Instruction: Generate impression based on findings.

Input: Status post fall down 3 stairs. Evaluate for instability and ligamentous injury. The incomplete fusion of the anterior arch of C1, C1 retrosomatic cleft, and absence of the right posterior arch of C1 are better depicted on the prior CT. There appears to be mild high T2 signal and swelling of the prevertebral soft tissues at the C1 through C3 levels and a small amount of fluid anterior to the dens. There also appears to be mild high T2 signal in the anterior C1 vertebra. The anterior atlanto-axial ligament appears attenuated inferiorly, but the apical ligament and tectorial membrane appear to be grossly intact. There is no abnormal signal in the spinal cord. The vertebral body heights and disc spaces are preserved. There is no significant spinal canal stenosis. There is mild heterogeneity of the thyroid gland and a nodule along the inferior aspect of the left thyroid lobe that measures up to 10 mm.

Output: 1. Suggestion of mild prevertebral edema at the C1 through C3 levels and apparent mild bone marrow edema in C1 and perhaps partial disruption of the anterior atlanto-axial ligament, which features developmental anomalies that are better depicted on the recent CT, but no evidence of spinal cord injury or subluxation. The constellation of findings may be related to acute traumatic injury and/or reactive changes related to the biomechanical alteration associated with the underlying C1 vertebra developmental anomaly. However, assessment for instability is not feasible without flexion and extension images.2. No evidence of cervical spinal cord injury.3. Mild heterogeneity of the thyroid gland and a nodule along the inferior aspect of the left thyroid lobe, which may represent a lymph node or exophytic thyroid lesion. A thyroid ultrasound may be useful for further evaluation.


Instruction: Generate impression based on findings.

Input: 55 year old with FNA proven carcinoma at 2 sites in the right breast (3 and 9 o'clock position) presents for MRI evaluation. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:Following multiple suspicious lesions (all measurements: AP x LR x CC) are present;An irregularly shaped enhancing mass (21 x 19 x 14 mm) at anterior 3 o'clock positionAn irregularly shaped enhancing mass (19 x 16 x 16 mm) at posterior 9 o'clock positionA round enhancing mass (10 x 9 x 10 mm) with ill-defined margins at posterior 12 o'clock positionEnhancing subcentimeter masses at posterior 3 and 8 o'clock positionLEFT BREAST:No abnormal enhancement is seen in left breast. AXILLAE:No abnormal lymph nodes are identified in either axillary region.

Output: Multicentric cancer in the right breastBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Multiple hypodensities on CT involving splenium corporis callosum c/f demyelination versus embolic stroke: mild left hemiparesis, fatigue. MRI Brain: There are multiple areas of restricted diffusion in the right cerebral hemisphere, including the right occipital lobe, right corona radiata, cortex of the post central gyrus, and splenium of the right corpus callosum. These lesions display abnormal high T2 signal. There is also enhancement associated with the occipital and right corpus callosal lesion. There is no evidence of intracranial hemorrhage or mass. The pituitary gland appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The right posterior cerebral artery is occluded distal to the origin of the posterior communicating artery (P2). There also appears to be focal narrowing of the distal left posterior cerebral artery P1 segment. There is also focal loss of flow related enhancement in the distal right M1 middle cerebral artery segment. The rest middle and anterior cerebral arteries appear to be patent. The intracranial internal carotid arteries demonstrate no significant stenosis. The vertebral arteries, and basilar arteries also are patent with no significant stenosis. There is no evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion. There appear to be several small thyroid nodules.

Output: 1. Findings compatible with multiple right cerebral hemisphere subacute infarcts involving multiple vascular territories.2. The right posterior cerebral artery is occluded distal to the origin of the posterior communicating artery (P2) and distal right M1 middle cerebral artery segment.3. No significant steno-occlusive disease in the neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Left breast invasive mammary carcinoma grade 2 with a satellite lesion located immediately inferiorly on MRI presents for bracketed needle localization. On review of the prior studies, a spiculate mass is identified in the left lower outer quadrant. Target spiculated mass morphology are located in the left breast in the lower outer quadrant region located in mid-breast 3 o’clock. A focal asymmetry immediately inferior to the mass seen on MRI is not definitely seen on the mammogram or on the specimen. The procedure, risks including bleeding, mistargeting and infection, and benefits of bracketed needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using inferior to superior approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a posterior 9 cm Kopans needle was placed along the posterior aspect of the spiculated mass. Using coordinates from the grid, an anterior 7 cm Kopans needle was placed along the anterior aspect of the spiculated mass possibly covering the inferior focal asymmetry seen on MRI. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Kulkarni, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass, calcifications and spring wires to be within the specimen. The spiculations reach up to the lateral margin and therefore additional lateral margin was obtained which was not imaged.

Output: Successful bracketed needle localization of the left breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: 58 years Female (DOB:9/27/1958)Reason: rule out structural etiology for new headaches History: New sudden onset sharp HAPROVIDER/ATTENDING NAME: NAOUM ISSA SERVICES ANCILLARY The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right transverse and sigmoid sinuses are larger relative to their left sided counterparts.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on findings.

Input: Lung mass, evaluate brain metastases. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild diffuse cerebral volume loss. There is a subcentimeter focus of encephalomalacia in the left caudate. There is also mild scattered cerebral white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is a retention cyst or secretions in the right ethmoid air cells.

Output: 1. No evidence of acute intracranial mass, although the lack of intravenous contrast limits the assessment for metastatic disease. (A minor contrast extravasation occurred and further attempts for intravenous line insertion were declined.)2. Probable chronic small vessel white matter ischemic disease and a chronic left caudate lacunar infarct.


Instruction: Generate impression based on findings.

Input: Preoperative planning for a brain tumor. Altered mental status. There is an enhancing bithalamic mass with extension into the posterior basal ganglia on the left side, which measures up to 36 mm. There is diffuse T2 hyperintensity in the right limbic system distribution and in the posterior corpus callosum. There is also a T2 hyperintense left medial temporal lesion and a punctate focus of encephalomalacia in the right caudate nucleus. There is effacement of the third ventricle and dilatation of the bilateral lateral ventricles. There is no midline shift or herniation. There are skin fiducial markers.

Output: 1. Preoperative planing MRI for a bithalamic mass that likely represents a high-grade glioma with associated obstructive hydrocephalus. Abnormality in the right limbic system distribution and posterior corpus callosum may be related to seizure activity and/or non-enhancing tumor infiltration, but is incompletely assessed on these limited surgical planning images. 2. Unchanged left medial temporal lesion. 3. Chronic punctate lacunar infarct in the right caudate nucleus.


Instruction: Generate impression based on findings.

Input: Clinical question: Explanation for leg pain. Signs and symptoms: Left leg pain, numbness. Pre and post enhanced lumbar MRI:T10-T11, T11-T12, T12-L1, L1-L2 and L2-L3 levels demonstrate no spinal stenosis or neural foraminal compromise. Minimal hypertrophic changes of posterior elements are present.L3-L4 demonstrate moderate disc disease and loss of disc height, mild right facet and ligamentum flavum hypertrophy and left-sided prior laminectomy with resultant mild expansion of thecal sac. There is a central and left for small disc protrusion at this level which results in mild flattening of the thecal sac. No evidence of spinal stenosis or neural foraminal compromise. Expected mild posterior epidural thickening at the surgical site with enhancement is noted.L4-L5 demonstrate moderate disc disease and loss of disc height, central and leftward disc extrusion with evidence of inferior migration of disc fragment posterior to the body of L5 on the left. Finding results in significant left lateral recess compromise, moderate central spinal stenosis and patent bilateral neural foramina.L5-S1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet hypertrophy and mild right ligamentum flavum hypertrophy is also noted. There is evidence of a prior left-sided laminectomy with resultant localized expansion of thecal sac posteriorly. There is widening of the appearance space along the left lateral aspect of the thecal sac along the surgical path with expected enhancement representing epidural scarring. The enhancement extends anteriorly and is inseparable from the left S1 nerve root. There is a shallow central and left paramedian broadbase disc protrusion at this level with subtle mass effect on the thecal sac. No convincing evidence of central spinal stenosis however mild decreased caliber of thecal sac from left sided epidural scarring is noted. Additionally note is made of a right-sided far lateral small disc protrusion resulting in moderate right neural foraminal and right lateral recess compromise.

Output: 1.L3-L4 demonstrate small central and leftward disc protrusion and evidence of a prior left-sided laminectomy without spinal stenosis.2.L4-L5 demonstrates a central and leftward disc herniation and with inferior migration of the disc fragment on the left which is often significant left lateral recess and moderate central spinal stenosis and without neural foraminal. There is evidence of left-sided laminectomy at this level also as detailed.3.L5-S1 demonstrate postoperative changes of left sided laminectomy with mild expansion of thecal sac. Left-sided epidural thickening and enhancement suggestive of epidural fibrosis/scarring. A central and left paramedian shallow disc protrusion with subtle mass effect on the thecal sac is noted. A right-sided far lateral shallow broad-based disc protrusion at this level with resultant moderate right neural foraminal and lateral recess compromise.


Instruction: Generate impression based on findings.

Input: 97-year-old female with sacral ulcer, evaluate for osteomyelitis The bones appear demineralized suggestive of osteopenia. Severe degenerative disease affects the visualized lower lumbar spine. Moderate osteoarthritis affects bilateral hips.The sacrum cannot be adequately evaluated due to overlying bowel gas and stool. A lateral view may be considered. If there is persistent clinical concern for osteomyelitis, MRI is recommended.Foley catheter and vascular calcifications are noted.

Output: 1.The sacrum cannot be adequately evaluated due to overlying bowel gas and stool. A lateral view may be considered. If there is persistent clinical concern for osteomyelitis, MRI is recommended.2.Degenerative disease as described above.


Instruction: Generate impression based on findings.

Input: Pituitary MRI dated 1/15/15. There is a hypoenhancing lesion within the right pituitary gland that measures up to 12 AP x 10 SI x 15 RL mm and protrudes slightly into the right cavernous sinus. There is no mass effect upon the optic apparatus. The pituitary stalk is intact. There is an unchanged punctate T2 hyperintense lesion is along the dorsal aspect of the clivus.

Output: 1. No significant interval change in the right pituitary adenoma.2. Unchanged probable ecchordosis physaliphora


Instruction: Generate impression based on findings.

Input: 57-year-old female with a new headache with a lung nodule and history of sarcoidosis. Evaluate for mass or evidence of neurosarcoid. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no evidence of abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of scattered fluid in the ethmoid sinuses. The right globe is small and deformed with what appears to be diffuse retinochoroidal enhancement.

Output: 1. No gross intracranial stigmata of neurosarcoidosis.2. Abnormality involving the right orbit may be related to trauma.


Instruction: Generate impression based on findings.

Input: Diagnosis: Lumbago with sciatica, right side Lumbago with sciatica, left sideClinical question: low back and leg painSigns and Symptoms: low back and leg pain Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is loss of disc space height and disc desiccation as well as a diffuse disc bulge. There are some endplate reactive changes at this level which are high signal on T1 and low signal on T2 STIR. The fat at the lateral recess bilaterally and the fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a disc bulge present at this level associated with loss of disc space height and disc desiccation. There is mild ligamentum flavum hypertrophy at this level. The fat at the lateral recess bilaterally and the fat surrounding the exiting nerve roots within the neural foramina is not effaced at this level.At L3-4 there is a large central disc extrusion present which compresses the thecal sac and effaces spinal fluid surrounding the nerve roots creating a moderate degree of spinal stenosis. The fat at the right lateral recesses partially effaced at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is disc desiccation present associated loss of disc space height at T12-L1 and T11-T12 associated with a minor disc bulge at T11-T12.

Output: There are multilevel degenerative changes present in the lumbar spine mainly in the form of disc disease. This is worse at L3-4 there is a moderate degree of spinal stenosis as a result of a central disc extrusion associated with encroachment of the right lateral recess more than the left lateral recess nerve roots.


Instruction: Generate impression based on findings.

Input: Reason: synovitis without erosions . History: pain and swelling negative wrist x-ray LIGAMENTS: The scapholunate and lunotriquetral ligaments appear intact within the limitations of a non arthrogram examination.TRIANGULAR FIBROCARTILAGE COMPLEX: Motion artifact limits evaluation of the intrinsic ligaments and triangular fibrocartilage complex. There is increased signal abnormality and indistinctness of the ulnar aspect of the triangular fibrocartilage complex indicating erosion of the ulnar styloid and foveal attachments. TENDONS: There is circumferential fluid within the tendon sheath of the extensor carpi ulnaris as well as foci of low signal intensity debris indicating a tenosynovitis. The flexor and extensor tendons appear intact.BONES: There is a small erosion along the ulnar aspect of the triquetrum with associated increased bone marrow signal abnormality on fluid sensitive sequences. Otherwise no erosions are evident.ADDITIONAL

Output: Findings consistent with the patient's known history of rheumatoid arthritis, including a small carpal bone erosion and synovitis, as described above.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:11/12/1952)Reason: eval for worsening osteomyelitis History: eval for worsening osteomyelitisPROVIDER/ATTENDING NAME: YASMIN H. KARIMI Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Exam is degraded due to motion artifact.Incidental note is made of partial empty sella.MRI thoracic spine:At T11-T12 there is erosion of the endplates and T2 signal hyperintensity within the T11-T12 vertebral bodies as well as the T11-T12 disc. There appears to be some adjacent epidural thickening which is not well imaged on this exam. This involves predominantly in the right hemicord canal and right anterior aspect of the spinal canal. Compared to the 11/23/2016 exam the epidural component appears to be slightly thicker..A lesion adjacent to the aorta at the L3 vertebral level is not well imaged on this exam. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There is a large left renal cyst present measuring 46 x 34 mm axial dimensions which is incompletely visualized on this exam.

Output: 1.Findings are suspicious for T11-T12 discitis osteomyelitis and possibly epidural involvement. Compared to the prior exam the subdural component appears to be thicker on the current exam.2.A periaortic lesion is not well demonstrated on this exam because it is at the periphery of the imaging. It is not clear if this has progressed.3.To the extent of visualization is no compromise of the cervical spinal cord or exiting nerve roots. Please note that the cervical spine exam is degraded by patient motion and lack of axial imaging.4.Thoracic spine exam is degraded due to patient motion and likely of intravenous contrast administration.


Instruction: Generate impression based on findings.

Input: 33 year old female with PFO, TIA, mild LV dysfunction, pre-endometrial surgery. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 57%. The LVEDV is 99 ml (normal range 109+/-23), LV end diastolic volume index is 58 ml/m2 (normal range: 65+/-11), LVESV is 42 ml (normal range 31+/-10), and LV end systolic volume index is 25 ml/m2 (normal range 18+/-5). The LV mass is 58 g (normal range 114+/-24) and the LV mass index is 34 g/m2 (normal range 67+/-11). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is an crescent shaped artifact on the late gadolinium enhancement images along the anterolateral and inferolateral wall of the left ventricle.There is no LV thrombus. No evidence of myocardial iron overload. Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 53%, the RV end diastolic volume index is 62 ml/m2 (normal range 69+/-14), the RVEDV is 107 ml (normal range 110+/-24), the RV end systolic volume index is 29 ml/m2 (normal range 22+/-8), and the RVESV is 50 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve is trileaflet, opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1.Normal sized left ventricle with normal systolic function (LVEF 57%) without evidence of underlying myocardial fibrosis inflammation or infiltration.2.Normal sized right ventricle with normal systolic function (RVEF 53%).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Clinical question: 25 years old male with fevers, vomiting, headaches, mental status change. Rule out intracranial increase pressure, mass, bleed. Signs and symptoms: Altered mental status, vomiting, fever and headaches. Non-enhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass, mass effect, midline shift or hydrocephalus.There is evidence of a prior in the right posterior temporal -- occipital junction with the extensor and inferior to the suboccipital region. There is underlying parenchymal encephalomalacia of right cerebellum and right occipital lobe. Please correlate with history regarding the reason for surgery. Follow-up with an MRI is recommended if there was a recurrence of tumor at this site. No acute finding on the current exam.Images through posterior fossa also demonstrate bilateral patchy and linear calcification that may be result of prior treatment. There is also ex vacuo dilatation of the fourth ventricle. Patchy calcification within the pons is also noted. This finding may be also result of prior treatment or a cavernoma. This finding and may also further evaluated with an MRI examination.Other than above described craniotomy calvarium is intact.Visualized mastoid air cells and middle ear cavities are unremarkable.There is limited view of paranasal sinuses are unremarkable.

Output: 1.No evidence of acute intracranial findings.2.Focal encephalomalacia right occipital and right cerebellum under a right-sided posterior temporal, occipital, suboccipital craniotomy site. Please correlate with past medical history.3.Patchy calcification of bilateral cerebellum may be result of prior treatment.4.Patchy calcification of the pons could result of prior treatment and or a cavernoma.5.If clinical concern persist recommend follow-up with an MRI exam.


Instruction: Generate impression based on findings.

Input: The imaged portions of the facial nerves are grossly unremarkable. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is nonspecific high T2 signal within a few right mastoid air cells.

Output: No evidence of acute infarct or intracranial mass lesions.


Instruction: Generate impression based on findings.

Input: Evaluate for progression of leptomeningeal carcinomatosis from breast cancer treated with WBRT. The abnormal leptomeningeal enhancement has markedly diminished and there is minimal residual T2-FLAIR hyperintensity in the left parietal sulci. There is no evidence of intraparenchymal abnormal enhancement. There is unchanged nonspecific patchy T2 hyperintensity in the periventricular white matter, particularly in the parietal regions. There is no evidence of intracranial hemorrhage, mass, or acute infarct.. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.

Output: 1. Interval improvement in the leptomeningeal carcinomatosis.2. No evidence of intraparenchymal metastases.


Instruction: Generate impression based on findings.

Input: Follow up previous MRI abnormal signal: seizure, and free of seizure for 8 months. There is unchanged high T2 signal in the white matter of the inferior right precentral gyrus in a linear and branching configuration. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Unchanged high T2 signal in the white matter of the inferior right precentral gyrus, without abnormal enhancement. This may represent prominent perivascular spaces or migrational abnormality, for example, and less likely a neoplastic process.


Instruction: Generate impression based on findings.

Input: History of myocarditis in 2/2015, repeat at 4 months to evaluate function and delayed gadolinium enhancement Left VentricleThe left ventricle is normal in size. The contractility has slightly improved with the overall LV ejection fraction equal to 55%, as compared to 53% on the prior exam. The LV end diastolic volume index is 68 ml/m2 (normal range: 74+/-15), the LVEDV is 153 ml (normal range 142+/-34), the LV end systolic volume index is 30 ml/m2 (normal range 25+/-9), the LVESV is 68 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 124 g (normal range 164+/-36). There are no regional wall motion abnormalities present. Using similar dose of MultiHance, the enhancement of the left ventricular myocardium is reduced in extent. It is again noted in an epicardial distribution at the mid inferolateral and apical lateral wall. A thin rim of epicardial enhancement at the mid anterolateral wall is again noted. No new enhancement is identified.No intracardiac thrombus is present.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 52%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 197 ml (normal range 142+/-31), the RV end systolic volume index is 42 ml/m2 (normal range 31+/-9), and the RVESV is 94 ml (normal range 54+/-17). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely. There is no significant dephasing inferior to the aortic valve to suggest significant aortic regurgitation. Dedicated through plane imaging of the aortic valve was not performed.Mitral ValveThe mitral valve opens widely. There is no significant mitral regurgitation. Dedicated through plane imaging of the mitral valve was not performed.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation visualized. Dedicated through plane imaging of the pulmonic valve was not performed.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation visualized. Dedicated through plane imaging of the tricuspid valve was not performed.AortaThe ascending thoracic aorta is normal in size. There is a left sided aortic arch.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no pericardial thickening or effusion.

Output: 1. Persistent enhancement and epicardial distribution from the mid inferolateral wall extending to the apical lateral wall. A thin rim of enhancement is again noted, not as prominent, at the mid anterolateral wall. The pattern is suggestive of prior myocarditis.2. Left ventricular ejection fraction equal to 55%


Instruction: Generate impression based on findings.

Input: 33-year-old male with history of Peutz-Jeghers and abdominal pain ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy with cystic duct stump. Fatty liver infiltration. SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific 2-3mm cyst in the tail of the pancreas without obvious connection to the main pancreatic duct. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: T2 hyperintense cysts in bilateral kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel caliber is within normal limits without evidence of obstruction. The terminal ileum is within normal limits. BONES, SOFT TISSUES: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Nonspecific 2-3mm cyst in the tail of the pancreas. A 12-24 month follow-up is recommended. 2.No small bowel hamartomas or tumors are evident.


Instruction: Generate impression based on findings.

Input: There is no evidence of intracranial hemorrhage or acute infarct. There are scattered small foci of T2 hyperintensity throughout the supratentorial white matter that are most compatible with chronic small vessel ischemic disease. There is mild global volume loss that is some what more prominent in the parietal lobes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a 4 mm T2 hypointense and T1 hyperintense lesion within the middle of the pituitary gland. The major cerebral flow voids are intact. The craniocervical junction is within normal limits. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.

Output: 1.No evidence of intracranial hemorrhage, acute infarct, or structural abnormality. 2.4 mm pituitary lesion is incompletely evaluated on this exam and may represent a pars intermedia or Rathke's cleft cyst, or a microadenoma. Further characterization with a pituitary MRI suggested.3.Mild presumed chronic small vessel ischemic disease and global volume loss.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate for prior strokes. Signs and symptoms: Dementia. Non-enhanced head CT:There is no detectable hemorrhage, edema, mass-effect, midline shift or hydrocephalus. The cortical sulci, ventricular system and CSF cisterns remain all within normal patient stated age of 86. Very minute amount of periventricular low attenuation could represent minimal small vessel disease of indeterminate age. Entirely exclude a small vessel ischemic stroke as the cause for dementia recommend an MRI examination.Calvarium is intact. Visualized paranasal sinuses and mastoid air cells are unremarkable.

Output: Very minimal small vessel ischemic disease of indeterminate age is suspected. Examination is otherwise unremarkable for patient stated age of 86. MRI examination would significantly better assess the extent of small vessel disease.


Instruction: Generate impression based on findings.

Input: Female, 55 years old, with anaplastic astrocytoma status post RT/TMZ + TMZ. Cortical thickening involving the left anterior temporal tip, the amygdala and insula is unchanged over multiple prior examinations. No pathologic enhancement is seen in these areas. Ill-defined periventricular T2 hyperintensity along the left lateral ventricle is also unchanged and may be related to treatment effect. A few additional scattered punctate foci of subcortical T2 hyperintensity in the adjacent white matter are nonspecific. No pathologic parenchymal enhancement is seen. A developmental venous anomaly is redemonstrated in the left thalamus. Ventricular size and morphology are stable and normal.

Output: Stable thickening of the left anterior temporal tip, amygdala and insula with no specific findings to suggest progressive disease.


Instruction: Generate impression based on findings.

Input: Female, 35 years old. Reason: left shoulder pain History: left shoulder pain ROTATOR CUFF: The rotator cuff tendons and muscles appear normal, without evidence of tear.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a labral injury that represents a superior labral anterior to posterior tear (series 501, image 16).BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: 1.Findings compatible with a superior labral anterior-posterior tear.2.No evidence of rotator cuff tear. Additional findings as above.


Instruction: Generate impression based on findings.

Input: Neuroblastoma with relapse x 2; progression of disease. Extensive diffuse marrow abnormality is seen in the bilateral frontal bones with probable extension into the bilateral parietal bones. Exact extent of tumor is best evaluated with MRI, if clinically indicated. There is a thick band of epidural enhancement in the bifrontal region which measures 7 mm in maximum dimension consistent with epidural spread of tumor (best seen image 15-22). There is minimal mass effect on the superior sagittal sinus which is mildly displaced posteriorly. There is no evidence of intraparenchymal mass or edema. No abnormal leptomeningeal enhancement is seen. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Extensive marrow abnormality in the bilateral frontal bones, probably extending to the bilateral parietal bones consistent with osseous metastases. Thick band of epidural enhancement in the bifrontal region consistent with epidural spread of tumor. Extent of disease may be better evaluated with MRI, if indicated clinically.


Instruction: Generate impression based on findings.

Input: Reason: evaluate posterior circulation History: subacute left occipital stroke MRI of the brainThere is a new focus of diffusion restriciton present involving the medial left occipital lobe centered in the left cuneus but extending to the precuneus, cingulate gyrus and near the calcarine fissure.A mild degree (5-10 in the right hemisphere; 4-7 in the left) of punctate foci of diffusion restriction are present in the anterior circulation bilaterally.There is redemonstration of foci of encephalomalacia centered in the right middle frontal gyrus, right inferior parietal lobule and posterior temporal lobe, right cerebellar hemisphere and medial occipital lobes.Punctate foci of SWI hypointensity are present in the left occipital lobe adjacent to the parieto-occipital sulcus and left cuneus as well as in the right cerebellar hemisphere.There is redemonstration of a punctate T2/FLAIR hyperintense lesion in the left thalamus 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 demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are mediums size. The vertebral arteries are similar in size.MRA neck:The origins of great vessels from the aortic arch are not included on this exam. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. Findings suggest stenosis at the origin of the left vertebral artery.

Output: 1.Findings are compatible with a subacute infarction along the left occipital lobe centered in the left cuneus but extending to the precuneus, cingulate gyrus and near the calcarine fissure.2.Mild degree of microinfarcts are scattered in the anterior circulation territories bilaterally (right more than left).3.MRA on this 1.5T magnet is not able to provide adequate evaluation of the parieto-occipital arteries.4.Old lacunar infarct in the left thalamus.5.Findings suggest stenosis at the origin of the left vertebral artery.6.Multiple foci of encephalomalacia are redemonstrated intracranially (as detailed above) which are likely related to prior foci of infarction.


Instruction: Generate impression based on findings.

Input: There is straightening of the normal cervical lordosis. The vertebral body heights are well-maintained. There is diffuse disc desiccation and degenerative bone marrow signal changes, but no evidence of tumor. At C3-4, a posterior disc osteophyte complex results in central spinal stenosis with compression of the spinal cord, which displays patchy high T2 signal, as well as at least moderate neural foraminal narrowing bilaterally. At C4-5 and C5-6 posterior disc osteophyte complexes result in moderate spinal canal stenosis and bilateral neural foraminal narrowing. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. The paravertebral soft tissues are unremarkable. THORACIC SPINE

Output: 1.Degenerative spondylosis in the cervical spine, in which a disc-osteophyte complex at C3-4 compresses the spinal cord, with associated edema or myelomalacia.2.Prominence ligamentum flavum thickening and possible calcification or ossification with associated moderate narrowing of the spinal canal at T10-11. 3.Degenerative spondylosis in the lumbar spine and congenital narrowing of the spinal canal result in compression of the spinal cord at L1-2 with associated edema or myelomalacia and indentation upon the cauda equina nerve roots at L2-3 and L3-4. In addition, the degenerative spondylosis is associated with moderate neural foraminal stenosis on the left at L3-4 and on the right at L4-5, as well as mild left neural foraminal narrowing at L4-5.4.Patchy enhancement surrounding the L4 through S1 spinous processes may be related to Baastrup disease.5.No gross evidence of lymphoma involving the spine.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Headache [R51], Reason for Study: ^Reason: Pt with year long almost always left sided headache. Exam normal but look for space occupying lesion (MRA coming too). Also look for evidence of pseudotumor - pt with 38 BMI. History: chronic left headache Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion. There is no evidence of abnormal enhancement. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The paranasal sinuses and mastoid air cells are clear.About 3.5mm downward displacement of bilateral cerebellar tonsil through the foramen magnum. There is no evidence of flattening of posterior aspect of eye globe, buckling of optic nerve sheath or extension of CSF space within the optic nerve sheath. Dural sinuses show patent and no evidence of occlusion.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. No brain MR evidence of increased intracranial pressure.3. Normal brain MRA


Instruction: Generate impression based on findings.

Input: Paresthesias, evaluate for multiple sclerosis progression.. There are greater than 10 foci of T2/flair hyperintensity in the bilateral periventricular and subcortical white matter with appearance and distribution compatible with known demyelinating disease. Compared to 3/18/2015, there are no new lesions. Juxtacortical lesion involving the left precentral gyrus again seen. Minimal T1 hypointense lesions such as in the left superior parietal lobule are again seen. Brain parenchymal volume is preserved. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Calvarium and extracranial soft tissues are grossly unremarkable.

Output: No new demyelinating lesions to suggest disease progression.


Instruction: Generate impression based on findings.

Input: Sacral chordoma, restaging Again seen is a lobulated hyperintense lesion centered at the S3 level representing the known sacral chordoma. It now measures approximately 6.3 x 3.1 x 5.2 cm in the greatest transverse, AP and craniocaudal dimensions as compared to 6 x 2.5 x 4.5 cm previously. Again seen is extension of the mass into the anterior presacral soft tissues. An additional small nodule is again seen posterior to the left sacroiliac joint that now measures approximately 3.1 x 2 as compared to 1.9 x 1 cm previously. A third satellite lobular mass posterior to the right paraspinal musculature also appears increased from the prior exam now measuring 3.9 x 3.1 cm as compared to 3.3 x 3 cm previously. Additionally, there is new abnormal marrow signal within the right sacroiliac joint particularly within the ileum posteriorly in the sacrum anteriorly. New abnormal marrow signal also affects the left sacrum. Following contrast administration, there is some peripheral enhancement of the aforementioned lesions with new enhancement of the right sacroiliac joint particularly sacrum. Additional small foci of enhancement are noted in the left gluteal musculature (image 28/52 of series 11)Edema and fluid extending along the posterior inferior right sacrum appears similar to the prior study, which may be postoperative in etiology.There is mild diffuse heterogeneity of the bone marrow which appears similar to the prior study. There is fatty atrophy of the gluteal musculature, right greater than left, appearing similar to the prior study.

Output: Overall progression of sacral chordoma with increasing size of S3 lesion as well as increasing size of satellite lesions within the right paraspinal soft tissues. There is also new abnormal marrow signal and enhancement within the sacrum concerning for progression of disease.


Instruction: Generate impression based on findings.

Input: 38-year-old female with abdominal pain, nausea, vomiting. Evaluate for abdominal pain and any biliary/pancreatic abnormalities. Some sequences are degraded by patient motion artifact. Technologist noted a history of claustrophobia.ABDOMEN:LIVER, BILIARY TRACT: Normal intra and extrahepatic biliary ducts. The distalmost aspect of the common bile duct is not well seen, which is favored to be related to incomplete distention. No upstream ductal dilatation. Normal pre and postcontrast imaging of the hepatic parenchyma. Patent vasculature.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. Normal pancreatic parenchyma.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: 1.No acute abnormality identified.2.The distalmost aspect of the common bile duct is not well seen, which is favored to be related to incomplete distention. No upstream extrahepatic or intrahepatic ductal dilatation seen to suggest underlying stricture or obstruction.


Instruction: Generate impression based on findings.

Input: 65 year old male with a history of coronary artery disease s/p PCI to the left anterior descending artery in 2014 and amyloidosis s/p stem cell transplant in 2015 who is referred for cardiac MRI for further evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 59%, the LV end diastolic volume index is 64 ml/m2 (normal range: 74+/-15), the LVEDV is 138 ml (normal range 142+/-34), the LV end systolic volume index is 26 ml/m2 (normal range 25+/-9), the LVESV is 56 ml (normal range 47+/-19), the LV mass index is 38 g/m2 (normal range 85+/-15), and the LV mass is 84 g (normal range 164+/-36). There is moderate hypertrophy of the left ventricle (IVSd=14mm). The basal myocardial septal T1 relaxation time is 1099ms (upper limits of normal). There is diffuse circumferential late gadolinium enhancement involving the endocardial half of the myocardium. Although not reported on the prior study it was there also. This pattern is strongly suggestive of the diagnosis of cardiac amyloidosis. Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 54 ml/m2 (normal range 82+/-16), the RVEDV is 118 ml (normal range 142+/-31), the RV end systolic volume index is 22 ml/m2 (normal range 31+/-9), and the RVESV is 47 ml (normal range 54+/-17). 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.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThere is a 11x11mm nodule in the right upper lobe of the lung. This is unchanged from the prior study. 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 and systolic function (LVEF 59%). There is moderate left ventricular hypertrophy with global, circumferential late gadolinium enhancement involving the endocardial half of the myocardium. This pattern is strongly suggestive of cardiac amyloidosis. 2. The right ventricle is normal in size and systolic function (RVEF 60%). 3. Mild biatrial enlargement. 4. Right upper lobe lung nodule, unchanged from prior study. 5. When compared to the prior study from 10/2015, the LV wall thickness has increased a little; however, there are no other obvious changes noted. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: History of occasional neck pain and numbness of right hand and fingers for several years. There is straightening of the normal cervical lordosis without subluxation. The vertebral body and disc space heights are grossly preserved. The discs are desiccated. Mild multilevel degenerative endplate changes as well as marginal osteophytes are noted. The spinal canal is congenitally slender. There is focal abnormally increased T2 signal within the spinal cord at C4-5 and C5-C6 with associated thinning of the cord compatible with chronic myelomalacia. The cord is otherwise normal in caliber. The paravertebral soft tissues are grossly unremarkable. C2-C3: Posterior disc osteophyte complex and facet hypertrophy resulting in mild right and moderate left neuroforaminal stenosis. No significant central canal stenosis.C3-C4: Posterior disc osteophyte complex and facet hypertrophy resulting in mild central canal stenosis, severe left neuroforaminal stenosis, and mild right neuroforaminal stenosis.C4-C5: Posterior disc osteophyte complex and facet hypertrophy resulting in moderate central canal stenosis and moderate bilateral neuroforaminal stenosis.C5-C6: Posterior disc osteophyte complex with superimposed focal central component as well as facet hypertrophy resulting in severe spinal canal stenosis and indentation of the spinal cord as well as moderate bilateral neuroforaminal stenosis.C6-C7: Posterior disc osteophyte complex and facet hypertrophy without significant stenosis.C7-T1: No significant central canal or foraminal stenosis.

Output: Congenitally slender spinal canal. Multilevel cervical spondylosis most pronounced at C5-C6 where there is severe central canal stenosis and at C4-C5 where there is moderate central canal stenosis with associated chronic myelomalacia at both of these levels. Additional scattered neuroforaminal stenosis, some of which is severe.


Instruction: Generate impression based on findings.

Input: ORBITS: There is normal appearance of the globes, and extraocular muscles with no signal abnormality appreciated. The optic nerves are symmetric in caliber and signal intensity without mass or discrete abnormality. However, evaluation is limited due to lack of IV contrast.BRAIN: Evaluation is limited due to lack of IV contrast. There are remote postoperative findings related to right anterior temporal lobectomy. There is no acute infarct, mass effect or midline shift. There is increased T2 signal at the margin of the right temporal lobe resection and regional which may be postsurgical. The right fornix is small than the left which may be chronic and secondary to surgery. There is no definite abnormal T2 signal or volume loss in the left hippocampus, although evaluation is limited due to right temporal resection and lack of the contralateral comparison. There are no gray matter heterotopia or gross evidence for cortical dysplasia. The pituitary gland is not enlarged. There mass effect on the optic chiasm.

Output: 1.No intraorbital mass or significant abnormality, although evaluation is limited without IV contrast.2.No gray matter heterotopia or evidence for cortical dysplasia.3.No appreciable volume loss or signal abnormality in the left hippocampus, slightly limited due to lack of contralateral comparison.4.Remote postoperative findings related to right anterior temporal lobectomy.


Instruction: Generate impression based on findings.

Input: Female, 54 years old, with lacrimal gland enlargement. The left lacrimal gland is enlarged relative to the right. However, both lacrimal glands demonstrate similar T2 signal characteristics with only slightly more heterogeneity on the left. No discrete solid or cystic lesion is identified. Enhancement of both lacrimal glands is solid and fairly homogeneous. There are no findings to suggest significant inflammation in the adjacent orbital soft tissues. The extraocular muscles, optic nerve, orbital fat and globe are all within normal limits. Mucosal thickening and evidence for osteogenesis are demonstrated in the right maxillary sinus.

Output: Enlargement of the left lacrimal gland is seen without evidence for a discrete underlying cystic or solid lesion. The differential diagnosis would include inflammation, including idiopathic orbital inflammation (orbital pseudotumor), infectious or postinfectious processes, a manifestation of granulomatous or connective tissue disease. The possibility of a lacrimal gland tumor would remain in the differential as well.


Instruction: Generate impression based on findings.

Input: 71-year-old female with a history of pancreatic mass. Rule out stone or obstruction. ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of intra-or extrahepatic biliary ductal dilation. No gallstones are identified. No common duct stones are seen.SPLEEN: No significant abnormality noted.PANCREAS: There is a 7 x 7 millimeter focus of fluid signal intensity, which communicates with the main pancreatic duct within the body of the pancreas, consistent with a branch type IPMN, corresponding to the findings on recent CT examination (36; series 701). There is no dilation of the main pancreatic duct. No solid or nodular components are identified. There are multiple additional subcentimeter foci of fluid signal intensity in the tail of the pancreas, which also likely represent branch type IPMNs.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter foci of fluid signal intensity are identified within the kidneys bilaterally, which are too small to characterize, but likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple foci of fluid signal intensity in the body and tail of the pancreas, which appear most consistent with subcentimeter branch type IPMNs.


Instruction: Generate impression based on findings.

Input: Paresthesia, intermittent. Evaluate for demyelination. The cranial-cervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable.There is no evidence of abnormal enhancement, cord compression or mass. Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: Minimal bulging of disc, no neuroforaminal narrowing or spinal stenosis. C4-C5: Minimal bulging disc, no neuroforaminal narrowing or spinal stenosis. C5-C6: Minimal posterior disc, no neuroforaminal narrowing or spinal stenosis. C6-C7: no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: Normal spinal cord signal intensity.Minimal bulging discs at the level of C3-4, C4-5 and C5-6 without evidence of spinal canal stenosis or neuroforaminal narrowing. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Reason: New onset of right arm and leg weakness for the past two weeks. History: right arm and leg weakness for the past two weeks. The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal. There is heterogeneous signal within the C4-5 disk space associated with endplate reactive changes which are bright on T2 and dark on T1 and irregularity of the adjacent endplates. There is also associated pre-vertebral signal hyperintensity. There is left-sided facet hypertrophy at this level associated with narrowing of the left neural foramen and encroachment of the left-sided exiting nerve roots.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal. There is a diffuse disk bulge at this level associated with narrowing of the neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are inflammatory changes present the C4-5 disk space. The possibility of this is related to a diskitis cannot be excluded. Given the fact that the patient is on hemodialysis, hemodialysis related arthropathy may be an additional possibility here.2.There is encroachment of the left-sided exiting nerve roots at C4-5 related to left-sided facet hypertrophy.3.There are milder degenerative changes present at C6-7.4.Findings were reported to Andrew Benchman at the time of this dictation.


Instruction: Generate impression based on findings.

Input: Post polio syndrome, status post decompressive surgery in 2004; rule out compression of cord. Prior history of cervical myelopathy and polio now with increasing lower extremity weakness. Cervical spine: Craniovertebral junction appears within normal limits. There are post operative changes related to C4 corpectomy and C3-C5 fusion. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits and unchanged from previous.The cervical spinal cord demonstrates linear areas of increased T2 signal extending from C3 to C5, consistent with myelomalacia which remains unchanged from previous exam.Degenerative changes are seen in the cervical spine as described below:C2-3: There is a central disc osteophyte complex with effacement of the ventral thecal sac, similar to previous exam. There is uncovertebral hypertrophy resulting in mild narrowing of the right neural foramen. No significant spinal canal stenosis. No interval changes.C3-4: No significant disc bulge or compromise to the spinal canal or neural foramina.C4-5: Posterior disc osteophyte complex with mild bilateral foraminal narrowing. There is no significant spinal canal stenosis. No interval changes.C5-6: There is a right paracentral focal disc protrusion with narrowing of the bilateral neural foramina. There is no spinal canal stenosis. No interval changes.C6-7: There is mild disc bulge resulting in mild bilateral neuroforaminal narrowing. No significant compromise to the spinal canal. No interval changes.C7-T1: There is disc bulge resulting in effacement of the ventral thecal sac, unchanged from previous. There is moderate bilateral neural foraminal narrowing. There is minimal if any spinal canal stenosis. No interval changes.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Lumbar spine: There is significant scoliosis of the lumbar spine. There are post surgical changes in the lumbar spine with metallic artifact at S1 and deformation extending through most of the lumbar region on the right. For the purposes of this dictation last fully formed disc is designated L5-S1. The vertebral body heights and disc heights are maintained and unchanged.No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus is low-lying with the conus terminating at the L3 level. Paraspinal soft tissue structures are unremarkable.At L1-L2, there is no significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.At L2-L3, there is no significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.. At L3-L4, there is no significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis..At L4-L5, there is no significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis..At L5-S1, there is no significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.

Output: 1. Postsurgical changes of anterior corpectomy and fusion of the cervical spine from C3 through C5. There is redemonstration of myelomalacia of the cord extending from C3 through C5, without interval changes.2. There are multilevel degenerative disc changes in the cervical spine, overall appearing similar to the previous exam. Degenerative changes are worst at C7-T1 reflecting moderate bilateral neural foraminal narrowing and minimal if any spinal canal stenosis.3. Severe scoliosis and postoperative changes in the lumbar spine. No significant spinal stenosis or neural neuroforaminal compromise noted.4. Low-lying spinal cord with conus terminating at the T3 level.


Instruction: Generate impression based on findings.

Input: 48-year-old male with elbow pain. Evaluate ulnar collateral ligament from the tear. Suboptimal examination secondary to the inability to use a dedicated elbow coil. A flex coil was utilized resulting in suboptimal image quality. Additionally, severely limited examination secondary to a the inability to properly position the patient and respiratory motion artifact related to the patient's ventilator.LIGAMENTS: Note is made of postsurgical changes consistent with the patient's history of prior ulnar collateral ligament reconstruction and ulnar nerve transposition. There is no convincing evidence of re-tear of the ulnar collateral ligament on this limited examination. Foci of metallic susceptibility artifact are presumably postsurgical in etiology. TENDONS: The common flexor and extensor tendons appear intact.ARTICULAR SURFACES AND BONE: There is near full thickness articular cartilage degeneration along the capitellum with underlying subchondral signal abnormality. Severe degenerative changes affect the elbow joint. 2 foci of metallic susceptibility artifact, consistent with surgical anchors, are identified within the olecranon. No additional bone marrow signal abnormality is identified. Multiple subcentimeter ossicles are identified along the medial and lateral epicondyles.SURROUNDING STRUCTURES: Note is made of postsurgical changes consistent with the stated history of ulnar nerve release. Linear low signal intensity abnormality along the medial aspect of the elbow presumably represents scarring from prior surgery.ADDITIONAL

Output: 1. Severely limited examination without convincing evidence of re-tear of the ulnar collateral ligament reconstruction. 2. Severe degenerative changes affect the elbow. 3. Moderate-sized elbow joint effusion.


Instruction: Generate impression based on findings.

Input: 43-year-old female with history of Crohn's disease status post total colectomy with ongoing neurological manifestations without bone formation with question of mesenteric vasculitis. ABDOMEN:MRA: The celiac and SMA arteries are widely patent without significant steno-occlusive disease. No evidence of vasculitis. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post proctocolectomy end ileostomy in the right lower quadrant. A parastomal hernia is again noted without evidence of obstruction. Interval resolution of peristomal edema and increased enhancement. Incomplete distention of proximal small bowel. There are loops of dilated ileum in the right abdomen that subsequently collapse on later sequences favoring peristalsis (series 18, image 20; series 22, 23). No abnormal areas of enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Probable nabothian cysts.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small volume pelvic ascites.

Output: 1.Interval resolution of inflammatory changes involving end ileostomy. No abnormal areas of bowel enhancement. Persistent parastomal hernia.2.No evidence of mesenteric artery stenosis or vasculitis.


Instruction: Generate impression based on findings.

Input: 29 years Female (DOB:7/11/1986)Reason: hx of SLE, eval for lupus cerebritis History: memory issues, blurry visionPROVIDER/ATTENDING NAME: DANA P EDELSON DANA P EDELSON The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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: No abnormal lesions are appreciated within the brain parenchyma to explain the patient's blurry vision and memory issues.


Instruction: Generate impression based on findings.

Input: 46-year-old male with left shoulder pain and left hand weakness. Evaluate for cervical radiculopathy. Examined somewhat motion degraded. The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies are appropriate in height. The bone marrow signal is within normal limits. There is mild multilevel loss of disc height involving the C3-4, C4-5 and C6-7 levels. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Interspace observations:C2-3: No spinal canal or neuroforaminal stenosis.C3-4: Small disc osteophyte complex. Mild left neural foraminal narrowing. No spinal canal stenosis.C4-5: Small disc osteophyte complex eccentric to the left. Mild left neuroforaminal narrowing. No spinal canal stenosis.C5-6: Tiny disc osteophyte complex. Mild/moderate left neuroforaminal narrowing. No spinal canal stenosis.C6-7: Left paracentral disc protrusion which causes effacement of the thecal sac on the left as well as mild indentation indentation of the left aspect of the ventral spinal cord. There is no cord signal abnormality. There is no neural foraminal narrowing.C7-T1 through T2-T3: No significant compromise to the spinal canal or neural foramina.

Output: Degenerative changes including a left paracentral disc protrusion at the C6-7 level which causes effacement of the thecal sac as well as mild indentation of the left aspect of the ventral cord. There is no cord signal abnormality. Left-sided multilevel neural foraminal stenoses as above.


Instruction: Generate impression based on findings.

Input: Left knee pain. Evaluate for lateral meniscus tear. MENISCI: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: There is near full thickness degeneration of the articular cartilage of the inferior aspect of the lateral facet of the patella. The articular cartilage of the medial facet of the patella is preserved. Articular cartilage of the tibiofemoral compartment is intact.Bone marrow signal intensity is within normal limits.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL

Output: 1. No evidence of meniscal tear.2. Degeneration of the articular cartilage along the lateral facet of the patella.3. Baker's cyst.


Instruction: Generate impression based on findings.

Input: Known Chiari and syrinx. Evaluate for change in syrinx. Also evaluate for cord tethering. There is an upper cervical syrinx associated with Chiari 1 malformation. Please refer to the report of the recent brain and cervical spine MRI from February 27, 2016, for more details.The thoracic vertebral column alignment is anatomic in the sagittal plane on the right degenerative. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There is minimal focal (6 mm long) dilatation of the thoracic cord central canal at T9 level, measuring 1 mm x 3 mm axially. Otherwise, the thoracic central canal is prominent between T6-T9 levels. Otherwise, the spinal cord displays normal signal and morphology. The conus medullaris is normal appearing. The tip of the conus medullaris lies at the T12 level, which is normal. The paravertebral soft tissues are unremarkable.

Output: 1.Small thoracic syrinx at T9 level, as described above. Otherwise, the mid/lower thoracic central canal between T6 and T9 levels is prominent.2.Normal position of the conus medullaris.3.Chiari I malformation and upper cervical syrinx. Please refer to the report of the recent brain and cervical spine MRI from February 27, 2016 for more details.


Instruction: Generate impression based on findings.

Input: 3-month-old ex-full term with history of ALTE at home and seizures. Ischemic changes noted on previous MRI. Evaluate for interval change. There is interval resolution in the previously seen mild symmetric apparent diffusion restriction along the perirolandic cortex and within the occipital subcortical white matter. No abnormal diffusion restriction is seen currently. No sequelae of the prior abnormality are noted.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal. No extra-axial fluid collection is identified. The pattern of myelination is normal for age.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.

Output: 1. Interval resolution of the previously seen mild diffusion restriction along the perirolandic cortex and occipital subcortical white matter without definite sequelae.2. No new intracranial abnormality.


Instruction: Generate impression based on findings.

Input: Alzheimer's disease with late onset [G30.1] / Dementia in other diseases classified elsewhere without behavioral disturbance [F02.80], Reason for Study: ^Reason: cognitive decline suggestive of Alzheimer's disease History: Memory decline There is no evidence of acute ischemic or hemorrhagic lesion on the scan.Multifocal scattered FLAIR/T2 high signal intensity on periventricular white matter are nonspecific, most likely represent nonspecific small vessel disease.Diffuse but mild atrophy of brain is seen with prominent Sylvian fissures and CSF spaces on bifrontal lobes.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Prominent CSF spaces especially at bilateral sylvian fissures and bilateral frontal area indicating mild brain atrophy as described above.


Instruction: Generate impression based on findings.

Input: 18-year-old male with a history of germinoma status post biopsy, chemotherapy, radiation therapy now off therapy evaluation. There is no new mass or enhancement in the region of the pineal gland to suggest tumor recurrence. Again seen is susceptibility effect in the pineal region related to chronic blood products and/or mineralization. Again seen are right transfrontal surgical tracts related to prior third ventriculostomy and pineal mass biopsy. No evidence of parenchymal signal abnormality, edema or mass effect is seen. No pathologic parenchymal or meningeal enhancement is observed. The ventricular system is normal in size and morphology. Multiple small mucous retention cysts are seen in the bilateral maxillary sinuses.

Output: Stable examination with no evidence of recurrent tumor in the pineal region.


Instruction: Generate impression based on findings.

Input: Questioning back pain. Left-sided radiculopathy. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is dextroscoliosis of the upper lumbar spine and mild levocurvature of the lower lumbar spine which was also present on prior abdominal CT. There is also minimal retrolisthesis of L1 on L2. There is extensive low T1 signal involving the left aspect of the sacrum with also increased STIR hyperintensity on the sagittal STIR sequence which partially includes the pelvis. Axial T2 images demonstrate linear areas of T2 signal hyperintensity suspicious for insufficiency fracture. The conus medullaris is normal in position.Distended gallbladder with gallstones, cystic lesion involving the pancreatic head, and renal cysts are again seen and better evaluated on prior dedicated abdominal CT. Multilevel degenerative changes are seen, as described below:L1-L2: Mild disc bulge and bilateral facet arthropathy. No spinal canal or neural foraminal stenosis.L2-L3: Mild disc bulge and moderate bilateral facet arthropathy. Minimal narrowing of the spinal canal. There is mild left neural foraminal narrowing. Right neural foramen is patent.L3-L4: Mild disc bulge and moderate facet arthropathy, particularly on the right. There is mild spinal canal stenosis. There is mild narrowing of the left neural foramen. Right neural foramen is patent.L4-L5: Minimal disc bulge and moderate facet arthropathy. No significant spinal canal or neural foraminal stenosis.L5-S1: Minimal disc bulge and advanced bilateral facet arthropathy. There is no significant spinal canal stenosis. There is mild to moderate right-sided neural foraminal stenosis. Left neural foramen is patent.

Output: 1. Multilevel degenerative changes throughout the lumbar spine with scoliosis. There is no high-grade spinal canal or high-grade neural foraminal stenosis at any level. Mild or mild to moderate degrees of stenoses as detailed above.2. There is diffuse low T1 and increased STIR signal throughout the left aspect of the sacrum. There are linear areas of high T2 signal within this region likely representing sacral insufficiency fracture. Pathologic fracture is not excluded and would suggest follow-up MR pelvis evaluation with contrast.Dr. Ali discussed findings with Tanya Roberts (Dr. Datta's nurse) at 1315 hrs on 11/17/2016.


Instruction: Generate impression based on findings.

Input: Absence seizure and memory difficulties. There is a punctate focus of susceptibility effect and enhancement in the right superior frontal sulcus. There is no evidence of intracranial hemorrhage or acute infarct. There are mild nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. 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 are grossly unremarkable. There is scattered paranasal sinus mucosal thickening. There is an enhancing T2 hyperintense lesion in the left parietal skull that measures up to 15 mm in width.

Output: 1. A nonspecific punctate focus of susceptibility effect and enhancement in the right superior frontal sulcus may be neoplastic or vascular in nature. 2. Mild nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. 3. A lesion in the left parietal skull may be neoplastic or vascular in nature. 4. The hippocampi are unremarkable.


Instruction: Generate impression based on findings.

Input: 71 years, Male, Reason: evaluate for HCC History: cirrhosis with rising AFP. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology with recanalization of the umbilical vein.Enhancing right segment 8 lesion with associated increased T2 signal and equivocal washout appears slightly increased in size measuring 3.1 x 1.8 cm, previously 2.7 x 1.7 cm, and now contains a low intensity focus. There are two additional enhancing lesions without enhancement which appears slightly more prominent. Two well-circumscribed segment 7 lesions with intrinsic T1 shortening and without significant enhancement are stable may represent dysplastic nodules.SPLEEN: Splenomegaly.PANCREAS: Cystic lesion in the pancreatic head is slightly decreased in size measuring 1.3 x 1.3 cm (3/99), previously 1.5 x 1.3 cm. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonenhancing left renal cyst with a thin septation is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small periumbilical hernia containing a recannulized periumbilical vein is unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Arterially enhancing segment 8 lesion with equivocal washout appears slightly increased in size suspicious for hepatocellular carcinoma. Two adjacent enhancing lesions may represent additional foci of hepatocellular carcinoma.2.Segment 7 lesions seen on prior exams with intrinsic T1 shortening may represent dysplastic nodules.3.Stable cystic lesion in the pancreatic head.


Instruction: Generate impression based on findings.

Input: Female 89 years old Reason: eval for stone History: gallstone pancreatitis. The absence of intravenous contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LIVER, BILIARY TRACT: Scattered T2 hyperintense lesions within the liver, many of which are too small to characterize. These are incompletely evaluated in the absence of contrast and may represent cysts/hemangiomas. A T2 hyperintense lesion adjacent to the gallbladder may represent an additional liver cyst/hemangioma or alternatively a gallbladder diverticulum. There are no gallstones. There is minimal left intrahepatic duct dilatation. The common duct is within normal limits.SPLEEN: No significant abnormality noted.PANCREAS: There is relatively good preservation of T1 hyperintense signal within the pancreatic body and tail with mild loss in the pancreatic head. The pancreas is mildly enlarged and edematous and demonstrates diffuse diffusion restriction which may reflect acute inflammation in the context of this patient with acute pancreatitis. There is a 6.1 x 1.0 cm pocket of elongated loculated fluid along the duodenum and pancreatic head. There is no pancreatic duct dilatation.Evaluation for vascular complications and for pancreatic necrosis is limited by lack of intravenous contrast.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter T2 hyperintensities are suggestive of renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild thickening of the wall of the first and second part of the duodenum which is likely secondary to the inflammatory process and may represent duodenitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Cardiomegaly. Small bilateral pleural effusions and compressive atelectasis. Mild ascites. Diffuse anasarca.

Output: 1.No gallstones.2.Findings consistent with acute pancreatitis and peripancreatic fluid collection. Evaluation for vascular complications and for pancreatic necrosis is limited by lack of intravenous contrast.3.Mild thickening of the wall of the first and second part of the duodenum which is likely secondary to the inflammatory process and may represent duodenitis.


Instruction: Generate impression based on findings.

Input: 41-year-old female with questionable medial meniscus tear on exam. Evaluate for soft tissue lesions. Presents with left knee pain. Secondary to the patient's body habitus, a HD coil was not able to be utilized, resulting in slightly suboptimal image quality. Patient motion artifact limits examination.MENISCI: There is a bucket-handle type tear of the medial meniscus with much of the body and posterior horn of the meniscus flipped anteriorly and centrally. There is also a peripheral longitudinal tear of the anterior horn of the lateral meniscus extending to the femoral articular surface. The posterior horn of the lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is perhaps mild degeneration of the articular cartilage of the lateral facet of the patella inferiorly, but this is equivocal. Subjectively, there appears to be mild diffuse thinning of the articular cartilage of the medial compartment. There is heterogeneous bone marrow signal abnormality consistent with residual islands of red marrow.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: Bucket handle tear of the medial meniscus and other findings as described above.


Instruction: Generate impression based on findings.

Input: Brain metastases from renal cancer. There are postoperative findings related to right frontal craniotomy with confluent T2 hyperintensity in the right frontal lobe white matter surrounding a resection cavity. There is no midline shift. The basal cisterns are patent. There is no significant change in size of two subcentimeter cerebellar lesions or a few punctate right frontal lobe lesions with mild enhancement. A lesion in the right cerebellar hemisphere and a lesion in the right frontal lobe are associated with susceptibility effect. There is no evidence of acute infarction. The ventricles are unchanged in size. The orbits and paranasal sinuses are grossly unremarkable. There is perhaps slight interval decrease in size of the left inferior parietal bone enhancing lesion, which measures up to 10 mm. There is dolichocephaly.

Output: 1.No significant interval change in size of the subcentimeter supratentorial and cerebellar metastases and post-treatment findings.2. Perhaps slight interval decrease in size of the left inferior parietal bone enhancing lesion.


Instruction: Generate impression based on findings.

Input: 64 years Female (DOB:8/25/1952)Reason: Hx brain met s/p surg+RT surveillance exam History: Hx brain met s/p surgery surveillance examPROVIDER/ATTENDING NAME: STEVEN J. CHMURA SUSAN HONG The patient status post left frontal craniotomy. The cystic cavity at the left middle frontal gyrus currently measures 29 x 13 mm and previously measured 31 x 16 mm. There is surrounding T2 and FLAIR signal hyperintensity present there is associated susceptibility effect. On postcontrast imaging there is no significant contrast enhancement associated with this.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.Incidental note is made of a developmental venous anomaly in the left parietal lobe.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 AP dimension of the eyes is increased bilaterally on the left-sided AP dimension the left eye is 31 mm on the right-sided is 34 mm. This appears to be associated with some scleral banding just these represent staphylomas.

Output: 1.Status post left frontal lobe surgery for removal of a metastatic lesion. There is no evidence for local recurrence.2.No new brain metastases are identified on the current exam.3.The patient had a contrast reaction following gadolinium administration. Please see above notes in the technique section of this report.


Instruction: Generate impression based on findings.

Input: Other amnesia [R41.3] / Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: please do dr javed MS protocol History: numbness, hx optic neuritis Motion artifacts degraded exam quality.Brain MRISubtle increased FLAIR signal intensities on bilateral frontal lobe subcortical white matter which is non specific or possibly artifactual.There is no definitive white matter high signal intensity on FLAIR scan which can suggest multiple sclerosis plaque on this scan.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Cervical spine MRIStraightened and slightly lordotic cervical spine with minimal disc dessication at the level of C34, C45 and C56 with minimal bulging of discs. However, there is no evidence of spinal canal stenosis or neuroforaminal stenosis.Spinal cord signal intensity is normal.There is no abnormal enhancement.

Output: 1. No evidence of abnormal FLAIR signal intensity on this scan. No evidence of abnormal enhancement.2. No evidence of spinal cord signal abnormality.3. Straightened cervical spine with minimal but multi-level disc dessication.


Instruction: Generate impression based on findings.

Input: 70-year-old female with right adrenal gland lesion noted on recent CT. Thorax for further characterization. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in size, morphology, and signal characteristics. Signal artifact from prior cholecystectomy. No focal lesion is identified. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: The spleen is normal in signal and morphology. No pancreatic ductal dilatation.ADRENAL GLANDS: There is subtle nodularity of the posterior limb of the right adrenal gland. This appears to have signal drop out on the out of phase images (series 10 images 89 and 90) compatible with an adrenal adenoma. There is no enhancement on the postcontrast images.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Within the right hemiabdomen there is a 3.0 x 2.2 x 2.7 cm nonenhancing cystic collection with high T2 and minimally bright T1 intrinsic signal. There is no enhancement on the postcontrast images. This is not significantly changed from the most recent CT scan, but is new compared to 9/20/2006. This is nonspecific but may represent a peritoneal inclusion cyst.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with a small right adrenal adenoma.2.Nonspecific cystic collection in the right hemiabdomen which is unchanged compared to 2/22/2016, but was not present on the previous CT scan from 9/20/2006. This may represent a peritoneal inclusion cyst, but follow-up imaging can be considered as clinically warranted.


Instruction: Generate impression based on findings.

Input: Male, 16 years old, with weakness. Assess for transverse myelitis. Patchy, discontiguous ventral spinal cord T2 hyperintensity is redemonstrated beginning at approximately C3 and continuing down to the T1 level. These lesions are limited to the superficial ventral aspect of the spinal cord involving no more than the anterior one third of cord transverse area. No significant interval change is seen in the transverse or craniocaudal extent of this abnormality. The affected region of the spinal cord demonstrates volume loss compatible with chronicity.No additional or new areas of spinal cord signal abnormal are seen. No evidence of pathologic spinal cord or leptomeningeal enhancement is seen. Diffusion-weighted imaging is degraded in portions of the cervical and thoracic spine, but no definite diffusion restriction is seen. No epidural abnormalities are suspected.The cervical lordosis is straightened, but spinal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No areas of concerning marrow replacement or pathologic marrow enhancement are seen. The intervertebral discs are preserved with no significant bulging or herniation. The spinal canal and neural foramina remain patent.

Output: Again seen is a region of specifically ventral spinal cord signal abnormality spanning from approximately C3 down to T1 showing no significant interval change from the prior examination. This abnormality demonstrates features of chronicity including spinal cord volume loss and lack of enhancement.The differential diagnosis for this finding is broad and would include sequelae of prior viral myelitis as well as a postinfectious autoimmune process. Similar features can also be seen in demyelinating disease such as neuromyelitis optic. The possibility of spinal cord ischemia should also be considered, though this would be a somewhat atypical imaging presentation. Neoplastic etiologies are felt to be unlikely.


Instruction: Generate impression based on findings.

Input: 63-year-old male with history of right knee pain, status post 3 arthroscopies. MENISCI: A tear of the posterior horn of the medial meniscus extends to the tibia. There is a tear in the posterior horn of the lateral meniscus that extends to the tibia. The roots of the menisci are intact.ARTICULAR CARTILAGE AND BONE: Chondral degeneration of the posterior aspect of the lateral femoral condyle. There is focal, near full thickness chondral defect overlying the medial meniscus. There is severe full-thickness chondral loss in the patellofemoral compartment, with associated subchondral marrow edema of the patella.LIGAMENTS: The MCL and LCL complex are intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1.Tears of the posterior horns of the medial and lateral menisci, extending to the tibia.2.Chondromalacia patella.


Instruction: Generate impression based on findings.

Input: Preoperative planning for a cystic lesion in the left cerebellar pontine angle. There is a cystic lesion in the left cerebellopontine angle cistern that measures up to approximately 25 mm. There is associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere. There is a small developmental venous anomaly in the right inferior frontal gyrus. There is scattered mild mucosal thickening in the paranasal sinuses. There is a small amount of fluid signal in the right mastoid air cells. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Limited preoperative planning MRI demonstrates a left cerebellopontine angle cistern cyst that measures up to approximately 25 mm with associated posterior deviation of the left cranial nerve 7 and 8 complex and mass effect upon the brainstem, left middle cerebellar peduncle, and left cerebellar hemisphere.


Instruction: Generate impression based on findings.

Input: Female, 33 years old, with bilateral frontal headaches. The cerebellar tonsils are ectopic descending proximally 4 mm below the level of the foramen magnum. As a result, the foramen magnum is slightly crowded.Elsewhere, brain parenchymal morphology is within normal limits. No pathologic parenchymal signal abnormality is seen. No abnormal parenchymal or extra-axial enhancement is detected. Diffusion-weighted images are within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.Trace mucosal inflammation is seen within the paranasal sinuses.

Output: 1.Cerebellar tonsillar ectopia with mild crowding of the foramen magnum.2.No other significant intracranial abnormality.3.Trace paranasal sinus mucosal inflammation.


Instruction: Generate impression based on findings.

Input: Nontraumatic intracranial hemorrhage, unspecified [I62.9], Reason for Study: ^Reason: evaluate vasculopathy and hemorrhage History: headache, neck pain Brain MRIThere are 2 high signal intensities on diffusion-weighted images. One is curvilinear shaped lesion located on the right proximal pre central sulcus which has suspicious restricted diffusion on ADC map, another is at the right right internal capsule genu with slight extension toward posterior limb which does not show ADC abnormality thus likely represent artifacts. On FLAIR/T2 weighted images, there are multifocal high signal intensity lesions especially involving bilateral fronto parietal convexity sulci. In particular, the lesion seen on DWI appears to be matching with one of high signal intensity lesions within the right precentral sulcus. The right internal capsule lesion is associated with an artifacts on FLAIR/T2 images. Gradient echo images do not show any definitive susceptibility artifacts on these lesions. Corresponding T1 weighted images do not show any significant abnormal finding.Constellation of above findings indicate possible artifacts related to higher molecular materials than CSF such as cellular content or proteinaceous materials within the sulci. However, the possibility of cortical acute ischemic infarction can not be excluded. Further imaging evaluation may be obtained with Brain MRI with and without contrast enhancement if clinically indicated.Previously seen corpus callosum ICH has gotten smaller and the extent of IVH also appears to get decreased which represent normal evolution and resorption process.Ventricle size remains within normal limits. No evidence of ventriculomegaly.The cranial-cervical junction is normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate severe stenosis involving bilateral distal ICAs as well as proximal and distal basilar artery. Comparing to prior CT angiography, bilateral distal ICA stenosis appear to be improved but the basilar artery has been worse.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.

Output: 1. A couple of DWI high signal intensity lesions are seen. The internal capsule lesion is likely an artifact, but the right precentral sulcus lesion could represent local blood brain barrier disruption related changes or subcortical ischemic infarction. Brain MRI pre and post enhanced scan can be considered to clarify the nature of the lesion.2. Previously known corpus callosum hemorrhage and IVH has been decreased in size and extent which represent normal evolution. No ventriculomegaly is seen.3. No other acute ischemic or hemorrhagic lesion is seen.4. Slightly improved the stenosis degree of bilateral distal ICA but worsened basilar artery luminal stenosis since prior CT angiography.5. Normal neck MRA.