Instruction: Generate impression based on findings.

Input: 81 years Male (DOB:2/28/1935)Reason: reversible dementia, posterior circulation, imbalance causes History: memory loss, imbalancePROVIDER/ATTENDING NAME: MEGAN J HUISINGH-SCHEETZ MEGAN J HUISINGH-SCHEETZ MRI of the brainThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are patchy lesions within the thalami and brainstem which are also high signal on T2 and FLAIR MRI. A couple punctate lesions are present in the cerebellar hemispheres.A small focus of susceptibility effect is present along the dentate nucleus of the right cerebellar hemisphere.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is a fenestration of the proximal left A2 segment. The posterior communicating arteries are identified and are small.. The right vertebral artery is larger than the left vertebral artery. There is extracranial origin the left posterior inferior cerebellar.

Output: 1.Periventricular and subcortical white matter lesions as well as lesions in the brainstem and cerebellum of a mild degree are nonspecific. At this age they are most likely vascular related. 2.Findings are compatible with old lacunar infarcts in the thalami bilaterally.3.There is no evidence for acute ischemic cerebral infarction.4.There is no evidence for intracranial cerebrovascular occlusion or stenosis. There is no evidence for intracranial aneurysm on the basis of this exam.


Instruction: Generate impression based on findings.

Input: The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left hip was localized fluoroscopically, and a spot radiograph was obtained. The course of the femoral artery was noted on the patient's skin using an ink marker. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 15 ml of a 50/50 mixture of Omnipaque 240 (to confirm the intra-articular position of the needle) and dilute Multihance (0.1 cc in a 10 cc vial of saline, for subsequent MR imaging) were injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the MRI suite for further imaging in stable condition. Please refer to the subsequent MRI report for further information.Exposure time: 63 seconds

Output: Successful fluoroscopic-guided injection of the left hip.


Instruction: Generate impression based on findings.

Input: Fall status post head trauma. Patchy hypodensity within the periventricular and subcortical white matter represent small vessel disease of indeterminate age. There is hypodensity of the right thalamus, possibly representing subacute ischemia.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. The calvaria and skull base are radiographically normal. The paranasal sinuses and mastoid air cells are normally aerated.

Output: Small vessel ischemic disease of indeterminate age. Possible acute/subacute ischemia of the right thalamus. MRI can be obtained for further evaluation if clinically indicated.


Instruction: Generate impression based on findings.

Input: 72 year old male patient with CNS lymphoma status post therapy. Patient is in CR, restaging examination. There is redemonstration of post-treatment changes in the left frontal lobe with regions of encephalomalacia and mild expansion of left frontal horn similar to the prior exam. Mild signal changes of right anterior frontal lobe is also noted which remains stable. On the post enhanced images, there is no detectable abnormal enhancement to suggest residual or recurrence of tumor. There are no diffusion-weighted abnormalities to suggest acute ischemia. Multiple small patchy foci of flair hyperintensity in the periventricular and subcortical white matter of the bilateral cerebral hemispheres and pons are redemonstrated and likely represent chronic small vessel ischemic disease. There is a tiny 6 mm focus of enhancement within the anterior falx cerebri, which remains unchanged from prior studies, and exerts no surrounding mass effect. There is no midline shift or herniation. The ventricular system is stable in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Post-treatment changes in the bilateral frontal lobes without evidence of tumor recurrence.2. Subcentimeter focus of enhancement along the anterior falx cerebri remains unchanged and likely represents a tiny meningioma and remains unchanged. No evidence of intracranial mass effect.


Instruction: Generate impression based on findings.

Input: 22-year-old male with left buttock abscess. Evaluate for fistulous tracts. Large condylomata are present at the anal verge that are inflamed and indurated on physical examination. 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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Several enlarged lymph nodes, a left inguinal node on image 146/191 measures 1.5 x 1.5 cm, and a left obturator node measures 0.9 x 2.4 cm. These are unchanged since 8/2/08.BOWEL, MESENTERY: There is a mixed attenuation mass in the perianal region with a focus of rim enhancement surrounding fluid attenuation, compatible with an abscess. This lesion most likely contains a solid component and fluid that may be multiloculated. The lesion has increased in size since the 8/2/08 examination. The lesion in the left medial buttock measures 3 x 7.3 cm and axial image 156/171. This lesion extends craniocaudally approximately 8 cm on coronal image 26/103.No evidence of a fistula, however, MRI may be better to further determine presence of fistula/abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the dependent pelvis.

Output: Increased size of left buttock mixed attenuation mass which most likely represents an abscess with associated inflammatory changes. No evidence of fistulas, however, MRI may be better to further determine disease.


Instruction: Generate impression based on findings.

Input: 56 year old with history of intraductal and invasive ductal carcinoma of the left breast status post left mastectomy with chemotherapy, radiation, and hormonal therapy. There is heterogeneous amount of fibroglandular tissue in the right breast.Mild parenchymal enhancement is noted in the right breast.Status post left mastectomy.No abnormal enhancement is seen in the right breast or the left mastectomy bed. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: 38 years Female (DOB:2/13/1978)Reason: new leukemia, HA, eval for hemorrhage or small strokes (no neuro deficits) History: see abovePROVIDER/ATTENDING NAME: CARA ANN ROSENBAUM SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 5 x 3 mm axial dimension enhancing focus present in the left occipital lobeA couple punctate foci of diffusion restriction are present in the right and left occipital lobes.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the left sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.There is small enhancing lesion present in the left occipital lobe and the possibility this represents leukemic involvement given the patient's clinical history cannot be excluded. Another strong possibility is that this represents a subacute focus of cerebral infarction. 2.A couple punctate foci of diffusion restriction are present in the occipital lobes. It is quite possible this represents microinfarcts in the appropriate clinical setting.3.Opacities within the left sphenoid sinus are nonspecific but could represent acute sinusitis.


Instruction: Generate impression based on findings.

Input: A patient submitted outside study for review. Submitted for review are digital mammographic images (4/21/15, 10/14/15), ultrasound images of right breast (10/14/15), images from ultrasound guided biopsy of right breast and postprocedural right mammographic images (10/21/2015) performed at Advocate Lutheran General Hospital. For comparison, digital mammographic images (5/27/14, 12/6/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (4/21/15, 10/14/15):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B), unchanged in pattern and distribution. Multiple surgical clips are present at 12:00 position in the right breast, at the site of prior surgery. There is a developing mass at the site of prior surgery in the right breast, measuring 35 x 30 mm on CC view of 10/14/2015. No abnormal findings are seen in the right retroareolar region, where breast MRI (11/2/15) demonstrated an enhancing mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF RIGHT BREAST (10/14/15):An irregularly shaped hypoechoic mass is visualized at 12:00 position in the right breast, measuring 21 x 18 x 23 mm, corresponding to the mass seen on the mammogram. No abnormal lymph nodes are visualized in 4 images of right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POSTPROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (10/21/2015):Ultrasound guided needle biopsy was performed for the mass in the right breast with an appropriate needle placement. A marker clip (coil shaped) is present within the mass at anterior aspect.Per outside radiology report, the result was malignant; invasive ductal carcinoma.

Output: Biopsy proven carcinoma in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Clinical question: Per Neurology, concern about facial nerveSigns and Symptoms: right sided facial droop, right sided eye weakness BRAINThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional foci of T2 and FLAIR signal hyperintensity are present in the brainstem and internal capsulesNo abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left vertebral artery is larger than the right vertebral artery and invades into the left cervical medullary junction.There is hypertrophy of the cruciate ligaments are present associated with narrowing of the cervical medullary junction and effacement of spinal fluid ventral and posterior to the cervical medullary junction.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Incidental note is made of hyperostosis frontalis interna.IACNo abnormal foci of enhancement are appreciated within the internal auditory canals. The cochlea and semicircular canals appear intact. The cochlear nerve can be followed bilaterally tracking into the cochlea. The modiolus is well formed bilaterally.Enhancement of the right facial nerve is slightly more conspicuous than enhancement of the left facial nerve. This could be considered a variation of normal.No abnormal enhancing lesions are appreciated at the cerebellopontine angle cisterns nor the internal auditory canals.

Output: 1.No evidence for acute ischemic cerebral infarction. 2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No mass lesion associated with the facial nerve is appreciated. Some minor asymmetry in the enhancement pattern of the right facial nerve relative to the left is nonspecific. This could imply inflammation but it could be variation of normal as well.


Instruction: Generate impression based on findings.

Input: Clinical question: rule-out acute bleed or mass. Signs and symptoms : history of metastatic cancer.? Microhemorrhage on previous MRI. Now with headaches. Nonenhanced head CT:A punctate focus of high density in the left cerebellum measuring 2.5-mm is noted on axial image 10. This finding was not detected on prior head CT from 3 -- 31 -- 11 and could represent minimal hemorrhage.A single focus of subcortical low attenuation measuring approximately 5 mm in transaxial dimension in the subcortical white matter of right frontal lobe is similar to prior exam and is a nonspecific finding. Possibility of an old small vessel stroke should be considered. This finding was present on prior MRI examination from 6 -- 5 -- 11 as well.There is no evidence of any additional foci of abnormality. The cortical sulci, ventricular system and all CSF cisterns remain within normal.

Output: 1.Small punctate focus of high density in the left cerebellum may represent minimal bleed.2.Possible minimal small vessel disease.


Instruction: Generate impression based on findings.

Input: Progressive bilateral severe sensorineural hearing loss. The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. There is a small amount of fluid within the bilateral mastoid air cells.

Output: No evidence of retrocochlear or inner ear lesions.


Instruction: Generate impression based on findings.

Input: Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy in 01/2014 for a fibroadenoma. She then had an MR guided biopsy along with terminal duct excision in 07/2014 for a papilloma. Two standard digital views of both breasts with 2 cleavage views were performed and reviewed with the aid of R2 CAD. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign calcifications are noted bilaterally. Biopsy clip with stable mass in the left upper outer breast again seen. Stable MRI guided biopsy clip in the left central breast. Pacemaker obscures the left axillary region. Mild postsurgical change in the left retroareolar region.

Output: No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Right facial droop, right upper extremity and lower extremity weakness There are 2 restricted diffusion areas. The larger one is on the right periventricular white matter extended to the left basal ganglia. There is another small focal restricted diffusion on the right side basal ganglia and external capsule junction area. Both lesions are compatible with acute ischemic infarct. There is no evidence of hemorrhage transformation.On FLAIR images, bilateral patch high signal intensities on periventricular white matter indicate moderate to severe degree nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: Left periventricular white matter acute ischemic infarct and the right basal ganglia focal acute ischemic infarction without hemorrhage transformation as described above.Moderate to severe degree non specific small vessel disease.


Instruction: Generate impression based on findings.

Input: BRAIN: There are multiple patchy foci of T2 hyperintensity within the supratentorial subcortical white matter bilaterally. There is involvement of the right greater than left anterior temporal lobe, with smaller foci more posteriorly in the left temporal lobe. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are unremarkable. There is a right maxillary sinus retention cyst.CERVICAL SPINE: The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The imaged spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1.Multiple prominent patchy areas of bilateral signal abnormality within the subcortical white matter are nonspecific with the differential including gliosis, demyelinating disease, infectious/inflammatory etiologies such as encephalitis or vasculitis, CADASIL, or less likely metabolic disease, among other etiologies and follow-up imaging is suggested, possibly with contrast. MR spectroscopy could also be considered.2.Normal cervical spine MRI.


Instruction: Generate impression based on findings.

Input: 47-year-old man with history of Crohn's with diarrhea and weight loss. ABDOMEN:LIVER, BILIARY TRACT: The liver and gallbladder appear normal. There is no intra or extrahepatic biliary duct dilatation.SPLEEN: Spleen is unremarkable.PANCREAS: No significant abnormality noted. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter cyst in the left renal midpole. Kidneys are otherwise unremarkable.RETROPERITONEUM, LYMPH NODES: Multiple mildly enlarged lymph nodes are seen within the mesentery. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: There are multiple areas of short segment circumferential thickening of the small bowel wall with luminal narrowing and proximal dilatation. The most significant and proximal strictured area measures approximately 3.7 cm in length in the distal jejunum/proximal ileum within the left hemiabdomen (301/13). The jejunum proximal to this affected small bowel is dilated up to 4.4 cm (301/12). Multiple additional areas of small bowel wall thickening and luminal narrowing are seen distally with skipped short segments of relatively normal-appearing small bowel. The terminal ileal wall is also thickened over a length of approximately 3.6 cm, however is seen to open on the later portions of the imaging study. These areas of small bowel wall thickening demonstrated ill-defined enhancement, mild diffusion restriction, and surrounding fibrofatty proliferation.The colon is decompressed which limits evaluation, but appears otherwise normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Multiple areas of small bowel inflammation and stricturing with skipped areas of normal appearing small bowel compatible with Crohn's.2.Small bowel obstruction at a 3.7cm-long area of strictured distal jejunum/proximal ileum in the left hemiabdomen.3.Inflammation and thickening of the terminal ileal wall without evidence of stricture at this site.


Instruction: Generate impression based on findings.

Input: 50-year-old male. Pain in right shoulder for two months. Assess for right shoulder injury after lifting weights. ROTATOR CUFF: Tendinosis of the supraspinatus and infraspinatus without evidence of a tear. The teres minor and subscapularis tendons are normal in signal intensity and morphology. No evidence of edema, atrophy, or retraction of the rotator cuff muscles.SUPRASPINATUS OUTLET: Mild AC joint osteoarthritis without significant impingement on the supraspinatus muscle.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is fraying/irregularity of the anterior and posterior glenoid labrum likely representing degeneration. Small degenerative cyst in the humeral head.BICEPS TENDON: Biceps tendon is normal in signal intensity and located in the bicipital groove.ADDITIONAL

Output: 1. Supraspinatus and infraspinatus tendinopathy without evidence of a full thickness tear. 2. Glenoid labrum degenerative changes.


Instruction: Generate impression based on findings.

Input: Multiple myeloma. Low back pain and leg weakness. Rule out cord compression. The study is markedly limited by patient motion.COMPLETE SPINE LIMITED:There is loss of the normal fatty signal throughout the marrow. This is associated with mildly increased STIR signal in the lumbar and lower thoracic vertebral bodies, some with coexisting vertebral body compression fractures as described below.While there is no cervical spinal cord compression, there is degenerative disc-osteophyte complex at C5-C6 resulting in mild narrowing of the spinal canal. There is reversal of the normal cervical lordosis which may relate to patient position. The vertebral bodies are preserved in height.In the thoracic spine, there is mild central height loss involving T8 vertebral body with minimal posterior retropulsion but no significant narrowing of the spinal canal. More subtle vertebral body compression fractures are present at T7 and T12. Additionally, there is a small posterior epidural bulge and signal abnormality at T11-T12 and perhaps also at T5 level, which results in minimal to mild spinal canal stenosis but no compression of the spinal cord.LUMBAR SPINE:In addition to the diffuse infiltrative marrow signal abnormality, there is a large, infiltrative presacral soft tissue mass, more pronounced on the right side. This is better assessed on the abdomen/pelvis CT scan from May 28 2016.There is also multilevel central vertebral body compression fractures at all the lumbar levels, most pronounced at L3 where there is about 50% height loss. Multilevel degenerative changes are also present. In the lower lumbar levels, this is combined with posterior epidural soft tissue component at L4 and L5 levels resulting in up to moderate spinal canal stenosis.

Output: 1.Markedly limited examination, by patient motion. 2.While there is no definite spinal cord compression or signal abnormality, there is strong suggestion of small posterior epidural soft tissue components at T11-T12 and T5 levels, resulting in minimal to mild spinal canal stenosis.3.In the lumbar spine, there is also posterior epidural soft tissue at L4, L5 and the sacral levels contributing to spinal canal stenosis, up to moderate.4.Infiltrative presacral soft tissue mass is incompletely assessed. However, it involves the lumbosacral plexus roots, especially on the right. This is probably causing or at least contributing to the lower extremity weakness.5.There is also diffuse loss of the normal marrow signal, compatible with a diffuse infiltrative process, multiple myeloma. This is associated with multilevel vertebral body compression fracture, most pronounced in the lumbar spine but no significant retropulsion. The lumbar fractures and T12 fracture are unchanged compared to the previous MRI from 2011 and probably represent chronic osteoporotic fractures.Dr. Monther Qandeel discussed the above findings with Dr. Zainab Abdul-Rahim over the phone on 6/15/2016 11:42 AM.


Instruction: Generate impression based on findings.

Input: There are scattered T2 hyperintensities in the cerebral white matter representing chronic small vessel ischemic disease. There is also encephalomalacia in the right pons. There is no evidence of acute infarction, mass lesions, or intracranial hemorrhage. There is mild diffuse cerebral volume loss. There is fluid in the mastoids, right more than left. There is status post bilateral lens transplant.

Output: 1. No evidence of acute infarction or hemorrhage. 2. Scattered T2 hyperintensities in the cerebral white matter are nonspecific, but may represent chronic small vessel ischemic disease.3. Chronic right pons infarct.4. Nonspecific effusions in the mastoids, right more than left.


Instruction: Generate impression based on findings.

Input: Chronic postconcussive headache after patient hit in head with hammer. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered mild cerebral white matter T2 hyperintense lesions. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There appears to be a small residual right frontal scalp hematoma. The orbits, skull, and mastoid air cells are grossly unremarkable. There is mild scattered paranasal sinus mucosal thickening. There are postoperative findings in the upper cervical spine.

Output: 1. Apparent small residual right frontal scalp hematoma, but no evidence of intracranial hemorrhage. 2. Scattered mild cerebral white matter lesions are nonspecific, but likely represent chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: Seizures. There is T2 hyperintensity and volume loss involving the left hippocampus. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: Findings compatible with left medial temporal sclerosis.


Instruction: Generate impression based on findings.

Input: There is transitional spinal anatomy. For the purposes of this exam, last fully formed disc is at L6-S1.There is developmental partial fusion of the C6 and C7 vertebrae on the left side, with overall diminutive appearance of the disc and decreased AP dimension of the C6 and C7 vertebral bodies. There is mild left foraminal narrowing at this level.There is redemonstration of a moderate-severe compression deformity involving T5 is predominantly left-sided with mild to moderate loss of height on the right. There does not appear to be significant progression since the prior MRI. Other scattered Schmorl's nodes appear similar and are not consecutive vertebrae. There appears to be a developmental abnormality involving the left posterior lateral T6 vertebral body which is diminutive and deformed, with medialization of the left costovertebral junction. The left pedicle is developmentally slender. There is moderate left foraminal narrowing at the T5-T6 level.There is redemonstration of segmentation anomaly involving L2 on L3 on the right side with single right-sided foramen and two on the left. There is disc desiccation on the right L1-L2 level, and to a lesser degree at L3-L4. There is mild developmental disc narrowing at L6-S1.Levoscoliosis is again noted of the upper lumbar spine. The spine is in normal sagittal alignment. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Apparent patchy hyperintense signal in the cervical cord on sagittal images is artifactual. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is no pathological enhancement, although sagittal T1 post contrast images are limited due to artifact indwelling dental hardware. Minimal enhancement along the ventral aspect of left T5 vertebral body in the area of fracture is likely reactive.There is a rightward predominant disc bulge at L1-L2 with mild right foraminal narrowing. There is mild-moderate developmental narrowing of the left L2-L3 foramen.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of spine. There is facet arthropathy and ligamentum flavum thickening along the lumbar spine.There is free fluid within the pelvis, which is likely physiologic. The bladder is well distended.

Output: 1.Transitional spinal anatomy with segmentation anomalies as detailed above. If surgery is to be contemplated, correlation with imaging of entire spine is recommended.2.Redistribution of moderate-severe predominantly left-sided compression deformity involving T5 without evidence of pathological enhancement. Minimal enhancement centrally likely is reactive. Associated moderate left foraminal narrowing at T5-T6.3.Previously questioned posterior T6 abnormality is favored to be developmental given the slender appearance of the left T6 pedicle.4.Other scattered mild foraminal narrowing as detailed above due to segmentation anomalies.


Instruction: Generate impression based on findings.

Input: Reason: patellar chondromalacia History: R knee pain MENISCI: There is globular increased signal within the posterior horn and body of the medial meniscus which may reflect mild intrasubstance degeneration. No fluid-filled or unstable tear is evident. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Note is made of linear decreased signal abnormality within the articular cartilage of the femoral trochlea, centrally, likely representing an articular cartilage cleft, but we see no fluid-filled defects. There is relative sparing of the articular cartilage of the tibiofemoral articulation.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Low signal intensity cleft within the articular cartilage of the femoral trochlea and mild intrasubstance degeneration of the medial meniscus with other findings as described above, but otherwise no findings to account for the patient's pain.


Instruction: Generate impression based on findings.

Input: 60-year-old female with benign neoplasm of connective and other soft tissues of the lower limb including the hip. History of PVNS. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: Previously noted subchondral cyst along the medial facet of the patella is no longer visualized. There is focal loss articular cartilage along the medial aspect of the patella appearing similar to the prior exam. No abnormal marrow signal.LIGAMENTS: The anterior collateral ligament is intact. The posterior collateral ligament is intact. The medial collateral ligament is intact. Lateral collateral ligament complex is intact.EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: No evidence of tumor recurrence.


Instruction: Generate impression based on findings.

Input: Images are degraded by persistent patient motion. Given this caveat:There is subtle increased T2 hyperintensity (best visualized with axial FLAIR technique) primarily involving the mesial temporal lobes. There is also mild atrophy involving the anterior right temporal lobe. These findings are not associated with restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. There is no abnormal enhancement within the brain. Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There are no vascular anomalies.

Output: There is subtle increased T2 hyperintensity (best visualized with axial FLAIR technique) primarily involving the mesial temporal lobes. There is also mild atrophy involving the anterior right temporal lobe. These findings are not associated with restricted diffusion, susceptibility abnormality, or enhancement. This is nonspecific in appearance but most likely suggest residua from a prior inflammatory/infectious process.


Instruction: Generate impression based on findings.

Input: 52-year-old male with medial joint line pain, evaluate for meniscal tear. MENISCI: There is slight blunting of the free edge of the body of the medial meniscus seen on the coronal images, not evident on the prior study. There also appears to be a defect in the femoral surface fibers of the inner aspect of the body of the medial meniscus, seen on the sagittal images. These findings are suggestive of a tear, unless the patient has undergone a prior partial meniscectomy. There is also mild fraying of the undersurface fibers of the posterior horn of the medial meniscus. The anterior horn of the medial meniscus appears normal. There is a thin vertically oriented linear focus of high signal intensity in the posterior horn of the lateral meniscus near its root, but this appears similar to the prior study and is not necessarily of any current clinical significance.ARTICULAR CARTILAGE AND BONE: There is a focal full-thickness defect of the articular cartilage near the median eminence of the patella that appears slightly more prominent on the current study. There is a small subchondral cyst within the patella underlying this defect, appearing similar to the prior study. There is mild superficial fraying of the articular cartilage of the medial and lateral facets, appearing similar to the prior study. The articular cartilage of the medial tibiofemoral compartment appears subjectively thinned, perhaps slightly more than on the prior study, suggesting mild degeneration. Mild subchondral edema type signal within the far medial aspect of the medial tibial plateau and medial femoral condyle is likely degenerative in etiology.LIGAMENTS: The medial collateral and lateral collateral ligament complexes are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Defect of the articular cartilage of the patella appearing slightly more prominent on the current study with additional areas of degeneration as described above.2.Findings suggestive of a tear of the inner fibers of the body of the medial meniscus as described above.


Instruction: Generate impression based on findings.

Input: 11 year old female with knee pain for months, evaluate for OCD healing MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Focus of low T1 intensity along the weight-bearing portion of the articular surface of the medial femoral condyle measuring 14 x 6 mm (series 901, image 11) indicates an osteochondral defect. No significant depression of the articular surface is identified. No displaced bone fragment. The osteochondral defect does not involve the overlying articular cartilage. No articular cartilage defects are identified. No other fractures identified.LIGAMENTS: The cruciate ligaments are intact. The medial collateral ligament and lateral collateral complex are intact. EXTENSOR MECHANISM: No significant abnormality noted. The extensor mechanism is intact.ADDITIONAL

Output: Osteochondral defect along the weight-bearing portion of the articular surface of the medial femoral condyle.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate right frontal swelling with mass-effect. Evaluate for recurrence of tumor. Signs and symptoms: Worsening right frontal headache and left arm and leg weakness. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.There is interval increased vasogenic edema in the right frontal lobe and extensively involving the right basal ganglia. There is resultant increased mass effect and midline deviation to the left of approximately 14 mm. There is no evidence of hydrocephalus. There is a large irregularly shaped necrotic thick irregular rim enhancing tumor in the right frontal lobe and with expiration to the corpus callosum and across the midline. The largest has axial measurements of tumor are at least 40 x 47-mm. The tumor extends from the high convexity cortex of right frontal lobe and nearly the floor of right anterior cranial fossa and measuring at least 58-mm in cranial cephalad axis. No detectable additional focus of abnormal enhancement. Periventricular increased flair signal intensity left hemisphere likely post treatment change.

Output: 1.Significant internal increased right frontal lobe vasogenic edema and large necrotic enhancing mass as detailed/measured above.2.There is 14-mm leftward midline shift and without evidence of hydrocephalus.


Instruction: Generate impression based on findings.

Input: Residual/recurrent ganglioglioma (WHO Grade I), resection of posterior fossa lesion. STEALTH MRI with fiducial placement for surgery. Surgical planning MRI sequences demonstrate a heterogeneous mass within the left lateral aspect of the fourth ventricle, which measures up to 20 mm. Otherwise, there are post-treatment findings in the posterior fossa with diffuse bilateral cerebellar encephalomalacia and associated enlargement of fourth ventricle. There is also unchanged mild prominence of the third and lateral ventricle. There is no midline shift or herniation. There are skin-based fiducial markers.

Output: Surgical planning MRI sequences demonstrate a heterogeneous mass within the left lateral aspect of the fourth ventricle, which measures up to 20 mm. Otherwise, there are post-treatment findings in the posterior fossa with diffuse bilateral cerebellar encephalomalacia and associated enlargement of fourth ventricle. There is also unchanged mild prominence of the third and lateral ventricle.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis: paresthesias. Brain: There are extensive supratentorial, and to a lesser degree infratentorial, white matter T2 hyperintense lesions. Many of the lesions are also T1 hypointense. Overall, the lesions appear to have progressed since 2013, accounting for differences in technique. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.Cervical Spine: There is persistent scattered mild patchy T2 hyperintensity within the cervical spinal cord. There is irregularity of the dens, with what appears to be a chronic dens fracture or developmental malformation and associated hypertrophic changes that lead to compression of the spinal cord. There is multilevel degenerative spondylosis with up to mild spinal canal and neural foraminal stenosis. There are several small perineural cysts in the lower cervical and upper thoracic spine neural foramina. The vertebral bone marrow appears unchanged. The vertebral column alignment is intact. The vertebral body heights are preserved. The paraspinal soft tissues are unremarkable.

Output: 1. Extensive intracranial demyelinating disease related to multiple sclerosis. Overall, the lesions appear to have progressed since 2013, accounting for differences in technique. However, the degree of demyelinating disease in the cervical spine appears to be similar as in 2013.2. Irregularity of the dens, with what appears to be a chronic dens fracture or developmental malformation and associated hypertrophic changes that lead to compression of the spinal cord. 3. Multilevel degenerative spondylosis with up to mild spinal canal and neural foraminal stenosis.


Instruction: Generate impression based on findings.

Input: Cervical syrinx. There is a syrinx that measures up to 3 mm in width at the level of C5 through C7, which is unchanged. The cerebellar tonsils are not low-lying. There is no evidence of cervical spine mass lesions. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There are punctate nodules within the bilateral thyroid lobes.

Output: Unchanged small lower cervical syrinx.


Instruction: Generate impression based on findings.

Input: 50 year old woman with left-sided paresthesias since this morning. Evaluate for bleed / CVA. There is no evidence of intracranial hemorrhage, mass or edema. If stroke is a clinical concern, recommend MRI. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT. If stroke is of clinical concern, recommend MRI.


Instruction: Generate impression based on findings.

Input: Preoperative planning for tumor biopsy/resection. There is an ill-defined lesion centered in the right middle frontal gyrus with associated leptomeningeal and dural involvement. There is associated vasogenic edema as well, although this is incompletely characterized. In addition, there is predominantly leptomeningeal enhancement along the anterior frontal convexity with associated thickening of the overlying dura and underlying vasogenic edema. The ventricles are unchanged in size and configuration. Skin fiducial markers are present.

Output: Preoperative planning MRI demonstrates a right frontal lobe lesions with predominantly leptomeningeal and dural involvement.


Instruction: Generate impression based on findings.

Input: 21-year-old female with remote seizure history, CVA at 3 years of age with residual left-sided weakness. Presenting with bilateral dizziness, syncope. No neck pain. Rule out bleed. The patient is status post right frontal craniotomy with areas of encephalomalacia in the right frontal lobe and right basal ganglia. When accounting for difference in technique, these appear grossly similar to the prior MRI examination from 7/12/2007. There is ex vacuo dilatation of the right lateral ventricle. The ventricles appear mild to moderately dilated. There is no evidence of intracranial hemorrhage.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Postoperative findings. No acute intracranial abnormality is noted.


Instruction: Generate impression based on findings.

Input: History of radiation and resection x2 of possible AVM, and then subsequent cavernomas, multiple bleeds: Bilateral weakness, right side numbness, gait problems, double vision, worsening over past several months. There are postoperative findings related to suboccipital craniotomy. There are multiple brainstem cavernous malformations. In particular, there has been interval decrease in size and internal T1 hyperintensity of the posterior left pontine cavernous malformation, now measuring up to 8 mm, previously 20 mm. The other cavernous malformations do not appear to have significantly changed in size, accounting for differences in technique. There are multiple prominent venous structures that course through the brainstem and left cerebellum. The supratentorial brain is unremarkable and there is no evidence of acute infarct. There is decreased effacement of het fourth ventricle and the third and lateral ventricles are not particularly dilated. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable.

Output: Multiple brainstem cavernous malformations. In particular, the posterior left pontine cavernous malformation has decreased in size with evolution of the internal hemorrhage, now measuring up to 8 mm, previously 20 mm. The other cavernous malformations do not appear to have significantly changed in size, accounting for differences in technique. Multiple prominent venous structures in the brainstem and left cerebellar region likely represent associated "developmental venous malformations". However, evaluation for residual arteriovenous malformation is limited and an angiographic examination may be useful, if clinically warranted.


Instruction: Generate impression based on findings.

Input: A 60 year old female with systemic amyloidosis involving the gastrointestinal tract, the heart and possibly the nervous system. about 1 year ago finished the chemotherapy and the cardiac MRI after this treatment showed improvement in some parameters. Now referred to another cardiac MRI for follow up after suspicion of progression of the disease Left VentricleThe left ventricle is normal in size with hyperdynamic systolic function. The overall LV ejection fraction is 70%, the LV end diastolic volume index is 88 ml/m2 (normal range: 65+/-11), the LVEDV is 141 ml (normal range 109+/-23), the LV end systolic volume index is 27 ml/m2 (normal range 18+/-5), the LVESV is 43 ml (normal range 31+/-10), the LV mass index is 72 g/m2 (normal range 67+/-11), and the LV mass is 115 g (normal range 114+/-24). There is concentric left ventricular hypertrophy: the maximal thickness is at the basal anterior wall of about 15 mm, similar to the last cardiac MRI (1/29/2015). No definite regional wall motion abnormality. Delayed hyperenhancement has improved since previous study. There is still mild patchy delayed hyperenhancement involving the basal and mid anterior, anterolateral, and lateral walls. The T1-mapping times are still increased above 1150-1250 ms.No myocardial iron overload was noted.No intracavitary thrombus was noted.Left AtriumThe left atrium is moderately dilated. .Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 64%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 137 ml (normal range 110+/-24), the RV end systolic volume index is 31 ml/m2 (normal range 22+/-8), and the RVESV is 49 ml (normal range 35+/-13). Right AtriumThe right atrium is mildly dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.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. There is a catheter in the SVC.PericardiumThere is trace pericardial effusion.Extracardiac FindingsMild to moderate thoracolumbar disc degeneration. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with hyperdynamic systolic function, the LVEF is 70%. There is concentric left ventricular hypertrophy: the maximal thickness is at the basal anterior wall of about 15 mm, similar to the last cardiac MRI (1/29/2015).2. Delayed hyperenhancement has improved since previous study. There is still mild patchy delayed hyperenhancement involving the basal and mid anterior, anterolateral, and lateral walls. The T1-mapping times are still increased above 1150-1250 ms. 3. The right ventricle is normal in size with normal systolic function, the RVEF is 64%.4. There is biatrial dilatation. 5. There is a catheter in the SVC.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 66-year-old male with history of recurrent prostate cancer. PELVIS:PROSTATE:Prostate Size: Status post prostatectomy. No abnormal focal lesions or areas of enhancement to suggest residual or recurrent disease.Seminal Vesicles: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Status post prostatectomy without MR evidence of residual or recurrent disease.


Instruction: Generate impression based on findings.

Input: Cavernoma resection. There are postoperative findings related to left posterior midbrain cavernous malformation resection with a small amount of susceptibility effect along the margins of the surgical cavity. There is also a punctate focus of enhancement along the medial aspect of the surgical cavity as well. However, the surrounding edema has essentially resolved. There is no evidence of acute infarction. There is a prior right transfrontal ventricular shunt tract. The ventricles are unchanged in size. 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: Interval evolution of postoperative findings related to left posterior midbrain cavernous malformation resection with what likely represents a small amount of residual peripheral components of the otherwise grossly resected cavernous malformation, but the surrounding edema has essentially resolved.


Instruction: Generate impression based on findings.

Input: Metastatic thyroid cancer, status post resection April 20, 2014 Again seen are postsurgical findings related to a right frontotemporal craniotomy. There is no significant change in appearance of the posterior inferior frontal gyrus resection cavity with evidence of chronic blood products and intrinsic T1 hyperintensity. Unchanged surrounding FLAIR hyperintensity compatible with edema and/or gliosis. No significant mass effect. No new enhancement is seen at the resection cavity to suggest local recurrence.There is a punctate 2 mm enhancing nodule involving the left superior cerebellar hemisphere, best seen on series 10 with gadolinium 3-D FSPGR image 50, and not seen previously. No significant associated edema.Unchanged nonspecific punctate focus of susceptibility effect in the right basal ganglia. The ventricles and sulci are unchanged. There is no midline shift or mass effect. There is no evidence of acute infarction. There is an unchanged subcentimeter posterior nasopharynx retention cyst or Thornwaldt cyst. There is unchanged partially imaged asymmetric hyperenhancement of the left parotid gland, which may be treatment-related.

Output: 1. Post-treatment findings related to resection of a right frontal lobe metastasis without evidence of local tumor recurrence. There is however a 2 mm enhancing nodule involving the left superior cerebellar hemisphere which was not seen previously and suspicious for new metastatic focus. 2. No significant edema or mass effect.


Instruction: Generate impression based on findings.

Input: CCM yearly surveillance There is no appreciable interval change in the innumerable supratentorial and infratentorial cavernous malformations, the largest of which is located in the right occipital horn, which measures up to 16 mm. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is an unchanged cystic pineal gland. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are grossly unremarkable. There is interval increase in size of a right parietal scalp lesion, which appears to enhance.

Output: 1. No appreciable interval change in the innumerable supratentorial and infratentorial cavernous malformations.2. Interval increase in size of a nonspecific right parietal scalp lesion, which may be inflammatory in nature.3. Unchanged cystic pineal gland.


Instruction: Generate impression based on findings.

Input: Images are slightly limited by patient motion. There is a stable subcentimeter plaque-like enhancing lesion along the lateral aspect of the superficial lobe of the left parotid gland. The parotid glands themselves as well as the remaining salivary glands are unremarkable. Postoperative changes are again seen from previous left hemithyroidectomy with stable appearance of nonspecific soft tissue in the resection bed.There is a stable T2/STIR hyperintense enhancing lesion in the left superior C7 articular process that measures up to 15 mm CC. There is multilevel degenerative spondylosis. There is multilevel cervical spondylosis which appears unchanged.

Output: 1. Stable subcentimeter plaque like enhancing structure likely representing a lymph node along the superficial lobe of the left parotid gland. No intrinsic parotid gland pathology.2. Stable appearance of left C7 superior articulating process abnormal signal and enhancement which may represent an atypical hemangioma.3. Stable postoperative changes from previous left hemithyroidectomy.


Instruction: Generate impression based on findings.

Input: Generalized muscle weakness and left facial droop.. There is no evidence of acute infarct. There is interval evolution of the previously demonstrated infarcts in the left cerebral hemisphere watershed area, with associated encephalomalacia, minimal areas of susceptibility effect, and mild ex vacuo dilatation of the left lateral ventricle. Beyond this, there are a few scattered foci of T2 hyperintensity in the cerebral white matter bilaterally, consistent with mild small vessel ischemic disease. There is loss of flow void of the left internal carotid artery within the carotid canal. There is no mass effect, midline shift, or acute intracranial hemorrhage. The paranasal sinuses and mastoid air cells are unremarkable except for secretions and atelectasis of the left maxillary sinus and mild mucosal thickening in the sphenoid sinus.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Interval evolution of the previously demonstrated watershed zone infarct in the left cerebral hemisphere.2. Redemonstration of chronic left internal carotid artery occlusion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Reason: activity in left shoulder noted on PET scan, please evaluate for abnormality. History: left shoulder pain There is a focus of signal abnormality situated at the level of the glenohumeral joint along the anterior margin of the subscapularis, beneath the coracoid, and deep to the tendon of the short head of the biceps, measuring approximately 1.7 x 0.9 x 2.2 cm (TR x AP x CC). It is isointense to skeletal muscle on T1-weighted images, isointense to skeletal muscle on the coronal oblique T2-weighted images and is slightly hyperintense on the fat suppressed T2-weighted images. It enhances following gadolinium administration. The differential diagnosis includes focal pigmented villonodular synovitis, perhaps within the subcoracoid bursa. We cannot exclude the possibility of a malignancy on the basis of this study, however. There is intermediate signal intensity along the undersurface fibers of the supraspinatus and infraspinatus suggesting mild fraying, but we see no fluid-filled rotator cuff tear. There are small cysts within the humeral head. Moderate osteoarthritis affects the acromioclavicular joint. Although this study was not protocoled for detailed evaluation of the glenoid labrum or tendon of the long head of the biceps, we see no fluid-filled labral tear. The tendon of long head of the biceps appears normal. There is a small amount of fluid within the glenohumeral joint and tendon sheath of the long head of the biceps which is not necessarily of any clinical significance.

Output: Small soft tissue mass anterior to the subscapularis in the approximate location of the subcoracoid bursa with the signal characteristics as described above that may represent focal pigmented villonodular synovitis, although we cannot exclude the possibility of a malignant lesion on the basis of this study. Other findings as described above. Referral to orthopedic oncology is recommended.


Instruction: Generate impression based on findings.

Input: Right hamstring pain ACETABULAR LABRUM: Increased signal is noted within the anterior labrum likely reflecting intrasubstance degeneration.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: Again noted is increased fluid signal within the right hamstring tendons near the origin upon the initial tuberosity. The extent of which appears unchanged from the prior examination dated 12/30/2015. The remaining muscles and tendons of the pelvis appear unremarkable. Surgical defect within the right ischial tuberosity is again noted.ADDITIONAL

Output: Grossly unchanged signal irregularity of the right hamstring origin which likely reflects a combination of postsurgical change with possible chronic tear/degeneration.


Instruction: Generate impression based on findings.

Input: Metastatic lung cancer. Status post 2 cycles of chemo. Evaluate for treatment response. There has been resolution or interval decrease in size of the intracranial metastases. For example a right parietal enhancing lesion previously measuring 6 x 5 mm is no longer enhancing. Previously seen mild associated T2/FLAIR hyperintensity has also decreased. A prior 7 x 6 mm anterior right frontal lobe lesion is no longer appreciated. There is a very faint enhancing right occipital lesion measuring 1 to 2 mm, previously 2 x 3 mm. Additional tiny focus of enhancement in the left cerebellum is no longer perceptible. Additional punctate foci of enhancement in the right occipital lobe and posterior right frontal deep white matter have also decreased in conspicuity. Susceptibility effect is present at the site of some of the prior lesions compatible with mineralization or punctate chronic blood products.No new lesions, edema, or mass effect is evident. No evidence of acute ischemia. Ventricles and sulci are within normal limits.There is mild mucosal thickening involving the bilateral maxillary sinuses and right anterior ethmoid air cells which is increased in the interval. Bone marrow signal and extracranial soft tissues are grossly unremarkable.

Output: Previously seen multiple small intracranial metastases have decreased in size or no longer perceptible and consistent with treatment response.


Instruction: Generate impression based on findings.

Input: Female, 30 years old, with bilateral upper extremity neuropathy and paresthesias. Evaluate for cervical disc disease. Focal prominence of the central canal of the spinal cord is seen measuring less than 2 mm in diameter and extending for 5 mm in length at the C1-2 level. Otherwise, no focal spinal cord lesions are seen and the cord morphology is within normal limits. No epidural abnormalities are detected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is detected. The intervertebral discs are preserved with no evidence of spinal canal or foraminal stenosis.

Output: 1.A short segment of focal prominence of the central canal of the spinal cord is seen at the C1-2 level. This prominence measures less than 2 mm in diameter and as such may reflect normal variation versus a small syrinx.2.The remainder of the examination is unremarkable with no areas of disc degeneration, spinal canal stenosis or foraminal narrowing.


Instruction: Generate impression based on findings.

Input: Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: UnremarkableL1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: There is disc desiccation associated with a small central disc extrusion that extends slightly below the disc level, causing mild mass effect upon the anterior thecal sac, however without significant central or lateral recess stenosis. The neural foramina are patent.L5/S1:Unremarkable

Output: L4/5: There is disc desiccation associated with a small central disc extrusion that extends slightly below the disc level, causing mild mass effect upon the anterior thecal sac, however without significant central or lateral recess stenosis.


Instruction: Generate impression based on findings.

Input: Female; 70 years old. Reason: 70 year old female with history of recurrent acute pancreatitis, possibly due to autoimmune etiology. MRI/MRCP with secretin to r/o small tumor in pancreas, cystic lesion, or tumor History: recurrent acute pancreatitis, abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic steatosis. Small, wedge-shaped peripheral focus of arterial hyperenhancement in the right hepatic lobe is most likely related to transient hepatic arterial difference (series 100/56). No suspicious hepatic lesions. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality noted.PANCREAS: Prominent to mildly dilated pancreatic duct in the tail, with parenchymal atrophy, with transition point seen in the pancreatic body. In the region of the transition point, there is focal fullness of the pancreatic body which demonstrates slightly heterogeneous signal and restricted diffusion. These findings may be related to focal fibrosis with benign stricturing related to chronic pancreatitis. However, there is a suggestion of a small solid lesion seen in this location on postcontrast images (series 18/40). As a result, underlying neoplasm cannot be excluded, and endoscopic ultrasound correlation is recommended.Poor physiologic response to secretin.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Pancreatic abnormalities as detailed above with possible underlying neoplasm in the pancreatic body, for which endoscopic ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: Status post tumor resection Five lumbar type vertebral bodies are present. Again seen is anterolisthesis of L5 on S1 with evidence of bilateral posterior spinal fusion at this level. Vertebral body heights and alignment in the remainder of the lumbar spine are normal. There is disk desiccation at L4-L5 which is unchanged. The conus medullaris is normal in position and signal intensity.Previously seen enhancing mass along the left L5-S1 has been resected. Susceptibility artifact from hardware limits evaluation; however, there appears to be gross total resection of the tumor. Left sided rod also appears to have been removed but difficult to evaluate; CT or radiographs can better assess the hardware. Epidural soft tissue enhancement seen at the L5-S1 level compatible with scar tissue and venous plexus.Expected post surgical changes include paraspinous fluid collection. No large epidural hematoma or evidence of significant mass effect on the thecal sac is seen.Mild degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Disk desiccation and trace disk bulge. No spinal canal or neural foraminal stenosis.L5-S1: Postoperative changes as described above. No significant spinal canal or neural foramina stenosis is seen. Extensive epidural enhancement is compatible with scar tissue and epidural venous plexus.

Output: Interval postsurgical changes of resection of enhancing mass in the left L5-S1 neural foramina, presumably a nerve sheath tumor. Susceptibility artifact slightly limits evaluation however no residual tumor is appreciated.Prior posterior spinal spinal fusion at L5-S1 related to L5 on S1 anterolisthesis. CT or radiographs can better assess the hardware and fusion if clinically indicated.


Instruction: Generate impression based on findings.

Input: History of SLE, hyperreflexia, evaluate for brain lesions and myelopathy. Brain:There are scattered foci of susceptibility in the bilateral cerebral hemispheres in a cortical and subcortical distribution, which are nonspecific. There is no evidence of mass, mass effect, or midline shift. There is mild diffuse global parenchymal volume loss. The ventricles, sulci, and basal cisterns are otherwise normal in size. The midline structures are normal. There is no evidence for intracranial hemorrhage or extra-axial collection. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are grossly aerated. Cervical Spine:The sagittal images extend inferiorly to visualize the superior endplate of the T4 vertebral body.The cervical spine alignment is anatomic. The vertebral body and intervertebral disc space heights are preserved. The bone marrow demonstrates low T1 signal suggestive of red marrow reconversion. There is no significant spinal canal stenosis or neural foraminal narrowing at any level. The cord is normal in signal and morphology. The prevertebral soft tissues are unremarkable.

Output: 1. No evidence of acute infarct, intracranial mass, or mass effect.2. Multiple scattered cortical and subcortical foci of susceptibility compatible with chronic microhemorrhages. These are nonspecific but can be seen with thrombotic microangiopathy for example. 3. No evidence of cervical spinal canal stenosis or cord signal abnormality.4. Diffuse low T1 signal in the visualized bone marrow which is nonspecific but can be seen with marrow reconversion related to chronic anemia for example.


Instruction: Generate impression based on findings.

Input: Reason: 57 y.o. h/o of cerebral History: 57 y.o. female with known hx of cerebral aneurysm. Noted @ an outside clinic surveillance. Pt has a hx of htn, "brain tumor" that is being monitored, "brain aneurysm" that has required no intervention, and l ureteral stone diagnosed in 9/14 s/p stent and subsequent stent removal. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an homogeneously enhancing, well circumscribed 10x12mm mass located in the right occipital pole posteriorly involving the gray matter more than the white matter. The cerebellar tonsils are low lying extending 8 mm below the level of foramen magnum. The cerebellar tonsils are pointed inferiorly. There is associated marked syrinx in the visualized portions of the cervical spinal cord measuring approximately 10 mm in diameter.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.

Output: 1.There is a small cortically based right occipital lobe mass present. Differential considerations include primary brain tumor such as galnglioglioma as well as metastasis and lymphoma.2.There is a Chiari one malformation present associated with a spinal cord syrinx. The ventricles do not appear enlarged.3.If there is clinical concern for a cerebral aneurysm, an MRA of the brain would be more sensitive in its evaluation relative to MRI.


Instruction: Generate impression based on findings.

Input: The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level. There is unchanged clumping of left caudate equina nerve roots from L1 to L4 without corresponding abnormal enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine.

Output: Continued stable appearance of clumped cauda equina nerve roots likely relating to arachnoiditis. No evidence of drop metastases.


Instruction: Generate impression based on findings.

Input: 14-year-old male with a history of hereditary spherocytosis presents with abdominal pain and a distal common bile duct stone seen on an outside ultrasound.EXAMINATION: MRI/MRCP with and without IV contrast. 7/1/2016 15:22 ABDOMEN:LIVER, BILIARY TRACT: The common bile duct at the head of the pancreas is dilated up to 0.9 cm with an obstructing common bile duct stone (series 501, image 18). Multiple additional stones are present in the distal common bile duct (series 801, image 36). Mild intrahepatic biliary ductal dilatation. The gallbladder has been removed. No focal hepatic lesions are identified. The hepatic vasculature is patent.SPLEEN: Partial splenectomy has been performed. The residual spleen has a round, bilobed contour. The splenic artery is not clearly visualized.PANCREAS: The pancreas is normal appearance. No pancreatic ductal dilatation or perinephric fluid collection is identified.ADRENAL GLANDS: The adrenal glands are normal.KIDNEYS, URETERS: Too small to accurately characterize focus in the lower pole of the left kidney. No evidence of hydronephrosis. Circumaortic left renal vein is noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. No free fluid or pneumoperitoneum.BONES, SOFT TISSUES: The bones are normal in appearance.OTHER: No significant abnormality noted.

Output: Obstructing common bile duct stone at the head of the pancreas with multiple stones present in the distal common bile duct. Mild intra and extrahepatic biliary ductal dilatation.


Instruction: Generate impression based on findings.

Input: Altered mental status Patchy areas of low attenuation in the subcortical and periventricular white matter reflect small vessel ischemic disease of indeterminate age. If there is clinical concern for acute ischemia, MRI is recommended. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Small vessel ischemic disease of indeterminant age


Instruction: Generate impression based on findings.

Input: Meningioangiomatosis with left eye pain and vision loss. Brain: There is gyriform susceptibility effect along the medial anterior frontal lobes bilaterally, with unchanged mild subcortical white matter T2 hyperintensity. There is also a subcentimeter area of susceptibility effect in the superior vermis. There is no evidence of other intracranial tumors. There is no definite acute intracranial hemorrhage. There is no evidence of acute infarct. The ventricles are normal in size. There is a right frontal burr hole related to transfrontal biopsy.Orbits: There is a punctate enhancing lesion along the left superotemporal globe. The rest of the orbital contents are otherwise unremarkable bilaterally.

Output: 1. Areas of meningioangiomatosis along the medial anterior frontal lobes bilaterally and superior vermis appear grossly unchanged, accounting for differences in technique.2. A punctate left superotemporal lesion may represent a hamartoma related to the meningioangiomatosis.


Instruction: Generate impression based on findings.

Input: 60 years Female (DOB:4/4/1956)Reason: newly diagnosed lung cancer, eval for brain mets History: double vision, recent auto accident for unclear reasonPROVIDER/ATTENDING NAME: PHILIP C. HOFFMAN PHILIP C. HOFFMAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular punctate additional T2 and FLAIR hyperintense foci are present in the brainstem and external capsules.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter punctate lesions as well as some brainstem and external capsule punctate lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There is no evidence for brain metastases.


Instruction: Generate impression based on findings.

Input: 55-year-old male with history of alcoholic cirrhosis. Evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: Severe cirrhotic liver morphology. There is a tiny focus of T2 hyperintensity with arterial enhancement although no convincing washout located within segment 8 measuring 10 x 8 mm (image 70 of series 100). No other suspicious lesions identified.SPLEEN: Multiple tiny hypointense nodules representing siderotic nodules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large volume abdominopelvic ascites. Gastroesophageal varices.

Output: Subcentimeter segment 8 focus of hyperenhancement without washout may be perfusional in etiology or represent early HCC. Continued close followup is recommended. Large abdominopelvic ascites.


Instruction: Generate impression based on findings.

Input: History of epidermoid status post resection and most recently CyberKnife treatment: surveillance scan. Redemonstrated are postoperative findings related to left temporal craniotomy. There is a lobulated, non-enhancing, T2 hyperintense mass that displays restricted diffusion centered within the left choroid fissure with extension into the suprasellar cistern and third ventricle, as well as a punctate focus in the right occipital horn. The lesion appears to be unchanged in size, the main component of which measures 41 AP x 35 RL x 28 SI mm, with unchanged regional mass effect upon the brain parenchyma and left aspect of the optic apparatus. However, there is interval decrease in the T2 hyperintensity and enhancement in the adjacent brain parenchyma. There is a right transoccipital ventricular shunt catheter that terminates in the right lateral ventricle, which is unchanged. There is no evidence of acute intracranial hemorrhage or acute territorial infarct. There is no midline shift or herniation. The skull and scalp soft tissues are unchanged.

Output: 1.Stable size of the epidermoid cyst centered in the left choroid fissure with interval evolution of treatment effects in the adjacent brain parenchyma.2.The shunted ventricular system is unchanged in size, with a possible punctate fragment of epidermoid in the right occipital horn.


Instruction: Generate impression based on findings.

Input: 59-year-old male with elevated PSA PELVIS:PROSTATE:Prostate Size: 6.3 x 4.2 x 4.9 cm.Peripheral Zone: There is a 9 x 3 mm T2 hypointense focus with corresponding restricted diffusion in the midline peripheral zone base. An adjacent 5 mm hypointense focus in the contralateral right paramedian peripheral zone base may be contiguous with this lesion. Additional 4 mm focus in the right peripheral zone base with apparent corresponding restricted diffusion is noted.Central Gland: Moderate to severe degree benign prostatic hypertrophy.Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: Not present.BLADDER: No significant abnormality noted.LYMPH NODES: There is a 5 mm right external iliac lymph node. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Suspicious lesion in the midline peripheral zone base with extension to the contralateral right paramedian peripheral zone is amenable to biopsy.2.Additional 4 mm focus in the right peripheral zone base.


Instruction: Generate impression based on findings.

Input: 46 years, Female, paresthesias. Evaluate for demyelinating lesions. Brain: There are approximately 10 T2/FLAIR hyperintense lesions involving the periventricular and subcortical white matter. Many of these lesions are noted to be in a periventricular, perpendicular orientation as well as along the callososeptal interface highly suspicious for demyelinating disease. Although differences in technique limiting precise comparison, there are relatively larger lesions such as involving the posterior callosal body as well as the right parietal subcortical white matter which are convincingly new since prior. Few lesions with T1 hypointensity are also noted. Brain parenchymal volume is preserved. No intracranial mass or mass effect. No midline shift or herniation. Small bilateral maxillary mucus retention cysts are again seen.Cervical spine: Again seen is a T2 hyperintense lesion involving the cord in the dorsal midline at the C3 level, which is slightly decreased in size and compatible with evolution. No new lesion is definitively appreciated compared to 7/10/2015.Vertebral body heights in the cervical spine are normal. There is mild reversal of cervical lordosis at the C4-C5 level, which may be in part positional. Again seen is generalized T1 hypointensity involving the bone marrow signal which is nonspecific but can be seen in conditions such as chronic anemias. No discrete destructive osseous lesions are demonstrated. Mild multilevel degenerative changes are again seen including a disc extrusion at the C4-C5 level which contacts the ventral cord, without high-grade spinal canal stenosis overall at this level and similar to prior. Neural foramina throughout the cervical spine are patent.

Output: 1. Multiple T2/FLAIR hyperintense lesions in the supratentorial white matter are highly suspicious for demyelinating disease. Although differences in technique limit comparison, there does appear to be progression since 7/14/2015. For example, there are new lesions involving the right callosal body and right parietal lobe subcortical white matter. 2. Dorsal C3 cord lesion, which demonstrated enhancement on prior study, demonstrates slight decrease in size since 7/10/2015 and compatible with evolution. No new lesions within the cervical cord are appreciated.3. No significant change in disc extrusion at the C4-C5 level, which contacts the ventral cord without associated cord signal abnormality.


Instruction: Generate impression based on findings.

Input: Male, 25 years old, with diagnosis of von Hippel-Lindau disease, history of spinal hemangioblastoma, evaluate for growth of pre-existing lesion and for any new brain/spine lesions. Brain:No evidence of parenchymal edema or mass effect is seen. No pathologic parenchymal or leptomeningeal enhancement is seen. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid. The ventricles are normal in size and morphology. Opacification of the left mastoid air cells is seen.Spine:A 6 mm enhancing nodule is present along the dorsal surface of the spinal cord at the T10 level. At the same level of the cord, there is a cystic cavity somewhat eccentrically located within the left aspect of the cord measuring up to 7 mm in diameter and up to 21 mm in craniocaudal length. Associated cord edema extends from T7 down to T11.No additional masslike lesions are seen anywhere along the spinal cord or cauda equina. No epidural abnormalities are suspected.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow enhancement is seen. No significant disc degeneration is noted. The spinal canal and neural foramina are patent.

Output: 1.An enhancing nodule is evident along the dorsal surface of the spinal cord at the T10 level with an associated intramedullary cyst. Findings are compatible with a hemangioblastoma. Edema arising from this lesion extends up to T7 and down to T11.2.No additional hemangioblastomas are suspected within the spine.3.No lesions are seen intracranially to suggest additional hemangioblastomas. Evaluation of the brain is within normal limits.


Instruction: Generate impression based on findings.

Input: History of neuroblastoma of lumbar spine, relapse x 2 s/p chemo, transplant: weight loss, fatigue, sweats. Extreme worsening back pain, and numbness of left foot (baseline). There are postoperative findings related to laminectomies from T11-T12 to L4-L5. There is a redemonstration of an enhancing extradural mass in the right aspect of the canal from L2 to L4 with scalloping of the posterior vertebral bodies and extension through the right L2-L3 and L3-L4 neural foramina with associated compression of the respective nerve roots. The mass measures up to approximately 6 cm in length and 3 cm in width and results in moderate spinal canal stenosis. The imaged portions of the spinal cord are unremarkable. The vertebral body heights are mildly reduced at L2 through L4. There is kyphotic deformity of the lumbar spine centered at L2. There is atrophy of the right psoas muscle. There are bilateral renal cysts.

Output: 1. Postoperative findings related to laminectomies from T11-T12 to L4-L5 and redemonstration of residual neuroblastoma in the right aspect of the canal from L2 to L4 with extension through the right L2-L3 and L3-L4 neural foramina and moderate spinal canal narrowing. 2. Kyphotic deformity of the lumbar spine centered at L2 may be related to insufficient biomechanical support related to surgical anatomic alterations..


Instruction: Generate impression based on findings.

Input: There is no evidence of acute infarction, intracranial hemorrhage, or mass lesions. There is unchanged moderate T2 hyperintensity within the supratentorial and infratentorial cerebral white matter, which are likely related to micrangiopathy. There are also punctate foci of encephalomalacic in the left cerebellar hemisphere and left basal ganglia that likely represent chronic infarcts. There is a left hippocampal remnant cyst. The ventricles and sulci are stable in size and configuration. The major cerebral flow voids are grossly intact. There is a small amount of fluid within the bilateral mastoid air cells. There are bilateral lens implants.

Output: 1.No evidence of acute infarct, mass lesion, or intracranial hemorrhage.2.Unchanged moderate cerebral white matter signal abnormality likely related to microangiopathy and punctate foci of encephalomalacia in the left cerebellar hemisphere and left basal ganglia that likely represent chronic infarcts.


Instruction: Generate impression based on findings.

Input: 72-year-old female with history of right lower extremity radicular symptoms. Evaluate for degenerative disc disease or neuroforaminal compromise. Exam is limited by patient's body habitus.Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is mild to moderate loss of disc height at L4-5 with vacuum phenomenon. There is a grade 1/2 anterolisthesis of L4 on L5 measuring approximately 9 mm. There is no definitive MR evidence of a pars defect. Bone marrow signal is benign. The conus medullaris is normal in position terminating at the level of L1-2. There is fatty atrophy of the right psoas and iliacus muscles. There is an incompletely imaged round T2 hyperintense lesion within the right aspect of the pelvis seen only at the edge of the sagittal series. Multilevel degenerative changes are seen, as described below:Sagittal images demonstrate a trace disc bulge at T10-11 and T11-12. L1-L2: No significant disc disease. Mild ligamentum flavum and facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L2-L3: There are shallow foraminal disc protrusions encroaching on the neuroforamina. Mild ligamentum flavum and facet hypertrophy. No significant spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge with shallow bilateral foraminal disc protrusions and ligamentum flavum hypertrophy resulting in mild bilateral neuroforaminal stenosis. There is no significant spinal canal stenosis. L4-L5: There is disc bulge and uncovering with a superimposed central extrusion component extending 9 mm cranially. There is a central/right paracentral annular fissure which extends into the area of extruded disc. Additionally, there is ligamentum flavum and facet hypertrophy. These findings result in moderate spinal canal stenosis, moderate to severe neuroforaminal stenosis on the right and moderate neuroforaminal stenosis on the left. There is a left facet effusion.L5-S1: There is mild disc bulge with a left paracentral extrusion component extending 5 mm cranially as well as ligamentum flavum and facet hypertrophy resulting in mild left neuroforaminal narrowing. No significant spinal canal stenosis. There are bilateral facet joint effusions.

Output: 1. Grade 1/2 anterolisthesis of L4 on L5, degenerative in etiology, measuring approximately 9 mm with associated degenerative disc disease resulting in moderate spinal canal stenosis, moderate to severe right and moderate left neuroforaminal stenosis. No MR evidence of pars fracture.2. Advanced bilateral facet arthropathy at L4-5 and L5-S1.3. Partially imaged round T2 hyperintense lesion within the right aspect of the pelvis seen only at the edge of the sagittal series, but may relate to the right ovary. This is incompletely evaluated and correlation with dedicated pelvic ultrasound is recommended.


Instruction: Generate impression based on findings.

Input: Right C7 radiculopathy Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Minimal disc osteophyte complex. There is minimal spinal canal narrowing with partial effacement of the ventral and dorsal thecal sac. Overall no significant spinal canal or neural foraminal stenosis.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy. There is partial effacement of the ventral thecal sac without significant spinal canal stenosis. There is moderate right neural foraminal stenosis. No significant left neural foraminal stenosis.C5-6: Bilateral uncovertebral hypertrophy with mild to moderate left and mild right neural foraminal stenosis. No significant spinal canal stenosis.C6-7: There is uncovertebral hypertrophy with moderate right and no significant left neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.

Output: Mild to moderate degenerative changes in the cervical spine as detailed above including neural foraminal stenosis at the right C6-C7 level which may be contributing to patient's reported right C7 radiculopathy.


Instruction: Generate impression based on findings.

Input: Tuberous sclerosis with SEGAs: worsened headache. There are stigmata of tuberous sclerosis complex, including multiple "cortical tubers" and subependymal nodules. In particular, there is no significant interval change in size of the nodule in the left foramen of Monro region, which measures up to 16 mm or the nodule in the right foramen of Monro region, which measures up to 14 mm. The ventricles are unchanged in size and configuration. There is no evidence of intracranial hemorrhage or acute infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a right maxillary sinus retention cyst.

Output: Unchanged stigmata of tuberous sclerosis complex, including the bilateral subependymal giant astrocytomas.


Instruction: Generate impression based on findings.

Input: 81-year-old female with cholestasis and elevated LFTs Examination limited by respiratory artifact.ABDOMEN:LUNG BASES: Small pleural effusions.LIVER, BILIARY TRACT: No focal hepatic lesions. Perihepatic ascites. The portal and hepatic veins are suboptimally evaluated but appear patent. Cholelithiasis without biliary ductal dilation or choledocholithiasis. SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific edema about the pancreatic head.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, the largest measuring up to 13 cm in the left lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.Cholelithiasis without biliary ductal dilation or choledocholithiasis.2.Small pleural effusions and small amount of ascites.


Instruction: Generate impression based on findings.

Input: The intra-articular contrast remains within the distal radial ulnar joint. No intra-articular contrast is identified within the radiocarpal joint to suggest disruption of the triangular fibrocartilage complex. There is positive ulnar variance..Exposure time: 1 minute and 17 seconds.

Output: Right wrist arthrogram without evidence of disruption of the triangular fibrocartilage complex. Note is made of positive ulnar variance.


Instruction: Generate impression based on findings.

Input: One year follow up for meningioma and history of Alzheimer's disease. There is no appreciable change in the subcentimeter enhancing extra-axial mass along the left temporal convexity. There is unchanged nonspecific mild patchy cerebral white matter T2 hyperintensity. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No appreciable change in the subcentimeter enhancing extra-axial mass along the left temporal convexity, which likely represents a meningioma.


Instruction: Generate impression based on findings.

Input: 10 year old with glioblastoma treated with radiation and temozolomide. There are postoperative findings related to right transfrontal biopsy of the brainstem. There is unchanged patchy T2 hyperintensity in the right aspect of the posterior pons and midbrain, as well as the medial thalamus. There are also unchanged foci of intrinsic T1 hyperintensity in the vicinity, but no convincing areas of abnormal enhancement There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: No evidence of tumor progression.


Instruction: Generate impression based on findings.

Input: 83 year old woman with history of hypertension, breast cancer and ALL s/p chemotherapy with worsening LVH and diastolic dysfunction on echocardiogram; referred for cardiac MRI to evaluate for possible amyloidosis or infiltrate cardiomyopathy. Left VentricleThe left ventricle is normal sized with mildly reduced systolic function. There is LVH; on the 3 chamber view at end diastole, the anterior septum measures 23 mm. The basal inferolateral wall measures 18 mm. The overall LV ejection fraction is 49%, the LV end diastolic volume index is 67 ml/m2 (normal range: 65+/-11), the LVEDV is 136 ml (normal range 109+/-23), the LV end systolic volume index is 34 ml/m2 (normal range 18+/-5), the LVESV is 70 ml (normal range 31+/-10), the LV mass index is 84 g/m2 (normal range 67+/-11), and the LV mass is 172 g (normal range 114+/-24). There is hypokinesis of the basal segments, with preserved apical wall motion. There are diffuse, mid myocardial areas of intermediate late gadolinium enhancement involving the septum, lateral, anterior and basal inferior walls. There is late gadolinium enhancement in the right ventricular wall, as well as left atrium and adjacent to the mitral apparatus. There is shortening of the T1 inversion time post gadolinium administration. These findings are suggestive of an infiltrative process, such as amyloidosis. No intracardiac thrombus is present.Left AtriumThe left atrium is moderately dilated.Right VentricleThe right ventricle is normal in size with moderately reduced systolic function. The overall RV ejection fraction is 37%, the RV end diastolic volume index is 65 ml/m2 (normal range 69+/-14), the RVEDV is 133 ml (normal range 110+/-24), the RV end systolic volume index is 41 ml/m2 (normal range 22+/-8), and the RVESV is 83 ml (normal range 35+/-13). Enhancement is demonstrated by the right ventricular wall in the mid myocardial distribution, atypical for infarct.Right AtriumThe right atrium is moderately severely dilated. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is trivial mitral regurgitation, but the severity of mitral regurgitation can be underestimated by the MRI pulse sequence used in this study.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation, but the severity of tricuspid regurgitation can be underestimated by the MRI pulse sequence used in this study.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC is normal in size and drains normally into the right atrium. The IVC appears dilated.PericardiumThere is a small pericardial effusion.Extracardiac FindingsThere are bilateral pleural effusions, right greater than left. There is focal high signal within the left lower lobe, suggestive of aspiration. This is new since the radiograph of May 2015.

Output: 1. Impaired left ventricular systolic function with EF 49%, and relative hypokinesis of the basal segments. There is basal LVH. Diffuse mid myocardial enhancement throughout the left ventricle, right ventricular free wall and left atrium. Findings are compatible with cardiac amyloidosis.2. Reduced right ventricular systolic function with EF 37% 3. Biatrial dilatation. 4. Trivial mitral regurgitation and mild tricuspid regurgitation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.