Instruction: Generate impression based on findings.

Input: Vertebral body heights are maintained. There is no evidence of fracture or spondylolisthesis. Alignment is within normal limits. The conus is normal in signal intensity and morphology and terminates at an appropriate level. Redemonstrated is a left simple renal cyst, otherwise the paraspinal tissues are unremarkable.L1-L2: No significant abnormality, unchanged.L2-L3: Worsening disc bulge and new bilateral facet hypertrophy causing new mild bilateral neural foraminal stenosis.L3-L4: Diffuse annular disc bulge, ligamentum flavum thickening, mild left facet hypertrophy, and mild to moderate right facet hypertrophy. There is mild central, moderate left lateral recess, mild right lateral recess, mild to moderate left neural foraminal, and mild right neural foraminal stenosis. These findings are unchanged.L4-L5: Diffuse single disc bulge with focal protrusion centrally as well as into the left neural foramen. There is also ligamentum flavum thickening and mild bilateral facet hypertrophy. There is mild central, moderate left lateral recess, and mild to moderate bilateral neural foraminal stenosis. These findings are unchanged.L5-S1: Diffuse annular disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is moderate left neural foraminal and mild right neural foraminal stenosis. These findings are unchanged.

Output: 1.L2-L3: New mild bilateral neural foraminal stenosis.2.L3-L4: Mild central, moderate left lateral recess, mild right lateral recess, mild to moderate left neural foraminal, and mild right neural foraminal stenosis, unchanged.3.L4-L5: Mild central, moderate left lateral recess, and mild to moderate bilateral neural foraminal stenosis, unchanged.4.L5-S1: Moderate left neural foraminal and mild right neural foraminal stenosis, unchanged.


Instruction: Generate impression based on findings.

Input: Diagnosis: HeadacheClinical question: headacheSigns and Symptoms: change in character of headache following head trauma MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: 1.MRI of the brain is within normal limits. There is no evidence for acute cerebral infarction, intracranial mass or intracranial hemorrhage.2.MR venogram of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Autoimmune thyroiditis and epilepsy. There is persistent, albeit slightly reduced diffuse cortical and subcortical swelling and high T2 signal with associated mild gyriform enhancement involving the left posterior temporal, parietal, and occipital lobes. There may be slightly reduced diffusivity in the cortex in some of the affected areas. Patchy areas of high T2 signal in the right cerebellar hemisphere have subsided. There is persistent patchy high T2 signal in the pons bilaterally. The left thalamus lesion appears to have resolved. There is slightly less mass effect upon the left lateral ventricle and no significant midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Overall slight improvement of the edema involving the left posterior temporal, parietal, and occipital lobes. Furthermore, patchy areas of edema in the right cerebellar hemisphere have subsided and the left thalamus lesion appears to have resolved, which may have been related to seizure activity superimposed upon autoimmune encephalopathy. The nonspecific patchy high T2 signal in the pons bilaterally otherwise persists.


Instruction: Generate impression based on findings.

Input: Craniotomy for laser ablation for astrocytoma. There are postoperative findings related to laser ablation with interval decrease in size and enhancement of a tectal plate mass that now measuring approximately 12 x 18 mm in cross-section, previously 16 x 19 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The right cerebral convexity fluid collection has resolved. There is a right transfrontal Ommaya catheter that terminates adjacent to the right caudate nucleus. There are also postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. There is no midline shift or herniation. There is a left cerebellar hemisphere developmental venous anomaly. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues appear unchanged. There is diffuse paranasal sinus mucosal thickening.

Output: 1. Postoperative findings related to laser ablation with interval decrease in size of a tectal pilocytic astrocytoma.2. Postoperative findings related to endoscopic third ventriculostomy, with an apparent jet of cerebrospinal fluid into the third ventricle. Nevertheless, the third and lateral ventricles remain enlarged. 3. The right transfrontal Ommaya catheter terminates adjacent to the right caudate nucleus.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:9/2/1948)Reason: new left sided hand weakness History: left handed weakness and tinglingPROVIDER/ATTENDING NAME: MICHAEL A WARD JAMES A MASTRIANNI 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. Additionally there are patchy T2 and FLAIR hyperintense lesions in the pons and the midbrain.There are punctate T2 and FLAIR hyperintense foci present in the left thalamus and left basal ganglia. These are not associated with diffusion restriction.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.On susceptibility imaging there are punctate foci of signal loss present in the left thalamus and left basal ganglia.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 appears be a focal stenosis at the proximal the right middle cerebral artery M1 segment on the noncontrast MRA of the brain, however, on the MRA of the neck which is with contrast this is not apparent. As a result this apparent right M1 narrowing probably represents artifact. Along the distal posterior cerebral artery vasculature there are apparent foci of narrowing and dilation. The basilar artery appears somewhat irregular but not stenotic. The carotid siphon is also irregular but not stenotic on both sides. There appears to be narrowing of the right internal carotid artery at the distal cavernous segment with approximately 40% stenosis.There is asymmetry in the size of the A1 segments of the left A1 segment being larger than the right A1 segment.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 vertebral arteries are similar in size. The left vertebral artery smaller than 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 vertebral artery smaller than the right vertebral artery and the proximal left vertebral artery is stenotic.

Output: 1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree as well as some patchy lesions in the pons and midbrain are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the left thalamus and left basal ganglia may be related to prior lacunar infarcts.4.There is no intracranial cerebrovascular occlusion or stenosis appreciated. Some intracranial vasculature is irregular suggesting atherosclerosis.5.There is no evidence for extracranial cerebrovascular occlusion or stenosis.6.There are couple microhemorrhages present in the left thalamus and left basal ganglia. In isolation these are somewhat nonspecific. They could be hypertensive in nature given the locations.


Instruction: Generate impression based on findings.

Input: 23 years, Male, Reason: 23 year old with Primary Med. DLBCL with mets to brain now s/p 2 cycles HD MTX and Cytarabine in need of reimaging. There has been marked decrease in size of previously seen enhancing mass in the left occipital lobe as well as a decrease in surrounding vasogenic edema. There are postsurgical changes of left occipital craniotomy for biopsy with blood products at the site of the left occipital lesion with mild residual enhancement. Lesion previously 27 x 23 x 26 mm, now measures approximately 18 x 10 x 16 mm in the maximal AP, transverse, and craniocaudal dimensions, although note current maximal measurements include the central nonenhancing postsurgical change, while there was more solid enhancement on the preoperative study.There are blood products within the left occipital resection cavity as mentioned above as well as a punctate microhemorrhage in the left parietal deep white matter just anteriorly. No abnormal parenchymal or meningeal enhancement elsewhere in the brain. No evidence of acute ischemia. No evidence of intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. Right maxillary mucus retention cyst is again seen. Aside from the left parieto-occipital postsurgical changes, calvarium and extracranial soft tissues are grossly unremarkable.

Output: Significant decrease in size of left occipital mass and surrounding edema. Residual enhancing lesion as above. No new lesions.


Instruction: Generate impression based on findings.

Input: 44-year-old female with a subcentimeter echogenic right renal mass on recent ultrasound examination. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a focus of fluid signal intensity corresponding to the previously described hyperechoic focus in the superior pole of the right kidney, which likely represents a simple cyst. Multiple fluid signal intensity foci are identified within the kidneys bilaterally, consistent with simple cysts. No solid or enhancing mass lesions are identified.RETROPERITONEUM, LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Bilateral renal cysts without evidence of a solid or enhancing renal mass.


Instruction: Generate impression based on findings.

Input: Anosmia. No sinus drainage. Rule out abnormal sinus anatomy. There is inferior displacement and flattening of the right fovea ethmoidalis with expansion of the space between the crista gala and the right fovea ethmoidalis. The cribriform plate on the right is depressed inferiorly. There also appears to be inferior herniation of the brain parenchyma in this location.Findings are compatible with long-standing mass effect likely due to a meningocele or a encephalocele in this location. MRI is necessary for further evaluation. The paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Inferior displacement of the fovea ethmoidalis with inferior herniation of the brain parenchyma likely due to a meningocele or encephalocele. MRI examination is necessary for further evaluation.Findings discussed with Dr. A. Hong at 2pm on 3/26/2008.


Instruction: Generate impression based on findings.

Input: 47 year old woman with history of left breast DCIS s/p lumpectomy on 10/30/14. This was followed by biopsy of calcifications seen at a remote site in the inferior left breast on 11/26/14 which resulted in DCIS. There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.Numerous signal voids representing surgical clips are seen in the central and upper left breast. The biopsy clip in the inferomedial left breast seen on the prior mammogram is not visualized on this exam. No abnormal enhancement above background is seen in either breast, specifically no suspicious enhancement is present in the inferomedial left breast. No abnormal lymph nodes are identified in either axillary region.

Output: Post-operative changes in the left breast but no suspicious enhancing lesions on MRI to correlate to the mammographic calcifications/known DCIS. If additional breast conservation is being considered, the mammographic findings should guide localization. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: Left arm pain, tingling and hyperreflexia. Brain:There is no acute infarct or intracranial hemorrhage. There is no abnormal brain signal. The ventricles and the other CSF-containing spaces are normal in size. The morphology of the cerebellar tonsils and the relationship to the foramen magnum is normal. There is preservation of the CSF filled spaces at the level of foramen magnum. Accounting for a dominant left vertebral artery, the major intracranial vascular flow voids are preserved, reflecting gross patency. Mastoid air cells are clear. There is no gross orbital abnormality, accounting for artifact involving the anterior aspect of the orbits.Cervical spine:Sagittal alignment is notable for straightening which may reflect patient position. There is mild dessication of the discs at C2-C3, C3-C4 and C5-C6. There is mild disc height loss at C5-C6. The vertebral bodies are preserved in height. There is no suspicious marrow signal abnormality. The cervical spinal cord is normal. There is no significant spinal canal or foraminal stenosis at any level, down to T2-T3.

Output: 1.MRI of the brain is within normal limits; specifically no evidence of Chiari malformation.2.No significant spinal canal or foraminal stenosis in the cervical spine.


Instruction: Generate impression based on findings.

Input: Clinical question: Schwannoma, 3 months follow up lumbar tumor resection. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:Since prior exam there is significant decreased enhancement of cauda equina at L1 -- L2 surgical site compared to prior study. Posteriorly at the L2 level within the cauda equina there is a small focus of solid enhancement measuring approximately 2.5 x 3-mm in transaxial dimensions (axial post enhanced series 901 image 37 sagittal post enhanced series 801 image 7) highly suggestive of a small schwannoma.Tiny focus of enhancement at the T10 -- T11 disk level identified only on sagittal series and measuring approximately 9 mm in cranial cephalad access and as well suspected of additional schwannoma. This region was not included on prior exam.Multiple small additional intradural enhancing lesions consistent with patient's known schwannomas are again identified and without change. The largest of these lesions is at lower L5 level and measuring a maximum of 10.7-mm in size very similar to prior study.

Output: 1.Significant to near complete resolution of enhancement at the surgical site at L1 -- L2 level since prior study.2.Tiny solidly enhancing schwannoma measuring at 2.5 x 3 mm within the cauda equina at L2 level is identified.3.Multiple additional schwannomas are again identified without interval change.4.A small schwannoma at T10 -- T11 disk level within the spinal canal was not included in the field of prior study.


Instruction: Generate impression based on findings.

Input: Male 59 years old Reason: HCV, Cirrhosis, elevated AFP, US negative for HCC, eval for HCC in light of elevated AFP History: HCV, Cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Liver has a cirrhotic morphology. There are several hypervascular right hepatic lobe lesions. The largest measuring 1.0 x 1.0 cm on (image 532/series 1102). This lesion has washout to background liver on the delayed phase of imaging. (Image 545/series 1105). The lesions are also hyperintense on T2-weighted imaging.The hepatic and portal veins are patent.Particular enhancement of the hepatic parenchyma suggests fibrosis. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No ascites.

Output: Multiple hypervascular right hepatic lobe lesions. There are at least 2 hepatic lesions that meet the criteria for HCC.


Instruction: Generate impression based on findings.

Input: Male, 43 years old, with anoxic brain injury. Patchy gyriform cortical restricted diffusion is seen along the bilateral high convexities. Subtle diffusion restriction is also seen within the caudate bodies and the thalami.No significant associated edema or mass effect is seen. No hemorrhage is detected. Additional scattered non-specific T2 hyperintensities are evident. Ventricular size is within normal limits.

Output: Patchy bilateral ischemia involving the cortex of the high vertex and the deep gray nuclei compatible with hypoxic-ischemic injury.


Instruction: Generate impression based on findings.

Input: Prolactinoma, status post treatment. There is slight interval decrease in size of the heterogeneously enhancing pituitary tumor with suprasellar and right cavernous sinus extension, with encasement of the right internal carotid artery, now measuring 31 mm anterior posteriorly, 31 mm transversely, and 25 mm craniocaudally. The normal portion of the pituitary gland and stalk are deviated to superiorly and to the left. There is no mass effect upon the optic apparatus. There is a small area of encephalomalacia in the left basal ganglia.

Output: 1. Slight interval decrease in size of the pituitary macroadenoma.2. Chronic left basal ganglia infarct.


Instruction: Generate impression based on findings.

Input: Full-thickness burn injury Note that absence of intravenous contrast limits evaluation of inflammation and myonecrosis. There is diffuse increased signal on T2 sequences throughout subcutaneous tissues of the forearm. There is abnormal increased signal intramuscularly and intermuscularly within both the flexor and extensor compartments of the forearm which is most evident within the flexor compartment just proximal to the distal radial ulnar joint. The edema becomes confluent along the anterior margin of the flexor compartment.There is skin thickening and irregularity of the volar aspect of the forearm.Within the limits of the exam, there is no focal fluid collection.Bone marrow signal is normal.

Output: Subcutaneous, intermuscular and intramuscular edema of the forearm with no evidence of focal fluid collection within the limits of a nonenhanced exam.


Instruction: Generate impression based on findings.

Input: 60-year-old female status post fall, 2/28 with head trauma and negative CT head now with dizziness. No prior history of dizziness. Rule out subdural hematoma. There is no evidence of intracranial hemorrhage, mass or edema. Scattered diffuse white matter hypodensities consistent with small vessel disease, age indeterminate. If there is clinical concern for acute ischemia an MRI may be considered. No cortical stroke is seenThe 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.


Instruction: Generate impression based on findings.

Input: Female 45 years old Reason: Evaluate rotator cuff History: pain, weakness ROTATOR CUFF: There is a near full-thickness tear of the undersurface of the posterior fibers of the supraspinatus tendon near the insertion. There is no retraction.SUPRASPINATUS OUTLET: Fluid, some subchondral cyst formation indicating mild degenerative changes affecting the acromioclavicular joint.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: Biceps tendon is intact. ADDITIONAL

Output: Near full-thickness tear of the undersurface of the supraspinatus tendon.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (11/24/15, 6/10/16), ultrasound images of right breast (11/24/2015, 6/10/2016), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (6/21/2016), breast MRI (6/23/2016) performed at outside institution. For comparison, digital mammographic images (11/24/2014), ultrasound images (11/24/2014) are available. DIGITAL MAMMOGRAPHIC IMAGES OF BOTH BREASTS AND ULTRASOUND IMAGES OF RIGHT BREAST (11/24/15):The breast parenchyma is extremely dense (BiRADS Density Category D), unchanged in pattern and distribution. A BB marker is placed at upper outer quadrant of right breast, denoting the area of palpable lump. There is a partially circumscribed mass at the site of the BB marker. This mass is confirmed to be a simple cyst on ultrasound at 10:00 position in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. DIGITAL MAMMOGRAPHIC IMAGES OF RIGHT BREAST AND ULTRASOUND IMAGES OF RIGHT BREAST (6/10/2016):The breast parenchyma is extremely dense (BiRADS Density Category D), unchanged in pattern and distribution. A BB marker is placed at 12 o'clock position of right breast, denoting the area of palpable lump. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted at the area of palpable concern or elsewhere in right breast.On ultrasound, there is an ill-defined hypoechoic mass measuring 27 x 13 mm at 10:00 position in the right breast. Increased blood flow is observed in this area. Interval decrease of the simple cyst at 10:00 position in the right breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (6/21/2016):Ultrasound guided biopsy was performed for the abnormal hypoechoic masses at 12:00 position and 9:00 position of the right breast. The masses in the right breast appear more discontiguous than that seen in the prior study. The mass at 12:00 position was sampled by use of 11-gauge vacuum assisted needle, and the mass at 9:00 position was sampled with 14-gauge biopsy needle, with appropriate needle placement. Postprocedural right mammographic images show a marker clips at 12:00 position, and upper outer quadrant in the right breast, respectively. Distance between 2 clips is 32 mm on CC view. Per outside radiology report, pathology result for both sites was malignant.BREAST MRI (6/23/2016):Breast MRI was performed with a protocol outlined in the outside radiology report.There is extreme amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.Diffuse suspicious non-mass enhancement is seen at upper outer and upper inner quadrant in the right breast measuring 65 x 54 x 65 mm (AP x LR x CC). Simple cyst is seen at 10:00 position in the right breast.There are scattered enhancing foci, but no abnormal enhancement is seen in left breast. No abnormal lymph nodes are identified in either axillary region.

Output: 1. Biopsy proven malignancy in the right breast at 2 sites (12:00 and 9:00 position). Breast MRI demonstrated diffuse suspicious non-mass enhancement within upper outer and upper inner quadrant in the right breast, suggesting diffuse disease.2. No MRI evidence of malignancy in the left breast or either axillary region.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 71-year-old female with history of cirrhosis who presents for evaluation of a concerning lesion on CT. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology. Again noted is left hepatic lobe lesion measuring 2.4 x 2.3 cm (series 11, image 73). The right-sided component demonstrates T1 brightness without enhancement compatible with hemorrhagic component. The left-sided solid component does not demonstrate arterial enhancement given that the arterial phase is too early on the current exam; however, given enhancement and washout on the CT of this nodular component, this lesion remains suspicious for hepatocellular carcinoma. In addition, there is evidence of an enhancing capsule surrounding the lesion. The additional subcentimeter hypoattenuating lesion in the lateral left hepatic lobe noted on the CT examination is not identified on this examination and may have been a perfusional abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Again noted is collapse of L1 vertebral body and loss of height of L5 vertebral body.OTHER: No significant abnormality noted.

Output: 1.Cirrhosis with a left hepatic lobe lesion which remains highly suspicious for hepatocellular carcinoma as detailed.2.L1 vertebral body collapse and L5 vertebral body height loss persists.


Instruction: Generate impression based on findings.

Input: 30-year-old with history of gunshot wound to the left side of the head with increased tone in spasticity with question of previous stroke and question of new seizure. A bullet or structural abnormality left in the brain. There is no evidence of intracranial hemorrhage, mass or edema. Large left-sided encephalomalacia throughout the frontal parietal and temporal lobes with ex vacuo dilatation of the adjacent ventricles. Patient appears to be status post craniotomy. No acute cortical stroke identified. If there is clinical concern for acute ischemia, an MRI may be considered.The basal cisterns are normal in size and configuration.With exception of postsurgical craniotomy the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.No evidence of retained intracranial metallic fragments.

Output: 1. Left frontoparietal and temporal extensive encephalomalacia without evidence of acute ischemia. If there is clinical concern for acute ischemia, an MRI may be considered.2. No evidence of retained intracranial metallic fragments.


Instruction: Generate impression based on findings.

Input: 46-year-old female who had abdominal wound breakdown 4 months ago. Presenting with increasing pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal stone, unchanged from previous study. No evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Previously described metallic density is unchanged and is located in the hepatic flexure. This likely represents a metallic structure impacted in colon. Correlation with history of previous capsule study history is recommended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postsurgical changes at result. Status post hysterectomy and oophorectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the anterior pelvic wall has almost completely resolved. Small amount of fat stranding persists.There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.OTHER: No significant abnormality noted

Output: Interval resolution of postsurgical changes in the pelvis and anterior abdominal wall. There is some residual soft tissue density in the lower pelvic anterior abdominal wall. Pelvic MRI may be helpful for better characterization of this soft tissue density and to rule out endometrioma, if clinically indicated.Persistent metallic linear density in the hepatic flexure. Correlation with previous ingestion of capsule or other metallic structures recommended.


Instruction: Generate impression based on findings.

Input: Evaluate for cause of seizure Exam is degraded by moderate motion artifact. Within this limitation following observations can be made:No focal parenchymal abnormality is appreciated. No cortical structural abnormality or gray matter heterotopia is identified. Hippocampus is symmetric in size and signal, and internal architecture is preserved. No abnormal diffusion restriction. No mass, mass effect, or midline shift. Ventricles and sulci appear normal without evidence of ventriculomegaly. No extra-axial fluid collection. No gross intracranial hemorrhage. There is suggestion of inferior cerebellar vermis hypoplasia with superimposed volume loss of the vermis and to a lesser degree cerebellar hemispheres. Paranasal sinuses and mastoid air cells are clear. Orbits are intact. Osseous structures are unremarkable. Major intracranial vasculature remains patent. No obvious focus of abnormal enhancement within the limits of significantly degraded postgadolinium sequences.

Output: 1. There is moderate degree of motion degradation on this study which limits evaluation for subtle abnormalities. Within this limitation, no findings to suggest seizure focus are appreciated. If there is high suspicion for a structural lesion, consider repeat examination with sedation.2. Cerebellar volume loss which may be related to chronic antiepileptic medication use.


Instruction: Generate impression based on findings.

Input: BRCA2 mutation carrier. History of left breast pain. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Again noted are scattered non-uniquely enhancing foci and patchy areas of parenchymal enhancement, including a regionally enhancing area of breast tissue in the right upper outer breast. The appearance is benign (consensus of two attending breast radiologists). No abnormal axillary 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: New hepatic lesion. History of cirrhosis and alcohol abuse. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. The liver measures 16.7 cm in the craniocaudal dimension.There is a 4.0 x 4.0 cm right hepatic dome segment 8 lesion which bulges the liver contour and is heterogeneously T2 hyperintense in signal intensity with small cystic components. The lesion demonstrates restricted diffusion. On postcontrast images the lesion demonstrates peripheral contiguous thick walled mildly nodular enhancement with multiple internal enhancing septations. (Series 1002/36). There is no progressive enhancement of the lesion. In segment 5 of the liver there is a lobular arterial enhancing lesion measuring 2.5 x 1.8 cm (series 1002/62) demonstrating wash-out and suggestion of capsule formation on the delayed/equilibrium phase images (series 1004/62). The lesion contains intracellular fat and demonstrates restricted diffusion. No intrahepatic or extrahepatic biliary ductal dilatation. Normal distended gallbladder with pericholecystic fluid/gallbladder wall thickening, nonspecific in the setting of ascites. Cholelithiasis.The main portal vein is patent.SPLEEN: The spleen measures 12.1 cm in the craniocaudal dimension. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left periaortic collateral vessel formation suggestive of portal hypertension.BOWEL, MESENTERY: Trace perihepatic and right paracolic gutter and pelvic ascites.BONES, SOFT TISSUES: Severe compression fracture of L1. Bilateral gynecomastia. Small fat-containing umbilical hernia with trace fluid.OTHER: See recent CT chest report for pulmonary findings.

Output: 1.2.5 cm segment 5 lesion with enhancement and wash-out meeting imaging criteria for HCC.2.Indeterminate 4.0 cm lesion in the right hepatic dome, segment VIII demonstrating peripheral nodular thick-walled enhancement and numerous internal enhancing septations. Differential considerations include a hematoma or infection (in the appropriate clinical context). Otherwise, a primary hepatic neoplasm, such an atypical HCC or cholangiocarcinoma should be considered. 3. Cholelithiasis. Pericholecystic fluid and gallbladder wall thickening is nonspecific in the setting of ascites. No biliary ductal dilatation.4. Severe compression fracture of L1, unchanged dating back to 2013.


Instruction: Generate impression based on findings.

Input: 39 years Female (DOB:9/15/1976)Reason: Eval for optic nerve lesions History: optic neuritisPROVIDER/ATTENDING NAME: ADIL JAVED ADIL JAVED MRI orbits:The eyeballs 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. The suprasellar cistern is intact . Compared to prior MRI of the brain the optic nerve does not appear to have changed substantiallyOn the limited imaging of the intracranial structures are few periventricular white matter lesions present which have been identified on prior MRI. One lesion is adjacent to the trigone of the right lateral ventricleThere is some mild mucosal thickening in the maxillary sinuses.

Output: 1.Lack of contrast enhancement limits the ability to detect optic neuritis. Noncontrast MRI of the orbits does not reveal any intraorbital lesions.2.Periventricular white matter lesion present which is better assessed on MRI of the brain.


Instruction: Generate impression based on findings.

Input: 69-year-old female with left buttock pain radiating down left lateral leg. Evaluate for nerve entrapment, osteoarthritis. Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is mild disk disease with loss of disk height, mild to moderate ligamentum flavum hypertrophy and facet hypertrophy. A right facet effusion is also noted. There is grade 1 anterolisthesis of L3 on L4. Constellation of findings result in moderate central canal stenosis. No significant neuroforaminal compromise is seen.At L4-5 there is moderate disk disease with loss of disk height, moderate ligamentum flavum and facet hypertrophy. Grade 1 anterolisthesis of L4 on L5. There is no significant spinal canal stenosis. Mild right neuroforaminal compromise is present.At L5-S1 there is mild disk disease with loss of disk height, mild facet and ligamentum flavum hypertrophy, left greater than right. There is a large, broad-based disk protrusion in the midline and to the left, with effacement of the left lateral recess resulting in subtle mass effect on the descending S2 nerve root. No significant canal stenosis or neuroforaminal compromise is present.

Output: 1.Disk protrusion at L5-S1 results in effacement of the left lateral recess and subtle mass effect on the descending left S2 nerve root.2.Other degenerative changes, as above.


Instruction: Generate impression based on findings.

Input: CERVICAL: There is normal alignment of the cervical spine. The osseous marrow signal is benign. The cord signal is within normal limits. There is no abnormal enhancement. There is no spinal stenosis or disk herniation.THORACIC: There is normal alignment of the thoracic spine. The osseous marrow signal is benign. The cord signal is within normal limits. There is no abnormal enhancement. There are foci of expected thin curvilinear extramedullary vascular enhancement. There is no spinal stenosis or disk herniation.

Output: Unremarkable exam with no discrete cord lesions or abnormal enhancement.


Instruction: Generate impression based on findings.

Input: Pain. Question of rotator cuff tear. ROTATOR CUFF: There is increased signal intensity and thickening of the supraspinatus and infraspinatus tendons indicating tendinosis. Furthermore, there is an insertional tear of the supraspinatus tendon that extends posteriorly to involve the anterior fibers of the infraspinatus tendon. This tear involves the bursal surface fibers but appears to spare the articular surface fibers. The tear involves greater than 50% of the tendon thickness. The tear is approximately 2 cm in the AP dimension. There is minimal, 3 mm, retraction of the torn bursal surface fibers. There is also lobulated fluid signal along the myotendinous junction of the infraspinatus which is compatible with an interstitial tear/cyst formation. The supraspinatus and infraspinatus muscles are otherwise normal. The teres minor muscle/tendon is normal. There is undersurface tearing of the distal subscapularis tendon at its insertion associated with biceps tendon dislocation, with what we believe to be delamination and proximal retraction of the undersurface fibers. There is mild atrophy of the superior fibers of the subscapularis muscle.SUPRASPINATUS OUTLET: There is mild osteoarthritis of the acromioclavicular joint. There is fluid in the subacromial/subdeltoid bursa which is likely related to the aforementioned rotator cuff tears.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral alignment is within normal limits. There is mild blunting of the glenoid labrum but no discrete tear.BICEPS TENDON: The tendon of the long head of the biceps is dislocated medially from its groove and is perched on the lesser tuberosity. The tendon is indistinct at its transition in the rotator interval which we presume is due to tendinosis, although we cannot exclude the possibility of tearing.

Output: 1. Rotator cuff tears as described above with medial dislocation and degeneration of the tendon of the long head of the biceps.2. Additional degenerative changes as described above.


Instruction: Generate impression based on findings.

Input: History of neurofibromatosis type II history of acoustic neuroma and central lesions in the spine. Evaluate for change in lesion size: yearly follow up evaluate for change to tumor size. There are postoperative findings related to left suboccipital craniotomy for resection of a left vestibular schwannoma with left cerebellar hemisphere encephalomalacia. There are unchanged punctate foci of enhancement in the left cerebellopontine angle cistern and skeletonized internal auditory canal. There is an unchanged enhancing mass centered in the right internal auditory canal that measures up to 14 mm. There is no significant interval change in the bilateral Meckel cave enhancing masses, measuring up to 25 mm on the right and 20 mm on the left. There is slight increase in size of an enhancing mass centered in the right Oc-C1 neural foramen with mild protrusion into the spinal canal that measures up to approximately 24 mm, previously 22 mm. There is also an unchanged mildly enhancing mass with areas of susceptibility effect along the tentorial apex that measures up to 18 mm. There is an unchanged cluster of enlarged right superior frontal gyrus perivascular spaces. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Apparent slight interval increase in size of the right craniocervical junction mass.2. Unchanged appearance of the left vestibular schwannoma resection bed without evidence of gross recurrent tumor.3. Unchanged right vestibular schwannoma.4. Unchanged bilateral trigeminal nerve schwannomas.5. Unchanged tentorial apex probable meningioma.


Instruction: Generate impression based on findings.

Input: 59-year-old female with a strong family history of breast cancer in her mother and maternal grandmother, and sister diagnosed at age 38. History of benign left breast biopsy in 1998. History of basal cell carcinoma of right upper lip diagnosed at age 50. No current breast complaints. There is heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.A few enhancing foci are unchanged in the right breast.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 44-year-old female with altered mental status. Evaluate for stroke or PRES. Images are somewhat limited by patient motion. There are several oval foci of T2/FLAIR hyperintensity in the cerebral white-matter, which appear perpendicular to the long axis of the lateral ventricles. These are most conspicuous along the right lateral ventricular margin. Allowing for differences in technique, these have not appreciably changed since prior exams, allowing for differences in technique. There is no abnormal restricted diffusion.There are multiple foci of punctate susceptibility artifact in the cerebrum and cerebellum without associated edema, reflecting chronic microhemorrhages. There is no mass-effect, midline shift or brain herniation. The ventricles, sulci and basal cisterns are mildly to moderately enlarged relating to global volume loss greater than expected for patient's stated age. The major intracranial vascular flow voids are preserved.There are mucous retention cysts in the maxillary sinuses.

Output: 1. Continued stable appearance of scattered nonspecific white matter lesions with unchanged differential.2. Persistent global volume loss greater than expected for patient's stated age.


Instruction: Generate impression based on findings.

Input: Female, 8 months old, with history of progressive astrocytoma status post craniotomy and chemotherapy. Evaluate disease status. The lobular suprasellar mass shows minimal if any interval increase in size. For example, in the sagittal plane, the lesion measures up to 59 mm, previously 57 mm when measured similarly, a difference which could be accounted for by technique. The lesion itself remains predominately solidly enhancing with areas of central necrosis and some cystic components which project into the left middle cranial fossa. It is possible that these cystic components have increased slightly in size as well.Mass effect on the adjacent frontal and temporal lobes is approximately similar to prior. The bilateral ICAs and proximal circle of Willis vessels are encased by the tumor. Encephalomalacia in the right frontal lobe is unchanged. Slight prominence of the lateral and third ventricles is unchanged as well.

Output: While it is possible that the large optic pathway/hypothalamic astrocytoma has increased slightly in size, the difference relative to the prior examination is on the order of 1 or 2 mm and may not be entirely reliable. Morphologically, no significant changes are seen.


Instruction: Generate impression based on findings.

Input: 68-year-old man with history of multiple myeloma. Please evaluate for new myeloma lesions. There is diffuse, symmetric heterogeneous signal intensity within the bone marrow of the proximal femurs, with sparing of the epiphyses and apophyses, and similar findings within the bones of the pelvis, consistent with red marrow reconversion, which often occurs in the setting of bone marrow stimulating therapies. There is no abnormal T2 signal in these regions. The left hip mass identified on the nuclear medicine PET scan is not identified on this study.

Output: No discrete myelomatous lesions are appreciated. Findings compatible with red marrow reconversion, as described above.


Instruction: Generate impression based on findings.

Input: Diagnosis: Multiple sclerosisClinical question: MS, f/u progressionSigns and Symptoms: cognitive declineComments: 3T DCAM, Dr Javed MS protocol version 1.1, No DTI | The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of periventricular and subcortical white matter T2 and FLAIR signal hyperintense lesions in both hemispheres of the brain. When compared to the 9/20/2013 exam there does not appear to be convincing evidence for progression of these lesions. Additional lesions are present in the internal capsules, pons, medulla, cerebral peduncles and middle cerebellar peduncles which were also present on the prior exam as well and are unchanged. These lesions are also associated with T1 hypointensity.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 right transverse and sigmoid sinuses are larger than the left upper parts.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, internal capsule and subcortical white matter lesions and posterior fossa white matter lesions are present which are compatible with patient's diagnosis of demyelinating disorder. These are unchanged since the 2013 exam.


Instruction: Generate impression based on findings.

Input: MRI BRAIN: The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with marked chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.MRA HEAD: There is a 3.1 mm aneurysm projecting off the A2 segment of the right ACA and is directed towards the left. The distal right vertebral artery is hypoplastic and terminates into the right PICA. There is is otherwise dolichoectasia of the vertebrobasilar system. The left PCOM is small is size. The intracranial internal carotid arteries are normal in course and caliber. The middle, anterior and posterior cerebral arteries are otherwise unremarkable. There is no evidence of flow-limiting stenosis.

Output: 1. periventricular white matter changes are present which are nonspecific and are more than expected at this age. Etiology is uncertain.2. 3 mm right A2 aneurysm projecting towards the left. 3. No evidence for intracranial cerebrovascular stenosis.


Instruction: Generate impression based on findings.

Input: Male 71 years old Reason: hx of bladder cancer s/p radical cystectomy evaluate for metastatic disease. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Again seen are cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy is similar to prior.BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES:Status post bilateral hip arthroplasty with metallic artifact in the lower pelvis.OTHER: No significant abnormality noted.

Output: 1.No evidence of tumor recurrence in the abdomen or pelvis.


Instruction: Generate impression based on findings.

Input: MRI brain: There is no evidence of acute ischemia, edema or mass effect. There are no areas of abnormal signal. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There are mildly prominent bilateral cervical lymph nodes, nonspecific. There is mildly heterogeneous attenuation involving the bilateral parotid glands which can be seen in connective tissue disorders such as Sjogren's disease.MRI spine:There is extensive expansile T2 signal abnormality throughout the cervical spinal cord extending up to T2-T3 level. There are additional areas of hyperintense T2 signal abnormality involving T10 and T7-T8 vertebral levels, which are of indeterminate age but does not clearly appreciated on prior MRI dated 8/26/2015.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine.There is diffuse hypointense signal involving the liver and spleen. Nonspecific mild diffuse low T1 marrow signal which can be seen in conditions such as anemia.

Output: 1. Interval development of extensive T2 signal abnormality throughout the cervical spinal cord, extending up to T2-T3 consistent with inflammatory myelitis related to NMO, for example. Additional small foci of T2 hyperintensity at the T7-T8 and T10 levels may also represent inflammatory/demyelinating plaques, possibly chronic but not seen on prior MRI from 8/26/2015. 2. Unremarkable MRI brain.3. Low T2 signal is noted in the partially imaged liver and spleen which can be seen with iron deposition and can be correlated with clinical findings.4. Mild heterogeneous signal involving the bilateral parotid glands which can be seen in connective tissue disorders such as Sjogren's.


Instruction: Generate impression based on findings.

Input: Ms. Snow is a 46 year old female with a personal history of left breast lumpectomy in 5/2015 for IDC/DCIS treated with radiation. Family history of breast cancer in maternal grandmother and maternal aunt. There is scattered fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.Expected postsurgical changes in the left breast, compatible with recent history of left breast lumpectomy. No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary or internal mammary region.

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


Instruction: Generate impression based on findings.

Input: Evaluate for cervical rib. We see no cervical rib. There is severe multilevel degenerative disc disease from C3-C4 to C7-T1. There is also mild multilevel facet joint osteoarthritis. Loss of the normal cervical lordosis is noted.

Output: Multilevel degenerative disc disease without cervical rib.


Instruction: Generate impression based on findings.

Input: 74 years Female (DOB:8/28/1941)Reason: F/U MRI. H/O lumbar spinal stenosis s/p decompressive surgery in 2012. Please compare to MRI from 2014. History: low back pain, persistent bilateral lower extremity weaknessPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. The patient is status post L3-4 hemilaminectomy. There is a mottled appearance to the lumbar marrow.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and diffuse disc bulge at this level. There is partial effacement of fat at the lateral recess at this level. This is stable compared to the prior exam.At L4-5 there is anterior subluxation of L4 on L5 by 7 mm. There is loss of disc space height this desiccation and diffuse disc bulge at this level associated with moderate bilateral facet hypertrophy and effacement of the fat at the lateral recess bilaterally. Overall there is a moderate degree of spinal stenosis at this level. Although the neural foraminal are narrowed, within the neural foramina the exiting nerve roots are surrounded by fat. This is stable compared to the prior examAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is some loss of disc space height and disc desiccation as well as a disc bulge at this level associated with partial effacement of fat within the neural foramina. There is partial effacement of the fat at the lateral recess bilaterally at this level. Overall there is mild to moderate spinal stenosis at this level. There is a left far lateral disc protrusion present at this level This has been stable since prior exam. There are some endplate reactive changes present this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level. Some minor endplate reactive changes at this level.

Output: There are multilevel degenerative changes present in the lumbar spine which overall appears stable compared to the previous exam. The worst levels at L4-5 where there is some mild subluxation of L4 on L5 associated with a moderate degree of spinal stenosis.


Instruction: Generate impression based on findings.

Input: Evaluate for residual posterior fossa tumor and possible spinal metastases: status post posterior fossa tumor resection. Brain: There are interval postoperative findings related to suboccipital craniotomy for resection of a posterior fossa tumor. There is residual non-enhancing extra-axial tumor in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, and the upper cervical spinal canal, which measures up to approximately 45 mm. There is associated mass effect upon the adjacent right cerebellar hemisphere, brainstem, and upper spinal cord. There is interval insertion of a right transfrontal ventricular catheter with high T2 signal and susceptibility effect surrounding the catheter in the right frontal lobe, as well as globular blood products surrounding the catheter in the right lateral ventricle and layering blood products in the bilateral occipital horns. There are areas of T2 hyperintensity and restricted diffusion in the medial cerebral hemispheres. The third and lateral ventricles are less dilated. 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.Spine: Aside from the mass effect upon the right and posterior upper cervical spinal cord by the inferior extension of the posterior fossa tumor, the rest of the spinal cord appears intact, without discernible abnormal signal. There is no evidence of drop metastases within the spinal canal. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant posterior disc herniation.

Output: 1. Interval partial resection of a tumor arising from the fourth ventricle with residual tumor in the right inferior fourth ventricle, cerebellopontine angle, right premedullary cistern, and the upper cervical spinal canal, measuring up to approximately 45 mm, and areas of acute ischemia along the medial cerebellar hemispheres bilaterally.2. Interval right transfrontal ventricular catheter insertion with decrease in size of the triventricular system, but complicated by mild right frontal lobe edema and scattered areas of intraventricular hemorrhage.3. No evidence of drop metastases within the spinal canal.


Instruction: Generate impression based on findings.

Input: Reason: Breast CA, new lesion right side of T12 suspicious for a metastasis. Please obtain core biopsies to document tumor. History: Pain at site of left rib fractures. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. No hematoma formation identified on post procedural images

Output: T12 vertebral bone biopsy under CT guidance. A total of seven samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Reason: bilateral arm numbness and tingling numbness to digits 2 3 4 on the left hand History: see above The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk dessication. There is a sclerotic focus at C5 located posteroinferiorly.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is loss of disk space height, disk bulge as well as endplate and uncovertebral osteophytes this level associated with narrowing of the neural foramina and encroachment of the exiting nerve root bilaterally. There is partial effacement of the spinal fluid ventral and posterior to the spinal cord at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge at this level. There are endplate and uncovertebral osteophytes this level associated with narrowing of the neural foramina and encroachment of the exiting nerve roots left worse than right.At 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 are degenerative changes in the cervical spine worse at C5-6 where there is neural foraminal narrowing and encroachment of exiting nerve roots and a mild degree of spinal stenosis.


Instruction: Generate impression based on findings.

Input: 19 year old man with history of frequent palpitations and mildly reduced LV function on transthoracic echocardiogram, referred for cardiac MRI. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 56%, the LV end diastolic volume index is 96 ml/m2 (normal range: 74+/-15), the LVEDV is 186 ml (normal range 142+/-34), the LV end systolic volume index is 42 ml/m2 (normal range 25+/-9), the LVESV is 82 ml (normal range 47+/-19), the LV mass index is 51 g/m2 (normal range 85+/-15), and the LV mass is 99 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.The native T1 myocardial relaxation time is 944ms which is normal.There is no myocardial iron overload. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 104 ml/m2 (normal range 82+/-16), the RVEDV is 203 ml (normal range 142+/-31), the RV end systolic volume index is 50 ml/m2 (normal range 31+/-9), and the RVESV is 98 ml (normal range 54+/-17). There are no regional RV wall motion abnormalities noted.Right AtriumThe right atrium is normal in size.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is mild pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Coronary Arteries:The left main coronary artery arises normally and gives rise to the left anterior descending and left circumflex arteries. The right coronary artery arises normally.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size with normal systolic function (EF 56%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size with normal systolic function (EF 52%). There are no regional wall motion abnormalities in the right ventricle without MRI evidence of arrhythmogenic right ventricular dysplasia.3. Normal origins of the coronary arteries. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache for past 3 months behind the right eye, on OCP. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is a 5 mm wide cyst within the pineal gland. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a prominent left posterior condylar vein that may slightly indent the left lateral cerebellar hemisphere. The major cerebral flow voids are otherwise intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1. No evidence of intracranial hemorrhage, mass, or acute infarct. 2. A prominent left posterior condylar vein likely represents an anatomic variant, but can be a manifestation of raised intracranial pressure, although there are no other findings to suggest intracranial hypertension or venous sinus thrombosis.


Instruction: Generate impression based on findings.

Input: 43 year old female with history of low back pain and spasms. There is mild straightening of the lumbar spine. Alignment is otherwise unremarkable. Vertebral body heights are maintained.There is continued progression of L4 superior endplate degenerative changes with enlargement of the known Schmorl's node. Additionally, there is evolution of endplate marrow signal now demonstrating fat characteristics at L4-5. The remaining bone marrow signal is unremarkable.The spinal cord, conus and cauda equina are unremarkable with the spinal cord terminating at the mid L1 level.T12-L1: No significant disk abnormality. No spinal canal stenosis or neural foraminal narrowing.L1-2: There is mild diffuse disk bulge with a left paracentral/subarticular disk extrusion causing mild effacement of the left lateral recess which deflects the adjacent nerve roots. There is mild neural foraminal narrowing. No significant spinal canal stenosis.L2-3: There is mild diffuse disk bulge with a tiny right paracentral protrusion. No significant spinal canal stenosis or neuroforaminal narrowing. There is a new tiny central annular fissure.L3-4: There is mild diffuse disk bulge with a superimposed protrusion which effaces the inferior aspect of the spinal canal. There is moderate narrowing of the right neuroforamina. The left neural foramen is unremarkable. No significant spinal canal stenosis.L4-5: There is moderate diffuse disk bulge with slight effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild lateral foraminal narrowing.L5-S1: There is mild diffuse disk bulge, asymmetric on the left. No significant spinal canal stenosis. Mild left neuroforaminal narrowing with mild suspected impingement of the exiting L5 nerve root.

Output: Mild progression of degenerative disease as above.


Instruction: Generate impression based on findings.

Input: Reason: Assess R shoulder structures; patient with pain and instability History: Pain and instability R shoulder ROTATOR CUFF: Intermediate signal intensity in the supraspinatus tendon is suggestive of supraspinatus tendinopathy. There is undersurface fraying and thickening involving the subscapularis and supraspinatus tendons. The infraspinatus muscle and tendon appear unremarkable. The remaining musculature is within normal limits.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenoid labrum appears intact. Bone marrow signal is unremarkable.BICEPS TENDON: Contrast opacifies the biceps tendon sheath, and extends inferiorly, out of field-of-view, likely iatrogenic. ADDITIONAL

Output: 1.Mild/moderate tendinosis and mild undersurface fraying and thickening of the supraspinatus and subscapularis tendons.2.Unremarkable appearance of the glenoid labrum.


Instruction: Generate impression based on findings.

Input: 84 years Male (DOB:6/10/1932)Reason: Degenerative disk disease lumbar spine History: Lower back painPROVIDER/ATTENDING NAME: TARIQ MUSLIM MALIK TARIQ MUSLIM MALIK Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is a disc bulge and disc desiccation at this level associated bilateral facet and ligamentum flavum hypertrophy. There is effacement of the fat at the lateral recess bilaterally but more on the right than the left. There is narrowing of the neural foramina with partial effacement of the fat surrounding the exiting nerve roots.At L4-5 there is some loss of disc space height, disc bulge and moderate to marked bilateral facet ligamentum flavum hypertrophy. There is mild anterior subluxation of L4 on L5. There is effacement of the fat at the lateral recess bilaterally. There is narrowing the spinal canal and crowding of the nerve roots within the thecal sac at this level. Overall there is a moderate to marked degree of spinal stenosis at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is a 46 mm cystic lesion present off the inferior pole of the right kidney. There is a 32 mm cystic lesion along the superior aspect of the right kidney. Both of these cystic lesions are only partially imaged on this exam.

Output: 1.There are degenerative changes present in the lower lumbar spine.2.There is a moderate to severe degree of spinal stenosis present at L4-5 related to disc disease and facet disease as well as a small degree of subluxation.3.There is encroachment of the nerve roots at the lateral recess bilaterally at L5-S1 but worse on the right side compared to the left. There is mild to moderate spinal stenosis at L5-S1.4.There are large cystic lesion along the right kidney. These are not completely imaged on this exam. Please refer to abdomen CT exam from 9/2/2015 for further comments


Instruction: Generate impression based on findings.

Input: Patient with multiple vertebral lesions. History of MEN II with carcinoid. Please perform bone biopsy. Serial CT images obtained during the biopsy procedure demonstrate the needle placement within the vertebral lesion. Following needle removal images obtained that demonstrate no complications .

Output: T5 vertebral bosdy and right pedicle bone biopsy under CT guidance. A total of six samples were delivered to pathology for analysis.


Instruction: Generate impression based on findings.

Input: Reason: low back pain and bilateral lower extremity radicular sx, evaluate for spinal stenosis Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. There is multilevel disk desiccation . There is epidural lipomatosis in the sacral spinal canal which is stable compared to prior exam.There is focal fatty replacement present in the sacral alae bilaterally.At L5-S1 there is a disk bulge present associated with bilateral facet hypertrophy. There is narrowing of the neural foramina bilaterally with some mild encroachment exiting nerve roots at this level . Compared to the previous exam is no significant interval change.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate bilateral facet hypertrophy present at this levelAt L3-4 there is no significant compromise to spinal canal or neural foramina. There is moderate facet and ligamentum flavum hypertrophy present at this levelAt L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of cystic lesions in the left kidney which are present on the prior exam and have not changed substantially. Most likely they represent cysts.

Output: 1.There are degenerative changes present in the lower lumbar spine mainly in the form of facet hypertrophy associated with encroachment of the exiting nerve roots at L5-S1. These findings are stable compared to the previous 2010 exam.


Instruction: Generate impression based on findings.

Input: Clinical question: New ischemia. Signs and symptoms: 78-year-old female with right arm weakness and numbness. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate several tiny bilateral cerebellar chronic nonhemorrhagic ischemic strokes in this distribution of bilateral PICA branches as well as bilateral superior cerebellar arteries. Unremarkable pons and medulla. There is no significant change in the extent of this finding since prior exam from October 2014.Images through the supratentorial space demonstrate extensive varying size patchy foci of FLAIR and T2 hyperintensity in bilateral cerebral hemispheres and bilateral basal ganglia consistent with chronic nonhemorrhagic small vessel ischemic strokes. Additionally a small focus of chronic minimally hemorrhagic cortical stroke in the right anterior frontal lobe is present. There is also no significant interval change in the extent of supratentorial chronic ischemic strokes since prior study. Mild prominence of bilateral cerebral cortical sulci and mildly prominent supratentorial ventricular system remain similar to prior exam.The signal void of major intracranial arterial branches are present and identified. Images through the orbits are unremarkable and all paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal patterns. Unremarkable calvarium and soft tissues of the scalp.Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes with resultant mild right neural foraminal compromise.C3-C4 demonstrate mild left-sided uncovertebral hypertrophy with resultant mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate moderate disc disease and loss of disc height, moderate asymmetric left facet hypertrophy and mild ligamentum flavum and right facet degenerative changes. Constellation of findings result in moderate right and severe left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate advanced disc disease and loss of disc height, moderate asymmetric left facet hypertrophy, mild bilateral ligamentum flavum and right facet degenerative/hypertrophic changes. Constellation of findings results in mild central spinal stenosis, significant right and moderate left neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, larger ventral (right greater than left) disc osteophyte complex and mild bilateral facet and ligamentum flavum hypertrophy is noted. Constellation of findings results in mild central spinal stenosis and significant bilateral (right > left) neural foraminal compromise.C7-T1 demonstrate mild degenerative disc disease and moderate bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is resultant significant bilateral neural foraminal compromiseThe alignment of vertebral condyle remains anatomic. The signal intensity and caliber of cervical and upper most visualized thoracic cord is unremarkable.

Output: 1.Nonenhanced brain MRI demonstrate no acute intracranial process and no restricted diffusion. Extensive chronic bilateral cerebellar strokes as well as supratentorial chronic small vessel ischemic strokes and a right frontal cortical stroke remains nearly identical to prior study from October of 2014.2.Examination of cervical spine demonstrate extensive degenerative changes primarily at C4-C5 through C6-C7 levels with resultant mild central spinal stenosis at all of these levels. Additionally there are multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.


Instruction: Generate impression based on findings.

Input: Brain MRI:No evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. There is right PCA territorial encephalomalacia indicating prior ischemic infarction and appears similar to the recent prior CT but increased compared to the MRI from 2009 at which time infarct was acute. Evidence of Wallerian degeneration along the right corticospinal tract. Additional periventricular and subcortical T2/Flair hyperintensities are nonspecific but compatible with small vessel ischemic changes.There is ex-vacuo dilatation of the temporal horn of the right lateral ventricle. No hydrocephalus. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. A right lens prosthesis is noted.Brain MRA: The V3 segment of the right vertebral artery is moderately narrow with opacification more distally intracranially and better seen on the postgadolinium sequence. There is a left dominant vertebral artery. The right PICA is not clearly seen. The AICA arteries are patent. There is some irregularity involving the right superior cerebellar artery.At least moderate stenosis suspected in the right PCA involving right P2 and distally. The PCA appears diminutive within the right ambient cistern and is not visualized beyond the quadrigeminal cistern. The posterior communicating arteries are not visualized bilaterally.Mild atherosclerotic narrowing is noted of the left paraclinoid ICA. The remaining anterior circulation is patent without significant steno-occlusive disease.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch. There are is irregularity and narrowing involving the right V1 segment at the origin and just beyond the origin. There is a 5 mm enhancing structure at the right carotid bifurcation and is unclear if this represents a small aneurysm or an extravascular mass. 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.

Output: 1.No evidence of acute infarct. Chronic right PCA territory infarct.2.High grade right PCA stenosis similar to 2/22/2009 CTA. 3.The V3 segment of the right vertebral artery is moderately narrow with opacification more distally intracranially and better seen on the postgadolinium sequence. Irregularity and narrowing involving the right V1 segment at the origin and just beyond the origin.4.7 mm enhancing structure at the right carotid bifurcation. Prior CTA neck demonstrates a 3 mm enhancing lesion in this location. Finding likely represents a normal carotid body and less likely carotid body paraganglioma (6 mm considered 2 standard deviations above normal by CTA, Nguyen RP et al. AJNR 2011 32: 1096-1099).


Instruction: Generate impression based on findings.

Input: Reason: r/o worsening of syringomyelia History: L sided insensate to sharp. Limited exam of the complete spine. Cord compression protocol images obtained.Cervical:Patient is status post Chiari decompression, with postoperative changes including removal of the posterior arch of C1 and expansion of the adjacent thecal sac. This appears unchanged compared to prior exam. The intracranial stent is again visualized, traversing the fourth ventricle with its tip terminating likely within the superior fourth ventricle, unchanged in position. Images through supratentorial space demonstrate normal size of the supratentorial ventricular system and with maintained midline similar to prior exam. There is no evidence of spinal cord compression. There is diffuse increased T2 signal intensity of the dorsal aspect of the cervico-medullary junction, with more discrete central canal prominence extending inferiorly through the entire cervical and thoracic spinal cord. Full evaluation of the extent and size of this syringohydromyelia is limited by cord compression technique. There is unchanged tenting of the cervical medullary junction of the cord posteriorly, likely representing spinal cord tethering at this site.

Output: 1. No evidence of spinal cord compression.2. Status-post Chiari decompression, with stable postoperative changes as described above.3. Syringohydromyelia is redemonstrated throughout the cervical and thoracic spinal cord, however is incompletely evaluated by this limited study. If there is persistent clinical concern, a dedicated complete spine MRI should be obtained to further evaluate the spinal cord.


Instruction: Generate impression based on findings.

Input: 62 year-old female with left cerebellar peduncle hemorrhage, follow-up.IMAGE ACQUISITION: Nonenhanced CT of the head Again identified is a hyperattenuating focus in the left posterior pons, which appears to not have significantly changed in size. However, there is subtle increased associated vasogenic edema, as evidenced per recent MRI.No hydrocephalus or midline shift.Postsurgical changes with left temporal occipital encephalomalacia, unchanged. Mild hypoattenuation in periventricular and subcortical white matter, most consistent with small vessel ischemic disease.Visualized paranasal sinuses and mastoid air cells are clear.

Output: Stable size of left posterior pontine hemorrhagic lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left shoulder pain, evaluate for labral tear. ROTATOR CUFF: There is mildly increased T2 weighted signal within the anterior fibers of the supraspinatus tendon suggesting mild tendinosis. No discrete tears are identified. The supraspinatus muscle is intact. The remaining muscles and tendons of the rotator cuff are unremarkable.SUPRASPINATUS OUTLET: The acromioclavicular joint is within normal limits. No significant fluid is present within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Nonspecific cystic changes are present within the posterior humeral head. Bone marrow signal is otherwise within normal limits without fractures. Glenohumeral joint alignment is within normal limits. The articular cartilage of the glenohumeral joint is grossly intact. Linear, increased T2 signal underlying the anterior superior labrum is compatible with a sublabral foramen, a normal variant. No labral tears are identified.BICEPS TENDON: Mildly increased T2 weighted signal within the tendon of the long head of the biceps suggests mild tendinosis. No discrete tears are identified.ADDITIONAL

Output: Mild supraspinatus and biceps tendinosis without rotator cuff or labral tears.


Instruction: Generate impression based on findings.

Input: Diagnosis: Cerebral infarction, unspecifiedClinical question: assess for stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are punctate foci of signal hyperintensity present in the pons. Additionally there is a hypointense focus on susceptibility imaging located at the expected location of the right thalamus and adjacent internal capsule and centrum semiovale.The right cerebral peduncle is asymmetrically smaller than the left cerebral peduncle.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the right frontal sinus and some mucosal thickening in the left maxillary sinus.. 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 posterior communicating arteries are barely visible. The left vertebral artery is larger than the right vertebral artery.MRA neck:The MRA of the neck is degraded by patient motion which occurred during the dynamic phase of the exam and is a result and noncontrast MRA of the neck could no longer be performed. To the extent of visualization possible on the basis of NASCET criteria significant stenosis at the carotid bifurcations is not suspected.The origins of the great vessels from the aortic arch and the origins of the vertebral arteries are not adequately assessed on this exam due to motion artifact.

Output: 1.The MR angiogram of the neck is degraded significantly by patient motion as detailed above. Although there is no convincing evidence for stenosis at the carotid bifurcations a subtle abnormality could be overlooked. In addition the origins of the great vessels from the aortic arch and the vertebral arteries are not adequately evaluated.2.There is no evidence for acute cerebral ischemic infarction.3.No evidence for intracranial cerebrovascular occlusive disease.4.Findings suggest a prior hemorrhage involving the right thalamus and adjacent centrum semiovale with associated adjacent encephalomalacia and Wallerian degeneration.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.Microhemorrhages in the pons are suggestive of hypertensive etiology based on location7.A small lesion in the left thalamus is suspected to be related to prior lacunar infarct8.Signal changes in the brainstem are likely vascular related.


Instruction: Generate impression based on findings.

Input: 20-year-old male with history of pre-ALL which is in remission. Now with headache and possible seizure-like activity. Assess for structural masses or abnormalities. There are multiple foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but may represent treatment-related changes. Brain parenchyma is otherwise unremarkable for age. Hippocampus and visualized cortical structures demonstrate no focal lesions to suggest possible seizure focus. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.T1 hyperintense focus involving the left parietal calvarium may represent focal fat or hemangioma. There is mild mucosal thickening involving the maxillary sinuses. Calvarium and extracranial soft tissues are otherwise unremarkable.

Output: 1. No evidence of intracranial mass or findings to suggest leukemic involvement in the brain.2. Several nonspecific foci of T2/FLAIR hyperintensity in the supratentorial white matter which are nonspecific but may represent sequela of prior treatment.


Instruction: Generate impression based on findings.

Input: 65-year-old male. Lower extremity pain, swelling, status post trauma. Evaluate for soft tissue disease. No fracture is evident. Mild edema of the mid gastrocnemius muscle involving the medial and lateral heads. No hematoma or muscle rupture. Diffuse reticular subcutaneous edema of the right lower leg. There is also subcutaneous edema in the left lower leg seen on the coronal views to a lesser degree.Severe osteoarthritis of the bilateral knees with bone on bone apposition.

Output: Mild edema of the medial and lateral heads of the mid gastrocnemius without evidence of muscle rupture or hematoma. Diffuse subcutaneous edema of the right lower leg. No fracture.


Instruction: Generate impression based on findings.

Input: Female 26 years old Reason: eval for cervical instability History: cervical and clival abscess. The cervical vertebrae appear slightly demineralized, but we see no focal osteolysis of the spine to suggest osteomyelitis. There are grade 1 retrolistheses of C2, C3, and C4 on extension measuring 2 mm or less. Skull base abnormalities are better seen on CT and MRI studies; although we see destruction of the posterior clinoid process as well as gas density in the soft tissues immediately superior to the anterior arch of C1.

Output: Mild retrolistheses on extension as described above. Destruction of the posterior clinoid process and gas density within the soft tissues superior to the anterior arch of C1 presumably reflect known skull base infection.


Instruction: Generate impression based on findings.

Input: Female, 63 years old, with radicular symptoms in the C7-C8 distribution of the left upper extremity. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: Mild left facet hypertrophy. No significant spinal canal or foraminal stenosis. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild bilateral foraminal narrowing.C4-5: Bilateral facet arthropathy. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. Moderate to severe bilateral foraminal narrowing. C5-6: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. Mild bilateral foraminal narrowing. C6-7: Bilateral facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No significant foraminal narrowing. C7-T1: Mild bilateral facet arthropathy. No significant spinal canal stenosis. No significant foraminal narrowing

Output: Multilevel degenerative findings are seen which contribute to a mild spinal canal stenosis at C4-5, as well as scattered foraminal narrowing most severely affecting the C4-5 level.


Instruction: Generate impression based on findings.

Input: Reason: Intracranial metastases and history of CVA with new neuro deficits, please evaluate History: As above. There are multifocal infratentorial and supratentorial areas of diffusion restriction involving the bilateral cerebellum, bilateral occipital lobes, bilateral medial frontal and parietal lobes as well as the head of the left caudate consistent with acute infarcts. These lesions are associated with increased T2 signal without susceptibility. A lesion in the left occipital lobe which exhibits gyriform diffusion restriction also demonstrates mild scattered enhancement, most likely representing infarction. There are 2 additional small curvilinear foci of enhancement within the right temporal lobe posterior to the right temporal horn which are associated with diffusion restriction. There is no definite enhancing lesions to suggest intracranial metastases. There are scattered additional areas of increased T2 signal without associated diffusion restriction which likely represent old infarcts. There is encephalomalacia in left cerebellum and right caudate.There is no evidence of intracranial hemorrhage. 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.Multiple intratentorial and supratentorial areas of diffusion restriction likely consistent with acute infarcts. Distribution suggests an embolic etiology.2.Curvilinear regions of enhancement in the left occipital lobe and right temporal lobe are associated with diffusion restriction and likely represent subacute infarcts, however underlying adjacent leptomeningeal metastatic deposits cannot be entirely excluded. Follow-up of these regions may be considered.


Instruction: Generate impression based on findings.

Input: 11 years, Female, right lateral ventricle mass. Again seen is a T2 hypointense and enhancing lobulated mass involving the atrium of the right lateral ventricle in the region of the choroid plexus. The mass measures approximately 15 x 20 mm (coronal T2, image 20) in the transverse and craniocaudal dimensions which is unchanged when measured in the same plane as prior. Ventricles remain unchanged in size and are not dilated.There is no evidence of acute infarct or acute hemorrhage. No evidence of intraparenchymal mass or intracranial mass effect. No midline shift or herniation. Major flow-voids are preserved. Calvarium and extracranial soft tissues are unremarkable.

Output: Unchanged right lateral ventricular mass which may represent a choroid plexus papilloma. Ventricles remain normal in size.


Instruction: Generate impression based on findings.

Input: There is a right sided lung lesion present adjacent to the paravertebral space at the level of the carina. MRI of the brainThere a several punctate foci of diffusion restriction along the left superior and middle frontal gyri.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This has progressed along the areas of diffusion restriction.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The current exam was performed on a 1.5T magnet whereas the prior was performed on a 3T magnet. The distal internal carotid arteries and the proximal MCA are ACA arteries are less visualized on the current exam than on the prior. On the current exam the supraclinoid ICAs and ACA A1s appear smaller whereas the proximal MCA m1 segments are not readily visualized.There is prominent lenticulostriate vasculature presnt in the basal ganglia.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are identified. The vertebral arteries are similar in size.

Output: 1.Moya moya proximal intracranial anterior circulation vasculature narrowing appears to have progressed on this exam, however, this appearance may exaggerated by the use of lower field strength on the current exam.2.Several punctate foci of acute/subacute infarction are present in the left frontal lobe.3.Periventricular and subcortical white matter signal changes of a mild degree are present which are likely vascular related. This has mildly progressed along the left frontal lobe compared to the prior exam along the areas of punctate infarctions.4.No significant intracranial hemorrhage is appreciated.


Instruction: Generate impression based on findings.

Input: 20 year old woman with history of near syncope and precordial T-wave inversions on ECG who presents for cardiac MRI to evaluate for possible ARVC. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 78 ml/m2 (normal range: 65+/-11), the LVEDV is 152 ml (normal range 109+/-23), the LV end systolic volume index is 32 ml/m2 (normal range 18+/-5), the LVESV is 62 ml (normal range 31+/-10), the LV mass index is 31 g/m2 (normal range 67+/-11), and the LV mass is 61 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 61%, the RV end diastolic volume index is 77 ml/m2 (normal range 69+/-14), the RVEDV is 149 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 59 ml (normal range 35+/-13). There are no regional wall abnormalities. Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation. Coronary Arteries:The ostium of the left main coronary arises normally from the left cusp. The ostium of the right coronary artery arises normally from the right cusp. Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is trivial tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal size left ventricle with normal systolic function (LVEF 59%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal size right ventricle with normal systolic function (RVEF 61%). No regional wall motion abnormalities. No MRI evidence of arrhythmogenic right ventricular cardiomyopathy. 3. Normal origin of the coronary arteries.4. No evidence of structural heart disease. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left ear pain, swelling, and drainage. Previous abnormal CT: otorrhea and otalgia. There is a fluid collection in the inferior external auditory canal and auricle that measures up to 28 mm, with extensive enhancement of the surrounding subcutaneous tissues and posterior aspect of the left glenoid fossa and parotid gland. The left inner ear structures and mastoid air cells are intact. The right temporal bone region is unremarkable. There are inflammatory mucosal changes in the left maxillary and ethmoid sinuses. The imaged intracranial structures and orbits are unremarkable.

Output: 1. Left inferior external auditory canal and auricle abscess, with extension of the inflammatory process to the left glenoid fossa and parotid gland. 2. Findings suggestive of sinusitis.