPS TENDON: The tendon of the long head of the biceps appears intact. There is a small focus of low signal intensity within the biceps tendon sheath which could represent a small cartilage fragment, but this is equivocal.

Output: 1. Labral tear as described above with adjacent degeneration of the articular cartilage of the glenoid.2. Focal tendinosis and/or tearing of the undersurface fibers of the distal supraspinatus tendon.3. Equivocal loose cartilage fragment within the tendon sheath of the long head of the biceps tendon.


Instruction: Generate impression based on findings.

Input: 70 old male with NSCLC status post RT to the right lung, assess for response, has history of rheumatoid pulmonary nodules CHEST:LUNGS AND PLEURA: Previously noted spiculated mass in the posterior segment of the right upper lobe is less well delineated on the current exam due increased atelectasis involving its segment as well as an increasing right loculated pleural effusion.Noted are multiple pulmonary nodules, some demonstrating cavitation that are stable and may be related to rheumatoid nodules or secondary to chronic infection.Marked changes of centrilobular emphysema with scarring and areas of bronchiectasis noted particularly at the lung basesMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable small hypodense lesions, most likely representing hepatic cystsSPLEEN: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Extrarenal pelvis bilaterally and/or peripelvic cysts, with punctate, nonobstructing calculus in the right kidneyPANCREAS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fractures of T7, T8, 6 vertebrae are stable. However new fracturesare noted at T4 and T5. At T4 there is extension posteriorly into the spinal canal. MRI of the thoracic spine is recommended to evaluate for stenosis/cord compressionOTHER: Atherosclerotic changes of the aorta

Output: 1. Increased atelectasis in associated pleural reaction is identified in the posterior segment right upper lobe.2. Multiple pulmonary nodules, some cavitating are stable and again consistent with rheumatoid nodules and/or chronic infection.3. Extensive centrilobular emphysema, as well as scarring and bronchiectatic changes, more pronounced in the lower lobes unchanged4. New compression fractures at T4 and T5 with extension of the T4 fracture into the spinal canal. Correlation with previous MRI (12/10/09) to evaluate for stenosis/cord compression


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for cervical spinal disease. Signs and symptoms: Right-sided cervical radiculopathy. Nonenhanced cervical MRI:The signal intensity in the alignment of the vertebral column is unremarkable.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild disc disease and loss of disc height without significant facet or ligamentum flavum hypertrophy. No spinal stenosis however mild to moderate left neural foraminal compromise is detected.C4-C5 demonstrate mild degenerative disease without spinal stenosis however moderate left neural foraminal compromise is present.C5-C6 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet hypertrophy changes and mild bilateral ligamentum flavum hypertrophy. No evidence of spinal stenosis. Moderate left and mild right neural foraminal compromise is however present.C6-C7 demonstrate advanced disc disease and loss of disc height, mild bilateral ligamentum flavum and facet hypertrophic changes are noted. There is no evidence of central spinal stenosis. Moderate right and significant left neural foraminal compromise are detected.C7-T1 demonstrate mild disc disease, moderate right and mild left facet and ligamentum flavum hypertrophy. There is significant right and mild left neural foraminal compromise.The signal intensity and caliber of the cervical cord and upper most visualized thoracic cord is unremarkable.

Output: 1.Degenerative changes of cervical spine most noticeable at C5-C6 and C6-C7 levels however without evidence of central spinal stenosis at any level.2.Multilevel neural foraminal compromise (some severe) as detailed per level above.3.Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: 19 years Male (DOB:1/1/1997)Reason: history of sickle cell anemia with Moya Moya History: surveillance examPROVIDER/ATTENDING NAME: ELIZABETH M DRUMM ELIZABETH M DRUMM MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are multiple punctate T2 and FLAIR hyperintense foci between the anterior and middle cerebral artery territories within the subcortical and periventricular white matter. These were also present on the prior exam. These are stable compared to the prior exam.No significant perfusion delay is hypoperfusion is appreciated in the anterior cerebral artery territories are the posterior cerebral artery territoriesNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The current MR angiogram was performed on a 1.5 Tesla MRI unit with a low spatial resolution whereas the prior MR angiogram was performed on a 3 Tesla magnet with a high spatial resolution. There is significant difference in spatial resolution between the 2 studies.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal middle and posterior cerebral arteries.The A1 segments are occluded at their origin and reconstituted distally.There is a stenosis present at the left posterior cerebral artery at the proximal P2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The right posterior communicating arteries is medium-sized. The left posterior communicating artery is very small. The left vertebral artery is larger than the right vertebral artery.

Output: 1.There is occlusion of the anterior cerebral artery A1 segments proximally with distal reconstitution. This was also identified on the prior exam. Please note that there are spatial resolution limitations on the current exam which were not present on the prior exam making assessment for interval change slightly less reliable.2.There is a stenosis suspected of the left posterior cerebral artery at the proximal P2 segment was not present on the prior exam3.There is no hypoperfusion on the basis of perfusion exam..4.Punctate lesions in the watershed zones between the anterior middle cerebral artery territories are stable and most likely related to ischemia.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. 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.

Output: No mass, signal abnormality, or structural anomaly. Specifically, there are no MRI findings to explain the patient's chronic headaches.


Instruction: Generate impression based on findings.

Input: 50 year-old female with family history of breast cancer in her grandmother in her 40s. History of left benign biopsy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 6-year-old with history of allergies and chronic frontal headaches x 10 months. Increasing frequency, duration with fevers and conjunctivitis. Evaluate for intracranial lesion/sinusitis. CT of brain.Examination demonstrates focal area of low attenuation in the left high convexity anterior frontal lobe (images 32 and 33). This finding is nonspecific and could represent a small area of encephalomalacia of undetermined etiology. Possibility of edema cannot be ruled out and I recommend further evaluation with a dedicated infused MRI of brain.CT of paranasal sinuses.The frontal sinuses are not pneumatized. The sphenoid sinus remains within normal limits. Ethmoid sinuses are essentially unremarkable.Minimal patchy areas of mucoperiosteal thickening consistent with chronic inflammatory sinus disease of maxillary sinuses are noted. The right osteomeatal unit of the maxillary sinus is occluded secondary to mucoperiosteal thickening. The left osteomeatal is also suspected of being occluded secondary to mucoperiosteal thickening over this region is not very well visualized.

Output: 1.The small superficially located foci of low attenuation in the left frontal lobe as detailed. Unremarkable CT of brain otherwise. Follow-up MRI is recommended.2.Minimal chronic inflammatory sinus disease of maxillary sinuses with occluded OMUs.


Instruction: Generate impression based on findings.

Input: Parkinson disease. Paralysis agitans. Presurgical planning for deep brain stimulator placement. The study is significantly limited by patient motion. There are scattered frontoparietal white matter T2 hyperintense foci that are noncontrast-enhancing and non diffusion-restricted. These are most compatible with chronic microvascular ischemia. Additionally within motion limitation, there is narrowing and blurring of the pars compacta of the substantia nigra which also loses its expected T2 hyperintensity. These findings are also associated with generalized enlargement of the sulci and other CSF-containing spaces reflecting volume loss. There is a 1 cm, left anterior frontal, contrast-enhancing dural-based mass that is isointense to gray-matter on both T1 and T2. This is associated with mild thickening of the adjacent dura as well as minimal skull inner table hyperostosis. This is most compatible with a meningioma. Otherwise, there is no mass effect or midline shift. There is no intracranial hemorrhage. Major intracranial vessels are patent.There is minimal mucosal thickening in the maxillary sinuses without fluid, which is likely of no significance.

Output: 1.Study limited by patient motion as described above.2.Substantia nigra changes along with generalized brain volume loss patible with known Parkinson's disease.3.Frontoparietal white matter changes are probably chronic microvascular ischemia.4.1 cm left frontal dural based mass consistent with incidental small convexity meningioma.Given the presence of significant patient motion degrading the study for preplanning purposes, and after discussion with the ordering physician, the study (Axial T1) will be repeated with sedation and a QSM (quantitative susceptibility mapping) sequence will be obtained as well.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate syrinx, structural lesion. Signs and symptoms: Myoclonus and dystonia. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates normal anatomical development and morphology of the brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, leptomeningeal, calvarial, or soft tissues of the scalp or retro-orbital enhancement.Normal visualization of signal void of major intracranial arterial branches.Normal signal intensity of the intracranial venous sinuses and with normal pattern of enhancement.Unremarkable orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with straightening of cervical lordosis.There is generalized uniform smaller than expected caliber of the spinal canal believed to represent a congenital anatomical variation of short pedicles.Foramen magnum is unremarkable.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord without evidence of syrinx.CSF flow study demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. There is also detectable biphasic flow through the fourth ventricle.Axial images are degraded due to motion artifact which makes precise assessment for subtle findings including neural foraminal compromise difficult.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate moderate disc disease with loss of disc height and moderate right neural foraminal compromise.C7 is unremarkable.C7-T1 is unremarkable.

Output: 1.Negative pre and post enhanced brain MRI.2.Nonenhanced cervical MRI demonstrate congenitally small spinal canal. Unremarkable foramen magnum. Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord to T2 level. Mild degenerative changes and unremarkable exam otherwise.3.CSF flow demonstrate biphasic flow through the foramen magnum both anteriorly and posteriorly and through the fourth ventricle.


Instruction: Generate impression based on findings.

Input: 29-year-old male with recent Crohn's, occasional right lower quadrant pain ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Above average stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Mild thickening of the terminal ileum without evidence of active inflammation.2.Above average stool burden.


Instruction: Generate impression based on findings.

Input: Female; 55 years old. Reason: Thcikened bile duct wall at last MRI MRCP likely due to recent stent change, pls. f/u History: PSC LIVER, BILIARY TRACT: Stable areas of focal dilatation and stricturing involving the intrahepatic biliary tree with pruning and irregularity of the common bile duct.A right percutaneous biliary catheter is again seen with interval decreased biliary wall thickening and enhancement of both the right intrahepatic bile ducts and common bile duct, suggesting that the prior findings were secondary to postsurgical change.Small hemangiomas in segments 6 and 7 are unchanged. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter bilateral renal cysts. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable subcentimeter T2 hyperintense focus in the right T12 vertebral body, likely representing an atypical hemangioma. OTHER: No significant abnormality noted.

Output: 1.Stable irregular appearance of the biliary tree, compatible with primary sclerosing cholangitis. 2.Interval decreased biliary wall thickening and enhancement, suggesting that the prior findings were secondary to postsurgical change.


Instruction: Generate impression based on findings.

Input: 54 year old male patient with known pancreatic mass. Yearly surveillance exam, last on 8/2015. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic neck/body cystic lesion measures 1.8 x 1.2 cm (image 21, series 5), previously 1.2 x 0.9 cm. There is no suspicious mural nodularity or postcontrast enhancement. An adjacent punctate cystic focus is grossly stable in size. No new pancreatic lesion is identified. The main pancreatic duct is normal in size. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable enlarged mesenteric lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Interval enlargement of a probable pancreatic neck/body side-branch IPMN measuring up to 1.8 cm in size without suspicious features.