Instruction: Generate impression based on findings.

Input: Glioblastoma. Status post resection and chemoradiation treatment. The study is limited by patient motion. The left temporal resection cavity has regressed in size. There is contrast enhancement extending from anterior-superior surgical margin that measures in the axial plane 2.0 cm x 0.8 cm and craniocaudally 1.0 cm. There is confluent T2-hyperintensity in the medial left temporal lobe associated with mild expansion which has mildly improved with less extension toward the subinsular region and the left deep nuclei. Encephalomalacia in the anterior aspect of the left temporal lobe has evolved as well. The remainder of the brain shows no abnormal contrast enhancement or mass-effect. Somewhat linear T2-hyperintensity in the right parietal white-matter is unchanged. There is no midline shift or brain herniation.There is mild ethmoid mucosal thickening. The orbits are grossly unremarkable. The fluid underneath the left temporal craniotomy flap is improved and the overlying soft-tissue swelling is also improved. Given the degree of motion as well as susceptibility effect in the treatment bed, it is difficult to accurately assess the perfusion characteristics of the contrast enhancement focus. However, there is a suggestion of mildly increased corrected cerebral blood volume correlating with the infiltrative T2 signal in the medial aspect of the left temporal lobe.There is fluid signal intensity in both mastoid air cells, more pronounced on the left, might be congestive or inflammatory. There is a retention cyst in the right side of the nasopharynx, which is unchanged.

Output: 1.The examination is at least moderately limited by patient motion.2.Contrast enhancement along the anterior-superior surgical margin is of unknown significance. This is nonspecific and may represent residual tumor or posttreatment change.3.Confluent T2-hyperintensity and mass-effect in the medial aspect of the left temporal lobe have slightly improved since January 2016 and may represent evolving posttreatment change admixed with infiltrating tumor.


Instruction: Generate impression based on findings.

Input: 87-year-old female with left lower facial droop. Fall. There is no evidence of intracranial hemorrhage, mass or edema. An area of hypodensity within the right basal ganglia is of uncertain. Acute MCA abnormality cannot be entirely excluded. MRI is recommended for further evaluation if clinically indicated. Scattered periventricular and subcortical white matter hypodensity is consistent with small vessel ischemic change, age indeterminate.The ventricles and basal cisterns are normal in size and configuration.Groundglass pattern of the left sphenoid bone is consistent with fibrous dysplasia. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Right basal ganglia hypodensity is of uncertain chronicity. MRI can be obtained if concern remains for acute ischemia.


Instruction: Generate impression based on findings.

Input: Left hip pain; prior labral surgery in 2006 ACETABULAR LABRUM: Postsurgical changes prior anterior superior labral tear with scarring and thickening of the capsule. There is a focal area of contrast entering the anterior labrum best seen on series 7 image 14/26 concerning for a labral detachment. Additional areas of signal abnormality are seen on series 10 image 13/26 may represent additional small tearing or postoperative change.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Findings concerning for anterior labral detachment.


Instruction: Generate impression based on findings.

Input: 48-year-old female with recurrent non-secreting pituitary adenoma status post surgery x 2 as well as radiation therapy. Redemonstrated is a stable postoperative appearance of the pituitary gland with the pituitary stalk shifted to the right and the pituitary gland smaller on the right than on the left. As before, a defect is noted along the right side of the floor of the sella likely indicating the site of surgical approach. There is asymmetric pituitary enhancement with bandlike enhancement of the right side of the pituitary appearing similar to prior studies. There is no mass effect or areas of new enhancement identified. Non-pneumatization of the sphenoid sinus is again noted. Limited visualization of the brain parenchyma demonstrate no mass lesion or midline shift. There is redemonstration of borderline cerebellar tonsillar ectopia with the inferior tip of the cerebellar tonsils measuring approximately 4 mm below the level of the foramen magnum.

Output: Stable postoperative changes of the pituitary as described primarily involving the right side of the sella without significant interval change compared to prior studies.


Instruction: Generate impression based on findings.

Input: 70-year-old female with history of left IDC status post neoadjuvant chemotherapy, preoperative planning There is heterogeneous amount of fibroglandular tissuein both breasts.Mild parenchymal enhancement is noted bilaterally.Interval reduction in the segmental non mass enhancement in the left upper inner quadrant, now measures 18 X 10 X 9 mm, previously measured 105 x 36 x 40 mm (AP x LR x CC). The signal intensity of enhancement has reduced significantly and minimal residual enhancement is noted at the site. Previously noted skin retraction of the left medial anterior breast has resolved. Distance between the posterior depth clip artifact and the anterior residual non mass enhancement is 30 mm. Stable enhancing focus identified in the left breast 3:00 position.No abnormal enhancement is seen in right breast. No abnormal axillary lymph nodes are identified in either axillary region.

Output: Significant response to neoadjuvant chemotherapy in the left breast.No abnormal enhancement in the right breast or abnormal lymph nodes in either axillary regions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: Negative MRI of the brain including gadolinium enhancement. Specifically, there are no MRI findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Male, 61 years old, with weakness. Assess for CNS metastases versus ischemia. A punctate focus of mild diffusion bright signal is seen within the right globus pallidus with equivocal ADC correlation. No other definite areas of restricted diffusion are seen.Moderate patchy T2 hyperintensity is seen within the subcortical and periventricular regions as well as the pons. No evidence of mass effect or parenchymal edema is seen. No significant intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles are normal in size and morphology.On postcontrast images no pathologic parenchymal or extra-axial enhancement is detected.A few scattered small nonspecific T2 hyperintense enhancing skull lesions are demonstrated.

Output: 1.Moderate chronic small vessel ischemic disease.2.No definite evidence of acute ischemia. A punctate focus of questionable diffusion signal abnormality within the right globus pallidus is nonspecific and may simply be artifactual.3.No evidence of intracranial metastases.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The right hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 0:30

Output: Successful intra-articular contrast injection for right hip MRI arthrogram.


Instruction: Generate impression based on findings.

Input: 62 year old male with cognitive slowing. Evaluate for recurrence of sinus thrombosis and/or ischemia. Additional history includes dural AV fistula (left occipital draining into straight sinus) status post resection on December 2012. Also history of stage III nasopharyngeal cancer. Redemonstrated are postsurgical changes of a prior left suboccipital craniotomy for resection of a left dural AV fistula. There is interval increase in T2/FLAIR hyperintensity in the left occipital lobe as well as in the the left cerebellar hemisphere with volume loss favored to represent encephalomalacia but progressed since prior study from 2013. There are vascular clips along the left tentorial leaf which preclude evaluation on susceptibility and diffusion-weighted sequences. No evidence of acute infarct or new hemorrhage is appreciated.A tubular area of encephalomalacia begins near a right frontal burr hole within the right superior frontal gyrus and extends to the right frontal horn periventricular region, which may be related to prior instrumentation. Gliosis along the tract is increased since prior study from 2013.Again demonstrated are multiple small foci of susceptibility abnormality within the basal ganglia and right thalamus, appearing similar to the previous examination which may be related to the previous vascular congestion. There are also a few punctate foci of susceptibility along the posterior aspect of the right lateral ventricle which may be chronic hemosiderin deposition from the prior procedure. The medial aspect of the left transverse sinus is diminutive compatible with chronic occlusion as before. The distal aspect of the transverse sinus, sigmoid sinus, and left jugular vein appear patent. Remainder of the major intracranial venous system also appears patent.There is no abnormal brain parenchymal enhancement, mass, mass effect, midline shift, hydrocephalus. There is mild global parenchymal volume loss. A small enhancing mass is seen with T2 hyperintensity measuring up to 17 x 12 mm, coronal T2 image 20 mm, within the right deep lobe of the right parotid gland and not significantly changed in size since remote MRI dated 11/11/2012. There is an opacity in the left inferior mastoid air cell. There is mild diffuse paranasal sinus mucosal thickening.

Output: 1.Compared to MRI brain dated 5/6/2013, there is increase in T2/FLAIR hyperintensity in the left cerebellar hemisphere as well as in the left occipital lobe with also increase in volume loss likely representing evolution of encephalomalacia. There is also increase in FLAIR signal abnormality favored to represent increased gliosis along the prior right frontal surgical tract. There is no otherwise no new focus of edema, hemorrhage, or infarct.2.The medial aspect of the left transverse sinus appears chronically occluded as before. Remainder of the major venous system appears patent.3.Postsurgical changes of a prior left suboccipital craniotomy for resection of a left dural AV fistula. 4.Small enhancing mass within the deep lobe of the right parotid gland which is not significantly changed in size since 2012 and favored to represent a pleomorphic adenoma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: still needs contrast exam History: brain lesion There is a 22 x 3 mm axial dimension mass along the medial aspect of the right frontal lobe involving cingulate gyrus. It appears to have two components one which is attached to the falx cerebri which measures a 24 x 16 mm axial dimensions and the surrounding component which appears to be involving the brain parenchyma. The parafalcine component has lower T2 signal and appears to have some flow voids and as a heterogeneous 4 as the component that invades the brain and the leptomeninges appears to enhance more and is associated with bright T2 signal and also is associated with flow-voids. There is associated vasogenic pattern edema.

Output: 1.There is a right parafalcine mass present which involves the adjacent right cingulate gyrus and right frontal lobe. This appears to be composed of to differing components one component is extra-axial another one at the invades the leptomeninges and extends into the brain. Differential considerations include metastatic disease as well as lymphoma, granulomatous disease and in an unusual set of circumstances a superimposed metastasis to a meningioma.


Instruction: Generate impression based on findings.

Input: History of transaminitis, cholestasis, and liver failure. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in signal and morphology. No focal parenchymal lesion. The portal vein, hepatic vein, and hepatic artery are patent.Prominent gallbladder wall thickening and edema. The gallbladder however is not distended and there is no enhancement on the postcontrast images. No cholelithiasis or choledocholithiasis. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas has normal signal and morphology. The main pancreatic duct is not dilated. The pancreatic duct joins the common bile duct at the major papilla.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is nonspecific fluid/edema within the retroperitoneum.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse soft tissue anasarca.OTHER: No significant abnormality noted.

Output: 1.Nondistended gallbladder with prominent gallbladder wall thickening suggestive of edema. There is no associated enhancement to indicate active inflammation. Appearance most likely reflects an edematous state given the patient's anasarca.2.No cholelithiasis, choledocholithiasis, or biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: 62 year old male patient with hematuria and pain in PKD patient. Assess polycystic kidney disease. ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter T2 hyperintensities in the liver likely represent cysts. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Evaluation of the kidneys is limited secondary to lack of IV contrast. The kidneys are enlarged, measuring approximately 25 cm in length, and entirely replaced by innumerable mostly T2 hyperintense lesions, which likely represent cysts. Several of the lesions demonstrate fluid-fluid levels with intrinsic T1 hyperintensity compatible with blood products or proteinaceous material. Numerous T2 hypointense lesions also likely represent cysts with more chronic blood products. Most of the complicated cysts and cysts that have areas of complexity appear to have corresponding T1 hyperintensity suggesting blood products. There is no dominant mass. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Enlarged kidneys entirely replaced by innumerable cysts some of which are complex/complicated likely with blood products. No dominant mass is identified, however, study is limited secondary to lack of IV contrast.


Instruction: Generate impression based on findings.

Input: SCLC status post 6 cycles of chemotherapy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a subcentimeter cystic lesion in the left parotid gland. There are postoperative findings in the right face and periorbital region.

Output: No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: Diagnosis: Neoplasm of unspecified nature of brainClinical question: s/p crani for tumor resectionSigns and Symptoms: s/p crani for tumor resection Since the prior exam the patient is undergone left-sided parietal craniotomy for a left precuneus mass. Associated vasogenic edema has not changed. There are blood products present at the surgical site which have bright signal on T1 as well as susceptibility effect.There is a scalp soft tissue swelling associated with the patient's surgical siteNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Status post recent left parietal lobe surgery. A ring-enhancing lesion is no longer present in the left precuneus. There are blood products present at the surgical site


Instruction: Generate impression based on findings.

Input: 74-year-old female status post fall with positive forgetfulness and headaches. Concern for subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Multiple areas of hypoattenuation in the periventricular and subcortical white matter distribution consistent with small vessel ischemic disease common age indeterminate. If there is clinical concern for ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel disease, age indeterminate. If there is clinical concern for ischemia, MRI may be considered.


Instruction: Generate impression based on findings.

Input: 60 years, Female, Reason: eval biliary system, abnormal ERCP at OSH unable to see biliary drainage History: abd pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Common bile duct appears normal. No obstructing lesions or stones. Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No evidence of pancreatic divisum. No ductal dilatation. Normal enhancement of the parenchyma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Normal MRCP status post cholecystectomy.


Instruction: Generate impression based on findings.

Input: 11-year-old male presents with a first time seizure, evaluate for structural abnormality. There is no evidence of a mass or acute infarct. There is a focus of encephalomalacia in the left posterior occipital lobe with cortical hemosiderin deposition causing blooming artifact on susceptibility weighted images. No additional hemorrhagic foci are identified. There is no associated vasogenic edema. The ventricles and basal cisterns are normal in size and configuration. The mesial temporal lobes are normal in configuration and signal intensity. 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. Single focus of encephalomalacia in the left occipital lobe with cortical hemosiderin deposition. Differential considerations include chronic focal cortical prior hemorrhage from other causes such as cortical venous thrombosis and conceivably an underlying vascular malformation. Acute process is unlikely since there is no evidence of surrounding brain parenchymal edema.Underlying neoplasm is considered less likely given the lack of mass effect. 2. No additional hemorrhagic foci are identified. For further characterization, post-contrast sequences are recommended.


Instruction: Generate impression based on findings.

Input: History of retinoblastoma, esthesioneuroblastoma, and relapsed osteosarcoma, here for chemotherapy. Brain: There are postoperative findings related to craniofacial resection with frontal mesh cranioplasty. There is a heterogeneously enhancing lobulated sinonasal mass that extends into the right pterygopalatine fossa and medial right masticator space. The tumor also appears to bulge slightly into the anterior cranial fossa with associated mild dural thickening and enhancement. Overall, the mass measures up to approximately 6.5 cm. Although the tumor has not significantly changed in size, the signal characteristics of the tumor have evolved. There are retained secretions within the maxillary and sphenoid sinuses, likely attributable to obstruction by the mass. There are minimal nonspecific punctate foci of cerebral white matter T2 hyperintensity. There is no evidence of acute infarction or intracranial hemorrhage. The ventricles are normal in size and configuration. There is new fluid within the right mastoid and middle ear cavities.Orbits: There are postoperative findings related to right enucleation with an orbital prosthesis in position. The tumor once again bulges slightly into the medial and inferior extraconal portions of the right orbit. The left orbit appears to be intact.

Output: 1. Postoperative findings in the craniofacial region without significant change in size of the sinonasal mass that extends into the right pterygopalatine fossa, medial right masticator space, and right orbit, where there has been enucleation. The tumor also appears to bulge slightly into the anterior cranial fossa with associated mild dural thickening and enhancement, which may be reactive in nature.2. New fluid within the right mastoid and middle ear cavities may represent otomastoiditis.


Instruction: Generate impression based on findings.

Input: Reason: degenerative changes in neck. radicular pain in the neck and shoulder and arm - all R sided The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level as well as small uncovertebral osteophytes on the right side more than the left with mild narrowing of the right-sided neural foramenAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level as well as small uncovertebral osteophytes on the right side more than the left with mild narrowing of the right-sided neural foramenAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level as well as small uncovertebral osteophytes on the right side more than the left with mild narrowing of the right-sided neural foramenAt C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There mild degenerative changes present in the cervical spine without significant compromise of or exiting nerve roots


Instruction: Generate impression based on findings.

Input: Reason: history of ALL s/p high dose methotrexate last week: rule out stroke/neurotoxicity sudden onset left hand tingling and left leg numbness - dragging left foot There is infiltrative diffusion restriction involving the posterior right frontal lobe white matter. There is corresponding mild increased T2/FLAIR signal in this area. In addition, in the left parietal lobe there is subcortical susceptibility within a focus of adjacent nodular susceptibility, without corresponding hyperdensity seen on CT. This may relate to hemosiderin deposition from prior hemorrhage. There is no abnormal enhancement.The gray-white matter differentiation is otherwise preserved. There is no midline shift or mass effect. There is no evidence for hydrocephalus.

Output: 1. An infiltrative appearing area of diffusion restriction and FLAIR hyperintensity in the right frontal lobe white matter is suspicious for methotrexate toxicity. Recommend correlation with medical history.2. Left parietal lobe subcortical susceptibility may relate to hemosiderin deposition from prior hemorrhage. No associated discrete mass or enhancement.


Instruction: Generate impression based on findings.

Input: Reason: ICH noted on head CT History: history of head trauma MRI of the brainThere is T1 signal hyperintensity present within the left geniculated nucleus measuring approximate 7 mm in size. A similar lesion which is T1 hyperintense is present in the right superior colliculus measuring 4 mm. The margins of these two lesions are rather ill-defined. On the T2, FLAIR, SWI and DWI imaging these are not conspicuous. No diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are of uncertain significance in isolation.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate arch opacification of the maxillary sinus is associated with blood products. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. There is extracranial origin of the left posterior inferior cerebellar artery. There is no convincing evidence for arteriovenous malformation on this exam.

Output: 1.Small lesions identified in the left geniculated nucleus and the right superior colliculus are present. It is suspected that this represents calcified lesions. Although the MR angiogram did not demonstrate that these are vascular lesions, the possibility cannot be excluded on the basis of this exam.2.No evidence for cerebrovascular occlusive disease.3.No evidence for intracranial aneurysm.


Instruction: Generate impression based on findings.

Input: 50-year-old female with metastatic colon cancer, left hydronephrosis, flank pain ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense segment 7/8 hepatic lesion is unchanged and compatible with a cyst. Reference right hepatic lesion is stable to slightly increased in size. There is a lesion in the caudate lobe with faint T2 hyperintensity. Restricted diffusion along the right liver lobe capsule is suspicious for metastatic seeding.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Grade 3 left hydroureteronephrosis with mild restriction of the left kidney parenchyma. The left ureter is dilated down to the level of a left periureteral lesion measuring 2.4 x 2.5 cm, slightly increased when compared to the prior examination measurement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild tethering of colon and small bowel adjacent to a reference periureteral pelvic lesion without evidence of obstruction. Scattered left subcentimeter peritoneal nodularity.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: There is minimally heterogeneous solid, T1 hypointense, T2 isointense left adnexal mass measuring 4.8 x 5.1 cm, not present on the prior study. There is a heterogeneous right adnexal lesion measuring 2.3 x 2.4 cm, also not present on the prior study. Mild tethering of the vagina adjacent to the periureteral pelvis lesion.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Focus of enhancement along the sigmoid mesentery measuring 1.2 x 1.3 cm. Small amount of free fluid within the dependent portion of the pelvis. There is no evidence of obstruction.There is a right peritoneal nodule or abnormal lymph node measuring 9 x 9 mm (series 1304, image 463) and adjacent lymph nodes similar to the prior examination.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 11/30/2016 09:45:00)CAUDATE LIVER LESION: 1.7 x 0.9 cm (Image 37, Series 701); 1.5 x 1.0 cm on prior (12/3/2015) (Image 97, Series 5).L PERITONEAL FOCUS: NOT MEASURED OR NOT INCLUDED IN CURRENT EXAM; 0.6 x 0.9 cm on prior (11/4/2016) (Image 88, Series 201).L PERIURETERAL LESION: 2.5 x 2.4 cm (Image 255, Series 1306); 1.5 x 1.1 cm on prior (11/4/2016) (Image 132, Series 201).SEGMENT 8/7 LIVER LESION: 0.7 x 0.7 cm (Image 45, Series 701); 0.7 x 0.7 cm on prior (11/4/2016) (Image 62, Series 201).RIGHT HEPATIC LESION: 1.8 x 1.4 cm (Image 43, Series 701); 1.8 x 1.4 cm on prior (11/4/2016) (Image 63, Series 201).LEFT ADNEXAL LESION: 5.1 x 4.8 cm (Image 219, Series 1305).RIGHT ADNEXAL LESION: 2.3 x 2.4 cm (Image 249, Series 1305).SIGMOID MESENTERY LESION: 1.2 x 1.3 cm (Image 265, Series 1310).

Output: 1.Left periureteral lesion as described above resulting in unchanged left grade 3 hydroureteronephrosis and tethering of adjacent colon and bowel. Enhancing sigmoid mesentery nodularity as above.2.New bilateral, left greater than right, adnexal lesions as described above suspicious for metastases.3.Right liver lobe and caudate lesion compatible with metastatic disease. 4.Peritoneal nodularity and liver capsule seeding as described above.5.Other findings and reference measurements as above.


Instruction: Generate impression based on findings.

Input: Malignant neoplasm of brain, unspecified [C71.9], Reason for Study: ^Reason: Grade III glioma. History: glioma Redemonstration of prior right frontal lobe tumor resection cavity is seen, unchanged.Heterogeneous T1 and T2 signal intensity lesions with minimal enhancement on the posterior aspect of the resection cavity are again seen, unchanged in terms of signal characteristics, extent of the lesion and measured the size since prior scan.T2 hyperintensity lesion along the left frontal horn, left frontal encephalomalacia are unchanged. Right cerebral peduncle volume loss and minimal T2 hyperintensity are again seen, unchanged. There is no evidence of new abnormal enhancing lesion on the scan.The ventricles, sulci and cisterns are unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Stable right frontal resection cavity as well as ill defined heterogeneous signal intensity lesion posterior aspect of the resection cavity, unchanged since prior scan.2. No evidence of new enhancing lesion on this scan.3. No evidence of growing lesion on this scan.


Instruction: Generate impression based on findings.

Input: 60-year-old male with decreased strength. Evaluate rotator cuff. ROTATOR CUFF: There is a full-thickness tear of the anterior fibers of the supraspinatus at the level of its insertion on the greater tuberosity measuring approximately 20 mm in the AP dimension with approximately 1.5 cm of retraction. There is moderate fatty atrophy of the supraspinatus. There is partial thickness articular surface and interstitial tearing of the infraspinatus tendon. There is moderate fatty infiltration of the infraspinatus. There is interstitial tearing of the subscapularis at the level of the myotendinous junction. There is moderate fatty infiltration of the subscapularis muscle. The teres minor muscle and tendon appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Moderate degenerative changes affect the acromioclavicular joint with inferior osteophyte formation along the acromion process.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and increased signal abnormality within the anterior labrum suggesting degeneration/degenerative tearing. Mild osteoarthritic changes affect the glenohumeral joint.BICEPS TENDON: There is deformity and increased signal intensity traversing the intra-articular portion of the long head of the biceps tendon indicating a combination of a longitudinal split tearing and tendinosis. There is circumferential fluid within the tendon sheath of the long head of the biceps which may reflect fluid extension from the joint versus a mild tenosynovitis.ADDITIONAL

Output: 1. Full-thickness rotator cuff tear with mild retraction as described above.2. Degeneration/tearing of the glenoid labrum.3. Tendinosis and longitudinal split tear of the intra-articular portion of the long head of biceps tendon. 4. Osteoarthritis of the glenohumeral and acromioclavicular joints.


Instruction: Generate impression based on findings.

Input: 32 years, Male, epilepsy. Laser ablation. Prior depth electrodes have been removed. Placement of laser fiber via right posterior parietal approach is seen which terminates in the right anterior medial temporal lobe along the dura. There is extensive peripheral enhancement involving the right medial temporal lobe reflecting the ablation zone.Multiple prior right-sided burr whole craniotomies and evidence of prior depth electrodes is noted. There is no evidence of intracranial mass effect or herniation. Subcortical band heterotopia again noted. Ventricles remain normal in size.

Output: Extensive peripheral enhancement is seen in the right medial temporal lobe likely reflecting laser ablation zone.


Instruction: Generate impression based on findings.

Input: 23-year-old male with preoperative planning for occipital lesion biopsy and questionable lymphoma. Redemonstrated is an intraparenchymal enhancing lesion in the left occipital lobe, measuring up to 28 x 24 x 26 mm in the anteroposterior, transverse, and craniocaudal dimensions, respectively. There is extensive surrounding vasogenic edema. There are no additional parenchymal lesions. There is local mass effect without midline shift or herniation. The ventricles are unchanged in appearance. The calvarium is intact. There is a retention cyst in the right maxillary sinus. There is also mild right mastoid air cell opacification. There are skin fiducial markers.

Output: Preoperative planning MRI demonstrates a left occipital lobe mass that may represent lymphoma with surrounding vasogenic edema.


Instruction: Generate impression based on findings.

Input: Nasopharyngeal carcinoma surveillance after treatment. There is no evidence of measurable nasopharyngeal tumor. There is a nodular area with high T2 signal and mild enhancement at the junction between the right carotid and retropharyngeal spaces just inferior to the skull base that measures up to 15 mm. There is otherwise no significant upper cervical lymphadenopathy. There is no evidence of skull base of adjacent intracranial tumor. The orbits are unremarkable. There is mucosal thickening within the bilateral maxillary and ethmoid sinuses. The major salivary glands are unremarkable.

Output: 1. No evidence of measurable nasopharyngeal tumor.2. A nodular area with high T2 signal and mild enhancement at the junction between the right carotid and retropharyngeal spaces just inferior to the skull base that measures up to 15 mm may represent treated lymphadenopathy. Otherwise, there is no significant upper cervical lymphadenopathy.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:3/9/1984)Reason: 32yo with CF, admitted for AMS w/seizure, found to have watershed infarct on previous imaging w/concern for PRES. Has been stable for several days, now with HA w/blurred vision. Eval for acute change. History: headachePROVIDER/ATTENDING NAME: LAURA J CARLSON BRYAN A CAMPBELL MRI of the brainThere is redemonstration of FLAIR and T2 signal hyperintensity involving the right middle frontal gyrus and right precentral gyrus and small portions of the right superior frontal gyrus and right postcentral gyrus as well as a separate focus along the medial aspect of the right superior parietal lobule. Since the prior exam diffusion restriction associated with this has subsided.Previously noted diffusion restriction and FLAIR signal hyperintensity along the small portion of gray matter adjacent to the left superior frontal sulcus and some portions of the right parietal lobe are not identified on the current exam. Currently no FLAIR or T2 signal hyperintensity is clearly appreciated at these locations.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells demonstrate some scattered opacities in the left ethmoid air cells. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are identified. The left posterior communicating artery has an infundibulum and is small to medium sized. The right posterior communicating artery is tiny. The anterior choroidal arteries can also be identified. There is some fenestration of the distal left A1 segment. The anterior communicating artery is medium-sized. The anterior communicating artery is fenestrated. The left vertebral artery is larger than the right vertebral artery.

Output: 1.There are findings compatible with subacute infarction involving the watershed zone along the right hemisphere which includes frontal lobe and parietal lobe.2.Since the prior exam diffusion restriction in the left frontal lobe and portions of the right parietal lobe have not progressed to any significant permanent FLAIR signal hyperintensity.3.There is no evidence for intracranial cerebrovascular occlusive


Instruction: Generate impression based on findings.

Input: 29-year-old female patient with joint line pain. MRI for possible meniscus tear status post ORIF tibial plateau fracture. Evaluation of the knee is limited by metal susceptibility artifact related to a plate and screw device affixing the proximal tibia; this is despite techniques to reduce artifact including a MAVRIC pulse sequence.MENISCI: There is perhaps mild blunting of the free edge of both the medial and lateral menisci, but this is equivocal and we see no discrete meniscal tears.ARTICULAR CARTILAGE AND BONE: Evaluation of the articular cartilage is extremely limited. There may be focal degeneration along the lateral tibial plateau beneath the posterior horn of the lateral meniscus. Furthermore, the articular cartilage of the medial compartment appears subjectively thinned with focal degeneration of the medial tibial plateau adjacent to the posterior horn of the medial meniscus.A subcentimeter low signal intensity focus within the posterior medial aspect of the distal femur may reflect sequela of a benign cortical defect.LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Limited study as described above showing mild blunting of the free edge of the menisci but no discrete tears and possible cartilage degeneration.


Instruction: Generate impression based on findings.

Input: Male, 11 years old. History of stage 4 neuroblastoma s/p chemo, radiation, transplant. Intermittent stabbing pains in bilateral legs. Intermittent abdominal pain. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy. No focal lesion in the surgical bed.KIDNEYS, URETERS: Surgical changes adjacent to the left kidney. Focal atrophy of the left lower pole with small cystic areas without local abnormal enhancement or solid nodular component, likely postprocedural in etiology. No focal lesion or hydronephrosis on the right. No obstructing urinary stone.RETROPERITONEUM, LYMPH NODES: Scattered signal voids in the retroperitoneum and left upper abdomen, corresponding with surgical clips.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction. No free intra-abdominal air or abnormal free fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.No evidence of local tumor recurrence, metastatic disease, or other acute abnormality.2.Focal atrophy of the left lower renal pole and findings of scarring and cyst formation, may be postsurgical in etiology.


Instruction: Generate impression based on findings.

Input: Evaluate for focal lesion to explain dysarthria and eye movement abnormality: Myasthenia Gravis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain, brainstem, cerebellum, and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. There are small choroid plexus glomus cysts. The ventricles and basal cisterns are otherwise 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: Unremarkable brainstem.


Instruction: Generate impression based on findings.

Input: History of slurred speech, pain in the right shoulder and multiple sclerosis. Reason for study: Stroke or other acute findings. This is a slightly motion degraded exam. There is redemonstration of multiple supratentorial periventricular and subcortical white matter lesions, as well as lesions in the brainstem and cerebellar hemispheres not significantly changed in the interval. Extent of the white matter lesions and motion degradation makes evaluation difficult, however, no new lesion is appreciated. Many of the lesions demonstrates T1 hypointensity. No enhancing lesions are seen within the brain parenchyma. There is no evidence of intracranial hemorrhage, mass, or acute infarct.Partial visualization of the cervical cord again demonstrates T2 hyperintensity in the right aspect of the cord, which was present previously (7/10/2014, not included on most recent study). There is ,however, a smaller T2 hyperintense lesion in the dorsolateral spinal cord at the C1 level which appears new and demonstrates enhancement compatible with active demyelination. The pituitary gland appear unremarkable. 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. Redemonstration of multiple supratentorial and infratentorial lesions compatible with demyelinating disease. No significant interval change in lesions in the brain parenchyma.2. New enhancing focus in the dorsolateral cervical cord at the C1 level compatible with active demyelination.


Instruction: Generate impression based on findings.

Input: Tremor, unspecified [R25.1] / Encephalopathy, unspecified [G93.40], Reason for Study: ^Reason: Evaluate for structural abnormality History: Attention problems, tremor, developmental delay No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal signal intensity.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Normal brain MRI.


Instruction: Generate impression based on findings.

Input: 51 years Male (DOB:3/23/1965)Reason: left facial numbness History: left facial numbnessPROVIDER/ATTENDING NAME: NAVNEET CHEEMA MAHESH PADMANABAN MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is larger than the right A1 segment. There is fetal origin of the posterior cerebral arteries bilaterally associated with hypoplastic P1 segments The left vertebral artery functionally appears to and in the left posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries, however, the origins of the vertebral arteries are not imaged adequately for evaluation.. The left common carotid artery originates from the innominate artery.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease. However, the origins of the vertebral arteries are not imaged adequately for evaluation.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: History of polycystic ovarian syndrome and elevated DHEAS. Evaluate ovaries and adrenal glands. ABDOMEN:LIVER, BILIARY TRACT: The liver is borderline enlarged but has normal signal characteristic. Punctate focus of increased T2 signal in the right lobe liver without associated enhancement, likely a simple cyst. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: Spleen is normal in size.PANCREAS: The pancreas is normal in signal and morphology. The main duct is normal in caliber.ADRENAL GLANDS: The right adrenal gland is unremarkable. The left adrenal gland has questionable subtle nodularity, but no clear mass lesion. The glands are normal in size.KIDNEYS, URETERS: Subcentimeter left renal cyst. No mass lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal mass lesion.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Anteverted retroflexed uterus which is normal in size. The endometrium and junctional zone are unremarkable.Moderately enlarged ovaries containing numerous similarly sized peripheral follicles consistent with the diagnosis of polycystic ovarian syndrome. There is an additional dominant follicle on the left measuring 14 mm. The right ovary measures 3.2 x 2.0 x 2.8 cm while the left ovary measures 4.3 x 1.9 x 2.9 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Numerous peripherally positioned similarly sized follicles and moderately enlarged ovaries consistent with the diagnosis of polycystic ovarian syndrome.2.Essentially normal appearance of the adrenal glands.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are diffusely prominent, with at least moderate dilatation of the ventricles which appears to be due to an ex vacuo in associated with a relatively decreased white matter volume. There is also volume loss noted involving the cerebellum. Redemonstrated is a polymicrogyric appearance of the posterior parietal and occipital lobes bilaterally. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. There is no significant thinning of the corpus callosum. Fluid is present with a single left mastoid air cell. The right mastoid air cells are clear.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified an. Incidental note is made of ACA triplication as well as a hypoplastic right vertebral artery ending in PICA, both congenital vascular variations.Brain MRV:There is normal venous flow demonstrated within the internal cerebral veins, vein of Galen, straight sinus, superior sagittal sinus and within the bilateral transverse and sigmoid sinuses. No dural venous sinus thromboses or occlusions are identified. Note is made of a hypoplastic left transverse sinus.

Output: 1.Stable prominent expansile dilatation of the ventricles with associated enlargement of extracerebral subarachnoid space. Findings are favored to relate to decreased white matter volume which may in part relate to patient's history of prematurity and associated chronic periventricular leukomalacia, given the lack of associated abnormal signal. 2.Fluid is present with a single left mastoid air cell.3.Stable polymicrogyric appearance of the posterior parietal and occipital lobes bilaterally.4.Negative noncontrast brain MRA and MRV.


Instruction: Generate impression based on findings.

Input: Diagnosis: Unsteadiness on feetClinical question: ?cerebellar deficit or subacute combined deficiencySigns and Symptoms: unsteady gait The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. At this age they're likely of little clinical significance and can be considered age related.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of partial empty sella. Incidental note is made of a developmental venous anomaly in the left superior frontal gyrus.

Output: 1.There is no evidence for intracranial mass lesions. Please note that subacute combined degeneration may manifest itself in the cervical spinal cord. Although there is no evidence of that on this exam of the brain, MRI of the cervical spinal cord may be helpful to assess the spinal cord.


Instruction: Generate impression based on findings.

Input: Slurred speech. MRI: There is no evidence of acute intracranial hemorrhage, mass-effect, or midline shift. There is mild scattered periventricular and subcortical white matter T2 hyperintensity, but no acute infarct. There is mineralization of the bilateral basal ganglia and dentate nuclei. There is diffuse cerebral volume loss. There is opacification of a right ethmoid air cell. The skull and orbital contents are grossly unremarkable.MRA: The right vertebral artery is relatively hypoplastic diffusely and the right A1 is also hypoplastic. Otherwise, there is no evidence of significant steno-occlusive lesions in the head and neck and no evidence of cerebral aneurysms.

Output: 1. Mild chronic small vessel ischemic disease and diffuse cerebral volume loss, but no evidence of acute infarction.2. No evidence of significant steno-occlusive lesions in the head and neck and no evidence of cerebral aneurysms.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of right lateral ventricular tumor (low grade astrocytoma) complains of occipital head pain more to touch and not headache. Evaluate for infection or abnormality. CSF-density cyst is again seen in the right parietal lobe. It measures approximately 4.7 x 5 cm in greatest axial dimension; measuring approximately 4.4 x 4 cm on prior MRI from 2008. The size and configuration of the ventricles and basal cisterns are unchanged. There is no evidence of intracranial hemorrhage, mass or edema. Right intracranial catheter is again seen in the extra-axial space on the right with tip at the level of the right sylvian fissure. Thinning of the right parietal skull reflects old craniotomy. The calvaria and skull base are otherwise radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Slight enlargement of CSF-density cyst in the right parietal lobe. Otherwise, stable postsurgical changes as above. Please note that lack of IV contrast limits evaluation for infection.


Instruction: Generate impression based on findings.

Input: THORACIC SPINE: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body and disc heights are well maintained. There is a T1 and T2 hyperintense focus in the T11 vertebra, likely representing a hemangioma. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no pathological enhancement. There is a small right paracentral disc protrusion at T6-T7 and a small left paracentral disc protrusion at T10-T11. There is no significant spinal canal or foraminal stenosis at these or other levels within the thoracic spine.LUMBAR SPINE: There is mild anterolisthesis of L4 on L5 measuring 3 mm and retrolisthesis of L5 on S1 measuring 8 mm. The vertebral body heights are well-maintained. There is disc dessication at L2-L3, L4-L5 and L5-S1. There is moderate to severe loss of disc height at L5-S1. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.T12-L1: No significant disc bulge, herniation, spinal canal or foraminal stenosis.L1-L2: Mild disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, but no significant spinal canal or foraminal stenosis.L2-L3: Disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, but no significant spinal canal or foraminal stenosis.L3-L4: Disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, but no significant spinal canal or foraminal stenosis.L4-L5: Disc bulge, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis. No significant foraminal stenosis.L5-S1: Disc bulge with superimposed central/right paracentral disc extrusion abutting the descending S1 nerve roots, bilateral facet degeneration and thickening of the ligamentum flavum, contributing to mild right and moderate left foraminal stenosis, but no significant central spinal canal stenosis.

Output: 1. Small right paracentral disc protrusion at T6-T7. Small left paracentral disc protrusion at T10-T11. No significant spinal canal or foraminal stenosis within the thoracic spine.2. Degenerative changes of the lower lumbar spine with disc bulge and superimposed central/right paracentral disc extrusion at L5-S1, contributing to mild right and moderate left foraminal stenosis and effacement of the lateral recesses. Given reported history of left leg radiculopathy, symptoms may be related to impingement of the left L5 nerve root in the neural foramen as well as the traversing left S1 nerve root in the lateral recess.3. Mild anterolisthesis of L4 on L5 and retrolisthesis of L5 on S1. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 61 year old female with a family history of breast cancer in her mother diagnosed at age 60 and ovarian cancer at 86, maternal grandmother diagnosed at age 60, and paternal aunt diagnosed at age 60. Personal history of skin cancer diagnosed at age of 52. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate to marked parenchymal enhancement is noted bilaterally. A few high T2 signal cysts are seen.No abnormal enhancement is seen in either breast. Extensive nodular parenchymal enhancement is similar to prior studies. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Female 89 years old Reason: soft tissue swelling and tenderness History: tenderness on palpation and therapy There is a well-circumscribed collection within the flexor musculature of the right arm in the region of the distal biceps muscle. The collection measures approximately 4.5 x 3.5 x 10.0 cm. It is hypointense on T2-weighted images and isointense with hyperintense foci on T1-weighted imaging. There is surrounding interstitial edema and inflammation. Postcontrast imaging demonstrates peripheral enhancement, however, there is no internal enhancement. The adjacent bone demonstrates normal cortex and marrow signal.

Output: Large collection in the region of the distal biceps muscle is most consistent with a bland hematoma. Superimposed or developing infection cannot entirely be excluded. Follow-up to resolution is recommended.


Instruction: Generate impression based on findings.

Input: Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Redemonstrated is a subcentimeter sebaceous cyst overlying the right frontal bone, as well as smaller similar appearing foci elsewhere in subcutaneous tissues.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.

Output: 1.Negative MRI of the brain.2.Negative MRA of the brain.3.Negative MRA of the neck.4.Specifically, there are no MRI/MRA findings to explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: Diagnosis: Other amnesiaClinical question: memory lossSigns and Symptoms: memory loss The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific.


Instruction: Generate impression based on findings.

Input: Male 14 years old Reason: eval for hamstring tear History: hamstring pain for a month BONE MARROW: Increased T2 signal is present within the left ischium and ilium with associated surrounding periosteal edema. SOFT TISSUES: The common hamstring tendons and muscle bellies of the biceps femoris, semimembranosus and semitendinosus muscles demonstrate normal signal and morphology.JOINTS: No significant abnormality noted.ADDITIONAL

Output: 1.Bone marrow edema of the left ischium and ilium with associated periosteal edema suggestive of a periosteal sleeve avulsion of the biceps femoris. 2.Normal signal and morphology of the biceps femoris, semimembranosus and semitendinosus musculature and tendons.


Instruction: Generate impression based on findings.

Input: 29 years, Male, history of medulloblastoma and VP shunt. Evaluate for leukoencephalopathy.. There are extensive areas of FLAIR hyperintensity in the subcortical and bilateral periventricular white matter in the bilateral cerebral hemispheres. Small lacunar infarcts are also seen in the right greater than left basal ganglia. There is moderate degree of global parenchymal volume loss, particularly in the left cerebral hemisphere including encephalomalacia in the left temporal lobe. There is ex vacuo dilatation of the lateral ventricles left greater than right. There is a right transfrontal VP shunt catheter with the tip in the right frontal horn. There is no evidence of hydrocephalus. There is no restricted diffusion to suggest acute ischemia. There are multiple foci of susceptibility effect in the bilateral cerebral hemispheres consistent with chronic microhemorrhages and likely related to prior treatment. There is T1 hyperintensity involving the bilateral basal ganglia and the dentate nuclei within the cerebellum which may be related to prior radiation.There is T2/FLAIR hyperintensity involving the bilateral cerebellum and to a lesser degree in the pons. Areas of cystic change are noted in the right cerebellar hemisphere which may related to prior tumor. There is no abnormal parenchymal or meningeal enhancement in the posterior fossa or elsewhere in the brain to suggest tumor recurrence.Major flow-voids are preserved. There is mild mucosal thickening throughout the paranasal sinuses. The sphenoid sinus is under pneumatized. Extensive T1 hyperintensity involving the skull base is compatible with prior radiation.

Output: 1. Extensive areas of white matter signal abnormality particularly supratentorially are compatible with leukoencephalopathy related to prior chemoradiation. 2. There is parenchymal volume loss, particularly in the left cerebral hemisphere including encephalomalacia in the left temporal lobe.3. Multifocal areas of susceptibility effect compatible with chronic microhemorrhages and/or mineralization also likely related to prior treatment.4. No findings to suggest tumor recurrence.


Instruction: Generate impression based on findings.

Input: 12 years, Female, evaluate for intracranial mass or intraorbital mass. Severe headaches and history of neuroblastoma. MRI brain: A single focus of T2/FLAIR hyperintensity (series 701, image 10) is unchanged within the right temporal lobe subcortical white matter with no associated restricted diffusion, enhancement, susceptibility or mass effect. No new suspicious lesions are identified.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No abnormal leptomeningeal enhancement. Major flow-voids are preserved. Empty sella is not identified. There is also mild mucosal thickening in scattered paranasal sinuses.MRI Orbits: There is subtle flattening of the posterior aspects of the globes at the optic nerve head insertion. Although there is no frank optic nerve head elevation, there is questioned punctate enhancement at the optic nerve heads. Artifact on diffusion-weighted images limits evaluation for associated optic nerve head restriction. There is also mild fluid distention of the distal optic nerve sheath which is nonspecific. Grossly, mild flattening of the posterior globes was noted on the prior exam.No abnormal orbital mass or other abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.

Output: 1. Stable to slightly decreased conspicuity of nonspecific nonenhancing T2 hyperintense right temporal lobe white matter lesion. No abnormal parenchymal enhancement or new abnormal signal.2. Slight flattening of the posterior aspects of the globes at the optic nerve head insertion without frank elevation of the optic nerve head, although there is punctate enhancement suggested and slight fluid distention of the optic nerve sheath distally. The flattening of the posterior globes is grossly similar to prior exam, although correlation with ophthalmological exam is recommended to assess for papilledema, and consideration may be made for lumbar puncture. If further assessment is needed of cranial nerves to evaluate exotropia, MRI of the cranial nerves may be obtained. No evidence of associated empty sella to suggest pseudotumor cerebri.Dr. Yang discussed these findings over the telephone with Dr. JAMES W. MITCHELL on 10/4/2016 9:00 AM.


Instruction: Generate impression based on findings.

Input: 64-year-old male with superficial swelling of the left knee and medial knee pain. Please evaluate for baker's cyst as well as meniscal tear. Examination is limited as images are suboptimal due to body habitus.MENISCI: There is a complex tear including a radial component involving the posterior horn of the medial meniscus. The lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is no evidence of bone marrow edema. There is generalized thinning of the patellar cartilage without a focal defect.LIGAMENTS: The collateral and cruciate ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: Limited examination with a complex tear including a radial component involving the posterior horn of the medial meniscus.


Instruction: Generate impression based on findings.

Input: Grade 2 Ependymoma posterior fossa f/u post RT. There are postsurgical findings related to suboccipital craniectomy for posterior fossa mass resection are again seen. There is a small of expansile T2 hyperintense enhancing lesion centered on the right inferior cerebellar peduncle consistent with residual tumor, which measures approximately 10 x 9 x 15 mm, similar to prior examination. There has been no significant change of this lesion, allowing for evolution of surrounding postoperative effects. There is no evidence of tumors elsewhere in the brain. The ventricles are unchanged in size. There is no evidence of midline shift or herniation. There is no evidence of acute ischemia or new hemorrhage. There is a small right maxillary mucus retention cyst.

Output: Postoperative findings related to posterior fossa ependymoma resection with a small residual right inferior cerebellar peduncle tumor appears similar to prior examination from 5/18/2016. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 54 year old with history of left breast cancer status post mastectomy and reconstruction. Screening exam is performed. Minimal parenchymal enhancement is noted in the right breast. There is heterogeneous amount of fibroglandular tissue in the right breast.The patient is status post left mastectomy. There is no suspicious enhancement in the left breast reconstruction. Stable oval mass measuring up to 8 mm in the left lateral chest wall. No abnormal enhancement is seen in the right breast. No abnormal axillary lymph nodes are identified in either axillary region. Post-surgical change in the left axilla is noted.

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


Instruction: Generate impression based on findings.

Input: Numbness in thumb radiating to shoulder, atrophy of thenar eminence There is cerebellar tonsillar ectopia. Craniovertebral junction appears otherwise within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained aside from mild reversal of cervical lordosis. Bone marrow signal is benign. No abnormal enhancement is seen in the cervical cord, spine, or paraspinous soft tissues. Examination is slightly motion degraded; however, no cord signal abnormality is definitively appreciated.There appears to be mild congenital narrowing of the cervical spinal canal with superimposed degenerative changes; individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex with mild to moderate spinal canal stenosis. There is bilateral uncovertebral hypertrophy with moderate to severe bilateral neural foraminal stenosis.C4-5: Small disc osteophyte complex, ligamentum flavum thickening, and bilateral uncovertebral hypertrophy. There is mild impression on the right ventral cord with overall mild to moderate degree of spinal canal stenosis. Uncovertebral hypertrophy results in moderate to severe bilateral neural foraminal stenosis.C5-6: Small disc osteophyte complex, ligamentum flavum thickening, and bilateral uncovertebral hypertrophy. There is mild impression on the cord with mild to moderate degree of spinal canal stenosis. Uncovertebral hypertrophy results in moderate to severe bilateral neural foraminal stenosis, C6-7: Small disc osteophyte complex, ligamentum flavum thickening, and bilateral uncovertebral hypertrophy. There is mild spinal canal stenosis. There is moderate left and mild right neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissue structures appear within normal limits.

Output: Multilevel degenerative changes in the cervical spine with mild to moderate degree of spinal canal stenosis at C3-C4, C4-C5, C5-C6, and to a slightly lesser degree at C6-C7. There is significant neural foraminal stenosis at these levels bilaterally as detailed above which may be impinging on the exiting nerve roots.


Instruction: Generate impression based on findings.

Input: Nystagmus and fasciculation. There is no evidence of intracranial mass, infarct, or hemorrhage. There are a few scattered foci of T2/FLAIR hyperintensity in the white matter. A relatively more prominent 7 mm focus involves the lateral left precentral gyrus and without associated mass effect or enhancement. Brain parenchyma is otherwise unremarkable. No abnormal enhancement. Ventricles are normal in size. Cavum septum pellucidum and cavum vergae incidentally noted. 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 mucosal thickening in the paranasal sinuses which is nonspecific.

Output: There are a few scattered foci of T2/FLAIR hyperintensity in the white matter, including a relatively more prominent one in the left frontal lobe measuring up to 7 mm. These foci are very nonspecific and may be related to, for example, prior inflammation, infection, or less likely demyelination. Brain parenchyma is otherwise unremarkable. Specifically, no lesion within the posterior fossa is appreciated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 51 year old female with known right triple negative breast cancer with right axillary lymph node metastasis, status post neoadjuvant chemotherapy. There is scattered fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Hydromark Clip is present at anterior 10 o'clock in the right breast. It is presumably placed in the proven carcinoma. There are no abnormal enhancement in the right breast, suggesting complete resolution of the right breast cancer.There is a small metallic artifact at the edge of a benign appearing lymph node located at superior anterior right axilla, suggesting a presence of marker clip. Thus, this lymph node is presumably a proven metastatic node. In addition, several benign appearing lymph nodes are present in the right axilla. No abnormal enhancement is seen in left breast. Port-A-Cath is seen in the upper inner left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: 1. Complete imaging resolution of right breast cancer and right axillary lymph node.2. No MR evidence for malignancy in the left breast or left axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Reason: r/o infection source or injury. History: 27yo female with new onset of right hip pain and weakness, now walking with a cane. No pmhx outside of working in a labor intensive job. She also has one bottle of positive blood culture. There is a right hip joint effusion with synovial enhancement. Edema type signal and enhancement is seen within the surrounding musculature including the abductors, quadriceps, iliopsoas and gluteal musculature. No discrete fluid collection is seen to suggest abscess formation. The underlying bone marrow signal is unremarkable.

Output: Right hip joint effusion with synovial enhancement and enhancement within the surrounding musculature is nonspecific and has a differential ranging from infection to connective tissue disease. Further evaluation with joint aspiration is recommended.


Instruction: Generate impression based on findings.

Input: Clinical question to be answered: Evaluate for etiology of new onset of severe headaches and epistaxis. Signs and symptoms: Complains a one week history of severe headaches No evidence of hemorrhage, edema, mass effect, midline shift or hydrocephalus. Cortical sulci, ventricular system and CSF cisterns remain within normal. There is apparent crowding of cerebellar tonsils at the level foramen magnum which may represent ectopia of the cerebellar tonsils. This finding can be further evaluated with an MRI exam. Calvarium is intact. Mastoid air cells and limited view of paranasal sinuses are unremarkable.

Output: Negative CT of brain for any acute findings. Possible ectopic cerebellar tonsils as detailed.


Instruction: Generate impression based on findings.

Input: Provided history of prostate cancer. 7/15/2015 biopsy demonstrated 4+4 LLB, LMB and 3+4 LLM prostatic adenocarcinoma. PELVIS:PROSTATE:Prostate Size: 3.7 x 4.8 x 4.1 cmPeripheral Zone: There is intrinsic T1 weighted signal hyperintensity (series 1001/20) in the left lateral base through mid gland of the peripheral zone reflecting post-biopsy hemorrhage. This obscures the region of the patient's known prostatic adenocarcinoma where there is low T2-weighted signal and mild restricted diffusion. 5 mm focus of T2 weighted hypointensity (series 901/11) and associated restricted diffusion (series 504/184) in the right medial apex may represent an additional site of disease. No other suspicious foci are identified.Central Gland: Mild changes of benign prostatic hyperplasia.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: There is mild bulging of the prostate at the level of the left mid gland and base (series 9 and 1/14) but no frank extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: Non-specific subcentimeter left obturator lymph node measuring 0.9 x 0.8 cm (series 901/26).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Post-biopsy changes of the left peripheral zone. There is slight bulging of the prostate contour but no frank extraprostatic extension. No seminal vesicle invasion. Nonspecific subcentimeter left obturator lymph node.2.Possible additional 5 mm focus of prostatic adenocarcinoma in the right apex.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: history of MS now with acute neurologic symptomsSigns and Symptoms: history of MS now with new neurologic symptoms MRI of the brainA punctate focus of signal hyperintensity is present in the right frontal periventricular white matter. It does not correspond to a focus of diffusion restriction on the ADC maps. It represents T2 shine through.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small subdural effusion redemonstrated in the posterior fossa which is stable and could simply relate to some atrophy.There is redemonstration of a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR signal hyperintense lesions are present in the brainstem and cerebellar hemispheres. There is no substantial change since last years exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left posterior communicating artery is medium-sized. The right posterior communicating artery is tiny. The anterior communicating artery is medium-sized. The left vertebral artery is very small relative to the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery. There is narrowing of the left subclavian artery by approximately 65% proximal to the origin of the left vertebral artery. The left vertebral artery origin is tortuous. The left vertebral artery is smaller than the right vertebral artery.

Output: 1.There are multiple periventricular and subcortical white matter lesions as well as brainstem and cerebellar lesions present which are stable when compared to the prior exam and compatible with patient's clinical history of multiple sclerosis.2.65% stenosis at the left subclavian artery proximal to the left vertebral artery origin. Please note the left vertebral artery is much smaller than the right vertebral artery. This has not changed substantially since last years exam.3.There is no evidence for intracranial cerebrovascular occlusive disease appreciated.


Instruction: Generate impression based on findings.

Input: 65-year-old female with HCC, please evaluate for metastases LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.The prominent pericardial recess in the right paratracheal region.Probable tracheal diverticulum unchanged from the prior exam.CHEST WALL: Degenerative changes in the thoracic spineUPPER ABDOMEN: Hypodense lesions with internal calcification within the right lobe of liver compatible with treatedtumor (recent MRI dated 6/29/11).

Output: No evidence of metastatic disease within the chest.


Instruction: Generate impression based on findings.

Input: Male, 52 years old, with GBM status post resection. Postoperative findings are again seen status post resection of tumor from the left temporal lobe. A hematoma within the operative bed has decreased in size.Irregular enhancing tissue along the operative margins continues to decrease in size when compared to the prior examinations. Ependymal enhancement along the atrium and temporal horn has also become less conspicuous. Extensive T2 hyperintensity extending throughout the temporal and occipital lobes and into the parietal lobe has not significantly changed. Prior mass effect upon the ventricle has also been relieved.No new enhancing lesions are seen. Scattered small foci of FLAIR hyperintensity elsewhere in the cerebral hemispheres are nonspecific and not significantly changed. The ventricles have returned to normal caliber and morphology. Evidence of endoscopic paranasal sinus surgery is redemonstrated with persistent frontal and ethmoid mucosal thickening.

Output: Continued interval decrease in the size of the enhancing tissue along the left temporal operative margins. Mass effect is also improved. No new lesions are seen.


Instruction: Generate impression based on findings.

Input: 50-year-old female with abdominal fullness and pain ABDOMEN:LIVER, BILIARY TRACT: Multiple simple and minimally complex hepatic cysts are again identified. The largest in the right lobe of the liver measures 11.1 x 15.7 cm and exerts mass effect on the intrahepatic IVC.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered subcentimeter T2 hyperintensities in bilateral kidneys presumably benign cysts.RETROPERITONEUM, LYMPH NODES: Cluster of nonspecific subcentimeter right lower quadrant lymph nodes, partially imaged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Subcentimeter right cardiophrenic lymph nodes.

Output: 1.Multiple T2 hyperintense lesions compatible with simple and minimally complex hepatic cyst formation. No suspicious features are identified. Continued follow-up is recommended if clinically warranted.


Instruction: Generate impression based on findings.

Input: Evaluate for new demyelinating lesions. History of worsening right sided weakness, double vision. There is no evidence of acute ischemic infarction. There are extensive T2 hyperintense supratentorial and infratentorial lesions, which appear grossly unchanged compared to the MRI from 2015. Many of the lesions are also T1 hypointense, but there is no evidence of associated enhancement. There is no evidence of intracranial hemorrhage or mass. The pituitary gland appears unremarkable. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No significant change in the extensive supratentorial and infratentorial demyelinating lesions.2. No evidence for acute ischemic infarction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 81-year-old male with history of parotid ACC. Status post chemo/RT Images at the level of the skull base and cavernous sinuses and including paranasal sinuses are unremarkable. Opacification of right mastoid air cells is a new finding since prior study.Postoperative changes of right-sided parotidectomy is again identified. This finding remains stable since prior study and no evidence of recurrence of tumor at the surgical site is detected.No evidence of any masses or pathologic adenopathy in the soft tissues of the neck is detected. Images at the level of the apices of the lungs demonstrate minimal scarring on the left also stable since prior. No metastatic lesion is detected.Bony density of area of exam is negative for metastatic lesions.CT of brain with infusion.This examination demonstrates an enhancing lesion measuring approximately 12.5 mm x 9.3-mm in transaxial dimension within the right cerebellopontine angle. Multiple prior studies were reviewed which failed to demonstrate this finding. This lesion is not associated with any definitive bony changes and is at least partially at the level of the right internal auditory canal which also appears normal in size and morphology. This finding may represent choroid plexus at the level of the right foramina of Luschka, however due to lack of its visualization on prior examination possibility of tumor cannot be excluded and an MRI examination of brain with infusion is recommended to exclude this possibility.This examination is otherwise negative and in particular no evidence of metastatic disease to the brain parenchyma, leptomeninges or the calvarium is detected. Also as noted above there is evidence of interval development of opacification of mastoid air cells on the right side. Small vessel disease again identified.

Output: 1.No evidence of recurrence of disease in the neck.2.Extra-axial right CP angle enhancing lesion which may represent choroid plexus of the fourth ventricle at the level of foramina of Luschka however to exclude possibility of tumor an MRI is recommended. This finding was not identified on any of the prior studies.


Instruction: Generate impression based on findings.

Input: 12-year-old female with dog bite wound to the left ankle. Assess anterior tibial tendon and deep peroneal nerve. TENDONS: The flexor and extensor tendons appear intact. The peroneal tendons appear intact. The Achilles tendon is within normal limits.LIGAMENTS: The lateral collateral ligament complex appears intact. The distal tibiofibular syndesmotic complex appears intact. The visualized components of the deltoid ligament appear intact.ARTICULAR SURFACES AND BONE: There is focal edema within the anterior aspect of the talar dome that could represent injury from the patient's dog bite. There is a small amount of fluid within the ankle joint which is nonspecific. The bone marrow signal intensity is otherwise within normal limits.ADDITIONAL

Output: 1. Although we see no specific findings to confirm injury to the deep peroneal nerve, the nerve cannot be completely identified amidst the focal edema within the soft tissues of the ankle and we cannot completely exclude the possibility of injury.2. Small focus of edema within the anterior aspect of the talar dome may represent injury related to the patient's history of a dog bite; note that we cannot exclude the possibility of focal osteomyelitis.3. Normal-appearing tendons.


Instruction: Generate impression based on findings.

Input: BRAIN: Interval progression of numerous oval and punctate T2/FLAIR signal hyperintensities in the periventricular and subcortical white matter, some of which are oriented perpendicular to long axis of the lateral ventricles. There is also prominent T2 hyperintensity within the globus pallidus bilaterally, which may represent chronic small vessel ischemic changes. There are no masses, mass effect or midline shift. There has been interval progression of mild prominence of the ventricles and sulci, consistent with age-related volume loss. There is no evidence for intracranial hemorrhage or diffusion restriction to suggest acute ischemia.The cerebellar tonsils are in normal position. Flow voids are present within the major vessels indicating patency. Again noted is a prominent rounded flow void associated with a known ACOM aneurysm which is grossly similar in configuration but incompletely evaluated. There is no abnormal enhancement within the brain. Lack of dedicated cranial nerve imaging limits evaluation of the abducens nerve. ORBITS:The globes are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated.

Output: 1.No acute intracranial abnormality. Significant interval progression of white matter lesions which are nonspecific, with a differential diagnosis including chronic small vessel ischemic changes, demyelinating disease, as well as infectious/inflammatory etiologies. Please correlate clinically.2.No abnormality involving the orbits.3.Incomplete evaluation of known ACOM aneurysm, with grossly similar configuration.


Instruction: Generate impression based on findings.

Input: 57 years Female (DOB:1/21/1959)Reason: behavioral abnormlities History: NonePROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. Along the posterior aspect of the left periventricular white matter there is a 2 mm x 5 mm T2 and FLAIR hyperintense lesion present without any susceptibility effect or contrast enhancement.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.

Output: In isolation a very small left periventricular white matter lesion is nonspecific and probably of little clinical significance. Differential considerations may include prior injury or vascular event.


Instruction: Generate impression based on findings.

Input: Neck pain, left hand numbness and tingling. History of cervical and lumbar fusion, status post MVA x2. Cervical: Craniovertebral junction demonstrates moderate degenerative changes but is otherwise within normal limits. The cervical vertebral bodies are appropriate in height. There are changes related to previous posterior decompression and fusion from C3 through C6 (laminectomy, dual posterior rods and lateral mass screws that are bilateral C3, C5 and C6 and only on the left at C4). There is solid osseous fusion anteriorly and posteriorly. There is mild cervical kyphosis with apex at the C4-C5 level. Alignment is otherwise maintained. Bone marrow signal is benign.No abnormal cord signal. There is effacement of the dorsal thecal sac at the C2-C3 level with mild impression on the dorsal cord. There is also mild spinal canal stenosis at the C7-T1 level related to disc bulge. Spinal canal is well decompressed from C3 to C6. There is loss of disc height at the C6-C7 and C7-T1 levels. Individual levels as below:C2-3: Minimal narrowing of the spinal canal. No significant neural foraminal stenosis.C3-4: No significant compromise to the spinal canal. Mild left worse than right neural foraminal stenosis. C4-5: No significant compromise to the spinal canal. There is mild to moderate right and mild left neural foraminal narrowing.C5-6: No significant compromise to the spinal canal or left neural foramina. Mild right neural foraminal narrowing.C6-7: Uncovertebral hypertrophy with mild to moderate right and minimal left neural foraminal narrowing. No significant spinal canal stenosis.C7-T1: There is disc bulge, uncovertebral hypertrophy, and bilateral facet arthropathy which result in mild to moderate bilateral neural foraminal stenosis, right worse in left. There is mild mild spinal canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar: Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild loss of normal lumbar lordosis. There is minimal anterolisthesis of L3 on L4 and L4-L5 with evidence of prior interbody fusion at these levels. Posterior fusion hardware is also seen at L4-L5 with bilateral paraspinous rods and pedicle screws. Bone marrow signal is benign.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: There is loss of disc space with disc bulge, with arthropathy, ligamentum flavum thickening resulting in mild to moderate spinal canal stenosis. There is minimal bilateral neural foraminal narrowing.L3-L4: Anterior fusion. Minimal spinal canal narrowing related to facet arthropathy and ligamentum flavum thickening above the level of the laminectomy. No significant neural foraminal stenosis.L4-L5: Anterior and posterior fusion. Spinal canal is surgically decompressed. Susceptibility artifact limits evaluation; within this limitation, mild right worse in left neural foraminal stenosis is suspected, but no high-grade neural foraminal stenosis is evident.L5-S1: Left-sided facet arthropathy with mild left neural foraminal stenosis. No significant right neural narrowing. No significant spinal canal stenosis.Bilateral renal cysts.

Output: 1. Postsurgical changes of prior laminectomy and C3 to C6 fusion with solid osseous fusion anteriorly and posteriorly. There are degenerative changes at the C7-T1 level with mild spinal canal stenosis and mild to moderate neural foraminal stenosis at this level. Otherwise no high-grade spinal canal or neural foraminal stenosis is seen in the cervical spine.2. Postsurgical changes of interbody fusion at L3-L4 and L4-L5 as well as posterior decompression and fusion at L4-5. Degenerative changes are seen including mild spinal canal stenosis at the L2-L3 level. There is also mild bilateral L2-L3 and mild left L5-S1 neural foraminal stenosis. No high-grade spinal canal or neural foraminal stenosis in the lumbar spine.