Instruction: Generate impression based on findings.

Input: Reason: parkinsonism and memory loss History: as above MRI brain: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 4 mm subependymoma lesion present along the left lateral ventricle which has a cystic appearance and follows spinal fluid on all pulse sequences. Most likely it represents a subependymomas cystThere is periventricular linear T2 and flair signal hyperintensity in the left periventricular white matter comparedNormal 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.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disk desiccation presentC2 is congenitally fused to C3 .At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is a loss of disk space height and the disk bulge present at this level associated with mild facet hypertrophy.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disk bulge present at this level associated with loss of disk space height . There is narrowing of the right neural foramen.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are end plate and uncovertebral osteophytes present at this level. There is narrowing of the neural foramina bilaterally with encroachment of right-sided exiting nerve roots. There are some endplate reactive changes present at this level. There is mild narrowing of the spinal canal present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a minor disk bulge at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.

Output: 1.There are degenerative changes present in the cervical spine worst at C5-6 where there is some mild encroachment of right-sided exiting nerve roots within the neural foramen.2.There is nonspecific findings present within the brain such as a subependymomas cyst and left periventricular white matter and lesion which are probably of little clinical significance.


Instruction: Generate impression based on findings.

Input: Patient presenting with severe headache, evaluate. MRI: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. The cerebellar tonsils are minimally low-lying.MRA: There is no evidence of significant steno-occlusive lesions. There appears to be a trace outpouching along the inferior aspect of the paraclinoid left internal carotid artery, which may represent an infundibulum.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. No evidence of significant steno-occlusive lesions.3. Possible trace outpouching along the inferior aspect of the paraclinoid left internal carotid artery, which may represent an infundibulum.4. A neck MRA was performed instead of a brain MRV. The be recalled for an MRV at no additional cost, if needed.


Instruction: Generate impression based on findings.

Input: History of alcoholic cirrhosis presents for HCC screening. History of TIPS. ABDOMEN:LIVER, BILIARY TRACT: Lobular liver contour widened fissures and left hepatic lobe hypertrophy compatible with cirrhosis. A TIPS shunt catheter is noted.No suspicious liver lesion.No ascites or varices. Normally distended gallbladder containing multiple gallstones.No biliary ductal dilatation.SPLEEN: The spleen measures 11.1 cm in length without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Stable examination. Cirrhosis with no suspicious liver lesion.


Instruction: Generate impression based on findings.

Input: History of cirrhosis with abnormal ultrasound, evaluate for HCC. ABDOMEN:LIVER, BILIARY TRACT: The liver is cirrhotic in morphology. A TIPS is again noted connecting the right portal vein and hepatic vein. The hepatic arteries and portal venous system are patent. There is a new lesion within segment 7/8 of the liver (series 501, image 413) measuring 2.3 x 2.4 cm which corresponds to that seen on recent ultrasound. The lesion demonstrates increased T1 signal with loss of signal on out of phase images compatible with microscopic fat content. The lesion also demonstrates increased T2 signal. Evaluation of enhancement characteristics is limited by early timing of arterial phase imaging. No additional new suspicious hepatic lesions are identified. No biliary ductal dilatation.SPLEEN: Splenomegaly. The spleen measures 20 cm in craniocaudal dimension, similar to the prior examination. Multiple collateral vessels are seen in the splenic hilum.PANCREAS: Cystic lesions in pancreatic head and uncinate process, compatible with side branch IPMNs. The larger lesion measures 19 x 12 mm (series 1001, image 17), not significantly changed from the 2012 measurement of 19 x 10 mm. The smaller anterior lesion measures 9 x 9 mm (series 1001, image 17), unchanged from 9 x 9 mm previously. No significant pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small simple renal cysts are present bilaterally.RETROPERITONEUM, LYMPH NODES: Enlarged para-aortic lymph nodes are not significantly changed.BOWEL, MESENTERY: Esophageal and gastric varices, unchanged. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominal pelvic ascites, new from prior.

Output: 1.New 2.4 cm segment 7/8 liver mass with features highly suspicious for HCC. Lesion was also described on 11/4/2015 ultrasound at which time findings were communicated to Dr. G. Reddy.2.Cirrhotic liver morphology with sequela of portal hypertension. 3.New mild-moderate ascites.4.Side branch IPMNs in the pancreatic head and uncinate process, unchanged.


Instruction: Generate impression based on findings.

Input: Male, 18 years old, with hydrocephalus, aqueductal stenosis, history of third ventriculocisternostomy. Yearly follow-up examination. Lateral and third ventriculomegaly is again seen appearing similar in degree to the prior examinations. For example, the transverse diameter of the lateral ventricles measures approximately 65-mm which is unchanged. The fourth ventricular caliber and morphology are within normal limits.On thin section sagittal T2-weighted imaging, a defect is again seen within the floor of the third ventricle. On cine flow imaging, unambiguous and brisk flow related signal is detected from the basal cistern, through this defect, into the third ventricle.As before, the cerebral aqueduct is not patent anteriorly, and at the point where the tectum contacts the tegmentum, the tegmentum appears somewhat nodular.Sequelae of prior right frontal ventriculostomy is again seen. The corpus callosum remains thinned but intact. The periventricular white matter is also thinned similar to prior.

Output: 1.Stable lateral and third ventriculomegaly.2.The third ventriculocisternostomy remains patent.3.Occlusion of the cerebral aqueduct is again seen with no change in the somewhat nodular appearance of the midbrain tegmentum.4.Anatomic distortion of the brain likely secondary to prior hydrocephalus is unchanged.


Instruction: Generate impression based on findings.

Input: Vertigo. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are a few scattered foci of high T2 signal in the cerebral white matter, the largest of which is located in the left peritrigonal region. 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: Few nonspecific cerebral white matter lesions. Otherwise, no evidence of intracranial hemorrhage, mass, or acute infarct.


Instruction: Generate impression based on findings.

Input: Reason: Eval Rotator cuff tear History: left shoulder pain Patient motion artifact limits multiple sequences.ROTATOR CUFF: There are multiple foci of intermediate signal intensity and thickening in the supraspinatus at the level of its insertion on the greater tuberosity and more proximally which likely represent moderate focal tendinosis. The supraspinatus muscle appears intact. The infraspinatus muscle and tendon appear intact. The subscapularis and teres minor muscles and tendons appear intact.SUPRASPINATUS OUTLET: There is a trace amount of fluid within the subacromial subdeltoid bursa. Mild to moderate osteoarthritis affects the acromioclavicular joint with slight bulging of the joint capsule.GLENOHUMERAL JOINT AND GLENOID LABRUM: The glenohumeral joint alignment is anatomic. There is heterogeneity and intermediate signal intensity within the anterior superior labrum which may reflect degeneration.BICEPS TENDON: The tendon of the long head of the biceps appears intact. ADDITIONAL

Output: Rotator cuff tendinosis without evidence of a full-thickness rotator cuff tear or retraction. Osteoarthritis of the acromioclavicular joint. Other findings as described above.


Instruction: Generate impression based on findings.

Input: Evaluation of the distal femur lesion. FEMUR: ACETABULAR LABRUM: No significant abnormality noted.ARTICULAR CARTILAGE AND BONE: Interval resolution of distal femoral bone infarction. No significant abnormality.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: 1.Interval resolution of distal femoral bone infarction.2.Progressive patellofemoral chondromalacia.3.Partial thickness cartilage tear noted in the posterior lateral femoral condyle. Underlying lateral meniscus is intact. Mild medial femoral condyle bone marrow edema.


Instruction: Generate impression based on findings.

Input: There are scattered punctate foci of T2 hyperintensity primarily within the subcortical white matter without associated restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Bubbly secretions are noted within the left sphenoid sinus suggesting acute sinus disease. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Mild chronic small vessel ischemic disease.2.Bubbly secretions are noted within the left sphenoid sinus suggesting acute sinus disease.


Instruction: Generate impression based on findings.

Input: Intermediate risk prostate cancer. Evaluate extent of disease. PELVIS:PROSTATE:Prostate Size: 3.3 x 5.3 x 4.7 cmPeripheral Zone: In the left mid gland/apex there is a 1.6 x 0.9 x 1.1 cm lesion demonstrating T2-weighted hypointensity (series 901/9), restricted diffusion (series 704/ 224) and early enhancement with washout (series 1701/1211).Central Gland: Changes of BPH.Seminal Vesicles: No evidence of seminal vesicle invasion.Extracapsular Extension: The left mid gland/apex lesion broadly abuts the fibromuscular capsule and bulges it suspicious for extraprostatic extension.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.6 cm left mid gland/apex lesion with broad abutment and bulging of the adjacent capsule suspicious for extraprostatic extension. No pelvic lymphadenopathy.


Instruction: Generate impression based on findings.

Input: Severe headaches and vomiting. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered patchy cerebral and pontine white matter T2 hyperintensity. There is cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants. There is a small effusion associated with the right C1-2 facet joint.

Output: 1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2. Findings suggestive of chronic small vessel ischemic disease.


Instruction: Generate impression based on findings.

Input: History of myxofibrosarcoma grade 2 status post radical resection free flap and postoperative chemo RT: palpable soft tissue prominence in the right sternocleidomastoid muscle. There are post-treatment findings related to composite resection of the right mandible, right neck dissection. There is diffuse right sternocleidomastoid muscle volume loss and fatty atrophy of the residual right hemitongue. There is a 5 mm diameter focus of susceptibility effect in the subcutaneous tissues overlying the mid right sternocleidomastoid muscle. There is also a subcentimeter relatively T2 hyperintense right level 5 lymph node posterior to the mid right sternocleidomastoid muscle. Otherwise, there is no significant cervical lymphadenopathy by size criteria. The remaining salivary glands appear unchanged and the thyroid gland is unremarkable. The cervical spine is unremarkable. The imaged portions of the intracranial structures and orbits are unremarkable.

Output: Post-treatment findings with atrophy of the right sternocleidomastoid muscle. A 5 mm diameter focus of susceptibility effect in the subcutaneous tissues overlying the mid right sternocleidomastoid muscle is nonspecific and may be attributable to treatment effects versus less likely neoplasm. Likewise, a subcentimeter right level 5 lymph node posterior to the mid right sternocleidomastoid muscle is nonspecific.


Instruction: Generate impression based on findings.

Input: History shortness of breath. LUNGS AND PLEURA: Interstitial fibrosis consisting of inter and intralobular reticulation, volume loss and traction bronchiectasis, with little honeycombing but a few areas of ground glass opacity.MEDIASTINUM AND HILA: Scattered upper limits normal sized mediastinal lymph nodes, not unexpected in interstitial lung disease.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: 25 x 18 mm heterogeneous right adrenal lesion could be an adenoma a follow-up CT or MRI might be advisable.Right renal cyst.

Output: 1. Moderate to severe interstitial lung disease in a pattern most consistent with NSIP.2. Right adrenal lesion possibly an adenoma, see above.


Instruction: Generate impression based on findings.

Input: 39-year-old male with shoulder pain. Evaluate rotator cuff. ROTATOR CUFF: There is intermediate signal intensity within the supraspinatus tendon indicating mild tendinosis. Best seen on the sagittal oblique images is a 6 mm focus of increased signal intensity along the anterior fibers of the supraspinatus tendon at the greater tuberosity likely representing a concealed interstitial tear with mild edema in the underlying greater tuberosity. The supraspinatus muscle appears normal. The infraspinatus muscle and tendon appear normal. The teres minor muscle and tendon appear normal. There is apparent thickening of the subscapularis tendon which may reflect mild tendinosis but this is likely exaggerated by the arm positioned in mild internal rotation. SUPRASPINATUS OUTLET: There is an os acromiale. Mild edema within the os is present, however to a lesser degree than that seen on the right. We see no frank osteoarthritic changes of the acromioclavicular joint. There is trace fluid in the subdeltoid bursa of questionable clinical significance.GLENOHUMERAL JOINT AND GLENOID LABRUM: Joint alignment is within normal limits. There is a small amount of fluid in the joint with no frank effusion present. There is intermediate signal intensity within the superior labrum which may reflect degeneration or degenerative tearing but we see no fluid filled tear on this non-arthrogram study. The articular cartilage appears normal.BICEPS TENDON: The tendon of the long head of the biceps muscle appears normal.

Output: 1.Os acromiale2.Mild tendinosis of the supraspinatus tendon with possible small concealed interstitial tear at its insertion.3.Findings suggestive of degeneration/degenerative tearing of the superior labrum.


Instruction: Generate impression based on findings.

Input: Clinical question: Evaluate brain lesion. Signs and symptoms: 49-year-old female with brain lesion and edema seen on head CT. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a well-demarcated hemorrhagic enhancing tumor along the medial aspect of the right high convexity frontal lobe. The tumor measures approximately 20 x 15 x 20 mm and demonstrate fairly extensive surrounding vasogenic edema with resultant leftward deviation of midline of approximately 6 mm. There is no evidence of ventriculomegaly and CSF cisterns remain widely patent.The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences and without detectable abnormal parenchymal or meningeal enhancement.Unremarkable images through the orbits including axial fat sat postcontrast enhanced series.Unremarkable calvarium, paranasal sinuses and mastoid air cells.

Output: 1.Single hemorrhagic enhancing mass in the right frontal lobe (20 x 15 x 20 mm) with surrounding vasogenic edema and resultant 6 mm midline shift. Differentials of a cavernoma or less likely a hemorrhagic metastatic tumor should be considered.2.Unremarkable pre and post enhanced brain MRI otherwise.


Instruction: Generate impression based on findings.

Input: Reason: mycosis fungoides with new onset chest pain History: pleuritic chest pain LUNGS AND PLEURA: Mild streaky basilar opacities compatible with subsegmental atelectasis. The examination was not optimized for evaluation of pulmonary medicine. However at least one subsegmental filling defect is visible in the right lower lobe on the source images and other questionable very small defects are visible in left lower lobe arteries. In the presence of chest pain and unexplained basilar atelectasis this is suspicious for pulmonary embolism. A text page was sent to Dr. Sadiq at the time of interpretation.MEDIASTINUM AND HILA: Multiple small collateral vessels are present.No significant lymphadenopathy.CHEST WALL: Decrease in the size of an enlarged left axillary node which now measures 16 x 14 mm.Obstruction of the left axillary and subclavian veins of uncertain etiology with extensive collateral formation suggesting chronicity.New focal area of sclerosis or contrast pooling in the posterior T2 vertebral body, not visible on the recent CT of 11/3/2010, all of uncertain significance. If clinically indicated this could be further evaluated by MRI.UPPER ABDOMEN: Very limited evaluation with no gross abnormalities.

Output: 1. Subsegmental right lower lobe pulmonary embolus and possibly additional small emboli in the left lower lobe. A repeat examination could be performed with CTA technique for more optimal evaluation if clinically indicated.2. Focal area of sclerosis or contrast pooling in the posterior T2 vertebral body of uncertain significance.


Instruction: Generate impression based on findings.

Input: This exam is limited due to lack of contrast as well as incomplete spinal imaging due to the patient terminating the exam prior to completion.BRAIN: There are postoperative findings related to occipital craniotomy. There is a right frontal approach ventriculostomy catheter terminating near the foramen of Monro. The ventricles are nondilated. There is a subcentimeter focus of decreased diffusion centered within the left precentral gyrus with surrounding T2 hyperintensity as well as additional foci of T2 hyperintensity and central T2 hypointensity within the right insula and right temporal lobe. There is an additional punctate focus of T2 hyperintensity within the right frontal subcortical white matter. There is mild susceptibility effect within the cerebral aqueduct suggestive of blood products. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: There is patchy bone marrow signal throughout the cervical and thoracic spine without T2 hyperintense on the STIR sequences to suggest edema. A single sagittal T1 weighted lumbar spine sequence was performed revealing two intrathecal masses that measure approximately 6 x 9 mm at the L1 level and 14 x 15 mm at the L2-L3 level. The vertebral body heights are preserved. The spinal cord displays normal signal.There are mild degenerative changes of the cervical spine with multilevel disc desiccation as well as minimal grade 1 retrolisthesis of C5 on C6 where left-sided uncovertebral arthropathy results in moderate left neural foramen stenosis. There are mild degenerative changes of the thoracic spine with multilevel disc desiccation, loss of disc height, and endplate degenerative as well as a small left paracentral disk extrusion at T6-T7 that indents the thecal sac and the left aspect of the spinal cord without significant spinal canal stenosis. There is also a smaller left paracentral disc protrusion at T7-T8 without spinal canal or neural foramen stenosis. There is a nonspecific patchy focus of high attenuation within the left lung apex.

Output: 1.This exam is limited due to lack of contrast as well as incomplete spinal imaging due to the patient terminating the exam prior to completion.2.Postoperative findings related to occipital craniotomy and right frontal approach ventriculostomy catheter placement without hydrocephalus.3.Four foci of signal abnormality within the brain are nonspecific but suspicious for metastases although one demonstrates significant diffusion restriction and could represent a small acute infarct.4.No evidence for spinal cord or conus compression.5.Two intrathecal masses at the L1 and L2-L3 levels are suggestive of metastases, although other mass lesions remain in the differential.6.Heterogeneous bone marrow signal is nonspecific without contrast although may represent treatment-related changes.


Instruction: Generate impression based on findings.

Input: Coronary artery disease, assess for viability, three-vessel CAD, body surface area equals 2.4 sq m2 Left VentricleThe left ventricle is moderately enlarged. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 111.7 ml/m2 (normal range: 74+/-15), the LVEDV is 268 ml (normal range 142+/-34), the LV end systolic volume index is 60 ml/m2 (normal range 25+/-9), the LVESV is 144 ml (normal range 47+/-19. There are no regional wall motion abnormalities present. There is enhancement involving the inferior and inferolateral walls, extending from the base to nearly the apex, sparing the extreme base and apex. This is compatible with a myocardial infarct in the circumflex coronary artery territory. The basilar component of this infarct is extensive, approximately 80% wall thickness, involving the inferolateral wall and the inferior walls. As it approaches the mid chamber, this becomes transmural. At this location, there is a sessile thrombus that lines the subendocardial infarct (series 2/1/2001 image 23), measuring a maximum of 3 mm thickness. The apical component of the infarct is isolated to the infero-lateral wall.There is akinesia demonstrated by the basal one quarter of the inferior wall and basal one half of the lateral wall. Severe hypokinesia is demonstrated by the basal half of the interventricular septum. The majority of the anterior wall is moderately hypokinetic. Normal contractility is demonstrated by the remaining segments.The anterolateral, anterior, mid and apical inferior walls and entire septum are viable. These findings were discussed over the phone with the resident caring for the patient at 5:00 PM on 6/15/2015.Left AtriumThe left atrium is normal in size.Right VentricleThe right ventricle is normal in size. The overall RV ejection fraction is 62%, the RV end diastolic volume index is 81.7 ml/m2 (normal range 82+/-16), the RVEDV is 183 ml (normal range 142+/-31), the RV end systolic volume index is 30.8 ml/m2 (normal range 31+/-9), and the RVESV is 69 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 mitral regurgitation, not quantified. 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. There is a myocardial infarct in the circumflex coronary arterial territory, extending from nearly the base to the apex. This involves the inferolateral and inferior walls at the base, where it involves 80% wall thickness. The infarct becomes transmural at the mid chamber and extends to the apical lateral wall. 2. Localized, sessile thrombus measuring 3 mm in thickness lines the subendocardium adjacent to the infarct at the mid lateral wall.3. Left ventricular ejection fraction equals 46%.


Instruction: Generate impression based on findings.

Input: Female 20 years old Reason: Desmoid tumor on chemotherapy; assess response to therapy PELVIS: The large infiltrating pelvic desmoid tumor appears similar in size and extent compared to the prior examination. The reference region of the mass now measures 9.8 x 7.6 cm (series 19/85), previously measuring 9.6 x 7.3 cm, when applying a similar measuring technique. Muscular invasion into the left rectus abdominis, left abductor musculature and left iliopsoas muscle appears similar to the prior exam. The mass encases the left external iliac artery and vein, with persistent occlusion of the left external iliac vein, and extensive collateral formation. The left leg remains edematous, and T2 signal extends inferiorly from the from the mass into the muscular compartment to the level of the mid thigh, consistent with venolymphatic obstruction.UTERUS, ADNEXA: Trace free fluid within the pelvis is likely physiologic.BLADDER: The urinary bladder is displaced to the right. LYMPH NODES: Multiple prominent left inguinal lymph nodes are again noted. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: The bone marrow signal is normal and there is no definite evidence of osseous involvement.

Output: Stable size of the left pelvic desmoid tumor with associated muscular invasion and venolymphatic obstruction resulting in swelling of the left lower extremity.


Instruction: Generate impression based on findings.

Input: Male 83 years old Reason: r/o osteonecrosis History: left lateral foot ulcer; h/o diabetes The patient has undergone resection of the fifth ray through the fifth metatarsal diaphysis. There is a small focus of heterotopic ossification seen in the soft tissues distal to the remaining fifth metatarsal. There is ulceration of the lateral soft tissues just distal to the remaining fifth metatarsal. There is adjacent low T1 signal suggesting scarring. We see no abnormality of the bone marrow to indicate osteomyelitis. There is also scarring of the subcutaneous fat adjacent to the base of the fifth metatarsal.Patient also has amputation of the second toe and distal phalanx of the first toe. Mild deformity of the head of the second metatarsal, but we see no features of osteomyelitis. Mild osteoarthritis affects the first metatarsophalangeal joint. Mild to moderate osteoarthritis affects the midfoot. Small collection of fluid within the flexor hallux longus tendon sheath at the knot of Henry may represent a focal tenosynovitis, but is not necessarily of any clinical significance.

Output: Soft tissue ulcer and other findings as above, but we see no evidence of osteomyelitis.


Instruction: Generate impression based on findings.

Input: Altered mental status, hypernatremia now corrected. There is a small area of high T2 with slightly restricted diffusion in the periphery of the left cerebellar hemisphere. There is high T1 signal and restricted diffusion along the left transverse and sigmoid sinuses. There is scattered patchy cerebral white matter T2 hyperintensity bilaterally. There are small areas of encephalomalacia in the left basal ganglia and left middle frontal gyrus. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable. There is diffuse mild paranasal sinus mucosal thickening.

Output: 1. A small area of high T2 with slightly restricted diffusion in the periphery of the left cerebellar hemisphere likely represents a late subacute infarct.2. High T1 signal and restricted diffusion along the left transverse and sigmoid sinuses may represent subacute venous thrombosis. CT or MR venography may be useful for further evaluation.3. Scattered patchy cerebral white matter T2 hyperintensity bilaterally likely represent chronic small vessel ischemic disease.4. Small chronic infarcts in the left basal ganglia and left middle frontal gyrus.


Instruction: Generate impression based on findings.

Input: 17-year-old female with history of esthesioneuroblastoma status post chemotherapy radiation therapy and resection, evaluate for residual disease Neck: Again seen are post-operative findings related to right medial maxillectomy and right anterior and posterior ethmoidectomy. Previously demonstrated enhancement within the right frontoethmoidal treatment bed is again noted, however has decreased along its inferoposterior border. There is persistent mucosal thickening in the right maxillary sinus, unchanged. There is no new or enlarging mass. No new enhancement or mass involving the orbits. There is leftward nasal septal deviation. There is a subcentimeter Thornwaldt or nasopharyngeal retention cyst which has decreased in size. A previously demonstrated nonspecific 10 mm by 16mm right level 2 lymph node is again noted and is unchanged. Additional small scattered cervical lymph nodes are also nonspecific. No significant cervical lymphadenopathy by size criteria. Evidence of right thyroid lobectomy also noted.Brain: There is no evidence of intracranial extension of tumor. There is an unchanged prominent perivascular space in the right basal ganglia. The brain parenchyma otherwise appears unremarkable and there is no evidence of acute infection or 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.

Output: 1.Previously demonstrated enhancement within the right frontoethmoidal treatment bed is again noted, however has decreased along its inferoposterior border.2.No evidence of intracranial tumor.


Instruction: Generate impression based on findings.

Input: No intra-articular contrast traverses the scapholunate or lunotriquetral interval to suggest a tear. No intra-articular contrast is identified within the radiocarpal joint. Please refer to the subsequent MRI report for further information.Exposure time: 1 minute and 12 seconds.

Output: Fluoroscopic guided injection of dilute gadolinium into the right wrist for subsequent MRI arthrogram examination.


Instruction: Generate impression based on findings.

Input: 58 year old male with hx of multivessel CAD, s/p multiple PCI, s/p CABG 2/2016 (Lima to LAD, SVG to DG and SVG to OM), PVC ablation. Now with fatigue and angina x 2-3 weeks. MEDICATIONS: amlodipine, aspirin, rosuvastatin, lisinopril, prasugrel, lorazepam. First Pass PerfusionDuring hyperemia, there was an area of hypoperfusion in the basal inferior and inferoseptal wall, which corresponds to the below described myocardial infarction. Viability/ Myocardial ScarThere is late gadolinium enhancement in more than 50% of the thickness of the wall at the basal inferior wall compatible with an old transmural myocardial infarction. This segment is not likely to be viable. The remainder of the left ventricle is free of myocardial infarction and likely to be viable. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 63%, the LV end diastolic volume index is 77 ml/m2 (normal range: 74+/-15), the LVEDV is 194 ml (normal range 142+/-34), the LV end systolic volume index is 28 ml/m2 (normal range 25+/-9), the LVESV is 72 ml (normal range 47+/-19), the LV mass index is 60 g/m2, and the LV mass is 151 g. There is an area of thinning and hypokinesis of the basal to mid inferior wall . The native T1 myocardial relaxation time in this area was also elevated at 1166 ms suggestive of diffuse fibrosis or inflammation. The native T1 myocardial relaxation times in the septum and ventricular lateral wall were normal <1030 ms.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is mildly dilated with normal systolic function. The overall RV ejection fraction is 58%, the RV end diastolic volume index is 88 ml/m2 (normal range 82+/-16), the RVEDV is 223 ml (normal range 142+/-31), the RV end systolic volume index is 37 ml/m2 (normal range 31+/-9), and the RVESV is 93 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.AortaThe aortic root is normal in size. There is a left sided aortic arch with a normal brachiocephalic branching pattern.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC 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.There is a transmural myocardial infarction involving the basal inferior wall similar to previous MRI 6/2016. Most of the infarcted segment is not likely to be viable. The remainder of the myocardium is free of myocardial infarction or ischemia and is viable.2.The left ventricle is normal in size with normal systolic function. LVEF 63%3.The right ventricle is mildly dilated with normal systolic function. RVEF 58%I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 56-year-old woman strong family history of breast cancer and BRCA2 positive. Family history of breast cancer in sister at age 35 paternal aunt at age 45. There is a heterogeneous amount of fibroglandular tissue in both breasts.Minimal parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on findings.

Input: Provided history of vaginal yellow discharge and pain. History of stage II B cervical cancer status post chemoradiation. PELVIS:UTERUS, ADNEXA: Anteverted uterus.The uterus measures 6.6 x 4.1 cm in the sagittal plane.There is a well-defined intramural fundal poorly enhancing mass measuring 1.8 x 1.8 cm in the sagittal plane compatible with a fibroid.The endometrium is normal in thickness.The inner myometrium/junctional zone is difficult to accurately measure. The uterus is otherwise heterogeneous in signal intensity.The cervical stroma is unremarkable. The cranial aspect of the vaginal canal appears to be filled and mildly distended with non-enhancing fluid/air with mild dorsal vaginal wall hyperemia. No discrete enhancing mass lesion is identified.The ovaries are normal in size morphology and signal intensity without a discrete lesion. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis. Underdistended colon. BONES, SOFT TISSUES: Small nonspecific inguinal lymph nodes are noted.OTHER: No significant abnormality noted.

Output: The cranial aspect of the vaginal canal appears to be filled and mildly distended with non-enhancing fluid/air with mild dorsal vaginal wall hyperemia. No discrete enhancing mass lesion is identified.


Instruction: Generate impression based on findings.

Input: History of gastric perforation with repair. History of necrotic cholecystitis status post cholecystectomy. Elevated bilirubin and white blood count. The study is limited by poor image quality secondary to respiratory motion and poor signal-to-noise.ABDOMEN:LUNG BASES: There is at least a moderate right pleural effusion and small left pleural effusion.LIVER, BILIARY TRACT: There is some loss of signal intensity on in phase sequences compared to the out of phase imaging sequences compatible with iron deposition.No suspicious focal hepatic lesion.No biliary ductal dilatation is present. There is no obvious obstructive mass or stone.The patient is status post cholecystectomy. There is an approximately 5.1 x 3.3 cm fluid collection with septations in the gallbladder fossa with equivocal rim enhancement on postcontrast imaging raising the possibility of superinfection of a postoperative fluid collection. Delayed images demonstrate no evidence of hepatobiliary agent excretion into this collection i.e. speaking against a bile leak.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic and the parenchyma is nearly completely replaced by numerous subcentimeter simple and minimally complex/hemorrhagic cysts, consistent with acquired cystic kidney disease. No discrete suspicious solid mass is evident.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate volume ascites. There is a more focal suspected loculated perihepatic fluid collection measuring 10.3 x 1. 8 cm (series 601/30). Additional more focal suspected loculated perigastric fluid collection abutting the greater curvature of the gastric body measuring approximately 9 x 1.5 cm.The gastric wall appears edematous which may be posttreatment related.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted.

Output: 1.Study is limited by poor image quality secondary to respiratory motion.2.No biliary ductal dilatation or obvious obstructing mass or stone.3.Anasarca and moderate volume ascites with more focal suspected loculated perihepatic, perigastric and gallbladder fossa fluid collections. Equivocal rim enhancement raises the possibility of superinfection. No evidence of hepatobiliary agent excretion into the gallbladder fossa collection, speaking against a bile leak. If there is continued clinical concern for a bile leak a nuclear medicine HIDA scan may be considered.4.Changes of acquired cystic kidney disease associated with hemodialysis. No focal suspicious solid renal mass.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with gait disorder and abnormal involuntary movements. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement, edema or enhancement is seen.The visualized spinal cord shows normal signal intensity and morphology. No pathologic spinal cord signal abnormality or enhancement is seen. No epidural lesions are suspected.The intervertebral discs are well-maintained with no significant bulging or herniation. The spinal canal and neural foramina are patent.

Output: No significant abnormalities are detected which would account for the patient's symptoms.


Instruction: Generate impression based on findings.

Input: 18-year-old male patient with history of partial lateral meniscectomy in the past presents with lateral knee pain. MENISCI: There is attenuation of the body and posterior horn of the lateral meniscus as well as blunting and complex tearing of the free edge, likely representing a re-tear. The medial meniscus is intact without discrete tearing.ARTICULAR CARTILAGE AND BONE: Tiny osteophytes are noted in the lateral compartment. There are no fluid-filled cartilage defects.LIGAMENTS: The anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament complex, and patellar retinacula are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1.Findings compatible with a re-tear of the free edge of the body and posterior horn of the lateral meniscus.2.Moderate joint effusion.


Instruction: Generate impression based on findings.

Input: Altered mental status and right upper extremity abnormal movement. History of metastatic high grade serous papillary ovarian carcinoma; status post 6 different lines of therapy. Assess for stroke or new metastasis. The examination is at least mildly limited by motion, which is most pronounced on the postcontrast brain MRI sequences and the cranial MRA.BRAIN MRI:There are changes of previous metastasectomy in the posterior right frontal lobe with underlying T2 FLAIR hyperintense signal and susceptibility, which may reflect associated gliosis and chronic blood products. There is a punctate focus of diffusion restriction involving the lateral image of the left hippocampus, abutting the temporal horn. There is no other focus of diffusion restriction. There is no contrast enhancing or space-occupying brain lesion. Punctate T2-hyperintense foci in the cerebral white-matter, predominantly frontoparietal, are nonspecific but may reflect chronic microvascular ischemia. The ventricles and other CSF-containing spaces are mildly enlarged, reflecting mild global brain volume loss. A partially empty sella might be an incidental finding at this age.There is no destructive skull lesion, accounting for the small craniotomy near the vertex. There are changes of bilateral eye lens replacement. The mastoid air cells are clear.CRANIAL MRA:There is no significant stenosis in the intracranial anterior or posterior circulations. Minimal contour irregularity is seen such as at the right P1 and left M1 segments and may reflect mild atherosclerotic narrowing or artifact.

Output: 1.There is punctate diffusion restriction in the left hippocampus which may be related to acute ischemia or seizure and can be seen with entities such as transient global amnesia. There is however no large vascular territory infarct. 2.There are postsurgical changes related to resection of lesion in the posterior right frontal lobe with adjacent gliosis and chronic blood products. No enhancing lesions are seen in the brain to suggest metastatic disease. Note however that post gadolinium images are motion degraded which may limit sensitivity for detection of small lesions.3.Nonspecific changes related to mild chronic microvascular ischemia and/or treatment.4.No significant steno-occlusive intracranial arterial lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Female, 42 years old, with paresthesias. Evaluate for demyelinating lesions. No definite pathologic spinal cord signal abnormality is seen. No evidence of any epidural abnormality is seen.Straightening of the normal cervical lordosis is likely positional. Sagittal alignment is otherwise unremarkable. Vertebral body height and morphology are within normal limits. No evidence of pathologic marrow replacement or marrow edema is seen.C2-3: Unremarkable. C3-4: Facet hypertrophy. No significant spinal canal stenosis. Mild right foraminal narrowing. C4-5: Mild facet hypertrophy. Left uncovertebral hypertrophy. Small central disc protrusion which slightly contacts the ventral cord. Minimal left foraminal narrowing.C5-6: Disc osteophyte formation with a left paracentral disc protrusion which contacts and mildly deforms the ventral spinal cord. Moderate left and mild right foraminal narrowing. C6-7: Left facet hypertrophy. No significant spinal canal stenosis. Minimal left foraminal narrowing. C7-T1: Unremarkable.

Output: 1.No evidence of any discrete spinal cord lesion is seen to suggest the presence of demyelinating disease.2.However, a disc protrusion at C5-6 does contact and mildly deform the ventral spinal cord, though no significant generalized spinal canal or foraminal stenosis is seen.


Instruction: Generate impression based on findings.

Input: Clinical question: 70-year-old with ovarian carcinoma and history of hemorrhagic stroke. Altered mental status. Nonenhanced CT of brain:There is a large area of encephalomalacia in the right posterior temporal -- occipital region with ex vacuo dilatation of adjacent cortical sulci and ventricle. There was a large acute hemorrhagic stroke on this side on prior study.There is a subtle area of cortical and subcortical low attenuation in high convexity of the left posterior frontal and precentral stroke post which may represent a small cortical stroke of indeterminate age. This finding was not present on prior exam. Please correlate with history and follow up with an MRI is recommended. There is no evidence of hemorrhage. No midline shift is detected.

Output: 1.A very subtle small left precentral sulcus low-attenuation of cortex and subcortical white matter which is too small to determine the age however it is a new finding since prior examination. Correlate with history and follow-up with an MRI for acute ischemic stroke.2.Previously noted large area of hemorrhage in the right posterior temporal -- occipital junction has evolved into a large area of encephalomalacia and minimal demineralization. Unremarkable exam otherwise.


Instruction: Generate impression based on findings.

Input: Study is degraded due to motion.MRI BRAIN: There is mild gyriform right parietal-temporal-occipital diffusion hyperintensity with ADC isointensity, also extending to involve the insular cortex. There is corresponding intrinsic T1 hyperintensity along the cortex, suggestive of laminar necrosis. There is associated FLAIR hyperintensity, which also involves the white matter. Other patch areas of T2/FLAIR hyperintensity is present elsewhere in the subcortical and periventricular white matter, especially involving the right greater than left the frontal lobes.Ventricles and sulci are prominent, suggestive of general volume loss, which is much more than the expected for the patient's age. In addition, there is focal volume loss in the right frontal lobe and in the left temporal-occipital lobe from old infarcts with associated ex vacuo dilatation of the adjacent lateral ventricle. There are deep left cerebellar white matter lacunar infarcts.Foci of punctate susceptibility are noted in the right thalamus, most likely due to chronic hemosiderin from previous microhemorrhage. The right red nucleus also demonstrates mild increased susceptibility, perhaps relating to greater iron deposition.MRA BRAIN:The left MCA is not visualized.There is small triangular-shaped outpouching at the origin of the proximal left A1 segment, which may represent a tiny infundibulum versus aneurysm. Incidentally noted, a small vessel arises from the posterior margin of the vessel at this level, along an expected course of the anterior choroidal artery as it is posteriorly directed, but it is difficult to determine if the proximal aspect of the tiny vessel is tortuous and perhaps arising anteriorly prior to coursing posteriorly.There are mild irregularities of the proximal right A1, the distal right M1 and more diffusely involving the more distal right MCA segments, with areas of focal narrowing suggested at the M1 bifurcation.There is a hypoplastic left P1 with fetal origin of the left PCA.There is mild irregularity of the mid to distal right P2 and of the distal left P2.The right proximal V4 is not visualized. The right V4 just proximal to the PICA origin has a normal caliber, with moderate focal narrowing shortly after the PICA origin, and the very distal right V4 is not visualized.There are mild irregularities of the proximal to mid basilar artery.MRA NECK:Evaluation is limited due to lack of contrast. There is poor flow related enhancement of the entire right vertebral artery although the origin is visualized and is patent. The carotid vessels and cervical left vertebral artery are unremarkable.

Output: 1. Right parietal, temporal, and occipital laminar necrosis with mild diffusion hyperintensity and ADC isointensity, suggesting evolving late subacute infarct.2. Underlying moderate chronic small vessel ischemic changes with scattered chronic infarcts.3. The left middle cerebral artery is likely chronically occluded.4. Tiny outpouching involving the origin of the left A1 segment, favored to represent an infundibulum although a tiny aneurysm is not entirely excluded. CTA head could be obtained for further evaluation.5. The right cervical vertebral artery is not well visualized likely with slow flow, as there are significant irregularities and discontinuous nonvisualization of the right V4 segment. Origin of the vessel is visualized and appears patent.6. Atherosclerotic irregularities of other intracranial vessels to a lesser degree, as detailed above.


Instruction: Generate impression based on findings.

Input: Reason: eval for adductor tear History: hip pain for 2 years in groin ACETABULAR LABRUM: There is a small nondisplaced tear through the anterior superior labrum.ARTICULAR CARTILAGE AND BONE: No significant abnormality noted.SOFT TISSUES: No significant abnormality noted. ADDITIONAL

Output: Small nondisplaced tear of the anterior superior acetabular labrum.


Instruction: Generate impression based on findings.

Input: Ataxia, neck pain, back pain Cervical spine: Examination is mildly motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. Minimal degenerative changes are seen including mild ligamentum flavum thickening at C5-C6 and to a lesser degree C3-C4 and C6-C7 levels. There are also minimal disc bulges at C3-C4, C4-C5, and C5-C6 levels. Trace retrolisthesis of C4 on C5 and C5 on C6 is also noted. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.Thoracic spine: The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Minimal degenerative changes in the cervical spine without significant spinal canal or neural foraminal stenosis at any level.2. Thoracic MRI is within normal limits.


Instruction: Generate impression based on findings.

Input: Female, 79 years old, with clinical findings of stroke. Also with increased muscular tone on the right. Brain:No restricted diffusion is seen. However, extensive patchy white matter T2 hyperintensity is seen involving the high bilateral frontal lobes, the periventricular regions, the anterior temporal tips, and the brainstem. Also noted is extensive prior lacunar ischemia involving the basal ganglia. These findings show little significant interval change from the prior exam.A few scattered foci of susceptibility are seen within the brain indicating prior microscopic hemorrhage. Hemosiderin staining is also seen within the bilateral basal ganglia likely related to prior lacunar ischemia. No acute intracranial hemorrhage is seen and no abnormal extra-axial fluid collections are detected. The ventricles and sulci are mildly prominent compatible with parenchymal volume loss. Postcontrast images show no evidence of pathologic parenchymal or extra-axial enhancement. Loss of the right intracranial vertebral flow void is again seen compatible with occlusion is noted on prior CTA.C-spine:The cervical lordosis is mildly straightened similar to prior. Sagittal alignment is otherwise unremarkable. Degenerative endplate signal alteration is seen at C3, C4, C5 and T1. No concerning marrow replacement is seen.The spinal cord is thinned and T2 hyperintense at C4-5, findings which are relatively similar to the prior examination 2010. Elsewhere, the spinal cord demonstrates normal signal intensityPostcontrast images show no evidence of any pathologic marrow space, epidural, intramedullary or leptomeningeal enhancement.C2-3: Facet hypertrophy, particularly on the left where the facet complex is mildly edematous, progressed from prior. No spinal canal stenosis. Mild left foraminal narrowing similar to prior.C3-4: Ligamentum flavum thickening. Mild posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis without significant interval change. Moderate left and mild right foraminal narrowing, unchanged. C4-5: Left facet hypertrophy and ligamentum flavum thickening, unchanged. Posterior disc-osteophyte complex formation causing a moderate to severe spinal canal stenosis, impingement of the spinal cord, and chronic-appearing cord thinning and T2 hyperintensity. The degree of stenosis and cord impingement is unchanged. Severe bilateral foraminal narrowing, unchanged. C5-6: Ligamentum flavum thickening, unchanged. Minimal posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Mild right foraminal narrowing, unchanged. C6-7: Ligamentum flavum thickening, progressed. Left facet hypertrophy, progressed. Mild posterior disc-osteophyte complex formation and uncovertebral hypertrophy, progressed. Mild generalized spinal canal narrowing, progressed, without cord impingement. Severe bilateral foraminal narrowing, progressed from prior. C7-T1: Facet hypertrophy and ligamentum flavum thickening, progressed. No significant spinal canal or foraminal stenosis.

Output: 1. No acute intracranial abnormality including no evidence of any acute ischemia.2. Extensive of extensive prior bilateral small vessel and lacunar ischemic disease is seen. This may simply reflect an advanced state of routine small vessel disease. However the pattern of abnormalities is in some ways atypical, and therefore the possibility of some other arteriopathy or vasculopathy, for example CADASIL, may also be entertained.3. Fairly extensive degenerative disease is redemonstrated within the cervical spine. A severe stenosis at C4-5 with chronic cord impingement and myelomalacia is unchanged from prior. Degenerative disease and spinal/foraminal stenoses at other levels have in some cases progressed.


Instruction: Generate impression based on findings.

Input: Base of tongue status squamous cell carcinoma status post chemoradiation for T4Nx left oral tongue cancer, previous history of cT1 N2a squamous cell carcinoma of the left tonsil in 1994. There is an ill-defined enhancing ulcerative mass involving the left tongue base and oral tongue with extension across the midline and left glossotonsillar sulcus. Overall, the mass measures up to approximately 4 cm. There are superimposed post-treatment findings in the neck, including diffuse pharyngeal mucosal and retropharyngeal edema, and left tonsillar fossa tissue deficiency, with a defect suggestive of a left pharyngocutaneous fistula. There are secretions in the pharynx and larynx. There is no significant cervical lymphadenopathy based on size criteria. There are unchanged right thyroid nodules. There is diffuse high T2 signal in the hypopharynx and portions of the larynx, without associated discrete mass lesions in this area. There is a posterior disc-osteophyte complex at C5-6 with mild spinal canal stenosis. The imaged portions of the orbits and intracranial structures are grossly unremarkable.

Output: 1. Post-treatment findings in the neck with a persistent infiltrating and ulcerated mass involving the oral tongue and tongue base that likely represents recurrent squamous cell carcinoma and superimposed inflammation.2. Suggestion of possible left pharyngocutaneous fistula formation and deficiency of soft tissue overlying the left hyoid bone, likely due to necrosis and perhaps superimposed infection or inflammation.3. No significant cervical lymphadenopathy.4. Secretions in the pharynx and larynx indicate aspiration.


Instruction: Generate impression based on findings.

Input: 75-year-old male with a history of melanoma and recently diagnosed lung cancer (poorly differentiated carcinoma). No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. There is mild asymmetry of the lateral ventricles.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are two punctate foci of susceptibility in the bilateral occipital lobes compatible with chronic microhemorrhages and nonspecific. Brain parenchyma is otherwise unremarkable for age.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Scattered minimal mucosal thickening in the paranasal sinuses. There is opacification of the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.

Output: 1. No evidence of intracranial metastatic disease.2. Minimal chronic small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: 58-year-old male with history of metastatic rectal carcinoid status postY90 embolization in 2011. Evaluate and compare to previous. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology. Again noted are scattered rim-enhancing lesions, not significantly changed. There are multiple new subcentimeter scattered lesions demonstrating T2 hyperintensity, diffusion restriction, and arterially enhancement without evidence of washout. Reference new arterially enhancing left hepatic lobe lesion measures 11 x 9 cm (series 901, image 154). No intra or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cysts are 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: Interval worsening of arterially enhancing lesions within the liver consistent with metastatic disease from patient's known rectal carcinoid.


Instruction: Generate impression based on findings.

Input: Reason: hydrocephalus, aqueductal stenosis , eval for changes, 1 year follow up History: yearly follow up , eval for changes. Stenosis of the cerebral aqueduct and third ventriculostomy defect appears similar to the prior exam. Dilated lateral and third ventricles are unchanged in size. Fourth ventricle is unchanged. Robust CSF flow is unchanged.Scattered foci of intraparenchymal and intraventricular susceptibility is unchanged. Small amount of FLAIR signal surrounding the right frontal ventriculostomy catheter tract likely represents glial cyst and is unchanged. No new areas of abnormal T2 signal.No midline shift or mass effect. No diffusion abnormality. No extra-axial fluid collection. Normal flow voids within the major intracranial vascular structures. Partial empty sella is unchanged. Prominent mucous retention cyst in the right maxillary sinus is unchanged.

Output: Stable exam with no significant change in lateral and third ventriculomegaly.


Instruction: Generate impression based on findings.

Input: Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: stroke History: stroke There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered high signal intensities on FLAIR images indicate non specific small vessel disease.Multifocal high signal intensities on the left pons and left middle cerebellar peduncle indicate chronic ischemic infarctions with tissue losses.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.There is a right frontal burr hole. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly ectatic bilateral ICA cavernous sinus and paraclinoid segments indicating atherosclerotic changes. There is no intracranial arterial aneurysm. There is no intracranial arterial luminal narrowing or irregularity.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Atherosclerotic changes of bilateral cavernous sinus and paraclinoid segments of ICAs as described above. Otherwise unremarkable.


Instruction: Generate impression based on findings.

Input: Check for peroneal tendon and ATFL tear TENDONS: No significant abnormality noted. The tendons and peroneal tendons specifically are well visualized and uniform throughout.LIGAMENTS: No significant abnormality noted. Specifically the ATFL is observed and intact. In addition, the posterior talofibular ligament is also uniform and intact.ARTICULAR SURFACES AND BONE: No significant abnormality noted. ADDITIONAL

Output: Os trigonum with an associated adjacent ganglion cyst. Appearance can be associated with mild posterior ankle impingement.


Instruction: Generate impression based on findings.

Input: 66-year-old male with primary CNS lymphoma diagnosed in 05/2014 (follows with Dr. Nabhan) status post autologous bone marrow transplant with Carmustine and Thiotepa conditioning between 12/2/14 and 12/30/14. He was diagnosed after experiencing gait instability, slurred speech, and cognitive slowing that began in March 2014. History of PCN SNHL status post ABMT for follow-up. There is no significant interval change in size of the lesions in the bilateral basal ganglia, right thalamus and left frontal periventricular white matter, and left cerebellar hemisphere. There is mild intrinsic high T1 associated with many of the lesions without appreciable enhancement. There is no significant interval change in the size and morphology of the ventricular system with unchanged coaptation of the right frontal horn. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or acute infarct. There is a faint left frontal lobe developmental venous anomaly. There is new mild mucosal thickening of the bilateral ethmoid sinuses. There is mucosal thickening and enhancement with secretions in the bilateral maxillary sinuses. The skull and extracranial soft tissues are otherwise unchanged.

Output: 1. No significant interval change in the treated multifocal CNS lymphoma.2. Interval development of acute sinusitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Soft tissue mass in region of left trapezius. There is an area of prominent subcutaneous fat that measures up to approximately 5 cm in width overlying the left trapezius muscle in the posterior left lower neck. There is no associated enhancing component and the underlying trapezius muscle is intact. There is no significant lymphadenopathy in the neck. The thyroid and major salivary glands are unremarkable. The major cervical flow voids are intact. The osseous structures are unremarkable. The orbits and imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.

Output: Findings compatible with a posterior left lower neck subcutaneous lipoma that measures up to approximately 5 cm in width.


Instruction: Generate impression based on findings.

Input: Prior history of stroke and interatrial shunt on TTE now with altered mental status status post cystectomy. There are few punctate foci of restricted diffusion in the right occipital lobe and right cerebellar hemisphere suspicious for acute infarct. There are additional multiple scattered small foci of restricted diffusion adjacent to the intraparenchymal hemorrhages described below which are suspected to be artifactual.Innumerable foci of hemorrhage throughout the supratentorial and infratentorial brain. Some lesions demonstrate cystic encephalomalacia compatible with chronic infarcts while others contain some internal T1 or T2 hyperintensity indicating more subacute hemorrhagic infarcts. While most of the lesions have a thin rim of increased T2 signal suggestive of gliosis, no lesions demonstrate clear perilesional T2 edema signal to suggest acute hemorrhage. No evidence of extra-axial hemorrhage.This process is superimposed on a background of mild periventricular and subcortical white matter T2 hyperintensities indicating mild chronic small vessel ischemic changes.The ventricles and basal cisterns are normal in size and configuration.The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.Angiography:Intracranial carotid arteries are widely patent. There is a complete circle of Willis. Left dominant vertebrobasilar system. No significant stenosis in the intracranial anterior or posterior circulation. No intracranial aneurysms.

Output: 1. Punctate foci of restricted diffusion in the right occipital lobe and right cerebellar hemisphere are suspicious for small infarcts.2. Innumerable foci of parenchymal hemorrhage throughout the supratentorial and infratentorial brain. These lesions have variable imaging characteristics suggesting a spectrum of both chronic and subacute hemorrhages. While none of the lesions have significant perilesional edema to suggest an acute hemorrhage, noncontrast CT would be useful to confirm absence of acute intraparenchymal hemorrhage. Differential of these multiple hemorrhages is broad but includes thrombotic microangiopathy and coagulopathy. Hemorrhagic metastases while also in the differential is much less likely.


Instruction: Generate impression based on findings.

Input: Reason: Evaluate progression of hepatic and pancreatic cysts History: history of large cysts, abdominal pain, early satiety ABDOMEN:LIVER, BILIARY TRACT: Multiple simple cysts are seen throughout the liver, the largest of which measures 15.1 x 15 .3 cm, previously 15.1 x 14.4 cm (image 24, series 8). This largest cyst is again filled with debris with intrinsic T1 hyperintensity and T2 hypointense rim suggesting prior hemorrhage. No mural nodule or enhancing solid component is seen within this cyst. This is again causes mass effect on the right kidney, IVC, common duct, pancreas, and duodenum without evidence of obstruction, appearing similar to the prior study.No intrahepatic or extrahepatic biliary duct dilation. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: Reference, multiloculated cystic lesion in the pancreatic tail measures 5.8 x 3.3 cm, previously 5.4 x 2.6 cm (image 17; series 10). There is again some enhancement of the septations, however no mural nodular enhancement. Differential considerations include a serous cystadenoma as well as a branch-type IPMN. No pancreatic duct dilation is seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mass effect on the right kidney from the previously described hepatic cysts, appearing similar to the prior study. No significant abnormalities noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.

Output: 1.No significant change in multiple benign appearing liver cysts, the largest of which again contains internal debris and causes mass effect on the surrounding structures without obstruction.2.Slight interval increase in size of reference cystic lesion in the pancreatic tail which may represent a serous cystadenoma or IPMN.


Instruction: Generate impression based on findings.

Input: 34-year-old woman with history of cervical cancer status post trachelectomy, now with irregular menses and outflow obstruction. PELVIS:UTERUS, ADNEXA: The patient is status post trachelectomy. The remaining uterus appears normal. Junction zone thickness is normal.Bilateral ovarian follicles are noted including a peripherally enhancing cystic lesion in the right ovary, likely corpus luteum.BLADDER: The bladder appears normal.LYMPH NODES: Small pelvic lymph nodes with fatty hila are noted in the pelvis and inguinal regions.BOWEL, MESENTERY: Partially visualized small bowel and colon are normal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a moderate amount of fluid in the pelvis.

Output: Postoperative findings without evidence of recurrent disease. Additional physiologic findings as above.


Instruction: Generate impression based on findings.

Input: Reason: eval for tendon or meniscus tear History: sudden onset right medial knee pain MENISCI: Lateral meniscus is intact. There is complex tearing of the body of the medial meniscus with radial and horizontal components and fragmentation as well as extrusion of the meniscal body 5 mm medially and inferiorly into the medial gutter.ARTICULAR CARTILAGE AND BONE: Bone marrow edema along the anterior medial tibial plateau and medial femoral condyle which is likely reactive. Moderate tricompartmental osteophytes.Diffuse thinning of the articular cartilage in the lateral compartment. Large region of full-thickness cartilage loss in the medial compartment spanning approximately 2.6 cm along the medial femoral condyle and medial tibial plateau. Full-thickness cartilage loss along the medial patellar facet with diffuse thinning of the lateral patellar facet. Diffuse thinning of the trochlear cartilage.LIGAMENTS: No significant abnormality noted. EXTENSOR MECHANISM: Patellar and quadriceps tendons are intact.ADDITIONAL

Output: 1.Complex medial meniscal tear.2.Extensive full-thickness cartilage loss in the medial compartment.


Instruction: Generate impression based on findings.

Input: Sciatica [724.3], Reason for Study: ^Reason: history of spinal stenosis and nerve root compression. Progression? History: Lumbar pain For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. There is minimal anterolisthesis of L3 on L4, no change since prior scan.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. The conus medullaris terminates at the T12-L1 level. 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: T12-L1: no neuroforaminal narrowing or spinal stenosis. L1-L2: no neuroforaminal narrowing or spinal stenosis. L2-L3: There is broad based left side far lateral disc protrusion. No definitive imaging evidence of nerve root compression by the disc. No change since prior scan. L3-L4: Decreased disc height with dessication. Diffuse broad based disc bulging. Associated with bilateral ligamentum flavum thickening, there is moderate to severe spinal canal stenosis, no change since prior scan. L4-L5: Disc dessication was seen. There is broad based left side foraminal disc protrusion with extension toward far lateral aspect. Deformed thecal sac and left side nerve roots around the left side recess were seen. No significant interval change since prior scan. L5-S1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Multifocal (L2-L3, L3-L4 and L4-L5 intervertebral disc herniations) disc herniations and spinal canal stenosis of L34 were again demonstrated, no change since prior scan.2. No abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 54 years Female (DOB:3/21/1962)Reason: PAtient with h/o seizures since 2013, no prior MRI brain History: SeizuresPROVIDER/ATTENDING NAME: SANDRA LYNN ROSE SANDRA LYNN ROSE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. A 2 mm-sized focus of signal loss and susceptibility imaging is present in the right frontal subcortical white matter at the level of the superior frontal gyrus.There is a developmental venous anomaly present in the right periventricular white matter.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.MRI pituitary:The pituitary gland is appropriate in overall height and morphology. The infundibulum of the pituitary gland is midline. No suprasellar or intrasellar mass is identified. The cavernous sinuses are intact bilaterally.A small cyst which is hypointense on T1 and hyperintense on T2 and does not enhance following gadolinium and is administration is present within the pituitary gland along the midline just behind the pituitary stalk.

Output: 1.There is a small cystic lesion in the pituitary gland centrally which could represent a Rathke's cleft cyst.2.There is a microhemorrhage present in the right frontal lobe which isolation is nonspecific and of unknown clinical significance. There is an associated developmental venous anomaly. It is conceivable this represents a small cerebral cavernous malformation, however, this is nonspecific.


Instruction: Generate impression based on findings.

Input: 52-year-old female with pain over the left patella after fall. MENISCI: There is globular increased signal abnormality within the posterior horn of the medial meniscus. There is some extension of this increased signal abnormality to the femoral articular surface suggestive of fraying/degenerative tearing. The anterior horn appears intact. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is partial-thickness articular cartilage degeneration along the weightbearing surface of the medial femoral condyle there is subjective thickening of distal articular cartilage of the lateral compartment. There is sparing of the patellofemoral articular cartilage. No full-thickness or near full-thickness articular cartilage defects are identified. Note is made of a focus of signal abnormality in the distal femoral metaphysis with imaging characteristics consistent with an enchondroma.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Mild fraying/degenerative tearing of the medial meniscus as described above.2. Articular cartilage degeneration as described above.


Instruction: Generate impression based on findings.

Input: 4 month old male; rule out bleed. Prominent extra-axial fluid bilaterally with questionable peripheral high attenuation that could represent intracranial hemorrhage; if clinically concerned for bleed, recommend MRI for further evaluation.There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Prominent extra-axial fluid bilaterally with questionable peripheral high attenuation that could represent intracranial hemorrhage; if clinically concerned for bleed, recommend MRI for further evaluation.


Instruction: Generate impression based on findings.

Input: Possible right facial droop. There is a punctate focus of restricted diffusion in the superior left precentral gyrus. There is no evidence of intrcranial mass or acute infarct. There is mild cerebral white matter T2 hyperintensity predominantly in the periventricular regions, which may represent chronic small vessel ischemic disease. There is also a focal subcentimeter defect in the right thalamus. 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 minimal fluid signal within the mastoid air cells bilaterally. Deformity of the nasal skeleton is better depicted on the prior CT.

Output: 1. A punctate focus of restricted diffusion in the superior left precentral gyrus is nonspecific, but may represent a chronic microhemorrhage.2. Probable chronic mild small vessel ischemic disease and a chronic right thalamus lacunar infarct, but no evidence of acute cerebral infarction or mass.


Instruction: Generate impression based on findings.

Input: 49 year old female. Abdominal pain. Is there a persistent GE junction leak? CHEST:LUNGS AND PLEURA: Bilateral lower lobe consolidation and volume loss. Small bilateral pleural effusions. There is possible abscess or small hematoma in the cysts splenic bed, left sub-diaphragmatic region seen best on coronal image 79.MEDIASTINUM AND HILA: Endotracheal tube is present in the expected position. Low lung volumes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Marked hepatomegaly. The liver measures 27 cm craniocaudally.SPLEEN: Status post splenectomy.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic and scarred kidneys without evidence of hydronephrosis. There is a questionable 3-cm mass adjacent to the right lung hilum on coronal image 69 and axial image 106. This may be further evaluated with dedicated renal MRI examination and/or noncontrast CT scan.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The patient is status post a vertical sleeve gastrectomy with innumerable surgical clips under the left hemidiaphragm. A stent is present in the gastric remnant. There are multiple surgical drains in the upper abdomen, one in the gastrohepatic region and another at the left lateral aspect of the gastrectomy site.A percutaneous jejunostomy tube is present in the expected position.No free air. No definite leak at the GE junction, but this may be difficult to detect on an examination without esophageal enteric contrast.BONES, SOFT TISSUES: Open midline abdominal wound in the supraumbilical region. OTHER: IVC filter is in expected position.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: A Foley catheter is present in the decompressed urinary bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A rectal tube is in expected position.BONES, SOFT TISSUES: There is scoliosis of the thoracolumbar spine. Degenerative changes in the lumbosacral spine and pelvis.OTHER: Anasarca.

Output: Bibasilar lower lobe consolidation. Hepatomegaly. Anasarca. Questionable right renal mass at the hilum. Status post splenectomy with questionable hematoma or subdiaphragmatic fluid collection on the left. Multiple additional findings, as described above. Postop changes after partial gastrectomy.


Instruction: Generate impression based on findings.

Input: Reason: right parietal lesion? History: seizure.Additional history from EMR: Fell out of hairdressing chair with subgaleal hematoma. Outside CT showed right parietal hematoma. MRI brain:There is a rounded area in the right parietal lobe measuring 1.6 x 1.9 cm with increased T1 signal and susceptibility, compatible with hemorrhage. A fluid level and hemosiderin rim, as well as focal eccentric T2 hypointensity and susceptibility suggests blood products of various ages. There is no significant enhancement and only adjacent minimal edema. No obvious abnormal vasculature is associated with the lesion. No significant mass effect.There is no evidence of acute infarct. Left temporal lobe developmental venous anomaly is noted. Ventricles are mildly asymmetric but not enlarged. 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.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is minimally decreased central flow related enhancement within the distal basilar artery, possibly representing a tiny fenestration, although the basilar is patent without stenosis. The vertebral arteries and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.

Output: Right parietal lobe hematoma with blood products of various ages, with only mild vasogenic edema. No associated enhancement or abnormal vasculature. Follow up MRI is suggested, as there could be a an underlying lesion obscured by the blood products, such as a cavernoma amongst other possibilities.


Instruction: Generate impression based on findings.

Input: 69-year-old male with a history of multiple sclerosis now with weakness, changes in speech and consciousness. Evaluate for an MS exacerbation. MRI Brain:Again seen are scattered hyperintense T2/FLAIR white matter abnormalities, which are grossly unchanged compared to the prior exam. There is a left parietal periventricular lesion suggestive of a chronic demyelinating lesion while most of the additional scattered foci demonstrate a more nonspecific appearance and may represent mild chronic small vessel ischemic changes. Apparent FLAIR hyperintense foci involving the middle cerebellar peduncles are likely artifactual.There is no evidence of intracranial hemorrhage, mass, or acute infarct. No evidence of intracranial mass effect, midline shift, or herniation. There is mild global parenchymal volume loss. There is a left lens implant. There is severe rightward nasal septal deviation. There is minimal paranasal sinus opacification. Bone marrow signal and remainder of the extracranial soft tissues are grossly unremarkable.MRI Cervical spine:There is no definite cervical cord signal abnormality with motion degradation slightly limiting evaluation.There is mild straightening of the cervical spinal curvature. The cervical vertebral bodies are appropriate in height. Bone marrow signal is benign. There are multilevel degenerative changes with disc height loss and disc osteophyte complexes throughout the cervical spine with up to moderate spinal canal stenosis at the C5-C6 level where there is mild impression on the left ventral aspect of the cord related to left paracentral disc osteophyte complex. There is also mild spinal canal stenosis at the C4-C5 and C6-C7 levels.There is prominent multilevel neural foraminal narrowing secondary to facet and uncovertebral hypertrophy throughout the spine with moderate to severe neural foraminal stenoses at the left greater than right C3-C4 level, bilaterally at C4-C5, bilaterally at C5-C6, right greater than left C6-C7, and to a milder degree at the left C7-T1 level. There is an ovoid posterior superficial subcutaneous lesion at the C4 level measuring 1.2 x 1.5 cm which may represent a sebaceous cyst and can be correlated with clinical exam.

Output: 1.No evidence of progression of demyelinating disease in the brain. No evidence of acute infarct or intracranial mass effect.2.No definite evidence of demyelinating disease in the cervical cord within the limits of mild motion degradation.3. Moderate degree of multilevel degenerative changes throughout the cervical spine with up to moderate spinal canal stenosis at the left C5-C6 level and moderate to severe neural foraminal stenoses at multiple levels as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 69 years, Male, ependymoma, 3 month follow-up for change. There is been interval evolution of postsurgical changes related to recent suboccipital craniectomy for posterior fossa ependymoma resection. As noted before, there has been near total resection. There is a small focus of expansile T2 signal and enhancement centered on the right inferior cerebellar peduncle, which measures approximately 12 x 9 x 14 mm, and is compatible with minimal residual tumor. No significant change of this lesion allowing for evolution of surrounding postoperative changes. No suspicious enhancement elsewhere in the brain. Ventricles have decreased in size since prior; no hydrocephalus. No evidence of midline shift or herniation. No evidence of acute ischemia or new hemorrhage. Chronic blood products are evident in the resection cavity and decreased since prior. Small right maxillary mucus retention cyst again seen. Bilateral lens implants.

Output: Evolution of postsurgical changes related to posterior fossa ependymoma resection. Again seen is small residual tumor, which appears to be intraparenchymal, centered on the right inferior cerebellar peduncle, and measuring approximately 12 x 9 x 14 mm. No significant change of this lesion allowing for evolution of surrounding postoperative changes. No suspicious enhancement elsewhere in the brain.


Instruction: Generate impression based on findings.

Input: Pain, evaluate for stress fracture. MENISCI: There is fraying of the inner margin of the medial meniscal body. Lateral meniscus is intact.ARTICULAR CARTILAGE AND BONE: Full-thickness chondral loss is noted in the medial femoral condyle. Partial thickness chondral loss is noted in the lateral patellar femoral compartment. Bone marrow signal is within normal limits. No stress fracture identified along the medial tibia at the site of clinical concern. No bony contusions. Tiny osteophytes are seen in the tibiofemoral and patellofemoral compartments.LIGAMENTS: ACL, PCL, MCL and LCL are intact.EXTENSOR MECHANISM: Quadriceps and patellar tendons are intact.ADDITIONAL

Output: 1. Mild osteoarthritis most pronounced in the medial compartment.2. No stress fracture3. Fraying of the inner margin of the medial meniscal body.


Instruction: Generate impression based on findings.

Input: Evaluated for etiology of headaches. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells demonstrate minor opacities on the right. The visualized portions of the orbits are intact, however, eye motion partially obscures visualization of the anterior orbits.

Output: MRI of the brain is within normal limits. There is no evidence for an intracranial mass. Angiographic studies are more sensitive for detecting aneurysms.


Instruction: Generate impression based on findings.

Input: Multiple sclerosis. There are multiple, greater than 10, T2 hyperintense white matter lesions, primarily in a periventricular distribution. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.

Output: No significant interval change in the intracranial demyelinating lesions, accounting for differences in technique.


Instruction: Generate impression based on findings.

Input: History of urothelial cancer. Status post right nephroureterectomy. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Mildly fatty liver.SPLEEN: Mild splenomegaly measuring 14 cm in craniocaudal dimension without a focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Status post right nephroureterectomy. No evidence of residual or recurrent disease in the nephrectomy bed.RETROPERITONEUM, LYMPH NODES: Subcentimeter mesenteric lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: No evidence of local recurrence or metastatic disease.


Instruction: Generate impression based on findings.

Input: Brain:MRI better characterizes the cerebellar tonsillar ectopia as extending 7 mm below the level of foramen magnum. Cerebellar tonsillar morphology remains somewhat rounded, although the leftward tonsil appears more pointed than the right. This does efface the posterior CSF space at the level of the cerebellar tonsils.Additionally, there are small foci of T2 hyperintensity primarily in a periventricular white matter distribution, although similar appearing lesions are also present within the right thalamus, left superior cerebellar peduncle, right pontine/brachium pontis border, midline anterior pons, and the right cerebellar hemisphere. These are not associated with mass effect or restricted diffusion.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Redemonstrated is mucosal thickening and a superimposed air-fluid level in the left maxillary sinus. A minimal amount of mucosal thickening is present within the right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. Cervical spine:There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable.T2 hyperintense foci are present within the right lateral lingula as well as within the cervical cord at C2, C2/3, C4, an C4/5.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Mild disc bulge without stenosisC6/7: Mild disc bulge without stenosisC7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no definite thoracic cord lesions, although images are somewhat degraded by motion.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable.A T2 hyperintense focus is noted within the thoracic cord at the L1 level.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: Disc desiccation, slight disc height loss, and the small left paracentral disc protrusion causing minimal left lateral recess stenosis.L5/S1:There is a small right paracentral/foraminal disc protrusion which abuts and deforms the right S1 nerve root sheath origin.

Output: 1.MRI better characterizes the cerebellar tonsillar ectopia as extending 7 mm below the level of foramen magnum. Cerebellar tonsillar morphology remains somewhat rounded, although the leftward tonsil appears more pointed than the right. This does efface the posterior CSF space at the level of the cerebellar tonsils. These findings are consistent with Chiari I malformation.2.There are small foci of T2 hyperintensity primarily in a periventricular white matter distribution, although similar appearing lesions are also present within the right thalamus, left superior cerebellar peduncle, right pontine/brachium pontis border, midline anterior pons, and the right cerebellar hemisphere. These are not associated with mass effect or restricted diffusion. There are also T2 hyperintense lesions within the cervical cord and distal thoracic cord. This constellation of features and locations is most suggestive of a demyelinating process such as multiple sclerosis.3.L4/5: Small left paracentral disc protrusion causing minimal left lateral recess stenosis.4.L5/S1:There is a small right paracentral/foraminal disc protrusion which abuts and deforms the right S1 nerve root sheath origin.5.Redemonstrated is mucosal thickening and a superimposed air-fluid level in the left maxillary sinus. A minimal amount of mucosal thickening is present within the right maxillary sinus.